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Self-Harm and Suicide Prevention among Young People

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (31 May 2021) | Viewed by 45647

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Dr. Maria Michail

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Guest Editor

Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
Interests: suicide prevention in primary care settings; understanding self-harm in young people with multiple vulnerabilities; interventions to reduce suicide risk among across different settings; the role of technology in suicide prevention
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Dr. Anna Lavis

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Assistant Guest Editor

Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
Interests: social media; self-harm; suicidality; relationships between eating disorders and self-harm; lived experiences and meanings of self-harm and suicidality in social and cultural context; qualitative methodology, especially ethnography; medical humanities
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Dr. Pooja Saini

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Assistant Guest Editor

School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
Interests: suicide and self-harm prevention particularly in primary care and community settings; health inequalities particularly in Black and Asian Minority Ethnic Groups and coproduction; public and patient involvement and engagement
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Suicide is a global public health concern and one of the leading causes of death in young people worldwide. Among the strongest predictors of death by suicide are self-harm and previous suicide attempts, both of which are the focus of suicide prevention interventions for young people. We know that suicidal behaviour (e.g., attempted suicide) and self-harm (with and without suicidal intent) are more prevalent among certain groups of young people or those who present with multiple vulnerabilities or intersecting needs. For example, young people who identify as lesbian, gay, bisexual, transsexual, questioning or queer (LGBTQ+) are three times more likely to experience suicidal ideation and attempt suicide compared to heterosexual young people. Young people in care and care leavers are also at significantly higher risk of self-harm and suicide compared to young people in the general population. There are also more deaths by suicide among people who face additional social and economic disadvantages, such as migrants and refugees.

In order to develop interventions for self-harm and suicidal behaviour that are targeted, personalised and address the specific needs of young people, we first need to understand the underlying factors and processes that drive self-harming and suicidal behaviour among young people, particularly those with multiple vulnerabilities. Suicidal behaviour and self-harm are complex phenomena that are underpinned by a coming together of biological, experiential, psychological, sociological, cultural, and political factors. It may be that suicide and self-harm rates among young people are increasing in spite of global efforts in suicide prevention, because our understanding of these concepts remains disjointed. This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) focuses on bringing together research across different disciplines to understand the pathways, processes, experiences, and factors that underlie self-harm and suicidal behaviour among young people, particularly those with multiple vulnerabilities. This includes (but is not limited to) young people who identify as LGBTQ+; those in care and care leavers; young carers; those with severe mental health problems; and those from Black, Asian and Minority Ethnic (BAME) backgrounds. For this Special Issue, empirical papers (quantitative, qualitative, mixed methods) including systematic reviews and meta-analyses are invited from the fields of public health, medicine, psychology, psychiatry, anthropology and sociology.

Dr. Maria Michail
Dr. Anna Lavis
Dr. Pooja Saini
Guest Editors

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Keywords

young people
suicide
self-harm
suicidal behaviour
mechanisms
pathways

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The 2nd Edition: Self-Harm and Suicide Prevention among Young People in the Context of Global Challenges in International Journal of Environmental Research and Public Health (2 articles)

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Research

14 pages, 580 KiB

Open AccessArticle

A Case Series Study of Help-Seeking among Younger and Older Men in Suicidal Crisis

by Pooja Saini, Jennifer Chopra, Claire A. Hanlon and Jane E. Boland

Int. J. Environ. Res. Public Health 2021, 18(14), 7319; https://doi.org/10.3390/ijerph18147319 - 8 Jul 2021

Cited by 8 | Viewed by 3403

Abstract

Due to the continuing high suicide rates among young men, there is a need to understand help-seeking behaviour and engagement with tailored suicide prevention interventions. The aim of this study was to compare help-seeking among younger and older men who attended a therapeutic centre for men in a suicidal crisis. In this case series study, data were collected from 546 men who were referred into a community-based therapeutic service in North West England. Of the 546 men, 337 (52%) received therapy; 161 (48%) were aged between 18 and 30 years (mean age 24 years, SD = 3.4). Analyses included baseline differences, symptom trajectories for the CORE-34 Clinical Outcome Measure (CORE-OM), and engagement with the therapy. For the CORE-OM, there was a clinically significant reduction in mean scores between assessment and discharge (p < 0.001) for both younger and older men. At initial assessment, younger men were less affected by entrapment (46% vs. 62%; p = 0.02), defeat (33% vs. 52%; p = 0.01), not engaging in new goals (38% vs. 47%; p = 0.02), and positive attitudes towards suicide (14% vs. 18%; p = 0.001) than older men. At discharge assessment, older men were significantly more likely to have an absence of positive future thinking (15% vs. 8%; p = 0.03), have less social support (45% vs. 33%; p = 0.02), and feelings of entrapment (17% vs. 14%; p = 0.02) than younger men. Future research needs to assess the long-term effects of help-seeking using a brief psychological intervention for young men in order to understand whether the effects of the therapy are sustainable over a period of time following discharge from the service. Full article

(This article belongs to the Special Issue Self-Harm and Suicide Prevention among Young People)

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13 pages, 327 KiB

Open AccessArticle

Race, Family Conflict and Suicidal Thoughts and Behaviors among 9–10-Year-Old American Children

by Shervin Assari, Shanika Boyce, Mohsen Bazargan and Cleopatra H. Caldwell

Int. J. Environ. Res. Public Health 2021, 18(10), 5399; https://doi.org/10.3390/ijerph18105399 - 18 May 2021

Cited by 6 | Viewed by 2860

Abstract

Family conflict is known to operate as a major risk factor for children’s suicidal thoughts and behaviors (STBs). However, it is unknown whether this effect is similar or different in Black and White children. Objectives: We compared Black and White children for the association between family conflict and STBs in a national sample of 9–10-year-old American children. Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study. This study included 9918 White or Black children between the ages of 9 and 10 living in married households. The predictor variable was family conflict. Race was the moderator. The outcome variable was STBs, treated as a count variable, reflecting positive STB items that were endorsed. Covariates included ethnicity, sex, age, immigration status, family structure, parental education, and parental employment, and household income. Poisson regression was used for data analysis. Results: Of all participants, 7751 were Whites, and 2167 were Blacks. In the pooled sample and in the absence of interaction terms, high family conflict was associated with higher STBs. A statistically significant association was found between Black race and family conflict, suggesting that the association between family conflict and STBs is stronger in Black than White children. Conclusion: The association between family conflict and STBs is stronger in Black than White children. Black children with family conflict may be at a higher risk of STBs than White children with the same family conflict level. These findings align with the literature on the more significant salience of social relations as determinants of mental health of Black than White people. Reducing family conflict should be regarded a significant element of suicide prevention for Black children in the US. Full article

(This article belongs to the Special Issue Self-Harm and Suicide Prevention among Young People)

12 pages, 315 KiB

Open AccessArticle

Exploring Lived Experiences of Adolescents Presenting with Self-Harm and Their Views about Suicide Prevention Strategies: A Qualitative Approach

by Anum Naz, Amna Naureen, Tayyeba Kiran, Muhammad Omair Husain, Ayesha Minhas, Bushra Razzaque, Sehrish Tofique, Nusrat Husain, Christine Furber and Nasim Chaudhry

Int. J. Environ. Res. Public Health 2021, 18(9), 4694; https://doi.org/10.3390/ijerph18094694 - 28 Apr 2021

Cited by 8 | Viewed by 4067

Abstract

Suicide is a serious global public health problem and the third leading cause of death in those 15–35 years old. Self-harm is the major predictor of future suicide attempts and completed suicide yet remains poorly understood. There is limited evidence on effective interventions for adolescents who present with self-harm. To identify and develop acceptable preventive and therapeutic interventions it is essential to understand the factors that contribute to self-harm and suicide in young people, in the context of their emotions, interpersonal difficulties, available support and prevention strategies. This qualitative study aimed at exploring the lived experiences of adolescents presenting with self-harm and their views about potential prevention strategies. Semi-structured interviews with 16 adolescents (12–18 years) presenting with a self-harm episode in a public hospital in Pakistan. A topic guide was developed to facilitate the interviews. The following themes emerged using the framework analysis; predisposing factors (interpersonal conflicts, emotional crisis etc.), regret and realization that self-harm is not the only option, perceived impact of self-harm, and suggestions for suicide prevention strategies (sharing, distraction techniques, involvement of family). This study may help in refining a contextual and culturally based explanatory model of self-harm in adolescents and in informing development of culturally acceptable interventions. Full article

(This article belongs to the Special Issue Self-Harm and Suicide Prevention among Young People)

13 pages, 1233 KiB

Open AccessArticle

The Violence of the Cut: Gendering Self-Harm

by Amy Chandler and Zoi Simopoulou

Int. J. Environ. Res. Public Health 2021, 18(9), 4650; https://doi.org/10.3390/ijerph18094650 - 27 Apr 2021

Cited by 5 | Viewed by 4911

Abstract

Taking as a starting point the frequent characterisation of self-harm as “an adolescent thing for girls,” this paper offers a sociologically informed, qualitative exploration of self-harm as a gendered practice. We move beyond statistical constructions of this “reality,” and critically examine how this characterisation comes to be, and some of its effects. Our data are drawn from a pilot study that developed a collaborative arts-based inquiry into meanings of self-harm. The authors worked with two groups: one of practitioners and another of people who had self-harmed, meeting over six sessions to discuss and make art in response to a range of themes relating to the interpretation and explanation of self-harm. Through data generation and analysis, we collaboratively seek to make sense of the gendering of self-harm, focusing on a series of dualistic Cartesian “cuts” between male and female, violence and vulnerability, and inside and outside. In conclusion, we call for more multi- and interdisciplinary explorations of self-harm, and greater use of diverse, arts-based, and qualitative methodologies, in order to further expand and nuance understandings and ethical engagements with self-harm, and those who are affected by it. Full article

(This article belongs to the Special Issue Self-Harm and Suicide Prevention among Young People)

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13 pages, 360 KiB

Open AccessArticle

Developing Public Service Announcements to Help Prevent Suicide among Young People

by Maria Ftanou, Nicola Reavley, Jo Robinson, Matthew J. Spittal and Jane Pirkis

Int. J. Environ. Res. Public Health 2021, 18(8), 4158; https://doi.org/10.3390/ijerph18084158 - 14 Apr 2021

Cited by 4 | Viewed by 3693

Abstract

Background: Suicide is the leading cause of death among young people in Australia. Media campaigns have the potential to reach a broad audience, change attitudes and behaviours, and, ultimately, help prevent suicide. Little is known about the type of content or format suicide prevention media message should take to help prevent suicide among young people. Objective: the objective of this study was to involve young people aged 18 to 24 years in developing three suicide prevention public service announcement (PSAs) targeting young people at risk of suicide appropriate for testing in a randomised controlled trial (RCT). Method: fifteen young people attended at least one of four workshops in Melbourne, Australia. The workshops focused on exploring the appropriateness of three key suicide prevention media PSAs: “Talk to someone”, “Find what works for you”, and “Life can get better”. Young people also provided input into message content, format, and design. Results: participants perceived that all three suicide prevention PSAs were useful and helpful. Participants were concerned that the PSAs may not be suitable for nonwestern cultural groups, could trivialise psychological suffering, and that the actions they promoted could seem distant or unattainable to young people at risk. The featuring of young people, especially young people with hopeful narratives of how they overcame a suicidal crisis, was considered to be an important characteristic of suicide prevention PSAs targeting young people. Conclusions: Developing suicide prevention PSAs with young people is rare but essential to better understand young people’s needs and improve the quality of suicide prevention media PSAs. Further research is needed to evaluate the impact of suicide prevention PSAs developed by young people, for young people. Full article

(This article belongs to the Special Issue Self-Harm and Suicide Prevention among Young People)

16 pages, 366 KiB

Open AccessArticle

A Qualitative Study of Understanding Reasons for Self-Harm in Adolescent Girls

by Michelle Miller, Marcus Redley and Paul O. Wilkinson

Int. J. Environ. Res. Public Health 2021, 18(7), 3361; https://doi.org/10.3390/ijerph18073361 - 24 Mar 2021

Cited by 19 | Viewed by 8302

Abstract

Objective: Self-harm is an important public health issue in the UK. Young people who self-harm frequently feel misunderstood, and unable to access help. Improving understanding is key to informing the development and delivery of effective treatments and services. Methods: In this qualitative study, we interviewed nine adolescent girls (13–17 years old) with recurrent self-harm, recruited from NHS specialist child and adolescent mental health services. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Findings revealed that self-harm is experienced as powerful mental and physical urges, sated only by self-harming, suggesting that self-harm could be considered a compulsive rather than impulsive disorder, representing a new perspective on the behaviour. Five themes emerged: emotion regulation; an addictive urge; self-harm to survive; interpersonal triggers; interpersonal relationships, not mechanical distractors, reduce self-harm. Conclusions: This study provides further evidence that non-suicidal self-injury may be engaged in to reduce suicidal risk. Seeking the company of helpful friends or family members may reduce the urge to self-harm. Repetitive self-harm may be a compulsive behaviour. Full article

(This article belongs to the Special Issue Self-Harm and Suicide Prevention among Young People)

17 pages, 367 KiB

Open AccessArticle

A Qualitative Account of Young People’s Experiences Seeking Care from Emergency Departments for Self-Harm

by Sadhbh J. Byrne, India Bellairs-Walsh, Simon M. Rice, Sarah Bendall, Michelle Lamblin, Emily Boubis, Brianna McGregor, Meghan O’Keefe and Jo Robinson

Int. J. Environ. Res. Public Health 2021, 18(6), 2892; https://doi.org/10.3390/ijerph18062892 - 12 Mar 2021

Cited by 30 | Viewed by 7367

Abstract

Many young people who engage in self-harm do not seek help from health services. For those that do, emergency departments (EDs) are a key point of contact. Substantial gaps remain in current knowledge related to young consumers’ experiences and views on optimal treatment of self-harm in the ED. In this study, semi-structured interviews were conducted with thirteen young people (M_age = 21.2 years), who were engaged with care at headspace early intervention centers and had presented to an ED with a self-inflicted physical injury. Participants were asked to describe their experience in the ED and the care they received. Data were analyzed thematically. Three inter-related themes were identified: 1. The ED was experienced through a lens of significant distress, 2. The ED environment and processes were counter-therapeutic, and 3. Staff were perceived to be disinterested, dismissive, and lacking in knowledge. The study highlights the overwhelmingly negative nature of participants’ experiences, and presents recommendations for service and practice improvements, such as the provision of staff training and increased aftercare. Full article

(This article belongs to the Special Issue Self-Harm and Suicide Prevention among Young People)

21 pages, 368 KiB

Open AccessArticle

Exploring the Processes Involved in Seeking Help from a General Practitioner for Young People Who Have Been at Risk of Suicide

by Jack Farr, Andrew D. R. Surtees, Hollie Richardson and Maria Michail

Int. J. Environ. Res. Public Health 2021, 18(4), 2120; https://doi.org/10.3390/ijerph18042120 - 22 Feb 2021

Cited by 12 | Viewed by 4870

Abstract

General practitioners (GPs) play a key role in the early identification and management of suicide risk in young people. However, little is known about the processes involved in how, when and why a young person decides to seek help from their GP. Eight young people, aged 17–23, took part in semi-structured interviews exploring their experiences of help seeking when feeling suicidal. Data were analysed using framework analysis. The analysis identified three main themes and seven subthemes. The main themes explored were: understanding when to seek help from a GP, barriers and facilitating factors at the GP consultation, and help seeking as a non-linear and dynamic process. The processes involved in how, when and why young people seek help from a GP when feeling suicidal were found to be dynamic and to fluctuate over time. Help seeking was initially related to how young people were able to understand and articulate their distress, the availability of informal support networks, and their perception of the GP as a source of help. During a GP consultation, help seeking was influenced by how safe and supported the young people felt. Perceived GP training, communication and validation of young people’s concerns were important factors to help facilitate this process. Subsequent help seeking was influenced by prior experience of GP consultations and the availability of alternative support. Full article

(This article belongs to the Special Issue Self-Harm and Suicide Prevention among Young People)

21 pages, 1618 KiB

Open AccessArticle

The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents—A Network Approach

by Dora Gyori, Bernadett Frida Farkas, Lili Olga Horvath, Daniel Komaromy, Gergely Meszaros, Dora Szentivanyi and Judit Balazs

Int. J. Environ. Res. Public Health 2021, 18(4), 1840; https://doi.org/10.3390/ijerph18041840 - 14 Feb 2021

Cited by 10 | Viewed by 3620

Abstract

Although earlier research has highlighted that psychiatric disorders significantly impair patients’ quality of life (QoL), few studies have examined the relationship between nonsuicidal self-injury (NSSI) and QoL. Our aim was to investigate whether QoL mediates the mental disorder–NSSI relationship, and to study the QoL ratings agreement of self and parents in a clinical population of adolescents. We involved 202 adolescents from Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, aged 13–18 years. All participants completed the Deliberate Self-Harm Inventory, Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen, and the Mini International Neuropsychiatric Interview Kid. To map the interrelationship between the NSSI, mental disorders, and QoL dimensions, Mixed Graphical Models were estimated. Adolescents with a history of NSSI rated their QoL to be significantly lower than adolescents without NSSI. Self and parents’ QoL ratings are closer in the NSSI sample than in the no-NSSI sample. Among all QoL dimensions, only family problems had a direct significant association with NSSI engagement. Our results highlight that, contrary to our hypothesis, the presence of mental disorders mediates the relationship between most QoL dimensions and the occurrence of NSSI. Our results draw attention to the potential causal effect of environmental factors (e.g., peer problems) on mental disorders that, in turn, result in NSSI. The present paper highlights the importance of network modelling in clinical research. Full article

(This article belongs to the Special Issue Self-Harm and Suicide Prevention among Young People)

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