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