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Title: A sequence analysis of patterns in self-harm in young people with and without experience of being looked after in care
Authors: Wadman, R
Clarke, D
Sayal, K
Armstrong, M
Harroe, C
Majumder, P
Vostanis, P
Townsend, E
First Published: 8-Jun-2017
Publisher: Wiley
Citation: Br J Clin Psychol, 2017, 56 (4), pp. 388-407
Abstract: OBJECTIVES: Young people in the public care system ('looked-after' young people) have high levels of self-harm. DESIGN: This paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (CaTS). METHODS: Young people in care (looked-after group: n = 24; 14-21 years) and young people who had never been in care (contrast group: n = 21; 13-21 years) completed the CaTS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across 6 months. RESULTS: Young people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity, and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence 6 months prior to most recent self-harm. CONCLUSIONS: Sequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode are needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended. PRACTITIONER POINTS: Self-harm (and factors associated with self-harm) can change and evolve over time; assessments need to reflect this. Looked-after young people reported feeling better after first self-harm; fearlessness of death, access to means, and impulsivity were reported as key in recent self-harm. Underlying emotional distress, particularly depression and self-hatred were important in both first and most recent self-harm. Looked-after young people should undergo regular monitoring and assessment of each self-harm episode and access to potentially fatal means should be restricted. The CaTS would have clinical utility as an assessment tool Recruiting participants can be a significant challenge in studies with looked-after children and young people. Future research with larger clinical samples would be valuable.
DOI Link: 10.1111/bjc.12145
ISSN: 0144-6657
eISSN: 2044-8260
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2017 The British Psychological Society. Deposited with reference to the publisher’s open access archiving policy. (
Appears in Collections:Published Articles, Dept. of Neuroscience, Psychology and Behaviour

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