Methodological issues associated with collecting sensitive information over the telephone - experience from an Australian non-suicidal self-injury (NSSI) prevalence study

<p>Abstract</p> <p>Background</p> <p>Collecting population data on sensitive issues such as non-suicidal self-injury (NSSI) is problematic. Case note audits or hospital/clinic based presentations only record severe cases and do not distinguish between suicidal and non-suicidal intent. Community surveys have largely been limited to school and university students, resulting in little much needed population-based data on NSSI. Collecting these data via a large scale population survey presents challenges to survey methodologists. This paper addresses the methodological issues associated with collecting this type of data via CATI.</p> <p>Methods</p> <p>An Australia-wide population survey was funded by the Australian Government to determine prevalence estimates of NSSI and associations, predictors, relationships to suicide attempts and suicide ideation, and outcomes. Computer assisted telephone interviewing (CATI) on a random sample of the Australian population aged 10+ years of age from randomly selected households, was undertaken.</p> <p>Results</p> <p>Overall, from 31,216 eligible households, 12,006 interviews were undertaken (response rate 38.5%). The 4-week prevalence of NSSI was 1.1% (95% ci 0.9-1.3%) and lifetime prevalence was 8.1% (95% ci 7.6-8.6).</p> <p>Methodological concerns and challenges in regard to collection of these data included extensive interviewer training and post interview counselling. Ethical considerations, especially with children as young as 10 years of age being asked sensitive questions, were addressed prior to data collection. The solution required a large amount of information to be sent to each selected household prior to the telephone interview which contributed to a lower than expected response rate. Non-coverage error caused by the population of interest being highly mobile, homeless or institutionalised was also a suspected issue in this low prevalence condition. In many circumstances the numbers missing from the sampling frame are small enough to not cause worry, especially when compared with the population as a whole, but within the population of interest to us, we believe that the most likely direction of bias is towards an underestimation of our prevalence estimates.</p> <p>Conclusion</p> <p>Collecting valid and reliable data is a paramount concern of health researchers and survey research methodologists. The challenge is to design cost-effective studies especially those associated with low-prevalence issues, and to balance time and convenience against validity, reliability, sampling, coverage, non-response and measurement error issues.</p

Prevalence of and risk factors for non-suicidal self-injury in rural China: Results from a nationwide survey in China

Background Non-suicidal self-injury (NSSI) is a highly prevalent and serious public health problem among adolescents worldwide. However, to date there were no studies assessing the prevalence of NSSI defined by suggested DSM-5 criteria among Chinese adolescents. We aimed to conduct a nationwide survey to explore the prevalence of and risk factors for NSSI among school-based adolescents in rural China. Methods A total sample of 15,623 adolescents in rural China were enrolled by using a multistage sampling method. Data was collected by self-report questionnaires including demographic characteristics, neglect, maltreatment, loneliness, resilience, social support and emotional management ability. NSSI was defined by suggested DSM-5 criteria, according to which the engagement in self-injury took place more than 5 times a year. Multinomial logistic regression models were used to estimate the association between risk factors and NSSI. Results There were 12.2% of adolescents (n = 1908) met the suggested DSM-5 criteria. Approximately 29% reported a history of NSSI at least once during the last year. Significant differences were found in several demographic factors including gender, ethnicity, grade, and family structure between adolescents with and without experiencing NSSI. The top three NSSI behaviors among adolescents with NSSI experience were hitting self, pinching, and pulling hair, with a prevalence rate of 16.7%, 14.1% and 11.2%, respectively. Female, Han ethnicity, fathers’ education level, neglect, maltreatment, loneliness, social support, suicidal behaviors and emotional management ability were significantly associated with NSSI by multivariate analysis. No significant relationship was found between resilience and risk of NSSI. Limitation The DSM-5 has proposed 6 groups of criteria for NSSI, we only used criteria on frequency given its more accepted feasibility and pragmatic application. Consequently, it may different from other prevalence that estimated by other criteria. Conclusion To the best of our knowledge, this is the first study reporting prevalence of NSSI defined by suggested DSM-5 criteria among adolescent in rural China. In comparison to finding from the similar samples of adolescents, Chinese rural adolescents seem to have a relative higher prevalence. The potential risk factors for NSSI include female, father's education, Han ethnicity, psychosocial factors and suicide behaviors. More evidence for further understanding of context of the occurrence, improving access to health care utilization, and identifying the role of psychosocial factors and family relationship, is needed for the prevention and management of NSSI.Published versio

Cadetlife: Development of a national suicide prevention program for adolescents, based on principles of mental health promotion

Australia is well known for its national strategies for suicide prevention. Despite the rhetoric in policy documents, only a few programs have been developed which are firmly based in principles of Mental Health Promotion, as opposed to programs aiming to enhance early detection and clinical care. This paper will explore the 2 year development and national dissemination of a large scale suicide prevention program for the Australian Defence Force Cadets, a three-service force (Army, Air Force and Navy) for 25,000 young people aged 12 to 17 years. We will explore why we chose particular aspects of health promotion, how the program was conceptualised and created, and the complexity of working with 3 differing military services. Two of our 13 video micro-vignettes will be shown to prompt discussion about mental health promotion. The on-line national evaluation of 25,000 subjects will be discussed

Suicidal ideation, suicide attempts and non-suicidal self-injury among lesbian, gay, bisexual and heterosexual adults: findings from an Australian national study

Objectives: This study investigated associations between sexual orientation and measures of suicidality and non-suicidal self-injury in Australian adults. Previous studies of sexual orientation and suicidality have been limited by unclear conceptualisations of suicidal intent, failure to differentiate between homosexuality and bisexuality, inattention to gender differences and use of convenience-based samples. Methods: A large (N = 10,531) representative national sample of Australian adults was used to investigate associations between sexual orientation (heterosexual, homosexual, bisexual) and (1) suicidal ideation, (2) attempted suicide and (3) non-suicidal self-injury, for males and females separately, in a series of sequentially adjusted logistic regression models. Results: Sexual minority participants were at greater risk of suicidality and self-injury than heterosexuals, after adjusting for age and other covariates, with patterns of risk differing by sexual orientation and gender. Compared with their heterosexual counterparts, gay men, but not bisexual men, were more likely to report suicidal ideation (odds ratio = 3.05, 95% confidence interval = [1.65, 5.60]) and suicide attempts (odds ratio = 4.16, confidence interval = [2.18, 7.93]). Bisexual women, but not lesbian women, were more likely to report suicidal ideation (odds ratio = 4.40, confidence interval = [3.00, 6.37]) and suicide attempts (odds ratio = 4.46, confidence interval = [2.41, 8.24]). Neither bisexual nor gay men were more likely than heterosexual men to report self-injury. However, bisexual women, but not lesbian women, were more likely than heterosexual women to report self-injury (odds ratio = 19.59, confidence interval = [9.05, 42.40]). Overall, bisexual females were at greatest risk of suicidality and self-injury. Conclusion: Clinicians working with sexual minority populations are encouraged to openly discuss suicidal and self-injurious thoughts and behaviours with their clients and may consider using therapeutic strategies to reduce internalised stigma and enhance personal and social resources

The effects of a universal mental health promotion programme on depressive symptoms and other difficulties in Year Eight high school students in Queensland, Australia

A 20-week universal mental health promotion programme (the Aussie Optimism Program), based on cognitive–behavioural intervention procedures and targeting cognitive and social risk and protective factors, was delivered to 417 year eight students (mean age 13\ua0years) from three secondary schools in Brisbane, Australia. Students were assessed with the Centre for Epidemiological Studies Depression Scale, Children’s version, and the Strengths and Difficulties Questionnaire before and after completing the programme. Results indicated that the programme was most beneficial for students experiencing emotional and behavioural difficulties before commencement of the programme; however, the lack of a control group and other methodological limitations prevents conclusions being drawn about the efficacy of this programme. Nevertheless, the results raise the question of whether the costs of developing and maintaining a universal mental health promotion programme outweigh the benefits of helping only a small proportion of students

The psychological impact in children of using Microskin, a novel spray-on semi permanent cover for mature scars from burns

Objective: To examine the impact in young people on self esteem, behaviour, body image, peer relationships and family function, of using a new product to cover mature scars from burns. Methods: 20 young people with a range of severity of burn and a variety of placement of burn scars were randomised to the Microskin use group or to waitlist. Assessments on a range of variables were taken on entry to the study and at 6 weeks after usage began. Results: Remarkable improvements are reported in self-esteem, behaviours, body image, peer relationships and family function as well as social behaviour, Conclusions and implications for discussion: This remarkable new product appears to be able to assist young people to come to terms with permanent mature scars from burns. Reductions in social anxiety, as well as surprising improvements in a range of internal psychological functioning, and family dynamics suggest that the product should be made more easily available, Further studies are planned to support the current evidence from the pilot study