Alcohol Harm Reduction Compared To Harm Reduction For Other Drugs
The Impact of Alcohol on Self-harm and Suicide in Ireland - New Insights.
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Prof Ella Arensman National Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Ireland “Facing the Fear”: Alcohol and Mental Health in Ireland Dublin, 20 th November 2013 The Impact of Alcohol on Self-harm and Suicide In Ireland - New Insights
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Prof Ella Arensman's presentation about the impact of alcohol on self-harm and suicide in Ireland, providing new insights from recently collected data. Prof Arensman is Director of Research with the National Suicide Research Foundation and Adjunct Professor with the Department of Epidemiology and Public Health, University College Cork. This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.
Transcript of The Impact of Alcohol on Self-harm and Suicide in Ireland - New Insights.
Prof Ella Arensman
National Suicide Research Foundation & Department of Epidemiology and Public Health,
University College Cork, Ireland
“Facing the Fear”: Alcohol and Mental Health in Ireland Dublin, 20th November 2013
The Impact of Alcohol on Self-harm and Suicide In Ireland - New Insights
Overview
The association between alcohol and self-harm
The impact of alcohol on seasonal patterns of self-harm among men and women
The impact of alcohol on self-harm among adolescents
Alcohol, associated mental health problems and suicide risk
Evidence based actions
Irish National Registry of Deliberate Self-Harm(NRDSH)
Objectives• To establish the incidence of
hospital treated deliberate self-harm
• To describe the pattern of presentations and the nature of the self-harm behaviour involved
• To monitor trends over time and by area
• To estimate the risk of repeated self-harm presenting to hospital
In 2012, there were 12,010 presentations made by 9,483 individuals
Trends in rates of self-harm, 2002-2012 - NRDSH
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
25
50
75
100
125
150
175
200
225
250
Women Men
Ag
e-s
tan
da
rdis
ed
ra
te p
er
10
0,0
00
+20%
+6%
Incidence of self-harm by age and gender (NRDSH, 2012)
10
-14
15
-19
20
-24
25
-29
30
-34
35
-39
40
-44
45
-49
50
-54
55
-59
60
-64
65
-69
70
-74
75
-79
80
-84
85
+0
100
200
300
400
500
600
700
Men WomenAge group
Ra
te p
er
10
0,0
00
Alcohol was involved in 38% of all cases (42% in men, 36% in women)
Alcohol involvement in self-harm by age and gender (NRDSH, 2012)
5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+0%
10%
20%
30%
40%
50%
60%
MaleFemale
% o
f cas
es in
volv
ing
alco
hol
Association between peaks of self-harm and public holidays
Average number of self-harm presentation to hospital per day: n=33
Six dates in the year on which 50 or more self-harm presentations were made, 5 of which were public holidays or the day after:
- January 1st
- October 1st - March 17th and 18th
- June 5th
Alcohol abuse is one of the factors contributing to the high rates of self-harmamong young people and adults in Ireland
Direct effects: Impairs problem-solving ability Increases impulsivity and lack of control Increases feelings of depression, stress, anger or anxiety
Long term and indirect effects: Isolation (loss of work, relationships, etc.) Neurobiological deficits
The impact of alcohol
Rossow et al, 2007; Madge et al, 2008; McMahon et al, 2010;Khalily & Hallahan, 2012
Janu
ary
Febr
uary
Mar
ch
April
May
June July
Augu
st
Sept
embe
r
Oct
ober
Nov
embe
r
Dec
embe
r
0.75
0.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
1.20 MalesFemales
The impact of alcohol on seasonal patterns of self-harm: 2006-2012
Non-Alcohol related self-harm
The impact of alcohol on seasonal patterns of deliberate self-harm: 2006-2012
Alcohol related self-harmJa
nuar
y
Febr
uary
Mar
ch
April
May
June July
Augu
st
Sept
embe
r
Oct
ober
Nov
embe
r
Dec
embe
r
0.75
0.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
1.20 MalesFemales
Main outcomes
Alcohol contributes to increasing rates of self-harm and it causes increases of self-harm at specific times in the year, such as a peak of self-harm in July and August.
This peak would not exist if alcohol would not be involved.
Proportion of ED presentations involving alcohol by weekday
Monday Tuesday Wednesday Thursday Friday Saturday Sunday0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Male Female
Perc
entg
ae o
f pre
sent
ation
s in
volv
ing
alco
hol
Alcohol involvement by hour of presentation to hospital due to self-harm
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 1 2 3 4 5 6 70
500
1000
1500
2000
2500
3000
3500
No alcohol involved Alcohol involved
Hour of presentation
Num
ber o
f pre
sent
ation
s
Western Area of Northern Ireland: Frequency of self-harm presentations to hospital by day of the
week with and without the involvement of alcoholMen
Mon Tue Wed Thu Fri Sat Sun0
50
100
150
200
250
300
Alcohol involved
No alcohol involved
Day of the week
Num
ber o
f pre
sent
ation
s
Western Area of Northern Ireland: Frequency of self-harm presentations to hospital by day of the week with
and without the involvement of alcoholWomen
Mon Tue Wed Thu Fri Sat Sun0
50
100
150
200
250
300
350
Alcohol involved
No alcohol involved
Day of the week
Num
ber o
f pre
sent
ation
s
Trends in highly lethal methods of self-harm and alcohol involvement (2004-2012)
2004 2005 2006 2007 2008 2009 2010 2011 20120
50
100
150
200
250
Num
ber o
f pre
sent
ation
s
Males with alcohol
Females with alcohol
Main outcomes
Alcohol is associated with increasing self-harm among both men and women
Alcohol contributes to increases of self-harm at specific times in the year and week
Alcohol is associated with increasing trends in highly lethal methods of self-harm, in particular among men
International comparative study on self-harm and associated factorsChild and Adolescent Self Harm in Europe (CASE)
The CASE study is a multi-centre study in 6 countries across Europe and 1 non-European centre (Australia).
Objectives:
The prevalence of self harm-among 15-17 year olds and the relationship with risk factors (e.g. depression, anxiety, alcohol, drug use/misuse etc.) and protective factors (e.g. coping, help seeking) across different countries
Young people’s opinions on the prevention of mental health difficulties
Prevalence of self-harm in adolescents across different countries
0
5
10
15
20
25
Australia England Norway Belgium Ireland Hungary Netherlands
Females Males
%
Madge et al, 2008
Proportion of adolescent self-harm due to heavy drinking
0 10 20 30 40 50 60
Ireland
Belgium
Australia
Netherlands
England
Hungary
Norway
Percentage
Other factors considered: age, gender, depression, impulsivity and negative life events Rossow et al, 2007
Main outcomes
Heavy alcohol consumption increases risk of self- harm independent of other factors
Less so in Ireland than in other countries
Reducing Irish adolescents’ heavy drinking should reduce their rate of deliberate self harm (<17%)
Suicide Support and Information System (SSIS): Obtaining a complete picture of suicide cases and open
verdicts by accessing multiple sources
Coroners' verdict records & Post mortem reports (Response Rate: 100%)
Close family members/ friends (Response Rate: 66.0%)
GP/Psychiatrist/Psychologist (Response Rate: 77.1%)
• Period and area covered:
Sept. 2008-June 2012, City and County Cork
• Number of consecutive cases: 275 suicide cases + 32 open verdicts meeting screening criteria; Total N=307
• Overrepresentation of men (80.1%); Men significantly younger than women
• Nearly two thirds had a history of self-harm (65.2%); 69.1% were diagnosed with depression, and alcohol/and or drug abuse was present among 60.7%
• Among those with alcohol and/or drug abuse, 48.6% had abused alcohol, 27.6% had abused both alcohol and drugs, and 21% had abused drugs
Among 20.8% an increase in alcohol and/or drug abuse was observed in the year prior to death
Second SSIS Report: Key findings from a study looking at 307 suicide deaths in
Cork
Characteristics of the suicide act
Method of suicide: hanging (63.8%), drowning (12.4%), intentional overdose of medication/drugs (9.8%), other methods (14%)
At the time of death, the majority (79%) had alcohol and/or drugs in their toxicology. 24.4% had alcohol + drugs, 34.6% had drugs only, and 20% had alcohol only
Use of alcohol and/or drugs increases the risk of a fatal outcome (Kaplan et al, 2013)
Demographic, psychosocial and psychiatric factors associated with suicide in Men aged <40 years versus Men aged > 40 years
Family or close friend died by suicide
History of self-harm
Day of the week died: Saturday
Agricultural occupation
Diagnosed with depression
Diagnosed with a physical illness
In paid employment
Antidepressants in toxicology
Marital status: Married/Co-habiting
Drugs in toxicology
Living alone
Method of suicide: Hanging
History of alcohol only abuse
0 10 20 30 40 50 60 70 80
Men aged ≥ 40 Years
Full-time student
Day of the week died: Monday
Diagnosed with depression
Family or close friend died by suicide
History of self-harm
Living with family of origin
Unemployed
History of alcohol and drug abuse
Alcohol in toxicology
Benzodiazepines in toxicology
Opiates in toxicology
Marital status: Single
Method of suicide: Hanging
0 10 20 30 40 50 60 70 80
Men aged < 40 Years
Day of the week died: Thursday
Divorced/Seperated
Living alone
Left suicide note/message
Treated as psychiatric in-patient
Diagnosed with depression
Construction/production sector
Treated as psychiatric out-patient
Unemployed
History of alcohol and/or drug abuse
Psychiatric diagnosis
Drugs in toxicology
Cause of death: Hanging
0 10 20 30 40 50 60 70 80
Percentage
Agricultural sector
Day of the week died: Saturday
Living with family of origin
History of alcohol and/or drug abuse
Family or close friend died by suicide
Married/Co/habiting
In paid employment
Cause of death: Hanging
0 10 20 30 40 50 60 70 80
Percentage
Had history of self-harm No history of self-harm
Demographic, psychosocial and psychiatric factors associated with suicide in those with and without a history of self-harm
Evidence based actions
National strategies to reduce access to alcohol should be intensified.
National strategies to increase awareness of the risks involved in the use and misuse of alcohol should be intensified, starting at pre-adolescent age.
Active consultation and collaboration between the mental health- and addiction services needs to be arranged for patients who present with dual diagnosis (psychiatric disorder and and alcohol/drug abuse).
Evidence based actions
Health care professionals working with people who engage in self-harm should receive training in the assessment and management of self-harm and co-morbid alcohol and drug misuse/abuse.
Health care professionals prescribing medication to people at risk of self-harm or suicide should carefully monitor compliance with appropriate use of medication.
Evidence based actions
Breaking the commercially reinforced links between alcohol and sport.
Recruit the major national sporting organisations as partners in the development of a national positive mental health promotion campaign.
Irish Examiner March 28th 2013
Thank you!
Prof Ella ArensmanNational Suicide Research Foundation &
Department of Epidemiology and Public HealthUniversity College Cork
Western gateway BuildingWestern Road
CorkT: 021 4205551
E-mail: [email protected]
The National Suicide Research Foundation is in receipt of funding from the National Office for Suicide Prevention
