Interrupting the Self-Harm Continuum.

Background: Nonsuicidal self-injury (NSSI) has increased rapidly and is frequently linked to suicidal behavior; it has been argued that these behaviors are key points on a self-harm continuum. Aims: The current research explored self-harm and help-seeking behaviors, with the aim of identifying possibilities for prevention of further harm, including suicide. Methods: An online survey of 304 New Zealanders was undertaken, with the majority being aged under 25 and female. Results: Nearly half of the sample had engaged in self-harm and most of those had experienced suicidal thoughts; close to a quarter had made a suicide attempt. NSSI was used as a way of dealing with emotional distress. Very few sought help of any kind, especially professional support; of those who did seek professional support, most found it helpful but did not necessarily stop self-harming as a result. Limitations: Men are under-represented in the sample - though this is in accordance with the population of people who engage in NSSI. Conclusion: Many participants engaged in NSSI and also had suicidal thoughts using NSSI as an emotion regulation strategy; some participants appeared to use NSSI rather than attempting suicide. Given a link between NSSI and suicidal thoughts and behaviors, reluctance to seek help and on-going injurious behavior among some who do seek help, there is a need for increased identification and proactive support specifically focusing on improving emotion regulation and targeted at injurious behavior.

The Effect of Gender on Identification and Interpretation of Non-Suicidal Self-Injury.

INTRODUCTION: Reported rates of non-suicidal self-injury (NSSI) differ by gender but may be under-reported and under-recognised in men. People engaging in NSSI rarely seek professional help without encouragement, so others play a key role in its identification and potential intervention. The current research investigated others' interpretations of NSSI, examining whether gender affects the likelihood of NSSI identification and views of how common and acceptable NSSI is. METHOD: Participants (N = 429; 74.1% female, 23.3% male; please see below for further demographic information) responded to two vignettes describing a person self-injuring by punching a wall or by cutting themselves. The person's gender in each vignette was manipulated. Following each vignette, the participants rated the level to which they agreed the behaviour was common for the gender of the person described, as well as the level to which they agreed the behaviour was acceptable for the gender of the person described, on a 5-point Likert scale. Following both vignettes, participants were presented with a definition of NSSI and rated the level to which they agreed cutting and wall-punching were forms of NSSI on 5-point Likert scales. Independent-samples t tests and goodness of fit χ2 tests were conducted as appropriate. RESULTS: Participants were more likely to identify wall-punching as common for men and cutting as common for women. However, there was no significant difference in whether wall-punching was identified as NSSI or considered to be an acceptable behaviour, regardless of the gender of the person engaging in it. That is, although research suggests that men are far more likely to engage in wall-punching as a form of NSSI than women, participants did not recognise this. Overall, the results indicated a gender-dependent difference in how acceptable and common NSSI is thought to be, but no noticeable difference in identification of a behaviour as NSSI. Wall-punching, typically a form of NSSI engaged in by males, tended not to be identified as such. CONCLUSION: There is an effect of gender on how NSSI is interpreted, and it seems that men's NSSI is, and will continue to be, under-recognised. This has important implications for the treatment of men's NSSI, which is more likely to be seen as aggression and therefore deserving of punishment than an attempt at emotion regulation.

Standardizing definitions and reporting guidelines for the infertility core outcome set: an international consensus development study† ‡.

STUDY QUESTION: Can consensus definitions for the core outcome set for infertility be identified in order to recommend a standardized approach to reporting? SUMMARY ANSWER: Consensus definitions for individual core outcomes, contextual statements and a standardized reporting table have been developed. WHAT IS KNOWN ALREADY: Different definitions exist for individual core outcomes for infertility. This variation increases the opportunities for researchers to engage with selective outcome reporting, which undermines secondary research and compromises clinical practice guideline development. STUDY DESIGN, SIZE, DURATION: Potential definitions were identified by a systematic review of definition development initiatives and clinical practice guidelines and by reviewing Cochrane Gynaecology and Fertility Group guidelines. These definitions were discussed in a face-to-face consensus development meeting, which agreed consensus definitions. A standardized approach to reporting was also developed as part of the process. PARTICIPANTS/MATERIALS, SETTING, METHODS: Healthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus development methods. MAIN RESULTS AND THE ROLE OF CHANCE: Forty-four potential definitions were inventoried across four definition development initiatives, including the Harbin Consensus Conference Workshop Group and International Committee for Monitoring Assisted Reproductive Technologies, 12 clinical practice guidelines and Cochrane Gynaecology and Fertility Group guidelines. Twenty-seven participants, from 11 countries, contributed to the consensus development meeting. Consensus definitions were successfully developed for all core outcomes. Specific recommendations were made to improve reporting. LIMITATIONS, REASONS FOR CAUTION: We used consensus development methods, which have inherent limitations. There was limited representation from low- and middle-income countries. WIDER IMPLICATIONS OF THE FINDINGS: A minimum data set should assist researchers in populating protocols, case report forms and other data collection tools. The generic reporting table should provide clear guidance to researchers and improve the reporting of their results within journal publications and conference presentations. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials statement, and over 80 specialty journals have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S): This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility Group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and a financial interest in NexHand. E.H.Y.N. reports research sponsorship from Merck. A.S. reports consultancy fees from Guerbet. J.W. reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. A.V. reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from Human Fertilisation and Embryology Authority for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER: Core Outcome Measures in Effectiveness Trials Initiative: 1023.

Measuring patient-centredness in publicly funded fertility care: A New Zealand validation and international comparison of the Patient-Centred Questionnaire-Infertility.

BACKGROUND: The Patient-Centred Questionnaire-Infertility (PCQ-Infertility) has proven to be a reliable instrument to assess the extent of patient-centredness of fertility care in European countries. AIMS: To validate the PCQ-Infertility in New Zealand (NZ) and to compare results with international experience. MATERIALS AND METHODS: A cross-sectional 46-item questionnaire study among 409 women undergoing publicly funded fertility care (intrauterine insemination or in vitro fertilisation / intracytoplasmic sperm injection) in three fertility clinics in the Northern Auckland region was performed between October 2015 and September 2016. Inclusion of eligible participants was both retro- and prospective. The questionnaire was distributed by email link and women were asked to complete it with their partner. Internal consistency and construct validity were determined and correction for case mix was performed. Mean dimension scores, adjusted for 'current pregnancy', 'educational level' and 'treatment type', were calculated for each dimension of the PCQ-Infertility. NZ results were compared with PCQ-Infertility results from five countries. RESULTS: Of 409 invited women, 255 questionnaires were submitted (response rate 62%), of which 216 (53%) were analysable. The dimension 'Care organization' had poor internal consistency, but overall the questionnaire had high internal consistency (Cronbach's α = 0.93). Construct validity was also good. International comparison showed NZ to have the second highest overall score. In New Zealand, the lowest scoring domain was 'Continuity and transition'. CONCLUSIONS: The NZ version of the PCQ-infertility proved a valid instrument for the assessment of patient-centredness of publicly funded fertility care. Future research should focus on international inequities in patient-centred fertility care and use of the tool for quality improvement. Local use of the PCQ-Infertility is encouraged.

Fantasy-Driven Versus Contact-Driven Users of Child Sexual Exploitation Material: Offender Classification and Implications for Their Risk Assessment.

Since the advent of the Internet, convictions for the possession, display, trading, and distribution of child sexual exploitation material (CSEM) have risen steadily, but little is known about their appropriate assessment and treatment, especially concerning their risk of reoffending. It has been suggested that a conceptual distinction of fantasy- versus contact-driven CSEM users might be of merit. Sixty-eight offenders recruited from sex offender treatment providers were assessed via an anonymous computer survey including a variety of clinical and risk-related variables; the findings showed differences in the psychological profiles between CSEM users and contact child sex offenders. Numerical and spatial methods of data analysis were used to identify subgroups of CSEM users; these confirmed the twofold distinction of fantasy- versus contact-driven offending. The spatial representation of participants identified three dimensions as crucial in the classification of these subgroups: direct sexual contact with a minor, possession of fantasy-generating material, and social contact with other users with a sexual interest in minors; potentially differentiating distinct offender subgroups with different risks and needs. The current study informed the development of an empirical model of CSEM users that could aid in the assessment of risk of reoffending and cross-over to contact sex offending.

Sexual abuse and subsequent suicidal behaviour. Exacerbating factors and implications for recovery.

Suicidal behaviour is a cause for concern among many western countries; in general, it is most common among young women. This research used qualitative methods to explore the narratives of 24 women, to contextualise their insights, and to examine the meanings of events leading to and implicated in the recovery from suicidal behaviour. The research confirms sexual abuse as a common precursor to suicidal behaviour; several women asserted that they would not have attempted suicide if they did not have a sexual abuse history. The women noted that the effects of sexual abuse were exacerbated by problems with disclosure, linking to issues of control, with implications for intervention and recovery.