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Chartrand H, Tefft B, Sareen J, Hiebert-Murphy D, Katz LY, Klonsky ED, Wang Y, Kim H, Bolton JM. A Longitudinal Study of Correlates, Discharge Disposition, and Rate of Re-presentation to Emergency Services of Adults who Engage in Non-suicidal Self-injury. Arch Suicide Res 2022; 26:1141-1158. [PMID: 33306000 DOI: 10.1080/13811118.2020.1856259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In DSM-5, non-suicidal self-injury (NSSI) and suicide attempts (SA) are classified as distinct disorders in the section of conditions for further study. However, some have questioned the validity of distinguishing NSSI from SA. The objective of this study was to longitudinally examine the correlates, discharge disposition, and rate of re-presentation to emergency services of adults who engaged in NSSI and compare them to (a) adults who engage in SA and (b) adults with no self-harm or suicidal ideation (SI). METHOD Data came from 4,772 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Winnipeg, Canada between January 2009 and June 2012. Chart reviews were conducted for all presentations with NSSI (n = 158), and a sample of those with SA (n = 172) and no SH or SI (n = 173). RESULTS Among the adults who returned to emergency services, those who originally presented with SA re-presented significantly sooner than those who presented with NSSI. (χ2(1) = 7.457, p = 0.006). Those who originally presented with NSSI that returned to hospital did not return with repeat NSSI, but instead the majority re-presented with suicidal thoughts and SA. Further, those who re-presented with NSSI and SA were less likely to be hospitalized or to receive a referral to mental health services, and more likely to be discharged to usual care at time of initial presentation. CONCLUSIONS Overall, these findings indicate a trajectory of escalation of self-harm behavior for certain people who engage in NSSI, especially those who re-present to emergency services.HIGHLIGHTSA quarter of people with self-harm re-present to emergency services within four-and-a-half years.Those with suicide attempts re-presented significantly sooner than non-suicidal self-injury.There is a need for increased interventions in emergency services for those with self-harm.
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What is Known About the Role of Friendship in Adolescent Self-Harm? A Review and Thematic Synthesis. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Eggermont K, Bastin M, Luyckx K, Claes L. Do Gender and Age Moderate the Relationship between Friendship Quality and Non-Suicidal Self-Injury in Community Children and Adolescents? Psychol Belg 2021; 61:315-326. [PMID: 34824862 PMCID: PMC8588898 DOI: 10.5334/pb.1067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/19/2021] [Indexed: 01/02/2023] Open
Abstract
In the present study, we investigated the relationship between friendship quality (dimensions) and non-suicidal self-injury (NSSI) as well as the moderating role of gender and age in this relationship. The sample consisted of 463 children and adolescents (50.10% female, age range: 9-17 years). Friendship quality and NSSI were measured using the Friendship Qualities Scale (FQS; Bukowski, Hoza, & Boivin, 1994) and the Self Harm Inventory (SHI; Sansone, Wiederman, & Sansone, 1998), respectively. Overall, total friendship quality and NSSI were significantly and negatively related. Additionally, the relationship between total friendship quality and NSSI was moderated by gender and age. Specifically, girls with low friendship quality reported more NSSI; whereas for boys an opposite effect was found. As for age, friendship quality and NSSI were positively related in older participants. In younger participants, a relationship between friendship quality and NSSI seemed rather absent. This study highlights the important association between friendship quality and NSSI, as well as gender- and age-related differences in this association, which should be taken into account in the prevention and treatment of NSSI.
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Affiliation(s)
- Kristina Eggermont
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Margot Bastin
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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Vigfusdottir J, Dale KY, Gratz KL, Klonsky ED, Jonsbu E, Høidal R. The psychometric properties and clinical utility of the Norwegian versions of the deliberate self-harm inventory and the inventory of statements about self-injury. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-01189-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractDeliberate self-harm (DSH) is a widespread transdiagnostic health problem with increasing prevalence among adolescences, and young adults. It is therefore essential to effectively chart the epidemiology of DSH, as well as to assess the efficacy of interventions designed to modify this behavior. The aim was to translate and analyze the psychometric properties of the Norwegian versions of two instruments designed to assess DSH: the Deliberate Self-harm Inventory (DSHI) and the Inventory of Statements About Self-Injury (ISAS), as well as to assess the prevalence of DSH within a nonclinical Norwegian adult population. Of the 402 participants who completed a questionnaire packet comprising the DSHI, ISAS, general questions about DSH, and other related measures, 30.6% reported some form of DSH. Those with a history of DSH reported greater difficulties with emotion regulation than those without. Participants with and without a history of DSH did not differ in unrelated constructs, including social desirability. The frequency of specific DSH behaviors was in accordance with previous research, with cutting being the most frequent. The factor structure of DSH functions in the Norwegian ISAS was generally comparable to the factor structure of the English version. Overall, results indicate that: a) the Norwegian versions of the DSHI and ISAS behave as expected and in accordance with prior research in other languages and other populations, and b) both the DSHI and ISAS have high internal consistency and adequate construct, convergent, and discriminant validity, and may be applied to evaluate DSH in adult Norwegian populations.
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Neyshabouri MD, Dolatshahi B, Mohammadkhani P. PTSD symptoms and self-injury behaviors among Iranian soldiers: the mediator roles of rumination and social support. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1733333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Parvaneh Mohammadkhani
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Walker KL, Hirsch JK, Chang EC, Jeglic EL. Non-Suicidal Self-Injury and Suicidal Behavior in a Diverse Sample: The Moderating Role of Social Problem-Solving Ability. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9755-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Craigen LM, Healey AC, Walley CT, Byrd R, Schuster J. Assessment and Self-Injury: Implications for Counselors. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1177/0748175610362237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Chartrand H, Kim H, Sareen J, Mahmoudi M, Bolton JM. A comparison of methods of self-harm without intent to die: Cutting versus self-poisoning. J Affect Disord 2016; 205:200-206. [PMID: 27449552 DOI: 10.1016/j.jad.2016.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/06/2016] [Accepted: 07/02/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) in DSM-5 Section 3 is restricted to damaging the skin, while self-poisoning is not considered NSSI even if there was no suicidal intent. The objective of this study was to compare correlates of people who self-cut and those who self-poison without suicidal intent, to determine whether people who harm themselves by cutting are a distinct subgroup. METHODS There were 12,435 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Manitoba between January 2009 and December 2013. Chart reviews were conducted for all presentations with self-harm without suicidal intent (n=219; 1.8% of the total sample). People presenting with cutting (n=47) were compared to those presenting with self-poisoning (n=116). RESULTS There were no differences between the groups on most demographic measures, except for age, where the people who cut were younger. Mental disorders were common in both groups. 31.9% of the cutting group had an alcohol use disorder, as did 25% of the self-poisoning group. Cluster B personality traits/disorder was diagnosed more frequently in the cutting group (51.1%) than the self-poisoning group (37.9%), but this difference was non-significant. Previous non-suicidal self-harm was more common among people cutting. LIMITATIONS We were unable to draw conclusions about the risk of suicide. CONCLUSIONS People who engage in non-suicidal self-harm have high rates of mental disorders. The method that people use to harm themselves does not appear to distinguish these groups; they appear to be similar on most demographic and diagnostic correlates. Further study is required to determine the validity of NSSI, including studies that compare those who self-harm with and without suicidal intent.
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Affiliation(s)
- Hayley Chartrand
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Huntae Kim
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jitender Sareen
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Minoo Mahmoudi
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James M Bolton
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Abstract
Naturalists have not identified suicide in nonhuman species in field situations, despite intensive study of thousands of animal species. In this review, evidence on suicidal behavior among animals is analyzed to discover analogies with human suicidal behavior. Literature was retrieved by exploring Medline/PubMed and PsychINFO databases (1967–2007) and through manual literature searches. Keyword terms were “suicide or suicidal behavior” and “animal or animal behavior.” Few empirical investigations have been carried out on this topic. Nevertheless, sparse evidence supports some resemblance between the self-endangering behavior observed in the animal kingdom, particularly in animals held in captivity or put under pressure by environmental challenges, and suicidal behavior among humans. Animal models have contributed to the study of both normal and pathological human behaviors: discovering some correlates of suicide among animals could be a valid contribution to the field.
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Affiliation(s)
- Antonio Preti
- Department of Psychology, University of Cagliari, Genneruxi Medical Center, Cagliari
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Segal DL, Connella A, Miller T, Coolidge FL. Deliberate self-harm among younger and older adults. DEATH STUDIES 2016; 40:440-444. [PMID: 27050389 DOI: 10.1080/07481187.2016.1171265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined self-harming behaviors among younger and older adults who completed the Self-Harm Inventory (SHI). A 2 (age group) × 2 (gender) analysis of variance showed a significant main effect for age such that younger adult students (M = 3.42, SD = 3.86) had higher SHI total scores than community-dwelling older adults (M = 1.58, SD = 2.35). Younger adults endorsed "Yes" responses significantly more frequently than older adults on 13 of 22 items. Future research should examine specific behaviors of older adults who self-harm more frequently and explore relationships between self-harming behaviors and other risk and resiliency factors for elder suicide.
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Affiliation(s)
- Daniel L Segal
- a Psychology Department , University of Colorado , Colorado Springs , Colorado , USA
| | - Alyssa Connella
- a Psychology Department , University of Colorado , Colorado Springs , Colorado , USA
| | - Tory Miller
- a Psychology Department , University of Colorado , Colorado Springs , Colorado , USA
| | - Frederick L Coolidge
- a Psychology Department , University of Colorado , Colorado Springs , Colorado , USA
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Prevalence and Correlates of Self-Harm in the German General Population. PLoS One 2016; 11:e0157928. [PMID: 27362348 PMCID: PMC4928828 DOI: 10.1371/journal.pone.0157928] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/07/2016] [Indexed: 11/23/2022] Open
Abstract
The study aimed at evaluating the psychometric properties of the German version of the Self- Harm Inventory (SHI) and examining the lifetime prevalence and correlates of self-harm in a representative German population sample (N = 2,507; age mean = 48.79, SD = 18.11; range 14 to 94 years; 55.5% women) using the SHI. All participants answered the German SHI, the short form of the Barratt Impulsiveness Scale (BIS-15), the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and provided sociodemographic information. The one-factorial structure of the SHI was replicated using a confirmatory factor analysis. Internal consistency coefficients were sufficient and in line with previous studies. Almost half of the sample (49%) acknowledged at least one self-harming behavior over the life-span, most frequently indirect forms of self-harm. The rate of participants who engaged in at least one SHI behavior was higher among men than women (51.6% vs. 46.9%, respectively, χ2= 5.38, p = 0.020). Higher SHI scores were related to younger age, male gender, living alone, more symptoms of anxiety and depression (PHQ-4), higher impulsivity scores (BIS-15), and suffering from obesity grade 2. Women engaged more often in discreet forms of self-harm than men, e.g., preventing wounds from healing, exercising an injury, starving, and abusing laxatives. In terms of other indirect self-harming behaviors, men admitted more often driving recklessly, being promiscuous and losing a job on purpose, while women reported more frequently engaging in emotionally abusive relationships. With respect to direct self-harm, women were more likely to endorse suicide attempts and cutting, while men admitted more often head-banging. The findings suggest that self-harm constitutes a common problem. Future longitudinal studies are required to examine the natural course, sociodemographic and psychopathological risk factors, as well as possible time-trends of self-harming behaviors in more depth.
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12
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Attentional Bias Moderates the Link Between Attachment-Related Expectations and Non-suicidal Self-Injury. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9761-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chartrand H, Bhaskaran J, Sareen J, Katz LY, Bolton JM. Correlates of Nonsuicidal Self-Injury and Suicide Attempts Among Tertiary Care, Emergency Department Patients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:276-83. [PMID: 26175325 PMCID: PMC4501585 DOI: 10.1177/070674371506000606] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 12/01/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA. METHODS Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 (n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates. RESULTS NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI. CONCLUSIONS NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles.
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Affiliation(s)
- Hayley Chartrand
- Graduate Student, Department of Psychology, University of Manitoba, Winnipeg, Manitoba
| | - Joanna Bhaskaran
- Graduate Student, Department of Psychology, University of Manitoba, Winnipeg, Manitoba
| | - Jitender Sareen
- Professor, Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Laurence Y Katz
- Professor, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - James M Bolton
- Associate Professor, Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Tapola V, Wahlström J, Kuittinen M, Lappalainen R. The co-occurrence of nonsuicidal and suicidal self-injurious acts in adult women: A pilot study of similarities and differences. NORDIC PSYCHOLOGY 2015. [DOI: 10.1080/19012276.2014.997784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Horton M, Wright N, Dyer W, Wright-Hughes A, Farrin A, Mohammed Z, Smith J, Heyes T, Gilbody S, Tennant A. Assessing the risk of self-harm in an adult offender population: an incidence cohort study. Health Technol Assess 2014; 18:1-151, vii-viii. [PMID: 25348581 DOI: 10.3310/hta18640] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Self-harm is common among prisoners, particularly female prisoners. In 2007, concerned about the rising incidence, the prison service introduced a care-planning system called Assessment, Care in Custody, and Teamwork (ACCT). To date, it does not incorporate a standardised diagnostic test to estimate the risk of future self-harm. OBJECTIVE To identify potential screening instruments, or items from those instruments, to predict the risk of self-harm among prisoners. PARTICIPANTS Prisoners who had been assigned to an ACCT during the recruitment period. DESIGN A multistage prospective cohort study. Following a pilot study, instruments were administered to prisoners by interview at baseline, and followed up for 6 months (or until point of release if this was sooner) to ascertain self-harm status. Instruments were assessed for unidimensionality, scalability (Mokken) and quantitative structure (Rasch). Area under the curve (AUC) analysis was used to examine the ability of instruments and/or their items to predict future self-harm. Cox proportional hazards regression models were used to examine the multivariate predictive ability of the scales and various sociodemographic and sentencing factors. SETTING Three prisons (including one women's prison) in northern England. MAIN OUTCOME MEASURES A set of standardised questionnaires, including the Prison Screening Questionnaire (PriSnQuest), Revised Borderline Symptom List-23 (frequency-based responses) (BSL-23-F), Self-Harm Inventory (SHI), Patient Health Questionnaire (PHQ-9) and the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), together with sociodemographic and sentencing data. RESULTS In total, 450 prisoners consented to participate in the study, of whom 26% were female. The mean age of participants was 31.2 years. Over half of male prisoners recruited were on remand, compared with just over one-fifth (22.6%) of female prisoners. The average tariff of those sentenced was 41 months, of which 14.7 months, on average, had been served. Just over one-third of ACCTs had been initiated because of a known self-harm event, and over one-quarter (27.8%) of participants self-harmed during the follow-up period. Thus, almost half (46.7%) of those entered into the study were reported to have self-harmed, either from their index ACCT, or subsequently, or both. Cutting was the most frequent behaviour (51%). All screening instruments showed some evidence of unidimensionality, and four out of five showed scaling criteria consistent with ordinal scaling, so verifying the validity of the cut points. However, many showed gender bias and failure to fit the Rasch measurement model. While a resolution was made in most cases, both ordinal raw scores and latent interval scale estimates failed to show predictive value when applied within AUC analysis (0.491-0.566) or adjusted Cox proportional hazards models. However, good predictive values were shown for gender-specific sets of items, thus providing easily applied screening indexes. CONCLUSIONS While four out of five potential screening instruments were found to have acceptable psychometric properties within this setting, their predictive validity of all instruments was poor under AUC analysis. Gender-specific item sets were put together to form two screening indexes with formative indicators which gave reasonable AUC values, particularly so for females. The indexes provide identification of low-medium-high risk of self-harm, and so may help to inform potential care pathways and decisions to sign prisoners off from the ACCT. Future work should concentrate on refining a set of predictive screening items among different offender populations and investigating the time point at which this set of items should be administered. Future work may also look at the different magnitudes of risk as indicators for care pathways. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mike Horton
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Nat Wright
- HMP Leeds Health Care Department, Leeds, UK
| | - Wendy Dyer
- Department of Sociology and Criminology, University of Durham, , UK
| | - Alex Wright-Hughes
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Jamie Smith
- North East Offender Health Commissioning Unit, Durham University Science Park, County Durham, UK
| | - Tom Heyes
- Brampton Primary Care Medical Centre, Rotherham, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Alan Tennant
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Development of item bank to measure deliberate self-harm behaviours: facilitating tailored scales and computer adaptive testing for specific research and clinical purposes. Psychiatry Res 2014; 217:240-7. [PMID: 24703572 DOI: 10.1016/j.psychres.2014.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/07/2014] [Accepted: 03/11/2014] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to investigate the application of item banking to questionnaire items intended to measure Deliberate Self-Harm (DSH) behaviours. The Rasch measurement model was used to evaluate behavioural items extracted from seven published DSH scales administered to 568 Australians aged 18-30 years (62% university students, 21% mental health patients, and 17% community members). Ninety four items were calibrated in the item bank (including 12 items with differential item functioning for gender and age). Tailored scale construction was demonstrated by extracting scales covering different combinations of DSH methods but with the same raw score for each person location on the latent DSH construct. A simulated computer adaptive test (starting with common self-harm methods to minimise presentation of extreme behaviours) demonstrated that 11 items (on average) were needed to achieve a standard error of measurement of 0.387 (corresponding to a Cronbach׳s Alpha of 0.85). This study lays the groundwork for advancing DSH measurement to an item bank approach with the flexibility to measure a specific definitional orientation (e.g., non-suicidal self-injury) or a broad continuum of self-harmful acts, as appropriate to a particular research/clinical purpose.
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Latimer S, Meade T, Tennant A. Measuring engagement in deliberate self-harm behaviours: psychometric evaluation of six scales. BMC Psychiatry 2013; 13:4. [PMID: 23286337 PMCID: PMC3605243 DOI: 10.1186/1471-244x-13-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 12/28/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Engagement in Deliberate Self-Harm (DSH) is commonly measured by behavioural scales comprised of specific methods of self-harm. However, there is a scarcity of information about the degree to which the methods relate to the same DSH construct although such scales are routinely used to provide a DSH total score. This study addresses the shortfall by evaluating the dimensionality of six commonly used behavioural measures of DSH. METHODS The DSH measures were Self-Injury Questionnaire Treatment Related (SIQTR), Self-Injurious Thoughts and Behaviors Interview (SITBI), Deliberate Self-Harm Inventory (DSHI), Inventory of Statements About Self-Injury (ISAS), Self-Harm Information Form (SHIF) and Self-Harm Inventory (SHI). The behavioural scales contained in each measure were administered to 568 young Australians aged 18 to 30 years (62% university students, 21% mental health patients, and 17% community members). Scale quality was examined against the stringent standards for unidimensional measurement provided by the Rasch model. RESULTS According to the stringent post-hoc tests provided by the Rasch measurement model, there is support for the unidimensionality of the items contained within each of the scales. All six scales contained items with differential item functioning, four scales contained items with local response dependency, and one item was grossly misfitting (due to a lack of discrimination). CONCLUSIONS This study supports the use of behavioural scales to measure a DSH construct, justifies the summing of items to form a total DSH score, informs the hierarchy of DSH methods in each scale, and extends the previous evidence for reliability and external validity (as provided by test developers) to a more complete account of scale quality. Given the overall adequacy of all six scales, clinicians and researchers are recommended to select the scale that best matches their adopted definition of DSH.
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Affiliation(s)
- Shane Latimer
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Tanya Meade
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Alan Tennant
- Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Gt. George Street, Leeds, LS13EX, UK
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Stewart D, Ross J, Watson C, James K, Bowers L. Patient characteristics and behaviours associated with self-harm and attempted suicide in acute psychiatric wards. J Clin Nurs 2012; 21:1004-13. [PMID: 22512008 DOI: 10.1111/j.1365-2702.2011.03832.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The study examined events before and after incidents of self-harm and attempted suicide and the characteristics of patients who engage in these behaviours. BACKGROUND Psychiatric inpatient populations have an elevated risk of self-harm and suicide, but relatively little is known about the circumstances of these events during an admission. DESIGN Retrospective case note analysis. METHOD Data were collected on conflict (aggression, rule breaking, etc.) and containment (coerced medication, restraint, etc.) during the first two weeks of admission for a sample of 522 acute psychiatric inpatients. RESULTS One in 10 patients self-harmed, and 4% attempted suicide. Aggression, attempting to leave the ward without permission and medication refusal were frequent precursors to incidents. Pro re nata medication and de-escalation were the most frequent interventions to follow an incident. Self-harm and attempted suicides during the current admission were significantly associated with younger age and a history of self-harm. CONCLUSIONS A minority of the sample were involved in these behaviours, but incidents occurred soon after admission and sometimes repeatedly during the course of a day. Assessment of risk should be completed as early as possible. RELEVANCE TO CLINICAL PRACTICE At-risk patients should be monitored for signs of withdrawal from ward activity, wanting to leave the ward without permission or non-compliance with medication to enable early intervention.
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Affiliation(s)
- Duncan Stewart
- Health Service and Population Research, Institute of Psychiatry, Kings College London, London, UK.
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Baetens I, Claes L, Muehlenkamp J, Grietens H, Onghena P. Differences in psychological symptoms and self-competencies in non-suicidal self-injurious Flemish adolescents. J Adolesc 2012; 35:753-9. [DOI: 10.1016/j.adolescence.2011.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 07/14/2011] [Accepted: 11/05/2011] [Indexed: 10/14/2022]
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The relationship between non-suicidal self-injury and temperament in male and female adolescents based on child- and parent-report. PERSONALITY AND INDIVIDUAL DIFFERENCES 2011. [DOI: 10.1016/j.paid.2010.11.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Polman E. When More Pain Is Preferred To Less: The Effect of Anger in Decision Making. SOCIAL COGNITION 2011. [DOI: 10.1521/soco.2011.29.1.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Claes L, Houben A, Vandereycken W, Bijttebier P, Muehlenkamp J. Brief report: the association between non-suicidal self-injury, self-concept and acquaintance with self-injurious peers in a sample of adolescents. J Adolesc 2009; 33:775-8. [PMID: 19910041 DOI: 10.1016/j.adolescence.2009.10.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Revised: 09/09/2009] [Accepted: 10/23/2009] [Indexed: 10/20/2022]
Abstract
The current study investigated the association between non-suicidal self-injury (NSSI), self-concept and acquaintance with NSSI peers in a sample of 150 high school students (60% female) with a mean age of 15.56 (SD=2.00) years. Analyses showed that students with NSSI rated themselves lower on academic intelligence, physical attractiveness, social skills and emotional stability than their non-NSSI peers. The self-injurers also had more friends who engaged in NSSI, and having more NSSI acquaintances was negatively related to self-esteem. It could be that adolescents with lower self-esteem are more attracted to self-injuring peers, or that adolescents with low self-esteem are more vulnerable to copy NSSI to deal with their problems or to gain a certain identity in their peer group. Future studies must test these possible NSSI pathways.
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Affiliation(s)
- Laurence Claes
- Department of Psychology, Katholieke Universiteit Leuven, Tiensestraat 102, Leuven, Belgium.
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Sansone RA, Wiederman MW, McLean JS. The relationship between history of overdose and medically self-sabotaging behaviors. J Psychosom Res 2009; 67:457-8. [PMID: 19837209 DOI: 10.1016/j.jpsychores.2009.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 07/29/2009] [Accepted: 08/11/2009] [Indexed: 11/26/2022]
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Stewart D, Bowers L, Warburton F. Constant special observation and self-harm on acute psychiatric wards: a longitudinal analysis. Gen Hosp Psychiatry 2009; 31:523-30. [PMID: 19892210 DOI: 10.1016/j.genhosppsych.2009.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Special observation (the allocation of nurses to watch over nominated patients) is a method of preventing patients harming themselves. This study assessed the relationship between constant special observation (keeping a patient within eyesight or reach) and rates of self-harm on acute psychiatric wards. METHOD A longitudinal analysis of officially collected data covering a period of 2 1/2 years from 16 acute wards at three Hospitals in London. RESULTS There was no statistically significant association between constant special observation and self-harm outcomes. Use of observation varied markedly between hospitals and wards, but overall, there was a significant decline over time. Self-harm incidents were rare (recorded in only 7% of ward weeks) and did not decline over time, but were correlated over consecutive weeks. CONCLUSION The lack of association with self-harm suggests that the use of constant special observation could be reduced without compromising patient safety.
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Affiliation(s)
- Duncan Stewart
- School of Community and Health Sciences, City University, E1 2EA London, UK.
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Dougherty DM, Mathias CW, Marsh-Richard DM, Prevette KN, Dawes MA, Hatzis ES, Palmes G, Nouvion SO. Impulsivity and clinical symptoms among adolescents with non-suicidal self-injury with or without attempted suicide. Psychiatry Res 2009; 169:22-7. [PMID: 19631392 PMCID: PMC3062197 DOI: 10.1016/j.psychres.2008.06.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 12/17/2007] [Accepted: 06/12/2008] [Indexed: 11/25/2022]
Abstract
This study examined clinical characteristics and laboratory-measured impulsive behavior of adolescents engaging in either non-suicidal self-injury with (NSSI+SA; n=25) or without (NSSI-Only; n=31) suicide attempts. We hypothesized that adolescent with NSSI+SI would exhibit more severe clinical symptoms and higher levels of behavioral impulsivity compared to adolescents with NSSI-Only. Adolescents were recruited from an inpatient psychiatric hospital unit and the two groups were compared on demographic characteristics, psychopathology, self-reported clinical ratings, methods of non-suicidal self-injury, and two laboratory impulsivity measures. Primary evaluations were conducted during psychiatric hospitalization, and a subset of those tested during hospitalization was retested 4-6 weeks after discharge. During hospitalization, NSSI+SA patients reported worse depression, hopelessness, and impulsivity on standard clinical measures, and demonstrated elevated impulsivity on a reward-directed laboratory measure compared to NSSI-Only patients. In the follow-up analyses, depression, hopelessness, suicidal ideation, and laboratory impulsivity were improved for both groups, but the NSSI+SA group still exhibited significantly more depressive symptoms, hopelessness, and impulsivity than the NSSI-Only group. Risk assessments for adolescents with NSSI+SA should include consideration not only of the severity of clinical symptoms but of the current level impulsivity as well.
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Affiliation(s)
- Donald M. Dougherty
- Neurobehavioral Research Laboratory and Clinic Department of Psychiatry The University of Texas Health Science Center at San Antonio, TX, U.S.A
| | - Charles W. Mathias
- Neurobehavioral Research Laboratory and Clinic Department of Psychiatry The University of Texas Health Science Center at San Antonio, TX, U.S.A
| | - Dawn M. Marsh-Richard
- Neurobehavioral Research Laboratory and Clinic Department of Psychiatry The University of Texas Health Science Center at San Antonio, TX, U.S.A
| | | | - Michael A. Dawes
- Neurobehavioral Research Laboratory and Clinic Department of Psychiatry The University of Texas Health Science Center at San Antonio, TX, U.S.A
| | - Erin S. Hatzis
- Wake Forest University Health Sciences Winston-Salem, NC, U.S.A
| | - Guy Palmes
- Wake Forest University Health Sciences Winston-Salem, NC, U.S.A
| | - Sylvain O. Nouvion
- Neurobehavioral Research Laboratory and Clinic Department of Psychiatry The University of Texas Health Science Center at San Antonio, TX, U.S.A
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Latimer S, Covic T, Cumming SR, Tennant A. Psychometric analysis of the self-harm inventory using Rasch modelling. BMC Psychiatry 2009; 9:53. [PMID: 19689823 PMCID: PMC2736947 DOI: 10.1186/1471-244x-9-53] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 08/19/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deliberate Self-Harm (DSH) is the intentional destruction of healthy body tissue without suicidal intent. DSH behaviours in non-clinical populations vary, and instruments containing a range of behaviours may be more informative than ones with restricted content. The Self-Harm Inventory (SHI) is a widely used measure of DSH in clinical populations (mental and physical health) and covers a broad range of behaviours (self-injury, risk taking and self-defeating acts). The test authors recommend the SHI to screen for Borderline Personality Disorder (BPD) using a cut-off score of five or more. The aim of this study was to investigate the psychometric characteristics of the SHI in non-clinical samples. METHODS The SHI was administered to a sample of 423 non-clinical participants (university students, age range 17 to 30). External validation was informed by the administration of the Depression Anxiety Stress Scales 21 (DASS-21) to a sub-sample (n = 221). Rasch analysis of the SHI was conducted to provide a stringent test of unidimensionality and to identify the DSH behaviours most likely to be endorsed at each total score. RESULTS The SHI showed adequate fit to the Rasch model and no modifications were required following checks of local response dependency, differential item functioning and unidimensionality. The scale identified gender and age differences in scores, with females and older participants reporting higher levels of DSH. SHI scores and DASS-21 scores were related. CONCLUSION The recommended cut-off point of five is likely to comprise mild forms of DSH and may not be indicative of psychopathology in a non-clinical population. Rather it may be more indicative of developmentally related risk taking behaviours while a higher cut-off point may be more suggestive of psychopathology as indicated by higher levels of depression, stress and anxiety.
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Affiliation(s)
- Shane Latimer
- School of Psychology, University of Western Sydney, Locked Bag 1797 Penrith South DC 1797 NSW, Australia
| | - Tanya Covic
- School of Psychology, University of Western Sydney, Locked Bag 1797 Penrith South DC 1797 NSW, Australia
| | - Steven R Cumming
- Faculty of Health Sciences, University of Sydney, PO Box 170 Lidcombe 1825 NSW, Australia
| | - Alan Tennant
- Faculty of Medicine and Health, Worsley Building, University of Leeds, Leeds LS2 9JT, UK
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Abstract
The aims of this study were to identify specific risk factors associated with completed suicide in a sample of suicide victims diagnosed with mental illness and to discriminate completed suicides from attempted suicide in individuals who did not kill themselves for at least the next 2 years after the index attempt. Ninety-four adults (34 women; 60 men; mean age = 50.81 [SD = 18.08]) admitted to the Division of Psychiatry of the Department of Neurosciences of the University of Parma who died by suicide between 1994-2004 were matched for sex and age (+/- 2 years) with 94 outpatients (mean age = 50.70 [SD = 18.08]) who made at least one suicide attempt during the years of the study. Data were gathered by proxy-based interviews with referring psychiatrists and general practitioners and from examination of medical records. Suicide victims were more likely to be not married, have poor social support (OR = 5.28), and have more voluntary and compulsory admissions to hospitals (1 admission: OR = 5.44; > 1 admissions: OR= 8.84) than suicide attempters. Suicide victims were also less likely to have had stressful life events during their childhood and adolescence (OR = 0.09) and to be divorced or widowed than were the attempters.
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