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      An Exploration of Differences Between Deliberate Self-Harm with and without Suicidal Intent Amongst a Clinical Sample of Young People in Singapore: A Cross-Sectional Study

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          Abstract

          This study examined differences between young people with mental illness who engage in deliberate self-harm with and without suicidal intent, as well as socio-demographic and clinical factors that are related to the increased likelihood of suicide attempt amongst self-harming young people. A total of 235 outpatients with mental illness who had engaged in deliberate self-harm were recruited from a tertiary psychiatric hospital in Singapore. Participants completed a self-report questionnaire which collected information on their socio-demographic background, self-harm history, diagnosis, depressive symptoms and childhood trauma. A total of 31.1% had reported a history of attempted suicide. Multiple logistic regression conducted found that engaging in self-harm ideation between 1 and 7 days (OR = 4.3, p = 0.30), and more than 1 week (OR = 10.5, p < 0.001) (versus no engagement in any self-harm ideation at all), were significantly associated with greater likelihood of attempted suicide. This study reports a relatively high prevalence rate of reported suicide attempts amongst young people with mental illness who engaged in self-harm. Identifying self-harm behaviors and treating it early could be the first step in managing potential suicidal behaviors among those who engage in self-harm.

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          Most cited references34

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          Self-injury.

          People have engaged in self-injury-defined as direct and deliberate bodily harm in the absence of suicidal intent-for thousands of years; however, systematic research on this behavior has been lacking. Recent theoretical and empirical work on self-injury has significantly advanced the understanding of this perplexing behavior. Self-injury is most prevalent among adolescents and young adults, typically involves cutting or carving the skin, and has a consistent presentation cross-nationally. Behavioral, physiological, and self-report data suggest that the behavior serves both an intrapersonal function (i.e., decreases aversive affective/cognitive states or increases desired states) and an interpersonal function (i.e., increases social support or removes undesired social demands). There currently are no evidence-based psychological or pharmacological treatments for self-injury. This review presents an integrated theoretical model of the development and maintenance of self-injury that synthesizes prior empirical findings and proposes several testable hypotheses for future research.
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            Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts.

            Non-suicidal self-injury (NSSI) is a prevalent behavioral problem, yet many fundamental aspects of NSSI remain unknown. This case series study reports on the diagnostic correlates of adolescents with a recent history of NSSI and examines the relation between NSSI and suicide attempts. Data are from clinical interviews with 89 adolescents admitted to an adolescent psychiatric inpatient unit who engaged in NSSI in the previous 12 months. Results revealed that 87.6% of adolescents engaging in NSSI met criteria for a DSM-IV Axis I diagnosis (M=3.0, S.D.=2.2, range=0 to 8 diagnoses), including externalizing (62.9%), internalizing (51.7%), and substance use (59.6%) disorders. Most adolescents assessed also met criteria for an Axis II personality disorder (67.3%). Overall, 70% of adolescents engaging in NSSI reported a lifetime suicide attempt and 55% reported multiple attempts. Characteristics of NSSI associated with making suicide attempts included a longer history of NSSI, use of a greater number of methods, and absence of physical pain during NSSI. These findings demonstrate the diagnostic heterogeneity of adolescents engaging in NSSI, highlight the significant overlap between NSSI and suicide attempts, and provide a point of departure for future research aimed at elucidating the relations between non-suicidal and suicidal self-injury.
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              International prevalence of adolescent non-suicidal self-injury and deliberate self-harm

              Background The behaviours of non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research. Methods We conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe. Results Fifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3) and DSH (16.1% SD = 11.6) studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization. Conclusion NSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.
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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
                23 February 2020
                February 2020
                : 17
                : 4
                : 1429
                Affiliations
                [1 ]Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore 539747, Singapore; shazana_mohamed_shahwan@ 123456imh.com.sg (S.S.); edimansyah_abdin@ 123456imh.com.sg (E.A.); yunjue_zhang@ 123456imh.com.sg (Y.Z.); rajeswari_sambasivam@ 123456imh.com.sg (R.S.); wen_lin_teh@ 123456imh.com.sg (W.L.T.); siow_ann_chong@ 123456imh.com.sg (S.A.C.); mythily@ 123456imh.com.sg (M.S.)
                [2 ]Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore 539747, Singapore; say_how_ong@ 123456imh.com.sg
                Author notes
                Author information
                https://orcid.org/0000-0002-1016-3298
                https://orcid.org/0000-0003-4530-1096
                Article
                ijerph-17-01429
                10.3390/ijerph17041429
                7068476
                32102199
                6dd01ded-178e-48c5-befc-dcc815393fba
                © 2020 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
                : 23 December 2019
                : 20 February 2020
                Categories
                Article

                Public health
                deliberate self-harm,mental illness,young people,suicide attempt
                Public health
                deliberate self-harm, mental illness, young people, suicide attempt

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