KAUNAS UNIVERSITY OF MEDICINE

Agnė Laskytė

SOCIAL AND PSYCHOLOGICAL CHARACTERISTICS OF

15-17 YEAR OLD LITHUANIAN PUPILS WHO

DELIBERATELY CAUSE SELF-HARM

Summary of the Doctoral Dissertation

Biomedical Sciences, Public Health (10 B)

Kaunas, 2009

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The dissertation has been accomplished at Kaunas University of Medicine during 2004–2008. Research advisor Assoc. Prof. Dr. Nida Žemaitienė (Kaunas University of Medicine, Biomedical Sciences, Public Health – 10 B) Consultants: Prof. Dr. Habil. Apolinaras Zaborskis (Kaunas University of Medicine, Biomedical Sciences, Public Health – 10 B) Prof. Dr. Habil. Danutė Gailienė (Vilnius University, Social Sciences, Psychology – 06 S) The doctoral dissertation is defended at the Council of Public Health Research of Kaunas University of Medicine. Chairperson

Prof. Dr. Habil. Irena Misevičienė (Kaunas University of Medicine, Biomedical Sciences, Public Health – 10 B)

Members:

Prof. Dr. Habil. Kęstutis Kardelis (Lithuanian Academy of Physical Education, Social Sciences, Education – 07 S) Assoc. Prof. Dr. Arnoldas Jurgutis (Klaipėda University, Biomedical Sciences, Public Health – 10 B) Dr. Virginija Adomaitienė (Kaunas University of Medicine, Biomedical Sciences, Medicine – 07 B) Dr. Lina Jaruševičienė (Kaunas University of Medicine, Biomedical Sciences, Public Health – 10 B)

Opponents:

Prof. Dr. Vylius Leonavičius (Vytautas Magnus University, Social Sciences, Sociology – 05 S) Dr. Aurelijus Veryga (Kaunas University of Medicine, Biomedical Sciences, Public Health – 10 B)

Doctoral dissertation will be defended at the open session of the Council of Public Health Research of Kaunas University of Medicine on the 13th May 2009 at 10 a.m. in the room 422 of the Training-laboratorial building of Kaunas University of Medicine. Address: Eivenių str. 4, LT – 50009 Kaunas, Lithuania. The summary of the doctoral dissertation was sent on the 10th April 2009. The dissertation is available at the library of Kaunas University of Medicine. Address: Eivenių str. 6, LT – 50161 Kaunas, Lithuania.

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KAUNO MEDICINOS UNIVERSITETAS

Agnė Laskytė

SĄMONINGAI SAVE ŽALOJANČIŲ 15–17 METŲ

LIETUVOS MOKSLEIVIŲ SOCIALINĖ IR PSICHOLOGINĖ

CHARAKTERISTIKA

Daktaro disertacijos santrauka Biomedicinos mokslai, visuomenės sveikata (10 B)

Kaunas, 2009

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Disertacija rengta 2004 – 2008 metais Kauno medicinos universitete. Mokslinė vadovė doc. dr. Nida Žemaitienė (Kauno medicinos universitetas, biomedicinos mokslai, visuomenės sveikata – 10 B) Konsultantai: prof. habil. dr. Apolinaras Zaborskis (Kauno medicinos universitetas, biomedicinos mokslai, visuomenės sveikata – 10 B) prof. habil. dr. Danutė Gailienė (Vilniaus universitetas, socialiniai mokslai, psichologija – 06 S) Disertacija ginama Kauno medicinos universiteto Visuomenės sveikatos mokslo krypties taryboje: Pirmininkė

prof. habil. dr. Irena Misevičienė (Kauno medicinos universitetas, biomedicinos mokslai, visuomenės sveikata – 10 B)

Nariai:

prof. habil. dr. Kęstutis Kardelis (Lietuvos kūno kultūros akademija, socialiniai mokslai, edukologija – 07 S) doc. dr. Arnoldas Jurgutis (Klaipėdos universitetas, biomedicinos mokslai, visuomenės sveikata – 10 B) dr. Virginija Adomaitienė (Kauno medicinos universitetas, biomedicinos mokslai, medicina – 07 B) dr. Lina Jaruševičienė (Kauno medicinos universitetas, biomedicinos mokslai, visuomenės sveikata – 10 B)

Oponentai:

prof. dr. Vylius Leonavičius (Vytauto Didžiojo universitetas, socialiniai mokslai, sociologija – 05 S) dr. Aurelijus Veryga (Kauno medicinos universitetas, biomedicinos mokslai, visuomenės sveikata – 10 B)

Disertacija bus ginama viešame Visuomenės sveikatos krypties tarybos posėdyje 2009 m. gegužės mėn. 13 d. 10 val Kauno medicinos universiteto Mokomojo laboratorinio korpuso 422 auditorijoje. Adresas: Eivenių g. 4, LT – 50009 Kaunas, Lietuva. Disertacijos santrauka išsiuntinėta 2009 m. balandžio mėn. 10 d. Disertaciją galima peržiūrėti Kauno medicinos universiteto bibliotekoje. Adresas: Eivenių g. 6, LT – 50161 Kaunas, Lietuva.

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1. INTRODUCTION For over a decade, suicides of young people have been a very important

public health concern. According to the data provided by the Department of Statistics of Lithuania, the number of suicides among the school-aged children varies from 20 to 33 per annum, whereas suicide as the cause of death is number three on the list of causes. One of the key objectives in solving this relevant problem is to disclose suicide risk factors. Research carried out in various countries provide clear evidence that one of the most threatening signs of the possible suicidal behaviour is self-harm or attempted suicide at an early age.

Adolescence is singled out by many experts of personality development and health as a particularly vulnerable period in view of auto-destructive behaviour. Such conclusion is supported by the European statistical data that show the average number of suicides and self-harm in the 0−14 year old age group for 100,000 inhabitants which in 2004 for females was 0.12 and males — 0.34. The annual average number in the 15−29 year old group for females was 2.98 and males — 13.37. In Lithuania, this number is 3−4 times higher; in 2004, in the 15−29 year old group there were 31.15 cases for 100,000 inhabitants (female — 8.65 and male — 53.08). These facts demonstrate that with the increase of age, the rate of suicides is also increasing and that in this respect 15 years of age can be called a particularly critical period.

In order to reduce the probability of suicidal behaviour in adolescence, a great deal of research is carried out aimed at identifying causes of such behaviour. The data of monitoring and research show that deliberate self-harm as suicidal behaviour of the teenager tells about his unsatisfied needs, his wish to change his distressing condition and to demonstrate to others how bad he feels, his attempt to control a shift in interpersonal relations, and – irrespective of the causes for his act – each such case must be treated with all seriousness and responsibility.

Suicides and attempted suicides of teenagers in Lithuania have also been rather widely researched. However, self-harming behaviour, its reasons and motivations behind this behaviour have been so far less examined by Lithuanian scientists. According to various authors, self-harm attempts are from 0 to 100 less frequent than suicides and are to be considered signs of an increased suicide risk. The research in the proliferation of deliberate self-harm is rather complicated and it is hardly possible to find out the exact number of people who have harmed themselves. Usually the indicator of the spread of

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self-harm behaviour is the number of people admitted to hospitals after such attempts. However, the international research shows, only 3−10% of teenagers who have harmed themselves are admitted to hospitals. Estimation of the spread of deliberate self-harm in Lithuania is obstructed by absence of any general records of such cases. Obviously such cases are recorded in medical institutions, but due to the absence of a single registration system and cooperation among medical institutions, accessibility of the data and the use of the data for prevention or identification of the causes (social and psychological factors) of self-harm behaviour becomes a complicated process. Thus, it is natural that the detail research of the problem of deliberate self-harm of adolescents is still a missing link in the research of Lithuanian scientists.

Aim and objectives: To research social and psychological peculiarities of deliberate self-harm

of 15-17 year old Lithuanian pupils. The objectives of the study: 1. To assess distribution of pupils’ deliberate self-harm, types of self-

harm, and socio-demographic irregularities. 2. To disclose subjective reasons for deliberate self-harm of pupils. 3. To analyse the relationship between stressful life experience and

pupils’ deliberate self-harm. 4. To identify the importance of smoking, alcohol, and drug abuse to

deliberate self-harm. 5. To investigate the relationship between the pupils’ deliberate self-

harm and subjective indices of psychic health and general condition. 6. To assess the need for help to pupils who deliberately harm

themselves. Scientific novelty Detailed analysis of research and scientific publications carried out over

the past decade and aimed at identifying the spread of teenage suicides, attempted suicides, and sociological and psychological factors that have an impact on this phenomenon have showed that this is a topical issue and professionals of many different fields take interest in it, however, the research data available is fragmentary and it is difficult to identify the actual scope of the problem on the basis of such data. The research available usually focuses on the respondents who represent individuals admitted to medical institutions for their deliberate self-harm, but nothing is known about those who never had

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any medical assistance. On the other hand, different methodologies for assessment are used in such type of research, samples selected for research are small and usually representative only of the female population of major cities. These deficiencies reasonably impede the possibility of identifying the real situation in Lithuania on the basis of the available scientific research.

In order to know the phenomenon of deliberate self-harm of pupils in Lithuania better, we selected the research methodology tried and tested in several countries abroad, namely, we chose random sampling that would represent the population of 15−17 year old pupils and an anonymous questionnaire that would cover the issues emphasising the teenagers’ lifestyle and adaptation aspects. This allowed us to assess the spread of the deliberate self-harm behaviour on the national level, types of self-harm, and its causes; to identify significant psychological and social characteristics of such behaviour in teenage females and males; and to provide premises for further systematic monitoring of deliberate self-harm behaviour.

Practical importance This scientific research has given an opportunity to analyse in detail

psychological and social characteristics of deliberate self-harm of pupils. The results of the research have been published in research publications and presented at conferences, also presented to wider public. The data obtained can be useful in planning and implementing deliberate self-harm and suicide prevention among teenagers.

2. MATERIAL AND METHODS OF THE STUDY

The research was carried out in 2006 and was a further development of the

initiative started by Prof. Dr. Habil. Danutė Gailienė over a decade ago of cooperation among Vilnius University, Kaunas University of Medicine, and Oslo University (Norway) in the area of suicide prevention. Two groups of researchers were formed for the implementation of this research. The group investigating the factor of deliberate self-harm has been lead by Assoc. Prof. Dr. Nida Žemaitienė.

Selection of the respondents and description of the group researched

Fifteen to seventeen year old pupils were selected for the research. Calculations made by researchers showed that at least 1,020 pupils (95% reliability and 3% precision) in each age group had to be selected for the survey (total number of at least 3060 pupils). It was sought that the

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respondents would represent the population in terms of age, sex, and place of residence. In order to make a selection, stratified random sampling method was used. Considering the number of 15−17 year old teenagers in each county and the ratio of pupils living in towns or villages, a selection of schools and grades was made. In each such school, one class in grades nine, ten, and eleven was chosen, so questionnaires were filled by all pupils who were at school on the particular day. 848 respondents participated in the research: 2200 (57.2%) of female respondents and 1648 (42.8%) of male respondents from 52 schools. Response rate — 86.0%.

The characteristics of teenagers, who participated in the survey with respect to their age, sex, and place of residence, are provided in Table 1.

Table 1. Social-demographic characteristics of the sample group

Place of residence

Age (n/%) Total

Teenage girls (years of age) Teenage boys (years of age)

15 16 17 Total 15 16 17 Total n (%)

Villages 177 (25.6)

233 (33.8)

280 (40.6)

690 (100.0)

152 (28.8)

190 (36.0)

186 (35.2)

528 (100.0)

1218 (31.6)

Cities 418 (27.7)

499 (33.0)

593 (39.3)

1510 (100.0)

303 (27.0)

405 (36.2)

412 (36.8)

1120 (100.0)

2630 (68.4)

Total 595 (27.0)

732 (33.3)

873 (39.7)

2200 (100.0)

455 (27.6)

595 (36.1)

598 (36.3)

1648 (100.0)

3848 (100.0)

Research procedure

Prior to performing the survey, written authorisations were issued by Kaunas Regional Biomedical Research Ethics Committee (8 February 2006, No. BE-2-2, on the basis of the minutes No. 7/2006) and the Ministry of Education and Science as well as consents were provided by the managers of the selected schools. Teachers, psychologists, and social pedagogues of the selected schools were introduced to the procedure and helped to carry out the survey.

The questionnaire was translated into the Lithuanian language and later, translated back into English by an independent translator and submitted to the authors for checking. After the consent of the authors of the questionnaire was received, a test research was carried out that was intended for the clarification of whether the respondents understood the questions, what the uncertainties were, and how long it would take to complete the questionnaire. The test research was carried out in 2005, at Kaunas Martynas Mažvydas Secondary School. Pupils of one class in grades nine, ten, and eleven participated in it.

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Pupils were encouraged to ask the researchers if they had any questions during the completion of the questionnaire. In view of the queries made, instructions for filling the questionnaire were amended and some questions were formulated in more detail.

The survey took place in classes and lasted one period. It was sought that the pupils would reply to the questions individually and sincerely and that they would feel safe, therefore the questionnaire was anonymous and after completion the respondents placed it into an envelope and sealed the envelope. The envelopes were handed to the Department of Preventive Medicine of Kaunas University of Medicine.

The instrument of research and its assessment

Through mediation of Oslo University, the group for suicide research and prevention received an authorisation from Keith Hawton, professor of Oxford University, to use Lifestyle and Coping questionnaire in the research that was developed in 1998 and used as one part of the study on child and adolescent self-harm in Europe (CASE Study).

The method of the questionnaire was used for the survey. The questionnaire included 100 open and closed type questions. All the questions cover eleven scales of information about the individual.

1. Personal information — sex, age, place of residence, and family composition (complete/incomplete). Locations where the respondents live were divided according to the size into villages or cities.

2. Information about the lifestyle — nutrition habits, smoking, the use of alcohol and drugs. Closed-type questions were provided for the respondents with the selection of a single answer about their lifestyle.

Smoking habits of the respondents were assessed according to the number of cigarettes they usually smoked per week (possible options were: "I never smoke“, “I smoked, but stopped”, “No more than 5 cigarettes per week”, “6−20 cigarettes per week", “21−50 cigarettes per week “, and “More than 50 cigarettes per week“). Two groups of teenagers were identified. Pupils who specified that they smoked at least one cigarette a week were attributed to the smoking group and pupils who specified that they never smoked — to the non-smoking group.

The use of alcohol by pupils was assessed on the basis of the number of units of alcohol (one unit of alcohol is approximately 0.33 litres of beer or cider, a glass of wine, or 0.25 grammes of spirits) they usually consumed per week (possible options were: “I never drink alcohol”, “One unit” “2−5 units”,

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“6−10 units”, “11−20 units”, and “More than 20 units”). Two groups of teenagers were identified. Pupils who specified that they consumed at least one unit of alcohol per week were attributed to the group that consumed alcohol and pupils who specified that they never consumed alcohol – to the group that did not consume alcohol.

There were two questions that allowed the teenagers to assess how many times they consumed alcohol in a 30-day period to be really drunk and how often did it happen over the previous year (possible options were: “Not a single time”, “Once”, “2 or 3 times”, “4−10 times”, “More than 10 times”).

The pupils who replied that at least once over the past years they used one type of drugs specified in the list were attributed to the drug-users group. Drugs in the questionnaire were divided into five groups: 1) cannabis substances: hashish, marihuana, and cannabis; 2) ecstasy; 3) opiates: heroin, opium, and morphine; 4) LSD and stimulants: cocaine and amphetamine; and 5) other drugs and narcotic substances, excluding medicines. Pupils, who did not fill in this part of the questionnaire, were attributed to the group that does not use drugs.

3. Stressful events and problems — if pupils experienced any event in their life specified in the list (e.g., difficulties in learning, difficulties in meeting and communicating with friends, disagreements and involvement in fight with friends, bullying, divorce of parents, illness, problems with police, losses, suicide in the family or of a relative, sexual orientation, etc.), they were asked whether that event took place over the past 12 months or more that a year ago. Later, the respondents were divided into two groups: those who suffered a stressful event and those who did not suffer such an event.

The pupils were asked (closed-type questions) whether they had any serious personal and other problems and asked for professional assistance.

4. Deliberate self-harm or suicide attempts — teenagers were asked whether they ever deliberately overdosed any medicines or attempted to harm themselves in any other way. If the reply was negative, they were directed to another part of the questionnaire starting from question forty-five. If the reply was positive and they attributed themselves to those who harmed themselves, they had to answer further questions. Teenagers were asked to describe what specifically they did to harm themselves, where they did it (at home or anywhere else), whether they were intoxicated with drugs or alcohol, why they harmed themselves, who they asked for assistance prior to causing self-harm and after that, and whether they wanted to commit suicide.

Cases of self-harm or other deliberate attempt to harm themselves were classified according to the criteria set by the authors of the questionnaire,

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taking into account the type of self-harm described in the questionnaire. According to the type of self-harm, they were divided into the following four groups: external, internal, mixed, and unspecified type of self-harm. The external self-harm group included the respondents who, willing to harm themselves, cut their body, jumped from a high building, went on hunger, etc.; the internal self-harm group included those who harmed themselves by using large doses of medicines (exceeding the amount prescribed by the doctor) or intoxicating substances; the group of mixed self-harm included those who used several methods to harm themselves or harmed themselves more than once; and the group of unspecified self-harm included those who failed to specify how they harmed themselves.

The pupils were asked how long ago they started thinking about self-harm. They had to choose one of the five replies, i.e., starting from “Less than an hour before self-harm” to “A month or more before self-harm.”

5. Motivation for deliberate self-harm — understanding of the factors that lead to deliberate self-harm is inclusion of the motivation behind such behaviour into research. Teenagers were asked to select from a list of eight factors that would explain the reasons of self-harm. They could make a choice of more than one reason if they found them appropriate (e.g., “I wanted to die", “I wanted to threaten someone”, “I wanted to draw someone’s attention”, etc.). The list of motives was completed on the basis of those used by John Bancroft and his colleagues in their research in 1976 and 1979.

Adolescents who caused self-harm also had an opportunity to describe in their own words the reasons for self-harm by replying to the question “Please describe why you decided to harm yourself then?” Replies to this question were grouped according to the similarity of the motives and divided into the following seven categories: 1) depressing feelings; 2) relationship with family members; 3) relationship with friends; 4) difficulties at school; 5) abuse; 6) other; and 7) unspecified reason. When assessing the reasons, the replies were attributed only to one of the categories. In case of uncertainty, (if the reply gave several reasons), three experts assisted in categorising the reply. The group of experts included Aurelijus Veryga, psychiatrist and Doctor of Biomedical Science, Nida Žemaitienė, psychologist, Associated Professor, and Doctor of Biomedical Science, and Agnė Laskytė, psychologist and the author of this dissertation.

6. Search for assistance and in-patient treatment — the question about seeking assistance prior and after self-harm and also assistance regarding the problem that motivated self-harm, contained a list of possible sources of help: a family member, a friend, a teacher, a family doctor, a social worker, a

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psychologist and a psychiatrist, a help line, an assistance and consultation centre, other sources (i.e., internet, books, magazines, etc.). Pupils could specify several sources of help.

Teenagers who replied that they did not seek help prior to self-harm were asked to describe in a free form why they did not do it. Replies were divided into four categories: 1) mistrust of others; 2) denial of the need for assistance; 3) other reasons; and 4) unspecified reasons. The replies were attributed only to one of the categories.

Teenagers who replied that they did not seek help after self-harm were asked to describe in a free form why they did not do it. Replies were divided into four categories: 1) mistrust of others; 2) denial of the need for assistance; 3) other reasons; 4) unspecified reasons. The replies were attributed only to one of the categories.

The questionnaire included a question to the teenagers who deliberately harmed themselves whether they were admitted to hospital as a result of self-harm. This allowed to compare the self-harm models for those who were admitted to hospitals and those who were not admitted to hospitals; to identify the difference in the statistical data on the suicides of teenagers as against the self-harm of teenagers who never contacted professionals.

7. Thoughts about self-harm — all respondents were asked whether they ever seriously considered self-harm, but did not do it and asked for help instead after such thoughts and what were the sources of help they sought. By analogy, they had to select a reply from the list provided as described above.

8. Coping strategies — all respondents were asked which of the actions they took when they were worried or sad and how often (never, seldom, often) they took such actions: talk to someone, accuse themselves, get angry, stay in their room, think of how they behaved in such situations earlier, drink alcohol, try to think of the causes of anxiety, or try to sort things. Teenagers were also asked who, in their opinion, they could talk to about the things that worried them (they could opt for several appropriate replies): father/stepfather, mother/stepmother, brother/sister, other relative, a friend, a teacher, or anyone else.

9. Psychological characteristics — this scale of the questionnaire was intended for investigating the mental condition during the completion of the questionnaire.

Hospital Anxiety and Depression (HAD) scale has been used that consists of 14 questions for screening depression and anxiety symptoms and is recognized suitable for testing adolescents. The scale is comprised of two parts with seven questions in each part: anxiety subscale (HADa) (statements

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related with frequent pathological forms of anxiety — generalised anxiety and panic disorders) and depression subscale (HADd) (statements relevant to essential symptoms of depression). The respondents had to select a statement out of four options based on their experience over the past week. Cronbach alpha index identified during this test and showing the reliability of scales was 0.64 for anxiety subscale and 0.63 for depression subscale.

Also, the short version of eight questions of the Robson Self-Concept Questionnaire (1989) to measure the teenagers’ self-esteem was used. During this test, Cronbach alpha index was 0.68.

The questionnaire also contained a short version of R. Plutchik and H.M. Van Praag (1989) scale to rate impulsivity of teenagers. During this test, Cronbach alpha index was 0.53.

10. Prevention of self-harm and suggestions to the researchers – all the respondents had an opportunity in a free form to provide suggestions of how self-harm in young people could be prevented. Many respondents provided more than one suggestion. Suggestions of each respondent were divided into several categories. We identified 10 categories in all: 1) assistance from a psychologist or other professional and psychological education; 2) information; 3) parents’ attention; 4) friends’ attention; 5) internal strength; 6) spending of leisure; 7) conditions at school; 8) lack of communication and attention; 9) they cannot be helped; and 10) other.

Also, respondents were asked about their opinion of what else young people should be asked and how to improve life in their environment.

11. Opinion about the questionnaire — the respondents were asked to share their opinion about the questionnaire and specify which other questions could be included (open-type questions). They had to answer whether all their replies were sincere. Three possible answers could be provided from "I replied to all the questions sincerely and openly” to “I filled in the questionnaire anyhow”. This gave an idea to what extent the replies of the respondents could be trusted.

Statistical data analysis

Data analysis of statistical research was carried out by using SPSS 16.0 for Windows. The respondents were identified by allocating a sequence number to each of them. The number was written down on the questionnaire for future reference.

To test internal reliability of the scales (anxiety, impulsivity, self–esteem, etc.) of the questionnaire, Cronbach alpha index was used. Recommendations provided in the literature for the score of Cronbach alpha index differ. Two

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important limits of 0.5 (for the comparison of groups) and 0.8 (for the comparison of individuals are given). Cronbach alpha scores received during this test were assessed in view of the fact that the groups of respondents were compared.

In order to forecast deliberate self-harm of teenagers we used binary logistic regression. Using this method we tested whether the variables selected on the basis of scientific literature and included into the model were important for the forecast of deliberate self-harm of Lithuanian teenagers. Variables that had the prognostic value were thus separated from those that did not have the prognostic value.

Logistic regression has several analogues of coefficients of determination in linear regression. One and the same rule applies to them: the higher the coefficient, the more adjusted to the data the logistic regression is, even though coefficients are not compared because of their dissimilar definitions. We will rely on one such coefficient, that of Nagelkerke R2. The coefficient shows the part of dispersion that is explained by the logistic regression model. It may vary between 0 and 1. The higher the coefficient, the better adjusted to the data the logistic regression is.

In the case of independent sampling, for nominal variables χ2 criterion was used to compare two empirical probabilities.

To estimate nonparametric rank variable connection strength we used Kendall’s tau-c and Somer’s d correlation coefficients.

To estimate the interface of two independent and one dependent variable and independent variables, dispersion analysis of two factors was employed.

3. RESULTS

Distribution and types of deliberate self-harm of pupils

According to the research, 7.3% (9.9% female and 3.8% male; p<0.01) pupils of 15−17 years of age harmed themselves. 16.0% of them did it less than a month ago, 34.0% — 1−12 months ago, and 50.0% — more than a year ago.

More than a third of respondents (11.9%; 17.2 % of females and 4.7 % of males; p<0.01) replied that during the year they had suicidal thoughts. Pupils who had such thoughts, compared to others, more often deliberately harmed themselves (26.9 % and 4.7 % respectively; p<0.001).

The distribution of self-harm behaviour between the adolescents residing in the cities and the villages was not dissimilar. It was identified that 192

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teenagers (7.3%) residing in cities and 89 (7.3%) residing in the villages deliberately harmed themselves.

The difference was identified in the family composition of the teenagers who deliberately harmed themselves and those who did not self-harm. More teenagers who harmed themselves as compared to the teenagers who did not self-harm, came from incomplete families than from complete families (49.1% and 30.5%; 50.9% and 69.5% respectively; p<0.01). Pupils who harmed themselves more frequently than their peers who did not self-harm lived only with one of the parents (27.4% and 20.3%; p< 0.01) or some family member (7.1% and 3.2 %; p<0.01) or other people (9.3% and 3.1 %; p<0.01).

In their descriptions of how they harmed themselves, 34.2% of pupils specified that they used large doses of medicines or intoxicating substances and 26.0% — slashed their arms/hands, legs, other parts of the body, burnt themselves with cigarettes, tried to hang themselves or performed other acts. 11.0% of the respondents specified several different types of self-harm inflicted at different times or mixed type of self-harm. Nearly a third (28.8%) of those who confessed to deliberate self-harm did not specify the type of self-harm. The research disclosed that most frequent external self-harm of teenagers was to slash their arms/hands. Such type of self-harm was specified by 78.0% of all teenagers who externally harmed themselves. Comparing the data according to sex, it was established that such type of self-harm was more typical of female teenagers than of male teenagers (88.0% and 12.0% respectively; p<0.001).

Teenage girls more frequently than teenage boys specified that they used such types of self-harm as slashing their arms/hand and overdosing of medicines. Male adolescents, compared to their female counterparts, tend not to specify the type of self-harm (Table 2).

The analysis of the types of self-harm and the place of residence of teenagers shows significant difference. Teenagers who live in villages specified less frequently that they harmed themselves externally, i.e. slashed, burnt themselves, etc. (Table 2).

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Table 2. Distribution of the types of deliberate self-harm (n/%) Types of self-

harm Teenage

girlsTeenage

boys Villages Cities Total

External 63 (28.9) 10 (15.9)* 16 (18.0) 57 (29.7) ^ 73 (26.0) Internal 84 (38.5) 12 (19.0)** 37 (41.6) 59 (30.7) 96 (34.2)

Non-specified act 47 (21.6) 34 (54.0)** 29 (32.6) 52 (27.1) 81 (28.8)

Mixed 24 (11.0) 7 (11.1) 7 (7.9) 24 (12.5) 31 (11.0) Total 218 (100.0) 63 (100.0) 89 (100.0) 192 (100.0) 281 (100.0)

*p<0.05, **p<0.01, comparing teenage girls with boys; ^ p<0.05, comparing respondents living in the cities with those living in the villages.

We carried out binary logistic regression analysis by selecting the

following demographic factors as independent variables: place of residence (village or city), age of the teenager, and composition of the family (possible options: lives with both mother and father, with one parent, with one of the parents and a step-parent/partner, with a member of the family or with someone else). The dependent variable was deliberate self-harm. Calculations were made separately for female and male teenagers (Table 3).

Table 3. Relationship between deliberate self-harm and socio-demographic factors in the group of teenage girls and boys

Sex Attributes analysed Odds ratio (CI 95 %)

Teenage girls

Lives with one parent 1.75 (1.26-2.43); p<0.05 Lives with one parent and a step-parent/partner 1.49 (0.77-2.87)

Lives with another member of the family 3.08 (1.77-5.35); p<0.001 Lives with someone else (not mentioned above) 3.34 (1.82-6.10); p<0.001

Teenage boys

Lives with one parent 1.85 (0.99-3.48) Lives with one parent and a step-parent/partner 2.67 (0.91-7.85)

Lives with another member of the family 1.69 (0.39-7.29) Lives with someone else (not mentioned above) 7.43 (3.53-15.65); p<0.001

CI – Confidence interval. The results show that neither age nor the place of residence is statistically

significantly related with deliberate self-harm when the binary logistic regression model includes the factor of the family composition (Table 3). This factor, irrespective of other demographic factors (included into the analysis) is statistically significantly related with deliberate self-harm in adolescence.

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Statistical reliability of the model (Nagelkerke R2) is 0.30 in the sample of female teenagers and 0.53 in the sample of male teenagers.

On the basis of the data of the binary logistic regression analysis, the possibility of deliberate self-harm both in the case of female and male teenagers (compared to those who live in the family with both father and mother) considerably increases if they live “with someone else (not a family member): 3.34 times for girls and 7.43 times for boys.

Reasons for deliberate self-harm specified by the pupils

Detailed examination of the reasons for self-harm of pupils can be made by taking individual categories and describing replies that were attributed to each category.

The category “depressing feelings” included several sub-categories: 1) despair, disappointment with life: “I was disappointed with life", “I lost hope”, “I was totally disappointed”, “too much of everything”, and “I was sick with routine”; 2) the feeling of loneliness and being unwanted: “I felt lonely”, “no one loves me", “I was afraid of loneliness”, and “no one needed me“; 3) nervous strain: I wanted to relax”, “I was under stress”, and “life made me nervous"; 4) sadness: “I was sad”, “I felt unhappy”, and “I wanted to be understood”; 5) shame, guilt: “I was ashamed to look into other’s eyes”, “I am useless”, and “it would be better without me”; 6) anger: “I didn’t get on with anybody” and “I hated myself”; 7) bad mood: “I was in bad mood.”

The category of “relationships with family members” included the following sub-categories: 1) disagreements of children and parents: “I didn’t get on well with my parents” and “My parents didn’t let me to go out”; 2) the lack of parental love and attention: “I miss my mother”, and “I miss love from the family”; 3) the problem specified abstractly: “In my home people drink alcohol”, “family problems”.

The following replies were allocated to the category of “relationships with friends”: “I had an argument with my friend”, "I betrayed my friend”, and “I had enough of my classmates.”

The following replies were allocated to the category of “difficulties at school”: “I had difficulties in learning”, “I didn’t want to go to school”, and I got a bad mark.”

The following replies were allocated to the category of “abuse”: “I harmed myself because of bullying that I regularly suffer”, “Because of an attempt to rape me”, “Because I was raped”, and “Because of physical and moral violence.”

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The following replies were allocated to the category “other reasons”: “I was drunk”, “I was wondering if it hurt”, “I wanted to make a remembrance of this day”, and “I wanted to get ill.”

In their reply why they decided to self-harm, more than a third of pupils who harmed themselves mentioned depressing feelings, a tenth of the pupils mentioned problem relationship with members of the family, and a little less than a tenth of the pupils mentioned problem relationship with friends. A third of them did not specify the reason for self-harm (Table 4).

Table 4. Distribution of the reasons for self-harm specified by teenage girls and boys (n/%)

Reason for self-harm Teenage girls Teenage boys Total

Depressing feelings 100 (45.9)** 13 (20.6) 113 (40.2)

Problem relationship with parents 28 (12.8)* 2 (3.2) 30 (10.7)

Problem relationship with friends 15 (6.9) 6 (9.5) 21 (7.5)

Difficulties at school 8 (3.7) 2 (3.2) 10 (3.6)

Abuse 8 (3.7) 0 (0) 8 (2.8)

Other reasons 6 (2.8) 4 (6.3) 10 (3.6)

Reason unspecified 53 (24.3) 36 (57.1)** 89 (31.7)

Total 218 (100.0) 63 (100.0) 281 (100.0)

*p<0.05, **p<0.01, comparing teenage girls with boys. Teenage girls twice as often as teenage boys mentioned depressing feelings

and four times as often — problem relationship with members of the family. Teenage boys twice as often as teenage girls did not specify the reasons for self-harm. The analysis of other replies establishes no statistically significant differences.

Relationship between pupils’ deliberate self-harm and stress factors

The analysis of the incidence of stressful life experience among 15−17 year old pupils showed that the most recurrent problem mentioned by teenagers was difficulties at school. This was mentioned by 63.0% of the respondents (62.1% of teenage girls and 54.6% of teenage boys). A more detailed presentation of incidence of stress experience in teenagers is provided in Table 5. Considering possible differences between teenage females and males, the data for each sex was analysed separately.

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The data provided in Table 5 show that any stressful life experience mentioned in the questionnaire is statistically significant with respect to the deliberate self-harm of pupils. Only the death of a close acquaintance (not parents, brothers or sisters) made an exception.

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Table 5. The relationship between deliberate self-harm and stress factors in the samples of teenage girls and boys

Stress factor Teenage girls Teenage boys

SH Total OR CI 95% SH Total OR CPI 95% n (%) n (%)

Difficulties in learning 177 (81.2) 1357 (61.7) 2.93*** 2.07-4.17 8 (12.7) 1066 (64.7) 3.90*** 1.85-8.25

Difficulties in meeting or

communicating with friends

103 (47.2) 749 (34.0) 1.85*** 1.40-2.46 31 (49.2) 393 (23.8) 3.27*** 1.97-5.44

Disagreements and involvement

in fight with friends

98 (45.0) 507 (23.0) 3.14*** 2.35-4.19 34 (54.0) 643 (39.0) 1.88* 1.13-3.12

Difficulties in relationship with a boy friend/ a

girl friend

117 (53.7) 668 (30.4) 3.01*** 2.27-4.00 35 (55.6) 434 (26.3) 3.72*** 2.23-6.19

Bullying at school 100 (45.9) 625 (28.4) 2.35*** 1.77-3.13 35 (55.6) 440 (26.7) 3.64*** 2.19-6.06

Divorce of parents 74 (33.9) 502 (22.8) 1.87*** 1.38-2.52 25 (39.7) 316 (19.2) 2.93*** 1.74-4.92

Serious arguments, fight with one parent or both parents

102 (46.8) 484 (22.0) 3.68*** 2.76-4.92 22 (34.9) 262 (15.9) 3.01*** 1.76-5.14

Disagreement or fight of parents 92 (42.2) 559 (25.4) 2.37*** 1.78-3.16 23 (36.5) 236 (14.3) 3.70*** 2.17-6.31

Serious illnesses or accidents in

the family 108 (49.5) 950 (43.2) 1.33* 1.01-1.76 32 (50.8) 569 (34.5) 2.02** 1.22-3.34

Serious illness or an accident

involving of a friend

96 (44.0) 625 (28.4) 2.16*** 1.63-2.88 30 (47.6) 562 (34.1) 1.80* 1.09-2.98

Physical abuse 32 (14.7) 124 (5.6) 3.53*** 2.30-5.42 22 (34.9) 139 (8.4) 6.73*** 3.88-11.68 Problems with

police 48 (22.0) 192 (8.7) 3.60*** 2.51-5.18 28 (44.4) 459 (27.9) 2.14** 1.29-3.56

Deaths of family members

(parents, brother, or sister)

35 (16.1) 240 (10.9) 1.66* 1.12-2.45 15 (23.8) 159 (9.6) 3.13*** 1.71-5.72

Deaths of other close

acquaintances 120 (55.0) 1119 (50.9) 1.21 0.91-1.60 29 (46.0) 752 (45.6) 1.02 0.61-1.69

Suicides of family members or close friends

35 (16.1) 180 (8.2) 2.42*** 1.63-3.61 17 (27.0) 96 (5.8) 7.05*** 3.86-12.84

Suicide attempts by a family

member 65 (29.8) 196 (8.9) 6.00*** 4.27-8.43 18 (28.6) 70 (4.2) 11.80*** 6.39-21.76

Suicide attempts by a friend 111 (50.9) 539 (24.5) 3.77*** 2.83-5.02 21 (33.3) 184 (11.2) 4.36*** 2.52-7.55

Anxiety because of sexual

orientation 26 (11.9) 75 (3.4) 5.34*** 3.25-8.79 19 (30.2) 48 (2.9) 23.17*** 12.08-44.45

Sexual abuse 31 (14.2) 81 (3.7) 6.41*** 3.99-10.28 15 (23.8) 28 (1.7) 37.79*** 17.04-83.79

SH – the respondents who specified in the questionnaire they harmed themselves, CI – confidence interval, OR – Odds ratio; *p<0.05, **p<0.01, ***p<0.001, when testing the relationship between self-harm and stress factors (suffered/did not suffer).

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The binary logistic regression analysis was carried out with demographic (the location where the respondent lives and age) and stress factors as independent variables. The dependent variable was deliberate self-harm. Calculations were made for teenage girls and boys separately (Table 6).

Table 6. The relationship between deliberate self-harm and stress factors in the samples of teenage girls and boys

Sex Attributes analysed Odds ratio (CI 95 %)

Teenage girls

Disagreements and involvement in fight with friends 1.68 (1.21 - 2.33); p<0.005 Difficulties in the relationship with a boy friend 1.96 (1.43 - 2.67); p<0.005

Bullying at school 1.72 (1.25 - 2.36); p<0.005 Serious arguments, fight with one parent or both parents 2.14 (1.56 - 2.95); p<0.005

Problems with police 2.38 (1.59 - 3.55); p<0.005 Suicide attempts by a family member 2.99 (2.04 - 4.37); p<0.005

Suicide attempts by a friend 2.21 (1.61 - 3.04); p<0.005

Teenage boys

Difficulties in learning 3.28 (1.45 - 7.41); p<0.005 Suicide attempts by a family member 8.36 (4.07 - 17.19); p<0.005 Anxiety because of sexual orientation 10.47 (4.50 - 24.36); p<0.005

Sexual abuse 8.92 (3.14 - 25.39); p<0.005 CI – Confidence interval.

According to the final models of the binary logistic regression analysis,

deliberate self-harm of pupils is mostly related with the following sets of stress factors: for teenage girls ⎯ suicide attempts by a family member or a friend, problems with police, quarrel, disagreement or fight with parents or friends, difficulties in the relationship with a boy friend, and bullying at school; for teenage boys ⎯ anxiety because of sexual orientation, sexual abuse, suicide attempts by a family member, and difficulties in learning (Table 6). These factors irrespective of other stress and demographic factors (included in the analysis) are statistically significantly related with deliberate self-harm in adolescence. Statistical reliability of the models (Nagelkerke R2) is 0.22 in the sample of female teenagers and 0.27 in the sample of male teenagers.

Presence of at least one stress factor specified in the scale of replies in the course of life increases the possibility of the deliberate self-harm on average by 1.38 times (CI 95% 1.32−1.45; p<0.001) for teenage girls and 1.30 times for teenage boys (1.30−1.50 respectively; p<0.001).

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The relationship between pupil’s deliberate self-harm and the frequency of use of addictive substances

According to the final models of the binary logistic regression analysis, by selecting smoking, weekly use of alcohol, the frequency of being drunk per month, and the use of drugs as independent variables, it is possible to assert that pupils’ deliberate self-harm is statistically significantly related with the following factors: in the sample of teenage girls ⎯ with smoking and at being drunk at least once over the past month, and in the sample of teenage boys ⎯ with the smoking and the use of drugs (Table 7).

Table 7. The relationship between deliberate self-harm and the use of additive substances in the samples of teenage girls and boys

Sex Attributes analysed Odds ratio (CI 95%)

Teenage girls Smokes 1.55 (1.41-1.71); p<0.001 Was drunk during the past month 1.47 (1.23-1.77); p<0.001

Teenage boys Smokes 1.21 (1.05-1.40); p<0.05 Used drugs during the past year 4.79 (2.71-8.48); p<0.001

CI – Confidence interval. These factors are statistically significant with respect to the deliberate self-

harm of teenagers irrespective of the use of other additive substances included into the analysis and demographic factors (the location where the teenager lives (village or city) and his/her age). Statistical reliability of the models (Nagelkerke R2) is 0.14 in the sample of female teenagers and 0.11 in the sample of male teenagers.

The relationship between the pupils’ deliberate self-harm and the

indices of psychic health and general condition Cronbach’s alpha, an index of internal reliability of scales, is 0.64 for

anxiety subscale, 0.63 — for depression subscale, 0.68 — for self-esteem subscale, and 0.53 — for impulsivity subscale. After rejecting the statements that are least related to the scale: the statement that belongs to the scale of anxiety symptoms “I cannot sit in one place, I want to be on the move all the time”, Cronbach’s alpha index goes up to 0.73 and the statement that belongs to the scale of impulsivity “I plan my activities”, Cronbach’s alpha index goes up to 0.59. It was not possible to increase the internal reliability of depression symptom and self-esteem scales by eliminating any statement from the scales. On the basis of scientific literature, Cronbach’s alpha indices used for comparison of groups are sufficient.

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According to the final models of the binary logistic regression analysis (Table 8), pupils’ deliberate self-harm is related with the following factors: in the sample of teenage girls — with anxiety symptoms and self-esteem and impulsivity scale indices, and in the sample of teenage boys — with expressed depression and anxiety symptoms and self-esteem and impulsivity scale indices. These factors are statistically significantly related with deliberate self-harm of teenagers irrespective of the indices of psychic health and general condition as well as demographic factors (location where the teenagers live and their age) included into the binary logistic regression analysis. Statistical reliability of the models (Nagelkerke R2) is 0.15 in the sample of female teenagers and 0.26 in the sample of male teenagers.

Table 8. The relationship between pupils’ deliberate self-harm and the indices of psychic health and general condition in the samples of teenage girls and boys

Sex Attributes analysed Odds ratio (CI 95%)

Teenage girls Anxiety symptoms scale 1.18 (1.13-1.24); p<0.001

Self-esteem scale 0.92 (0.88-0.97); p<0.01 Impulsivity scale 1.18 (1.03-1.16); p<0.01

Teenage boys

Anxiety symptoms scale 1.15 (1.07-1.25); p<0.001 Depression symptoms scale 1.15 (1.05-1.25); p<0.01

Self-esteem scale 0.91 (0.83-1.00); p<0.05 Impulsivity scale 1.32 (1.18-1.47); p<0.001

CI – Confidence interval. Search for help and the needs of the pupils who harm themselves 42.3% pupils (74.8% of teenage girls and 25.2% of teenage boys) did not

seek help prior to self-harm. Those who sought help, usually (40.0%) approached friends for assistance.

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Table 9. Distribution of the sources of help prior and after self-harm specified by teenage girls and boys (n/%)

Source of help Prior to self-harm After self-harm

Teenage girls Teenage boys Teenage girls Teenage boys Assistance (consultation) centre 2 (0.9) 2 (3.2) 4 (1.8) 5 (7.9)*

Help line 5 (2.3) 9 (14.3)** 3 (1.4) 5 (7.9)** Psychologist (psychiatrist) 9 (4.1) 2 (3.2) 11 (5.0) 5 (7.9)

Social worker 2 (0.9) 5 (7.9)** 1 (0.5) 6 (9.5)** Family doctor 0 (0.0) 2 (3.2)** 6 (2.8) 5 (7.9)

Teacher 4 (1.8) 7 (11.1)** 3 (1.4) 4 (6.3)* Friend 97 (44.5)** 15 (23.8) 92 (42.2) 19 (30.2)

Family members 25 (11.5) 11 (17.5) 41 (18.8) 12 (19.0) *p<0.05, **p<0.01, comparing teenage girls with boys.

As can be seen from Table 9, teenage girls sought friends’ help twice as

often as did teenage boys. Teenage boys, however, more often than their female counterparts, sought assistance of a teacher or a professional. According to the research, prior to self-harm, teenage boys approached teachers for help five times more frequently than did teenage girls, a family doctor — three times and a social worker — eight times more frequently than did teenage girls; they also called telephone help line six times more often than did their female counterparts. By analogy, teenage girls statistically significantly more often sought help of friends than of family members (p<0.01). No statistically significant difference was identified while analysing teenage boys’ replies to the same questions.

Teenagers who specified they did not seek help prior to self-harm were asked why they did not do it. The replies were divided into the following four categories: 1) mistrust of others (such replies as: “I am afraid to be misunderstood", “I don’t need anybody’s help”); 2) denial of the need for help (such replies as: “I didn’t want to get help”, “I thought everything will pass”); 3) other (such replies as: “This thought came suddenly to me”, “It was favourable to me”); and 4) no reasons specified. The replies provided by teenagers were allocated only to one category.

Nearly two thirds of the respondents (63.3%) did not specify the reasons why they did not ask for help, 21.7% — expressed mistrust of others, 10.0 % — denied they needed help and 5.0% — specified other reasons for not asking for help. Statistically significant differences between sexes were not identified.

The majority of pupils who self-harmed (79.4%) said that they did not seek help after self-harm. Teenage boys, compared to teenage girls, more often specified that they did not seek help (90.5% and 76.1% respectively; p<0.01),

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yet statistically significantly they specified more often than teenage girls that they approached teachers or professionals for help (Fig. 2).

Pupils who specified they did not seek help after self-harm were asked to describe in a free form why they did not do it. The replies were allocated to the following categories: 1) mistrust of others (such replies as: “I was ashamed”, “I did not want to look weak”, “I thought I will be laughed at”, and “I was afraid of condemnation”); 2) denial of the need for help (such replies as: “I wanted to forget”, “Everything worked out anyway”, and “It was not possible to correct this”); 3) other (such replies as: “I wanted to die”, “Too much alcohol”, “I did this because of one person”); and 4) no reasons specified. The replies provided by teenagers were allocated only to one category.

While explaining why they did not seek help, pupils who harmed themselves most frequently (40.6%) denied the need for help. More than a third (38.4%) of the respondents did not specify why they did not seek help, 19.3% of the respondents said they mistrusted others, and 1.8% of the respondents specified other reasons. Teenage girls more often than their male peers, denied the need for help (44.5% and 27.0% respectively; p<0.05), and teenage boys more often than teenage girls failed to specify any reason why they did not seek help (52.4% and 34.4%; p<0.01).

The research data showed that teenage girls and boys received help from different sources. Most frequently, these were friends (39.5%). Teenage boys statistically significantly more than teenage girls received help from teachers, social workers, volunteers of help line, and assistance centres. The frequency of help received by teenage boys and girls from friends did not differ (Fig. 5.6.1).

The data of the research showed that 38 pupils (13.5%) were admitted to a medical institution after deliberate self-harm (13.3% of teenage girls and 14.3% of teenage boys who deliberately harmed themselves). The teenagers who said that they caused self-harm internally, statistically significantly more often were admitted to a hospital after self-harm than those who harmed themselves externally (4.1% of those who self-harmed externally and 19.8% of those who self-harmed internally; p<0.01).

All the respondents had an opportunity to provide suggestions in the questionnaire how self-harm of young people could be avoided. The majority of teenagers made several suggestions. As a result, suggestions of each teenager could be divided into several categories. In all, 10 categories were established: 1) assistance of a psychologist or another professional and psychological education (such replies as: “Schools could have a psychologist available”, “Lessons in psychology could be mandatory”, etc.); 2) information

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(such replies as: “More advertising or brochures with information where to ask for assistance should be available if one knows his/her friend wants to commit suicide”, “We usually do not know who we should tell or what should be done, etc.); 3) parents’ attention (such replies as: “If parents communicated with their children normally, there would not be such problems", “Parents must pay more attention to their children”, etc.); 4) friends’ attention (such replies as: “Friends should help each other", “Friends should be more tolerant”, etc.); 5) internal strength (such replies as: “Self-confidence of such people should be strengthened”, “They should understand somehow that life is beautiful”, etc.); 6) spending of leisure time (such replies as: “These people should find what to do and there will be no time for them to think about self-harm”, “More varied type of leisure is needed”, etc.); 7) conditions at school (such replies as: “The load of work should be reduced at schools”, “There should be nice environment in schools”, etc.); 8) lack of communication and attention (such replies as: “We should be more tolerant and communicative”, “There should be a lot of communication with such people", etc.); 9) they cannot be helped (such replies as: “Such people cannot be helped”, “Let them commit suicide! They cannot be helped by anybody ...”, etc.); and 10) other suggestions (such replies as: “The sale of cigarettes must be controlled”, “They must be threatened!”, etc.).

Teenagers mostly (44.1%) mentioned the lack of communication and attention and they saw solution of this problem as the main method for help. A quarter (20.9%) of respondents said that in this situation the best help would be a psychologist or another professional and psychological education. Such opinion was statistically significantly dominating among the teenagers who did not self-harm rather than among those who harmed themselves (p<0.05). 10.2% of respondents mentioned that the way a young person feels depends on important, close relatives (parents and others) and their presence, support, teaching, and closeness. Others mentioned the lack of variety in leisure activities (4.2%) as the reason (this reason was specified more often by teenagers who did not harm themselves; p<0.05) and suggested fighting bullying and abuse among the peers (3.8%), improving conditions at schools (2.6%), and other reasons (2.6%). 3.8% of the respondents thought (83 of the teenagers who did not cause self-harm and 25 of the teenagers who cause self-harm) that “no one could help” or expressed similar pessimistic thoughts and mood. Statistically significantly more teenagers who deliberately harmed themselves than those who did not harm themselves were of the opinion that self-harm of young people could not be avoided (8.9% and 2.3% respectively; p<0,01).

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4. CONCLUSIONS 1. Deliberate self-harm is characteristic to 7.3% of 15−17 old Lithuanian

pupils. Teenage girls harm themselves more often than do their male peers. The most frequent form of self-harm is overdose on medicines. Deliberate self-harm is not related to the place of residence, rather it is significantly related with the composition of the family: teenagers who live in incomplete families tend to harm themselves more often than teenagers who live in complete families.

2. Subjective reasons for deliberate self-harm were provided by 75.7% of teenage girls and 42.9% of teenage boys who harmed themselves (p<0.01). Depressive thoughts were most frequent reason for attempting suicide mentioned by pupils. Teenage girls specified this reason twice as often as did teenage boys.

3. Stressful life experience is an important factor for deliberate self-harm of pupils. The risk of self-harm for teenage girls was related with suicide attempts of family members and friends, quarrels and disagreements with parents and friends, bullying at school, and difficulties they experienced at law enforcement institutions. The risk of self-harm for teenage boys was related with sexual abuse, anxiety because of sexual orientation, suicide attempts of family members, and difficulties at school.

4. Deliberate self-harm in teenage years is related with the use of addictive substances. Smoking and at least one incident of getting drunk a month for teenage girls and smoking and the use of drugs for teenage boys increase the possibility of deliberate self-harm.

5. Subjective indices of psychic health and general condition of the pupils who self-harmed are poorer than those of their peers who did not harm themselves. Irrespective of sex, deliberate self-harm of teenagers is related with expressed anxiety symptoms and low index of self-esteem and high index of impulsivity scales. Expressed depression symptoms were significantly related only with the possibility of teenage boys' self-harm.

6. Pupils who deliberately harm themselves usually do not seek assistance with respect to the problems that cause self-harm: a fifth (21.7%) of the pupils who harmed themselves did not ask for help prior to self-harm because they did not trust others, nearly half (40.6%) of such pupils denied the need for help after self-harm, and a tenth (13.5%) were admitted to hospitals. Those who do seek help, usually approach friends for it. Teenage girls ask for friends' help more frequently than do teenage boys, whereas boys more frequently than girls get help from teachers or professionals.

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LIST OF THE AUTHOR’S PUBLICATIONS 1. Laskytė A, Žemaitienė N, Laskienė S. Sąmoningai save žalojantys

vaikai ir paaugliai: Lietuvoje atliktų tyrimų apžvalga. Visuomenės sveikata 2005;4(31):38–43.

2. Laskytė A. Lietuvos moksleivių sąmoningo savęs žalojimo epidemiologija. Psichologijos tyrimai Lietuvoje: vieta pasaulyje ir ateities vizija. Vilnius: Vilniaus universiteto leidykla; 2007. p. 54–60

3. Laskytė A. Lietuvos paauglių sąmoningo savęs žalojimo priežastys ir pagalbos šaltiniai. Visuomenės sveikata 2008;1(40):15–21.

4. Laskytė A, Žemaitienė N, Vaitkevičius R. Lietuvos paauglių sąmoningo savęs žalojimo ir stresą keliančios gyvenimo patirties sąsajos.Visuomenės sveikata 2008;4(43):56–63.

5. Laskytė A, Žemaitienė N. Lietuvos paauglių sąmoningo savęs žalojimo paplitimas ir būdai. Medicina 2009;45(2):132–9.

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REZIUMĖ Jaunų žmonių savižudybės jau daugiau kaip dešimtmetį išlieka labai

svarbia visuomenės sveikatos problema. Lietuvos statistikos departamento duomenimis, mokyklinio amžiaus vaikų savižudybių skaičius per metus svyruoja nuo 20 iki 33, o savižudybė pagal dažnį yra trečioje vietoje mirties priežasčių sąraše. Vienas svarbiausių šios aktualios problemos sprendimo uždavinių – atskleisti savižudybės rizikos veiksnius. Įvairiose šalyse atlikti tyrimai pateikia neabejotinų įrodymų, jog vienas grėsmingiausių galimo savižudiško elgesio rizikos ženklų yra sąmoningas savęs žalojimas ar bandymai žudytis jauname amžiuje.

Daugelis asmenybės raidos ir sveikatos ekspertų išskiria paauglystę, kaip ypatingai pažeidžiamą amžiaus tarpsnį autodestruktyvios elgsenos požiūriu. Tokią išvadą patvirtina ir Europos statistiniai duomenys, rodantys, kad savižudybių ir sąmoningų savęs žalojimų vidurkis 0-14 metų amžiaus vaikų grupėje 100 000 gyventojų 2004 metais buvo: moterims – 0,12, vyrams – 0,34. Atitinkamai metinis skaičius 15-29 metų grupėje moterų buvo 2,98, vyrų – 13,37. Lietuvoje šie skaičiai 3-4 kartus didesni: 15-29 metų grupėje 2004 metais buvo užregistruoti 31,15 atvejai 100 000 žmonių (8,65 moterų ir 53,08 vyrų). Pateikti faktai rodo, kad savižudybės su amžiumi dažnėja, o 15 metų amžius šiuo požiūriu gali būti įvardijamas kaip kritinis laikotarpis.

Siekiant sumažinti savižudiško elgesio tikimybę paauglystėje, atliekama nemažai tyrimų, kuriais bandoma išsiaiškinti minėto elgesio priežastis. Stebėjimų ir tyrimų duomenimis nustatyta, kad sąmoningas savęs žalojimas, kaip paauglio savižudiškas elgesys, liudija apie nepatenkintus poreikius, norą pakeisti kankinančią vidinę būseną, siekį parodyti kitiems, kaip blogai asmuo jaučiasi, pastangas suvaldyti tarpasmeninių santykių kaitą ir, nepriklausomai nuo jį paskatinusių priežasčių, turi būti vertinamas rimtai ir atsakingai.

Lietuvoje paauglių savižudybės ir bandymai nusižudyti taip pat gana plačiai tyrinėti. Tačiau save žalojantis elgesys, jo priežastys ir motyvai iki šiol susilaukė mažai Lietuvos mokslininkų dėmesio. Įvairių autorių duomenimis, paauglystėje bandymai žalotis pasitaiko nuo 10 iki 100 kartų dažniau nei savižudybė ir yra vertinami kaip padidintos savižudybės rizikos ženklai. Sąmoningo savęs žalojimo paplitimo tyrimai gana sudėtingi ir vargu ar apskritai įmanoma sužinoti tikslų save žalojusių jaunų žmonių skaičių. Dažniausiai, kaip tokio elgesio paplitimo rodiklis, naudojamas į gydymo įstaigas po tokių bandymų patekusių asmenų skaičius. Tačiau, užsienio mokslininkų tyrimų duomenimis, į gydymo įstaigas patenka vos 3-10 proc. save žalojusių paauglių. Lietuvoje sąmoningo savęs žalojimo paplitimo

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vertinimą apsunkina ir tai, kad nėra jokios bendros tokių atvejų apskaitos. Neabejotina, kad gydymo įstaigose tokie atvejai registruojami, tačiau dėl vieningos registracijos sistemos ir bendradarbiavimo tarp gydymo įstaigų stokos šių duomenų prieinamumas ir panaudojimas taikant profilaktines priemones ar siekiant atskleisti sąmoningai save žalojančių asmenų elgesio priežastis (socialinius bei psichologinius veiksnius) tampa sudėtingu procesu. Taigi, akivaizdu, kad išsamesni paauglių sąmoningo savęs žalojimo problemos tyrimai išlieka aktualia ir trūkstama grandimi Lietuvos mokslininkų darbuose.

Darbo tikslas buvo ištirti sąmoningai save žalojančių 15–17 metų Lietuvos moksleivių socialinius bei psichologinius ypatumus.

Tikslui pasiekti iškelti tokie uždaviniai: 1. Įvertinti moksleivių sąmoningo savęs žalojimo paplitimą, būdus bei jų

sociodemografinius netolygumus. 2. Atskleisti subjektyvias moksleivių sąmoningo savęs žalojimo priežastis. 3. Išanalizuoti ryšius tarp stresą sukeliančios gyvenimo patirties ir

moksleivių sąmoningo savęs žalojimo. 4. Nustatyti rūkymo, alkoholio bei narkotikų vartojimo reikšmę moksleivių

sąmoningam savęs žalojimui. 5. Išnagrinėti moksleivių sąmoningo savęs žalojimo, subjektyvių psichikos

sveikatos bei savijautos rodiklių sąsajas. 6. Įvertinti save žalojančių moksleivių pagalbos poreikius. Tyrimui buvo pasirinkti 15–17 metų amžiaus moksleiviai. Tiriamųjų

atrankai buvo naudojamas atsitiktinės sluoksninės atrankos sudarymo metodas. Buvo siekiama, kad respondentai reprezentuotų tiriamą populiaciją amžiaus, lyties, gyvenamosios vietos atžvilgiu. Atsižvelgiant į 15–17 metų paauglių skaičių kiekvienoje apskrityje bei kaime ir mieste gyvenančių paauglių santykį, atrinktos mokyklos bei tiriamos klasės. Kiekvienoje atrinktoje mokykloje numatyta apklausti moksleivius iš vienos devintos, dešimtos ir vienuoliktos klasių, taigi anketas užpildė visi tyrimo dieną mokykloje buvę moksleiviai. Tyrime dalyvavo 3848 respondentai: 2200 (57,2 proc.) merginų ir 1648 (42,8 proc.) vaikinų iš 52 mokyklų.

Tyrime taikytas anketinės apklausos metodas — Gyvenimo būdo ir prisitaikymo klausimynas. Klausimyną sudarė 100 atviro ir uždaro tipo klausimų. Jame pateikiami klausimai apima 11 informacijos apie asmenį skalių: 1) asmeninė informacija; 2) informacija apie gyvenimo būdą; 3) stresą sukeliantys įvykiai ir problemos; 4) sąmoningas savęs žalojimas ar savižudiški ketinimai; 5) sąmoningo savęs žalojimo motyvai; 6) pagalbos ieškojimas ir stacionarinis gydymas; 7) mintys apie savęs žalojimą; 8) įveikos strategijos; 9)

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psichologinės charakteristikos; 10) sąmoningo savęs žalojimo prevencija ir pasiūlymai tyrėjams; 11) nuomonė apie klausimyną.

Statistinė tyrimo duomenų analizė atlikta naudojant SPSS 16.0 for Windows programą.

Išvados: 1. Sąmoningas savęs žalojimas yra būdingas 7,3 proc. 15–17 metų amžiaus

Lietuvos moksleivių. Merginos žalojasi 2,5 karto dažniau nei vaikinai. Dažniausias savęs žalojimo būdas — vaistų perdozavimas. Moksleivių sąmoningo savęs žalojimo paplitimas nėra susijęs su gyvenamąja vieta, tačiau reikšmingai siejasi su šeimos sudėtimi: nepilnose šeimose gyvenantys paaugliai save žaloja dažniau nei gyvenantys pilnose šeimose.

2. Subjektyvius sąmoningo savęs žalojimo priežasčių paaiškinimus pateikė 75,7 proc. save žalojusių merginų ir 42,9 proc. vaikinų (p<0,01). Dažniausia moksleivių įvardinta savižudiškų paskatų priežastis — slegiantys jausmai. Merginos šią priežastį nurodo du kartus dažniau nei vaikinai.

3. Stresą sukelianti gyvenimo patirtis yra svarbus moksleivių sąmoningo savęs žalojimo rizikos veiksnys. Merginų sąmoningo savęs žalojimosi rizika siejosi su šeimos narių ar draugų bandymais nusižudyti, barniais ir nesutarimais su tėvais ar draugais, patyčiomis mokykloje bei sunkumais, kuriuos teko spręsti teisėtvarkos institucijose. Vaikinų sąmoningo savęs žalojimosi rizika siejosi su patirta seksualine prievarta, nerimu dėl lytinės orientacijos, šeimos narių bandymais žudytis ir sunkumais moksle.

4. Sąmoningas savęs žalojimas paauglystėje siejasi su priklausomybę sukeliančių medžiagų vartojimu. Merginų sąmoningo savęs žalojimo galimybę didino rūkymas ir bent vieno girtumo atvejis per mėnesį, vaikinų — rūkymas bei narkotikų vartojimas.

5. Subjektyvūs sąmoningai save žalojančių moksleivių psichikos sveikatos bei savijautos rodikliai prastesni nei nesižalojančių jų bendraamžių. Nepriklausomai nuo lyties, paauglių sąmoningas savęs žalojimas susijęs su išreikštais nerimo simptomais, žemais savigarbos ir aukštais impulsyvumo skalių rodikliais. Išreikšta depresijos simptomatika reikšmingai siejosi tik su vaikinų savęs žalojimo galimybe.

6. Sąmoningai save žalojantys moksleiviai dažniausiai neieško pagalbos dėl problemų, kurios paskatina žalotis: penktadalis (21,7 proc.) save žalojusių moksleivių nesikreipė pagalbos iki žalojimosi, nes nepasitikėjo kitais, beveik pusė (40,6 proc.) neigė pagalbos poreikį po žalojimosi, o dešimtadalis (13,5) pateko į gydymo įstaigas. Tie, kurie ieško pagalbos, dažniausiai kreipiasi į draugus. Merginos draugų pagalba naudojasi dažniau nei vaikinai, o vaikinams dažniau nei merginoms padeda mokytojai arba specialistai.

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INFORMATION ABOUT THE AUTHOR OF DOCTORAL DISSERTATION

First name AgnėSurname LaskytėAddress Eivenių 4, LT-5016, Kaunas, Lithuania, E-mail alaskyte@yahoo.com, agnus@cattery.lt Date of birth 14 August 1980Birthplace Kaunas, LithuaniaCurrent position assistant of Kaunas University of Medicine Faculty of Public

Health Department of Preventative Medicine Education 1986-1995 Kaunas Versmė secondary school1995-1997 Kaunas Varpas gymnasium 1997-1998 Kaunas Versmė secondary school1998-2002 Vytautas Magnus University, Faculty of Social Sciences,

Department of Psychology, Bachelor of Psychology 2002-2004 Vytautas Magnus University, Faculty of Social Sciences,

Department of Psychology, Master of Psychology