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      Methods of deliberate self-harm in a tertiary hospital in South Africa

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          Abstract

          Background

          Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm.

          Aim

          The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA.

          Setting

          The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa.

          Method

          Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH.

          Results

          Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH.

          Conclusion

          Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.

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          Most cited references34

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          Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology.

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            Self-harm in England: a tale of three cities. Multicentre study of self-harm.

            Self-harm is a major healthcare problem in the United Kingdom, but monitoring of hospital presentations has largely been done separately in single centres. Multicentre monitoring of self-harm has been established as a result of the National Suicide Prevention Strategy for England. Data on self-harm presentations to general hospitals in Oxford (one hospital), Manchester (three hospitals) and Leeds (two hospitals), collected through monitoring systems in each centre, were analysed for the 18-month period March 2000 to August 2001. The findings were based on 7344 persons who presented following 10,498 episodes of self-harm. Gender and age patterns were similar in the three centres, 57.0% of patients being female and two-thirds (62.9%) under 35 years of age. The largest numbers by age groups were 15-19 year-old females and 20-24 year-old males. The female to male ratio decreased with age. Rates of self-harm were higher in Manchester than Oxford or Leeds, in keeping with local suicide rates. The proportion of patients receiving a specialist psychosocial assessment varied between centres and was strongly associated with admission to the general hospital. Approximately 80% of self-harm involved self-poisoning. Overdoses of paracetamol, the most frequent method, were more common in younger age groups, antidepressants in middle age groups, and benzodiazepines and sedatives in older age groups. Alcohol was involved in more than half (54.9%) of assessed episodes. The most common time of presentation to hospital was between 10 pm and 2 am. Multicentre monitoring of self-harm in England has demonstrated similar overall patterns of self-harm in Oxford, Manchester and Leeds, with some differences reflecting local suicide rates. Diurnal variation in time of presentation to hospital and the need for assessment of non-admitted patients have implications for service provision.
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              Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis.

              This meta-analysis addressed the association between substance use disorder (SUD) and suicide outcomes based on current evidence.
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                Author and article information

                Journal
                S Afr J Psychiatr
                S Afr J Psychiatr
                SAJPsyc
                The South African Journal of Psychiatry : SAJP : the Journal of the Society of Psychiatrists of South Africa
                AOSIS
                1608-9685
                2078-6786
                21 April 2020
                2020
                : 26
                : 1399
                Affiliations
                [1 ]Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
                [2 ]Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
                [3 ]Department of Psychology, Stellenbosch University, Cape Town, South Africa
                [4 ]Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
                Author notes
                Corresponding author: Deirdre Pieterse, deirdre.pieterse@ 123456gmail.com
                Author information
                https://orcid.org/0000-0003-1610-494X
                https://orcid.org/0000-0002-6963-3557
                https://orcid.org/0000-0002-4931-5084
                https://orcid.org/0000-0002-6974-8215
                https://orcid.org/0000-0001-5576-1278
                https://orcid.org/0000-0001-9358-4073
                https://orcid.org/0000-0002-3626-9883
                Article
                SAJPsyc-26-1399
                10.4102/sajpsychiatry.v26i0.1399
                7203532
                a533b507-55f6-4761-80c3-b77b01515fc9
                © 2020. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 15 April 2019
                : 20 January 2020
                Categories
                Original Research

                deliberate self-harm,non-fatal suicide,general hospital,mental health,methods of self-harm,means restriction,suicide prevention

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