Reasons and patterns of self-harm patients.

IntroductionSelf-harm represents a complex and multifaceted public health issue of global significance, exerting profound effects on individuals and communities alike. It involves intentional self-poisoning or self-injury with or without the motivation to die. Although self-harm is highly prevalent, limited research has focused on the patterns and trends of self-harm among hospital populations in low- and middle-income countries, particularly within Africa. This study aims to explore the socio-demographic and clinical profile of patients presenting with self-harm and determine the common self-harm patterns at a tertiary facility in Kenya.MethodologyWe carried out a descriptive retrospective study and included patients from inpatient units and outpatient settings within the Secion of Psychiatry at the Aga Khan University Hospital, Nairobi from January 1st 2018 to December 31st 2022. A data abstraction tool was used to collect data from eligible files sourced from the medical records department for all patients who met the study criteria. Summary statistics were reported as frequencies and percentages for categorical data and as means and standard deviations for continuous data.ResultsA total of 507 files were reviewed in the given timeframe and 497 patients were included in the analysis. Of these patients, 28.1% (n = 144) presented with self-harm. The mean age of the self-harm patients was 26.5 years (SD = 10.5) and a majority (74.3%) were female. The first point-of-contact was at the emergency department in 72.9% of the cases. A majority of them, i.e. 89.6%, reported a past psychiatric diagnosis. Based on the psychiatric diagnosis evaluation of the patients- depression was the most common diagnosis at 88.2%, followed by anxiety disorder at 27.8% and bipolar mood disorder at 17.4%. The majority of reported self-harm cases involved overdose incidents (68.8%), with self-injury accounting for 56.3% of cases. Analgesics were the most frequently reported type of overdose, followed by tricyclic antidepressants. In context of self-injury, cutting emerged as the predominant form of self-harm. Family conflict was reported to be the most common reason for self-harm at 39.6%.ConclusionThis study shows a high rate of self-harm among patients with mental illness in this facility, necessitating the development of self-harm prevention and management protocols. A national registry of self-harm behavior would also help further elucidate the occurrence and mechanisms of self-harm in the population, improving the possibility for early interventions and prevention.引言 自我伤害（self-harm）是一类兼具复杂性与多面性的全球性公共卫生问题，对个体与社会群体均造成深远影响。其涵盖有意自我中毒或自我伤害行为，无论是否伴随自杀意图。尽管自我伤害患病率颇高，但针对低收入和中等收入国家（尤其是非洲地区）住院人群的自我伤害模式与趋势的研究仍较为匮乏。本研究旨在探讨肯尼亚某三级医疗机构内自我伤害患者的社会人口学特征与临床特点，并明确其常见自我伤害行为模式。 研究方法 本研究为描述性回顾性研究，研究对象为2018年1月1日至2022年12月31日期间，内罗毕阿迦汗大学医院精神科住院及门诊的符合纳入标准的患者。研究人员通过数据提取工具，从医院病案室调取符合研究纳入标准的患者病历以收集相关数据。分类数据以频数与百分比进行汇总统计，连续数据以均值与标准差进行汇总统计。 研究结果 本研究共回顾了该时间段内的507份病历，最终纳入497例患者进行分析，其中28.1%（n=144）为因自我伤害就诊的患者。自我伤害患者的平均年龄为26.5岁（标准差=10.5），其中多数（74.3%）为女性。72.9%的患者首诊科室为急诊科。89.6%的患者既往存在精神疾病诊断史。经精神疾病诊断评估显示，抑郁症为最常见诊断，占比88.2%；其次为焦虑障碍（anxiety disorder），占比27.8%，双相情感障碍（bipolar mood disorder）占比17.4%。多数自我伤害病例表现为药物过量行为（68.8%），另有56.3%的病例存在自我伤害行为。镇痛剂（analgesics）为最常见的过量服用药物类型，其次为三环类抗抑郁药。在自我伤害行为中，割伤为最主要的表现形式。家庭冲突为最常见的自我伤害诱因，占比39.6%。 结论 本研究显示，该医疗机构精神疾病患者中自我伤害发生率较高，亟需制定针对性的自我伤害预防与管理方案。此外，建立全国性自我伤害行为登记系统，有助于进一步阐明人群中自我伤害的发生情况与致病机制，从而提升早期干预与预防的可行性。