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      Help-seeking before and after episodes of self-harm: a descriptive study in school pupils in England

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      1 , , 1 , 1
      BMC Public Health
      BioMed Central

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          Abstract

          Background

          Deliberate self-harm in young people is a cause for concern in many countries. The vast majority of episodes of self-harm do not result in presentation to hospital and relatively little is known about to whom or where adolescents who harm themselves go for help.

          Methods

          This school-based survey of 5,293 15–16 year olds in the United Kingdom investigated sources of help and barriers to help seeking before and after an episode of self-harm.

          Results

          Friends (40%) and family (11%) were the main sources of support. Far fewer adolescents had sought help from formal services or health professionals. Barriers to help seeking include perceptions of self-harm as something done on the spur of the moment and therefore not serious or important or to be dwelt upon. Many adolescents felt they should be able to, or could cope on their own and feared that seeking help would create more problems for them and hurt people they cared about or lead to them being labelled as an 'attention seeker'. The decision to seek help was in some cases hampered by not knowing whom to ask for help. Gender and exposure to self-harm in the peer group influenced perceived barriers to help-seeking.

          Conclusion

          There are both push and pull factors' acting on young people in their understanding of what leads them to want to harm themselves and potential mechanisms for seeking help. The implications for community based prevention programmes are discussed.

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          Most cited references38

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          Deliberate self harm in adolescents: self report survey in schools in England.

          To determine the prevalence of deliberate self harm in adolescents and the factors associated with it. Cross sectional survey using anonymous self report questionnaire. 41 schools in England. 6020 pupils aged 15 and 16 years. Deliberate self harm. 398 (6.9%) participants reported an act of deliberate self harm in the previous year that met study criteria. Only 12.6% of episodes had resulted in presentation to hospital. Deliberate self harm was more common in females than it was in males (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1 to 4.9). In females the factors included in a multivariate logistic regression for deliberate self harm were recent self harm by friends, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem. In males the factors were suicidal behaviour in friends and family members, drug use, and low self esteem. Deliberate self harm is common in adolescents, especially females. School based mental health initiatives are needed. These could include approaches aimed at educating school pupils about mental health problems and screening for those at risk.
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            Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents.

            To compare motives and premeditation between adolescent deliberate self-poisoners and self-cutters. In a sample of 6,020 pupils aged 15 and 16 years who completed a self-report questionnaire, those who had deliberately cut themselves in the previous year (n = 220) were compared with those who had taken overdoses (n = 86). More adolescents who took overdoses than those who cut themselves said that they had wanted to die (66.7% versus 40.2%, chi2 = 14.94, p <.0001) and had wanted to find out if someone loved them (41.2% versus 27.8%, chi2 = 4.14, p =.042). Female self-cutters were more likely than male self-cutters to say that they had wanted to punish themselves (51.0% versus 25.0%, chi2 = 9.25, p =.002) and had tried to get relief from a terrible state of mind (77.2% versus 60.9%, chi2 = 4.78, p =.029). More self-cutters than self-poisoners had thought about the act of self-harm for less than an hour beforehand (50.9% versus 36.1%, chi2 = 5.25, p =.021). There are differences between adolescents' motives for overdoses and for self-cutting, and also gender differences in the reasons for self-cutting. The often impulsive nature of these acts (especially self-cutting) means that prevention should focus on encouraging alternative methods of managing distress, problem-solving, and help-seeking before thoughts of self-harm develop.
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              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?

              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.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2008
                24 October 2008
                : 8
                : 369
                Affiliations
                [1 ]University of Oxford Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
                Article
                1471-2458-8-369
                10.1186/1471-2458-8-369
                2592247
                18947435
                9ba31ae5-8710-4f65-ac9a-ef5b8e006af9
                Copyright © 2008 Fortune et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 September 2007
                : 24 October 2008
                Categories
                Research Article

                Public health
                Public health

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