Dr Keren Skegg. SPINZ Symposium, Dunedin, November 28 2006. http://www.spinz.org.nz

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

2. 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?

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

4. 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

5. 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%)

6. 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%)

9. 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
Men Women
Odds ratio (95% CI) Odds ratio (95% CI)
Internalizing disorder a only 1.8 (0.8 - 4.1) 2.9 (1.3 - 6.4)**
Internalizing disorder with suicidal/self-harmful thoughts 15.6 (5.3 - 45.6)** 11.8 (4.6 - 30.5)**
Externalizing disorder b only 1.2 (0.6 - 2.6) 2.0 (0.4 - 9.8)
Externalizing disorder with suicidal/self-harmful thoughts 11.3 (2.4 - 53.5)** 38.7 (8.6 - 173.7)**
Internalizing and Externalizing disorder only 2.9 (1.2 - 7.0)* 3.0 (0.9 - 9.9)
Internalizing and Externalizing disorder with suicidal/self-harmful
thoughts 5.0 (2.1 - 12.1) 23.2 (6.2 - 86.9)**
Suicidal/self-harm thoughts only (no internalizing disorder, externalizing
disorder, or other Axis I disorder ascertained) 4.9 (1.3 - 17.9)* ----
*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.

10. 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

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

12. 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