A sequence analysis of patterns in self-harm in young people with and without experience of being looked-after in care

Wadman, Ruth; Clarke, David; Sayal, Kapil; Armstrong, Miriam; Harroe, C.; Majumder, P.; Vostanis, Panos; Townsend, Ellen

Abstract

Objectives: Young people in the public care system (‘looked-after’ young people) have high levels of self-harm. Design: This paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (CaTS). Methods: Young people in care (looked-after group: n = 24; 14-21 years) and young people who had never been in care (contrast group: n = 21; 13-21 years) completed the CaTS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across six months. Results: Young people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence six months prior to most recent self-harm. Conclusions: Sequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode is needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended.

Citation

Wadman, R., Clarke, D., Sayal, K., Armstrong, M., Harroe, C., Majumder, P., Vostanis, P., & Townsend, E. (2017). A sequence analysis of patterns in self-harm in young people with and without experience of being looked-after in care. British Journal of Clinical Psychology, 56(4), 388-407. https://doi.org/10.1111/bjc.12145

• Journal Article Type: Article
• Acceptance Date: May 11, 2017
• Online Publication Date: Jun 8, 2017
• Publication Date: Nov 1, 2017
• Deposit Date: May 17, 2017
• Publicly Available Date: Jun 8, 2017
• Journal: British Journal of Clinical Psychology
• Print ISSN: 0144-6657
• Electronic ISSN: 2044-8260
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 56
• Issue: 4
• Pages: 388-407
• DOI: https://doi.org/10.1111/bjc.12145
• Keywords: self-harm; adolescence; sequence analysis; children in care; looked-after children
• Public URL: https://nottingham-repository.worktribe.com/output/965789
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/bjc.12145/full
• Additional Information: This is the peer reviewed version of the following article: Wadman, R., Clarke, D., Sayal, K., Armstrong, M., Harroe, C., Majumder, P., Vostanis, P. and Townsend, E. (2017), A sequence analysis of patterns in self-harm in young people with and without experience of being looked after in care. Br J Clin Psychol. doi:10.1111/bjc.12145 which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/bjc.12145/full This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Contract Date: May 17, 2017