Background: Suicide is the second leading cause of death among 15 to 29 year olds and 79% of global suicides occur in low- to-middle income countries. South Africa has the eight highest rate of suicide in the world, evidence that suicide is a serious public health concern. Identifying socio-demographic and clinical factors associated with high risk of serious self-harm or suicide, may be useful for improving patient care and strengthening appropriate referral pathways. Aim: To determine the sociodemographic and clinical factors associated with elevated levels of suicidal intent among self-harm patients who presented for treatment in the emergency room of an urban hospital in Cape Town, South Africa. Setting: A retrospective folder review of all patients who presented for treatment of deliberate self-harm to Groote Schuur Hospital. Methods: During the time period, 238 consecutive presentations for deliberate self-harm were identified and recorded on a data capture form.which obtained information about demographics, clinical characteristics and suicidal intent. The data was analysed using bivariate and multivariate analyses. Results: In our sample of 238 patients, 128 (54%) self-reported an elevated level of suicidal intent. Being of male gender, higher levels of education and having multiple reasons for selfharm were significant predictors of an elevated level of suicidal intent. Conclusion: Suicide is increasingly recognised as a serious public health problem globally, and in South Africa. Determining the socio demographic and clinical correlates for those at increased risk of suicidal behaviours, provides useful information on identifying vulnerable patients. This allows clinicians to improve patient risk assessment and public health awareness interventions may be closer targeted to at risk groups

no / Background: Self-harm (self poisoning and self-injury) is broadly characterised as any act intended to harm one's own body, without a conscious intent to die. Research indicates that when practitioners encounter self-harm they often remain anxious, fearful, frustrated, and challenged about such individuals, principally because they are constrained to understand and respond to self-harm almost exclusively within a problematised discourse (Walker, 2006). That is, a problem that must be diagnosed and contained. Women who self-harm with a diagnosis of BPD are often portrayed as being risky, chaotic and their identity can be unstable. The aim of this study was to examine and explore the subjective experiences of women who self-harm with a diagnosis of BPD. Participants: Four women who had a history of self-harming behaviour with the diagnosis of BPD volunteered for the study. Method: Face-to-face, in-depth narrative interviews were undertaken and were analysed within a framework which drew upon aspects of the ¿performance¿ (Langellier, 1989; 2001) and ¿narrative thematic¿ approaches (Reissman, 1993). Findings: Two of the participant's accounts illustrate how their self-harming appeared to have affected their selfhood and sense of agency. They discuss how the external signs of self-harm may take over their identity and how others communicate and interact with them. Despite the problematic nature of self-harm implications for practice are highlighted which practitioners may draw upon in their work around self-harm.

Yes / The aim of this study is to determine emergency nurses’ knowledge about, and perceived ability to support, people who are suicidal. A questionnaire consisting of 34 questions was sent out to 113 adult emergency nurses employed in two emergency departments. A total of 38 responded. Findings highlight differences in attitudes and show a correlation between suicide prevention training and nurses’ perceived competence to triage people who are suicidal. The article makes recommendations for future research, as well as nurse education and training on suicide prevention, to improve attitudes and increase emergency nurses’ ability to respond effectively to people who are suicidal.

This thesis presents four studies that examine the potential role that intrusive thoughts, dissociation and mindfulness in self-harming behaviours in young people and adults. A large online study was conducted with students and staff at a UK university. This examined a range of risk factors for self-harm derived from the literature, including dissociation, family background/trauma history and intrusive thoughts. This study was followed up with a qualitative study investigating triggers of self-harm, and the role of intrusive thoughts. A third study then looked at these factors in young people who were inpatients in an American psychiatric hospital, and who had all expressed intent to self- harm or commit suicide. This study also introduced a measure of trait mindfulness in order to investigate this potential way of dealing with intrusive thoughts. Finally, the risk factors identified in these studies were further investigated with an online survey with undergraduate students at a second UK university, dissociation, mindfulness and thought suppression. Intrusive thoughts were found to differ in content, frequency and effect between people with experience of self-harm and those without. A subgroup of potentially maladaptive behaviours were found to be associated with high scores on the predictors of self-harm, and therefore potentially predictive of self-harm. In the young people in hospital, the extent to which they reacted to their intrusive thoughts was inversely associated with the extent to which they were naturally mindful. Trait mindfulness scores were lower for those individuals with a history of childhood trauma, and for those meeting diagnostic criteria for Borderline Personality Disorder, in which self-harm is a key feature. These findings together suggest that mindfulness skills may play an important role in both dealing with intrusive thoughts and for protecting against self-harm. Overall, intrusive thoughts and dissociation were associated with experience of self- harming behaviours, while mindfulness skills were negatively associated with self-harm. Some potentially maladaptive behaviours (including smoking and eating pathology) represent risk factors for self-harm, and therefore may provide professionals with a way of identifying people for early intervention, if further longitudinal research shows evidence of progression. Alternatively, the differences in mindfulness between this group and the self-harmers may indicate that mindfulness training could benefit people who self-harm.

Author: Madeleine Ahlström and Hanna Puonti Title: To meet the invisible population - A qualitative study of men with deliberate self-injury [Att möta de osynliga - En kvalitativ studie om killar med självskadebeteende] Supervisor: Anders Östnäs Assessor: Jan Petersson   This study aims to provide a picture of the underlying causes why men deliberately hurt themselves. It also aims to provide a picture revolving how men self-harm and what the direct effects are from their self-harm. The study describes their behaviour and how the behaviour has evolved over time. There is also a focus in the study to illustrate how society´s operative approach towards men makes their self-harm invisible, and make them an invisible population that neither the scientists nor the general population chooses to see. Self-injury is strongly associated with girls and their way of harming themselves. Men have been excluded from studies of self-injury, also have there been very few scientists that found them of interest to study.   This is a study with a qualitative approach wich executed eight semi-structured interviews with men who have had a behavior of self-injury. The study takes on a hermeneutic approach to knowledge, to have the possibility to interpret in the analysis of the empirics. To analyse the data we have used a qualitative content analysis according to Graneheim and Lundman (2004). The results has been analysed by Antonovsky´s (2005) KASAM theory. The study has found that men have a self-injury that is multifaceted. The men in the study use different behaviours to manage various emotional factors that affect them. Deliberate self-injurious behaviours become a coping strategy for the men when they didn’t have other strategies to cope with when their faced difficulties.

Bakgrund: Självskadebeteende innebär att en person avsiktligen tillfogar sig fysiska kroppskador. Personer med ett självskadebeteende beskrivs som en svår grupp att behandla. Både inom somatisk och psykiatrisk vård framkom det att vårdpersonal upplevde det svårt att hantera och vårda personer med ett självskadebeteende. Syfte: Syftet med denna litteraturstudie var att belysa vårdpersonalens erfarenheter av och attityder till att vårda personer med ett självskadebeteende. Metod: Tio kvalitativa vetenskapliga artiklar utgör resultatet i denna litteraturstudie och kvalitetsgranskades med IMRAD-modellen. Innehållsanalys med en manifest ansats användes för att granska, analysera och sammanställa resultatet. Resultat: Det resultat som framkom sammanställdes i fyra huvudkategorier. Dessa var vårdpersonalens kompetens och förhållningssätt, vårdpersonalens känslomässiga reaktioner, hanteringsstrategier för att klara arbetet och organisationens inverkan. Slutsats: Bristfällig utbildning och negativa attityder försämrar omvårdnaden. Det är därför viktigt att vårdpersonal får utbildning och handledning för att de ska få verktyg att hantera sina känslor och därigenom medverka till god omvårdnad för personer med ett självskadebeteende. / Background: Self-harm behaviour means that a person intentionally inflict physical injury to the body. Persons with a self-harm behaviour is described as a difficult group of patients to attend. Caregivers in the somatic and psychiatric care experienced it hard to handle and care for people with a self-harm behaviour. Aim: The aim of this study was to describe caregivers’ experiences of and attitudes towards caring for persons who engage in self-harm. Method: Ten qualitative scientific articles constitutes the result of this study and was quality-assured with the IMRAD-model. Content analysis with a manifest approach was used to examine, analyze and compile the results. Results: The results obtained were summarized in four main categories. These were caregivers’ competence and approach, caregivers’ emotional reactions, coping strategies to cope with the work and impact of the organization. Conclusion: Lack of education and negative attitudes deteriorates caring. Therefore it is important that caregivers’ get education and supervision so that they get tools for the management of feelings and thereby being able to participate in providing a good care for persons with a self-harm behaviour.

This thesis comprises a narrative exploration of the lived experience of being someone who has self-injured. Self-injury, like pain, emotions, sensation and social life, is understood and examined as inherently embodied. The thesis is intended to contribute to sociological approaches to the study of embodiment and to sociological understandings of self-injury. Twelve participants were recruited in non-clinical sites. The sample was heterogeneous in terms of their experience of self-injury, contact with medical and psychiatric services, socio-economic background, household type, age and sexuality. Both men and women were interviewed in an attempt to counter the relative neglect of men in previous research. Two interviews were carried out with each participant: the first was a life-story interview, while the second explored self-injury more directly. The approach to data collection and analysis was intended to be collaborative, and comprised both narrative and thematic techniques. The thesis demonstrates the importance of studying self-injury as an embodied, socially situated and socially mediated behaviour. An embodied approach underlines the importance of the visibility of self-injury. The existence of visible marks and scars created by self-injury were important aspects of the lived experience of participants. The ways in which these marks were negotiated in social life represented a key focus of analysis. My analysis reveals the importance and utility of attending to the practical and material aspects of self-injury in attempting to understand the behaviour. I highlight the diverse ways in which self-injury is practised, and the equally various meanings and understandings it holds for practitioners A variety of complex and contradictory justifications for self-injury are critically examined. These justifications share a concern with pain, incarnate, suggesting that self-injury is: a method of transforming emotional pain into physical pain; a way of relieving emotional pain; painful; painless; attention-seeking; private. A sociological, narrative analysis illuminates the ways in which these understandings and justifications can be located within biographical, interpersonal and socio-cultural contexts. By locating these justifications within socio-cultural contexts, the complexities and contradictions of the accounts become understandable. My analysis confirms the importance of attending to socio-cultural understandings of bodies, emotions, authenticity and morality in exploring narratives about self-injury.

När ett barn har ett självskadebeteende påverkas föräldrarna, de hamnar i konflikter med varandra, familjedynamiken vänds upp och ned och syskonen hamnar i skymundan. Sjukskö-terskan har därför en viktig roll, att inte bara vårda och se till det sjuka barnet, utan se famil-jen som en helhet. Författarna till examensarbetet har valt att belysa föräldrars upplevelser av att ha barn med självskadebeteende. I Sverige är psykisk ohälsa bland barn och unga ett växande problem. Personer med självska-debeteende upplever oftast även någon form av psykisk ohälsa. Drygt 2,300 kvinnor och 1,300 män i åldern 15-29 år vårdades år 2011 för själskadebeteende men det finns olika typer av vårdformer samt söker inte alla hjälp, därför finns troligtvis ett stort mörkertal. Självskadebeteende och självmordsförsök ses allmänt som en komplikation vid psykisk ohälsa, där den vanligaste ohälsan är depression. Självskadebeteende och självmordsförsök skall dock inte förväxlas som samma fenomen, då självmordsförsök handlar om att avluta sitt liv. Självskadebeteende definieras med att avsiktligt skada sin kropp, utan avsikt till själv-mord. Föräldrar till barn med självskadebeteende kan känna sig misslyckade och maktlösa. De kän-ner även en skuld och skam över barnets beteende. Det är känslomässigt ansträngande för dem att hantera situationen. Det är därför av stor vikt att de får rätt handledning och stöd för att på bästa sätt kunna hjälpa sitt barn. Föräldrarna kunde känna en avsaknad av kunskap och förståelse gällande deras barns självskadebeteende. Sjukvårdpersonalen kan stötta föräldrarna genom att förmedla kunskap och information. De ska även undervisa, motivera, ge rådgivning samt emotionellt och praktiskt stöd till hela familjen. Insatserna bör utföras av sjuksköterskan i ett nära samarbete med andra yrkesgrupper för att få en så bra familjeorienterad vård som möjligt. / Background: Mental illness is a growing problem in society and is increasingly seen in younger people. Deliberate self-harm is seen as a complication of mental illness. Self-harm means that people intentionally injure themselves as a habit and with more or less severe de-gree, but with no intention to take their own life. Aim: The aim of the study is to illustrate parents’ experiences of their child’s deliberate self-harm behavior. Method: A literature-based study based on analysis of ten qualitative articles. Results: The results are presented in three main themes and ten subthemes. The first main theme is "A roller coaster of feelings", with three subthemes "First battle", "Feelings of guilt and shame" and "Anxiety and fear". The second main theme is "Parenthood and family rela-tionship" with four subthemes "Changing positions of power", "Parents in conflict", "Not being enough as a parent" and "A changed relationship". The last main theme is "Parents ex-perience of support" with three subthemes "The insufficient support", "Feeling seen" and "To get support from the surroundings". Conclusion: Health care professionals need to create a good relationship with both parents and patients, which can be done by meeting the parents' feelings and being responsive.

This study examines the impact features of nonsuicidal self-injury (NSSI) have on predicting a suicide attempt in a sample of young adult self-injurers. Participants completed the Inventory of Statements About Self-Injury, the Self-Harm Behavior Questionnaire and demographics questionnaires to assess lifetime self-injury frequency, number of different methods used, severity of methods, the desire to stop self-harming, functions, the experience of pain, and response latency. Results indicated that NSSI frequency, high severity methods, and endorsing more intrapersonal functions predicted the presence of a suicide attempt. Additionally, those who experienced pain while selfinjuring were found to be significantly more likely to report a history of suicide attempt compared to those who did not feel pain. Given extant literature, these findings suggest that in general the relationship between NSSI and suicidality is more complex than suggested and differs depending on which feature of suicidality is being measured (e.g. ideation, threats, gestures, plans, or attempts). Aside from other important implications discussed, researchers should individually evaluate facets of suicide when establishing risk.

Background: Self-harm is used to describe a group of diseases where the persons intention is to hurt thereself. This collective name includes conditions such as anorexia, burning, poisoning and self-cutting. The act of self-harm is almost never related to the patients' wish of death, it's more of a tool for the person to calm herself. Previous research shows that nurses often see these patients as troublesome often because of a lack of knowledge. There's just a few studies that examine the patients' views. Aim: The aim of this study was to describe how patients with self-harm was experiencing the meeting with the nurse. Method: The study was designed as a literature based study based on 12 qualitative articles. All articles are read and analyzed by Friberg (2012) model with the analysis of qualitative research. Results: The result of this study showed that the nurse plays a big part in how the patients experienced their treatment. If the patient feels that the nurse doesn't see, hear or respect her, the patient starts to feel that she is not worth health care. For the patient to feel and get better it's essential that there is a functional relationship between the patient and the nurse. Conclusion: Patients who self-harm is a difficult patientgroup to treat if there is a lack of knowledge. But these patients are dependent on the care that the nurse is providing them. Therefore a caring and trusting relationship is a must to provide high quality care.