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Zhang Q, Liu P, Zhang Y, Yan M. The Psychological Experiences of Adolescents Who Engage in Non-Suicidal Self-Injury: A Meta-Aggregative Synthesis of Qualitative Studies. Issues Ment Health Nurs 2024:1-11. [PMID: 39106276 DOI: 10.1080/01612840.2024.2374011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Non-suicidal self-injury (NSSI) is an international public health problem. Qualitative synthesis of the psychological experiences associated with NSSI in adolescents remains limited. This study aimed to systematically review the factors, emotional experiences, coping strategies, and help-seeking experiences of adolescents who engage in NSSI. A comprehensive search of 10 databases was conducted. Two researchers independently conducted study screening, data extraction, and quality assessment. Eighteen articles were included and analyzed using a meta-aggregation approach. Four themes were identified: (1) factors contributing to NSSI, (2) emotions associated with engaging in NSSI, (3) coping strategies, and (4) potential barriers to seeking help. Our findings provide a comprehensive picture of the psychological experiences of adolescents who engage in NSSI. They primarily adopt negative coping strategies to deal with serious problems, and there are potential barriers to seeking help. Further research is needed to explore the true needs of adolescents, as well as how schools, families, and hospitals can play a collaborative role in improving adolescents' psychological issues.
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Affiliation(s)
- Qian Zhang
- Academy of Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Panyu Liu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Yuhan Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Meiqin Yan
- Department of Science and Education, Children's Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, China
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Ahmad SI, Hinshaw SP. A Qualitative Analysis of Perspectives on Self-directed Violence in a Prospective Longitudinal Study of Young Women With and Without Childhood ADHD. J Atten Disord 2024; 28:1255-1266. [PMID: 38294171 PMCID: PMC11168017 DOI: 10.1177/10870547231221729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Non-suicidal self-directed violence (NSSDV) is a significant and growing youth public health crisis. Girls with ADHD are at increased risk of engaging in NSSDV, yet qualitative studies with this population-to better understand manifestations, motivations, and developmental course-are lacking. METHOD We conducted semi-structured, qualitative interviews with a sub-sample of 57 young women (32 with childhood ADHD, 25 neurotypical comparisons; mean age of 27 years, part of a larger prospective longitudinal study) regarding histories and manifestations of NSSDV. RESULTS Inductive and deductive analysis revealed several key themes, including self-perceived reasons for engaging in NSSDV (affect regulation, attention seeking, self-punishment, asserting control), impulsivity, secretiveness, and in some cases motivations for desistance. CONCLUSION Findings underscore the importance of early education and screening, especially among high-risk clinical populations. Increased resources and supports for professionals, parents, and peers are indicated, along with countering the persistent stigma associated with ADHD and NSSDV.
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Affiliation(s)
| | - Stephen P. Hinshaw
- University of California, San Francisco, USA
- University of California, Berkeley, USA
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Liu J, Gao Y, Liu X, Wang H. Developmental trajectories of non-suicidal self-injury in adolescence: The effect of social support and socioeconomic status. Suicide Life Threat Behav 2024. [PMID: 38949258 DOI: 10.1111/sltb.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/02/2024] [Accepted: 06/24/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) in early adolescence has been amply documented. However, there has been little research on the progression of NSSI over time. Most studies have focused on the risk factors for NSSI, with less attention devoted to understanding the role of protective factors. This paper aimed to expand existing knowledge about the development of NSSI, with an emphasis on the impacts of protective factors such as social support and socioeconomic status (SES). METHODS A total of 436 adolescents completed self-report surveys that addressed social support including friend, family, and teacher support, objective and subjective SES, and NSSI at three different points in time for 2 years. RESULTS Latent growth curve analyses revealed that NSSI increased across early adolescence to mid-adolescence. Support from friends and family negatively predicted adolescents' initial NSSI level. Furthermore, subjective SES negatively predicted the rate of NSSI. CONCLUSIONS These findings contribute to an understanding of the influences of both social support and SES on NSSI over time. NSSI interventions and education should include considerations of both the value of support from friends and family as well as subjective SES.
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Affiliation(s)
- Jinmeng Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yemiao Gao
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xia Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Hui Wang
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
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Lindquist EG, West AE. What Do My (Online) Friends Think? A Topic Modeling Approach to Identifying Patterns of Response to Self-Injurious Behaviors on Reddit. Arch Suicide Res 2024; 28:537-553. [PMID: 36998237 DOI: 10.1080/13811118.2023.2193594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Approximately 17% of adolescents and young adults will engage in non-suicidal self-injury (NSSI) at least once in their lifetime, leading the World Health Organization to identify self-injury as one of the top five public health concerns for adolescents. Despite the widespread prevalence of this behavior, NSSI continues to be heavily stigmatized in both medical and community settings, deterring many engaged in NSSI from seeking informal support from friends and family as well as formal psychological or psychiatric treatment. In contrast to the low rates of in-person help-seeking for NSSI, online support groups are highly utilized by those engaged in NSSI. Thus, an empirical study of responses to frequent, voluntary disclosure of NSSI on social media is needed to better understand how these communities meet the needs of those who self-injure. METHOD The current project used latent Dirichlet allocation to identify frequent and favored themes in response to self-injury content in the largest self-injury group on Reddit (over 100,000 members). Reddit, the 9th most visited website in the world, is a chat-based social media platform that has 430+ million active users and billions of site visits, with current estimates suggesting that ∼63% of the U.S. population are Reddit users. RESULTS Identified themes included: (1) recovery encouragement; (2) provision of social and instrumental support; and (3) daily realities of living with NSSI. Responses that encouraged recovery received more upvotes on Reddit than any other type of comment. CONCLUSION These results can inform evidence-based, person-centered, dimensional treatments for NSSI.
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Bilello D, Townsend E, Broome MR, Burnett Heyes S. Friendship and self-harm: a retrospective qualitative study of young adults' experiences of supporting a friend who self-harmed during adolescence. Front Psychol 2024; 14:1221661. [PMID: 38370107 PMCID: PMC10869467 DOI: 10.3389/fpsyg.2023.1221661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction Self-harm amongst young people is becoming increasingly prevalent. Understanding, responding to, and supporting young people who self-harm is vital. Friends are typically the first and sometimes the only source of support sought by adolescents who self-harm. Despite their important role as confidants, friends' perspectives and experiences remain poorly understood. Methods We conducted retrospective qualitative semi-structured interviews, prompted by an adapted version of the Card Sort Task for Self-Harm (CaTS-FF), about the experiences of nine female young adults (18-20 years old) who supported a friend who self-harmed during adolescence. Data were analyzed using thematic analysis. Results Four themes were developed: (1) "I did not realize my friend was on the road to self-harm": Friends' reactions to self-harm; (2) "That's what friends do": the role of friends; (3) The impact of supporting a friend who self-harms; and (4) "They were quite formative years": reflecting on growth through the experience. Discussion The present findings highlight the complex experiences of young people supporting a friend who self-harms. Despite being willing to take on the role of a supporter, participants experienced a range of difficult emotions and consequences. The temporal transition running through the four themes reflects the evolving nature of participants' attitudes, knowledge, and friendships. Overall, results highlight the unmet needs of adolescents supporting young people who self-harm, as well as identifying potential pathways to "support the supporters" toward resilience.
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Affiliation(s)
- Delfina Bilello
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham, United Kingdom
| | - Matthew R. Broome
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stephanie Burnett Heyes
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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Andersson H, Svensson E, Magnusson A, Holmqvist R, Zetterqvist M. Young adults looking back at their experiences of treatment and care for nonsuicidal self-injury during adolescence: a qualitative study. Child Adolesc Psychiatry Ment Health 2024; 18:16. [PMID: 38245758 PMCID: PMC10800066 DOI: 10.1186/s13034-024-00706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is associated with stigma, and negative attitudes among healthcare professionals toward NSSI have been reported. A person-centered approach that focuses on how individuals with lived experience of NSSI perceive the treatment and care they receive is invaluable in reducing barriers to help-seeking and improving treatment and mental healthcare services. The aim of the current qualitative study was to explore the perceptions of young adults when they look back upon their experiences of psychiatric treatment for NSSI during adolescence. METHODS Twenty-six individuals with lived experience of NSSI who were in contact with child and adolescent psychiatry during adolescence were interviewed. The interviews were analyzed using thematic analysis. RESULTS Three main themes were developed: Changed perceptions in retrospect, The importance of a collaborative conceptualization and Lasting impression of the relationship. Participants' perception of themselves as well as the treatment changed over time. The importance of a joint understanding of NSSI and an agreed-upon treatment focus was emphasized. The relationship to the mental health professionals, and experiences of how NSSI was communicated, were salient several years later. CONCLUSIONS Healthcare professionals need to communicate about NSSI in a respectful manner and include the perspective of the adolescent with lived experience of NSSI in a joint conceptualization of NSSI and treatment focus.
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Affiliation(s)
- H Andersson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden
| | - E Svensson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - A Magnusson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - R Holmqvist
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - M Zetterqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden.
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Tan RHS, Shahwan S, Zhang Y, Sambasivam R, Ong SH, Subramaniam M. How do professionals and non-professionals respond to non-suicidal self-injury? Lived experiences of psychiatric outpatients in Singapore. BMC Psychol 2024; 12:14. [PMID: 38178150 PMCID: PMC10768356 DOI: 10.1186/s40359-023-01512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND For young people who engage in non-suicidal self-injury (NSSI), receiving negative responses to their NSSI can pose a barrier to future help-seeking. This qualitative study aimed to explore helpful and unhelpful ways in which professionals and non-professionals respond to NSSI, from the perspectives of individuals with lived experiences of NSSI. METHODS Semi-structured interviews were conducted with 20 outpatients (6 males, 14 females) aged 17 to 29 years from a tertiary psychiatric hospital in Singapore, who had reported engaging in NSSI behavior in an earlier study. The interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. RESULTS Professionals' responses were organized into three main themes: 'prescribing solutions without understanding needs', 'disapproval or judgment', and 'helpful responses'. Non-professionals' responses were organized into four main themes: 'emotionally charged responses', 'avoidance and inaction', 'poor understanding of reasons for NSSI', and 'providing tangible support and acknowledging NSSI'. Participants also described how unhelpful responses negatively impacted their willingness to seek help. CONCLUSIONS Our findings provide a better understanding of responses to NSSI that are considered helpful and unhelpful, and can be used to improve existing guidelines on responding to NSSI.
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Affiliation(s)
- Rachel Hsiao Shen Tan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Rajeswari Sambasivam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Say How Ong
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
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Wright LC, Lopez Chemas N, Cooper C. Lived experience codesign of self-harm interventions: a scoping review. BMJ Open 2023; 13:e079090. [PMID: 38151276 PMCID: PMC10753750 DOI: 10.1136/bmjopen-2023-079090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES This study aims to map existing literature describing how people with lived experience of self-harm have engaged in codesigning self-harm interventions, understand barriers and facilitators to this engagement, and how the meaningfulness of codesign has been evaluated. DESIGN Scoping review by Joanna Briggs Institute methodology. A protocol was published online (http://dx.doi.org/10.17605/OSF.IO/P52UD). DATA SOURCES PubMed, Embase, PsycINFO, Web of Science, Cochrane Library, PROSPERO, ClinicalTrials.gov and relevant websites were searched on 24 December 2022 (repeated 4 November 2023). ELIGIBILITY CRITERIA We included studies where individuals with lived experience of self-harm (first-hand or caregiver) have codesigned self-harm interventions. DATA EXTRACTION AND SYNTHESIS Results were screened at title and abstract level, then full-text level by two researchers independently. Prespecified data were extracted, charted and sorted into themes. RESULTS We included 22 codesigned interventions across mobile health, educational settings, prisons and emergency departments. Involvement varied from designing content to multistage involvement in planning, delivery and dissemination. Included papers described the contribution of 159 female, 39 male and 21 transgender or gender diverse codesigners. Few studies included contributors from a minoritised ethnic or LGBTQIA+ group. Six studies evaluated how meaningfully people with lived experience were engaged in codesign: by documenting the impact of contributions on intervention design or through postdesign reflections. Barriers included difficulties recruiting inclusively, making time for meaningful engagement in stretched services and safeguarding concerns for codesigners. Explicit processes for ensuring safety and well-being, flexible schedules, and adequate funding facilitated codesign. CONCLUSIONS To realise the potential of codesign to improve self-harm interventions, people with lived experience must be representative of those who use services. This requires processes that reassure potential contributors and referrers that codesigners will be safeguarded, remunerated, and their contributions used and valued.
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Affiliation(s)
- Lucy C Wright
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Natalia Lopez Chemas
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Qin Y, Wu D, Liu J, Peng J, Li C. Perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers: a qualitative study. Front Psychiatry 2023; 14:1237436. [PMID: 38148747 PMCID: PMC10750419 DOI: 10.3389/fpsyt.2023.1237436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
Background The prevalence of non-suicidal self-injury among adolescents has increased over the years. Most parents, however, are poorly informed and confused about this behavior. Sharing caretaking experiences with parents in similar situations seems to be beneficial. Nevertheless, few researchers have explored the views of parents who share their caretaking experiences with peers. Aim This study aimed to investigate the perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers as well as the motivations for and barriers to this behavior. Methods This qualitative study adopted a purposive sampling method. Participants (16 mothers and 2 fathers) were recruited from the mental health center of a tertiary hospital in Chengdu, Sichuan, China. A total of 18 semistructured face-to-face individual interviews were conducted. All interviews were audio-recorded and analyzed thematically using NVivo 11. Results Three themes and nine subthemes were identified: (1) sharable caretaking experiences: reflection and transformation, self-emotional management, and diversified support; (2) motivations for sharing: empathy, reciprocity, and meaning; and (3) barriers to sharing: inadequate knowledge, low self-identity, and concerns for children. Conclusion Parents accumulate a wealth of experience during their long-term care of adolescents with repeated non-suicidal self-injury. Although most parents are willing to share their caretaking experiences with peers, there are several barriers. Therefore, in order to increase parents' motivation to share, psychological education is necessary.
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Affiliation(s)
- Yuan Qin
- School of Nursing, Chengdu Medical College, Chengdu, China
- Chongqing Mental Health Center, Chongqing, China
| | - Dongmei Wu
- Department of Nursing, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Jiao Liu
- School of Nursing, Zunyi Medical University, Zunyi, China
| | - Jianyan Peng
- Department of Nursing, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunya Li
- Department of Nursing, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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Townsend ML, Matthews EL, Miller CE, Grenyer BF. Adolescent self-harm: Parents' experiences of supporting their child and help-seeking. J Child Health Care 2023; 27:516-530. [PMID: 35313747 DOI: 10.1177/13674935211062334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Self-harm in children and adolescents is a growing public health issue. Parents are forefront in identifying, responding to and supporting their child to seek help. A sequential mixed-method study which included an online survey (N = 37) and a semi-structured interview (n = 10) was conducted to understand parents' experiences of supporting and accessing help for their child. Parents (M = 45.70 years, SD = 6.18) with a child who has engaged in self-harm behaviours (M = 16.89 years, SD = 3.91) participated. Parents sought help from a range of services and perceived psychiatrists, private psychologists and friends as the most helpful and school psychologists, paediatricians, Emergency Department (ED) and the national youth mental health organisation as the least helpful. Two themes were interpreted from the qualitative data: (1) An emotional journey into the dark unknown, and (2) The promise of psychological help. A series of recommendations for other parents in similar situations, as well as health professionals were made. Parents want health professionals to provide appropriate referrals, work collaboratively with families, meaningfully connect with and validate parents, provide practical and psychological support for families and establish parent support groups. There remains a need for widely available evidence-informed resources, information and support for parents.
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Affiliation(s)
- Michelle L Townsend
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Emily L Matthews
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Caitlin E Miller
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Brin Fs Grenyer
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Miettinen TM, Kaunonen M, Kylmä J, Rissanen ML, Aho AL. Experiences of Help from the Perspective of Parents Whose Adolescent Is Harming Themselves or Has Died by Suicide. Issues Ment Health Nurs 2023; 44:1083-1095. [PMID: 37801715 DOI: 10.1080/01612840.2023.2258211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Adolescent self-harm or suicide are emotionally difficult for parents, thus also parents need help. This qualitative descriptive study aimed to produce knowledge on the experiences of help received by Finnish parents (n = 23) whose adolescent is harming themselves or has died by suicide. The parents received diverse help for themselves, and for their self-harming adolescent or the deceased adolescent's sibling. Parents described negative experiences, but also factors that promoted their experience of help. There are many barriers to help related to the parents themselves, the adolescent, or to the social support system. Professional help should be easier to obtain and be based on the parents' individual expectations.
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Affiliation(s)
| | - Marja Kaunonen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Wellbeing Services County of Pirkanmaa, Hospital Services, General Administration, Finland
| | - Jari Kylmä
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Marja-Liisa Rissanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- South-Eastern Finland University of Applied Sciences, Health Care, Mikkeli, Finland
| | - Anna Liisa Aho
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Ma S, Su Z. Current status of nonsuicidal injuries and associated factors among junior high school students in Hainan Province, China: a cross-sectional study. BMC Psychol 2023; 11:199. [PMID: 37408085 DOI: 10.1186/s40359-023-01227-x] [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: 10/27/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND To summarize the general status of nonsuicidal self-injury (NSSI) behaviour and the characteristics of junior high school students and to determine the risk factors associated with NSSI behaviour. METHODS Five middle schools in the rural and urban areas of Hainan Province were randomly selected for this cross-sectional study, and junior high school students were administered questionnaires, including the General Sociodemographic Questionnaire, Ottawa Self-Injury Scale, Anxiety Self-Rating Scale, Depression Self-Rating Scale, Adolescent Lifestyle Scale, and Parenting Style Scale. RESULTS The NSSI rate among junior high school students in Hainan Province was 28.9%, with a higher prevalence among girls than boys (P < 0.05). The age range was 11-16 years, with a mean age of 13.08 ± 0.911 years. The most common form of self-injury was scratching/bruising, followed by hitting oneself, pulling out hair, biting, head banging, and cutting. The NSSI methods of scratching/bruising, hitting oneself and cutting more commonly occurred in girls than boys (P < 0.05). The most common sites of self-injury were the face, scalp, lips, forearm/elbow, axilla/wrist, hands/fingers, and thighs/knees. Significant differences were observed in the distribution of self-injury sites (nose, lips, genitals, and axillae/wrists) between the two genders (p < 0.05). The most important motivation for undertaking NSSI behaviours was to release negative emotions. The risk factors affecting NSSI behaviours were female gender (OR = 1.793), depression (OR = 1.961), anxiety (OR = 1.495), interpersonal relationship factors (OR = 1.099), academic stress factors (OR = 1.062), maternal emotional warmth (OR = 0.97), and maternal overinterference (OR = 1.036). CONCLUSIONS The NSSI rate among junior high school students in Hainan was 28.9%, affecting girls more than boys. The form and site of self-injury between boys and girls were significantly different. The motivation for committing self-injurious behaviours was mainly to regulate bad emotions. Risk factors for NSSI behaviours included female gender, anxiety, depression, interpersonal relationship factors, academic stress factors, and maternal emotional overinterference, while maternal emotional warmth was a protective factor.
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Affiliation(s)
- Siying Ma
- Department of Hospital Infection-control, the First Hospital of Hainan Medical University, Haikou City, Hainan Province, 570102, China
| | - Zhaoxia Su
- Department of Psychology, the First Hospital of Hainan Medical University, No. 29 Yilong West Road, Longhua District, Haikou City, Hainan Province, 570102, China.
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Clarke T, Platt R. Children's Lived Experiences of Wellbeing at School in England: a Phenomenological Inquiry. CHILD INDICATORS RESEARCH 2023; 16:963-996. [PMID: 37274807 PMCID: PMC9981449 DOI: 10.1007/s12187-023-10016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 06/07/2023]
Abstract
This phenomenological inquiry investigated children's wellbeing experiences at school, including their hedonic (feeling good) and eudaimonic (doing good) accounts, a distinction often overlooked. Further, while phenomenological inquiries of children's mental ill-health exist, wellbeing, a fundamental part of mental health, is neglected. This is at odds with positive psychology which favours strengths-based approaches to studying human development. Phenomenology provides rich detail, facilitating deeper understanding of why and how certain factors affect wellbeing, as described by children themselves. A sample of 15 children (aged 9-11), attending one English primary school broadly representative of the national socio-demographic, engaged in interviews. Children's experiences of 'feeling good' at school were characterised by: an interdependence on peers' emotional states (described as 'a domino effect'), a need to feel cared for by, and trust, adults, and desire for autonomy over their time. Children attributed mistrust in adults to adults disregarding seemingly incidental events which felt significant to children. Children experienced 'doing well' as equating to academic attainment, conveying a fixation with test scores, using language of 'correctness' and efficiency. Shame pervaded when 'correctness' was not achieved, with children describing being ridiculed for poor test scores. Recommendations for schools to support children's hedonia include prioritising wellbeing curricula and emotional literacy, greater staff reflexivity, and prioritisation of pupil voice. To foster children's eudaimonia, recommendations include the need for teachers to provide formative, personalised feedback for pupils focused on the learning process, and the need for Government to embrace a range of ways pupils can feel successful beyond academic attainment. Supplementary Information The online version contains supplementary material available at 10.1007/s12187-023-10016-2.
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Affiliation(s)
- Tania Clarke
- Faculty of Education, University of Cambridge, 184 Hills Rd, Cambridge, CB2 8PQ UK
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Bond KS, Lyons JN, Cottrill FA, Sabo AV, Baillie SE, Rossetto A, Kelly L, Kelly CM, Reavley NJ, Jorm AF, Morgan AJ. Evaluation of the Conversations about Non-Suicidal Self-Injury Mental Health First Aid Course: Effects on Knowledge, Stigmatising Attitudes, Confidence and Helping Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3749. [PMID: 36834439 PMCID: PMC9963380 DOI: 10.3390/ijerph20043749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a common mental health problem, with a 19% lifetime prevalence in Australian adolescents and 12% in adults. Though rates of professional help-seeking for NSSI are low, disclosure to family and friends is more common, providing opportunities for them to encourage professional support. Mental Health First Aid® Australia's Conversations about Non-Suicidal Self-Injury course provides evidence-based training for the general public to support a person engaging in NSSI. METHODS This uncontrolled trial evaluated the effects of the Conversations about Non-Suicidal Self-Injury course on participants' knowledge, confidence, stigmatising attitudes, and intended and actual helping behaviours. Surveys were administered pre- and post-course, and at a six-month follow-up. A linear mixed-model analysis determined mean change over time, and effect sizes were estimated using Cohen's d. Course satisfaction was assessed using descriptive statistics and summative content analysis of qualitative data. RESULTS The pre-course survey was completed by 147 Australian participants (77.5% female, mean age 45.8 years), 137 (93.2%) at post-course and 72 (49%) at follow-up. Knowledge, confidence, quality of intended helping behaviours, and quality of actual helping behaviours increased significantly at both time points. Social distance decreased significantly at all time points and stigma decreased significantly at post-course. The course was perceived to be highly acceptable by participants. CONCLUSIONS There is initial evidence that the Conversations about Non-Suicidal Self-Injury course is effective and acceptable for members of the public who may support a person engaging in NSSI.
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Affiliation(s)
- Kathy S. Bond
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Julia N. Lyons
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Fairlie A. Cottrill
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Amanda V. Sabo
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
| | - Simone E. Baillie
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Alyssia Rossetto
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
| | - Louise Kelly
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Claire M. Kelly
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Nicola J. Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
| | - Anthony F. Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
| | - Amy J. Morgan
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
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15
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Mughal F, Chew-Graham CA, Babatunde OO, Saunders B, Meki A, Dikomitis L. The functions of self-harm in young people and their perspectives about future general practitioner-led care: A qualitative study. Health Expect 2023; 26:1180-1188. [PMID: 36797811 PMCID: PMC10154897 DOI: 10.1111/hex.13733] [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: 04/19/2022] [Revised: 01/27/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Self-harm in young people is a serious concern but a deeper understanding of the functions of self-harm in young people can tailor care and inform new clinical interventions to reduce repeat self-harm and suicide risk. General practitioners (GPs), as frontline healthcare professionals, have an important role in managing self-harm in young people. This study aimed to explore the functions of self-harm in young people and their perspectives on future GP-led care. METHODS A qualitative study using interviews with young people aged between 16 and 25 years with a personal history of self-harm was conducted. Interviews were transcribed and analysed using reflexive thematic analysis. FINDINGS Four distinct functions were identified: (1) handling emotional states; (2) self-punishment; (3) coping with mental illness and trauma; and (4) positive thoughts and protection. Young people valued GP-led support and felt future GP interventions should include self-help and be personalised. CONCLUSIONS These findings support clinicians, including GPs, to explore the functions of self-harm in young people aged 16-25 in a personalised approach to self-harm care. It should be noted that self-harm may serve more than one function for a young person and thus interventions should recognise this. PATIENT AND PUBLIC CONTRIBUTION A group consisting of young people with lived experience of self-harm, carers, the public, and those who work with young people who harm themselves conceived this study idea, informed recruitment methods and the interview topic guide, and supported the interpretation of findings.
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Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Keele, UK.,Division of Psychology and Mental Health, Centre for Mental Health and Safety, University of Manchester, Manchester, UK
| | | | | | | | - Aula Meki
- Specialist Psychotherapies Service, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, UK
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16
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Samways B. Professionals' attitudes towards people with intellectual disabilities who self-harm: A literature review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:954-971. [PMID: 34338080 PMCID: PMC9608005 DOI: 10.1177/17446295211025959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND National Institute for Health and Care Excellence (NICE, 2013) Guidance on Self-Harm states that professionals supporting people who self-harm should demonstrate compassion, respect and dignity. This literature review examines the evidence for professionals' attitudes towards people with intellectual disabilities who self-harm. METHOD Four databases (PsychInfo, IBSS, CINAHL and Medline) were systematically searched to find relevant research since 2000. RESULTS Four studies met the criteria. Attitudes of professionals supporting people with intellectual disabilities are contrasted with those of professionals in settings focused on supporting people without intellectual disabilities. Professionals supporting people with intellectual disabilities tended to display attitudes and attributions reflective of biobehavioural and psychosocial theories of self-harm, with a greater emphasis on relationships. CONCLUSION Much more research is needed which examines the attitudes of professionals supporting people with intellectual disabilities who self-harm.
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Affiliation(s)
- Beverley Samways
- Beverley Samways, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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17
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Townsend E, Ness J, Waters K, Rehman M, Kapur N, Clements C, Geulayov G, Bale E, Casey D, Hawton K. Life problems in children and adolescents who self-harm: findings from the multicentre study of self-harm in England. Child Adolesc Ment Health 2022; 27:352-360. [PMID: 35042280 PMCID: PMC9786245 DOI: 10.1111/camh.12544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm, a significant and increasing global problem in children and adolescents, is often repeated and is associated with risk of future suicide. To identify potential interventions, we need to understand the life problems faced by children and adolescents, and by sub-groups of younger people who self-harm. Our aims were to include the following: (a) investigate the type and frequency of life problems in a large sample of children and adolescents who self-harmed. (b) Examine whether problems differ between those who repeat self-harm and those who do not. METHODS We analysed data for 2000 to 2013 (follow up until 2014) from the Multicentre Study of Self-harm in England on individuals aged 11 to 18 years who presented to one of the five study hospitals following self-harm and received a psychosocial assessment including questions about problems, which precipitated self-harm. RESULTS In 5648 patients (12,261 self-harm episodes), (75.5% female, mean age 16.1 years) the most frequently reported problems at first episode of self-harm were family problems. Problems around study/employment/study and relationships with friends also featured prominently. The types of problems that precede self-harm differed between late childhood/early adolescence. Abuse, mental health problems and legal problems significantly predicted repeat self-harm for females. CONCLUSION The most common problems reported by both genders were social/interpersonal in nature, indicating the need for relevant services embedded in the community (e.g. in schools/colleges). Self-harm assessment and treatment choices for children and adolescents must take age and gender into account. To prevent future self-harm, individualised supports and services are particularly needed for abuse, mental health and legal problems.
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Affiliation(s)
- Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Muzamal Rehman
- Centre for Self-harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Caroline Clements
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Galit Geulayov
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Elizabeth Bale
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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18
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Knowles S, Sharma V, Fortune S, Wadman R, Churchill R, Hetrick S. Adapting a codesign process with young people to prioritize outcomes for a systematic review of interventions to prevent self-harm and suicide. Health Expect 2022; 25:1393-1404. [PMID: 35521681 PMCID: PMC9327872 DOI: 10.1111/hex.13479] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Research and clinical outcomes that matter to people with lived experience can significantly differ from those outcomes studied by researchers. To inform a future Cochrane review of suicide and self‐harm prevention interventions, we aimed to work with young people with relevant lived experience to agree on priority outcomes. Design Four participatory codesign workshops were completed across two sites (New Zealand, United Kingdom) with 28 young people in total. We iteratively adapted the methods over the course of the study. Results ‘Improved coping’ and ‘safer/more accepting environment to disclose’ were the final top‐rated outcomes. ‘Reduction of self‐harm’ was considered a low priority as it could be misleading, stigmatizing and was considered a secondary consequence of other improvements. In contrast to typical research outcomes, young people emphasized the diversity of experience, the dynamic nature of improvement and holistic and asset‐based framing. Methodologically, dialogue using design materials (personas) to thematically explore outcomes was effective in overcoming the initial challenge of disparate quantitative ratings. Discussion The results will directly inform the development of a Cochrane review, enabling identification of whether and how outcomes of most importance to young people are measured in trials. Rather than producing discrete measurable outcomes that could be easily added to the systematic review, the young people challenged the academic conceptualization of outcomes, with implications for future evidence synthesis and intervention research, and for future codesign. Patient or Public Contribution Young people with lived experience were codesigners of the outcomes, and their feedback informed iterative changes to the study methods.
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Affiliation(s)
- Sarah Knowles
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Vartika Sharma
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand.,Children and Young People Satellite, Cochrane Common Mental Disorders, The University of Auckland, Auckland, New Zealand
| | - Sarah Fortune
- Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ruth Wadman
- Department of Health Sciences, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Hetrick
- Department of Psychological Medicine, School of Medicine, 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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19
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Gomez-Baya D, Babić Čikeš A, Hirnstein M, Kurtović A, Vrdoljak G, Wiium N. Positive Youth Development and Depression: An Examination of Gender Differences in Croatia and Spain. Front Psychol 2022; 12:689354. [PMID: 35126220 PMCID: PMC8814576 DOI: 10.3389/fpsyg.2021.689354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Depression is a major public health issue and the literature has consistently showed that the rates of depression increase dramatically during youth transition to adulthood, and gender differences merge in this period. Positive youth development (PYD) framework is focused on strengths that make young people more resistant to negative outcomes, like depression, and more capable to choose a positive life direction. The aim of the study was to examine the relationship between the 5Cs of PYD and depression in Croatia and Spain, as well as to analyze gender differences. This research was conducted within the PYD Cross-National Project. High school and university students from Eastern Croatia and Southern Spain participated in the study (M age = 19.37, SD = 2.11; 62.3% female). There were 584 students from Croatia and 768 students from Spain, who filled in self-reports of PYD and depression (i.e., PYD-SF and PHQ-9, respectively). Results showed that male participants presented more Competence and Confidence, while female participants reported more Connection, Caring, Character, overall PYD, but also more depressive symptoms. Furthermore, Confidence and Connection were negative correlates of depressive symptoms, with neither Spain nor Croatia showing remarkable gender differences. These results may have some implications concerning the promotion of the 5Cs of PYD as a recommendable approach to promote youth mental health in Croatia and Spain from a gender perspective. Youth mental health services and initiatives that engage the partnership of youth contexts, such as the family, schools and neighborhoods, should not only address risk factors for mental health problems, but also protecting factors as the 5Cs, thus providing a more inclusive and sustainable support for youth well-being.
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Affiliation(s)
- Diego Gomez-Baya
- Department of Social, Developmental and Educational Psychology, Faculty of Education, Psychology and Sport Sciences, University of Huelva, Huelva, Spain
| | - Ana Babić Čikeš
- Department of Psychology, Faculty of Humanities and Social Sciences, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marina Hirnstein
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Ana Kurtović
- Department of Psychology, Faculty of Humanities and Social Sciences, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Gabrijela Vrdoljak
- Department of Psychology, Faculty of Humanities and Social Sciences, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Nora Wiium
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
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20
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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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21
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Townsend ML, Miller CE, Matthews EL, Grenyer BFS. Parental Response Style to Adolescent Self-Harm: Psychological, Social and Functional Impacts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413407. [PMID: 34949017 PMCID: PMC8703416 DOI: 10.3390/ijerph182413407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022]
Abstract
Adolescent self-harm is a significant public health issue. We aimed to understand how parent stress response styles to their child's self-harm affects their wellbeing and functioning and the wider family. Thirty-seven participants in Australia (parents; 92% female) completed a mixed methods survey regarding their adolescent child's self-harm. We conducted Pearson zero-order correlations and independent t-tests to examine the impact of parent response style on their quality of life, health satisfaction, daily functioning, and mental health. We also used thematic analysis to identify patterns of meaning in the data. Two-thirds of participants reported mental ill health and reduced functional capacity due to their adolescent's self-harm. Parents with a more adaptive response style to stress had better mental health. Qualitative analyses revealed parents experienced sustained feelings of distress and fear, which resulted in behavioural reactions including hypervigilance and parental mental health symptoms. In the wider family there was a change in dynamics and parents reported both functional and social impacts. There is a need to develop psychological support for the adolescent affected and parents, to support more adaptive response styles, and decrease the negative effects and facilitate the wellbeing of the family unit.
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Affiliation(s)
- Michelle L. Townsend
- School of Psychology, University of Wollongong, Wollongong, NSW 2522, Australia; (C.E.M.); (E.L.M.); (B.F.S.G.)
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
- Correspondence:
| | - Caitlin E. Miller
- School of Psychology, University of Wollongong, Wollongong, NSW 2522, Australia; (C.E.M.); (E.L.M.); (B.F.S.G.)
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Emily L. Matthews
- School of Psychology, University of Wollongong, Wollongong, NSW 2522, Australia; (C.E.M.); (E.L.M.); (B.F.S.G.)
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, NSW 2522, Australia; (C.E.M.); (E.L.M.); (B.F.S.G.)
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
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22
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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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23
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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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24
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“I can’t describe it and they can’t see the rain.” an interpretative phenomenological analysis of the experience of self-harm in young adults who report difficulties identifying and describing their feelings. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02273-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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25
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Boussat ML, Fourcade L, Mourouvaye M, Grandclerc S, Moro MR, Lachal J. [Qualitative study of parents' experience after their teen's suicide attempt]. Encephale 2021; 48:390-396. [PMID: 34538622 DOI: 10.1016/j.encep.2021.05.005] [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: 10/15/2020] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Suicidal attempts are frequent during adolescence and concern the whole family, particularly parents whose role is crucial in provision of therapeutic support. Yet very few studies have been performed bearing on their lived experience. In this study, we will analyze the experience of parents after the suicidal attempt of their adolescent. PARTICIPANTS & METHODS Qualitative study based on semi-structured interviews of 13 parents of teenagers followed in child and adolescent psychiatry for suicidal behavior. Interview included 5 to 6 open and conversational questions. We analyzed interviews, after transcription, using the Interpretative Phenomenological Analysis approach. RESULTS The parents' wellness and behavior are directly affected by their child's mental status. When they are informed of the suicidal attempt, they feel very deep sadness, in a form of initial distress which is part of the grieving process regarding their image of idealized parents. They feel anger against the teenager, their anger is also directed against family members and close friends as well as against caregivers. Given the uncertainty, they doubt their own educative and empathetic competences, and lack confidence in their capacity for providing help. They express their need for help and support with regard to understanding their child's suicidal attempt, with regard to the emotional turmoil they experience and in reinforcing their competencies as carers. CONCLUSION It appears that parents are extremely touched by their teenager suicidal attempt. They need a personal follow up, including familial medical care but also a personal space of support. Parents group, as well as psycho educative intervention, are also welcomed to give efficient method to lift their child.
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Affiliation(s)
- M L Boussat
- APHP, Hôpital Cochin, Maison de Solenn, 75014 Paris, France
| | - L Fourcade
- APHP, Hôpital Necker, Department of Child and Adolescent Psychiatry, 75015 Paris, France
| | - M Mourouvaye
- APHP, Hôpital Necker, Department of Child and Adolescent Psychiatry, 75015 Paris, France
| | - S Grandclerc
- APHP, Hôpital Cochin, Maison de Solenn, 75014 Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Établissement public de santé mentale ERASME, pôle de psychiatrie de l'enfant et de l'adolescent, 92160 Antony, France
| | - M-R Moro
- APHP, Hôpital Cochin, Maison de Solenn, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
| | - J Lachal
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, 63000 Clermont-Ferrand, France.
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26
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Stänicke LI. The Punished Self, the Unknown Self, and the Harmed Self - Toward a More Nuanced Understanding of Self-Harm Among Adolescent Girls. Front Psychol 2021; 12:543303. [PMID: 33897508 PMCID: PMC8064031 DOI: 10.3389/fpsyg.2021.543303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/04/2021] [Indexed: 11/13/2022] Open
Abstract
Self-harm among adolescents, mostly girls, has increased in the last years. Self-harm is associated with mental illness and the risk of suicide. This qualitative study aims to explore the lived experience of self-harm as it is related to everyday life and challenges among adolescents. Nineteen girls (13-18 years of age) in a clinical population (strategic selection) participated in personal interviews analyzed by Interpretative Phenomenological Analysis to capture how they made meaning of self-harm and essential features of experiencing self-harm. Adult persons with the first-hand experience of self-harm were included in the research analysis. Data-analysis resulted in three superordinate themes which all speak about ways to handle inner pain and vulnerability: 1. "I deserve pain," 2. "I don't want to feel anything," and 3. "I'm harmed, and no one cares." Each superordinate theme included four main themes characterizing essential features of difficult experiences during self-harm, the purpose of the action, self-descriptions, and the role of others during self-harm. The three superordinate themes are discussed as emerging self-representations - "the punished self," "the unknown self," and "the harmed self" - during the transitional age of adolescence. This article argues that subjective personal data on self-harm related to adolescents' everyday lives may indicate diversity in the capacity to integrate difficult needs, feelings, and traumatic experiences as part of the self. This knowledge may bring a nuanced understanding of self-harm in adolescence, enhance self-understanding and treatment motivation, and inform clinical adjustment.
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Affiliation(s)
- Line Indrevoll Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway.,Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway
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27
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Gray N, Hasking P, Boyes ME. The impact of ambivalence on recovery from non-suicidal self-injury: considerations for health professionals. JOURNAL OF PUBLIC MENTAL HEALTH 2021. [DOI: 10.1108/jpmh-07-2020-0093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Non-suicidal self-injury (NSSI) is a growing public health concern. Continued NSSI is often associated with negative outcomes, yet the behaviour usually serves a purpose for individuals who self-injure (e.g. emotional relief). As such, individuals who self-injure often experience ambivalence about the behaviour. The purpose of this paper is to highlight the importance of recognising ambivalence as a natural and expected part of the recovery process.
Design/methodology/approach
This paper draws on literature regarding NSSI recovery, ambivalence towards stopping the behaviour and challenges for both clients and health professionals.
Findings
This paper argues that ambivalence towards self-injury can be challenging for both clients and health professionals. Clients may feel shame and sense of failure if they experience a setback; health professionals may experience frustration towards clients who continue to self-injure despite treatment.
Originality/value
Validation of the clients’ experience can have significant positive outcomes in treatment and help-seeking behaviours. Acknowledgement of client ambivalence during the recovery process will serve to validate clients’ experience and facilitate rapport. Health professionals who accept ambivalence as a natural part of the recovery process may experience less frustration with clients who continue to self-injure.
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28
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How should we respond to non-suicidal self-injury disclosures?: An examination of perceived reactions to disclosure, depression, and suicide risk. Psychiatry Res 2020; 293:113430. [PMID: 32871486 DOI: 10.1016/j.psychres.2020.113430] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022]
Abstract
Identifying those who engage in non-suicidal self-injury (NSSI) rely heavily on self-disclosure. However, less than half of those who engage in NSSI disclose their self-injurious behavior often due to the fear of negative reaction. This study examined how perceived reactions to NSSI disclosure (i.e., 'negative reactions', 'tangible aid,' and 'emotional support') may be associated with suicide risk through depression. Participants were 385 undergraduate students who had a lifetime history of engaging in and disclosing at least one of their NSSI acts. Perceived reactions to NSSI disclosure were assessed through the Self-injury Social Reactions Questionnaire; suicide risk was assessed through the Suicidal Behavior Questionnaire Revised; depression was assessed through the Beck Depression Inventory-II. Path analyses were conducted to examine the indirect effects of perceived reactions to NSSI disclosure on suicide risk through depression. Exploratory analyses of independent models examining each reaction separately were conducted as well. In the full model, negative reactions and emotional support were indirectly associated with suicide risk through depression. In the independent models, all three reaction types were associated with suicide risk through depression. The current study elucidates a potential mechanism in which specific perceived reactions to NSSI disclosure may influence one's suicide risk.
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29
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Holland J, Sayal K, Berry A, Sawyer C, Majumder P, Vostanis P, Armstrong M, Harroe C, Clarke D, Townsend E. What do young people who self-harm find helpful? A comparative study of young people with and without experience of being looked after in care. Child Adolesc Ment Health 2020; 25:157-164. [PMID: 32542877 DOI: 10.1111/camh.12384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Self-harm amongst young people is an increasing problem, with looked-after young people at higher risk. Despite this, little research exists on what young people who self-harm find helpful. METHOD One hundred and twenty-six 11-21 year olds (53 who had experience of the care system and 73 who did not) were recruited from the community and NHS. All participants had self-harmed in the past 6 months. Participants completed an Audio Computer-Assisted Self-interview (ACASI) regarding their views about the support they had received, how helpful it was, and what further help they felt they needed. RESULTS Looked-after young people reported the three most helpful sources of support were Child and Adolescent Mental Health Services (CAMHS), friends and pets and the least helpful were CAMHS, Accident and Emergency (A&E) and Social services. For non-looked-after young people, CAMHS, counselling and Harmless (user-led support service for self-harm) were most helpful and CAMHS, cognitive behavioural therapy (CBT) and general practitioner (GP) were the least. Compared with the other group, more looked-after young people had received help from A&E and CAMHS, whereas more non-looked-after young people had accessed GPs, parents, psychological therapies, self-help books and websites. More looked-after young people found support groups helpful, and more non-looked-after young people reported that distraction techniques, medication and their siblings were helpful. CONCLUSION Young people who self-harm have mixed views about CAMHS. Differences in the pattern of access and preferences for support between looked-after and non-looked-after young people should be reflected in service availability and commissioning. KEY PRACTITIONER MESSAGE Little is known about what young people who self-harm find helpful, particularly for looked-after young people. CAMHS was named amongst the most helpful and the least helpful services by both looked-after and non-looked-after young people. Social services and A&E were frequently cited amongst the least helpful sources of support. Young people report finding informal support helpful, including family and friends. There appears to be a need for explorations of the reasons behind the apparent negative perception of statutory services in young people, and what is required to shift that.
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Affiliation(s)
- Josephine Holland
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,CANDAL (Centre for ADHD and Neurodevelopmental Disorders across the Lifespan), Institute of Mental Health, Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,CANDAL (Centre for ADHD and Neurodevelopmental Disorders across the Lifespan), Institute of Mental Health, Nottingham, UK
| | - Alexandra Berry
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Chelsea Sawyer
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Pallab Majumder
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Panos Vostanis
- Department of Neurosciences, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Marie Armstrong
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - David Clarke
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
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30
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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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31
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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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32
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Hambleton AL, Hanstock TL, Halpin S, Dempsey C. Initiation, meaning and cessation of self-harm: Australian adults’ retrospective reflections and advice to adolescents who currently self-harm. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1737509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ashlea L. Hambleton
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| | - Tanya L. Hanstock
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| | - Sean Halpin
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| | - Caitlin Dempsey
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
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33
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Stänicke LI, Haavind H, Rø FG, Gullestad SE. Discovering One’s Own Way: Adolescent Girls’ Different Pathways Into and Out of Self-Harm. JOURNAL OF ADOLESCENT RESEARCH 2019. [DOI: 10.1177/0743558419883360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Self-harm is associated with mental illness and suicide risk. The present study aims to increase knowledge of adolescent girls’ pathways into and out of self-harm. The participants were 19 girls, 13 to 18 years of age, who were strategically selected from an outpatient care unit. A naturalistic multiple case study was done with personal interviews. The interviews were analyzed using Interpretative Phenomenological Analysis, and the capacity for “mentalization”—representation of behavior in terms of mental states—was measured with the Reflective Functioning Scale. The analysis of the topic “beginning self-harm” resulted in two meta-themes: (a) beginning self-harm as a way to handle difficult feelings and relational problems and (b) becoming influenced by peers to experiment with self-harm. The analysis of the topic “quitting self-harm” resulted in three meta-themes: (a) ambivalence toward help, treatment, and ending self-harm; (b) finding one’s own way of quitting self-harm; and (c) exploring self-harm together with the therapist. Three case stories illustrate variations in trajectories of change and capacity for mentalization. The findings suggest that self-harm may be a way of handling developmental challenges in autonomy and identity formation during adolescence. Adolescents need an opportunity to discover their own way of quitting self-harm. Variations in mentalization may provide for different pathways.
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