Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS)

Area of Science:

• Psychiatry
• Developmental Psychology
• Clinical Psychology

Background:

• Self-harm is a critical issue in adolescent mental health.
• Limited research exists on the immediate precursors to adolescent self-harm.
• Understanding the dynamic interplay of factors leading to self-harm is crucial for effective intervention.

Purpose of the Study:

• To develop and utilize the Card Sort Task for Self-harm (CaTS) to investigate the sequential patterns of thoughts, feelings, events, and behaviors preceding self-harm in adolescents.
• To differentiate between the antecedents of first-time versus most recent self-harm episodes.

Main Methods:

• Forty-five adolescents (13-21 years) with recent repeated self-harm completed the CaTS.
• Lag sequential analysis was employed to identify significant transitions in self-harm precursors.
• State transition diagrams were used to visualize these sequential patterns.

Main Results:

• A significant sequential structure was observed in the CaTS data, highlighting differences between first and most recent self-harm episodes.
• Life events were distal precursors, while the wish to die and hopelessness were proximal antecedents in most recent episodes.
• A perceived benefit (feeling better) after self-harm was associated with first episodes but not most recent ones.

Conclusions:

• The CaTS provides a systematic method for understanding the dynamic interplay of factors leading to adolescent self-harm.
• The CaTS can identify modifiable proximal factors, such as negative emotions, impulsivity, and access to means, for targeted clinical interventions.
• Further research with larger, diverse samples is needed to explore gender, age, and self-harm type differences.