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Abou Seif N, John-Baptiste Bastien R, Wang B, Davies J, Isaken M, Ball E, Pitman A, Rowe S. Effectiveness, acceptability and potential harms of peer support for self-harm in non-clinical settings: systematic review. BJPsych Open 2022; 8:e28. [PMID: 35034666 PMCID: PMC8811789 DOI: 10.1192/bjo.2021.1081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/19/2021] [Accepted: 12/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many people who have self-harmed prefer informal sources of support or support from those with lived experience. However, little is known about whether peer support improves outcomes for people who have self-harmed or about the risks of peer support interventions in non-clinical settings. AIMS The aims of this review were to examine the effectiveness, acceptability and potential risks of peer support for self-harm, and how these risks might be mitigated. METHOD We searched bibliographic databases and grey literature for papers published since 2000. We included peer support for self-harm that occurred in voluntary-sector organisations providing one-to-one or group support, or via moderated online peer support forums. RESULTS Eight of the ten papers included focused on peer support that was delivered through online media. No study compared peer support with other treatments or a control group, so limited conclusions could be made about its effectiveness. Peer support for self-harm was found to be acceptable and was viewed as having a range of benefits including a sense of community, empowerment, and access to information and support. The most commonly perceived risk associated with peer support was the potential for triggering self-harm. CONCLUSIONS Our findings highlighted a range of benefits of being part of a group with very specific shared experiences. Mitigations for potential risks include organisations using professional facilitators for groups, trigger warnings for online forums, and providing regular supervision and training so that peers are prepared and feel confident to support vulnerable people while maintaining their own emotional health.
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Affiliation(s)
| | | | - Belinda Wang
- Division of Psychiatry, University College London, UK
| | | | | | | | - Alexandra Pitman
- Division of Psychiatry, University College London, and Camden and Islington NHS Foundation Trust, UK
| | - Sarah Rowe
- Division of Psychiatry, University College London, UK
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Pitkänen J, Remes H, Aaltonen M, Martikainen P. Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults. BMC Psychiatry 2022; 22:14. [PMID: 34986806 PMCID: PMC8728977 DOI: 10.1186/s12888-021-03654-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. METHODS The study is based on Finnish administrative register data on all individuals born 1986-1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16-21 in 2002-2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. RESULTS An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34-0.43, and after 0.29, 95% CI 0.25-0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18-0.26, and after 0.18, 95% CI 0.14-0.22). The largest differences were observed in inpatient care. CONCLUSIONS The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.
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Affiliation(s)
- Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland. .,International Max Planck Research School for Population, Health and Data Science, Rostock, Germany.
| | - Hanna Remes
- grid.7737.40000 0004 0410 2071Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014 Helsinki, Finland
| | - Mikko Aaltonen
- grid.7737.40000 0004 0410 2071Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland ,grid.9668.10000 0001 0726 2490Law School, University of Eastern Finland, Joensuu, Finland
| | - Pekka Martikainen
- grid.7737.40000 0004 0410 2071Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014 Helsinki, Finland ,grid.419511.90000 0001 2033 8007Max Planck Institute for Demographic Research, Rostock, Germany ,grid.10548.380000 0004 1936 9377Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Brennan C, Saraiva S, Mitchell E, Melia R, Campbell L, King N, House A. Self-harm and suicidal content online, harmful or helpful? A systematic review of the recent evidence. JOURNAL OF PUBLIC MENTAL HEALTH 2022. [DOI: 10.1108/jpmh-09-2021-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
There are calls for greater regulation of online content related to self-harm and suicide, particularly that which is user-generated. However, the online space is a source of support and advice, including an important sharing of experiences. This study aims to explore what it is about such online content, and how people interact with it, that may confer harm or offer benefit.
Design/methodology/approach
The authors undertook a systematic review of the published evidence, using customised searches up to February 2021 in seven databases. The authors included empirical research on the internet or online use and self-harm or suicide content that had been indexed since 2015. The authors undertook a theoretically driven narrative synthesis.
Findings
From 4,493 unique records, 87 met our inclusion criteria. The literature is rapidly expanding and not all the evidence is high quality, with very few longitudinal or intervention studies so little evidence to understand possible causal links. Very little content online is classifiable as explicitly harmful or definitively helpful, with responses varying by the individual and immediate context. The authors present a framework that seeks to represent the interplay in online use between the person, the medium, the content and the outcome.
Originality/value
This review highlights that content should not be considered separately to the person accessing it, so online safety means thinking about all users. Blanket removal or unthinking regulation may be more harmful than helpful. A focus on safe browsing is important and tools that limit time and diversify content would support this.
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McGillivray L, Rheinberger D, Wang J, Burnett A, Torok M. Non-disclosing youth: a cross sectional study to understand why young people do not disclose suicidal thoughts to their mental health professional. BMC Psychiatry 2022; 22:3. [PMID: 34983460 PMCID: PMC8728900 DOI: 10.1186/s12888-021-03636-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Prevalence of suicidal ideation increases rapidly in adolescence, and many choose not to seek help and disclose their ideation. Young people who do disclose suicidal ideation, prefer to do so with peers and family compared to mental health professionals, who are best placed to provide evidence-based treatment. This study aimed to identify key factors associated with young people's decision to, or not to disclose suicidal thoughts to their mental health practitioner. METHODS A community-based sample of young Australians (16 - 25 years), who had experienced suicidal ideation and engaged with a mental health professional, completed an online questionnaire (N=513) which assessed demographic characteristics, severity of depression, anxiety, psychological distress, and suicidal ideation, lifetime suicide attempts, exposure to suicide loss, personal suicide stigma, prioritisation of mental health issues, and therapeutic alliance. Logistic regression analyses were used to identify factors associated with disclosure. RESULTS Though the full sample had engaged in therapy, 39% had never disclosed suicidal ideation to their clinician. Those who had disclosed were more likely to report greater therapeutic alliance (OR=1.04, 95% CI=1.02-1.06), personal suicide stigma (OR=1.04, 95% CI=1.01-1.06), prioritisation of suicidal ideation (OR=.24, 95% CI=0.14-0.42), and lifetime history of suicide attempt (OR=.32, 95% CI=0.18-0.57). The most common reason for not disclosing was concern that it would not remain confidential. CONCLUSION These findings provide new insights into why young people may not seek help by disclosing suicidal ideation, despite having access to a mental health professional, and establish evidence to inform practice decisions and the development of prevention strategies to support young people for suicide.
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Affiliation(s)
- Lauren McGillivray
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia.
| | - Demee Rheinberger
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Jessica Wang
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Alexander Burnett
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
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Norman H, Marzano L, Oskis A, Coulson M. " My Heart and My Brain Is What's Bleeding, These Are Just Cuts." An Interpretative Phenomenological Analysis of Young Women's Experiences of Self-Harm. Front Psychiatry 2022; 13:914109. [PMID: 35911219 PMCID: PMC9330153 DOI: 10.3389/fpsyt.2022.914109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Engagement in self-harm, defined as intentional self-poisoning or self-injury irrespective of the apparent purpose of the act, is increasing, particularly among girls and young women. Understanding the behavior from the perspective of those who self-harm is, therefore, vital in designing effective interventions and treatments. The current brief research report presents a key theme from an Interpretative Phenomenological Analysis of the experience of self-harm among eight young women, aged between 18 and 29. The theme Is Self-Harm Bad? concerns the way in which participants both acknowledged and resisted a negative conception of self-harm that was often constructed from other people's attitudes. Three subthemes explore the reasons why participants were reluctant to endorse self-harm as bad: Self-Harm is the Symptom, Self-Harm Works (Until it Doesn't) and Self-Harm is Part of Me. The findings highlight the disparity between the characterization of self-harm as a highly risky behavior and the lived experience of self-harm as a functional means of emotion regulation. From a clinical perspective, the findings explored in this brief report suggest that highlighting the risks of self-harm may not be a sufficient deterrent. The recently revised draft National Institute for Health and Care Excellence (NICE) guidance recommends that everyone presenting to hospital following self-harm should be given a comprehensive psychosocial assessment, of which the function is, in part, to understand why the person has self-harmed. The current study underlines the importance of seeing past the behavior to the underlying causes and exploring the meaning of self-harm to the individual in order to implement effective preventative interventions.
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Affiliation(s)
- Hilary Norman
- Faculty of Science and Technology, Middlesex University, London, United Kingdom
| | - Lisa Marzano
- Faculty of Science and Technology, Middlesex University, London, United Kingdom
| | - Andrea Oskis
- Faculty of Science and Technology, Middlesex University, London, United Kingdom
| | - Mark Coulson
- School of Psychology, Faculty of Social Sciences, University of East Anglia, Norwich, United Kingdom
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Lindkvist RM, Westling S, Eberhard S, Johansson BA, Rask O, Landgren K. 'A Safe Place Where I Am Welcome to Unwind When I Choose to'-Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:300. [PMID: 35010557 PMCID: PMC8751031 DOI: 10.3390/ijerph19010300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Evidence is lacking on how to manage imminent suicidality in adolescents with self-harm. Brief Admission by Self-referral (BA) is a crisis-management intervention, developed for adults with self-harm at risk for suicide. Structured, individualized and based on responsible autonomy, BA aims to provide a respite while minimizing negative effects of hospitalization. This qualitative interview study illuminates adolescents' experiences of BA, adapted for this target group. Nineteen adolescents aged 14 to 19 years, described BA as helpful for timely rest and recovery to save themselves from impulses to self-harm. The individual contract, which is a prerequisite for access to BA, was perceived to give access to professional support in a safe environment, also among adolescents not using their contract. Being trusted with responsibility to self-admit was also hard work with struggles of self-doubt. Challenges included experiencing distrust from staff and fear of not being able to abstain from self-harm, which BA is conditioned upon. However, this condition was also perceived to induce self-motivation and growth. BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm. Suggestions for improvement included continually informing staff about important features of BA. To further evaluate benefits and challenges of BA, future research may evaluate clinical and health-economic outcomes and perspectives from parents and caregivers.
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Affiliation(s)
- Rose-Marie Lindkvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
| | - Sofie Westling
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
- Office of Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, 22185 Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, 22185 Lund, Sweden;
| | - Sophia Eberhard
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
- Psychiatry, Habilitation and Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Region Skåne, 20502 Malmö, Sweden
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
- Psychiatry, Habilitation and Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Region Skåne, 20502 Malmö, Sweden
| | - Olof Rask
- Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden; (S.W.); (S.E.); (B.A.J.); (O.R.)
- Psychiatry, Habilitation and Aid, Child and Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Region Skåne, 20502 Malmö, Sweden
| | - Kajsa Landgren
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, 22185 Lund, Sweden;
- Department of Health Sciences, Lund University, 22240 Lund, Sweden
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Pimenta SM, Hunter SC, Rasmussen S, Cogan N, Martin B. Young People’s Coping Strategies When Dealing With Their Own and a Friend’s Symptoms of Poor Mental Health: A Qualitative Study. JOURNAL OF ADOLESCENT RESEARCH 2021. [DOI: 10.1177/07435584211062115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Young people struggle to seek help for their mental health, despite having different resources available. As the coping process is very complex, and elements such as trust and availability of resources have been said to influence it, this study aimed to understand how young people cope with their own or a friend’s symptoms of poor mental health. Eleven young people (13–15 years old) were interviewed. Thematic Analysis of the interviews showed that participants reported different coping strategies for dealing with their own hypothetical symptoms and those of a friend. Participants identified the social impact of experiencing symptoms of poor mental health and choice of resources as the main factors influencing their coping strategies. For their own symptoms, young people expressed concern about being judged and that they would only disclose to someone they trust. Participants would not disclose a friend’s symptoms because they did not want to break their trust. Finally, choice of resources was mainly influenced by the severity of symptoms being experienced, especially when it comes to asking for professional help. This study contributes to a better understanding of the different ways in which young people cope with their own symptoms and symptoms experienced by a friend.
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Affiliation(s)
| | - Simon C. Hunter
- Glasgow Caledonian University, UK
- University of Western Australia, Perth, Australia
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Yip PSF, Chan WL, Chan CS, He L, Xu Y, Chan E, Chau YC, Cheng Q, Cheng SH, Cheung F, Chow J, Chow S, Fung J, Hsu SM, Law YW, Lo B, Miu SM, Ng WM, Ngai K, Tsang C, Xiong C, Xu Z. The Opportunities and Challenges of the First Three Years of Open Up, an Online Text-Based Counselling Service for Youth and Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13194. [PMID: 34948802 PMCID: PMC8701729 DOI: 10.3390/ijerph182413194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 11/22/2022]
Abstract
We present the opportunities and challenges of Open Up, a free, 24/7 online text-based counselling service to support youth in Hong Kong. The number of youths served more than doubled within the first three years since its inception in 2018 in response to increasing youth suicidality and mental health needs. Good practice models are being developed in order to sustain and further scale up the service. We discuss the structure of the operation, usage pattern and its effectiveness, the use of AI to improve users experience, and the role of volunteer in the operation. We also present the challenges in further enhancing the operation, calling for more research, especially on the identification of the optimal number of users that can be concurrently served by a counsellor, the effective approach to respond to a small percentage of repeated users who has taken up a disproportional volume of service, and the way to optimize the use of big data analytics and AI technology to enhance the service. These advancements will benefit not only Open Up but also similar services across the globe.
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Affiliation(s)
- Paul Siu Fai Yip
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China;
| | - Wai-Leung Chan
- Youth and Community Services, Caritas Hong Kong, Hong Kong, China; (W.-L.C.); (S.C.); (W.M.N.)
| | - Christian S. Chan
- Department of Psychology, The University of Hong Kong, Hong Kong, China;
| | - Lihong He
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
| | - Yucan Xu
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
| | - Evangeline Chan
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
| | - Yui Chi Chau
- Head Office, Hong Kong Children and Youth Services, Hong Kong, China;
| | - Qijin Cheng
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China;
| | | | - Florence Cheung
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
| | - James Chow
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
| | - Shirley Chow
- Youth and Community Services, Caritas Hong Kong, Hong Kong, China; (W.-L.C.); (S.C.); (W.M.N.)
| | - Jerry Fung
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
| | - Siu-Man Hsu
- Headquarter, The Hong Kong Federation of Youth Groups, Hong Kong, China;
| | - Yik Wa Law
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China;
| | - Billie Lo
- IT Unit, The Hong Kong Federation of Youth Groups, Hong Kong, China;
| | - Sze-Man Miu
- Jockey Club Online Youth Emotional Support, The Boys’ and Girls’ Clubs Association of Hong Kong, Hong Kong, China;
| | - Wai Man Ng
- Youth and Community Services, Caritas Hong Kong, Hong Kong, China; (W.-L.C.); (S.C.); (W.M.N.)
| | - Ken Ngai
- Independent Researcher, Hong Kong, China;
| | - Christy Tsang
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
| | - Cynthia Xiong
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
| | - Zhongzhi Xu
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; (L.H.); (Y.X.); (E.C.); (F.C.); (J.C.); (J.F.); (C.T.); (C.X.); (Z.X.)
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Understanding Perceptions of Nonsuicidal Self-Injury: Descriptive and Injunctive Norms. Psychiatr Q 2021; 92:1657-1671. [PMID: 34169388 DOI: 10.1007/s11126-021-09933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a major public health concern. Web-based personalized feedback interventions (PFIs) may be a cost-effective and efficient way to treat NSSI. In order to develop a PFI, it is imperative to assess descriptive and injunctive norms. The current study examines descriptive and injunctive norms of NSSI within college students and adults in the community, comparing how perceived norms may differ for those who do or do not engage in NSSI. Study 1 calculated percentages of NSSI behavior within the student sample. Study 2 then examined perceived descriptive and injunctive norms between those with and without history of NSSI in both samples. Study 1 indicated that 19% of undergraduate students had histories of NSSI. Additionally, there was a general tendency to overestimate the percentage of people who engage in NSSI and the number of times a typical person engages in NSSI. Finally, those who engaged in NSSI believed that most people do not understand why individuals engage in NSSI; comparatively, the majority of people without history of NSSI still indicated that they understand why others would engage in NSSI. These research findings may be utilized in a PFI to reduce shame and NSSI behavior.
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Colman L, Delaruelle K, Luypaert C, Verniest R, Bracke P. Burdens in mental health recovery: Causal beliefs and their relation to stigma and help seeking recommendations. Int J Soc Psychiatry 2021; 67:992-1004. [PMID: 33203313 DOI: 10.1177/0020764020973249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lay attitudes are often seen as potential barriers to mental health recovery. But apart from perceiving them as potential barriers, they can also play an important role in stimulating individuals to consult (in)formal help sources, in particular through the process of help referral. Where existing research mainly focusses on actual help seeking behaviour, this study will focus on lay publics' referral behaviour. AIMS This study analyses the relation between causal beliefs and stigmatising attitudes and social distance on the one hand, and (in)formal help seeking recommendations on the other. METHODS Data from a survey carried out in 2019, assessing the attitudes of Public Health Insurance Provider (HIP) members towards mental health problems, was used. Part of the survey questions was based on a quantitative quasi-experimental design, using hypothetical written vignettes. The weighted data represent a sample of the adult Flemish population (22-94 years, N = 5675). Multiple linear regression analysis was used to examine the relation between causal beliefs and stigma, while binominal logistic regression analysis was used to investigate the relation between causal beliefs and help seeking recommendations. RESULTS The results reveal that causal beliefs significantly associate with stigma, measured by stigmatising attitudes and social distance: personal- or biogenetic beliefs associate with more stigma, where psychosocial beliefs associate with less stigma. Concerning help seeking recommendations, psychosocial beliefs associate with recommending psychological or psychotherapeutic care, biogenetic beliefs associate with advising help from general practitioners and suggesting psychiatric help, while personal beliefs negatively associate with recommending formal help. Meanwhile, biogenetic beliefs associate with less informal help seeking recommendations (e.g. family, friends and online self-help), where personal beliefs associate with more informal help seeking recommendations and psychosocial beliefs only associate with online help referral. CONCLUSION This study highlights the importance of causal beliefs in affecting public stigma and help seeking recommendations.
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Affiliation(s)
- Lisa Colman
- Department of Sociology, HeDeRa (Health and Demographic Research), Ghent University, Ghent, Belgium
| | - Katrijn Delaruelle
- Department of Sociology, HeDeRa (Health and Demographic Research), Ghent University, Ghent, Belgium
| | - Carolien Luypaert
- Health Promotion and Research Department CM, Christian Mutuality (CM), Schaarbeek, Belgium
| | - Rebekka Verniest
- Health Promotion and Research Department CM, Christian Mutuality (CM), Schaarbeek, Belgium
| | - Piet Bracke
- Department of Sociology, HeDeRa (Health and Demographic Research), Ghent University, Ghent, Belgium
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Fadum EA, Carlsen EØ, Ramberg M, Strand LA, Håberg SE, Borud E, Martinussen M. Social and life skills in adolescents who have self-harmed: analysis of survey responses from a national sample of adolescents in Norway. BMJ Open 2021; 11:e054707. [PMID: 34772755 PMCID: PMC8593742 DOI: 10.1136/bmjopen-2021-054707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Social and life skills (SLS) may be important in the prevention and treatment of self-harm, but few studies have described this relationship. We examined three components of SLS in adolescents who reported self-harm that was, according to themselves, diagnosed by a clinician. DESIGN Cross-sectional. SETTING National screening prior to military service. PARTICIPANTS 176 284 residents of Norway born in 1999-2001 received a declaration of health. We included 171 486 individuals (84 153 (49%) women and 87 333 (51%) men) who were 17 (n=1 67 855) or 18 years of age (n=3631) when they completed the declaration. OUTCOME MEASURE The main outcome was clinically diagnosed self-harm, defined as self-harm that the adolescents themselves stated had been diagnosed by a clinician. Components of SLS were social interactions; coping strategies; and emotional regulation/aggression. The association between SLS and self-reported clinically diagnosed self-harm was assessed in hierarchical multiple regression models controlling for sex; school absence; and feelings of emotional pain. RESULTS Three percent (n=5507) of the adolescents reported clinically diagnosed self-harm. The three components of SLS together added little to the prediction of clinically diagnosed self-harm (∆R2=0.02). After controlling for school absence and emotional pain, emotional regulation/aggression was the only SLS-component that was independently associated with clinically diagnosed self-harm (OR 1.33, 95% CI 1.31 to 1.36). The young men who said they had been clinically diagnosed for self-harm scored slightly worse on social interactions (Hedge's g (g) = -0.13, p<0.001) and emotional regulation/aggression (g = -0.18, p<0.001) than the young women in this group. CONCLUSION Young women and young men who reported clinically diagnosed self-harm had more problems with emotional regulation/aggression than other adolescents, but did not have worse social interactions or coping strategies.
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Affiliation(s)
- Elin Anita Fadum
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
| | - Ellen Øen Carlsen
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria Ramberg
- Department of Child and Adolescent Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Leif Aage Strand
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
| | - Siri Eldevik Håberg
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Oslo, Norway
| | - Einar Borud
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
- Institute of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Troms, Norway
| | - Monica Martinussen
- Regional Centre for Child and Youth Mental Health & Child Welfare, UiT The Arctic University of Norway, Tromso, Norway
- Norwegian Command and Staff College, Norwegian Defence University College, Oslo, Norway
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Dixon-Ward KC, Chan SWY. 'Faking it': Exploring adolescent perceptions of depression (in)authenticity and 'attention seeking'. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:177-196. [PMID: 34716598 DOI: 10.1111/bjc.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Attitudes towards peers who are not perceived to be legitimately depressed, or whose depression 'authenticity' is questioned, represent a current gap in adolescent depression stigma research. This research study, therefore, investigated how perceptions of depression inauthenticity are framed in adolescent Reddit communities. METHODS This observational study used an internet-mediated, qualitative methodology to analyse forum posts from April 2019 to January 2020 on three adolescent-based subreddits. Posts were extracted using the Baumgartner Reddit Corpus. Identifiable information was removed to protect anonymity. RESULTS Inductive thematic analysis identified two overarching themes, namely, public stigma and self-stigma associated with depression inauthenticity. Public stigma could be further dissected into five subthemes: (i) dichotomy between 'real' and 'fake depression'; (ii) aggression towards 'fakers'; (iii) stereotypes; (iv) attention; and (v) diagnosis. On the other hand, the theme of self-stigma consisted of subthemes: (i) self-doubt and (ii) validation and invalidation. CONCLUSIONS Adolescents framed a dichotomy between so-called 'real' and 'fake depression', with hostility directed at peers perceived to be 'fake depressed'. Perceptions of depression inauthenticity were confused and inconsistent. Public and self-stigma towards depression inauthenticity enforced barriers to help-seeking. While future research should investigate to what extent these observations based on online forums mimic stigma in real-life settings, our findings have highlighted the needs for 'fake depression' stigma to be addressed by adolescent depression literacy and stigma interventions. Recent movements towards reconceptualizing depression as a dimensional construct may help to challenge these stigmatizing views of a dichotomy between 'real' and 'fake' depression. PRACTITIONER POINTS There is widespread stigma concerning perceived inauthenticity related to depression in these online adolescent communities, with vitriol targeted at peers perceived to be so-called 'fake depressed'. Adolescent depression literacy and stigma programmes should tackle stigma towards perceived inauthenticity and promote the message that all adolescent distress deserves attention and help. This involves challenging perceptions that only supposedly 'authentic', diagnosed, or diagnosable, depression is worthy of attention and support. Prevention Programmes should work to mitigate barriers to help-seeking posed by misunderstandings that distress which is kept secret is more 'authentic', and tackle gender and age stereotypes surrounding perceived inauthenticity. There is a need for clinically approved online resources targeted at adolescents who feel unsure about whether their symptoms could be indicators of depression, and to make professional advice and help more accessible for young people.
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Affiliation(s)
| | - Stella W Y Chan
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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63
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Miettinen TM, Kaunonen M, Kylmä J, Rissanen ML, Aho AL. Experiences of Help From the Perspective of Finnish People Who Self-Harmed During Adolescence. Issues Ment Health Nurs 2021; 42:917-928. [PMID: 33822682 DOI: 10.1080/01612840.2021.1904468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Adolescent self-harm is a widespread phenomenon, and a significant problem worldwide. This study describes the experiences of help from the perspective of Finnish people who have suffered self-harm during adolescence. Data were collected from 27 participants as essays and interviews. Participants included both females and males with different backgrounds and treatment experiences. The data were analysed using inductive content analysis. Participants described having received help from other people in informal and formal ways, and they had both positive and negative experiences of help. The results show that several barriers exist for self-harming adolescents to access help, thus improvement in this area are necessary.
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Affiliation(s)
| | - Marja Kaunonen
- Faculty of Social Sciences, Tampere University, Tampere, Finland.,Pirkanmaa Hospital District, Tampere, Finland
| | - Jari Kylmä
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Marja-Liisa Rissanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland.,Savonia University of Applied Sciences, Kuopio, Finland
| | - Anna Liisa Aho
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Mughal F, Dikomitis L, Babatunde OO, Chew-Graham CA. Experiences of general practice care for self-harm: a qualitative study of young people's perspectives. Br J Gen Pract 2021; 71:e744-e752. [PMID: 33950851 PMCID: PMC8340729 DOI: 10.3399/bjgp.2021.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Self-harm is a growing concern and rates of self-harm in young people (aged 12-25 years) presenting to general practice are rising. There is, however, little evidence about young people's experiences of GP care and on accessing general practice. AIM To explore the help-seeking behaviours, experiences of GP care, and access to general practice of young people who self-harm. DESIGN AND SETTING In this qualitative study, semi-structured interviews were conducted with young people aged 16-25 years from England with previous self-harm behaviour. METHOD Interviews with 13 young people took place between April and November 2019. Young people were recruited from the community, third-sector organisations, and Twitter. Data were analysed using reflexive thematic analysis with principles of constant comparison. A patient and public involvement advisory group informed recruitment strategies and supported interpretation of findings. RESULTS Young people described the avenues of help-seeking they employ and reflected on the mixed experiences of seeing GPs that can influence future help-seeking. Preconceptions and a lack of knowledge about accessing general practice were found to be barriers to help-seeking. GPs who attempt to understand the young person and establish relationship-based care can facilitate young people accessing general practice for self-harm. CONCLUSION It is important young people are aware of how to access general practice and that GPs listen, understand, and proactively follow-up young people who self-harm. Supporting young people with self-harm behaviour requires continuity of care.
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Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Keele; affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, Keele University, Keele; honorary clinical research fellow, Unit of Academic Primary Care, University of Warwick, Coventry
| | | | | | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Keele; honorary professor of primary care mental health, Midlands Partnership NHS Foundation Trust, Stafford
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Lustig S, Koenig J, Resch F, Kaess M. Help-seeking duration in adolescents with suicidal behavior and non-suicidal self-injury. J Psychiatr Res 2021; 140:60-67. [PMID: 34098387 DOI: 10.1016/j.jpsychires.2021.05.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
Prompt access to appropriate professional care for adolescents with self-harm thoughts and respective behaviors (suicidal behavior and non-suicidal self-injury [NSSI]) is crucial as both are associated with an increased risk of suicide in later life. The present study aimed to describe the duration from initial onset of thoughts and incidents of self-harm until first clinical presentation in children and adolescents and to identify factors affecting help-seeking duration. Onset of self-harm thoughts and behaviors, time of first clinical presentation, and psychiatric and demographic variables were obtained from n = 672 adolescents (11-19 years) from the Germany-based AtR!Sk (Ambulanz für Risikoverhalten & Selbstschädigung) cohort-study at an outpatient clinic for risk-taking and self-harm behaviors. In 22% of overall cases, the first self-harm thoughts and behaviors occurred after contact to professional care was already established. Focusing on actual help-seeking delay only, it took between M = 0.99 years (after first suicide attempt) and M = 1.98 years (after first thoughts of NSSI) until participants sought professional help. Overall, help-seeking duration and help-seeking delay were longer for participants with more severe psychopathology (i.e., BPD, depressive symptoms, general symptom severity). The findings revealed a substantial delay of receiving appropriate professional care in adolescents with self-harm thoughts and behavior. The correlation between treatment latency and higher psychopathology may emphasize the need of prompt treatment. A better understanding of barriers and facilitators to professional help will contribute to enhance measures of tailored support for young patients in their help-seeking process.
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Affiliation(s)
- Sophia Lustig
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany; Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
| | - Julian Koenig
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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Simonsson O, Engberg H, Bjureberg J, Ljótsson B, Stensils J, Sahlin H, Hellner C. Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Caregivers: Qualitative Study. JMIR Form Res 2021; 5:e17910. [PMID: 34297001 PMCID: PMC8367103 DOI: 10.2196/17910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/01/2020] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nonsuicidal self-injury (NSSI) is common in adolescence and is associated with several adverse outcomes. Despite this, few established treatment options exist. Online treatment seems promising for several conditions; however, knowledge on NSSI is scarce. It is important to explore how online treatment for NSSI is experienced to improve such interventions and learn more about factors that are important in the treatment of adolescents with NSSI. Objective This study aims to explore the experiences of a novel online treatment for adolescents with NSSI and their caregivers. Methods A qualitative study using thematic analysis was conducted through semistructured interviews with 9 adolescents and 11 caregivers at treatment termination or at the 6-month follow-up of the online emotion regulation individual therapy for adolescents. Results A total of 3 overarching themes were identified. The theme support can come in different shapes showed how support could be attained through both interaction with the therapist as well as through the format itself (such as through the fictional characters in the material and the mobile app). Caregivers found it helpful to have their own online course, and adolescents accepted their involvement. The theme self-responsibility can be empowering as well as distressing showed that self-responsibility was highly appreciated (such as deciding when and how to engage in treatment) but also challenging; it caused occasional distress for some. The theme acquiring new skills and treatment effects showed the advantages and challenges of learning several different emotion regulation skills and that decreased emotion regulation difficulties were important treatment outcomes for adolescents. In addition, several different skills seemed to facilitate emotion regulation, and having access to such skills could hinder NSSI. Conclusions Online emotion regulation individual therapy for adolescents seems to offer an accepted way to deliver family interventions for this target group; facilitate skills training with several means of support, including support from both the mobile app and the therapist; contribute to decreasing emotion regulation difficulties and teaching skills that could hinder NSSI; and cause (in some individuals) distress because of the self-responsibility that is inherent to online formats, which needs to be addressed.
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Affiliation(s)
- Olivia Simonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Hedvig Engberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Medical Unit of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Julia Stensils
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Hanna Sahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Hall S, Melia Y. I Just Pulled Myself Together and Realised I had to be Responsible: Adolescents' Experiences of Having a Friend Who Self-Harms. CHILD & YOUTH CARE FORUM 2021; 51:291-311. [PMID: 34131376 PMCID: PMC8191706 DOI: 10.1007/s10566-021-09629-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
Background Self-harm usually begins during adolescence and adolescents that self-harm most commonly confide in friends, yet to date, there is little research from the friend's perspective. Objective This qualitative study explores adolescents' experiences of what it is like to have a friend who self-harms by cutting and what this experience means for friendship, the wider peer group and psychological well-being. Methods Semi-structured interviews were conducted face-to-face with a community sample of eight females aged between 13 and 18 years, living in England. Interpretative Phenomenological Analysis was used to analyse the data. Results Four superordinate themes emerged: desperately searching for meaning, I will be there at all costs, too hot to handle and identification. Adolescents were concerned about escalations in their friends' behaviours and felt a sense of duty to help, but the majority experienced a dilemma as to whether to disclose to others and all reported some form of distress. Conclusions The results highlight the important, yet complex nature of friendship in this context. Friends play a key role in supporting adolescents who self-harm but need greater support managing this role and the effects. Schools/colleges should educate young people about self-harm to increase their knowledge and skills in relation to supporting a friend with this issue. Furthermore, they should promote environments for talking about mental health openly to give young people increased opportunities for help-seeking.
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Affiliation(s)
- Sarah Hall
- Clinical Psychologist, The Darwin Centre, Queens Road, Stoke-on-Trent, ST4 7LF UK
| | - Yvonne Melia
- Clinical Psychologist, The Science Centre, Staffordshire University Doctorate in Clinical Psychology, Leek Road, Stoke-on-Trent, ST4 2RU UK
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Čuš A, Edbrooke-Childs J, Ohmann S, Plener PL, Akkaya-Kalayci T. "Smartphone Apps Are Cool, But Do They Help Me?": A Qualitative Interview Study of Adolescents' Perspectives on Using Smartphone Interventions to Manage Nonsuicidal Self-Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3289. [PMID: 33810106 PMCID: PMC8004854 DOI: 10.3390/ijerph18063289] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 01/05/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a major mental health problem associated with negative psychosocial outcomes and it most often starts in early adolescence. Despite this, adolescents are rarely involved in informing the development of interventions designed to address their mental health problems. This study aimed to (1) assess adolescents' needs and preferences about future interventions that are delivered through smartphones and (2) develop a framework with implications for designing engaging digital mental health interventions. Fifteen adolescent girls, aged 12-18 years, who met diagnostic criteria for a current NSSI disorder and were in contact with mental health services, participated in semi-structured interviews. Following a reflexive thematic analysis approach, this study identified two main themes: (1) Experiences of NSSI (depicts the needs of young people related to their everyday experiences of managing NSSI) and (2) App in Context (portrays preferences of young people about smartphone interventions and reflects adolescents' views on how technology itself can improve or hinder engaging with these interventions). Adolescent patients expressed interest in using smartphone mental health interventions if they recognize them as helpful, relevant for their life situation and easy to use. The developed framework suggests that digital mental health interventions are embedded in three contexts (i.e., person using the intervention, mental health condition, and technology-related factors) which together need to inform the development of engaging digital resources. To achieve this, the cooperation among people with lived experience, mental health experts, and human computer interaction professionals is vital.
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Affiliation(s)
- Anja Čuš
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (A.Č.); (S.O.); (P.L.P.)
| | - Julian Edbrooke-Childs
- Evidence-Based Practice Unit, University College London, London WC1E 6BT, UK;
- Anna Freud National Centre for Children and Families, London N1 9JH, UK
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (A.Č.); (S.O.); (P.L.P.)
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (A.Č.); (S.O.); (P.L.P.)
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, 89081 Ulm, Germany
| | - Türkan Akkaya-Kalayci
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (A.Č.); (S.O.); (P.L.P.)
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Nomura K, Minamizono S, Maeda E, Kim R, Iwata T, Hirayama J, Ono K, Fushimi M, Goto T, Mishima K, Yamamoto F. Cross-sectional survey of depressive symptoms and suicide-related ideation at a Japanese national university during the COVID-19 stay-home order. Environ Health Prev Med 2021; 26:30. [PMID: 33673802 PMCID: PMC7934991 DOI: 10.1186/s12199-021-00953-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Background We aimed to estimate the prevalence of depressive symptoms as well as suicide-related ideation among Japanese university students during the stay-home order necessitated by the coronavirus disease 2019 pandemic in Japan, and offer evidence in support of future intervention to depression and suicide prevention strategies among college and university students. Methods The data for this cross-sectional study were derived from the Student Mental Health Survey conducted from May 20 to June 16, 2020 at a national university in Akita prefecture. Among the 5111 students recruited, 2712 participated in this study (response rate, 53%; mean age ± standard deviation, 20.5 ±3.5 years; men, 53.8%). Depressive symptoms were identified by using the Patient Health Questionnaire-9 (PHQ-9). Results The prevalence of moderate depressive symptoms based on a PHQ-9 score ≥10 and suicide-related ideation based on question 9 of PHQ-9 ≥1, which encompasses thoughts of both suicide and self-harm, was 11.7% and 6.7%, respectively. Multivariable logistic regression analyses showed that risk factors for depression included being a woman, smoking, alcohol consumption, and social network communication using either video or voice. For suicide-related ideation, alcohol consumption was the only risk factor. Exercise and having someone to consult about worries were associated with decreased risk of both depressive symptoms and suicide-related ideation. Conclusions Negative lifestyles of smoking and drinking, and being a woman, may be important risk factors for depressive symptoms, whereas exercise and having someone to consult about worries may be protective factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12199-021-00953-1.
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Affiliation(s)
- Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan.
| | - Sachiko Minamizono
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Eri Maeda
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Roseline Kim
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Toyoto Iwata
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Junko Hirayama
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Kyoichi Ono
- Department of Cell Physiology, Akita University Graduate School of Medicine, Akita, Japan
| | | | | | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
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Kerner B, Carlson M, Eskin CK, Tseng CH, Ho JMGY, Zima B, Leader E. Trends in the utilization of a peer-supported youth hotline. Child Adolesc Ment Health 2021; 26:65-72. [PMID: 32449589 DOI: 10.1111/camh.12394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peer-supported youth hotlines have been in operation for many years but studies on the acceptance of this hotline model or on the demographics of the callers are lacking. This study was performed to examine the utilization of a metropolitan peer-supported youth hotline between 2010 and 2016. METHOD The change in demographics, contact channels, and the reasons for contact were analyzed with standard linear regression analysis in 67,478 contacts over 7 years. RESULTS The data revealed a significant increase in hotline utilization from 8008 annual contacts in 2010 to 12,409 contacts in 2016 (p = .03). The majority of contacts were made by 15-year-old and 16-year-old girls, but contacts by children aged 13 years old and younger have also increased significantly over the years (p = .003). In 2016, anxiety and stress were among the leading reasons for contact (20.14%), followed by sadness and depression (17.21%), suicidal ideation (14.18%), and self-harm (8.15%). Recommendations for follow-up with outside mental health resources were made in 56.22% of contacts. More than 60% of contacts had found information about the hotline on the Internet. More than 30% used text messaging to reach out to the hotline. CONCLUSIONS Our data indicate that adolescents increasingly utilize a peer-supported youth hotline to get help for mental health concerns. Therefore, it should be explored whether this hotline model could also be used for prevention and early intervention. KEY PRACTITIONER MESSAGE Peer-supported youth hotlines are well accepted and frequently utilized by adolescents to get help for mental health issues. Our data indicate that peer-supported youth hotlines could be utilized to identify youth at risk for depression and suicide. Further research should evaluate whether peer-supported youth hotlines could serve in the prevention and in early mental health intervention, and how they could be effectively linked to other mental health resources in the community.
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Affiliation(s)
- Berit Kerner
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Bonnie Zima
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elaine Leader
- Cedars-Sinai Medical Center, Teen Line, Los Angeles, CA, USA
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Asarnow JR, Hughes J, Cohen D, Berk M, McGrath E, Huey SJ. The Incubator Treatment Development Model: The SAFETY Treatment for Suicidal/Self-Harming Youth. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Matthews EL, Townsend ML, Gray AS, Grenyer BFS. Ideal standards for policy on student self-harm: What research and practice tells us. SCHOOL PSYCHOLOGY INTERNATIONAL 2021. [DOI: 10.1177/0143034320975846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
School communities face challenges in responding effectively to the rising incidence of student self-harm. Evidence-informed guidelines may provide a platform for schools to provide better responses and improve the outcomes of students who engage in self-harm. This paper critically reviews policies published in English targeted for schools or education settings on effective early identification and intervention for children and adolescent self-harm. A grey literature search was conducted using Start Page web search engine with a documentary analysis approach applied to review polices that met criteria. The review identified 16 policies that aim to help school and education staff to identify and respond to student self-harm. The key themes include identification and risk assessment, intervention, roles and responsibilities, as well as addressing issues surrounding evidence-based psychological education and intervention. An evidence-informed policy that addresses multiple aspects of responding to and reducing student self-harm may be a vital foundation of a school’s response to this growing public health issue. This paper outlines key points that will help inform the development of evidence-informed guidelines for schools to respond to student self-harm and presents an exemplar policy framework for use by schools.
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Affiliation(s)
| | - Michelle L. Townsend
- School of Psychology, University of Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | | | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Australia
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73
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Fortune S, Sharma V, Bowden L, Hobbs L, Marshall D, Mitchell C, Clarke A, Robinson J, Shave R, Macleod E, Witt KG, Hawton K, Jordan V, Hetrick SE. Prevention of self-harm and suicide in young people up to the age of 25 in education settings. Hippokratia 2021. [DOI: 10.1002/14651858.cd013844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah Fortune
- Department of Social and Community Health, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Vartika Sharma
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
| | - Linda Bowden
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Linda Hobbs
- Department of Psychological Medicine; Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - David Marshall
- Centre for Reviews and Dissemination; University of York; York UK
- Cochrane Common Mental Disorders Group, Centre for Reviews and Dissemination; University of York; York UK
| | - Claire Mitchell
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | | | - Jo Robinson
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Roger Shave
- Clinical Advisory Services Aotearoa; Christchurch New Zealand
| | - Emily Macleod
- Research School of Psychology, ANU College of Health and Medicine; The Australian National University; Canberra Australia
| | - Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
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74
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Faura-Garcia J, Orue I, Calvete E. Clinical assessment of non-suicidal self-injury: A systematic review of instruments. Clin Psychol Psychother 2021; 28:739-765. [PMID: 33283952 DOI: 10.1002/cpp.2537] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022]
Abstract
There has been an increase in the number of assessment instruments for non-suicidal self-injury (NSSI). However, previous reviews are inconsistent and do not provide a comprehensive psychometric assessment of the instruments. This study aimed to systematically assess and compare the psychometric properties of clinically relevant instruments to measure NSSI in any population. Through a systematic review guided by COSMIN and PRISMA, two searches were conducted in English and Spanish in February 2020 in 13 databases including grey literature. Of the 7,813 initial records, 152 validations were extracted. From these, 83 instruments (22 versions or adaptations) were excluded for not measuring NSSI, having no potential clinical utility or not including psychometric properties. Finally, 26 (22 versions, 35 adaptations and 19 creations) instruments measuring NSSI were included. Predominantly, the studies were North American self-reports in English for community adolescents, adaptations or versions emanating from a small number of instruments. Twenty-six indicators were categorized to assess NSSI. The most frequent instruments are structured interviews, and their indicators were related to NSSI function and topography. Evidence of validity and reliability was positive but limited. Despite the high number of instruments and diversity of evaluations, we found no instrument with sufficient evidence for clinical assessment. Findings broadly overview NSSI assessment instruments' current use and future improvement in clinical and research settings.
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Affiliation(s)
- Juan Faura-Garcia
- Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
| | - Izaskun Orue
- Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
| | - Esther Calvete
- Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
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75
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Werbart Törnblom A, Sorjonen K, Runeson B, Rydelius PA. Life Events and Coping Strategies Among Young People Who Died by Suicide or Sudden Violent Death. Front Psychiatry 2021; 12:670246. [PMID: 34512410 PMCID: PMC8429488 DOI: 10.3389/fpsyt.2021.670246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/02/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: Most empirically anchored psychological models of suicide focus either on the perceived situational stress or on vulnerability factors and coping deficits. The interaction between life stressors and vulnerability factors is less explored. Methods: This case-control study examines interactions between life events and coping strategies in three groups of young people: cases of suicide, cases of other sudden violent death (SVD), and control cases. Results: Four coping strategies, two more adaptive and two more maladaptive, were identified. Distinctive of the suicide and the SVD group was significantly less Planful Problem-Solving, and more Escape-Avoidance and Confrontive Coping than among the controls. Furthermore, Confrontive Coping had significantly higher level in the SVD group than in the suicide group. Between-group differences were partly accounted for differences in negative life events, early and late in life. Both target groups experienced significantly more adverse childhood experiences and recent stressful life events than the controls-the suicide group being more exposed to recent stressful life events even in comparison with the SVD group. This might indicate that adverse childhood experiences are a risk factor for both causes of death, whereas proximal stressful life events are a risk factor for death by suicide to a higher degree than for SVD. Conclusions: Improved understanding of the interplay between life events, both in the far past and present, and coping styles, may facilitate the identification of young people at risk of suicide and violent death.
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Affiliation(s)
- Annelie Werbart Törnblom
- Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden
| | - Kimmo Sorjonen
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden
| | - Per-Anders Rydelius
- Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden
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76
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A content analysis of YouTube depression personal account videos and their comments. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2021. [DOI: 10.1016/j.chbr.2020.100050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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77
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Kautz MM, Burke TA, Siegel DM, Case J, Alloy LB. The role of reward sensitivity and childhood maltreatment in predicting nonsuicidal self-injury. Suicide Life Threat Behav 2020; 50:1250-1263. [PMID: 33135809 DOI: 10.1111/sltb.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/07/2020] [Accepted: 06/24/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Findings from prior research on reward sensitivity in nonsuicidal self-injury (NSSI) have been mixed. Childhood maltreatment is an independent risk factor for NSSI and for hyposensitivity to rewards. This study aimed to disentangle the role of reward sensitivity as a predictor of NSSI for those with an elevated severity of childhood maltreatment. METHOD In a diverse undergraduate sample (N = 586), trait reward sensitivity (i.e., behavioral approach system subscales) and the severity of maltreatment were assessed as predictors of a lifetime history of NSSI. In a subset of this sample (n = 51), predictors of NSSI urge intensity were measured using ecological momentary assessment. RESULTS Individuals with elevated maltreatment who reported less positive responsiveness to rewards were more likely to have a lifetime history of NSSI. Those with elevated maltreatment who reported a lower likelihood to approach rewards experienced more intense NSSI urges across the ten-day observation period. However, those with elevated maltreatment who reported a greater likelihood to approach rewards experienced less intense NSSI urges. CONCLUSIONS The role of reward sensitivity as a cognitive risk factor for NSSI varies depending on childhood maltreatment history. Findings indicate that, for those with elevated maltreatment, hypersensitivity to approaching rewards may decrease risk for NSSI urges.
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Affiliation(s)
- Marin M Kautz
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Taylor A Burke
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - David M Siegel
- Graduate School of Applied and Professional Psychology, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - Julia Case
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, PA, USA
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78
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Voss C, Hoyer J, Venz J, Pieper L, Beesdo-Baum K. Non-suicidal self-injury and its co-occurrence with suicidal behavior: An epidemiological-study among adolescents and young adults. Acta Psychiatr Scand 2020; 142:496-508. [PMID: 32979220 DOI: 10.1111/acps.13237] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/13/2020] [Accepted: 09/17/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) comprising thoughts and behaviors is common and often co-occurring with suicidal behavior like ideation, plan, and attempt. As limited data are available for adolescents and young adults, this study aims to present prevalence estimates for lifetime NSSI, its co-occurrence with suicidal behavior, conditional probabilities and their association with socio-demographic characteristics, severity characteristics of suicidal behavior, and health service utilization. METHOD The epidemiological Behavior and Mind Health (BeMIND) study assessed in 2015/16 a random-community sample of N = 1180 aged 14-21 years from Dresden, Germany, regarding lifetime NSSI via self-administered questionnaire and suicidal behaviors via standardized interview. RESULTS Any lifetime NSSI was reported by 19.3% (thoughts: 18.0%, behaviors: 13.6%) of the sample with higher prevalence in females (OR = 2.7, 95% CI 1.9-3.8, P < 0.001). Lifetime prevalence of co-occurring NSSI and suicidal behavior was 7.7%. Females had a 3.3- to 8.8-fold odds of co-occurrence than males. Among those with any NSSI, 39.6% endorsed suicidal behavior, and 66.3% of those with any suicidal behavior reported NSSI. 42.3% of those with any NSSI reported to have used mental healthcare services at any time during their life with higher rates in those with co-occurring suicidal behavior (62.3%). CONCLUSION Non-suicidal self-injury and co-occurring suicidal behavior is common in adolescents and young adults-especially females. The limited utilization of mental healthcare services underpins the need for improving recognition of NSSI and suicidal behavior as well as the accessibility of mental healthcare services during adolescence and emerging adulthood.
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Affiliation(s)
- C Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Hoyer
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J Venz
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - L Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - K Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
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79
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Piccirillo ML, Burke TA, Moore-Berg SL, Alloy LB, Heimberg RG. Self-Stigma Toward Nonsuicidal Self-Injury: An Examination of Implicit and Explicit Attitudes. Suicide Life Threat Behav 2020; 50:1007-1024. [PMID: 32462657 PMCID: PMC11137797 DOI: 10.1111/sltb.12640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evidence suggests that individuals without a history of nonsuicidal self-injury (NSSI) are likely to view NSSI as a stigmatized behavior. However, there is limited evidence evaluating the presence of self-stigma among individuals who have engaged in NSSI. METHODS We recruited a university sample (n = 351) and employed implicit and explicit measures to examine the degree of stigmatization toward those with NSSI scarring, as compared to nonintentional disfigurement (i.e., accidental scarring) and to tattoos (i.e., a culturally sanctioned form of intentional tissue alteration). We examined the extent to which bias is related to indicators of NSSI severity among those with a history of NSSI. RESULTS We provide evidence that negative biases toward NSSI may represent the effects of self-stigma. However, findings suggest that biases were generally attenuated among participants with a history of NSSI as compared to those without. Participants who had lower levels of NSSI explicit bias were more likely to have a history of more severe engagement in NSSI; however, no significant relationships were found between implicit bias and NSSI severity indicators. CONCLUSIONS We present a theoretical rationale for attenuated biases among individuals with a history of NSSI and discuss implications of this research for NSSI recovery.
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Affiliation(s)
- Marilyn L Piccirillo
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Taylor A Burke
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Samantha L Moore-Berg
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, PA, USA
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80
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Park Y, Mahdy JC, Ammerman BA. How others respond to non‐suicidal
self‐injury
disclosure: A systematic review. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2020. [DOI: 10.1002/casp.2478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Yeonsoo Park
- Department of Psychology University of Notre Dame Notre Dame Indiana USA
| | - Jasmine C. Mahdy
- Department of Psychology University of Guelph Guelph Ontario Canada
| | - Brooke A. Ammerman
- Department of Psychology University of Notre Dame Notre Dame Indiana USA
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81
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Mahsoon A, Sharif L, Banakhar M, Alasmee N, Almowallad E, Jabali R, Bahamil A, Assur S. Parental Support, Beliefs about Mental Illness, and Mental Help-Seeking among Young Adults in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5615. [PMID: 32759778 PMCID: PMC7432931 DOI: 10.3390/ijerph17155615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 12/02/2022]
Abstract
Mental illness is not uncommon among young adults, but negative attitudes towards mental disorders and lack of parental support might be associated with hesitancy in seeking professional help. This study aimed to examine the relationships of parental support, beliefs about mental illness, and mental help-seeking among young adults in Saudi Arabia. This quantitative cross-sectional study included a convenience sample of 236 young adults (ages 18-25) with the majority of the total (86.4%) being female. Data were collected via three self-administered questionnaires: The Perceived Parental Support Scale, Beliefs toward Mental Illness scale, and Mental Help Seeking Attitude Scale. Results indicated that the participants had a moderately negative attitude toward mental illness, a moderately positive attitude toward parental support, and a highly positive attitude toward mental help-seeking. No significant relationships were found among the study variables. The study highlights that despite young adults' positive attitude toward mental help-seeking and parental support, they have negative views toward people with mental illnesses. Educational programs in schools and media are needed to improve attitudes and enhance readiness to interact with people with mental illness.
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Affiliation(s)
- Alaa Mahsoon
- Nursing Public Health, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (A.M.); (M.B.)
| | - Loujain Sharif
- Nursing Mental Health, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (L.S.); (N.A.)
| | - Maram Banakhar
- Nursing Public Health, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (A.M.); (M.B.)
| | - Nofaa Alasmee
- Nursing Mental Health, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (L.S.); (N.A.)
| | - Esraa Almowallad
- Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (E.A.); (R.J.); (A.B.)
| | - Razan Jabali
- Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (E.A.); (R.J.); (A.B.)
| | - Amjad Bahamil
- Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (E.A.); (R.J.); (A.B.)
| | - Sara Assur
- Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (E.A.); (R.J.); (A.B.)
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82
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Wadman R, Nielsen E, O'Raw L, Brown K, Williams AJ, Sayal K, Townsend E. "These Things Don't Work." Young People's Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach. Arch Suicide Res 2020; 24:384-401. [PMID: 31322056 DOI: 10.1080/13811118.2019.1624669] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although UK clinical guidelines make tentative recommendations for "harm minimization" strategies for repeated self-harm, this is in the absence of empirical evidence supporting their acceptability or effectiveness. We explore young people's views of harm minimization strategies (e.g., snapping elastic bands on skin, drawing on skin with red ink), as a proxy for self-harm. In this mixed methods study we examine data (secondary analysis) from: (1) an online questionnaire (N = 758) observing the frequency of these strategies being used as a form of self-harm, and as a form of alternative coping (viewed as distinct from self-harming), and (2) semi-structured interviews (N = 45), using thematic analysis to identify themes related to harm minimization. Predominant themes suggest that many young people viewed harm minimization strategies as a proxy for self-harm as ineffective. Where such strategies were reported as helpful, their utility was reported to be short-lived or situation-specific. Findings from both studies indicate that some young people described using harm minimization (e.g., elastic band snapping) as a form of self-harm (e.g., to break the skin). Harm minimization strategies should not be recommended in isolation and their use must be monitored. Further research is urgently needed to develop an evidence base that informs practice.
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83
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Shepherd V. An exploration around peer support for secondary pupils in Scotland with experience of self-harm. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2020. [DOI: 10.1080/02667363.2020.1772726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Victoria Shepherd
- Highland Council Psychological Service, Highland Council, Scotland, UK
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84
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Quarshie ENB, Waterman MG, House AO. Adolescents at risk of self-harm in Ghana: a qualitative interview study exploring the views and experiences of key adult informants. BMC Psychiatry 2020; 20:310. [PMID: 32546144 PMCID: PMC7298808 DOI: 10.1186/s12888-020-02718-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/04/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Ghana, rates of self-harm in young people are as high as they are in high income countries. Self-reported interpersonal, familial and societal stressors form the most important background, and self-harm is seen by young people as a way of responding to that stress. In the present study, we obtained the views of key adult informants about self-harm among adolescents in Ghana - what they thought as possible reasons for self-harm in young people and what actions might be needed at an individual or population level to respond to the problem. METHODS We interviewed face-to-face 11 adults, using a semi-structured interview guide. We used an experiential thematic analysis technique to analyse the transcribed interviews. RESULTS The analysis identified five themes: "underestimating the prevalence of self-harm in adolescents", "life on the streets makes self-harm less likely", "self-harm in adolescents is socially and psychologically understandable", "ambivalence about responding to adolescent self-harm", and "few immediate opportunities for self-harm prevention in Ghana". Adolescent self-harm was acknowledged but its scale was underestimated. The participants offered explanations for adolescent self-harm in social and psychological terms that are recognisable from accounts in high income countries. Low rates among street-connected young people were explained by their overarching orientation for survival. Participants agreed that identification was important, but they expressed a sense of inadequacy in identifying and supporting adolescents at risk of self-harm. Again, the participants agreed that self-harm in adolescents should be prevented, but they recognised that relevant policies were not in place or if there were policies they were not implemented - mental health and self-harm were not high on public or political priorities. CONCLUSIONS The adults we interviewed about young people who self-harm see themselves as having a role in identifying adolescents at risk of self-harm and see the organisations in which they work as having a role in responding to individual young people in need. These are encouraging findings that point to at least one strand of a policy in Ghana for addressing the problem of self-harm in young people.
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Affiliation(s)
| | | | - Allan O House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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85
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Aguirre Velasco A, Cruz ISS, Billings J, Jimenez M, Rowe S. What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry 2020; 20:293. [PMID: 32527236 PMCID: PMC7291482 DOI: 10.1186/s12888-020-02659-0] [Citation(s) in RCA: 202] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/11/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Increasing rates of mental health problems among adolescents are of concern. Teens who are most in need of mental health attention are reluctant to seek help. A better understanding of the help-seeking in this population is needed to overcome this gap. METHODS Five databases were searched to identify the principal barriers, facilitators and interventions targeting help-seeking for common mental health problems in adolescents aged 10-19 years. The search was performed in June 2018 and updated in April 2019. Two independent screening processes were made using the eligibility criteria. Quality assessment of each study was performed, and findings summarised using a narrative synthesis. RESULTS Ninety studies meet the inclusion criteria for this review for barrier and facilitators (n = 54) and interventions (n = 36). Stigma and negative beliefs towards mental health services and professionals were the most cited barriers. Facilitators included previous positive experience with health services and mental health literacy. Most interventions were based on psychoeducation, which focused on general mental health knowledge, suicide and self-harm, stigma and depression. Other types of interventions included the use of multimedia and online tools, peer training and outreach initiatives. Overall, the quality of studies was low to medium and there was no general agreement regarding help-seeking definition and measurements. CONCLUSION Most of the interventions took place in an educational setting however, it is important to consider adolescents outside the educational system. Encouraging help-seeking should come with the increased availability of mental health support for all adolescents in need, but this is still a major challenge for Child and Adolescent Mental Health Services. There is also a need to develop shared definitions, theoretical frameworks and higher methodological standards in research regarding help-seeking behaviours in adolescents. This will allow more consistency and generalisability of findings, improving the development of help-seeking interventions and ensuring timely access to mental health treatments.
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Affiliation(s)
- Antonia Aguirre Velasco
- Child and Adolescent Mental Health Service, Children’s Hospital Dr. Roberto del Río, Santiago, Chile
| | | | - Jo Billings
- División of Psychiatry, University College London, London, UK
| | | | - Sarah Rowe
- División of Psychiatry, University College London, London, UK
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86
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Quarshie ENB, Waterman MG, House AO. Adolescent self-harm in Ghana: a qualitative interview-based study of first-hand accounts. BMC Psychiatry 2020; 20:275. [PMID: 32487040 PMCID: PMC7268665 DOI: 10.1186/s12888-020-02599-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/12/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recent prevalence studies suggest that self-harm among adolescents in sub-Saharan Africa is as common as it is in high income countries. However, very few qualitative studies exploring first-person accounts of adolescent self-harm are available from sub-Saharan Africa. We sought to explore the experiences and first-person perspectives of Ghanaian adolescents reporting self-harm - for deeper reflections on the interpretive repertoires available in their cultural context for making sense of self-harm in adolescents. METHODS Guided by a semi-structured interview protocol, we interviewed one-to-one 36 adolescents (24 in-school adolescents and 12 street-connected adolescents) on their experiences of self-harm. We applied experiential thematic analysis to the data. RESULTS Adolescents' description of the background to their self-harm identified powerlessness in the family context and unwanted adultification in the family as key factors leading up to self-harm among both in-school and street-connected adolescents. Adolescents' explanatory accounts identified the contradictory role of adultification as a protective factor against self-harm among street-connected adolescents. Self-harm among in-school adolescents was identified as a means of "enactment of tabooed emotions and contestations", as a "selfish act and social injury", as "religious transgression", while it was also seen as improving social relations. CONCLUSIONS The first-person accounts of adolescents in this study implicate familial relational problems and interpersonal difficulties as proximally leading to self-harm in adolescents. Self-harm in adolescents is interpreted as an understandable response, and as a strong communicative signal in response to powerlessness and family relationship difficulties. These findings need to be taken into consideration in the planning of services in Ghana and are likely to be generalisable to many other countries in sub-Saharan Africa.
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Affiliation(s)
| | | | - Allan O House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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87
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Record RA, Straub K, Stump N. #Selfharm on #Instagram: Examining User Awareness and Use of Instagram's Self-harm Reporting Tool. HEALTH COMMUNICATION 2020; 35:894-901. [PMID: 30961389 DOI: 10.1080/10410236.2019.1598738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Self-harm-related posts on social media are a growing public health concern. To address the high rate of self-harm posts on their platform, Instagram introduced (in 2016) a tool for users to anonymously report posts that suggest engagement in, or support for, self-harm. Grounded in diffusion of innovation and the theory of planned behavior, the purpose of this study was to evaluate awareness of, and intention to use, the self-harm reporting tool among Instagram users. Survey data collected from 417 undergraduate Instagram users suggests that users are generally unaware that the self-harm reporting feature exists within the platform. However, once informed that the tool is available, regression analysis found attitudes, subjective norms, and perceived behavioral control to predict high intention to use the tool as a method for addressing risks of self-harm. Implications from these findings extend theoretical understandings of social media-based health behavior as well as practical recommendations for reducing risks of self-harm on social media platforms.
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88
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Plener PL. Tailoring treatments for adolescents with nonsuicidal self-injury. Eur Child Adolesc Psychiatry 2020; 29:893-895. [PMID: 32236748 DOI: 10.1007/s00787-020-01523-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
Abstract
Nonsuicidal Self-Injury (NSSI) in adolescence is highly prevalent and seems to be on the rise. To deliver evidence-based treatments to a large and growing number of adolescents, it is crucial to provide scaleable, manualized interventions that have the potential to fit into a stepped-care approach. The work by Kaess et al. (2019) was able to show a reduction of NSSI both by the brief intervention "Cutting Down", as well as by regular psychotherapeutic treatment. Future treatment strategies for NSSI should tailor treatment approaches to fit adolescents´ needs.
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Affiliation(s)
- Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria. .,Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075, Ulm, Germany.
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89
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Thorn P, Hill NT, Lamblin M, Teh Z, Battersby-Coulter R, Rice S, Bendall S, Gibson KL, Finlay SM, Blandon R, de Souza L, West A, Cooksey A, Sciglitano J, Goodrich S, Robinson J. Developing a Suicide Prevention Social Media Campaign With Young People (The #Chatsafe Project): Co-Design Approach. JMIR Ment Health 2020; 7:e17520. [PMID: 32391800 PMCID: PMC7248803 DOI: 10.2196/17520] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions. OBJECTIVE This study aimed to document key elements of the co-design process; to evaluate young people's experiences of the co-design process; and to capture young people's recommendations for the #chatsafe suicide prevention social media campaign. METHODS In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people's experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators. RESULTS The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services. CONCLUSIONS This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web.
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Affiliation(s)
- Pinar Thorn
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Nicole Tm Hill
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michelle Lamblin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Zoe Teh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sarah Bendall
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Kerry L Gibson
- The University of Auckland, Auckland CBD, Auckland, New Zealand
| | - Summer May Finlay
- The University of Canberra, Bruce, ACT, Australia
- The University of Wollongong, Wollongong, NSW, Australia
| | | | | | | | | | | | | | - Jo Robinson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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90
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Bundock K, Chan C, Hewitt O. Adolescents' Help-Seeking Behavior and Intentions Following Adolescent Dating Violence: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:350-366. [PMID: 29683049 DOI: 10.1177/1524838018770412] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The review aimed to systematically identify and summarize empirical work examining adolescent victims' help-seeking behaviors and intentions in relation to their own experience of adolescent dating violence (ADV) and to critically evaluate the literature. Three main objectives were addressed: identify factors associated with help seeking, identify help-seeking source (who adolescents disclose to), and explore the barriers and facilitators for help seeking. Results were separated into actual help seeking and help-seeking intentions. A systematic search was conducted via an electronic search on February 10, 2017. Studies were identified by systematically searching the following electronic databases: Amed, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, Medline, PsychINFO, and PubMed. Nineteen studies were included in the review. Adolescents were more likely to go to informal sources of support, with friends being the most commonly reported source. The majority of studies found females were more likely than males to seek help; however, inconsistencies in gender differences emerged. The variation in measurement and definition of ADV and help seeking included in this review impacts on its conclusions. Adolescents identify a number of barriers to help seeking for ADV. Emotional factors were identified as important barriers to seeking help; however, very little research in this review explored this area. Further research is required on age and cultural differences, use of the Internet, and preference for different sources for different types of abuse. There is a need for a greater focus on help seeking to ensure government campaigns are appropriately meeting the needs of young people experiencing ADV.
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Affiliation(s)
- Kerrie Bundock
- Oxford Institute of Clinical Psychology Training, Isis Education Centre, Oxford, England
| | - Carmen Chan
- Oxford Health NHS Foundation Trust, Oxford, England
| | - Olivia Hewitt
- Oxford Institute of Clinical Psychology Training, Isis Education Centre, Oxford, England
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91
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[Development of an Online Intervention for Adolescents and Young Adults Engaging in Nonsuicidal Self-injury]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:141-155. [PMID: 32114946 DOI: 10.13109/prkk.2020.69.2.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Development of an Online Intervention for Adolescents and Young Adults Engaging in Nonsuicidal Self-injury Nonsuicidal self-injury (NSSI) is a prevalent phenomenon in adolescence. Despite the existence of effective psychotherapeutic interventions, the majority of affected adolescents and young adults do not receive any treatment. Structural (e. g., no specific interventions, limited resources, limited accessibility) as well as individual factors (e. g., low help-seeking behavior) impede access to adequate clinical care for adolescent NSSI. Online interventions offer the possibility to provide specific interventions independent of one's location or local healthcare structures. Because of its high confidentiality and accessibility, the Internet also reaches adolescents with low help-seeking behavior. There is already evidence for online interventions concerning different mental health issues, like depression and anxiety. However, regarding NSSI, there are no effective, online interventions. Thus, we developed an online intervention based on an already evaluated short term program specific for adolescents and young adults with NSSI within the German STAR consortium (STAR: Self-Injury - Treatment, Assessment, Recovery). Within a randomised controlled trial, the intervention will be evaluated regarding its efficacy.
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92
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Daukantaitė D, Lantto R, Liljedahl SI, Helleman M, Westling S. One-Year Consistency in Lifetime Frequency Estimates and Functions of Non-Suicidal Self-Injury in a Clinical Sample. Front Psychiatry 2020; 11:538. [PMID: 32612546 PMCID: PMC7308529 DOI: 10.3389/fpsyt.2020.00538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/26/2020] [Indexed: 11/13/2022] Open
Abstract
Non-suicidal self-injury (NSSI), the direct, deliberate destruction of one's own bodily tissue in the absence of an intent to die, is frequently used for evaluating treatment in clinical care. One instrument for assessing NSSI is the Inventory of Statements About Self-Injury (ISAS). The ISAS is a self-rating measure examining the lifetime frequencies of NSSI behaviors and further exploring NSSI functions. The study aimed to examine the consistency of self-reported lifetime NSSI frequencies and functions (via the ISAS) in a clinical sample of individuals with current self-harm and/or recurrent suicidal behaviors over one year. Fifty-two individuals (84.6% women) completed the ISAS three times over 1 year. We found relatively good test-retest stability for most NSSI behaviors and functions, but the correlation coefficients and frequencies of NSSI behaviors varied substantially. Approximately, 50% of participants reported lower lifetime frequencies of NSSI behaviors at the later time points, with approximately 20% reporting a significant reduction in their lifetime frequencies over one year. This unexpected finding raises concerns about the accuracy of reporting lifetime NSSI frequencies among individuals with multiple psychiatric diagnoses and extensive NSSI behaviors across their lives. Further research is needed to determine more reliable ways of collecting data on the lifetime frequency of NSSI in clinical samples and the accuracy of lifetime NSSI frequency estimates in general.
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Affiliation(s)
| | - Reid Lantto
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Clinical Psychiatric Research Center, Region Skåne, Lund, Sweden
| | - Sophie I Liljedahl
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Marjolein Helleman
- School of Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Sofie Westling
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Clinical Psychiatric Research Center, Region Skåne, Lund, Sweden
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93
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Brown RC, Fischer T, Goldwich DA, Plener PL. "I just finally wanted to belong somewhere"-Qualitative Analysis of Experiences With Posting Pictures of Self-Injury on Instagram. Front Psychiatry 2020; 11:274. [PMID: 32372983 PMCID: PMC7186324 DOI: 10.3389/fpsyt.2020.00274] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/20/2020] [Indexed: 11/18/2022] Open
Abstract
Non-suicidal self-injury (NSSI) is a common phenomenon among adolescents, but is often not disclosed due to fear of stigmatization. Social media is frequently used to publish photos of NSSI and share experiences with NSSI. Objectives of this study were to find out more about the motivation for publishing NSSI content and to investigate the effect that sharing this content on social media has on young people. In the current study, we interviewed N=59 participants (mean age = 16.7 years [SD = 1.2 years]; 72.9% female), who had all posted NSSI content within the past month on the social media platform Instagram. Semi-structured interviews were conducted via the Instagram messaging app. Interviews were analyzed qualitatively, assisted by the Software Atlas.ti 7. Participants were asked about their motivation for and their experiences with posting NSSI content online. Motivations for posting pictures online were mainly social (connecting, disclosure, communicating), while self-focused reasons like documenting NSSI or recovery were also mentioned. All participants reported having received positive reactions (being offered help, connecting, receiving empathy), as well as negative comments (harassment, being misunderstood) to their own NSSI content by other Instagram users. Participants' reactions to other users' NSSI content on Instagram was often identification with the content or being triggered, but also wanting to offer help or sometimes even being deterred from NSSI. None of the participants mentioned successful referral to professional help through their online NSSI activity. One target for future interventions could therefore be social media, or other online platforms, where adolescents might be more easily reached. Mental health practitioners should be aware of their clients' online activity and encourage reflection upon positive and negative effects of viewing or sharing NSSI content online.
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Affiliation(s)
- Rebecca C Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | | | | | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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94
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Ohlis A, Bjureberg J, Lichtenstein P, D'Onofrio BM, Fruzzetti AE, Cederlöf M, Hellner C. Comparison of suicide risk and other outcomes among boys and girls who self-harm. Eur Child Adolesc Psychiatry 2020; 29:1741-1746. [PMID: 32056009 PMCID: PMC7641927 DOI: 10.1007/s00787-020-01490-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/02/2020] [Indexed: 11/25/2022]
Abstract
Little is known about sex differences in outcomes of self-harm, and there are inconclusive results concerning the association between sex, self-harm, and suicide attempts. The aim of this study was to explore sex differences in outcomes of self-harm in adolescence. In this cohort study, all individuals (0-17 years) enrolled at the child- and adolescent mental health services (CAMHS) in Stockholm between 2001 and 2015 (N = 110,072) were followed in national registers from their last contact with the CAMHS, until end of 2015. Exposure was self-harm as reason for contact, outcome measures were: alcohol-/substance use disorder, psychiatric hospitalization, non-violent or violent crime, and suicide. Differences in outcomes rates between exposed versus unexposed males, and exposed versus unexposed females, were examined using Cox regressions, expressed as hazard ratios (HR) with 95% confidence intervals (CI). Median follow-up time was 5.8 years (Q1: 2.3 years; Q3: 9.7 years). Self-harm was documented in 2.2% (N = 1241) males and 8.7% (4716) females. Exposed individuals had higher HR for all outcomes as compared with unexposed individuals of their own sex. Exposed females had more pronounced risk for drug use disorder (HR 11.2; 95% CI 9.9-12.7) compared with exposed males (HR 6.5, 95% 5.2-8.0). Both males and females who had engaged in self-harm had elevated risks for future suicide. Adjusting for socio-economic status and age at start of follow-up only marginally affected the associations. Females and males with self-harm had similarly elevated risk for suicide, and self-harm was also an important risk marker for other adverse outcomes within both sexes.
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Affiliation(s)
- Anna Ohlis
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Alan E Fruzzetti
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Martin Cederlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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95
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Torok M, Han J, Baker S, Werner-Seidler A, Wong I, Larsen ME, Christensen H. Suicide prevention using self-guided digital interventions: a systematic review and meta-analysis of randomised controlled trials. LANCET DIGITAL HEALTH 2019; 2:e25-e36. [PMID: 33328037 DOI: 10.1016/s2589-7500(19)30199-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Digital interventions that deliver psychological self-help provide the opportunity to reach individuals at risk of suicide who do not access traditional health services. Our primary objective was to test whether direct (targeting suicidality) and indirect (targeting depression) digital interventions are effective in reducing suicidal ideation and behaviours, and our secondary analyses assessed whether direct interventions were more effective than indirect interventions. METHODS In this systematic review and meta-analysis, we searched online databases MEDLINE, PubMed, PsycINFO, and Cochrane CENTRAL for randomised controlled trials published between database inception to May 21, 2019. Superiority randomised controlled trials of self-guided digital interventions (app or web based, which delivered theory-based therapeutic content) were included if they reported suicidal ideation, suicidal plans, or suicide attempts as an outcome. Non-inferiority randomised controlled trials were excluded to ensure comparability of the effect. Data were extracted from published reports, and intention-to-treat data were used if available. The primary outcome was the difference in mean scores of validated suicidal ideation measures (Hedges'g) with the associated 95% CI for the analysis of digital intervention effectiveness on suicidal ideation. We also present funnel plots of the primary outcome measure (suicidal ideation) for direct and indirect interventions to assess for publication bias. We calculated I2 (with I2 CI) values to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcomes. This study is registered with PROSPERO, CRD42018102084. FINDINGS The literature search yielded 739 articles (including manual searching) for suicidality and 8842 articles for depression. After screening, 14 papers reporting on 16 studies were included in the narrative review and meta-analysis. The 16 studies (ten on direct interventions and six on indirect interventions) provided baseline data for 4398 participants. The primary outcome of overall post-intervention effect for suicidal ideation was small but significant immediately following the active intervention phase (Hedges'g -0·18, 95% CI -0·27 to -0·10, p<0·0001; I2=0%, I2 CI 0·0-47·9). The secondary objective, comparing direct and indirect interventions, showed that direct interventions (targeting suicidality) significantly reduced suicidal ideation at post-intervention (g -0·23, 95% CI -0·35 to -0·11, p<0·0001; I2=17·6%, I2 CI 0·0-58·6), but indirect interventions (targeting depression) failed to reach significance (g -0·12, 95% CI -0·25 to 0·01, p=0·071; I2=0%, I2 CI 0·0-30·7). INTERPRETATION Self-guided digital interventions directly targeting suicidal ideation are effective immediately post-intervention. Indirect interventions were not significant for reducing suicidal ideation. Our findings suggest that digital interventions should be promoted and disseminated widely, especially where there is a lack of, or minimal access to, health services. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Jin Han
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Simon Baker
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Iana Wong
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark E Larsen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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96
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Pretorius C, Chambers D, Coyle D. Young People's Online Help-Seeking and Mental Health Difficulties: Systematic Narrative Review. J Med Internet Res 2019; 21:e13873. [PMID: 31742562 PMCID: PMC6891826 DOI: 10.2196/13873] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 01/20/2023] Open
Abstract
Background Young people frequently make use of the internet as part of their day-to-day activities, and this has extended to their help-seeking behavior. Offline help-seeking is known to be impeded by a number of barriers including stigma and a preference for self-reliance. Online help-seeking may offer an additional domain where young people can seek help for mental health difficulties without being encumbered by these same barriers. Objective The objective of this systematic literature review was to examine young peoples’ online help-seeking behaviors for mental health concerns. It aimed to summarize young peoples’ experiences and identify benefits and limitations of online help-seeking for this age group. It also examined the theoretical perspectives that have been applied to understand online help-seeking. Methods A systematic review of peer-reviewed research papers from the following major electronic databases was conducted: PsycINFO, Cumulative Index of Nursing and Allied Health Literature, PubMed, Cochrane Library, Association for Computing Machinery Digital Library, and Institute of Electrical and Electronics Engineers Xplore. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search was conducted in August 2017. The narrative synthesis approach to reviews was used to analyze the existing evidence to answer the review questions. Results Overall, 28 studies were included. The most common method of data collection was through the use of surveys. Study quality was moderate to strong. Text-based query via an internet search engine was the most commonly identified help-seeking approach. Social media, government or charity websites, live chat, instant messaging, and online communities were also used. Key benefits included anonymity and privacy, immediacy, ease of access, inclusivity, the ability to connect with others and share experiences, and a greater sense of control over the help-seeking journey. Online help-seeking has the potential to meet the needs of those with a preference for self-reliance or act as a gateway to further help-seeking. Barriers to help-seeking included a lack of mental health literacy, concerns about privacy and confidentiality, and uncertainty about the trustworthiness of online resources. Until now, there has been limited development and use of theoretical models to guide research on online help-seeking. Conclusions Approaches to improving help-seeking by young people should consider the role of the internet and online resources as an adjunct to offline help-seeking. This review identifies opportunities and challenges in this space. It highlights the limited use of theoretical frameworks to help conceptualize online help-seeking. Self-determination theory and the help-seeking model provide promising starting points for the development of online help-seeking theories. This review discusses the use of these theories to conceptualize online help-seeking and identify key motivations and tensions that may arise when young people seek help online.
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Affiliation(s)
| | - Derek Chambers
- Connecting for Life, Health Service Executive, Cork, Ireland
| | - David Coyle
- School of Computer Science, University College Dublin, Dublin, Ireland
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97
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Sheehy K, Noureen A, Khaliq A, Dhingra K, Husain N, Pontin EE, Cawley R, Taylor PJ. An examination of the relationship between shame, guilt and self-harm: A systematic review and meta-analysis. Clin Psychol Rev 2019; 73:101779. [PMID: 31707184 PMCID: PMC6891258 DOI: 10.1016/j.cpr.2019.101779] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/12/2019] [Accepted: 09/14/2019] [Indexed: 01/29/2023]
Abstract
Self-harm is a major public health concern associated with suicide risk and significant psychological distress. Theories suggest that aversive emotional states are an important process that drives self-harm. Shame and guilt may, in particular, be important emotions in self-harm. This review therefore sought to provide a systematic review and meta-analysis of the relationship between shame, guilt, and self-harm. A systematic search of electronic databases (PsycINFO; Medline; CINAHL Plus; Web of Science and ProQuest) was undertaken to identify studies measuring shame, guilt and self-harm (including suicidal and non-suicidal behaviour). Meta-analysis was undertaken where papers focused on the same subtype of shame or guilt and shared a common outcome. Thirty studies were identified for inclusion. Most forms of shame were associated with non-suicidal self-injury (NSSI), but research was sparse concerning suicidal behaviour. Fewer studies examined guilt and findings were more varied. Methodological issues included a paucity of longitudinal designs and lack of justification for sample sizes. Results of this review support the link between shame and self-harm, particularly NSSI. The direction of this relationship is yet to be established. Clinically, consideration should be given to the role of shame amongst individuals who present with NSSI. This review was pre-registered on PROSPERO (CRD42017056165).
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Affiliation(s)
- Kate Sheehy
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Amna Noureen
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Ayesha Khaliq
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Katie Dhingra
- School of Social Sciences, Leeds Beckett University, LS1 3HE England, United Kingdom
| | - Nusrat Husain
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
| | - Eleanor E Pontin
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Rosanne Cawley
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Peter J Taylor
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
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98
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Social representations about the functions of deliberate self-harm: Adolescents and parents. J Adolesc 2019; 73:113-121. [PMID: 31102879 DOI: 10.1016/j.adolescence.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The understanding of the social representations about the functions of deliberate self-harm can be an important factor for the comprehension of this phenomenon. Nonetheless, only a few studies focused on this topic and specifically on the social representations from adolescents with and without a history of deliberate self-harm and their parents. METHODS This article presents two studies that analysed these representations. Study 1 compared the social representations from 411 Portuguese adolescents (219 females and 192 males, aged 12-19 years), from which 109 reported having a history of deliberate self-harm. Study 2 focused on the comparison of the social representations from 471 parents (265 mothers and 206 fathers, aged 33-62 years) of Portuguese adolescents. Of the parents in Study 2, 120 had children with a history of deliberate self-harm. RESULTS In Study 1, adolescents without a history of deliberate self-harm perceived most interpersonal functions as more relevant than adolescents with a history of these behaviours, while adolescents with a history of deliberate self-harm emphasized one intrapersonal function. In Study 2, no differences were found between parents of adolescents with and without a history of deliberate self-harm. However, results revealed differences between the representations of mothers and fathers in several intrapersonal functions. CONCLUSIONS This research provides important insight regarding the social representations about the functions of deliberate self-harm from adolescents with and without a reported history of these behaviours and their parents. The impact for clinical intervention and prevention programs is discussed.
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Gebreegziabher Y, Girma E, Tesfaye M. Help-seeking behavior of Jimma university students with common mental disorders: A cross-sectional study. PLoS One 2019; 14:e0212657. [PMID: 30794639 PMCID: PMC6386312 DOI: 10.1371/journal.pone.0212657] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/08/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Globally, the mental health help-seeking behavior of university students is reported to be poor; less than one-third of university students with common mental disorders (CMDs) report having sought help from formal sources. Failure to seek treatment is associated with prolonged disability and poor mental health outcomes, including suicide. In Ethiopia, little is known about the help-seeking behavior of university students for CMDs. OBJECTIVE This study aimed to assess the prevalence and determinants of help seeking, and sources of help sought by Jimma University undergraduate students with CMDs. METHOD Seven hundred and sixty students were selected to participate in this cross-sectional study using multi-stage sampling. Sources of help were identified using the Actual Help-Seeking Questionnaire. CMDs were assessed using the 10-item Kessler Psychological Distress Scale. Binary logistic regression analysis was used for both univariate and multivariable analysis. RESULTS Of the sampled students, 58.4% were found to have current CMDs. Of those with current CMDs, 78.4% had sought help for their problems. The majority (83.8%) of participants who sought help did so from informal sources. Compared to students who had 'very good' overall levels of satisfaction with life, those who had 'good', 'fair', and 'poor or very poor' overall level of satisfaction with life were less likely to seek help (p-value = 0.021, 0.014, and 0.011, respectively). Lastly, having no previous history of help-seeking was significantly associated with seeking help for CMDs (p-value<0.001). CONCLUSION More than half of Jimma University students were found to have a high risk of CMDs and the majority of those with CMDs sought help from informal sources. Future studies are needed to explore the barriers of seeking help from formal resources, and the effects of not receiving help from formal sources for CMDs symptoms.
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Affiliation(s)
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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