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., …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