Journal of Korean Academy of Nursing (대한간호학회지)

Korean Society of Nursing Science (한국간호과학회)
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Adolescents' Experiences of Non-Suicidal Self-Injury: An Interpretative Phenomenological Analysis Study

청소년의 비자살적 자해 경험: 해석 현상학적 분석

  • Ko, Jung A (Department of Nursing, Hwasung Medi-Science University) ;
  • Kim, Ji Young (College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University)
  • 고정아 (화성의과학대학교 간호학과) ;
  • 김지영 (전북대학교 간호대학.전북간호과학연구소)
  • Received : 2023.05.18
  • Accepted : 2023.09.22
  • Published : 2023.10.31
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Abstract

Purpose: This qualitative study used interpretative phenomenological analysis and photovoice methods to explore the meaning of non-suicidal self-injury experienced by adolescents. Methods: Participants were adolescents enrolled in middle and high schools in Gyeonggi-do and Jeollabuk-do who were selected through snowball sampling. Six participants had repeatedly engaged in self-injurious behavior for over a year. Data were collected through in-depth interviews and the photovoice method between November 2020 and July 2021. The collected data were analyzed using six steps of interpretative phenomenological analysis. Results: The results yielded 5 main themes and 18 subthemes. The main themes were 'a silent cry to an indifferent world', 'a heartache that one endures with scars', 'an inescapable cycle', 'filling the space in one's heart', and 'healing the wounds'. The study findings revealed that the self-injurious behavior of adolescents began as a consequence of feeling lost and struggling with conflicts at home and school, which helped them relieve tension and pain. Nonetheless, inflicting self-injury only left signs of regret and remorse, which became a trace that the participants wanted to hide. However, the wounds healed after receiving attention and support from others. They were determined to stop engaging in repeated self-injurious behaviors and made efforts to do so. Conclusion: This study can be used as a basis for the development of educational programs to prevent non-suicidal self-injury in adolescents. Additionally, it can inform nursing interventions that focus on building support systems to help adolescents who attempt self-injury.

Keywords

References

  1. Seong Y, Bae YB, Kim SJ. Non-suicidal self-injury in South Korea: A systematic review of studies from 2000 to 2018. Cognitive Behavior Therapy in Korea. 2019;19(2):251-280. https://doi.org/10.33703/cbtk.2019.19.2.251
  2. Kim JW. "#Self-harm proof"...adolescents' self-injury, 'Please look at me' is SOS [Internet]. Seoul: Edaily; c2020 [cited 2020 Nov 6]. Available from: https://www.edaily. co.kr/news/read?newsId=01298886625963096.
  3. Ministry of Health and Welfare (MOHW). Activities to clean harmful information on suicide involving the public [Internet]. Sejong: MOHW; c2019 [cited 2019 Jul 16]. Available from: https://blog.naver.com/mohw2016/221587260331.
  4. Lee JH, Cho YY, Jeon JY. 2018 student emotion and behavioral problems screening test [Internet]. Seoul: Hankyoreh21; c2018 [cited 2018 Nov 11]. Available from: https://www.hani.co.kr/arti/society/society_general/869668.html.
  5. Korea Youth Counseling & Welfare Institute (KYCI). Issue paper [Internet]. Busan: KYCI; c2020 [cited 2020 May 6]. Available from: https://www.kyci.or.kr/fileup/issuepaper/IssuePaper_202002.pdf.
  6. Farkas BF, Takacs ZK, Kollarovics N, Balazs J. The prevalence of self-injury in adolescence: A systematic review and meta-analysis. European Child & Adolescent Psychiatry. Forthcoming 2023 Jul 24. https://doi.org/10.1007/s00787-023-02264-y
  7. Dzombak JWP, Haynos AF, Rienecke RD, Van Huysse JL. Brief report: Differences in nonsuicidal self-injury according to binge eating and purging status in an adolescent sample seeking eating disorder treatment. Eating Behaviors. 2020;37:101389. https://doi.org/10.1016/j.eatbeh.2020.101389
  8. Lee DG, Ham KA, Bae BH. Adolescents' self-injurious behaviors: Suicidal self-injury and non-suicidal self-injury in female middle school students. Korean Journal of Counseling and Psychotherapy. 2016;28(4):1171-1192. https://doi.org/10.23844/kjcp.2016.11.28.4.1171
  9. Nock MK. Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science. 2009;18(2):78-83. https://doi.org/10.1111/j.1467-8721.2009.01613.x
  10. Valencia-Agudo F, Burcher GC, Ezpeleta L, Kramer T. Nonsuicidal self-injury in community adolescents: A systematic review of prospective predictors, mediators and moderators. Journal of Adolescence. 2018;65:25-38. https://doi.org/10.1016/j.adolescence.2018.02.012
  11. Thomassin K, Shaffer A, Madden A, Londino DL. Specificity of childhood maltreatment and emotion deficit in nonsuicidal self-injury in an inpatient sample of youth. Psychiatry Research. 2016;244:103-108. https://doi.org/10.1016/j.psychres.2016.07.050
  12. Lee HJ, Ji Y, Choi TY. Clinical characteristics and therapeutic intervention of nonsuicidal self-injury in adolescents. Journal of the Korean Society of Biological Therapies in Psychiatry. 2022;28(1):5-17. https://doi.org/10.22802/jksbtp.2022.28.1.5
  13. Grandclerc S, De Labrouhe D, Spodenkiewicz M, Lachal J, Moro MR. Relations between nonsuicidal self-injury and suicidal behavior in adolescence: A systematic review. PLoS One. 2016;11(4):e0153760. https://doi.org/10.1371/journal.pone.0153760
  14. Buelens T, Luyckx K, Gandhi A, Kiekens G, Claes L. Non-suicidal self-injury in adolescence: Longitudinal associations with psychological distress and rumination. Journal of Abnormal Child Psychology. 2019;47(9):1569-1581. https://doi.org/10.1007/s10802-019-00531-8
  15. Nock MK, Kessler RC. Prevalence of and risk factors for suicide attempts versus suicide gestures: Analysis of the national comorbidity survey. Journal of Abnormal Psychology. 2006;115(3):616-623. https://doi.org/10.1037/0021-843X.115.3.616
  16. Tak CH, Yoon BH, Kim KM, Sea YH, Jung HR, Song JH, et al. Predictive factors of self-injurious behavior with suicidal ideation in adolescents. Mood and Emotion. 2017;15(3):149-155.
  17. Kim MY, Yu J. Factors contributing to non-suicidal self injury in Korean adolescents. Journal of Korean Academy of Community Health Nursing. 2017;28(3):271-279. https://doi.org/10.12799/jkachn.2017.28.3.271
  18. Lee HL, Lee YH. Influence of reward sensitivity/punishment sensitivity on anxiety, depression, and self-harm behavior: The role of stress and controllable attribution style. Korean Journal of Youth Studies. 2015;22(12):567-593.
  19. Fox KR, Franklin JC, Ribeiro JD, Kleiman EM, Bentley KH, Nock MK. Meta-analysis of risk factors for nonsuicidal self-injury. Clinical Psychology Review. 2015;42:156-167. https://doi.org/10.1016/j.cpr.2015.09.002
  20. Shin SJ, Han JH. A study on the experience of self-injury interruption of non-suicidal self-injury youth. Korean Journal of Counseling. 2021;22(5):185-221. https://doi.org/10.15703/kjc.22.5.202110.185
  21. Seo M, Kim J, Lee T, Kim E. A qualitative study on the process of nonsuicidal self-injury and recovery among adolescents with counseling experiences. Korean Journal of Counseling. 2019;20(4):179-207. https://doi.org/10.15703/kjc.20.4.201908.179
  22. Lee JG, Cho SH. A study on middle school students' experience of non-suicidal self-injury. The Korea Journal of Youth Counseling. 2020;28(2):233-255. https://doi.org/10.35151/kyci.2020.28.2.011
  23. Son JY. The meaning of nonsuicidal self-injury in female youths. Korean Journal of Youth Studies. 2020;27(1):55-83. https://doi.org/10.21509/KJYS.2020.01.27.01.55
  24. Oh YS, Jang YJ. A qualitative study of counselors' experiences working with non-suicidal self-injury adolescents. The Korea Journal of Youth Counseling. 2021;29(1):175-204. https://doi.org/10.35151/kyci.2021.29.1.009
  25. Kwon KI, Kim JY. A phenomenological study on counselors' experience of difficulties and coping strategies in non-suicidal self-injury crisis counseling for adolescent. The Korea Journal of Youth Counseling. 2020;28(1):269-291. https://doi.org/10.35151/kyci.2020.28.1.012
  26. Gulbas LE, Hausmann-Stabile C, De Luca SM, Tyler TR, Zayas LH. An exploratory study of nonsuicidal self-injury and suicidal behaviors in adolescent Latinas. American Journal of Orthopsychiatry. 2015;85(4):302-314. https://doi.org/10.1037/ort0000073
  27. Kelada L, Whitlock J, Hasking P, Melvin G. Parents' experiences of nonsuicidal self-injury among adolescents and young adults. Journal of Child and Family Studies. 2016;25(11): 3403-3416. https://doi.org/10.1007/s10826-016-0496-4
  28. Kruzan KP, Whitlock J. Processes of change and nonsuicidal self-injury: A qualitative interview study with individuals at various stages of change. Global Qualitative Nursing Research. 2019;6:2333393619852935. https://doi.org/10.1177/2333393619852935
  29. Smith JA, Flowers P, Larkin M. Interpretative phenomenological analysis: Theory, method and research. 1st Engl. Ed. Kim MY, Lee GS, translator. Seoul: Hanuri Publishing Co; c2015. p. 11-283.
  30. Pringle J, Drummond J, McLafferty E, Hendry C. Interpretative phenomenological analysis: A discussion and critique. Nurse Researcher. 2011;18(3):20-24. https://doi.org/10.7748/nr2011.04.18.3.20.c8459
  31. Burton A, Hughes M, Dempsey RC. Quality of life research: A case for combining photo-elicitation with interpretative phenomenological analysis. Qualitative Research in Psychology. 2017;14(4):375-393. https://doi.org/10.1080/14780887.2017.1322650
  32. Wang CC. Photovoice: A participatory action research strategy applied to women's health. Journal of Women's Health. 1999;8(2):185-192. https://doi.org/10.1089/jwh.1999.8.185
  33. Harper D. Talking about pictures: A case for photo elicitation. Visual Studies. 2002;17(1):13-26. https://doi.org/10.1080/14725860220137345
  34. Seo C, Kim KM. A study on the process of mourning for adolescents who lost their parents due to suicide: Using photovoice. Korean Journal of Youth Studies. 2017;24(9):55-83. https://doi.org/10.21509/KJYS.2017.09.24.9.55
  35. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 2nd Engl. Ed. Kwon JS, Kim JJ, Namkoong K, Park WM, Shin MS, Yu BH, et al., translator. Seoul: Hakjisa; c2015. p. 886-887.
  36. Jacobson CM, Hill RM, Pettit JW, Grozeva D. The association of interpersonal and intrapersonal emotional experiences with non-suicidal self-injury in young adults. Archives of Suicide Research. 2015;19(4):401-413. https://doi.org/10.1080/13811118.2015.1004492
  37. Latz AO. Understanding community college student persistence through photovoice: An emergent model. Journal of College Student Retention: Research, Theory & Practice. 2015;16(4):487-509. https://doi.org/10.2190/CS.16.4.b
  38. Yardley L. Dilemmas in qualitative health research. Psychology and Health. 2000;15(2):215-228. https://doi.org/10.1080/08870440008400302
  39. McLaughlin KA, Hatzenbuehler ML, Mennin DS, Nolen-Hoeksema S. Emotion dysregulation and adolescent psychopathology: A prospective study. Behaviour Research and Therapy. 2011;49(9):544-554. https://doi.org/10.1016/j.brat.2011.06.003
  40. McMahon EM, Reulbach U, Keeley H, Perry IJ, Arensman E. Reprint of: Bullying victimisation, self harm and associated factors in Irish adolescent boys. Social Science & Medicine. 2012;74(4):490-497. https://doi.org/10.1016/j.socscimed.2011.12.001
  41. Yun KS, Ha JH. The effect of social support on non-suicide self-injury: The moderated mediation effect of loneliness by emotional regulation skills. Korean Journal of Counseling and Psychotherapy. 2021;33(3):1155-1177. https://doi.org/10.23844/kjcp.2021.08.33.3.1155
  42. Kim GM. Clinical characteristics of NSSI and predictors of suicide attempts in clinically depressed Korean adolescents. Korean Journal of Psychosomatic Medicine. 2019;27(1):69-76. https://doi.org/10.22722/KJPM.2019.27.1.69
  43. Lewis SP, Seko Y. A double-edged sword: A review of benefits and risks of online nonsuicidal self-injury activities. Journal of Clinical Psychology. 2016;72(3):249-262. https://doi.org/10.1002/jclp.22242
  44. Ong SH. Living with self-harm behaviours. 1st Engl. Ed. Moon HG, translator. Seoul: Happywitches; c2009. p. 1-86.
  45. Buser TJ, Buser JK. Conceptualizing nonsuicidal self-injury as a process addiction: Review of research and implications for counselor training and practice. Journal of Addictions & Offender Counseling. 2013;34(1):16-29. https://doi.org/10.1002/j.2161-1874.2013.00011.x
  46. Lee DH, Yang MJ, Kim SR. Understanding adolescents' self injurious behaviors: A review of the literature. The Korea Journal of Youth Counseling. 2010;18(1):1-24. https://doi.org/10.35151/kyci.2010.18.1.001
  47. Coyle TN, Shaver JA, Linehan MM. On the potential for iatrogenic effects of psychiatric crisis services: The example of dialectical behavior therapy for adult women with borderline personality disorder. Journal of Consulting and Clinical Psychology. 2018;86(2):116-124. https://doi.org/10.1037/ccp0000275
  48. Kim S. The effects of adolescents' impulsiveness on self-injury: Moderating effects of social support. Journal of Future Social Work Research. 2019;10(1):273-298. https://doi.org/10.22836/kaswpr.2019.10.1.273
  49. Deliberto TL, Nock MK. An exploratory study of correlates, onset, and offset of non-suicidal self-injury. Archives of Suicide Research. 2008;12(3):219-231. https://doi.org/10.1080/13811110802101096