Dr. Jessica Garisch, Dr. Marc Wilson, Dr Robyn Langlands, Dr. Lynne Russell, Angelique O’Connell, Tahlia Kingi & Emma Brown

Non-Suicidal Self-Injury (NSSI) in New Zealand

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Background

What is non-suicidal self-injury (NSSI) Deliberate destruction of body tissue Not culturally appropriate Without suicidal intent

Distinguishing between NSSI and suicide Past research investigating ‘deliberate self-harm’ typically does

not disentangle suicidal and non-suicidal intent. However NSSI is a potential suicide risk factor

People may attempt to manage suicidal thoughts through self-injuring (Klonsky, 2007).

Repeated NSSI may desensitise people to the physical and psychological cues (e.g., pain, the sight of blood) that ordinarily inhibit engaging in suicidal behaviours (Joiner, 2005).

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Previous Research our team has been involved in...

Research on the functions of NSSI (Langlands, 2012; Wilson & Langlands, 2011)

NSSI predominantly represents attempts to avoid or escape from intense, negative emotional experiences. Cognitive avoidance (e.g. escape from unwanted thoughts) is also an important factor (based on an interview study with adults, N=24)

The emotional avoidance and regulatory functions are central reinforcement and maintaining factors for NSSI (based on a survey study across New Zealand, N=198)

Negative intrapersonal experiences and avoidant coping styles were found to vary as a function of NSSI history and recency (based on a survey study university students, N=408).

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Previous Research our team has been involved in...

Interviewing youth and guidance counsellors in the Wellington region (Gilbertson & Wilson, 2008) : issue of ‘attention seeking’

‘Real’ self-injury is private but worthy of assistance, while ‘attention-seeking’ self-injury is public and unworthy

To seek help entails moving from one category (private, worthy) into the other category (public, unworthy)

Social perception of NSSI hinders help-seeking and encourages secrecy?

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Previous Research our team has been involved in...

Research in secondary schools in the Wellington region (Garisch & Wilson; 2010)

Longitudinal survey (over 1600 participants, aged 16-19) Prevalence lifetime hx ever NSSI: 49% by the time students leave

school

Guidance counsellor interviews NSSI not routinely talked about in school, considered “abnormal”,

“taboo” “ew” factor, dilemmas of whether to talk about it as fear of contagion.

Stereotypes study NSSI associated w/ negative characteristics e.g. manipulative,

attention seeking.

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Continuing questions...

What factors are causal to the development and cessation of NSSI

What factors are protective

Are these factors variable by gender, ethnic background, age, etc.

How can we encourage help-seeking related to NSSI, given the stigma and social barriers to disclosure?

What do schools, communities, whānau and young people need to manage this behaviour effectively?

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Youth Wellbeing Study

Research into the development and cessation of NSSI among New Zealand adolescents

Overall project includes

Longitudinal Survey over five years (students complete survey 1+ times/yr)

Interviews and focus groups with pastoral care staff in intermediate and secondary schools

Interviews and focus groups with young people aged 12-19 years Interviews and focus groups with parents + whānau

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Longitudinal survey: What was measured?

Demographics NSSI:

NSSI thoughts and behaviour measured by DSHI (Lundh et al. (2007)) Functions of NSSI (Inventory of Statements About Self-injury (ISAS; Klonsky et

al., 2009) Intrapersonal factors

Emotion regulation (The Emotion Regulation Index for Children and Adolescents (ERICA), MacDermott et al., 2010)

DASS anxiety and depression scales (DASS-21; Lovibond & Lovibond (1995)) Impulsivity (BIS-11; Patton et al., 1995) Inventory of Parent and Peer attachment (Armsden & Greenberg , 1987). Resilience (Resilience Scale for Adolescents (READ: Hjemdal et al., 2006) AOD use (CRAFFT; see Knight et al., 2002)

Interpersonal functioning and social environment Bullying (items taken from Youth 2000) Abuse history (brief screening items; Thombs et al., 2007)

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Preliminary results

5 schools; N= 362 (165 male, 189 female (8 missing)) 12-14 years (mean 13.33)

Prevalence of NSSI Screening Question: Sometimes people hurt themselves deliberately

(i.e., on purpose) to cause damage to their body but NOT to kill themselves (e.g. cut, burned, scratched, or carved your skin, banged or hit yourself, or prevented wounds from healing). Sometimes people have thoughts about hurting themselves on purpose, but do not actually hurt themselves. Please indicate whether you have had thoughts about hurting yourself on purpose (but not actually done this), have hurt yourself on purpose (e.g. cut, burnt, scratched or carved your skin, etc.), or have never done this:  

 NO, I have never hurt myself on purpose 78.15% YES, I have hurt myself on purpose 20.17% I have thought about hurting myself on purpose 1.68%

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Type of NSSI

Not thought about

Thought about (not done)

Done once

Done a few times

Done many times

Cutting 86.9 3.6 2.3 4.3 2.9

Scratched 90.7 1.8 2.0 4.1 1.4

Carving 92.5 1.6 2.5 1.8 1.6

Sticking sharp objects

93.4 0.5 3.2 1.8 1.1

Prevent wounds heal

93.4 1.6 2.9 1.6 0.5

Punch self 94.3 0.9 2.0 1.6 1.1

Bitten self 95.0 1.8 1.6 1.1 0.5

Burned 95.9 1.6 1.1 0.7 0.7

Rubbed glass

97.1 0.9 1.1 0.7 0.2

Sandpapered

98.4 0.5 0.7 0.5 0

Acid on skin 99.5 0.2 0.2 0 0

Bleach 99.5 0.2 0.2 0 0

Prevalence of Types of Non-Suicidal Self-Injury

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Preliminary Results: Covariates

Construct Internal reliability

Correlation w/ NSSI

Emotion regulation .81 -.36 ***

Self-esteem .90 -.48***

Anxiety .86 .54***

Depression .91 .59***

Bullying (frequency) .33***

Attachment to parents .87 -.29**

Attachment to friends .88 -.26*

Alcohol and Drug use .64 .46***

Impulsivity .80 .35***

Resilience .95 .31***

Abuse history .72 .59***

*p<.05, **p<.01, ***p<.001

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Sex differences in prevalence T-test

Female participants (µ=2.79, s.d.=6.14) had significantly higher total engagement in NSSI (thoughts and behaviours) than male participants (µ=.99, s.d.= 3.45); t(2, 352)=-3.35*** Males

No: 85.9% Thought about self-injuring: 1.8% Yes, had self-injured: 12.3%

Females No: 70.6% Thought about self-injuring: 1.6% Yes, had self-injured: 27.8%

Contrary to previous findings with older adolescents in New Zealand, where there was no significant overall l ifetime difference in prevalence rates (Garisch & Wilson, 2010).

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Sex Difference continued...

Construct Males: Correlation w/ NSSI

Females: Correlation w/ NSSI

Emotion Regulation -.16 (p=.08) -.48***

Self-esteem -.30*** -.57***

Depression .42*** .66***

Anxiety .28** .64***

Parent attachment -.24 (p=.16) -.34*

Friends attachment -.15 (p=.39) -.35*

Abuse history .38*** .62***

AOD .39*** .49***

Impulsivity .17 (p=.06) .41***

Resilience .20* .40***

Frequency bullied .32*** .35****p<.05, **p<.01, ***p<.001©YWS

Pastoral care staff interviews + focus groups

4 Interviews and focus groups w/ pastoral care staff (N=7): Participants attributed NSSI to a range of factors, particularly self-esteem, supports available to them, and emotional difficulties:

“often the cutting..they have a self-image that is either unrealistic or unnecessarily negative...I’m useless...I’m not good enough”

“Nice young girl who’ve been bought up to be polite, caring, empathetic, and looks after others but tends to neglect her own needs...high standards of behaviour in the household...anger is not allowed, so it’s suppressed, so they cut...they’ve got to let it out somewhere, so this is how they do it”

“they do not have an emotional attachment that is functioning well enough for them ...”

“...He would get really angry and then cut himself....sort of help bring him down...”

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Pastoral care staff interviews + focus groups

Social context in schools Not clearly distinguished from suicidal behaviour Stereotypes e.g. “Attention seeking”, “Emo”, “drama queens” Not typically talked about among staff

“but it’s very quickly shoved back in the wardrobe....the staff, it’s like a hot potato...the minute they see anything like that ...they don’t wanna know...it’s straight over to us...I think from their point of view they link it very closely with suicide...there’s very little understanding amongst staff of why people may self-harm...for them it’s scary.”

“some education is required around the reasons why people do these things...how to handle disclosure...how to handle it themselves...some of them get quite emotionally upset and take that home with them...they worry...so some of them avoid going down that path in the first place because they don’t want to go there at all”

“I think it would come as a shock to them how common it is”

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Summary

NSSI serves to regulate emotions (and cognitions), and through this is a reinforcing behaviour for some people.

There is negative stigma of NSSI as ‘attention seeking’, manipulative, drama, etc., which may lead people to continue this behaviour secretly rather than be labelled.

Approximately 1 in 5 young people may have engaged in NSSI by their first year in secondary school (and up to 1 in 2 by completion of secondary school).

There are significant sex differences in the correlates of NSSI. Risk and protective factors are likely to differ by demographic factors.

School pastoral care staff have a broad view of NSSI and it’s complexity, but show concern for the general knowledge of NSSI held among staff. Education and training would be beneficial for school staff e.g. prevalence and functions.

Want to keep track of outcomes and resource development?http://www.victoria.ac.nz/psyc/research/youth-and-wellbeing-study

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Acknowledgements

Health Research Council of New Zealand

Participating schools and pastoral care staff

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