{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T17:05:52Z","timestamp":1778173552404,"version":"3.51.4"},"reference-count":31,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,6,9]]},"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the incidence and outcomes of self-harm from ambulance records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective, observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Osaka City, Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 365 adolescents aged 10\u201319\u2005years with emergency self-harm such as poisoning by drugs or gas, cutting skin, jumping from heights, hanging and drowning and treated by emergency medical service personnel from January 2010 through December 2012.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measurements<\/jats:title>\n                    <jats:p>Incidence per 100\u2005000 persons and outcome at the scene or hospital arrival by age and gender. Poisson regression models for incidence evaluation were used; reporting relative risks (RRs) and their 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the study period, a total of 425 self-harm events were documented in 365 adolescents. The incidence of self-harm increased significantly between the ages of 11 and 19\u2005years, from 6.3 to 81.0 among boys and the ages of 12 and 19\u2005years from 6.3 to 228.3 among girls, respectively (both p&lt;0.001). Although there was no incidence difference between girls and boys in the group aged 11\u201314\u2005years (RR 1.20; 95% CI 0.59 to 2.47), the incidence was significantly higher among girls than boys in the group aged 15\u201319\u2005years (RR 4.18; 95% CI 3.20 to 5.45). The overall proportion of death by self-harm was 4.9%. The proportion of hospital admission and death by self-harm was higher among boys than among girls (38.6% vs 25.2%, p=0.016 and 14.8% vs 2.4%, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The incidence of emergency treatment for self-harm by adolescents increased with age and our findings also demonstrated the gender paradox. It would be necessary to establish active, gender-specific and comprehensive prevention strategies for adolescent self-harm, based on our findings showing the age and gender differences of self-harm among adolescents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-011419","type":"journal-article","created":{"date-parts":[[2016,7,5]],"date-time":"2016-07-05T22:58:48Z","timestamp":1467759528000},"page":"e011419","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Incidence and outcomes of emergency self-harm among adolescents: a descriptive epidemiological study in Osaka City, Japan"],"prefix":"10.1136","volume":"6","author":[{"given":"Tasuku","family":"Matsuyama","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuhisa","family":"Kitamura","sequence":"additional","affiliation":[{"name":"Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosuke","family":"Kiyohara","sequence":"additional","affiliation":[{"name":"Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumito","family":"Hayashida","sequence":"additional","affiliation":[{"name":"Osaka Municipal Fire Department, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Nitta","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan"},{"name":"Department of Pediatrics, Osaka Medical College, Takatsuki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Kawamura","sequence":"additional","affiliation":[{"name":"Kyoto University Health Services, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taku","family":"Iwami","sequence":"additional","affiliation":[{"name":"Kyoto University Health Services, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bon","family":"Ohta","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,7,5]]},"reference":[{"key":"2025121223181427000_6.7.e011419.1","unstructured":"World Health Organization. Mental health: Suicide Prevention. http:\/\/www.who.int\/mental_health\/suicide-prevention\/en\/ (accessed 30 May 2015)."},{"key":"2025121223181427000_6.7.e011419.2","unstructured":"Centers for Disease Control and Prevention. Violence prevention: Suicide. http:\/\/www.cdc.gov\/violenceprevention\/suicide\/index.html (accessed 30 May 2015)."},{"key":"2025121223181427000_6.7.e011419.3","unstructured":"Ministry of Health, Labour and Welfare. Specified Report of Vital Statistics: Age-Adjusted Death Rates by suicides (Japanese). http:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/jinkou\/tokusyu\/suicide04\/ (accessed 30 May 2015)."},{"key":"2025121223181427000_6.7.e011419.4","unstructured":"National Institutes of Health. Health & Education: Suicide Prevention. http:\/\/www.nimh.nih.gov\/health\/topics\/suicide-prevention\/index.shtml (accessed 30 May 2015)."},{"key":"2025121223181427000_6.7.e011419.5","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.152.3.359"},{"key":"2025121223181427000_6.7.e011419.6","doi-asserted-by":"publisher","DOI":"10.1016\/0165-0327(94)90029-9"},{"key":"2025121223181427000_6.7.e011419.7","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291703007943"},{"key":"2025121223181427000_6.7.e011419.8","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.181.3.193"},{"key":"2025121223181427000_6.7.e011419.9","doi-asserted-by":"publisher","DOI":"10.1001\/2013.jamapsychiatry.55"},{"key":"2025121223181427000_6.7.e011419.10","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1819.2003.01088.x"},{"key":"2025121223181427000_6.7.e011419.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.adolescence.2010.04.004"},{"key":"2025121223181427000_6.7.e011419.12","unstructured":"Niigata City. Epidemiology of suicide attempts in Niigata City (Japanese). http:\/\/www.city.niigata.lg.jp\/iryo\/kokoro\/jisatsu\/jittaihaaku.html (accessed 30 May 2015)."},{"key":"2025121223181427000_6.7.e011419.13","first-page":"247","article-title":"Characteristics of suicides according to prehospital records in Kishiwada City, Osaka Prefecture","volume":"55","author":"Toyoda","year":"2008","journal-title":"Nihon Koshu Eisei Zasshi"},{"key":"2025121223181427000_6.7.e011419.14","unstructured":"Japan Statistical Association. 2010 Population Census of Osaka-city (Japanese). http:\/\/www.city.osaka.lg.jp\/shisei_top\/category\/1756-0-0-0-0.html (accessed 30 May 2015)."},{"key":"2025121223181427000_6.7.e011419.15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.802058"},{"key":"2025121223181427000_6.7.e011419.16","unstructured":"Osaka Municipal Fire Department. 2013 Emergency Annual Statistics. Osaka: Osaka-Shi Shoubo (Japanese). http:\/\/www.city.osaka.lg.jp\/shobo\/page\/0000267911.html (accessed 30 May 2015)."},{"key":"2025121223181427000_6.7.e011419.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2005.04.018"},{"key":"2025121223181427000_6.7.e011419.18","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.60.8.837"},{"key":"2025121223181427000_6.7.e011419.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2010.05.017"},{"key":"2025121223181427000_6.7.e011419.20","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1996.01830040075012"},{"key":"2025121223181427000_6.7.e011419.21","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.107.047704"},{"key":"2025121223181427000_6.7.e011419.22","doi-asserted-by":"publisher","DOI":"10.1097\/01.chi.0000120022.14101.11"},{"key":"2025121223181427000_6.7.e011419.23","doi-asserted-by":"crossref","first-page":"201","DOI":"10.4103\/2277-9175.142046","article-title":"Recurrent suicide attempt and female hormones","volume":"3","author":"Mousavi","year":"2014","journal-title":"Adv Biomed Res"},{"key":"2025121223181427000_6.7.e011419.24","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-199912000-00010"},{"key":"2025121223181427000_6.7.e011419.25","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.90.12.1885"},{"key":"2025121223181427000_6.7.e011419.26","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.3390\/ijerph120302359","article-title":"Gender differences in suicide prevention responses: implications for adolescents based on an illustrative review of the literature","volume":"12","author":"Hamilton","year":"2015","journal-title":"Int J Environ Res Public Health"},{"key":"2025121223181427000_6.7.e011419.27","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph9020531"},{"key":"2025121223181427000_6.7.e011419.28","doi-asserted-by":"publisher","DOI":"10.2466\/pms.100.3c.920-924"},{"key":"2025121223181427000_6.7.e011419.29","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jad.2014.12.048","article-title":"Interventions to prevent repeat suicidal behavior in patients admitted to an emergency department for a suicide attempt: a meta-analysis","volume":"175","author":"Inagaki","year":"2015","journal-title":"J Affect Disord"},{"key":"2025121223181427000_6.7.e011419.30","unstructured":"Cabinet Office, Government of Japan. 2015 White paper on Suicide Prevention in Japan (Japanese). http:\/\/www8.cao.go.jp\/jisatsutaisaku\/whitepaper\/en\/w-2015\/summary.html (accessed 20 Apr 2016)."},{"key":"2025121223181427000_6.7.e011419.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2008.01879.x"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2016-011419","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T07:18:23Z","timestamp":1765610303000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2016-011419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2016,7,5]]},"published-print":{"date-parts":[[2016,7]]}},"alternative-id":["10.1136\/bmjopen-2016-011419"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2016-011419","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7]]}}}