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Ravi Amruth's presentation at the inaugural [2013] Teesside University Undergraduate Research Conference, in which he presented his original piece of research into deliberate self-harm.

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  • Hello! My name’s Ravi Amruth, and I’m here to present my dissertation research, called “Cutting Comments: Student Views on Deliberate Self-Harm.”Firstly, I’ll take you through the background of deliberate self-harm, before talking you through my research, and discussing how it can hopefully help when applied in the real world.
  • Deliberate self-harm is defined as being a mostly private behaviour, that results actively or passively [so by commission or omission] in harm to the self.It’s estimated that one in 600 adults are admitted to hospital, and 19,000 teenagers – that’s 19,000 people your age – annually are admitted to Accident and Emergency wards as a result of engaging in deliberate self-harming behaviours. Of course, we can never know the true amount of people who engage in self-harming behaviours, simply because not all go to hospital, and not all admit to being deliberate self-harmers.In recent times, newspapers have stated that deliberate self-harm is becoming an epidemic. This has extended to empirical research papers, which have stated that deliberate self-harm is becoming a ‘cost burden’ on the NHS – which is something we continuously be keeping an eye on in an era of credit crunches, recessions, and looming cuts to public services.
  • Existing research has shown that there is a stigma around deliberate self-harm, and has looked into the likelihood of developing said stigma. This stigma has a massive effect on self-harming individuals, as it can stop them seeking help. This, in theory, could increase the risk of repeating such behaviours – a dangerous fact when there is an increased suicide risk with each repetition of self-harming behaviours. Of course, from the business side of things, there would also be a cost increase as a result of self-harmers being admitted to hospital as a result of their repeated injuries from self-harming behaviours.This study aimed to build on existing knowledge and explain why a stigma is held towards deliberate self-harmers. This study also aimed to identify any gender differences in the perception of deliberate self-harm. Females are more likely to continue deliberate self-harming behaviours into adulthood if they engage in them as youngsters, and are also seen to outnumber males when it comes to deliberate self-harm. Finally, this study aimed to seek a wide range of subjective undergraduate views – deliberate self-harm becomes more common after the age of 16, and it is thoughts that the views of those who may know self-harmers, may be self-harmers, and may go on to work with self-harmers have been sought with this study.
  • As this study sought subjective views Q-Methodology was chosen as the research method.Q-Methodology is seen as being qualiquantilogical - a bridge between qualitative and quantitative methods, in that it can gain the subjective views of more qualitative methods without losing the scientific rigour of more quantitative methods.
  • Q-Methodology is also seen as being vibrant and interactive when contrasted to other research methods, as it’s not ‘yet another survey’. Participants have to actively interact with the data and sort statements based on how much they agree with them [participants place statements they highly agree with at plus 6; statements they feel neutral about at 0; and statements they highly disagree with at -6].
  • For this study, an online variant was used. There is said to be no disparity between the data that can be sought from this online variant, and traditional, paper-based Q-Sorts, and it is said to largely be quicker and eliminate many fatigue effects.
  • Participants in this study were asked to sort 40 statements. These statements were sourced through a variety of methods, including:The media – including one particular statement from the Daily Mail which stated that deliberate self-harm is becoming an “epidemic”.Existing Q-Methodological research – these mainly centred around people’s feelings as to why others engage in self-harming behaviours.- And quasi-naturalistic sources – these are statements that are overheard in the street, have been stated by friends, etc., which adds a nice element of ecological validity to the data at hand.
  • After the 40 participants submitted their 40 Q-Sorts, 5 distinct viewpoints were found. I’m not going to go through all of the factors here [if you want to read about all the factors, I might try to sell you a copy of my dissertation on your way out], but I will talk about three of the most important or interesting factors.Firstly, there was factor A. Participants acknowledged that there is a stigma present, and it has a massive effect on deliberate self-harm. This factor seemed quite knowledgeable around the topic, and indicated, in line with previous research, that self-harm is not used to actively commit suicide, and is used more as a method of communication to express internal distress. However, factor A stated that the media portrays deliberate self-harm inaccurately, and participants expressing this factor would know, as they stated that the media was the main source of their information on deliberate self-harm.Secondly, there was factor B. This factor gave the most insight into the negative views towards deliberate self-harm. It was mostly males who identified this factor, and their sources of information were personal experience and the experience of friends and family. They stated that deliberate self-harm is an immature behaviour, to the point where they stated that it could be grown out of, despite one in 600 adults being admitted to hospital as a result of engaging in deliberate self-harm. Factor B also stated that self-harm is a weak behaviour, and that the phenomenon could possibly be linked to a particular genre of music or media – perhaps showing they believe that people could engage in deliberate self-harm in order to fit in to a certain group. Interestingly, participants expressing this factor tended to only give shallow definitions of deliberate self-harm when asked. Finally, there was factor E. This factor stated that there is a stigma present, but also stated that deliberate self-harm is a negative behaviour that is becoming more common. There was one female who expressed this factor, who stated that her main source on deliberate self-harm was the experience of her friends or family.She stated that self-harm is a justified action – not only can it be used as a means to communicate inner pain or turmoil, but can actively be used as self-medication to heal pain. However, she also stated that deliberate self-harm is embarrassing, though this may be because she had close links to deliberate self-harm. Lastly, she also stated that deliberate self-harmers could potentially be a danger to the people around them as they may use deliberate self-harm to prepare to commit violent acts on others.
  • This study is seen to have succeeded in its aims – an insight has been gained into negative views towards deliberate self-harm [though these are by no means exhaustive], we’ve had an insight into undergraduate views, and we’ve seen some gender differences [perhaps, this study can be seen to agree with existing research that states that females are naturally more compassionate?]Hopefully, these findings can be used to educate people, therefore reduce the stigma around deliberate self-harm, reducing the reoccurrence, and therefore reducing the cost effect on the NHS. Of course, education doesn’t always work – a classic study by Oldham and Kasser found that education, in some cases, can increase negative views. But there is empirical evidence to state that inclusive dialogues, or contact interventions can reduce the stigma around elements of mental health.Future research, hopefully, should centre around the media’s relationship with deliberate self-harm – both in terms of its portrayal of existing deliberate self-harm, or perhaps its encouragement of self-harming behaviours [for instance, the ‘emo’ subculture that’s been inextricably linked with depression].
  • Thank you for watching this presentation. I’d like to welcome any questions you may have.
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    1. 1. Ravi Amruth, Psychology BSc(Hons)K0221004@tees.ac.uk
    2. 2. • Mostly private behaviour (Fox & Hawton, 2004)• “Avoidable physical harm to the self”(Turp, 2003, p.36)• 1 in 600 adults (Kreitman, 1990)• 19,000 teenagers annually(Hawton et al., 1996, as cited in SCIE,2005)• “Cost burden”(Sinclair, Grey, Rivero-Arias, Saunders & Hawton, 2011,p.263)Deliberate Self-Harm
    3. 3. • Existing research has stated that thereis a stigma around deliberate self-harm(Angermeyer, Matschinger & Corrigan,2004; Hinshaw, 2005, as cited in Law,Rostill-Brookes & Goodman, 2009)• This study aimed to:– Pinpoint why there may be such a stigma– Identify any gender differences in the perceptionof deliberate self-harm.– Seek the wide range of subjective views withinan undergraduate populationStudy Aims
    4. 4. • Q-Methodology– Subjective viewpoints– „Qualiquantilogical‟(Stenner & Stainton-Rogers, 2004)– Vibrant!Method
    5. 5. • Q-Methodology– Subjective viewpoints– ‘Qualiquantilogical’(Stenner & Stainton-Rogers, 2004)– Vibrant!Method
    6. 6. Method
    7. 7. • The media• Existing research(Rayner & Warner, 2003)(Dick, Gleeson, Johnstone, & Weston, 2010)• Quasi-naturalistic sources(Boulanger & Lefin, 2008)Statement Sources
    8. 8. • Varimax rotation used• 5 Factors found• Each analysed using factor analysis– Factor A• ‘A stigma is present and the media is at fault. Self-harmers are suffering as a result’– Factor B• ‘Self-harmers are immature on many levels and need toself-harm to show how they feel inside’.– Factor E• ‘There is a clear stigma around deliberate self-harm,which is a justified, yet incredibly negative behaviourthat is becoming more prevalent.Results
    9. 9. • Study succeeded in its aims• Statements around the reasoning aroundself-harm similar to previous research(Rayner & Warner, 2003; Dick, Gleeson,Johnstone, & Weston, 2010)• Reasons for negative attitudes can be usedin education to reduce stigmatisation• Future research should centre around themedia and its relationship with deliberate self-harm– Message it portrays– „Emo‟ subculture (Scott & Chur-Hansen, 2008).Discussion
    10. 10. Any questions?Ravi AmruthPsychology BSc (Hons)k0221004@live.tees.ac.uk@RaviAmruthThank You!
    11. 11. Angermeyer, M., Matschinger, H.,& Corrigan, P., (2004). Familiarity with mental illness and social distance from people withschizophrenia and major depression: testing a model using data from a representative population survey. SchizophreniaResearch 69, 175–182.Baker, R., Thompson, C., Mannion, R., (2003). Q methodology in health economics. Journal of Health Services Research & Policy, 11(1), 38-45.Boulanger, P. M., & Lefin, A. L., (2008) Working Paper 3: Social discourses on well-being in Belgium: dimensions andconstituents. A Q-Methodology approach. Retrieved from http://www.wellbebe.be/Mydocs/QMeth-Report.pdf on the 2nd ofApril, 2012.Dick, K., Gleeson, K., Johnstone, L., Weston, C., (2010). Staff beliefs about why people with learning disabilities self-harm: a Q-methodology study. Journal of Learning Disabilities, 39, 233-242.Fox, C., & Hawton, K. (2004). Deliberate self-harm in adolescence. London: Jessica Kingsley Publishers.Kreitman, N., (1990). Research issues in the epidemiological and public health aspects of suicide and para-suicide. In D.Goldberg & D. Tantam (Eds) The Public Health Impact of Mental Disorder. P.73-82. Stuttgart: Hogrefe & Huber.Law, G., Rostill-Brookes, H. H., & Goodman, D. D. (2009). Public stigma in health and non-healthcare students:Attributions, emotions and willingness to help with adolescent self-harm. International Journal Of NursingStudies, 46(1), 107-118.Matteo, E. K., & You, D. (2012). Reducing mental illness stigma in the classroom. Teaching Of Psychology, 39(2), 121-124.Mercadillo, R. E., Luiz-Díaz, J., Pasaye, E. H., & Barrios, F. A. (2011). Perception of suffering and compassion experience: Brain genderdisparities. Brain And Cognition, 76(1), 5-14.Oldham, J. D., & Kasser, T. (1999). Attitude change in response to information that male homosexuality has a biological basis. Journal of sex& marital therapy, 25(2), 121–4.Rayner, G., & Warner, S., (2003). Self-harming behaviour: from lay perceptions to clinical practise. Counselling PsychologyQuarterly, 16, 4, p.305-329.Reber, B. H., Kaufman, S. E., & Cropp, F., (2000). Assessing Q-Assessor: A validation study of computer-based Q-Sorts versuspaper sorts. Operant Subjectivity, 23, 4, 192-209.Scott, L., & Chur-Hansen, A. (2008). The mental health literacy of rural adolescents: Emo subculture and SMS texting.Australasian Psychiatry, 16(5), 359-362.Sinclair, J. A., Gray, A., Rivero-Arias, O., Saunders, K. A., & Hawton, K. (2011). Healthcare and social services resource useand costs of self-harm patients. Social Psychiatry And Psychiatric Epidemiology, 46(4), 263-271.Social Care Institute for Excellence, (2005). Deliberate self-harm (DSH) among children and adolescents: who is at risk andhow is it recognised. Retrieved from http://www.scie.org.uk/publications/briefings/files/briefing16.pdf on the 1st ofReferences