Self-harm is prevalent in prison populations and is a well-established risk factor for suicide. Researchers typically rely on self-report to measure self-harm, yet the accuracy and predictive value of self-report in prison populations is unclear. Using a large, representative sample of incarcerated men and women, we aimed to examine the level of agreement between self-reported self-harm history and historical medical records, and investigate the association between self-harm history and medically verified self-harm after release from prison. During confidential interviews with 1315 adults conducted within 6 weeks of expected release from 1 of 7 prisons in Queensland, Australia, participants were asked about the occurrence of lifetime self-harm. Responses were compared with prison medical records and linked both retrospectively and prospectively with ambulance, emergency department and hospital records to identify instances of medically verified self-harm. Follow-up interviews roughly 1, 3 and 6 months after release covered the same domains assessed in the baseline interview as well as self-reported criminal activity and contact with health care, social and criminal justice services since release. Agreement between self-reported and medically verified history of self-harm was poor, with 64 (37.6%) of 170 participants with a history of medically verified self-harm disclosing a history of self-harm at baseline. Participants with a medically verified history of self-harm were more likely than other participants to self-harm during the follow-up period. Compared to the unconfirmed-negative group, the true-positive (adjusted hazard ratio [HR] 6.2 [95% confidence interval (CI) 3.3-10.4]), false-negative (adjusted HR 4.0 [95% CI 2.2-6.7]) and unconfirmed-positive (adjusted HR 2.2 [95% CI 1.2-3.9]) groups were at increased risk for self-harm after release from prison. Self-reported history of self-harm should not be considered a sensitive indicator of prior self-harm or of future self-harm risk in incarcerated adults. To identify those who should be targeted for preventive strategies, triangulation of data from multiple verifiable sources should be performed whenever possible.

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Accuracy and predictive value of incarcerated adults' accounts of their self-harm histories: findings froman Australian prospective data linkage study.

Causes of community suicides among indigenous South Australians.

Aboriginal suicidal behaviours in remote Australia present as very different phenomena to suicidal behaviours in mainstream Australian society. Multiple suicide threats and behaviours often appear to express ways of executing violence or retaliation, rather than the immediate wish to die. This may be a response to the lack of choices in the face of an historical context of intergenerational trauma, grief and loss. Aboriginal youth are grasping the possibility of death, and the threat of dying, as a violent means to gain control over their lives. This enactment of agency can give instant ‘power’ to those violent and vulnerable enough to use it. Using examples of such a suicidal crisis common within these communities, this paper argues that those who work within Australian Aboriginal communities need to better understand the continuing impacts of colonialism and inter-generational trauma and ‘decolonisation’. Further, the approach taken in providing services to communities may need to be adapted from the mo...

'I'm going to kill myself if you don't ...': contextual aspects of suicide in Australian Aboriginal communities

Aboriginal Youth Suicide in Central Australia: Developing a consistent data system & referral pathway

Theoretical, empirical, and experiential attempts at disentangling the functions of Non-Suicidal Self-Injury (NSSI) have been driven by the desire to answer the complex question: Why do people engage in self-injurious behaviours? A recently developed behavioural model of NSSI—the Experiential Avoidance Model (EAM; Chapman, Gratz, & Brown, 2006)—proposes that self-injury functions primarily as a form of negatively reinforced, experiential avoidance and places particular emphasis on emotional avoidance. Experiential avoidance is conceptualised as a behavioural process whereby people are unwilling to tolerate distressing emotions, thoughts, memories, or physical sensations and engage in behaviours to change, avoid, or escape from these aversive, intrapersonal experiences (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). Although the results of international studies support the key assumptions of this model to varying degrees (Klonsky, 2007; Klonsky & Glenn, 2008; Nock & Prinstein, 2004), the EAM has never been empirically evaluated within Aotearoa New Zealand. To determine whether experiential avoidance is the primary function of NSSI for people living within Aotearoa New Zealand, I designed and conducted three studies. For my first study, I interviewed 24 people who had engaged in nonsuicidal self-injurious behaviours in the previous 12 months about the antecedents and consequences of their most recent episode of self-injury. The interviews were analysed using a framework based on behavioural principles, which I developed for the purpose of this research. This method of analysis, which I called Interpretative Functional Analysis, allowed me to identify, and then compare, the functions served by discrete self-injurious episodes. Results supported the EAM (Chapman et al., 2006) in that self-injury episodes functioned predominantly as attempts to avoid or escape from intense, negative emotional experiences. Cognitive avoidance, however, also played a significant role in the self-injury trajectory, which highlighted the importance of investigating unwanted thoughts in subsequent studies. The second study involved surveying 198 people across Aotearoa New Zealand who had self-injured in the previous 12 months to further test whether the key assumptions of the EAM (Chapman et al., 2006) apply to a New Zealand-based population. Quantitative findings supported the model and were consistent with extant international studies in that experientially avoidant, intrapersonal functions (i.e., affect regulation and self-punishment) were identified as primary to the reinforcement and maintenance of NSSI. Intrapersonal functions, in general, were more highly endorsed than interpersonal functions. Finally, both negative affect and cognitions decreased following episodes of self-injury, while joviality increased. The increase in positive emotions undermines the EAM's (Chapman et al., 2006) exclusive focus on negative reinforcement, suggesting that positive reinforcement also has an important role to play in the continued use of NSSI. Analyses of the open-ended, survey responses highlighted the impact of particular contextual factors (such as interpersonal conflict and community norms) on the incidence and maintenance of NSSI. Conducting a thematic analysis of the consequences of people's most recent episode of NSSI allowed me to identify two distinct themes within this data corpus. Specifically, through self-injury participants assumed two paradoxical roles, that of transgressor and helper. For my final study, I surveyed university students across two time-points (Time 1 N = 408, Time 2 N = 224) about their general intrapersonal experiences (i.e., emotions and thoughts) and dispositional coping styles (e.g., global experiential avoidance, thought suppression). Negative intrapersonal experiences and avoidant coping styles were found to vary as a function of NSSI history and recency. Negative automatic thoughts and guilt at Time 1 also predicted new episodes of self-injury at Time 2. Additionally, thought suppression, not global experiential avoidance, was identified as a partial mediator of Time 1 relationships between negative intrapersonal experiences and NSSI. To conclude, the findings from this thesis are situated within a global context, and implications for clinical practice and future research studies are discussed.

Does Non-Suicidal Self-Injury FunctionPrimarily as an Experientially AvoidantBehaviour within Aotearoa New Zealand?

In this small qualitative grounded theory study (21 interviews and focus groups with a total of 26 participants) investigating the understandings of and attitudes toward suicide and self-harm of Aboriginal peoples in a coastal region of New South Wales, Australia, we found that cultural factors particular to these communities influence the way such behavior is defined in an Aboriginal context. A continuation of certain "traditional" cultural forms of self-harm behavior was evident in participant definitions, notably the practice of female hair cutting, also described as a mourning ritual, which appears to serve as a marker both to the individual and others.

Terri Farrelly

Papers

Definitions of suicide and self-harm behavior in an Australian aboriginal community.