By Their Own Young Hand: Deliberate Self-Harm And Suicidal Ideas in Adolescents

264 Pages·2006·0.78 MB·English

by  Keith Hawton

By Their Own Young Hand
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By Their Own Young Hand
Deliberate Self-harm and
Suicidal Ideas in Adolescents
Keith Hawton
and Karen Rodham
with Emma Evans
Jessica Kingsley Publishers
London and Philadelphia
Firstpublishedin2006
byJessicaKingsleyPublishers
116PentonvilleRoad
LondonN19JB,UK
and
400MarketStreet,Suite400
Philadelphia,PA19106,USA
www.jkp.com
Copyright©KeithHawton,KarenRodhamandEmmaEvans2006
TherightofKeithHawton,KarenRodhamandEmmaEvanstobeidentifiedasauthors
ofthisworkhasbeenassertedbytheminaccordancewiththeCopyright,
DesignsandPatentsAct1988.
Table3.3isadaptedfromRodham,K.,Hawton,K.andEvans,E.(2004)
‘Reasonsfordeliberateself-harm:comparisonofself-poisonersandself-cuttersinacommunitysampleof
adolescents’.JournaloftheAmericanAcademyofChildandAdolescentPsychiatry.Reproducedwithpermission
fromLippincott,Williams&Wilkins.
Table4.1isadaptedfromHawton,K.etal.(2002)‘Deliberateself-harminadolescents:selfreportsurveyin
schoolsinEngland’.BritishMedicalJournal.Reproducedwithpermission
fromtheBritishMedicalJournal.
Table5.1andFigures5.1to5.4areadaptedfromEvans,E.,Hawton,K.andRodham,K.(2005)‘Inwhat
waysareadolescentswhoengageinself-harmorexperiencethoughtsofself-harmdifferentintermsof
help-seeking,communicationandcopingstrategies?’.JournalofAdolescence.Reproducedwithpermission
fromElsevier.
Allrightsreserved.Nopartofthispublicationmaybereproducedinanymaterialform(including
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LibraryofCongressCataloginginPublicationData
Hawton,Keith,1942-
Bytheirownyounghand:deliberateself-harmandsuicidalideasinadolescents/KeithHawtonandKarenRodham,
withEmmaEvans.
p.cm.
Includesbibliographicalreferencesandindex.
ISBN-13:978-1-84310-230-4(pbk.:alk.paper)
ISBN-10:1-84310-230-7(pbk.:alk.paper) 1. Self-destructivebehaviorinadolescence.2. Teenagers—Suicidal
behavior.3. Youth—Suicidalbehavior. I.Rodham,Karen,1970-II.Evans,Emma,1975-III.Title.
RJ506.S39H392006
616.85’8200835—dc22
2006013532
BritishLibraryCataloguinginPublicationData
ACIPcataloguerecordforthisbookisavailablefromtheBritishLibrary
ISBN-13:9781843102304
ISBN-10:1843102307
ISBNpdfeBook:1846425298
PrintedandboundinGreatBritainby
AthenaeumPress,Gateshead,TyneandWear
Contents
Acknowledgements 10
Chapter 1 Introduction and Overview 11
Part 1 The Nature of Deliberate Self-harm in Adolescents
Chapter 2 Investigating Deliberate Self-harm in
Adolescents 21
Introduction 21
Clinicalversuscommunity-basedstudies 21
Therationaleforaschool-basedstudy 23
Aimsoftheproject 23
Choosinganappropriatemethodofdatacollection 23
Developingthequestionnaire 25
Testingthequestionnaire 33
Sampleofschoolpupils 33
Issuesofconsent 35
Howweimplementedthestudy 37
Safety-netarrangements 38
Summary 38
Chapter 3 The Nature, Prevalence and Impact of
Deliberate Self-harm and other Suicidal
Phenomena in Adolescents 40
Introduction 40
Deliberateself-harm 40
Attemptedsuicide 46
Thoughtsofself-harm 47
Suicidethreatsandplans 48
Methodsusedinactsofdeliberateself-harm 48
Themotivationbehinddeliberateself-harm 52
Premeditation 56
Repetitionofdeliberateself-harm 57
Hospitalpresentation 58
Impactofdeliberateself-harm 60
Summaryandimplications 62
Chapter 4 How Do Adolescents who Deliberately
Self-harm or Have Thoughts of Self-harm
Differ from other Adolescents? 65
Introduction 65
Gender 65
Age 67
Ethnicity 69
Internationaldifferences 70
Psychosocialandhealthcharacteristicsofadolescentswho
deliberatelyself-harmorhavethoughtsofself-harm 71
Summaryandimplications 90
Chapter 5 Adolescents’ Help-seeking, Coping
Strategies and Attitudes and their Relevance
to Deliberate Self-harm 94
Introduction 94
Help-seeking,communicationandcoping 95
Recognitionofproblemsandtheneedforhelp 97
Copingstrategiesemployedbyadolescents 98
Talkingtoothers 102
Towhomdidadolescentswhoengagedindeliberate
self-harmturnforhelp? 102
Whatstoppedadolescentsfromseekinghelp? 104
Didadolescentswhohadthoughtsofself-harm
seekhelp? 106
Attitudestowardsyoungpeoplewhoengageindeliberate
self-harm 106
Attitudestowardscontactinghelpingagencies 108
Summaryandimplications 110
Part 2 Prevention and Treatment of Deliberate Self-harm
in Adolescents
Chapter 6 Schools and Deliberate Self-harm 117
Introduction 117
Whybasepreventionstrategiesinschools? 118
Whatapproacheshavebeenusedinschools? 120
Primaryprevention 120
Secondaryprevention 126
Tertiaryprevention:dealingwiththeaftermath 129
Summaryandimplications 131
Chapter 7 The Health Service and Deliberate
Self-harm 132
Introduction 132
Generalpractitionerservices 133
Generalhospitalemergencyservices 141
Assessmentofadolescentswhohavedeliberately
self-harmed 144
Treatmentoptionsfollowingdeliberateself-harm 151
Summaryandimplications 157
Chapter 8 Self-help, Crisis Lines, the Internet and
the Media and Deliberate Self-harm 160
Introduction 160
Self-helpbooks 160
Confidentialtelephoneservices 161
TheInternet 163
Themedia 168
Summaryandimplications 172
Chapter 9 Conclusions and Looking to the Future 174
Concludingcomments 190
Appendix I Guidelines Used in the Schools Study for
Categorising Respondents’ Descriptions of
Deliberate Self-harm 194
Appendix II Information Sheet Given to Participants After
Completing the Questionnaire 201
Appendix III Self-harm: Guidelines for School Staff 202
Appendix IV Robson’s Self Concept Scale (Short Version) 224
Appendix V Useful Contact Addresses in the UK for Young
People with Problems, or their Friends or Relatives
in Need of Advice. 225
Appendix VI Sources of Information about Deliberate
Self-harm, Suicide and Mental Health Problems 230
Appendix VII Further Reading 233
References 237
Subject Index 258
Author Index 261
List of Figures
Figure3.1 Methodsofdeliberateself-harmdescribedbyadolescentsin
ourschoolsstudywhoreportedharmingthemselvesinthe
previousyear 49
Figure3.2 Methodsofdeliberateself-harmdescribedbyadolescentsin
ourschoolsstudywhoreportedharmingthemselvesinthe
previousyear,bygender 51
Figure3.3 Motivesfordeliberateself-harmreportedbyadolescentsin
ourschoolsstudywhohadharmedthemselvesinthe
previousyear 54
Figure3.4 Icebergmodelshowingthepercentageofadolescentsinour
schoolsstudywhoreportedpresentingornotpresentingto
hospitalfollowingtheirmostrecentactofdeliberateself-harm 59
Figure4.1 Frequencyofdeliberateself-harmbyageandgenderin12-
to18-year-oldspresentingtothegeneralhospitalinOxford,
1990–2003 68
Figure4.2 Associationbetweendeliberateself-harmanddrugusein
thepreviousyearinself-harmerscomparedwithother
adolescentsinourschoolsstudy 76
Figure4.3 Associationbetweendeliberateself-harminthepreviousyear
andalcoholuseinourschoolsstudy 77
Figure4.4 Associationbetweendeliberateself-harminthepreviousyear
andsmokinginourschoolsstudy 78
Figure4.5 Associationbetweendeliberateself-harminthepreviousyear
andhavingfriendswhohadalsoengagedindeliberateself-
harminthepreviousyearinourschoolsstudy 85
Figure5.1 Copingstrategiesemployedbyadolescentsinourschools
studywhenfacedwithstressfulsituations,accordingtohistory
ofdeliberateself-harm,thoughtsofself-harmorneither 100
Figure5.2 Copingstrategiesemployedbyadolescentsinourschools
studywhenfacedwithstressfulsituations,accordingtohistory
ofdeliberateself-harm,thoughtsofself-harmorneither,by
gender 101
Figure5.3 Peoplewithwhomadolescentsinourschoolsstudyfeltthatthey
couldtalkaboutproblems,accordingtohistoryofdeliberate
self-harm,thoughtsofself-harmorneither,bygender 103
Figure5.4 Sourcesofhelpapproachedbyadolescentsinourschools
studyengagingindeliberateself-harm,bygender 104
FigureAIII.1Cycleofself-harm 206
List of Tables
Table3.1 Prevalenceofdeliberateself-harminourschoolsstudy 41
Table3.2 Prevalenceofdeliberateself-harminourschoolsstudy,
bygender 42
Table3.3 Prevalenceofdeliberateself-harminschoolpupilsin
countriesparticipatingintheChildandAdolescentSelf-harm
inEurope(CASE)study,bygender 45
Table3.4 Comparisonofthemotiveschosenbyself-cuttersandself-
poisonersinordertoexplaintheiracts 55
Table4.1 Associationsbetweendeliberateself-harmintheprevious
yearandanxiety,depression,impulsivityandself-esteemin
ourschoolsstudy 72
Table5.1 Pupilswhoidentifiedthemselvesashavingseriouspersonal,
emotional,behaviouralormentalhealthproblems:recognition
ofneedforhelpandwhetherhelpwassought 99
Table5.2 Responsesofadolescentsinourschoolsstudytostatements
aboutattitudestowardspeoplewhoharmthemselves(percent-
agesinagreement),accordingtowhetherinthepreviousyear
theyhadself-harmed,hadthoughtsofself-harmorneither 107
Acknowledgements
MuchofthisbookisbasedonastudyweconductedinschoolsinEnglandin
order to examine the prevalence of deliberate self-harm and thoughts of
self-harminadolescents,andthefactorsassociatedwiththese.Thisstudywas
madepossiblebyagenerousgrantfromtheCommunityFund.Thestudywas
carried out in conjunction with Samaritans. We acknowledge the support of
Simon Armson, Jackie Wilkinson and Su Ray from that organisation. We also
thank other members of the advisory group for the study, including the
late Richard Harrington and Nicola Madge. The study was conducted in
collaborationwiththeChildandAdolescentSelf-harminEurope(CASE)study.
Someoftheresearchmethodsusedforthestudyweredevelopedthroughthis
collaboration.Theseniorcollaboratorsfromtheothercentresinvolvedinthat
study are Ella Arensman, Diego De Leo, Sandor Fekete, Kees van Heeringen,
ErikJandeWildeandMetteYstgard.NicolaMadgecoordinatedthisgroup.We
thank Philip Robson for help with the development of our measure of
self-esteem,LouiseHarrissforassistancewithsomeoftheanalyses,SueSimkin
for helping us in the preparation of the book in several ways, Nicola Madge,
Ann McPherson and Anne Stewart for their advice, Sarah Fortune for her
commentsonpartofthemanuscriptandTaniaCastro-Martinezforsecretarial
support. We also thank the Oxfordshire Adolescent Self-Harm Forum for
permission to reproduce in adapted form its guideline for schools (Appendix
III);Lippincott,WilliamsandWilkinsforgrantinguspermissiontoreproduce
in modified form Table 3.3, which was originally published in Rodham, K.,
Hawton,K.andEvans,E.(2004)‘Reasonsfordeliberateself-harm:comparison
ofself-poisonersandself-cuttersinacommunitysampleofadolescents.’Journal
of theAmericanAcademyof ChildandAdolescentPsychiatry43,82–87;theBritish
MedicalJournalforgrantinguspermissiontoreproduceinmodifiedformTable
4.1,whichwasoriginallypublishedinHawton,K.,Rodham,K.,Evans,E.and
Weatherall,R.(2002)‘Deliberateselfharminadolescents:selfreportsurveyin
schools in England.’ British Medical Journal 325, 1207-1211; and Elsevier for
granting us permission to reproduce in modified form Table 5.1 and Figures
5.1,5.2,5.3and5.4,whichwereoriginallypublishedinEvans,E.,Hawton,K.
and Rodham, K. (2005) ‘In what ways are adolescents who engage in self-
harm or experience thoughts of self-harm different in terms of help-seeking,
communicationandcopingstrategies?’Journalof Adolescence28,573–587.