The timing of deliberate self harm behaviour

Abstract

Objectives: To critically review the scientific literature relating to the timing of deliberate self harm behaviour and completed suicide.Method: A literature search of the Medline and CINAHL databases from 1970-2002 was performed, using deliberate self harm, overdose, self poisoning, suicide, parasuicide, and time, timing, day, week, month and season as key words. Relevant secondary references were retrieved and hand searching of important journals was done.Results: The time of day of non-fatal self harm shows a marked diurnal variation, with an evening peak that is related to non-violent episodes, concomitant alcohol use, and a younger age. It is not conclusively linked to the degree of suicidal intent or particular psychiatric diagnoses. Completed suicides more commonly occur earlier in the day, at the beginning of the week and during springtime, but show no overall increase during many national events and holidays.Conclusions: Circadian biological mechanisms involving the serotonin-melatonin axis, Cortisol secretion and sleep abnormalities appear to be implicated. Psychosocial explanations for these epidemiological findings include alcohol use, a sense of personal isolation and the ‘broken promise’ effect.

TPH gene polymorphism and aging: Indication of combined effect on the predisposition to violent suicide

“…Alternatively, Tph1 gene, which is dominantly expressed in the pineal gland [Patel et al, 2004], might influence suicidal risk via melatonin synthesis. Triggering effects of sunshine on suicidal behavior [Petridou et al, 2002], as well as marked diurnal and seasonal variations in suicide commitment [Blenkiron, 2003] indeed point to possible involvement of hormones responsible for biological rhythms, such as melatonin. Finally, the investigated polymorphism might serve as a marker of adjacent locus that confers susceptibility to suicidal behavior (there are several genes with expression in brain, located nearby Tph1, see http:// www.ncbi.nlm.nih.gov/mapview/MVtxtindex.html?…”

Seasonal Differences in the Day-of-the-Week Pattern of Suicide in Queensland, Australia

“…Temporal variations in suicide rates have attracted attention in research from both clinical and epidemiological perspectives [1]. In an effort to understand and explain the phenomenon, many studies on this topic have mainly focused on the monthly or seasonal patterns, or patterns of the day of the week and time of the day [2].…”

Cyclic variations in demand for out-of-hours services in child and adolescent psychiatry: implications for service planning

“…Demand for provision outside normal working hours was at its greatest over weekends and between 17.00 h and 00.59 h on weekdays, which is in keeping with other studies focusing mainly on adults. 14,15 In the majority of cases a telephone consultation to the attending paediatrician or psychiatric senior house officer was sufficient to draw up a management plan until the young person could be assessed by the regular daytime liaison team. On days without normal daytime cover, young people still required specialist mental health assessments and hence the peak in referrals between 09.00 h and 12.59 h and the higher proportion of bedside assessments on those days.…”

“…13,15,16,21 This study analysed whether these factors would also be reflected in the referral pattern to out-of-hours service in child and adolescent psychiatry. The results showed no more referrals than usual during the holidays or when it was hot or rainy.…”

“…For example, more individuals present in the evening and at weekends, in spring, and on days with nice weather. [13][14][15][16] This study set out to investigate cyclic variations in demand for paediatric psychiatric provision outside normal working hours in a large and diverse urban population. We wanted to find out whether service-dependent factors such as the availability of liaison daytime cover, the introduction of A&E waiting targets or high A&E workload were associated with demand for out-of-hours provision.…”