Closing in on Crisis: Informing Clinical Practice Regarding Nonsuicidal Self-Injury in Youth

Abstract

Nonsuicidal self-injury (NSSI) in youth is a major public health concern. A retrospective chart review was conducted within a hospital system to examine (a) youth self-reports of reasons for engaging in NSSI and (b) additional contextual circumstances that may contribute to youth NSSI. Detailed history, physical examination, and treatment/discharge data were extracted by thoroughly reviewing all electronic documents in each medical record. The final sample (N = 135) were predominantly female (71.1%), and well over half (63.8%) reported Medicaid or uninsured status. Qualitative content analysis of youth self-reports and hospital progress notes showed that NSSI served as an emotional and functional coping mechanism. Five primary themes characterized the contextual influences on youth engaging in NSSI: (1) Personal Emotions, (2) Trauma, (3) Relationship Quality, (4) Sense of Loss, and (5) Risk Behaviors. Practical clinical practice suggestions for working with youth are discussed using these themes as a template for assessing risk and protective factors.

A qualitative content analysis study using electronic medical records to understand youth suicide attempts

“…current study findings among youth who attempted suicide with the findings ofYoung et al (2017) study with youth who presented for NSSI underscores the importance of risk factors within the identified themes for the full continuum of self-directed violence. Nurses and other clinicians may find it helpful to use these themes in their framework for conducting comprehensive assessments of youth's risk for self-harm.The frequent reports of trauma within these participants stories, while concerning, are consistent with literature.…”

“…Emotions & Symptoms). These four themes align with a qualitative study by Young et al (2017) who, using similar methods, studied youth presenting to emergency departments with nonsuicidal selfinjury (NSSI), a known risk factor for suicide attempt/completion (Nock et al, 2006, Wilkinson & Goodyer, 2011. The alignment of | 79 Chartier et al, 2010;Felitti et al, 1998).…”