Physical and mental illness comorbidity among individuals with frequent self-harm episodes: A mixed-methods study

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Sadath, A
Troya, MI
Nicholson, S
Cully, G
Leahy, D
Ramos Costa, AP
Benson, R
Corcoran, P
Griffin, E
Phillip, E
Cassidy, E
Jeffers, A
Shiely, F
Alberdi-Páramo, Í
Kavalidou, K
et al.
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Background: Research has indicated an increased risk of self-harm repetition and suicide among individuals with frequent self-harm episodes. Co-occurring physical and mental illness further increases the risk of self-harm and suicide. However, the association between this co-occurrence and frequent self-harm episodes is not well understood. The objectives of the study were (a) to examine the sociodemographic and clinical profile of individuals with frequent self-harm (regardless of suicidal intent) episodes and, (b) the association between physical and mental illness comorbidity, self-harm repetition, highly lethal self-harm methods, and suicide intent. Methods: The study included consecutive patients with five or more self-harm presentations to Emergency Departments across three general hospitals in the Republic of Ireland. The study included file reviews (n = 183) and semi-structured interviews (n = 36). Multivariate logistic regression models and independent samples t-tests were used to test the association between the sociodemographic and physical and mental disorders comorbidity on highly lethal self-harm methods and suicidal intent, respectively. Thematic analysis was applied to identify themes related to physical and mental illness comorbidity and frequent self-harm repetition. Findings: The majority of individuals with frequent self-harm episodes were female (59.6%), single (56.1%), and unemployed (57.4%). The predominant current self-harm method was drug overdose (60%). Almost 90% of the participants had history of a mental or behavioral disorder, and 56.8% had recent physical illness. The most common psychiatric diagnoses were alcohol use disorders (51.1%), borderline personality disorder (44.0%), and major depressive disorder (37.8%). Male gender (OR = 2.89) and alcohol abuse (OR = 2.64) predicted the risk of a highly lethal self-harm method. Suicide intent was significantly higher among those with a diagnosis of major depressive disorder (t = 2.43; p = 0.020). Major qualitative themes were (a) the functional meaning of self-harm (b) self-harm comorbidity (c) family psychiatric history and (d) contacts with mental health services. Participants described experiencing an uncontrollable self-harm urge, and self-harm was referred to as a way to get relief from emotional pain or self-punishment to cope with anger and stressors. Conclusion: Physical and mental illness comorbidity was high among individuals with frequent self-harm episodes. Male gender and alcohol abuse were associated with highly lethal self-harm methods. The mental and physical illness comorbidity of individuals with frequent self-harm episodes should be addressed via a biopsychosocial assessment and subsequent indicated treatment interventions.

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Frontiers in Psychiatry
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© 2023 Sadath, Troya, Nicholson, Cully, Leahy, Ramos Costa, Benson, Corcoran, Griffin, Phillip, Cassidy, Jeffers, Shiely, Alberdi-Páramo, Kavalidou and Arensman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Psychiatry (incl. psychotherapy)
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Sadath, A; Troya, MI; Nicholson, S; Cully, G; Leahy, D; Ramos Costa, AP; Benson, R; Corcoran, P; Griffin, E; Phillip, E; Cassidy, E; Jeffers, A; Shiely, F; Alberdi-Páramo, Í; Kavalidou, K; Arensman, E, Physical and mental illness comorbidity among individuals with frequent self-harm episodes: A mixed-methods study, Frontiers in Psychiatry, 2023, 14, pp. 1121313