In practical terms, this can be translated to "do as little harm as humanly possible and, when it is necessary to harm, act with humility, awareness and gratitude to what is being sacrificed on your behalf".
Invasion success in small demes is expected to be higher for agents (be it genes or symbionts) in which the fecundity cost is conditional on the expression of the harming act (such as CI).
The present results fall within the range reported in a recent review (Casiano et al., 2013) of "deliberate self-harm" (acts of both suicidal and nonsuicidal self-injury) in incarcerated juveniles.
The clinicians under-detected suicidal and self-harm acts, but over-detected suicidal ideation.
11 12 However, suicide attempts comprise a relatively small proportion of self harm acts, and the longer term outcomes associated with non-suicidal self harm are not known.
Suicide on the other hand is a fatal self-inflicted act before which a person may have carried out one or more self-harm acts [ 9].
It is notable that only those with actual self-harm acts can be rated using this scale rather than those with suicide ideation.
Among the cases with self-harm, we checked the concurrent validity of the CSPS with PSIS, HAMD, BSSI, BHS and also confirmed the predictive validity with the number of self-harm acts during 6-month follow-up period.
Although interventions have yet to be developed with demonstrable efficacy in relation to preventing self-harm acts [ 40], recent studies have suggested the need for psychiatric and social approaches to reduce isolation, especially in middle-age [ 41].
The control group was defined as those with general medical diagnoses without prior self-harm acts and was adopted based on the rationale of establishing the differentiation validity of the CSPS.
Thirdly, we failed to recruit more patients and/or follow up the participants for longer than 6 months due to resource shortage, thus generalization was limited to emergency attendees with self-harm and the exclusion of those with severe physical complications after the index self-harm acts, cognitive dysfunctions, or those who refused to participate at baseline assessment.
