A Theory-Based Longitudinal Investigation Examining Predictors of Self-Harm in Adolescents With and Without Bereavement Experiences

Abstract

Background: Research has demonstrated that exposure to suicide can lead to increased vulnerability for self-harm or suicide. As a result, ideation-to-action models of suicide (e.g., the Integrated Motivational-Volitional Model of Suicide; IMV) recognise exposure as a significant risk factor which may be implicated in the translation of thoughts into actions. However, few studies have tested this theoretical link explicitly within an adolescent population, and examined how it compares to other types of bereavements. Methods: A 6-month prospective questionnaire study was conducted with 185 Scottish adolescents aged 11-17 (113 adolescents also completed the questionnaire at followup). The questionnaire included measures on experiences with bereavement and lifetime engagement in self-harm, as well as measures of defeat, entrapment, social support, coping, and other psychological variables. Results: At baseline, 12% of young people reported exposure to a suicide death, and 61% to a non-suicide death. In addition, 21% of pupils reported ever engaging in self-harm, while 23% had experienced self-harm ideation without engaging in it. Cross-sectional multivariate logistic regressions showed that family social support, glorifying/normalising beliefs about suicide, and family self-harm were significantly associated with self-harm group membership (control, ideation, or enactment groups). At follow-up, 10% of pupils reported exposure to a suicide death and 16% to a nonsuicide death for the first time. A total of 26% of the sample reported self-harm at T2 (11% of participants for the first time), and 24% reported self-harm ideation without engaging in it. Multivariate analyses found that self-harm ideation and family self-harm at baseline were the only variables to predict self-harm group membership prospectively, in the expected directions. Bereavement experiences, whether by suicide or non-suicide, did not predict self-harm group status at baseline nor at follow-up.

The prevalence of childhood bereavement in Scotland and its relationship with disadvantage: the significance of a public health approach to death, dying and bereavement

“…This article is the first published study of the prevalence of childhood bereavement in Scotland, drawing upon a large, nationally representative sample and collating children’s bereavement experiences from 10 months until approximately 10 years. It is also the first large-scale prevalence study undertaken in the United Kingdom for more than 15 years and, unlike other published studies, 2 , 45 it draws upon detailed longitudinal data in which the timing and extent of bereavement can be ascertained. The findings presented here therefore represent an important touchstone for policymakers, practitioners, academics and wider civil society.…”

“…Furthermore, the increase in the rate of exposure to bereavement throughout each of the sweeps in this longitudinal study signifies the potential for an overall prevalence of childhood bereavement (up until the age of 18) that far outstrips any previous estimates of childhood bereavement based on surveys with smaller school-based samples of adolescents. 2 , 8 A number of reasons may account for this, particularly in relation to study design: in the GUS study, data are collected timeously (rather than retrospectively) from a nationally representative sample of children which encompasses those who may not be engaged in school or participate in school surveys.…”

“…Of note is that, in this study, responses about bereavement were completed by parents, whereas in other studies that estimate the prevalence of childhood bereavement, the responses tend to come directly from young people themselves. 2 , 8 This is important given that it is widely recognized that it is the meaning that children give to bereavement that is key to how they understand and cope with their experience. 20 , 49 , 50 While this methodological approach was, in part, necessitated by the age of the children participating in the early sweeps of the GUS research, it means that this study does not account for children’s relational experiences of bereavement but instead parent/carer recollection.…”

“…In Scotland, there are no prevalence studies but a recent survey of 185 children aged 11–17 estimated that 72% had experienced a bereavement. 8 This reflects estimates across the United Kingdom more widely: in England, it is estimated that 78% of 11- to 16-year-olds have experienced the death of a family member or close friend. 2 In Great Britain, it is estimated that 4–7% of children will experience the death of a parent by the age of 16.…”

Does Mental Well-Being Protect against Self-Harm Thoughts and Behaviors during Adolescence? A Six-Month Prospective Investigation

“…While the IMV model provides one of the most comprehensive accounts to date of the processes involved in the development of self-harm thoughts and behaviors, it is still relatively new and, therefore, not exhaustive. Further, few studies have investigated the hypothesized pathways of the IMV in young people, despite adolescents being a high-risk group [18][19][20]. Identifying the factors associated with reduced risk of self-harm in young people and why, is key to understanding and preventing self-harm in this population [6,21].…”