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
