Suicidal Idealization and Self-harming Behaviors in Adolescents

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AbstractThe present study will be designed to investigate the prevalence of suicidal ideation and self-harming behavior in adolescents. The sample will be consisted of 1000 American adolescents and will be selected from different schools. It will be hypothesized that the prevalence of suicidal ideation and self-harming behavior in adolescents has increased; there will be the positive predictive relationship between suicidal ideation and self-harming behavior in adolescents. It will also assume that females show increased suicidal ideation and self-harming behavior. Suicidal ideation questionnaire and self-harming behavior scale will be used to assess the suicidal ideation and self-harming behavior in adolescents respectively. Results will indicate the one-fourth prevalence of self-harming behaviors and one-third of suicidal ideation. It will also conclude that suicidal ideation and self-harming behavior in adolescents are positively associated, and females will score high on suicidal ideation and self-harming behavior than males. The present research will have significant implication in the field of developmental psychopathology.IntroductionSuicide is the third leading cause of death in adolescents with age 15-24 years. Research has shown some reasons behind it including intrapersonal and interpersonal. To avoid the stress caused by interpersonal and intrapersonal conflicts, individuals use self-harming behavior as a coping strategy (Nixon, Cloutier, & Jansson, 2008). Self-harming behavior increases with age from childhood to adolescents as adolescence is the period of storm and stress and most of the time it becomes difficult for the youngsters to cope with the challenges of life. According to researchers, self-harming behavior usually begins with early adolescence age that is 12-14 years, and the prevalence rate keeps on increasing as it has reached to almost 41.9% in adolescents that is an alarming situation (adolescents (Hilt, Nock, Lloyd-Richardson & Prinstein, 2008; Muehlenkamp, Claes, Havertape, & Plener, 2012).Self-harming BehaviorSelf-harming behavior, also known as self-injury- is defined as direct, deliberate destruction of body tissue with and without suicidal attempt (Nock & Favazza, 2009). It was once thought to be associated with depression, eating disorder, borderline personality disorder, or any other pathological symptoms. But now, some studies have reported that non-psychiatric population is also showing this behavior and is most commonly observed in adolescents (Cerutti, Manca, Presaghi, & Gratz, 2012). Research has explored many factors that lead to self-harming behaviors and most common are intrapersonal and interpersonal issues. Intrapersonal factors include variables that are related to the identity crisis, academic anxiety, emotional regulation, and depression; whereas interpersonal issues are related to peer relationships, intimate relationships, and parenting (Nock & Prinstein 2004). Many researchers have shown that adolescents who are engaged in self-harming behaviors to cope with anxiety, depression, psychological distress, conduct behavior, and anger outburst (Nock, 2009; Baetens, Claes, Muehlenkamp, Grietens, & Onghena, 2012). So, the self-harming behavior is an escape strategy from painful emotions (Chapman, Gratz, & Brown, 2006).Self-harming behavior and suicidal attempts is quiet related and is reported from some studies, but still, the results are ambiguous. Some of the studies suggest that self-harming is utilized to alleviate the symptoms of stress rather than attempting suicides, whereas some studies suggest that self-harming behavior is a way to avoid suicide (Alderman, 1997). So research shows an ambiguous relationship between the two variables as some shows self-harming behavior is an initiation of suicidal attempt while some suggest that it is a way to avoid suicide. According to Walsh (2006), both suicide and self-harming behavior are completely distinct behavioral and psychological phenomena.Suicidal ideation Suicidal ideation refers to active thoughts about killing oneself or pervasive thoughts about wanting to be dead; and not associated with preparatory behavior. Research has confirmed that self-harming behavior is linked suicidal attempts (Miller & Smith, 2008). Adolescents who experience stressful situations utilize different strategies to change such situations and minimize their impact. Adolescents rely on available social resources including interpersonal networks such as family and friends; or psychological resources such as change thing, using defenses; and other behavioral strategies (Lazarus & Folkman, 1984). But those individuals who do not have a supportive network or some psychological resource system often feel isolated and depressed and start using drugs, and when the problem becomes totally out of control, they prefer to start having self-killing thoughts. But the major problem lies in finding which variable is the predictor and what is the outcome.Literature Review Literature has shown a strong relationship self-harming behavior and suicidal ideation. During adolescence, a high percentage of boys (83%) who have inflicted self-harm had also shown suicidal ideation as compared to those who have never inflicted self-harm (29%) (King et al. 2001; Muehlenkamp & Gutierrez, 2004). Having suicidal thoughts are considered as important indicators of emotional illness; as in adolescent suicidal ideation is strongly linked psychiatric symptoms such as low self-esteem, stress, anxiety, sleep and eating disturbances (Stewart, Donaghey, Deary, & Ebmeier, 2008). Research has also shown that adolescents with high suicidal ideation are at a higher risk to attempt suicide (Reinherz, Tanner, Berger, Beardslee, & Fitzmaurice, 2006).The literature on gender differences shows that females show the increased practice of self-harming behavior as compared to males (Whitlock, Eckenrode, & Silverman, 2006). Findings by Whitlock, Muehlenkamp, and Eckenrode (2008) conclude that there are different classes of self-injury groups, but one of them is boys who use ‘self-battery’ a form of self-injury behavior that practices such behaviors in different social settings. Results concerning race and self-harming behaviors are mixed, as some studies suggest that it is more frequent in Caucasians while others show increased rates in the sample of minorities (Whitlock, Eckenrode, & Silverman, 2006).Researchers emphasize that it is important to identify suicidal ideations as most often it leads to self-harming actions; moreover knowing suicidal ideation is a way to detect self-harming behaviors that will help in initiating prevention strategies. Based upon available literature present study is aimed to investigate the prevalence of suicidal ideation and self-harming behavior in adolescents along with studying the relationship between suicidal ideation and self-harming behavior.Research QuestionWhat is the prevalence of suicidal ideation and self-harming behavior in adolescents?What is the relationship between suicidal ideation and self-harming behavior in adolescents?What is the gender and age differences in suicidal ideation and self-harming behavior?MethodResearch DesignSurvey research will be carried out to investigate the prevalence of suicidal ideation and self-harming behavior.SampleA sample of 1000 boys and girls with an age range of 12 – 24 years of age will be selected from different schools of the city.Instruments A pack of three questionnaires will be used to collect the data.Demographic questionnaire It will consist 12 items that include information regarding demographic variables such as gender, date of birth, parents alive, parents living together, parental age, parental education, family socioeconomic status, family structure, number of the sibling, birth order, grade, and last class scores.Suicidal Ideation Questionnaire Suicidal Ideation Questionnaire (SIQ; Reynengage, 1988), a self-reported measure consisting of 30-items will be used to study the current level of suicidal ideation. It is a 7-point Likert scale ranging from 6 = almost every day to 0 = I never had this thought, with a total score ranging from 0 to 180.Self-Harm QuestionnaireSelf-Harm Questionnaire (SHQ; Ougrin, & Boege, 2013) will be used to identify self-harming behavior in adolescents. It consists of three screening questions such as “Have you ever thought about harming yourself on purpose?” along with questions that inquire about any past behavior related to self-harming behavior or thinking. If the participants will report that they have previously been involved in self-harming behavior then further 12 open-ended questions like “What feelings do you have before self-harm?” will be assessed about the previous self-harming behaviors, functions, severity, and consequences of it.Procedure The main study will be conducted using surveys; adolescents will be approached at different schools. Permission will be taken from school administration to conduct the survey. Purpose of the study will be explained to them, and their written informed consent will be taken from the school administration. Students will be approached in classes and questionnaires will be distributed. They will be asked not to disclose their identity anywhere on the questionnaires.ResultsThe data will be analyzed using SPSS. Means, standard deviations, frequency, and percentages of the different variables will be calculated. Table of descriptive will show increased the mean value of suicidal ideation in females as compared to males. I would expect that students who will report self-harming behavior will use more than one method including self-scratching, wrist cutting, head hitting, etc. Females will be more likely to be involved in self-scratching behavior, whereas boys will be involved in head-hitting behavior. The expected reason for self-harming behavior will be peer rejection and stress dissolution. The Pearson product moment correlation will be used to investigate the relationship between suicidal ideation and self-harming behavior in adolescents.I would expect the significant positive relationship between suicidal ideation and self-harming behavior. Independent sample-test will be used to find out the gender differences in suicidal ideation and self-harming behavior. I would expect significant gender differences in both variables, and females will score high on both scales. Age of the participants will be distributed in 3 categories with young adolescent (12-15), middle adolescents (16-19), and late adolescent (20-24). ANOVA will be used to assess the mean differences in 3 age groups. ANOVA will indicate that middle adolescents will score high on suicidal ideation; whereas self-harming behavior would be high in both young and middle adolescents as compared to older adolescents. Regression analysis will be used to find out the predictive relationship between demographic variables, suicidal ideation, and self-harming behavior. Results of regression analysis will indicate that suicidal ideation, age, and poor academic grades will be significant predictor self-harming behavior.DiscussionSelf-harming behavior and suicidal ideation has gained much attention in the past few decades as a common psychological problem, especially in adolescents. We investigated the prevalence rate of suicidal ideation and self-harming behaviors in adolescents. We explored the relationship between suicidal ideation and self-harming in a sample of American adolescents. Our first research question was about to find out the prevalence of suicidal ideation and self-harm in adolescents. We assumed that one-fourth of our sample was involved in self-harming behaviors and one-third of them had suicidal ideation once in a lifetime.We also studied the most prevalent self-harming behaviors in adolescents that include self-scratching, head hitting, and wrist cutting. Females will be more likely to be involved in self-scratching behavior, whereas boys will be involved in head-hitting behavior. A significant positive relationship between suicidal ideation and self-harming behavior will be observed in the present study. Results of regression analysis will indicate that suicidal ideation, age, and poor academic grades will be significant predictor self-harming behavior. The present findings are also inconsistent with the past findings that indicate the strong predictive relationship between suicidal ideation and self-harming behavior (Dougherty et al., 2009).I would expect significant gender differences in both variables, and females will score high on both scales. The findings will be supported by past findings that indicate the girls tend to involve in self-harming behavior more than males (Nixon, Cloutier, Jansson, 2008). Middle adolescents will score high on suicidal ideation; whereas self-harming behavior would be high in both young and middle adolescents as compared to older adolescents. These results will also be confirmed by past findings that early and middle adolescent are at more risk of involving in self-harming behaviors.The present also has some limitations: firstly the data was collected from schools only, and the majority of the adolescents studying there belong to the wealthy families. So there are some issues related to external validity. Therefore, in future data should be preferably collected through random sampling from homes instead of schools. Secondly, this study includes self-reported measures only rather triangulation method should be used to collect data. The study has significant implications in the field of developmental psychopathology. Serious intervention should be implemented in future for the solution of these behaviors and thoughts. In future, it is recommended to conduct a study on exploring the psychosocial factors involved in causing suicidal ideation and self-harming behavior.ReferencesAlderman, T. O. (1997). The scarred soul: Understanding and ending self-inflicted violence. CA: New Harbinger.Muehlenkamp, J. J., & Gutierrez, P. M. (2004). An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide Life-Threatening Behavior, 34, 12–23.Nixon, M. K., Cloutier, P., & Jansson, S. M. (2008). Non-suicidal self-harm in youth: a population-based survey. Canadian Medical Association Journal, 178(3), 306–312.Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of abnormal psychology, 118(4), 816.Osuch, E.A., Noll, J.G., & Putnam, F.W. (1999). The motivations for self‐injury in psychiatric inpatients. Psychiatry, 62, 334‐346.Reinherz, H. Z., Tanner, J. L., Berger, S. R., Beardslee, W. R, & Fitzmaurice, G. M. (2006). Adolescent Suicidal Ideation as Predictive of Psychopathology, Suicidal Behavior, and Compromised Functioning at Age 30. Am J Psychiat, 163, 1226-32.Stewart, M. E., Donaghey, C., Deary, I. J., Ebmeier, K. P. (2008). Suicidal thoughts in young people: Their frequency and relationships with personality factors. Pers Indiv Differ, 44, 809-20.Walsh, B. (2006). Treating self-injury: A practical guide. New York: Guilford PressWhitlock, J. L., Muehlenkamp, J., & Eckenrode, J. (2008). Variation in non-suicidal self-injury: identification of latent classes in a community population of young adults. J Clin Child Adolesc Psychol, 37, 725–735.Whitlock, J., Eckenrode, J., & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics. 117, 1939–1948.Whitlock, J.L. & Knox, K. (2007). The relationship between suicide and self‐injury in a young adult population. Archives of Pediatrics and Adolescent Medicine. 161(7), 634‐640.King, R. A., Schwab-Stone, M., Fisher, A. J., Greenwald, S., Kramer, R. A., Goodman, S. H., … & Gould, M. S. (2001). Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. Journal of the American Academy of Child & Adolescent Psychiatry, 40(7), 837-846.

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