A sequence analysis of patterns in self‐harm in young people with and without experience of being looked after in care

摘要

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 (Ca TS ). 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 Ca TS , 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.