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Keith Hawton

Publications and source records attributed to Keith Hawton.

At least 19 recordsLinked to original sources
PubMed2006

Suicide in adolescents: using life charts to understand the suicidal process.

BACKGROUND: A greater understanding of the pathways which lead young people to take their lives is important in ensuring that prevention strategies and health service delivery are as effective as possible. In this study we examined the duration, development and characteristics of the suicidal process in young people who ultimately died by suicide. METHODS: Life charts of psychological autopsy information from multiple informants were used to identify the suicidal process among 27 young people who died by suicide. RESULTS: Life charts were generated for 27 young people who died by suicide, of whom 93% (n=25) were male, with an average age at death of 20.9 years (SD=2.4). Three types of suicidal process were identified: Group I characterised by longstanding difficulties which spanned the developmental domains of home, school and peers. The suicidal process was longstanding, and included deliberate self-harm prior to their death and direct communication to friends and family about suicidal ideas and plans. The second group was characterised by evidence of an established psychiatric disorder. Two subgroups were identified, namely those individuals with a protracted suicidal process which lasted approximately 5-9 years, and those with a brief suicidal process lasting approximately one year. The third and smallest group was characterised by the emergence of the suicidal process as an acute response to life events among young people who appeared to have previously been functioning well, without apparent mental illness or known self-harm. However, two out of five in this group communicated specific suicidal intent in the weeks before their death. CONCLUSIONS: The suicidal process may emerge and disappear in the lives of young people. Repeated episodes of self-cutting by young men, against a backdrop of substance abuse, relationship difficulties, and mental health problems require further clinical attention.

Adolescent↗
PubMed2006

Variations in time of hospital presentation for deliberate self-harm and their implications for clinical services.

BACKGROUND: Variation in number, characteristics and management of deliberate self-harm (DSH) patients presenting to hospital during the 24-h cycle and day of the week may have implications for patient services. We have investigated how patient characteristics and clinical management of DSH episodes vary according to hour and day of presentation. METHODS: Time of presentation was studied in 5348 DSH patients who presented to a general hospital following 9101 episodes during a 6-year period. Patient characteristics were identified through routine clinical monitoring. RESULTS: Presentations varied markedly during the 24-h cycle, ranging from a peak between 8 pm and 3 am (average hourly rate of 6.6% of all episodes) to a low between 4 am and 10 am (1.4%). The majority (72.0%) occurred outside office hours. DSH associated with alcohol use and interpersonal problems was more frequent during the late evening or night, and at the weekend. A greater proportion of daytime presentations involved high suicide intent (although a larger number of high intent acts presented at other times), and more were admitted and assessed. LIMITATIONS: This study was based on DSH presentations to one hospital. Time and date of presentation and of psychosocial assessment, not time of DSH, were available for analysis. CONCLUSIONS: Peak times for DSH presentations are at night and the weekend, suggesting that specialist DSH services in general hospitals should be available 24 h a day, 7 days a week. Time of presentation should not be used as a proxy measure of suicide intent.

Adult↗
PubMed2006

Systematic review of resource utilization in the hospital management of deliberate self-harm.

BACKGROUND: Deliberate self-harm (DSH) is a significant public health problem, representing a major burden in terms of morbidity to the individual and health-service utilization. While clinical guidelines suggest good practice for the short-term hospital management of DSH, there remains considerable variability in the way that services are provided. METHOD: A systematic review of the literature was undertaken to examine the current evidence on hospital resource use and costs involved in the short-term hospital management of adults following DSH and to elucidate the factors that influence these differences, in terms of clinical characteristics and service provision. RESULTS: Twenty-one papers reporting on 17 studies met the inclusion criteria for review. Clinical characteristics associated with an increase in resource use included overdose with tricyclic antidepressants (TCAs) compared with selective serotonin re-uptake inhibitors (SSRIs) (weighted ratio 2.6:1) and co-ingestion of alcohol with SSRIs. Variations in service provision, including medical admissions policy and provision of a specialist liaison service, affected resource utilization independently of the clinical needs of patients. CONCLUSIONS: Overdoses of TCAs incur substantially greater hospital costs than overdoses of SSRIs. Variations in the medical seriousness of DSH, and in the structure of service provision, affect the resources used in its short-term hospital management, with little evidence about the impact these differences have on clinical outcome. Research is needed to evaluate the impact of different styles of service provision on outcome, and to incorporate these factors into the trial design of future cost-effectiveness studies of interventions following DSH.

Health Care Costs↗
PubMed2006

Deliberate self-harm patients of no fixed abode: a study of characteristics and subsequent deaths in patients presenting to a general hospital.

BACKGROUND: International studies report high rates of deliberate self-harm (DSH) and suicide in the homeless. Little is known about DSH among homeless people in the UK and their subsequent risk of death from suicide and non-suicidal causes. METHOD: We have carried out a study of no fixed abode (NFA) patients using data collected through the Oxford Monitoring System for Attempted Suicide. We describe the demographic and clinical characteristics of NFA DSH patients and the findings of a mortality follow-up study of a cohort of these patients. RESULTS: Between July 1988 and December 2002, 10,346 persons presented following 17,352 DSH episodes. Of these persons, 374 (3.6%) were of NFA. Compared with domiciled DSH patients, NFA patients were more likely to be male, single, unemployed, to have been a recent victim of violence and violent towards others, to have a criminal record and to have a personality disorder. More NFA patients faced problems with drugs and alcohol, social isolation, finances, the law and housing and had received psychiatric treatment within the previous 12 months. Substantially more NFA patients had a past history of DSH and re-presented with a further episode of DSH within 12 months. In the cohort of DSH patients who presented between January 1978 and December 1997 and who were followed up until December 2000, mortality from probable suicide and from all causes was approximately double that of domiciled patients. CONCLUSIONS: NFA DSH patients are a vulnerable group of patients at high risk of DSH repetition and with increased mortality from all causes. Good liaison between medical and psychiatric services is important. Specialist services may need to be developed to meet the particular needs of this patient group.

Adolescent↗
PubMed2006

Life problems and physical illness as risk factors for suicide in older people: a descriptive and case-control study.

BACKGROUND: The role of physical illness and life problems in contributing to suicide in older people is potentially important with regard to suicide prevention. METHOD: The aim of the study was to determine the life problems other than psychiatric illness contributing to suicide in older people. Semi-structured psychological autopsy interviews, covering life problems and physical illness prior to death, were conducted with informants for 100 people aged 60 years old and over who died through suicide in five English counties. Interviews were completed with informants for 54 age- and sex-matched control subjects who died through natural causes. RESULTS: The three most frequent life problems associated with suicide were physical illness, interpersonal problems, and bereavement. Physical health problems were present in 82% and felt to be contributory to death in 62%. Pain, breathlessness and functional limitation were the most frequent symptoms. Interpersonal problems were present in 55% of the sample and contributory in 31%. The corresponding figures for bereavement-related problems were 47% and 25%. In the case-control analysis, the problems found to be risk factors for suicide were problems related to a bereavement over 1 year before death (OR 3.5, 95% CI 1.2-10.6), and problems with accommodation (OR 5.0, 95% CI 1.1-22.8), finances (p=0.01), and retirement (p=0.02). CONCLUSION: Physical illness, interpersonal problems and bereavement are commonly associated with suicide in older people, but financial, accommodation, retirement and long- term bereavement-related problems may be more specific risk factors.

Aged↗
PubMed2006

The effects of a celebrity suicide on suicide rates in Hong Kong.

BACKGROUND: Deaths of celebrities, especially by suicide, can be followed by an increase in population suicide rates, particularly where there is extensive media reporting. We have examined the impact on suicides following the death of a famous Hong Kong pop singer whose death from suicide by jumping from a height, occurred on 1st April 2003, and resulted in extensive and often dramatic media coverage. METHODS: Data on suicides were obtained from the Hong Kong Census and Statistics Department and the Coroner's Court. The numbers of suicides in 2003 before and after the death of celebrity were compared to the same period in 1998-2002. The case files and suicide notes of people who died by suicide in 2003 were also studied qualitatively. RESULTS: There was a significant increase in suicides following the celebrity death, compared with the average over the preceding three months as well as the corresponding monthly average during 1998-2002. It was particularly marked in a subgroup comprising males, aged 25-39 years, many of whom died by jumping. The name of the celebrity was often mentioned in case files and suicide notes. LIMITATIONS: The statistical results in showing the excess of suicides were based on aggregated data only. CONCLUSIONS: This study provides further confirmation of the potential harmful consequences of sensational and excessive reporting of celebrity deaths.

Adult↗
PubMed2006

Suicidal behaviour and the menstrual cycle.

BACKGROUND: To investigate the available data regarding possible associations between phases of the menstrual cycle and suicidal behaviour. METHOD: A systematic search of major relevant databases was performed using appropriate search terms. RESULTS: Forty-four relevant studies were identified in total, 13 pertaining to suicide, two pertaining to both attempted and completed suicide, 23 to suicide attempts, three to suicide attempts in those suffering from the premenstrual syndrome (PMS), three to suicidal ideation and two to repetitive self-harming behaviours. A variety of methodologies were used in these studies and there were notable differences in the conclusions reached. Studies with better methodology suggest that a positive relationship exists between aspects of the menstrual cycle and non-fatal suicidal behaviour. Such behaviour appears to be more common in those phases of the menstrual cycle when oestrogen levels are lowest (the late luteal and follicular phases), and in those suffering from PMS. CONCLUSIONS: There appears to be an association between the menstrual cycle and non-fatal suicidal behaviours. Interaction between oestrogen and the serotonergic system may provide a possible mechanism.

Estrogens↗
PubMed2006

Suicide in older people without psychiatric disorder.

OBJECTIVE: To determine the psychological characteristics and nature of life problems, including physical illness, in people 60 years and over dying through suicide in the absence of psychiatric disorder. METHODS: Psychological autopsy interviews with relatives and friends for 23 people aged 60 years or over who had died through suicide and did not have a psychiatric disorder at the time of death. RESULTS: Three (13%) of the sample had significant psychiatric symptoms, one had a diagnosis of personality disorder, and ten (43.5%) had significantly abnormal personality traits. Physical illness and recent bereavement were the commonest life problems associated with suicide. Five (21.7%) of the sample were suffering from severe physical illness at the time of death. CONCLUSION: Sub-syndromal psychiatric disorder may be less important than personality factors, physical illness, and recent bereavement as important contributory factors to suicide in older people not suffering from psychiatric illness at the time of death.

Aged↗
PubMed2006

Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort.

BACKGROUND: Little information is available about older deliberate self-harm (DSH) patients and their outcome. METHODS: This study is a prospective investigation and follow-up of 730 consecutive patients (459 females and 271 males) aged 60 years and over who presented to a general hospital following DSH over a 20-year period, 1978-1997. Outcome has been examined in terms of repetition of DSH, and deaths by the end of 2000 identified through official death registers. RESULTS: DSH involved self-poisoning in 88.6% of cases, 49.3% of the overdoses including paracetamol (acetaminophen), 24.0% minor tranquillizers, and 15.9% antidepressants. Nearly three-quarters of episodes involved high suicidal intent. Common problems preceding DSH were physical illness (46.1%), social isolation (33.5%), relationship problems with family (29.4%) or partner (25.9%), and bereavement or loss (16.7%). Repetition of DSH occurred in 15.3% of cases, 8.2% in the first year following DSH. By the end of 2000, 432/661 (65.4%) of traced patients had died. There were 30 suicides and open verdicts, which were 49 times and 33 times more frequent respectively than expected from general population death rates. Prior DSH before initial presentation was the main risk factor for suicide, with some evidence of high suicide intent being another factor. There were also excess deaths due to several types of physical disorder. CONCLUSIONS: DSH in older people is closely related to suicide, both in terms of suicidal intent and risk of eventual suicide, especially when DSH is repeated. The range of problems experienced by older DSH patients requires extensive and multidisciplinary clinical interventions.

Age Distribution↗
PubMed2006

Monitoring deliberate self-harm presentations to general hospitals.

Monitoring of deliberate self-harm (DSH) presentations to hospitals (and in other settings) is receiving increased attention in many countries. This is due to greater recognition of the size of the problem and awareness of its relevance to suicide prevention policy initiatives, because of the strong association between DSH and suicide. A system for monitoring all DSH presentations has been in place in the general hospital in Oxford for 30 years. Based on our experience, in this paper we describe procedures for monitoring, including case definition and identification, linkage of persons and episodes in order to investigate repetition of DSH and other outcomes (including deaths), and data protection and ethical issues. We also provide details of how to carry out monitoring, including different models of data collection, and what data to collect. Finally we consider the potential uses of the data for both clinical and research purposes, including evaluation of national suicide prevention initiatives.

Hospitalization↗
PubMed2006

The hospital management of fatal self-poisoning in industrialized countries: an opportunity for suicide prevention?

Suicide by self-poisoning is a prevalent cause of death worldwide. A substantial proportion of individuals who poison themselves come into contact with medical services before they die. Our focus in the current study was the medical management of drug self-poisoning in industrialized countries and its possible contribution to suicide prevention. We reviewed the literature to determine the proportion of self-poisoning suicides who reach hospital alive, the sociodemographic and clinical characteristics of in-hospital overdose deaths, the in-hospital management this group of patients receives, and whether there are specific aspects of pre-hospital care and in-hospital management that have the potential to improve survival. Between 11% and 28% of individuals who died following deliberate ingestion of drugs reached hospital alive. The substances which were most frequently implicated in death were paracetamol (acetaminophen) and paracetamol compounds, tricyclic antidepressants, and benzodiazepines. Most patients received fairly intensive treatment, yet death may have been preventable in a small proportion of cases. Only one intervention (the administration of acetylcysteine) was shown to reduce mortality and this was in a highly selected group of patients (those who had ingested paracetamol and developed fulminant hepatic failure). It is possible that other interventions such as better airway management, the prompt administration of activated charcoal, and improved pre-hospital care may improve outcomes but their potential contribution to suicide prevention needs to be investigated in future studies.

Adolescent↗
PubMed2005

Alcohol dependence, excessive drinking and deliberate self-harm: trends and patterns in Oxford, 1989-2002.

BACKGROUND: Problems relating to alcohol use are very common among deliberate self-harm (DSH) patients, and alcohol abuse increases the risk of both DSH and suicide. In the UK, per capita consumption of alcohol has risen by 50% since 1970. The proportion of women (but not men) drinking in excess of government-recommended limits has also increased. We investigate trends, by gender and age group, in alcohol problems and usage among DSH patients. METHOD: Data collected by the Oxford Monitoring System for Attempted Suicide were used to examine trends in alcohol disorders and alcohol consumption shortly before, or at, the time of self-harm by patients aged 15 years or over between 1989 and 2002. RESULTS: Data were available on 10,414 patients who were involved in 17,511 episodes of DSH. The annual numbers of both male and female DSH patients rose progressively over the study period. Although rates of alcohol disorders and consumption remained higher in males than females, substantial increases were seen in females of all ages in rates of alcohol problems, excessive drinking and consumption of alcohol within 6 h of DSH and as part of the act of DSH. Rates for males largely remained unchanged. CONCLUSIONS: There has been a significant increase in excessive drinking and consumption of alcohol around the time of DSH by females but not males. These changes may relate to increases in the affordability and availability of alcohol and to social changes in drinking patterns. They have implications for services for DSH patients and may have an impact on future patterns of suicidal behaviour.

Adolescent↗
PubMed2005

Factors associated with the non-assessment of self-harm patients attending an Accident and Emergency Department: results of a national study.

BACKGROUND: Psychosocial assessment of self-harm patients by mental health service staff is an important aspect of their care. Nevertheless, in England around half of those attending a general hospital following a self-harm episode do not receive such an assessment. We have investigated the reasons for this and the characteristics of patients associated with self-discharge or planned discharge without a psychosocial assessment. METHOD: 8-week audits of self-harm attendances were carried out in 32 Accident and Emergency Departments in England. Where a specialist psychosocial assessment by mental health services was not carried out, information on the reason for this was requested. Due to incomplete data 10 of the 32 hospitals were excluded from analysis. RESULTS: There were 2780 self-harm attendances at the 22 hospitals. Psychosocial assessments were carried out on 59% of episodes. Among those not assessed, 57% discharged themselves and the remainder were discharged by hospital staff. In multivariable models, being male, taking illegal drugs/alcohol, attendance out of office hours and not being admitted to a hospital bed were associated with an increased risk of self-discharge. Younger subjects were more likely to self-discharge, but this association was explained by age-related admission patterns. Young age (<45 years), no previous self-harm and not being admitted were associated with an increased likelihood of discharge by hospital staff without a psychosocial assessment. The apparent increased risk of discharge without an assessment for those who self-lacerated was attenuated after allowing for their lower admissions rates. LIMITATIONS: Missing data from 10 hospitals led to their exclusion from analysis. Only the primary reason for discharge was reported on the audit forms. CONCLUSIONS: Those at elevated risk of suicide--older patients and those with a history of self-harm--were the least likely to be discharged by hospital staff without a psychosocial assessment. However, males (at increased risk of suicide compared with females), those who had taken illegal drugs or/and alcohol and those attending 'out of hours' were more likely to self-discharge. Services need to be modified and evaluated, based on further information about why such individuals are not currently engaging in services.

Adult↗
PubMed2005

Problem-solving ability and repetition of deliberate self-harm: a multicentre study.

BACKGROUND: While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. METHOD: As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. RESULTS: Factor analysis identified five dimensions--Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance--characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems--was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. CONCLUSIONS: The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

Adaptation, Psychological↗
PubMed2005

Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials.

BACKGROUND: This review was undertaken to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication. METHODS: Electronic databases and reference lists were searched, and pharmaceutical companies and experts contacted to identify randomised controlled trials comparing management strategies for antidepressant-induced sexual dysfunction. RESULTS: Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 to 0.6). Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF) (WMD 19.36, 95% CI 15.00 to 23.72). Another trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 to 1.55). In a further study the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo. DISCUSSION: The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.

Antidepressive Agents↗
PubMed2005

In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies?

The purpose of this study was to ascertain whether adolescents who deliberately harmed themselves or had thoughts of self-harm differed from other adolescents in terms of help-seeking, communication and coping strategies. The participants were 6020 15-16 year-old school pupils who were surveyed using an anonymous self-report questionnaire. Adolescents with one or more episodes of deliberate self-harm (DSH) in the previous year were more likely to identify themselves as having serious problems than other adolescents. However, a substantial proportion of adolescents with either DSH or thoughts of self-harm did not identify themselves as having serious problems. Adolescents with DSH were most likely to feel the need for help but not try to get any; they were less able to talk to family members and teachers and had fewer categories of people who they were able to talk to. Like other adolescents, those with DSH or thoughts of self-harm were more likely to seek and receive help from their friends than from other sources. They differed from other adolescents in terms of coping strategies they reported employing when faced with difficulties, showing less focus on problems and more avoidant behaviours. The findings have important implications for preventive strategies, including educational programmes on emotional health and coping, and for the clinical care of adolescents identified as at risk or having self-harmed.

Adaptation, Psychological↗
PubMed2005

The epidemiology and prevention of suicide by hanging: a systematic review.

BACKGROUND: Hanging is one of the most commonly used methods for suicide worldwide. In England and a number of other countries, its incidence has increased over the last 30 years. This review summarizes the published literature on suicide by hanging. The focus is on its epidemiology in England and on identifying potential means of prevention. METHODS: We searched Medline (1966-2003), Embase (1980-2003), CINAHL (1982-2003) and PsycINFO (1967-2003). As considerable research on suicides occurring in prisons and psychiatric hospitals in England and Wales has been carried out by the National Confidential Inquiry into Suicide and Homicide (Manchester) and the Prison Service's Safer Custody Group, we obtained additional information from these sources. RESULTS: Only a small proportion (around 10%) of hanging suicides occur in the controlled environments of hospitals, prisons, and police custody; the remainder occur in the community. The most commonly used ligatures (rope, belts, flex) and ligature points (beams, banisters, hooks, door knobs, and trees) are widely available; thus prevention strategies focused around restriction of access to means of hanging are of limited value. Around 50% of hanging suicides are not fully suspended--ligature points below head level are commonly used. Case fatality following attempted suicide by hanging is around 70%; the majority (80-90%) of those who reach hospital alive survive. CONCLUSION: Strategies to reduce suicide by hanging should focus on the prevention of suicide in controlled environments, the emergency management of 'near-hanging' and on the primary prevention of suicide in general. More research is required to better understand the recent rise in popularity of this method.

Adolescent↗