Developing a new model of understanding self-injury in secure settings: the role of risk, protective and attitude factors

Abstract

This PhD aimed to develop further the Integrated Model of Self Injurious Activity (Ireland & York, 2012) within a secure forensic population. This model was based upon the Interpersonal Psychological Theory of Suicidal Behaviour (Joiner, 2005). The PhD aimed to explore risk, protective and function factors for self-injurious behaviour focusing upon components such as attitudes, cognitions, temperament, state and social environmental factors. Study 1 comprised a Delphi study with 33 experts. Experts generated questions to ask individuals about their attitude towards engaging in self-injurious behaviour. These questions were based upon exploration of the components of the Theory of Planned Behaviour (Ajzen, 1991). Study 2 was conducted with 47 participants using a functional assessment approach of file information, patient interviews and staff interviews. Thematic analysis was used to examine background factors, triggers, consequences and functions for self-injurious behaviour. It was also used to examine times when risk of self-injury was raised but not carried out in order to gain protective information. Some differences between staff and patients were observed as predicted. There was overlap with the Integrated Model of Self Injurious Activity and Self Determination Theory as predicted. Study 3 was conducted with 111 participants, again using a functional assessment approach of file information, patient interviews and staff interviews. These results also indicated overlap with the Integrated Model of Self Injurious Activity. The results of studies 2 and 3 indicated that the majority of protective factors identified were cognitive in nature which is a novel finding. Study 4 involved 80 participants. They were asked to complete psychometrics relating to coping, social support, resilience, impulsivity and suicidal ideation. They were also asked about their attitudes towards self-injury. The results indicated that previous tendency to engage in self-injurious behaviour was predicted by positive attitudes towards self-injury among other predictors. A revised model incorporating findings was developed. The current research indicates that the Revised Integrated Model of Self Injurious Activity holds potential in the explanation and understanding of potential risk and protective factors for self-injury. This is of benefit both theoretically and clinically.