Biomedical subjects

J Fagg

Publications and source records attributed to J Fagg.

At least 19 recordsLinked to original sources

PubMed2001

Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment: a neglected population at risk of suicide.

OBJECTIVES: Deliberate self-harm (DSH) patients, despite their risk of suicide, are often discharged directly from accident and emergency (A&E) departments without undergoing a psychiatric assessment. The aims of this study were to determine the characteristics and outcome of these patients. METHODS: The characteristics of DSH patients who were discharged directly from an A&E department over a 2-year period were investigated, comparing those who had a psychiatric assessment with those who did not. In a matched control design, the outcome of a group of patients who did not receive a psychiatric assessment was compared with that of a group of patients who were assessed. RESULTS: Of DSH patients who were discharged directly from the A&E department 58.9% (145/246) did not have a psychiatric assessment. Nonassessed patients were more likely to have a past history of DSH, to be in the 20-34 year age group, and to have exhibited difficult behaviour in the A&E department. Patients presenting between 5 p.m. and 9 a.m. were less likely to be assessed than those attending between 9 a.m. and 5 p.m. Further DSH during the subsequent year occurred in 37.5% of the nonassessed patients compared with 18.2% of matched assessed patients. They were also more likely to have psychiatric treatment. CONCLUSION: A substantial proportion of DSH patients discharged directly from A&E departments do not receive a psychiatric assessment. Nonassessed patients may be at greater risk of further DSH and completed suicide than those who are assessed. Hospital services need to be organised such that DSH patients managed in A&E departments can receive an assessment of psychosocial problems and risk.

Adult↗

PubMed2001

Outcome of women admitted to hospital for depressive illness: factors in the prognosis of severe depression.

BACKGROUND: A previous study of women 9 months after discharge from in-patient treatment for depression found that low self-esteem as measured by a self-report questionnaire at admission was associated with a worse prognosis. This study investigates the womens' outcome more than 4 years after discharge and the continued prognostic relevance of self-esteem and other variables. METHOD: Fifty-six women who had been admitted to hospital with major depression and studied in detail during their admission and 9 months following discharge were traced 4-5 years later. Possible prognostic factors were investigated in relation to time to recovery and recurrence, and to a global outcome measure. RESULTS: In keeping with other published work only 16 out of 52 (31%) women had recovered and remained well. Fifteen out of 52 (29%) subjects had experienced depressive symptoms for more than 70% of the follow-up time or died from unnatural causes. Low self-esteem scores recorded at the initial admission correlated with slow recovery but not subsequent recurrence of depression. The occurrence of one or more life events in the year preceding admission was associated with a better prognosis. CONCLUSIONS: The poor long-term prognosis of many women with severe depression was confirmed. Social factors, such as social support and marital relationships were less important for prognosis than in previous studies of less severely ill subjects. The prognostic value of self-esteem warrants further investigation and appears to have therapeutic implications.

Adult↗

PubMed2000

Deliberate self-harm in adolescents in Oxford, 1985-1995.

Deliberate self-harm (DSH) has been one of the major health problems of adolescents in the U.K. for many years. Any changes in rates of DSH or the demographic characteristics of the patient population are likely to have important implications for clinical services and for future suicidal behaviour. Following a decline in rates in the late 1970s and mid 1980s, there were signs in the late 1980s that rates were beginning to increase again. We have used data collected by the Oxford Monitoring System for Attempted Suicide on the basis of patients presenting to the general hospital in Oxford to review trends in DSH in under 20-year-olds between 1985 and 1995. There was a substantial increase in the numbers of teenage DSH patients during the 11-year study period, with an increase between 1985-1986 and 1994-1995 of 27.7% in males, 28.3% in females, and 28.1% overall. There were no demographic changes within the catchment area to explain a change of this size. As rates of repetition of DSH also increased in both sexes during the study period the overall number of episodes of DSH rose even more between 1985-1986 and 1994-1995 (+56.9% in males, +46.3% in females, and +49.4% overall). As in previous studies the majority of adolescents had interpersonal problems and/or difficulties with studying or employment. Self-poisoning with paracetamol and paracetamol compounds became increasingly common such that by 1995 these were used in almost two-thirds of overdoses. The recent increase in DSH in adolescents has important implications for general hospital and adolescent psychiatric services. The greater frequency of repetition of DSH may herald increased future suicide rates. The case for restricting the amount of paracetamol available is overwhelming. Evaluative trials of specific interventions following adolescent DSH are urgently required.

Adolescent↗

PubMed1999

Repetition of deliberate self-harm by adolescents: the role of psychological factors.

The aim of this study was to examine the relationship between psychological variables and repetition of deliberate self-harm by adolescents (n=45) aged 13-18 years who had been admitted to a general hospital having taken overdoses. Standardized measures of depression, hopelessness, suicidal intent, impulsivity, trait and state anger, self-esteem and problem-solving (both self-report and observer-rated) were administered to the adolescents while still in the general hospital. Repetition was assessed on the basis of previous overdoses (n=14) and repetition of self-harm (self-poisoning and self-injury) during the subsequent year (n=9). Adolescents with a history of a previous overdose and/or who repeated self-harm during the following year (n=18) differed from non-repeaters in having higher scores for depression, hopelessness and trait anger, and lower scores for self-esteem, self-rated problem-solving and effectiveness of problem-solving rated on the basis of the Means End Problem Solving test, all measured at the initial assessment. These differences largely disappeared when level of depression was controlled for. Similarly, differences found between repeaters and non-repeaters in the year following the index overdoses for problem-solving were much reduced when account was taken of differences in depression scores. Depression is a key factor associated with risk of repetition of adolescent self-harm (and hence of suicide risk). In the management of adolescents who have harmed themselves, careful assessment of depression and appropriate management of those who are depressed is essential.

Adolescent↗

PubMed1999

The geographical distribution of suicides in farmers in England and Wales.

Farmers in England and Wales have an elevated risk of suicide. The aim of this study was to investigate the geographical distribution of suicides in farmers. Rates of suicide (including suicide and open verdicts) of farmers in England and Wales between 1981 and 1993 were calculated on a county basis. Trends in rates and differences in rates between counties, regions and England and Wales were then analysed. There were 719 suicides (634 suicide verdicts and 85 open verdicts). There was evidence of a decline in annual rates of suicide in farmers during the study period in England but not Wales. There was no evidence of geographical heterogeneity of farming suicides according to counties, but a relatively high rate for Devon (N = 62 suicides). County farming suicide rates did not appear to be related to local general population suicide rates, density of farmers or type of farm holding. While identification of counties with relatively large numbers of farming suicides should assist targeting of local preventive programmes, it is clear that any significant prevention strategies should be implemented on a national basis.

Adolescent↗

PubMed1998

Stress in farmers: a survey of farmers in England and Wales.

OBJECTIVES: To investigate potential sources of stress for farmers in England and Wales METHOD: A postal questionnaire was sent to a randomly selected group of 800 members of the National Farmers' Union and 200 members of the Farmers' Union of Wales. RESULTS: 500 questionnaires (51%) were returned completed between October 1995 and March 1996. Farmers had problems with record keeping and paperwork (62%), difficulty understanding forms (56%), and problems arising from the effects of new legislation and regulations (49%). Nearly a quarter (23%) reported financial problems and most worried about money (79%). Very few were socially isolated, with over 90% having at least one confidant. 70% worked > 10 hours a day, and 31% had health problems which interfered with their work, including more than a quarter of those < 50. 16% of the sheep farmers reported symptoms which they attributed to organophosphate poisoning. The farmers most vulnerable to financial and other problems were those with small farms and mixed farming operations. Farmers in Wales also seemed more vulnerable than those in England, but a lower response rate from members of the Farmers' Union of Wales means this difference should be interpreted cautiously. CONCLUSION: The survey confirms findings from several regional studies that many farmers are experiencing considerable stress from various causes. Local and national initiatives to assist farmers, including outreach programmes, should be encouraged. Policy makers should be aware of the potential impact of legislation, particularly on the more vulnerable groups.

Adult↗

PubMed1998

Methods used for suicide by farmers in England and Wales. The contribution of availability and its relevance to prevention.

BACKGROUND: Farmers in the UK have an elevated risk of suicide. It has been suggested that this may be related to their ease of access to dangerous means for suicidal behaviour. The extent to which farmers use these means and changes in their use may be relevant to suicide prevention. METHOD: Data on 719 deaths in farmers of both genders in England and Wales between 1981 and 1993 in which a verdict of suicide or undetermined cause (open verdict) was recorded were analysed. RESULTS: Of 702 deaths in male farmers, firearms were involved in 40.0%, hanging in 29.6%, carbon monoxide in 16.4%, poisoning in 8.0% (over half of which involved agricultural or horticultural poisons) and other methods in 6.1%. There was a considerable excess of deaths due to firearms compared with the distribution of methods of suicide and open verdict deaths in males in the general population. Hanging was also somewhat more frequent. During the study period there was a reduction in firearm death rates, particularly after 1989 when there was national legislation on firearm ownership, registration and storage. There were also fewer farming suicides after this date. By the end of the study period hanging was more frequent than deaths involving firearms. CONCLUSIONS: Farmers who commit suicide tend to use methods to which they have easy access. Restriction of the ready availability of such methods, particularly in farmers known to be depressed or otherwise at risk, might prevent some suicides.

Adolescent↗

PubMed1997

Psychological effects of continuation versus discontinuation of hormone replacement therapy by estrogen implants: a placebo-controlled study.

There is conflicting evidence regarding the effects of hormone replacement therapy (HRT) with estrogens on psychological and psychiatric symptoms of menopause. Forty women already attending a menopause clinic for continuing HRT by estrogen implants were studied in a randomized, double-blind, placebo-controlled study of estrogen reimplantation versus implantation of a placebo preparation. Assessment included self rating with visual analog scales, standardized psychological and menopause rating scales (Hospital Anxiety and Depression Scale, Self-Concept Questionnaire, Cognitive Failures Questionnaire, Greene Menopause Index), and interview with the Present State Examination. No difference in outcome with regard to either psychological or psychiatric symptoms was found 2 months after entry to the study between the women who received an active implant and those who received a placebo implant, in spite of the former group having a significant rise in estradiol levels. The only effect of HRT on physical symptoms was a nonsignificant reduction in flushes. Psychiatric morbidity of the study population was high with nearly half being "psychiatric cases" according to the Present State Examination at both initial assessment and follow-up. At entry to the study nearly all the women had levels of estradiol in the premenopausal range and four had supraphysiological levels. It appears likely that women were returning requesting a new implant because of symptoms related to nonhormonal factors. Women receiving continuing HRT for menopausal symptoms should be reassessed both for hormonal status and current psychosocial factors when they present with recurrent symptoms, especially those of a psychological or psychiatric nature.

Adult↗

PubMed1997

Deliberate self-harm in alcohol and drug misusers: patient characteristics and patterns of clinical care.

The aims of this study were to describe the characteristics of alcohol and drug misusers presenting to a general hospital following suicide attempts and to investigate the patterns of clinical care they received before and after the attempts. The Oxford Monitoring System for Attempted Suicide and patient case-notes were used to obtain information on alcohol and drug misusers assessed by the general hospital psychiatric services after deliberate self-harm in 1992. Of 724 patients, 200 (28%) were substance misusers (36% of males, 23% of females). Both alcoholics and drug misusers were more likely than other attempters to be male, have histories of personality disorder and criminal offences and to make repeat attempts, and the drug misusers were more likely to be living alone and unemployed. These are characteristics associated with particularly high risk of suicide. A large proportion of the substance misusers had received specific treatment for their misuse before their attempts and the majority were offered this afterwards. Over a quarter did not accept the care they were offered. The general hospital management of attempted suicide patients must include systematic assessment for evidence of alcohol and drug misuse and maintain close links with substance misuse services. Patients identified as having problems in the use of alcohol without having developed dependence and/or physical symptoms are a group that warrants specific attention. Audits should be conducted in general hospitals to ensure that sufficient attention is being paid to the detection and management of suicide attempters with substance misuse.

Journal Article↗

PubMed1997

Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?

OBJECTIVE: To investigate the relationship between the availability of paracetamol and its use for overdose and suicide. DESIGN: Analysis of routinely collected information on time trends for paracetamol suicides, non-fatal overdoses, and sales. SETTING: England and Wales and France. RESULTS: There were strong correlations between trends in paracetamol sales in the UK and trends in non-fatal paracetamol overdose in Oxford between 1976 and 1993 (Spearman's r = 0.86; 95% confidence interval (CI) 0.54, 0.96) and between paracetamol sales and non-fatal overdoses in France between 1974 and 1990 (r = 0.99; 95% CI 0.97, 1.00). Sales figures were also correlated with paracetamol related suicides in both England and Wales, 1983-91 (r = 0.72; 95% CI 0.11, 0.94) and France, 1974-90 (r = 0.79; 95% CI 0.50, 0.92). Similarly strong relationships were observed between trends in non-fatal overdoses and suicide by paracetamol poisoning in England and Wales (r = 0.85; 95% CI 0.61, 0.95) and France (r = 0.79; 95% CI 0.50, 0.92). It is estimated that approximately 32,000 overdoses involving paracetamol occur annually in England and Wales. Fatality rates from paracetamol overdose were four times as high in England and Wales (0.4%, 95% CI 0.38, 0.46) as in France (0.1%, 95% CI 0.06, 0.17). CONCLUSION: Trends towards greater availability of paracetamol are paralleled by increases in its use for both non-fatal overdose and suicide. Paracetamol related morbidity and mortality seem to be less frequent in France where the quantity of paracetamol in a single purchase is limited. Although not conclusive, these data add to a body of evidence which suggests that restrictions in the quantity of paracetamol available as a single purchase in the UK may reduce suicide and liver failure related to paracetamol.

Acetaminophen↗

PubMed1997

Trends in deliberate self-harm in Oxford, 1985-1995. Implications for clinical services and the prevention of suicide.

BACKGROUND: Deliberate self-harm (DSH) has been a major health problem in the UK for nearly three decades. Any changes in rates of DSH or the demographic characteristics of the patient population are likely to have important implications for clinical services and suicide prevention. METHOD: Data collected by the Oxford Monitoring System for Attempted Suicide were used to review trends in DSH between 1985-1995. RESULTS: There was a substantial increase in DSH rates during the 11-year study period, with a 62.1% increase in males and a 42.2% increase in females. The largest rise was in 15-24-year-old males (+ 194.1%). Changes in DSH rates correlated with changes in national suicide rates in both males and females in this age group. Rates of repetition of DSH increase in both genders during the study period. Paracetamol self-poisoning has continued to increase, half of all overdoses in 1995 involving paracetamol, and antidepressant overdoses have become more common. CONCLUSIONS: The increase in DSH, especially in young males, has important implications for general hospital DSH and medical services. It may herald a reversal of recent progress towards achievement of national suicide targets.

Adolescent↗

PubMed1996

Does the duration of illness before treatment affect the time taken to recover on treatment in severely depressed women?

This study examines the link between duration of depression before treatment is introduced and the duration of depressive illness after treatment in a population of 59 female psychiatric inpatients. Most women were suffering with severe depression and the majority had had previous depressive illnesses. Calculation of the rank order correlation coefficient demonstrated no significant correlation between the duration of depression before initiation of treatment and the duration after treatment was introduced. This finding is discussed in relation to other relevant studies.

Adult↗

PubMed1996

Deliberate self-poisoning and self-injury in children and adolescents under 16 years of age in Oxford, 1976-1993.

BACKGROUND: Deliberate self-harm (DSH) is common in adolescents in the United Kingdom and suicide has greatly increased in frequency in older male adolescents. There is, however, very little information about DSH in older children and young adolescents. METHOD: Analysis of data collected by the Oxford Monitoring System for Attempted Suicide between 1976 and 1993 for all cases of DSH in under 16-year-olds referred to the general hospital in Oxford. RESULTS: Seven hundred and fifty-five individuals were involved in 854 episodes of DSH. There were very few cases under 12 years of age but after that the behaviour increased greatly in frequency with each year of age, especially in girls. Eighty-five per cent were girls, the sex ratio being 5.7 girls to each boy. Most cases involved self-poisoning. During the final six years of the study period paracetamol was involved in 54.7% of overdoses, compared with 19.5% in 1976-1981. A minority of individuals had had previous psychiatric treatment. The most frequent problems were relationship difficulties with parents, followed by difficulties with friends, school and social isolation. Among those who reported previous episodes of DSH, in the majority of cases these had not come to medical attention. Repetition of self-harm occurred in 9.4% of cases within a year of an episode and 19.3% during the overall study period. There was some indication that repetition was most common in youngsters discharged from the Accident and Emergency Department without a psychiatric assessment. CONCLUSIONS: DSH in under 16-year-olds is not uncommon and there is evidence that it occurs far more frequently in the community than is reflected in general hospital figures. The problem of paracetamol self-poisoning in this age group needs to be addressed. A psychiatric assessment should be performed in all cases coming to the general hospital.

Adolescent↗

PubMed1995

Attempted suicide in Oxford University students, 1976-1990.

During the 14 years between the beginning of academic year 1976-7 and the end of academic year 1989-90, 216 Oxford University students (119 females and 97 males) were referred to the general hospital in Oxford because of suicide attempts (254 in all). The rate of attempted suicide during university term-time (106/100,000) was lower than in other young people of similar age in Oxford City (164/100,000). The difference was particularly marked in females (178/100,000 v. 269/100,000). The lower rate in the students may in part reflect their generally higher socio-economic status. Very few of the attempts by the students appeared to be failed suicides. The most frequent problems faced by the students at the time of their attempts were interpersonal, especially difficulties regarding partners, followed by academic problems. The latter were usually problems with ongoing course work rather than with the Finals examinations. Approximately a quarter of the students had psychiatric problems, with personality disorders and depression being most common. At least 30% had a history of previous attempts. Suggestions are made concerning measures for improving the management and prevention of attempted suicide by students.

Adolescent↗

PubMed1995

Suicide in Oxford University students, 1976-1990.

BACKGROUND: The aim was to determine the extent, characteristics and timing of suicide in Oxford University students. METHOD: Students who died from suicide or undetermined cause between October 1976 and September 1990 were identified through University records and individual colleges. Information about each student was sought from coroners, college staff, general practitioners and hospital case notes. RESULTS: There were 21 suicides (16 men and 5 women) and one open verdict (female). The observed number of suicides (O) was greater than the number expected (E = 11.09) on the basis of mortality statistics for England and Wales (O/E = 1.89; 95% CI 1.17 to 2.90). When deaths due to undetermined cause were included, however, the difference between O and E (17.03) was much reduced (O/E = 1.29; 95% CI 0.81 to 1.95). There was no evidence of an association with the Finals examination but two-thirds of the students had been worried about academic achievement or their courses. Nearly half appeared to have had a psychiatric disorder (mostly depression). CONCLUSIONS: The much publicised apparent excess of Oxford University student suicides may be partly artefactual. Measures for preventing student suicides include careful induction upon arrival at university, means of alleviating academic stress and worries, and readily available and closely associated student counselling and psychiatric services.

Cause of Death↗

PubMed1995

Media influence on parasuicide. A study of the effects of a television drama portrayal of paracetamol self-poisoning.

BACKGROUND: Paracetamol self-poisoning, which carries a significant risk of fatal liver damage, is increasing in the UK, especially among adolescents. There is concern that media portrayal of suicidal behaviour may influence its occurrence. We have investigated the effects of two broadcasts of a television drama showing a teenage girl's overdose of paracetamol. METHOD: Data from the Oxford Monitoring System for Attempted Suicide were used to examine changes in the number of overdoses and the use of paracetamol in the three week period before and after both broadcasts. An analysis of log-linear models was carried out, using additional data from two previous years, in order to control for the effects of gender, age group, time period, season, year and drug. A questionnaire was used to ascertain whether the programme had influenced patients' decisions to take an overdose or their choice of drug. RESULTS: An increase in paracetamol overdoses occurred following the first broadcast, but when data from the two previous years were examined and the log-linear analysis was used there was no evidence of significant effects attributable to the broadcasts. The questionnaire study revealed that very few people had seen either episode, and only two claimed that it had influenced them (one in terms of getting help). CONCLUSIONS: It is important to use sound methodology to avoid interpreting chance fluctuations as a media effect. The potential positive benefits of such programmes should also be investigated.

Acetaminophen↗

PubMed1994

Attempted suicide in Oxford and Utrecht.

BACKGROUND: Attempted suicide rates are much higher in the UK than in the Netherlands. We have compared the characteristics of suicide attempters referred to general hospitals in Oxford and Utrecht. METHOD: We compared the characteristics of referrals for attempted suicide to a general hospital in Oxford and one in Utrecht, for the years 1988 and 1989. RESULTS: Most of the attempters in Oxford were young whereas attempters in Utrecht were older; this age difference was particularly marked in females. Utrecht attempters appeared more often to have socio-economic problems and to suffer from psychiatric and personality disorders (except substance abuse), even when account was taken of the age differences of the two populations. CONCLUSIONS: There is some evidence for different thresholds for attempted suicide in the UK and the Netherlands, although other social explanations for the difference in attempted suicide rates are feasible and require further study.

Adolescent↗

PubMed1994

Seasonal and weather factors in parasuicide.

BACKGROUND: Seasonal variation in suicide and parasuicide has previously been reported. Few investigations have examined whether meteorological factors could influence suicidal behaviour, and the inconclusive results produced may be due to a variety of methodological problems. The present study overcomes some previous difficulties and tested whether parasuicide admission rate is related to weather variables. METHOD: Over 12,000 admissions for parasuicide were analysed by month, season, and in relation to meteorological data, which were measured close to the admitting hospital. RESULTS: Marked seasonal (P < 0.001) and monthly (P < 0.001) variations in mean daily parasuicide numbers were seen in women but not men. Small but highly significant correlations were demonstrated between parasuicide rate and weather parameters (P < 0.01), which were more marked in women (P < 0.01). These effects were additional to the monthly variation (P < 0.05). CONCLUSIONS: Weather has a small influence on parasuicide. Gender differences in body temperature regulation might account for the sex difference seen.

Cross-Sectional Studies↗