Psychological profile in an adolescent community sample: its relation to self-harm

Background: Self-harm is a concerning problem amongst young people, yet the current understanding of the psychological basis to self-harm is limited, particularly that which relates to adolescents in the general community. Aim: The aim of this study was to 1) expand on past research by including a measure of coping strategies and 2) identify distinct psychological profiles and explore the association of these profiles with self-harm rates. Methods: 944 school students from 4 secondary schools aged 11 to 19 and 166 first year psychology students in Sydney, Australia completed a self-report questionnaire. Each participant completed measures of depression, anxiety, and stress, impulsivity, coping strategies, and risk of developing an eating disorder. Clusters of students based on only on psychological profile were formed using non-hierarchical cluster analysis. Differentiation across clusters was then sought based on self-harm rate. Finally, other characteristics of the individual were compared across clusters, including communication with family and friends, bullying, and sexual orientation. Results: Community participants grouped naturally into six distinct clusters of individuals of which four could be described as "normal" in having a desirable psychological profile while the other two clusters were characterized by having an undesirable psychological profile that could be loosely described as psychopathology. The six clusters of individuals could also be divided into three with comparatively low rates of self-harm (5-16% lifetime prevalence) and those with comparatively high rates (25-58% lifetime prevalence). Not surprisingly the three low self-harm rate clusters were also among those characterized by a "normal" psychological profile. Of the three high self-harm rate clusters one was characterized only by high scores on impulsivity but was otherwise unremarkable (lifetime self-harm prevalence 33%). The two remaining high self-harm rate clusters were characterized by complex but quite different psychological profiles. One of these clusters scored high on psychological pathology, high on problem solving skills and high on positive outlook (lifetime self-harm prevalence 25%) while the other scored high on psychological pathology, average on problem solving, low on social support, low on positive outlook and also high on withdrawing as a coping strategy (lifetime self-harm rate 58%). Conclusions: The results presented here carry four key messages. First, adverse psychological factors are clearly associated with elevated rates of both recent and lifetime self-harm. Second, finding three clusters of individuals with high self-harm rates but quite distinct adverse psychological profiles suggests that there maybe multiple paths to self-harm and attempting to find a single model incorporating all risk factors may therefore be unproductive. This has important implications for future research in this area and for clinicians working with adolescents, ie there is no single profile to look out for. These results stand in contrast to previous literature that focuses primarily on identifying a single risk profile for adolescent self-harm. Third, the presence of self-harm in the three psychologically "normal" groups suggests that a subset of adolescents who self-harm may not be identifiable through any known risk factors. This makes it difficult for clinicians, school personnel, and parents to identify adolescents who engage in self-harm. Fourth, although some aspects of psychopathology are not amenable to remedy, their effects on self-harm rates may be ameliorated by teaching adolescents good coping skills and ensuring adequate social support since this differentiates clusters that both have adverse psychological profiles but quite different self-harm rates.