Characteristics of Self-Injury in Young Adolescents : Findings from Cross-Sectional and Longitudinal Studies in Swedish Schools

Self-injury in adolescents (e.g. when individuals cut, burn, hit or otherwise deliberately cause themselves direct injury), has gained recognition as a potentially important mental health problem during the past decade. Relatively little has been known about the scope and characteristics of this behavior in Swedish adolescents. This thesis consists of three studies that in different ways explore the characteristics of self-injury among adolescents in the general community. In Study 1 a convenience sample of 202 adolescents responded to a battery of self-report questionnaires on self-injury and a number of related factors at two different occasions. At these times 36.5 % and 40.2 % respectively reported to have deliberately engaged in self-injurious behaviors. Self-injury also showed robust relationships with general psychopathology, an absence of positive feelings to parents, and a ruminative style of emotion regulation. These latter two factors were also predictors of self-injury, independently of general psychopathology. Additionally, in girls, results also indicated a relationship between self-injury and symptoms of eating disorder and negative body esteem. Study 2 used a longitudinal survey design with a 1-year interval to further investigate self-injury in a community sample of 1052 adolescents. The battery of self-report questionnaires on self-injury and related factors was again employed, and both conventional statistical methods and hierarchical cluster analysis were used to analyze the results. Results indicated that 41.5 % and 42.9 % respectively had engaged in self-injury, as reported at the two occasions of data collection. The cluster analyses identified eight different subgroups of self-injuring adolescents (in each gender) based on patterns of self-injury. In both boys and girls a fairly large proportion (about 60 %) of self-injuring adolescents were found in a subgroup reporting low-frequency self-injury only, and little psychological difficulties. The analysis also identified a small subgroup of both girls and boys (about 5 % of self-injuring girls and 3 % of self-injuring boys) reporting frequent self-injury and multiple self-injury methods, as well as often reporting pronounced forms of both externalizing and internalizing psychopathology. A third subgroup of interest was found in girls (consisting of about 10 % of self-injuring girls) who showed a pattern of cutting behaviors as their main form of self-injury, primarily related to internalizing forms of psychopathology. Additionally, the cluster analyses identified subgroups within each gender, which were characterized by different patterns of self-injury, associated with varying degrees and forms of psychopathology. Overall, the subgroups of self-injuring girls were both more stable over time and associated with more psychological problems. Study 3 analyzed data collected through interviews with both self-injuring adolescents (n = 66) and a group of their non-injuring peers (n = 31) from the sample used in Study 2. Around 2/3 of the adolescents that were asked were willing to engage in an interview and also reported positively about it afterwards. Interviewing adolescents about self-injury gave varying amounts of additional information not covered in the questionnaires. Only about 1 in 5 of those who reported self-injury in a questionnaire acknowledged currently engaging in self-injury when interviewed. In about half of the cases, adolescents did not share any information about self-injury at all in the interview; others still reported having ceased to engage in such behavior. Further, in only about 1 of 4 cases where sufficient information was presented to the interviewer to allow for an assessment of the severity of the behavior, was the problem assessed as serious. The rates of self-injury were also compared approximately one year after the interview between those adolescents who were interviewed and a matched control group. Results did not indicate that being interviewed about one’s situation affected the tendency to self-injure. Taken together, these studies demonstrate that among young Swedish adolescents in the general community, a large proportion indicate having engaged in some form of self-injury. Even though self-injury in these studies appears to be clearly related to other psychological difficulties, only in a minority of the cases does this appear to be a serious problem. The findings highlight that self-injury in adolescents may have different clinical and developmental implications for different individuals. School based interventions may be warranted to address self-injury in the general community, and addressing self-injury in this setting may provide important information about individuals’ self-injurious behaviors, and also provide a setting where support and care can be conveyed. However, such procedures need to be further developed in order to be sufficiently attractive for adolescents

Journal Staff

The aim of this study was to examine the association between autobiographical memory specificity and future thinking in a depressed sample. A total of 88 individuals who meet the DSM-IV criteria of major depression were included and completed the autobiographical memory test (AMT) and the future thinking task (FTT). The FTT was an index of number of future plausible events, rating of likelihood and emotional valence. The results showed that positive future thinking was significantly correlated with retrieval of specific positive autobio-graphical memories (r = 0.23). Moreover, correlational analyses showed that positive autobiographical memo-ries were negatively correlated with extended autobiographical memories, repeated autobiographical memories, semantic associations and non-responses on the AMT. Self-report measures of depression and anxiety were not correlated with either the FTT or the AMT. The results of this cross-sectional study only give weak support for an association between autobiographical memory specificity and future thinking

Depressive Symptoms and Deliberate Self-Harm in a Community Sample of Adolescents: A Prospective Study

The associations between depressive symptoms and deliberate self-harm were studied by means of a 2-wave longitudinal design in a community sample of 1052 young adolescents, with longitudinal data for 83.6% of the sample. Evidence was found for a bidirectional relationship in girls, with depressive symptoms being a risk factor for increased self-harm one year later and self-harm a risk factor for increased depressive symptoms. Cluster analysis of profiles of depressive symptoms led to the identification of two clusters with clear depressive profiles (one severe, the other mild/moderate) which were both characterized by an overrepresentation of girls and elevated levels of self-harm. Clusters with more circumscribed problems were also identified; of these, significantly increased levels of self-harm were found in a cluster characterized by negative self-image and in a cluster characterized by dysphoric relations to parents. It is suggested that self-harm serves more to regulate negative self-related feelings than sadness

Självskadebeteende : Upptäcka, förstå och behandla

Att möta människor som avsiktligt skadar sig själva är en utmanande situation. Hur förstår man vilken funktion det självskadande beteendet fyller för personen? Hur hanterar man sina egna tankar och känslor?I den här boken ges kunskap och praktisk vägledning för att skapa en konstruktiv och hjälpsam behandling och relation vid självdestruktiva handlingar. Författarna beskriver hur utredning och bedömning genomförs samt hur interventioner och behandling kan skräddarsys och utvärderas. Lika stor vikt fästs vid teori och forskning som vid erfarenheter och exempel ur den kliniska vardagen. Boken riktar sig till såväl studerande som yrkesverksamma inom människovårdande yrken

Behandling av självskadande patienter i heldygnsvård: Fynd från forskningen

Rapporten du har framför dig handlar om hur vi bör utformaheldygnsvård för patienter med självskadebeteende. Även omdet har utvecklats fler och bättre behandlingsalternativ inomöppenvården behöver vi en god och välfungerande slutenvårdvid de tillfällen det är nödvändigt. För att göra det behöver vi vetavad den vården som ges idag har för effekter och undersöka vadsom skulle kunna göra den bättre. De studier som den här rapportenbygger på visar att många av de åtgärder som ofta används inomslutenvården inte leder till minskat självskadebeteende. Forskningensäger tvärtom att det finns risker med vissa av de insatser somanvänds mot den här patientgruppen t.ex. olika tvångsåtgärder.Att patienter ska mötas med medkänsla, respekt och värdighetär Nationella Självskadeprojektets främsta ståndpunkt och någotsom är särskilt viktigt i svåra situationer. Ett gott bemötande går attförena med en mer effektiv slutenvård, det visar de forskningsfyndsom rapportens andra del behandlar. Där lyfts de spår som vikan utgå ifrån när vi fortsätter förbättringsarbetet på psykiatriskaavdelningar:• Intermittent istället för ständig övervakning.• Meningsfulla dagliga aktiviteter, särskilt om vårdtiden är lång.• Bättre kompetens hos personalen vad gäller självskadebeteende.• Fler yrkeskategorier bland personalen.• Personaltäthet som gör att personalen kan vara omtänksamtvaksam och frågvis utan att missa något annat viktigt.• Goda rutiner på avdelningen.• Arbete med kvalitetsförbättring, exempelvis med hjälp avSafewardsmodellen

Internetbehandling med KBT : En praktisk handbok

Internetbaserad KBT ger tillgång till fungerande behandling för psykisk ohälsa på patientens villkor. Metoden har utvecklats i snabb takt genom utbredda forskningsinsatser, där Sverige kan betraktas som världsledande inom området.Internetbehandling med KBT ger en grundlig genomgång av behandlingsarbetet med betoning på praktiska aspekter och tillämpningen i olika verksamheter. Särskilt fokus ligger på att skapa ett fungerande behandlingsupplägg, praktiska förberedelser, behandlarens roll och viktiga terapeutfärdigheter samt hur vanliga svårigheter hanteras. Läsaren får också en teoretisk orientering, kunskap om befintligt forskningsstöd och vilka fördelar metoden har för patienter, behandlare och verksamheter. Fallexempel, checklistor och annat praktiskt material gör boken till ett mycket användbart hjälpmedel.Besök gärna författarnas egen Facebook-sida för boken, eller lyssna på programmet Vetenskap och Miljö i Sveriges Radio där man diskuterar nätet som terapirum

Deliberate self-harm in Swedish university students – onset and relationships with anxiety and mindfulness

Objective: Previous research has indicated that some forms of deliberate self-harm (DSH) are quite common in non-clinical samples and that these behaviours are associated with psychological variables such as anxiety and mindfulness. This study contributes information on the onset and the frequency of DSH in two samples of Swedish university students as well as its association with related constructs and gender. Method: Two samples of Swedish university students (n=500 and n=187 respectively) filled out questionnaires on DSH. Results: In the first sample 30.8 % of the respondents reported DSH at least once in their life and in the second 18.9 % reported ongoing or recent DSH. In the second sample DSH was shown to be positively correlated with anxiety and negatively correlated with mindfulness. Conclusion: In this non-clinical sample DSH is quite frequent and the identified relationships with anxiety and mindfulness are relevant for prevention and treatment of such behaviour