Title: Understanding gender differences in young people’s experience of self-harm, in order to influence gender-sensitive change in our mental health services
Funder: Department of Health and Social Care

Abstract: Background:Self-harm involves a person causing intentional injury to themselves, irrespective of the intention to die. It is associated with multiple adverse outcomes and is the single best predictor of subsequent suicide. There is no single effective therapy to treat self-harm. In younger teenagers, self-harm is much more common in girls than boys, but in older adolescents this gap decreases. In recent years there has been a sharp increase in young girls presenting with self-harm. There has been little research to identify the reasons behind this striking gender difference, therefore we have few ideas about how to make services more responsive to these gender differences. Aim: A mixed-methods study, using qualitative and quantitative methods, to identify and understand gender differences in self-harm, with a view to informing improvements to services for young people. Objectives: Identify gender differences in risk and protective factors for self-harm across adolescence. Explore gender differences in young people's experiences of and motivations for self-harm, as well as their experiences of services and therapy. Integrate findings from objectives 1 and 2 to facilitate collaborative work between patients and staff, identifying areas for improvements in services and therapy for young people who self-harm. Develop a logic model of how self-harm services can become more gender sensitive. This logic model will form a starting point for future work.Methods:This project comprises three workstreams: Quantitative analysis of gender differences in risk factors for self-harm across adolescence, using longitudinal data from the Millennium Cohort Study. Longitudinal qualitative study with mixed creative methods. Participants bring and create images to help explain their motivation for and experiences of self-harm. Interviews at 0, 9 and 18 months will be analysed by gender using poly-textual thematic analysis to identify gender differences in emerging themes. An experience based co-design project where staff and patients work collaboratively. Findings from workstreams 1 and 2 will be presented to participants to provide a stimulus for identifying areas for gender-sensitive improvement in clinical care and subsequent practical solutions. Findings will be summarised in a logic model which will form the foundation for post-doctoral work in developing a complex intervention for self-harm. Young people will be supported through creative workshops to develop dissemination material.Timelines:Workstreams 1 and 2 will be completed alongside each other in the first 30 months and workstream 3 completed in months 30-42. The final dissertation will be written up and disseminated in months 42-48. Impact and Dissemination: Workstreams 1 and 2 will develop a greater understanding of the gender differences in self-harm across adolescence. These findings will be integrated into workstream 3, where young people and staff will work collaboratively to develop gender-sensitive service change to improve treatment for young people who self-harm. Findings will be disseminated through 3 peer-reviewed publications and presentations at national and international conferences. Young people will develop a performance piece in collaboration with a theatre company to disseminate findings to peers.In post-doctoral work findings will be used to develop a complex intervention, which will be tested with feasibility RCT.

Lay abstract: Aim: Understanding gender differences in young people's experience of self-harm, in order to influence gender-sensitive change in our mental health servicesBackground:Self-harm involves a person causing an injury to themselves, whether or not they wanted to die. It is not an illness, but a behaviour that tells us that someone is struggling. In younger teenagers, self-harm is much commoner in girls. As people get older this changes so that there are roughly equal numbers of adult men and women who self-harm. In recent years, episodes of self-harm in young girls have increased far more than in boys. This research project aims to explore if boys and girls have different reasons for self-harm and different experiences of treatment. We hope this will help us develop better, more gender-sensitive services and treatments in the future.Design and Methods:This research project is made up of 3 parts:1. Analysing a large set of data that contains information about young people at several different ages during their teens. The data will be reviewed to identify any factors that might increase or decrease the risk of self-harm, and how these might be different for boys and girls.2. Interviews with young people using pictures and other creative methods at 3 different times over the course of 18 months. Participants are asked to choose or create images to help explain their experiences of self-harm. The images act as a starting point for discussion around what self-harm means to them personally and their experiences of treatment. These interviews will then be analysed to find similarities and differences between boys and girls.3. Young people who have self-harmed will work together with professionals from the Child and Adolescent Mental Health Service (CAMHS), using creative methods. Young people will be supported to create a presentation that highlights important gender differences found in the first and second parts of the project. This will be shown to staff and young people to spark discussion. They will then list areas for improvements to make patient care more gender-sensitive and work together to find solutions that can be put into practice. This information can be used by other services in the future who want to improve their self-harm service to meet the needs of boys and girls. Young people will then work with a theatre company to create a performance piece to showcase the results of the study.Public and Patient Involvement:Patient involvement is central to this project. Young people helped to design this project and will continue to be actively involved throughout the research - including deciding the methods used to collect interview information and activities for group work, working together with staff to identify areas for service change and spreading the findings of the research to their peers and other professionals.Outcomes and Dissemination:The outcomes will include a better understanding of how boys and girls differ in their experiences of and reasons for self-harm, and staff and patients will work together to develop changes to current services that are relevant and important to them. Research findings will be shared with professionals through scientific papers and presentations. Findings will be shared with patients and the public through a performance piece that has been designed by service users themselves with support from a local theatre company. I will use the findings from this project in my future work to develop a therapy for self-harm which is sensitive to the different needs of boys and girls. This therapy will then undergo testing to determine if it is effective and acceptable.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH