MINOR SELF-HARMAND PSYCHIATRIC DISORDER Keren Skegg, ShyamalaNada-Raja and Terrie Moffitt
What about self-harm in a population-based sample?Not all self-harm gets to hospitalIs self-harm in a general population-basedsample also associated with psychiatricdisorder?
Dunedin Multidisciplinary Health andDevelopment Study (DMHDS) 958 (94%) participated in assessments of both their self-harm and psychiatric status at age 26 years
Three mutually exclusive groups ofpeople who reported these behaviours in the previous yearICD self-harm - 15 men and 10 women ( allepisodes involved overdose or cutting)Other self-harmful behaviours but no ICDself-harm - 73 men and 46 women (mainlyself-battery)Intoxication to deal with emotional pain butno other self-harmful behaviours -78 menand 58 women
Any psychiatric disorder in same year: menICD self-harm -15/15 (100%)Other self-harmful behaviour - 43/73 (59%)Intoxication to deal with emotional pain -58/78 (74%)No self-harm - 114/322 (35%)
Any psychiatric disorder in same year: womenICD self-harm - 10/10 (100%)Other self-harmful behaviours - 34/46(74%)Intoxication to deal with emotional pain -41/58 (71%)No self-harm - 133/356 (37%)
Table 2 Odds Ratios (and 95% Confidence Intervals) for Self-harm c among Participants with Psychiatric Disorders, and with Suicidal/Self-harmful thoughts during the Year, vs. no DSM IV or Suicidal/Self-harmful Thoughts during the Year Men Women Odds ratio (95% CI) Odds ratio (95% CI)Internalizing disorder a only 1.8 (0.8 - 4.1) 2.9 (1.3 - 6.4)**Internalizing disorder with suicidal/self-harmful thoughts 15.6 (5.3 - 45.6)** 11.8 (4.6 - 30.5)**Externalizing disorder b only 1.2 (0.6 - 2.6) 2.0 (0.4 - 9.8)Externalizing disorder with suicidal/self-harmful thoughts 11.3 (2.4 - 53.5)** 38.7 (8.6 - 173.7)**Internalizing and Externalizing disorder only 2.9 (1.2 - 7.0)* 3.0 (0.9 - 9.9)Internalizing and Externalizing disorder with suicidal/self-harmfulthoughts 5.0 (2.1 - 12.1) 23.2 (6.2 - 86.9)**Suicidal/self-harm thoughts only (no internalizing disorder, externalizingdisorder, or other Axis I disorder ascertained) 4.9 (1.3 - 17.9)* ----*p<.05; **p<.01. a any anxiety or depressive disorder. B any substance dependence or antisocial personality disorder, C ICD self-harm and other self-harmful behaviours combined.
LimitationsStructured interview schedule forpsychiatric disordersAlthough disorder occurred in same 12month period as self-harm, not known ifoccurred at same timeAnalysis limited by small numbersengaging in different types of self-harm
StrengthsPopulation-based sample, 94% responseratePast year data for both self-harm andpsychiatric disorderSeparate self-harm interview
Clinical Implications Even minor self-harm is often associated with treatable psychiatric disorder, so take every opportunity to screen for psychiatric symptoms Take suicidal thoughts seriously in young men even in the absence of psychiatric disorder