Concern about exposure to suicide-related content, both in the media and online, is prevalent. Research evidence is inconclusive, with evidence both that the exposure to fictional suicide media content such as this results in contagion and some that refutes this claim 52, More research will be required into the nuance of these types of exposures and those that may be particularly vulnerable. It is important that parents and professionals are aware of what digital and media content young people are accessing, and then discuss this with them and consider restricting access in some situations.
The 13 Reasons Why Toolkit is an example of a response to these concerns and provides guidance for young people, parents, professionals and educators. Alternative subcultures, such as goth or emo do appear to be associated with greater risk of self-harm and suicide 54, 55 , though the direction of association or specifics about what aspects of these subcultures are harmful require further research.
These theories are based on the concept that thoughts about suicide and suicidal acts are distinct processes, and that factors that influence the development of suicidal thoughts are different to those which lead to the transition from thoughts to acts.
There is some evidence to suggest that altered pain tolerance is associated with self-harm, though it is not yet clear whether this is a consequence or cause of the behaviour This may be through psychological or biological mechanisms and requires more research. However, there is already evidence that those who self-harm have higher pain thresholds and that these people also have higher levels of personality features such as introversion, neuroticism and lower self-worth Different types of school-based prevention programme have been developed which fit into the categories of universal prevention delivered to whole school populations , selective prevention delivered to groups identified as being at higher risk and indicated prevention delivered to those already known to engage in self-harm behaviour aimed at reducing its severity and frequency.
Many of these programmes do not as of yet have clear evidence for their effectiveness, however, two universal interventions have shown promise. There has been some success shown with the Youth Aware of Mental Health Programme, which in the SEYLE Randomized Control Trial showed effectiveness in both reducing severe suicidal ideation and suicide attempts compared with controls 60 and in the Signs of Suicide SOS prevention programme which had promising results in reducing suicidal thoughts and behaviours 61, As there are many reasons young people may self-harm there is potential in trying to address particular aspects of the aetiology of self-harm.
For example, by addressing self-criticism through novel interventions such as Autobiographical Self Enhancement Training. This has shown some potential positive effects, but limited effect on suicidality Digital platforms are so commonly used by young people and a wealth of information may be shared online. Electronic health records also hold a great deal of unstructured information on self-harm and suicide risk. There is the potential, using novel technological advancements, such as Natural Language Processing, to detect risk of self-harm and suicide in both digital platforms 64 and in routinely collected electronic health records 65 ; which could lead to better detection of young people at risk and targeting of interventions.
The following provide further useful information and resources about self-harm. Please be aware that not all resources will have undergone formal evaluation. Some resources are country-specific and therefore may not applicable to other settings. The authors cannot guarantee that the following resources will remain up-to-date. ACAMH uses cookies in order to deliver a personalised, responsive service and to improve the site. Continue Find out more. Risk factors for self-harm Self-harm is more common in females, whereas completed suicide is more common in males 1.
Methods of self-harm and suicide There is variability in methods of self-harm according to the availability of means and exposures and the method of self-harm does not necessarily predict the method of suicide. Prevention It is a minority of young people who self-harm, who present to hospital 37 , which makes prevention challenging on an individual level. Less established risk factors and exposures The rise of social media and the internet has caused concern and while there is evidence that suggests aspects of online activity may increase self-harm and suicide, there is also the potential for the internet to serve as a means of seeking positive interactions and support Prevention Different types of school-based prevention programme have been developed which fit into the categories of universal prevention delivered to whole school populations , selective prevention delivered to groups identified as being at higher risk and indicated prevention delivered to those already known to engage in self-harm behaviour aimed at reducing its severity and frequency.
Self-harm and suicide in adolescents. Lancet London, England. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health. Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital.
British Journal of Psychiatry. Global patterns of mortality in young people: a systematic analysis of population health data. Adolescent suicidal behaviours in 32 low- and middle-income countries. Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies. Clin Psychol Rev. Organization WH. International statistical classification of diseases and related health problems 11th Revision [ Nock MK.
Annual Review of Clinical Psychology. Steele M, Doey T. Suicidal Behaviour in Children and Adolescents. Youth self-harm in low- and middle-income countries: Systematic review of the risk and protective factors. International Journal of Social Psychiatry.
A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown. Self-harm and psychosocial characteristics of looked after and looked after and accommodated young people. Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study.
The Lancet Psychiatry. Prevalence, distribution, and associated factors of suicide attempts in young adolescents: School-based data from 40 low-income and middle-income countries. Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. Int J Public Health. Method of self-harm in adolescents and young adults and risk of subsequent suicide. J Child Psychol Psychiatry. Naghavi MA-O. Global, regional, and national burden of suicide mortality to systematic analysis for the Global Burden of Disease Study The global distribution of fatal pesticide self-poisoning: Systematic review.
BMC Public Health. Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, The natural history of self-harm from adolescence to young adulthood: a population-based cohort study. The Lancet. What distinguishes adolescents with suicidal thoughts from those who have attempted suicide?
A population-based birth cohort study. Borderline personality disorder in adolescence. Developmental trajectories of self-injurious behavior, suicidal behavior and substance misuse and their association with adolescent borderline personality pathology.
Other examples include ingesting toxic chemicals, extreme skin picking, hair pulling and deliberate interference with wound healing. The individual gains a superficial sense of emotional and mental relief after the harmful act is completed followed by feelings of shame or guilt resulting in even more negative emotions until this cycle continues. Studies have shown that there are four main reasons why individuals engage in self harm behavior:.
Self-harm is often misconstrued as being directly linked with suicide but this is not the case as the two are drastically different. Since suicide and self-harm are inflictions of pain, they often get grouped together under the same subject. Although it sometimes is true that individuals who engage in self-harm may later commit suicide, generally individuals who engage in self-harm do not wish to end their life but rather engage in self-harm as a way to cope with their life.
Individuals who attempt suicide do so with the intent to end their life due to their suffering. The most significant difference between suicide and self-harm is the intent.
Suicide attempts usually come from a place of despair, hopelessness, and worthlessness. Both behaviours, however, were intended to escape or relieve negative emotions.
Certain personal characteristics distinguish between individuals who engage in NSSI and those who attempt suicide. Those who attempt suicide tend to have more symptoms of depression and display more anger and aggression. Individuals who engage primarily in NSSI tend to present with more emotional instability and volatility. Suicidal ideation is predictive of later suicide attempts, but not NSSI. Suicide attempts and NSSI are correlated with each other. Those who engage in NSSI are at increased risk for suicide compared to individuals who do not self-injure, but the risk remains very low i.
The risk of death is higher for those with previous suicide attempts. It has been found that approximately half of offenders who died by suicide had made at least one previous suicide attempt. NSSI and suicide attempts are distinct behaviours.
In order to effectively treat and manage both of these behaviours, they should not be grouped together. Rather, their different characteristics, motivations and purposes suggest that different approaches may be needed. Brown, M.
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