Self-harm can be conceptualized as the act of direct destruction or alteration of body tissue by an individual (Gratz, 2006). It is important to note that there is a difference between self-harm and suicide. This is given the fact that the individual inflicting destruction and alteration to their body tissue in self-harm harbors no intention of taking their lives. This is even though the self-harm may result in injuries that are severe enough to lead to tissue damage (Gratz, 2006).
Self-harm is one of the fields that have received little attention from scholars, and few studies have been carried out in this field. This is even though deliberate self-harm continues to be reported among youths, especially teenagers and college students.
This literature review will address some of the studies that have been carried out in this field. The author will analyze six articles that report on the findings of studies conducted by various scholars in this field. A comparison will be made between the articles, with a special focus on the similarities and differences among the articles. A critique of the methodologies that were used in the studies will be provided in the literature review of the articles. This is together with recommendations for future research in the field of deliberate self-harm. In comparing the articles and the studies reported therein, this author will focus on the constructs of the studies, samples used, methodologies employed, and the findings of the studies.
Factors Associated with Ideation and Acts of Deliberate Self-Harm among 18-Year Old Boys, Haavisto, Sourander, Multimaki, Parkkola, Santalahti, Helenius, et al. 2005
The findings of this study were reported in an article that was published in the Social Psychiatry Epidemiol journal in 2005. The research was a prospective follow-up study that used as its sample boys aged 18 years.
The construct of any study can be viewed as the concept around which the study revolves. The construct, in this case, is “deliberate self-harm” among 18 years old boys. Haavisto et al. (2005) conceptualize their construct as the deliberate affliction of harm and alteration of the body tissue on the part of the teenagers. This is even though teenagers have no intention of taking their lives by committing suicide. The concept is operationalized in this study by linking it to the factors that are associated with ideation and acts of “deliberate self-harm” among the sample.
Haavisto et al (2005) had four objectives that they set out to address in this study. One was to identify the rate of ideation and deliberate self-harm among the sample. The second was to analyze the use of mental health services among the sample. The third was to identify risk factors, factors that had been analyzed at the age of 8 years. Finally, the study sought to assess the cross-sectional factors at the age of 18 years as far as ideation and self-harm acts are concerned (Haavisto et al, 2005).
The study used as its sample 2,348 Finnish boys that were born in 1981. As earlier indicated, the study used the methodology of a ten-year follow-up design. First, the scholars examined the participants at the age of 8 years. This was followed-up at age 18, after ten years when the boys were called-up for the military. The scholars exploited the compulsory military call-up for Finnish men to access the entire male age group after ten years. Data was collected using self-reported questionnaires administered to the participants. Given the fact that at baseline (8 years) the participants were still minors, the scholars used alternative sources of information to collect data on the boys. Information was collected from parents, teachers and to some extent, the participants themselves.
The use of a follow-up design for the study was an excellent choice on the part of the scholars. This is given the fact that they were able to study and compare developments on teenagers and children as far as deliberate self-harm is concerned using the same sample. The sample was not substituted, and as such, the methodology gives more accurate results. However, it is important to note that the scholars collected information from teachers and parents at baseline, but used data from the participants only after ten years. This reduces the validity of the findings, given the fact that information provided by the teachers and parents at baseline cannot be accurately counterchecked with that of the participants ten years later. The teachers, the parents of the participants may be biased.
The scholars found that the prevalence of ideation of deliberate self-harm among the respondents stood at 4.0 percent (Haavisto et al, 2005). That of self-harm acts stood at 2.2 percent in the preceding six months (Haavisto et al, 2005).
One of the major findings of this study was the effects of depressive symptoms during childhood on self-harm in adulthood. It is against this backdrop that the scholars conclude by saying that it is important for the parents and teachers to pay attention to the mental health of children early in life. This is given the fact that this will affect their psychological and mental health later in life. One way to avert suicide among teenagers, according to Haavisto et al. (2005), is to identify and address psychiatric problems in childhood.
Antecedents of Hospital Admission for Deliberate Self-Harm from a 14-Year Follow-Up Study using Data Linkage, Mitrou, Gaudie, Lawrence, Silburn, Stanley & Zubrick, 2010
The findings of this study were published in the BMC Psychiatry journal in 2010. Just like in Haavisto et al’s (2005) study that was analyzed above (article 1), the construct in this study is deliberate self-harm. The conceptualization of the construct is the same as that of Haavisto et al. (2005). However, Mitrou et al. (2010) operationalize their construct by linking antecedents of deliberate self-harm to hospital admission for attempted suicide or injuries to body tissue caused by deliberate self-harm later in life. These scholars are of the view that previous episodes of deliberate self-harm are strong indicators of suicides in the future (Mitrou et al. 2010).
The major objective of this study, as reported in this article, was to determine whether individual and socio-ecological factors that are reported in childhood and early adolescence are in any way connected to hospitalization for deliberate self-harm that occurred later in life (Mitrou et al. 2010).
Whereas Haavisto et al. (2005) used a sample population of 2,348 Finnish boys aged 18 years as the sample for their study, Mitrou et al. (2010) used 2,736 children aged between four and sixteen years. It is important to note that both studies used a fairly large sample of participants. However, whereas those used in Haavisto et al. (2005) were of uniform age (8 and 18 years), Mitrou et al. (2010) used a sample that was not uniform in age (between 4-16 years at baseline).
The methodology of the two studies (Haavisto et al. and Mitrou et al.) was similar. Both involved follow-up of the same sample over some years. However, Mitrou et al. (2010) did the follow-up for 14 years while Haavisto et al. (2005) did a follow-up for ten years.
Just like in Haavisto et al (2005), the use of this methodology increased the validity of the findings given that the same sample was used both at baseline and at the end of the survey. However, the internal validity of Mitrou et al (2010) was enhanced given that data at both baselines and the end of the survey was collected from the participants and their caregivers such as parents and teachers.
Mitrou et al (2010) identified six factors at childhood that predicted future hospitalization due to deliberate self-harm (DSH). These included femininity, a primary caregiver being a smoker, a step-family, increased emotional and behavioral problems, inconsistent parenting, and having a teenage mother (Mitrou et al. 2010). There were factors such as weight and income that were found to have no impact on future DSH hospitalization.
Just like in Haavisto et al. (2005), Mitrou et al. (2010) conclude their study by asserting that it is very important to consider the relationships between the child and the caregiver, as this will affect the future of the child. This is especially so because smoking by caregivers impacts the psychiatric and psychological development of the child.
Revictimisation and Self-Harm in Females who Experienced Childhood Sexual Abuse, Noll, Horowitz, Bonanno, Trickett & Putnam, 2003
This article published in the Journal of Interpersonal Violence in 2003 reported on the findings of the study that was conducted by these scholars on a sample of females who had confirmed childhood sexual abuse. The construct of this study was subtly different from that of the previous two studies. Noll et al. (2003) does address the issue of self-harm among the participants. However, this is not the only concept in the study neither is it the central one. The scholars aimed at finding out the relationship between childhood sexual abuse among the females and subsequent sexual assaults, physical abuse, deliberate self-harm, and lifetime traumas in later life (Noll et al. 2003).
The sample used in this study is also significantly different from that used in Haavisto et al. (2005) and Mitrou et al. (2010) studies. Noll et al. (2003) used a sample of females that had a history of sexual abuse in their childhood. This is a sharp contrast from the sample of 18 years old boys used by Haavisto et al. (2005). The sample in Noll et al. (2003) was also relatively small, and it was divided into two groups. This included 84 abused females and 82 non-abused females that acted as the comparison group (Noll et al. 2003).
This study assumed the methodology of a longitudinal survey, which was quasi-experimental. This is given the fact that the study involved two groups; the experimental group and the control group. Observations made in the experimental group composed of females with a history of childhood sexual abuse were compared with those of the control group (Noll et al. 2003). The accuracy of this study was enhanced given the fact that the scholars could determine the exact traits that were associated with childhood trauma. However, the methodology had inbuilt limitations given the fact that the scholars could not attribute with 100 percent accuracy the differences between the two groups to childhood sexual abuse. This is given that the differences could be attributed to other factors that were not captured by the research design.
The scholars found that abused females were more likely to report sexual assaults, physical abuse, self-inflicted harm, and lifetime traumas in adulthood than their un-abused counterparts. Just like in the previous two studies, Noll et al. (2003) conclude that childhood developments have a significant impact on the life of the individual in adulthood.
Posttraumatic Stress Symptoms Mediate the Relation between Childhood Sexual Abuse and Non-Suicidal Self-Injury, Weierich & Nock, 2008
In this study, Weierich & Nock (2008) try to analyze the relationship between childhood abuse and non-suicidal self-injury (NSSI). This was the major objective of their study. This study is similar to that of Haavisto et al. (2005) and Mitrou et al. (2010) analyzed above. This is given the fact that the same construct of self-harm, which is non-suicidal is addressed here. The construct is similarly operationalized by linking it to developments in childhood, in this case, sexual abuse. However, subtle differences in operationalization of the construct are discernible given that Weierich & Nock (2008) introduce the aspect of post-traumatic stress symptoms as the link between childhood sexual abuse and self-injury.
The sample used in this study is significantly similar to that in Noll et al. (2003) as analyzed above as far as size is concerned. A total of 86 adolescents are used for this study. Unlike in the other studies, Weierich & Nock (2008) used a very diverse sample. It was made up of both males and females drawn from various ethnic and racial backgrounds.
Unlike in Haavisto et al. and Mitrou et al. studies, this study did not take the design of a follow-up of the same sample over a long period. Instead, the participants filled out a questionnaire that measured their childhood abuse and NSSI later in life (Weierich & Nock, 2008). The participants were required to report on their childhood experiences and NSSI. This methodology had a higher validity given that there was not a long duration of time spent observing the participants, also cutting down on the resources that the scholars would have spent. However, the methodology relied on the accuracy of recall of childhood events on the part of the participants. There is the likelihood that some of the events were forgotten, exaggerated, or suppressed by the participants, reducing the validity of the study.
The study found that there is a significant relationship existing between childhood sexual abuse and self-harm later in life (Weierich & Nock, 2008). It is similar to the conclusions of the other three studies linking childhood experiences to the quality of life of the participants.
Early Predictors of Deliberate Self-Harm among Adolescents: A Prospective Follow-Up Study from Age 3 to Age 15, Sourander et al. 2006
The findings of this study were published in the Journal of Affective Disorders in 2006. Similar to the Haavisto et al. (2005) and Mitrou et al (2010) studies, Sourander et al. (2006) addressed the concept of deliberate self-harm among the participants. The construct is similarly operationalized by linking it to events in early life.
The major objective of this study is to analyze the predictors of ideation and acts of DSH at age 3 and age 12. The study involved a sample of 839 parents and children.
This study was also a follow-up survey, spanning fifteen years. It is similar to that of Haavisto et al. (2005) and Mitrou et al. (2010) and unlike that of Noll et al. (2003) and Weierich & Nock (2008). The information was collected from the children and the parents at various intervals of their life using questionnaires. The validity of this methodology is to be found in the fact that the same sample was followed for some time. However, there are limitations given the long time needed for the study and the resources used by the scholars.
The study found that between the ages of 12 and 15 years, there was a sharp increase in ideations and acts of DSH (Sourander et al. 2006). This was especially so in the case of female respondents. The scholars conclude that events in early childhood predict the likelihood of DSH in the future. This summation is similar to that of studies previously analyzed.
Risk Factors for Deliberate Self-Harm Among Female College Students: The Role and Interaction of Childhood Maltreatment, Emotional Inexpressivity, and Affect Intensity/Reactivity, Gratz, 2006
The findings of this study were published in the American Journal of Orthopsychiatry in 2006. Gratz (2006) aimed at analyzing the role of childhood events such as emotional maltreatment on self-harm behavior. Similar to earlier studies analyzed above [Haavisto et al. (2005), Mitrou et al. (2010), and Sourander et al. (2006)], the construct in this study is DSH among the respondents.
The sample in this study is similar to that used in Noll et al. (2003) in composition. It is given the fact that it was comprised of 249 female college students. Just like in the other studies analyzed above, data was collected using self-report questionnaires. The methodology of the self-report questionnaire had the strength of increasing the validity of the findings given the fact that the same set of samples was used for the study. However, the respondents were required to recall childhood events, and this was the major weakness of the methodology. The participants could forget some events or engage in selective recall.
The study found that maltreatment in childhood significantly led to self-harm behaviors. It is similar to the other studies that connected childhood traumatic events to psychological and psychiatric disorders later in life.
Conclusion: Recommendations for Future Research
The studies analyzed above clearly indicate that childhood traumatic events may lead to acts of DSH. However, it is important to address, in future research, the exact connection between the events in childhood and DSH. Weierich & Nock (2008) made an effort to this end in their study. However, they identified a single connection; that of posttraumatic stress symptoms. It is important to carry out a study to identify other mediating factors. It is also important to carry out studies to identify whether there are differences between the effects of childhood traumatic events and DSH between females and males. A gender-comparative study is called for. This field also stands to benefit from further studies into the cause of DSH among teenagers and the adult population. It is given the fact that most of the studies conducted in this field identify traumatic childhood events as the major causes of DSH. It is important to ascertain whether there are other probable causes of this behavior.
Gratz, K. L. (2006). Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. American Journal of Orthopsychiatry, 76(2), 238-250.
Haavisto, A., et al. (2005). Factors associated with ideation and acts of deliberate self-harm among 18-year-old boys: A prospective 10-year follow-up study. Social Psychiatry Epidemiol, 40, 912-921.
Mitrou, F., et al. (2010). Antecedents of hospital admission for deliberate self-harm from a 14-year follow-up study using data-linkage. BMC Psychiatry, 10(82), 1-11.
Noll, J. G., Horowitz, L. A., Bonanno, G. A., Trickett, P. K., & Putnam, F. W. (2003). Revictimisation and self-harm in females who experienced childhood sexual abuse: Results from a prospective study. Journal of Interpersonal Violence, 18(12), 1452-1471.
Sourander, A., et al. (2006). Early predictors of deliberate self-harm among adolescents. A prospective follow-up study from age 3 to age 15. Journal of Affective Disorders, 93, 87-96.
Weierich, M. R., & Nock, M. K. (2008). Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury. Journal of Consulting and Clinical Psychology, 76(1), 39-44.