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Taylor PJ, Adeyemi I, Marlow K, Cottam S, Airnes Z, Hartley S, Howells V, Dunn BD, Elliott RA, Hann M, Latham C, Robinson C, Turpin C, Kellett S. The Relational Approach to Treating Self-Harm (RELATE): study protocol for a feasibility randomised controlled trial study of cognitive analytic therapy for adults who self-harm versus treatment at usual. Pilot Feasibility Stud 2024; 10:101. [PMID: 39026281 PMCID: PMC11256374 DOI: 10.1186/s40814-024-01526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Self-harm is a prevalent behaviour that has a major detrimental impact on a person's life. Psychological therapies have the potential to help, but evidence of effective interventions remains limited. Access and acceptability of interventions can also be a significant challenge, with individuals either being unable to access help or having to endure long waiting lists. Cognitive analytic therapy (CAT) is a time-limited and relationally-focused psychotherapy that may provide a valuable treatment option for people who self-harm. This protocol outlines the methodology for the first feasibility randomised controlled trial (RCT) of CAT for adults that self-harm. The trial will aim to determine the feasibility, acceptability and safety of undertaking larger-scale evaluations of CAT for self-harm within an RCT context. METHOD An RCT design with 1:1 allocation to CAT plus treatment as usual (TAU) or TAU alone. Participants will be adult outpatients with three or more instances of self-harm in the past year (target sample of n = 60). CAT will be 8 one-to-one weekly 60-min sessions plus a follow-up session up to 8 weeks after the last session. Assessments will occur at baseline, 12 weeks and 18 weeks after randomisation. Qualitative interviews with participants will gain insights into the feasibility and acceptability of CAT. Feasibility outcomes will be judged against progression criteria. DISCUSSION CAT may be an effective and accessible treatment option for people who self-harm, providing a more relationally orientated alternative to more behavioural therapies. The proposed feasibility RCT is an important first step in evaluating CAT as a treatment for self-harm. TRIAL REGISTRATION The trial was pre-registered (21/10/22) on ISR CTN (ISRCTN code: ISRCTN75661422).
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Affiliation(s)
- Peter James Taylor
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Isabel Adeyemi
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katie Marlow
- Rotherham, Doncaster, and South Humber NHS Foundation Trust, Doncaster, UK
| | - Sarah Cottam
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Zerena Airnes
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Victoria Howells
- Rotherham, Doncaster, and South Humber NHS Foundation Trust, Doncaster, UK
| | | | - Rachel A Elliott
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Mark Hann
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Cameron Latham
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Catherine Robinson
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Clive Turpin
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Stephen Kellett
- Rotherham, Doncaster, and South Humber NHS Foundation Trust, Doncaster, UK
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Chen Y, Luo J, Jiang L, Shi W, Jia P, Zhang J, Zhao L. Association between positive youth development and non-suicidal self-injury: A longitudinal survey of children and adolescents in southwest China, 2019-21. J Affect Disord 2024; 350:755-760. [PMID: 38211752 DOI: 10.1016/j.jad.2024.01.072] [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: 07/19/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) could lead to serious problems (exp. suicidal attempts) among children and adolescents. Positive youth development (PYD) focuses on comprehensive development instead of a single problem. This study aims to explore the longitudinal relationship between NSSI and PYD among Chinese children and adolescents. METHODS The longitudinal study used the three-wave dataset from the Chengdu Positive Child Development (CPCD) in southwest China between 2019 and 2021, including 10,370 participants. The parallel process Latent Growth Curve Model (LGCM) was utilized to analyze the relationship between PYD and NSSI across time. RESULTS The study results demonstrated that the initial level of NSSI is negatively associated with the initial value (β = -0.730, p < 0.01) and the growth rate (β = -0.012, p < 0.01) of PYD, and the development rate of the two variables are negatively related to each other(β = -0.120, p < 0.01). LIMITATIONS The specific relationships between PYD attributes and NSSI should be explored in the future. And the cultural variation among countries deserves more research. Moreover, the dynamic cohort research leads to a relatively high loss of participants. CONCLUSIONS PYD and NSSI are closely associated among children and adolescents. Instead of playing a protective role, PYD tends to be predicted by NSSI behaviors over time.
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Affiliation(s)
- Yuxin Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Jingsong Luo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Lihua Jiang
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wei Shi
- Institute for Disaster Management and Reconstruction(IDMR), Sichuan University, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Jinquan Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Kabir R, Syed HZ, Vinnakota D, Okello S, Isigi SS, Abdul Kareem SK, Parsa AD, Arafat SY. Suicidal behaviour among the university students in the UK: A systematic review. Heliyon 2024; 10:e24069. [PMID: 38293523 PMCID: PMC10826643 DOI: 10.1016/j.heliyon.2024.e24069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
Introduction Identifying risk factors would help consider suicide prevention in any specific population. We aimed to assess suicidal behaviour among university students in the UK. Methods An extensive keyword search was conducted through PubMed, Cochrane, CINHAL Plus, PubMed Central, Web of Science, Trip database, and Science Direct, following the PRISMA guidelines to identify different publications. The search strategy for the literature review was based on the Population Exposure Outcome framework. Critical appraisal utilised the CASP tool for cohort studies and the AXIS tool for cross-sectional studies, resulting in 14 included studies. A narrative synthesis was performed. Results Postgraduate and undergraduate students used different suicidal methods such as poisoning, jumping, hanging, drowning, and suffocating, with jumping most preferred by male students. The predisposing factors of suicide among university students included: mental health problems (depression, psychological stress, psychosis, mania, neuroticism, financial anxiety, imperfect parents' connection with students), sexual orientation with risk of suicide among non-heterosexual students due to lowered self-esteem from feeling disregarded, disrespected and insufficient attention from the surrounding. Suicidal behaviour was high among unmarried students, male and unemployed female students, and students with childhood experiences such as physical abuse, family violence, emotional abuse, neglect, and physical punishment-gender, with females seeking more services from general hospitals with more suicide attempts in older females. High risk was also noted in males, with increased risk in white students compared to black students. Conclusion The review highlighted that students with previous mental health problems, a history of experiencing sexual abuse in childhood, bad relationships with their mother, disrespect and disregard in the community due to sexual identity are the major contributing factors for suicide among university students in the UK.
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Affiliation(s)
- Russell Kabir
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Haniya Zehra Syed
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Divya Vinnakota
- Faculty of Health Sciences and Wellbeing, University of Sunderland, London, UK
| | - Sharon Okello
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Sharon Shivuli Isigi
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex, UK
| | | | - Ali Davod Parsa
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex, UK
| | - S.M. Yasir Arafat
- Department of Psychiatry, Enam Medical College & Hospital, Savar, Dhaka, Bangladesh
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Yu H, Mu Q, Li K. Effects of physical exercise on non-suicidal self-injury in adolescents: the chain mediating role of perceived social support and self-concept. Front Psychiatry 2023; 14:1201863. [PMID: 37876620 PMCID: PMC10591106 DOI: 10.3389/fpsyt.2023.1201863] [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: 04/07/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023] Open
Abstract
Objective To study the effect of physical exercise on non-suicidal self-injury in adolescents and to verify the chain mediating role of perceived social support and self-concept. Methods: A survey study was conducted on 1,426 adolescents in Chengdu, Sichuan Province. A chain mediation model was used to verify whether perceived social support and self-concept played a mediating role. Results Physical exercise was significantly negatively associated with non-suicidal self-injury in adolescents (β = -0.53, p < 0.01) and significantly positively associated with perceived social support and self-concept (β = 0.52, 0.54, p < 0.01), and perceived social support and self-concept were significantly negatively associated with non-suicidal self-injury (β = -0.59, p < 0.01; β = -0.64, p < 0.01), and perceived social support was able to significantly and positively associate self-concept (β = 0.76, p < 0.01). Conclusion Perceived social support and self-concept play a chain mediating role in the effect of physical exercise on non-suicidal self-injury in adolescents, and it is recommended that the development of perceived social support and self-concept be emphasized during adolescents' development, which has the potential to reduce the incidence of non-suicidal self-injurious behaviors in adolescents.
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Affiliation(s)
- Haoran Yu
- Institute of Sports Training, Chengdu Sport University, Chengdu, Sichuan, China
| | - Qinglei Mu
- Institute of Physical Education, Chengdu University, Chengdu, Sichuan, China
| | - Ke Li
- Institute of Sports Training, Chengdu Sport University, Chengdu, Sichuan, China
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Kaufman EA, Meddaoui B, Seymour NE, Victor SE. The Roles of Minority Stress and Thwarted Belongingness in Suicidal Ideation among Cisgender and Transgender/Nonbinary LGBTQ+ Individuals. Arch Suicide Res 2023; 27:1296-1311. [PMID: 36214309 DOI: 10.1080/13811118.2022.2127385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Rates of suicidal ideation (SI), attempts, and death by suicide are consistently elevated among persons from sexual and gender minority groups relative to the general population. Experiences of minority stress and thwarted belongingness may contribute to elevated risk, and be most pernicious among persons with multiple marginalized identities. AIM The present study sought to examine the relation between gender identity (cisgender vs. transgender and nonbinary individuals [TNB]) and recent SI among a convenience sample of lesbian, gay, bisexual, questioning, and queer adults. METHODS Participants (N = 807) completed an online survey with measures of minority stress, SI, and thwarted belongingness. RESULTS We tested a mediation model in which TNB identity was indirectly associated with SI via minority stress (β = 1.94, SE = 0.30, Bootstrap 95% CI = [1.39, 2.58]). We also investigated thwarted belongingness as a moderator between minority stress and SI, and found evidence of a two-way interaction (β = 0.01, SE = 0.001, p < .001). The conditional indirect effect of gender identity on SI through minority stress was higher for individuals with higher levels of thwarted belongingness (β = 0.07, SE = 0.02, Bootstrap 95% CI = [0.04, 0.11]). CONCLUSION Gender identity was indirectly associated with SI through minority stress and elevations in minority stress were associated with more frequent SI. The minority stress and SI association was strongest for participants reporting higher thwarted belongingness. Building and maintaining strong social support networks may be especially important for persons with intersecting gender and sexual minority identities who face minority stress. HIGHLIGHTSTNB gender identity was indirectly associated with SI via minority stressThwarted belongingness moderated the relation between minority stress and SIThe minority stress SI relation was strongest at higher thwarted belongingness.
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Hill RM, Hussain Z, Vieyra B, Gallagher A. Reporting Ethical Procedures in Suicide Prevention Research: Current Status and Recommendations. Arch Suicide Res 2023; 27:1373-1390. [PMID: 36415164 DOI: 10.1080/13811118.2022.2131493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ethical concerns frequently arise in suicide prevention research regarding participant safety and confidentiality. Despite a substantial literature on managing and navigating ethical concerns in suicide research, little attention has been paid to the reporting of ethical procedures. Furthermore, standard procedures for reporting ethical risk management procedures have not been developed. METHOD A review of the current literature was performed to examine the current state of reporting of ethical procedures within suicide research. Articles published in 2020 (N = 263) from three suicide-focused publications were screened and then coded (n = 131) to identify reporting of procedures for the ethical conduct of research and suicide risk management steps taken by the research teams. RESULTS The majority of articles reported ethical review or approval (84.7%) and reported the use of an informed consent process (77.9%). Only 28.2% included risk mitigation procedures. Of those 29.7% of those articles reported conducting risk evaluation, 66.7% reported resource dissemination, and 51.4% reported an intervention. CONCLUSION As empirical support for brief interventions accrues, suicide prevention researchers should consider establishing standards for the reporting of procedures to ensure the safety of participants with suicidal risk.HighlightsReporting suicide safety protocols helps ensure high ethical standards in research.Fewer than 1/3 of articles reviewed reported risk mitigation procedures in 2020.Standard procedures for reporting safety protocols in suicide research are needed.
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Kapoor S, Freitag S, Bradshaw J, Valencia GT, Lamis DA. The collective impact of childhood abuse, psychache, and interpersonal needs on suicidal ideation among individuals with bipolar disorder: A discriminant analysis. CHILD ABUSE & NEGLECT 2023; 141:106202. [PMID: 37116450 DOI: 10.1016/j.chiabu.2023.106202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Suicide is one of the ten leading causes of death in the United States. Childhood abuse, psychache (intense emotional pain), and interpersonal needs are widely known to be associated with suicidal thoughts and behaviors. However, only a limited number of studies investigate whether these variables, when analyzed collectively, are able to distinguish between a group of individuals who report suicidal ideation and those who deny such thoughts. PARTICIPANTS AND SETTING Data were collected from individuals (N =177) with a diagnosis of bipolar disorder participating in an intensive outpatient program that provides mental health care to indigent, mostly minority patients in Southeast United States. METHODS The dependent variable was item number 9 on the Beck Depression Inventory that asks about any suicidal thoughts in the past two weeks. We utilized discriminant analysis to test whether childhood abuse, interpersonal needs, and psychache were collectively able to accurately identify group membership of the study participants. RESULTS The discriminant model included six independent variables: three different types of childhood abuse (emotional, physical, and sexual), interpersonal needs (perceived burdensomeness and thwarted belongingness), and psychache. Results revealed that the model was able to correctly classify group membership in 75% of the individuals in the study. CONCLUSION In context of bipolar disorder, history of childhood abuse (particularly sexual and emotional abuse), intense psychache, and greater perceived thwarted belongingness and burdensomeness put an individual at a higher risk of suicidal ideation. Gaining insight into the interactions among these variables may lead to formulating early interventions to prevent suicide in patients reporting this constellation of symptoms.
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Affiliation(s)
- S Kapoor
- Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, AZ, United States of America
| | - S Freitag
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - J Bradshaw
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - G T Valencia
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - D A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America.
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Clements C, Farooq B, Hawton K, Geulayov G, Casey D, Waters K, Ness J, Kelly S, Townsend E, Appleby L, Kapur N. Self-harm in university students: A comparative analysis of data from the Multicentre Study of Self-harm in England. J Affect Disord 2023; 335:67-74. [PMID: 37149057 DOI: 10.1016/j.jad.2023.04.112] [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] [Received: 05/13/2022] [Revised: 03/21/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Increases in poor mental health and suicide have been identified among university students in the UK. However, little is known about self-harm in this group. AIMS To describe and identify care needs of university aged-students who self-harm via comparisons with an age-equivalent non-student group who self-harm. METHODS Observational cohort data from The Multicentre Study of Self-harm in England were used to investigate students aged 18 to 24 years who presented to emergency departments for self-harm, 2003 to 2016. Data were collected via clinician reports and medical records from five hospitals in three English regions. Characteristics, rates, repetition, and mortality outcomes were investigated. RESULTS The student sample included 3491 individuals (983, 28.2 % men; 2507, 71.8 % women; 1 unknown) compared to 7807 (3342, 42.8 % men; 4465, 57.2 % women) non-students. Self-harm increased over time in students (IRR 1.08, 95%CI 1.06-1.10, p < 0.01) but not in non-students (IRR 1.01, 95%CI 1.00-1.02, p = 0.15). There were differences in monthly distribution of self-harm with more presentations by students in October, November, and February. Characteristics were broadly similar, but students reported more problems with studying and mental health. Repetition (HR 0.78, 95%CI 0.71-0.86, p < 0.01) and mortality (HR 0.51, 95%CI 0.33-0.80, p < 0.01) were lower in students than non-students. CONCLUSIONS Self-harm in students may be directly related the student experience, such as academic pressure, relocation, and the transition to independent living. Wellbeing initiatives targeting these factors, alongside mental health awareness training for academic and non-academic staff may help to support students at risk.
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Affiliation(s)
- Caroline Clements
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | - Bushra Farooq
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Samantha Kelly
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
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Griffin K, Twynstra J, Gilliland JA, Seabrook JA. Correlates of self-harm in university students: A cross-sectional study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:959-966. [PMID: 34242122 DOI: 10.1080/07448481.2021.1909049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Objective: To determine the prevalence of university students who have ever engaged in self-harm and to examine its correlates. Frequency of thinking about self-harm was explored as a secondary outcome. Participants: Students at Western University in London, Ontario, Canada. Methods: This cross-sectional study was completed via an online questionnaire. Logistic regressions assessed the influence of sociodemographic and behavioral factors associated with lifetime self-harm and thoughts about self-harm. Results: The sample consisted of 2626 university students. Almost 25% engaged in self-harm in their lifetime and close to 33% have thought about harming themselves. A non-straight sexual orientation, marijuana use, prescription drugs not prescribed, and mental health problems increased the risk of both outcomes. Females were over two times more likely to engage in self-harm than males. Conclusion: This study provides evidence that is needed for developing effective interventions to reduce the risk of self-harm by targeting university students who are most at-risk.
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Affiliation(s)
- Kylie Griffin
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Jasna Twynstra
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jason A Gilliland
- Department of Geography, Western University, London, Ontario, Canada
- Human Environments Analysis Laboratory, Western University, London, Ontario, Canada
- Department of Paediatrics, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
- Human Environments Analysis Laboratory, Western University, London, Ontario, Canada
- Department of Paediatrics, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Taylor PJ, Duxbury P, Moorhouse J, Russell C, Pratt D, Parker S, Sutton C, Lobban F, Drake R, Eccles S, Ryder D, Patel R, Kimber E, Kerry E, Randles N, Kelly J, Palmier-Claus J. The Mental Imagery for Suicidality in Students Trial (MISST): study protocol for a feasibility randomised controlled trial of broad-minded affective coping (BMAC) plus risk assessment and signposting versus risk assessment and signposting alone. Pilot Feasibility Stud 2023; 9:43. [PMID: 36932430 PMCID: PMC10021063 DOI: 10.1186/s40814-023-01273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Going to university is an important milestone in many people's lives. It can also be a time of significant challenge and stress. There are growing concerns about mental health amongst student populations including suicide risk. Student mental health and counselling services have the potential to prevent suicide, but evidence-based therapies are required that fit these service contexts. The Broad-Minded Affective Coping intervention (BMAC) is a brief (6 sessions), positive imagery-based intervention that aims to enhance students access to past positive experiences and associated emotions and cognitions. Pilot data provides preliminary support for the BMAC for students struggling with suicidal thoughts and behaviours, but this intervention has not yet been evaluated in the context of a randomised controlled trial (RCT). The Mental Imagery for Suicidality in Students Trial (MISST) is a feasibility RCT that aims to determine the acceptability and feasibility of evaluating the BMAC as an intervention for university students at risk of suicide within a larger efficacy trial. Key feasibility uncertainties have been identified relating to recruitment, retention, and missing data. Intervention acceptability and safety will also be evaluated. METHOD MISST is a feasibility randomised controlled trial design, with 1:1 allocation to risk assessment and signposting plus BMAC or risk assessment and signposting alone. Participants will be university students who self-report experiences of suicidal ideation or behaviour in the past 3 months. Assessments take place at baseline, 8, 16, and 24 weeks. The target sample size is 66 participants. A subset of up to 20 participants will be invited to take part in semi-structured qualitative interviews to obtain further data concerning the acceptability of the intervention. DISCUSSION The BMAC intervention may provide an effective, brief talking therapy to help university students struggling with suicidal thoughts that could be readily implemented into university student counselling services. Depending on the results of MISST, the next step would be to undertake a larger-scale efficacy trial. TRIAL REGISTRATION The trial was preregistered (17 December 2021) on ISRCTN (ISRCTN13621293) and ClinicalTrials.gov (NCT05296538).
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Affiliation(s)
- Peter James Taylor
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Paula Duxbury
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jane Moorhouse
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Chloe Russell
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Dan Pratt
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK.,Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sophie Parker
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK.,Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Chris Sutton
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
| | - Fiona Lobban
- LA14YW, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Richard Drake
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Steve Eccles
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - David Ryder
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
| | - Rafeea Patel
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Eirian Kerry
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Nathan Randles
- School of Medicine, Keele University, Newcastle-Under-Lyme, UK
| | - James Kelly
- Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Doctorate in Clinical Psychology, Lancaster University, Lancaster, UK
| | - Jasper Palmier-Claus
- LA14YW, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK. .,Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK.
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Masland SR, Victor SE, Peters JR, Fitzpatrick S, Dixon-Gordon KL, Bettis AH, Navarre KM, Rizvi SL. Destigmatizing Borderline Personality Disorder: A Call to Action for Psychological Science. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:445-460. [PMID: 36054911 DOI: 10.1177/17456916221100464] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite recognition that borderline personality disorder (BPD) is one of the most stigmatized psychological disorders, destigmatization efforts have thus far focused on the views and actions of clinicians and the general public, neglecting the critical role that psychological science plays in perpetuating or mitigating stigma. This article was catalyzed by recent concerns about how research and editorial processes propagate stigma and thereby fail people with BPD and the scientists who study BPD. We provide a brief overview of the BPD diagnosis and its history. We then review how BPD has been stigmatized in psychological science, the gendered nature of BPD stigma, and the consequences of this stigmatization. Finally, we offer specific recommendations for researchers, reviewers, and editors who wish to use science to advance our understanding of BPD without perpetuating pejorative views of the disorder. These recommendations constitute a call to action to use psychological science in the service of the public good.
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Affiliation(s)
| | - Sarah E Victor
- Department of Psychological Sciences, Texas Tech University
| | - Jessica R Peters
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | | | - Alexandra H Bettis
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
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12
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Predictive Factors of Suicidal Ideation in Spanish University Students: A Health, Preventive, Social, and Cultural Approach. J Clin Med 2023; 12:jcm12031207. [PMID: 36769853 PMCID: PMC9918125 DOI: 10.3390/jcm12031207] [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: 12/28/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Suicide, as the ultimate expression of suicidal ideation, has accompanied human beings throughout history within specific social and cultural contexts. However, in recent decades the increase in suicides, especially in developed countries after the Second Demographic Transition and the rise of postmaterialist values, has been increasing in the youth population. This study is created from a quantitative perspective and aims to determine the predictors of suicidal ideation in university students in Spain. The fieldwork was carried out in a large sample of Spanish universities over several weeks in 2022, with the participation of hundreds of university students (n = 1472). The predictors of suicidal ideation were gender, types of social relationships, history of bullying, health status, taking antidepressant medication, increased anxiety after COVID-19, economic difficulties in continuing studies, and perspective on their future. The results highlight the need for the greater involvement of universities by establishing programs for preventing, detecting, and treating suicidal ideation, always in coordination with health systems to prevent further suicides in their university community.
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13
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Jacobson SV, Gilbert AC, O'Loughlin CM, Widman C, Law KC, Ammerman BA. Effects of sexual orientation and NSSI severity on suicide risk. J Psychiatr Res 2023; 157:174-179. [PMID: 36470199 DOI: 10.1016/j.jpsychires.2022.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION People who identify as sexual minorities are at increased risk for suicide. Non-suicidal self-injury (NSSI) is also a risk factor for suicide and NSSI severity may contribute to development of capability for lethal self-injury. Further research is needed to understand how NSSI severity increases suicide risk, specifically in high-risk populations like sexual minorities. The current study seeks to examine whether sexual minority adults exhibit greater NSSI severity and suicide risk than heterosexuals, and if NSSI severity moderates the relationship between sexual orientation and suicide risk. METHODS Undergraduate students (N = 1,994) who reported five or more acts of NSSI in their lifetime completed online self-report questionnaires including sexual orientation, NSSI severity, and suicide risk. RESULTS A factorial ANOVA demonstrated main effects of sexual orientation and NSSI severity on suicide risk. DISCUSSION The lack of significant interaction effect indicates NSSI severity does not amplify the effect of on sexual orientation on suicide risk; rather, it predicts the same level of increased risk across orientations. Therefore, suicidality related to both sexual orientation and NSSI severity are equally important treatment targets.
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Affiliation(s)
- Samantha V Jacobson
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA.
| | - Anna C Gilbert
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | | | - Cammy Widman
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Keyne C Law
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA.
| | - Brooke A Ammerman
- Department If Psychology, University of Notre Dame, Notre Dame, IN, USA
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14
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Lan Z, Pau K, Mohd Yusof H, Huang X. Hierarchical topological model of the factors influencing adolescents' non-suicidal self-injury behavior based on the DEMATEL-TAISM method. Sci Rep 2022; 12:17238. [PMID: 36241902 PMCID: PMC9568609 DOI: 10.1038/s41598-022-21377-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/27/2022] [Indexed: 01/06/2023] Open
Abstract
This study analyzed the factors influencing adolescents' non-suicidal self-injury (NSSI) behavior and their interrelationships, and established a total influencing factor model. Through a literature analysis and semi-structured interviews with 87 adolescents and 27 experts in Guangxi Province, China, 13 influencing factors were identified from six aspects: physiological factors, cognitive factors, emotional factors, social support factors, social environment, and NSSI behavior. A system of factors influencing adolescents' NSSI behavior and a model of the factors influencing the comprehensive antagonism multilevel explanatory structure were obtained using a combination of Decision-Making Trial and Evaluation Laboratory technique and Total Adversarial Interpretive Structural Model. In descending order, NSSI, emotional state, self-efficacy, and self-cognition influenced adolescents' NSSI behavior. Social environment, exercise, and recreation had a greater impact on other factors, while NSSI, emotional regulation ability, and emotional state were greatly affected by other factors. Emotion regulation ability, self-cognition, self-efficacy, family support, school support, social support, and sleep were found to be the core factors influencing NSSI behavior of adolescents. These factors could be used to directly intervene in adolescent NSSI behavior. Timely treatment of adolescents' negative emotional states is directly conducive to preventing NSSI behavior and alleviating its severity.
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Affiliation(s)
- Zhensong Lan
- grid.464329.e0000 0004 1798 8991School of Public Administrations, Hechi University, Hechi, 546300 China ,grid.444506.70000 0000 9272 6490Department of Psychology and Counseling, Faculty of Human Development, Sultan Idris Education University, 35900 Tanjong Malim, Perak Malaysia
| | - Kee Pau
- grid.444506.70000 0000 9272 6490Department of Psychology and Counseling, Faculty of Human Development, Sultan Idris Education University, 35900 Tanjong Malim, Perak Malaysia
| | - Hapsah Mohd Yusof
- grid.444506.70000 0000 9272 6490Department of Psychology and Counseling, Faculty of Human Development, Sultan Idris Education University, 35900 Tanjong Malim, Perak Malaysia
| | - Xuefang Huang
- grid.464329.e0000 0004 1798 8991School of Public Administrations, Hechi University, Hechi, 546300 China
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15
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Campbell F, Blank L, Cantrell A, Baxter S, Blackmore C, Dixon J, Goyder E. Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health 2022; 22:1778. [PMID: 36123714 PMCID: PMC9484851 DOI: 10.1186/s12889-022-13943-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Worsening mental health of students in higher education is a public policy concern and the impact of measures to reduce transmission of COVID-19 has heightened awareness of this issue. Preventing poor mental health and supporting positive mental wellbeing needs to be based on an evidence informed understanding what factors influence the mental health of students. Objectives To identify factors associated with mental health of students in higher education. Methods We undertook a systematic review of observational studies that measured factors associated with student mental wellbeing and poor mental health. Extensive searches were undertaken across five databases. We included studies undertaken in the UK and published within the last decade (2010–2020). Due to heterogeneity of factors, and diversity of outcomes used to measure wellbeing and poor mental health the findings were analysed and described narratively. Findings We included 31 studies, most of which were cross sectional in design. Those factors most strongly and consistently associated with increased risk of developing poor mental health included students with experiences of trauma in childhood, those that identify as LGBTQ and students with autism. Factors that promote wellbeing include developing strong and supportive social networks. Students who are prepared and able to adjust to the changes that moving into higher education presents also experience better mental health. Some behaviours that are associated with poor mental health include lack of engagement both with learning and leisure activities and poor mental health literacy. Conclusion Improved knowledge of factors associated with poor mental health and also those that increase mental wellbeing can provide a foundation for designing strategies and specific interventions that can prevent poor mental health and ensuring targeted support is available for students at increased risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13943-x.
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Affiliation(s)
| | | | | | | | | | - Jan Dixon
- University of Sheffield, Sheffield, UK
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16
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Peel-Wainwright KM, Hartley S, Boland A, Rocca E, Langer S, Taylor PJ. The interpersonal processes of non-suicidal self-injury: A systematic review and meta-synthesis. Psychol Psychother 2021; 94:1059-1082. [PMID: 34090311 DOI: 10.1111/papt.12352] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Understanding the processes underlying non-suicidal self-injury (NSSI) is important given the negative consequences of this behaviour. Qualitative research has the potential to provide an in-depth exploration of this. There has been limited research regarding the interpersonal processes associated with NSSI; therefore, a meta-synthesis was conducted to investigate this. METHODS A search of PsycINFO, MEDLINE, Web of Science, and CINAHL electronic databases from date of inception to November 2020 was conducted. In total, 30 papers were included in the final review. A meta-ethnographic approach was utilized to synthesize the data. RESULTS Two overarching themes were found. Within 'Powerful relational dynamics', NSSI was cited as a response to participants becoming stuck in aversive or disempowering relational positions with others. Within the 'Taking matters into their own hands' subtheme, NSSI was reported as a way for participants to get interpersonal and emotional needs met. LIMITATIONS Several included papers did not comment on the researcher-participant relationship, which may have affected qualitative results. A small number of potentially eligible papers were unavailable for synthesizing. CONCLUSION Findings provide a more nuanced investigation of the interpersonal processes underlying NSSI. Consistent with relevant theories, NSSI appears to be a way of mitigating difficult interpersonal experiences or getting interpersonal needs met. NSSI may be engaged in as a substitute to other, less damaging ways to cope. An argument is made for a more empathetic understanding of NSSI and the use of relational interventions. PRACTITIONER POINTS Self-injury may occur in response to interpersonal stressors Self-injury can be a means to get interpersonal needs met Self-injury may replace other means of coping that become blocked or thwarted Emotional distress can be closely linked with interpersonal factors for this group Relational therapies may be beneficial where interpersonal processes are linked to NSSI.
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Affiliation(s)
- Kelly-Marie Peel-Wainwright
- Divison of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, UK.,Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Samantha Hartley
- Divison of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, UK.,Pennine Care NHS Foundation Trust, UK
| | - Angel Boland
- Divison of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, UK.,Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Eleanor Rocca
- Divison of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, UK.,Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Susanne Langer
- Department of Psychology, Manchester Metropolitan University, UK
| | - Peter J Taylor
- Divison of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, UK
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17
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Wang Y, Feng Y, Han M, Duan Z, Wilson A, Fish J, Sun S, Chen R. Methods of attempted suicide and risk factors in LGBTQ+ youth. CHILD ABUSE & NEGLECT 2021; 122:105352. [PMID: 34655994 DOI: 10.1016/j.chiabu.2021.105352] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study aimed to identify patterns of attempted suicide methods and risk factors in lesbian, gay, bisexual, transgender, queer and other gender/sexual minority (LGBTQ+) youth by comparing them to non-LGBTQ+ youth. METHODS A total of 9281 Chinese college students completed the study, 8313 participants were included in the analysis of which 1032 were LGBTQ+ youth and 7281 were non-LGBTQ+ youth. Sociodemographic information was collected along with several scales and self-report items. This included anxiety scores using the Generalized Anxiety Disorder (GAD)-7, depression scores using the Patient Health Questionnaire (PHQ)-9, mania score using the Altman Self-Rating Mania (ASRM), Childhood Trauma Questionnaire (CTQ), and Intimate Partner Violence (IPV) victimization using the World Health Organization's definition. Self-report items were used to further collect history of non-fatal self-injurious behaviors, parents' related risk factors, history of suicide attempts, and methods of attempted suicide. RESULTS The prevalence of attempted suicide in LGBTQ+ youth was 4.2%, which in comparison was more than four times higher than non-LGBTQ+ youth. LGBTQ+ youth 19-22 years old were at a significantly higher risk of attempting suicide than non-LGBTQ+ youth. The most common method of attempted suicide was cutting of the wrist, followed by jumping from a high height. There were some common suicide risk factors that were similar between LGBTQ+ and non-LGBTQ+ youth, such as living in a rural area, having a history of a psychiatric disorder, and having a history of non-fatal self-injurious behaviors. The associated increased risk factors for LGBTQ+ youth were having a higher score for CTQ-emotional abuse and CTQ-sexual abuse. LIMITATION The causality of risk factors to attempted suicide cannot be assumed due to the cross-sectional nature of the survey. Also, due to the relatively small sample size within the subgroups, we did not assess LGBTQ+ youth separately according to the different sexuality groups. CONCLUSION LGBTQ+ youth showed a higher prevalence of attempted suicide when compared to their heterosexual peers. Emotional and sexual abuse showed higher rates among LGBTQ+ youth, the cumulative effects of childhood trauma might explain the difficulties in developing healthy coping styles.
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Affiliation(s)
- Yuanyuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China; School of Psychology, Beijing Normal University, Beijing, China
| | - Meng Han
- Department of Medical Psychology, The School of Health Humanities, Peking University, Beijing, China; Vanke School of Public Health, Tsinghua University, Beijing, China.
| | - Zhizhou Duan
- Preventive health service, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Julie Fish
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Shufang Sun
- Brown University School of Public Health, Department of Behavioral and Social Sciences, International Health Institute, US
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China.
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18
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Williams AJ, Arcelus J, Townsend E, Michail M. Understanding the processes underlying self-harm ideation and behaviors within LGBTQ+ young people: A qualitative study. Arch Suicide Res 2021; 27:380-396. [PMID: 34806945 DOI: 10.1080/13811118.2021.2003273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aims to understand the processes underlying self-harmful thoughts and behaviors, with and without suicidal intent, among LGBTQ+ young people. METHOD Nineteen semi-structured interviews took place between October 2019 and May 2020. Participants were aged between 16 and 25 years, had experiences of self-harm ideation and behaviors, and were part of the LGBTQ+ umbrella. A range of sexualities and gender identities were represented: eleven participants were cisgender, six were transgender and two were non-binary. Interviews were transcribed verbatim and anonymised. Thematic analysis and reflective member-checking were used to develop a thematic framework. RESULTS Three themes were developed from the interviews and evaluated by four participants who engaged with reflective member-checking. Findings indicated that internal processes and external responses to being LGBTQ+ resulted in self-harmful thoughts and behaviors. Alongside these, additional stressors related to being a young person were led to difficulties with self-harm. CONCLUSIONS Findings from this study indicate that young people often struggle with accepting their LGBTQ+ identity for a number of reasons, whether this is due to access to a resource or their own feelings about their identity. These negative self-perceptions can be enhanced by poor responses from others and additional life stressors which impact their self-esteem or self-perception.HIGHLIGHTSUnderstanding and accepting that one is LGBTQ+ is not always a simple process, struggling with these thoughts can influence self-harm.Lack of LGBTQ+ terminology hinders self-acceptance and caused young people to engage with self-harm.Peers and family members responses to a young people's LGBTQ+ identity is highly significant and can directly led to self-harmful thoughts and experiences.
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19
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Simões ÉV, Oliveira AMND, Pinho LBD, Lourenção LG, Oliveira SMD, Farias FLRD. Reasons assigned to suicide attempts: adolescents' perceptions. Rev Bras Enferm 2021; 75Suppl 3:e20210163. [PMID: 34787243 DOI: 10.1590/0034-7167-2021-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/03/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE identify the reasons for attempting suicide from the perspective of adolescents. METHODS qualitative study conducted with ten adolescents who attempted suicide and were attending a Centro de Atenção Psicossocial Infanto-Juvenil located in a city in the south of Brazil. Semi-structured interviews were held in July 2020 using WhatsApp. Data were analyzed according to Minayo's Content Thematic Analysis. RESULTS the adolescents' reports listed the reasons that triggered suicide attempts, such as changes in the adolescents' life cycle and violence, which led them to attempt suicide to solve problems. FINAL CONSIDERATIONS Data analysis revealed the reasons that triggered suicide attempts from the adolescents' perspective and difficulties to cope with problems, probably explained by their lack of experience in dealing with frustrations and disappointments.
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20
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Taylor PJ, Fien K, Mulholland H, Duarte R, Dickson JM, Kullu C. Pilot service evaluation of a brief psychological therapy for self-harm in an emergency department: Hospital Outpatient Psychotherapy Engagement Service. Psychol Psychother 2021; 94 Suppl 1:64-78. [PMID: 32338445 DOI: 10.1111/papt.12277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/14/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Brief psychological therapies may be helpful for people who have recently self-harmed. The current paper reports on a service evaluation of a novel brief therapy service based within an Emergency Department, Hospital Outpatient Psychotherapy Engagement (HOPE) Service. This service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help people who present with self-harm-related difficulties. The primary aim of this service evaluation was to ascertain the feasibility of HOPE in terms of attendance rates. The study also examined variables associated with engagement, and change over time in psychological distress for those attending the service. METHOD The HOPE service was evaluated over a ten-month period. Consenting patients completed measures of psychological distress and working alliance across four therapy sessions and one follow-up session. Measures of emotion regulation style and self-harm function were also completed at the point of referral. RESULTS Eight-nine patients were referred to the service (83 eligible referrals). Fifty-three (64%) attended at least one therapy session. Baseline variables did not distinguish people who attended and people who did not. Psychological distress decreased significantly across the sessions. Most people reported a good working alliance with their therapist. CONCLUSIONS The results of this service evaluation support the feasibility of the HOPE service, demonstrating good engagement rates given the complexity of the population and context. Whilst there was evidence of reductions in distress, randomized controlled trials are needed to determine if HOPE has clinical efficacy. PRACTITIONER POINTS Rates of engagement with HOPE suggest the service is feasible in an Emergency Department context Working alliance scores were positive for the majority of patients The HOPE service shows promise as a brief intervention for people who self-harm but requires further evaluation Randomized controlled trials are needed to determine the clinical efficacy of the HOPE service.
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Affiliation(s)
- Peter J Taylor
- Division of Psychology & Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Kirsten Fien
- Institute of Population Health Sciences, University of Liverpool, UK
| | - Helen Mulholland
- Institute of Population Health Sciences, University of Liverpool, UK
| | - Rui Duarte
- Institute of Population Health Sciences, University of Liverpool, UK.,Liverpool Reviews and Implementation Group, University of Liverpool, UK
| | - Joanne M Dickson
- Division of Psychology, School of Arts and Humanities, Edith Cowan University, Perth, Western Australia, Australia
| | - Cecil Kullu
- Mersey Care NHS Foundation Trust, Merseyside, UK
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21
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Williams AJ, Jones C, Arcelus J, Townsend E, Lazaridou A, Michail M. A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide. PLoS One 2021; 16:e0245268. [PMID: 33481862 PMCID: PMC7822285 DOI: 10.1371/journal.pone.0245268] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations. OBJECTIVES The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups. DATA SOURCES MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020). STUDY ELIGIBILITY CRITERIA Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12-25 years). SYNTHESIS METHODS 2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses. RESULTS Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences. CONCLUSIONS Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives. PROSPERO REGISTRATION NUMBER CRD42019130037.
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Affiliation(s)
- A. Jess Williams
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- School of Psychology, Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Christopher Jones
- School of Psychology, Centre for Applied Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Jon Arcelus
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ellen Townsend
- School of Psychology, Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Aikaterini Lazaridou
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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22
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The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020826. [PMID: 33478019 PMCID: PMC7835774 DOI: 10.3390/ijerph18020826] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022]
Abstract
This scoping review of UK evidence aimed to describe what is known about Lesbian, Gay, Bisexual, and Trans (LGBT+) health inequalities in relation to cancer, mental health, and palliative care to inform research, policy and public health interventions. Using a scoping review methodology, we identified studies from database searches, citation tracking, and expert consultation. The in/exclusion criteria was based on the PICOS framework. The data were charted and then summarised to map the theoretical approaches and the main types of evidence and identify knowledge gaps. In total, 279 articles were screened and 83 were included in the final review. We found that there is limited UK research examining LGBT+ health inequality in cancer, mental health and palliative care. We would argue that this thin evidence base is partly due to national policy discussions of LGBT+ health inequality that are framed within a depoliticised ‘it’s getting better’ narrative, and an unwillingness to adequately acknowledge the unjust social and economic relations that produce LGBT+ health inequality. In addition, LGBT+ health inequality is depoliticised by existing public health explanatory theories, models and frameworks that exclude sexual orientation and gender diversity as dimensions of power that interlock with those of socio-economic, race and ethnicity. This is a barrier to developing public health interventions that can successfully tackle LGBT+ health inequality
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23
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Zhornitsky S, Le TM, Dhingra I, Adkinson BD, Potvin S, Li CR. Interpersonal Risk Factors for Suicide in Cocaine Dependence: Association with Self-Esteem, Personality Traits, and Childhood Abuse. Suicide Life Threat Behav 2020; 50:867-883. [PMID: 32030810 PMCID: PMC7518050 DOI: 10.1111/sltb.12621] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 01/10/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Studies have linked cocaine dependence to suicidality. According to the Interpersonal Theory of Suicide, suicidal behavior becomes likely with the simultaneous presence of perceived burdensomeness (PB), lack of (or thwarted) belongingness (TB), and acquired fearlessness about death (FAD). Here, we examined personality and other variables, including depression, self-esteem, childhood abuse, and substance use, as predictors of these risk factors in cocaine-dependent individuals (CDs). METHODS Seventy CDs and 70 healthy controls (HCs) participated. We examined group differences in a group-by-sex analysis of variance and identified predictors of PB, TB, and FAD in stepwise regressions. RESULTS CDs exhibited elevated PB and TB but not FAD, compared to HCs. CDs also exhibited elevated harm avoidance, novelty seeking, depression, and lower self-esteem and reward dependence. Females reported elevated sexual abuse, harm avoidance, reward dependence, depression, but lower FAD, relative to males, among CDs and HCs. Among CDs, PB was predicted by lower self-esteem and greater emotional abuse; TB was predicted by lower self-esteem and reward dependence, as well as greater emotional and sexual abuse; and FAD was predicted by lower harm avoidance and greater physical abuse. CONCLUSIONS Interventions targeting suicidality in cocaine dependence should take into consideration self-esteem, personality traits, and childhood abuse.
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Affiliation(s)
- Simon Zhornitsky
- Department of Psychiatry Yale University School of Medicine New Haven Connecticut
| | - Thang M. Le
- Department of Psychiatry Yale University School of Medicine New Haven Connecticut
| | - Isha Dhingra
- Department of Psychiatry Yale University School of Medicine New Haven Connecticut
| | - Brendan D. Adkinson
- Interdepartmental Neuroscience Program Yale University School of Medicine New Haven Connecticut
| | - Stephane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal Montreal QC Canada
- Department of Psychiatry Faculty of Medicine Université de Montréal Montréal QC Canada
| | - Chiang‐shan R. Li
- Department of Psychiatry Yale University School of Medicine New Haven Connecticut
- Interdepartmental Neuroscience Program Yale University School of Medicine New Haven Connecticut
- Department of Neuroscience Yale University School of Medicine New Haven Connecticut
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24
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Quarshie ENB, Waterman MG, House AO. Prevalence of self-harm among lesbian, gay, bisexual, and transgender adolescents: a comparison of personal and social adversity with a heterosexual sample in Ghana. BMC Res Notes 2020; 13:271. [PMID: 32493429 PMCID: PMC7271418 DOI: 10.1186/s13104-020-05111-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/25/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES We sought to estimate the prevalence of self-reported self-harm among adolescents identifying as lesbian, gay, bisexual, and transgender (LGBT) in Ghana, and compare self-reported personal and social adversities related to self-harm in this group to those in a random sample of heterosexual adolescents from the same locality. RESULTS A total of 444 adolescents aged 13-21 years, comprising 74 LGBT adolescents and 370 heterosexual adolescents, provided data. The lifetime prevalence estimate of self-harm was higher in the LGBT group (47%) than the heterosexual group (23%). The LGBT group reported a higher rate of self-harm during the previous 12 months (45%), compared to the heterosexual group (18%). LGBT adolescents reported more alcohol and substance use and more personal social adversities, including various forms of victimisation, than heterosexual adolescents. They were no more likely to report difficulty in making and keeping friends or schoolwork problems than were heterosexual adolescents.
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Affiliation(s)
| | | | - Allan O House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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25
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Rehman Z, Lopes B, Jaspal R. Predicting self-harm in an ethnically diverse sample of lesbian, gay and bisexual people in the United Kingdom. Int J Soc Psychiatry 2020; 66:349-360. [PMID: 32122180 PMCID: PMC7488821 DOI: 10.1177/0020764020908889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Poor mental health is prevalent in lesbian, gay and bisexual (LGB) people due in part to social stigma. The social, psychological and clinical risk factors for self-harm among LGB people are unclear, which limits our ability to predict when and how this will occur and, crucially, how to prevent it. AIMS Drawing on the cognitive-behavioral approach in clinical psychology, this study identifies the predictors of self-harm in LGB people in the United Kingdom. RESULTS Women, lesbians, those with lower income and younger people were more likely to engage in self-harm. Self-harmers exhibited much more discrimination, LGB victimization and, thus, internalized homophobia and depressive symptomatology than non-self-harmers. The structural equation model showed direct effects of age and gender, and indirect effects of income and sexual orientation, on self-harm, through the mediating variables of discrimination, LGB victimization and internalized homophobia. CONCLUSIONS Consistent with the cognitive-behavioral model, the results indicate that exposure to situational stressors can increase the risk of developing a self-hatred and depressive psychological self-schema, resulting in greater risk of self-harm as a maladaptive coping strategy. An integrative clinical intervention for enhancing psychological wellbeing in LGB people is proposed to mitigate the risk of self-harm in this population.
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Affiliation(s)
- Zaqia Rehman
- Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
| | - Barbara Lopes
- CINEICC, Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Rusi Jaspal
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
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26
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Ream GL. An Investigation of the LGBTQ+ Youth Suicide Disparity Using National Violent Death Reporting System Narrative Data. J Adolesc Health 2020; 66:470-477. [PMID: 31982330 DOI: 10.1016/j.jadohealth.2019.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/17/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE This study explored law enforcement and medical examiner reports about adolescent and young adult deaths by suicide for novel and understudied risk factors and described variability by sexual orientation and gender identity in those risk factors' prevalence. It also sought to explain why the suicide disparity between lesbian, gay, bisexual, transgender, queer/questioning, and other sexual/gender minority (LGBTQ+) youth and non-LGBTQ+ youth is wider in adolescence than in young adulthood. METHODS This study involved coding of law enforcement and medical examiner reports from the National Violent Death Reporting System (NVDRS) for all 394 LGBTQ+ youth who died by suicide in NVDRS participating states between 2013 (the year that NVDRS began coding for sexual orientation and transgender status) and 2016 (the latest year of NVDRS available), along with 394 non-LGBTQ+ cases matched with them on dimensions of sex, urbanicity, race, and military service. RESULTS Fifty-nine percent of 12- to 17-year-old LGBTQ+'s cases mentioned an LGBTQ+-specific contributing circumstance, whereas only 30% of 18- to 29-year-old LGBTQ+'s cases mentioned an LGBTQ+-specific contributing circumstance. However, there were 3.6 times as many cases of LGBTQ+ 18- to 29-year-olds as there were of LGBTQ+ 12- to 17-year-olds. Cases of gay males, bisexual males, and bisexual females were particularly likely to include family/peer rejection and bullying as contributing circumstances, while lesbians' cases more often mentioned romantic breakups. CONCLUSIONS The LGBTQ+/non-LGBTQ+ suicide disparity may be greater for adolescents because LGBTQ+-specific contributing circumstances are more prevalent among adolescents. Prevention efforts should be tailored to clients' age and specific LGBTQ+ subgroup.
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Affiliation(s)
- Geoffrey L Ream
- School of Social Work, Adelphi University, Garden City, New York.
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27
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Henry RS, Perrin PB, Sawyer A, Pugh M. Health Conditions, Access to Care, Mental Health, and Wellness Behaviors in Lesbian, Gay, Bisexual, and Transgender Adults. Int J Chronic Dis 2020; 2020:9094047. [PMID: 32206669 PMCID: PMC7079213 DOI: 10.1155/2020/9094047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 01/07/2023] Open
Abstract
This study examined relationships among wellness behaviors, physical health conditions, mental health, health insurance, and access to care among a sample of 317 lesbian, gay, bisexual, and transgender (LGBT) adults. Participants completed a web-administered survey from May 2013 to April 2014. Of the sample, 41.6% of the participants reported having one or more health conditions. Most participants (92.1%) reported access to a health care facility and current health insurance coverage (84.9%), though 24.9% of those with health insurance reported being incapable of paying the copayments. Physical health conditions, age, and self-esteem explained 24% of the variance in engagement in wellness behaviors; older age, a greater number of health conditions, higher self-esteem, possession of health insurance, and ability to access to care were associated with increased wellness behaviors. Providing affordable insurance coverage, improving access to care, and properly treating mental health in LGBT individuals could improve wellness behaviors.
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Affiliation(s)
- Richard S. Henry
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ashlee Sawyer
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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28
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Liu RT, Sheehan AE, Walsh RFL, Sanzari CM, Cheek SM, Hernandez EM. Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis. Clin Psychol Rev 2019; 74:101783. [PMID: 31734440 PMCID: PMC6896220 DOI: 10.1016/j.cpr.2019.101783] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/01/2019] [Accepted: 11/06/2019] [Indexed: 01/17/2023]
Abstract
The current review presents a meta-analysis of the existing empirical literature on the prevalence of non-suicidal self-injury (NSSI) among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as on correlates of NSSI within sexual and gender minority populations. Eligible publications (n = 51) were identified through a systematic search of PsycINFO, MEDLINE, and Embase, supplemented by a search of references of prior reviews on this topic. NSSI prevalence rates were quite elevated among sexual (29.68% lifetime) and gender (46.65% lifetime) minority individuals compared to heterosexual and/or cisgender peers (14.57% lifetime), with transgender (46.65% lifetime) and bisexual (41.47% lifetime) individuals being at greatest risk. Even among these group findings, sexual minority youth emerged as an especially vulnerable population. Moreover, current evidence suggests these rates and differences between LGBT and heterosexual and/or cisgender peers have not declined over time. These findings may in some measure be due to the existence of LGBT-specific risk correlates combined with general risk correlates being more severe among sexual and gender minority populations. Additional research, particularly employing a longitudinal design, is needed in this area to advance efforts to reduce risk for NSSI among sexual and gender minority individuals.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States.
| | - Ana E Sheehan
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Rachel F L Walsh
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Christina M Sanzari
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Shayna M Cheek
- Department of Psychology and Neuroscience, Duke University, United States
| | - Evelyn M Hernandez
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
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29
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Williams AJ, Arcelus J, Townsend E, Michail M. Examining risk factors for self-harm and suicide in LGBTQ+ young people: a systematic review protocol. BMJ Open 2019; 9:e031541. [PMID: 31719085 PMCID: PMC6858144 DOI: 10.1136/bmjopen-2019-031541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Young people who identify as Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (LGBTQ+) are at increased risk for self-harm, suicide ideation and behaviours. However, there has yet to be a comprehensive understanding of what risk factors influence these behaviours within LGBTQ+ young people as a whole. The purpose of this systematic review is to examine risk factors associated with self-harm, suicidal ideation and behaviour in LGBTQ+) young people. METHODS AND ANALYSIS A systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (MEDLINE, Scopus, EMBASE, PsycINFO and Web of Science) will be systematically searched for cross-sectional, prospective, longitudinal, cohort and case-control designs which examine risk factors for self-harm and/or suicidal ideation and behaviour in LGBTQ+ young people (aged 12-25 years). Only studies published in English will be included. No date restrictions will be applied. Study quality assessment will be conducted using the original and modified Newcastle-Ottawa Scales. Meta-analysis or narrative synthesis will be used, dependent on findings. ETHICS AND DISSEMINATION This is a systematic review of published literature and thereby ethical approval was not sought. The review will be submitted to a peer-reviewed journal, be publicly disseminated at conferences focusing on mental health, self-harm and suicide prevention. The findings will also be shared through public engagement and involvement, particularly those related to young LGBTQ+ individuals. PROSPERO REGISTRATION NUMBER CRD42019130037.
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Affiliation(s)
- A Jess Williams
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Self-Harm Research Group, University of Nottingham, Nottingham, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ellen Townsend
- Self-Harm Research Group, University of Nottingham, Nottingham, UK
| | - Maria Michail
- Institute for Mental Health, University of Birmingham, Birmingham, UK
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30
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Sheehy K, Noureen A, Khaliq A, Dhingra K, Husain N, Pontin EE, Cawley R, Taylor PJ. An examination of the relationship between shame, guilt and self-harm: A systematic review and meta-analysis. Clin Psychol Rev 2019; 73:101779. [PMID: 31707184 PMCID: PMC6891258 DOI: 10.1016/j.cpr.2019.101779] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/12/2019] [Accepted: 09/14/2019] [Indexed: 01/29/2023]
Abstract
Self-harm is a major public health concern associated with suicide risk and significant psychological distress. Theories suggest that aversive emotional states are an important process that drives self-harm. Shame and guilt may, in particular, be important emotions in self-harm. This review therefore sought to provide a systematic review and meta-analysis of the relationship between shame, guilt, and self-harm. A systematic search of electronic databases (PsycINFO; Medline; CINAHL Plus; Web of Science and ProQuest) was undertaken to identify studies measuring shame, guilt and self-harm (including suicidal and non-suicidal behaviour). Meta-analysis was undertaken where papers focused on the same subtype of shame or guilt and shared a common outcome. Thirty studies were identified for inclusion. Most forms of shame were associated with non-suicidal self-injury (NSSI), but research was sparse concerning suicidal behaviour. Fewer studies examined guilt and findings were more varied. Methodological issues included a paucity of longitudinal designs and lack of justification for sample sizes. Results of this review support the link between shame and self-harm, particularly NSSI. The direction of this relationship is yet to be established. Clinically, consideration should be given to the role of shame amongst individuals who present with NSSI. This review was pre-registered on PROSPERO (CRD42017056165).
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Affiliation(s)
- Kate Sheehy
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Amna Noureen
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Ayesha Khaliq
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Katie Dhingra
- School of Social Sciences, Leeds Beckett University, LS1 3HE England, United Kingdom
| | - Nusrat Husain
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
| | - Eleanor E Pontin
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Rosanne Cawley
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Peter J Taylor
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
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