به زمان بندی اعمال خوداسیبی عمدی : آیا هر گونه ارتباطی با قصد خودکشی، اختلال روانی یا مدیریت روانپزشکی وجود دارد؟

Objective: To investigate the common perception that more serious suicide attempts tend to occur earlier in the day. Methods: Prospective study of 158 adults referred for psychiatric assessment from the general hospital following an episode of deliberate self-harm. The main outcome measures used were Beck's Suicide Intent score, ICD-10 psychiatric diagnosis, alcohol consumption at the time of the attempt, and follow-up decision recorded by the interviewing duty psychiatrist. The patient also completed a checklist of current precipitating problems. Results: A marked circadian variation in timing of the act was found, peaking between 2200 and 2400 h. “Early” acts (0300–1459 h) were significantly less likely to involve alcohol consumption, more likely to lead to admission to a medical ward, and involved more patient-identified problems than “late” acts. People who took overdoses early in the day were more likely to have concerns about their own mental health. Compared to earlier acts of self-harm, late evening (2200–2359 h) cases were less likely to be diagnosed as depressed or offered psychiatric follow up. No relation was found between time of day of self-harm and Beck's Suicide Intent score. Conclusions: Implications arise regarding clinical risk assessment and current staffing levels in the accident and emergency department. The interviewing psychiatrist could concentrate on excluding depression and teaching problem solving to those who self-harm in the morning or afternoon, and on the detection and treatment of alcohol dependence for late evening cases.

There is a circadian pattern to the frequency of deliberate self-harm and suicide. For self-harm, the highest rate is between 1600 and 0200 h [1], [2] and [3]. The evening peak may be less evident in those aged over 40 years [4]. Those choosing violent methods tend to harm themselves earlier in the day [5]. No overall sex difference has been reported, although women may be more likely to present during normal working hours [6]. In a 10-year retrospective analysis of Italian mortality statistics, Williams and Tansella [7] found a clear diurnal pattern amongst 25 987 successful suicides, death occurring most commonly between 0600 and 1600 h. Two studies have examined the association between diagnosis and the timing of the act in self-harm populations. Caracciolo et al. [5] found a trend, which was not statistically significant, towards a late morning peak in self-harm for those given a diagnosis of depression. However, Buckley et al. [2] found no clear pattern for this subgroup. The significance of the timing of deliberate self-harm episodes is seldom mentioned in psychiatric textbooks, and is absent from most rating scales estimating suicidal risk or repetition [8] and [9]. Nevertheless, a popular conception exists amongst mental health professionals that more serious suicide attempts occur earlier in the day. Conversely, evening episodes, especially when associated with alcohol use, are often regarded as being of low suicide intent, and less likely to be associated with depressive disorders. Because these beliefs have been under-researched, we undertook this study to investigate the hypotheses that deliberate self-harm occurring earlier in the day (between 0300 and 1459 h), when compared with episodes occurring later in the day, is associated with: higher suicidal intent; higher rates of coexisting mental disorders, such as depression; lower rates of alcohol use around the time of deliberate self-harm; and, lower rates of a past history of deliberate self-harm. We also wanted to determine whether psychiatric management decisions were related to the time at which an act of self-harm had taken place.