1
|
Levkovich I, Stregolev B. Non-Suicidal Self-Injury among Adolescents: Effect of Knowledge, Attitudes, Role Perceptions, and Barriers in Mental Health Care on Teachers' Responses. Behav Sci (Basel) 2024; 14:617. [PMID: 39062440 PMCID: PMC11273488 DOI: 10.3390/bs14070617] [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: 05/10/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) involves the deliberate harm of one's body without the intent to commit suicide and is particularly concerning among adolescents. Teachers play a critical role as gatekeepers in identifying and addressing self-harm, underscoring the importance of their knowledge and response strategies in this area. This study explored how teachers' knowledge, attitudes towards NSSI, perceived roles, and workplace barriers affect their responses to students exhibiting NSSI behaviors. METHODS A cross-sectional survey was conducted among 203 middle and high school teachers in Israel. Data were collected during July and August 2023 using six validated questionnaires. RESULTS Higher levels of teacher knowledge, positive attitudes, and strong role perceptions correlated with more effective responses to NSSI, whereas increased workplace barriers tended to diminish response efficacy. Positive correlations emerged between role perception and both knowledge and attitudes, whereas negative correlations emerged between workplace barriers, attitudes, and role perceptions. Teaching experience moderated the impact of role perception and workplace barriers on responses. Significant differences were observed between regular and special education settings, although no differences were noted in referral rates or years of seniority. CONCLUSIONS These findings suggest that enhancing teacher knowledge and attitudes towards NSSI, while addressing workplace barriers, can improve response efficacy in educational settings.
Collapse
Affiliation(s)
- Inbar Levkovich
- Faculty of Education, Faculty of Education, Tel-Hai Academic College, Kiryat Shmona 12208, Israel
| | - Batel Stregolev
- Faculty of Graduate Studies, Oranim Academic College, Kiryat Tivon 36006, Israel;
| |
Collapse
|
2
|
Terrani KF, Bhogadi SK, Hosseinpour H, Spencer AL, Alizai Q, Colosimo C, Nelson A, Castanon L, Magnotti LJ, Joseph B. What Is Going on in Our Schools? Review of Injuries Among School Children Across the United States. J Surg Res 2024; 295:310-317. [PMID: 38056358 DOI: 10.1016/j.jss.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/11/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Children spend most of their time at school and participate in many activities that have the potential for causing injury. This study aims to describe the nationwide epidemiology of pediatric trauma sustained in school settings in the United States. METHODS In the 3-y analysis of 2017-2019 American College of Surgeons-Trauma Quality Program, all pediatric trauma patients (≤18 y) injured in a school setting were included and stratified based on place of injury, into elementary, middle, and high school (HS) groups. Descriptive statistics and multivariable logistic regression analysis were performed to identify the independent predictors of intentional injuries. RESULTS 23,215 pediatric patients were identified, of which 15,264 patients were injured at elementary (57.6%), middle (17.5%), and high (25%) schools. The mean age was 9.5 y, 66.9% were male, 63.9% were white, the median injury severity score was 2 [1-4], and 95.6% had a blunt injury. Elementary school students were more likely to sustain falls (85%) and humerus fractures (43%) whereas HS students were more likely to be injured by assaults (17%). Overall, 7% of the students sustained intentional injuries. On multivariable logistic regression, male gender (odds ratio [OR] 1.54), Black race (OR 2.94), American Indian race (OR 1.88), Hispanic ethnicity (OR 1.77), positive drug screen (OR 4.9), middle (OR 5.2), and HSs (OR 10.6) were identified as independent predictors of intentional injury (all P < 0.01). CONCLUSIONS Injury patterns vary across elementary, middle, and HSs. Racial factors appear to influence intentional injuries along with substance abuse. Further studies to understand these risk factors and efforts to reduce school injuries are warranted to provide a safe learning environment for children.
Collapse
Affiliation(s)
- Kristina F Terrani
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Audrey L Spencer
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Qaidar Alizai
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Christina Colosimo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Adam Nelson
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Lourdes Castanon
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Louis J Magnotti
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
| |
Collapse
|
3
|
Elyoseph Z, Levkovich I. Beyond the Surface: Teachers' Perceptions and Experiences in Cases of Non-Suicidal Self-Injury Among High School Students. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228231223275. [PMID: 38174720 DOI: 10.1177/00302228231223275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Non-suicidal self-injury (NNSI) among adolescents is a significant concern. This study aimed to explore teachers' perceptions and experiences in cases of NSSI among their students. This qualitative-phenomenological study used in-depth, semi-structured interviews conducted with 27 teachers from high-schools in Israel. Thematic analysis was used to identify patterns and themes. Theme 1 highlighted the emotional impact of discovering self-injury incidents, including panic, confusion, and helplessness. Theme 2 focused on teachers' limited professional support and their need for training and guidance. Theme 3 explored teachers' desire to help students and their strategies for building connections and providing empathy, sometimes despite emotional detachment. Theme 4 emphasized the importance of involving parents and the need for effective communication. This study emphasizes the importance of providing teachers comprehensive training to address NSSI effectively. These findings provide a better understanding of teachers' experiences and underscore the need for enhanced support systems.
Collapse
Affiliation(s)
- Zohar Elyoseph
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College, Kiryat Tiv'on, Israel
| |
Collapse
|
4
|
Tan RHS, Shahwan S, Zhang Y, Sambasivam R, Ong SH, Subramaniam M. How do professionals and non-professionals respond to non-suicidal self-injury? Lived experiences of psychiatric outpatients in Singapore. BMC Psychol 2024; 12:14. [PMID: 38178150 PMCID: PMC10768356 DOI: 10.1186/s40359-023-01512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND For young people who engage in non-suicidal self-injury (NSSI), receiving negative responses to their NSSI can pose a barrier to future help-seeking. This qualitative study aimed to explore helpful and unhelpful ways in which professionals and non-professionals respond to NSSI, from the perspectives of individuals with lived experiences of NSSI. METHODS Semi-structured interviews were conducted with 20 outpatients (6 males, 14 females) aged 17 to 29 years from a tertiary psychiatric hospital in Singapore, who had reported engaging in NSSI behavior in an earlier study. The interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. RESULTS Professionals' responses were organized into three main themes: 'prescribing solutions without understanding needs', 'disapproval or judgment', and 'helpful responses'. Non-professionals' responses were organized into four main themes: 'emotionally charged responses', 'avoidance and inaction', 'poor understanding of reasons for NSSI', and 'providing tangible support and acknowledging NSSI'. Participants also described how unhelpful responses negatively impacted their willingness to seek help. CONCLUSIONS Our findings provide a better understanding of responses to NSSI that are considered helpful and unhelpful, and can be used to improve existing guidelines on responding to NSSI.
Collapse
Affiliation(s)
- Rachel Hsiao Shen Tan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Rajeswari Sambasivam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Say How Ong
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| |
Collapse
|
5
|
Kuhlemeier A, Shattuck D, Willging C, Ramos MM. Associations Between Nonsuicidal Self-Injury and School-Based Health-Promotive Factors for Sexual and Gender Minority Youth and Their Peers. LGBT Health 2023; 10:617-628. [PMID: 37358568 PMCID: PMC10734899 DOI: 10.1089/lgbt.2021.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Purpose: The purpose of this study was to identify associations between school-based, health-promotive factors and nonsuicidal self-injury (NSSI) for sexual and gender minority youth and their heterosexual and cisgender peers. Methods: Using data from the 2019 New Mexico Youth Risk and Resiliency Survey (N = 17,811) and multilevel logistic regression to account for school-based clustering, we compared the effect of four school-based health-promotive factors on NSSI for stratified samples of lesbian/gay, bisexual, and gender-diverse (hereafter, gender minority [GM]) youth. Interactions were examined to evaluate the impact of school-based factors on NSSI for lesbian/gay, bisexual, (compared with heterosexual) and GM (compared with cisgender) youth. Results: Stratified analyses showed that three school-based factors (adult at school who listens, adult at school who believes they will be successful, clear school rules) were associated with lower odds of reporting NSSI for lesbian/gay and bisexual youth, but not GM youth. Interaction effects showed that lesbian/gay youth demonstrated greater reductions in odds of NSSI when reporting school-based supports compared with heterosexual youth. Associations between school-based factors and NSSI were not significantly different for bisexual compared with heterosexual youth. GM youth appear to experience no health-promotive effect on NSSI of school-based factors. Conclusions: Our findings underscore the potential of schools to provide supportive resources that reduce the odds of NSSI for most youth (i.e., heterosexual and bisexual youth), but are particularly effective in reducing NSSI among lesbian/gay youth. However, more study is needed to understand the potential impact of school-based health-promotive factors on NSSI for GM youth.
Collapse
Affiliation(s)
- Alena Kuhlemeier
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Daniel Shattuck
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Cathleen Willging
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Mary M. Ramos
- Division of Adolescent Medicine, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
6
|
Hamza CA, Robinson K, Hasking PA, Heath NL, Lewis SP, Lloyd-Richardson E, Whitlock J, Wilson MS. Educational stakeholders' attitudes and knowledge about nonsuicidal self-injury among university students: A cross-national study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2140-2150. [PMID: 34380005 DOI: 10.1080/07448481.2021.1961782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a commonly occurring, yet historically poorly understood, mental health concern among post-secondary students. The present study sought to identify the current knowledge needs of university stakeholders to inform training efforts around effective NSSI response and student support on university campuses. Participants were 1,762 university students, staff, and student-staff (77% female) from seven universities in Canada, the USA, New Zealand, and Australia. Participants completed an online survey about their attitudes and knowledge of both general mental health and NSSI. University stakeholders reported significantly greater stigma toward NSSI than mental illness in general. Student-staff reported greater perceived knowledge and comfort, and demonstrated greater knowledge of NSSI, than students and staff. Findings underscore the need for additional training and resources to reduce stigma and increase knowledge about NSSI on university campuses internationally.
Collapse
Affiliation(s)
- Chloe A Hamza
- Applied Psychology and Human Development, University of Toronto Ontario Institute for Studies in Education, Toronto, Ontario, Canada
| | - Kealagh Robinson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Penny A Hasking
- Health Sciences, School of Psychology, Curtin University, Perth, Australia
| | - Nancy L Heath
- Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | | | - Janis Whitlock
- Family Life Development Center, Cornell University, Ithaca, New York, USA
| | - Marc S Wilson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| |
Collapse
|
7
|
Zheng Y, Wang J, Jiang Q, Liao M, Huang F. Non-suicidal self-injury and suicidal ideation among adolescents: the chain-mediating role of rumination and decentering. Front Psychiatry 2023; 14:1179518. [PMID: 37779633 PMCID: PMC10540194 DOI: 10.3389/fpsyt.2023.1179518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To explore the relationship between non-suicidal self-injury and suicidal ideation in adolescents and examine the roles of rumination and decentering in that relationship. Method By means of a questionnaire, 175 adolescent patients in a psychiatric hospital in Fujian Province were given the Functional Assessment of Self-Mutilation: Chinese Version, Positive and Negative Suicide Ideation, Ruminative Response Scale: Chinese Version, and Experiences Questionnaire: Decentering Scale. Results (1) Adolescent non-suicidal self-injury was significantly positively related to suicidal ideation and rumination and significantly negatively related to decentering. Suicidal ideation was significantly positively related to rumination and significantly negatively related to decentering. Rumination was significantly negatively related to decentering. (2) Rumination and decentering played a complete chain-mediating role between non-suicidal self-injury and suicidal ideation. Non-suicidal self-injury was found to indirectly affect suicidal ideation along three pathways: the independent mediating role of rumination (the mediating effect accounted for 40.166%), independent mediating role of decentering (the mediating effect accounted for 41.274%), and chain-mediating role of rumination and decentering (the mediating effect accounted for 14.958%). Conclusion Adolescent non-suicidal self-injury can indirectly affect suicidal ideation through rumination and decentering. In the future, mindfulness and other methods should be used to improve individuals' levels of decentering and cultivate emotional regulation abilities, so as to reduce the incidence of non-suicidal self-injury and suicide in adolescents.
Collapse
Affiliation(s)
| | | | | | - Meiling Liao
- School of Health, Fujian Medical University, Fuzhou, China
| | - Fajie Huang
- School of Health, Fujian Medical University, Fuzhou, China
| |
Collapse
|
8
|
Perkins N, De Riggi M, Hasking P, Heath N. Slipping through the cracks: The critical role of school principals in addressing and responding to nonsuicidal self‐injury among adolescents. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Melissa De Riggi
- Department of Education and Counseling Psychology McGill University Montreal Canada
| | | | - Nancy Heath
- Department of Education and Counseling Psychology McGill University Montreal Canada
| |
Collapse
|
9
|
Polihronis C, Cloutier P, Kaur J, Skinner R, Cappelli M. What's the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal. Arch Suicide Res 2022; 26:325-347. [PMID: 32715986 DOI: 10.1080/13811118.2020.1793857] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Research emphasizes the importance of asking about suicidality. Unfortunately, misperceptions of harm remain which can compromise clinical care, research, and public health surveillance efforts. Our objective was to evaluate the empirical evidence on whether and how asking about suicide related behaviors (SRB), such as suicidal ideation and suicide attempts, and non-suicidal self-injury (NSSI) results in harmful outcomes. We reviewed and rated seventeen studies and conducted a systematic review and random-effects meta-analysis on eight studies comparing those asked vs. not asked on immediate and later SRB, NSSI, and psychological distress (PD). Forest plots demonstrated no statistically significant effects of asking on SRB, NSSI, or PD. Eight RCTs provided the strongest evidence and demonstrated either low or unclear risk of bias, and the remaining cohort studies were of low to moderate quality. With the current available evidence, we found no harmful outcomes of asking, however more RCTs with a low risk of bias are required to firmly conclude that asking through self-report and interview methods does not further exacerbate distress, SRB and NSSI compared to those not asked.
Collapse
|
10
|
Madjar N, Daka D, Zalsman G, Shoval G. Depression symptoms as a mediator between social support, non-suicidal self-injury, and suicidal ideation among Arab adolescents in Israel. SCHOOL PSYCHOLOGY INTERNATIONAL 2021. [DOI: 10.1177/0143034321998741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of the current study was to explore whether depression symptoms mediate the relationships between perceptions of social support from three sources; namely parents, teachers, and peers, and non-suicidal self-injury (NSSI) and suicidal ideation. We also tested the interactions between the different sources of support. Focusing on the Arab-Israeli population is unique as it is an ethnic minority characterized with strong familial support, and less access to mental health services compared to the ethnic majority. Adolescents (N = 276; 65.6% girls; mean age 15.1 years) from the Arab minority in northern Israel were sampled (74% response rate). Participants were evaluated using validated scales assessing perceived social support, NSSI and suicidal ideation. Path analysis with Bayesian estimation supported the hypothesized model. Depression symptoms fully mediated the relationships between school-related social support (i.e., teachers and peers) and NSSI, and partially between parents’ support and suicidal ideation. Interactions between the social support sources were not significant, and cluster analysis indicated that each source is independently essential to understand NSSI and suicide ideation. This model emphasizes the importance of school-related factors in adolescents’ particular aspects of mental health, and suggests that one source of social support may not compensate for a lack of another.
Collapse
Affiliation(s)
- Nir Madjar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petakh Tikva, Israel
| | - Doaa Daka
- School of Education, Bar-Ilan University, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petakh Tikva, Israel
| | - Gil Zalsman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petakh Tikva, Israel; Department of Psychiatry, Columbia University, New York, USA
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petakh Tikva, Israel
| | - Gal Shoval
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petakh Tikva, Israel
| |
Collapse
|
11
|
Matthews EL, Townsend ML, Gray AS, Grenyer BFS. Ideal standards for policy on student self-harm: What research and practice tells us. SCHOOL PSYCHOLOGY INTERNATIONAL 2021. [DOI: 10.1177/0143034320975846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
School communities face challenges in responding effectively to the rising incidence of student self-harm. Evidence-informed guidelines may provide a platform for schools to provide better responses and improve the outcomes of students who engage in self-harm. This paper critically reviews policies published in English targeted for schools or education settings on effective early identification and intervention for children and adolescent self-harm. A grey literature search was conducted using Start Page web search engine with a documentary analysis approach applied to review polices that met criteria. The review identified 16 policies that aim to help school and education staff to identify and respond to student self-harm. The key themes include identification and risk assessment, intervention, roles and responsibilities, as well as addressing issues surrounding evidence-based psychological education and intervention. An evidence-informed policy that addresses multiple aspects of responding to and reducing student self-harm may be a vital foundation of a school’s response to this growing public health issue. This paper outlines key points that will help inform the development of evidence-informed guidelines for schools to respond to student self-harm and presents an exemplar policy framework for use by schools.
Collapse
Affiliation(s)
| | - Michelle L. Townsend
- School of Psychology, University of Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | | | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| |
Collapse
|
12
|
Chen X, Zhou Y, Li L, Hou Y, Liu D, Yang X, Zhang X. Influential Factors of Non-suicidal Self-Injury in an Eastern Cultural Context: A Qualitative Study From the Perspective of School Mental Health Professionals. Front Psychiatry 2021; 12:681985. [PMID: 34650451 PMCID: PMC8505804 DOI: 10.3389/fpsyt.2021.681985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/31/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Adolescent non-suicidal self-injury (NSSI) is becoming a serious public health concern worldwide. In recent years, there has seen a significant increase in both the growth rate and cases of NSSI in Eastern countries, such as Japan, India, and China. In China, most schools have a mental health office that comprises mental health professionals (MHPs), who are the first to respond to student mental health problems, which include NSSI. MHPs possess comprehensive knowledge as well as unique insight into adolescent NSSI. However, very few studies on NSSI have incorporated their perspectives. In this work, we seek to add novel insight by conducting a study focusing on adolescent NSSI from the perspective of MHPs. Methods: We recruited a total of 24 MHPs from different schools using purposive sampling and conducted a semi-structured interview on NSSI-related issues. Each interview was voice recorded and lasted ~30 min. A thematic analysis was performed for the responses to study the most common and concerning issues underlying NSSI. Results: We extracted three major themes and eight sub-themes from the interview records, which included (1) the impact of Chinese culture on NSSI (sex-bias discrimination, overly high expectations, and inappropriate parenting style); (2) life events in school (internet use, academic pressure, and romantic relationships); and (3) opinions on the status quo of NSSI in China (ignorance and stigma). Conclusion: Results showed that culturally sensitive influential factors, such as sex-bias discrimination, the imposing of unrealistic expectations for personal achievement, and inappropriate parenting style, should be given more attention to prevent, assess, and intervene in NSSI. Emerging factors of modern society and adolescent lifestyles, such as academic pressure, internet use, and romantic relationships, should also be considered for treatments.
Collapse
Affiliation(s)
- Xiaoyu Chen
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ying Zhou
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Li Li
- Huangpu School, Shenzhen, China
| | - Yanfei Hou
- Department of Humanities and Mental Nursing, School of Nursing, Southern Medical University, Guangzhou, China
| | - Ding Liu
- College of Psychology, Shenzhen University, Shenzhen, China
| | - Xueling Yang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyuan Zhang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
13
|
Simone AC, Hamza CA. Examining the disclosure of nonsuicidal self-injury to informal and formal sources: A review of the literature. Clin Psychol Rev 2020; 82:101907. [DOI: 10.1016/j.cpr.2020.101907] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 11/27/2022]
|
14
|
Incidence, Severity and Responses to Reportable Student Self-Harm and Suicidal Behaviours in Schools: A One-Year Population-Based Study. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09390-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractSchool staff have a unique opportunity to detect and respond to mental health issues including self-harm and suicidal behaviour in adolescents. There is limited knowledge about how these incidents are managed in schools. This study aims to understand the incidence rates, perceived severity and management of self-harm and suicidal behaviour incidents by schools. A total of 1525 school incidents were analysed for rate, severity and response. Pearson’s χ2 test was used to understand incident rates of self-harm and suicidal behaviours compared to all other incidents, and if incident category was related to emergency service involvement. A Kruskal–Wallis ANOVA analysed differences in severity ratings for incidents, and relative risk ratios determined the probability that first responder services will be engaged in self-harm and suicidal behaviour incidents. Self-harm and suicidal behaviour incidents (n = 77) accounted for 5.05% of all incidents and were more likely to be rated highly severe compared to other incidents. Incidents of self-harm and suicidal behaviours were 1.43 times more likely to have police involvement and 8.37 times more likely to have ambulance involvement compared to other incidents that caused harm to students, staff or property including welfare and violence incidents. The findings highlight the severity of reportable self-harm and suicidal behaviour incidents as they required an emergency response. We discuss the potential missed opportunity for early intervention by school staff and services, which may hinder future disclosure or help-seeking by at-risk young people. Training of school staff may provide knowledge and confidence to respond appropriately to self-harm and suicidal behaviour incidents and prevent escalation requiring emergency intervention.
Collapse
|
15
|
Madjar N, Mansbach-Kleinfeld I, Daeem R, Farbstein I, Apter A, Fennig S, Elias R, Shoval G. Discrepancies in adolescent-mother dyads' reports of core depression symptoms: Association with adolescents' help-seeking in school and their somatic complaints. J Psychosom Res 2020; 137:110222. [PMID: 32841758 DOI: 10.1016/j.jpsychores.2020.110222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Parents of adolescents with mental problems do not always recognize the symptoms in their children, particularly regarding depression, and therefore do not seek professional help. Adolescents themselves tend to seek help from school personnel for their emotional or social difficulties. In contrast, adolescents do report somatic complaints and parents are likely to seek help for these problems. The current study explored whether the divergence between maternal and child reports of depression symptoms is associated with child's help-seeking in school and patterns of somatic complaints. METHOD A sample of 9th grade students (N = 693; 56% girls; mean age = 15.1) and their mothers representing the Muslim and Druze populations in northern Israel were interviewed simultaneously and independently. Maternal reports were classified either as underestimating, matching, or overestimating their own child self-report of three core symptoms of depression (depressed mood, anhedonia, and irritability). Adolescents reported whether they had consulted school staff and were classified into clusters based on self-reported somatic complaints. RESULTS Maternal misidentification of their child's depression symptoms was associated with increased help-seeking in school, particularly by boys if depressed mood or irritability were misidentified and particularly by girls if anhedonia was misidentified. Hierarchical cluster analysis indicated that the number and severity of somatic complaints was higher among adolescents whose depression symptoms were not identified, regardless of gender. CONCLUSION Mental health professionals, educators and parents should be aware that adolescents may attempt to communicate their emotional difficulties through somatic complaints and by seeking help in school.
Collapse
Affiliation(s)
- Nir Madjar
- School of Education, Bar-Ilan University, Ramat-Gan, Israel.
| | | | | | | | - Alan Apter
- Schneider Medical Center for Children in Israel, Petach Tikvah, Israel; Ruppin Academic Center, Netanya, Israel; Inter-Disciplinary Center, Herzliya, Israel
| | - Silvana Fennig
- Schneider Medical Center for Children in Israel, Petach Tikvah, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Gal Shoval
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach Tikvah, Israel
| |
Collapse
|
16
|
Quarshie ENB, Waterman MG, House AO. Adolescents at risk of self-harm in Ghana: a qualitative interview study exploring the views and experiences of key adult informants. BMC Psychiatry 2020; 20:310. [PMID: 32546144 PMCID: PMC7298808 DOI: 10.1186/s12888-020-02718-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/04/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Ghana, rates of self-harm in young people are as high as they are in high income countries. Self-reported interpersonal, familial and societal stressors form the most important background, and self-harm is seen by young people as a way of responding to that stress. In the present study, we obtained the views of key adult informants about self-harm among adolescents in Ghana - what they thought as possible reasons for self-harm in young people and what actions might be needed at an individual or population level to respond to the problem. METHODS We interviewed face-to-face 11 adults, using a semi-structured interview guide. We used an experiential thematic analysis technique to analyse the transcribed interviews. RESULTS The analysis identified five themes: "underestimating the prevalence of self-harm in adolescents", "life on the streets makes self-harm less likely", "self-harm in adolescents is socially and psychologically understandable", "ambivalence about responding to adolescent self-harm", and "few immediate opportunities for self-harm prevention in Ghana". Adolescent self-harm was acknowledged but its scale was underestimated. The participants offered explanations for adolescent self-harm in social and psychological terms that are recognisable from accounts in high income countries. Low rates among street-connected young people were explained by their overarching orientation for survival. Participants agreed that identification was important, but they expressed a sense of inadequacy in identifying and supporting adolescents at risk of self-harm. Again, the participants agreed that self-harm in adolescents should be prevented, but they recognised that relevant policies were not in place or if there were policies they were not implemented - mental health and self-harm were not high on public or political priorities. CONCLUSIONS The adults we interviewed about young people who self-harm see themselves as having a role in identifying adolescents at risk of self-harm and see the organisations in which they work as having a role in responding to individual young people in need. These are encouraging findings that point to at least one strand of a policy in Ghana for addressing the problem of self-harm in young people.
Collapse
Affiliation(s)
| | | | - Allan O House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
17
|
Te Maro B, Cuthbert S, Sofo M, Tasker K, Bowden L, Donkin L, Hetrick SE. Understanding the Experience and Needs of School Counsellors When Working with Young People Who Engage in Self-Harm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4844. [PMID: 31810234 PMCID: PMC6926739 DOI: 10.3390/ijerph16234844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/09/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022]
Abstract
Self-harm rates are increasing globally and demand for supporting, treating and managing young people who engage in self-harm often falls to schools. Yet the approach taken by schools varies. This study aimed to explore the experience of school staff managing self-harm, and to obtain their views on the use of guidelines in their work. Twenty-six pastoral care staff from New Zealand were interviewed. Interviews were analyzed and coded using thematic analysis. Three themes emerged: The burden of the role; discrepancies in expectations, training, and experience; and the need for guidelines to support their work. This research, therefore, demonstrated a need for guidelines to support school staff to provide support around decision making and response to self-harm in the school environment.
Collapse
Affiliation(s)
- Ben Te Maro
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (B.T.M.); (L.B.); (L.D.)
| | - Sasha Cuthbert
- Department of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (S.C.); (K.T.)
| | - Mia Sofo
- Department of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (S.C.); (K.T.)
| | - Kahn Tasker
- Department of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (S.C.); (K.T.)
| | - Linda Bowden
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (B.T.M.); (L.B.); (L.D.)
| | - Liesje Donkin
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (B.T.M.); (L.B.); (L.D.)
| | - Sarah E. Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (B.T.M.); (L.B.); (L.D.)
- Orygen The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne 3010, Australia
| |
Collapse
|
18
|
Glennon SD, Viola SB, Blakely AO. Increasing school personnel's self‐efficacy, knowledge, and response regarding nonsuicidal self‐injury in youth. PSYCHOLOGY IN THE SCHOOLS 2019. [DOI: 10.1002/pits.22300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sara D. Glennon
- Department of Psychological ServicesCypress–Fairbanks Independent School DistrictHouston Texas
| | - Shannon B. Viola
- Department of Arts and SciencesUniversity of Houston‐VictoriaVictoria Texas
| | - Alane O. Blakely
- Department of Psychological ServicesCypress–Fairbanks Independent School DistrictHouston Texas
| |
Collapse
|
19
|
Evans R, Parker R, Russell AE, Mathews F, Ford T, Hewitt G, Scourfield J, Janssens A. Adolescent self-harm prevention and intervention in secondary schools: a survey of staff in England and Wales. Child Adolesc Ment Health 2019; 24:230-238. [PMID: 31588199 PMCID: PMC6767699 DOI: 10.1111/camh.12308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2018] [Indexed: 12/03/2022]
Abstract
BACKGROUND Adolescent self-harm is a major public health concern. To date there is a limited evidence-base for prevention or intervention, particularly within the school setting. To develop effective approaches, it is important to first understand the school context, including existing provision, barriers to implementation, and the acceptability of different approaches. METHODS A convenience sample of 222 secondary schools in England and Wales were invited to participate in a survey, with a 68.9% (n = 153) response rate. One member of staff completed the survey on behalf of each school. Participants responded to questions on the existing provision of adolescent self-harm prevention and intervention, barriers to delivery, and future needs. RESULTS Adolescent self-harm is an important concern for senior management and teachers. However, emotional health and well-being is the primary health priority for schools. Health services, such as Child and Adolescent Mental Health Services, and on-site counselling are the main approaches schools currently use to address adolescent self-harm, with counselling cited as the most useful provision. Fifty-two per cent of schools have received some staff training on adolescent self-harm, although only 22% rated the adequacy of this training as high. Where schools do not have existing provision, respondents stated that they would like staff training, specialist student training, external speakers, posters and assemblies, although the latter four options were infrequently ranked as the most useful approaches. Key barriers to addressing adolescent self-harm were: lack of time in the curriculum; lack of resources; lack of staff training and time; and fear of encouraging self-harm amongst adolescents. CONCLUSIONS Adolescent self-harm is a priority for schools. Intervention might focus on increasing the availability of training to teaching staff.
Collapse
Affiliation(s)
- Rhiannon Evans
- DECIPHerSchool of Social SciencesCardiff UniversityCardiffUK
| | - Rachel Parker
- DECIPHerSchool of Social SciencesCardiff UniversityCardiffUK
| | | | - Frances Mathews
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Tamsin Ford
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Gillian Hewitt
- DECIPHerSchool of Social SciencesCardiff UniversityCardiffUK
| | | | - Astrid Janssens
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| |
Collapse
|
20
|
Hasking PA, Lewis SP, Robinson K, Heath NL, Wilson MS. Conducting research on nonsuicidal self-injury in schools: Ethical considerations and recommendations. SCHOOL PSYCHOLOGY INTERNATIONAL 2019. [DOI: 10.1177/0143034319827056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research on nonsuicidal self-injury (NSSI) has grown significantly over the last 15 years, with much of this work focused on factors that initiate and maintain NSSI among school-aged youth. Although this work is important, it does raise several ethical concerns. In this article we outline key ethical issues underlying NSSI research in schools and offer recommendations for conducting ethically sound and productive research in this area. Ethical concerns addressed include: 1) recruitment of minors to research; 2) disclosure and confidentiality; 3) the risk of iatrogenic effects; 4) duty of care; 5) engaging schools in research; and 6) safety of the researchers. In each area, we offer recommendations to assist researchers, ethics committees, and schools in working together to conduct ethical NSSI research, further our understanding of NSSI, and address and respond to these behaviors in schools.
Collapse
|
21
|
Whitlock JL, Baetens I, Lloyd-Richardson E, Hasking P, Hamza C, Lewis S, Franz P, Robinson K. Helping schools support caregivers of youth who self-injure: Considerations and recommendations. SCHOOL PSYCHOLOGY INTERNATIONAL 2018. [DOI: 10.1177/0143034318771415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Non-suicidal self-injury (NSSI) is a significant international mental health concern, with consequences for not only youth who self-injure, but for their entire family system. Helping caregivers respond productively to their child’s self-injury is a vital part of effectively addressing NSSI. This paper will assist school-based mental health practitioners and other personnel support caregivers of youth who self-injure by reviewing current literature, highlighting common challenges faced by school-based professionals, and providing evidenced-informed recommendations for supporting caregivers of youth who self-injure. We posit that schools can best support caregivers by having clear and well-articulated self-injury protocols and by engaging caregivers early. Once engaged, helping caregivers to navigate first conversations, keep doors open, know what to expect, seek support for themselves and understand and address safety concerns will ultimately benefit youth who self-injure and the school systems that support them. We also review recommendations for working with youth whose caretakers are unwilling or unable to be engaged.
Collapse
Affiliation(s)
- Janis L. Whitlock
- Bronfenbrenner Center for Translational Research, Cornell University, USA
| | | | | | | | - Chloe Hamza
- Ontario Institute for Studies in Education at the University of Toronto, Canada
| | | | | | | |
Collapse
|