Variations in Risk and Treatment Factors Among Adolescents Engaging in Different Types of Deliberate Self-Harm in an Inpatient Sample

Abstract

This study employs a framework adopted in 2008 by Jacobson, Muehlenkamp, Miller, and Turner to explore differences in risk and treatment factors in a sample of 476 adolescent inpatients grouped with relation to their involvement in deliberately self-harmful (DSH) behavior. Participants were assigned to groups indicating no DSH, nonsuicidal self-injury (NSSI) only, suicide attempts (SA) only, and NSSI + SA. Groups were compared with respect to their status on a variety of background risk factors (e.g., maltreatment, presenting psychopathology, family history) and in-treatment behaviors (e.g., critical incidents resulting from self-injurious gestures) linked to DSH. Findings generally supported the conclusions drawn by Jacobson et al. in terms of the overall severity of youth exhibiting NSSI + SA, with some important similarities observed between the NSSI-only and NSSI + SA groups.

This study was funded by a grant from the National Institute of Mental Health (MH72980). I acknowledge the support provided at various phases of this project by Robert Bailey, James Bow, Joy Wolfe Ensor, Rashmi Bhandari, Ruth Robinson, Esther Petrovich, Elizabeth Rakstis, Vicki Alley, Dianne Tomaine, Judy Valentine, and Rowell Huesmann. Assistance with data coding was provided by Sara Chase, Jessica Luitjohan, Rebecca Gerhardstein, Sarah Savoy, and Andrew Terranova.

Notes

¹ Seclusion involves moving an individual into an unfurnished room and preventing him or her from exiting until the he or she is deemed no longer to be at risk for harming self or other. Restraint refers to a restricting an individual's movement via three possible methods. Physical restraint involves staff limiting movement by holding a youth. Mechanical restraint involves the use of some apparatus to limit movement (e.g., strapping a youth to a bed). Chemical restraint involves the use of medication to reduce agitation. Chemical restraint is not applied as such at the host facility, and thus none of the incidents recorded for this study involved that form of restraint. Incidents occur when a member of the treatment staff determines that a youth's behavior is presenting the threat of imminent harm to him- or herself or another person. There are no other circumstances at the host facility that allow the use of seclusion or restraint.

Note. NSSI = nonsuicidal self-injury only; SA = suicide attempts only; NSSI + SA = combined–both NSSI and SA.

^a n = 146.

^b n = 119.

^c n = 64.

^d n = 147.

Note. NSSI = nonsuicidal self-injury only; SA = suicide attempts only; NSSI + SA = combined–both NSSI and SA. Raw means are presented; log-transformed scores were used in inferential analysis.

^a n = 146.

^b n = 119.

^c n = 64.

^d n = 147.

²Exploratory analyses of interaction effects (using p < .05) among sex, racial/ethnic status (White/non-White), and NSSI/SA grouping on treatment variables did not reveal any significant moderation by the demographic factors.

Note. NSSI = nonsuicidal self-injury only; SA = suicide attempts only; NSSI + SA = combined–both NSSI and SA. Raw means are presented. GAF = Global Assessment of Functioning; hx = history; DSMD = Devereaux Scales of Mental Disorders.

^a n = 146.

^b n = 119.

^c n = 64.

^d n = 147.

³Exploratory analyses of interaction effects among sex, racial/ethnic status (White/non-White), and NSSI/SA grouping on background risk variables suggested some qualification for the main effect analyses of NSSI/SA grouping. Sex × NSSI/SA grouping effects were observed for sexual abuse (p < .05, partial η² = .02) and DSMD internalizing problems (p < .05, partial η² = .02). With respect to sex, girls in the NSSI + SA group had the most extensive histories of sexual abuse, with scores significantly higher than the No-DSH and SA-only groups; there were no significant differences for boys. Boys in the SA-only group had the highest DSMD internalizing scores, with scores significantly higher than the No-DSH and NSSI-only groups; there were no significant differences for girls (all p < .05).

With respect to race/ethnicity (i.e., minority status), Minority Status × NSSI/SA grouping effects were observed for emotional abuse (p < .05, partial η² = .02) and DSMD internalizing problems (p < .05, partial η² = .03). Non-Whites in the NSSI-only group had the most extensive histories of emotional abuse, with scores significantly higher than the No-DSH and SA-only groups. Nonwhites in the combined group also had significantly higher scores on emotional abuse than did the No-DSH group. There were no significant differences for Whites. Whites in the SA-only group had the highest DSMD internalizing scores, scoring significantly higher than Whites in the NSSI-only and No-DSH groups. Whites in the combined group scored significantly higher than did Whites in the NSSI-only and No-DSH groups (all p < .05).