The implementation and first insights of the French-speaking Swiss programme for monitoring self-harm

Abstract

AIMS OF THE STUDY: Self-harm is a major risk factor for suicide but remains poorly documented. No data on self-harm in French-speaking Switzerland exist. To address this deficiency, the Swiss Federal Office of Public Health commissioned a specific self-harm monitoring programme. We present and discuss its implementation and first findings. METHODS: Every patient aged 18-65 years presenting for self-harm to the emergency departments of the Lausanne and Neuchâtel general hospitals were included in the monitoring programme over a 10-month period (December 2016 to September 2017). Clinicians collected anonymous sociodemographic and clinical data. RESULTS: The sample included 490 patients (54.9% female and 45.1% male) for 554 episodes of self-harm, showing a higher proportion of patients aged 18-34 (49.2%) than older age groups (35-49, 33.7% and 50-65, 17.1%). Patients were mostly single (56.1%) and in problematic socioeconomic situations (65.7%). Self-poisoning was the most commonly used method (58.2%) and was preferred by women (71% of females and 42.5% of males, Fisher's exact test, p <0.001) and the majority of patients (53.3%) had experienced at least one previous episode of self-harm. The self-harm rate was 220 per 100,000 inhabitants in Lausanne and 140 in Neuchâtel. Suicidal intent was clear for 50.6% of the overall sample, unclear for 25.1% and absent for 24.3%. It differed significantly between sites (χ 2 (2) = 9.068, p = 0.011) as Lausanne reported more incidents of unclear intent (27.7% versus 17.4% in Neuchâtel) and Neuchâtel more incidents with absence of intent (33.1% versus 21.3% in Lausanne). In Lausanne, patients more frequently resorted to methods such as jumping from a height (11.4%) and hanging (9%) than in Neuchâtel (1.6% and 4.9%, Fisher's exact test, p = 0.006).CONCLUSIONS: Our results are globally consistent with previous research on self-harm. We found significant intersite differences in methods, suicidal intent and self-harm rates. Our findings highlight the importance of implementing local self-harm monitoring to identify specific at-risk groups and develop targeted preventive intervention.

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

“…The distribution of these diagnoses is consistent with the general prevalence of mental disorder within the Swiss population [35] and, except for SB, with the literature [8,36,37]. The finding related to SB is also in agreement with its general prevalence in Switzerland, which is higher than most European countries [38][39][40]. From a socio-demographic point of view, no significant differences in gender were observed, as previously described [36], but some recent works have reported an excess of male patients [28].…”

Suicidality Associated With Deep Brain Stimulation in Extrapyramidal Diseases: A Critical Review and Hypotheses on Neuroanatomical and Neuroimmune Mechanisms

“…While comprehensive data on SI and SB rates of subjects with a co-morbid neurological condition or physical illness are often limited (Ostertag et al, 2019;Costanza et al, 2020d,i), clinical evidence of suicidality possibly associated with DBS treatment for PD subjects was first documented in a series of case reports (Doshi et al, 2002;Balash et al, 2007;Rodrigues et al, 2010). Additionally, analyses of initial cohorts of PD patients undergoing STN and GPi DBS in the early 2000s observed a notable rate of suicidality (1.5-4.6% for complete suicides, 0-6.1% for SA, and 12.5-16.6% for SI) despite the interventional success concerning motor symptom improvement (Berney et al, 2002;Houeto et al, 2002;Krack et al, 2003;Burkhard et al, 2004;Funkiewiez et al, 2004; Table 1).…”

Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms

“…Similar to the scarcity of data on SI and SB in patients with comorbid illness [32][33][34], fairly little is known about the association between CTE and suicidality to date. Thus, the primary objective of this report is to describe the occurrence of severe suicidality in two retired contact sports professionals who exhibited CTE.…”