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Evidence shows that young people may have experienced increased levels of posttraumatic stress and depression during the COVID-19 pandemic. However, the landscape on self-harm is still unclear. This study aimed to examine the role of COVID-19 related posttraumatic stress, depression and resilience as predictors of self-harm with and without suicidal intent. Participants were 625 young people aged 17–25 years old (M = 20.2 years, SD = 2.47). Resilience was measured using the self-reported Child & Youth Resilience Scale Measure – Revised (CYRM-R). Posttraumatic stress related to COVID-19 were measured using the Impact of Event Scale- Revised. Depression was measured using the depression subscale of the Depression, Anxiety and Stress Scale–21. Self-harm was evaluated with two dichotomous items. Participants reported high levels of depression and COVID-19 posttraumatic stress, and a significant percentage reported engaging in self-harm. Hierarchical logistic regressions showed that caregiver resilience decreased approximately 20% the odds of engaging in self harm with and without suicidal intent remaining a consistent predictor even after accounting posttraumatic stress and depression in the models. Posttraumatic stress and depression predicted a one-fold increase in the odds of engaging in self-harm with and without suicidal intent. However, posttraumatic stress was no longer a significant predictor when depression was entered in the model in self-harm without suicidal intent. The COVID-19 pandemic may have increased the likelihood of engaging in self-harm in young people. However, caregiver resilience seems to operate as a protective factor. This important finding carries implications beyond the context of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: PROs are valuable tools in clinical care to capture patients' perspectives of their health, symptoms and quality of life. However the COVID-19 pandemic has had profound impacts on all aspects of life, in particular healthcare and research. This study explores the views of UK and Irish health professionals, third sector and pharmaceutical industry representatives and academic researchers on the impact of COVID-19 on PRO collection, use and development in clinical practice. Methods: A volunteer sample took part in a 10 question cross sectional qualitative survey, on the impact of COVID-19, administered online via Qualtrics. Demographic data was descriptively analysed, and the qualitative free text response data was subject to thematic analysis and summarised within the Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Results: Forty nine participants took part located in a range of UK settings and professions. Participants highlighted staff strengths during the pandemic including colleagues' flexibility and ability to work collaboratively and the adoption of novel communication tools. Weaknesses were a lack of staff capacity to continue or start PRO projects and insufficient digital infrastructure to continue studies online. Opportunities included the added interest in PROs as useful outcomes, the value of electronic PROs for staff and patients particularly in relation to integration into systems and the electronic patient records. However, these opportunities came with an understanding that digital exclusion may be an issue for patient groups. Threats identified included that the majority of PRO research was stopped or delayed and funding streams were cut. Conclusions: Although most PRO research was on hold during the pandemic, the consensus from participants was that PROs as meaningful outcomes were valued more than ever. From the opportunities afforded by the pandemic the development of electronic PROs and their integration into electronic patient record systems and clinical practice could be a lasting legacy from the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Higher levels of physical activity (PA) and screen time (ST) are associated with positive and negative mental health outcomes among adolescents, respectively. Research is needed to determine the interrelationship between ST and PA with depressive symptoms and the influence of ST modes. This study examines the associations between ST and PA level with depressive symptoms among 1756 adolescents (15.2 ± 1.6y; 995 female) in Ireland. Participants completed the Quick Inventory of Depressive Symptomatology and self-reported weekly ST (TV, computer, and phone use) and PA level (low, moderate, and high). Linear regressions examined associations between ST mode, PA level and relevant covariates with depressive symptoms in the full sample by gender, and in a sample stratified by PA level. Chi-square tests and one-way ANOVA examined gender differences in hours of ST, PA levels, and depressive symptoms. Differential associations were observed depending on the gender and ST mode. Higher levels of computer (β = 0.106, p ≤ 0.000) and phone use (β = 0.138, p ≤ 0.000) showed the strongest associations with depressive symptoms. PA level was inversely associated with depressive symptoms (β = – 0.175, p ≤ 0.000). When the sample was stratified by PA level, only associations between phone use and depressive symptoms were moderated by PA level for males and females. These findings highlight the complex interrelationships between ST, PA, and depressive symptoms, and that associations may vary based on gender and ST mode. This may have implications for future interventions. Increasing PA and reducing ST should be targeted concurrently with consideration given to different media and genders. Future research should explore longitudinal and prospective associations. [ABSTRACT FROM AUTHOR]

Purpose: To assess relationships between the Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet (MD), Dietary Inflammatory Index (DII®) and Energy-adjusted DII (E-DII™) scores and pro-inflammatory cytokines, adipocytokines, acute-phase response proteins, coagulation factors and white blood cells. Methods: This was a cross-sectional study of 1862 men and women aged 46–73 years, randomly selected from a large primary care centre in Ireland. DASH, MD, DII and E-DII scores were derived from validated food frequency questionnaires. Correlation and multivariate-adjusted linear regression analyses with correction for multiple testing were performed to examine dietary score relationships with biomarker concentrations. Results: In fully adjusted models, higher diet quality or a less pro-inflammatory diet was associated with lower concentrations of c-reactive protein, neutrophils (all dietary scores), complement component 3 [C3], interleukin 6 [IL-6], tumour necrosis factor-alpha [TNF-α], white blood cell count [WBC], the neutrophil-to-lymphocyte ratio [NLR] (DASH, DII and E-DII), monocytes (DASH and DII) and resistin (DII and E-DII). After accounting for multiple testing, relationships with C3 (DASH: β = − 2.079, p =.011 and DII: β = 2.521, p =.036), IL-6 (DASH: β = − 0.063, p =.011), TNF-α (DASH: β = − 0.027, p =.034), WBC (DASH: β = − 0.028, p =.001 and DII: β = 0.029, p =.02), neutrophils (DASH: β = − 0.041, p =.001; DII: β = 0.043, p =.007; E-DII: β = 0.029, p =.009) and the NLR (DASH: β = − 0.035, p =.011) persisted. Conclusions: Better diet quality, determined by the DASH score, may be more closely associated with inflammatory biomarkers related to health in middle- to older-aged adults than the MD, DII and E-DII scores. [ABSTRACT FROM AUTHOR]

Community Mental Health Teams (CMHTs) are increasingly being considered effective models of recovery focused care, however their effectiveness and factors that may affect it have not fully evaluated. Cross-sectional study in Ireland included 106 members from 8 CMHTs. We examined CMHT's effectiveness and the effects of authentic leadership, team cohesion, team members' experience and team tenure on effectiveness, by administering the Team Effectiveness Scale, Authentic Leadership Questionnaire, and Organizational Cohesion Scale. Data on demographics, discipline, years of experience, tenure in the same team, full or partial membership, and number of team members were collected. Results from multilevel regression analysis indicated significant association (p < 0.05) between effectiveness of CMHTs and factors including team cohesion, authentic leadership, size of the team and full membership. Therefore, to increase CMHTs effectiveness, interventions are needed to those areas: a switch to make leadership styles more authentic, to improve team cohesion, smaller team size and full membership. [ABSTRACT FROM AUTHOR]

Autism evidence-based practices (EBPs) are those with demonstrated improved outcomes for students with autism across a range of skill areas, yet issues persist in adopting these in classroom settings- particularly in general education (GE) settings. This research aimed to identify teacher training, years of experience, access to allied professionals and knowledge and use of autism EBPs in GE settings in Ireland. 369 mainstream primary school teachers reported their characteristics and their knowledge and use of EBPs. Results indicated that the majority of teachers received little initial teacher education training in autism, almost no continuous professional development (CPD) before educating a child with autism, and received little support from allied professionals. Knowledge and use of EBPs differed significantly across teacher characteristics, with findings discussed in relation to teacher training. [ABSTRACT FROM AUTHOR]

Depression and anxiety are highly comorbid constructs. However little is known about the mechanisms that underpin this comorbidity/connectivity or the divergence between constructs that seems to occur in adolescence. The current study targeted emotion regulation (ER) as a potential plausible mechanism for explaining how anxiety and depression symptoms in adolescence might begin to connect, perpetuate, and ultimately diverge from one another. Using data from a cross-sectional school-based study, of adolescent females (age 11–18 years; N = 615; majority were white (97.7%)), we modelled variation in ER using latent profile analysis. Then, using network analysis (NA), we generated separate depression-anxiety symptom networks for adolescents at varying levels of ER. Three latent classes of ER were identified (low ER 15%, intermediate ER 34%, high ER 51%). The results of the network comparison test found no significant differences in global strength between the 'low ER' and the 'intermediate ER' ability network. This study is among the first to attempt to model change in depression-anxiety symptom connectivity in adolescence in relation to a common contextual/risk factor. The current study therefore offers a unique contribution to the examination of the role of transdiagnostic factors in the study of adolescent depression and anxiety from a network perspective, and provides a promising framework for the study of ER among anxiety and depression symptomatology in adolescence. [ABSTRACT FROM AUTHOR]

New mothers in Western societies report being influenced by ideologies which suggest mothering comes naturally to women and is joyful and fulfilling. However, research reveals motherhood-related negative thoughts are common even among non-depressed new mothers, and it has been suggested experiencing such thoughts may be related to guilt and shame. This study updates and extends Hall and Wittkowski's (2006) prevalence survey of motherhood-related negative thoughts by assessing new mothers' perceptions of the social acceptability of negative thoughts, and by exploring relationships with guilt, shame and psychological distress. A cross-sectional survey design was used. A self-selected sample of non-clinical new mothers (N = 395) from the United Kingdom and Ireland completed online questionnaires including measures of the frequency and social acceptability of motherhood-related negative thoughts, shame and guilt proneness, depression and motherhood experience. Hierarchical regression analyses were used to explore relationships between variables. The frequency of negative thoughts was much higher than reported by Hall and Wittkowski. After controlling for demographic variables and social support, frequency of negative thoughts significantly predicted shame and guilt, whereas social acceptability of negative thoughts significantly predicted guilt. Negative thoughts, shame, guilt and motherhood experience relative to expectations significantly predicted depression score. These results suggest that negative thoughts are more common in early motherhood than previously reported, are considered socially unacceptable, and are related to guilt, shame and depression scores. The findings increase our understanding of postnatal distress in non-clinical populations. Future research should explore information and/or interventions aimed at "normalising" negative thoughts in early motherhood. Highlights: Negative thoughts were more frequent in non-clinical new mothers than previously reported. New mothers found negative thoughts related to motherhood difficult to share with others. Frequency of negative thoughts in new mothers was related to guilt and shame. Frequency of negative thoughts, guilt and shame were related to depression score. Interventions for mothers that "normalise" negative thoughts should be considered. [ABSTRACT FROM AUTHOR]

Purpose: To examine the impact of new controlled drugs legislation introduced in May 2017 on benzodiazepine receptor agonist (BZRA) prescribing in Ireland. Methods: A repeated cross-sectional analysis was conducted using publically available monthly pharmacy claims data from the General Medical Services (GMS) database. The study population comprised all GMS-eligible individuals aged ≥ 16 years from January 2016 to September 2019. Monthly prevalence rates of individuals receiving BZRA prescriptions per 10,000 eligible population were calculated and trends examined over time. Segmented linear regression of prevalence rates was used to examine changes before and after introduction of the legislation stratified by gender and age groups. Regression coefficients (β) and 95% confidence intervals (CIs) for monthly change were calculated. Results: Pre-legislation (January 2016 to April 2017), there was a significant monthly decline in benzodiazepine prevalence rate (β = − 1.18; 95% CI − 1.84, − 0.51; p < 0.001) but no significant change in Z-drug prescribing. Post-legislation (May 2017 to September 2019), increases in prevalence rates were observed for benzodiazepines (β = 1.04; 95% CI 0.17, 1.92; p = 0.021) and Z-drugs (β = 1.04; 95% CI 0.26, 1.83; p = 0.010). Post-legislation trends showed increases in BZRA prevalence rates among the youngest subgroup (16–44 years), with variable changes in the middle-aged subgroup (45–64 years) and no changes in the oldest subgroup (≥ 65 years). Conclusions: This study indicates that introduction of new legislation had limited impact on BZRA prescribing on the main public health scheme in Ireland. Interventions targeting specific population subgroups may be required to achieve sustained reductions in prescribing. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: All pregnant women should be given advice on the benefits of pelvic floor muscle exercises (PFMEs) in preventing urinary incontinence (UI) and know how to exercise correctly. This study explored women's knowledge and practice of PFMEs, their sources of knowledge and prevalence of UI before and during pregnancy. Methods: We conducted a cross-sectional study with 567 women, 239 primiparous and 328 multiparous, recruited from one maternity hospital in Ireland. Logistic regression was used to examine associations. Results: Pre-pregnancy, 41% of women (n = 232) learnt to do PFMEs, 30% (n = 172) did exercises and 28% (n = 159) experienced UI. Women more likely to report UI were aged ≥ 35 years (p = 0.03), had a BMI ≥ 30 kg/m2 (p = 0.01) or did PFMEs but were unsure they were exercising correctly (p = 0.03). During pregnancy, 50% of women (n = 281) received PFME information during antenatal visits and 38.6% (n = 219) attended antenatal classes. Women less likely to do PFMEs daily or weekly had no formal educational qualification (p = 0.01), did not do PFMEs pre-pregnancy (p < 0.0001) or did not attend the physiotherapist-led PFME education session (p < 0.0001). In multivariable analysis, the two factors significantly associated with UI during pregnancy were being aged 30–34 years (p = 0.05) and reporting UI pre-pregnancy (p < 0.0001). Conclusions: This benchmarking exercise revealed considerable gaps in the totality of PFME education and services offered in the site hospital. We recommend that others do likewise to enable learning from those who have addressed service deficits. [ABSTRACT FROM AUTHOR]

Background/objectives: The reliability of an estimate of iodine intake is largely dependent on the quality of the food composition data. We aimed to assess the impact of variations in food composition data for iodine and season on the estimates of iodine intake in young children.Subjects/methods: Cross-sectional dietary intake study of Irish 2-year-olds participating in the Cork BASELINE Birth Cohort Study (n=468; 30% of the cohort at the 2-year follow-up) were used to assess the impact of variation in iodine food composition data on estimates of iodine intake, dietary adequacy and risk of exceeding the tolerable upper intake level (UL).Results: Mean (SD) iodine intakes calculated using UK (147 (71)) and Irish (177 (93)) food composition data were significantly different (P < 0.001) (mean difference (95% confidence interval) = 30 (26-33) µg/day) and largely adequate (7-14% below the estimated average requirement). Intakes at the 95th percentile were 138% and 173% of the UL using UK and Irish food composition data, respectively, of which milk accounted for 106% and 150% of the UL. This translated into 22% and 35% of toddlers exceeding the UL, using UK and Irish composition data, respectively. The mean (SD) daily intake of cow's milk among the 91% of consumers was 309 (208) ml. Intakes of cow's milk at the 75th and 95th percentiles were 452 and 706 ml, respectively. Using Irish composition data for iodine in cows' milk, a daily intake of 450 ml could result in a toddler exceeding the UL from milk alone.Conclusions: Variability in food composition has a large impact on assessments of iodine intake, particularly among young children for whom milk contributes a large proportion of their daily nutrient intake. Although this is unlikely to result in long-term adverse effects, our study highlights the need for development of valid biomarkers of individual iodine status. [ABSTRACT FROM AUTHOR]

Purpose: There are limited data on the contribution of fortified foods and nutritional supplements to intakes of vitamin D in young children. Our objective was to examine the intake, adequacy, risk of excessive intake and sources of dietary vitamin D. Methods: The nationally representative cross-sectional dietary survey of young children (aged 1-4 years) ( n 500) was used to evaluate vitamin D intake and quantify the contribution of the base diet, fortified foods and nutritional supplements to total intake. Results: Median (IQR) intakes of vitamin D were generally low in this young population, ranging from 2.0 (1.9) to 2.5 (4.9) µg/day. Ninety-three and 78 % of children had intakes below 10 and 5 µg/day, respectively. While vitamin D supplement users (17 %) had the highest intakes [6.7 (6.4) µg/day] ( P < 0.001), 74 % had intakes below 10 µg/day. Vitamin D-fortified foods, consumed by 77 % of children [2.2 (2.0) µg/day], made nutritionally significant contributions to intake [0.8 (1.6) µg/day], particularly in younger children [1.5 (4.6) µg/day]. Children who did not use nutritional supplements or fortified foods had significantly ( P < 0.001) lower intakes of vitamin D than the other groups [1.0 (0.8) µg/day]. Our analyses show the importance of milk and yoghurt, meat and fortified ready-to-eat cereals as sources of vitamin D in this age group. The use of nutritional supplements or fortified foods at current levels does not represent a risk of intakes exceeding the European Food Safety Authority (EFSA) tolerable upper intake level (UL) (50 µg/day), as intakes did not exceed or even approach the UL (P95: 22 % of UL). Conclusion: Intakes of vitamin D in preschool children in Ireland are generally low. Nutritional supplements and fortified foods make significant contributions to intakes of vitamin D, without risk of unacceptably high intakes. Though supplements are effective in raising intakes of vitamin D in users, uptake is low (17 %). Food fortification may represent a suitable public health approach to increasing vitamin D intakes. The national food consumption data of Irish preschool children provide the ideal starting point for modelling of fortification scenarios to identify which foods and levels of addition will ensure effective and safe increases in vitamin D intake. [ABSTRACT FROM AUTHOR]

Purpose: To examine the role of family conflict in the relationship between attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD).Methods: A cross-sectional national population survey was carried out among 10,838 14-16 year old students in all secondary schools in Iceland. Three latent measures, financial status, ADHD and CD, and one observed measure, family structure, were included in the study. A structural equation model was used to evaluate direct effects between ADHD and CD for four different groups; females and males, experiencing family conflict and those not experiencing family conflict.Results: ADHD was significantly and positively associated with CD for all groups. When controlling for financial status and family structure it was found that ADHD was positively and significantly associated with CD for adolescent females and males not experiencing family conflict as well as for those experiencing family conflict. The link between ADHD and CD was significantly stronger for those adolescents who had experienced family conflict compared to those who had not experienced family conflict. These results suggest that family conflict moderates the association between ADHD and CD for both girls and boys.Conclusions: The results of this study indicate that family environment and ADHD symptoms are important when predicting CD among adolescent youth. Most notably, family conflict exacerbates the effects of ADHD symptoms on CD among both females and males. [ABSTRACT FROM AUTHOR]

Objective:To (1) examine the opinions of medical staff working in spinal cord injury (SCI) centres (SCICs); (2) evaluate their knowledge, attitudes and practices towards obesity prevention and management; (3) report the number of beds and dietitians available at each SCIC.Methods:A 37-item questionnaire was sent to 23 SCICs in the UK, the Netherlands, Belgium and the Republic of Ireland between September 2012 and January 2013.Results:Eighteen SCICs returned the questionnaires for analysis. All respondents stated that they had an interest in obesity treatment but only 2.3% of the respondents received training in obesity management. Sixty-one percent of staff did not consider body mass index (BMI) to be appropriate for use in SCI patients and subsequently less than half of the respondents use BMI routinely. The majority of respondents reported that they are confident in dealing with overweight (74.5%) and obese (66.1%) SCI adults, less than half (44.1%) are confident in treating overweight and obese SCI children. Respondents also indicated the need for nationally adopted guidelines and a lack of physical activity provision. There were 17.5 whole-time equivalent (WTE) dietitians recorded in 22 SCICs, equivalent to 47.8 beds per WTE dietitians (range 10-420). Non-UK SCIC dietitians are significantly better resourced than in UK SCICs (beds per WTE dietitian: 36 vs 124, P=0.035).Conclusion:Medical staff expressed the need to participate in obesity prevention and management. Appropriate training should be considered for all medical staff and the development of specific weight management guidelines and dietetic provision should be considered. [ABSTRACT FROM AUTHOR]

The ethnic profile in Ireland has changed in recent years with an increase in the number of immigrant families. No previous studies have examined mental health issues in immigrant children in Ireland. This study aimed to examine the rates of psychological disturbance in a sample of second-generation immigrant children and to compare them with a group of Irish children living in the same geographic area. Primary school-aged children were recruited from a randomly selected school in Dublin, the capital city, and examined using Child Behavior Checklist 1.5-5 (CBCL). In addition to CBCL, parents also filled in a family background questionnaire. The CBCL revealed that immigrant girls had a significant higher mean score of internalising score (14.56; SD = 3.03) than Irish boys (8.38, SD = 6.5). Immigrant girls also had a higher mean score (4.8; SD = 2.4) on withdrawn scale in comparison to Irish girls (2; SD = 1.7) and Irish boys (2; SD = 1.83). Borderline clinically significant means were detected for the Pervasive developmental problem on the CBCL-DSM orientated subscale in immigrant children. Despite the detected borderline clinically significant means for the Pervasive developmental problem in immigrant children and the higher scores of immigrant girls on internalising and withdrawn scales, larger studies are still needed to replicate the results. [ABSTRACT FROM AUTHOR]

This study examines ethnic and gender differences in exposure to discrimination and its association with depressive symptoms among five immigrant groups. Data were derived from a cross-sectional survey of 900 adult immigrants (50.8 % men, 49.2 % women) sampled from five ethnic immigrant communities in Toronto between April and September 2001. Men reported higher levels of discrimination than women. Ethiopians had the highest perception of discrimination followed by Korean, Iranian, Vietnamese, and Irish immigrants. With regard to discrimination-related depressive symptoms, Iranian and Korean men showed a greater risk than their Irish counterparts. Among women, Vietnamese and Irish seemed to be more vulnerable to discrimination than other ethnic groups. Despite experiencing the highest level of discrimination, Ethiopian men and women showed no association between discrimination and depressive symptoms. The exposure and psychological response to discrimination vary significantly across ethnicities and gender. [ABSTRACT FROM AUTHOR]

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Aim: Being physically active has many proven health benefits and promoting physical activity to patients in primary care is an important component of public health programmes. This study examined the knowledge and practices of general practitioners and physiotherapists in the promotion of physical activity in primary care. Subject and methods: A cross-sectional population survey was conducted in Ireland to establish participants' knowledge of physical activity guidelines and current practice in the promotion of physical activity. A total of 342 general practitioners (response rate 65 %; n = 543) and 89 physiotherapists (response rate 88 %; n = 101) responded to the survey. Results: More physiotherapists (50.5 %; n = 45) than general practitioners (28 %; n = 97) correctly reported the minimal physical activity guidelines ( X² = 16.56, p < .005, df = 1). General practitioners reported screening physical activity opportunistically (41 %; n = 139) and when related to a patient's presenting complaint (37 %; n = 126). Physiotherapists reported screening physical activity routinely (34 %; n = 30) and when related to the presenting complaint (28 %; n = 25). With the exception of overweight patients, general practitioners were more likely than physiotherapists to promote physical activity to patients with known cardiovascular risk factors such as hypertension ( X² = 49.65, p < .001, df = 2) and hypercholesterolemia ( X² = 32.58, p < .001, df = 2). Physiotherapists, however, were more likely to promote physical activity to healthy populations ( X² = 9.91; p < .01, df = 2). Education and advice was the intervention most frequently used (general practitioners 76 %; n = 258, physiotherapists 97 %; n = 86). Conclusion: Despite high levels of awareness of physical activity promotion amongst general practitioners and physiotherapists, there is scope to improve physical activity promotion particularly to healthy populations and ongoing challenges to incorporate evidence based interventions into routine care. [ABSTRACT FROM AUTHOR]

Purpose: We sought to estimate the prevalence of potentially inappropriate prescribing (PIP) in the Northern Ireland (NI) population aged ≥70 years, to investigate factors associated with PIP and to calculate total gross cost of PIP. Methods: A retrospective cross-sectional population study was carried out in those aged ≥70 years in 2009/2010 who were in primary care in NI. Data were extracted from the Enhanced Prescribing Database, which provides details of prescribed and dispensed medications for each individual registered with a general practitioner. Twenty-eight PIP indicators from the Screening Tool of Older Persons potentially inappropriate Prescriptions (STOPP) criteria were applied to these data. PIP prevalence according to individual STOPP criteria and the overall prevalence of PIP were estimated. The relationship between PIP and polypharmacy, age and gender was examined using logistic regression. Gross cost of PIP was ascertained. Results: The overall prevalence of PIP in the study population ( n = 166,108) was 34 %. The most common examples of PIP identified were proton pump inhibitors at maximum therapeutic dose for >8 weeks (17,931 patients, 11 %), non-steroidal anti-inflammatory drugs >3 months (14,545 patients, 9 %) and long-term long-acting benzodiazepines (10,147 patients, 6 %). PIP was strongly associated with polypharmacy, with those receiving seven different medications being fivefold more likely to be exposed to PIP than those on zero to three medications (odds ratio 5.04, 95 % confidence interval 4.84-5.25) The gross cost of PIP was estimated to be €6,098,419 Conclusions: Consistent with other research, the prevalence of PIP was high among the study cohort, increased with polypharmacy and was associated with significant cost. [ABSTRACT FROM AUTHOR]

There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from single-episode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated. [ABSTRACT FROM AUTHOR]