Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study

Geulayov, Galit; Casey, Deborah; McDonald, Keltie; Foster, Paul J.; Pritchard, Kirsty; Wells, Celia; Clements, Caroline; Kapur, Navneet; Ness, Jennifer; Waters, Keith; Hawton, Keith

doi:10.1016/s2215-0366(17)30478-9

Cited by 235 publications

(223 citation statements)

References 32 publications

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“…A long follow-up of administrative hospital discharge data allows population-level studies with sufficient numbers, minimal attrition and no self-report bias, but as a drawback inpatient care captures only the most severe outcomes of high-risk health behaviour and thus represents a conservative estimate of the occurrence of health problems. The observed associations between parental social background and parental and offspring health problems were strong and highly consistent, and inpatient care can be considered the tip of the iceberg of harm caused by high-risk health behaviours 40. It is, however, possible that measures of less severe and more prevalent parental health problems and high-risk health behaviours would have explained a larger part of the educational gradient in adolescent health problems, but further research is needed to confirm this.…”

Section: Discussionmentioning

confidence: 94%

Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems?

Remes

Moustgaard

Kestilä

et al. 2019

J Epidemiol Community Health

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BackgroundAdolescent health problems are more prevalent in families with low socioeconomic position, but few studies have assessed the role of parental health in this association. This study examines the extent to which parental health problems, particularly those related to high-risk health behaviour, might explain the association between parental education and adolescent health problems due to violence, self-harm and substance use.MethodsWe used longitudinal register data on a 20% representative sample of all families with children aged 0–14 years in 2000 in Finland with information on parental social background and parental and offspring health problems based on hospital discharge data. We estimated discrete-time survival models with the Karlson-Holm-Breen method on hospital admissions due to violence, self-harm and substance use among adolescents aged 13–19 years in 2001–2011 (n=145 404).ResultsHospital admissions were 2–3 times more common among offspring of basic educated parents than tertiary educated parents. Similar excess risks were observed among those with parental mental health problems and parental health problems due to violence, self-harm and substance use. The OR for offspring of basic educated parents was attenuated from OR 2.73 (95% CI 2.34 to 3.18) to OR 2.38 (2.04 to2.77) with adjustment for parental health problems, particularly those due to violence, self-harm and substance use. Having both low parental education and parental health problems showed simple cumulative effects.ConclusionsThe excess risks of hospital admissions due to violence, self-harm and substance use among adolescents with lower educated parents are largely independent of severe parental health problems.

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Section: Discussionmentioning

confidence: 94%

Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems?

Remes

Moustgaard

Kestilä

et al. 2019

J Epidemiol Community Health

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“…It is still possible, however, that individuals had a self-harm event prior to this look-back period and before their CPRD records began. Furthermore, we recognize that not all people who have a self-harm episode will present to healthcare services and those who do represent the “tip of the iceberg” of self-harm events [30]. However, our inclusion of self-harm reported to both primary and secondary care builds upon those studies which used only one of those sources to ascertain self-harm [4–6].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for self-harm in people with epilepsy

et al. 2018

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ObjectiveTo estimate the risk of self-harm in people with epilepsy and identify factors which influence this risk.MethodsWe identified people with incident epilepsy in the Clinical Practice Research Datalink, linked to hospitalization and mortality data, in England (01/01/1998–03/31/2014). In Phase 1, we estimated risk of self-harm among people with epilepsy, versus those without, in a matched cohort study using a stratified Cox proportional hazards model. In Phase 2, we delineated a nested case–control study from the incident epilepsy cohort. People who had self-harmed (cases) were matched with up to 20 controls. From conditional logistic regression models, we estimated relative risk of self-harm associated with mental and physical illness comorbidity, contact with healthcare services and antiepileptic drug (AED) use.ResultsPhase 1 included 11,690 people with epilepsy and 215,569 individuals without. We observed an adjusted hazard ratio of 5.31 (95% CI 4.08–6.89) for self-harm in the first year following epilepsy diagnosis and 3.31 (95% CI 2.85–3.84) in subsequent years. In Phase 2, there were 273 cases and 3790 controls. Elevated self-harm risk was associated with mental illness (OR 4.08, 95% CI 3.06–5.42), multiple general practitioner consultations, treatment with two AEDs versus monotherapy (OR 1.84, 95% CI 1.33–2.55) and AED treatment augmentation (OR 2.12, 95% CI 1.38–3.26).ConclusionPeople with epilepsy have elevated self-harm risk, especially in the first year following diagnosis. Clinicians should adequately monitor these individuals and be especially vigilant to self-harm risk in people with epilepsy and comorbid mental illness, frequent healthcare service contact, those taking multiple AEDs and during treatment augmentation.Electronic supplementary materialThe online version of this article (10.1007/s00415-018-9094-2) contains supplementary material, which is available to authorized users.

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“…Therefore, it was not possible to analyze the impact of intentional injury on subsequent suicide ideation or nonmedically treated suicidal behaviors. Given the prevalence of suicidal behaviors that do not lead to inpatient care, and the ubiquity of undisclosed self‐directed violence among high‐risk groups (Geulayov et al., ), additional research is needed to evaluate the relative impact of intentional trauma with regard to a broader range of suicide‐specific outcomes (e.g., nonsuicidal self‐injury, suicide ideation, undisclosed and/or untreated suicide attempts). Additional research that includes more nuanced suicide‐related outcomes may also elucidate the extent to which relatively low absolute risk of suicidal behavior observed in this study does not represent the full impact of intentional injury with regard to suicidality in this population.…”

Section: Discussionmentioning

confidence: 99%

Intentional Injury and the Risk of Subsequent Hospitalization for Attempted Suicide

DeCou

Jin

Rivara

et al. 2018

Suicide & Life Threat Behav

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Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study

Abstract: UK Department of Health.

Cited by 235 publications

References 32 publications

Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems?

Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems?

Risk factors for self-harm in people with epilepsy

Intentional Injury and the Risk of Subsequent Hospitalization for Attempted Suicide

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