Some notes on self-injury in New Zealand: Prevalence, correlates and functions Jessica Garisch Tamsyn Gilbertson Robyn Langlands Angelique O’Connell Lynne Russell Marc Wilson Emma Brown Tahlia Kingi

So what are we talking about…? Non-Suicidal Self-Injury (NSSI) is… (from the International Society for Study of Self-injury, 2007): “…the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. It is also sometimes referred to as self-injurious behavior, non-suicidal self-directed violence, self-harm, or deliberate self-harm (although some of these terms, such as self harm, do not differentiate non-suicidal from suicidal intent).” “As such, NSSI is distinguished from suicidal behaviors involving an intent to die, drug overdoses, and socially-sanctioned behaviors performed for display or aesthetic purposes (e.g., piercings, tattoos). Although cutting is one of the most well-known NSSI behaviors, it can take many forms including but not limited to burning, scratching, self-bruising or breaking bones if undertaken with intent to injure oneself. Resulting injuries may be mild, moderate, or severe.”

Why do people do it…?

Prevalence… 2,087 ED presentations across 4 regions over 12 months, 20% repeat presentations 1 24% - Lifetime prevalence among community-based New Zealand adults 2 48% of adolescents presenting to CAMHS reported SH at initial assessment 3 20% of 9,000 secondary students reported SH in previous year 4 31% of 1,700 secondary students thought of SH in previous month, 20% acted on it over 5 years 5  (conflation between SSI and NSSI) 1. Hatcher et al., Nada-Raja et al., Fortune et al., Fortune et al., Pryor & Jose, 02/04 to 09/09.

SampleNMeasure# itemsLifetime Prevalence level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† Prevalence… † r=.40 with suicidal behaviour

SampleNMeasure# itemsLifetime Prevalence level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† year-old School students 325De Leo & Heller (2004)114.8% Prevalence… † r=.40 with suicidal behaviour

SampleNMeasure# itemsLifetime Prevalence level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† year-old School students 325De Leo & Heller (2004)114.8% year-old School students 1,162Lundh et al’s (2007) DSHI1448.7% level PSYC students 593Lundh et al’s (2007) DSHI1443.7% Prevalence… † r=.40 with suicidal behaviour

SampleNMeasure# itemsLifetime Prevalence level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† year-old School students 325De Leo & Heller (2004)114.8% year-old School students 1,162Lundh et al’s (2007) DSHI1448.7% level PSYC students 593Lundh et al’s (2007) DSHI1443.7% level PSYC students 722Lundh et al’s (2007) DSHI (SV)739.7%‡ Prevalence… † r=.40 with suicidal behaviour ‡ correlates.79 with the full 14-item DSHI

Self-injury is most likely when… …one is experiencing peer victimisation AND one is highly alexithymic.

Self-injury is most frequent, most diverse, and most thought about when… …one is highly perfectionistic AND highly alexithymic.

These are all psychological, contextual and interpersonal predictors of SI Why do those who self-injure, self-injure?

N Training? NSSI client attempted Suicide? NSSI client COMPLETED suicide Non-NSSI client attempted Suicide? Non-NSSI client COMPLETED suicide Tell active/past SI client of research? Mental Health Nurse8861%90%49%88%65%56/58% General Practitioner160%62%25%88%56%31/25% Social Worker5744%86%16%72%26%33/32% Clinical Psychologist5777%86%25%83%30%28/32% Psychiatrist10%100%0%100% 0/0% Counsellor3234%69%9%78%13%28/25%

ISAS subscale Global Mean (SD) Most recent Mean (SD) Affect regulation4.62 (1.62)4.57 (1.74) Self-punishment4.14 (1.91)3.89 (2.15) Marking distress2.82 (2.00)2.66 (1.96) Anti-dissociation/ feeling generation2.68 (2.16)2.04 (2.25) Anti-suicide2.22 (1.98)2.02 (2.27) Self-care1.49 (1.48)1.34 (1.51) Toughness1.29 (1.53)1.04 (1.54) Interpersonal influence1.18 (1.47)0.92 (1.36) Interpersonal boundaries1.16 (1.51)0.89 (1.50) Sensation-seeking0.77 (1.21)0.52 (1.17) Autonomy0.77 (1.18)0.60 (1.17) Revenge0.68 (1.26)0.62 (1.37) Peer-bonding0.14 (0.56)0.15 (0.81) Affect regulation was the most strongly endorsed function and, overall, intrapersonal functions were the most strongly endorsed.

The ‘paradox of self-injury’ Self-injury worthy of help is private, but attention-seeking self-injury is public.  How does one seek help for ‘worthy’ self-injury without becoming unworthy?

Where next? Towards understanding how NSSI starts, stops, and continues… Year 9 and older Longitudinal Funded by the Health Research Council of New Zealand To be on our newsletter mailing list

Work in progress: 716 Year 9 students from 12 schools… Average age 13.3 years, SD=0.51 years 42% Male, 90% described selves as 100% heterosexual, straight 67% Pakeha, 9% Maori, 7% PI Completed Suicidal Behaviors Questionnaire (SBQ): - 15% exceeded recommended cutoff - 3.3% reported having attempted suicide Completed Deliberate Self-Harm Inventory (DSHI): - 75% never thought about self-injury - 8% thought about self-injury but never done it - 17% engaged in self-injury (girls about twice as likely) Of those who have engaged in self-injury,: - 17% carved pictures or marks into their skin (15% scratched to point of bleeding) - 16% stuck sharp objects into their skin - 15% prevented wounds from healing - 13% cut - 13% caused bruises - 11% bitten themselves

Correlation between SBQ and Self-Injury History… r=.58 Negatively correlated with both NSSI and SI: Self-esteem, resilience, emotion regulation, Attachment to parents and peers, ethnic identity and family closeness. (also being bullied in all forms) Positively correlated with both NSSI and SI: Impulsivity, depression, anxiety But… Parental attachment more strongly negative than peer attachment Depression more strongly negative than anxiety Depression more strongly associated with SI Emotion regulation (and to a less extent, anxiety and family closeness) mores strongly associated with SI Being bullied by social media more of an issue that txt, Ostracism more strongly related to SI

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