Background Self-harm is a major and growing public health issue among young people worldwide. Self-harm is an important risk factor for suicide, which is one of the leading causes of death for young people. Although suicide rates are declining overall, this trend is not seen in young people. Young people with mental distress and/or suicidal thoughts are reluctant to seek help, and often drop out of treatment initiated after a self-harm episode. Many young people who self-harm have had contact with healthcare before their first self-harm episode, but often for reasons other than suicidal thoughts or psychiatric problems. In this context, physical illness is associated with increased risk for self-harm and suicide among young people. The present thesis investigated how young people perceived the help and support they received before and after an episode of self-harm. A further aim was to map the inpatient somatic healthcare contacts young patients had before an episode of self-harm, and determine any relationship to risk for self-harm and suicide. Method Four studies were conducted using qualitative and quantitative methods. Participants were people aged 16-24 years. The definition of self-harm was based on the intentional self-harm criteria in the International Classification of Diseases, tenth revision, which includes all forms of self-harm without ascribing suicidal intent. In the first two studies, 10 respective 9 participants with a first healthcare contact for self-harm were interviewed during 2009-2011. The interviews covered participants’ knowledge and experience of professional care before their healthcare contact for self-harm. Participants were interviewed a second time 6 months later about their experiences with professional care during the period since their initial interview. Qualitative content analysis was used for all interviews. For the next two studies, we selected 16,235 participants with a first hospitalisation for self-harm during 1999-2009 from the Swedish National Inpatient Register. These cases were compared with matched controls to determine the odds of having been admitted with a non-psychiatric diagnosis during the year preceding the self-harm admission. To assess risk for suicide, data were retrieved from the Swedish Cause of Death Register for all deceased participants until 2013, and group differences were determined using survival analysis. Results In the first interview, participants described how they wanted more information on where they could turn for professional help. They also wanted different help-seeking pathways and emphasised the importance of the quality of professional contact. After 6 months, participants stressed the importance of being able to rely on professionals and treatment. Their life circumstances significantly affected their treatment, and practical help was appreciated. The register studies showed that young people admitted for self-harm were more likely to have been hospitalised with symptomatic diagnoses such as abdominal pain and syncope/collapse, and somatic illnesses such as epilepsy and diabetes mellitus type 1. A higher proportion of cases (4.5%; women 2.6%, men 8.8%) died during the study period than controls (0.3%; women 0.2%, men 0.6%) (p<0.001). For both cases and controls, a higher proportion of those with a previous somatic admission died from suicide during the study period than those without a somatic admission (cases: 4.2% vs. 2.8%, p<0.05). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04-1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year. Conclusion These findings suggest that healthcare providers need to find new ways to reach young people at risk for suicidal behaviour. Access to professional help should be easy and direct. Treatment for young people after self-harm should be flexible, and be receptive to input from the patient. The importance of and need for basic practical help should not be overlooked. Somatic healthcare contact provides an opportunity for intervention, particularly as psychiatric problems can manifest as physical symptoms, and physical illness is a risk factor for self-harm and suicide.

Selbstvergiftung in der Akutmedizin – 2005–2012 Zusammenfassung Ziel. Beschreibung des Trends der akuten Selbstvergiftung in der Notfall- und Intensivmedizin. Methode. Elektronische Akten erwachsener Patienten, die zwischen 2005 und 2012 wegen einer akuten Selbstvergiftung infolge eines Selbstmordversuches (Selbstmordgruppe), einer Berauschung (Intoxikationsgruppe) oder Medikamentenüberdosierung zwecks Schmerzlinderung (Überdosierungsgruppe) in der Notaufnahme des Universitätsklinikums Leipzig eingewiesen worden waren, wurden ausgewertet. Ergebnisse. 3533 Patienten (62,6 % männlich) wurden identifiziert, mit einem Anstieg von 305 Fällen im Jahre 2005 auf 624 in 2012. Die Aufnahmerate bezogen auf die Gesamtaufnahmen stieg von 1,2 % im Jahre 2005 auf 1,9 % im Jahre 2012 an. 31,7 % der Patienten waren < 25 Jahre alt. Die Ursachen der Selbstvergiftung waren Suizidversuch (18,1 %), Intoxikation (76,8 %) und Medikamentenüberdosierung (2,9 %). Bei 80 Fällen war eine genaue Gruppenzuordnung nicht möglich. Während psychotrope Medikamente bei 71,6 % der Suizidversuche angewandt wurden, war Alkoholintoxikation die Ursache bei 80,1 % der Fälle in der Intoxikationsgruppe. Selbstvergiftung mit mindestens zwei Substanzen lag bei 52,0 % der Suizidversuche, 10,3 % der Intoxikationsgruppe und 29,7 % der Gruppe mit Medikamentenüberdosierung vor. Während die Alkoholintoxikation nach wie vor am häufigsten vorkam, gab es eine drastische Zunahme der Intoxikationen mit Cannabinoiden, Crystal Meth und Gamma- Hydroxybuttersäure in den Jahren 2011 und 2012. Eine Aufnahme auf die Intensivstation war bei 16,6 % der Fälle erforderlich. Es gab 22 Todesfälle (0,6 % der gesamten Studienpopulation), von denen 15 aus der Suizidgruppe (2,3 %), vier aus der Intoxikationsgruppe (0,15 %), und drei aus der nicht eindeutig zugeordneten Gruppe (3.8 %) waren. Zusammenfassung. Akute Selbstvergiftung ist ein zunehmendes medizinisches Problem. Psychotrope Medikamente stellen nach wie vor die häufigsten Suizidversuchsmittel dar. Obwohl die Alkoholintoxikation weiterhin am häufigsten vorkommt, nehmen illegale Drogen als notfallmedizinischer Einweisungsgrund zu. / Self-poisoning in the acute care medicine 2005–2012 Abstract Objective. To describe the trend of acute self-poisoning in the emergency and intensive care. Methods. Electronic charts of adults who presented to the emergency department of the University Hospital Leipzig with selfpoisoning following a suicide attempt (suicide group), intoxication (intoxication group), drug overdose for relief of pain or discomfort (drug overdose group) between 2005 and 2012 were analyzed. Results. 3533 adults (62.6 % males) were identified, with the yearly admissions increasing from 305 in 2005 to 624 in 2012. The admission rate in relation to the total emergency department admissions also increased, from 1.2 % in 2005 to 1.9 % in 2012. 31.7 % of the patients were younger than 25 years. The reasons for self-poisoning were suicide attempt (18.1 %), intoxication (76.8 %) and drug overdose (2.9 %). The reason could not be clearly classified in 80 patients. Psychotropic drugs were used in 71.6 % of suicide attempts, while alcohol was the sole cause of intoxication in 80.1 % of cases in the intoxication group. Self-poisoning using at least two substances was observed in 52.0 % of the suicide attempts, 10.3 % of those with intoxication and 29.7 % of those with drug overdose. While alcohol remains the most common cause of intoxication, there was a drastic increase in the consumption of cannabinoids, Crystal Meth and gamma-hydroxybutyrate in the years 2011 and 2012. ICU admission was necessary in 16.6 % of the cases. There were 22 deaths (0.6 % of the study population), of whom 15 were in the suicide group (2.3 %), four (0.15 %) in the intoxication group, and three in the not clearly classified group (3.8 %). Conclusion. Acute self-poisoning is an increasing medical issue. Psychotropic drugs remain the most common means of suicide attempt. Although alcohol intoxication is very frequent, intake of illicit drugs as the cause of emergency admission is increasing.

Awareness of sexual exploitation has increased over the past decade. However, physical and psychological health needs, risks, health seeking behaviour and use of health services by sexually exploited young people have been inadequately explored. Methodology/method Phase 1: descriptive, phenomenological, approach to encourage young people involved in or vulnerable to sexual exploitation to describe their personal accounts of health, risks, health seeking and support. Phase 2: quantitative methodology consisting of a questionnaire survey with professionals supporting young people involved in or vulnerable to sexual exploitation. Data analysis Phase 1: phenomenological approach to data analysis (Giorgi, 1985). Phase 2: questionnaire data were analysed using software S.P.S.S. and thematic content analysis (Burnard, 2006). Results/findings Intentional self harm and substance misuse were concordant themes from phase 1 and 2. Novel themes that emerged from this study included a taxonomy of risk behaviours related to health, and the use of youth offending teams for health support Conclusion A significant range of physical and psychological health problems were reported alongside risks to health and barriers to health support for sexually exploited young people. Psycho-social vulnerability factors undermine health and impact on health seeking behaviour.

Syftet med studien är att analysera olika rapporter gällande sex som självskadebeteende samt varför unga skadar sig själva med sex. Sex som självskada är inte lika synligt som andra typer av självskador som att skära sig eller att bränna sig. Utifrån de utvalda rapporterna som utgör empirin vill vi undersöka varför ungdomar genomför skadliga handlingar genom sex och också vilka skillnader och likheter som framkommer i rapporterna. Vi vill belysa sex som självskada och få en ökad förståelse för ämnet. Vårt empiriska material består av fem olika rapporter med en koppling till sex som självskada. Även om vårt fokus huvudsakligen är icke suicidala självskador hos unga, så är det viktigt att nämna att det är en högre risk för självmordstankar om det finns ett självskadebeteende. Vi har använt oss av textanalys som är en kvalitativ metod när vi analyserade rapporterna. Vårt resultat visade på fem återkommande teman. Dessa är orsaker till sex som självskada, begreppet sex som självskada, kön- och åldersskillnader, ond cirkel samt bemötande och behandling. Dessa teman har sedan kopplats till teorier om genus, identitet och sexualitet med en utgångspunkt i socialkonstruktivism. / The aim of the study is to analyse different reports regarding sex as a self-injurious behaviour and why adolescents harm themselves through sex. Sex as a self injury is not as visible as other types of deliberate self harm such as cutting or burning skin and it can be anyone around you. Based on selected reports as our empirical material we want to acknowledge why youngsters conduct harmful actions through sex and also what differences and similarities the reports share. We want to pay attention to the topic of sex as a self injury and gain an increased understanding of it. Our empirical material consist of five different reports with a connection to sex as self injury. Although our focus is mainly on non-suicidal self injury among adolescents, it is important to mention that there is a higher risk of suicidal thoughts in connection to self injurious behaviour. We have analysed the reports through a qualitative method, text analysis. Our results showed fives recurring themes. These are causes of sex as self injury, differences in how the concept is used, differences among age and gender, vicious cycle and treatment. The themes are then connected to theories such as gender, sexuality and identity with a premisses of social construction.

<p>The main purpose of this thesis was to take part of girl’s descriptions and experiences of their treatment for deliberate self-harm and to investigate whether they still experience effects of the treatment today. Our main research questions where; how do the girls describe their experiences of the treatment method, do the girls describe that they still experience any effects of the treatment, and finally how do the girls look back on their treatment today? In order to answer these questions, we carried out eight qualitative telephone interviews with girls that had undergone treatment in a specific treatment centre. We chose to analyze the material from the salutogenic theory and the concepts of SOC (sense of coherence) and with a hermeneutic approach. Our result showed that the treatment methods that where most important where dialectic behaviour therapy, horse therapy and finally environmental therapy. Several of the girls could see remaining effects of the treatment today, while other girls could not see any of these effects. A couple of the girls expressed that they should have been dead if they had not been taken care of by the treatment centre while other girls meant that the treatment did not make any difference.</p>

<p>Uppsatsen belyser vägen ur ett självskadande beteende där tre kvalitativa intervjuer har gjorts för att närma sig vändpunktsprocesserna. Även en självbiografisk bok har använts som empiriskt stöd. Syftet är att kunna urskilja hur vägen ut ur ett självskadande beteende kan se ut för olika personer. Det empiriska materialet belyses även utifrån Antonovskys teori om KASAM, Ebaugh Fuchs teori om exitprocesser samt tidigare forskning. De frågeställningar som ligger till grund för uppsatsen är följande: är det möjligt att kunna urskilja en vändpunkt (yttre och inre faktorer)? Vilken betydelse har personer i individens omgivning haft för vägen ut ur ett självskadande beteende? Hur har samhällets insatser hjälpt individen att ta sig ur sitt beteende? De slutsatser som kan konstateras är att det för samtliga intervjudeltagare samt i den självbiografiska boken går att urskilja någon form av vändpunkt. Utifrån de berättelser vi tagit del av kan vi konstatera att vändpunkter kan se väldigt olika ut. Ytterligare en slutsats är att samtliga kvinnor är eniga om att vårdinsatserna är för denna patientgrupp bristfällig eller ibland helt lyser med sin frånvaro. Det viktigaste i intervjudeltagarnas tillfrisknande är deras egen jagstyrka och motivation. Samtliga kvinnor har i dag nya hanteringsstrategier för att klara av livets motgångar och svårigheter.</p> / <p> </p><p>This thesis highlights self-harming behavior and the journey to recovery. To approach the turning point and the following process three qualitative interviews has been done. An autobiographical book has been used as an empirical data. The purpose is to distinguish how the journey to recovery can differ between diverse people. The empirical data has been illustrated by using Antonovskys theory sence of coherence, Ebaugh Fuchs process of roll exit and current research. The issued questions grounding the thesis are: is it possible to distinguish a turning point (outer and inner factors)? How important were the people surrounding the individual to find the way out? And how did society's efforts help the individual out of its behavior? The conclusions that are determined are that with all of the interviewed and the autobiographical book, a turning point can be discerned. From the stories given to us we can determine that the turning points can differ considerably. Yet another conclusion is that all of the women agree that the care effort towards these types of patients is insufficient or even non-existent. The most important part in the recovery of the interviewed is their own strength and motivation. All of these women today have new strategies on how to handle life's adversity and difficulties.</p>

Uppsatsen belyser vägen ur ett självskadande beteende där tre kvalitativa intervjuer har gjorts för att närma sig vändpunktsprocesserna. Även en självbiografisk bok har använts som empiriskt stöd. Syftet är att kunna urskilja hur vägen ut ur ett självskadande beteende kan se ut för olika personer. Det empiriska materialet belyses även utifrån Antonovskys teori om KASAM, Ebaugh Fuchs teori om exitprocesser samt tidigare forskning. De frågeställningar som ligger till grund för uppsatsen är följande: är det möjligt att kunna urskilja en vändpunkt (yttre och inre faktorer)? Vilken betydelse har personer i individens omgivning haft för vägen ut ur ett självskadande beteende? Hur har samhällets insatser hjälpt individen att ta sig ur sitt beteende? De slutsatser som kan konstateras är att det för samtliga intervjudeltagare samt i den självbiografiska boken går att urskilja någon form av vändpunkt. Utifrån de berättelser vi tagit del av kan vi konstatera att vändpunkter kan se väldigt olika ut. Ytterligare en slutsats är att samtliga kvinnor är eniga om att vårdinsatserna är för denna patientgrupp bristfällig eller ibland helt lyser med sin frånvaro. Det viktigaste i intervjudeltagarnas tillfrisknande är deras egen jagstyrka och motivation. Samtliga kvinnor har i dag nya hanteringsstrategier för att klara av livets motgångar och svårigheter. / This thesis highlights self-harming behavior and the journey to recovery. To approach the turning point and the following process three qualitative interviews has been done. An autobiographical book has been used as an empirical data. The purpose is to distinguish how the journey to recovery can differ between diverse people. The empirical data has been illustrated by using Antonovskys theory sence of coherence, Ebaugh Fuchs process of roll exit and current research. The issued questions grounding the thesis are: is it possible to distinguish a turning point (outer and inner factors)? How important were the people surrounding the individual to find the way out? And how did society's efforts help the individual out of its behavior? The conclusions that are determined are that with all of the interviewed and the autobiographical book, a turning point can be discerned. From the stories given to us we can determine that the turning points can differ considerably. Yet another conclusion is that all of the women agree that the care effort towards these types of patients is insufficient or even non-existent. The most important part in the recovery of the interviewed is their own strength and motivation. All of these women today have new strategies on how to handle life's adversity and difficulties.

The main purpose of this thesis was to take part of girl’s descriptions and experiences of their treatment for deliberate self-harm and to investigate whether they still experience effects of the treatment today. Our main research questions where; how do the girls describe their experiences of the treatment method, do the girls describe that they still experience any effects of the treatment, and finally how do the girls look back on their treatment today? In order to answer these questions, we carried out eight qualitative telephone interviews with girls that had undergone treatment in a specific treatment centre. We chose to analyze the material from the salutogenic theory and the concepts of SOC (sense of coherence) and with a hermeneutic approach. Our result showed that the treatment methods that where most important where dialectic behaviour therapy, horse therapy and finally environmental therapy. Several of the girls could see remaining effects of the treatment today, while other girls could not see any of these effects. A couple of the girls expressed that they should have been dead if they had not been taken care of by the treatment centre while other girls meant that the treatment did not make any difference.

Avsiktligt självskadebeteende bland normalbefolkningen är ett välkänt men ännu relativt outforskat fenomen. Syftet med föreliggande studie var att kartlägga förekomst och former av, samt könsskillnader i, avsiktligt självskadebeteende i en ickeklinisk ungdomspopulation, samt att undersöka eventuella samband mellan självskadebeteende och hjälpbehov, självmordsförsök, självkänsla, copingstrategier och aggressivitet. En förenklad version av Deliberate Self-Harm Inventory administrerades tillsammans med övriga frågor bland 211 gymnasieungdomar i Mellansverige. Resultatet visade att 37 % av tonåringarna skadat sig själva under det senaste året. Signifikanta könsskillnader förekom gällande såväl prevalens som form av självskadebeteende. Självskadebeteende visade sig samvariera med hög grad av aggressivitet och låg självkänsla. Ungdomar med självskadebeteende använde sig av mer maladaptiva copingstrategier än andra ungdomar. / Deliberate self-harm in the normal population is a well known phenomenon, that is still relatively under-researched. The purpose of the present study was to examine the prevalence and methods of, and gender differences in, deliberate self-harm in an adolescent community sample. The relationships between deliberate self-harm and help-seeking behaviors, attempted suicide, self-esteem, coping strategies and aggression were also explored. A simplified version of The Deliberate Self-Harm Inventory was administered among 211 Swedish adolescents. Results showed a 37 % prevalence rate of self-harming behavior during the recent year. Significant gender differences regarding prevalence and methods of self-harm were identified, and high rates of deliberate self-harm was associated with high aggression, low self-esteem and maladaptive coping-strategies.

Background: The purpose of the present study was to investigate the prevalence and characteristics of deliberate self-harm in a Swedish University population. Method: A random sample of first year students at University of Kalmar was invited to participate in an Internet-based survey in the autumn of 2007. A total of 139 (53,1 %) completed the anonymous survey. Results: The results showed that 25,2 % (n=35) of the students reported having engaged in some kind of deliberate self-harm at least once, and deliberate self-harm was endorsed by 7,9 % within the past year. The most frequently procedures to self-harm were to tear, carve or pinch self, cutting skin and hitting self on purpose. 37,1 % reported that they had told no one about their self-injurious behaviors and 36,4 % significantly reported that they had no one they trusted and who they could talk to if they were concerned about something. Students with self-injurious behavior were also more likely to report a history of emotional, sexual and/or physical abuse, alcohol and drug use, cut classes and questioning their sexual orientation. Conclusions: Findings suggest that self-harm is associated with risk factors and that self-injury is not only associated with adolescence but also with adulthood. It is therefore important to continue studies in both populations.