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Singapore Med J 2013; 54(9): 491-495; http://dx.doi.org/10.11622/smedj.2013170
Deliberate self-harm in adolescent psychiatric outpatients in Singapore: prevalence and associated risk factors
Loh C, Teo YW, Lim L
Correspondence: Dr Cheryl Loh, Cheryl_loh@cgh.com.sg
ABSTRACT
INTRODUCTION Deliberate self-harm (DSH) is frequently seen in adolescents with a range of mental health problems. The prevalence and features of DSH vary among different countries and settings. This study examines the prevalence of self-harm in a sample of adolescents seen at a psychiatric outpatient clinic in Singapore.
METHODS Information regarding self-harm, as well as its associated demographic and clinical risk factors, was extracted from the clinical records of 542 consecutive, new patients, aged 12–19 years, who presented between 2006 and 2010.
RESULTS DSH was reported in 23.6% of patients, and was positively associated with the female gender (odds ratio [OR] 4.54), mood disorders (OR 4.58), adjustment disorders (OR 3.41) and regular alcohol use (OR 4.80). However, there was no association with parental marital status, anxiety disorder, habitual smoking or family history of psychiatric illness.
CONCLUSION DSH is a significant clinical problem that may be influenced by biological and clinical factors. Adolescents presenting with DSH should be examined for mood and alcohol use disorders.
Keywords: adolescent outpatients, deliberate self-harm
Singapore Med J 2013; 54(9): 491-495; http://dx.doi.org/10.11622/smedj.2013170
REFERENCES
| 1. Laukkanen E, Rissanen ML, Honkalampi K, et al. The prevalence of self-cutting and other self-harm among 13- to 18-year old Finnish adolescents. Soc Psychiatry Psychiatr Epidemiol 2009; 44:23-8. http://dx.doi.org/10.1007/s00127-008-0398-x | ||||
| 2. Wan YH, Hu CL, Hao JH, Sun Y, Tao FB. Deliberate self-harm behaviours in Chinese adolescents and young adults. Eur Child Adolesc Psychiatry 2011; 20:517-25. http://dx.doi.org/10.1007/s00787-011-0213-1 | ||||
| 3. Madge N, Hewitt A, Hawton K, et al. Deliberate self-harm within an international community sample of young people: comparative findings from the Child and Adolescent Self-harm in Europe (CASE) study. J Child Psychol Psychiatry 2008; 49:667-77. http://dx.doi.org/10.1111/j.1469-7610.2008.01879.x | ||||
| 4. Shin YM, Chung YK, Lee YM, Oh EY, Cho SM. Childhood predictors of deliberate self-harm behaviour and suicide ideation in Korean adolescents: a prospective population-based follow-up study. J Korean Med Sci 2009; 24:215-22. http://dx.doi.org/10.3346/jkms.2009.24.2.215 | ||||
| 5. Hawton K, Rodham K, Evans E, Weatherall R. Deliberate self harm in adolescents: self report survey in schools in England. BMJ 2002; 325:1207-11. http://dx.doi.org/10.1136/bmj.325.7374.1207 | ||||
| 6. De Leo D, Heller TS. Who are the kids who self-harm? An Australian self-report school survey. Med J Aust 2004; 181:140-4. | ||||
| 7. Brunner R, Parzer P, Haffner J, et al. Prevalence and Psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Arch Pediatr Adolesc Med 2007; 161:641-9. http://dx.doi.org/10.1001/archpedi.161.7.641 | ||||
| 8. Moran P, Coffey C, Romaniuk H, et al. The natural history of self-harm from adolescence to young adulthood: a population-based cohort study. Lancet 2012; 379:236-43. http://dx.doi.org/10.1016/S0140-6736(11)61141-0 | ||||
| 9. Pelkonen M, Marttunen M, Pulkkinen E, Laippala P, Aro H. Characteristics of out-patient adolescents with suicidal tendencies. Acta Psychiatr Scand 1997; 95:100-7. http://dx.doi.org/10.1111/j.1600-0447.1997.tb00381.x | ||||
| 10. Csorba J, Dinya E, Plener P, Nagy E, Páli E. Clinical diagnoses, characteristics of risk behaviour, differences between suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injury. Eur Child Adolesc Psychiatry 2009; 18:309-20. http://dx.doi.org/10.1007/s00787-008-0733-5 | ||||
| 11. Hintikka J, Tolmunen T, Rissanen ML, et al. Mental disorders in self-cutting adolescents. J Adolesc Health 2009; 44:464-7. http://dx.doi.org/10.1016/j.jadohealth.2008.10.003 | ||||
| 12. Tuisku V, Pelkonen M, Kiviruusu O, et al. Factors associated with deliberate self-harm behaviour among depressed adolescent outpatients. J Adolesc 2009; 32:1125-36. http://dx.doi.org/10.1016/j.adolescence.2009.03.001 | ||||
| 13. Schilling EA, Aseltine RH Jr, Glanovsky JL, James A, Jacobs D. Adolescent alcohol use, suicide ideation, and suicide attempts. J Adolesc Health 2009; 44:335-41. http://dx.doi.org/10.1016/j.jadohealth.2008.08.006 | ||||
| 14.Asarnow JR, Porta G, Spirito A, et al. Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TORDIA study. J Am Acad Child Adolesc Psychiatry 2011; 50:772-81. http://dx.doi.org/10.1016/j.jaac.2011.04.003 | ||||
| 15.Wilkinson P, Kelvin R, Roberts C, Dubicka B, Goodyer I. Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT). Am J Psychiatry 2011; 168:495-501. http://dx.doi.org/10.1176/appi.ajp.2010.10050718 | ||||
| 16.Anderson M, Standen P, Noon J. Nurses' and doctors' perceptions of young people who engage in suicidal behaviour: a contemporary grounded theory analysis. Int J Nurs Stud 2003; 40:587-97. http://dx.doi.org/10.1016/S0020-7489(03)00054-3 | ||||
| 17. Platt S, Salter D. A comparative investigation of health workers' attitudes towards parasuicide. Soc Psychiatry 1987; 22:202-8. http://dx.doi.org/10.1007/BF00583555 | ||||
| 18. Le Cessie S, van Houwelingen JC. A goodness-of-fit test for binary regression models, based on smoothing methods. Biometrics 1991; 47:1267-82. http://dx.doi.org/10.2307/2532385 | ||||
| 19. Students Health Survey. Singapore: Health Promotion Board, 2006. | ||||
| 20.Subramaniam M, Cheok C, Lee IM, et al. Nicotine dependence and psychiatric disorders among young males in Singapore. Nicotine Tob Res 2009; 11:1107-13. http://dx.doi.org/10.1093/ntr/ntp108 | ||||
| 21. Lew K, Barlow PJ. Dietary practices of adolescents in Singapore and Malaysia. Singapore Med J 2005; 46:282-8. | ||||
| 22. Scoliers G, Portzky G, Madge N, et al. Reasons for adolescent deliberate self-harm: a cry of pain and/or a cry for help? Soc Psychiatry Psychiatr Epidemiol 2009; 44:601-7. http://dx.doi.org/10.1007/s00127-008-0469-z | ||||
| 23. Klonsky ED. The functions of deliberate self-harm: a review of the evidence. Clin Psychol Rev 2007; 27:226-39. http://dx.doi.org/10.1016/j.cpr.2006.08.002 | ||||
| 24. Boergers J, Spirito A, Donaldson D. Reasons for adolescent suicide attempts: associations with psychological functioning. J Am Acad Child Adolesc Psychiatry 1998; 37:1287-93. http://dx.doi.org/10.1097/00004583-199812000-00012 | ||||
| 25.Lee NBC, Fung D, Teo J, Chan YH, Cai YM . Five-year review of adolescent mental health usage in Singapore. Ann Acad Med Singapore 2003; 32:7-11. | ||||
| 26. Pelkonen M, Marttunen M, Henriksson M, Lönnqvist J. Adolescent adjustment disorder: precipitant stressors and distress symptoms of 89 outpatients. Eur Psychiatry 2007; 22:288-95. http://dx.doi.org/10.1016/j.eurpsy.2006.04.010 | ||||
| 27. Lewinsohn PM, Rohde P, Klein DN, Seeley JR. Natural course of adolescent major depressive disorder: I. Continuity into young adulthood. J Am Acad Child Adolesc Psychiatry 1999; 38:56-63. http://dx.doi.org/10.1097/00004583-199901000-00020 | ||||
| 28. Pelkonen M, Marttunen M, Henriksson M, Lönnqvist J. Suicidality in adjustment Disorder -clinical characteristics of adolescent outpatients. Eur Child Adolesc Psychiatry 2005; 14:174-80. http://dx.doi.org/10.1007/s00787-005-0457-8 | ||||
| 29. Portzky G, Audenaert K, van Heeringen K. Suicide among adolescents. A psychological autopsy study of psychiatric, psychosocial and personalityrelated factors. Soc Psychiatry Psychiatr Epidemiol 2005; 40:922-30. http://dx.doi.org/10.1007/s00127-005-0977-x | ||||
| 30.Wood A, Trainor G, Rothwell J, Moore A, Harrington R. Randomized trial of group therapy for repeated deliberate self-harm in adolescents. J Am Acad Child Adolesc Psychiatry 2001; 40:1246-53. http://dx.doi.org/10.1097/00004583-200111000-00003 | ||||
| 31. Hazell PL, Martin G, McGill K, et al. Group therapy for repeated deliberate self-harm in adolescents: failure of replication of a randomized trial. J Am Acad Child Adolesc Psychiatry 2009; 48:662-70. | ||||
| 32. Green JM, Wood AJ, Kerfoot MJ, et al. Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation. BMJ 2011; 342:d682. http://dx.doi.org/10.1136/bmj.d682 | ||||
| 33. March J, Silva S, Petrycki S, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA 2004; 292:807-20. http://dx.doi.org/10.1001/jama.292.7.807 | ||||
| 34. Asarnow JR, Jaycox LH, Tang L, et al. Long-term benefits of short-term quality improvement interventions for depressed youths in primary care. Am J Psychiatry 2009; 166:1002-10. http://dx.doi.org/10.1176/appi.ajp.2009.08121909 | ||||
| 35. Goodyer I, Dubicka B, Wilkinson P, et al. Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial. BMJ 2007; 335:142. http://dx.doi.org/10.1136/bmj.39224.494340.55 | ||||
| 36. Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA 2008; 299:901-13. http://dx.doi.org/10.1001/jama.299.8.901 | ||||