Summary / Abstract

Title: Deliberate self-harm in adolescents: hopelessness, depression, problems and problem-solving

Synopsis: This study looks at a group of adolescents who have taken overdoses and examines the type and severityof their problems. It measures hopelessness and depression, and whether these adolescents feel their parents understand them. Thestudy also examines the ways in which these adolescents perceive their overdose as a problem-solving mechanism. The studyshows that hopelessness in adolescent self-harm is an important independent variable over and above the level of depression. Theadolescents report a wide range of problems with severe and significant problems particularly in the area of family relationshipsand school. Finally, the paper postulates links between severity of problems, hopelessness and deficits in problem-solvingabilities, and suggests areas for potential therapeutic interventions. hopelessness, adolescents, self harm, parents, depression, school, deliberate self harm, problem solving, DSH group, control group, overdose, McLaughlin, report, Warwick, Miller, parental understanding, Psychiatry, problem solving abilities, risk group, suicidal intent, family relationships, questionnaires, perceived parental understanding, significant differences, clinic control, paper postulates links, reported problems, Clinical Psychology, family friends, psychiatric history,

Related links for: Deliberate self-harm in adolescents: hopelessness, depression, problems and problem-solving

Additional keywords for: Deliberate self-harm in adolescents: hopelessness, depression, problems and problem-solving

journal adolescence 1996 19 523 532 deliberate self harm adolescents hopelessness depression problems problem solving jo ann mclaughlin peter miller hilary warwick study looks group adolescents taken overdoses examines type severity problems measures hopelessness depression adolescents feel parents understand study examines ways adolescents perceive overdose problem solving mechanism study shows hopelessness adolescent self harm important independent variable level depression adolescents report wide range problems severe significant problems area family relationships school paper postulates links severity problems hopelessness deficits problem solving abilities suggests areas potential therapeutic interventions 1996 association professionals services adolescents introduction late 1960s non fatal deliberate self harm dsh adolescence greatly increased kreitman schreiber 1979 increase slowed mid 80s recently started increase hawton fagg 1992 advances understanding behaviour aspects remain uncertain consequently management difficult area clinical resources scarce dsh associated significant morbidity mortality age group studies reported risk repetition 12 40 hawton 1986 greatest risk repeat first months attempt otto 1972 found 4 3 adolescent suicide attempters sweden died suicide subsequent 10 15 years goldacre hawton 1985 reported figure 0 24 oxford region mean follow period 2 8 years reduction rate suicide recently highlighted target government white paper health nation secretary state health 1991 prediction prevention suicide high risk group remains poorly understood area areas possible interest concepts hopelessness problemsolving proposed stotland 1969 beck et al 1975 individual sense hopelessness defined terms system negative expectancies concerning future life sense hopelessness originate temporary reprint requests correspondence addressed dr j mclaughlin consultant child psychiatrist child family therapy clinic 18 19 st johns street mansfield u k 0140 1971 96 06052310 25 00 0 1996 association professionals services adolescents 524 j mclaughlin p miller h warwick permanent cognitive deficiency difficulty generating solutions problems leading state feels stressful situation hypothesized state leads maladaptive problem solving techniques self harm importance hopelessness suicide dsh recognised adults research identified factor hopelessness key variable linking depression suicidal behaviour beck et al 1975 depression suicidal intent show little correlation hopelessness scores controlled suicide intent highly associated hopelessness depression scores controlled group depressed inpatients hopelessness best predictor suicide 10 year follow beck et al 1985 compared adults adolescents life experiences draw problem solving resources call critical role played problem solving appraisal predicting hopelessness suicidal ideation group young adults confirmed adults rudd et al 1994 hopelessness links inadequate problem solving important factor contributing dsh adolescents sense hopelessness shown differentiate group self harming adolescents depressed risk group swedo et al 1991 contrast rotheram borus trautman 1988 studied group 44 hispanic black female adolescents found hopelessness predictive suicidal behaviour point view supported cole 1989 found depression hopelessness predicted self harming ideation attempts group adolescent college students sadowski kelly 1993 showed group adolescents self harmed poorer social problem solving skills group psychiatric patients normal controls linked hopelessness depression hawton 1986 pointed current understanding motivation leading dsh adolescence inadequate study reasons explain dsh hawton et al 1982 marked differences found ways attempts explained adolescents viewed assessors terms suicidal intent motivation clinicians rarely judged behaviour intended result death likely attribute behaviour hostile manipulative motives investigation important area necessary better understanding links problems hopelessness motivation dsh make easier identify risk self harm understanding indicate likely benefit specific interventions cognitive therapy role parents adolescents self harm greatest importance understanding problems motivation precipitating dsh outcome subsequent treatment little research comparing parent perception reasons dsh child view situation parents unaware extent child concerns feelings hopelessness prior serious suicide attempt sought appropriate help parents underestimate seriousness episode dsh hawton 1986 clear demonstration child feelings lead better compliance future treatment addition reder et al 1991 outlined hypothesis links deliberate self harm problem solving adolescence suggesting act dsh underrated attempt resolve relationship difficulties 525 deliberate self harm adolescents study examines problems problem solving parental understanding hopelessness depression consecutive series adolescents west yorkshire region deliberately taken overdoses hypotheses 1 dsh subjects likely report feelings hopelessness matched age sex depression control group adolescents 2 dsh subjects report problems rate severe matched controls 3 parents dsh subjects underestimate number severity reported problems control groups 4 dsh subjects rate parents understanding problems control group 5 dsh subjects exhausted problem solving abilities inclusion criteria age 12 16 years attending school deliberate self harm excluding cases selflaceration order exclude admission variables method consecutive cases dsh presenting casualty departments leeds western health district interviewed parents subject asked take study case adolescents living away home local authority care adults responsible daily care interviewed time study dsh subjects parents routinely interviewed child psychiatrist basic demographic clinical data extracted assessment interview package self rated instruments adolescent questionnaires parent accompanying child hospital prior psychiatric assessment parents attended asked complete questionnaires independently assessment instruments assessor demographic routine clinical data suicide intent scale beck et al 1974 total score range 0 30 assess degree suicidal intent higher scores corresponding higher intent subject 1 reasons dsh i problem areas identified list family relationships peers boyfriend girlfriend school employment prospects finances ii evaluation degree hopelessness related reas iii ways felt overdose change problems 526 j mclaughlin p miller h warwick 2 visual analogue scales perceived parental understanding problems perceived parental criticism 3 hopelessness scale children kazdin et al 1983 self rating scale based beck hopelessness scale adults affective motivational cognitive components reflect negative expectancies adult scale items rephrased tested inpatient children 17 items consisting thoughts feelings future subject rates true false 4 children depression inventory kovaks 1981 patterned beck depression inventory self rating scale 27 items refer affective cognitive behavioral symptoms depression designed school age children adolescents parents parent complete independently 1 reasons dsh perceived problem areas degree hopelessness related 2 visual analogue scales parents assessment degree criticism understanding adolescent problems controls two control groups identified first group risk adolescents attending child psychiatric outpatients history self harm second group drawn randomly two local schools matching original group age sex groups asked complete package questionnaires problem list visual analogue scale parental understanding criticism hopelessness scale child depression inventory parents questionnaires subjects parents statistical analyses carried chi square analysis stated results demographics sixty consecutive cases deliberate self harm dsh presented 9 months study able 51 85 study fifteen percent excluded due incomplete data available mainly due assessor variables failure give questionnaires failure collect completed mean age group 14 8 range 12 17 eighty percent female 20 male school control group made 37 individuals mean age 14 3 range 13 15 95 female 5 male clinic control risk group 32 individuals mean age 14 3 range 12 16 64 female 36 male past psychiatric history thirteen 25 dsh group previous psychiatric history 7 13 previously self harmed 527 deliberate self harm adolescents school 40 0 boy girl friend problem areas number problems 30 20 10 family friends job money figure 1 total number reported problems dsh group combined control group perceived self parents dsh group parents dsh group control group parents control group three 8 school control group 9 29 clinic controls previous psychiatric history control groups previous history self harm excluded problem areas groups asked possible problem areas lives asked rate problem scale 0 4 1 2 reflecting minor moderate problem expected improve 3 4 indicating perceived improve figure 1 illustrates total number reported problems dsh group combined controls problems reported family friends boy girlfriend show statistically significant increase dsh group compared control severe problems considered different pattern emerges dsh group shows significantly problems family school areas figure 2 parents completed problem area questionnaire results presented based mothers number fathers responding small results illustrated figures 1 2 parents dsh group control group showed high level agreement children types problems parental understanding trying gain subjective measure adolescent felt understood parent results likert scale provided measure perceived parental understanding 528 j mclaughlin p miller h warwick school 12 0 boy girl friend problem areas number problems 8 6 10 family friends job money 4 2 figure 2 total number severe problems reported dsh group combined control group perceived self parents dsh group parents dsh group control group parents control group 90 0 dsh reporting high understanding 40 30 20 10 50 60 70 80 school control clinical control figure 3 perceived parental understanding percent adolescents reporting high understanding mother h father scored five scored five subdivided low high understanding subgroups figure 3 seen dsh group perceive parents understanding 529 deliberate self harm adolescents 25 0 controls number subjects 20 15 10 5 dsh group figure 4 number subjects depressed subgroup reporting high h low hopelessness scores significantly school control group clinic control group chisquare p 0 01 suggest perceived parental understanding specific problem dsh high risk groups hypothesis adolescents taken overdose consider parents understand control adolescents proven degree adolescents felt criticised parents rated significant differences groups measures parents asked felt understood criticized child significant differences parents mothers rating adolescents repeating pattern lower understanding dsh group clinic control hopelessness mean score hopelessness scale dsh school controls clinic controls differ significantly respective scores 5 98 d 4 0 3 43 d 1 7 4 13 d 3 1 kruskal wallis p value 0 008 first listed hypothesis hopelessness predict membership dsh group age sex degree depression taken account order analyse data group split two groups high hopelessness group score five low hopelessness group scores five fifty percent dsh group high hopelessness score 10 29 school clinic control groups respectively achieving high hopelessness score significantly dsh group scored high hopelessness questionnaire measure levels depression order control depression hopelessness scores high level 530 j mclaughlin p miller h warwick depression analysed score cdi greater 11 results presented figure 4 control groups taken significant result produced chi square analysis level p 0 05 level depression two groups mean scores dsh 20 8 controls 18 1 n difference hypothesis confirmed depressed group hopelessness predict membership dsh group problem solving dsh subjects asked thought taking overdose change problems thirty four 68 answered expected influence problems fourteen 41 said influence problem dead group significantly higher scores hopelessness 5 1 vs 8 1 p 0 05 depression 14 6 vs 22 5 p 0 014 questionnaires remainder 14 41 answered help get away problems time 6 23 said let people know bad felt 11 32 said make people help groups overdose interpreted attempt solve problems albeit dysfunctional nineteen 38 dsh group said unable think suggesting ability generate solutions problems exhausted group offering answer higher hopelessness scores 5 1 vs 7 6 p 0 07 failing reach significance difference depression scores 17 5 vs 18 1 p 0 06 answer questions suggests exhaustion problemsolving ability associated cognitive state hopelessness discussion results confirmed hypothesis adolescents engaging acts deliberate self harm likely report feelings hopelessness future depression taken account line workers researched field adult population appear important adolescents point important comment two control groups group school controls likelihood low rates psychiatric disorder clinic control group defined risk group self harmed significant area hopelessness marked difference deliberate self harm group risk group suggesting hopelessness important factor causality deliberate self harm linked hopelessness inevitably problems people feel hopeless interestingly group self harmed report increase number problems right board specifically areas family friends boy girlfriends looks problems rated severe individuals significant differences groups family school areas reflects encountered clinical practice emphasises importance school problems group 531 deliberate self harm adolescents specifically ask nature school problems involved bullying raising possibility effective school anti bullying policies lead reduction adolescent self harm ability generate different solutions problems past described sign healthy psychological functioning results study suggest substantial proportion dsh group felt unable generate solutions problems group inability see different ways problem lead cycle hopelessness eventual self harm repercussions interventions help individuals increase problem solving abilities expected adolescent ratings parental understanding deliberate self harm group control groups present school controls interestingly significant difference deliberate self harm group clinic control groups suggest independent risk factor deliberate self harm association children families problems limitations study type response rate self report questionnaires 85 introduced sample bias failure subjects due mainly assessor variables refusal great significance results dependant validated selfreport scales depression hopelessness questionnaires problemsolving problem areas devised locally validated experimentally research independent clinical assessments areas desirable relatively small sample size subgroups explain differences noted reach statistical significance authors believe study contributes weight evidence implicating hopelessness independent variable deliberate self harm addition poor problemsolving abilities alongside feelings important important implications therapeutic involvement group recent evidence raised possibility effectiveness model cognitive therapy young people self harmed salkovskis et al 1990 results suggest model cognitive therapy underpinned techniques aimed improving problem solving ability generating solutions problems attempting reverse vicious circle hopelessness despair help patients reduce risk repetition ultimately reduce risk successful suicide references beck t weissman lester d trexler l 1974 measurement pessimism hopelessness scale journal consulting clinical psychology 42 861 865 beck t schuyler d herman i 1974 development suicidal intent scales prediction suicide beck t resnik h l p lettieri d eds bowie charles press beck t kovacs m weissman 1975 hopelessness suicidal behavior journal american medical association 234 146 1149 beck t steer r kovacs m gamion b 1985 hopelessness eventual suicide 10 year prospective study patients hospitalised suicidal intention american journal psychiatry 142 559 563 cole d 1989 psychopathology adolescent suicide hopelessness coping beliefs depression journal abnormal psychology 98 248 255 532 j mclaughlin p miller h warwick goldacre m hawton k 1985 repetition self poisoning subsequent death adolescents take overdoses british journal psychiatry 146 395 398 hawton k 1986 suicide attempted suicide children adolescents london sage hawton k fagg j 1992 deliberate self poisoning self injury adolescents study characteristics trends oxford 1976 1989 british journal psychiatry 161 816 823 hawton k cole d o grady j osborn m 1982 adolescents take overdoses characteristics problems contacts helping agencies british journal psychiatry 104 118 123 kazdin e french n h unis esveldt dawson k sherick r b 1983 hopelessness depression suicidal intent psychiatrically disturbed patient children journal consulting clinical psychology 51 504 510 kovacs m 1981 rating scales assess depression school aged children acta paedopsychiatrica 46 305 315 kreitman n schreiber m 1979 parasuicide young edinburgh women 1968 75 psychological medicine 9 469 479 otto u 1972 suicidal acts children adolescents acta psychiatrica scandinavica supplement 233 7 123 reder p lucey c fredman g 1991 challenge deliberate self harm young adolescents journal adolescence 14 135 148 rotheram borus m j trautman p d 1988 hopelessness depression suicidal intent adolescent suicide attempters journal american academy child adolescent psychiatry 27 700 704 rudd m d rajab m h dahm p f 1994 problem solving appraisal suicide ideators attempters american journal orthopsychiatry 64 136 149 sadowski c kelly m l 1993 social problem solving suicidal adolescents journal consulting clinical psychology 61 121 127 salkovskis p m atha c storer d 1990 cognitive behavioral problem solving treatment patients repeatedly attempt suicide controlled trial british journal psychiatry 157 871 876 secretary state health 1991 health nation london hmso stotland e 1969 psychology hope san francisco josey bass swedo e rettew d c hoppenheimer m lum d dolan goldberger e 1991 adolescent suicide attempters distinguished risk adolescents paediatrics 88 620 629, com_apnet_jado_jado_1996_0051, KnowledgeStor, Knowledge-Stor,