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Biomedical subjects

Keith Hawton

Publications and source records attributed to Keith Hawton.

At least 37 records · Page 2Linked to original sources
PubMed2005

Gunshot suicides in England--a multicentre study based on coroners' records.

BACKGROUND: Gunshot suicides account for 2.5% of suicides in England and Wales. This amounts to more than 100 deaths per year. Information about such deaths may assist in the development of suicide prevention strategies. METHOD: We have examined coroners' inquest records for all gunshot suicides between 1st January 2000 and 31st December 2001 in 24 coroners' jurisdictions in England. RESULTS: Fifty-eight gunshot suicides were identified, including one homicide-suicide. Ninety-three per cent of cases were male. Sport or occupational usage was the main reason for owning the gun. Ten per cent were farmers or farm-workers. In 20% of cases the gun did not belong to the individual who used it for suicide. This was more likely in younger suicides. Seven (12.1%) individuals used illegally owned handguns. Large amounts of alcohol had been consumed before the act in nine cases. Nearly three-quarters (72.9%) of individuals with diagnostic information had a probable diagnosis of depression. However, only 22.4% had ever had contact with psychiatric services. Two shotgun certificate holders were under the care of psychiatric services at the time of their death and two others had a history of previous self-harm. CONCLUSIONS: Strategies to reduce the number of gunshot suicides need to focus on limiting access to guns. These include restricting access to guns by non-certificate holders and those who may be at increased risk of suicide, and holding regular gun amnesties.

Adolescent↗
PubMed2005

Ethnic and gender differences in drinking, smoking and drug taking among adolescents in England: a self-report school-based survey of 15 and 16 year olds.

Concern has been mounting about the increasing numbers of adolescents who (ab)use drugs, alcohol and cigarettes. The aim of this study was to establish the prevalence according to gender and ethnicity of drinking, smoking and drug-use in a representative sample of 15 and 16 year olds. The sample consisted of 6020 15- and 16-year-old pupils from 41 schools in England who completed an anonymous self-report survey. There were clear gender and ethnic differences in self-reported substance use. For example, more males than females reported drinking and drug taking. More females reported smoking, but males were more likely to be heavy smokers. Asian, Black and other boys and Black and Asian girls were less likely to report drinking during a typical week compared to White participants. Asian females were less likely to report smoking compared to White females. Cannabis was the most commonly used drug for both genders. Black males were more likely than White males to have used cannabis, opiates and other drugs. However, Asian females were more likely than their White counterparts to have used opiates, but were significantly less likely to have used cannabis. Asian males were more likely than White males to have used ecstasy. The results confirm gender differences in substance use and demonstrate that there are different patterns of substance use between ethnic groups. These findings have implications for targeting prevention campaigns through the media and educational initiatives.

Adolescent↗
PubMed2005

Suicidal phenomena and abuse in adolescents: a review of epidemiological studies.

OBJECTIVE: To conduct a systematic review of the international literature to determine whether adolescents who had experienced abuse were more likely to also experience suicidal thoughts and behaviors than other adolescents, and to investigate the nature of this association. METHOD: Reports of community- or school-based studies of adolescents on the association between the prevalence of suicidal phenomena and abuse were searched for via electronic databases, reviewing reference lists and contacting experts in the field. RESULTS: Ten relevant studies were identified. Adolescents who had been physically or sexually abused were significantly more likely to experience suicidal thoughts and behaviors than other adolescents. This association appeared to be direct in most studies in which multivariate analyses were conducted. There is evidence that other factors (e.g., low self-esteem) may play a mediating role in the relationship between abuse and suicidal phenomena. CONCLUSIONS: There is a clear link between abuse and suicidal phenomena occurring during childhood and adolescence.

Adolescent↗
PubMed2005

Suicidal intent in deliberate self-harm and the risk of suicide: the predictive power of the Suicide Intent Scale.

BACKGROUND: Suicidal intent at the time of deliberate self-harm (DSH) is known to be associated with risk of future suicide in DSH patients. The predictive power of suicidal intent to identify particular individuals who are at high risk of suicide is unclear. METHOD: Clinical and demographic data on 4156 DSH patients presenting to hospital 1993 and 1997 were analysed. Follow-up information on eventual suicide was available for 2489 patients (mean follow-up 5.2 years). The predictive value of the Beck Suicidal Intent Scale (SIS) was examined using Receiver Operating Characteristic (ROC) plots. RESULTS: Thirty males (2.9%) and 24 females (1.7%) died by suicide. Despite a robust association between suicidal intent and eventual suicide, the positive predictive value (PPV) of the SIS was low (4%). Predicted probabilities of suicide assigned to individual patients were also low, even for those who eventually died by suicide. LIMITATIONS: Assessment and follow-up information was not available for all patients. CONCLUSIONS: The SIS cannot predict which individual patients will ultimately die by suicide. Nonetheless, information regarding suicidal intent is valuable in the clinical risk assessment and management of DSH patients.

Humans↗
PubMed2005

Pain and deliberate self-harm: an important association.

OBJECTIVE: The aim of this study was to establish how often pain was a factor contributing to an episode of deliberate self-harm. METHOD: Retrospective case note examination of all deliberate self-harm patients with concurrent medical problems admitted to a general hospital over 2 years. RESULTS: Pain was considered to be a contributory factor in the episode of deliberate self-harm in 75 (4%) of the total number of episodes of deliberate self-harm (1665) over the 2-year period. These patients were older and had higher suicide intent scores, but lower rates of previous psychiatric illness or alcohol or drug misuse than did the deliberate self-harm patients with medical problems but no pain. Although 60% had experienced pain for more than 6 months only, 8 (12%) were attending the local Pain Clinic at the time of the deliberate self-harm. CONCLUSION: We propose closer collaboration between general hospital services and local pain clinics for deliberate self-harm patients with painful disorders. Clinicians need to assess suicidal ideation and risk of self-harm when prescribing for this population.

Adult↗
PubMed2005

Deliberate self-harm in children and adolescents: a research update.

PURPOSE OF REVIEW: We outline research developments in 2004 and early 2005 published in English language journals on deliberate self-harm among children and adolescents up to the age of 18 years. RECENT FINDINGS: The main issue of concern in recent times has been the risk/benefit profile of using antidepressants, especially selective serotonin reuptake inhibitors, in depressed children and adolescents. Other important topics include treatment approaches, particularly cognitive behaviour therapy, dialectical behaviour therapy and multisystemic therapy, barriers to help seeking, the Internet and prevention. SUMMARY: Rates of deliberate self-harm appear to be rising among young people. Risk factors associated with deliberate self-harm are becoming clearer and the evaluation of treatments is progressing. However, the recent conflicting evidence and guidelines regarding selective serotonin reuptake inhibitors and suicidality are presenting major difficulties for clinicians. The role of the Internet and initiatives to prevent suicidal behaviour in adolescents require further research.

Journal Article↗
PubMed2005

Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials.

OBJECTIVE: Observational studies suggest that long-term lithium treatment has a strong antisuicidal effect in mood disorders, but it is uncertain whether this association is a genuine therapeutic effect or is due to confounding factors in nonrandomized studies. The authors conducted a systematic review and meta-analysis of randomized trials to investigate the effect of lithium, compared to placebo and other active treatments, on the risk of suicide, deliberate self-harm, and all-cause mortality in patients with mood disorder. METHOD: The data source was the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register, incorporating results of searches of MEDLINE (1966-June 2002), EMBASE (1980-June 2002), CINAHL (1982-March 2001), PsycLIT (1974-June 2002), PSYNDEX (1977-October 1999), and LILACS (1982-March 2001). The Cochrane Central Register of Controlled Trials (CENTRAL) was searched with the term "lithium" for new records entered into the database from 1999 to 2003. Studies selected included randomized, controlled trials comparing lithium with placebo or all other compounds used in long-term treatment for mood disorders (unipolar depression, bipolar disorder, schizoaffective disorder, dysthymia, and rapid cycling, diagnosed according to DSM or ICD criteria). Of 727 references identified in the search, 52 articles were marked as possibly relevant on the basis of the abstract, and 32 randomized, controlled trials were eligible for inclusion in the review. Two independent reviewers extracted the data, and disagreements were resolved by consensus with a third reviewer. Methodological quality was assessed according to the criteria of the Cochrane Collaboration. When the outcomes of interest were not reported, an attempt was made to obtain the required data from the original authors. RESULTS: In 32 trials, 1,389 patients were randomly assigned to receive lithium and 2,069 to receive other compounds. Patients who received lithium were less likely to die by suicide (data from seven trials; two versus 11 suicides; odds ratio=0.26; 95% confidence interval [CI]=0.09-0.77). The composite measure of suicide plus deliberate self-harm was also lower in patients who received lithium (odds ratio=0.21; 95% CI=0.08-0.50). There were fewer deaths overall in patients who received lithium (data from 11 trials; nine versus 22 deaths; odds ratio=0.42, 95% CI=0.21-0.87). CONCLUSIONS: Lithium is effective in the prevention of suicide, deliberate self-harm, and death from all causes in patients with mood disorders.

Cause of Death↗
PubMed2005

Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury.

BACKGROUND: Self-harm is associated with a high risk of suicide. It is unclear whether suicidal intent at the time of self-harm is a risk factor for future suicidal behaviour. AIMS: To investigate the relationship between suicidal intent and patient characteristics, repetition of self-harm, and suicide. METHOD: Clinical and demographic data on 4415 patients presenting to hospital following self-harm between 1993 and 2000 were analysed. Suicidal intent was measured using the Beck Suicide Intent Scale (SIS). Follow-up information on repetition of self-harm and suicide was investigated for 2489 patients presenting between 1993 and 1997. RESULTS: Suicidal intent at the time of self-harm was associated with risk of subsequent suicide, especially within the first year and among female patients. Suicide was more strongly associated with scores on the circumstances section of the SIS than the self-report section. The association between repetition of self-harm and SIS scores was different for male and female patients. CONCLUSIONS: The measurement of suicidal intent in the assessment of self-harm patients is beneficial for the evaluation of future suicide risk. A shortened measuring scale might be useful in clinical practice.

Adolescent↗
PubMed2005

Suicide by hanging: multicentre study based on coroners' records in England.

We studied 162 cases of hanging by suicide occurring in 24 coroners' jurisdictions in England within a 6-month period in 2001. Prison and psychiatric ward suicides accounted for only 6% of these. The most frequently used ligatures (ropes, belts and cable) and ligature points (beams, girders, lofts and trees) are commonly available in community settings, limiting opportunities for prevention. In only half the cases (52%) were victims fully suspended with both feet off the ground. Four per cent had also taken an overdose.

Adult↗
PubMed2005

Schizophrenia and suicide: systematic review of risk factors.

BACKGROUND: Suicide risk is greatly increased in schizophrenia. Detection of those at risk is clinically important. AIMS: To identify risk factors for suicide in schizophrenia. METHOD: The international literature on case-control and cohort studies of patients with schizophrenia or related conditions in which suicide was reported as an outcome was systematically reviewed. Studies were identified through searching electronic databases and reference lists, and by consulting experts. RESULTS: Twenty-nine eligible studies were identified. Factors with robust evidence of increased risk of suicide were previous depressive disorders (OR=3.03, 95% CI 2.06-4.46), previous suicide attempts (OR=4.09, 95% CI 2.79-6.01), drug misuse (OR=3.21, 95% CI 1.99-5.17), agitation or motor restlessness (OR=2.61, 95% CI 1.54-4.41), fear of mental disintegration (OR=12.1, 95% CI 1.89-81.3), poor adherence to treatment (OR=3.75, 95% CI 2.20-6.37) and recent loss (OR=4.03, 95% CI 1.37-11.8). Reduced risk was associated with hallucinations (OR=0.50, 95% CI 0.35-0.71). CONCLUSIONS: Prevention of suicide in schizophrenia is likely to result from treatment of affective symptoms, improving adherence to treatment, and maintaining special vigilance in patients with risk factors, especially after losses.

Depressive Disorder↗
PubMed2005

Suicide prevention and audit.

Suicide is a devastating event and a major public health issue. On average one person dies every 2 hours in England as a result of suicide. It is the commonest cause of death in men under the age of 35 years. This article reviews the epidemiology, causal factors and prevention of suicide, and also briefly discusses the role of audit in this area.

Age Factors↗
PubMed2005

The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies.

The results of a systematic review of the international literature on the prevalence of suicidal phenomena in adolescents, including the influence of survey method, gender, and ethnicity are reported. The literature was searched using six electronic databases to identify all population-based studies of self-reported suicidal phenomena; 128 studies were included, comprising 513,188 adolescents. The mean proportion of adolescents reporting they had attempted suicide at some point in their lives was 9.7% (95% CI, 8.5-10.9), and 29.9% (95% CI, 26.1-33.8) of adolescents said they had thought about suicide at some point. Females were significantly more likely than males to report most suicidal phenomena. A lower prevalence of some suicidal phenomena was found for Asian populations. The prevalence of suicidal phenomena varied depending on the terminology used and tended to be higher in studies employing anonymous questionnaires than in studies employing non-anonymous methods (questionnaires or interviews), although most of these differences were not statistically significant.

Adolescent↗
PubMed2005

Social problem solving in adolescents with suicidal behavior: a systematic review.

There is an increasing focus on deficiencies in problem solving as a vulnerability factor for suicidal behavior in general and hence a target for treatment in suicide attempters. In view of the uncertainty of evidence for this in adolescents we conducted a systematic review of the international research literature examining the possible relationship between deficiencies in social problem-solving skills and suicidal behavior in this population. This was based on searching two electronic databases: Medline 1966 to September 2003 and PsychInfo 1887 to September 2003. Twenty-two studies of social problem-solving skills in adolescents with suicidal behavior were found. Most of these studies, which compared adolescent patients with suicide attempts versus either nonsuicidal psychiatric or normal controls, found evidence for problem-solving deficits in the attempters; however, few of the differences remain after controlling for depression and/or hopelessness. Because most of the studies are cross-sectional, it is difficult to differentiate between the possibilities that deficiencies in problem-solving skills lead to depression when adolescents are faced by adversity and hence to suicidal behavior, or whether depression is the main factor which undermines problem-solving skills. Future research, preferably with longitudinal research designs, is required to determine the nature of the association between problem-solving skills and suicidal behavior in adolescents. This has important implications for therapeutic interventions.

Adolescent↗
PubMed2005

The usefulness of coroners' data on suicides for providing information relevant to prevention.

Coroners' records are an accessible source of information on suicides. To assess their usefulness in relation to the investigation of specific methods of suicide, we examined coroners' records for 492 suicides across 24 jurisdictions in England. Generally data on demographic variables were well recorded. Information on contact with general practitioner and psychiatric services was less commonly available. Where those who had self-poisoned died in hospital, information on treatment and blood levels of drugs taken were not routinely available. For suicides by hanging, information on the source of ligature was frequently missing. Where firearms were used, information about licensing and storage were not routinely recorded. Generally there was wide variation across coroners in information relevant to specific methods. The use of standardized forms by coroners would assist studies of factors associated with suicide and potentially provide a representative source of information relevant to suicide prevention.

Coroners and Medical Examiners↗
PubMed2005

Schizophrenia and deliberate self-harm: a systematic review of risk factors.

Deliberate self-harm (DSH) is a strong predictor of suicide in schizophrenia. The aim of this review was to identify risk factors for DSH in schizophrenia. This systematic review of the international literature examined cohort and case-control studies of patients with schizophrenia or related diagnoses that reported DSH as an outcome. Studies were identified by searching electronic databases and reference lists, and by consulting international experts. Fourteen studies met the eligibility criteria. Of the 29 variables examined by two or more studies, five (past or recent suicidal ideation, previous DSH, past depressive episode, drug abuse or dependence, and higher mean number of psychiatric admissions) were associated with an increased risk of DSH, and one (unemployment) was associated with a reduced risk. Schizophrenic patients with these risk factors need careful follow-up and monitoring, with treatment of any associated comorbid depression or drug abuse. Large, prospective studies of DSH in schizophrenia are needed to further define risk factors and to build on the findings of this review.

Adult↗
PubMed2005

Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors.

OBJECTIVE: To determine the main risk factors for suicide and nonfatal suicidal behavior in patients with bipolar disorder through a systematic review of the international literature. DATA SOURCES: Studies were identified through electronic searches of MEDLINE (1966-December 2003), EMBASE (1980-December 2003), PsycINFO (1872-November 2003), and Biological Abstracts (1985-December 2003) using index and free-text search terms for bipolar disorder, bipolar depression, manic depression, mania, and affective disorders; combined with terms for self-harm, self-injury, suicide, attempted suicide, automutilation, self-mutilation, self-poisoning, and self-cutting; and combined with terms for risk, case control, cohort, comparative, longitudinal, and follow-up studies. No language restrictions were applied to the search. STUDY SELECTION: Included studies were cohort, case-control, and cross-sectional investigations of patients with bipolar disorder in which suicide (13 studies) or attempted suicide (23 studies) was reported as an outcome. The selected studies also used diagnostic tools including the DSM, International Classification of Diseases, and Research Diagnostic Criteria. DATA SYNTHESIS: Meta-analysis of factors reported in more than 1 study identified the main risk factors for suicide as a previous suicide attempt and hopelessness. The main risk factors for nonfatal suicidal behavior included family history of suicide, early onset of bipolar disorder, extent of depressive symptoms, increasing severity of affective episodes, the presence of mixed affective states, rapid cycling, comorbid Axis I disorders, and abuse of alcohol or drugs. CONCLUSIONS: Prevention of suicidal behavior in patients with bipolar disorder should include attention to these risk factors in assessment and treatment, including when deciding whether to initiate treatment aimed specifically at reducing suicide risk.

Bipolar Disorder↗
PubMed2004

The epidemiology and management of self-harm amongst adults in England.

BACKGROUND: Previous research into the epidemiology and management of self-harm has been largely based in centres with a special interest in this behaviour or focused on hospital admissions only. There are no national data on the characteristics and management of people presenting to hospital following self-harm. METHODS: Data were collected from 8-week service audits carried out in a stratified random sample of 31 general hospitals in England. RESULTS: 4033 episodes of self-harm resulting in presentation to Accident and Emergency Departments were identified. Overdose alone accounted for 79 per cent of episodes, 80 per cent of presentations were outside normal office hours (9 am - 5 pm, Monday to Friday) and the peak period of attendance was from 8 pm to 2 am. In only 56 per cent of episodes was a specialist psychosocial assessment conducted prior to discharge and less than half (46 per cent) led to admission to a hospital bed. Psychiatric admission occurred in 10 per cent. Episodes involving older subjects (>45 years) and those using methods other than laceration or overdose were the most likely to lead to assessment and admission. CONCLUSIONS: Non-fatal self-harm is one of the strongest predictors of suicide, yet nearly half of all hospital attendances in England following self-harm do not lead to a specialist assessment. Patterns of service provision should take account of the observation that most self-harm attendances occur outside normal working hours and those at greatest risk of repetition are the least likely to receive assessments.

Adolescent↗