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Original article

Vol. 149 No. 0506 (2019)

The implementation and first insights of the French-speaking Swiss programme for monitoring self-harm

  • Louise Ostertag
  • Philippe Golay
  • Yves Dorogi
  • Sebastie§n Brovelli
  • Marta Bertran
  • Ioan Cromec
  • Bénédicte Van Der Vaeren
  • Riaz Khan
  • Alessandra Costanza
  • Karine Wyss
  • Anne Edan
  • Francesca Assandri
  • Rémy Barbe
  • Solenn Lorillard
  • Stéphane Saillant
  • Laurent Michaud
DOI
https://doi.org/10.4414/smw.2019.20016
Cite this as:
Swiss Med Wkly. 2019;149:w20016
Published
04.02.2019

Summary

AIMS OF THE STUDY

Self-harm is a major risk factor for suicide but remains poorly documented. No data on self-harm in French-speaking Switzerland exist. To address this deficiency, the Swiss Federal Office of Public Health commissioned a specific self-harm monitoring programme. We present and discuss its implementation and first findings.

METHODS

Every patient aged 18–65 years presenting for self-harm to the emergency departments of the Lausanne and Neuchâtel general hospitals were included in the monitoring programme over a 10-month period (December 2016 to September 2017). Clinicians collected anonymous sociodemographic and clinical data.

RESULTS

The sample included 490 patients (54.9% female and 45.1% male) for 554 episodes of self-harm, showing a higher proportion of patients aged 18–34 (49.2%) than older age groups (35–49, 33.7% and 50–65, 17.1%). Patients were mostly single (56.1%) and in problematic socioeconomic situations (65.7%). Self-poisoning was the most commonly used method (58.2%) and was preferred by women (71% of females and 42.5% of males, Fisher’s exact test, p <0.001) and the majority of patients (53.3%) had experienced at least one previous episode of self-harm. The self-harm rate was 220 per 100,000 inhabitants in Lausanne and 140 in Neuchâtel. Suicidal intent was clear for 50.6% of the overall sample, unclear for 25.1% and absent for 24.3%. It differed significantly between sites (χ2(2) = 9.068, p = 0.011) as Lausanne reported more incidents of unclear intent (27.7% versus 17.4% in Neuchâtel) and Neuchâtel more incidents with absence of intent (33.1% versus 21.3% in Lausanne). In Lausanne, patients more frequently resorted to methods such as jumping from a height (11.4%) and hanging (9%) than in Neuchâtel (1.6% and 4.9%, Fisher’s exact test, p = 0.006).

CONCLUSIONS

Our results are globally consistent with previous research on self-harm. We found significant inter-site differences in methods, suicidal intent and self-harm rates. Our findings highlight the importance of implementing local self-harm monitoring to identify specific at-risk groups and develop targeted preventive intervention.

References

  1. World Health Organization. Preventing suicide: a global imperative. Geneva: World Health Organization; 2014; Available from: http://apps.who.int/iris/bitstream/handle/10665/131056/9789241564779_eng.pdf?sequence=1.
  2. Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry. 2002;181(03):193–9. doi:.https://doi.org/10.1192/bjp.181.3.193
  3. Suokas J, Suominen K, Isometsä E, Ostamo A, Lönnqvist J. Long-term risk factors for suicide mortality after attempted suicide--findings of a 14-year follow-up study. Acta Psychiatr Scand. 2001;104(2):117–21. doi:.https://doi.org/10.1034/j.1600-0447.2001.00243.x
  4. Suominen K, Isometsä E, Suokas J, Haukka J, Achte K, Lönnqvist J. Completed suicide after a suicide attempt: a 37-year follow-up study. Am J Psychiatry. 2004;161(3):562–3. doi:.https://doi.org/10.1176/appi.ajp.161.3.562
  5. Christiansen E, Jensen BF. Risk of repetition of suicide attempt, suicide or all deaths after an episode of attempted suicide: a register-based survival analysis. Aust N Z J Psychiatry. 2007;41(3):257–65. doi:.https://doi.org/10.1080/00048670601172749
  6. World Health Organization. Practice manual for establishing and maintaining surveillance systems for suicide attempts and self-harm. Geneva: World Health Organization; 2016; Available from: http://apps.who.int/iris/bitstream/handle/10665/208895/9789241549578_eng.pdf;jsessionid=DB9894D3EC5DD66BE3521E9D66E8022C?sequence=1.
  7. World Health Organization. Preventing suicide: a resource for non-fatal suicidal behaviour case registration. Geneva: World Health Organization; 2014; Available from: http://apps.who.int/iris/bitstream/handle/10665/44757/9789241502665_eng.pdf?sequence=1.
  8. Van Heeringen C, Jannes S, Buylaert W, Henderick H, De Bacquer D, Van Remoortel J. The management of non-compliance with referral to out-patient after-care among attempted suicide patients: a controlled intervention study. Psychol Med. 1995;25(5):963–70. doi:.https://doi.org/10.1017/S0033291700037454
  9. Da Cruz D, Pearson A, Saini P, Miles C, While D, Swinson N, et al. Emergency department contact prior to suicide in mental health patients. Emerg Med J. 2011;28(6):467–71. doi:.https://doi.org/10.1136/emj.2009.081869
  10. Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Hazell P, et al. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev. 2016;5(5):CD012189.
  11. Hawton K, Casey D, Bale E, Ryall J, Brand F, Geulayov G. Self-harm in Oxford. Oxford: Centre for Suicide Research, Department of Psychiatry, Warneford Hospital & Emergency Department Psychiatric Service (Barnes Unit), John Radcliffe Hospital, 2014.
  12. Hawton K, Bale L, Casey D, Shepherd A, Simkin S, Harriss L. Monitoring deliberate self-harm presentations to general hospitals. Crisis. 2006;27(4):157–63. doi:.https://doi.org/10.1027/0227-5910.27.4.157
  13. Hawton K, Bergen H, Casey D, Simkin S, Palmer B, Cooper J, et al. Self-harm in England: a tale of three cities. Multicentre study of self-harm. Soc Psychiatry Psychiatr Epidemiol. 2007;42(7):513–21. doi:.https://doi.org/10.1007/s00127-007-0199-7
  14. Geulayov G, Kapur N, Turnbull P, Clements C, Waters K, Ness J, et al. Epidemiology and trends in non-fatal self-harm in three centres in England, 2000-2012: findings from the Multicentre Study of Self-harm in England. BMJ Open. 2016;6(4):e010538. doi:.https://doi.org/10.1136/bmjopen-2015-010538
  15. Griffin E, Dillion CB, Arensman E, Corcoran P, Williamson E, Perry IJ. National self-harm registry Ireland: annual report 2016. Cork: National Suicide Research Foundation; 2017.
  16. Perry IJ, Corcoran P, Fitzgerald AP, Keeley HS, Reulbach U, Arensman E. The incidence and repetition of hospital-treated deliberate self harm: findings from the world’s first national registry. PLoS One. 2012;7(2):e31663. doi:.https://doi.org/10.1371/journal.pone.0031663
  17. Schmidtke A, Bille-Brahe U, DeLeo D, Kerkhof A, Weinacker B, Löhr C. Sociodemographic characteristics of suicide attempters in Europe. In: Schmidtke A, Bille-Brahe U, DeLeo D, Kerkhof A, editors. Suicidal Behaviour in Europe: results from the Who/Euro Multicentre Study on Suicidal Behaviour. 1st ed. Göttingen: Hogrefe & Huber; 2004. p. 29-43.
  18. Schmidtke A, Bille-Brahe U, DeLeo D, Kerkhof A, Bjerke T, Crepet P, et al. Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatr Scand. 1996;93(5):327–38. doi:.https://doi.org/10.1111/j.1600-0447.1996.tb10656.x
  19. Chan Chee C, Paget LM. Le Recueil d’information médicalisé en psychiatrie (RIM-P) : un outil nécessaire pour la surveillance des hospitalisations suite à une tentative de suicide [The psychiatric hospital discharge database (RIM-P): An essential tool for the surveillance of hospitalization after a suicide attempt]. Rev Epidemiol Sante Publique. 2017;65(5):349–59. doi:.https://doi.org/10.1016/j.respe.2017.05.006
  20. Kõlves K, Vecchiato T, Pivetti M, Barbero G, Cimitan A, Tosato F, et al. Non-fatal suicidal behaviour in Padua, Italy, in two different periods: 1992-1996 and 2002-2006. Soc Psychiatry Psychiatr Epidemiol. 2011;46(9):805–11. doi:.https://doi.org/10.1007/s00127-010-0251-x
  21. Muheim F, Eichhorn M, Berger P, Czernin S, Stoppe G, Keck M, et al. Suicide attempts in the county of Basel: results from the WHO/EURO Multicentre Study on Suicidal Behaviour. Swiss Med Wkly. 2013;143:w13759. doi:.https://doi.org/10.4414/smw.2013.13759
  22. Caldera T, Herrera A, Renberg ES, Kullgren G. Parasuicide in a low-income country: results from three-year hospital surveillance in Nicaragua. Scand J Public Health. 2004;32(5):349–55. doi:.https://doi.org/10.1080/14034940410029496
  23. Evans JG. Deliberate self-poisoning in the Oxford area. Br J Prev Soc Med. 1967;21(3):97–107.
  24. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192(2):98–105. doi:.https://doi.org/10.1192/bjp.bp.107.040113
  25. Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med. 1999;29(1):9–17. doi:.https://doi.org/10.1017/S0033291798007867
  26. Steffen T, Maillart A, Michel K, Reisch T. Monitoring des suizidalen Verhaltens in der Agglomeration Bern der Jahre 2004 bis 2010 im Rahmen der WHO/Monsue Multicenter Study on Suicidal Behaviour. Bern: Bundesamt für Gesundheit & Berner Bündnisses gegen Depressionen, 2011. German.
  27. Muheim F, Eichhorn M, Berger P, Czernin S, Stoppe G, Keck M, et al. Suicide attempts in the county of Basel: results from the WHO/EURO Multicentre Study on Suicidal Behaviour. Swiss Med Wkly. 2013;143:w13759. doi:.https://doi.org/10.4414/smw.2013.13759
  28. Bursztein Lipsicas C, Mäkinen IH, Apter A, De Leo D, Kerkhof A, Lönnqvist J, et al. Attempted suicide among immigrants in European countries: an international perspective. Soc Psychiatry Psychiatr Epidemiol. 2012;47(2):241–51. doi:.https://doi.org/10.1007/s00127-010-0336-6
  29. Brückner B, Muheim F, Berger P, Riecher-Rössler A. Charakteristika von Suizidversuchen türkischer Migranten im Kanton Basel-Stadt: Resultate der WHO/EURO-Multizenterstudie. Nervenheilkunde. 2011;30(7):517–22. doi:. [German.].https://doi.org/10.1055/s-0038-1628389
  30. Taylor R, Page A, Morrell S, Carter G, Harrison J. Socio-economic differentials in mental disorders and suicide attempts in Australia. Br J Psychiatry. 2004;185(06):486–93. doi:.https://doi.org/10.1192/bjp.185.6.486
  31. Schrijvers DL, Bollen J, Sabbe BGC. The gender paradox in suicidal behavior and its impact on the suicidal process. J Affect Disord. 2012;138(1-2):19–26. doi:.https://doi.org/10.1016/j.jad.2011.03.050
  32. Kupferschmid S, Gysin-Maillart A, Bühler SK, Steffen T, Michel K, Schimmelmann BG, et al. Gender differences in methods of suicide attempts and prevalence of previous suicide attempts. Z Kinder Jugendpsychiatr Psychother. 2013;41(6):401–5. doi:.https://doi.org/10.1024/1422-4917/a000256
  33. Townsend E, Ness J, Waters K, Kapur N, Turnbull P, Cooper J, et al. Self-harm and life problems: findings from the Multicentre Study of Self-harm in England. Soc Psychiatry Psychiatr Epidemiol. 2016;51(2):183–92. doi:.https://doi.org/10.1007/s00127-015-1136-9
  34. Cvinar JG. Do suicide survivors suffer social stigma: a review of the literature. Perspect Psychiatr Care. 2005;41(1):14–21. doi:.https://doi.org/10.1111/j.0031-5990.2005.00004.x
  35. Han J, Batterham PJ, Calear AL, Randall R. Factors influencing professional help-seeking for suicidality. Crisis. 2018;39(3):175–96. doi:.https://doi.org/10.1027/0227-5910/a000485
  36. Swiss Federal Office of Public Health. National action plan: preventing suicide in Switzerland. Bern: Swiss Federal Office of Public Health; 2016; Available from: https://www.bag.admin.ch/dam/bag/en/dokumente/psychische-gesundheit/politische-auftraege/motion-ingold/bericht_suizidpr%C3%A4vention.pdf.download.pdf/Report%20Suicide%20prevention%20in%20Switzerland.pdf.
  37. Swiss Federal Statistical Office. Specific causes of death. Neuchâtel: Swiss Federal Statistical Office; 2017; Available from: https://www.bfs.admin.ch/bfs/en/home/statistics/health/state-health/mortality-causes-death/specific.html.
  38. Brovelli S, Dorogi Y, Feiner AS, Golay P, Stiefel F, Bonsack C, et al. Multicomponent intervention for patients admitted to an emergency unit for suicide attempt: an exploratory study. Front Psychiatry. 2017;8:188. doi:.https://doi.org/10.3389/fpsyt.2017.00188
  39. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Association; 2013.
  40. Hawton K, Bergen H, Cooper J, Turnbull P, Waters K, Ness J, et al. Suicide following self-harm: findings from the Multicentre Study of self-harm in England, 2000-2012. J Affect Disord. 2015;175:147–51. doi:.https://doi.org/10.1016/j.jad.2014.12.062
  41. Rivest R. The MD5 Message-Digest Algorithm. United States: RFC Editor; 1992.
  42. Bancroft JH, Skrimshire AM, Reynolds F, Simkin S, Smith J. Self-poisoning and self-injury in the Oxford area. Epidemiological aspects 1969-73. Br J Prev Soc Med. 1975;29(3):170–7. doi:.https://doi.org/10.1136/jech.29.3.170
  43. Bursztein Lipsicas C, Mäkinen IH, Apter A, De Leo D, Kerkhof A, Lönnqvist J, et al. Attempted suicide among immigrants in European countries: an international perspective. Soc Psychiatry Psychiatr Epidemiol. 2012;47(2):241–51. doi:.https://doi.org/10.1007/s00127-010-0336-6
  44. Ville de Lausanne. Portail statistique 2017. Lausanne: Office d’appui statistique et économique; 2017; Available from: http://www.lausanne.ch/lausanne-officielle/statistique/portrait-lausanne/mainArea/01/links/0/linkBinary/Lausanne%20-%20Portrait%20statistique_2017.pdf. French.
  45. Observatoire Suisse de la Santé (OBSAN). Taux de suicide et taux de suicide assisté. Bern: OBSAN; 2014; Available from: https://www.obsan.admin.ch/fr/indicateurs/suicide. French.
  46. Ivey-Stephenson AZ, Crosby AE, Jack SPD, Haileyesus T, Kresnow-Sedacca MJ. Suicide trends among and within urbanization levels by sex, race/ethnicity, age group, and mechanism of death, United States, 2001-2015. MMWR Surveill Summ. 2017;66(18):1–16. doi:.https://doi.org/10.15585/mmwr.ss6618a1
  47. Hawton K, Zahl D, Weatherall R. Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. Br J Psychiatry. 2003;182(06):537–42. doi:.https://doi.org/10.1192/bjp.182.6.537
  48. Swiss Federal Office Of Public Health. Income and living conditions (SILC): poverty in Switzerland. Bern: Swiss Federal Office Of Public Health; 2015; Available from: https://www.bfs.admin.ch/bfs/en/home/statistics/catalogues-databases/press-releases.assetdetail.2460202.html.
  49. Hawton K, Harriss L, Hodder K, Simkin S, Gunnell D. The influence of the economic and social environment on deliberate self-harm and suicide: an ecological and person-based study. Psychol Med. 2001;31(5):827–36. doi:.https://doi.org/10.1017/S0033291701003993
  50. Etat de Neuchâtel. Atlas statistique du canton de Neuchâtel. Neuchâtel: Etat de Neuchâtel; 2018; Available from: https://sitn.ne.ch/geoclip6v3/index.php?indics=popstruct.partresidetr&indics2=popstruct.popetr&view=map8&lang=fr#i2=popstruct.popetr;l=fr;i=popstruct.partresidetr;v=map8;s=2017;s2=2017;z=2474993,1255261,121873,87897. French.
  51. Hawton K, Saunders K, Topiwala A, Haw C. Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review. J Affect Disord. 2013;151(3):821–30. doi:.https://doi.org/10.1016/j.jad.2013.08.020
  52. Gibb SJ, Beautrais AL, Fergusson DM. Mortality and further suicidal behaviour after an index suicide attempt: a 10-year study. Aust N Z J Psychiatry. 2005;39(1-2):95–100. doi:.https://doi.org/10.1080/j.1440-1614.2005.01514.x
  53. Sher L, Grunebaum MF, Burke AK, Chaudhury S, Mann JJ, Oquendo MA. Depressed multiple-suicide-attempters: a high-risk phenotype. Crisis. 2017;38(6):367–75. doi:.https://doi.org/10.1027/0227-5910/a000475
  54. Daigle MS, Pouliot L, Chagnon F, Greenfield B, Mishara B. Suicide attempts: prevention of repetition. Can J Psychiatry. 2011;56(10):621–9. doi:.https://doi.org/10.1177/070674371105601008
  55. Levi-Belz Y, Beautrais A. Serious suicide attempts: toward an integration of trends and definitions. Crisis. 2016;37(4):299–309. doi:.https://doi.org/10.1027/0227-5910/a000386
  56. Arensman E, Corcoran P, McMahon E. The iceberg model of self-harm: new evidence and insights. Lancet Psychiatry. 2018;5(2):100–1. doi:.https://doi.org/10.1016/S2215-0366(17)30477-7
  57. Geulayov G, Casey D, McDonald KC, Foster P, Pritchard K, Wells C, et al. Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study. Lancet Psychiatry. 2018;5(2):167–74. doi:.https://doi.org/10.1016/S2215-0366(17)30478-9
  58. Hawton K, Rodham K, Evans E, Weatherall R. Deliberate self harm in adolescents: self report survey in schools in England. BMJ. 2002;325(7374):1207–11. doi:.https://doi.org/10.1136/bmj.325.7374.1207

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