Abstract Background The prevalence of adolescent self-harm in Northern Ireland (NI) and its associated factors are unknown. Given the established relationship between conflict and mental health, and ...NI׳s recent history of conflict, it is important to investigate the factors associated with self-harm in NI. This study aimed to determine the prevalence of self-harm in NI adolescents and the factors associated with it, including exposure to the NI conflict. Methods Observational study of 3596 school pupils employing an anonymous self-report survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, exposure to the NI conflict, social and internet influences, and psychological variables. Results Self-harm was reported by 10% of respondents. In univariate analyses, exposure to the NI conflict was associated with self-harm alongside established risk factors. In multivariate analyses, bullying and exposure to self-harm were associated with lifetime self-harm in both girls and boys. Alcohol use, drug use, physical and sexual abuse, and self-esteem were also associated with self-harm in girls. In boys, absence of exercise, sexual orientation concerns, anxiety and impulsivity were additional risk factors. The internet/social media and the self-harm of others were also key influences. Limitations This is a cross-sectional study. Conclusions The rate of self-harm was lower than elsewhere in the UK/Ireland. The study highlights the factors which should be considered in terms of risk assessment. In addition to established risk factors, the findings suggest that more research on the legacy of the NI conflict as well as the influence of new technologies warrant urgent attention.
Self-harm is a risk factor for suicide in adolescents, with the prevalence highest in young people in group and residential care programs. Although no established risk factors for self-harm exist, ...adolescents who self-harm may have decreased pain sensitivity, but this has not been systematically investigated.
To assess somatosensory function using quantitative sensory testing (QST) in children and adolescents living in care grouped by the number of episodes of self-harm in the past year and compare their somatosensory profiles with community control participants to investigate associations with the incidence or frequency of self-harm.
Recruitment for this cross-sectional study began January 2019 and ended March 2020. Exclusion criteria included intellectual disability (intelligence quotient <70), autism spectrum disorder, or recent serious injury. Children and adolescents aged 12 to 17 years with no underlying health conditions were recruited from local authority residential care settings in Glasgow, UK, and schools and youth groups in London and Glasgow, UK. The volunteer sample of 64 participants included adolescents ages 13 to 17 years (34 53% females; 50 78% living in residential care; mean SD age, 16.34 1.01 years) with varying incidents of self-harm in the past year (no episodes, 31 48%; 1-4 episodes, 12 19%; and ≥5 episodes, 2 33%).
Participants were tested using a standardized QST protocol to establish baseline somatosensory function.
Associations between somatosensory sensitivity, incidence and frequency of self-harm, residential status, age, gender, and prescription medication were calculated. Secondary outcomes assessed whether self-harm was associated with specific types of tests (ie, painful or nonpainful).
A total of 64 participants ages 13 to 17 years completed testing (mean SD age, 16.3 1.0 years; 34 53%. females and 30 47% males; 50 78% living in group homes). Adolescents with 5 or more self-harm incidences showed significant pain hyposensitivity compared with community control participants after adjusting for age, gender, and prescription drug use (SH group with 5 or more episodes vs control: -1.03 95% CI, -1.47 to -0.60; P < .001). Hyposensitivity also extended to nonpainful stimuli, similarly adjusted (SH group with 5 or more episodes vs control: -1.73; 95% CI, -2.62 to -0.84; P < .001). Pressure pain threshold accounted for most of the observed variance (31.1% 95% CI, 10.5% to 44.7%; P < .001).
The findings of this study suggest that sensory hyposensitivity is a phenotype of Adolescents who self-harm and that pressure pain threshold has clinical potential as a quick, inexpensive, and easily interpreted test to identify adolescents at increased risk of repeated self-harm.
Many conditions may affect the temporomandibular joint (TMJ), but its incidence in individual joint diseases is low. However, inflammatory arthropathies, particularly rheumatoid and psoriatic ...arthritis and ankylosing spondylitis, appear to have a propensity for affecting the joint. Symptoms include pain, restriction in mouth opening, locking, and noises, which together can lead to significant impairment. Jaw rest, a soft diet, a bite splint, and medical therapy, including disease-modifying antirheumatic drugs (DMARDs) and simple analgesia, are the bedrock of initial treatment and will improve most symptoms in most patients. Symptom deterioration does not necessarily follow disease progression, but when it does, TMJ arthroscopy and arthrocentesis can help modulate pain, increase mouth opening, and relieve locking. These minimally invasive procedures have few complications and can be repeated. Operations to repair or remove a damaged intra-articular disc or to refine joint anatomy are used in select cases. Total TMJ replacement is reserved for patients where joint collapse or fusion has occurred or in whom other treatments have failed to provide adequate symptomatic control. It yields excellent outcomes and is approved by the National Institute of Health and Care Excellence (NICE), UK. Knowledge of the assessment and treatment of the TMJ, which differs from other joints affected by inflammatory arthritis due to its unique anatomy and function, is not widespread outside of the field of oral and maxillofacial surgery. The aim of this article is to highlight the peculiarities of TMJ disease secondary to rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and how to best manage these ailments, which should help guide when referral to a specialist TMJ surgeon is appropriate.
The present study aimed to draw on 2 theoretical models to examine the relationship between perceived ethnic discrimination and psychological distress in a sample of ethnic minority young people (
N
...= 154). Analysis provided no support for the hypothesis derived from the self-esteem theory of depression that self-esteem (personal and ethnic) moderates the discrimination-distress relationship. There was, however, partial support for a mediating role of self-esteem, as predicted by the transactional model of stress and coping. This mediational relationship was moderated by gender, such that both forms of self-esteem exerted a mediating role among men but not women. The authors consider the implications of their findings for theory and future research examining the consequences of discrimination on psychological well-being.
This study investigated an integrative model involving the relationship between perfectionism (
P. L. Hewitt & G. L. Flett, 1991
) and coping (
C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989
) ...to predict changes in hopelessness and general psychological distress among college students. Results indicated that changes in psychological well-being (4-5 weeks later) were predicted by socially prescribed perfectionism, and, as theorized, avoidance coping moderated the link between perfectionism and psychological well-being beyond initial levels of distress. Support was also found for the adaptive effects of cognitive reconstruction coping and other-oriented perfectionism, whereas, under certain conditions, self-oriented perfectionism was shown to be maladaptive. These findings offer support for the proposed model. Implications for intervention and suggestions for future research are discussed.
Objectives: This study had three aims: (1) to independently replicate the future thinking effect, that parasuicides, when compared with controls, show a deficit in positive future thinking but no ...increase in negative future thinking; (2) to determine whether positive future thinking and socially prescribed perfectionism discriminate general hospital parasuicides from controls beyond measures of affect and; (3) to explore the relationship between future thinking and perfectionism.
Design: A cross‐sectional design was employed. Three groups of participants took part: hospital parasuicide patients (N = 22), hospital controls (N = 22) and community controls (N = 21).
Methods: Parasuicide patients admitted, via accident and emergency, to a general hospital were matched with hospital and community controls and assessed on measures of hopelessness, depression, anxiety, perfectionism, and future thinking.
Results: There was evidence to support the future thinking effect. A discriminant function analysis revealed that social perfectionism and positive future thinking did indeed discriminate parasuicides from controls beyond the effects of hopelessness, depression, and anxiety. Exploratory relationships between perfectionism and positive future thinking were also reported.
Conclusions: The results reinforce the importance of future thinking in parasuicide. Moreover, the role of social perfectionism in the suicidal process was elucidated and ought to be replicated within a prospective design.
Suicide is a global concern hence cross-cultural research ought to be central to national suicide prevention strategies. This study sought to investigate suicide notes drawn from Northern Ireland and ...the United States as these countries have broadly similar suicide rates but markedly different cultures. A theoretical-conceptual analysis of sixty suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars (1996) across countries. The results suggested that there were more psychological commonalities than differences. Two differences emerged which suggested that aspects of the interpersonal components may be more salient in Northern Irish rather than American suicides. It is argued that more wide-ranging cross-cultural studies are required to enhance our ability to identify and predict those most at risk from suicide.PUBLICATION ABSTRACT
Suicide is an important public health issue among rural communities although there is no single pattern of suicide in rural areas. Despite this, there are common themes in much of the research ...evidence on suicide in rural areas. From the published research in the area, a conceptual model of rural suicide has been developed which can be used by clinical and public health services when considering possible routes of intervention.
A conceptual model can be defined as 'a type of diagram which shows a set of relationships between factors that are believed to impact or lead to a target condition'. The model presented here uses the 'Cry of pain/ Entrapment' model of suicide risk to build a framework of factors which are associated with suicide in rural areas. Cross-setting factors associated with suicide rates include gender, poverty, mental illness, substance use, biological factors including apparent genetic risk, coping skills and media coverage of suicide. There are, however, other factors that appear to have particular importance in rural areas. These include rural stressors, such as isolation and political and social exclusion; factors affecting support, including social support, cultural norms on help-seeking, stigma associated with mental illness service availability; factors affecting the decision to self-harm, including modelling and cultural views on self-harm, and issues affecting the likelihood of self-harm resulting in death, including method availability, norms on methods of self-harm and treatment availability after harm occurs. Identifying which of these areas are the greatest local priorities helps to target activity.
This model provides a way of considering suicide in rural areas. Local staff can use it to consider which issues are most relevant to their area. It allows classification of existing interventions, and deciding which other areas of work might be of local value. For researchers and service planners, it provides a way of classifying interventions and describing projects.
Intravenous heparin is routinely given after thrombolytic therapy for patients with acute myocardial infarction in the United States and in some, but by no means all, other countries. Several trials ...have documented improved infarct-artery patency in patients treated with heparin; however, none was large enough individually to assess the effect of heparin on clinical outcomes. We performed a systematic overview of the 6 randomized controlled trials (1,735 patients) to summarize the available data concerning the risks and benefits of intravenous heparin versus no heparin after thrombolytic therapy. Mortality before hospital discharge was 5.1% for patients allocated to intravenous heparin compared with 5.6% for controls (relative risk reduction of 9%, odds ratio 0.91, 95% confidence interval 0.59 to 1.39). Similar rates of recurrent ischemia and reinfarction were observed among those allocated to heparin therapy or control. The rates of total stroke, intracranial hemorrhage, and severe bleeding were similar in patients allocated to heparin; however, the risk of any severity of bleeding was significantly higher (22.7% vs 16.2%; odds ratio 1.55, 95% confidence interval 1.21 to 1.98). There was no significant difference in the observed effects of heparin between patients receiving tissue-type plasminogen activator and those receiving streptokinase or anisoylated plasminogen streptokinase activator complex, or between patients who did and did not receive aspirin. The findings of this overview demonstrate that insufficient clinical outcome data are available to support or to refute the routine use of intravenous heparin therapy after thrombolysis. It is not known if these findings are due to lack of statistical power, inappropriate levels of anticoagulation, or lack of benefit of intravenous heparin. Large randomized studies of heparin (and of newer antithrombotic regimens) are needed to establish the role of such therapy.
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