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Deliberate self-harm (DSH) is a public health problem that mainly affects adolescents and young adults. Evidence suggests that multiple methods are used with a self-aggressive intent. The present article focuses on the development and factorial validation of the Inventory of Deliberate Self-harm Behaviours for Portuguese adolescents. This instrumen...
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Citations
... Nationally, the prevalence of these behaviors among adolescents ranges between 7% and 40.8% (Duarte et al., 2020;Gaspar et al., 2022;Guerreiro et al., 2017;Nobre-Lima et al., 2017). DSH are non-fatal and self-aggressive behaviors, regardless of suicidal intent (Duarte et al., 2019;Gouveia-Pereira et al., 2022;Madge et al., 2008). These behaviors are often understood as part of a spectrum, arranged according to their severity (i.e., level of physical harm caused by each method of DSH), and according to the Gateway Theory, they might be an entry point to a wider spectrum of suicidal thoughts and behaviors (STBs) (Grandclerc et al., 2016;Hamza et al., 2012). ...
... These behaviors are often understood as part of a spectrum, arranged according to their severity (i.e., level of physical harm caused by each method of DSH), and according to the Gateway Theory, they might be an entry point to a wider spectrum of suicidal thoughts and behaviors (STBs) (Grandclerc et al., 2016;Hamza et al., 2012). The diversity of these behaviors (i.e., number of DSH methods) and suicidal ideation (SI) (i.e., thoughts or willingness to commit suicide) is also a predictor of suicide attempts (SA) (Duarte et al., 2019;Duarte et al., 2020;Gouveia-Pereira et al., 2022;Hawton et al., 2012). ...
... The Inventory of Deliberate Self-Harm Behaviors (ICAL) is a self-report measure that was previously validated for Portuguese adolescents and indicated acceptable psychometric properties (Duarte et al., 2019). The participants were asked to indicate the lifetime frequency of 14 DSH behaviors (e.g., cutting, biting), with a four-option response format ("No", "Yes -1 time", "Yes, 2-10 times", "Yes, more than 10 times"). ...
Introduction: Family conflicts are considered a risk factor for deliberate self-harm (DSH) and even suicidal thoughts and behaviors. Research also shows that adolescents are increasingly engaging in online DSH activities. However, studies on this topic are scarce. Aims: This study’s first goal is to replicate the effect of family conflicts on suicidal ideation (SI) and, according to the gateway theory, include DSH diversity as a step preceding SI. Second, we aim to consider online activities in understanding suicidal risk. We start by describing online DSH activities, and propose a sequential mediation model in which family conflicts predict DSH and SI through online DSH activities. Methods: The convenience sample of this cross-sectional study consisted of 357 adolescents and young adults between 12 and 22 years old who completed a self-report questionnaire measuring family conflicts, online DSH activities, identification with DSH-related content creators, DSH, and suicidal ideation. Results: The results showed that 85.3% of our community sample used the internet for DSH-related purposes. Results also revealed an independent mediation effect of DSH diversity on the relationship between family conflicts and SI, and a sequential mediation effect of online DSH activities, identification, and DSH diversity. Conclusions: Engaging in online DSH activities is only predictive of DSH or SI if adolescents perceive a shared identity with this community of creators. The findings might yield implications regarding the design of prevention strategies that include a further supervision of online platforms and psychological interventions that incorporate the family system and peers.
... Suicidal behavior is a public health concern in several countries (Arbuthnott and Lewis, 2015;Duarte et al., 2019;Guerreiro et al., 2017). In 2014, the World Health Organization (WHO) classified suicidal behavior as a public health problem and stated that suicide was the second leading cause of death amongst young people aged between 15 and 29 years old, worldwide. ...
... DSH is one of the most significant and predictive risk factors for suicide attempts (SA; Barrocas et al., 2015;Duarte et al., 2020b) and research has established an unambiguous association between DSH and suicide. These behaviors may be understood as a gateway to suicide (Barrocas et al., 2015;Castellví et al., 2017;Duarte et al., 2019;Klonsky et al., 2012;Parra et al., 2015;Whitlock et al., 2013) since engaging in DSH might increase tolerance for physical pain and contribute to the capacity to kill oneself (Duarte et al., 2020b;Gouveia-Pereira et al., 2022;Hamza et al., 2012;Klonsky et al., 2014;Pompili et al., 2015). ...
... Studies have shown that nine out of ten adolescents who attempted suicide have a previous history of DSH behavior (Duarte et al., 2020a) and that young people with DSH have a threefold suicide risk, regardless of the presence of other risk factors, such as depression (Barrocas et al., 2015;Duarte et al., 2019;Klonsky et al., 2014). It is also known that engaging in more severe (e.g., cutting versus biting) DSH methods, and engaging in more different methods (i.e., DSH diversity) contribute to a significantly higher risk of suicide (Duarte et al., 2020a(Duarte et al., , 2020bGouveia-Pereira et al., 2022;Pompili et al., 2015). ...
In Portugal, the lifetime prevalence of DSH in adolescents is situated between 16% and 35% (Duarte et al., 2020a; Gouveia-Pereira et al., 2016). Help-seeking is an important facilitator to stop these behaviors, although it is known that most individuals who engage in self-harm do not ask for help (Rowe et al., 2014). Study one (n = 222) examines the differences between two groups of young adults with a history of deliberate self-harm (participants who asked for help and participants who did not ask for help) regarding these behaviors' severity and diversity, suicidal ideation, and family conflicts. Participants completed a self-report questionnaire which included an open-ended question focused on the reasons that may or may not contribute for seeking help. Significant differences between the two groups were found for all variables and are further discussed, followed by a qualitative analysis concerning the help-seeking motives. Study two (n = 110) used a self-report questionnaire to analyze the expectations of young adults with a history of deliberate self-harm concerning their social support network and the role of healthcare workers when they asked or thought about asking for help. These expectations included contents related with problem-solving, confidentiality, understanding and trust, support, and unburdening. Identifying facilitators and barriers to help-seeking can be a relevant step in planning and managing interventions within deliberate self-harm. Future directions and limitations are discussed.
... Regarding the less mentioned dimensions, the consumption of psychoactive substances has been associated with NSSI and SA (Fortune et al., 2008;Stewart et al., 2017), and it can also be a self-injurious method (Duarte et al., 2019a;Gouveia-Pereira, & Gomes, 2019;Hawton et al., 2003). The psychological functions that were referenced by the participants are in accordance with those described by the literature (e.g., Klonsky, 2007), as well as the several self-injurious methods that can be utilized (Duarte et al., 2019a;Gouveia-Pereira, & Gomes, 2019;Klonsky, 2007;Klonsky et al., 2015). ...
... Regarding the less mentioned dimensions, the consumption of psychoactive substances has been associated with NSSI and SA (Fortune et al., 2008;Stewart et al., 2017), and it can also be a self-injurious method (Duarte et al., 2019a;Gouveia-Pereira, & Gomes, 2019;Hawton et al., 2003). The psychological functions that were referenced by the participants are in accordance with those described by the literature (e.g., Klonsky, 2007), as well as the several self-injurious methods that can be utilized (Duarte et al., 2019a;Gouveia-Pereira, & Gomes, 2019;Klonsky, 2007;Klonsky et al., 2015). ...
Introduction: Non-suicidal self-injury, suicidal thoughts and behaviors present
high prevalence rates in adolescence.
Aims: This study aimed to describe adolescents’ perceptions about these
phenomena, and to analyze and compare the differences of these perceptions
among adolescents with and without a history of non-suicidal selfinjury,
suicidal ideation, and suicide attempts.
Methods: The convenience sample consisted of 452 adolescents in ages between
12 and 18 (M(SD) = 15.59(1.50), 48% male and 52% female. For
data collection, the Free Association Test was used in a survey, and data was
analyzed through content analysis.
Results: Results showed that 10.8% of the participants presented a history
of non-suicidal self-injury, 19.9% suicidal ideation, and 2.7% suicide
attempts. Perceptions were grouped into eight dimensions: Consumption
of Psychoactive Substances; Death/Suicide; Interpersonal Factors;
Intrapersonal Factors; Moral Judgments; Negative Emotions; Psychological
Functions; and Self-Injurious Methods. Further analysis revealed that
adolescents with and without a history of non-suicidal self-injury, suicidal
ideation, and suicide attempts presented differences in their perceptions of
these phenomena.
Conclusions: These findings contribute to the understanding regarding the
perceptions of adolescents about these phenomena and might have implications
regarding their prevention and intervention.
... Since DSH involves multiple types of self-aggressive behavior, the actual physical harm caused by DSH can vary significantly (Muehlenkamp et al., 2012). DSH diversity refers to the number of methods or behaviors employed for DSH, while DSH severity refers to the degree of physical damage caused by each DSH method or behavior and is usually categorized according to its levels of severity (Croyle and Waltz, 2007;Duarte et al., 2019;Skegg, 2005). It is known that DSH diversity and STBs are associated (Andover et al., 2012;Duarte et al., 2020;Kiekens et al., 2018;Stewart et al., 2017). ...
... To assess DSH, we selected the Inventory of Deliberate Self-Harm Behaviors (ICAL, Duarte et al., 2019), since it is validated for Portuguese adolescents, it comprises a variety of DSH methods, and it allows the categorization of these methods according to their severity. This is a self-report inventory asking participants about the lifetime frequency of 13 different deliberate self-harm (DSH) behaviors, with a four-option response format ("No", "Yes -1 Time", "Yes, 2-10 Times", "Yes, More than 10 Times"). ...
... The prevalence and diversity of DSH were in accordance with other national (Duarte et al., 2019(Duarte et al., , 2020 and international studies (e.g., Calvete et al., 2015;Muehlenkamp et al., 2012). Females showed higher prevalence and diversity of DSH than males, which is also consistent with previous studies (Bresin and Schoenleber, 2015;Laye-Gindhu and Schonert-Reichl, 2005;Plener et al., 2009). ...
Deliberate self-harm (DSH) in adolescence is a predictor of suicidal thoughts and behaviors (STBs). However, there is still a lack of research systematizing the association between DSH and STBs. Therefore, our main goal was to analyze if DSH diversity and severity predicted suicidal ideation and suicide attempts.
Our sample comprised 237 Portuguese adolescents and young adults with a history of DSH, from community (80.2%, n=190) and clinical (19.8%, n=47) settings, aged between 14 and 23 years (M=17.31, SD=1.36).
Results showed that DSH diversity and severity were significant predictors of suicidal ideation and suicide attempts.
These results were further discussed, underlining the impact that DSH has for suicide risk and highlighting the need to address further variables to understand these suicidality trajectories.
... Previous findings revealed that intrapersonal functions are the most common among adolescents with deliberate self-harm (e.g. Klonsky, 2007), while participants without these behaviours tend to emphasize interpersonal functions (Batejan et al., 2015;Duarte, Gouveia-Pereira, & Gomes, 2019). Hence, for the first study, we hypothesize that adolescents with a history of deliberate self-harm will significantly emphasize intrapersonal functions and, on the other hand, adolescents without a history of deliberate self-harm will significantly emphasize interpersonal functions. ...
... Our findings are similar to those found in previous research (Bresin et al., 2013;Duarte et al., 2019) and specifically in the study conducted by Batejan et al. (2015), where participants without a history of deliberate self-harm mentioned more interpersonal functions. The discrepancies between the social representations from adolescents without these behaviours and the social representations of adolescents with deliberate self-harm imply that the personal experience of deliberate self-harm builds and/or changes the social representations from adolescents. ...
Introduction
The understanding of the social representations about the functions of deliberate self‐harm can be an important factor for the comprehension of this phenomenon. Nonetheless, only a few studies focused on this topic and specifically on the social representations from adolescents with and without a history of deliberate self‐harm and their parents.
Methods
This article presents two studies that analysed these representations. Study 1 compared the social representations from 411 Portuguese adolescents (219 females and 192 males, aged 12–19 years), from which 109 reported having a history of deliberate self‐harm. Study 2 focused on the comparison of the social representations from 471 parents (265 mothers and 206 fathers, aged 33–62 years) of Portuguese adolescents. Of the parents in Study 2, 120 had children with a history of deliberate self‐harm.
Results
In Study 1, adolescents without a history of deliberate self‐harm perceived most interpersonal functions as more relevant than adolescents with a history of these behaviours, while adolescents with a history of deliberate self‐harm emphasized one intrapersonal function. In Study 2, no differences were found between parents of adolescents with and without a history of deliberate self‐harm. However, results revealed differences between the representations of mothers and fathers in several intrapersonal functions.
Conclusions
This research provides important insight regarding the social representations about the functions of deliberate self‐harm from adolescents with and without a reported history of these behaviours and their parents. The impact for clinical intervention and prevention programs is discussed.
Reports of sex and age differences in the presentation of borderline symptoms have been limited to the Western literature and have not systematically compared adolescents with emerging and older adults with borderline personality disorder (BPD). This study aimed to examine the impact of age and sex on the expression of borderline symptoms in adolescents, young adults, and older adults with BPD. A sample of 493 Iranian individuals with a confirmed diagnosis of BPD was segregated into 2 age groups: 134 young people aged 12–25 (mean = 17.60), and 142 adults aged 26 and older (mean = 31.69). Young people were divided into: 241 adolescents (mean = 15.59) and 100 young adults (mean = 22.45). Older groups compared with their younger counterparts showed significantly greater severity of borderline symptoms and greater difficulties with emotion regulation, but younger groups showed greater emotional and behavioral dysregulation. Sex differences generally mirrored those reported in the Western literature. Despite being limited by its cross‐sectional design, this study suggests that adolescents, young adults, and older adults differ significantly in the way their borderline symptoms are expressed. The development of gender identity in adolescents with BPD and a disturbed sense of self is a neglected but potentially fruitful area of future research.
Suicidality is a multifaceted phenomenon affected by several multisystemic vulnerabilities, including demographic, psychopathological, and family factors. However, few studies have explored the contribution of specific features of deliberate self-harm (DSH) to suicide risk, particularly DSH diversity, while also accounting for other relevant explanatory family and mental health dimensions. The main goal of this study was to examine if DSH diversity predicts the risk for suicide in adolescents in the presence of sociodemographics, depressive symptoms, and family relationship characteristics. This study consisted of 437 Portuguese adolescents (53.8% male, 42.8% female, 3.4% non-binary; Mage= 15.2, SD = 1.87), of which 220 confirmed having a lifetime history of DSH. The participants completed a self-report questionnaire measuring depressive symptomatology, interparental conflicts, family communication, DSH, and suicidal ideation. A logistic regression analysis was conducted. Our multivariate model revealed that depressive symptoms, family communication, and DSH diversity are predictors of suicide risk in adolescents. The strongest predictor was depressive symptoms. The analyses indicated that our global model has excellent predictive validity to discriminate between those with and without suicide risk, and the inclusion of DSH diversity enhances the identification of these vulnerable youth. In addition, our results suggest that non-binary gender adolescents are particularly at risk. The set of characteristics we found that predict suicide risk highlights the multisystemic nature of this phenomenon: individual/ psychopathological and relational dimensions. We also underscore the need to be vigilant of adolescents’ number of used DSH behaviors. Our findings provide valuable information for developing multisystemic targeted interventions aimed at preventing and reducing suicide risk among adolescents.
Os comportamentos autolesivos, sejam eles suicidários ou não suicidários, constituem atualmente um incontornável problema de saúde pública, pela sua elevada incidência e impacto. Os comportamentos autolesivos não suicidários
são mais comuns na fase da adolescência, mesmo em jovens com um desenvolvimento normativo. A sua prevalência
é, contudo, consideravelmente superior na população clínica, com 50% a 60% dos adolescentes com psicopatologia
a apresentar episódios únicos ou repetidos de comportamentos autolesivos não suicidários. Estes comportamentos podem associar-se a mais do que uma causa e função, em resultado da interação entre múltiplos fatores de risco e de manutenção, como por exemplo, genéticos, biológicos, psiquiátricos, psicológicos, sociais e culturais. A prevalência significativa de comportamentos autolesivos não suicidários na população clínica e os desafios associados à abordagem destes jovens, seja numa componente de avaliação ou de intervenção, contribuem para a pertinência desta revisão narrativa cujos objetivos são a caracterização destes comportamentos e, por outro lado, a pesquisa de evidência sobre a vertente de avaliação e intervenção na perspetiva das terapias cognitivo-comportamentais.
In the past 10 years, there has been a growing interest in self-injurious behavior (SIB) among adolescents. The lifetime prevalence of SIB is between 16 and 22% in community sample with females more likely to engage in SIB. There are conflicting results about the global distribution of the prevalence of SIB and whether the SIB has increased in the 21st century. Our aim in the current study was to conduct a systematic search of and meta-analysis on the prevalence of SIB in adolescents over the past 5 years’ worth of published papers and to examine gender, continental, and year differences. We conducted a systematic search in June 2020 of six databases (PubMed, Scopus, Web of Science, OVID Medline, PsycINFO, EBSCO) with three main search terms: “self-injurious behavior,” “prevalence,” and “adolescence.” Article inclusion criteria were (a) written in English; (b) published between January 1, 2015, and June 18, 2020; and (c) focused on a community sample. Titles and abstracts of the articles were screened first. Then, the relevant full texts were read, and those that met the inclusion criteria were collected. We used Comprehensive Meta-Analysis software was used to conduct the analyses. After the screening process 97, articles were included in the meta-analysis. The age of the samples ranged from 11.00 to 18.53 years. The overall average prevalence of nonsuicidal self-injury in the studies was 16%. There was a significant gender difference: females reported a higher prevalence than males (19.4% and 12.9%, respectively). A significantly higher prevalence was found among Asian articles than those from other continents (19.5% and 14.7%, respectively). The prevalence of SIB did not change significantly between 2013 and 2018. The current research draws attention to the high prevalence of SIB among adolescents, especially among females and those living in Asia. It is important to address this behavior, both in terms of prevention and intervention.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00787-023-02264-y.
