Increasing rates of self-injury in the United Kingdom coupled with the apparent lack of understanding, highlights a need for research to be conducted in this area. A dearth of research illuminating the experiences of self-cutting, together with increased awareness of the differences in perspective between people who self injure and professionals, also provides a rationale for this study. This study aims to explore the experiences of people who self-injure in order to identify and understand the processes involved in self-cutting, and develop a theory which aids this understanding. A grounded theory approach is used to meet the aim of the study, generating data through in-depth interviews with 10 people who engage in self-cutting. Participants shared their experiences of self-injury emphasising both the meaning and function of cutting for them, and the struggle they face living with the behaviour. Although the experiences of participants were unique to each individual, clear commonalities in experience emerged during data analysis and were explored with subsequent participants,in keeping with the grounded theory method. As data generation and analysis developed, the aim of the study became more focused, resulting in an exploration of the urge to self-injure and how people who engage in self-cutting respond to this urge. Findings relate to the core category, living with the urge and main categories of experience namely underlying urge, triggering the urge, satisfying the urge and resisting the urge. Discussion of the findings offers a substantive theory, asserting that people who self-injure face a paradox of finding it very difficult to live with self-cutting, while simultaneously facing the challenge of living without the behaviour. This paradox can be understood within the context of the core category, living with the urge, a process which begins before the participants start self injuring, continues while they are cutting, through to when they are trying to live without cutting. The discussion contributes knowledge relating to commonalties between self-cutting and the experience of addiction; issues for prevention; repetitive nature of cutting; the relationship between people who cut and their cutting tools; and ultimately highlights how difficult it is for the participants to break-free from the world of cutting. Implications of the findings for health and social care practitioners, and education and training are discussed, and recommendations for research are made.

Deliberate self-harm (DSH) is a major health concern, especially for high-risk populations such as incarcerated youth. DSH refers to socially unacceptable, deliberate behaviour that causes harm to the body regardless of intent to die. There is limited research concerning prevalence rates as well as risk and protective factors for high-risk, adolescent groups. Participants were recruited from a correctional facility for youth aged 12-18. Male (n = 36) and female (n = 51) incarcerated adolescents (N = 87; mean age = 15.9) completed a survey that measured social-demographic characteristics, current depressed mood, lifetime alcohol and drug use, perceptions of social support (availability and satisfaction), approach-avoidance coping, problem-solving confidence, and DSH. The prevalence rates (81% lifetime, 74% annual, and 51% while incarcerated) for this mainly Aboriginal and Métis population were much higher than previous offender, community, and hospital findings. Youth reported much higher rates of DSH on a checklist than in response to a general question previously used in such research, suggesting that previously reported prevalence rates are likely grossly underestimated. Hypotheses regarding risk and protective factors were only partially supported. Depressed mood and drug use were positively, directly related to annual DSH frequency. Depressed mood proved to be a significant risk factor as well for incarcerated DSH. Overall, protective factors did not predict DSH well for this group of offenders. Only approach coping was inversely related to DSH frequency. Participants in this study reported very low levels of protective factors, which likely affected the outcome of statistical analyses. In general, youth reported high rates of risk factors and low rates of protective factors. Rates of DSH warranting medical attention increased with duration and frequency of such behaviour, as did actually receiving medical attention. Although 74% of offenders indicated that medical attention had been warranted at least once, only 50% actually received medical attention. Offenders were equally likely to receive medical attention whether they had engaged in DSH once or repetitively. It is likely that offenders prefer to keep their behaviour private, which affects how often they seek medical attention, even if they believe it is warranted. Recommendations are advanced for detecting and responding to DSH in incarcerated youth.

Tyrėjai vis dažniau skiria dvi save žalojančių paauglių grupes: mėginančius nusižudyti ir nesuicidiškai save žalojančius, kurie nesiekia mirties. Tačiau iki šiol buvo atlikta mažai populiacinių tyrimų, mėginančių šias dvi grupes tiesiogiai palyginti, todėl informacija apie šių grupių psichologinių ypatumų ir save žalojančio elgesio vidinių veiksnių skirtumus yra gana prieštaringa. Tyrime buvo naudojamas „Gyvenimo būdo ir prisitaikymo klausimynas“ (orig. Lifestyle and Coping Skills Questionnaire), kurį Lietuvoje adaptavo ir paauglių save žalojančio elgesio tyrimui pritaikė A. Laskytė ir N. Žemaitienė. Dalis jų surinktų duomenų analizuojama šiame darbe. Tikslas: ištirti bendros populiacijos paauglių suicidinio ir nesuicidinio save žalojančio elgesio vidinius veiksnius: motyvus, savižudiškus ketinimus, žalojančio elgesio ypatumus ir su šiais faktoriais galimai susijusius asmens psichologinius ypatumus. Taip pat atskleisti būdingus šių veiksnių skirtumus merginoms ir vaikinams. Tiriamieji: 15-17 metų amžiaus Lietuvos moksleiviai, kurie pildydami „Gyvenimo būdo ir prisitaikymo klausimyną“, atsakė, kad bent kartą gyvenime sąmoningai save žalojo. Klausimyno pildymo metu paaiškindami save žalojančio elgesio priežastis, prie teiginio „Aš norėjau numirti“ paaugliai galėjo atsakyti „Taip“ arba „Ne“. Pagal šį atsakymą jie buvo suskirstyti į dvi grupes: suicidiškai save žalojančių – norėjusiųjų numirti (n=163), ir nesuicidiškai save žalojančių – nenorėjusiųjų numirti (n=118). Rezultatai:... [toliau žr. visą tekstą] / Researches often differentiate two groups of self-harming adolescents: those who attempters a suicide, and those who are harming themselves in a non-suicidal way, and they don‘t seek the death. However just a few community-based research, which would directly compare these groups, were done so far, and therefore information about the differences of the psychological peculiarity and self-harming behavior‘s internal factors between the groups is ambivalent. Lifestyle and Coping Skills Questionnaire (Hawton, 2006), adapted and adjusted for the research of adolescents self-harming behavior by A. Laskytė and N. Žemaitienė in 2006, was used in this work. A part of their collected data is also used in this work. The aim: to examine the intrapersonal factors of suicidal and non-suicidal self-harm in a community sample population: the motives, suicidal intentions, the peculiarities of harming self-harm and person‘s psychological traits that could be possibly related to those factors. It also aimed to reveal the typical differences of these factors between the genders. The sample: 15-17 year old Lithuanian pupils who, while answering into Lifestyle and Coping Skills Questionnaire, responded that they were harming themselves at least once in a life time. In the questionnaire while explaining the reasons of self-harming behavior, into the proposition “I wanted to die” they could write “Yes” or “No”- in this way they were separated into two groups: suicidal self-harmers – who wanted to... [to full text]

Deliberate self-harm (DSH) is a major health concern, especially for high-risk populations such as incarcerated youth. DSH refers to socially unacceptable, deliberate behaviour that causes harm to the body regardless of intent to die. There is limited research concerning prevalence rates as well as risk and protective factors for high-risk, adolescent groups. Participants were recruited from a correctional facility for youth aged 12-18. Male (n = 36) and female (n = 51) incarcerated adolescents (N = 87; mean age = 15.9) completed a survey that measured social-demographic characteristics, current depressed mood, lifetime alcohol and drug use, perceptions of social support (availability and satisfaction), approach-avoidance coping, problem-solving confidence, and DSH. The prevalence rates (81% lifetime, 74% annual, and 51% while incarcerated) for this mainly Aboriginal and Métis population were much higher than previous offender, community, and hospital findings. Youth reported much higher rates of DSH on a checklist than in response to a general question previously used in such research, suggesting that previously reported prevalence rates are likely grossly underestimated. Hypotheses regarding risk and protective factors were only partially supported. Depressed mood and drug use were positively, directly related to annual DSH frequency. Depressed mood proved to be a significant risk factor as well for incarcerated DSH. Overall, protective factors did not predict DSH well for this group of offenders. Only approach coping was inversely related to DSH frequency. Participants in this study reported very low levels of protective factors, which likely affected the outcome of statistical analyses. In general, youth reported high rates of risk factors and low rates of protective factors. Rates of DSH warranting medical attention increased with duration and frequency of such behaviour, as did actually receiving medical attention. Although 74% of offenders indicated that medical attention had been warranted at least once, only 50% actually received medical attention. Offenders were equally likely to receive medical attention whether they had engaged in DSH once or repetitively. It is likely that offenders prefer to keep their behaviour private, which affects how often they seek medical attention, even if they believe it is warranted. Recommendations are advanced for detecting and responding to DSH in incarcerated youth.

Background: The use of health data from sources such as administrative and medical records to examine efficacy of health interventions is becoming increasingly common. Addressing selection bias inherent in these data is important; treatments are allocated according to clinical need and resource availability rather than delivered under experimental conditions. Propensity score (PS) methods are widely used to address selection bias due to observed confounding. This project used PS methods with observational cohort data relating to individuals who had attended an Emergency Department (ED) following self-harm (including self-poisoning and self-injury). This group is at greatly increased risks of further self-harm, suicide and all-cause mortality compared to the general population. However, it is not clear how hospital management affects risks of these adverse outcomes. Methods: A systematic review of PS methods with record-based mental health care data was used to determine the most appropriate methodological approach to estimate treatment effects following presentation to ED following self-harm. Following this review, PS stratification and PS matching methods were used with observational self-harm data to address observed baseline differences between patients receiving different types of clinical management following their hospital presentation (specialist psychosocial assessment, medical admission, referral to outpatient mental health services and psychiatric admission). Effects on repeat attendance for self-harm, suicide and all-cause mortality within 12 months were estimated. Advice on the interpretation and dissemination of results was sought from service users. Results: The systematic review resulted in 32 studies. The quality of the implementation and reporting of methods was mixed. Sensitivity analysis of the potential impacts of unobserved confounding was largely absent from the studies. Results from analysis of the self-harm cohorts showed that, broadly, prior to PS adjustment, individuals receiving each of the four categories of hospital management had higher risks of repeat attendance for self-harm, suicide and all-cause mortality than those not receiving that management. The use of PS methods resulted in attenuation of most of these increased risks. Psychosocial assessment appeared to be associated with reduced risk of repeat attendance for self-harm (risk ratio 0.87, 95% CI 0.80 to 0.95). Three advisors attended a group meeting and a further two provided responses by email. As a result of advisors' recommendations, an information sheet is being developed containing information about what patients can expect when attending hospital following self-harm and how treatment might influence future risk. Conclusions: Propensity score methods are a promising development in evaluating routine care for individuals who have self-harmed. There is now more robust evidence that specialist psychosocial assessment is beneficial in reducing risk of further attendances for self-harm. Advisors offered different perspectives to the researchers, leading to novel suggestions for dissemination.

Introduction. Recent studies have suggested a secular increase in the prevalence of self-harm, suicidal ideation and depression in young people. This study aims to report the changes in prevalence of psychological disturbance over time in a clinic population. Method: Data on the prevalence of psychological symptoms was measured by the Youth Self-Report (YSR) and Child Behaviour Checklist (CBCL), in a 21-year clinic cohort of adolescents aged from 12 to 17. This data was analysed to investigate secular changes and predictors of disorder. Results: Significant secular increases were demonstrated in parent reports of self-harm and suicidal ideation, of 5percent and 4percent per cohort year respectively, but there was no significant change in the anxious/depressed sub-scale. There were no changes demonstrated in self-reports of self-harm, suicidal ideation or anxiety/depression. Self-harm and suicidal ideation, both parent reported and self-reported, significantly increased with increasing age, female gender, drug use, anxiety/depression and other clinically significant scores on the YSR and CBCL sub-scales. The YSR was a more accurate predictor of both self-harm and suicidal ideation than the CBCL. Conclusions: The results of this study suggest that there has not been a significant increase in psychological disorder in this population. There was, however, an apparent increase due to increasing parental awareness of some symptoms, particularly self-harm and suicidal ideation. While parents have a higher rate of reporting disorder, young people's self-reports remain a more accurate predictor of specific symptoms, including self-harm and suicidal ideation.

Introduction. Recent studies have suggested a secular increase in the prevalence of self-harm, suicidal ideation and depression in young people. This study aims to report the changes in prevalence of psychological disturbance over time in a clinic population. Method: Data on the prevalence of psychological symptoms was measured by the Youth Self-Report (YSR) and Child Behaviour Checklist (CBCL), in a 21-year clinic cohort of adolescents aged from 12 to 17. This data was analysed to investigate secular changes and predictors of disorder. Results: Significant secular increases were demonstrated in parent reports of self-harm and suicidal ideation, of 5percent and 4percent per cohort year respectively, but there was no significant change in the anxious/depressed sub-scale. There were no changes demonstrated in self-reports of self-harm, suicidal ideation or anxiety/depression. Self-harm and suicidal ideation, both parent reported and self-reported, significantly increased with increasing age, female gender, drug use, anxiety/depression and other clinically significant scores on the YSR and CBCL sub-scales. The YSR was a more accurate predictor of both self-harm and suicidal ideation than the CBCL. Conclusions: The results of this study suggest that there has not been a significant increase in psychological disorder in this population. There was, however, an apparent increase due to increasing parental awareness of some symptoms, particularly self-harm and suicidal ideation. While parents have a higher rate of reporting disorder, young people's self-reports remain a more accurate predictor of specific symptoms, including self-harm and suicidal ideation.

No description available.

Non-suicidal self-injury (NSSI) is a dangerous and common behaviour, particularly among adolescents. Childhood trauma, insecure child-parent attachment, psychological distress, and impulsivity are some of the risk factors for NSSI that have been previously identified. However, the pathways from distal risk factors to NSSI and the ways in which these correlated risk factors interact with each other remains unclear. Identifying these pathways will provide valuable insight into the aetiology of NSSI and potentially highlight targets for treatment and intervention. In this dissertation I examine data from multiple large samples of young people, looking at multiple risk and protective factors together, and examining moderation and mediation pathways between risk factors. Using longitudinal data from 933 adolescents with no prior history of NSSI I demonstrated that the association between childhood family adversity before age 5 and new onset of NSSI between the ages of 14 and 17 was mediated by age 14 family functioning and possibly mental illness. Next, I validated a new measure of child perceptions of positive parenting, which I used to demonstrate the uni-directional prospective association between positive parenting and lower rates of NSSI amongst 1489 adolescents (ages 14-25). I then used this new measure of positive parenting to demonstrate that the prospective parenting-NSSI association was mediated by psychological distress. This is also one of the first prospective studies to show that impulsivity is independently predictive of NSSI. Using data I collected myself from a sample of 596 adolescents (ages 16-19) I validated a much needed measure of childhood trauma, with which I then demonstrated that the trauma-NSSI association was mediated by attachment and distress. Using data from this sample I was also able to reaffirm my previous findings that the attachment-NSSI association was mediated by psychological distress, and that impulsivity was uniquely associated with NSSI. Finally, using data from a sample of 559 Flemish 13 year-olds, I demonstrated that behavioural problems were more salient to NSSI than emotional problems among young adolescents, and that the attachment-NSSI association might be mediated by hyperactivity and conduct problems. Together, these findings reaffirm that childhood trauma, insecure child-parent attachment, psychological distress, and impulsivity are robust risk factors for NSSI and potential targets for treatment and intervention. Moreover, both distress and child-parent attachment may be viable targets for interventions aimed at attenuating the impact of early childhood trauma after it has occurred. Future research should use randomised controlled trails to test the efficacy of NSSI treatments aimed at these risk factors.

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