Minor Self-harm and Psychiatric Disorder

MINOR SELF-HARM AND PSYCHIATRIC

DISORDERKeren Skegg, Shyamala

Nada-Raja and Terrie Moffitt

What about self-harm in a population-based sample?

Not all self-harm gets to hospital

Is self-harm in a general population-based sample also associated with psychiatric disorder?

Dunedin Multidisciplinary Health and Development Study (DMHDS)

958 (94%) participated in assessments of both their self-harm and psychiatric status at age 26 years

Three mutually exclusive groups of people who reported these behaviours

in the previous year

ICD self-harm - 15 men and 10 women ( all episodes involved overdose or cutting)Other self-harmful behaviours but no ICD self-harm - 73 men and 46 women (mainly self-battery)Intoxication to deal with emotional pain but no other self-harmful behaviours -78 men and 58 women

Any psychiatric disorder in same year: men

ICD 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: women

ICD 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 2Odds 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

*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.

---- 4.9 (1.3 - 17.9)*Suicidal/self-harm thoughts only (no internalizing disorder, externalizing disorder, or other Axis I disorder ascertained)

23.2 (6.2 - 86.9)**5.0 (2.1 - 12.1)Internalizing and Externalizing disorder with suicidal/self-harmful thoughts

3.0 (0.9 - 9.9)2.9 (1.2 - 7.0)*Internalizing and Externalizing disorder only

38.7 (8.6 - 173.7)**11.3 (2.4 - 53.5)**Externalizing disorder with suicidal/self-harmful thoughts

2.0 (0.4 - 9.8)1.2 (0.6 - 2.6)Externalizing disorder b only

11.8 (4.6 - 30.5)**15.6 (5.3 - 45.6)**Internalizing disorder with suicidal/self-harmful thoughts

2.9 (1.3 - 6.4)**1.8 (0.8 - 4.1)Internalizing disorder a only

Odds ratio (95% CI)Odds ratio (95% CI) 

WomenMen

Limitations

Structured interview schedule for psychiatric disordersAlthough disorder occurred in same 12 month period as self-harm, not known if occurred at same timeAnalysis limited by small numbers engaging in different types of self-harm

Strengths

Population-based sample, 94% response ratePast year data for both self-harm and psychiatric 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