Predicting Deliberate Self‐Harm in Adolescents: A Six Month Prospective Study

Few studies have investigated the extent to which psychosocial/psychological factors are associated with the prediction of deliberate self‐harm (DSH) among adolescents. In this study, 737 pupils aged 15–16 years completed a lifestyle and coping survey at time one and 500 were followed up six months later. Six point two percent of the respondents (n = 31) reported an act of DSH between Time 1 and Time 2. In multivariate analyses, worries about sexual orientation, history of sexual abuse, family DSH, anxiety, and self‐esteem were associated with repeat DSH during the course of the study, but history of sexual abuse was the only factor predictive of first‐time DSH. The findings suggest that school‐based programs focused on how young people cope with psychosocial stressors may offer promise.     

Suicidal and deliberate self-harm ideation among patients with physical illness: the role of coping styles

The relationship between coping styles and suicidal ideation (SI) or deliberate self-harm (DSH) ideation among patients with physical illness was examined. Four hundred fifteen adult male medical inpatients completed the Coping Styles Questionnaire. Patients with and without SI, and with and without DSH, were compared on coping styles. Sixteen percent of patients (n = 67) had SI and 18.3% (n = 76) had DSH. SI was associated with higher scores on emotional coping and lower scores on rational and detachment coping styles, compared with those without SI. DSH, compared with those without DSH, was associated with significantly higher scores on avoidance coping strategies. These data suggest coping styles among medical patients with and without SI or DSH may differ. The mechanism of this link is not entirely clear, but it may be that coping styles reflect one possible pathway of the association between poor physical health and SI and DSH. Replication of these results in a longitudinal study is needed. If replicated, incorporation of these data into the development of intervention strategies focused on improving coping strategies may be worthwhile.     

Motives and suicide intent underlying hospital treated deliberate self-harm and their association with repetition

The association between motives for deliberate self-harm (DSH), level of suicide intent, and history of DSH is poorly understood. As part of the WHO/EURO Multicentre Study on Suicidal Behavior, the Suicide Intent Scale, and the Motives for Parasuicide Questionnaire were administered to 146 patients presenting with DSH in the Cork region in Ireland. DSH patients reporting high suicide intent were more motivated to escape from their problem (M = 3.15, p < .001) compared to those with low suicide intent, who were more motivated to appeal to others (M = 1.61, p < .001) and to get a temporary break from their problem (M = 2.47, p < .001). Repeaters more often reported motives aimed at escape (M = 2.98, p < .01), revenge (M = .60, p < .005), and appeal (M = 1.43, p = <.05). Selfharming patients are characterized by ambivalence and struggle with aversive thoughts and situations. Therapeutic approaches should include distress management and coping strategies.     

Distinguishing Between Subgroups of Adolescents Who Self‐Harm

The differences in factors associated with subgroups of adolescents in the continuum of deliberate self‐harm (DSH) phenomena were investigated. In an anonymous self‐report survey of 6,020 adolescents aged 15 and 16 years, 3.2% of adolescents (5.3% females, 1.3% males) reported DSH with intent to die, 2.8% (4.3% females; 1.5% males) reported DSH without intent to die, and 15% (22.4% females; 8.5% males) reported thoughts of DSH without acts. Regression analysis indicated considerable overlap in vulnerability factors along the spectrum of DSH thoughts and acts. A uniquely distinct relationship was found between DSH of a friend and DSH without intent to die on one hand and DSH of a family member with DSH with intent to die on the other. Results indicate that familial and nonfamilial social influences on DSH behavior may be important in designing prevention programs and that educational programs for the promotion of psychological well‐being may be helpful for adolescents at any point along the spectrum of DSH that was examined.     

Thoughts of Self‐Harm and Help‐Seeking Behavior among Youth in the Community

The association between thoughts of self‐harm and help‐seeking among youth with symptoms of depression was examined. Data were drawn from the Health Behavior of School‐aged Children Study (n = 15, 686), a nationally representative sample of youth in the United States. Analyses focused on comparing help‐seeking behaviors among youth with and without thoughts of deliberate self‐harm (DSH) when depressed. Depressed youth with thoughts of DSH exhibited different patterns of help‐seeking than those without. Both groups most frequently sought help from friends and parents. However, adolescents with thoughts of DSH were statistically more likely than youth without to seek help from friends (DSH: 69.9%; no DSH: 57.8%; AOR = 1.46), but less likely to seek help from parents (DSH: 53.7%; no DSH: 73.1%; AOR = 0.47). Youth with DSH were more likely to seek help from school officials (AOR = 1.05), health professionals (AOR: 1.83), or a counselor (AOR = 1.93) compared with those without thoughts of DSH who were more likely to seek help from a sibling (AOR: 0.77) or other relatives (AOR: 0.78). Results may help inform programs to improve identification of youth at risk of self‐harm in community and school settings.     

The influence of cognitive emotion regulation strategies and depression severity on deliberate self-harm

Elaborating on previous studies on emotion regulation and deliberate self-harm (DSH), in the present study we distinguish between strategies of cognitive content (e.g., suicidal cognitions of perceived burdensomeness, helplessness, poor distress tolerance) and cognitive process (e.g., nonacceptance of emotional responses, lack of awareness of emotional responses). Young women who harmed themselves (n = 85) were compared with young women without a history of DSH (n = 93) across a broad range of strategies. Significant group differences were found for all measures, even when depression severity was controlled for. In addition, logistic regression analyses showed that both cognitive content strategies and cognitive process strategies made significant independent contributions to the prediction of group membership. Controlling for depression severity, suicidal cognitions, and nonacceptance of emotional responses independently predicted DSH. The strong association between suicidal cognitions and DSH seems to indicate the important role of these cognitions in recurrent and chronic DSH. The strong association between nonacceptance of emotional responses and DSH underscores the notion that DSH can be a way to avoid emotional problems. These findings are discussed in relation to recent cognitive-behavioral interventions and specific therapeutic techniques to further insight into how these interventions might work.     

Deliberate Self‐Harm in Adolescents Aged 12–18: A Cross‐Sectional Survey of 18,104 Students

Little is known about accurate prevalence and associated factors of deliberate self‐harm (DSH) among adolescents in Asian countries. In this study, the prevalence and associated factors of DSH among adolescents in Japan were examined. Data were derived from a cross‐sectional survey using an anonymous self‐report questionnaire and enrolling 8,620 adolescents aged 12–15 and 9,484 aged 15–18. DSH in the previous 12 months was reported by 3.3% (95% CI, 2.9–3.7) of junior and 4.3% (3.9%–4.7%) of senior high school respondents. The prevalence was more than four times as high among girls as among boys for both age groups. DSH was further strongly associated with having suicidal thoughts, having depression/anxiety symptoms, and having used recreational drugs. These associated factors were similar for both sexes and for both older and younger teenagers. A substantial minority of adolescents present with DSH, even among those aged 12–15. The prevalence of DSH in Japan was in the lower ranges of those reported for Western countries. The identified associated factors were not dissimilar from those reported in the West.     

Deliberate Self-Harm and State Dissociation: An Experimental Investigation

The purpose of this study was to test the relation between deliberate self-harm (DSH) and state dissociation. Participants (N = 85) were randomly assigned to self-administer either a very mild electric shock below their pain threshold (a no-self-harm control condition) or an electric shock they were told could “cause minor tissue damage that would heal quickly,” but which was in fact equal to a predetermined pain threshold (a DSH condition). After task completion, 42 participants rated the extent of their dissociation before the shock and 43 rated the extent of their dissociation after the shock. Results indicated that women in the DSH group experienced more dissociation compared to men, but only after the shock. Potential reasons for this gender effect are discussed.     

Exploring Thematic Nightmare Content and Associated Self‐Harm Risk

Nightmares have been shown to be robust predictors of self‐harm risk, beyond depressive symptoms and hopelessness at times. However, few studies have investigated associations between nightmare content and increased self‐harm risk. This study explored associations of thematic nightmare content with history of self‐harm, and risk of self‐harm phenomena the morning following a nightmare. A mixed‐method diary study was performed. Prospective nightmare reports were obtained from 72 participants. A total of 47 nightmare reports met inclusion criteria and were analyzed for themes using inductive thematic analysis. Chi‐square and bootstrap Pearson's correlation tests were performed to assess the associations between nightmare themes and self‐harm history, and risk of self‐harm phenomena following a nightmare. “ Powerlessness to Change Behavior” was associated with a history of self‐harm engagement, whereas “Financial Hardship” indicated reduced risk. Themes were not significantly associated with increased risk of self‐harm phenomena following a nightmare. Content may be of use in detecting lifetime history of self‐harm engagement, particularly in populations where disclosure is seen as taboo. However, nightmare symptom severity remains a better indicator of risk. Evidence for the utility of nightmare content in assessing immediate self‐harm risk is presently lacking. Replication with increased power is recommended.     

The relationship between implicit and explicit motives, goal pursuit, and autobiographical memory content during a diary study

This online diary study investigated how motives interact with goal pursuit to predict daily autobiographical experiences. Participants (N = 141) completed measures of implicit and explicit achievement, provided daily memories and reports of their goal pursuit during a 3-week diary period. A stronger implicit achievement motive at the onset of the study was associated with more agentic (and fewer communal) autobiographical content. Goal progress was linked with using more agentic words, while goal attainability was related to using more communal words. Interactions between motives and goal pursuit on autobiographical memory suggests a trade-off: Favorable goal pursuit conditions may prompt people not motivated for achievement to shift their focus from agentic to communal themes, while individuals motivated for achievement maintain their priorities.     

Midlife Care Givers: Effectiveness of a Psychoeducational Intervention for Midlife Adults With Parent-Care Responsibilities

The purpose of this study was to develop, implement, and evaluate a psychoeducational group intervention that addressed the needs of adult children caring for aging parents. The intervention consisted of four 2-hour sessions and included 70 care givers, 54 to 72 years of age, who were currently caring for a parent 60 years of age or older. A delayed-treatment, control-group design with follow-up after a 4-week interval was used to study three primary variables identified through an extensive literature review as essential for care givers. These included knowledge, care giver burden, and skill development. Skill development did not change following participation, nor did care giver burden variables measured. Significant increases were found at the .05 level for knowledge, overall coping resources, and self disclosure following group participation.     

Solving the puzzle of deliberate self-harm: the experiential avoidance model

Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.     

The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university

Despite the theoretical emphasis on the role of emotion dysregulation in deliberate self-harm (DSH), few studies have examined this relationship. The present study sought to examine the role of emotion dysregulation in DSH by extending the findings of Gratz (2006) regarding the environmental (i.e. childhood maltreatment) and individual (i.e. emotional inexpressivity and affect intensity/reactivity) factors associated with DSH among 249 female undergraduates. Specifically, the present study examined whether emotion dysregulation (a) is associated with DSH above and beyond these other risk factors and (b) mediates the relationship between these risk factors and DSH. Findings indicate that overall emotion dysregulation distinguished women with frequent DSH from those without a history of DSH, adding reliably to the prediction of DSH status above and beyond maltreatment, inexpressivity, and affect intensity/reactivity. Moreover, among self-harming women, emotion dysregulation accounted for a significant amount of additional variance in DSH frequency and mediated the relationship between emotional inexpressivity and DSH frequency. Results also suggest the particular relevance of two specific dimensions of emotion dysregulation to DSH: limited access to effective emotion regulation strategies and a lack of emotional clarity, each of which reliably improved the prediction of DSH status and accounted for unique variance in DSH frequency among self-harming women above and beyond the other risk factors in the models. Results suggest the potential utility of teaching self-harming women more adaptive ways of responding to their emotions, including nonavoidant strategies for modulating emotional arousal and the ability to identify, label, and differentiate among emotional states.     

Psychosocial correlates of emotional distress and risk behavior in african-american women at risk for hiv infection

We examined a model of stress and coping in 749 African-American women at risk for HIV infection. Women in the sample were either homeless, intravenous drug users (IVDUs) sexual partners of IVDUs, or prostitutes. A model was hypothesized based on stress and coping theory and research. Antecedents studied were personal resources, specifically self-esteem and available support. Mediators were threat appraisal and coping efforts. Outcomes studied were emotional distress and HIV risk behaviors. Structural equation modeling techniques were used to test hypothesized pathways between these variables. Forty-five percent of the variance in emotional distress in these women was explained by the model with self-esteem and avoidant coping the strongest predictors. Ten percent of the variance in risk behavior was explained by the model with emotional distress the strongest predictor. Direct and indirect pathways predicting risk behavior and distress are discussed. Implications of results for intervention and theory building are considered.     

In their words: Connecting on‐line weblogs to developmental processes

This paper seeks to connect adolescents' communication within on‐line weblogs or blogs to developmental processes. A total of 195 English language blogs written by self‐identified 14‐ to 18‐year‐olds were selected; three entries from each blog were analysed, resulting in a sample of 585 entries. Blogger demographics, self‐presentation, and blog entries (format, style, content, and tone) were coded. The blog authors in our sample were overwhelmingly female and lived within the US; the majority were between 15‐ and 16‐years of age. Bloggers utilized usernames and userpictures for self‐presentation and in addition to gender, frequently presented information about their age and location. The majority of the entries used text, were narrative and reflective in style, and contained themes related to their authors' peers and everyday life. Emotional tone was present and entries with romantic, identity, and future‐related themes often contained emotional tone. Blog authors seemed to be using blogs to create narratives and to reflect about the people and events in their lives. Our results show that adolescent bloggers project off‐line themes to their blogs, suggesting that their on‐line and off‐line contexts are psychologically connected.     

Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients

This study examines the efficacy of a short-term individual therapy, Manual Assisted Cognitive Treatment (MACT), which was developed to treat parasuicidal (suicidal or self-harming) patients. In this trial, MACT was modified to focus on deliberate self-harm (DSH) in patients with borderline personality disorder (BPD). Thirty BPD patients who were engaged in DSH while in ongoing treatments, i.e., treatment-as-usual (TAU), were randomly assigned to receive MACT (N = 15) or not. DSH and level of suicide ideation were assessed at the baseline, at completion of the MACT intervention, and six months later. Results indicated that MACT was associated with significantly less frequent DSH upon completion of the intervention and with significantly decreased DSH frequency and severity at the six months follow-up. Moreover, MACT's contribution to reducing DSH frequency and severity was greater than the contribution by the amount of concurrent treatments. In contrast, MACT did not affect the level of suicide ideation and time-to-repeat of DSH. In conclusion, MACT seems to be a promising intervention for DSH in patients with BPD. More definitive studies are needed.     

Maternal coping strategies and emotional distress: results of an early intervention program for low birth weight young children

Several questions were examined with Infant Health and Development Program (IHDP) data (N = 843). Are effects of intervention services found for maternal emotional distress and coping strategies, and are these effects different for different groups of mothers? Do maternal distress, coping, and life events moderate (or mediate) the intervention effects reported earlier for children's test scores and behavior problems (IHDP, 1990)? The intervention reduced maternal distress, especially for women with less than a high school education. Maternal distress did not moderate or mediate the influence of the intervention on child outcomes. Maternal coping was not influenced by the intervention and did not moderate the influence of the intervention on child outcomes. Life events moderated the influence of the intervention on children's test scores; the intervention was more effective for children whose mothers had fewer life events.     

Emotional distress in nonmetropolitan persons living with HIV disease enrolled in a telephone-delivered, coping improvement group intervention.

The study delineated depressive symptoms and modeled emotional distress in persons living with HIV disease in nonmetropolitan areas of 13 U.S. states. Participants (N=329) were enrolled in a randomized clinical trial of a telephone-delivered, coping improvement group intervention, and 60% reported moderate or severe levels of depressive symptomatology on the Beck Depression Inventory. Structural equation modeling indicated that participants who experienced more severe HIV symptomatology, received less social support, and engaged in more avoidant coping also experienced more emotional distress (a latent construct comprising depressive symptoms and emotional well-being). Greater HIV-related stigma and rejection by family led to more emotional distress, with social support and avoidant coping mediating almost entirely the effects of the former 2 variables. The model accounted for 72% of the variance in emotional distress in nonmetropolitan persons living with HIV disease.     

Patterns of coping with cancer.

We identified five patterns of coping in a sample of 603 cancer patients: "seeking or using social support," "focusing on the positive," "distancing," "cognitive escape-avoidance," and "behavioral escape-avoidance." Relationships of these coping patterns to sociodemographic characteristics, medical factors, stress appraisals, psychotherapeutic experience, and emotional distress were tested using correlational and regression techniques. Type of cancer, time since diagnosis, and whether a person was currently in treatment had few or no relationships to coping. The specific cancer-related problem (e.g., pain, fear of future) was also not associated with how individuals coped. Perceptions of its stressfulness, however, were related to significantly more coping through social support and more of both forms of escape-avoidance. Coping through social support, focusing on the positive, and distancing was associated with less emotional distress, whereas using cognitive and behavioral escape-avoidance was associated with more emotional distress. Implications of the results for understanding coping processes and intervention with cancer patients are discussed.     

Coping self-efficacy mediates the effects of negative cognitions on posttraumatic distress

Although cognitive distortions have predicted posttraumatic distress after various types of traumatic events, the mechanisms through which cognitive distortions influence posttraumatic distress remain unclear. We hypothesized that coping self-efficacy, the belief in one's own ability to manage posttraumatic recovery demands, would operate as a mediator between negative cognitions (about self, about the world, and self-blame beliefs) and posttraumatic distress. In the cross-sectional Study 1, data collected among 66 adult female victims of child sexual abuse indicated that coping self-efficacy mediated the effects of negative cognitions about self and about the world on posttraumatic distress. The same pattern of results was found in a longitudinal Study 2, conducted among 70 survivors of motor vehicle accidents. Coping self-efficacy measured at 1 month after the trauma mediated the effects of 7-day negative cognitions about self and about the world on 3-month posttraumatic distress. In both studies self-blame was not related to posttraumatic distress and the effect of self-blame on posttraumatic distress was not mediated by coping self-efficacy. The results provide insight into a mechanism through which negative cognitions may affect posttraumatic distress and highlight the potential importance of interventions aimed at enhancing coping self-efficacy beliefs.