School-Based Prevention Targeting Non-Suicidal Self-injury: A Pilot Study

Abstract

Non-suicidal self-injury (NSSI) is prevalent in adolescence and is associated with increased risk for a variety of subsequent negative mental health outcomes, necessitating an evidence-based preventive approach. This pilot study examines the potential iatrogenic effects and feasibility of an evidence-based school program for the prevention of NSSI. Differences are examined between a general in-classroom prevention program (Happyles) and this program combined with a 1-h in-classroom psychoeducation module on NSSI (HappylesPLUS) in terms of primary (e.g., delay in NSSI onset and decrease in NSSI frequency, urges, probability of future engagement) and secondary outcomes (e.g., psychological distress, emotion regulation, help-seeking, and stigma) using a mixed-method design. A total of 651 secundary school pupils (M age = 12.85 years; 49.8% female versus 50.2% male) were assigned to the Happyles program and HappylesPLUS. Participants filled out validated self-report questionnaires pre (T0) and post (T1, 6 weeks after T0) the school prevention program, including the Youth Outcome Questionnaire (YOQ), the Brief Non-Suicidal Self-Injury Assessment Test (BNSSI-AT), the Difficulties in Emotion Regulation Scale (DERS), the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF), and the Peer Mental Health Stigmatization Scale (PMHSS). Qualitative semi-structured interviews (at T2,6 weeks after T1) were conducted with participants with and without a history of NSSI. Overall, results show no iatrogenic effects of the NSSI-focused psychoeducation module. In terms of our primary outcome, both groups reported a reduced likelihood of future NSSI engagement from T0 to T1. Regarding secondary outcome measures, we also observed increased emotional awareness in both groups. The qualitative data suggest that the addition of the NSSI-specific module to the Happyles program may have direct benefits to some students with lived experience, such as increased help-seeking behavior for NSSI. Findings of this pilot study show that incorporating NSSI-specific modules into evidencebased school prevention programs is feasible and does not lead to iatrogenic effects. Future work is needed to evaluate the potential (longer-term) benefits of incorporating NSSI-focused modules to evidence-based mental health programs in the prevention of NSSI.

Do Gender and Age Moderate the Relationship between Friendship Quality and Non-Suicidal Self-Injury in Community Children and Adolescents?

“…Girls who are engaging in NSSI could be helped with interventions focusing on interpersonal skills and friendship dynamics. Current prevention and treatment approaches already focus on interpersonal functioning (e.g., Baetens et al, 2020;Gonzales & Bergstrom, 2013;Muehlenkamp, Walsh, & McDade, 2009) but to our knowledge, there do not yet exist prevention or intervention programs specifically targeting friendship quality.…”

Bullying Victimization: Investigating the Unique Contribution of Homophobic Bias on Adolescent Non-suicidal Self-injury and the Buffering Role of School Support

“…Given that schools are the main places where adolescents experience significant stressors, it is in the school setting that they also should find positive support and assistance when struggling with mental health problems. Several schoolbased prevention programs aiming at supporting adolescent coping with intense emotions and stress have been developed, but their effects on NSSI have been documented only to a limited extent (Baetens et al, 2020). For example, one of the most extensive programs in Europe, the Saving and Empowering Young Lives in Europe (SEYLE) program, involving 168 schools from ten countries, including Italy, only focused on the prevention of suicide in schools (Wasserman et al, 2015).…”

“…For example, one of the most extensive programs in Europe, the Saving and Empowering Young Lives in Europe (SEYLE) program, involving 168 schools from ten countries, including Italy, only focused on the prevention of suicide in schools (Wasserman et al, 2015). In a recent pilot study examining the feasibility of a school-based mental health program for the prevention of NSSI in Belgium, the authors found that the addition of the NSSI-specific module to the program had direct benefits to some students with lived experience, such as increased help-seeking behavior for NSSI (Baetens et al, 2020), thus suggesting that effective school-based prevention programs need to include NSSI-specific psychoeducation. Overall, the literature documents the efficacy of cognitivebehavioral approaches in treating adolescent difficulties to manage negative emotions and distress in school contexts (Werner-seidler et al, 2017), with limited examples also in Italy (Ruini et al, 2009).…”

On the Risks of Medicalization of Adolescents Self-Injuring Acts

“…Two programs have been shown to reduce self-injuring acts, the Youth Aware of Mental Health Program (YAM) and Happyles [6] [46]. There are also programs targeting teachers and other school personel [6].…”