European studies suggest that 13.5% of girls and 4.3% of boys had at least one episode of DSH ( most frequent forms being self-mutilations and overdoses).DSH is a huge public health problem. What causes DSH?
Many consider DSH as a maladaptive coping mechanism. Is there evidence to link particular coping mechanisms and DSH?
Diogo F. Guerreiro, Diana Cruz, Diana Frasquilho, Jose ́ C. Santos, Maria L. Figueira, and Daniel Sampaio attempt to answer this key question by reviewing the literature of past decade.
DSH as defined in the 7 country CASE study ( as an act with a non-fatal outcome, in which an individual deliberately did one or more of the following: behaviors intended to cause self-harm; ingested a substance in excess of the prescribed or generally recognized therapeutic dose; ingested a recreational or illicit drug as an act of self-harm or ingested a non-ingestible substance or object) was used to search literature .
Much of the present literature on coping is based on the model proposed by Lazarus.Lazarus and Folkman (1984) defined coping ‘‘as constantly changing cognitive and behavioral efforts to manage specific external and or internal demands that are appraised as taxing or exceeding the resources of the person. There are two global coping styles: 1. Emotion-focused coping (distancing, escape, avoidance) – directed at regulating emotional distress.2.Problem- focused coping – deals with the problem that is causing the distress and alters the troubled person-environment relation that is causing the distress.
Eighteen studies met the inclusion criteria.Variability of methods was too much and meta-analysis of the results was not possible. Seven studies significantly correlated emotion-focused coping style with DSH in adolescents. Avoidant coping strategies were directly related to DSH in numerous studies.Problem-focused coping has been less consistently correlated with DSH in adolescents.
Examples of emotion-focused strategies more likely to be seen in adolescents who engaged in DSH were: avoiding the problem,use of drugs and alcohol,getting angry , rumination, self-blame, helplessness and preoccupation with problems.Problem-focused strategies included request for help, talking to someone,confrontation and active problem solving and logical analysis.
Limitations: All studies are
cross-sectional in nature. huge heterogeneity of measures used in these studies make conclusions difficult.
Conclusions: The use of an emotion-focused coping style, and in particular avoidant coping strategies, has been consistently associated with DSH in adolescents.Predominant use of a problem-focused coping style is possibly a protective factor for DSH in adolescents.
Summary of the article:
Association between deliberate self–harm and coping in adolescents: a critical review of the last 10 years’literature. Guerreiro DF, Cruz D, Frasquilho D, Santos JC, Figueira ML, Sampaio D. Arch Suicide Res. 2013;17(2):91-105