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The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
The Impact of Alcohol on Self Harm & Suicide in Ireland
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The Impact of Alcohol on Self Harm & Suicide in Ireland

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The Impact of Alcohol on Self Harm & Suicide in Ireland …

The Impact of Alcohol on Self Harm & Suicide in Ireland
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  • 1. The Impact of Alcohol on Self-Harm and Suicide in Ireland Prof. Ella Arensman National Suicide Research Foundation Department of Epidemiology and Public Health, UCC Research Reproduced by Theresa Lowry-Lehnen RGN, BSc (Hon’s) Nursing Science, PGCC, Dip Counselling, Dip Psychotherapy, BSc (Hon’s) Clinical Science, PGCE (QTS), H. Dip. Ed, MEd, PhD Student Health Psychology
  • 2. Trends in Rates of Self-Harm, 2002-2012 - NRDSH 0 25 50 75 100 125 150 175 200 225 250 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Age-standardisedrateper100,000 Women Men +20% +6%
  • 3. Incidence of Self-Harm by Age and Gender (NRDSH, 2012) 0 100 200 300 400 500 600 700 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Rateper100,000 Age group Men Women Alcohol was involved in 38% of all cases (42% in men, 36% in women)
  • 4. Alcohol Involvement in Self-Harm by Age and Gender (NRDSH, 2012) 0% 10% 20% 30% 40% 50% 60% %ofcasesinvolvingalcohol Male Female
  • 5. National Registry of Deliberate Self-Harm In 2012, there were 12,010 presentations made by 9,483 individuals: Since 2003 there have been 111,682 presentations of self-harm recorded by the Registry A Northern Ireland registry operates across the 5 trusts in NI, with full coverage obtained as of 2012
  • 6. Suicide Approx. 550 p.a. Medically treated DSH Approx. 12,000 p.a “Hidden” cases of self-harm Approx. 60,000 p.a. Suicide and Medically Treated Deliberate Self Harm in Ireland: The Tip of the Iceberg
  • 7. Rates of Self-Harm per 100,000 by Age and Gender 0 100 200 300 400 500 600 700 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Rateper100,000 Age group Men Women
  • 8. Methods of Self-Harm by Gender Alcohol was involved in 38% of all cases (42% in men, 36% in women) 54% 19% 5% 7% 3% 12% Drug overdose only Self-cutting only Overdose & self- cutting Attempted hanging only Attempted drowning only Other 69% 16% 4% 2% 2% 7% Men Women
  • 9. Association Between Peaks of Self-Harm and Public Holidays  Average number of self-harm presentation to hospital per day: n=33  Six dates in the year on which 50 or more self-harm presentations were made, 5 of which were public holidays or the day after: - January 1st - October 1st - March 17th - March 18th - June 5th
  • 10. Repetition of Self-Harm by Gender Repetition of Self- Harm by Method
  • 11. Repetition of Self-Harm by Recommended Next Care Repetition by Number of Self-Harm Presentations
  • 12. The Extent of Repeated Self-Harm Presentations Number of DSH acts in 2003- 2011 Persons Presentations Number (%) Number (%) One 48,066 77.1% 48,066 48.2% Two 7,899 12.7% 1,5798 15.8% Three 2,709 4.3% 8,127 8.2% Four 1,297 2.1% 5,188 5.2% Five - Nine 1,713 2.8% 11,010 11% 10 or more 635 1.0% 11,483 11.5%
  • 13. The Impact of Alcohol Alcohol abuse is one of the factors contributing to the high rates of self- harm among young people and adults in Ireland Direct effects:  Impairs problem-solving ability  Increases impulsivity and lack of control  Increases feelings of depression, stress, anger or anxiety Long term and indirect effects:  Isolation (loss of work, relationships, etc.)  Neurobiological deficits Alcohol contributes to increasing rates of self-harm and it causes increases of self-harm at specific times in the year, such as a peak of self-harm in July and August.  Alcohol is associated with increasing self-harm among both men and women  Alcohol contributes to increases of self-harm at specific times in the year and week  Alcohol is associated with increasing trends in highly lethal methods of self-harm, in particular among men Rossow et al, 2007; Madge et al, 2008; McMahon et al, 2010;Khalily & Hallahan, 2012
  • 14. A&E Presentations Involving Alcohol By Weekday 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Monday Tuesday Wednesday Thursday Friday Saturday Sunday Percentgaeofpresentationsinvolvingalcohol Male Female
  • 15. Alcohol Involvement by Hour of Presentation to Hospital due to Self-Harm 0 500 1000 1500 2000 2500 3000 3500 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 1 2 3 4 5 6 7 Numberofpresentations Hour of presentation No alcohol involved Alcohol involved
  • 16. Western Area of Northern Ireland: Frequency of Self-Harm Presentations to Hospital by Day of the Week With and Without the Involvement of Alcohol Men 0 50 100 150 200 250 300 Mon Tue Wed Thu Fri Sat Sun Numberofpresentations Day of the week Alcohol involved No alcohol involved
  • 17. Western Area of Northern Ireland: Frequency of Self-Harm Presentations to Hospital by Day of the Week With and Without the Involvement of Alcohol Women 0 50 100 150 200 250 300 350 Mon Tue Wed Thu Fri Sat Sun Numberofpresentations Day of the week Alcohol involved No alcohol involved
  • 18. Trends in Highly Lethal Methods of Self-Harm and Alcohol Involvement (2004-2012) 0 50 100 150 200 250 2004 2005 2006 2007 2008 2009 2010 2011 2012 Numberofpresentations Males with alcohol Females with alcohol
  • 19. Prevalence of Self-Harm in Adolescents across Different Countries 0 5 10 15 20 25 Australia England Norway Belgium Ireland Hungary Netherlands Females Males % Madge et al, 2008
  • 20. Proportion of Adolescent Self-Harm due to Heavy Drinking 0 10 20 30 40 50 60 Ireland Belgium Australia Netherlands England Hungary Norway Percentage Other factors considered: age, gender, depression, impulsivity and negative life events . Rossow et al, 2007
  • 21. Main Outcomes  Heavy alcohol consumption increases risk of self- harm independent of other factors  Less so in Ireland than in other countries  Reducing Irish adolescents’ heavy drinking should reduce their rate of deliberate self harm (<17%)
  • 22. Suicide Support and Information System (SSIS): Obtaining a Complete Picture of Suicide Cases and Open Verdicts by accessing Multiple Sources Coroners' verdict records & Post mortem reports (Response Rate: 100%) Close family members/ friends (Response Rate: 66.0%) GP/Psychiatrist/ Psychologist (Response Rate: 77.1%) • Period and area covered: Sept. 2008-June 2012, City and County Cork • Number of consecutive cases: 275 suicide cases + 32 open verdicts meeting screening criteria; Total N=307
  • 23. • Overrepresentation of men (80.1%); Men significantly younger than women • Nearly two thirds had a history of self-harm (65.2%); 69.1% were diagnosed with depression, and alcohol/and or drug abuse was present among 60.7% • Among those with alcohol and/or drug abuse, 48.6% had abused alcohol, 27.6% had abused both alcohol and drugs, and 21% had abused drugs Among 20.8% an increase in alcohol and/or drug abuse was observed in the year prior to death Second SSIS Report: Key Findings from a Study of 307 Suicide Deaths in Cork
  • 24. Characteristics of the Suicide Deaths Study  Method of suicide: hanging (63.8%), drowning (12.4%), intentional overdose of medication/drugs (9.8%), other methods (14%)  At the time of death, the majority (79%) had alcohol and/or drugs in their toxicology. 24.4% had alcohol + drugs, 34.6% had drugs only, and 20% had alcohol only  Use of alcohol and/or drugs increases the risk of a fatal outcome (Kaplan et al, 2013)
  • 25. Demographic, Psychosocial and Psychiatric Factors Associated with Suicide in Men aged <40 years Versus Men aged > 40 years 0 10 20 30 40 50 60 70 80 Family or close friend died by suicide History of self-harm Day of the week died: Saturday Agricultural occupation Diagnosed with depression Diagnosed with a physical illness In paid employment Antidepressants in toxicology Marital status: Married/Co-habiting Drugs in toxicology Living alone Method of suicide: Hanging History of alcohol only abuse Men aged ≥ 40 Years 0 10 20 30 40 50 60 70 80 Full-time student Day of the week died: Monday Diagnosed with depression Family or close friend died by suicide History of self-harm Living with family of origin Unemployed History of alcohol and drug abuse Alcohol in toxicology Benzodiazepines in toxicology Opiates in toxicology Marital status: Single Method of suicide: Hanging Men aged < 40 Years
  • 26. 0 10 20 30 40 50 60 70 80 Day of the week died: Thursday Divorced/Seperated Living alone Left suicide note/message Treated as psychiatric in-patient Diagnosed with depression Construction/production sector Treated as psychiatric out-patient Unemployed History of alcohol and/or drug abuse Psychiatric diagnosis Drugs in toxicology Cause of death: Hanging Percentage 0 10 20 30 40 50 60 70 80 Agricultural sector Day of the week died: Saturday Living with family of origin History of alcohol and/or drug abuse Family or close friend died by suicide Married/Co/habiting In paid employment Cause of death: Hanging Percentage Had History of Self-Harm No History of Self-Harm Demographic, Psychosocial and Psychiatric Factors Associated with Suicide in those With and Without a History of Self-Harm
  • 27. National Clinical Programme for Mental Health  A programme for the management of self-harm among people presenting to hospital emergency departments Key objectives:  Enhance assessment and management of self-harm for people presenting to EDs at national level and ensure continuity of care, e.g. referral to indicated treatment, and follow-up  Standardisation of evidence based treatment options nationally for people who have engaged in self-harm based on best available evidence
  • 28. Evidence Based Actions  National strategies to reduce access to alcohol should be intensified.  National strategies to increase awareness of the risks involved in the use and misuse of alcohol should be intensified, starting at pre-adolescent age.  Active consultation and collaboration between the mental health- and addiction services needs to be arranged for patients who present with dual diagnosis (psychiatric disorder and alcohol/drug abuse).
  • 29. Evidence Based Actions  Health care professionals working with people who engage in self- harm should receive training in the assessment and management of self-harm and co-morbid alcohol and drug misuse/abuse.  Health care professionals prescribing medication to people at risk of self-harm or suicide should carefully monitor compliance with appropriate use of medication.
  • 30. Evidence Based Actions Breaking the commercially reinforced links between alcohol and sport. Recruit the major national sporting organisations as partners in the development of a national positive mental health promotion campaign. Irish Examiner March 28th 2013
  • 31. Reference Prof. Ella Arensman National Suicide Research Foundation Department of Epidemiology and Public Health, UCC
  • 32. Acknowledgements •Data Registration Officers: Liisa Aula, Agnieszka Biedrycka, Grace Boon, Kate Brennan, James Buckley, Ursula Burke, Lisa Byrne, Laura Cosgrove, Rita Cullivan, Breda Heavey, Ailish Melia, Catherine Murphy, Mary Nix, Diarmuid O’Connor, Kathleen O’Donnell, Eileen Quinn, Karen Twomey, Una Walsh •Department of Health •Health Service Executive – South: Daniel Flynn, Mary Kells, Mary Joyce, Catalina Suares, Louise Dunne • Health Service Executive: National Office for Suicide Prevention, Suicide Prevention Resource Officers, Hospital staff, HSE departments/units •NSRF: Ivan Perry, Margaret Kelleher, Eileen Williamson, Paul Corcoran, Eve Griffin, Amanda Wall, Helen Keeley, Caroline Daly, Celine Larkin. The late Dr Michael Kelleher, founder of the NSRF •Prof. Ella Arensman. National Suicide Research Foundation. Department of Epidemiology and Public Health, UCC •

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