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Keith Hawton

Publications and source records attributed to Keith Hawton.

67 records · Page 4Linked to original sources
PubMed2003

Comorbidity of axis I and axis II disorders in patients who attempted suicide.

OBJECTIVE: The authors compared the characteristics of suicide attempters with and without comorbid psychiatric and personality disorders to identify factors that explain the high suicide risk associated with psychiatric comorbidity. METHOD: A representative group of 111 patients who had attempted suicide (72 female and 39 male) was assessed for psychiatric and personality disorders according to ICD-10 criteria. The characteristics of patients with both types of disorder were compared with those of patients without comorbid disorders. A semistructured interview schedule and standardized questionnaires were used to investigate patients' background characteristics, the circumstances of the suicide attempts, psychological characteristics, and outcome after 12-20 months. RESULTS: Comorbidity of psychiatric and personality disorders was present in 49 patients (44%). More patients with comorbid disorders had made previous suicide attempts (N=41 [84%] versus N=28 [45%]) and repeated attempts during the follow-up period (N=25 [51%] versus N=9 [15%]). Differences in precipitants and motives for the index episode were also found: patients with comorbid disorders were more depressed and hopeless, reported more episodes of aggression, were more impulsive, and had lower self-esteem and poorer problem-solving skills. Differences in self-esteem and problem-solving skills distinguished between the groups in a stepwise discriminant function analysis. More of the patients with comorbid disorders reported not being loved by their parents and parental suicidal behavior. CONCLUSIONS: Suicide attempters with comorbid psychiatric and personality disorders show marked differences from those without both of these disorders. Comorbidity may contribute to greater suicide risk. Some of the characteristics of patients with comorbid disorders pose major clinical challenges that should be addressed in an effort to reduce suicide risk.

Adolescent↗
PubMed2003

Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital.

BACKGROUND: Deliberate self-harm (DSH) is the strongest risk factor for future suicide. Up-to-date information on the extent of risk is lacking. AIMS: To investigate the risk of suicide after DSH during a long follow-up period. METHOD: A mortality follow-up study to 2000 was conducted on 11 583 patients who presented to hospital after DSH between 1978 and 1997. Data were obtained from a general hospital DSH register in Oxford and the Office for National Statistics, and from equivalent mortality registers in Scotland and Northern Ireland. RESULTS: Three hundred patients had died by suicide or probable suicide. The risk in the first year of follow-up was 0.7% (95% CI 0.6-0.9%), which was 66 (95% CI 52-82) times the annual risk of suicide in the general population. The risk after 5 years was 1.7%, at 10 years 2.4% and at 15 years 3.0%. The risk was far higher in men than in women (hazard ratio 2.8,95% CI 2.2-3.6). In both genders it increased markedly with age at initial presentation. CONCLUSIONS: Following DSH there is a significant and persistent risk of suicide, which varies markedly between genders and age groups. Reduction in the risk of suicide following DSH must be a key element in national suicide prevention strategies.

Adolescent↗
PubMed2003

Correlates of relative lethality and suicidal intent among deliberate self-harm patients.

Conflicting findings have been reported regarding the relationship between the potential lethality of acts of deliberate self-harm (DSH) and suicidal intent, and how each relates to patient characteristics. This study examines the relationship of suicidal intent of DSH to lethality, the relationship of both to patient characteristics, and determines if intent or lethality are risk factors for repetition of DSH. Potential lethality and Suicide Intent Scale (SIS) scores for DSH episodes were examined in a representative sample of 150 patients presenting to a general hospital. Follow-up interviews were completed 12 to 20 months later. Lethality was strongly associated with high intent. Both lethality and intent were associated with male gender. Suicidal intent but not lethality was associated with the presence of psychiatric disorder and depression. Intent was significantly correlated with hopelessness scale score. Although intent was correlated with both depression and self-esteem scale scores, these correlations became nonsignificant when the effect of hopelessness was removed. Repetition of DSH during the follow-up period was related to neither lethality nor intent scores for the original episodes. Lethality and suicidal intent, although related, have somewhat different correlates. Both should be considered when assessing DSH patients, but their relationship to further suicidal behavior does not appear to be straightforward.

Adolescent↗
PubMed2002

Deliberate self harm in adolescents: self report survey in schools in England.

OBJECTIVE: To determine the prevalence of deliberate self harm in adolescents and the factors associated with it. DESIGN: Cross sectional survey using anonymous self report questionnaire. SETTING: 41 schools in England. PARTICIPANTS: 6020 pupils aged 15 and 16 years. MAIN OUTCOME MEASURE: Deliberate self harm. RESULTS: 398 (6.9%) participants reported an act of deliberate self harm in the previous year that met study criteria. Only 12.6% of episodes had resulted in presentation to hospital. Deliberate self harm was more common in females than it was in males (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1 to 4.9). In females the factors included in a multivariate logistic regression for deliberate self harm were recent self harm by friends, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem. In males the factors were suicidal behaviour in friends and family members, drug use, and low self esteem. CONCLUSIONS: Deliberate self harm is common in adolescents, especially females. School based mental health initiatives are needed. These could include approaches aimed at educating school pupils about mental health problems and screening for those at risk.

Adolescent↗
PubMed2002

Deliberate self harm patients with depressive disorders: treatment and outcome.

BACKGROUND: Depression is the most common psychiatric disorder in deliberate self-harm (DSH) patients and in those who commit suicide. The aim of this study was to examine the treatment received by DSH patients with depression and their progress following DSH. METHODS: A representative sample of 106 patients with an ICD-10 depressive episode who presented to a general hospital following an episode of DSH were investigated in terms of their treatment before and after the episode and their outcome at follow-up. RESULTS: Prior to the index episode of DSH, 39 patients (36.8%) were receiving treatment from the psychiatric services and a further 35 (33.0%) were receiving treatment for mental health problems from their general practitioner. Fifty-two patients (49.1%) were receiving antidepressants (in therapeutic dosages in 93.6%). After the episode of DSH 94 patients (88.7%) were offered treatment with the psychiatric services, either as a new referral or continuation of treatment they were receiving prior to DSH. Of the patients who were followed-up, 36.3% remained in contact with the psychiatric services, 52.3% showed poor compliance with recommended treatment and 60.2% no longer fulfilled the diagnostic criteria for depression. Almost one-third reported a further episode of DSH during the follow-up period. LIMITATIONS: The nature and quality of non-physical treatments provided by the psychiatric services was not investigated. Reports of the treatment provided by general practitioners, the timing of improvement in symptoms and compliance with treatment largely relied on patients' self report. CONCLUSIONS: All patients presenting following DSH need to be carefully screened for depressive illness. Randomised controlled studies need to be conducted on DSH patients with depression to determine which treatments are effective.

Adult↗
PubMed2002

The grief experiences and needs of bereaved relatives and friends of older people dying through suicide: a descriptive and case-control study.

BACKGROUND: Little is known about grief experiences of individuals bereaved through suicide of older people. Legal procedures may be one source of distress. Studies have suggested that guilt feelings, and a sense of rejection, shame or stigma, are probably more frequent in relatives bereaved through suicide than in those bereaved through other modes of death. METHODS: We examined (a) problems experienced during legal procedures after death and (b) grief experiences, in 85 relatives and friends bereaved through the suicide of person 60 years old or over. In a case-control study the bereavement reactions in a subgroup of 46 people were compared with those of a control group bereaved by the natural death of an older person. Interviews, carried out 6-21 months after the deaths, included a semi-structured assessment of problems following the death, the Grief Experience Questionnaire (GEQ) and the Montgomery and Asberg Depression Rating Scale (MADRS). RESULTS: Thirty-six (42.4%) of those bereaved through suicide reported problems in their dealings with the coroner's office, and 33 (38.8%) described distress caused by media reporting of the inquest. Depression scores were similar in the group of individuals bereaved through suicide and those bereaved through natural causes. The former scored higher on subscales of the GEQ measuring stigmatisation, shame, sense of rejection and "unique reactions" compared with those bereaved through natural death. LIMITATIONS: The participation rate of potential subjects was somewhat low, especially in the control group. Proportions of different kinships to the deceased differed in the study and control groups. CONCLUSIONS: Problems in the media reporting of coroners' inquests and in inquest procedures are a frequent source of distress for bereaved relatives. The common themes of stigma, shame, and sense of rejection in bereavement after suicide suggest that these areas should be specifically addressed in the counselling of relatives bereaved in this way.

Adult↗
PubMed2002

Family history of suicidal behaviour: prevalence and significance in deliberate self-harm patients.

OBJECTIVE: To investigate whether there are differences between the characteristics of deliberate self-harm (DSH) patients with and without a family history of suicidal behaviour. METHOD: In 146 DSH patients, those with and without a positive family history were compared with regard to the nature and repetition of their DSH episodes, and psychological and psychiatric characteristics. RESULTS: Fifty-two (35.6%) patients had a family history of suicidal behaviour. DSH was more frequent in patients' mothers (17.1%) than fathers (2.7%). Patients with a family history of suicidal behaviour, especially females, had higher state anger scores. CONCLUSION: Family history of suicidal behaviour appears to be associated with greater anger. Absence of other associations suggests that family history probably has less implication for individuals who have already engaged in DSH than in contributing to its initiation. Future studies should include patients with violent or life-threatening DSH acts.

Adolescent↗
PubMed2002

United Kingdom legislation on pack sizes of analgesics: background, rationale, and effects on suicide and deliberate self-harm.

Following increasing concern in the UK about the mortality and morbidity associated with self-poisoning with analgesics, especially paracetamol (Tylenol, acetaminophen), legislation was introduced in 1998 to modify packs sold over-the-counter. The most important change was a reduction in the maximum size of packs. In this paper the background to the legislation, the rationale behind it, and its early impact are reviewed. The changes have had significant positive initial benefits on the mortality and morbidity associated with self-poisoning with analgesics.

Acetaminophen↗
PubMed2002

Why people engage in parasuicide: a cross-cultural study of intentions.

Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.

Adolescent↗
PubMed1996

Does electroconvulsive therapy (ECT) have any role in the management of intractable thalamic pain?

Three patients with intractable thalamic pain unresponsive to a range of previous treatments received a course of six bilateral electroconvulsive therapy (ECT) treatments over 2 weeks. There was no evidence of any improvement in the intensity of the pain, pain relief or mood as measured on visual analogue scales and with standard measures. Propofol was used as the anaesthetic induction agent. Two patients showed wide changes in blood pressure during ECT but all three patients showed prompt recovery. In the light of the negative findings of this study and those of a previous study of the use of unilateral ECT in similar patients it is concluded that ECT is not an effective treatment for post-stroke thalamic pain.

Adult↗
PubMed1987

ECT for Post-stroke Depression: Beta Blockade to Modify Rise in Blood Pressure.

A 60-year-old normotensive woman, who 3 years previously had had a cerebral haemorrhage, developed a severe depressive illness that failed to respond to tricyclic antidepressants and lithium, alone and combined. Electroconvulsive therapy (ECT) was administered using intravenous beta-blockade with practolol and atenolol prior to induction of anaesthesia to prevent the surge in blood pressure normally seen following the convulsion. The blood pressure did not rise and her depression responded to a series of nine ECT treatments. There were no associated complications.

Journal Article↗