Some notes on self-injury in New Zealand: Prevalence , correlates and functions
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Some notes on self-injury in New Zealand: Prevalence, correlates and functions
Jessica GarischTamsyn GilbertsonRobyn LanglandsAngelique O’ConnellLynne RussellMarc WilsonEmma BrownTahlia Kingi
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So what are we talking about…?
Non-Suicidal Self-Injury (NSSI) is… (from the International Society for Study of Self-injury, 2007):
“…the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. It is also sometimes referred to as self-injurious behavior, non-suicidal self-directed violence, self-harm, or deliberate self-harm (although some of these terms, such as self harm, do not differentiate non-suicidal from suicidal intent).”
“As such, NSSI is distinguished from suicidal behaviors involving an intent to die, drug overdoses, and socially-sanctioned behaviors performed for display or aesthetic purposes (e.g., piercings, tattoos). Although cutting is one of the most well-known NSSI behaviors, it can take many forms including but not limited to burning, scratching, self-bruising or breaking bones if undertaken with intent to injure oneself. Resulting injuries may be mild, moderate, or severe.”
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Why do people do it…?
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Why do people do it…?
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Prevalence…
• 2,087 ED presentations across 4 regions over 12 months, 20% repeat presentations1
• 24% - Lifetime prevalence among community-based New Zealand adults2
• 48% of adolescents presenting to CAMHS reported SH at initial assessment3
• 20% of 9,000 secondary students reported SH in previous year4
• 31% of 1,700 secondary students thought of SH in previous month, 20% acted on it over 5
years5
(conflation between SSI and NSSI)
1. Hatcher et al., 2009.2. Nada-Raja et al., 2004.3. Fortune et al., 2005.4. Fortune et al., 2010.5. Pryor & Jose, 02/04 to 09/09.
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Sample N Measure # items Lifetime Prevalence
1. 100-level PSYC students
285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†
Prevalence…
† r=.40 with suicidal behaviour
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Sample N Measure # items Lifetime Prevalence
1. 100-level PSYC students
285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†
2. 16-18 year-old School students
325 De Leo & Heller (2004) 1 14.8%
Prevalence…
† r=.40 with suicidal behaviour
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Sample N Measure # items Lifetime Prevalence
1. 100-level PSYC students
285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†
2. 16-18 year-old School students
325 De Leo & Heller (2004) 1 14.8%
3. 16-18 year-old School students
1,162 Lundh et al’s (2007) DSHI 14 48.7%
4. 100-level PSYC students
593 Lundh et al’s (2007) DSHI 14 43.7%
Prevalence…
† r=.40 with suicidal behaviour
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Sample N Measure # items Lifetime Prevalence
1. 100-level PSYC students
285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†
2. 16-18 year-old School students
325 De Leo & Heller (2004) 1 14.8%
3. 16-18 year-old School students
1,162 Lundh et al’s (2007) DSHI 14 48.7%
4. 100-level PSYC students
593 Lundh et al’s (2007) DSHI 14 43.7%
5. 100-level PSYC students
722 Lundh et al’s (2007) DSHI (SV) 7 39.7%‡
Prevalence…
† r=.40 with suicidal behaviour‡ correlates .79 with the full 14-item DSHI
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The
impo
rtan
ce o
f Al
exith
ymia
Self-injury is most likely when…
…one is experiencing peer victimisation AND one is highly alexithymic.
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The
impo
rtan
ce o
f Ale
xith
ymia
2
Self-injury is most frequent, most diverse, and most thought about when…
…one is highly perfectionistic AND highly alexithymic.
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These are all psychological, contextual and interpersonal predictors of SI
Why do those who self-injure, self-injure?
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N Training?
NSSI client attempted Suicide?
NSSI client COMPLETED suicide
Non-NSSI client attempted Suicide?
Non-NSSI client COMPLETED suicide
Tell active/past SI client of research?
Mental Health Nurse 88 61% 90% 49% 88% 65% 56/58%
General Practitioner 16 0% 62% 25% 88% 56% 31/25%
Social Worker 57 44% 86% 16% 72% 26% 33/32%
Clinical Psychologist 57 77% 86% 25% 83% 30% 28/32%
Psychiatrist 1 0% 100% 0% 100% 100% 0/0%
Counsellor 32 34% 69% 9% 78% 13% 28/25%
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Inte
rper
sona
lIn
trap
erso
nal
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ISAS subscaleGlobal
Mean (SD)Most recent Mean (SD)
Affect regulation 4.62 (1.62) 4.57 (1.74)Self-punishment 4.14 (1.91) 3.89 (2.15)Marking distress 2.82 (2.00) 2.66 (1.96)Anti-dissociation/ feeling generation 2.68 (2.16) 2.04 (2.25)Anti-suicide 2.22 (1.98) 2.02 (2.27)Self-care 1.49 (1.48) 1.34 (1.51)Toughness 1.29 (1.53) 1.04 (1.54)Interpersonal influence 1.18 (1.47) 0.92 (1.36)Interpersonal boundaries 1.16 (1.51) 0.89 (1.50)Sensation-seeking 0.77 (1.21) 0.52 (1.17)Autonomy 0.77 (1.18) 0.60 (1.17)Revenge 0.68 (1.26) 0.62 (1.37)Peer-bonding 0.14 (0.56) 0.15 (0.81)
Affect regulation was the most strongly endorsed function and, overall, intrapersonal functions were the most strongly endorsed.
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The ‘paradox of self-injury’
Self-injury worthy of help is private, but attention-seeking self-injury is public.
How does one seek help for ‘worthy’ self-injury without becoming unworthy?
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Where next?
Towards understanding how NSSI starts, stops, and continues…
Year 9 and older
Longitudinal
Funded by the Health Research Council of New Zealand
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Work in progress: 716 Year 9 students from 12 schools…
Average age 13.3 years, SD=0.51 years42% Male, 90% described selves as 100% heterosexual, straight67% Pakeha, 9% Maori, 7% PI
Completed Suicidal Behaviors Questionnaire (SBQ):- 15% exceeded recommended cutoff- 3.3% reported having attempted suicide
Completed Deliberate Self-Harm Inventory (DSHI):- 75% never thought about self-injury- 8% thought about self-injury but never done it- 17% engaged in self-injury (girls about twice as likely)
Of those who have engaged in self-injury,:- 17% carved pictures or marks into their skin (15% scratched to point of bleeding)- 16% stuck sharp objects into their skin- 15% prevented wounds from healing- 13% cut- 13% caused bruises- 11% bitten themselves
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Correlation between SBQ and Self-Injury History… r=.58
Negatively correlated with both NSSI and SI:• Self-esteem, resilience, emotion regulation, Attachment to parents and
peers , ethnic identity and family closeness.
(also being bullied in all forms)
Positively correlated with both NSSI and SI:• Impulsivity, depression, anxiety
But…• Parental attachment more strongly negative than peer attachment• Depression more strongly negative than anxiety• Depression more strongly associated with SI• Emotion regulation (and to a less extent, anxiety and family closeness)
mores strongly associated with SI• Being bullied by social media more of an issue that txt, email• Ostracism more strongly related to SI
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