Waiting for harm: deliberate self-harm and suicide in young people--a review of the literature

Clinical pathways for suicidality in emergency settings: a public health priority

Rates of self-harm in Australia are increasing and constitute a concerning public health issue. Although there are standard treatment pathways for physical complaints, such as headache, abdominal pain and chest pain, in Emergency Medicine, there is no national pathway for self-harm or other psychiatric conditions that present to the emergency department. Herein we outline the difference between clinical practice guidelines and clinical pathways, discuss pathways we have identified on self-harm in Australia and overseas and discuss their applicability to the Australian context and the next steps forward in addressing this public health issue.

Persistence of psychological problems in adolescence: a one year follow-up study

Objectives: To examine the prevalence and persistence of psychological problems in older adolescents.

Methods: This study is a one year follow-up of 110 adolescents, 64 girls and 46 boys attending three secondary schools in Ireland. All were 16 at initial testing. The Youth Self Report (YSR) was the measure used.

Results: Over a fifth of adolescents have problems in the clinical range. These problems persisted from 16 to 17. Females reported more problems than males at both ages. Some females showed a slight reduction in internalising problems at 17. Both males and females showed an increase in externalising problems at 17. Odds ratios indicate that those in the clinical ranges of the YSR at 16, had increased risk of being in the clinical range at 17 compared to those in the no problem range at 16. In comparison to those with no suicidal feeling, those with suicidal feelings at 16 were at an increased risk of still feeling suicidal at 17. More males remained psychologically healthy than girls.

Conclusions: A large proportion of adolescents in this sample have psychological problems and these appear to persist over a one year period. These problems impact substantially on the adolescents themselves, their families and society. Given the increasing suicide rate in young people and the persistence of suicidal feelings in this cohort, the inadequacy of mental health services in Ireland for adolescents, particularly those ages 16-18 is highlighted. The challenge of developing and providing adolescent friendly services is addressed.

Factors associated with self-reported depression and self-esteem among school-going adolescents from a geographically defined region in Ireland

BACKGROUND

Recent reviews indicate that mental health problems in the young are increasing.

AIMS

To measure the prevalence of, and risk factors associated with, depression and low self-esteem among Irish post-primary students.

METHOD

1,428 students, randomly selected from a sample of post-primary schools, were given an anonymised questionnaire. Analyses included bivariate and multivariate logistic regression.

RESULTS

Questionnaires were completed by 992 (69.9%) respondents. 206 (20.8%) had a high depression score. Being from a single parent family (OR 2.8, 95% CI 1.5-5.4, p<0.001); having low self esteem (OR 13.44 95% CI 8.9-20.3, p<0.001); being female (OR, 3.7, 95% CI 2.5-5.6 p<0.001) and having a low fitness level (OR 1.8, 95% CI 1.2-2.8 p<0.006) were independently associated with a high depression score.

CONCLUSIONS

The level of self-reported depression was high among these respondents and risk factors identified include having low self-esteem, being female, being from a single parent family and having a low fitness level.

The Needs of Adolescent Girls who Self-Harm

People who self-harm are typically intelligent, adolescent or young adult, middle to upper class girls, who do so to feel something or, paradoxically, to stop feeling and calm down. Girls who self-harm need to feel understood, listened to non-judgmentally, and responded to in relation to the unspoken suffering behind the self-harm behavior. The aim of treatment of girls who self-harm is to facilitate understanding of the act and provide alternative, healthier coping strategies.

Self-harm in young people: a perspective for mental health nursing care

AIMS

This paper addresses the assessment and management of self-harm in young people by a nurse consultant-led self-harm service in the UK. The purpose of the paper is to present some of the theoretical perspectives of the service and how these have influenced current practice with this group of young people.

BACKGROUND

Self-harm in young people continues to be a serious concern for health services globally. Rates of self-harm in teenagers in the UK are among the highest in Europe. The current literature offers information on the nature of self-harm and some evidence of specific interventions mainly from a 'psychiatric perspective'. This paper examines the development of a locally based nurse-led self-harm team involved in the care of this group of young people. A sociological view of children and young people is applied in examining the way society construes self-harm and the formation of the behaviour as a deviant act. Self-harm is considered in the context of transition through adolescence and the growth of self-identity.

CONCLUSION

The locally based child and adolescent mental health service has drawn together the evolving nurse consultant role, mental health nursing and medical sociology. This integration of people and theory will enhance the services understanding of self-harm in young people. At an international level, there is a need to consider the sociological dimensions of self-harm in young people as a way forward for mental health nurses who are involved in working with this group of people.

Struggling for hopefulness: a qualitative study of Swedish women who self-harm

There has been an increase in the number of Swedish psychiatric patients who self-harm, yet self-harm is seldom described in published research. The aim of this study was to describe how people who self-harm experience received care and their desired care. Nine participants, all Swedish women who had been treated for inpatient or outpatient psychiatric care, narrated their experiences of care for self-harm. Using qualitative content analysis, two themes were formulated: 'Expecting to be confirmed while being confirmed fosters hopefulness'; and, 'Expecting to be confirmed while not being confirmed stifles hopefulness'. Each of these themes emerged from five subthemes that clustered around positive and negative aspects of being seen-not being seen, being valued-being stigmatized, being connected-disconnected, being believed-doubted, and being understood-not being understood. Of significance is for nurses to view persons who self-harm as human beings and to grasp the importance of being confirmed by staff that can foster hopefulness in persons who self-harm, yet realize the possibility of the paradoxical nature of hopefulness and being confirmed.

Self-Harm Among Adolescents with Developmental Disabilities: What Are They Trying to Tell Us?

Self-harm behavior exhibited by adolescents with developmental disabilities can be the most challenging behavior for caregivers and health care professionals to address. Past interventions have taken a behavioral approach and focused on functional analysis to guide assessment and treatment. However, self-harm behavior is becoming more recognized as a means of communication. Therefore, it is important for health care professionals and caregivers to listen to adolescents' attempts to communicate and try to understand the meaning of the behavior. Early assessment is crucial to understanding the meaning of the behavior, and early intervention is necessary to prevent escalation or chronicity. Thorough assessment guides interventions and must be implemented in the context of clients' families and social world, and the broader community. Establishment of trusting relationships among adolescents, their families, and health care professionals is imperative. This article discusses self-harm behavior from a psychosocial perspective related to prevalence, onset, purpose, maintenance, and escalation. It also introduces a comprehensive framework to guide assessment and intervention.

Nurses' and doctors' attitudes towards suicidal behaviour in young people

This paper presents an exploratory study performed to identify the attitudes towards suicidal behaviour in young people, amongst nurses (and nursing lecturers), and doctors working in in-patient medical and mental health care settings. The Suicide Opinion Questionnaire (SOQ) was administered to 59 participants. Responses were scored using eight clinical scales, and tested by using a Kruskal-Wallis one way analysis of variance. An Independent Sample t-test was used to analyse gender differences. Qualitative interviews were conducted in a sample of respondents. SOQ findings revealed no overall significant differences in the relevant groups of nurses and doctors, with the exception of gender and the clinical scale relating to a 'Cry for Help'. The focused interviews generated five categories relating to suicidal behaviour and young people. Nurses and doctors working in these areas possess a range of influential perceptions of suicidal behaviour and need to be considered in the contexts of care and treatment of young people.