Deliberate self-harm in children and adolescents: a qualitative study exploring the needs of parents and carers.

Deliberate Self-harm (DSH) is a serious public health problem and is becoming more prevalent among young people in Ireland. Research tends to focus on the DSH patient. However, parental involvement is recognized as an important factor in their child's prognosis. This study aimed to describe parents' and carers' experiences of self-harm in their child in order to identify their support needs. A focus group methodology was used to generate qualitative data. Representative participants whose children had engaged in suicidal behaviour were recruited from the Paediatric Emergency, Child and Adolescent Mental Health Teams and Family Support Services. Twenty-five participants attended the focus group meeting. A transcript-based conceptual analysis was conducted to identify and explore emerging themes. Participants expressed the need for support; information about suicidal behaviour in young people; skills for parenting an adolescent; and advice on managing further incidents. Parents described significant difficulties in family communication, in parent-child relationships, and in the area of discipline following self-harm. These findings support current research that identifies the need for service development and information for parents/carers of young people who self-harm.

Parents of young people with self-harm or suicidal behaviour who seek help - a psychosocial profile.

BACKGROUND: Deliberate Self-Harm (DSH) is a common problem among children and adolescents in clinical and community populations, and there is a considerable amount of literature investigating factors associated with DSH risk and the effects of DSH on the child. However, there is a dearth of research examining the impact of DSH on parents, and there are few support programmes targeted at this population. This cross-sectional study examines the profile of a sample of parents of young people with DSH who participated in a support programme (Supporting Parents and Carers of young people with self-harm: the SPACE programme), with the goal of investigating pre-test parental well-being, family communication, parental satisfaction, perceived parental social support, and child strengths and difficulties. METHODS: Participants were 130 parents who attended the SPACE programme between 2009 and 2012, and who completed six questionnaires at baseline: the General Health Questionnaire-12, Strengths and Difficulties Questionnaire, Kansas Parenting Satisfaction Scale, General Functioning Scale of the McMaster Family Assessment Device, Multidimensional Scale of Perceived Social Support, and a demographic questionnaire. RESULTS: The majority of parents met criteria for minor psychological distress (86%) and rated the quantity and severity of their children's difficulties as being in the abnormally high range (74%) at baseline. A majority of participants (61%) rated their perceived social support as being poor. Lower parental well-being was significantly correlated with poorer family communication, poorer parenting satisfaction, and a greater number of difficulties for the child. Perceived social support was not significantly correlated with parental well-being. Parents whose children were not attending school at baseline had significantly lower well-being scores than those whose children were. Parents whose children had received a formal diagnosis of a mental health disorder also had significantly lower well-being scores than those whose children had not. CONCLUSIONS: Parents of young people with DSH behaviours face considerable emotional and practical challenges; they have low levels of well-being, parenting satisfaction, social support, and experience poor family communication. Given the importance of parental support for young people with DSH behaviours, consideration should be given to the need for individual or group support for such parents.

A pilot study evaluating a support programme for parents of young people with suicidal behaviour.

BACKGROUND: Deliberate self harm (DSH) is a major public health concern and has increased among young people in Ireland. While DSH is undoubtedly the result of interacting factors, studies have identified an association between DSH and family dysfunction as well as the protective role of positive family relationships. Following a focus group meeting held to identify the needs of parents and carers of young people with DSH, a support programme (SPACE) was developed. The aims of the current study are to evaluate the effectiveness of the SPACE programme in decreasing parental psychological distress, reducing parental report of young peoples' difficulties, increasing parental satisfaction and increasing parents' ratings of their own defined challenges and goals. METHODS: Participants were recruited from a Mental Health Service within a paediatric hospital, Community Child and Adolescent Mental Health Teams and family support services. All services were located within the greater Dublin area in Ireland. Forty-six parents of children who had engaged in or expressed thoughts of self harm attended the programme and participated in the evaluation study. The programme ran once a week over an 8-week period and included topics such as information on self harm in young people, parenting adolescents, communication and parental self-care. Seventy percent (N = 32) of the original sample at Time 1 completed measures at Time 2 (directly following the programme) and 37% (N = 17) of the original sample at Time 1 completed them at Time 3 (6 months following the programme). A repeated measures design was used to identify changes in parental wellbeing after attendance at the programme as well as changes in parental reports of their children's difficulties. RESULTS: Participants had lower levels of psychological distress, increased parental satisfaction, lower ratings of their own defined challenges and higher ratings of their goals directly after the programme. These changes were maintained at 6-month follow up in the 37% of participants who could be followed up. Furthermore the young people who had engaged in or expressed thoughts of self harm had lower levels of difficulties, as reported by their parents, following the programme. CONCLUSION: These findings suggest that the SPACE programme is a promising development in supporting the parents of young people with suicidal behaviour. The programme may also reduce parental reports of their children's difficulties. Further evaluation using a randomized controlled trial is indicated.