New Strategies for Practice-Based Evidence: A Focus on Self-Harm

Off track or on? Associations of positive and negative life events with the continuation versus cessation of repetitive adolescent nonsuicidal self-injury

OBJECTIVE

This study examined how patterns of repetitive (≥5 instances) nonsuicidal self-injury (NSSI) associate with measures of resilience and life events retrospectively reported to have occurred within the last year, 1 to <5 years ago, and 5 to <10 years ago.

METHOD

Life events reported by 557 young adults (mean [SD] age 25.3 [0.68]; 59.2% women) were classified as positive, negative, or profoundly negative based on their relationship to participants' mental health and well-being. We subsequently examined how these categories, together with resilience, were cross-sectionally associated with reporting no NSSI, and the (full/partial) cessation/continuation of repetitive NSSI from adolescence to young adulthood.

RESULTS

Repetitive NSSI in adolescence was associated with (profoundly) negative life events. Relative to cessation, NSSI continuation was significantly associated with more kinds of negative life events (odds ratio [OR] = 1.79) and fewer kinds of positive life events 1 to <5 years ago (OR = 0.65) and tended to be associated with lower resilience (b = -0.63, p = 0.056). Neither life events nor resilience significantly differentiated individuals reporting full or partial cessation.

CONCLUSION

Resilience appears important for the cessation of repetitive NSSI, but contextual factors must still be considered. Assessing positive life events in future studies holds promise.

"What I couldn't do before, I can do now": Narrations of agentic shifts and psychological growth by young adults reporting discontinuation of self-injury since adolescence

PURPOSE

We explore young adults' narrations of life events in association with nonsuicidal self-injury (NSSI) discontinuation, psychological growth, and agency.

METHODS

Transcripts from eleven face-to-face interviews with individuals who quantitatively reported injuring themselves in adolescence (2007-2008) but not in young adulthood (2017) were narratively analysed.

RESULTS

We found that at starting points, a period preceding an agentic shift in the narrative, participants endured stressful living conditions and mental illness. During this period, participants perceived no point in trying to initiate change because they did not perceive themselves as having the capacity to do so and nor could they adequately utilize any formal or informal support. After a turning point that enabled agency due to gaining a sense of belongingness, liberation, or perspective, participants underwent a process of attaining psychological well-being. However, narrating psychological growth also required momentum points, encompassing the management of and moving on from stressful contexts, along with the recognition of milestones marking improvement relative to the starting points.

CONCLUSIONS

NSSI discontinuation was narrated in conjunction with psychological growth when participants also experienced themselves as situated within an agentic context, because agency is understood as necessary to react to and manage current and future life circumstances.

Identifying Suicide and Self-Harm Research Priorities in North West England

Background: Understanding and effectively managing self-harm and suicide require collaborative research between stakeholders focused on shared priorities. Aims: We aimed to develop a consensus about suicide and self-harm research priorities in the North West of England using the Delphi method. Method: Items for the Delphi survey were generated through group discussions at a workshop with 88 stakeholders and subsequent thematic analysis of key themes. A total of 44 participants who were experts-by-experience, researchers, and clinicians based within health services including third-sector organizations completed the Delphi survey. Results: A three-round survey reached consensus on 55 research priority items identifying key priorities in each of the following groups: offenders, children and young people, self-harm in community settings, and crisis care in the community. Limitations: The pool of delegates at the workshop and subsequent self-selection into the Delphi may have introduced bias into the study. Conclusion: The current paper highlights specific actionable priorities were identified in four areas that can be used to inform research efforts and future policy and practice, based on shared areas of perceived importance and concern. Future work is needed to confirm the significance of these priority areas, including the use of evidence synthesis approaches to ascertain the extent to which these priorities have already been investigated and where gaps in understanding remain.

WASP (Write a Scientific Paper): Qualitative research and evidence based practice: implications and contributions

Qualitative methodologies are commonly used in the social sciences. This paper discusses how this type of research can enhance evidence-based practice in health care settings. Examples taken from qualitative studies are included in order to demonstrate how such research can be applied to medical settings. Additionally, this paper describes some of the unique characteristics inherent in qualitative research.

Self-Injury, Help-Seeking, and the Internet

Abstract. Background: Although increasing numbers of young people are seeking help online for self-injury, relatively little is known about their online help-seeking preferences. Aims: To investigate the perspectives of young people who self-injure regarding online services, with the aim of informing online service delivery. Method: A mixed-methods exploratory analysis regarding the perspectives of a subsample of young people who reported a history of self-injury and responded to questions regarding preferences for future online help-seeking (N = 457). The sample was identified as part of a larger study (N = 1,463) exploring self-injury and help-seeking. Results: Seven themes emerged in relation to preferences for future online help-seeking: information, guidance, reduced isolation, online culture, facilitation of help-seeking, access, and privacy. Direct contact with a professional via instant messaging was the most highly endorsed form of online support. Conclusion: Young people expressed clear preferences regarding online services for self-injury, supporting the importance of consumer consultation in development of online services.

"Knowing that I'm not alone": client perspectives on counselling for self-injury

BACKGROUND

Self-injury is an increasingly common phenomenon among clinical and non-clinical populations. Health care providers generally recommend behavioural interventions that address coping skills for people who self-injure despite a lack of a consistent evidence base about their effectiveness. There is limited understanding about experiences of counselling for self-injury from the perspectives of clients.

AIM

To understand clients' experiences of counselling for self-injury.

METHOD

Ten interviews were conducted, audio-recorded and transcribed. Data were analysed using Grounded Theory (GT).

RESULTS

One central category, "Developing a healing reconnection with self and others" and four categories: (i) Building trust; (ii) seeing beyond the cutting; (iii) human contact and (iv) integrating experiences.

CONCLUSIONS

Overcoming self-injury is possible within the context of a trusting and accepting therapeutic relationship. Participants perceived counselling to be helpful when counsellors were willing to work with underlying issues rather than focus primarily on the cessation of self-injury. Counsellors and mental health practitioners must look beyond the behaviour to meet with the person and facilitate the development of a therapeutic relationship, which promotes a healing reconnection with self and others.