Some notes on self-injury in New Zealand: Prevalence, correlates and functions

Jessica GarischTamsyn GilbertsonRobyn LanglandsAngelique O’ConnellLynne RussellMarc WilsonEmma BrownTahlia Kingi

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.”

Why do people do it…?

Why do people do it…?

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.

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

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

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

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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Self-injury is most likely when…

…one is experiencing peer victimisation AND one is highly alexithymic.

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2

Self-injury is most frequent, most diverse, and most thought about when…

…one is highly perfectionistic AND highly alexithymic.

These are all psychological, contextual and interpersonal predictors of SI

Why do those who self-injure, self-injure?

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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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.

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?

Where next?

Towards understanding how NSSI starts, stops, and continues…

Year 9 and older

Longitudinal

Funded by the Health Research Council of New Zealand

To be on our newsletter mailing list email jessica.garisch@vuw.ac.nz

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

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

To be on our newsletter mailing list email jessica.garisch@vuw.ac.nz