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      Adverse Childhood Experiences and Hospital-Treated Self-Harm

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          Abstract

          Adverse childhood experiences (ACEs) have been implicated in a range of negative health outcomes in adulthood, including increased suicide mortality. In this study, we explored the relationship between ACEs and hospital-treated self-harm. Specifically, we investigated whether those who had a history of repeat self-harm reported more ACEs than those who had self-harmed for the first time. Patients ( n = 189) admitted to two hospitals in Glasgow (UK) following first-time ( n = 41) or repeated ( n = 148) self-harm completed psychosocial measures. Univariate analyses revealed that those presenting with repeat self-harm reported higher depressive symptoms, anxiety symptoms, intent to die, and ACEs, and lower dependent attachment style. However, only ACEs, along with female gender and depressive symptoms, significantly differentiated between the repeat self-harm group and the first-time self-harm group in the multivariate model. Controlling for all other psychosocial variables, participants who reported 4+ ACEs were significantly more likely to be in the repeat self-harm group as compared to those who experienced 0–3 ACEs. This finding highlights the pernicious effect of exposure to multiple ACEs. Further research is urgently required to better understand the mechanisms that explain this relationship. Clinicians should be aware of the extent of the association between ACEs and repeat self-harm.

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          Most cited references31

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          Working models of attachment: implications for explanation, emotion and behavior.

          Two studies examined attachment style differences in social perception. In Study 1, participants wrote open-ended explanations for hypothetical relationship events and described how they would feel and behave in response to each event. Compared with secure participants, preoccupied participants explained events in more negative ways; they also reported more emotional distress and behaviors that were likely to lead to conflict. Avoidant participants also provided negative explanations, but did not report emotional distress. Path analysis indicated that attachment style differences in behavior were mediated by explanation patterns and emotional distress. Study 2 was designed to replicate Study 1 and test the relative importance of attachment style and relationship quality to predicting each outcome. Results indicated that both variables were significant predictors of explanations, but only attachment style predicted emotional responses. These findings are consistent with the idea that adults with different working models of attachment are predisposed to think, feel, and behave differently in their relationships.
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            Fatal and non-fatal repetition of self-harm. Systematic review.

            Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions. To estimate rates of fatal and non-fatal repetition of self-harm. A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria. Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide. After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.
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              Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis

              Background Non-fatal self-harm is one of the most frequent reasons for emergency hospital admission and the strongest risk factor for subsequent suicide. Repeat self-harm and suicide are key clinical outcomes of the hospital management of self-harm. We have undertaken a comprehensive review of the international literature on the incidence of fatal and non-fatal repeat self-harm and investigated factors influencing variation in these estimates as well as changes in the incidence of repeat self-harm and suicide over the last 30 years. Methods and Findings Medline, EMBASE, PsycINFO, Google Scholar, article reference lists and personal paper collections of the authors were searched for studies describing rates of fatal and non-fatal self-harm amongst people who presented to health care services for deliberate self-harm. Heterogeneity in pooled estimates of repeat self-harm incidence was investigated using stratified meta-analysis and meta-regression. The search identified 177 relevant papers. The risk of suicide in the 12 months after an index attempt was 1.6% (CI 1.2–2.4) and 3.9% (CI 3.2–4.8) after 5 years. The estimated 1 year rate of non-fatal repeat self-harm was 16.3% (CI 15.1–17.7). This proportion was considerably lower in Asian countries (10.0%, CI 7.3–13.6%) and varies between studies identifying repeat episodes using hospital admission data (13.7%, CI 12.3–15.3) and studies using patient report (21.9%, CI 14.3–32.2). There was no evidence that the incidence of repeat self-harm was lower in more recent (post 2000) studies compared to those from the 1980s and 1990s. Conclusions One in 25 patients presenting to hospital for self-harm will kill themselves in the next 5 years. The incidence of repeat self-harm and suicide in this population has not changed in over 10 years. Different methods of identifying repeat episodes of self-harm produce varying estimates of incidence and this heterogeneity should be considered when evaluating interventions aimed at reducing non-fatal repeat self-harm.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                11 June 2018
                June 2018
                : 15
                : 6
                : 1235
                Affiliations
                [1 ]Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK; Karen.wetherall@ 123456glasgow.ac.uk (K.W.); Andrea.clark@ 123456glasgow.ac.uk (A.C.); Rory.oconnor@ 123456glasgow.ac.uk (R.C.O.C)
                [2 ]School of Psychology and Neuroscience, University of St Andrews, South St, St Andrews KY16 9JP, UK; cr487@ 123456st-andrews.ac.uk
                [3 ]Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, 3000 Leuven, Belgium; olivia.kirtley@ 123456kuleuven.be
                [4 ]NHS Greater Glasgow and Clyde, Commonwealth House, 32 Albion Street, Glasgow G1 1LH, UK; Michael.Smith2@ 123456ggc.scot.nhs.uk
                Author notes
                Author information
                https://orcid.org/0000-0002-2728-9356
                https://orcid.org/0000-0001-5879-4120
                https://orcid.org/0000-0003-1977-5909
                https://orcid.org/0000-0002-3650-4994
                Article
                ijerph-15-01235
                10.3390/ijerph15061235
                6026473
                29891825
                27a76334-3198-465d-b2a7-c1d9cee241d9
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 22 April 2018
                : 05 June 2018
                Categories
                Article

                Public health
                suicidal behaviour,self-harm,risk factors,adverse childhood experiences
                Public health
                suicidal behaviour, self-harm, risk factors, adverse childhood experiences

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