View
19
Download
0
Category
Preview:
DESCRIPTION
Self Harm Cases Presenting to BC Children’s Hospital 1997-2002. Mhairi Nolan, CHIRPP Coordinator, Health Canada, BCIRPU Kate Turcotte, Social Science Researcher, BCIRPU Ian Pike, Director, BCIRPU. Introduction. - PowerPoint PPT Presentation
Citation preview
Self Harm Cases Presenting to BC Children’s Hospital
1997-2002
Mhairi Nolan, CHIRPP Coordinator, Health Canada, BCIRPU
Kate Turcotte, Social Science Researcher, BCIRPU
Ian Pike, Director, BCIRPU
Introduction
• Describe the circumstances and means by which children & youth (5-19 years) are harming themselves, as presenting to BC Children's Hospital emergency department (1997-2002)
Ranking of cause of death among youth, by age group,
BC, 1998-2002. (VISTA) Age Group (years)
5-9 10-14 15-19 20-24
Transport Transport Transport Transport
Neoplasms Neoplasms Intentional Injury Intentional Injury
Unintentional Injury Unintentional Injury Unintentional Injury Unintentional Injury
Congenital Intentional Injury Neoplasms Neoplasms
Endocrine & Metabolic Congenital Circulatory System Circulatory System
Nervous System Nervous System Nervous System Nervous System
Intentional Injury Circulatory System Congenital Signs/ Symptoms
Infectious & Parasitic Endocrine & Metabolic Respiratory System Endocrine & Metabolic
Circulatory System Respiratory System Endocrine & Metabolic Congenital
Digestive System Signs/ Symptoms Blood Respiratory System
Five-year age specific mortality rates (per 100,000
population) due to suicide, BC, 2000-2004 (VISTA)
0
0.5
1
1.5
2
2.5
3
3.5
4<1 1-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85+
Age Group (years)
Ra
te p
er
10
0,0
00
males
females
Five-year age specific hospital separation rates (per 100,000 population) due to suicide/self harm, BC,
1996/1997-2000/2001 (BC Health Data Warehouse)
0
50
100
150
200
250
1
1-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85-8
9
90+
Age Group (years)
Ra
te p
er
10
0,0
00
males
females
Hospital separations rates (per 100,000 population) due to self harm among male youth, by age group (years),
BC, 1989/90-2000/01. (BC Health Data Warehouse)
020
406080
100120140
160180
1989
/90
1990
/91
1991
/92
1992
/93
1993
/94
1994
/95
1995
/96
1996
/97
1997
/98
1998
/99
1999
/00
2000
/01
Year
Rat
e p
er 1
00,0
00
5-9
10-14
15-19
20-24
Hospital separations rates (per 100,000 population) due to self harm among female youth, by age group (years),
BC, 1989/90-2000/01. (BC Health Data Warehouse)
0
50
100
150
200
250
300
350
40019
89/9
0
1990
/91
1991
/92
1992
/93
1993
/94
1994
/95
1995
/96
1996
/97
1997
/98
1998
/99
1999
/00
2000
/01
Year
Rat
e p
er 1
00,0
00
5-9
10-14
15-19
20-24
Aim
• To continue the investigation of intentional injury among children and youth aged 5-19 years in BC, including: – suicide gestures– suicide attempts– self harm by ingestion, cutting, and burns &
hanging
Methods
• Using the BC CHIRPP database, cases coded as intentional self harm were selected and analyzed for the years 1997 to 2002, ages five years and over
• Descriptive analysis provided for the dataset as a whole, as well as subdivided into the following five categories: – Suicide gestures– Suicide attempts– Ingestion– Cutting– Burns & Hanging
Limitations • CHIRPP data is:
– self reported by the patient, or reported by proxy by a parent or guardian
– taken from the chart
• Older teens do not always present at paediatric hospitals– age group above 15 years is under represented
• Cases presenting to BC Children’s Hospital are not representative of a specific geographic area– no trends can be suggested
Results - Overall
Age Group Sex
(years) Male Female Total
5-14 27 (10.5%) 86 (33.5%) 113 (44.0%)
15-19 27 (10.5%) 117 (45.5%) 144 (56.0%)
Total 54 (21.0%) 203 (79.0%) 257 (100%)
Percentage of self harm by type, ages 5-19 years, CHIRPP 1997-2002
attempt36%
cutting16%
ingestion35%
gesture10%
burn/hanging3%
Percentage of self harm by type, excluding hangings and burns, by age group (years), CHIRPP 1997-2002
0
5
10
15
20
25
attempt cutting ingestion gesture
Self Harm
Per
cen
tag
e
5-14
15-19
Suicide Gestures
Age Group Sex
(years) Male Female Total
5-14 * 9 (34.6%)
15-19 * 10 (38.5%)
Total 7 (26.9%) 19 (73.1%) 26 (100%)
Suicide Gestures
• Location: – Predominantly at home (61.5%)– Unspecified for 26.9%
• Mechanism of Injury:– Ingestion (73.1%), 26.3% of these
acetaminophen– Cutting (26.9%), using razors/shavers, safety
pins, nails/screws/bolts/ tacks, glass or mirrors
Suicide Gestures
• 69.2% classified as poisoning or toxic effect
• 19.2% classified as open wounds of the wrist or lower leg
• Remainder included superficial injuries or no injury detected
Suicide Attempts
Age Group Sex
(years) Male Female Total
5-14 12 (12.9%) 27 (29.0%) 39 (41.9%)
15-19 9 ( 9.7%) 45(48.3%) 54 (58.1%)
Total 21 (22.6%) 72 (77.4%) 93 ( 100%)
Suicide Attempts
• Location:– Predominantly at home (49.5%)– Unspecified or missing (39.8%)
• Mechanism of Injury:– Ingestion (75.3%), 30.0% of these acetaminophen
alone– Cutting (14.0%), using knives (46.1%), razors/shavers
and scissors– Strangulation (5.4%), involved belts, clothing,
rope/string and pet supplies
Percentage of suicide attempts by ingestion, by
substance, ages 5-19 years, CHIRPP 1997-2002
Other37%
Psychoactive13%
Acetaminophen30%NSAID
10%
Acetaminophen+
10%
Suicide Attempts
• 80.6% of attempted suicides classified as poisoning or toxic effect
• 12.9% classified as open wounds of the forearm or wrist
Ingestions
Age Group Sex
(years) Male Female Total
10-14 8 ( 8.9%) 32 (35.6%) 40 (44.4%)
15-19 10 (11.1%) 40 (44.4%) 50 (55.6%)
Total 18 (20.0%) 72 (80.0%) 90 (100%)
Ingestions
• Location:– Predominantly at home (41.1%)– Other/unspecified (36.7%)– Remaining in other homes, institutional
homes/hospital, school, and on highway/other road (5.6% each)
Ingestions
• Ingested predominantly:– multiple medications (23.4%) including
combinations with acetaminophen– acetaminophen/ ASA alone (21.1%)– psychoactive medications (20.0%)
• Other products include antifreeze, cleaning products, liquid/solid fuels, topical medication, small rocks/stones/gravel, and unknown
Percentage of ingestion-related cases by ingested substance, ages 10-19 years,
CHIRPP 1997-2002
0.0
5.0
10.0
15.0
20.0
25.0
Aceta
mino
phen
/ASA
Psych
oactiv
e
Mult
iple
Aceta
mino
phen
+
NSAID
Other
Med
s/Alco
hol
Street
Dru
gs
Other
Pro
ducts
Ingested Substance
Per
cen
tag
e
Cuttings
Age Group Sex
(years) Male Female Total
10-14 * 18 (43.9%)
15-19 * 23 (56.1%)
Total * 41 (100%)
Cuttings
• Location:– Predominantly at home (31.7%)– Institutional home (19.5%)– Hospital (17.1%)– Unspecified (17.1%)
Cuttings
• Cutting Implement:– Razor/shaver (36.6%)– Knife (26.8%)– Other (17.1%), including pins/needles,
scissors and glass
Percentage of cutting cases by body part, ages 10-19
years, CHIRPP 1997-2002
Wrist54%
Forearm28%
Other body part18%
Burns & Hanging
• 6 hangings
• ≤ 5 burn cases
Visit Disposition
• Of all BC CHIRPP self-harm cases, patients were most likely to be admitted to hospital for:– Suicide attempts (60%)– Ingestions (50%)– Suicide gestures (31%)– Cutting (17%)
Discussion
• Deliberate self-harm is recognized as a distinct set of practices separate from suicide attempts or gestures
• Variously defined as the deliberate and voluntary infliction of physical harm to one’s own body that is not life threatening and is without any conscious suicidal intent
Continuum of self-destructive behaviour (Laye, 2003)
NormalCompletedSuicide
Suicidalbehaviourand/orAttemptedSuicide
Direct self-harm Active Visible
Indirect self-harm Passive Secondary and invisible
Self-mutilation Self-injury SubstanceAbuse
EatingDisorder
Smoking RiskyBehaviours
Self Destructive Behaviour
Discussion
• Deliberate self-harm behaviour typically originates in adolescence
• There are demonstrated differences in their distributions according to sex– Males at all ages are consistently more likely
than females to commit suicide – Deliberate self-harm is more common among
females than males
Discussion
• Success of male suicide can be accounted for by their tendency to use more lethal and irreversible methods such as hanging and firearms
• Females tend toward the use of poisons, gases, and drugs
Discussion
• This study determined that deliberate self-harm acts among adolescents presenting to the BC Children’s Hospital were predominately:– suicide attempts (36%)– ingestion (35%)
• Of all suicide attempts, 75% were by ingestion
Discussion
• Ingestion was predominately through the use of acetaminophen/ASA and psychoactive medication
• Most common place chosen for the attempt was the young person's home (41%)
Conclusions
• Hospital separation data indicate that self harm among males aged 15-24 years have declined over the past 12 years, from approximately 140 to 60 per 100,000
• The trend among females aged 15-19 years declined from approximately 350 to 175 per 100,000
Conclusions
• Further investigation is warranted to determine the full extent of the problem in BC, as well as to explore prevention and treatment options for youth and support for their families
Recommended