Self Harm Cases Presenting to BC Children`s Hospital 1997-2002

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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)
4
3
2.5
males
2
females
1.5
1
Age Group (years)
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
5-9
0
1-4
0.5
<1
Rate per 100,000
3.5
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)
250
150
males
females
100
50
Age Group (years)
90+
85-89
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
5-9
1-4
0
1
Rate per 100,000
200
Hospital separations rates (per 100,000 population) due
to self harm among male youth, by age group (years),
180
160
140
120
100
80
60
40
20
0
5-9
10-14
15-19
Year
2000/01
1999/00
1998/99
1997/98
1996/97
1995/96
1994/95
1993/94
1992/93
1991/92
1990/91
20-24
1989/90
Rate per 100,000
BC, 1989/90-2000/01. (BC Health Data Warehouse)
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)
400
300
5-9
250
10-14
200
15-19
150
20-24
100
50
Year
2000/01
1999/00
1998/99
1997/98
1996/97
1995/96
1994/95
1993/94
1992/93
1991/92
1990/91
0
1989/90
Rate per 100,000
350
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
(years)
Sex
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
ingestion
35%
cutting
16%
gesture
10%
burn/hanging
3%
attempt
36%
Percentage of self harm by type, excluding hangings and
burns, by age group (years), CHIRPP 1997-2002
25
Percentage
20
15
5-14
15-19
10
5
0
attempt
cutting
ingestion
Self Harm
gesture
Suicide Gestures
Age Group
(years)
Sex
Male
Female
5-14
*
9 (34.6%)
15-19
*
10 (38.5%)
Total
7 (26.9%)
19 (73.1%)
Total
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
(years)
Sex
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
Other
37%
NSAID
10%
Acetaminophen
+
10%
Acetaminophen
30%
Psychoactive
13%
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
(years)
Sex
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%)
72 (80.0%)
90 (100%)
Total
18 (20.0%)
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
25.0
Percentage
20.0
15.0
10.0
5.0
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Ingested Substance
Cuttings
Age Group
(years)
Sex
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
Other body part
18%
Wrist
54%
Forearm
28%
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)
Self Destructive Behaviour
Completed
Suicide
Suicidal
behaviour
and/or
Attempted
Suicide
Normal
Direct self-harm
Active
Visible
Self-mutilation
Self-injury
Indirect self-harm
Passive
Secondary and invisible
Substance
Abuse
Eating
Disorder
Smoking
Risky
Behaviours
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 selfharm 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

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