Data Report No. 1 : Self-harm Including Suicide

This report focuses on our examination of extant data which have been sourced with respect to self-harm and suicide in Australia. Moreover, specific areas of concern regarding elevated rates of suicide for rural males and data anomalies which emerged during our examination of these data are discussed. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.

Safeguarding rural Australia : addressing masculinity and violence in rural settings : suicide and other violent self-harm in an Australian rural context : analysis of secondary data

This report is an update of an earlier one produced in September 2009 (see Carrington et al. 2009) which remains as an ePrint through the project’s home page. The report focuses on our examination of extant data which have been sourced with respect to self-harm and suicide among males living in regional and remote Australia and which were available in public data bases at production time. Moreover, specific areas of concern regarding elevated rates of suicide for rural males and data anomalies which emerged during our examination of these data are discussed.

Vulnerability or resilience? Psycho-social factors associated with deliberate self-harm among adolescents

Background: Deliberate self-harm (DSH) is common among adolescents in Ireland and internationally. Psychological factors, negative life events and lifestyle factors have been found to be associated with self-harm in this group. However, large scale population-based studies of adolescent selfharm and its correlates have been lacking, and internationally a standardised methodology was needed to facilitate comparative studies. The focus on vulnerability which has been prevalent in this field has meant that research has failed to examine resilient adaptation among at-risk adolescents. Method: Data were obtained from a cross-sectional school-based study conducted in Ireland and in each of the six other centres which participated in the Child and Adolescent Self-harm in Europe (CASE) study. In Ireland, 3,881 adolescents in 39 schools in completing the anonymous questionnaire, while across all 7 centres, over 30,000 young people participated. Data were gathered on health and lifestyle, self-harm thoughts and behaviour, a wide range of life events, psychological characteristics (anxiety and depressive symptoms, self-esteem, impulsivity and coping style), and support available to young people. Results: This thesis reports the findings of the Irish CASE centre as well as one international study. The factors associated with DSH among Irish adolescents differed by gender, but among both genders drug use and knowing a friend who had engaged in self-harm were associated with DSH. Among Irish boys, strong associations were found between bullying and poor mental health and DSH. Among boys who had been bullied, psychological and school factors were associated with DSH, while family support was protective. Links between stressful life events, psychological characteristics and DSH within the international CASE sample were examined. Increased history of self-harm thoughts and acts was associated with greater depression, anxiety and impulsivity, lower self esteem and an increased prevalence of ten different negative life events, supporting the hypothesis of a “dose-response” relationship between these risk factors and the self-harm process. Associations between coping style, mental health factors (depressive symptoms, anxiety and self-esteem) and self-harm were examined among Irish adolescents. Emotion-oriented coping was strongly associated with poorer mental health and self-harm thoughts and acts. A mediating effect of emotion-oriented coping on associations between mental health factors and DSH was found for both genders and between problem-oriented coping and mental health factors for girls. Similar mediating effects of coping style were found when risk of self-harm thoughts was examined. Resilient adaptation among adolescents exposed to suicidal behaviour of others was examined. Self-harm thoughts were common in these adolescents. Among those exposed to suicidal behaviour of others, vulnerability factors were drug use and higher levels of anxiety among boys, while for girls drug use, bullying and abuse were vulnerability factors, while resilience was associated with higher self-esteem and use of problem-oriented coping. Conclusion: These findings can aid in the identification of young people at risk of self-harm in the school setting and highlight the importance of mental health, peer-related and lifestyle factors in the development of DSH. High-risk groups of young people such as bullying victims and those exposed to suicidal behaviour of others have distinctive profiles of risk factors which differ from those of their peers. Findings relating to the importance of positive coping skills can inform positive mental health programmes, many of which aim to enhance life skills and build resilience among young people. Knowledge of the factors associated with positive adaptation among at-risk adolescents can inform prevention efforts among this group.

Anger, aggression, and self-harm in PTSD and complex PTSD

This study examined the contribution of complex posttraumatic stress disorder (PTSD) diagnosis and symptomatology to the difficulties of anger, aggression, and self-harm in a Northern Ireland clinical community sample. A "current complex PTSD" (CCPTSD) group (n = 11) was compared with a "current PTSD" group (n = 31) on self-report measures of these variables. The CCPTSD group demonstrated significantly higher levels of physical aggression and selfharm than the PTSD group. The complex PTSD symptom of 'alterations in self-perception' was a significant predictor of aggression and history of self-harm, suggesting the potential role of posttraumatic shame and self-loathing in PTSD theoretical models of these destructive behaviors. Social desirability was a notable confounding influence in the assessment of anger, aggression, and self-harm in traumatised individuals.

Trauma typology as a risk factor for aggression and self-harm in a complex PTSD population: The mediating role of alterations in self-perception

This study examined the role of prolonged, repeated traumatic experiences such as childhood and sectarian trauma in the development of posttraumatic aggression and self-harm. Forty-four adult participants attending therapy for complex trauma in Northern Ireland were obtained via convenience sampling. When social desirability was controlled, childhood emotional and physical neglect were significant correlates of posttraumatic hostility and history of self-harm. These relationships were mediated by alterations in self-perception (e.g., shame, guilt). Severity of sectarian-related experiences was not related to self-destructive behaviors. Moreover, none of the trauma factors were related to overt aggressive behavior. The findings have implications for understanding risk factors for posttraumatic aggression and self-harm, as well as their treatment. © 2013 Copyright Taylor & Francis Group, LLC.

Students who self-harm: coping style, rumination and alexithymia

Counsellors working with students or other young adults may encounter individuals who have self-harmed, either with suicidal or non-suicidal intent. Recent US studies reported rates of self-injury of up to 37% of the student population, but studies in the UK have focussed primarily on younger adolescents. This study examined reported self-harm incidents (scratching, cutting, poisoning, overdose etc) from a sample of 617 university students. A total of 27% reported at least one incident of self-harm, with almost 10% having harmed themselves while at university. Gender differences were not significant but psychology students reported significantly more self-harm than other students. Participants reporting self-harm scored significantly higher on maladaptive coping styles, rumination, and alexithymia (specifically difficulty in identifying emotions) and these differences were most marked for students reporting repetitive and recent self-harm. Rumination and Alexithymia factor 1 (difficulty identifying feelings) emerged as the most robust factors predicting self-harm status. Comments from students who self-harmed at university highlighted the importance of accessible services and academic staff support. The implications of these findings for counselling interventions are discussed, including challenging negative rumination tendencies and developing mindfulness skills.

Mapping non-suicidal self-injury in adolescence: Development and confirmatory factor analysis of the impulse, self-harm and sucidal ideation questionnaire for adolescents (ISSIQ-A)

Non-suicidal self-injury (NSSI) is the deliberate, self-inflicted destruction of body tissue without suicidal intent and an important clinical phenomenon. Rates of NSSI appear to be disproportionately high in adolescents and young adults, and is a risk factor for suicidal ideation and behavior. The present study reports the psychometric properties of the Impulse, Self-harm and Suicide Ideation Questionnaire for Adolescents (ISSIQ-A), a measure designed to comprehensively assess the impulsivity, NSSI behaviors and suicide ideation. An additional module of this questionnaire assesses the functions of NSSI. Results of Confirmatory Factor Analysis (CFA) of the scale on 1722 youths showed items' suitability and confirmed a model of four different dimensions (Impulse, Self-harm, Risk-behavior and Suicide ideation) with good fit and validity. Further analysis showed that youth׳s engagement in self-harm may exert two different functions: to create or alleviate emotional states, and to influence social relationships. Our findings contribute to research and assessment on non-suicidal self-injury, suggesting that the ISSIQ-A is a valid and reliable measure to assess impulse, self-harm and suicidal thoughts, in adolescence.

The risk-taking and self-harm inventory for adolescents: Development and psychometric evaluation

In this study, we report on the development and psychometric evaluation of the Risk-Taking (RT) and Self-Harm (SH) Inventory for Adolescents (RTSHIA), a self-report measure designed to assess adolescent RT and SH in community and clinical settings. 651 young people from secondary schools in England ranging in age from 11.6 years to 18.7 years and 71 young people referred to mental health services for SH behavior in London between the ages of 11.9 years and 17.5 years completed the RTSHIA along with standardized measures of adolescent psychopathology. Two factors emerged from the principal axis factoring, and RT and SH were further validated by a confirmatory factor analysis as related, but different, constructs, rather than elements of a single continuum. Inter-item and test–retest reliabilities were high for both components (Cronbach's α = .85, rtt = .90; Cronbach's α .93, rtt = .87), and considerable evidence emerged in support of the measure's convergent, concurrent, and divergent validity. The findings are discussed with regard to potential usefulness of the RTSHIA for research and clinical purposes with adolescents.