Adolescents, families and schools: A triangulated approach to understanding nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) is the direct and intentional destruction of body tissue without the intention to end one’s life and is typically engaged in to regulate emotion. Family factors may contribute to understanding why NSSI onsets in adolescence and provide a means by which NSSI prevention and intervention can occur. The relationship between NSSI and family functioning is dynamic; poor family functioning can be an antecedent to NSSI, and in turn, NSSI can impact family functioning and the wellbeing of parents. Self-injury research requires better understanding of these dynamic relationships, and how the family can assist recovery from NSSI. In addition, NSSI is often brought to the attention of school mental health staff before the parents, which creates challenges for schools and families. Parents are dissatisfied with the communication from schools while school mental health staff are at a loss when encountered with self-injuring students. Such findings regarding NSSI, families and schools have been consistent across several western countries. Nevertheless, international research regarding NSSI is rare. Therefore the current thesis used an international, triangulated approach to understand NSSI among adolescents, and to inform how families and schools can assist prevention, intervention, and ultimately, recovery. The thesis addressed four main aims: 1) to understand how family functioning – both adolescent and parent reported – relates to NSSI and recovery from NSSI; 2) to cross-nationally compare the experiences of NSSI among young people and their parents; 3) to understand the impact that NSSI has on parents and the family; 4) to explore how school mental health staff can address NSSI.
   The aims of the thesis were achieved in five papers. In paper 1, 272 Australian adolescents completed a self-report questionnaire; results indicated that poorer family functioning and emotion regulation were related to NSSI, and lack of recovery from NSSI. Expanding on this, paper 2 reported the dyadic self-report data from Australian adolescents and their parents: 117 dyads participated, and in 23 of these the adolescent reported a history of self-injury. Parents were typically unaware of how poorly family functioning was perceived by their adolescent who self-injured. Paper 3 aimed to qualitatively understand the experience of young people who self-injure, their relationship with their parents, and their feelings toward recovery. This paper also aimed to compare the experiences of young people in Australia (n=48), Belgium (n=25) and the United States (n=25), which were found to be similar. Young people were ambivalent about recovery, and wanted their parents to remain calm and understanding when responding to NSSI. Moving from the experiences of young people to their parents, paper 4 reported qualitative data gathered from 16 Australian parents and 22 parents in the US. Parents felt uncertain about how to resume normal family functioning after they discovered their child’s NSSI, and were fearful that conflict would lead to another NSSI episode. The Australian parents were then asked about their experiences with school mental health staff, the results of which are presented in paper 5. Additionally, 19 school mental health staff members participated in interviews inquiring about their experiences with students who self-injure and their parents. Parents were favourable in their assessment of school mental health staff, but wanted more support to be directed at them as parents. However, the school mental health staff reported that their primary role was to support the students, not the parents. The results of the five papers have implications for individual and family-based prevention and intervention initiatives, as well education programs for parents, school mental health staff, and external mental health professionals.