What Happens When You Tell Someone You Self-injure? The Effects of Disclosing NSSI to Adults and Peers

Penelope Hasking; Clare S. Rees; Graham Martin; Jessie Quigley

Disclosures

BMC Public Health. 2015;15(1039) 

In This Article

Results

At baseline 526 (10.2; 28 % male; 72 % female) adolescents reported a history of NSSI. The most frequent methods were cutting, self-battery and severe scratching. Among those who self-injured the average lifetime frequency was 16.92 episodes (range 1–300 times). Average age of first episode was 12.53 years (sd = 2.45). The majority of injuries were rated as 'not at all serious' or needing first aid (88 %), with 31 participants stating that at least once they had to see a doctor as a result of NSSI.

Of the sample, 70 % had sought help from someone for an emotional or behavioural problem, most often friends (50.2 %), parents (44.3 %), or a teacher (11 %). Only 6.6 % had sought help from a mental health professional, and 2.6 % from a family doctor. Among self-injurers, 83 % had sought help, preferentially from friends (68 %), parents (30 %), and teachers (13 %). When asked what problem they were seeking help for, participants cited family problems, fights with friends and problems at school as primary sources of distress; only three explicitly cited NSSI as the problem for which they sought help.

Disclosure of NSSI

Of the sample, 308 reported at baseline that they confided their NSSI to someone else (58.56 %). Confidantes included: friends n = 106 (68.83 %), parents n = 41 (26.62 %), mental health workers n = 21 (13.64 %), general practitioners n = 12 (7.79 %), boy/girlfriends n = 18 (11.69 %), siblings/cousins n = 5 (3.25 %), and teachers: n = 5 (3.25 %). No gender, χ 2 (1, N = 249) = 3.42, p = .18, or age, t(241) = 1.76, p = .08, differences were observed according to whether NSSI was disclosed, thus these were not controlled in remaining analyses.

Participants who self-injured were more likely to report a history of suicide ideation, χ 2 (1, N = 2535) = 372.46, p < .001, and attempt, χ 2 (1, N = 2509) = 169.05, p < .001. Similarly, NSSI at baseline was associated with subsequent ideation and attempt (all p < .001). Disclosure of NSSI was not related to suicide ideation, at any time point (all p > .05).

In order to determine if there were differential consequences associated with confiding in peers or adults, participants were classified based on the first response provided to: 'Who did you tell?' Friends, siblings, boy/girlfriends and online friends were classed as peers, while parents, teachers, mental health workers and GPs were classed as adults. Where status as a peer or adult was unclear (e.g. cousins) confidantes were excluded from analyses. Classified this way, 67.8 % told a peer and 32.2 % told an adult. No gender, χ 2 (1, N = 304) = .38, p = .54, or age, t(302) = .94, p = .35, differences were observed according to whom NSSI was disclosed, thus these were not controlled in remaining analyses.

NSSI in the Social Group

At baseline, adolescents who disclosed their NSSI to someone were more likely to have friends who self-injured, χ 2 (1, N = 526) = 28.01, p < .001 (73.9 % vs 50.0 %), and have a greater number of friends who self-injured, t(470) = 5.16, p < .001 (mean = 2.84 vs 1.68). Among those who did not report having friends who self-injure at baseline, disclosure of their own NSSI was related to an increased likelihood of reporting having friends who self-injured at Time 2, χ 2 (1, N = 102) = 17.26, p < .001, and Time 3, χ 2 (1, N = 78) = 8.72, p = .003. Choice to disclose to a peer or adult was not related to the probability of having a friend who self-injures (all p > .05), number of friends self-injuring (p = .23), or acquiring friends who self-injure over the course of the study (all p > .05).

Help-Seeking Behaviour

At baseline, those who had disclosed their NSSI were more likely to report previously seeking help for an emotional and/or behavioural problem from a boy/girlfriend, χ 2 (1, N = 526) = 11.55, p = .001, but did not differ in help-seeking from any other source. Not surprisingly, adolescents who confided their NSSI to adults were more likely to report seeking help from a parent for an emotional and/or behavioural problem, χ 2 (1, N = 200) = 7.92, p = .005, but no other differences in sources of support were observed.

Both disclosure and time had an effect on actual help-seeking and help-seeking intentions ( Table 2 ). Overall, actual help-seeking did not change from baseline to Time 2 (p > .05), but increased by Time 3, F(1157) = 6.29, p = .01. Help seeking intentions decreased over the first year, F(1157) = 24.04, p < .001, but increased by Time 3, F(1157) = 29.47, p < .001. In those who had disclosed their NSSI, significant effects of time were evident on help-seeking in multivariate analyses, but there was no effect of whether disclosure was to peers or adults, and no interaction. Both actual help-seeking, F (2604) = 10.73, p < .001, and intentions to seek help increased over time, F (2604) = 4.51, p = .01, but while intentions demonstrated an initial increase F (1302) = 5.27, p = .02, they plateaued at Time 3, F (1302) = 3.78, p = .05. Conversely, actual help-seeking decreased initially, F (1302) = 9.04, p = .003, and then increased at Time 3, F (1302) = 12.28, p = .001 ( Table 2 ).

At baseline, among those who had engaged in NSSI only 36 (14.46 %) had not engaged the help of anyone for an emotional and/or behaviour problem. Among these participants, there was no relationship between disclosing NSSI and the probability of seeking help for an emotional and/or behavioural problem at Time 2, χ 2 (1, N = 36) = .49, p = .48, or Time 3, χ 2 (1, N = 36) = .07, p = .79. Participants who disclosed to peers were more likely to report actual help-seeking at Time 3 than those who disclosed to adults, χ 2 (1, N = 36) = 5.39, p = .02, specifically from friends, χ 2 (1, N = 36) = 8.00, p = .001.

Coping Strategies

Main effects of disclosure, time and an interaction between disclosure and time were observed on the combined coping variables. Specifically, the group that disclosed their NSSI reported less problem focused coping, F(1, 484) = 11.99, p < .001, and more non-productive coping, F (1484) = 5.31, p = .02, than those who did not disclose. Non-productive coping, F(2968) = 4.68, p = .009, incrementally decreased at each time point (all p < .001), while problem-solving, F (2968) = 6.81, p = .001, was stable from baseline to Time 2, F (1484) = 3.92, p = .05, but increased at Time 3, λ = .05, F (1484) = 10.49, p = .001. An interaction was only noted for non-productive coping; decreasing over time for both groups, but the initial effect over the first year was stronger for those who disclosed their NSSI (p = .02 vs p = .001).

Among those who disclosed NSSI, main effects of the target of disclosure (i.e. peer vs adult), main effects of time and interaction effects were observed on the combined dependent variables. Specifically, those who disclosed to peers reported more non-productive coping than those who disclosed to adults, F (1302) = 4.93, p = .03. Problem focused coping did not change from baseline to Time 2 (p > .05) but increased at the third data collection point, F (1302) = 13.49, p < .001. Similarly, non-productive coping was initially stable, (p > .05) but decreased by Time 3, F (1302) = 9.56, p = .002. Interaction effects were only evident for problem focused coping; adolescents who confided in peers demonstrated no growth in problem focused coping initially (p > .05) but improved by the final data collection point, F (1,97) = 5.63, p = .02, while those who confided in adults demonstrated steady growth in problem focused coping across Time 2, F (1,97) = 4.02, p = .05, and Time 3, F (1,97) = 8.85, p = .004.

Social Support

Changes over time and an interaction between disclosure and time were evident on the combined social support variables (Table 2). Social support from family increased from baseline to Time 2, F(1242) = 4.34, p = .04, but then decreased at Time 3, F(1242) = 4.78, p = .03. Interaction effects were observed on support from family, F(4484) = 2.45, p = .045, friends, F(4484) = 2.57, p = .04, and significant others, F(4484) = 3.49, p = .008. Support from family initially increased, then plateaued for both groups (disclosure group p = .045; no disclosure p = .005). Although not significant, support from friends decreased when NSSI was disclosed but increased when the behaviour was concealed. Similarly, support from significant others tended to decline over time for those who confided their NSSI (p = .025), while support increased (p = .025) for those who did not reveal their behaviour.

When considering differential effects of disclosure to peers and adults, disclosure, time and an interaction were evident on the combined dependent variables (Table 2). Adolescents who disclosed NSSI to peers reported more support from friends than those who confided in adults, F(1302) = 6.06, p = .01. Across the groups, family support increased from baseline to Time 2, F(1302) = 22.29, p < .001, and again at Time 3, F(1302) = 9.42, p = .002. Interaction effects were only evident when considering social support from friends; among those who confided in friends, perceived support from friends decreased from baseline to Time 2, F (1,97) = 10.71, p = .001, and again at Time 3, F (1,97) = 4.72, p = .03. Conversely, among those who confided in adults, perceived support from friends increased from baseline to Time 2, F (1,97) = 5.23, p = .02, and then stabilised (p > .05).

Reasons for Living

No main effect of disclosure or an interaction was observed on the combined reasons for living. There was an effect of time, but univariate analyses revealed the 'survival and coping beliefs' subscale to be the only significant variable, F (2482) = 9.40, p < .001. Significant increases in coping beliefs were evident at Time 2, F(1241) = 12.72, p < .001, and again at Time 3, F(1241) = 5.61 p = .01.

Despite not exerting an effect on the combined dependent variables, an interaction affecting the 'fear of social disapproval' subscale was evident in univariate analyses, F(2, 482) = 4.50 p = .01. While fear of social disapproval increased among participants who disclosed their NSSI, F(2, 176) = 3.23, p = .03, particularly from Time 2 to Time 3 (p = .01), there was no change among participants who did not disclose their behaviour, F(2, 176) = 2.12, p = .12.

Among those who disclosed their behaviour, reasons for living changed over time, and an interaction with disclosure to a peer or adult was observed. Across the sample scores on all subscales, except fear of suicide, increased over time (all p < .01). While moral objections, responsibility to family and survival and coping beliefs all demonstrated incremental gains at each time point (all p < .05), social disapproval did not change from baseline to Time 2 (p < .05) but increased by Time 3, F (1302) = 8.00, p = .005. An interaction effect was only observed for coping beliefs, F (2604) = 5.64, p = .004; no change was observed among those who confided in peers (all p > .05), while those who confided in adults demonstrated a sharp increase at Time 2, F (1,97) = 35.74, p < .001, and a slight decrease at Time 3, F (1,97) = 4.91, p = .03.

NSSI Severity

Main effects and an interaction between disclosure and time were evident on the severity of NSSI. On average, young people who disclosed their NSSI reported more severe NSSI, F(1310) = 6.19, p = .01. Severity of NSSI fluctuated over time, decreasing from baseline to Time 2, F(1310) = 8.02, p < .001, and then increasing at Time 3, F(1310) = 2.92, p = .01. Among those who disclosed their NSSI, severity of the behaviour decreased from baseline to Time 2, F(1143) = 4.41, p < .001, then stabilised, F(1143) = 1.25, p = .64. Among those who did not disclose their NSSI severity decreased from baseline to Time 2, F(1,59) = 3.38, p = .004, and increased at Time 3, F(1,59) = 5.07, p < .001.

Among those who disclosed their behaviour, reported NSSI severity changed over time, and an interaction with disclosure to a peer or adult was observed. On average, NSSI severity decreased from baseline to Time 2, F(1198) = 3.75, p = .001, and remained stable, F(1198) = .01, p = 1.0. However, this change was only evident among youth who disclosed to adults, F(2,50) = 5.76, p = .006, with no change over time seen for youth who disclosed to peers, F(2146) = 1.48, p = .23.

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