Some notes on self-injury in New Zealand: Prevalence, correlates and functions

Jessica GarischTamsyn GilbertsonRobyn LanglandsAngelique O’ConnellLynne RussellMarc WilsonEmma BrownTahlia Kingi

Please note that this presentation will include discussion of suicide and life-threatening behaviour

So what are we talking about…?

Does it cover…

• Overdosing?• Drinking ‘til you throw up?• Taking risks?• Accepting emotional abuse?• Depriving yourself of food? • Piercings?• Tattoos?• Brandings or scarification?• ‘Mortification of the flesh’?

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.”

What do we know about it…?

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What do we know about it…?

Why do people do it…?

Why do people do it…?

What do we know about it…?

…In New Zealand?

Prevalence…

• 2,087 ED presentations across 4 regions over 12 months, 20% repeat presentations1

• 24% - Lifetime prevalence among community-based New Zealand adults2

• 48% of adolescents presenting to CAMHS reported SH at initial assessment3

• 20% of 9,000 secondary students reported SH in previous year4

• 31% of 1,700 secondary students thought of SH in previous month, 20% acted on it over 5

years5

(conflation between SSI and NSSI)

1. Hatcher et al., 2009.2. Nada-Raja et al., 2004.3. Fortune et al., 2005.4. Fortune et al., 2010.5. Pryor & Jose, 02/04 to 09/09.

Sample N Measure # items Lifetime Prevalence

1. 100-level PSYC students

285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†

Prevalence…

† r=.40 with suicidal behaviour

Sample N Measure # items Lifetime Prevalence

1. 100-level PSYC students

285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†

2. 16-18 year-old School students

325 De Leo & Heller (2004) 1 14.8%

Prevalence…

† r=.40 with suicidal behaviour

Sample N Measure # items Lifetime Prevalence

1. 100-level PSYC students

285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†

2. 16-18 year-old School students

325 De Leo & Heller (2004) 1 14.8%

3. 16-18 year-old School students

1,162 Lundh et al’s (2007) DSHI 14 48.7%

4. 100-level PSYC students

593 Lundh et al’s (2007) DSHI 14 43.7%

Prevalence…

† r=.40 with suicidal behaviour

Sample N Measure # items Lifetime Prevalence

1. 100-level PSYC students

285 Sansone et al’s (1998) SHI 22 78.9%/54.9%†

2. 16-18 year-old School students

325 De Leo & Heller (2004) 1 14.8%

3. 16-18 year-old School students

1,162 Lundh et al’s (2007) DSHI 14 48.7%

4. 100-level PSYC students

593 Lundh et al’s (2007) DSHI 14 43.7%

5. 100-level PSYC students

722 Lundh et al’s (2007) DSHI (SV) 7 39.7%‡

Prevalence…

† r=.40 with suicidal behaviour‡ correlates .79 with the full 14-item DSHI

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Self-injury is most likely when…

…one is experiencing peer victimisation AND one is highly alexithymic.

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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 Nurse 88 61% 90% 49% 88% 65% 56/58%

General Practitioner 16 0% 62% 25% 88% 56% 31/25%

Social Worker 57 44% 86% 16% 72% 26% 33/32%

Clinical Psychologist 57 77% 86% 25% 83% 30% 28/32%

Psychiatrist 1 0% 100% 0% 100% 100% 0/0%

Counsellor 32 34% 69% 9% 78% 13% 28/25%

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ISAS subscaleGlobal

Mean (SD)Most recent Mean (SD)

Affect regulation 4.62 (1.62) 4.57 (1.74)Self-punishment 4.14 (1.91) 3.89 (2.15)Marking distress 2.82 (2.00) 2.66 (1.96)Anti-dissociation/ feeling generation 2.68 (2.16) 2.04 (2.25)Anti-suicide 2.22 (1.98) 2.02 (2.27)Self-care 1.49 (1.48) 1.34 (1.51)Toughness 1.29 (1.53) 1.04 (1.54)Interpersonal influence 1.18 (1.47) 0.92 (1.36)Interpersonal boundaries 1.16 (1.51) 0.89 (1.50)Sensation-seeking 0.77 (1.21) 0.52 (1.17)Autonomy 0.77 (1.18) 0.60 (1.17)Revenge 0.68 (1.26) 0.62 (1.37)Peer-bonding 0.14 (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

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