Deliberate Self-Harm Questionnaire Research Articles

PSYCHOPATHOLOGICAL DISTRESS AND SUICIDE AMONG ADULTS WITH MAJOR DEPRESSIVE DISORDER: THE MODERATING ROLE OF RESILIENCE AND MEDIATING ROLE OF DELIBERATE SELF-HARM

Background and Purpose: In the past year, 6.6% of patients with major depressive disorders attempted suicide. Suicidal ideation and behavior may be protected by resilience. Despite decades of research on suicide risk factors in young people, our understanding of the phenomenon has not improved significantly. Therefore, the current study aimed to investigate the relationship between Psychopathological Distress and Suicide in Adults with Major Depressive Disorder. The current study also examines Moderating Role of Resilience and Mediating role of Deliberate Self-Harm among Adults with Major Depressive Disorder.
 
 Methodology: Correlational research design was used in the present study. Data was taken from (n=300) adults with major depressive disorder through purposive sampling strategy. Attitude toward deliberate self-harm questionnaire, Columbia suicide screener, brief resilience scale, depression anxiety stress scale and beck depression inventory-II were used as an assessment measure.
 
 Findings: The result showed that psychopathological distress (r = .04, p < .005) with suicide, and, resilience significant negative (r = -.11, p < .004) relationship with suicide. However, deliberates self-harm (r = .21, p = .001) showed a significant positive relationship with suicide. Regression findings found that all models were significant. In the first step (ΔR2 = .02, F (1, 298) = .51, p = .000) psychopathological distress was a statistically significant predictor (β = .04, p = .000), In the second model (ΔR2 = -.06, F (2, 297) = 2.23, p < .004) resilience (β = -.11, p = .004) was significant predictor of suicide. In the third model (ΔR2 = -.03, F (3, 296) = 4.95, p < .001) deliberate self-harm (β = .23, p = .001) was significant predictor of suicide. In addition, mediation analysis revealed that deliberate self-harm was a significant (p = .05) mediator between psychopathological distress and suicide. Moderating findings showed significant interaction effect of psychopathological distress x resilience (B= -1.42, p= .00) and it revealed that resilience play a significant (p = .05) moderating role between psychopathological distress and suicide.
 
 Contributions. The study concludes that higher level of psychopathological distress and deliberate self-harm leads toward higher level of suicide which cause severe level of major depressive disorder. The present study will help to understand to enhance the resilience which reduce deliberate self-harm and suicide act among adults with major depressive disorder.
 
 Keywords: Psychopathological distress, resilience, deliberate self-harm, suicide, adults, major depressive disorder.
 
 Cite as: Qamar, T. (2023). Psychopathological distress and suicide among adults with major depressive disorder: The moderating role of resilience and mediating role of deliberate self-harm. Journal of Nusantara Studies, 8(1), 226-245. http://dx.doi.org/10.24200/jonus.vol8iss1pp226-245

Development and Validation of the ‘Self-Efficacy in Dealing with Self-Harm Questionnaire’ (SEDSHQ)

Clinicians find it challenging to engage with patients who engage in self-harm. Improving the self-efficacy of professionals who treat self-harm patients may be an important step toward accomplishing better treatment of self-harm. However, there is no instrument available that assesses the self-efficacy of clinicians dealing with self-harm. The aim of this study is to describe the development and validation of the Self-Efficacy in Dealing with Self-Harm Questionnaire (SEDSHQ). This study tests the questionnaire's feasibility, test-retest reliability, internal consistency, content validity, construct validity (factor analysis and convergent validity) and sensitivity to change. The Self-Efficacy in Dealing with Self-Harm Questionnaire is a 27-item instrument which has a 3-factor structure, as found in confirmatory factor analysis. Testing revealed high content validity, significant correlation with a subscale of the Attitude Towards Deliberate Self-Harm Questionnaire (ADSHQ), satisfactory test-retest correlation and a Cronbach's alpha of 0.95. Additionally, the questionnaire was able to measure significant changes after an intervention took place, indicating sensitivity to change. We conclude that the present study indicates that the Self-Efficacy in Dealing with Self-Harm Questionnaire is a valid and reliable instrument for assessing the level of self-efficacy in response to self-harm.

Emergency department nurse's attitudes towards patients who self-harm: A meta-analysis.

Self-harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self-harm injuries, and positive therapeutic patient-nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self-harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta-analyses examined the attitudes of ED nurses towards patients who self-harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta-analysis. The Self-Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta-analysis. The Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta-analysis. Results demonstrated limited empathy and negativity towards patients who self-harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self-harm educational content for ED staff should include areas of knowledge building including explanations and causes of self-harm; range, forms, and functions of self-harm; staff responses to self-harm; assessment, management, and interventions; professional practice issues.

Nurses knowledge and attitudes to individuals who self-harm: A quantitative exploration

Objective: Self-injury can be described as the deliberate destruction of the body without the intent to die, and is a distinct clinical presentation needing to be assessed separately from suicide and para-suicide. Nurses attitude to self-injury is a largely unexplored area particularly within Australia. The aim of this paper is to explore Australian general and mental health nurses’ attitudes towards self-injury taking into account their preparation as registered nurses (RNs) or enrolled nurses (ENs) and length of experience.Methods: This was a mixed methods exploratory design study. Phase one used a combination of two established surveys, the Self-Harm Antipathy Scale (SHAS) and the Attitudes Towards Deliberate Self-Harm Questionnaire (ATDSHQ). Nurses who were either RNs or ENs, mental health educated (MHE) or not, working in the area of mental health or emergency departments (ED) were recruited through a number of professional nursing organisations. A total of 172 nurses completed the phase one online questionnaire. The results of this survey are reported in this paper.Results: The key findings indicated a significant relationship between years of mental health nursing experience and mental health nursing qualification. A significant difference was noted in the knowledge level of self-injury between the mental health nurses who had a greater knowledge compared to those who were not mental health educated. Lastly, the attitudes of nurses to self-injury were generally found to be positive.Conclusions: These results extend much of what is in the literature on knowledge, attitudes and beliefs of nurses to non-suicidal self-injury (NSSI) and place these results in an Australian context. Further research to assess the effectiveness of increased education and community engagement should be undertaken.

Deliberate Self harm in Alcohol Dependent Outpatients in Tertiary Care Centre

Deliberate self harm (DSH) is a behavioral problem with significant clinical and public health importance. It is reported across several psychiatric illnesses like personality disorders, alcohol dependence syndrome (ADS) and affective disorders. A hospital based cross-sectional study was carried out to find the incidence of DSH in outpatients with alcohol dependence syndrome, to learn about the methods used for DSH and to describe the association of DSH with psychiatric co-morbidity in the study population. Data was collected from 100 consecutive outpatients with ADS using structured socio-demographic Performa and semistructured pre-validated DSH questionnaire. ADS and psychiatric co-morbidities were diagnosed by International Classification of Diseases Diagnostic criteria for research- Tenth Revision. (ICD-10 DCR) Incidence of DSH in them in 1 year was 25%. The commonest method of deliberate self-harm was consuming poison (76%). 84% had done DSH under intoxication.92% of them had stressful situation immediately before DSH. 48% had attempted DSH impulsively. 40% had past history of psychiatric disorder. 56% had past history of DSH. 56% had psychiatric co morbidities, of which Depressive disorders (39%) were the most common. 39% of patients with psychiatric co morbidity had past history of DSH. 16% with co morbid depressive disorder had attempted DSH in past 1 year. All patients presenting after deliberate self-harm need to be carefully screened for alcohol disorders and for co morbid psychiatric diagnoses. Abstaining from alcohol may be considered as a key to the resolution of deliberate self harm.

Psychometric properties of the Dutch version of the Attitude Towards Deliberate Self-Harm Questionnaire.

The attitude of nurses and treatment staff is crucial in the treatment of patients who self-harm. However, many patients experience that attitude as negative. The aim of this study was to investigate the psychometric properties of the Dutch version of the Attitude Towards Deliberate Self-Harm Questionnaire. A total of 261 questionnaires were used to measure validity and reliability. Sensitivity to change was measured using a post-test measurement (n = 171) and a subgroup of 78 participants were given the questionnaire twice for test-retest measurement. Factor analysis revealed four factors explaining 33% of the variance. Cronbach's alpha values ranged 0.585-0.809, with 0.637 for the total scale. Intraclass correlation coefficient was assessed in order to estimate test-retest reliability, revealing the questionnaire was stable over time; the exception was factor 3, which had a value of 0.63. Sensitivity to change was found for the total score, factor one and two, and for three of the five items of factor three. We conclude that the Dutch version of the Attitude Towards Deliberate Self-Harm Questionnaire possesses adequate psychometric properties and is potentially an acceptable instrument for measuring the attitude of nurses and health-care staff towards patients who self-harm in Dutch-speaking countries.

Danish emergency nurses' attitudes towards self-harm – a cross-sectional study

AimThe aim of this study was to examine Danish emergency nurses' attitudes toward people hospitalized after an acetaminophen poisoning. Furthermore, the study examined the relationship between attitudes and factors such as age, gender, and education on self-harm. MethodsA cross-sectional design was applied. Nurses from seven emergency departments (EDs) in a region in Denmark were asked to complete the Danish version of Attitudes towards Deliberate Self-Harm Questionnaire (ADSHQ). ResultsOf the 254 eligible nurses working in the ED, 122 returned the questionnaires, leaving the response rate at 48%. Results show that the emergency nurses generally held positive attitudes toward patients with acetaminophen poisoning. Nurses with longer ED experience held more positive attitudes, and women scored significantly higher than men on the whole scale. Only 19% of the respondents had received education on self-harm, and this education seems to produce more positive attitudes and a greater self-efficacy in relation to managing the patient group. ConclusionNurses working in the ED generally hold positive attitudes toward patients with acetaminophen poisoning. It is suggested that education on self-harm is a worthwhile endeavor with the potential to strengthen and improve attitudes, for the benefit of both the nurses and the patients.

Improving communication and practical skills in working with inpatients who self-harm: a pre-test/post-test study of the effects of a training programme

BackgroundDiffering perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme.MethodsPaired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r. Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively.ResultsOf the 281 persons who followed the training programme, 178 completed the questionnaires. The results show a significant increase in the total scores of the three questionnaires, with large to moderate effect sizes. Respondents were positive about the training, especially about the role of the lay expert.ConclusionA specialised training programme in how to care for patients who self-harm can result in a more positive attitude towards self-harm patients, an improved self-efficacy in caring for patients who self-harm, and a greater closeness with the patients. The deployment of lay experts is essential here.

A mixed method study to determine the attitude of Australian emergency health professionals towards patients who present with deliberate self-poisoning

IntroductionDeliberate self-poisoning is one of the frequent presentation types to emergency departments. It has been reported that attitudes of emergency staff may have negative consequences for the wellbeing of the self-poisoning patient. AimDetermine the attitude of nursing and medical staff towards patients who present with deliberate self-poisoning and to identify if differences exist between the two groups. DesignMixed-method. MethodologyThe “Attitudes towards Deliberate Self-Harm Questionnaire” was distributed to all nursing and medical staff who had direct patient contact at three emergency departments (N=410). Total and factor scores were generated and analysed against variables age, gender, length of experience working in the emergency department, level of education and by profession. Two open ended questions asked staff to write their perceptions and stories about patients who deliberate self-poison and were analysed using qualitative data analysis. ResultsForty-five percent of staff returned the questionnaire. The attitude of emergency nurses and doctors was positive towards patients who deliberately self-poison. Doctors had significantly higher total and Factor 2 ‘dealing effectively with the deliberate self-poisoning patient’ scores than nurses. After adjusting for length of time working in the emergency department only Factor 2 ‘dealing effectively with the deliberate self-poisoning patient’ remained statistically significant. Staff reported high levels of frustration, in particular to patients who represent. Conclusion/relevance to practiceThis information may be used to develop and implement educational strategies for staff to improve the experiences of and better support patients presenting to the emergency department who deliberately self-poison.

Psychiatric Nurses’ Attitudes Toward Patients with Borderline Personality Disorder Experiencing Deliberate Self-Harm

The aim of this descriptive study was to explore the attitudes of psychiatric nurses toward patients with borderline personality disorder (BPD) experiencing deliberate self-harm. A convenience sample of psychiatric nurses (N = 83) working on the adult behavioral health units of three psychiatric hospitals in Pennsylvania were surveyed about their attitudes toward BPD inpatients experiencing deliberate self-harm using the Adapted Attitudes towards Deliberate Self-Harm Questionnaire. Psychiatric nurses had positive attitudes toward hospitalized BPD patients with deliberate self-harm issues. Psychiatric nurses with more years of nursing experience and self-reported need for further BPD continuing education had more positive attitudes toward hospitalized BPD patients with deliberate self-harm issues, findings that nurse educators need to consider when planning curricula. Future studies need to examine the longitudinal effect of continuing education on nurses' attitudes and outcomes for BPD patients with deliberate self-harm issues.

Effectiveness of Education Programs in Changing Clinicians' Attitudes Toward Treating Borderline Personality Disorder

This exploratory study was conducted in Australia and New Zealand and examined the impact of two types of education programs (cognitive-behavioral and psychoanalytic) on clinicians' attitude toward deliberate self-harm behaviors in borderline personality disorder and toward working with patients with this disorder. The Attitudes Towards Deliberate Self-Harm Questionnaire was used to assess the attitudes of mental health and emergency medicine clinicians (N=65) before and after attending an education program and at the six-month follow-up. Compared with participants in the control group (N=22), participants in the cognitive-behavioral program (N=18) showed significant improvement in attitudes immediately after attending the program (p=.02), as did participants in the psychoanalytic education program (N=25) (p<.01). However, the six-month follow-up revealed that only the psychoanalytic education group maintained significant changes in attitude (p<.05). Results are discussed in terms of the use of relatively brief educational interventions in facilitating enduring attitude change toward working with patients with borderline personality disorder.

An examination of emergency department nurses’ attitudes towards deliberate self-harm in an Irish teaching hospital

The purpose of this study was to examine emergency department (ED) nurses' attitudes towards individuals presenting with deliberate self-harm (DSH), including the relationship between attitudes and factors such as age, academic achievements, length of experience, and self-harm education. The study adopted a quantitative descriptive and correlational design. ED nurses' attitudes, working in a level 1 trauma ED in the Republic of Ireland, were surveyed, using an amended version of McAllister's et al. [McAllister, M., Creedy, D., Moyle, W., Farrugia, C., 2002. Nurses' attitudes towards clients who self-harm. Journal of Advanced Nursing 40(5), 578-586.] Attitude Towards Deliberate Self-Harm Questionnaire (ADSHQ). The survey yielded an 85% (n=68) response rate. The study found that ED nurses held positive attitudes towards individuals presenting with DSH. No correlation was found between total scores and gender, ED experience, or a history of self-harm education, although older nurses and hospital trained nurses had less positive attitudes. Age and length of clinical experience produced a trend in which attitudes increased, reached a peak and then declined. Although ED nurses in this study hold positive attitudes, ongoing continuing education, which was identified as a key theme in the study, remains an important strategy to maintain and further improve attitudes. The need for research into aspects of care such as knowledge, awareness and empathy is recommended, as is the need to evaluate the extent to which the National Strategy for Suicide Prevention 2005-2014 recommendations [Department of Health and Children, Health Service Executive, National Suicide Review Group 2005. Reach Out - Irish National Strategy for Action on Suicide Prevention 2005-2014. <http://www.nosp.ie/reach_out.pdf> (accessed 22.02.08)] have been implemented.

Targeted Clinical Education for Staff Attitudes Towards Deliberate Self-Harm in Borderline Personality Disorder: Randomized Controlled Trial

The aim of the present study was to assess the impact of attending targeted clinical education on borderline personality disorder on the attitudes of health clinicians towards working with deliberate self-harm behaviours commonly exhibited by patients diagnosed with this complex disorder. Comparisons of clinicians across service settings, occupational fields, and other demographic areas were also made. A purpose-designed demographic questionnaire and the Attitudes Towards Deliberate Self-Harm Questionnaire were used to collect the demographic information and assess the attitudes of 99 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service, both before and after education attendance. Statistically significant improvements in attitude ratings were found for both emergency medicine clinicians and mental health clinicians in working with deliberate self-harm behaviours in borderline personality disorder, following attendance at the education program with a medium affect size (t(32)=-3.45, p=0.002, d=0.43 and t(65)=-5.12, p=0.000, d=0.42, respectively). Clinicians across occupational areas of nursing, allied health, and medical fields demonstrated equivocal levels of improvement in their attitude ratings. Results are discussed in terms of the necessity of providing regular access to targeted clinical education for health professionals working with patients diagnosed with borderline personality disorder.

Nurses' attitudes towards clients who self-harm.

Deliberate self-harm is frequently encountered by emergency department (ED) nurses. However, clients are often dissatisfied with the care provided and clinicians feel ambivalent, helpless or frustrated when working with clients who self-harm. The aim of the study was to develop and test a scale to identify relevant dimensions of ED nurses' attitudes to clients who present with self-injury. Items on Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) were drawn from a literature review and focus group discussions with ED nurses. The tool was piloted with 20 ED nurses not working in the target agencies. A survey of nurses working within 23 major public and 14 major private EDs in Queensland, Australia (n = 1008) was then undertaken. A total of 352 questionnaires were returned (35% response). Analysis revealed four factors that reflected nurses' attitudes toward these clients. The factors related to nurses' perceived confidence in their assessment and referral skills; ability to deal effectively with clients, empathic approach; and ability to cope effectively with legal and hospital regulations that guide practice. There was a generally negative attitude towards clients who self-harm. Correlations were found between years of ED experience and total score on the ADSHQ, and years of ED experience and an empathic approach towards clients who deliberately self-harm. There is a need for continuing professional development activities to address negative attitudes and provide practical strategies to inform practice and clinical protocols.