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Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4351 (Published 18 October 2017) Cite this as: BMJ 2017;359:j4351

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Re: Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

As a police doctor I see many cases where patients have a history of self harm. It is a frequent finding in cases of substance misuse and in detainees with mental health issues as listed in the article. A history of deliberate self harm is a very frequent observation in those threatening suicide.

The authors gave clear observations but did not seek to address the causes whilst I read with interest the theory of progesterone induced depression as a possible cause.

I wonder if the answer may not have been identified in the "Rat Park" experiments. Briefly and, therefore not with total accuracy, the concept of Opiate addiction being a purely chemical driven phenomena was derived when it was observed how a rat in a cage would, when offered two sources of water, (one pure and the other laced with opiates), rapidly become addicted to the opiate water. This theory of addiction was later challenged when rats were placed in "Rat Park", an environment that was filled with tunnels, wheels, toys , wood chips and space. The rat colony was happy and, when offered the two sources of water, tended to ignore the opiate water source. Removal of the friendly environment and reduction of the available space resulted in the rats becoming stressed and they started drinking the opiate.

Although this experiment looked at the effect of environment upon drug use, (and therefore environment as a contributing factor to dependency), I find the stressed behavior of the rats to be equally educational.

I would ask the researchers therefore if they were able to look at the incidence of deliberate self harm in relation to environment? Was the incidence of DSH more prevalent in industrial areas, was it less prevalent in smaller rural schools? Was there any correlation between family problems and involvement of Social Services in those that self harmed? And, lastly, was there any difference in the rate of DSH and socio-economic grouping?

Steven R. Hopkins
(GMC # 3133543)

Competing interests: No competing interests

21 October 2017
Steven Hopkins
Police Doctor
Sutton Coldfield