Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study.

There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from single-episode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated.

Self-report of suicidal thoughts and behavior vs. school nurse evaluations in Dutch high-school students.

BACKGROUND: Systematic screening to identify adolescents at risk for suicidal behavior is crucial to suicide prevention. AIMS: The current practice of screening and follow-up actions taken by school nurses in schools for secondary education in Rotterdam, the Netherlands, was studied. METHODS: In Rotterdam, an approach was developed in which, as a standard routine, students are invited to an interview with a school nurse after filling out a youth health survey in classroom setting. This health survey comprised, among other subjects, the Strengths and Difficulties Questionnaire (SDQ) and questions about suicidal thoughts and behaviors. The results from the interviews and the self-report questionnaires of nearly 4000 first-grade students in secondary education were analyzed. RESULTS: The vast majority of invitations were not followed by any action from the school nurse. Also, the majority of students whose self-report led to an "Attention Subject" for the nurse were not considered to be at risk by the nurse. The self-report of recent suicidal thoughts added to the predictive value of emotional distress as measured by the SDQ and other self-report conclusions. CONCLUSIONS: This study demonstrates the additional value of self-reported suicidal thoughts for Dutch preventive practices in youth health care.

Reasons for adolescent deliberate self-harm: a cry of pain and/or a cry for help? Findings from the child and adolescent self-harm in Europe (CASE) study.

The present study examines reasons for adolescent deliberate self-harm. A cross-sectional survey using an anonymous self-report questionnaire was carried out in seven countries (Australia, Belgium, England, Hungary, Ireland, the Netherlands and Norway). Data on 30,477 school pupils between the ages of 14-17 were analysed. Past year and lifetime deliberate self-harm were assessed, along with the self-reported reasons for deliberate self-harm. The results showed that 'wanted to get relief from a terrible state of mind' and 'wanted to die' were most commonly reported. Principal component analysis indicated two underlying dimensions in the reasons for deliberate self-harm, i.e. a cry of pain motive and/or a cry for help motive. The majority of self-harmers reported at least one cry of pain motive ('to die', 'to punish myself', and 'to get relief from a terrible state of mind') and an additional cry for help motive ('to show how desperate I was feeling', to frighten someone', 'to get my own back on someone', 'to find out whether someone really loved me', and 'to get some attention'). Females reported more reasons than males. Only females showed an age difference, with girls aged 16-17 more frequently reporting a cry for help motive. There was considerable consistency in choice of motives across countries and genders. Systematic assessment of the reasons for deliberate self-harm can help clinicians to better understand the meaning of self harming behaviour, select appropriate treatment, suggest alternative coping strategies, and hopefully prevent future suicidal behaviour.

Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not.

This international comparative study addresses differences between adolescents who engage in deliberate self-harm (DSH) and who receive help following the DSH episode versus those who do not. A standardised self-report questionnaire was completed by pupils aged 14-17 in Australia, Belgium, England, Hungary, Ireland, The Netherlands, and Norway (n=30,532). An act of DSH in the year prior to the study was reported by 1660 participants. Nearly half (48.4%) had not received any help following DSH, 32.8% had received help from their social network only and 18.8% from health services. Except for Hungary, cross-national comparisons revealed remarkably similar findings. Adolescents who had been in contact with health services following DSH reported more often a wish to die, lethal methods, alcohol/drug problems and DSH in the family compared to those who had not. However, those who received no help or help from their social network only were also heavily burdened.

Comparison of web-based versus paper-and-pencil self-administered questionnaire: effects on health indicators in Dutch adolescents.

OBJECTIVE: The aim of this study is to investigate differences in responses related to (mental) health and behavior between two methods of data collection: web-based (web) and paper-and-pencil (p&p). STUDY DESIGN: Within each participating school all third-grade classes (mainly 14-15-year-old pupils) were randomly assigned to either the Internet condition (n=271) or the paper-and-pencil condition (n=261). PRINCIPAL FINDINGS: Significant but small differences were found for the strengths and difficulties subscales "emotional symptoms" (p&p>web) and "prosocial behavior" (p&p>web), and carrying a weapon (web>p&p). Perceived level of privacy and confidentiality did not differ between the two modes. CONCLUSIONS: The findings suggest that in a controlled school setting, web-based administration of health indicators yields almost the same results as paper-and-pencil administration. To generalize these findings, we recommend repeated studies in other populations and settings.

Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study.

BACKGROUND: Deliberate self-harm among young people is an important focus of policy and practice internationally. Nonetheless, there is little reliable comparative international information on its extent or characteristics. We have conducted a seven-country comparative community study of deliberate self-harm among young people. METHOD: Over 30,000 mainly 15- and 16-year-olds completed anonymous questionnaires at school in Australia, Belgium, England, Hungary, Ireland, the Netherlands and Norway. Study criteria were developed to identify episodes of self-harm; the prevalence of self-harm acts and thoughts, methods used, repetition, reasons given, premeditation, setting for the act, associations with alcohol and drugs, hospitalisation, and whether other people knew, were examined. RESULTS: Self-harm was more than twice as common among females as males and, in four of the seven countries, at least one in ten females had harmed herself in the previous year. Additional young people had thought of harming themselves without doing so. More males and females in all countries except Hungary cut themselves than used any other method, most acts took place at home, and alcohol and illegal drugs were not usually involved. The most common reasons given were 'to get relief from a terrible state of mind' followed by 'to die', although there were differences between those cutting themselves and those taking overdoses. About half the young people decided to harm themselves in the hour before doing so, and many did not attend hospital or tell anyone else. Just over half those who had harmed themselves during the previous year reported more than one episode over their lifetime. CONCLUSIONS: Deliberate self-harm is a widespread yet often hidden problem in adolescents, especially females, which shows both similarities and differences internationally.

Deliberate self-harm in young people: differences in prevalence and risk factors between the Netherlands and Belgium.

BACKGROUND: This study aimed to examine prevalence and risk factors of deliberate self-harm in Dutch and Dutch-speaking Belgian adolescents. METHOD: A cross sectional survey using an anonymous self report questionnaire was performed in both countries. Data on 4,431 Belgian and 4,458 Dutch 15-16 year-old school pupils were analyzed. RESULTS: Results showed a significant difference between the two countries indicating that lifetime and past year prevalence of deliberate self-harm were both 2.8 times higher in Belgian adolescents than in Dutch adolescents. Further analyses identified differences in the prevalence of factors associated with deliberate self-harm, with Belgian adolescents showing significant higher scores on anxiety, less problem-oriented coping and more common use of alcohol and soft drugs. Belgian adolescents were also at higher risk for the experience of several life events in the previous year and before that such as conflicts with peers, parents and partner, being bullied at school or exposure to suicidal behavior in family and friends. In addition, Belgian adolescents showed less communication with family or teachers about their problems and difficulties. CONCLUSIONS: The results of the study suggest that the increased risk of deliberate self-harm among Belgian adolescents may be associated with an increased reporting of several important life events and with additional ineffective problem-solving such as less problem-oriented coping, more substance use and less communication about their problems. These results support the assumption that sociocultural aspects of nations can influence the risk of deliberate self-harm and are important to consider when developing prevention strategies.

Cross-national comparisons of the association between alcohol consumption and deliberate self-harm in adolescents.

How differences in drinking patterns may affect the impact of alcohol consumption on deliberate self-harm among adolescents is explored in this international comparative study. Schools in Australia, Belgium, England, Hungary, Ireland, the Netherlands, and Norway (N = 30,532) were surveyed. In all countries the risk of deliberate self-harm was significantly elevated among adolescents who reported some or numerous episodes of intoxication, controlling for confounding factors. The results support the assumption that intoxication is significantly related to the association between alcohol consumption and deliberate self-harm in adolescents.

Autobiographical memory specificity, psychopathology, depressed mood and the use of the Autobiographical Memory Test: a meta-analysis.

Reviewing the literature on autobiographical memory overgenerality, as measured by a cueing task like the Autobiographical Memory Test (AMT), gives a diffuse view of the moderating role of depression. This meta-analysis is an attempt to investigate the role of depression in the specificity of autobiographical memory, while accounting for the role of patient and task variables as possible moderators. Meta-analytic techniques are used to synthesize data from 14 studies on the recall of specific autobiographical memories in psychiatric and non-psychiatric samples. The results confirm the relationship between overgenerality and depression. The psychiatric patients are less specific than their non-clinical controls. It is not possible to establish that this result is solely due to a (co-morbid) diagnosis of depression. Self-reported depressed mood is also related to an impairment of autobiographical memory specificity. The way of presenting cues, audio taping responses and the maximum available amount of time to respond, are moderators of AMT performance.