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      Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait Islanders who are engaging in non-suicidal self-injury

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          Abstract

          Background

          Non-suicidal self-injury (NSSI) disproportionally affects Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is engaging in NSSI. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islanders who are engaging in NSSI were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions.

          Methods

          The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non-Indigenous frontline workers can take, and information they should have, to help someone who is engaging in NSSI. The statements were sourced from systematic searches of peer-reviewed literature, grey literature, books, websites and online materials, and existing NSSI courses. A panel was formed, comprising 26 Aboriginal and Torres Strait Islanders with expertise in NSSI. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important.

          Results

          From a total of 185 statements shown to the expert panel, 115 were endorsed as helping statements to be included in the re-developed guidelines.

          Conclusions

          A panel of Aboriginal and Torres Strait Islander people with expertise in NSSI were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander engaging in NSSI. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version. The re-developed guidelines will form the basis of an Aboriginal mental health first aid short course on NSSI for Indigenous community members and non-Indigenous frontline workers that will be evaluated in an upcoming trial.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12888-017-1465-1) contains supplementary material, which is available to authorized users.

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          Most cited references30

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          Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts.

          Non-suicidal self-injury (NSSI) is a prevalent behavioral problem, yet many fundamental aspects of NSSI remain unknown. This case series study reports on the diagnostic correlates of adolescents with a recent history of NSSI and examines the relation between NSSI and suicide attempts. Data are from clinical interviews with 89 adolescents admitted to an adolescent psychiatric inpatient unit who engaged in NSSI in the previous 12 months. Results revealed that 87.6% of adolescents engaging in NSSI met criteria for a DSM-IV Axis I diagnosis (M=3.0, S.D.=2.2, range=0 to 8 diagnoses), including externalizing (62.9%), internalizing (51.7%), and substance use (59.6%) disorders. Most adolescents assessed also met criteria for an Axis II personality disorder (67.3%). Overall, 70% of adolescents engaging in NSSI reported a lifetime suicide attempt and 55% reported multiple attempts. Characteristics of NSSI associated with making suicide attempts included a longer history of NSSI, use of a greater number of methods, and absence of physical pain during NSSI. These findings demonstrate the diagnostic heterogeneity of adolescents engaging in NSSI, highlight the significant overlap between NSSI and suicide attempts, and provide a point of departure for future research aimed at elucidating the relations between non-suicidal and suicidal self-injury.
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            A functional approach to the assessment of self-mutilative behavior.

            This study applied a functional approach to the assessment of self-mutilative behavior (SMB) among adolescent psychiatric inpatients. On the basis of past conceptualizations of different forms of self-injurious behavior, the authors hypothesized that SMB is performed because of the automatically reinforcing (i.e., reinforced by oneself; e.g., emotion regulation) and/or socially reinforcing (i.e., reinforced by others; e.g., attention, avoidance-escape) properties associated with such behaviors. Data were collected from 108 adolescent psychiatric inpatients referred for self-injurious thoughts or behaviors. Adolescents reported engaging in SMB frequently, using multiple methods, and having an early age of onset. Moreover, the results supported the structural validity and reliability of the hypothesized functional model of SMB. Most adolescents engaged in SMB for automatic reinforcement, although a sizable portion endorsed social reinforcement functions as well. These findings have direct implications for the understanding, assessment, and treatment of SMB.
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              Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis.

              Suicidal behavior and self-harm are common in adolescents and are associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm and links between self-harm and suicide and risk of suicide attempt, progress in reducing suicide death rates has been elusive, with no substantive reduction in suicide death rates over the past 60 years. Extending prior reviews of the literature on treatments for suicidal behavior and repetitive self-harm in youth, this article provides a meta-analysis of randomized controlled trials (RCTs) reporting efficacy of specific pharmacological, social, or psychological therapeutic interventions (TIs) in reducing both suicidal and nonsuicidal self-harm in adolescents.
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                Author and article information

                Contributors
                g.armstrong@unimelb.edu.au
                ironfield.n@unimelb.edu.au
                clairek@mhfa.com.au
                katrinad@mhfa.com.au
                kerry.arabena@unimelb.edu.au
                kathybond@mhfa.com.au
                ajorm@unimelb.edu.au
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                22 August 2017
                22 August 2017
                2017
                : 17
                : 300
                Affiliations
                [1 ]ISNI 0000 0001 2179 088X, GRID grid.1008.9, , Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, ; 207 Bouverie St, Carlton, Victoria 3010 Australia
                [2 ]Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, Victoria 3053 Australia
                [3 ]ISNI 0000 0001 2179 088X, GRID grid.1008.9, , Indigenous Health Equity Unit, Melbourne School of Population Health, University of Melbourne, ; 207 Bouverie St, Carlton, Victoria 3010 Australia
                Author information
                http://orcid.org/0000-0002-8073-9213
                Article
                1465
                10.1186/s12888-017-1465-1
                5568063
                28830485
                0e495936-500f-4471-a9b9-4cb1b751cd15
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 October 2016
                : 14 August 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: 1076796
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Clinical Psychology & Psychiatry
                non-suicidal self-injury,indigenous,mental health first aid,early intervention,helping behaviour,assistance

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