Uncovering key patterns in self-harm in adolescents: sequence analysis using the card sort task for self-harm (CaTS)

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

Abstract

Background

Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-Harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm.

Methods

Forty-five young people (aged 13-21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams).

Results:

A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode.

Limitations

Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care.

Conclusions

The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions.

Citation

Townsend, E., Wadman, R., Sayal, K., Armstrong, M., Harroe, C., Majumder, P., …Clarke, D. (2016). Uncovering key patterns in self-harm in adolescents: sequence analysis using the card sort task for self-harm (CaTS). Journal of Affective Disorders, 206, 161-168. https://doi.org/10.1016/j.jad.2016.07.004

• Journal Article Type: Article
• Acceptance Date: Jul 3, 2016
• Online Publication Date: Jul 9, 2016
• Publication Date: Dec 1, 2016
• Deposit Date: Jul 26, 2016
• Publicly Available Date: Jul 26, 2016
• Journal: Journal of Affective Disorders
• Print ISSN: 0165-0327
• Electronic ISSN: 1573-2517
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 206
• Pages: 161-168
• DOI: https://doi.org/10.1016/j.jad.2016.07.004
• Keywords: self-harm; adolescence; sequence analysis; card sort; negative emotions; impulsivity
• Public URL: https://nottingham-repository.worktribe.com/output/971749
• Publisher URL: http://www.sciencedirect.com/science/article/pii/S0165032716303585
• Additional Information: This article is maintained by: Elsevier; Article Title: Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS); Journal Title: Journal of Affective Disorders; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jad.2016.07.004; Content Type: article; Copyright: © 2016 The Authors. Published by Elsevier B.V.