NEW YORK (Reuters Health) Nov 21 - The characteristics of young patients who commit acts of deliberate self-harm varies widely, according to findings published in the October issue of the Journal of Clinical Psychiatry, and the risk of suicide is very high in this population.
"Deliberate self-harm and suicide are both major problems in young people," Drs. Keith Hawton and Louise Harriss, of the University of Oxford, UK, write. "Rates of deliberate self-harm (DSH), the term used for the intentional self-poisoning or self-injury in many European countries because of the mixed motivation that is often involved, are highest in young persons."
The researchers collected information on consecutive DSH patients between the ages of 15 and 24 years who presented to a general hospital during a 20-year period (1978 to 1997). National mortality registers were used to identify deaths to the end of 2000.
A total of 5459 subjects were included in the study: 3432 females and 2027 males. Overdoses accounted for the majority of DSH episodes (90.5%). These most often involved acetaminophen (44.0%). Increases in acetaminophen overdoses (from 33.3% to 53.4%) and antidepressant overdoses (9.3% to 11.9%) were observed during the study period.
Overdoses of minor tranquilizers and sedatives decreased (18.8% to 7.7%) decreased during the study. Of 708 self-injuries, self-cuts (88.5%) accounted for the majority of them. Overall, 36.1% of subjects had drunk alcohol immediately before DSH.
The most common problems faced by patients at the time of the DSH included difficulty with family (50.9%), problems in the relationship with a partner (45.7%), employment problems or problems with studies (41.9%), and difficulties with friends (22.5%). A prior history of DSH was observed in 26.3% of patients.
A total of 4843 subjects were followed-up until the year 2000. Of these, 141 patients (2.9%) had died (90 males (5.0%) and 51 females (1.7%); relative risk = 3.09). The overall risk of death was 4.1 times greater than expected.
Of the 141 deaths, 81 (57.4%) were categorized as probable suicides. This was 10.4 times more frequent than expected. Risk factors for suicide included male sex, previous DSH, psychiatric history (in females), and high suicide intent. There were excess numbers of deaths from respiratory disorders, circulatory disorders, and accidents that did not involve poisoning.
"Assessment of young DSH patients must include close attention to interpersonal problems, previous self-harm, previous and current psychiatric problems, alcohol and drug misuse, history of violence and criminality, and suicidal intent," the investigators conclude. "Treatment interventions for young DSH patients should especially focus on improving interpersonal difficulties by employing strategies such as problem-solving therapy and treatment for substance misuse and psychiatric disorders."