Aquest treball pretén presentar un primer model en relació a la conducta autolesiva que es dona al medi penitenciari tenint en compte les relacions que poden haver entre la conducta autolesiva en el medi comunitari i el medi penitenciari així com poder confirmar els tipus de conductes autolesives d’altres treballs. En aquest treball es fa primer una revisió de les diferents definicions de conductes autolesives i la seva classificació així com els diferents models explicatius. Tot seguit fem una revisió bibliogràfica dels diferents treballs que relacionen les autolesions i diferents trastorns psicopatològics, així com de la seva incidència a les presons. A continuació s’elabora una proposta de model amb el capítol de metodologia, amb especial èmfasi amb els participants, instruments i procediment emprat. Els resultats s’analitzen i es presenten en el capítol 7 i la discussió i les conclusions en el capítol 8.

Suicide in later life is a growing public health concern that is expected to increase as the baby boom generation reach late adulthood. In the general population, older adults have rates of suicide that are higher than any other age group. The rate of suicide is particularly higher for older men. In Canada, older men between 80 and 84 years have rates of suicide approximately six times greater than older women the same age. Older adults living in the community are a sub-set of the population that are at high risk for suicide yet are not typically a focus of suicide research. As a result they remain hidden from the view of mental health promotion and suicide prevention programs until a decline in mental status brings them to the attention of formal mental health care services. Improving our understanding of suicide in later life particularly among community-residing older men can inform suicide prevention strategies. To improve this understanding, the goals of this research were three-fold: to comprehensively describe the sociodemographic and clinical characteristics of community residing older adults who have experienced suicide-related behaviour; to describe the rates, risk and protective factors, and predictors of suicide-related behaviour among this population; and to compare these findings to a subpopulation of community-residing older adults with neurological conditions. To achieve these aims, this research utilized a secondary data analysis approach using health information from multiple linked datasets. The Canadian Institute of Health Information (CIHI) performed record linkages between Ontario hospital administrative data (Discharge Abstract Database, National Ambulatory Care Reporting System, and Ontario Mental Health Reporting System) and Ontario home care data (Home Care Reporting System). Home care data are sourced from the Resident Assessment Instrument–Home Care (RAI-HC) Assessment Instrument, the provincially mandated assessment tool used to identify the strengths, preferences and needs of all long-stay home care clients. The RAI-HC contains over 350 items across a wide range of domains including health, functional status and resource use. Linkages of these data records between home care and hospital sectors enabled the prospective examination of community-residing older adults with recent suicide-related behaviour. This is one of the first national and international studies to use the RAI-HC to examine older home care clients with experiences of suicide-related behaviour. The study samples consisted of Ontario home care clients aged 60 years or older assessed with the RAI-HC between April 2007 and September 2010. Clients’ initial RAI-HC assessment was examined followed by corresponding hospital records for suicide-related behaviour (N = 222,149). The prevalence of suicide-related behaviour for the sample was 1.01% (n=2,077) with higher rates for older men than women. Rates were examined across geographic regions of Ontario. Descriptive analyses demonstrated that older adults with suicide-related behaviour had more indicators of psychiatric distress (including cognitive impairment) and psychosocial dysfunction than the general home care population. Multivariate analyses showed significant effects for age and gender in the prediction of suicide-related behaviour after adjusting for risk and protective covariates. Tangible areas for intervention were revealed that may reduce future suicide risk such as managing alcohol use and dependence, managing pain, increasing positive social relationships, and reducing social isolation. Time-to-event analysis supported the multivariate regression findings. Analyses of two subpopulations of older adults with neurological conditions (dementia and Parkinson’s disease) demonstrated marked differences in suicide risk and protective factors compared to the general home care population. Findings suggest that a one-size-fits-all approach to suicide prevention and intervention is not appropriate for persons with these conditions, as their specific risk and protective factors need to be taken into consideration. This study based on provincial data covering the home care sector in Ontario defined high risk groups of older adults and provided evidence for risk and protective factors associated with suicide-related behaviour. Findings point to several areas that should be assessed by home care professionals to reduce risk in the older home care client population. This multi-dimensional profile of high risk older adults will assist in initiating a policy dialogue regarding the need for targeted suicide prevention strategies in Ontario’s home care sector.

Ohälsa bland ungdomar i Sverige inkluderar flera typer av folkhälsoproblem där psykisk ohälsa ökar och drabbar allt fler, vilket bland annat tar sig uttryck i självskadebeteende. Denna uppsats behandlar relationen mellan självskadebeteende och andra riskbeteenden utifrån datamaterialet kopplat till Liv & Hälsa ung i Sörmland. Det är en återkommande totalundersökning om levnadsvanor, riskbeteenden och hälsa bland elever i årskurs 7, 9 och 2 på gymnasiet. Enkäten besvarades av 2750 elever från årskurs 9 och 2770 elever från årskurs 2. Endast flickor i årskurs 9 (n=1313) och år 2 (n=1384) på gymnasiet inkluderas i denna uppsats. För att undersöka förekomst och skillnader bland populationen har en kvantitativ metod använts. Teorin att empowerment anses vara ett viktigt verktyg för hur samhället kan hjälpa individer att stärka och bygga upp sitt självförtroende och på det sättet öka hälsan bland ungdomar diskuteras. Resultaten visar att det är vanligare att de individer som självskadar sig även utför andra riskbeteenden som till exempel daglig rökning och snatteri jämfört med kontrollgruppen. Detta kan vara en indikator för att mer fokus bör läggas på att ytterligare forska kring detta område för att framtida preventiva åtgärder skall kunna minska antalet flickor som självskadar sig. / Unhealthiness among youths in Sweden includes several kinds of public health problems where mental illness is increasing and affecting more and more people, resulting in, for example, deliberate self-harm. This thesis discusses the relations between self-harm and other dangerous behaviors based on the data set from Liv & Hälsa ung in Sörmland. It is a recurring total population survey about lifestyle, dangerous behaviors and health among pupils in year 7, 9 and second year at high school. The survey was answered by 2750 pupils in year 9 and 2770 pupils in year 2 at high school. Only girls in year 9 (n=1313) and year 2 (n=1384) at high school is included in this thesis. A quantitative method was used to investigate occurrence and differences among the population. The empowerment theory is discussed, which is considered to be an important tool in order for the society to help individuals strengthen their self confidence and in that way increase the health level among youths. The results show that it is more common that self-harming individuals are also engaged in other dangerous behaviors, such as daily smoking and shoplifting, in comparison to the control group. This could serve as an indicator that the area requires more research in order to develop future preventive measures to reduce the number of girls harming themselves.

Research that explores the relationship between suicide and self-injury is limited, and the lack of clarity surrounding this topic can present challenges for professional counselors. Although persons who self-injure are at an increased risk for suicide (e.g., Toprak, Cetin, Guven, Can, & Demircan, 2011; Chapman & Dixon-Gordon, 2007), not all individuals who engage in self-injurious behaviors attempt or complete suicide (e.g., Hawton & Harriss, 2008; Howson, Yates, & Hatcher, 2008). Research on common and distinct risk factors for suicide and self-injury (e.g., Andover, Primack, Gibb, & Pepper, 2010; Brausch & Gutierrez, 2010; Greydanus & Apple, 2011; Hawton & James, 2005; Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Toprak et al., 2011; Wichstrom, 2009), as well as emotional antecedents and consequences for suicide and self-injury (e.g., Chapman & Dixon-Gordon, 2007), has contributed to our understanding of this complex relationship. However, the specific nature of the relationship remains unclear. This study serves to help fill the gap in the literature by examining advanced professional counselors’, as measured by the Supervisee Levels Questionnaire-Revised, conceptualizations of the relationship between suicide and self-injury and by exploring how the presence of self-injury impacts clinical assessment and interventions. Data was collected by means of an online survey. Analysis was conducted by a research team using qualitative content analysis. Seven categories emerged, including: relationship between suicide and self-injury, functions of self-injury, associated risk, suicide risk assessment, treatment planning and goals, intervention, and identification of self-injury.

This is a qualitative study aiming to illuminate and gain better understanding of deliberate self-harm. The study has a narrative perspective and is based on three women’s life stories, focusing on a period when they had an active self-harming behaviour. The study examines what the participants experienced as important to the initiation and the cessation of the deliberate self-harm. It is also examining identity performances and turning points which can be discerned in the life stories. The analysis is based on theories of the narrative perspective and on Erving Goffman's dramaturgical perspective. Our conclusions are that the participants of the study at the time prior to the self-harming behaviour felt as outsiders, and that they lacked strategies for dealing with emotions. We also found that functional relationships had an important role for the participants to enable the cessation of the deliberate self-harming behaviour. At the time when the participants managed to end the self-harming behaviour, they all had developed more functional relationships and did not feel the same alienation. They also feel that they have a different identity now than they had during the period of deliberate self-harm.         Keywords: Deliberate self-harm, identity performances, turning points, narrative   Nyckelord: Självskadebeteende, identitetsuttryck, vändpunkter, narrativ

In this study the aim is to examine how employees in treatment programmes relate to girls that self-harm. To achieve this four questions were formulated: (1) What experiences does the empolyees have of meeting girls that self-harm? (2) Based on the employees’ experiences, what has been the background to why the girls self-harm? (3) Based on the employees’ experience, what increases or decreases the risk of self-harm? (4) How do the employees’ work with girls that self-harm? The method being used was qualitative interviews with vignettes. The theoretical framework is Becker’s Labeling Theory and Bronfenbrenner’s Ecology of Human Development. The result shows that according to the employees issues in the family is a common factor among girls that self-harm. It also shows that the employees’ opinions on how to work with the girls’ physical wounds are divided. Some think that paying attention to the wounds can increase the risk of self-harm while others think that paying attention to the wounds can be helpful for the girls.

SAMMANFATTNING Vårdpersonal möter patienter med självskadebeteende på olika avdelningar inom sjukvården. Vårdpersonalen har ofta svårt att bemöta denne patientgrupp eftersom de trots allt vårdar patienterna efter bästa förmåga ändå skadar sig igen. Detta väcker frustration och negativa känslor som vrede och mindre sympati för dessa patienter. Oftast är det unga kvinnor som lindrar sin ångest med att skada sig själva medan unga män oftare väljer att vara våldsamma eller aggressiva. Syftet med studien var att belysa vårdpersonalens uppfattning och bemötande av patienter med självskadebeteende. Metoden är en artikelgranskning. Resultatet visade att det är viktigt att vårdpersonal ser, förstår och bemöter patienterna med respekt för att de skall få ett bättre självförtroende. Varje person är unik och en egen individ. Det är därför viktigt att se bakom självskadande för att se till varje persons behov och förstå att det oftast är andra problem som ligger bakom självskadandet. Vårdpersonal med utbildning till att vårda patienter med självskadebeteende är bättre på att ta hand om dessa patienter än personal utan utbildning. Mera kunskap och utbildning om självskadandet skulle hjälpa personal till att upptäcka problemet tidigare. Vården skulle då bli bättre och kanske kortare för patienter med självskadebeteende.

<p>Den psykiska ohälsan bland unga kvinnor ökar i samhället idag.  Självskadebeteendet kan vara ett sätt för dem att lindra sin ångest. Tidigare forskning visar att sjuksköterskor upplever en vanmakt och osäkerhet inför denna patientgrupp. Syftet med denna studie är att, genom kvalitativ analys av fyra självbiografier, beskriva unga kvinnors upplevelser av självskadebeteende. Resultatet bygger på fyra huvudkategorier med vardera två subkategorier som illustreras och förtydligas med citat från författarna. Huvudkategorierna speglar fyra områden som har stor betydelse för utvecklingen av självskadebeteendet. Resultatet beskriver författarnas gemensamma erfarenheter av självförakt och utanförskap, samt deras olika uppväxtförhållanden och personligheter. Diskussionen betonar att vårdpersonalen bör närma sig lidandet bakom självskadebeteendet med förståelse och respekt, vilket kräver kunskap om patienter som skadar sig själva.</p><p> </p><p> </p><p> </p> / <p>The mental unhealthiness amongst young women is increasing in society today. Self-harm behaviour can be a way for them to alleviate their anxiety. Previous research shows that nurses perceive powerlessness and uncertainty for this population. The purpose of this study is to describe the experiences of self-harm behaviour in young women through qualitative analysis of four autobiographies. The result is based on four major categories, each with two subcategories, illustrated and clarified with quotations from the authors. The major categories reflect four areas of key importance to the development of self-harm behaviour. The result describes the authors' common experience of self contempt and alienation, and their different growing conditions and personalities. The discussion emphasizes that health care providers should approach the suffering behind self-harm behaviour with understanding and respect, which requires knowledge of patients harming themselves.</p>

<p>SAMMANFATTNING</p><p>Vårdpersonal möter patienter med självskadebeteende på olika avdelningar inom sjukvården. Vårdpersonalen har ofta svårt att bemöta denne patientgrupp eftersom de trots allt vårdar patienterna efter bästa förmåga ändå skadar sig igen. Detta väcker frustration och negativa känslor som vrede och mindre sympati för dessa patienter. Oftast är det unga kvinnor som lindrar sin ångest med att skada sig själva medan unga män oftare väljer att vara våldsamma eller aggressiva. Syftet med studien var att belysa vårdpersonalens uppfattning och bemötande av patienter med självskadebeteende. Metoden är en artikelgranskning. Resultatet visade att det är viktigt att vårdpersonal ser, förstår och bemöter patienterna med respekt för att de skall få ett bättre självförtroende. Varje person är unik och en egen individ. Det är därför viktigt att se bakom självskadande för att se till varje persons behov och förstå att det oftast är andra problem som ligger bakom självskadandet. Vårdpersonal med utbildning till att vårda patienter med självskadebeteende är bättre på att ta hand om dessa patienter än personal utan utbildning.</p><p>Mera kunskap och utbildning om självskadandet skulle hjälpa personal till att upptäcka problemet tidigare. Vården skulle då bli bättre och kanske kortare för patienter med självskadebeteende.</p>

Research that explores the relationship between suicide and self-injury is limited, and the lack of clarity surrounding this topic can present challenges for professional counselors. Although persons who self-injure are at an increased risk for suicide (e.g., Toprak, Cetin, Guven, Can, & Demircan, 2011; Chapman & Dixon-Gordon, 2007), not all individuals who engage in self-injurious behaviors attempt or complete suicide (e.g., Hawton & Harriss, 2008; Howson, Yates, & Hatcher, 2008). Research on common and distinct risk factors for suicide and self-injury (e.g., Andover, Primack, Gibb, & Pepper, 2010; Brausch & Gutierrez, 2010; Greydanus & Apple, 2011; Hawton & James, 2005; Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Toprak et al., 2011; Wichstrom, 2009), as well as emotional antecedents and consequences for suicide and self-injury (e.g., Chapman & Dixon-Gordon, 2007), has contributed to our understanding of this complex relationship. However, the specific nature of the relationship remains unclear. This study serves to help fill the gap in the literature by examining advanced professional counselors’, as measured by the Supervisee Levels Questionnaire-Revised, conceptualizations of the relationship between suicide and self-injury and by exploring how the presence of self-injury impacts clinical assessment and interventions. Data was collected by means of an online survey. Analysis was conducted by a research team using qualitative content analysis. Seven categories emerged, including: relationship between suicide and self-injury, functions of self-injury, associated risk, suicide risk assessment, treatment planning and goals, intervention, and identification of self-injury.