Some notes on self-injury in New Zealand: Prevalence, correlates and functions – Wairarapa May 2014 Jessica Garisch Robyn Langlands Angelique O’Connell Lynne Russell Marc Wilson Emma Brown Tahlia Kingi Kealagh Robinson Maddie Judge Please note that this presentation will include discussion of suicide and life-threatening behaviour

So what are we talking about…? Does it cover… Overdosing? Drinking ‘til you throw up? Taking risks? Accepting emotional abuse? Depriving yourself of food? Piercings? Tattoos? Brandings or scarification? ‘Mortification of the flesh’?

So what are we talking about…? Non-Suicidal Self-Injury (NSSI) is… (from the International Society for Study of Self-injury, 2007): “…the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. It is also sometimes referred to as self-injurious behavior, non-suicidal self-directed violence, self-harm, or deliberate self-harm (although some of these terms, such as self harm, do not differentiate non-suicidal from suicidal intent).” “As such, NSSI is distinguished from suicidal behaviors involving an intent to die, drug overdoses, and socially-sanctioned behaviors performed for display or aesthetic purposes (e.g., piercings, tattoos). Although cutting is one of the most well-known NSSI behaviors, it can take many forms including but not limited to burning, scratching, self-bruising or breaking bones if undertaken with intent to injure oneself. Resulting injuries may be mild, moderate, or severe.”

What do we know about it…?

Why do people do it…?

What do we know about it…? …In New Zealand?

Prevalence… 2,087 ED presentations across 4 regions over 12 months, 20% repeat presentations 1 24% - Lifetime prevalence among community-based New Zealand adults 2 48% of adolescents presenting to CAMHS reported SH at initial assessment 3 20% of 9,000 secondary students reported SH in previous year 4 31% of 1,700 secondary students thought of SH in previous month, 20% acted on it over 5 years 5  (conflation between SSI and NSSI) 1. Hatcher et al., Nada-Raja et al., Fortune et al., Fortune et al., Pryor & Jose, 02/04 to 09/09.

SampleNMeasure# itemsLifetime Prevalence level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† Prevalence… † r=.40 with suicidal behaviour

SampleNMeasure# itemsLifetime Prevalence level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† year-old School students 325De Leo & Heller (2004)114.8% Prevalence… † r=.40 with suicidal behaviour

SampleNMeasure# itemsLifetime Prevalence level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† year-old School students 325De Leo & Heller (2004)114.8% year-old School students 1,162Lundh et al’s (2007) DSHI1448.7% level PSYC students 593Lundh et al’s (2007) DSHI1443.7% Prevalence… † r=.40 with suicidal behaviour

SampleNMeasure# itemsLifetime Prevalence level PSYC students 285Sansone et al’s (1998) SHI2278.9%/54.9%† year-old School students 325De Leo & Heller (2004)114.8% year-old School students 1,162Lundh et al’s (2007) DSHI1448.7% level PSYC students 593Lundh et al’s (2007) DSHI1443.7% level PSYC students 722Lundh et al’s (2007) DSHI (SV)739.7%‡ Prevalence… † r=.40 with suicidal behaviour ‡ correlates.79 with the full 14-item DSHI

Youth Wellbeing Study Longitudinal survey with secondary school students. Non-Suicidal Self-injury Primarily investigating – Risk and protective factors for the development of non-suicidal self- injury – Barriers to help-seeking

Trajectory of NSSI among young New Zealanders We have data spanning age-groups – 13 – 15 years olds – 16 – 19 year olds – University students (M=19 yo) How do these groups compare in prevalence, form and function of NSSI…

Prevalence YWS Wave 1 results – N=1027 (991 responded to questions on NSSI) 213 (21%) engaged in NSSI at least once – 81.6% had engaged in NSSI in the past year Senior secondary school students – N= % had engaged in NSSI at least once – 53.6% had engaged in NSSI in past year » 46.4% over a year ago University students – N= % had engaged in NSSI at least once

YWS wave 1: Further information on prevalence... Type of NSSINever thought about Thought about, never done Have done once Have done a few times Have done many times Cut Scratched Carved Punched/ banged Stuck sharp objects Prevent healing Bitten self Burn Rubbed glass Broken bones Rubbed sandpaper Dripped acid Used bleach/ cleaning agent

Prevalence of Types of NSSI YWS Wave 1 sample – Cutting most common – Severe scratching, carving the skin, punching or banging Senior Secondary School students – Sticking sharp objects into the skin, carved, scratch most common – Cutting Other types assessed (e.g. using acid, sandpaper, etc.) much less frequently reported. Types of NSSI generally cluster into 2 factors: ‘common’ + ‘uncommon’

Engagement in multiple types of NSSI University student data suggests that the majority of young people engage in 1 – 3 types of NSSI...

Engagement in multiple types of NSSI YWS Wave 1 Of the 213 who reported NSSI – 25.6% reported 1 form – 17.4% reported 2 forms – 15.5% reported 3 forms – 37.1% reported > 3 forms

Self-reported Function of NSSI Three datasets investigating functions – Senior Secondary school data – Adult data – Wave 1 YWS

Functions: Senior secondary school students Functional Assessment of Self-Mutilations (FASM; Lloyd et al., 1997) Identified three factors: – Intrapersonal (endorsed by 38.2% participants) “To feel more a part of a group” “To get your parents to understand or notice you” – Emotional relief/control (endorsed by 18.2%) “To feel something, even if it is pain” “To punish yourself” – Avoidance (endorsed by 20.0%) “To avoid being with people” “To avoid punishment or paying the consequences”

Adult Community Sample (Langlands, 2012) Using the Inventory of Statement about Self-Injury (ISAS) (Klonsky & Olino, 2008) Interpersonal Intrapersonal

YWS Wave 1: Four Clusters (Functions assessed using FASM (Klonsky & Olino, 2008) Interpersonal: Other-focused Interpersonal: self-focused Intrapersonal: Disconnection Intrapersonal: Affect & Punish