MINOR SELF-HARM AND PSYCHIATRIC DISORDER Keren Skegg, Shyamala Nada-Raja and Terrie Moffitt

What about self-harm in a population- based sample? Not all self-harm gets to hospital Is self-harm in a general population-based sample also associated with psychiatric disorder?

Dunedin Multidisciplinary Health and Development Study (DMHDS)‏ 958 (94%) participated in assessments of both their self-harm and psychiatric status at age 26 years

Three mutually exclusive groups of people who reported these behaviours in the previous year ICD self-harm - 15 men and 10 women ( all episodes involved overdose or cutting)‏ Other self-harmful behaviours but no ICD self-harm - 73 men and 46 women (mainly self-battery)‏ Intoxication to deal with emotional pain but no other self-harmful behaviours -78 men and 58 women

Any psychiatric disorder in same year: men ICD self-harm -15/15 (100%)‏ Other self-harmful behaviour - 43/73 (59%)‏ Intoxication to deal with emotional pain - 58/78 (74%)‏ No self-harm - 114/322 (35%)‏

Any psychiatric disorder in same year: women ICD self-harm - 10/10 (100%)‏ Other self-harmful behaviours - 34/46 (74%)‏ Intoxication to deal with emotional pain - 41/58 (71%)‏ No self-harm - 133/356 (37%)

Table 2 Odds Ratios (and 95% Confidence Intervals) for Self-harm c among Participants with Psychiatric Disorders, and with Suicidal/Self-harmful thoughts during the Year, vs. no DSM IV or Suicidal/Self-harmful Thoughts during the Year *p<.05; **p<.01. a any anxiety or depressive disorder. B any substance dependence or antisocial personality disorder, C ICD self-harm and other self-harmful behaviours combined ( )* Suicidal/self-harm thoughts only (no internalizing disorder, externalizing disorder, or other Axis I disorder ascertained)‏ 23.2 ( )**5.0 ( )‏ Internalizing and Externalizing disorder with suicidal/self-harmful thoughts 3.0 ( )‏2.9 ( )*Internalizing and Externalizing disorder only 38.7 ( )**11.3 ( )**Externalizing disorder with suicidal/self-harmful thoughts 2.0 ( )‏1.2 ( )‏Externalizing disorder b only 11.8 ( )**15.6 ( )**Internalizing disorder with suicidal/self-harmful thoughts 2.9 ( )**1.8 ( )‏Internalizing disorder a only Odds ratio (95% CI)‏ WomenMen

Limitations Structured interview schedule for psychiatric disorders Although disorder occurred in same 12 month period as self-harm, not known if occurred at same time Analysis limited by small numbers engaging in different types of self-harm

Strengths Population-based sample, 94% response rate Past year data for both self-harm and psychiatric disorder Separate self-harm interview

Clinical Implications Even minor self-harm is often associated with treatable psychiatric disorder, so take every opportunity to screen for psychiatric symptoms Take suicidal thoughts seriously in young men even in the absence of psychiatric disorder