Susan Rasmussen

Predicting depression, anxiety and self-harm in adolescents: The role of perfectionism and acute life stress

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis-stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children (n = 515) over a 6 month period (Time 1-Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism-critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionism-striving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.

Elaborating the cry of pain model of suicidality: Testing a psychological model in a sample of first‐time and repeat self‐harm patients

OBJECTIVES Few studies have specifically tested the Cry of Pain model (CoP model; Williams, 2001). This model conceptualizes suicidal behaviour as a behavioural response to a stressful situation which has three components: defeat, no escape potential, and no rescue. In addition, the model specifies a mediating role for entrapment on the defeat-suicidal ideation relationship, and a moderating role for rescue factors on the entrapment-suicidal ideation relationship. This is the first study to investigate the utility of this psychological model in a sample of first-time and repeat self-harm (SH) patients. METHOD One hundred and thirteen patients who had been admitted to hospital following an episode of SH (36 first-time, 67 repeat) and 37 hospital controls completed measures of defeat, entrapment/escape potential, rescue (social support and positive future thinking), as well as depression, anxiety, and suicidal ideation. RESULTS Analyses highlighted differences between the three participant groups on all of the CoP variables. Hierarchical regression analysis confirmed that total entrapment and internal entrapment mediated the relationship between defeat and suicidal ideation, whilst impaired ability to think positively about the future (but not social support) moderated the relationship between total and internal entrapment and suicidal ideation. CONCLUSIONS The findings provide further empirical support for the CoP Model. The findings are discussed in relation to theory and practice and we recommend that the findings are replicated within a prospective design.

Distinguishing adolescents who think about self-harm from those who engage in self-harm

BACKGROUND Adolescent self-harm is a major public health concern, yet little is known about the factors that distinguish adolescents who think about self-harm but do not act on these thoughts from those who act on such thoughts. AIMS Within a new theoretical model, the integrated motivational-volitional model, we investigated factors associated with adolescents having thoughts of self-harm (ideators) v. those associated with self-harm enaction (enactors). METHOD Observational study of school pupils employing an anonymous self-report survey to compare three groups of adolescents: self-harm enactors (n = 628) v. self-harm ideators (n = 675) v. those without any self-harm history (n = 4219). RESULTS Enactors differed from ideators on all of the volitional factors. Relative to ideators, enactors were more likely to have a family member/close friend who had self-harmed, more likely to think that their peers engaged in self-harm and they were more impulsive than the ideators. Enactors also reported more life stress than ideators. Conversely, the two self-harm groups did not differ on any of the variables associated with the development of self-harm thoughts. CONCLUSIONS As more adolescents think about self-harm than engage in it, a better understanding of the factors that govern behavioural enaction is crucial in the effective assessment of the risk of self-harm.

Adolescent self-harm: a school-based study in Northern Ireland

BACKGROUND The prevalence of adolescent self-harm in Northern Ireland (NI) and its associated factors are unknown. Given the established relationship between conflict and mental health, and NI׳s recent history of conflict, it is important to investigate the factors associated with self-harm in NI. This study aimed to determine the prevalence of self-harm in NI adolescents and the factors associated with it, including exposure to the NI conflict. METHODS Observational study of 3596 school pupils employing an anonymous self-report survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, exposure to the NI conflict, social and internet influences, and psychological variables. RESULTS Self-harm was reported by 10% of respondents. In univariate analyses, exposure to the NI conflict was associated with self-harm alongside established risk factors. In multivariate analyses, bullying and exposure to self-harm were associated with lifetime self-harm in both girls and boys. Alcohol use, drug use, physical and sexual abuse, and self-esteem were also associated with self-harm in girls. In boys, absence of exercise, sexual orientation concerns, anxiety and impulsivity were additional risk factors. The internet/social media and the self-harm of others were also key influences. LIMITATIONS This is a cross-sectional study. CONCLUSIONS The rate of self-harm was lower than elsewhere in the UK/Ireland. The study highlights the factors which should be considered in terms of risk assessment. In addition to established risk factors, the findings suggest that more research on the legacy of the NI conflict as well as the influence of new technologies warrant urgent attention.

The Structure and Temporal Stability of the Child and Adolescent Perfectionism Scale

In this study, the authors examined the factor structure and temporal stability of the Child and Adolescent Perfectionism Scale (CAPS; G. L. Flett, P. L. Hewitt, D. J. Boucher, L. A. Davidson, & Y. Munro, 1997) in 2 samples of adolescents (15-16 years old). In Sample 1 (n = 624), confirmatory factor analysis did not support a 2-factor structure (self-oriented and socially prescribed perfectionism). As in B. T. McCreary, T. E. Joiner, N. B. Schmidt, & N. S. Ialongo (2004), reanalysis suggested a 3-factor solution (i.e., socially prescribed perfectionism, self-oriented-Striving perfectionism, self-oriented-Critical perfectionism). The authors validated their 3-factor model in an independent replication sample (Sample 2; n = 514) and confirmed that the 3-factor structure was invariant across gender and time (test-retest over 6 months). Taking these analyses together, the authors concluded that their discriminant 3-factor structure is robust. Theoretical and clinical implications are discussed. More research on the predictive validity of the CAPS is suggested.

Patient preoperative expectations of total hip replacement in European orthopedic centers.

Patient expectations have been identified as a factor that may account for individual differences in recovery after total hip replacement (THR) surgery. However, patient expectations have not been studied within a valid theoretical framework. This study employed the World Health Organizations model of health, the International Classification of Functioning, Disability and Health (ICF), to classify the content of preoperative patient expectations of THR.

A comparison of substance use behaviours and normative beliefs in North-West European university and college students

Abstract The social norms approach is an increasingly popular intervention for substance use that has been used extensively in the American college system. It operates by correcting normative misperceptions individuals hold about their peers. However, there have been few direct comparisons of substance use misperceptions between student populations in different European countries. The current study sought to address this through use of a survey of substance use and normative beliefs at universities in five European countries. Students at each site were invited to take part in an online survey that included items on personal substance use and the perceived use of peers. A total sample of 6404 students was obtained. Mann-Whitney and χ2 analysis were used to demonstrate an apparent misperception effect, with the majority of students at each site significantly (p<0.05) overestimating the substance use of their peers. This study suggests that students in Europe are prone to misperceiving the substance use of their peers in a manner similar to their American college counterparts, despite the cultural and legislative differences between these settings. This provides support for the potential in using social norms approaches to reduce rates of harmful substance use in European student populations.

A survey study on the associations between misperceptions on substance use by peers and health and academic outcomes in university students in North-West Europe

Abstract Introduction: The basis of Social Norms Theory is that behavior is influenced by the perception of peer behavior. This implies that an overestimation (misperception) of substance use by peers would lead to an increase in personal substance use. It is hypothesized that the misperception of substance use by peers is negatively associated with health and academic performance, and that this association can be explained by an increase in personal substance use. The aim of this study is to investigate the associations of misperception of consumption of tobacco, alcohol, and recreational drugs with health and academic performance, and to test whether or not this association could be explained by substance use in a sample of university students. Methods: Data of 6403 university students in five European countries were gathered through a questionnaire about substance use by themselves and by peers, physical and mental health, and academic functioning. Misperception is defined as an overestimation of the estimated prevalence of substance use among students. Multivariate models are built with misperception regarding tobacco, alcohol and recreational drugs, and personal use of substances as independent variables, and health and academic performance as dependent variables. Results: Misperception is significantly associated with health and academic functioning. This association could not be explained by personal substance use. Conclusions: This study subscribes to an earlier work on the importance of social norms, which indicates a negative influence of misperceptions on health and academic outcomes.

Stepping Back From Crisis Points The Provision and Acknowledgment of Support in an Online Suicide Discussion Forum

Suicide is a global health concern, though little is known about the social practices that might support those who are contemplating suicide. Online forums provide a unique insight into the anonymous discussion of suicide, including sociocultural norms about suicide and the delicate management of online interaction. In this article, we examine the provision and acknowledgment of support in an online discussion forum about suicide, using discursive psychology to analyze the textual interaction. The analysis illustrates how forum threads function as case studies and enable members to gain support on numerous occasions. In this way, members can gain help at crisis points as and when these occur, while still maintaining authenticity as a valid forum member. The analysis also provides additional evidence for models of suicide which highlight the fluid nature of suicidality and contributes to the preventative work on suicide by demonstrating how support can be provided at crisis points.

The Associations Between Children's and Adolescents' Suicidal and Self-Harming Behaviors, and Related Behaviors Within Their Social Networks: A Systematic Review.

Social influences—including the suicidal and self-harming behaviors of others—have been highlighted as a risk factor for suicidal and self-harming behavior in young people, but synthesis of the evidence is lacking. A systematic review of 86 relevant papers was conducted. Considerable published evidence was obtained for positive associations between young peoples suicidal and self-harming behavior and that of people they know, with those reporting knowing people who had engaged in suicidal or self-harming behaviors more likely to report engaging in similar behaviors themselves. Findings are discussed in relation to a number of methodological and measurement issues—including the role of normative perceptions—and implications for the prevention of suicidal and self-harming behavior are considered.