Experiences of Help from the Perspective of Parents Whose Adolescent Is Harming Themselves or Has Died by Suicide.

Adolescent self-harm or suicide are emotionally difficult for parents, thus also parents need help. This qualitative descriptive study aimed to produce knowledge on the experiences of help received by Finnish parents (n = 23) whose adolescent is harming themselves or has died by suicide. The parents received diverse help for themselves, and for their self-harming adolescent or the deceased adolescent's sibling. Parents described negative experiences, but also factors that promoted their experience of help. There are many barriers to help related to the parents themselves, the adolescent, or to the social support system. Professional help should be easier to obtain and be based on the parents' individual expectations.

Depression and dissociation mediate the association between bullying victimization and self-cutting.

BACKGROUND: Bullying victimization is experienced by more than 10% of children and adolescents worldwide and has been associated with numerous negative mental health consequences, such as depression and dissociation. AIMS: We investigated the association between bullying victimization and self-cutting in a Finnish adolescent population and whether depression and dissociation act as mediators in this association. METHODS: We used cross-sectional questionnaire data from Finnish students (age 13-18; N = 3345; boys n = 1454; girls n = 1891). Logistic regression and mediation analyses were performed. RESULTS: Bullying victimized adolescents were younger, more likely to be afraid to go to school, had fewer friends, felt lonelier, and had a poorer relationship with family members, as well as higher level of depressive and dissociative symptoms compared to non-bullied adolescents. According to logistic regression analysis, the association between bullying and self-cutting remained significant despite all other adjustments besides those for depressive symptoms. In serial mediation analysis, depressive and dissociative symptoms mediated the effect of bullying victimization on self-cutting, regardless of their order in the model. CONCLUSIONS: Self-cutting is more common among bullying victimized adolescents than their peers. The association is mediated by depressive and dissociative symptoms. More studies are needed to clarify the exact mechanisms via which depressive and dissociative symptoms interact with the association between bullying and self-harm.

Social support may prevent self-cutting in adolescence: A 5-year follow-up study.

Self-cutting is common among adolescents. However, studies examining protective factors are rare. It has been suggested that social support may protect against self-cutting in adolescence. The aim of this study was to investigate the possible association of social relationships with the initiation of self-cutting. METHODS: The participants were community-dwelling Finnish adolescents (N = 4171) aged 13-18 years at baseline. The follow-up assessment was conducted 5 years later (N = 794). Those adolescents who had self-cut before the baseline assessment (N = 134) were excluded from the analysis, leaving a total of 660 participants to be analyzed. In this group, 37 adolescents initiated self-cutting during the 5-year follow-up period and 623 did not. Cox's proportional hazards models were used with several adjustments for possible confounding factors. FINDINGS: A higher age, male gender, good relationships with siblings, weekly meetings with friends, and personal experience of not being lonely associated with the noninitiation of self-cutting during the follow-up period. Good relationships with parents or peers had no association with the initiation of self-cutting. Depressive symptoms mediated the effect of subjective loneliness on initiating self-cutting. CONCLUSIONS: Social support produced by friends may have a protective effect against self-cutting.

Experiences of Help From the Perspective of Finnish People Who Self-Harmed During Adolescence.

Adolescent self-harm is a widespread phenomenon, and a significant problem worldwide. This study describes the experiences of help from the perspective of Finnish people who have suffered self-harm during adolescence. Data were collected from 27 participants as essays and interviews. Participants included both females and males with different backgrounds and treatment experiences. The data were analysed using inductive content analysis. Participants described having received help from other people in informal and formal ways, and they had both positive and negative experiences of help. The results show that several barriers exist for self-harming adolescents to access help, thus improvement in this area are necessary.

Competences in Social Media Use in the Area of Health and Healthcare.

In today's life, social media offer new working ways. People are increasingly expanding interactions from face-to-face meetings to online ways of communication, networking, searching, creating and sharing information, and furthermore taking care of patients/citizens via tweeting care, Facebook care, blogging care, vlogging care, infotainment care, gamification-care, infographic care, for instance. This chapter discusses the utilisation of social media in the healthcare domain including nursing education, practice and research. When in the current healthcare era, social media is used effectively and purposefully, it can give all of us a greater choice in how we live, how we take care of our health and how we learn and build both our professional competences and produce evidence-based, qualified data. Nurses need continuous education and proper tools to take the most of the benefits of social media, not forgetting privacy and ethical issues. This use of social media in professional nursing generates the need for new competences.

Factors helping adolescents to stop self-cutting: descriptions of 347 adolescents aged 13-18 years.

AIMS AND OBJECTIVES: To describe the factors contributing to the stopping of self-cutting among 13-18-year-old Finnish adolescents from the personal perspective of the adolescents. BACKGROUND: Self-cutting is quite common among adolescents. However, adolescents' personal descriptions of what helped them to stop self-cutting have not previously been investigated. DESIGN: Qualitative descriptive design with quantification. METHODS: The data were collected from 347 participants using structured self-rating questionnaires as a part of a larger research project focusing on the mental well-being of adolescents aged between 13-18 years in Finland. The participants were asked to write their own descriptions of how they had been able to stop self-cutting, if they had done so. The data were analysed using qualitative content analysis. Frequencies and percentages were calculated in relation to the total number of identified references to factors contributing to the stopping of self-cutting. This enabled the determination of the most important factors helping adolescents to stop self-cutting from their own perspective. RESULTS: Six main themes emerged: factors associated with self-cutting and meanings related to it (n = 173); personal factors (n = 126); factors associated with other people (n = 104); factors associated with care or therapy (n = 18); meanings related to the instruments used to cut (n = 1) and unidentified factors (n = 18). CONCLUSIONS: Factors associated with self-cutting and meanings related to it were the most important factors contributing to the stopping of self-cutting. Personal factors and those associated with other people were also important, while factors associated with care were of less importance in this study. RELEVANCE TO CLINICAL PRACTICE: The factors identified in this study could potentially be used in clinical practice to assist other adolescents in stopping their self-cutting.

Adolescent self-cutting elsewhere than on the arms reveals more serious psychiatric symptoms.

Self-cutting as a form of self-harm is a common and multifaceted phenomenon among adolescents. The aim of this study was to investigate whether the location of self-cutting (arms or other areas of the body) could help to assess the severity of the underlying psychiatric problems. A sample of adolescents who reported self-cutting (n = 440) was drawn from a large sample of community adolescents (n = 4,019). The majority of self-cutting adolescents, 296 (67.2%), reported cutting only the upper arms, while 144 (32.8%) also cut other parts of the body. The data included a structured self-rating questionnaire, questions about self-cutting, the Youth Self-Report (YSR) for adolescents aged 11-18 years, the Beck Depression Inventory, the Toronto Alexithymia Scale and the Adolescent Dissociative Experience Scale (A-DES). The results indicate that self-cutting on other parts of body than the arms was associated with female gender, a wide range of emotional and dissociative symptoms and suicidal ideation. In logistic regression analysis, the most pronounced association between self-cutting on other places than the arms was found with YSR subscales withdrawn/depressed, social problems and thought problems, and dissociation (A-DES). We conclude that self-cutting adolescents, mostly girls, with wounds elsewhere than on the arms present with the most serious psychiatric symptoms. It is important to perform a careful physical examination when an adolescent has unexplained wounds or scars on the arms or on other parts of the body. These adolescents also need a caring and conscientious psychiatric examination and possible psychiatric treatment.

Helping self-mutilating adolescents: descriptions of Finnish nurses.

This study focused on the views of Finnish nurses in regards to providing help for adolescents who self-mutilate. Nine nurses participated, and when the interviews and written descriptions were qualitatively analysed, four main categories of information emerged. The first category comprises the nurses' views on self-mutilation. The second category describes the people who are able to be helpers. The third category describes the content of help, which is made up of a variety of acts provided by non-health professionals that promote the healthy development of adolescents. The fourth category describes care provided by nurses to adolescents who self-mutilate. Guidelines for caring for self-mutilating adolescents are needed, including information on the phenomenon of self-mutilation.

A systematic literature review: self-mutilation among adolescents as a phenomenon and help for it-what kind of knowledge is lacking?

The aim of this review article is to present current knowledge of self-mutilation among adolescents as a phenomenon and to define what kind of knowledge is lacking based on existing literature. The literature searches were executed in the CINAHL and Medline databases in 2010. The analysed data consisted of 126 articles and inductive content analysis was carried out. Existing knowledge of self-mutilation was categorized into the following two classes: (1) self-mutilation as a phenomenon and (2) caring for persons who self-mutilate or self-harm.

Adolescent dissociation and alexithymia are distinctive but overlapping phenomena.

Findings on the association between dissociation and alexithymia in adult populations are inconsistent. Dissociation has also been related to other types of psychopathology. Few studies have been published on these connections among adolescents. We examined the association between Adolescent Dissociative Experiences Scale (A-DES) scores and those for the Toronto Alexithymia Scale (TAS), the 21-item Beck Depression Inventory (BDI-21) and the Youth Self-Report (YSR), as well as subscales of the TAS and the YSR, in a sample of Finnish adolescents aged 13 to 18 years (n=4019). Factor analysis suggested that dissociation can be considered distinctive from other psychopathology. A-DES scores, however, associated strongly with several other scales and subscales measuring psychiatric symptoms. In logistic regression models the strongest associations were observable between the A-DES and TAS subscale 'difficulty identifying feelings' (DIF) and the YSR subscale 'thought problems'. Thus, dissociation and alexithymia can be considered distinctive but overlapping phenomena.

Helping adolescents who self-mutilate: parental descriptions.

AIM: The purpose of this qualitative descriptive study was to explore parental views on how to help adolescents who self-mutilate. BACKGROUND: Self-harm, including self-mutilation, is common among adolescents. However, parental conceptions of helping adolescents who self-mutilate have rarely been investigated in nursing science. DESIGN: Qualitative descriptive design. METHOD: Four parents of self-mutilating adolescents were interviewed in depth. Qualitative content analysis was applied. RESULTS: Three main categories emerged: a description of an adolescent who self-mutilates and descriptions of ways to help self-mutilating adolescents and ways to help their parents and family. An adolescent who self-mutilates appears externally to feel very well, but inside feels lonely and inferior to others. Help may include an adolescent helping herself by performing some activities alone or in relation to other people and an adolescent receiving help from a safe and trusting human relationship. Such a relationship can be with anyone who knows about the self-mutilation and is of utmost importance, but a caring attitude is particularly expected from adults. Factors that facilitate helping were identified as well as those considered help-hindering or helpful. Help that had been provided to parents and the family included factors considered helpful and unhelpful. CONCLUSION: Adolescents who self-mutilate try to help themselves, but are in need of external, probably professional help. Parents are in need of information about self-mutilation as a phenomenon to be able to help their children. Help for self-mutilating adolescents as perceived by their parents also includes help for the whole family. RELEVANCE TO CLINICAL PRACTICE: The findings of this study could assist health care professionals in approaching and helping both self-mutilating adolescents and their parents.

Mental disorders in self-cutting adolescents.

PURPOSE: Self-cutting as a form of self-harm is common in general population adolescents. The aim of this study was to investigate the prevalence of mental disorders and associated factors among self-cutting community-dwelling adolescents. METHODS: A sample of adolescents who reported current self-cutting (n = 80) was drawn from a large sample of community adolescents (n = 4205). Of these 80 individuals, 44 consented to further detailed assessment. An age- and gender-matched control subject was selected for each study subject. Data collection included Structured Clinical Interviews for DSM-IV-TR, the Beck Depression Inventory, the Alcohol Use Disorders Identification Test (AUDIT), and the Youth Self-Report for adolescents aged 11-18 years (YSR). RESULTS: Major depressive disorder (63% vs. 5%), anxiety disorders (37% vs. 12%), and eating disorders (15% vs. 0%) were more common among self-cutting girls (n = 41) than among controls. None of the self-cutting boys (n = 3) had a DSM-IV-TR Axis I mental disorder. In multivariate model, the presence of major depressive disorder, the AUDIT score and the YSR internalizing subscale score were the factors that were independently associated with the presence of self-cutting in girls. CONCLUSIONS: Major depressive disorder, signs of alcohol misuse, and internalizing behavior strongly associate with self-cutting in community-dwelling adolescents, especially in girls.

The prevalence of alexithymia and its relationship with Youth Self-Report problem scales among Finnish adolescents.

This study investigated the relationship between alexithymia, depressive symptoms, and Youth Self-Report (YSR) self-image profiles among 13 to 18-year-old adolescents (n = 7087) attending school in Kuopio, Finland. The final sample consisted of 3936 adolescents (1801 boys, 2135 girls) who completed structured self-rating questionnaires (Toronto Alexithymia Scale [TAS] 20, Beck Depression Inventory [BDI], and YSR) during class periods at school. The overall prevalence of alexithymia was 7.3%. However, girls in all age groups were more frequently alexithymic than boys. Regardless of sex, alexithymic youths reported more depressive symptoms as well as internalizing and externalizing problems than the others. A YSR total score of more than 70 was recorded among 33.4% of alexithymic compared with 3.7% of nonalexithymic adolescents. The TAS-20 correlated significantly with the BDI score, YSR total score, and with internalizing problems. This study revealed alexithymia among adolescents to be associated with various complications such as depressive symptoms, high scores in YSR problem scales, and difficulties in social relationships. Our findings indicate that these adolescents are at high risk of mental disorders and require treatment interventions.

Descriptions of help by Finnish adolescents who self-mutilate.

PURPOSE: The purpose of this study is to describe help from the viewpoint of self-mutilating Finnish adolescents. METHODS: Methodological triangulation was used in data collection. Written descriptions were provided by 62 self-mutilating adolescents (aged 12-21 years) of the help they received and wished to receive, and individual interviews were conducted with 10 self-mutilating adolescents (aged 15-22 years). Qualitative content analysis was applied. FINDINGS: Three groups of people that can be of help were identified by the self-mutilating adolescents: age-mates, including peers and fellow self-mutilating adolescents; loved ones; and adults, including unknown adults, health and social care professionals, teachers and school counsellors, and parents. Factors contributing and hindering to help were identified. CONCLUSIONS: Self-mutilating adolescents want to be helped and, in their opinion, adults are duty-bound to help and care for them.

The prevalence of self-cutting and other self-harm among 13- to 18-year-old Finnish adolescents.

BACKGROUND: Deliberate self-harm has become more prevalent among adolescents. AIMS: To investigate the prevalence and the associated background factors of self-cutting and other self-harming behaviour. METHODS: The study sample included 4,205 adolescents aged 13-18 years. Background factors, social relationships, alcohol and substance abuse, self-harm and self-cutting were assessed by a structured questionnaire including the Youth Self Report and Beck Depression Inventory. RESULTS: The life-time prevalence of self-cutting was 11.5% and of other self-harm 10.2%, while the prevalence of current self-cutting was 1.8%. Self-cutting was associated with female gender and a very wide range of adverse psychosocial background variables. Parents living together were an independent protective factor. By contrast, there was no gender difference in the risk of other self-harm. Independent risk factors were depressive mood, somatic complaints, drug abuse, poor school performance and poor family relationships. No protective factors were found for other self-harm. CONCLUSIONS: During adolescence, self-cutting and other self-harm are common. Adolescents who have self-cutting or harm themselves have wide-ranging problems in their lives. The specific characteristics of these phenomena need further investigation.

Dissociation, self-cutting, and other self-harm behavior in a general population of Finnish adolescents.

A few studies on adult clinical samples have demonstrated that dissociation predicts self-harm behavior without intent to die. Furthermore, a similar association has been found from selected adolescent populations. However, no studies have been published on the association between dissociation and self-harm behavior in general populations of either adults or adolescents. We investigated whether a high level of dissociation predicts self-cutting or other self-harm behavior in a Finnish general population sample of 4019 adolescents aged between 13 and 18 years. Those with a high level of dissociation measured with the Adolescent Dissociative Experiences Scale had a higher risk of current self-cutting and other self-harm behavior, even when adjusted for several possible confounding factors. Self-cutting adolescents had higher Adolescent Dissociative Experiences Scale scores than those displaying other kinds of self-harm behavior. These results indicate that a high level of dissociation is an independent risk factor for self-harm behavior in adolescents, and may have value both in clinical work and further research.

Descriptions of self-mutilation among Finnish adolescents: a qualitative descriptive inquiry.

The purpose of this study was to describe self-mutilation from the perspectives of self-mutilating adolescents. A qualitative descriptive design was adopted. Self-mutilating adolescents were asked to write descriptions of their self-mutilation. Data analysis revealed three major categories: descriptions of the factors contributing to self-mutilation, descriptions of the act of self-mutilation, and descriptions of the sequels of self-mutilation. This study adds to our understanding of self-mutilation and the experiences of self-mutilating adolescents. In nursing practice and education, self-mutilation should be discussed based on existing knowledge to make nurses more familiar with it. Nurses should understand this phenomenon as a challenge for developing effective nursing practices.

Dissociation in a general population of Finnish adolescents.

Only a few studies have been published concerning dissociation in general population adolescents. We assessed dissociation using the Adolescent Dissociative Experiences Scale (A-DES) in a sample of Finnish adolescents aged 13 to 18 years (n = 4019). The A-DES had good internal reliability and factor analysis suggested a 1-factor solution to be optimal. The younger participants had somewhat higher A-DES scores, but there were no differences between the genders. The mean A-DES score of 0.88 in the whole sample was lower than that in previous studies in other countries. A high level of dissociation was associated with an age of 15 or less, daily smoking, frequent use of alcohol, abuse of legal drugs, cannabis use, social isolation, and poor school performance in mathematics.