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: Självskadebeteende anses vara vanligt förekommande i dagens samhälle. Beteendet anses inte vara ett uttryck för en vilja att dö utan ett sätt att hantera inre svårhanterad psykisk smärta. Självskadebeteende kan vara svårt att definiera eftersom det finns många olika metoder och svårighetsgrader. Det finns olika uppfattningar om hur prevalensen av självskadebeteende är fördelat mellan könen, den vanligaste uppfattningen är dock att beteendet är mer vanligt förekommande bland kvinnor. Enligt DSM-5 är självskadebeteende ännu inte en egen psykiatrisk diagnos. Syfte: Syftet med studien var att beskriva sjuksköterskors upplevelser av att vårda patienter med självskadebeteende. Metod: Detta är en allmän litteraturöversikt baserad på tio artiklar med kvalitativ ansats publicerade mellan 2002-2014. Resultat: Studien resulterade i fem teman. Dessa teman var: Positiva och negativa känslor, Uppfattning av självskadebeteende, Omvårdnadsrelationen, Upplevelsen av hjälpstrategier samt Arbetsgrupp och arbetsmiljö. Slutsats: Upplevelsen bland sjuksköterskor är att deras okunskap om ämnet är problematiskt i vården av patienter med självskadebeteende, vilket leder till upplevelser av frustration och maktlöshet som kan påverka den vårdande relationen negativt. Relationen bör präglas av visad förståelse, acceptans och engagemang för patienten. Ett realistiskt mål är att sjuksköterskans uppgift inte är att bota patienten, utan snarare att hjälpa patienten till självhjälp. Klinisk betydelse: Denna studie kan vara ett bidrag till kunskap för sjuksköterskor som möter den självskadande patienten, då resultatet ger en inblick i olika vårdkulturer och det kan vara givande att utvärdera arbetet på den egna avdelningen. Detta kan i sin tur bidra med kunskap till intern utbildning och kan användas som diskussionsunderlag.

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.

Background: Self-injury behavior is common in society. Nurses will meet patients with these problems during their daily work. Patients with self-injurious behavior do often feel misunderstood and are often dissatisfied with the health care they are given.   Aim: the aim of the study was to investigate nurses 'experiences of caring for patients with self-injurious behavior and nurses' perceived needs for education in the subject.   Method: A qualitative study with descriptive design was performed in order to explore the nurses’ experience of caring for patients with self-injurious behavior and nurses’ perceived needs for more education in the subject. The data collection consisted of eight semi-structured interviews and was analyzed with a qualitative content analysis.   Results: The results of the interviews develop into four main categories; "Nurses 'perception of self-injurious behavior", "nurses' experience of care", "emotional impact" and "nurses need of education".Nurses where satisfied with their workplace. The nurses have a perception that most patients self-harm as an anxiety-relieving action, but that there are exceptions where patients self-harm in an attention purpose. The nurses are satisfied with their treatment when they are acting low arousal approach, but they do also experience a difficulty in balancing the low arousal approach with the natural reactions that awakes when a self-harm incident happens. The nurses feel dissatisfied with their behavior when they are unsure of how to act. The nurses say they in larger extent became emotionally affected by self-harm when they were new employees on the psychiatric ward. With more experience the nurses became more accustomed to seeing self harm. The nurses are now experiencing a greater emotional impact when health care fails to help patients in the long term. All the nurses who participated in the study want more education in the subject.   Conclusion: The nurses say they thrive in their workplace and their work with patients who self-harm, but they sometimes experience difficulties in caring for these patients. Lack of time, stress and repetitive self-injurious acts are stressful for the nurses. The nurses describe that there is generally a negative attitude among health professionals towards these patients, which the nurses believe can change with more education on the subject. All nurses interviewed wanted more education about self-injury. / Bakgrund: Självskadebeteende är vanligt förekommande i samhället. Sjuksköterskor kommer i sitt dagliga arbete möta patienter med självskadeproblematik. Patienter med självskadebeteende är ofta missnöjda med sjukvården och känner sig missförstådda.   Syfte: Syftet med denna studie är att undersöka sjuksköterskors upplevelser av att vårda patienter med självskadebeteende samt sjuksköterskors upplevda behov av utbildning inom ämnet.             Metod: Denna studie har deskriptiv kvalitativ design. Åtta sjuksköterskor som arbetar på en psykiatrisk slutenvårdsavdelning har intervjuats angående deras upplevelser av att vårda patienter med självskadebeteende.   Resultat: Intervjuerna gav upphov till fyra huvudkategorier; “sjuksköterskornas uppfattning om självskadebeteende”, “sjuksköterskornas upplevelse av omvårdnaden”, “känslomässig påverkan” och “sjuksköterskornas behov av utbildning”. Resultatet visar att sjuksköterskorna är nöjd med sin arbetsplats och med patientgruppen. Sjuksköterskorna har en uppfattning om att de flesta patienter självskadar i ångestlindrande syfte men att det finns undantagsfall då patienter självskadar i uppmärksamhetssyfte. Sjuksköterskorna är nöjda med sitt bemötande då de agerar lågaffektivt men upplever samtidigt en svårighet i att balansera det lågaffektiva bemötandet med deras naturliga reaktioner vid en självskadeincident. Sjuksköterskorna beskriver att de blir missnöjda med sitt bemötande när de är osäkra på hur de ska agera vid självskadeincidenter. Sjuksköterskorna uppger att de i större mån blev känslomässigt påverkade av självskadebeteende när de var nyanställda på den psykiatriska avdelningen men att de med erfarenhet blivit mer vana vid att se självskador. Sjuksköterskorna upplever en större känslomässig påverkan när sjukvården inte lyckas hjälpa patienter långsiktigt. Alla sjuksköterskor som deltog i studien önskar mer kunskap om självskadebeteende.   Slutsats: Sjuksköterskorna uppger att de trivs bra på sin arbetsplats och att arbeta med denna patientgrupp men upplever ibland svårigheter i vårdandet av patienter med självskadebeteende. Tidsbrist, stress och upprepande självskadehandlingar är påfrestande för sjuksköterskorna. Sjuksköterskorna beskriver att det generellt finns en negativ attityd bland vårdpersonal gentemot dessa patienter, vilket sjuksköterskorna tror kan förändras med mer utbildning inom ämnet. Alla sjuksköterskor som intervjuades önskade mer kunskap om självskadebeteende.

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.

Concerns about suicide and self-harm in English prisons are not new (Third report of the commissioners of prisons, 1880, cited in Liebling, 1992). However, a distinct system of intervention and custody for children (as established by the Crime and Disorder Act 1998) is relatively modern, and as such contextual studies about self-harm have largely, to date, overlooked children as a discrete group existing within a separate framework from adults. Similarly, large-scale research exploring self-harm among children in community settings has largely excluded the group of marginalised young people who come to the attention of youth justice services. This study presents a unique analysis of 181 youth justice assessments (‘Assets’) for boys who were remanded or sentenced to custody in under-18 Young Offender Institutions during 2014-15, tracing the subjects of the assessments from the communities they offended in through to a period in custody, using incident reports completed whilst they were there. What results is a contextual study examining the characteristics of the boys and their behaviour in custody. The study considers two central hypotheses: first, that to result in meaningful and supportive interventions, a definition of self-harm among the boys in the research sample often needs to include the harm they have done to their own lives (what the middle classes might call their ‘prospects’) through offending, and, second, that children who display the common traits of self-harming behaviour in custody may be identifiable by a different set of characteristics and needs from those who self-harm in the community. The author concludes that there is a previously undefined set of risk factors which can be applied to children who self-harm in custody for the first time, moving beyond the known risks associated with adolescent self-harm in the general population. Furthermore, it is found that boys who self-harm in custody are often oing so to exercise agency in an environment where they have very limited power, in circumstances defined not only by the restriction of liberty they are experiencing, but by the difficulties they experienced before coming to custody. Recommendations are made as to how policy-makers, through the current reforms to the youth justice system and a revised approach to assessments upon entry to custody, and practitioners, through increased awareness and improved recording of children’s views can more appropriately intervene in these boys’ lives to benefit them and society more widely.