Eating disorders are severe psychiatric conditions associated with high mortality rates, particularly among young people. These disorders often co-occur with self-harm and suicidal ideation, yet the temporal dynamics between these variables remain poorly understood.

This study aims to elucidate the longitudinal associations between symptoms of body dissatisfaction and disordered eating, self-harm and suicidal ideation using structural equation modelling.

Repeated measures of these phenotypes were used to construct a hypothetical model that includes cross-path analyses within and between the variables in two cohorts: the Twins Early Development Study (TEDS; ages 16, 21 and 26 years; N = 5196), representing a general population sample, and the COVID-19 Psychiatry and Neurological Genetics study (COPING; data collected between June 2020 and July 2021; N = 490), which focused on individuals with a history of anxiety or depression. In the TEDS cohort, symptoms of disordered eating, self-harm and suicidal ideation showed limited continuity across adolescence and young adulthood, with peak symptom severity at age 21 years.

Cross-domain associations revealed that both self-harm and suicidal ideation at age 21 years were more strongly associated with disordered eating at 26 years than the reverse. In contrast, the COPING cohort exhibited greater stability in symptoms over time but showed minimal cross-domain effects.

The effects of self-harm and suicidal ideation on disordered eating in early adulthood are stronger than the influence of disordered eating on suicidality.

Research suggests that there may be an association between prescribed opioid use and suicide-related behaviours.

This 15-year retrospective population-based cohort study examines the relationship between opioid use, self-harm and suicide.

The study was based on the POPPY II study, a population-based cohort of 3 268 282 adults who initiated a prescription opioid between 1 July 2003 and 31 December 2018, in Australia. Prescription dispensing data were linked to hospitalisation, death and other data collections. Opioid use was defined as current opioid exposure, cumulative duration of exposure and estimated daily dose. Outcomes were self-harm hospitalisation and suicide mortality, categorised as overall and according to the method (opioid poisoning, non-opioid substance poisoning and other methods). Time-varying generalised estimating equations were used to assess the relationship with self-harm hospitalisation, and Cox proportional hazard models were used to assess the relationship with suicide mortality, controlling for known suicide-related risk factors.

There were 49 215 self-harm hospitalisations at a crude rate of 262 per 100 000 person-years and 3087 suicide deaths at a crude rate of 16.5 per 100 000 person-years. Intentional opioid poisoning was the least common method for both self-harm hospitalisation and suicide. Following multivariable adjustment, current opioid exposure, longer cumulative duration and higher doses were significantly associated with a greater risk of opioid-related self-harm or suicide. In adjusted models, associations for other methods of self-harm and suicide were not as strong or consistent.

Opioid poisoning was the least common method of self-harm and suicide. Despite this, for the minority of people prescribed high doses and/or a long duration of prescription opioids, there is an increased risk for opioid-related self-harm and suicide after controlling for known covariates. Suicide-related behaviours should be screened and monitored in people prescribed opioids, particularly among those on long-term and/or high-dose opioids.

There is growing consensus on essential components of care for hospital-presenting self-harm and suicidal ideation, yet these are often inconsistently implemented. This qualitative study aimed to explore the implementation of components of care across hospitals. Interviews were conducted with health professionals providing care for self-harm and suicidal ideation in hospital emergency departments. Participants (N = 30) represented 15 hospitals and various professional roles. A framework analysis was used, where factors affecting each care component were mapped by hospital and hospital grouping.

A timely, compassionate response was facilitated by collaboration between liaison psychiatry and emergency-department staff and the availability of designated space. Other factors affecting the implementation of care components included patient preferences for, and staff encouragement of, family involvement, time taken to complete written care plans and handover and availability of next care impacting follow-up of patients.

The findings suggest a need for further integration of all clinical professionals on the liaison psychiatry team in implementing care for self-harm; improved systems of handover; further training and awareness on the benefits and optimal processes of family involvement; as well as enhanced access to aftercare.

Childhood irritability increases the risk of later suicidal behaviors, but the moderators of this association have not been identified. We investigated harsh parenting as a moderator in the association of childhood irritability with adolescent suicide attempt and self-harm, and possible sex differences in these associations.

Data were from 9,480 children from the Millennium Cohort Study. We averaged parent ratings of child irritability and harsh parenting at ages 3, 5, and 7 years (range 1–3). Suicide attempt and self-harm were self-reported at age 17. Logistic regression models were used to estimate associations of irritability with suicide attempt and self-harm, adjusting for confounding factors. Interaction analyses were used to test the moderating role of harsh parenting and sex in these associations.

Children with greater irritability scores were at increased risk to attempt suicide (OR=1.72, 95% CI=1.42–2.08). Interaction analyses suggested that this risk in males was elevated regardless of harsh parenting. However, high levels of harsh parenting interacted with irritability in increasing the risk of suicide attempt in females. Children with high irritability were also more at risk of self-harm (OR = 1.16, 95% CI = 1.03–1.31) but this association was not moderated by harsh parenting in either sex.

Parental behaviors may play an important role in the pathway to suicide attempt of children with irritability, especially for females, who may have a heightened sensitivity to interpersonal stressors. Parenting interventions may be helpful in suicide prevention among females with irritability.

People with severe mental disorders (SMDs) have about 15 years shorter life expectancy than the general population. Cardiovascular disease (CVD) is among the leading causes of premature mortality and shares genetic underpinnings with SMDs. We investigated the link between clinical traits in SMDs and time to the first CVD diagnosis.

The study included 1,627 well-characterized participants with schizophrenia spectrum (SCZ, N = 998) and bipolar spectrum disorders (BDs, N = 629), and a reference group of 1,201 healthy controls. CVD diagnoses were obtained from two Norwegian national registries (covering both primary and specialist health care) for the period of 2006–2020. Applying Cox proportional hazard models, we investigated associations between SMD clinical traits and time to first CVD diagnosis in SMD participants, adjusting for age, sex, diagnosis, and tobacco use.

Among individuals with SMD, recurring self-harming behavior (SHB) was associated with a shorter time to first CVD diagnosis (p = .029) relative to those without SHB. In the subgroup with SHB and a history of attempted suicide(s), more suicide attempts were associated with shorter time to first CVD diagnosis (p = .041). Significant associations of time to first CVD diagnosis with age at SMD onset and comorbid substance use disorder were not demonstrated.

SHB and a history of suicide attempts in individuals with SMD seem to be associated with earlier CVD onset, and may improve the prediction of CVD, in addition to standard cardiovascular risk factors.

Pupils in alternative education provision, known as ‘Educated in Other Than At School’ (EOTAS) in Wales, UK, are among the most vulnerable learners and who, for reasons such as mental health or behavioural challenges, do not attend a mainstream or special school.

We compared self-harm, neurodevelopmental disorders and mental health conditions between EOTAS pupils and controls with similar characteristics, before and after being in EOTAS provision.

This population-based electronic cohort study included pupils in Wales aged 7–18 years, from the academic years 2010–11 to 2018–19. We linked data from Education Wales to primary and secondary healthcare records within the Secure Anonymised Information Linkage (SAIL) Databank. Individuals included in the EOTAS data-set were identified as cases. Controls were pseudo-randomly selected based on equivalent age and academic year distribution.

This study included 8056 pupils in EOTAS and 224 247 controls. Higher levels of deprivation, childhood maltreatment, self-harm, neurodevelopmental disorders and mental health conditions before EOTAS entry were linked to higher odds of being in EOTAS. Pupils in EOTAS provision had increased incidence of self-harm, neurodevelopmental disorders and mental health conditions, from 1 year after entering EOTAS provision up to 24 years of age, than pupils with similar characteristics not in EOTAS provision.

While EOTAS provision plays an important role, our findings indicate that it is not sufficient on its own to meet pupils’ social, emotional, behavioural and mental health needs. Additional support and better integration with health and social services are required.

We aimed to present the hospital presented age-specific rate ratio of Traveller women with self-harm or suicide-related ideation and further explore their experiences when attending hospitals in Ireland with thoughts of suicide.

A sequential mixed method analysis was adopted. National presentation data from 24 Irish Emergency Departments (EDs) for suicidal thoughts or self-harm, between 2018–2022 and qualitative interviews were conducted. Descriptive statistics, Poisson regression and rate ratios (95% confidence intervals), were used. Interpretative Phenomenological Analysis (IPA) was conducted on interviews with Traveller women presenting to EDs with suicidal thoughts in 2023. We involved lived experience women in the research.

693 Traveller women presentations were assessed in the 5-year period. Traveller women between 40–49 years of age had 7·81 (95% CI 6·39– 9·55) times higher risk of ideation presentation and those 50+ had 6·41 (95% CI 5·04–8·15) times higher risk of self-harm, when compared to White Irish females. One in four Traveller female presentations, requested no next of kin involvement when discharged. The ‘Power of human connection’ theme emerged from two Traveller women interviewed, reflecting the powerfulness of support in the participants experiences of suicidal ideation.

Results highlight the potential suicide risk of Traveller women over the age of 40 and the significant issue of social isolation when all forms of interpersonal support – family, Traveller organisations, and public health services – are lacking, but crucial for a collaborative safety plan upon ED discharge.

Understanding what psychosocial interventions can reduce self-harm and suicide within in-patient mental health settings can be challenging, due to clinical demands and the large volume of published reviews.

To summarise evidence from systematic reviews on psychosocial and ward-level interventions (excluding environmental modifications) for self-harm and suicide that may enhance patient safety in in-patient mental health settings.

We systematically searched Medline, Embase, CINAHL, PsycINFO and CDSR (2013–2023) for systematic reviews on self-harm and suicide prevention interventions that included in-patient data. Review quality was assessed using AMSTAR-2, primary study overlap via an evidence matrix, and evidence strength evaluated (GRADE algorithm). Findings were narratively synthesised, with input from experts-by-experience throughout (PROSPERO ID: CRD42023442639).

Thirteen systematic reviews (seven meta-analyses, six narrative), comprising over 160 000 participants, were identified. Based on quantitative reviews, cognitive–behavioural therapy reduces repeat self-harm by follow-up, and dialectical behaviour therapy decreases the frequency of self-harm. Narrative review evidence suggested that post-discharge follow-up, as well as system and ward-based interventions (e.g. staff training) may reduce suicide and/or self-harm. However, review quality varied, patient involvement was lacking and methodological quality of trials informing reviews was predominately low. Overlap was slight (covered area 12.4%).

The effectiveness of interventions to prevent self-harm and suicide in in-patient settings remains uncertain due to variable quality reviews, evidence gaps, poor methodological quality of primary studies and a lack of pragmatic trials and co-production. There is an urgent need for better, co-designed research within in-patient mental health settings.

Self-harm is widespread and often occurs in the community without resulting in hospital presentation. Individuals with depressive symptoms are at elevated risk. There are limited self-harm interventions designed for community and primary care settings. The Community Outpatient Psychological Engagement Service for Self-harm (COPESS) is a brief talking therapy intervention for self-harm based in community settings.

To assess the feasibility of evaluating the COPESS intervention in a community setting in relation to participant recruitment, retention, data collection and the acceptability of the intervention.

We used a mixed-method approach and a single-blind randomised controlled trial design with 1:1 allocation to either COPESS plus treatment as usual or treatment as usual alone. Adults with depressive symptoms and self-harm in the past 6 months were recruited from general practices. Secondary outcome measures were assessed at baseline and 1 month, 2 months and 3 months after randomisation. The trial was pre-registered on clinicaltrials.gov (NCT04191122) on 9 December 2019.

Fifty-five people were randomised (of an initial target of 60). Retention rates at follow-up assessments were high (>75%), as was attendance by all participants for all therapy sessions (93%). At 3 months, there were trends towards lower levels of self-harm urges, depressive symptoms and distress in the COPESS group compared with controls. Fidelity to the manualised COPESS therapy was moderate to high.

All progression criteria were met, supporting further evaluation of the intervention in a full-scale efficacy and/or cost-effectiveness trial. These findings add to the growing evidence base supporting the utility of brief psychological interventions for self-harm. COPESS has potential as a brief primary-care-based intervention for those struggling with self-harm.

Clinical guidelines for personality disorder emphasise the importance of patients being supported to develop psychological skills to help them manage their symptoms and behaviours. But where these mechanisms fail, and hospital admission occurs, little is known about how episodes of acutely disturbed behaviour are managed.

To explore the clinical characteristics and management of episodes of acutely disturbed behaviour requiring medication in in-patients with a diagnosis of personality disorder.

Analysis of clinical audit data collected in 2024 by the Prescribing Observatory for Mental Health, as part of a quality improvement programme addressing the pharmacological management of acutely disturbed behaviour. Data were collected from clinical records using a bespoke proforma.

Sixty-two mental health Trusts submitted data on 951 episodes of acutely disturbed behaviour involving patients with a personality disorder, with this being the sole psychiatric diagnosis in 471 (50%). Of the total, 782 (82%) episodes occurred in female patients. Compared with males, episodes in females were three times more likely to involve self-harming behaviour or be considered to pose such a risk (22% and 70% respectively: p < 0.001). Parenteral medication (rapid tranquillisation) was administered twice as often in episodes involving females than in males (64 and 34% respectively: p < 0.001).

Our findings suggest that there are a large number of episodes of acutely disturbed behaviour on psychiatric wards in women with a diagnosis of personality disorder. These episodes are characterised by self-harm and regularly prompt the administration of rapid tranquillisation. This has potential implications for service design, staff training, and research.

Emotional processing difficulties represent the core psychopathology of non-suicidal self-injury (NSSI), yet the underlying neural mechanisms remain unclear.

To investigate neural alterations associated with emotion reactivity and regulation in individuals with NSSI and examine whether emotional valence is related to these neural patterns.

During functional magnetic resonance imaging scans, unmedicated young adults with NSSI (n = 29) and matched controls (n = 25) completed an emotion regulation task in which they viewed pictures of different emotional categories with instructions to either attend to or regulate their emotions.

Individuals with NSSI showed increased neural activation in the right superior temporal gyrus (STG), right parahippocampal gyrus and right supramarginal gyrus during negative emotion reactivity and increased activation in the right middle temporal gyrus and left STG during positive emotion reactivity. Conversely, those with NSSI exhibited reduced activation in the left supplementary motor area, left inferior frontal gyrus, right putamen, right thalamus and right STG during negative emotion regulation and reduced activation in the left ventral striatum during positive emotion regulation. Notably, both hyperactivation of the STG during negative emotion reactivity and hypoactivation of the supplementary motor area during negative emotion regulation were associated with emotion dysregulation in individuals with NSSI.

We observed distinct neural patterns of emotional processing among individuals with NSSI, characterised by hyperactivation during emotion reactivity and hypoactivation during emotion regulation. Our findings provide a neurophysiological basis for therapeutic interventions that facilitate adaptive emotional processing in individuals with NSSI.