Bakgrund: Att skada sig själv är ingen ny företeelse utan tvärtom ett gammalt fenomen. I Sverige är det svårt att uppskatta antalet personer som skadar sig eftersom det finns få studier gjorda och för att det finns ett stort mörkertal som aldrig uppmärksammas. Att skära sig i huden är förmodligen det vanligaste sättet att skada sig på och orsakerna till självskadebeteendet varierar. Syfte: Syftet med litteraturstudien var att beskriva omvårdnad av patienter med självskadebeteende. Metod: Studien är baserad på 10 vetenskapliga artiklar. Resultat: Resultatet presenteras ur två olika perspektiv, omvårdnad ur patientperspektiv och omvårdnad ur personalperspektiv. Patienterna ville bli behandlade med värdighet, och att någon fanns till hands upplevdes betydelsefullt. Personalen försökte se människan bakom skadan och menade att grunden till en god omvårdnad byggde på empati där förförståelsen skulle läggas åt sidan. Diskussion: Det mest betydelsefulla var att se patienten som en människa och inte bara som en person med problem. Om personalen var empatisk uppnåddes tillit och förtroende. / Background: Self-harm is not a new problem, it´s rather an old phenomenon. In Sweden, it is difficult to estimate the number of people who harm themselves. There are few studies done and there is a large dark figure that is difficult to estimate. To cut the skin is probably the most common way to inflict self-harm and the causes varies. Purpose: The purpose of the literature study was to describe nursing care of patients with self-injury behaviour. Method: The study is based on 10 scientific articles. Result: The result is presented from two perspectives; nursing care from the patient perspective and from the nursing staff perspective. Patients wishes to be treated with dignity, and that someone being available was important. The staff tried to see the person behind the injury, and the caring was based on empathy, where the understanding of the behaviour should be set aside. Discussion: The most important objective was to see the patient as a person and not just as a person with problems. If the staff were empathetic, trust and confidence was achieved.

<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>

The present study examined the experience of self-cutting, what stops adolescent girls from engaging in self-cutting, and what message adolescent girls who are self-cutting would want to send to other girls taking part in this behavior. Using an existential-phenomenological method of interviewing, adolescent girls were asked a serious of questions in order to gain insight into their thoughts, feelings, and beliefs about the experience of self-cutting. Each interview was tape recorded, transcribed, and thematized. The participants in this study were labeled co-researchers due to the significant role that they had in the completion of this study. The co-researchers consisted of six adolescent girls aged 15 to 18 years old. They all attended high schools within a large urban school district in Florida. Through a reduction of the data obtained during the interviews, five superordinate themes were discovered for the first research question, which examined the experience of self-cutting. The themes depicted the following experience. Before engaging in self-cutting, each co-researcher had "A Lot of Feelings" stemming from "A Big Event" that they needed to "Release." They chose cutting because "Nothing [else] Ever Worked" and the act of cutting made them "Numb" and feel "No Pain." Themes developed from the second research question, which examined what stops adolescent girls from self-cutting, included "Thinking About the People Who Care" or when "Thinking About the Consequences" of cutting. If they could send a message to other girls who are cutting, the co-researchers in this study would say "Don't Do It." The co-researchers were able to articulate other coping strategies to serve the same function as cutting but sometimes refused to implement them. Results of this study support the findings of previous research.

The purpose of this investigation was to examine the role of distress tolerance in suicidality among Black college students. It was hypothesized that (1) individuals with low levels of distress tolerance would report higher levels of suicide ideation; (2) individuals with high levels of distress tolerance would report greater suicide attempts; (3) social support would moderate the relationship between distress tolerance and suicide ideation; (4) social support would moderate the relationship between distress tolerance and suicide attempts; and that (5) family and peer support would act as distinct buffers against suicidality. These hypotheses were tested by surveying 47 undergraduate university students (female = 49%; mean age = 22.45). Participants completed packets with self-report measures that included: the Self-Harm Behavior Questionnaire, the Distress Tolerance Scale, the Child and Adolescent Social Support, and demographics. Results suggested that individuals with low levels of distress tolerance showed greater history of self-harm behavior when compared to individuals with high levels of distress tolerance. Results indicated that social support moderated the relationship between distress tolerance level and history of self-harm behaviors. Results also indicated that family support acted as significant protective factor against suicidality.

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.

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]

Abstract   Author: Robert Andersson &amp; Oskar Karlsjö Title:“My first thought is a girl that cuts herself” – A qualitative study about professionals in human service organizations description of self-injurious behavior. Supervisor: Ann Ottengrim Assessor: Rickard Ulmestig   The purpose of this study has been to understand how professionals in human service organizations (HSO) describe self-injuries behaviour, how they describe the individuals that self-harm and if the professionals describe any possible differences in how men and women self-harm as well as how professional’s knowledge concerning self-injurious behaviour is contructed. The study answers three questions; - What kind of actions do professionals in HSO describe as being self-injurious behaviour? - How is knowledge constructed by professionals in HSO concerning self-injurious behaviour? - How are people who engage in self-injurious behaviour being described? - How do professionals in human service organizations describe potential differences between men and women´s self-injurious behaviour?   Qualitative interviews have been chosen as the method in this study to gather empirical data and the social constructionism theory has been implemented to analyse the empirical data. The result of this study shows that self-injurious behaviour is a complex and at the same time a dynamic phenomenon. There are a lot of different actions that are being describes as being self-injurious behaviour. An individual that cuts its own body tissue or an individual that often gets involved in psychical fights are examples of acts that are being described as having a self-injurious behaviour. The informants also described that their knowledge and what they define as self-injurious behaviour has changed over time in the field which indicates that self-injurious behaviour is a dynamic category. According to our results it doesn’t seem to exist a stereotype of whom and why someone engages in self-harm. But men tend to self-harm in a more severe way than women.

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.