Peer reactions to non-suicidal self-injury disclosures: a thematic analysis

Friendships and peer relationships and self-harm ideation and behaviour among young people: a systematic review and narrative synthesis

Friendships and peer relationships have an important role in the experience of self-harm ideation and behaviour in young people, yet they typically remain overlooked. This systematic review and narrative synthesis explores the extant literature on this topic to identify important relationships between these constructs. We did a keyword search of peer-reviewed empirical articles relating to friendships and peer relationships and self-harm ideation and behaviour in young people (aged 11-25 years). We identified 90 articles with evidence primarily from adolescents aged 11-18 years, including mixed genders and a majority of White individuals. Findings highlight substantive relationships between the key constructs, showing that: characteristics of friends and peers, including their self-harm ideation and behaviour, relate to and predict ego self-harm ideation and behaviour; friends and peers are important sources of support; and evidence on causal mechanisms is scarce but highlights potential peer selection and influence processes. Studies of the friends and peers of young people with self-harm ideation and behaviour highlight that: friends' attitudes to self-harm and suicide influence their responses to peers with self-harm ideation and behaviour; and friends who are bereaved and friend supporters experience negative outcomes such as symptoms of depression, anxiety, PTSD, and grief, alongside difficult emotions. Despite substantial heterogeneity across samples, study designs, and definition or measurement of the primary constructs, this work presents an initial step in organising a complex literature on a crucially important topic, which can help to inform future research and evidence-based interventions.

How do professionals and non-professionals respond to non-suicidal self-injury? Lived experiences of psychiatric outpatients in Singapore

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.

Friend support buffers the relationship between maltreatment and nonsuicidal self-injury in adolescence

BACKGROUND

Prior studies have mostly focused on the risk factors for nonsuicidal self-injury (NSSI), but only a few studies have emphasized the related protective factors. The present study examined whether maltreatment and behavioral problems were risk factors for NSSI. Moreover, we also sought to understand whether and how friend support provides a buffer against NSSI.

METHOD

A total of 436 adolescents completed self-report surveys that addressed maltreatment, behavioral problems, friend support, and NSSI at three different time points.

RESULTS

There were significant positive correlations between maltreatment and NSSI. In the mediation analyses, we found that maltreatment was indirectly associated with NSSI via behavioral problems. Friend support demonstrated a long-term buffering effect on NSSI. Specifically, friend support had a protective effect on NSSI not only under high maltreatment levels, but also under high behavioral problem levels.

CONCLUSION

These findings contribute to the understanding of the influences of both maltreatment, behavioral problems (risk factors), and friend support (protective factors) on NSSI. In the context of intervention and education, it is important to consider the value of friend support when discussing NSSI.

Support Seeking in the Context of Self-Injury Recovery: Perspectives From Individuals With Lived Experience

ABSTRACT

A sample of 229 university students responded to open-ended questions for the present study, which aimed to gain a deeper understanding of lived experiences of support seeking in the context of self-injury recovery. Inductive thematic analysis of the responses indicated themes from two domains: the benefits of support seeking and the barriers to support seeking. The first domain highlighted benefits from both professional sources (such as receiving diagnosis and referrals to therapy, learning emotion regulation strategies, and developing an improved understanding of self) and informal sources (such as receiving tangible aid, having a support system, and having a compassionate space). The second domain indicated that barriers could be both intrapersonal (such as desire to continue nonsuicidal self-injury, embarrassment and shame, establishing agency without others' support, and minimizing self-injury) and interpersonal (such as fear of being stigmatized, concern for others, and unhelpful prior experiences) in nature. Implications for future research, outreach efforts, and clinical practice are discussed.

The role of suicide stigma in self-disclosure among civilian and veteran populations

Widespread attempts to implement suicide prevention efforts may be hindered by stigma regarding suicidal thoughts and behaviors (STBs). Despite extensive literature linking general mental health stigma to numerous negative outcomes (i.e., reduced help-seeking), limited research has extended findings to STB-specific stigma. Thus, the present study aimed to examine the association between three types of STB stigma (public, self, and anticipated) and self-disclosure, a specific form of help-seeking for some individuals, among civilians and a population at heightened suicide risk, U.S. veterans. Participants (n = 500) reported a lifetime history of suicidal ideation (n = 253 identified as a U.S. veteran; n = 132 reported being enrolled in Veteran Health Administration [VHA] care) who completed self-report measures about their STB experiences, including stigma and self-disclosure. Results highlighted a significant association between greater self-stigma, as well as greater anticipated stigma, and a reduced likelihood of STB disclosure, among veterans but not civilians. No significant associations as a result of VHA care status were found. Together, findings suggest that individuals' concerns related to STBs and STB disclosure may be grounded in past experiences in the military, and thus highlight the need for prevention efforts that protect against negative consequences related to STB disclosure.

Needs of Youth Posting About Nonsuicidal Self-Injury: A Time-Trend Analysis

PURPOSE

Many youth who engage in nonsuicidal self-injury (NSSI) go online for information, resources, and support. Although research has noted the potential benefits and risks of online NSSI activity, little is known about the NSSI-related needs that youth express on social media, and, importantly, when these posts occur. This study elucidates the nature of these NSSI-related needs and how they may vary temporally, by time of day or day of week.

METHODS

A total of 3,500 posts made by 2,799 users of an international mental health-focused social network app were analyzed for the presence of NSSI-related needs. Posts were coded using a rubric that was developed using existing knowledge about youth's online NSSI activity. Furthermore, prominently expressed needs were tested for associations with specific times of the day and days of the week.

RESULTS

Users' frequently posted about suicidal ideation and behaviors, and difficult emotions; documented NSSI urges and interpersonal difficulties; and expressed feeling misunderstood and isolated. Furthermore, specific needs occurred more frequently during different times of the day (e.g., users were more likely to express suicidal ideation and behaviors just before midnight).

CONCLUSIONS

These findings have important implications for mental health professionals and policy makers. Youth who post about NSSI could benefit from the provision of tailored, evidence-based resources during times of need. Furthermore, clinicians may need to assess youth's online activity to inform intervention strategies and meet their NSSI-related needs.

Characterizing the choice to disclose nonsuicidal self-injury

OBJECTIVE

Despite nonsuicidal self-injury (NSSI) being a prevalent and problematic behavior, only approximately half of those who engage in NSSI disclose their behavior. Yet, limited research has explored the choice to disclose. This study sought to identify if NSSI characteristics, emotional distress, and perceived interpersonal obstacles discriminated between NSSI disclosure status. Exploratory aims also investigated reasons for one's disclosure decision and disclosure contextual factors.

METHOD

Participants included 977 undergraduate students (83% female) with a lifetime history of NSSI.

RESULTS

Greater NSSI intrapersonal functions, suicide risk, and significant other support, and lower depression symptoms were associated with NSSI disclosure. Exploratory results highlight perceptions of one's NSSI severity and desire to receive support in disclosure choice; intrapersonal functions and peer support were associated with the timing of disclosure.

CONCLUSIONS

Findings underscore the potential importance of individual attitudes toward NSSI, in addition to traditionally measured risk factors, as potential drivers in NSSI disclosure.

When language is maladaptive: recommendations for discussing self-injury

Purpose

The purpose of this paper is to call on researchers and clinicians to carefully consider the terminology used when discussing non-suicidal self-injury (NSSI), and specifically the use of the term “maladaptive” coping.

Design/methodology/approach

Drawing on literature regarding stigma, language and self-injury to support the argument that the term maladaptive is inappropriate to describe self-injury.

Findings

Use of the term maladaptive conflates short-term effectiveness with long-term outcomes and ignores context in which the behaviour occurs.

Social implications

Use of the term maladaptive to describe self-injury can invalidate the person with a history of NSSI, impacting stigma and potentially help-seeking. An alternate framing focussed on specific coping strategies is offered.

Originality/value

Language is a powerful medium of communication that has significant influence in how society shapes ideas around mental health. In proposing a change in the way the authors’ talk about self-injury there is potential to significantly improve the wellbeing of people with lived experience of self-injury.