Adolescent self-harm and suicide attempts: An analysis of emergency department presentations in Singapore 2025 Chong et al

ABSTRACT

Introduction: The rising rate of adolescent suicide, and the burden of self-harm and mental health disorders, pose significant threats to Singapore’s future health outcomes and human potential. This study sought to examine the risk profile and healthcare utilisation patterns of Singaporean adolescents who presented to the emergency department (ED) for suicidal or self-harm behaviour.

Method: A retrospective review of medical records for patients aged 10 to 19 years who visited Singapore’s KK Women’s and Children’s Hospital ED for suicidal or self-harm attempts from January to December 2021 was conducted.

Results: A total of 221 patients were identified, with a predominance of female patients (85.5%) over males (14.5%). The mean age was 14.2 ± 1.4 years. Intentional drug overdose (52.0%) was the most commonly used method. Significantly more females presented for intentional paracetamol overdose (46.6% versus [vs] 28.1%, P=0.049), whereas jumping from a height was more common among males (18.8% vs 5.8%, P=0.022). The most frequently observed mental health challenges were stress-related and emotional coping difficulties (50.7%), followed by mood and anxiety symptoms (53.4%). A history of self-harm and suicidal behaviours were the most common psychosocial risk factors. Within the year prior to their ED presentation, 15.4% had accessed healthcare services for mild medical ailments, 19.5% for medically unexplained symptoms, and 17.2% for previous self-harm or suicide attempts.

Conclusion: Most cases involved psychosocial and emotional regulation difficulties, some of which displayed sex-specific patterns, rather than complex psychiatric disorders. The identified predictive factors can help inform Singapore’s National Mental Health and Well-being Strategy, to guide targeted and transdiagnostic interventions in schools and community settings.

Open access

 

"Healthcare services utilisation 1 year prior to suicide or self-harm attempt

In the 1 year prior to their suicide or self-harm attempt, 43 (19.5%) had presented to a hospital ED or polyclinic in the SingHealth healthcare cluster at least once for a medically unexplained symptom that could possibly be due to somatisation."

"In the 1 year prior to presentation, 17.2% of patients had attended a non-mental healthcare institution in the SingHealth cluster for suicidal or self-harm behaviour, 19.5% for medically unexplained symptoms that might possibly be somatisation episodes, and 15.4% for common mild illnesses. Hence, these healthcare visits provide opportunities for psychosocial and suicide risk screening.9,35,36 Indeed, psychosomatic symptoms and frequent healthcare seeking behaviour for minor ailments may be red flags for mental health distress.37 Therefore, EDs and primary care clinics have an important role to play in conducting efficient psychosocial and suicide risk screening of adolescents, particularly those who seek medical care for non-mental health issues.38"

 

Interesting that visiting “medically unexplained symptoms” clinics is a factor in self harm and suicide attempts. Very concerning but also unsurprising that the authors double down on the psychosomatic ideology instead of considering that being told your symptoms are “psychosomatic” ie. “in your mind” might be what is causing the psychological trauma leading to those negative outcomes.

But of course, the standard medical narrative can never be questioned.

 

And that the stuff like think positive or trying sleep hygiene (leading to no sleep and worse insomnia by banning naps when issues are caused by PEM) or pushing through thereby making symptoms worse

are all harmful to both physical and mental health - the think positive/ toxic positivity mindfulness stuff gets my goat because it always used to be known that in proper psychology that’s the opposite of what’s needed even if laypersons like to jolly the sad people to smile to perform (it isn’t tackling what is wrong) and actual care should be well knowing of that