The suicide rate in Scotland is twice as high as that in England. However, the prevalence of self-harm is unknown.

To determine the prevalence of self-harm in adolescents in Scotland and the factors associated with it.

A total of 2008 pupils aged 15–16 years completed an anonymous lifestyle and coping survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, social influences, psychological variables and self-harm.

Self-harm was reported by 13.8% of the respondents. The majority (71%) of those who had self-harmed had done so in the past 12 months and girls were approximately 3.4 times more likely to report self-harm than boys. In multivariate analyses, smoking, bullying, worries about sexual orientation, self-harm by family and anxiety were associated with self-harm in both genders. In addition, drug use, physical abuse, serious boy/girlfriend problems, self-harm by friends and low levels of optimism were also associated with self-harm in girls.

Despite markedly different national suicide rates, the prevalence of self-harm in Scotland is similar to that in England with girls at least three times more likely to report self-harm than boys. The findings suggest a role for emotional literacy programmes in schools and highlight the importance of promoting positive mental health among adolescents.

Little is known about self-harm in the armed forces.

To investigate the characteristics of armed forces personnel presenting to a general hospital following self-harm and compare these with matched controls who had self-harmed.

Investigation of armed forces personnel presenting to hospital between 1989 and 2003 following self-harm and case–control comparison with people in the general population who had self-harmed.

One hundred and sixty-six armed forces personnel presented with self-harm during the study period, of whom 72.3% (120) were male. Nearly two-thirds (62.7%) were aged under 25 years. Relationship problems (62.0%), employment problems (43.9%) and alcohol misuse (40.5%) were common. Fewer armed forces personnel than controls had evidence of current or past psychiatric disorders or treatment or a prior history of self-harm, and their suicidal intent was lower (males only). Of 64 people in the armed forces who presented during the first 9 years of the study period, 1 had died (from natural causes) by the end of 2000, compared with 9 (5.1%) of the controls, 6 by probable suicide.

Self-harm by armed forces personnel may often be a response to interpersonal and employment problems complicated by alcohol misuse, with relatively low suicide intent.

The repetition of acute poisoning occurs frequently. The intention may change between episodes and many poisonings are treated outside the hospital setting. Few studies have taken this into account.

To quantify the repetition frequency regardless of the level of health care or the intention behind the poisoning, and to identify possible risk factors for repetition.

A prospective multicentre study of all acute poisonings in Oslo treated in hospital, at an out-patient clinic or by the ambulance service. Repetition was estimated using Kaplan– Meier calculations, and predictive factors were identified using Cox regression analysis.

The estimated 1-year repetition rate was 30% (95% CI 24–35). Independent predictors of repetition were middle age (30–49 years), poisoning with opiates or sedatives, unemployment or living on social welfare, a previous suicide attempt, and a history of psychiatric treatment. Intention was not a significant predictor.

Repetition of acute poisoning is high, irrespective of the level of healthcare and the intention behind the poisoning.

Acute psychiatric wards have been the focus of widespread dissatisfaction. Residential alternatives have attracted much interest, but little research, over the past 50 years.

Our aims were to identify all in-patient and residential alternatives to standard acute psychiatric wards in England, to develop a typology of such services and to describe their distribution and clinical populations.

National cross-sectional survey of alternatives to standard acute in-patient care.

We found 131 services intended as alternatives. Most were hospital-based and situated in deprived areas, and about half were established after 2000. Several clusters with distinctive characteristics were identified, ranging from general acute wards applying innovative therapeutic models, through clinical crisis houses that are highly integrated with local health systems, to more radical voluntary sector alternatives. Most people using the alternatives had a previous history of admission, but only a few community-based services accepted compulsory admissions.

Alternatives to standard acute psychiatric wards represent an important, but previously undocumented and unevaluated, sector of the mental health economy. Further evidence is needed to assess whether they can improve the quality of acute in-patient care.

Child and adolescent mental health disorders are present in around 10% of the population. Research indicates that many young people possess negative attitudes towards mental health difficulties among peers.

To assess the impact of a mental health teaching programme on adolescent pupils' understanding.

Two-group pre-test–post-test control group study in two English secondary schools. Experimental classes (School E) received a six-lesson teaching intervention on mental health; control classes (School C) did not. Participants were 14- and 15-year-old pupils. The intervention consisted of six lessons on mental health issues common to young people: stress; depression; suicide/self-harm; eating disorders; being bullied; and intellectual disability. School C was given access to these lesson plans and materials on completion of the study. Understanding was measured at two time points, Time 1 (T1) and Time 2 (T2), 8 months apart, by a Mental Health Questionnaire. Behavioural, emotional and relationship strengths and difficulties were measured by the self-rated Strengths and Difficulties Questionnaire (SDQ) with five subscales: hyperactivity, emotional symptoms, conduct problems, peer problems and prosocial behaviour.

At T2, pupils in School E compared with those in School C showed significantly more sensitivity and empathy towards people with mental health difficulties. They also used significantly fewer pejorative expressions to describe mental health difficulties. There was a significant reduction in SDQ scores on conduct problems and a significant increase on prosocial behaviour among School E pupils compared with controls. Pupils valued the intervention highly, in particular the lessons on suicide/self-harm.

Teaching 14- and 15-year-olds about mental health difficulties helps to reduce stigma by increasing knowledge and promoting positive attitudes. The intervention also reduced self-reported conduct problems and increased prosocial behaviour. Generally, participating pupils were positive about the importance of lessons on mental health, and said that they had learnt much about the lesson topics.

Symptoms of attention-deficit hyperactivity disorder (ADHD) are known to persist into adulthood in the majority of cases.

To determine the prevalence of methylphenidate, dexamfetamine and atomoxetine prescribing and treatment discontinuation in adolescents and young adults.

A descriptive cohort study using the UK General Practice Research Database included patients aged 15–21 years from 1999 to 2006 with a prescription for a study drug.

Prevalence of prescribing averaged across all ages increased 6.23-fold over the study period. Overall, prevalence decreased with age: in 2006, prevalence in males dropped 95% from 12.77 per 1000 in 15-year-olds to 0.64 per 1000 in 21-year-olds. A longitudinal analysis of a cohort of 44 patients aged 15 years in 1999 demonstrated that no patient received treatment after the age of 21 years.

The prevalence of prescribing by general practitioners to patients with ADHD drops significantly from age 15 to age 21 years. The fall in prescribing is greater than the reported age-related decrease in symptoms, raising the possibility that treatment is prematurely discontinued in some young adults in whom symptoms persist.

This study aimed to investigate the relationship between age at onset and time to first pharmacological treatment in patients with either bipolar I or II disorder. A total of 146 consecutive in-patients acutely admitted from the same catchment area were included. Patients were divided into four age groups: 0–12 years (23%); 13–18 years (32%); 19–29 years (26%); and 30 years (18%). Mean age at first affective episode was 20.2 years (s.d.=11.8). This represents a similar pattern to the age at onset seen in out-patients in the USA. Early age at onset predicted a longer time to first pharmacological treatment (ρ =0.695, P <0.01).

A reduction in suicide in England and Wales has been reported after the attacks of 11 September 2001 in the USA. It may be plausible therefore to expect a much greater impact on suicide in the UK in response to the events of 7 July 2005, caused by the first suicide terrorist attack by Islamic extremists on British soil.

To examine the effect of the 7 July 2005 terrorist attacks in London on suicide rates in England and Wales.

Analysis of number of suicide (ICD–10 codes X60–X84) and undetermined injury deaths (ICD–10 codes Y10–Y34) reported in England and Wales in the 12 weeks before and after 7 July 2005. We used Shewhart Control Charts based on Poisson rates to explore adjusted daily and weekly suicide rates and rate differences with respect to 7 July 2005.

A brief but significant reduction in daily suicide rate was observed a few days after the terrorist attack in London on 7 July 2005. Further reduction was also observed on the 21 July 2005, coinciding with the second wave of attacks. No similar reduction in suicide was seen during the same period in the previous 4 years. Poisson regression models with indicator variables for each day in July 2005 revealed a reduction of 40% of the expected daily rate for these 2 days only. We found no evidence of any longer-term effect on suicide.

The study findings are contrary to our expectation and only weakly support Durkheim's theory that periods of national threat lower the suicide rate through the impact on social cohesion. It is possible that previous experience of IRA terrorism in the UK may have limited the effect of the 7 July 2005 attacks on suicide in England and Wales. The shock value of suicide terrorism and its psychological potency appear to diminish over time as the tactic becomes overused.

Understanding trends in public attitudes towards people with mental illness informs the assessment of ongoing severity of stigma and evaluation of anti-stigma campaigns.

To analyse trends in public attitudes towards people with mental illness in England and Scotland using Department of Health Attitudes to Mental Illness Surveys, 1994–2003.

We analysed trends in attitudes for 2000 respondents in each survey year (6000 respondents in 1996 and 1997) using quota sampling methods and the adapted Community Attitudes Toward the Mentally Ill scale.

Comparing 2000 and 2003, there was significant deterioration for 17/25 items in England and for 4/25 items in Scotland. Neither country showed significant improvements in items between 2000 and 2003.

Public attitudes towards people with mental illness in England and Scotland became less positive during 1994–2003, especially in 2000–2003, and to a greater extent in England. The results are consistent with early positive effects for the ‘see me’ anti-stigma campaign in Scotland.