Characteristics of Self-Injury in Young Adolescents: Findings from Cross-Sectional and Longitudinal Studies in Swedish Schools

Sammanfattning: Self-injury in adolescents (e.g. when individuals cut, burn, hit or otherwise deliberately cause themselves direct injury), has gained recognition as a potentially important mental health problem during the past decade. Relatively little has been known about the scope and characteristics of this behavior in Swedish adolescents. This thesis consists of three studies that in different ways explore the characteristics of self-injury among adolescents in the general community. In Study 1 a convenience sample of 202 adolescents responded to a battery of self-report questionnaires on self-injury and a number of related factors at two different occasions. At these times 36.5 % and 40.2 % respectively reported to have deliberately engaged in self-injurious behaviors. Self-injury also showed robust relationships with general psychopathology, an absence of positive feelings to parents, and a ruminative style of emotion regulation. These latter two factors were also predictors of self-injury, independently of general psychopathology. Additionally, in girls, results also indicated a relationship between self-injury and symptoms of eating disorder and negative body esteem. Study 2 used a longitudinal survey design with a 1-year interval to further investigate self-injury in a community sample of 1052 adolescents. The battery of self-report questionnaires on self-injury and related factors was again employed, and both conventional statistical methods and hierarchical cluster analysis were used to analyze the results. Results indicated that 41.5 % and 42.9 % respectively had engaged in self-injury, as reported at the two occasions of data collection. The cluster analyses identified eight different subgroups of self-injuring adolescents (in each gender) based on patterns of self-injury. In both boys and girls a fairly large proportion (about 60 %) of self-injuring adolescents were found in a subgroup reporting low-frequency self-injury only, and little psychological difficulties. The analysis also identified a small subgroup of both girls and boys (about 5 % of self-injuring girls and 3 % of self-injuring boys) reporting frequent self-injury and multiple self-injury methods, as well as often reporting pronounced forms of both externalizing and internalizing psychopathology. A third subgroup of interest was found in girls (consisting of about 10 % of self-injuring girls) who showed a pattern of cutting behaviors as their main form of self-injury, primarily related to internalizing forms of psychopathology. Additionally, the cluster analyses identified subgroups within each gender, which were characterized by different patterns of self-injury, associated with varying degrees and forms of psychopathology. Overall, the subgroups of self-injuring girls were both more stable over time and associated with more psychological problems. Study 3 analyzed data collected through interviews with both self-injuring adolescents (n = 66) and a group of their non-injuring peers (n = 31) from the sample used in Study 2. Around 2/3 of the adolescents that were asked were willing to engage in an interview and also reported positively about it afterwards. Interviewing adolescents about self-injury gave varying amounts of additional information not covered in the questionnaires. Only about 1 in 5 of those who reported self-injury in a questionnaire acknowledged currently engaging in self-injury when interviewed. In about half of the cases, adolescents did not share any information about self-injury at all in the interview; others still reported having ceased to engage in such behavior. Further, in only about 1 of 4 cases where sufficient information was presented to the interviewer to allow for an assessment of the severity of the behavior, was the problem assessed as serious. The rates of self-injury were also compared approximately one year after the interview between those adolescents who were interviewed and a matched control group. Results did not indicate that being interviewed about one’s situation affected the tendency to self-injure. Taken together, these studies demonstrate that among young Swedish adolescents in the general community, a large proportion indicate having engaged in some form of self-injury. Even though self-injury in these studies appears to be clearly related to other psychological difficulties, only in a minority of the cases does this appear to be a serious problem. The findings highlight that self-injury in adolescents may have different clinical and developmental implications for different individuals. School based interventions may be warranted to address self-injury in the general community, and addressing self-injury in this setting may provide important information about individuals’ self-injurious behaviors, and also provide a setting where support and care can be conveyed. However, such procedures need to be further developed in order to be sufficiently attractive for adolescents.