Dr Katie McGill

© The Royal Australian and New Zealand College of Psychiatrists 2018. Background: The Australian Institute of Health and Welfare has reported an increased rate of hospital-treated intentional self-harm in young females (2000¿2012) in Australia. These reported increases arise from institutional data that are acknowledged to underestimate the true rate, although the degree of underestimation is not known. Objective: To consider whether the reported increase in young females¿ hospital-treated intentional self-harm is real or artefactual and specify the degree of institutional underestimation. Methods: Averages for age- and gender-standardised event rates for hospital-treated intentional self-harm (national: Australian Institute of Health and Welfare; state: New South Wales Ministry of Health) were compared with sentinel hospital event rates for intentional self-poisoning (Hunter Area Toxicology Service, Calvary Mater Newcastle) in young people (15¿24 years) for the period 2000¿2012. A time series analysis of the event rates for the sentinel hospital was conducted. Results: The sentinel hospital event rates for young females of 444 per 100,000 were higher than the state (378 per 100,000) and national (331 per 100,000) rates. There was little difference in young male event rates ¿ sentinel unit: 166; state: 166 and national: 153 per 100,000. The sentinel hospital rates showed no change over time for either gender. Conclusion: There was no indication from the sentinel unit data of any increase in rates of intentional self-poisoning for young females. The sentinel and state rates were higher than the national rates, demonstrating the possible magnitude of underestimation of the national data. The reported increases in national rates of hospital-treated self-harm among young females might be due to artefactual factors, such as changes in clinical practice (greater proportion admitted), improved administrative coding of suicidal behaviours or possibly increased hospital presentations of community self-injury cases, but not intentional self-poisoning. A national system of sentinel units is needed for the accurate and timely monitoring of all hospital-treated self-harm.

© 2017 The American Association of Suicidology Assessment of a patient after hospital-treated self-harm or psychiatric hospitalization often includes a risk assessment, resulting in a classification of high risk versus low risk for a future episode of self-harm. Through systematic review and a series of meta-analyses looking at unassisted clinician risk classification (eight studies; N¿=¿22,499), we found pooled estimates for sensitivity 0.31 (95% CI: 0.18¿0.50), specificity 0.85 (0.75¿0.92), positive predictive value 0.22 (0.21¿0.23), and negative predictive value 0.89 (0.86¿0.92). Clinician classification was too inaccurate to be clinically useful. After-care should therefore be allocated on the basis of a needs rather than risk assessment.

© 2019 Objective: This study aimed to identify the information that people who have attempted suicide and those who support them believed to be helpful to receive after an attempt. Methods: Thirty-seven people with lived experience of suicide attempt(s) (suicide attempt survivors and family members/friends of survivors) were recruited through two national lived experience community groups in Australia. Participants completed a semi-structured telephone interview that included questions about the types of information they believed important to receive after an attempt. Results: Using thematic analysis, the key information participants identified was helpful to receive following a suicide attempt was that which could challenge stigma and address negative community attitudes towards suicide. Participants spoke of a need for practical information and information that provided hope. Personal stories of recovery were identified as an important way of communicating this sort of health information. Conclusions: People who have attempted suicide and their family members and friends want information that challenges stigma and supports recovery expectations. Practice implications: Providing people with accurate information about recovery and using personal stories to communicate health information is one way people affected by suicide attempt identify can challenge stigma, and address information needs after a suicide attempt.