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The Impact of Alcohol on Self-harm and Suicide in Ireland - New Insights.

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Prof Ella Arensman's presentation about the impact of alcohol on self-harm and suicide in Ireland, providing new insights from recently collected data. Prof Arensman is Director of Research with the National Suicide Research Foundation and Adjunct Professor with the Department of Epidemiology and Public Health, University College Cork.

This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.

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The Impact of Alcohol on Self-harm and Suicide in Ireland - New Insights.

  1. 1. The Impact of Alcohol on Self-harm and Suicide In Ireland - New Insights Prof Ella Arensman National Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Ireland “Facing the Fear”: Alcohol and Mental Health in Ireland Dublin, 20th November 2013
  2. 2. Overview      The association between alcohol and self-harm The impact of alcohol on seasonal patterns of self-harm among men and women The impact of alcohol on self-harm among adolescents Alcohol, associated mental health problems and suicide risk Evidence based actions
  3. 3. Irish National Registry of Deliberate Self-Harm (NRDSH) • Objectives To establish the incidence of hospital treated deliberate selfharm • To describe the pattern of presentations and the nature of the self-harm behaviour involved • To monitor trends over time and by area • To estimate the risk of repeated self-harm presenting to hospital In 2012, there were 12,010 presentations made by 9,483 individuals
  4. 4. Trends in rates of self-harm, 2002-2012 NRDSH 250 +6% Age-standardised rate per 100,000 225 200 +20% 175 150 125 100 75 50 25 Women 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Men
  5. 5. Incidence of self-harm by age and gender (NRDSH, 2012) 700 600 Rate per 100,000 500 400 300 200 100 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 0 Age group Men Alcohol was involved in 38% of all cases (42% in men, 36% in women) Women
  6. 6. Alcohol involvement in self-harm by age and gender (NRDSH, 2012) 60% % of cases involving alcohol 50% 40% 30% Male Female 20% 10% 0%
  7. 7. 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 and 18th - June 5th
  8. 8. 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 Rossow et al, 2007; Madge et al, 2008; McMahon et al, 2010;Khalily & Hallahan, 2012
  9. 9. Main outcomes 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. This peak would not exist if alcohol would not be involved.
  10. 10. Proportion of ED presentations involving alcohol by weekday Percentgae of presentations involving alcohol 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Monday Tuesday Wednesday Male Thursday Female Friday Saturday Sunday
  11. 11. Alcohol involvement by hour of presentation to hospital due to self-harm No alcohol involved Alcohol involved 3500 Number of presentations 3000 2500 2000 1500 1000 500 0 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 Hour of presentation 1 2 3 4 5 6 7
  12. 12. 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 300 Number of presentations 250 200 150 Alcohol involved 100 No alcohol involved 50 0 Mon Tue Wed Thu Fri Day of the week Sat Sun
  13. 13. Western Area of Northern Ireland: Frequency of selfharm presentations to hospital by day of the week with and without the involvement of alcohol Women 350 Number of presentations 300 250 Alcohol involved 200 150 100 No alcohol involved 50 0 Mon Tue Wed Thu Fri Day of the week Sat Sun
  14. 14. Trends in highly lethal methods of self-harm and alcohol involvement (2004-2012) 250 Number of presentations 200 Males with alcohol 150 100 50 Females with alcohol 0 2004 2005 2006 2007 2008 2009 2010 2011 2012
  15. 15. Main outcomes    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
  16. 16. International comparative study on self-harm and associated factors Child and Adolescent Self Harm in Europe (CASE) The CASE study is a multi-centre study in 6 countries across Europe and 1 non-European centre (Australia). Objectives:  The prevalence of self harm-among 15-17 year olds and the relationship with risk factors (e.g. depression, anxiety, alcohol, drug use/misuse etc.) and protective factors (e.g. coping, help seeking) across different countries  Young people’s opinions on the prevention of mental health difficulties
  17. 17. Prevalence of self-harm in adolescents across different countries Females Males 25 % 20 15 10 5 0 Australia England Madge et al, 2008 Norway Belgium Ireland Hungary Netherlands
  18. 18. Proportion of adolescent self-harm due to heavy drinking Norway Hungary England Netherlands Australia Belgium Ireland 0 10 20 30 Percentage Other factors considered: age, gender, depression, impulsivity and negative life events 40 50 Rossow et al, 2007 60
  19. 19. Main outcomes Heavy alcohol consumption increases risk of selfharm 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%)
  20. 20. 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%) GP/Psychiatrist/ Psychologist (Response Rate: 77.1%) Close family members/ friends (Response Rate: 66.0%) • 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
  21. 21. Second SSIS Report: Key findings from a study looking at 307 suicide deaths in Cork • • • 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
  22. 22. Characteristics of the suicide act    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)
  23. 23. Demographic, psychosocial and psychiatric factors associated with suicide in Men aged <40 years versus Men aged > 40 years History of alcohol only abuse Method of suicide: Hanging Marital status: Single Method of suicide: Hanging Opiates in toxicology Living alone Benzodiazepines in toxicology Drugs in toxicology Alcohol in toxicology Marital status: Married/Co-habiting History of alcohol and drug abuse Antidepressants in toxicology Unemployed In paid employment Living with family of origin Diagnosed with a physical illness History of self-harm Diagnosed with depression Family or close friend died by suicide Agricultural occupation Diagnosed with depression Day of the week died: Saturday Day of the week died: Monday History of self-harm Full-time student Family or close friend died by suicide 0 10 20 30 40 50 60 70 80 Men aged < 40 Years 0 10 20 30 40 50 Men aged ≥ 40 Years 60 70 80
  24. 24. Demographic, psychosocial and psychiatric factors associated with suicide in those with and without a history of self-harm Had history of self-harm No history of self-harm Cause of death: Hanging Cause of death: Hanging Drugs in toxicology Psychiatric diagnosis In paid employment History of alcohol and/or drug abuse Married/Co/habiting Unemployed Treated as psychiatric out-patient Construction/production sector Family or close friend died by suicide Diagnosed with depression History of alcohol and/or drug abuse Treated as psychiatric in-patient Living with family of origin Left suicide note/message Living alone Day of the week died: Saturday Divorced/Seperated Agricultural sector Day of the week died: Thursday 0 10 20 30 40 50 60 70 80 Percentage 0 10 20 30 40 50 60 70 80 Percentage
  25. 25. 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 preadolescent 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 and alcohol/drug abuse).
  26. 26. Evidence based actions Health care professionals working with people who engage in selfharm 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.
  27. 27. 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
  28. 28. Thank you! Prof Ella Arensman National Suicide Research Foundation & Department of Epidemiology and Public Health University College Cork Western gateway Building Western Road Cork T: 021 4205551 E-mail: earensman@ucc.ie The National Suicide Research Foundation is in receipt of funding from the National Office for Suicide Prevention

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