Bakgrund:Ett av dagens problem är att vårdpersonal i mötet med föräldrar till barn med självskadebeteende, har en brist på förståelse för deras upplevelser. Föräldrars upplevelser är viktiga för vårdpersonal att veta om för att kunna ge god omvårdnad utan att vara dömande. Syfte: Syftet var att beskriva föräldrars upplevelser av att ha ett barn med självskadebeteende. Metod: Studien gjordes som en litteraturstudie baserad på sju kvalitativa artiklar. Resultat: I litteraturstudien framkom fyra huvudkategorier: Föräldrarna upplevde hjälplöshet, föräldrarna riktade sin ilska mot barnet, föräldrarna kände att det var deras fel och föräldrarna upplevde en brist på hjälp. De framkom även att flera föräldrar upplevde en brist på hjälp från vården. De visste inte var hjälpen fanns att söka eller var de skulle vända sig för att få stöd. Föräldrarna tror att de lättare kunnat hantera livet om de fått hjälp av vården. Diskussion: Bristen som föräldrarna upplevde av vården kan bero på felfördelning av resurser. Hade mer ekonomiska resurser prioriterats på vård av anhöriga, hade kanske behandlingstiden förkortats för barnet. Föräldrarna hade också känt sig mer meningsfulla och delaktiga i behandlingen. De framkom att föräldraras reaktioner liknar de som förekommer i en kris. Chockfasen, reaktionsfasen, bearbetningsfasen och nyorienteringsfasen är de delar som förekommer i en kris. Slutsats: Familjeperspektivet är viktigt att betona när vårdpersonal möter ett barn med självskadebeteende och deras anhöriga. Sjuksköterskan bör ha kunskap om andra instanser som kan ge stöd till patienten och anhöriga i en kris om de inte själva har kompetensen inom området. Forskning vore önskvärd om hur sjukvårdspersonal ska bemöta föräldrar för att ge bättre omvårdnad. / Background: One of today's problems is that health professionals in meeting with parents of children with self-harm, has a lack of understanding of their experiences. Parents' experiences are important for healthcare professionals to know about in order to provide good care without being judgmental. Objective: The objective was to describe parents' experiences of having a child with self-harm. Method: The study was done as a literature study based on seven qualitative articles. Results: The literature study revealed four main categories: The parents felt helpless, the parents directed their anger against the child, the parents felt it was their fault and the parents experienced a lack of help. They also found that many parents experienced a lack of help from health care. They did not know where help was to look or where to turn for support. Parents think they are more able to deal with life if they received help from health care. Discussion: The lack of parental experiences of care may be due to misallocation of resources. Had more funding priority in the care of relatives, was perhaps shortened the duration of treatment for the child. The parents had also felt more meaningful and involved in treatment. They found that parents' reactions are similar to those encountered in a crisis. Shock phase, reaction phase, processing phase and reorientation phase is the part that occurs in a crisis. Conclusion: The family perspective is important to remember when professionals encounter a child with self-harm and their relatives. The nurse should have knowledge of other agencies that can provide support to patients and families in a crisis if they do not have expertise in the area. Research would be desirable with focus on how the medical staff can provide better care to the parents.

SUMMARY Management of Public Health Teenagers psychological problems and turn for self – harm. Jurgita Čiuvašovienė Supervisor Nida Žemaitienė, Dr. Sc. Assoc. Prof. Department of Preventive Medicine. Faculty of Public Health, Kaunas University of Medicine. – Kaunas, 2005. – P.75 Aim of the study. To find out the psychological burden, experienced by teenagers, aged 15-16 and the reasons of bent for self-harm. Methods. The was carried out an anonymous questionnaire. 480 teenagers, aged 15-16 from Kaunas, Klaipėda and Jurbarkas, took part in the research. We‘ve used for the research Lifestale and coping questionare, which was created in the Oxford University. Microsoft Excel, SPSS 11,0 for Windows computer programs has been used to analyse the research data. Statistically reliable results are those, when p<0,05, P=95 percent. Results. According to the research data, deliberately harm themselves 3,96 % of all questioned teenagers. This data just slightly differs from the other research data (from 1509 teenagers, aged 15-16, deliberately harm themselves, as the average, 6,3% of teenagers, Ystgaard M., Reiholdt P., Husby J. 2002). The main ways of teenagers self-harm are cutting, drinking medicine by huge, non-therapical doses, attempt to drown and jumping from a roof. The main reasons to harm themselves deliberately were after arguing with parents, fights and problems with brothers, problems at studies, and drinking alcohol. The main cause of deliberate self-harm was a wish to... [to full text]

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.

Tyrimo tikslas - nustatyti save žalojančių ir turinčių savižudiškų tendencijų 16-19 metų mokinių asmenybės savybių ypatumus. Tyrime dalyvavo 174 mokiniai (71 mergaitė ir 103 berniukai). Siekiant atskleisti paauglių agresyvumo bruožą, buvo pasirinktas A. H. Buss ir M. Perry (1992) Agresijos klausimynas (angl. The Buss–Perry Aggression Questionnaire), tyrime naudojamos dvi agresyvumo skalės: fizinė agresija ir priešiškumas. Savigarbai matuoti, pasirinkta M. Rosenberg (1965) Savigarbos skalė (angl. Rosenberg Self-Esteem). Siekiant atskleisti paauglių saviveiksmingumo bruožą, pasirinkta R. Schwarzer ir M. Jerusalem (1995) Saviveiksmingumo skalė (angl. General Self-Efficacy scale). Impulsyvumo savybei matuoti pasirinkta E. S. Barratt (1995) Motorinio impulsyvumo skalė (angl. Motor Impulsiveness, Baratt Impulsiveness Scale). Neurotiškumo savybei matuoti buvo pasirinkta H ir S. Eysenck klausimyno (EPQ) (1986) neurotiškumo skalė. Sąmoningai save žalojančiam elgesiui matuoti naudota V. Jonušės (2010) sudaryta skalė, o savižudiškų tendencijų turinčiam elgesiui L. Šeibokaitės (2008) sudaryti klausimai. Rezultatai rodo, kad sąmoningai save žalojantys, turintys savižudiškų tendencijų ir tik turintys savižudiškų tendencijų berniukai pasižymi didesniu nurotiškumo, impulsyvumo, priešiškumo lygiu bei tik turintys savižudiškų tendencijų pasižymi ir didesniu fizinės agresijos lygiu, palyginus su to nedarančiais berniukais. Kontroliuojant savybių tarpusavio ryšius impulsyvumo, fizinės... [toliau žr. visą tekstą] / The aim - to identify personality traits characteristics between 16-19 age school children with deliberate self-harm and suicidal behavior The study included 174 school children (71 females and 103 males). A. H. Buss ir M. Perry (1992) Aggression Questionnaire was applied to measure school children aggression; two scales used in this study: hostility, physical aggression. To measure self-esteem was chosen M. Rosenberg (1965) Self-Esteem scale. To measure children‘s self-efficacy were applied R. Schwarzer ir M. Jerusalem (1995) General Self-Efficacy scale. Impulsivity was measured by E. S. Barratt (1995) Motor Impulsiveness, Baratt Impulsiveness Scale. To measure neuroticism were applied H and S. Eysenck personality questionnaire (EPQ) (1986). To measure deliberate self-harm we used the scale created by V.Jonušė (2010), for suicidal tendencies – questions created by L. Šeibokaitė (2008). The results show that boys who deliberately self-harm and show suicidal behavior, and those who have only suicidal tendencies, but don‘t self-harm, have a higher impulsivity, hostility, neuroticism levels and those who have only suicidal tendencies also have higer physical aggression level, compared with boys who don‘t show such behavior. Controlling the relations between personality traits, impulsivity, hostility and physical aggression importance for boys self-harm and suicidal behavior disappears. Boys self-esteem and self-efficacy are not related to boys deliberately self-harm and... [to full text]

Bakgrund: Begreppet självskadebeteende är svårdefinierat och tycks inte ha nått konsensus inom vården. Evidens tyder på en ökad förekomst av, framför allt unga, patienter med självskadebeteende. Patienterna uttrycker ett stort behov av att sjuksköterskorna har en förståelse för deras livsvärld och självskadebeteendets bakomliggande orsaker. Sjuksköterskor å andra sidan upplever att de saknar utbildning och tillfälle för reflektion för att möjliggöra en ökad förståelse och förbättrad vård kring patienter med självskadebeteende. Syfte: Att belysa sjuksköterskans upplevelse av vårdandet av patienter med självskadebeteende inom akutpsykiatrisk öppenvård. Metod: Semistrukturerade intervjuer med sex sjuksköterskor genomfördes vid två akutpsykiatriska öppenvårdsenheter, kvalitativ innehållsanalys användes. Resultat: Det framkom två teman utifrån sjuksköterskans beskrivning av vårdandet av patienter med självskadebeteende: Sjuksköterskans emotionella och kognitiva perspektiv och Sjuksköterskans vårdperspektiv. Sjuksköterskans brist på utbildning samt vikten av debriefing var två viktiga resultat. Slutsats: Resultatet visar att sjuksköterskor som arbetar med patienter med självskadebeteende upplever många starka känslor. Sjuksköterskorna beskriver en känsla av hopp och framtidstro, samtidigt som vårdandet även beskrivs som emotionellt tärande. Ett behov av utrymme för debriefing framkommer liksom ett behov av problemspecifik utbildning. Klinisk betydelse: Det saknas evidens kring omvårdnaden av patienter med självskadebeteende, denna studie ökar kunskapen om de känslor och svårigheter som uppstår i vårdandet av patienter med självskadebeteende. / Background: The concept of self-harm is difficult to define and seems to have no consensus within healthcare. Evidence tells that self-harm is a growing problem, especially among young people. The patients express a great need for understanding from the nurses about their individual life and reasons for self-harm acts. Nurses on the other hand experience a lack of both education and opportunity for reflection to enhance their understanding and care for patient who self-harm. Aim: To illuminate the nurses’, who work in an acute psychiatric care unit, experiences of caring for patients who self-harm. Method: Semi-structured interviews with six nurses were conducted in two acute psychiatric care units, using qualitative content analysis. Results: Two themes were found: ‘nurses’ emotional and cognitive perspective’ and ‘nurses’ health care perspective’. Nurses’ lack of education and need for debriefing are important findings. Conclusion: Results show that nurses working with patients who self-harm, experience a variety of strong feelings. The feelings of hope are described as well as caring for patients who self-harm are experienced as emotionally stressful. Results also show a need for debriefing and specific training and education of caring for self-harm. Clinical significance: There is a lack of evidence about how to care for patients who self-harm, the study provides increased knowledge about feelings and difficulties emerging while caring for these patients.

BAKGRUND: Litteraturen antyder att sjuksköterskor stigmatiserar och diskriminerar patienter med vissa diagnoser, i synnerhet schizofreni och borderline personlighetsstörning (BPS). BPS beskrivs som den psykiatriska diagnos med störst laddning och kring vilken det florerar flest stereotypa fördomar. SYFTE: Genom granskning av befintlig forskning i form av originalartiklar publicerade i vetenskapliga tidskrifter avser denna studie att sammanställa befintlig kunskap om sjukvårdspersonals attityder till patienter med borderline personlighetsstörning med eller utan självskadebeteende. METOD: Systematisk litteraturstudie. Litteratursökningar utfördes i databaserna PubMed, CINAHL och SCOPUS. RESULTAT: 21 studier inkluderades i resultatet. En rad olika studier påvisade en allmänt negativ attityd gentemot patienter med BPS med eller utan självskadebeteende. Vårdpersonal skattade mer negativa erfarenheter av att vårda patienter med BPS i jämförelse med schizofreni och depression. Vårdpersonal tenderade att skatta patienter med BPS som mer farliga, mindre trovärdiga samt ansåg att de hade mindre interpersonella färdigheter. SLUTSATS: Vårdpersonal, inte minst sjuksköterskor uppvisar negativa attityder i en icke försumbar utsträckning till patienter med BPS med eller utan självskadande beteenden. Detta kan leda till en inadekvat vård och behandling för den berörda patientgruppen. / BACKGROUND: The literature shows that nurses stigmatize and discriminate against patients with certain diagnoses, particularly schizophrenia and borderline personality disorder. Borderline personality disorder is generally described as being among the more heavy psychiatric conditions, and therefore very mired in stereotypes and prejudices. AIM: To summarize the current knowledge regarding attitudes of health professionals relating to borderline personality disorder and self-harm. METHOD: Systematic literature review. Literature search was made in the databases PubMed, CINAHL and SCOPUS. RESULTS: 21 studies were included in the results. A variety of studies demonstrated a general attitude of negativity toward patients with BPD with or without tendencies of self-harm. Clinicians reported more negative experiences working with BPD patients than with schizophrenia or depression patients. Caregivers tended to assess BPD patients as being more dangerous, less credible and having less interpersonal skills. CONCLUSION: Healthcare professionals, especially nurses, exhibit negative attitudes to a significant extent toward BPD patients as well as patients with self-harm tendencies. This may lead to inadequate care.

BACKGROUND: Non-suicidal self-injury (NSSI) occurs in 13% to 20% of adolescents, and is often indicative of deeper internal or social problems. A close review of current explanatory models of NSSI suggested that underlying individual sensory preferences may contribute substantial explanations for the self-regulatory functions of NSSI, as well as have implications for treatment approaches. In the context of integrating sensory processing models with prominent functional NSSI models, this dissertation research compared sensory preferences in youth who engaged in NSSI to sensory preferences of youth who did not engage in NSSI. OBJECTIVE: NSSI-engaging youth were hypothesized to have lower threshold sensory preferences (sensation avoiding and sensory sensitive), and higher sensitivity (low threshold) in touch processing, auditory processing, and modulation of sensory input affecting emotional response. Sensory preferences were hypothesized to predict NSSI functionality, and trauma history and symptomology were hypothesized to predict NSSI and sensory preferences. METHODS: Youth (n = 108; 56% female; 43% Hispanic) aged 8-14 completed self-report items regarding knowledge, thoughts, and engagement in NSSI, the Functional Assessment of Self-Mutilation (FASM) to evaluate type and functionality of NSSI, and the Adolescent / Adult Sensory Profile to evaluate sensory preferences (low registration, sensation seeking, sensory sensitive, sensation avoiding). Parents (90% female; Mage = 39.4 (SD = 6.9)) completed the Sensory Profile as a secondary measure of youth sensory preferences and the UCLA post- traumatic stress disorder reaction index (PTSD-RI) to evaluate youth trauma history and symptomology. RESULTS: NSSI-engaging youth (N = 14) scored significantly higher than Non-NSSI-engaging youth (N = 85) in the sensation avoiding (Cohen's d = .83) and low registration (Cohen's d = .66) domains. Auditory sensitivity (youth-reported) significantly predicted NSSI after controlling for age. While parent-reported sensory preferences and trauma history and symptomology were not predictive of NSSI, auditory sensitivity (parent-reported) predicted PTSD symptomology in youth with trauma history. CONCLUSIONS: Results provide preliminary insight into better understanding the self-regulatory role of NSSI, and offer insight into specific sensory preferences of young adolescents who engage in NSSI. In combination with future research, findings contribute to existing comprehensive models of NSSI, and provide evidence for sensory considerations in NSSI treatment.

BACKGROUND: Mental disorders amongst students, has increased, and foremost amongst girls. One way to regulate their emotions, is by deliberate self-harm. Due to their profession, school nurses have the ability to detect self-harm amongst students, and can therefor give them a good professional support. AIM: The aim of this study is to describe the school nurse's experience of deliberate self-harm amongst students. METHOD: The study is based on thirteen interviews with school nurses, via e-mail. The e-mails were then analyzed with an inductive qualitative content analysis. RESULTS: Four major categories were identified; how the pupil handles a feeling, different ways to identify, the signification of cooperation and the pupil need optimum support. The school nurse usually identifies deliberate self-harm at open reception and in healthcare conversations. A majority of the school nurses had unsatisfactory experiences when cooperating with child and adolescent psychiatric, and when cooperating with social services. CONCLUSION: School nurses need to be educated in deliberate self-harm amongst students; and guidance for all school nurses when in contact with student who self-harm themselves should be mandatory. Cooperation between social services, the school and child and adolescent psychiatric need to develop further. / BAKGRUND: Psykisk ohälsa bland elever har ökat och främst bland flickor. Ett sätt att hantera starka känslor kan vara genom självskada. Skolsköterskan är bland annat den profession som kan upptäcka självskadebeteende bland elever och därigenom ge stöd. SYFTE: Syftet med denna studie var att undersöka skolsköterskors erfarenheter när det gäller elever med självskadebeteende. METOD: Tretton mejlintervjusvar från skolsköterskor som analyserats utifrån kvalitativ innehållsanalys med induktiv ansats. RESULTAT: Fyra kategorier identifierades, att eleven hanterar upplevd känsla, att identifiering kan ske via olika forum, att samarbete är betydelsefullt och att eleven behöver optimalt stöd. Skolsköterskorna pekar på att självskadebeteendet är ett sätt att reglerar känslor men även att söka och få bekräftelse. Skolsköterskan identifierar ofta självskadebeteende på den öppna mottagningen eller vid hälsosamtalet. Externt samarbete menar mer än hälften av skolsköterskorna har brister och då i samarbetet med Barn och ungdomspsykiatrin (BUP) samt socialtjänst. Samarbete med föräldrar är något som skolsköterskan ser som viktigt. När inte skolans resurser angående stöd är tillräckligt söks stöd externt för eleven. SLUTSATS: Skolsköterskor behöver utbildning kring elever med självskadebeteende. Handledning för alla skolsköterskor i psykisk ohälsa borde vara obligatoriskt. Elevhälsa, BUP och socialtjänst behöver utveckla ett fungerande samarbete.

Bakgrund: Studier har visat att sjuksköterskor hade bristande kunskap om psykisk hälsa, bristande färdigheter att vårda patienter med självskadebeteende och få eller inga möjligheter att utveckla dessa färdigheter. Sjuksköterskor ansåg att det fanns behov av utbildning och träning inom detta område. Ett holistiskt synsätt innebar att sjuksköterskor ser patienten ur alla perspektiv. Syfte: Syftet var att beskriva hur interventioner påverkar sjuksköterskors bemötande av självskadande och suicidala patienter inom somatisk sjukvård, samt att översiktligt beskriva vilka interventioner som använts. Metod: Litteratursökning gjordes i databaserna PubMed och PsycINFO. 12 vetenskapliga artiklar med kvantitativ, kvalitativ eller mixad design kvalitetsgranskades, analyserades och sammanställdes till en litteraturöversikt. Resultat: Interventionerna påverkade sjuksköterskor genom att de förbättrade bemötandet av suicidala patienter och patienter med självskadebeteende. Attityder, kunskap, förståelse och uppfattning, trygghet och färdigheter förbättrades samt ett behov av fortsatt utbildning sågs efter interventioner. Diskussion: En kombination av flera utbildningsmetoder gav goda resultat. En positiv attityd skapade förtroendeingivande relationer. Kunskap, förståelse och medvetenhet gav bättre förutsättningar för adekvat bemötande. Ett holistiskt synsätt var en förutsättning för en hållbar vård. Slutsats: Litteraturöversikten visade att det framgångsrikt med enkla medel går att förbättra bemötandet av suicidala och patienter med självskadebeteende och därför rekommenderas att alla sjukvårdsavdelningar får möjlighet till en sådan utbildning. / Background: Studies have shown an insufficient knowledge in mental health among nurses. They had a lack of skills in caring for patients who self-harm and suicidal patients and were offered few or no opportunities to develop these skills. Nurses considered a need for education and training in this area. In a holistic view the nurse should see the patient from all perspectives. Aim: The aim was to describe how interventions affect nurses’ caring for suicidal patients and patients who self-harm in physical health care and to give a brief description of these interventions. Method: Articles were searched in the PubMed and PsycINFO databases. Twelve scientific researches with quantitative, qualitative and mixed method where examined, reviewed, analyzed and compiled into a literature review. Results: The interventions affected the nurses by improving their attitude, enhancing their knowledge, understanding, awareness and self-confidence and developing their skills and a need for further education in the caring of suicidal and self-harming patients. Discussion: A combination of interventions gave good results. A positive attitude created confident relationships. Knowledge, understanding and awareness created conditions for an adequate care. A holistic view was essential for a sustainable care. Conclusion: This review showed that the care of self-harming and suicidal patients could be improved with simple means and was therefore recommended to all health care staff.

Introduction: In Pakistan there is dearth of research on deliberate self-harm (DSH) and its predictors among adolescents. While the lack of research in Pakistan can be partly attributed to the sacrilegious status, criminalization and stigmatization attached to DSH, it is also an attribute of paucity of Urdu versions of the standardized psychological instruments. Previous research in developed countries has indicated that attachment theory can be used as a useful framework to understand the development of austere psychopathologies like DSH, as well as for studying pathways of interaction of interpersonal and intrapersonal factors of psychopathologies. In this study, standardized psychological instruments are translated into Urdu language as a first step. These instruments are then used to study pathways of interaction of interpersonal and intrapersonal factors of DSH, conceptualized within attachment framework. Method: The study was conducted in two steps. In step 1, Youth Health Risk Behavior Survey (YHRB), Inventory of Interpersonal Problems-32 (IIP-32) and Significant Others Scale (SOS), were translated into Urdu language. Along with these scales, Urdu translated versions of Hospital Anxiety and Depression Scale (HADS), Adolescent Relationship Scales Questionnaire (ARSQ), Life Events scale (LES) from CASE questionnaire and Family Affluence Scale-II (FAS-II) were reviewed for accuracy of translation through expert judgement and psychometric evaluation. Secondly, a cross sectional survey was conducted with 1290 adolescents (10 - 19 years age) using the translated Urdu versions of the instruments and demographic pro forma. Structural equation modelling was used to study the pathways of associations between predictors of DSH. Results: The extensive process of translation resulted in establishment of semantic, content, technical and construct equivalence of the translated instruments with the original English versions. Multiple imputation was performed to account for missing values in SPSS 20. Important structural adaptations were made in the scales based on factor analyses conducted in M plus. After modifications, all scales showed satisfactory CFI (≥ 0.90) and RMSEA (≤ 0.06). Results of the survey indicated that the prevalence of DSH (with, without and ambivalent suicidal intentions) was 7%. Two SEM models were constructed involving both mediation and moderation pathways. Results of Model 1 showed association of attachment with DSH was double mediated by social support, depression and anxiety. Model 2 also confirmed association of attachment with DSH with double mediation through relationship style problems, depression and anxiety. In order to understand the contextual picture of the concepts studied in this research both SEM models were also constructed by controlling for demographic factors. This resulted in confirming age, gender and family affluence as significant contributors but with very small effects. Discussion and conclusion: In the present study translation of the instruments helped in building a reservoir for future research. The results of translation and validation of instruments indicated that cultural differences, language needs and age must be accounted for while using standardized psychological instruments. Taking into consideration specific cultural and demographic background of Pakistan, this study also confirms the key role of attachment in influencing interaction of predictors of DSH. It is suggested that intrapersonal and interpersonal factors are influential points of intervention for designing clinical, school and community based awareness and prevention programs for DSH. The thesis also discusses the implications for policy guidelines along with recommendations for future research and other applications of the study.