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      Non-suicidal self-injury v. attempted suicide: new diagnosis or false dichotomy?

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          Summary

          Non-suicidal self-injury (NSSI) is a term that is becoming popular especially in North America and it has been proposed as a new diagnosis in DSM-5. In this paper we consider what self-harm research can tell us about the concept of NSSI and examine the potential pitfalls of introducing NSSI into clinical practice.

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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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            Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions.

            E. Klonsky (2011)
            Non-suicidal self-injury (NSSI) has received increased attention in the mental health literature and has been proposed as a diagnostic entity for DSM-5. However, data on NSSI in the United States adult population are lacking. The prevalence and nature of NSSI were examined in a random-digit dialing sample of 439 adults in the United States. Participants were recruited during July and August of 2008. Lifetime prevalence of NSSI was 5.9%, including 2.7% who had self-injured five or more times. The 12-month prevalence was 0.9%. Methods of NSSI reported included cutting/carving, burning, biting, scraping/scratching skin, hitting, interfering with wound healing and skin picking. Half of self-injurers reported multiple methods. The average age of onset was 16 years (median 14 years). Instances of NSSI infrequently co-occurred with suicidal thoughts and with use of alcohol or drugs and rarely required medical treatment. Most injurers reported that NSSI functioned to alleviate negative emotions. Fewer reported that they self-injured to punish themselves, to communicate with others/get attention or to escape a situation or responsibility. NSSI was associated with younger age, being unmarried and a history of mental health treatment, but not with gender, ethnicity, educational history or household income. Results are largely consistent with previous research in adolescent and young adult samples. Study limitations notwithstanding, this study provides the most definitive and detailed information to date regarding the prevalence and characteristics of NSSI in US adults. In the future, it will be important for large-scale epidemiological studies of psychopathology to include questions about NSSI.
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              Deliberate self-harm in Oxford, 1990-2000: a time of change in patient characteristics.

              Trends in deliberate self-harm (DSH) are important because they have implications for hospital services, may indicate levels of psychopathology in the community and future trends in suicide, and can assist in identification of means of suicide prevention. We have investigated trends in DSH and characteristics of DSH patients between 1990 and 2000 based on data collected through the Oxford Monitoring System for Attempted Suicide. During the 11-year study period 8590 individuals presented following 13858 DSH episodes. The annual numbers of persons and episodes increased overall by 36.3% and 63.1% respectively. Rates (Oxford City) declined, however, in the final 3 years. There were gender- and age-specific changes, with a rise in DSH rates in males aged > or = 55 years and in females overall and those aged 15-24 years and 35-54 years. Repetition of DSH increased markedly during the study period. Antidepressant overdoses, especially of SSRIs, increased substantially. Paracetamol overdoses declined towards the end of the study period. Alcohol abuse, use of alcohol in association with DSH, and violence increased, especially in females, and the proportion of patients in current psychiatric care and misusing drugs also rose. While overall rates of DSH did not increase markedly between 1990 and 2000, substantial changes in the characteristics of the DSH population and a rise in repetition suggest that the challenges facing clinical services in the management of DSH patients have grown.
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                Author and article information

                Journal
                British Journal of Psychiatry
                Br J Psychiatry
                Royal College of Psychiatrists
                0007-1250
                1472-1465
                May 2013
                January 02 2018
                May 2013
                : 202
                : 5
                : 326-328
                Article
                10.1192/bjp.bp.112.116111
                23637107
                a47e845e-414e-46d3-8e7b-5dea3f3f40d9
                © 2013

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