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Biomedical subjects

K Hawton

Publications and source records attributed to K Hawton.

At least 55 records · Page 3Linked to original sources
PubMed2000

Effect of death of Diana, princess of Wales on suicide and deliberate self-harm.

BACKGROUND: The death of the Princess of Wales in 1997 was followed by widespread public mourning. Such major events may influence suicidal behaviour. AIMS: To assess the impact of the Princess's death on suicide and deliberate self-harm (DSH). METHOD: Analysis, using Poisson regression, of the number of suicides and open verdicts ('suicides') in England and Wales following the Princess's death compared to the 3 months beforehand, and the equivalent periods in 1992-1996. Similar analysis on DSH presentations to a general hospital. RESULTS: Suicides increased during the month following the Princess's funeral (+17.4%). This was particularly marked in females (+33.7%), especially those aged 25-44 years (+45.1%). Suicides did not fall in the week between the death and the funeral. Presentations for DSH increased significantly during the week following the death (+44.3%), especially in females (+65.1%). Examination of case notes suggested that the influence of the death was largely through amplification of personal losses or exacerbation of existing distress. CONCLUSIONS: The death of a major public figure can influence rates of suicidal behaviour. For DSH, the impact may be immediate, but for suicide it may be delayed.

Adolescent↗
PubMed2000

Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse.

Paracetamol (acetaminophen) is one of the most frequently used drugs in intentional overdoses. We have investigated associations between its availability and its use for overdose and suicide around the world by means of a postal questionnaire and literature review. Countries that limit the quantity of paracetamol available in a single purchase generally report lower rates of paracetamol-related morbidity and mortality. National policy decisions regarding restrictions on its availability need to weigh the inconvenience caused to the many who use the drug safely against those of the few in whom overdose may be fatal. We recommend restricting the quantity of drug available as a single purchase as the most pragmatic means of reducing paracetamol-related suicide and liver failure.

Acetaminophen↗
PubMed1999

Effects of a drug overdose in a television drama on presentations to hospital for self poisoning: time series and questionnaire study.

OBJECTIVES: To determine whether a serious paracetamol overdose in the medical television drama Casualty altered the incidence and nature of general hospital presentations for deliberate self poisoning. DESIGN: Interrupted time series analysis of presentations for self poisoning at accident and emergency departments during three week periods before and after the broadcast. Questionnaire responses collected from self poisoning patients during the same periods. SETTING: 49 accident and emergency departments and psychiatric services in United Kingdom collected incidence data; 25 services collected questionnaire data. SUBJECTS: 4403 self poisoning patients; questionnaires completed for 1047. MAIN OUTCOME MEASURES: Change in presentation rates for self poisoning in the three weeks after the broadcast compared with the three weeks before, use of paracetamol and other drugs for self poisoning, and the nature of overdoses in viewers of the broadcast compared with non-viewers. RESULTS: Presentations for self poisoning increased by 17% (95% confidence interval 7% to 28%) in the week after the broadcast and by 9% (0 to 19%) in the second week. Increases in paracetamol overdoses were more marked than increases in non-paracetamol overdoses. Thirty two patients who presented in the week after the broadcast and were interviewed had seen the episode-20% said that it had influenced their decision to take an overdose, and 17% said it had influenced their choice of drug. The use of paracetamol for overdose doubled among viewers of Casualty after the episode (rise of 106%; 28% to 232%). CONCLUSIONS: Broadcast of popular television dramas depicting self poisoning may have a short term influence in terms of increases in hospital presentation for overdose and changes in the choice of drug taken. This raises serious questions about the advisability of the media portraying suicidal behaviour.

Acetaminophen↗
PubMed1999

Repetition of deliberate self-harm by adolescents: the role of psychological factors.

The aim of this study was to examine the relationship between psychological variables and repetition of deliberate self-harm by adolescents (n=45) aged 13-18 years who had been admitted to a general hospital having taken overdoses. Standardized measures of depression, hopelessness, suicidal intent, impulsivity, trait and state anger, self-esteem and problem-solving (both self-report and observer-rated) were administered to the adolescents while still in the general hospital. Repetition was assessed on the basis of previous overdoses (n=14) and repetition of self-harm (self-poisoning and self-injury) during the subsequent year (n=9). Adolescents with a history of a previous overdose and/or who repeated self-harm during the following year (n=18) differed from non-repeaters in having higher scores for depression, hopelessness and trait anger, and lower scores for self-esteem, self-rated problem-solving and effectiveness of problem-solving rated on the basis of the Means End Problem Solving test, all measured at the initial assessment. These differences largely disappeared when level of depression was controlled for. Similarly, differences found between repeaters and non-repeaters in the year following the index overdoses for problem-solving were much reduced when account was taken of differences in depression scores. Depression is a key factor associated with risk of repetition of adolescent self-harm (and hence of suicide risk). In the management of adolescents who have harmed themselves, careful assessment of depression and appropriate management of those who are depressed is essential.

Adolescent↗
PubMed1999

The geographical distribution of suicides in farmers in England and Wales.

Farmers in England and Wales have an elevated risk of suicide. The aim of this study was to investigate the geographical distribution of suicides in farmers. Rates of suicide (including suicide and open verdicts) of farmers in England and Wales between 1981 and 1993 were calculated on a county basis. Trends in rates and differences in rates between counties, regions and England and Wales were then analysed. There were 719 suicides (634 suicide verdicts and 85 open verdicts). There was evidence of a decline in annual rates of suicide in farmers during the study period in England but not Wales. There was no evidence of geographical heterogeneity of farming suicides according to counties, but a relatively high rate for Devon (N = 62 suicides). County farming suicide rates did not appear to be related to local general population suicide rates, density of farmers or type of farm holding. While identification of counties with relatively large numbers of farming suicides should assist targeting of local preventive programmes, it is clear that any significant prevention strategies should be implemented on a national basis.

Adolescent↗
PubMed1999

Do adolescents who take overdoses have specific psychological characteristics? A comparative study with psychiatric and community controls.

OBJECTIVE: To determine whether specific psychological factors characterize adolescents who take overdoses. METHOD: Measures of problem-solving, depression, anger, impulsivity, and self-esteem were investigated in 33 adolescents after an overdose, 30 psychiatric controls, and 30 community controls, the groups being matched for age and sex. All subjects were interviewed twice, 6 weeks apart. The first interview in the overdose group followed an overdose. RESULTS: Significant differences were found between the 3 groups on all of the variables at both interviews. However, when depressive affect (Beck Depression Inventory) was controlled for, all of these differences disappeared, except for impulsivity at the second interview. Here the overdose group remained more impulsive than the other groups even when depression was considered. CONCLUSIONS: Depression is the most important factor in the presentation of a range of psychological characteristics of adolescents who take overdoses, and this remains true at 6-week follow-up. Impulsivity is apparently an important factor, independent of depression, in adolescent self-poisoning. Further research is required to determine the mediating role of impulsivity in this behavior and to identify treatment strategies for it.

Adolescent↗
PubMed1999

Attempted suicide and major public holidays in Europe: findings from the WHO/EURO Multicentre Study on Parasuicide.

OBJECTIVE: The aim of the study was to examine the relationship between suicide attempts and major public holidays in Europe. METHOD: The analysis was based on data on 24 388 suicide attempts by persons aged 15 years or older in the period 1989-1996. Data from 13 centres (representing 11 countries) participating in the WHO/EURO Multicentre Study on Parasuicide were analysed. The analysis of the fluctuation of suicide attempts around public holidays was based on the daily number of suicide attempts for each centre. For each day in the period under examination a mean number of suicide attempts (mu) was calculated. The analysis was based on the assumption that the data followed a Poisson distribution. The observed number of daily suicide attempts was compared with the expected number of attempts. A multiplicative model for the expected number in each centre was developed. RESULTS: Before Christmas there were fewer suicide attempts than expected, and after Christmas there were approximately 40% more attempts than expected. In addition, more attempts than expected were registered on New Year's Day. In countries where people have the day off work on Whit Monday there were significantly fewer attempts during the 3 days before, but where Whit Monday is a normal working day significantly fewer attempts occurred on the Monday to Wednesday after Whit Sunday. CONCLUSION: There appears to be a transposition of a significant number of suicide attempts from before (and during) a major public holiday until after it. The division of holidays into non-working and working days showed that a 'holiday effect' could only be found around major public holidays, particularly Christmas, Easter and Whitsun. These findings support the theory of the 'broken-promise effect' for major public holidays.

Adolescent↗
PubMed1999

Suicide in young people. Study of 174 cases, aged under 25 years, based on coroners' and medical records.

BACKGROUND: Suicide rates in young males in the UK have risen markedly in recent years. AIMS: To investigate the characteristics of a series of consecutive suicides in under-25-year-olds. METHOD: We studied coroners' inquest notes, general practitioners' records and psychiatric case notes of 174 individuals (148 males and 26 females) whose deaths received a verdict of suicide or an open or accidental verdict (excluding traffic accidents) where the circumstances strongly suggested suicide. RESULTS: More individuals were of lower social class and unemployed than in the local population. Hanging and carbon monoxide poisoning were the most frequent methods of suicide, and coproxamol was the drug most often used in overdoses. Previous self-harm had occurred in 44.8%, nearly half of these having carried out multiple episodes and 80% having self-harmed within the previous year. Little support was found for an earlier finding of increasing frequency of general practitioner visits shortly before death. Only 22.4% of individuals were in the care of psychiatric services. CONCLUSIONS: Diverse strategies are required to prevent suicide in the very young.

Adolescent↗
PubMed1999

Suicide in nurses.

The worldwide English language literature on suicide in nurses is reviewed in this article. There is evidence from several countries that female nurses are at increased risk of suicide. Very little information is available about the specific causes. Increased risk in nurses has been statistically associated with smoking and negatively related to extent of caffeine consumption. Unlike some other high-risk occupational groups, it is unclear to what extent access to means for suicide contributes to nurses' risk. The methodological issues and specific needs of research concerning suicide in nurses are discussed.

Adolescent↗
PubMed1998

Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition.

OBJECTIVE: To identify and synthesise the findings from all randomised controlled trials that have examined the effectiveness of treatments of patients who have deliberately harmed themselves. DESIGN: Systematic review of randomised controlled trials of psychosocial and physical treatments. Studies categorised according to type of treatment. When there was more than one investigation in a particular category a summary odds ratio was estimated with the Mantel-Haenszel method. SETTING: Randomised trials available in electronic databases in 1996, in the Cochrane Controlled Trials Register in 1997, and from hand searching of journals to 1997. SUBJECTS: Patients who had deliberately harmed themselves shortly before entry into the trials with information on repetition of behaviour. The included trials comprised 2452 randomised participants with outcome data. MAIN OUTCOME MEASURE: Repetition of self harm. RESULTS: 20 trials reported repetition of self harm as an outcome variable, classified into 10 categories. Summary odds ratio (all for comparison with standard aftercare) indicated reduced repetition for problem solving therapy (0.73; 95% confidence interval 0.45 to 1.18) and for provision of an emergency contact card in addition to standard care (0.45; 0.19 to 1.07). The summary odds ratios were 0.83 (0.61 to 1.14) for trials of intensive aftercare plus outreach and 1.19 (0.53 to 2.67) for antidepressant treatment compared with placebo. Significantly reduced rates of further self harm were observed for depot flupenthixol versus placebo in multiple repeaters (0.09; 0.02 to 0.50) and for dialectical behaviour therapy versus standard aftercare (0.24; 0.06 to 0.93). CONCLUSION: There remains considerable uncertainty about which forms of psychosocial and physical treatments of patients who harm themselves are most effective. Further larger trials of treatments are needed.

Aftercare↗
PubMed1998

Adolescents who take overdoses: outcome in terms of changes in psychopathology and the adolescents' attitudes to care and to their overdose.

Adolescent self-poisoners were followed up 3 months after taking an overdose. High levels of psychopathology were found, with 72% (18/25) of the adolescents having a diagnosable psychiatric disorder and 48% (12/25) major depression. All the adolescents were offered follow-up treatment from health or social services. Compliance with treatment was very high. Seventy-two per cent of the adolescents found treatment useful to them. The adolscents received a generally sympathetic response from their significant others. Fifty-four per cent of the adolescents thought that their overdose had resulted overall in improvements to their lives but 44% would consider taking an overdose again in similar circumstances.

Adolescent↗
PubMed1998

The psychological autopsy approach to studying suicide: a review of methodological issues.

The psychological autopsy approach to studying suicide is becoming an increasingly used research method. It presents considerable methodological problems. In order to assist future researchers in this field and to help readers assess reports of psychological autopsy studies the authors have reviewed these issues on the basis of their own experience and those of other workers. The areas covered include research design, identification of subjects, sources of information and the particular issues concerned with approaching relatives and other informants, choice and recruitment of controls, the difficulties of conducting psychological autopsy interviews with relatives, problems for interviewers, the selection of appropriate measures to obtain information, and achieving valid and reasonably reliable conclusions from diverse information sources.

Autopsy↗