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Characteristics of Self-Injury in Young Adolescents: Findings from Cross-Sectional and Longitudinal Studies in Swedish Schools

Bjärehed, Jonas LU (2012)
Abstract (Swedish)
Popular Abstract in Swedish

Avhandlingens titel: Självskadebeteende bland ungdomar: resultat från tvärsnitts- och longitudinella studier i svenska skolor.

Självskadebeteende bland ungdomar (exempelvis när någon skär, bränner eller slår sig själva, eller avsiktligt åsamkar sig direkta skador på något annat sätt) har uppmärksammats som ett växande problem under de senaste årtiondena. Kunskap om omfattningen och arten av detta problem bland svenska ungdomar har dock varit tämligen begränsad. Föreliggande avhandling avser bidra med kunskap inom detta område, med fokus på självskadebeteende bland skolungdomar. Syftet med arbetet var dels att beskriva självskadebeteende bland ungdomar, dels att undersöka beteendets... (More)
Popular Abstract in Swedish

Avhandlingens titel: Självskadebeteende bland ungdomar: resultat från tvärsnitts- och longitudinella studier i svenska skolor.

Självskadebeteende bland ungdomar (exempelvis när någon skär, bränner eller slår sig själva, eller avsiktligt åsamkar sig direkta skador på något annat sätt) har uppmärksammats som ett växande problem under de senaste årtiondena. Kunskap om omfattningen och arten av detta problem bland svenska ungdomar har dock varit tämligen begränsad. Föreliggande avhandling avser bidra med kunskap inom detta område, med fokus på självskadebeteende bland skolungdomar. Syftet med arbetet var dels att beskriva självskadebeteende bland ungdomar, dels att undersöka beteendets samband med andra svårigheter som ungdomar kan uppleva, och slutligen att utforska möjligheten att bemöta självskadebeteende i ett skolsammanhang.

I Studie 1 besvarade 202 ungdomar (14 år gamla) en kortare version av ett instrument utformat för att mäta självskadebeteende (Deliberate Self-Harm Inventory; DSHI) vid två tillfällen. Instrumentets psykometriska egenskaper och praktiska lämplighet för sammanhanget undersöktes. Vid de två mättillfällena angav 36.5 % respektive 40.2 % av ungdomarna att de någon gång avsiktligt skadat sig själva. I studien framkom också ett samband mellan självskadebeteende och andra typer av problem, inklusive externaliserande och internaliserande symptom, dysfunktionella strategier för att reglera känslor (i from av ruminerande/ältandebeteenden) och en relativ avsaknad av positiva relationer till föräldrar. Dessa två sista faktorer framstod som särskilt viktiga då de predicerade självskadebeteende oberoende av andra symptom. För flickor framkom också ett samband mellan självskadebeteende och symptom på ätstörning samt negativ kroppsuppfattning.

I studie 2 undersöktes en andra, större och mer representativ grupp av ungdomar kring sitt självskadebeteende. Ett syfte med denna studie var att förstå den stora variation i självskadebeteendets allvarlighetsgrad som kan observeras hos olika individer. Genom statistiska metoder identifierades därför undergrupper av ungdomar med olika mönster av självskadebeteenden i denna studie. Sammantaget fick 1052 ungdomar (13-15 år gamla) besvara ett frågeformulär vid två olika tillfällen (med ett års mellanrum). Resultat liknande dem i studie 1 framkom då 41.5 % respektive 42.9 % i gruppen angav att de någon gång skadats sig själva vid de två mättillfällena. Åtta olika undergrupper av ungdomar identifierades. Det visade sig att merparten av ungdomarna som rapporterade självskadebeteende tillhörde undergrupper som kännetecknades av bara rapportera få självskadetillfällen och som inte urskilde sig nämnvärt från ungdomar som inte självskadat vad gäller förekomsten av andra problem. En minoritet av ungdomarna uppvisade dock självskadebeteenden i kombination med andra problem som kunde sägas klart utgöra ett allvarligt problem för individernas välbefinnande. Självskadebeteende bland ungdomar tycktes alltså ha olika kliniska och utvecklingsmässiga implikationer för olika individer.

I studie 3 intervjuades ungdomar för att ge en mer utförlig bild av deras självskadebeteende. Studien syftade till att använda intervjuer med elever i skolan för att samla viktig information om individers självskadebeteende som kunde komplettera informationen från frågeformulären. En förhoppning var att intervjun också kunde utgöra ett tillfälle för intervjuaren att förmedla förståelse och stöd kring individens livssituation. Ungdomar var i allmänhet villiga att delta i en sådan intervju och rapporterade att de upplevde det som positivt att prata om sin situation med en vuxen. Nyttan av intervjuer som informationskälla kring ungdomars självskadebeteende varierade dock. Bara i ungefär 1 av 5 fall då ungdomar intervjuades framkom att de var aktivt självskadande, trots att personen rapporterat detta i ett frågeformulär. Flera uppgav dock att de tidigare självskadat men numera slutat med detta och i ungefär hälften av intervjuerna delgav de intervjuade ingen information alls om självskadebeteende. I de fall där ungdomar delade med sig av information kring sitt självskadebeteende som medgav att en bedömning av problemets svårighetsgrad kunde göras bedömdes beteendet som allvarligt hos ungefär 1 av 4 ungdomar.

Sammantaget visar studierna i avhandlingen att en stor andel av svenska skolungdomar rapporterar att de någon gång avsiktligt skadat sig själva. Studierna visar att självskadebeteende bland ungdomar är tydligt relaterat till andra samtidiga problem, dock är det bara en mindre del av alla personer med självskadebeteende där detta verkar utgöra ett allvarligt problem. Implikationerna av beteendet och olika personers behov av stöd och hjälp varierar istället i hög grad för olika personer med självskadebeteende. Mot bakgrund av den relativt stora utbredningen av självskadebeteende bland skolungdomar kan det vara till nytta att utveckla skolbaserade metoder för att bemöta detta beteende. Intervjuer med ungdomar kan i vissa fall vara ett bra sätt att närma sig självskadebeteende och att förmedla stöd och omtanke. Sådana metoder behöver dock utvecklats ytterligare för att bli tillräckligt tilltalande för självskadande ungdomar. (Less)
Abstract
Self-injury in adolescents (e.g. when individuals cut, burn, hit or otherwise deliberately cause themselves direct injury), has gained recognition as a potentially important mental health problem during the past decade. Relatively little has been known about the scope and characteristics of this behavior in Swedish adolescents.

This thesis consists of three studies that in different ways explore the characteristics of self-injury among adolescents in the general community. In Study 1 a convenience sample of 202 adolescents responded to a battery of self-report questionnaires on self-injury and a number of related factors at two different occasions. At these times 36.5 % and 40.2 % respectively reported to have deliberately... (More)
Self-injury in adolescents (e.g. when individuals cut, burn, hit or otherwise deliberately cause themselves direct injury), has gained recognition as a potentially important mental health problem during the past decade. Relatively little has been known about the scope and characteristics of this behavior in Swedish adolescents.

This thesis consists of three studies that in different ways explore the characteristics of self-injury among adolescents in the general community. In Study 1 a convenience sample of 202 adolescents responded to a battery of self-report questionnaires on self-injury and a number of related factors at two different occasions. At these times 36.5 % and 40.2 % respectively reported to have deliberately engaged in self-injurious behaviors. Self-injury also showed robust relationships with general psychopathology, an absence of positive feelings to parents, and a ruminative style of emotion regulation. These latter two factors were also predictors of self-injury, independently of general psychopathology. Additionally, in girls, results also indicated a relationship between self-injury and symptoms of eating disorder and negative body esteem. Study 2 used a longitudinal survey design with a 1-year interval to further investigate self-injury in a community sample of 1052 adolescents. The battery of self-report questionnaires on self-injury and related factors was again employed, and both conventional statistical methods and hierarchical cluster analysis were used to analyze the results. Results indicated that 41.5 % and 42.9 % respectively had engaged in self-injury, as reported at the two occasions of data collection. The cluster analyses identified eight different subgroups of self-injuring adolescents (in each gender) based on patterns of self-injury. In both boys and girls a fairly large proportion (about 60 %) of self-injuring adolescents were found in a subgroup reporting low-frequency self-injury only, and little psychological difficulties. The analysis also identified a small subgroup of both girls and boys (about 5 % of self-injuring girls and 3 % of self-injuring boys) reporting frequent self-injury and multiple self-injury methods, as well as often reporting pronounced forms of both externalizing and internalizing psychopathology. A third subgroup of interest was found in girls (consisting of about 10 % of self-injuring girls) who showed a pattern of cutting behaviors as their main form of self-injury, primarily related to internalizing forms of psychopathology. Additionally, the cluster analyses identified subgroups within each gender, which were characterized by different patterns of self-injury, associated with varying degrees and forms of psychopathology. Overall, the subgroups of self-injuring girls were both more stable over time and associated with more psychological problems. Study 3 analyzed data collected through interviews with both self-injuring adolescents (n = 66) and a group of their non-injuring peers (n = 31) from the sample used in Study 2. Around 2/3 of the adolescents that were asked were willing to engage in an interview and also reported positively about it afterwards. Interviewing adolescents about self-injury gave varying amounts of additional information not covered in the questionnaires. Only about 1 in 5 of those who reported self-injury in a questionnaire acknowledged currently engaging in self-injury when interviewed. In about half of the cases, adolescents did not share any information about self-injury at all in the interview; others still reported having ceased to engage in such behavior. Further, in only about 1 of 4 cases where sufficient information was presented to the interviewer to allow for an assessment of the severity of the behavior, was the problem assessed as serious. The rates of self-injury were also compared approximately one year after the interview between those adolescents who were interviewed and a matched control group. Results did not indicate that being interviewed about one’s situation affected the tendency to self-injure.

Taken together, these studies demonstrate that among young Swedish adolescents in the general community, a large proportion indicate having engaged in some form of self-injury. Even though self-injury in these studies appears to be clearly related to other psychological difficulties, only in a minority of the cases does this appear to be a serious problem. The findings highlight that self-injury in adolescents may have different clinical and developmental implications for different individuals. School based interventions may be warranted to address self-injury in the general community, and addressing self-injury in this setting may provide important information about individuals’ self-injurious behaviors, and also provide a setting where support and care can be conveyed. However, such procedures need to be further developed in order to be sufficiently attractive for adolescents. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Nilsonne, Åsa, Department of Clinical Neuroscience, Karolinska Institutet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Non-suicidal self-injury, NSSI, Deliberate self-harm, DSH, Adolescents, cluster analysis
pages
122 pages
defense location
Edens hörsal, Paradisgatan 5 H, Lund
defense date
2012-09-28 13:15
ISBN
978-91-7473-372-3
language
English
LU publication?
yes
id
e100fed9-963b-4417-9f0a-f884ed843d99 (old id 3047976)
date added to LUP
2012-09-04 14:12:11
date last changed
2016-09-19 08:45:16
@misc{e100fed9-963b-4417-9f0a-f884ed843d99,
  abstract     = {Self-injury in adolescents (e.g. when individuals cut, burn, hit or otherwise deliberately cause themselves direct injury), has gained recognition as a potentially important mental health problem during the past decade. Relatively little has been known about the scope and characteristics of this behavior in Swedish adolescents. <br/><br>
This thesis consists of three studies that in different ways explore the characteristics of self-injury among adolescents in the general community. In Study 1 a convenience sample of 202 adolescents responded to a battery of self-report questionnaires on self-injury and a number of related factors at two different occasions. At these times 36.5 % and 40.2 % respectively reported to have deliberately engaged in self-injurious behaviors. Self-injury also showed robust relationships with general psychopathology, an absence of positive feelings to parents, and a ruminative style of emotion regulation. These latter two factors were also predictors of self-injury, independently of general psychopathology. Additionally, in girls, results also indicated a relationship between self-injury and symptoms of eating disorder and negative body esteem. Study 2 used a longitudinal survey design with a 1-year interval to further investigate self-injury in a community sample of 1052 adolescents. The battery of self-report questionnaires on self-injury and related factors was again employed, and both conventional statistical methods and hierarchical cluster analysis were used to analyze the results. Results indicated that 41.5 % and 42.9 % respectively had engaged in self-injury, as reported at the two occasions of data collection. The cluster analyses identified eight different subgroups of self-injuring adolescents (in each gender) based on patterns of self-injury. In both boys and girls a fairly large proportion (about 60 %) of self-injuring adolescents were found in a subgroup reporting low-frequency self-injury only, and little psychological difficulties. The analysis also identified a small subgroup of both girls and boys (about 5 % of self-injuring girls and 3 % of self-injuring boys) reporting frequent self-injury and multiple self-injury methods, as well as often reporting pronounced forms of both externalizing and internalizing psychopathology. A third subgroup of interest was found in girls (consisting of about 10 % of self-injuring girls) who showed a pattern of cutting behaviors as their main form of self-injury, primarily related to internalizing forms of psychopathology. Additionally, the cluster analyses identified subgroups within each gender, which were characterized by different patterns of self-injury, associated with varying degrees and forms of psychopathology. Overall, the subgroups of self-injuring girls were both more stable over time and associated with more psychological problems. Study 3 analyzed data collected through interviews with both self-injuring adolescents (n = 66) and a group of their non-injuring peers (n = 31) from the sample used in Study 2. Around 2/3 of the adolescents that were asked were willing to engage in an interview and also reported positively about it afterwards. Interviewing adolescents about self-injury gave varying amounts of additional information not covered in the questionnaires. Only about 1 in 5 of those who reported self-injury in a questionnaire acknowledged currently engaging in self-injury when interviewed. In about half of the cases, adolescents did not share any information about self-injury at all in the interview; others still reported having ceased to engage in such behavior. Further, in only about 1 of 4 cases where sufficient information was presented to the interviewer to allow for an assessment of the severity of the behavior, was the problem assessed as serious. The rates of self-injury were also compared approximately one year after the interview between those adolescents who were interviewed and a matched control group. Results did not indicate that being interviewed about one’s situation affected the tendency to self-injure. <br/><br>
Taken together, these studies demonstrate that among young Swedish adolescents in the general community, a large proportion indicate having engaged in some form of self-injury. Even though self-injury in these studies appears to be clearly related to other psychological difficulties, only in a minority of the cases does this appear to be a serious problem. The findings highlight that self-injury in adolescents may have different clinical and developmental implications for different individuals. School based interventions may be warranted to address self-injury in the general community, and addressing self-injury in this setting may provide important information about individuals’ self-injurious behaviors, and also provide a setting where support and care can be conveyed. However, such procedures need to be further developed in order to be sufficiently attractive for adolescents.},
  author       = {Bjärehed, Jonas},
  isbn         = {978-91-7473-372-3},
  keyword      = {Non-suicidal self-injury,NSSI,Deliberate self-harm,DSH,Adolescents,cluster analysis},
  language     = {eng},
  pages        = {122},
  title        = {Characteristics of Self-Injury in Young Adolescents: Findings from Cross-Sectional and Longitudinal Studies in Swedish Schools},
  year         = {2012},
}