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Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited.
Aims
We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm.
Method
A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t-test, with psychiatric records data. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition.
Results
Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94−9.94, P = 0.00). Three themes emerged when exploring participants’ CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm.
Conclusions
CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.
To describe public health nurses’ (PHN) experiences of referring to, and families’ experiences of being referred to, a multicomponent, community-based, childhood weight management programme and to provide insight into families’ motivation to participate in and complete treatment.
Design
Qualitative study using semi-structured interviews and the draw-and-write technique.
Setting
Two geographical regions in the south and west of Ireland.
Participants
Nine PHN involved in the referral process, as well as ten parents and nine children who were referred to and completed the programme, participated in the present study.
Results
PHN were afraid of misclassifying children as obese and of approaching the subject of excess weight with parents. Peer support from other PHN as well as training in how best to talk about weight with parents were potential strategies suggested to alleviate these fears. Parents recalled the anxiety provoked by the ‘medical terminology’ used during referral and their difficulty interpreting what it meant for the health of their child. Despite initial fears, concern for their children’s future health was a major driver behind their participation. Children’s enjoyment, the social support experienced by parents as well as staff enthusiasm were key to programme completion.
Conclusions
The present study identifies the difficulties of referring families to community weight management programmes and provides practical suggestions on how to support practitioners in making referrals. It also identifies key positive factors influencing parents’ decisions to enrol in community weight management programmes. These should be maximised by staff and policy makers when developing similar programmes.
To estimate the extent of under- and over-reporting, to examine associations with misreporting and sociodemographic and lifestyle characteristics and mental health status and to identify differential reporting in micro- and macronutrient intake and quality of diet.
Design
A health and lifestyle questionnaire and a semi-quantitative FFQ were completed as part of the 2007 Survey of Lifestyle, Attitudes and Nutrition. Energy intake (EI) and intake of micro- and macronutrients were determined by applying locally adapted conversion software. A dietary score was constructed to identify healthier diets. Accuracy of reported EI was estimated using the Goldberg method. ANOVA, χ2 tests and logistic regression were used to examine associations.
Setting
Residential households in Ireland.
Subjects
A nationally representative sample of 7521 adults aged 18 years or older.
Results
Overall, 33·2 % of participants were under-reporters while 11·9 % were over-reporters. After adjustment, there was an increased odds of under-reporting among obese men (OR = 2·01, 95 % CI 1·46, 2·77) and women (OR = 1·68, 95 % CI 1·23, 2·30) compared to participants with a healthy BMI. Older age, low socio-economic status and overweight/obesity reduced the odds of over-reporting. Among under-reporters, the percentage of EI from fat was lower and overall diet was healthier compared to accurate and over-reporters. The reported usage of salt, fried food consumption and snacking varied significantly by levels of misreporting.
Conclusions
Patterns in differential reporting were evident across sociodemographic, lifestyle and mental health factors and diet quality. Consideration should be given to how misreporting affects nutrient analysis to ensure sound nutritional policy.
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