Risk Factors and Prevention Strategies of Self-Harm in University Students: A Qualitative Approach
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Published
Mar 19, 2024
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Abstract
The aims of the study were to examine how university students identify meaning in self-harm, and how they explain risk factors and prevention strategies of self-harm. A qualitative approach was used along with purposive sampling and was based on in-depth interviews. Participants were 6 Thai university students, who repeatedly harmed themselves, and were recruited voluntarily. The data analysis used was thematic analysis. The results were described in the form of themes and sub-themes. Two themes and four sub-themes for participants’ meanings of self-harm: 1) releasing psychological suffering, and 2) self-punishment for rethinking self-care. Nine themes and twenty sub-themes for participants’ risk factors of self-harm: 1) depression, 2) feeling overwhelmed with life problems, 3) family relationships and communication in the family, 4) lacking a space to talk and be listened to, 5) self-pressuring, 6) Peer and romantic partner relationships, 7) emotion being triggered by social media and speech, 8) trauma recall, and 9) psychological traits. At last four theme and nine sub-themes for participants’ prevention strategies of self-harm: 1) consulting a psychiatrist and taking medications, 2) taking care of family members, peers, and romantic partners, 3) positive thinking, and
4) participating in social activities and pursuing activities to create more happiness. The results showed that the starting point of understanding self-harmed adolescents were provided by the non-family members. It is recommended that parents should clearly express care and concern toward their children’s feelings and prioritize physical health.
Keywords: Self-Harm, Meaning, Risk Factors, University Students, Qualitative Approach
References
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Bantjes, J., Nel, A., Louw, K.-A., Frenkel, L., Benjamin, E., & Lewis, I. (2017). ‘This Place is Making Me More Depressed’: The Organisation of Care for Suicide Attempters in a South African Hospital. Journal of Health Psychology, 22(11), 1434–1446. https://doi.org/10.1177/1359105316628744
Bergen, H., Hawton, K., Waters, K., Ness, J., Cooper, J., Steeg, S., & Kapur, N. (2012). Premature Death after Self-harm: A Multicentre Cohort Study. The Lancet, 380(9853), 1568-1574. https://doi.org/10.1016/S0140-6736(12)61141-6
Bhattacharya, K. (2017). Fundamentals of Qualitative Research: A Practical Guide. New York: Routledge.
Braun, V., & Clarke, V. (2006). Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa
Buckmaster, R., McNulty, M., & Guerin, S. (2019). Family Factors Associated with Self-harm in Adults: A Systematic Review. Journal of Family Therapy, 41(4), 537-558. https://doi.org/10.1111/1467-6427.12232
Cottrell, D. J., Wright-Hughes, A., Collinson, M., Boston, P., Eisler, I., Fortune, S., ... Farrin, A. J. (2018). Effectiveness of Systemic Family Therapy Versus Treatment as Usual for Young People after Self-harm: A Pragmatic, Phase 3, Multicentre, Randomised Controlled Trial. The Lancet Psychiatry, 5(3), 203-216. https://doi.org/10.1016/S2215-0366(18)30058-0
Department of Mental Health. (2019, July 2). The Department of Mental Health Recommends Observing 10 Warning Signs that People are at Risk of Suicide. Retrieved from https://dmh.go.th/news-dmh/view.asp?id=29785
Doyle, L., Treacy, M. P., & Sheridan, A. (2015). Self-harm in Young People: Prevalence, Associated Factors, and Help-seeking in School-going Adolescents. International Journal of Mental Health Nursing, 24(6), 485-494. https://doi.org/10.1111/inm.12144
Edmondson, A. J., Brennan, C. A., & House, A. O. (2016). Non-suicidal Reasons for Self-harm: A Systematic Review of Self-reported Accounts. Journal of Affective Disorders, 191, 109-117. https://doi.org/10.1016/j.jad.2015.11.043
Everett, B., & Gallop, R. (2001). The Link between Childhood Trauma and Mental Illness: Effective Interventions for Mental Health Professionals. London: Sage Publications. https://doi.org/10.4135/9781452205533
Fergusson, D., Doucette, S., Glass, K. C., Shapiro, S., Healy, D., Hebert, P., & Hutton, B. (2005). Association between Suicide Attempts and Selective Serotonin Reuptake Inhibitors: Systematic Review of Randomised Controlled Trials. BMJ, 330, 396. https://doi.org/10.1136/bmj.330.7488.396
Gardner, W., Pajer, K., Cloutier, P., Zemek, R., Currie, L., Hatcher, S., ... Lima, I. (2019). Changing Rates of Self-harm and Mental Disorders by Sex in Youths Presenting to Ontario Emergency Departments: Repeated Cross-sectional Study. The Canadian Journal of Psychiatry, 64(11), 789-797. https://doi.org/10.1177/0706743719854070
Guan, K., Fox, K. R., & Prinstein, M. J. (2012). Nonsuicidal Self-injury as a Time-invariant Predictor of Adolescent Suicide Ideation and Attempts in a Diverse Community Sample. Journal of Consulting and Clinical Psychology, 80(5), 842-849. https://doi.org/10.1037/a0029429
Hambleton, A. L., Hanstock, T. L., Halpin, S., & Dempsey, C. (2022). Initiation, Meaning and Cessation of Self-harm: Australian Adults’ Retrospective Reflections and Advice to Adolescents Who Currently Self-harm. Counselling Psychology Quarterly, 35(2), 260-283. https://doi.org/10.1080/09515070.2020.1737509
Hawton, K., Harriss, L., Hall, S., Simkin, S., Bale, E., & Bond, A. (2003). Deliberate Self-harm in Oxford, 1990-2000: A Time of Change in Patient Characteristics. Psychological Medicine, 33(6), 987–995. https://doi.org/10.1017/s0033291703007943
Hawton, K., Saunders, K. E., & O’Connor, R. C. (2012). Self-harm and Suicide in Adolescents. The Lancet, 379(9834), 2373-2382. https://doi.org/10.1016/S0140-6736(12)60322-5
Hetrick, S. E., Subasinghe, A., Anglin, K., Hart, L., Morgan, A., & Robinson, J. (2020). Understanding the Needs of Young People Who Engage in Self-harm: A Qualitative Investigation. Frontiers in Psychology, 10, 2916. https://doi.org/10.3389/fpsyg.2019.02916
Hill, K., & Dallos, R. (2012). Young People’s Stories of Self–harm: A Narrative Study. Clinical Child Psychology and Psychiatry, 17(3), 459-475. https://doi.org/10.1177/1359104511423364
Hopko, D. R., Sanchez, L., Hopko, S. D., Dvir, S., & Lejuez, C. W. (2003). Behavioral Activation and the Prevention of Suicidal Behaviors in Patients with Borderline Personality Disorder. Journal of Personality Disorders, 17(5), 460-478. https://doi.org/10.1521/pedi.17.5.460.22970
Joiner, T. E., Ribeiro, J. D., & Silva, C. (2012). Nonsuicidal Self-injury, Suicidal Behavior, and their Co-occurrence as Viewed Through the Lens of the Interpersonal Theory of Suicide. Current Directions in Psychological Science, 21(5), 342-347. https://doi.org/10.1177/0963721412454873
Kissil, K. (2011). Attachment-based Family Therapy for Adolescent Self-injury. Journal of Family Psychotherapy, 22(4), 313–327. https://doi.org/10.1080/08975353.2011.627801
Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The Relationship between Nonsuicidal Self-injury and Attempted Suicide: Converging Evidence from Four Samples. Journal of Abnormal Psychology, 122(1), 231-237. https://doi.org/10.1037/a0030278
Knorr, A. C., Tull, M. T., Anestis, M. D., Dixon-Gordon, K. L., Bennett, M. F., & Gratz, K. L. (2016). The Interactive Effect of Major Depression and Nonsuicidal Self-injury on Current Suicide Risk and Lifetime Suicide Attempts. Archives of Suicide Research, 20(4), 539-552. https://doi.org/10.1080/13811118.2016.1158679
Limsuwan, N., Lantomrattana, A., Prachason, T., Tantrarungroj, T., Lorterapong, P., Thongpan, M., & Waleeprakhon, P. (2023). The Qualitative Study of Intentional Self-harm in Thailand: Focusing on Predisposing Child-rearing Environments and Self-harm Cessation. Frontiers in Psychology, 14, 957477. https://doi.org/10.3389/fpsyg.2023.957477
MacDonald, S., Sampson, C., Turley, R., Biddle, L., Ring, N., Begley, R., & Evans, R. (2020). Patients’ Experiences of Emergency Hospital Care Following Self-harm: Systematic Review and Thematic Synthesis of Qualitative Research. Qualitative Health Research, 30(3), 471-485. https://doi.org/10.1177/1049732319886566
Mason, J. (2017). Qualitative Researching (3rd ed.). London: Sage Publications.
McAllister, M. (2003). Multiple Meanings of Self Harm: A Critical Review. International Journal of Mental Health Nursing, 12(3), 177-185. https://doi.org/10.1046/j.1440-0979.2003.00287.x
McAndrew, S., & Warne, T. (2005). Cutting Across Boundaries: A Case Study Using Feminist Praxis to Understand the Meanings of Self-harm. International Journal of Mental Health Nursing, 14(3), 172–180. https://doi.org/10.1111/j.1440-0979.2005.00378.x
Mitten, N., Preyde, M., Lewis, S., Vanderkooy, J., & Heintzman, J. (2016). The Perceptions of Adolescents Who Self-harm on Stigma and Care Following Inpatient Psychiatric Treatment. Social Work in Mental Health, 14(1), 1-21. https://doi.org/10.1080/15332985.2015.1080783
Muehlenkamp, J. J., Xhunga, N., & Brausch, A. M. (2019). Self-injury Age of Onset: A Risk Factor for NSSI Severity and Suicidal Behavior. Archives of Suicide Research, 23(4), 551-563. https://doi.org/10.1080/13811118.2018.1486252
NICE. (2022). Self-harm: Quality Standard. Retrieved from https://www.nice.org.uk/guidance/qs34
Paholpak, P., Rangseekajee, P., Arunpongpaisal, S., Piyavhatkul, N., Thepsuthammarat, K., & Paholpak, S. (2012). Characteristics and Burden of Hospitalization Because of Intentional Self-harm: Thai National, Hospital-Based Data for 2010. Journal of The Medical Association of Thailand, 95(7), 156-162.
Parker, D. (2017). Attachment and Object Relations: Transitional Phenomena in Relation to Self-harm Among Late Adolescent Girls (Doctoral Dissertation). Alliant International University, San Diego, USA.
Phothisita, C. (2013). Sciences and Arts of Qualitative Research (6th ed.). Bangkok: Amarin Printing & Publishing.
Robinson, J., McCutcheon, L., Browne, V., & Witt, K. (2016). Looking the Other Way: Young People and Self-harm. Melbourne: Orygen, The National Centre for Excellence in Youth Mental Health.
Shek, D. T. L. (2010). Objective Outcome Evaluation of the Project P.A.T.H.S. in Hong Kong: Findings Based on Individual Growth Curve Models. The Scientific World Journal, 10, 182-191. https://doi.org/10.1100/tsw.2010.18
Shek, D. T. L., Siu, A. M. H., Lee, T. Y., Cheung, C. K., & Chung, R. (2008). Effectiveness of the Tier 1 Program of Project P.A.T.H.S.: Objective Outcome Evaluation Based on a Randomized Group Trial. The Scientific World Journal, 8, 4-12. https://doi.org/10.1100/tsw.2008.16
Shek, D. T. L., & Yu, L. (2011). Prevention of Adolescent Problem Behavior: Longitudinal Impact of the Project P.A.T.H.S. in Hong Kong. The Scientific World Journal, 11, 546-567. https://doi.org/10.1100/tsw.2011.33
Singtakaew, A., & Chaimongkol, N. (2021). Deliberate Self-harm among Adolescents: A Structural Equation Modelling Analysis. International Journal of Mental Health Nursing, 30(6), 1649-1663. https://doi.org/10.1111/inm.12918
Siu, A. M. H. (2019). Self-harm and Suicide among Children and Adolescents in Hong Kong: A Review of Prevalence, Risk Factors, and Prevention Strategies. Journal of Adolescent Health, 64(6), S59-S64. https://doi.org/10.1016/j.jadohealth.2018.10.004
Stake, R. E. (2008). Qualitative Case Studies. In N. K. Denzin, & Y. S. Lincoln (Eds.), Strategies of Qualitative Inquiry (pp. 119–149). London: Sage Publications.
Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in Depressive Symptoms, Suicide-related Outcomes, and Suicide Rates among U.S. Adolescents after 2010 and Links to Increased New Media Screen Time. Clinical Psychological Science, 6(1), 3–17. https://doi.org/10.1177/2167702617723376
UNICEF. (2019, September 18). An Open Letter to the World’s Children: 8 Reasons Why I’m Worried, and Hopeful, about the Next Generation. Retrieved from https://www.unicef.org/child-rights-convention/open-letter-to-worlds-children
Van der Kolk, B. A. (1989). The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism. Psychiatric Clinics of North America, 12(2), 389-411. https://doi.org/10.1016/S0193-953X(18)30439-8
Van der Kolk, B. A., Perry, J. C., & Herman, J. L. (1991). Childhood Origins of Self-destructive Behavior. The American Journal of Psychiatry, 148(12), 1665-1671. https://doi.org/10.1176/ajp.148.12.1665
Vivekananda, K. (2000). Integrating Models for Understanding Self-injury. Psychotherapy in Australia, 7(1), 18–25.
Bantjes, J., Nel, A., Louw, K.-A., Frenkel, L., Benjamin, E., & Lewis, I. (2017). ‘This Place is Making Me More Depressed’: The Organisation of Care for Suicide Attempters in a South African Hospital. Journal of Health Psychology, 22(11), 1434–1446. https://doi.org/10.1177/1359105316628744
Bergen, H., Hawton, K., Waters, K., Ness, J., Cooper, J., Steeg, S., & Kapur, N. (2012). Premature Death after Self-harm: A Multicentre Cohort Study. The Lancet, 380(9853), 1568-1574. https://doi.org/10.1016/S0140-6736(12)61141-6
Bhattacharya, K. (2017). Fundamentals of Qualitative Research: A Practical Guide. New York: Routledge.
Braun, V., & Clarke, V. (2006). Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa
Buckmaster, R., McNulty, M., & Guerin, S. (2019). Family Factors Associated with Self-harm in Adults: A Systematic Review. Journal of Family Therapy, 41(4), 537-558. https://doi.org/10.1111/1467-6427.12232
Cottrell, D. J., Wright-Hughes, A., Collinson, M., Boston, P., Eisler, I., Fortune, S., ... Farrin, A. J. (2018). Effectiveness of Systemic Family Therapy Versus Treatment as Usual for Young People after Self-harm: A Pragmatic, Phase 3, Multicentre, Randomised Controlled Trial. The Lancet Psychiatry, 5(3), 203-216. https://doi.org/10.1016/S2215-0366(18)30058-0
Department of Mental Health. (2019, July 2). The Department of Mental Health Recommends Observing 10 Warning Signs that People are at Risk of Suicide. Retrieved from https://dmh.go.th/news-dmh/view.asp?id=29785
Doyle, L., Treacy, M. P., & Sheridan, A. (2015). Self-harm in Young People: Prevalence, Associated Factors, and Help-seeking in School-going Adolescents. International Journal of Mental Health Nursing, 24(6), 485-494. https://doi.org/10.1111/inm.12144
Edmondson, A. J., Brennan, C. A., & House, A. O. (2016). Non-suicidal Reasons for Self-harm: A Systematic Review of Self-reported Accounts. Journal of Affective Disorders, 191, 109-117. https://doi.org/10.1016/j.jad.2015.11.043
Everett, B., & Gallop, R. (2001). The Link between Childhood Trauma and Mental Illness: Effective Interventions for Mental Health Professionals. London: Sage Publications. https://doi.org/10.4135/9781452205533
Fergusson, D., Doucette, S., Glass, K. C., Shapiro, S., Healy, D., Hebert, P., & Hutton, B. (2005). Association between Suicide Attempts and Selective Serotonin Reuptake Inhibitors: Systematic Review of Randomised Controlled Trials. BMJ, 330, 396. https://doi.org/10.1136/bmj.330.7488.396
Gardner, W., Pajer, K., Cloutier, P., Zemek, R., Currie, L., Hatcher, S., ... Lima, I. (2019). Changing Rates of Self-harm and Mental Disorders by Sex in Youths Presenting to Ontario Emergency Departments: Repeated Cross-sectional Study. The Canadian Journal of Psychiatry, 64(11), 789-797. https://doi.org/10.1177/0706743719854070
Guan, K., Fox, K. R., & Prinstein, M. J. (2012). Nonsuicidal Self-injury as a Time-invariant Predictor of Adolescent Suicide Ideation and Attempts in a Diverse Community Sample. Journal of Consulting and Clinical Psychology, 80(5), 842-849. https://doi.org/10.1037/a0029429
Hambleton, A. L., Hanstock, T. L., Halpin, S., & Dempsey, C. (2022). Initiation, Meaning and Cessation of Self-harm: Australian Adults’ Retrospective Reflections and Advice to Adolescents Who Currently Self-harm. Counselling Psychology Quarterly, 35(2), 260-283. https://doi.org/10.1080/09515070.2020.1737509
Hawton, K., Harriss, L., Hall, S., Simkin, S., Bale, E., & Bond, A. (2003). Deliberate Self-harm in Oxford, 1990-2000: A Time of Change in Patient Characteristics. Psychological Medicine, 33(6), 987–995. https://doi.org/10.1017/s0033291703007943
Hawton, K., Saunders, K. E., & O’Connor, R. C. (2012). Self-harm and Suicide in Adolescents. The Lancet, 379(9834), 2373-2382. https://doi.org/10.1016/S0140-6736(12)60322-5
Hetrick, S. E., Subasinghe, A., Anglin, K., Hart, L., Morgan, A., & Robinson, J. (2020). Understanding the Needs of Young People Who Engage in Self-harm: A Qualitative Investigation. Frontiers in Psychology, 10, 2916. https://doi.org/10.3389/fpsyg.2019.02916
Hill, K., & Dallos, R. (2012). Young People’s Stories of Self–harm: A Narrative Study. Clinical Child Psychology and Psychiatry, 17(3), 459-475. https://doi.org/10.1177/1359104511423364
Hopko, D. R., Sanchez, L., Hopko, S. D., Dvir, S., & Lejuez, C. W. (2003). Behavioral Activation and the Prevention of Suicidal Behaviors in Patients with Borderline Personality Disorder. Journal of Personality Disorders, 17(5), 460-478. https://doi.org/10.1521/pedi.17.5.460.22970
Joiner, T. E., Ribeiro, J. D., & Silva, C. (2012). Nonsuicidal Self-injury, Suicidal Behavior, and their Co-occurrence as Viewed Through the Lens of the Interpersonal Theory of Suicide. Current Directions in Psychological Science, 21(5), 342-347. https://doi.org/10.1177/0963721412454873
Kissil, K. (2011). Attachment-based Family Therapy for Adolescent Self-injury. Journal of Family Psychotherapy, 22(4), 313–327. https://doi.org/10.1080/08975353.2011.627801
Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The Relationship between Nonsuicidal Self-injury and Attempted Suicide: Converging Evidence from Four Samples. Journal of Abnormal Psychology, 122(1), 231-237. https://doi.org/10.1037/a0030278
Knorr, A. C., Tull, M. T., Anestis, M. D., Dixon-Gordon, K. L., Bennett, M. F., & Gratz, K. L. (2016). The Interactive Effect of Major Depression and Nonsuicidal Self-injury on Current Suicide Risk and Lifetime Suicide Attempts. Archives of Suicide Research, 20(4), 539-552. https://doi.org/10.1080/13811118.2016.1158679
Limsuwan, N., Lantomrattana, A., Prachason, T., Tantrarungroj, T., Lorterapong, P., Thongpan, M., & Waleeprakhon, P. (2023). The Qualitative Study of Intentional Self-harm in Thailand: Focusing on Predisposing Child-rearing Environments and Self-harm Cessation. Frontiers in Psychology, 14, 957477. https://doi.org/10.3389/fpsyg.2023.957477
MacDonald, S., Sampson, C., Turley, R., Biddle, L., Ring, N., Begley, R., & Evans, R. (2020). Patients’ Experiences of Emergency Hospital Care Following Self-harm: Systematic Review and Thematic Synthesis of Qualitative Research. Qualitative Health Research, 30(3), 471-485. https://doi.org/10.1177/1049732319886566
Mason, J. (2017). Qualitative Researching (3rd ed.). London: Sage Publications.
McAllister, M. (2003). Multiple Meanings of Self Harm: A Critical Review. International Journal of Mental Health Nursing, 12(3), 177-185. https://doi.org/10.1046/j.1440-0979.2003.00287.x
McAndrew, S., & Warne, T. (2005). Cutting Across Boundaries: A Case Study Using Feminist Praxis to Understand the Meanings of Self-harm. International Journal of Mental Health Nursing, 14(3), 172–180. https://doi.org/10.1111/j.1440-0979.2005.00378.x
Mitten, N., Preyde, M., Lewis, S., Vanderkooy, J., & Heintzman, J. (2016). The Perceptions of Adolescents Who Self-harm on Stigma and Care Following Inpatient Psychiatric Treatment. Social Work in Mental Health, 14(1), 1-21. https://doi.org/10.1080/15332985.2015.1080783
Muehlenkamp, J. J., Xhunga, N., & Brausch, A. M. (2019). Self-injury Age of Onset: A Risk Factor for NSSI Severity and Suicidal Behavior. Archives of Suicide Research, 23(4), 551-563. https://doi.org/10.1080/13811118.2018.1486252
NICE. (2022). Self-harm: Quality Standard. Retrieved from https://www.nice.org.uk/guidance/qs34
Paholpak, P., Rangseekajee, P., Arunpongpaisal, S., Piyavhatkul, N., Thepsuthammarat, K., & Paholpak, S. (2012). Characteristics and Burden of Hospitalization Because of Intentional Self-harm: Thai National, Hospital-Based Data for 2010. Journal of The Medical Association of Thailand, 95(7), 156-162.
Parker, D. (2017). Attachment and Object Relations: Transitional Phenomena in Relation to Self-harm Among Late Adolescent Girls (Doctoral Dissertation). Alliant International University, San Diego, USA.
Phothisita, C. (2013). Sciences and Arts of Qualitative Research (6th ed.). Bangkok: Amarin Printing & Publishing.
Robinson, J., McCutcheon, L., Browne, V., & Witt, K. (2016). Looking the Other Way: Young People and Self-harm. Melbourne: Orygen, The National Centre for Excellence in Youth Mental Health.
Shek, D. T. L. (2010). Objective Outcome Evaluation of the Project P.A.T.H.S. in Hong Kong: Findings Based on Individual Growth Curve Models. The Scientific World Journal, 10, 182-191. https://doi.org/10.1100/tsw.2010.18
Shek, D. T. L., Siu, A. M. H., Lee, T. Y., Cheung, C. K., & Chung, R. (2008). Effectiveness of the Tier 1 Program of Project P.A.T.H.S.: Objective Outcome Evaluation Based on a Randomized Group Trial. The Scientific World Journal, 8, 4-12. https://doi.org/10.1100/tsw.2008.16
Shek, D. T. L., & Yu, L. (2011). Prevention of Adolescent Problem Behavior: Longitudinal Impact of the Project P.A.T.H.S. in Hong Kong. The Scientific World Journal, 11, 546-567. https://doi.org/10.1100/tsw.2011.33
Singtakaew, A., & Chaimongkol, N. (2021). Deliberate Self-harm among Adolescents: A Structural Equation Modelling Analysis. International Journal of Mental Health Nursing, 30(6), 1649-1663. https://doi.org/10.1111/inm.12918
Siu, A. M. H. (2019). Self-harm and Suicide among Children and Adolescents in Hong Kong: A Review of Prevalence, Risk Factors, and Prevention Strategies. Journal of Adolescent Health, 64(6), S59-S64. https://doi.org/10.1016/j.jadohealth.2018.10.004
Stake, R. E. (2008). Qualitative Case Studies. In N. K. Denzin, & Y. S. Lincoln (Eds.), Strategies of Qualitative Inquiry (pp. 119–149). London: Sage Publications.
Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in Depressive Symptoms, Suicide-related Outcomes, and Suicide Rates among U.S. Adolescents after 2010 and Links to Increased New Media Screen Time. Clinical Psychological Science, 6(1), 3–17. https://doi.org/10.1177/2167702617723376
UNICEF. (2019, September 18). An Open Letter to the World’s Children: 8 Reasons Why I’m Worried, and Hopeful, about the Next Generation. Retrieved from https://www.unicef.org/child-rights-convention/open-letter-to-worlds-children
Van der Kolk, B. A. (1989). The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism. Psychiatric Clinics of North America, 12(2), 389-411. https://doi.org/10.1016/S0193-953X(18)30439-8
Van der Kolk, B. A., Perry, J. C., & Herman, J. L. (1991). Childhood Origins of Self-destructive Behavior. The American Journal of Psychiatry, 148(12), 1665-1671. https://doi.org/10.1176/ajp.148.12.1665
Vivekananda, K. (2000). Integrating Models for Understanding Self-injury. Psychotherapy in Australia, 7(1), 18–25.
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Research Articles
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How to Cite
POOHONGTHONG, Chanadda; KANJANAPHITSARN, Supre; SURAT, Pongkamon.
Risk Factors and Prevention Strategies of Self-Harm in University Students: A Qualitative Approach.
Journal of Community Development Research (Humanities and Social Sciences), [S.l.], v. 17, n. 1, p. 89-104, mar. 2024.
ISSN 2985-0231.
Available at: <https://www.journal.nu.ac.th/JCDR/article/view/Vol-17-No-1-2024-89-104>. Date accessed: 28 apr. 2024.
doi: https://doi.org/10.14456/jcdr-hs.2024.6.