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Joint Presentations by INSYNC Researchers
Upcoming:
Association for Behavioral and Cognitive Therapies 42nd Annual Convention
November 13 - 16, 2008 in Orlando, FL.
Toward Evidence-Based Treatment of Non-Suicidal Self-Injury Among Adolescents
Chair: Nicholas Lofthouse
Presenters: Nancy Heath, L Katz, G. Libal, Nicholas Lofthouse, Mary K. Nixon
Past:
Research Rounds: Children’s Hospital of Eastern Ontario
October 11, 2005
Adolescent Self Injury: From Current Knowledge to Future Research through the Development of a Canadian Research Network
Presenters: Nancy Heath, Mary K. Nixon
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Association for Behavioral and Cognitive Therapies Annual Meeting, Chicago, MI.
November, 2006
Biopsychosocial Approaches to the Understanding and Treatment of Adolescent Self-Injury: Piloting Groups for Adolescents who Self Injure and their Parents
Chairs: Nicholas Lofthouse, Mary K. Nixon
Discussant: Nancy Heath
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Association of Behavioral and Cognitive Therapies Annual Conference, Philadelphia, PA.
November, 2007
Toward Evidence-Based Classification and Assessment of Non-Suicidal Self-Injury
Chair: Dr. Nicholas Lofthouse
A Review of Non-Suicidal Self-Injury Assessment Measures for Adolescents
Mary K. Nixon, Paula Cloutier, L. Humphries
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Canadian Academy of Child and Adolescent Psychiatry 27th Annual Conference, Montreal, Quebec
November 12, 2007
Symposium: An Integrated Approach to Research and Practice with Non-Suicidal Self Injuring Youth
Presenters: Dr. Mary K. Nixon, Dr. Nancy L. Heath, Ms. Paula Cloutier, Dr. Geoffrey Payne, Ms. Amy Ayers
Non suicidal self injury is defined as the deliberate destruction of body tissue without the conscious intent to take one’s life. Clinical and community prevalence studies in non developmentally delayed youth indicate that rates of self injury are between 40 and 60 % (Darche 1990, DeClemente 1991) and 14 to 17 % (Ross and Heath, 2001, Nixon et al, 2007 under review) respectively. Rates of self injury in youth may be increasing. Despite this, there remains a dearth of research on self injury in youth resulting in a lack of knowledge to guide both our understanding of this behaviour and the development of appropriate interventions.
This symposium was presented by a team of researchers who are members of a Canadian research network (INSYNC: Interdisciplinary National Self Injury in Youth Network Canada). The goal of this network is to develop knowledge, inform treatment, and facilitate knowledge translation using a biopsychosocial model of Self-Injury (SI). The topics presented included: Prevalence, Correlates and Predictors of SI in Youth: A Population Based Survey, School Counselors Experiences and Knowledge about SI in Youth, Emergency Services and SI in Youth: Characteristics and Referral patterns for Treatment and Neurobiological Perspectives of Self Injury: An Animal Model and Integration of Treatment for Adolescent SI: A Group Based Model
Each presenter provided new data in their area. Discussion was encouraged to promote dialogue about challenges and potential solutions associated with our current understanding of SI in youth, assessment of SI, and treatment approaches in this population.
Symposium Presentations:
1. Mary K. Nixon, Correlates and Predictors of Non-suicidal Self Harm in Youth: A Population Based Study
Co-authors: Gordon Barnes, PhD, School of Child & Youth Care, University of Victoria; Paula Cloutier, Mental Health Patient Service Unit, Children’s Hospital of Eastern Ontario; Anna Kucharski, MA, School of Child & Youth Care, University of Victoria.
Objectives: Community studies that have identified correlates and predictors of self injury are limited to select samples such as urban high schools and have identified associated psychosocial factors such as anxiety, depression, conduct problems and parent conflict in youth who self injure (Hawton et al, 2002, Ross and Heath, 2001). The purpose of the study is to 1) identify correlates of social, family and individual factors non-suicidal self harm (NSSH) in youth 2) identify mediating influences of these factors and 3) identify predictors of occurrence and frequency of NSSH, using a population based survey.
Method: Data was obtained for 568 youth from a randomized population based study of economic and psychological risk and protective factors associated with intentional and non-intentional injuries in a medium sized census area in Western Canada. A standardized definition for deliberate self harm (Hawton et al, 2002) was modified while questions associated factors were based on known scales (Brief Child and Family Phone Interview, Cunningham et al 2001)
Results: Significant predictors of self-harm included female gender Odds Ratio (OR) =2.9, 95% Confidence Interval (CI; 1.64-5.43), level of life stress OR=1.32(CI;1.11-1.57), non- heterosexual sexual orientation OR=2.44(CI;1.22-4.85), low body satisfaction OR=.51(CI;.32-.80), high sensation seeking OR=1.13(CI;1.01-1.27)and depression OR=3.00(CI;1.49-6.07). Frequency of self-harm was predicted by level of depressive symptomatology and lower body satisfaction.
Conclusion: Individual factors such as depression, sexual orientation, sensation seeking and body satisfaction are significant predictors of NSSH, in addition to female gender. Assessment of these factors when evaluating NSSH in the clinical setting is important.
Learning Objectives:
1) To review current research in correlates and predictors of NSSH in youth
2) To consider populations at risk for self harm
3) To consider clinical implications of these findings
2. Dr. Nancy L. Heath, School Counsellors’ Experiences with Self-Injury in the Schools
Co-authors: Jessica Toste and Erin Beettam
Objective: Self-injury (SI) is a growing concern amongst professionals working in the schools. As an integral part of promoting mental health, school counsellors are in a unique position to work with youth who engage in SI.
The current study sought to understand school counsellors’ experiences with SI. The objective was to examine school counsellors’ knowledge and perceptions regarding intervention, treatment, and training.
Method: Participants consisted of 213 school counsellors with years of experiences ranging from 0.5 to 38 years (M = 7.68, SD = 6.92). Participants were contacted through school counselling associations across North America, and invited to complete a 35-item online survey.
Results: Ninety-four percent of participants reported having worked with at least one student who self-injures; however, only 17% worked in schools that had SI protocols. Counsellors reported using empathetic listening (15%) and problem-solving skills building (14%). The majority listed cognitive-behavioural therapy (CBT) as the most effective treatment, but only 2% reported having used this approach. While 81% of participants stated that school counsellors should be conducting interventions, only 8% had received training in the area, and 40% felt that all students who approach them about their SI should be referred to psychiatry for evaluation.
Conclusion: School counsellors are central to assessment, treatment, and referral of students who engage in SI. Findings indicate that school counsellors currently have little training in the area of SI, although they are committed to intervention and treatment with these youth. Approaches to developing school resources will be discussed.
Learning Objectives:
1) To provide a descriptive analysis of how SI in currently being managed within high schools.
2) To outline the treatment approaches being utilized by school counsellors working with youth who engage in SI.
3) To discuss the current experiences of school counsellors and how this will inform professional development.
3. Paula Cloutier, Emergency Services and Self-Injury in Youth: Characteristics and Referral Patterns
Co-authors: Clare Gray, Mental Health Patient Service Unit, Children’s Hospital of Eastern Ontario; Allison Kennedy, Mental Health Patient Service Unit, Children’s Hospital of Eastern Ontario; Mary K. Nixon, Dept of Psychiatry, University of British Columbia
Objective: This study examines the clinical characteristics and referral patterns of youth who present to pediatric emergency mental health services with evidence of self-injury (SI).
Method: In the 2005/06 fiscal year, 233 (36.0%) individuals presented with SI (mean age 14.3 years, 75.5% female). Data was collected from self-reports, parental-reports and clinician-rated measures that comprise part of the assessment in the Crisis Intervention Program at the Children’s Hospital of Eastern Ontario.
Results: Clinically significant depressive and anxiety symptoms were reported in 82.2% and 36.3% of the sample respectively. Mild suicidal ideation was evident for 44.2% and 39.5% reported having moderate to severe suicidal ideation. Presentations to the ED were based on parental concern (29.8%), doctor (22.5%) or school recommendation (21.9%). The main concerns identified by caregivers were suicidal ideation (45.0%), low mood (39.4%) and SI (34.4%). 17.6% of this sample was admitted, 15.2% were referred for urgent outpatient crisis services and the remainder was referred elsewhere. Data from this group will be compared to a matched group with no evidence of SI.
Conclusions: Approximately one third of youth, who were often sent to the ED by a doctor or the school, presented with moderate to severe suicidal ideation. Comparing this group to youth in crisis situations who do not SI will offer insights into the dynamics of this behaviour. Given that a high proportion presented with no or mild suicidal ideation, education regarding SI, its management, and how to access appropriate clinical resources would be beneficial for schools and community physicians.
Learning Objectives:
1) Gain an understanding of the prevalence of self-injury seen by a crisis intervention program housed in the emergency department
2) Gain an understanding of the clinical characteristics of youth presenting to the ED and seen through a crisis intervention program, relative to age and gender matched peers who present to the same clinical service but have not self-injured
3) Gain an appreciation of the referral patterns in this population.
4. Dr. Geoffrey Payne, Neurobiological Perspectives of Self-Injury (SI): An Animal Model
Co-author: Amy Ayers, Northern Medical Program, University of Northern British Columbia
Objective: Early attempts to understand self-injury (SI) have focused on the role of a presenting psychopathology in explaining its onset. One of the major problems has been the underlying psychopathology is not consistent but the presenting symptom of SI which is associated with many conditions is; in particular non-suicidal adolescents. The goal of the current study was to determine what the underlying neurobiology is in promoting the onset of SI, an animal model was developed to fully characterize the underlying neurobiology of SI and the historical neurotransmitters (serotonin, dopamine and opioid) thought to be implicated in this behavior were analyzed.
Methods: Six week old female mice, analogous to adolescent humans, were administered the calcium channel agonist Bay K. 8644 (12 mg, dissolved in ethanol; intraperitoneal, n=30). The behavior in each mouse was followed for 60 minutes post-injection and biting behaviors (paw and foam stick) were noted. Assays of cerebral levels of serotonin, dopamine and opiates were collected at the conclusion of the 60 minutes and compared to age-matched sham (ethanol only) injected female mice.
Results: Data showed that the number of biting behaviors and levels of neurotransmitters were different in mice injected with the calcium channel agonist in comparison to sham injected animals.
Conclusions: The observations of alterations in serotonin, dopamine and opiate signaling in the animal model of SI suggest that all three are interacting to promote the onset of SI.
Learning Objectives:
1) To learn the historical background of the neurobiology underlying SI
2) To gain new neurobiological perspectives of how SI may be initiated
3) To gain insight into improving pharmacotherapy for individuals engaging in SI
5. Dr. Mary K. Nixon, Integration of Treatment for Adolescent Self Injury: A Group Based Model
Co-author: Harjit Aulakh, Saanich Child and Youth Mental Health
Objectives: This presentation will review and discuss the integration of a community based group treatment for self injuring adolescents and their parents, modeled on dialectical behaviour therapy and therapeutic support, within four regionally based community based mental health care services for children and youth in the Greater Victoria area.
Method: The first pilot of the group based treatment was conducted over the spring of 2004. Since then further modifications and refinements to the group approach have occurring, including improvement in handout materials, increased length of sessions and duration of treatment. Six further group sessions have been completed since the initial pilot, each lasting 12 weeks, with parents attending a separate parent group biweekly. The intake process for groups has also been streamlined
Results: Preliminary data from three groups indicated that 23 adolescents entered and 18 (78%) completed the sessions. The average age was 15.5 years. Mindfulness was the DBT skill most consistently reported as being the most helpful. The therapeutic support group component was rated very to extremely helpful. Parental validation and identification were also found beneficial as part of the parent group process. More complete data from the program evaluation will be available for all groups by time of presentation.
In addition, a review of how group treatments were integrated into a program for youth who self injured will be discussed, including aspects around intake, assessment, coordination with individual and/or family therapy, and psychiatric treatment.
Conclusion: Initial program evaluation is favourable. Reviewing integration of new services is important.
Learning Objectives:
1) To review the evidence for psychotherapeutic treatments for adolescent self injury
2) To review a group based psychotherapeutic treatment for adolescents who self injure and their parents
3) To review aspects of integrating group based treatments within a program for youth who self injure, delivered by community based mental health services in the Greater Victoria area
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