A Systematic Review: Non‐Suicidal Self‐injury in Australia and New Zealand's Indigenous Populations

Effects of an Aboriginal and Torres Strait Islander Mental Health First Aid training programme for non-suicidal self-injury on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions: an uncontrolled trial with precourse and postcourse measurement and 6-month follow-up

OBJECTIVES

Non-suicidal self-injury (NSSI) is a complex issue affecting Aboriginal and/or Torres Strait Islander Peoples in Australia. We evaluated the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) training course on assisting an Aboriginal and/or Torres Strait Islander person engaging in NSSI, including the effects on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions.

DESIGN

Uncontrolled trial with precourse and postcourse measurement (n=49) and 6-month follow-up (n=17).

SETTING

Participants attended courses that were run in Queensland and Victorian communities and through one national organisation.

PARTICIPANTS

Participants were 49 adults who worked directly with Aboriginal and/or Torres Strait Islander Peoples.

INTERVENTION

The 5-hour 'Talking About Non-Suicidal Self-Injury' course was delivered by accredited AMHFA instructors and teaches people how to support an Aboriginal and/or Torres Strait Islander person who is engaging in NSSI.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome measures were stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a person engaging in NSSI.

RESULTS

Improvements were observed in stigmatising attitudes, with significant changes from precourse in both the 'weak-not-sick' (postcourse p<0.0623; follow-up p=0.0058) and 'dangerous/unpredictable' (postcourse p<0.0001; follow-up p=0.0036) subscales. Participants' confidence in ability to assist increased significantly both postcourse (p<0.0001) and at follow-up (p<0.0001). Despite a high level of endorsement for the nine recommended assisting actions at precourse, significant improvements (p<0.05) were observed in endorsement for six and four of the assisting actions postcourse and at follow-up, respectively. Course content was rated as being somewhat (3.4%), mostly (13.8%) or very (82.7%) culturally appropriate by participants who identified as Aboriginal and/or Torres Strait Islander.

CONCLUSIONS

The results of this uncontrolled trial were encouraging, suggesting that the Talking About Non-Suicidal Self-Injury course was able to improve participants' attitudes, confidence and intended assisting actions.

Resilience to Self-Harm

Background: Although a wide range of studies discuss prevalence and risk factors associated with self-harm, protective factors that are equally important are rarely explored. Moreover, much of our understanding of young individuals who engage in self-harm come from studies conducted in Western countries with very little emphasis on marginalized groups. Aim: This scoping review identifies research on resilience among marginalized youth and youth living in low- and middle-income countries (LMICs) who show evidence of self-harm. Method: A scoping review following Arksey and O'Malley's (2005) framework was conducted. This effort included drawing upon peer-reviewed research published between January 2000 and September 2020 to identify protective factors and coping strategies that are employed by individuals 10-29 years old with self-harming tendencies. Results: A total of 15 original papers met the inclusion criteria. The majority of the LMIC publications were from China. Social support, positive youth development, and religiosity were the most frequently reported protective factors. Conclusion: Despite widespread concern about self-harm, there are few peer-reviewed articles that look at resilience or recovery among youth in LMICs and among marginalized young people. In addition to various internal and external protective factors, this scoping review identifies gaps in our understanding of resilience to self-harm among youth belonging to these groups.

The subjective experience of non-suicidal self-injury among female Chinese university students

OBJECTIVE

The purpose of this study was to explore the subjective experience of non-suicidal self-injury (NSSI) among female Chinese university students in Hong Kong.

DESIGN

Interpretative phenomenological analysis was used.

METHODS

Seven female students participated in the study, two engaged in biting and scratching, and three in cutting.

RESULTS

The majority of them indicated negative attitudes towards NSSI and saw no particular meaning attached to it. However, they all persisted with their behaviours, which suggested that they were unable to stop. Students found themselves in a paradoxical situation whereby although they saw no real benefit of NSSI, they still engaged in it to cope with distress. Feelings characterised by this distress were about entrapment and issues with academia, intimacy, loneliness, insecurity, negative self-worth, regulating distressing emotions, increasing positive physical sensations, healing oneself, and feeling alive.

CONCLUSIONS

The experience of hurting themselves persistently for these female students symbolised their struggle with academic or relationship difficulties, self-acceptance, emotional regulation and survival without self-injury.

Factors Associated with Thoughts of Self-Harm or Suicide among Aboriginal and Torres Strait Islander People Presenting to Urban Primary Care: An Analysis of De-Identified Clinical Data

Suicide amongst Aboriginal and Torres Strait Islander people is a major cause of premature mortality and a significant contributor to the health and life expectancy gap. This study aimed to estimate the prevalence of thoughts of self-harm or suicide in Aboriginal and Torres Strait Islander people attending an urban primary health care service and identify factors associated with these thoughts. Multilevel mixed-effects modified Poisson regression models were employed to analyse three years of data gathered during the annual Aboriginal and Torres Strait Islander health assessments. At their first health assessment, 11.5% (191/1664) of people reported thoughts of suicide or self-harm in the prior two weeks. Having children, participating in sport or community activities or being employed full-time decreased the risk of such thoughts. Conversely, factors relating to social exclusion including homelessness, drug use, unemployment and job insecurity increased the risk of thoughts of self-harm or suicide. Individual clinicians, health services, and policy-makers all have a role in suicide prevention. Clinicians need appropriate training to be able to respond to people expressing these thoughts. Aboriginal and Torres Strait Islander community organisations need sovereignty and self-determination over resources to provide programs that promote cultural connectivity and address social exclusion, thereby saving lives.