Non-suicidal self-injury and suicide risk among young adults : an examination of the role of perceived burdensomeness : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
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2019
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Massey University
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Abstract
Background: Non-suicidal self-injury (NSSI) is defined as direct, self-inflicted damage of
body tissue in the absence of the intent to die, and outside of that which is socially sanctioned
(Nock, 2009). The Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005; Van
Orden et al., 2010) posits that serious suicide attempts occur when an individual experiences
both thwarted belongingness and perceived burdensomeness (leading to the desire to die) and
the capability to act upon that desire (acquired capability). Current Study: The current
research suggests the possibility that in addition to the role played in suicidal behaviours,
perceived burdensomeness (PB) also plays a role in NSSI and conceivably in the transition
between NSSI and a suicide attempts. The aims of the current study were to gain further
insight into the role of PB and its relationship with NSSI and to explore themes, narratives
and meaning making of PB amongst those who have engaged in NSSI. The study
hypothesised that higher levels of PB will be present amongst individuals who have engaged
in NSSI compared with those who have not. Methods: A mixed methods approach was
utilised, consisting of an anonymous online survey completed by 159 young New Zealanders
(18 – 24 years of age). Results: A total of 36.9% of participants endorsed perceiving some
degree of burdensomeness towards significant others in their lives, while over half of
participants (51.6%) endorsed having engaged in NSSI. Question responses were combined
to produce an overall PB score to be used for comparison between groups. An interpretative
phenomenological analysis (IPA) was conducted consisting of six in-depth semi-structured
interviews with individuals who had engaged in NSSI and made at least one suicide attempt.
Study findings include the following, in a sample of individuals who engaged in self-
injurious behaviours, scores on a measure of PB increased as self-injurious behaviour moved
from NSSI to suicidal behaviour. Findings: Findings suggested that emotional regulation or
reducing internal distress was a major driver for engaging in NSSI. Regression analysis suggested that scores on a screening measure for Major Depressive Disorder, scores on a
screening measure for Borderline Personality Disorder, frequency of NSSI and number of
NSSI methods used were independently predictive of PB score, accounting for 39.8% of the
variation in PB scores. However Major Depression scores were most significantly predictive,
accounting for 34.2% of the variation in PB scores. A model of the interaction of PB, guilt
and shame has been proposed from the IPA findings. Major conclusions were that higher
levels of PB are present in individuals who have engaged in NSSI compared to those who
have not engaged in any self-injurious behaviours; that there is evidence to suggest that a
continuum of PB may exist moving from NSSI behaviours to suicidal behaviours and finally
that PB is an important construct both clinically and for research into NSSI and suicide
prevention. Study limitations are discussed and suggestions for future research made.
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Keywords
Self-injurious behavior, Suicide, Risk factors, New Zealand, Young adults, Psychology