Following are some academic references on self-injury. These are far more clinical than the rest of the resources that will appear on this page when it is through. But if you are wondering what the psychiatrists are saying about self-injury these days, these journal articles reveal a lot. This list is just a small sampling; more references can be obtained from the National Library of Medicineís website. I omitted articles dealing with self-injury in the mentally disabled, focusing instead on self-injury in the general population.

Friedman T, Newton C, Coggan C, et al. Predictors of A&E staff attitudes to self-harm patients who use self-laceration: Influence of previous training and experience. J Psychosom Res 2006;60:273-7.
OBJECTIVE: The aim of this study was to investigate the attitudes of accident and emergency (A&E) staff towards patients who self-harm through laceration. METHODS: We developed a questionnaire using focus group methodology. Questionnaires were distributed to 117 A&E staff members. RESULTS: Of the staff, 53.8% responded. The staff believed that self-laceration was an important problem but felt unskilled in managing patients. The staff were unsure of the relationship between self-laceration and both mental illness and risk of suicide. They had previously received little training in managing this condition. In those staff without previous training, a longer period working in A&E was correlated with higher levels of anger towards patients and an inclination not to view patients as mentally ill. A&E staff were keen for further training and wanted a higher proportion of patients to be seen by specialist mental health services. CONCLUSIONS: This study highlights the need for greater staff training in A&E. Despite considerable experience in the field, we found evidence for unhelpful attitudes amongst some staff. This is particularly true for more senior staff without previous DSH training, who, as a group, were less sympathetic to this group of patients. Unfavourable attitudes of health professionals are likely to adversely influence the quality of clinical care delivered to DSH patients who use self-laceration as well as those who use other methods of self-harm.

McCann T, Clark E, McConnachie S, Harvey I. Accident and emergency nursesí attitudes towards patients who self-harm. Accid Emerg Nurs 2006;14:4-10.
The study aimed to assess if accident and emergency (A&E) nurses have positive or negative attitudes towards patients with deliberate self-harm, and to assess if nursesí age, length of A&E experience, or in-service education influence their attitudes towards these patients. An adapted version of the Suicide Opinion Questionnaire was used to assess attitudes towards patients with deliberate self-harm. Data were collected from 43 Registered Nurses in the A&E department of a major city hospital in Australia. Data were analysed using SPSS. Most nurses had received no educational preparation to care for patients with self-harm. Over 20% claimed the department either had no practice guidelines for DSH or they did not know of their existence; one-third who knew about them had not read them. There were significant differences between respondents on several variables. Older and more experienced nurses had more supportive attitudes than younger and less experienced nurses. Nurses who had attended in-service education on DSH had more positive attitudes than non-attendees. Overall, the findings have implications for improving the educational preparation of A&E nurses, improving awareness and adoption of practice guidelines, mentoring nurses, and improving attitudes towards patients who self-harm.

Chapman AL, Gratz KL, Brown MZ. Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behav Res Ther 2006;44:371-94.
Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.

Lovell A. Danielís story: self-injury and the case study as method. Br J Nurs 2006 Feb 9-22;15:166-70.
This article explores the value of case study methodology as a means of investigating the relationship between people with learning disabilities and self-injury. One life story might appear to be of limited value in this regard; however, it is argued that it might not only be of use in demonstrating the development of an isolated self-injuring career, but there may also be insights into its entrenchment in the lives of others. The telling of one story might serve as a filter, through which the interventions of medication, mechanical restraint and behaviourism can be observed over time. Furthermore, studying one life in some detail might be used to illustrate broader concerns about the context of the transition from institutional to community care. The restrictions of such an approach are acknowledged, particularly in the telling of a story where the main characterís words cannot be heard, but maybe that is also the point of undertaking research about those at the margins of society.

Csorba J, Szelesne EF, Steiner P, et al. [Symptom specificity of adolescents with self-injurious actions.] Psychiatr Hung 2005;20:456-462. [Article in Hungarian]
As an introductory part of the paper, authors give a short overview of existing results in te literature related to self-injurious behaviour and adolescentsí deliberate self-harm. In their own random sample study, authors organized a self-report screen (provincial town, 3 educational facilities, 470 pupils aged between 14 and 18 years) by means of the translated version of Ottawa Self Injury Inventory (OSI) used widely in community-based studies in Canada. The Beck Depression Inventory was introduced to measure the key symptoms of depression among youngsters. 26 youngsters were found to have had at least one self-injurious action in their life-time. The authors describe the characteristics of these subjects on the basis of symptom occurrence statistics. Although the depressive symptoms have an expected correlation with the self-injurious ideas, depression does not seem to have the same relationships with the actual self-harm action. The authors attempt to give an explanation of this contradiction.

Hempstead K. The geography of self-injury: Spatial patterns in attempted and completed suicide. Soc Sci Med 2006
This study uses hospital discharge data, death certificates and medical examiner data for New Jersey for 1999-2001 to investigate whether fatal and non-fatal self-injury exhibit similar geographic patterns. Findings show that the demographic characteristics of individuals committing fatal and non-fatal self-injury are quite different. Furthermore, attempted and completed suicides have a somewhat different geographical pattern. Municipality-level determinants of suicide and non-fatal self-injury were estimated in two separate models. While measures of isolation such as low population density and high proportions of households with only one member were predictive of completed suicides, non-fatal self-injury was related to unemployment and median age. Both types of self-injury were more common in municipalities which lost population between 1990 and 2000, and where divorce rates were high. Population-based suicide prevention efforts should be aided by the knowledge that although there are some similarities in the spatial pattern of completed and attempted suicides, there are some important differences in significant determinants.

Woldorf GM. Clinical implications of the paradox of deliberate self-injury. J Spec Pediatr Nurs 2005;10:196-200. No abstract available.

Reece J. The language of cutting: Initial reflections on a study of the experiences of self-injury in a group of women and nurses. Issues Ment Health Nurs 2005;26:561-74.
Non-suicidal self-injury is a distressing act, which can arouse dissent and negative comment in service users and providers. The purpose of the study was to describe how women who self-injure and nurses assign meaning to shared discourses about self-injury. The wider study is framed in a grounded theory methodology. Fourteen qualified nurses and 11 women who have self-injured were interviewed using unstructured and initially open-ended interviews, lasting 45-90 minutes. Initially a thematic analysis was used to code data. In this report, three of the early themes are reported with some comparative interpretations. Nurses lack understanding of the meanings of cutting behaviour. A common language is needed if nurses are to be effective in helping women who have self-injured to express distress in less damaging ways.

Olfson M, Gameroff MJ, Marcus SC, et al. National trends in hospitalization of youth with intentional self-inflicted injuries. Am J Psychiatry 2005;162:1328-35.
OBJECTIVE: The authors examined national trends from 1990 to 2000 in the utilization of community hospital inpatient services by young people (5-20 years of age) with intentional self-inflicted injuries. METHOD: Discharge abstracts from a nationally representative sample of community hospitals were analyzed, with a focus on youth discharges (N=10,831) with a diagnosis of intentional self-inflicted injury (ICD-9-CM: E950-E959). Census data were used to derive national population-based rates of self-inflicted injuries requiring inpatient treatment. Overall population-based trends in hospitalizations for self-inflicted injury were calculated and stratified by gender and age. Among youths hospitalized with a self-inflicted injury, trends were also calculated for length of stay, inpatient costs, method of injury, and associated mental disorder diagnoses. RESULTS: The annual hospitalization rate of youths with self-inflicted injuries declined from 49.1 per 100,000 in 1990 to 44.9 per 100,000 in 2000, and the mean length of inpatient stay significantly declined from 3.6 days to 2.7 days. Among the hospitalized patients, there were increases in the rate of cutting (4.3% to 13.2%) and ingestion of acetaminophen (22.1% to 26.9%), antidepressants (10.0% to 14.0%), and opiates (2.3% to 3.3%) as a cause of injury, whereas there were decreases in the ingestion of salicylates (14.9% to 10.2%) and barbiturates (1.5% to 0.7%). There were significant increases in the proportion of subjects with primary mental disorder discharge diagnoses of depressive disorder (29.2% to 46.0%), bipolar disorder (1.3% to 8.2%), and substance use disorder (5.4% to 10.7%) and significant decreases in the rate of adjustment disorders (22.2% to 11.4%) and nonmental disorders (31.9% to 13.6%). After excluding cutting, which may be more closely related to self-mutilation than suicidal self-injury, the annual hospitalization rate of youths with self-inflicted injuries declined from 47.2 per 100,000 in 1990 to 39.4 per 100,000 in 2000. CONCLUSIONS: Over the decade of study, young people admitted to community hospitals with self-inflicted injuries tended to have more severe psychiatric diagnoses and to be treated during shorter inpatient stays. These trends suggest that the role of youth inpatient care has narrowed, becoming focused on those with severe psychiatric disorders.

Muehlenkamp JJ. Self-injurious behavior as a separate clinical syndrome. Am J Orthopsychiatry 2005;75:324-33.
The field of clinical psychology may benefit from adopting a deliberate self-injury syndrome as a distinct disorder for representation in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The phenomenological and empirical data supporting a deliberate self-injury syndrome are reviewed, and arguments for and against the adoption of a distinct syndrome are explored.

Harriss L, Hawton K, Zahl D. Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury. Br J Psychiatry. 2005;186:60-6.
BACKGROUND: Self-harm is associated with a high risk of suicide. It is unclear whether suicidal intent at the time of self-harm is a risk factor for future suicidal behaviour. AIMS: To investigate the relationship between suicidal intent and patient characteristics, repetition of self-harm, and suicide. METHOD: Clinical and demographic data on 4415 patients presenting to hospital following self-harm between 1993 and 2000 were analysed. Suicidal intent was measured using the Beck Suicide Intent Scale (SIS). Follow-up information on repetition of self-harm and suicide was investigated for 2489 patients presenting between 1993 and 1997. RESULTS: Suicidal intent at the time of self-harm was associated with risk of subsequent suicide, especially within the first year and among female patients. Suicide was more strongly associated with scores on the circumstances section of the SIS than the self-report section. The association between repetition of self-harm and SIS scores was different for male and female patients. CONCLUSIONS: The measurement of suicidal intent in the assessment of self-harm patients is beneficial for the evaluation of future suicide risk. A shortened measuring scale might be useful in clinical practice.

Rashid A, Brennen MD. Psychiatric assessment of patients with self-inflicted lacerations to the wrist and forearm admitted to a nonpsychiatric ward: The experience of a regional plastic surgery unit. Br J Plast Surg 2005.
In 1984, the Department of Health (DoH) recommended that all patients with deliberate self-harm (DSH) must have a mental assessment before discharge. DSH patients, especially those with lacerations to wrist and forearm, are a regular source of admission to plastic surgery units. In Northern Ireland, the regional plastic surgery service is provided at the Ulster Hospital, which does not have an on-site psychiatric department. Consequently, it was often difficult to arrange a psychiatrist assessment for these patients on the ward even when the assessment was required urgently. The objective of this study was to develop and validate a protocol that would ensure that these patients were assessed and followed up for their mental health as recommended by the DoH. In the absence of clear guidelines from the DoH and utilising the existing arrangement between Accident and Emergency (A&E) and the psychiatric services, all referring A&E departments were instructed at the time of referring patients with DSH to wrist and forearm to arrange a psychiatric examination before transferring the patient to the plastic surgery unit. Data were collected retrospectively (August 2002-October 2002) and prospectively (November 2002-October 2003) and comprised demographic features, previous history of self-harm, conduct of the patient in A&E and the ward, length of stay in the hospital and various aspects of psychiatric assessment and follow-up. In total, 42 referrals were made during the period studied. The average age was 28 years with a male to female ratio of 2:1. The average hospital stay was two days. Despite difficulties, our practice was found effective in ensuring psychiatry assessment and follow-up without risking the patientís physical health. The study also highlighted the need for collaboration between plastic surgeons and psychiatrists to improve services in regards to DSH patients.

Adams J, Rodham K, Gavin J. Investigating the self in deliberate self-harm. Qual Health Res 2005;15:1293-309.
In this study, the authors explored how a group of young people aged 16 to 26 years (who identified themselves as having engaged in deliberate self-harm) made sense of the self by conducting two online focus groups and four e-mail interviews. They analyzed data using interpretive phenomenological analysis. The concept of validation was the primary means of making sense of the self and concerned the desire to be considered legitimate and of worth. This desire was clearly evident across three realms of conflict: (a) the intrinsic or extrinsic self, which marked the distinction between objective fact and subjective opinion; (b) the accepted or denied self; and (c) the notion of normality. It is possible that having oneís denied self validated online might lead to an exacerbation of an individualís self-harming behavior. Further work is needed to explore the effects of online discussion forums on such taboo forms of behavior.

Lamprecht HC, Pakrasi S, Gash A, Swann AG. Deliberate self-harm in older people revisited. Int J Geriatr Psychiatry 2005;20:1090-6.
BACKGROUND: Deliberate self harm (DSH) in later life is under researched and is believed to be related to both mental illness and suicide. AIMS: The aim of the study was to examine deliberate self-harm (DSH) in older people presenting to acute hospital services over three years. METHOD: This was a retrospective observational study. We reviewed 97 episodes of DSH involving 82 patients aged 65 and over referred to the Liaison Psychiatric Service of the Tees and North East Yorkshire NHS Trust South Locality from 2000 to 2002. RESULTS: There was a year on year increase in the number of older people presenting with DSH, especially in men. Twenty-one percent of older men had no discernible psychiatric diagnosis. There were a small number of people who repeated DSH within a year and males were as likely to be repeaters as females. Twenty-three percent of all patients saw a General Practitioner (GP) in the 7 days before the episode of DSH and this increased to 58% in the 4 weeks preceding the episode of DSH. More males (56%) than females (26%) who presented with DSH were married. The most common method of DSH (93%) was medication overdose of which 66% used prescribed medication. There was no difference in the methods used to self-harm between men or women. CONCLUSION: DSH in the elderly may start to mirror some of the characteristics seen in younger adults with DSH. While the numbers of DSH per year are small among the elderly compared to younger adults, the observations suggest an increase in DSH in men. Marriage may no longer be a protective factor in prevention of DSH among older men. Longer-term observational studies of DSH in older people are required to confirm these changing patterns. GPs may have an important role to play in prevention of DSH in later life.

Haavisto A, Sourander A, Multimaki P, et al. Factors associated with ideation and acts of deliberate self-harm among 18-year-old boys. A prospective 10-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 2005;40:912-21.
BACKGROUND: The aims of the study were: (1) to identify the prevalence of ideation and acts of deliberate self-harm in 18-year-old boys; (2) to report the use of mental health services among these boys; (3) to identify risk factors assessed at age 8 and (4) to identify associated cross-sectional factors at age 18 of self-reported ideation and acts of deliberate self-harm. METHODS: The participants in this community-based 10-year follow-up study consisted of 2,348 boys born during 1981. At baseline, three informant sources were used: parents, teachers and the children themselves. The questionnaires used were the Rutter Parents Scale, the Rutter Teacher Scale and the Childrenís Depressive Inventory. At follow-up, boys' psychopathology, adaptive functioning and substance use were studied using the Young Adult Self-Report questionnaire. Further questions about demographic factors and life events were added at both stages. RESULTS: The prevalence of ideation of deliberate self-harm was 4.0%, and of acts 2.2%, during the preceding 6 months. Of the subjects who reported ideation, 9.7%, and of those who reported acts, 16.0%, had used mental health services during the previous year. Self-reported depressive symptoms at age 8 predicted ideation and acts of deliberate self-harm 10 years later. Suicidal boysí problems in many life areas were linked with suicidal tendency through psychiatric symptoms, especially anxious/depressed symptoms and aggressive behaviour. CONCLUSIONS: The connection between self-reported depressive symptoms at age 8 and ideation and acts of deliberate self-harm at age 18 is a good reason to already pay special attention to childrenís own intimations of distress in elementary school. It is likely that an effective way to prevent suicidality among adolescents is to search for and treat psychiatric problems among young people. Self-reported screening questionnaires used, e.g. in school healthcare, may provide an opportunity to recognize these problems.

Jacob R, Clare IC, Holland A, et al. Self-harm, capacity, and refusal of treatment: implications for emergency medical practice. A prospective observational study. Emerg Med J 2005;22:799-802.
OBJECTIVES: In the context of increasing attention to the rights of adults to make treatment decisions for themselves, this study investigated, among patients who have engaged in self-harm (i) the extent of valid decision making; (ii) the impact of mental disorders; and (iii) the effect of systematically providing relevant clinical information. DESIGN: A prospective observational study. SETTING: The emergency department of a large teaching hospital in southeast England. PARTICIPANTS: Seventy one adult men and women who had presented for treatment following self-harm. MAIN OUTCOME MEASURES: Semi-structured interviews were used to make clinical judgements about participantsí capacity to consent before, and following, the presentation of simple written information about the proposed treatment(s). Demographic data, and data about mental disorder and alcohol misuse, were also collected. RESULTS: Based on accepted legal criteria, only 28/71 (39.4%) of the patients were judged to have capacity to consent to the proposed intervention(s) initially. However, the number of patients judged to have capacity improved significantly (p<0.001) after the presentation of written information, to 45/71 (63.4%). Those judged incapable were significantly more likely (p<0.01) to refuse treatment. Continuing incapacity was significantly associated only with cognitive impairment (p<0.001) and/or severe psychiatric disturbance (p<0.01). CONCLUSIONS: Consistent with current views, capacity is not static, even among patients who have engaged in self-harm, but can be improved through a simple intervention. The findings are consistent with recent guidance about supporting this vulnerable group of patients, many of whom are ambivalent about treatment.

Skegg K. Self-harm. Lancet. 2005;366:1471-83.
The term self-harm is commonly used to describe a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial cutting in response to intolerable tension. As with suicide, rates of self-harm vary greatly between countries. 5-9% of adolescents in western countries report having self-harmed within the previous year. Risk factors include socioeconomic disadvantage, and psychiatric illness--particularly depression, substance abuse, and anxiety disorders. Cultural aspects of some societies may protect against suicide and self-harm and explain some of the international variation in rates of these events. Risk of repetition of self-harm and of later suicide is high. More than 5% of people who have been seen at a hospital after self-harm will have committed suicide within 9 years. Assessment after self-harm includes careful consideration of the patientís intent and beliefs about the lethality of the method used. Strong suicidal intent, high lethality, precautions against being discovered, and psychiatric illness are indicators of high suicide risk. Management after self-harm includes forming a trusting relationship with the patient, jointly identifying problems, ensuring support is available in a crisis, and treating psychiatric illness vigorously. Family and friends may also provide support. Large-scale studies of treatments for specific subgroups of people who self-harm might help to identify more effective treatments than are currently available. Although risk factors for self-harm are well established, aspects that protect people from engaging in self-harm need to be further explored.

Lowenstein LF. Youths who intentionally practise self-harm. Review of the recent research 2001-2004. Int J Adolesc Med Health 2005;17:225-30.
This is a review of the recent research into children and adolescents, who commit self-harm and how this is related to suicide attempts. The research indicated several types of self-harming. It has been noted by a number of investigators that it is more common for girls to carry out intentional self-harming. Many of these girls considered suicide, but this was not always the case and it was difficult to disentangle the two. It is therefore necessary to take this type of behaviour very seriously and protect anyone with this proclivity. The most common methods of self-harming are self-poisoning, overdosing, cutting and in some cases jumping from high places. Among the reasons for such behaviour are attention-getting, the releasing of negative emotions and conflicts often to do with family and relationships and sexual problems. When considering care and therapy it is vital to safeguard such young people from their own inclinations as self-harming and suicide are often closely related. Many suffer from depression, anxiety, impulsivity, low self-esteem and suicidal ideation. It is vital always to err on the side of caution, since over-protection and intensive monitoring is preferable to the tragedy of suicide.

McAndrew S, Warne T. Cutting across boundaries: A case study using feminist praxis to understand the meanings of self-harm. Int J Ment Health Nurs 2005;14:172-80.
Deliberate self-harm predominantly occurs in women under the age of 30 years. This qualitative case study using feminist methods explored the experiences of three women who each had a long history of self-harming behaviour. Psychoanalytical concepts are used to explore the meaning of the conflicts that these women experience. Emergent themes include: great expectations, I speak but no one hears, sexual naivety meets sexual violence, and redrawing the sexual map. This thematic analysis helps facilitate an insight into what these women are trying to communicate, and provides guidance for mental health professionals to more effectively respond to the challenges of working with women who self-harm.

Parker G, Malhi G, Mitchell P, et al. Self-harming in depressed patients: Pattern analysis. Aust N Z J Psychiatry 2005;39:899-906.
OBJECTIVE: As deliberate self-harm (DSH) is a common concomitant of depressive disorders, we undertook a study examining the relevance of possible determinants and correlates of DSH. METHOD: Three separate samples of depressed outpatients were studied to determine consistency of identified factors across samples, with principal analyses involving gender, age and diagnosis-matched DSH and non-DSH subjects. RESULTS: Across the samples, some 20% of subjects admitted to episodes of DSH. Women reported higher rates and there was a consistent trend for higher rates in bipolar patients. Univariate analyses examined the relevance of several sociodemographic variables, illicit drug and alcohol use, past deprivational and abusive experiences, past suicidal attempts and disordered personality functioning. Multivariate analyses consistently identified previous suicide attempts and high acting out behaviours across the three samples, suggesting the relevance of an externalizing response to stress and poor impulse control. CONCLUSIONS: Results assist the identification and management of depressed patients who are at greater risk of DSH behaviours.

Konradsen F, Hoek W, Peiris P. Reaching for the bottle of pesticideóA cry for help. Self-inflicted poisonings in Sri Lanka. Soc Sci Med 2006;62:1710-9.
This long-term study in Sri Lanka explored the complexities behind self-inflicted pesticide poisonings by 166 Sri Lankans. Using or threatening to use pesticides for self-harm has become a response to stressful events and a powerful message towards a specific individual, or to the outside world in general, conveying misgiving, anger, sadness, hopelessness, frustration, or simply a way to manipulate a situation to oneís own advantage. The effects of alcohol misuse are especially important in understanding self-harm at the community level in terms of the impact they have on the domestic environment. Also, issues around "love affairs," arranged marriages and domestic physical, sexual or psychological abuse in the domestic environment are referred to by many self-harmers or their relatives as a reason for ingesting poison. Clearly, easy access to lethal pesticides by impulsive individuals often living under economically or psychosocially stressful conditions, combined with insufficient treatment facilities and limited outreach programs, can be a deadly blend. A strategy aimed at reducing the availability of the most toxic pesticides and improving case management should be implemented, as it is likely to reduce death from pesticides although unlikely to impact on the number of episodes. Support to families plagued by domestic violence and male alcohol misuse is essential to improve the quality of life for the most vulnerable and to reduce the number of self-harm episodes in the long-term.

Hjelmeland H, Groholt B. A comparative study of young and adult deliberate self-harm patients. Crisis 2005;26:64-72.
Research has shown that the prevalence of deliberate self-harm (DSH) is higher in adolescents than in adults, but little is known about other differences. In this study we compare adolescent and adult DSH-patients regarding factors contributing to the suicidal act. In two regions in Norway, 98 persons under 20 years of age and 83 older persons were interviewed following an act of DSH. They were compared regarding intentions involved in the DSH, precipitating circumstances, level of suicidal intent, medical seriousness of the act, depression, hopelessness, and self-esteem. Few differences were found. The adults more often wanted to escape from unbearable thoughts or situations, or to receive care and attention. Adults also reported a slightly higher level of medical seriousness of the DSH act, more psychiatric problems, and substance abuse. The similarities between young and adult DSH-patients are striking. The differences found are most likely related to factors of age itself, such as cognitive immaturity, impulsivity, and lack of experience in enduring problems.

Evans E, Hawton K, Rodham K. In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? J Adolesc 2005;28:573-87.
The purpose of this study was to ascertain whether adolescents who deliberately harmed themselves or had thoughts of self-harm differed from other adolescents in terms of help-seeking, communication and coping strategies. The participants were 6020 15-16 year-old school pupils who were surveyed using an anonymous self-report questionnaire. Adolescents with one or more episodes of deliberate self-harm (DSH) in the previous year were more likely to identify themselves as having serious problems than other adolescents. However, a substantial proportion of adolescents with either DSH or thoughts of self-harm did not identify themselves as having serious problems. Adolescents with DSH were most likely to feel the need for help but not try to get any; they were less able to talk to family members and teachers and had fewer categories of people who they were able to talk to. Like other adolescents, those with DSH or thoughts of self-harm were more likely to seek and receive help from their friends than from other sources. They differed from other adolescents in terms of coping strategies they reported employing when faced with difficulties, showing less focus on problems and more avoidant behaviours. The findings have important implications for preventive strategies, including educational programmes on emotional health and coping, and for the clinical care of adolescents identified as at risk or having self-harmed.

Dennis M, Wakefield P, Molloy C, et al. Self-harm in older people with depression: Comparison of social factors, life events and symptoms. Br J Psychiatry 2005;186:538-9.
Studying non-fatal self-harm in older adults may provide insight into suicidal behaviour in this age group. The objectives of the study were to determine clinical factors that might help to differentiate those older adults with depression who are most at risk of self-harm and suicide. We examined social factors, life events, hopelessness and other depression symptoms in a group of 48 older people with depression referred following an episode of self-harm compared with 50 similarly aged people with depression who had no history of self-harm. The groups were similar in many respects, although those in the self-harm group were more likely to have a poorly integrated social network and were more hopeless.

Sinclair J, Green J.Understanding resolution of deliberate self harm: Qualitative interview study of patientsí experiences. BMJ 200514;330:1112.
OBJECTIVE: To explore the accounts of those with a history of deliberate self harm but who no longer do so, to understand how they perceive this resolution and to identify potential implications for provision of health services. DESIGN: Qualitative in-depth interview study. SETTING: Interviews in a community setting. PARTICIPANTS: 20 participants selected from a representative cohort identified in 1997 after an episode of deliberate self poisoning that resulted in hospital treatment. Participants were included if they had no further episodes for at least two years before interview. RESULTS: We identified three recurrent themes: the resolution of adolescent distress; the recognition of the role of alcohol as a precipitating and maintaining factor in self harm; and the understanding of deliberate self harm as a symptom of untreated or unrecognised illness. CONCLUSION: Patients with a history of deliberate self harm who no longer harm themselves talk about their experiences in terms of lack of control over their lives, either through alcohol dependence, untreated depression, or, in adolescents, uncertainty within their family relationships. Hospital management of deliberate self harm has a role in the identification and treatment of depression and alcohol misuse, although in adolescents such interventions may be less appropriate.

Storey P, Hurry J, Jowitt S, et al. Supporting young people who repeatedly self-harm. J R Soc Health 2005;125:71-5.
This paper explores the views and experiences of a group of 74 young people aged 16-22 who were interviewed following presentation in accident and emergency (A&E) departments after intentionally harming themselves. It focuses on a sub-group of 38 young people with a history of self-harm behaviour that extended from when they were under the age of 16, one-third of whom had been or were currently in care. Whilst some had kept their self-harming hidden and had not received any professional intervention until they reached adulthood, others had been in touch with services, although their treatment had not prevented them from continuing to self-harm. Medication was perceived as fobbing off, particularly when unaccompanied by other treatments. The young people described their encounters with counsellors and clinicians, some of whom they perceived not to understand or to listen to their perspective. Whilst not representative of all young people who self-harm, these views are important and deserve attention if interventions for children and adolescents are to prevent repetition of self-harm.

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