How primary care nurses can identify and manage self-harm
Primary care nurses need to be able to identify and manage self-harm. This research focus explores high risk groups and management strategies
Picture: iStock Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort studyYoung people who had tried different self-injury methods, especially self-poisoning, were 30 times more likely to die by suicide than peers who had not self-harmed, research into those at greatest risk of death following self-harm found.
Data from the Multicentre Study of Self-harm and NHS Digital in England provided a sample of 9,173 people aged 10-18 years who had presented to five hospitals with self-harm between 2000 and 2013.
Follow-up took place until the end of 2015, by which time 1% of the cohort had died: 44%
Primary care nurses need to be able to identify and manage self-harm. This research focus explores high risk groups and management strategies
Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort study
Young people who had tried different self-injury methods, especially self-poisoning, were 30 times more likely to die by suicide than peers who had not self-harmed, research into those at greatest risk of death following self-harm found.
Data from the Multicentre Study of Self-harm and NHS Digital in England provided a sample of 9,173 people aged 10-18 years who had presented to five hospitals with self-harm between 2000 and 2013.
Follow-up took place until the end of 2015, by which time 1% of the cohort had died: 44% by suicide, 22% by accidental death and 34% from other causes. Of the deaths by suicide, 82% involved self-injury and 76% were in those aged 18 or over. A change in method was common, especially from self-poisoning to a more lethal method.
The greatest indicators of death were being male, being an older adolescent at the time of presentation, repeated self-harm, the use of self-injury, especially hanging or asphyxiation, and higher risk of self-poisoning, including misusing illicit drugs.
Hawton K, Bale L, Brand F et al (2020) The Lancet Child and Adolescent Health. 4, 2, 111-120. doi: https://doi.org/10.1016/S2352-4642(19)30373-6
Understanding suicidal ideation and behaviour in individuals with chronic pain: a review of the role of novel transdiagnostic psychological factors
The risk of suicide for those in chronic pain is high: 23% of people have suicidal ideation and 15% attempt suicide. To explore why some people are more vulnerable, the psychological processes relevant to chronic pain and suicide – or transdiagnostic factors – were reviewed.
Three theoretical models were chosen: the interpersonal-psychological method, the integrated motivational-volitional model and the three-step theory.
The interpersonal-psychological model suggests a risk of suicide when individuals perceive they are a burden and have unmet need for social belonging and engagement. Mental defeat is strongly correlated to pain interference, depression, psychosocial disability, and may be a factor in strong suicidal ideation, but not always intent, and as such part of the motivational phase. Step three then asks whether the person is capable of, intends, and has the means to self-harm.
Three novel transdiagnostic factors need further investigation:
- Negative mental imagery – reported in self-harm and is strongly linked to suicidality
- Psychological flexibility – models of acceptance and commitment therapy are relevant with chronic pain
- Positive future orientation – the ability to see a changing, more manageable future, including interpersonal hopes
Kirtley O, Rodham K, Crane C (2020) The Lancet Psychiatry. 7, 3, 282-290. doi: https://doi.org/10.1016/S2215-0366(19)30288-3
Self-harm in a primary care cohort of older people: incidence, clinical management, and risk of suicide and other causes of death
The risk of suicide among older people who self-harm found suicidal intent is greater in the younger age group, and attempts are more often fatal, despite a lower incidence of self-harm overall, this research shows.
Primary and secondary care electronic records for 2001-2014 found 4,124 reported self-harm episodes in adults aged 65 years and over; 59.6% of women self-harmed compared to 40.4% of men.
This group was 20 times more likely to die than general population peers in the 12 months following self-harm and consistently at higher risk subsequently. Men aged 60 years or over are the highest risk age group.
The highest risk group had physical and mental ill health. The loss of functional ability, experience of bereavement and social isolation are known risk factors for self-harm.
Only 11.7% were referred to secondary services, while 59.3% were prescribed an antidepressant, including tricyclic antidepressants which are highly toxic in overdose.
Recommended management includes enhancing social connections, engaging in social and physical activity and safety planning.
Morgan C, Webb R, Carr M et al (2018) The Lancet Psychiatry. 5, 11, 905-912. doi: https://doi.org/10.1016/S2215-0366(18)30348-1
Thinking points
- Supporting someone who feels suicidal: see MIND resources
- Enhanced social engagement and interaction were highlighted in all papers
- More research is needed into associated comorbid risks
Related articles
- Three minutes to save a life: the course designed to raise suicide awareness
- Leave judgement at the door when talking about self-harm
- Annessa Rebair: Why suicide prevention must be part of pre-registration nurse education
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