The aim of this study was to examine risk of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery (GBP).
Concerns regarding severe adverse psychiatric outcomes after GBP have been raised.
This nationwide, longitudinal, self-matched cohort encompassed 22,539 patients who underwent GBP during 2008 to 2012. They were identified through the Swedish National Patient Register, the Prescribed Drug Register, and the Causes of Death Register. Follow-up time was up to 2 years. Main outcome measures were hazard ratios (HRs) for post-surgery self-harm or hospitalization for depression in patients with presurgery self-harm and/or depression compared to patients without this exposure; and standardized mortality ratio (SMR) for suicide post-surgery.
A diagnosis of self-harm in the 2 years preceding surgery was associated with an HR of 36.6 (95% confidence interval [CI] 25.5-52.4) for self-harm during the 2 years of follow up, compared to GBP patients who had no self-harm diagnosis before surgery. Patients with a diagnosis of depression preceding GBP surgery had an HR of 52.3 (95% CI 30.6-89.2) for hospitalization owing to depression after GBP, compared to GBP patients without a previous diagnosis of depression. The SMR for suicide after GBP was increased among females (n = 13), 4.50 (95% CI 2.50-7.50). The SMR among males (n = 4), was 1.71 (95% CI 0.54-4.12).
The increased risk of post-surgery self-harm and hospitalization for depression is mainly attributable to patients who have a diagnosis of self-harm or depression before surgery. Raised awareness is needed to identify vulnerable patients with history of self-harm or depression, which may be in need of psychiatric support after GBP.
To examine whether depressed mood and anger mediate the effects of sexual abuse and family conflict/violence on self-injurious behavior and substance use.
A cross-sectional national survey was conducted including 9,085 16-19 year old students attending all high schools in Iceland in 2004. Participants reported frequency of sexual abuse, family conflict/violence, self-injurious behavior, substance use, depressed mood, and anger.
Sexual abuse and family conflict/violence had direct effects on self-injurious behavior and substance use among both genders, when controlling for age, family structure, parental education, anger, and depressed mood. More importantly, the indirect effects of sexual abuse and family conflict/violence on self-injurious behavior among both males and females were twice as strong through depressed mood as through anger, while the indirect effects of sexual abuse and family conflict/violence on substance use were only significant through anger.
These results indicate that in cases of sexual abuse and family conflict/violence, substance use is similar to externalizing behavior, where anger seems to be a key mediating variable, opposed to internalizing behavior such as self-injurious behavior, where depressed mood is a more critical mediator.
Practical implications highlight the importance of focusing on a range of emotions, including depressed mood and anger, when working with stressed adolescents in prevention and treatment programs for self-injurious behavior and substance use.
The study of websites displaying methods of both physical self-harm and suicide has become an important aspect of deliberate self-injury and suicide research. However, little is known about contextual factors related to entering such sites. Using data from 3,567 respondents aged 15-30 in the US, UK, Germany, and Finland, we found that experiences of victimization are associated with entering pro-self-harm sites and pro-suicide sites. Also, the victimization context had relevance, as online victimization was particularly related to pro-self-harm behavior. The findings suggest a need to organize more specific online support for the victims of violence and online aggression.
Emotional experiences immediately prior to (emotional antecedents) and following (emotional consequences) deliberate self-harm and suicide attempts in female inmates (N = 63) were examined. Anger was the antecedent emotion reported by the largest proportion of individuals who had engaged in deliberate self-harm (45.16%), suicide attempts (40.9%), and ambivalent suicide attempts (30%). Relief and other positive emotional shifts were more common in deliberate self-harm (41.94%) (involving no intent to die) than in suicide attempts or ambivalent suicide attempts, particularly for persons with borderline personality disorder. These findings underscore the utility of discriminating between deliberate self-harm and suicidal behavior and highlight the potential role of anger in triggering such behaviors.
This study examined whether depressed adolescent outpatients with deliberate self-harm behaviour (DSH) differed from non-suicidal depressed adolescent outpatients in depressive and anxiety symptoms, alcohol use, perceived social support and number of negative life-events. Depressed adolescent outpatients (n=155) aged 13-19 years were interviewed using K-SADS-PL for DSM-IV Axis I diagnoses and completed self-report questionnaires. Suicidal behaviour was assessed by K-SADS-PL suicidality items. Depressed adolescents with DSH were younger, perceived less support from the family, had more severe depressive symptoms and used more alcohol than non-suicidal depressed adolescents. Adolescents with DSH and suicidal ideation or suicide attempts had more depressive and anxiety symptoms than adolescents with DSH only. Adolescents with severe internalizing distress symptoms are at risk not only for DSH, but also additional suicidal behaviour. Family interventions may be needed in the treatment of depressed adolescents with DSH.
Understanding the reasons for self-harm (SH) may be paramount for the identification and treatment of SH behavior. Presently, the psychometric properties for SH reason questionnaires are generally unknown or tested only in non-inpatient samples. Existing inpatient measures may have limited generalizability and do not examine SH apart from an explicit intent to die. The present study examined a newly developed, self-report measure of reason for self-harm. The Self-Harm Reasons Questionnaire (SHRQ) was administered to 143 undergraduate students. Results indicated that SH reasons covaried in meaningful and internally consistent ways, with subgroups of SH reasons correlating with hypothesized concomitants of SH, such as depressive symptoms. Findings have implications for prevention and intervention and the SHRQ offers a new, albeit preliminary, means by which to examine SH reasons in a non-inpatient sample.
The aim of this study was to test the hypothesis that young people who perceive their parents to have alcohol problems are more likely to self-injure, have suicide ideation, and to attempt suicide than young people without parental alcohol problems. We also tested whether the association between parental alcohol problems and self-injury, suicide ideation, and suicide attempt among young people differed depending on the gender of the child and the parent. Data came from the Danish National Youth Study 2014, a web-based national survey. A total of 75,853 high school and vocational school students participated. Self-injury, suicidal ideation, and suicide attempts were outcomes and the main exposure variables were perceived parental alcohol problems, gender of the parent with alcohol problems, cohabitation with a parent with alcohol problems, and severity of the parents' alcohol problems. Young people with parental alcohol problems had higher odds of self-injury [boys: OR = 1.59 (95% CI 1.40-1.82); girls: OR = 1.84 (95% CI 1.69-1.99)], suicidal ideation [boys: OR = 1.81 (95% CI 1.59-2.06); girls: OR 1.74 (95% CI 1.59-1.89)], and suicide attempt [boys: OR = 2.10 (95% CI 1.63-2.71); girls: OR = 2.09 (95% CI 1.80-2.42)] compared to young people without parental alcohol problems. Girls with parental alcohol problems had higher odds of self-injury than boys with parental alcohol problems, whereas no gender differences were found for suicidal ideation and suicide attempts. Also no differences were found depending on the gender of the parent with alcohol problems. This study shows that young people with parental alcohol problems have higher odds of self-injury, suicide ideation, and suicide attempts.
Dysfunction in affect regulation is a prominent feature that grossly impairs behavioural and interpersonal domains of experience and underlies a great deal of the psychopathology in borderline personality disorder (BPD). However, no study has yet been published that evaluates the psychometric properties of the translated Danish version of self-report measures sensitive to the different aspects and dimensions of dysfunction in affect regulation prevalent in BPD.
This study comprised a group of women diagnosed with BPD (n = 29) and a comparison group of healthy subjects (n = 29) who reported psychopathology and levels of affective instability, aggression, impulsivity and alexithymia by self-report measures.
Our results demonstrated that women with BPD have significant psychopathology and report significantly higher levels of dysfunction in separate components of affect regulation by self-report measures than the comparison group of healthy subjects. Our results also provided partial support for the psychometric appropriateness and clinical relevance of the translated Danish version of affect regulation measures.
The normative reference range indicated by our results makes the measures useful as a practical assessment tool.