[NICE surveillance report) Self-harm in over 8s: short-term management and prevention of recurrence (CG16, 2004)

NICE | February 2019 | Self-harm in over 8s: short-term management and prevention of recurrence 

Self-harm in over 8s: short-term management and prevention of recurrence (CG16, 2004) – surveillance decision: NICE will update the guideline.

NICE will update the following guidelines on self-harm to merge the content into 1 guideline:

Full details see NICE

 

 

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Adolescent self‐harm prevention and intervention in secondary schools

Research finds adolescent self‐harm is a priority for schools. Authors suggest interventions might focus on increasing the availability of training to teaching staff  | Child & Adolescent Mental Health

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Background

Adolescent self‐harm is a major public health concern. To date there is a limited evidence‐base for prevention or intervention, particularly within the school setting. To develop effective approaches, it is important to first understand the school context, including existing provision, barriers to implementation, and the acceptability of different approaches.

Methods

A convenience sample of 222 secondary schools in England and Wales were invited to participate in a survey, with a 68.9% (n = 153) response rate. One member of staff completed the survey on behalf of each school. Participants responded to questions on the existing provision of adolescent self‐harm prevention and intervention, barriers to delivery, and future needs.

Results

Adolescent self‐harm is an important concern for senior management and teachers. However, emotional health and well‐being is the primary health priority for schools. Health services, such as Child and Adolescent Mental Health Services, and on‐site counselling are the main approaches schools currently use to address adolescent self‐harm, with counselling cited as the most useful provision. Fifty‐two per cent of schools have received some staff training on adolescent self‐harm, although only 22% rated the adequacy of this training as high. Where schools do not have existing provision, respondents stated that they would like staff training, specialist student training, external speakers, posters and assemblies, although the latter four options were infrequently ranked as the most useful approaches. Key barriers to addressing adolescent self‐harm were: lack of time in the curriculum; lack of resources; lack of staff training and time; and fear of encouraging self‐harm amongst adolescents.

Conclusions

Adolescent self‐harm is a priority for schools. Intervention might focus on increasing the availability of training to teaching staff.

Key messages:

  • Self‐harm is a major public health concern amongst adolescents. Schools are key sites for prevention and intervention.
  • Emotional health and wellbeing is the primary health priority for schools, although self‐harm is also a concern.
  • Counselling is seen as the most useful school‐based provision to respond to adolescent self‐harm.
  • Only 52% of schools have received staff training on self‐harm, with 22% of schools rating the adequacy of training as high.
  • Key barriers to schools addressing adolescent self‐harm are: lack of time; lack of resources; lack of staff training and time; and fear of encouraging adolescents.

Evans, R. et al. | Adolescent self‐harm prevention and intervention in secondary schools: a survey of staff in England and Wales | Child & Adolescent Mental Health | published online 5th December

Victimised adolescents more likely to self-harm and have suicidal thoughts

Baldwin, J. R. et al. | 2018| Adolescent Victimization and Self-Injurious Thoughts and Behaviors: A Genetically Sensitive Cohort Study| Journal of the American Academy of Child & Adolescent Psychiatry | Vol.0 |Issue 0| DOI: https://doi.org/10.1016/j.jaac.2018.07.903

Children and young people that are victimised have double the likelihood of self-harm and their risk of suicide  is trebled compared to non-victimised peers according to researchers at King’s College London. The study looked at over 2000 twins born in England and Wales between 1994-95. They studied different forms of adolescent victimisation- including maltreatment, neglect, bullying, crime, sexual victimisation, and family violence- which were identified in interviews with the participants when they turned 18. Among their findings was that over a third of the sample had experienced one severe form of victimisation during their adolescence and 7 per cent had experienced at least three or more severe types of victimisation. Almost 20 per cent (18.9%) had had some form of self-injurious thoughts and behaviours. Victimized adolescents had an increased risk of suicidal ideation and over a quarter had atempted suicide.  

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Abstract

Objective

Victimized adolescents have elevated risk of self-injurious thoughts and behaviors. However, poor understanding of causal and non-causal mechanisms underlying this observed risk limits the development of interventions to prevent premature death among adolescents. We tested whether pre-existing family-wide and individual vulnerabilities account for victimized adolescents’ elevated risk of self-injurious thoughts and behaviors.


Method

Participants were 2,232 British children followed from birth to age 18 as part of the Environmental Risk (E-Risk) Longitudinal Twin Study. Adolescent victimization (maltreatment, neglect, sexual victimization, family violence, peer/sibling victimization, cyber-victimization, and crime victimization) was assessed through interviews with participants and co-informant questionnaires at the age 18 assessment. Suicidal ideation, self-harm, and suicide attempt in adolescence were assessed through interviews with participants at age 18.

Results

Victimized adolescents had an increased risk of suicidal ideation, self-harm, and suicide attempt. Co-twin control and propensity-score matching analyses showed that these associations were largely accounted for pre-existing familial and individual vulnerabilities, respectively. Over and above their prior vulnerabilities, victimized adolescents still showed a modest elevation in risk for suicidal ideation.

Conclusion

Risk for self-injurious thoughts and behaviors in victimized adolescents is only partly explained by the experience of victimization. Pre-existing vulnerabilities account for a large proportion of the risk. Therefore, effective interventions to prevent premature death in victimized adolescents should not only target the experience of victimization but also address pre-existing vulnerabilities.

The article is in press but may be requested through interlibrary loan by Rotherham NHS staff 

In the news:

BBC News Teenage victims ‘more likely to self-harm’

How can services meet the needs of young people who self-harm?

A space to talk. An evaluation of the WISH Centre’s services with young people who self-harm | Centre for Mental Health

Through analysing outcome data and speaking to users of WISH services and stakeholders, this report found that the WISH Centre’s work makes a difference to young people, by combining counselling and psychotherapy with facilitated peer support and outreach to young people in schools and communities.

It finds that young people who attend WISH have far fewer A&E attendances during that time than before, and at least two-thirds of young people had improved wellbeing after receiving therapy and over 80% reduce or stop self-harming.

The report concludes that The WISH Centre’s approach creates a safe space in which young people can get expert help in dealing with difficult issues and feelings while also helping each other. And by reaching out into schools and communities it helps to tackle stigma and make it easier for young people to seek help.

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Image source: centreformentalhealth.org.uk

In light of this research, the Centre for Mental Health is calling for:

  • CCGs and local authorities across the country to commission services similar to WISH to support young people struggling with self-harm;
  • Commissioning more for young men, and a specific offer for young people who identify as LGBT;
  • More support for parents, carers, teachers and other professionals;
  • Awareness-raising and myth-busting about self-harm to encourage young people to seek help.

One in four 14-year-old girls self-harm, reports Children’s Society

The Children’s Society | August 2018 | The Good Childhood Report 2018

Every year The Children’s Society produces a wellbeing report, a comprehensive report into children’s wellbeing to hear what children have to say about their lives, what makes them happy and what needs to be improved for this generation. 

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Image source: childrenssociety.org.uk

Key findings from the report:

  • Pressure to fit in with society’s expectations is making children unhappy
  • Alarming numbers of children are self-harming
  • Non-stop comments about appearance are harmful to girls’ well-being
  • Outdated gender stereotypes are damaging to boys’ and girls’ happiness
  • Family relationships are particularly important for girls

Children’s Society press release One in four 14-year-old girls self-harm

Read the full report at The Children’s Society

The Good Child Summary report  available here 

 

In the media:

BBC News Quarter of 14 year old girls self-harm 

The Telegraph Quarter of 14 year old girls self-harm, study finds, amid warning of ‘crisis in children’s mental health’ 

The Guardian Quarter of 14-year-old girls in UK have self-harmed, report finds

Young people bullied online are twice as likely to self-harm

A new systematic review with meta analyses examines  the relationship between cyberbullying and self- harm (SH) and suicidal behaviour. The researchers reviewed the evidence and found victims of cyber bullying are twice as likely to self harm than their peers. They also noted perpetrators are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. 

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ABSTRACT

Background: Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people.

Objective: The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations.

Methods: An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted.

Results: A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that, compared with nonvictims, those who have experienced cybervictimization were OR 2.35 (95% CI 1.65-3.34) times as likely to self-harm, OR 2.10 (95% CI 1.73-2.55) times as likely to exhibit suicidal behaviors, OR 2.57 (95% CI 1.69-3.90) times more likely to attempt suicide, and OR 2.15 (95% CI 1.70-2.71) times more likely to have suicidal thoughts. Cyberbullying perpetrators were OR 1.21 (95% CI 1.02-1.44) times more likely to exhibit suicidal behaviors and OR 1.23 (95% CI 1.10-1.37) times more likely to experience suicidal ideation than nonperpetrators.

Conclusions: Victims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviors. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. Policy makers and schools should prioritize the inclusion of cyberbullying involvement in programs to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies.

Full reference:

The full article can be read at JMIR 

Related: Science Daily Young victims of cyberbullying twice as likely to attempt suicide and self-harm, study finds

Relationship Between Mindfulness and Non-Suicidal Self-Injury

This research explored whether lack of mindfulness or problems in mindfulness are involved in self-injury.

Non-suicidal self-injury is a complex behaviour, disturbingly prevalent, difficult to treat and with possible adverse outcomes in the long term. Previous research has shown individuals most commonly self-injure to cope with overwhelming negative emotions. Mindfulness has been shown to be associated with emotion regulation, and mindfulness-based interventions have shown effectiveness in a wide range of psychological disorders.

Pairwise comparisons revealed current self-injurers reported significantly lower mindfulness than past self-injurers and non-self-injurers, with medium effect sizes of d = 0.51 and d = 0.77, respectively. In logistic regression, low mindfulness significantly predicted self-injury (B = 0.04, p < .001). These findings have clinical implications, suggesting that mindfulness-based interventions may assist individuals to give up self-injurious behaviours and may be an important part of prevention strategies.

Full reference: Caltabiano, G. & Martin, G. (2017) Mindless Suffering: the Relationship Between Mindfulness and Non-Suicidal Self-Injury. Mindfulness. 8(788)