A comparison of temporal pathways to self-harm in young people compared to adults: a pilot test of the Card Sort Task for Self-Harm (CaTS)online using Indicator Wave Analysis

This study uses an internet-mediated version of the CaTS (CaTS-online) to systematically compare the dynamic interplay of factors that lead to self-harm in young people (18-25 years) and adults using a longitudinal design. Traditionally, CaTS is a manual task with cards presented along a timeline in a tabletop manner. An online adaptation of CaTs could offer increased functionality and scope, including a more efficient process of recording, coding and tracking the order and frequency of cards, and the capacity to allow for multiple uses of the same card at different time points, which was not a feature of the manual version. Previous tests of the CaTS have focused on relatively small, clinical or targeted populations. An online version extends capacity to access a wider, more diverse participant pool [35] and allows the task to be performed anonymously and in less-formal settings [36]. Given the remote nature of CaTS-online, the study will draw on adult and late adolescent (18+) groups, herein specified as ‘young people’. Novel approaches to analysing the multi-dimensional nature of risk over time are necessary to advance understanding of when, why, and who is at risk of self-harm. A limitation of the sequence analysis approach previously employed by Townsend and colleagues [37] was that the use of the same card at multiple time points was prohibited, a restriction noted by young people in anecdotal feedback and in Patient Public Involvement work used to develop the original CaTS [37]. To address this issue the present study uses Indicator Wave Analysis (IWA) as a method of temporal measurement which allows multiple, simultaneous and sequential events to be analysed across varying time-spans [38]. In addition, IWA produces easy to interpret wave diagrams (known as indicator wave diagrams) which provide a profile of the factors (indicators) absent or prevalent relative to other indicators at a time point [38]. The use of IWA in psychological methods is novel, but as a method of allowing complex data to be plotted and examined in simplified diagrams, it is an attractive approach to aid interpretation and discourse of the fluctuating and complex nature of self-harm and suited to analysing the CaTS-online data. As IWA is a novel approach, and there is limited data specifically comparing adults and young people who self-harm, no specific predictions are made concerning the absence or presence of items across time. An additional aim of this study was to explore what can we learn from CaTS-online as a research tool and the potential for application of IWA as an analysis technique to support further development of CaTS. Research Questions: 1. Is there an association between cards that are selected as part of the CaTS and time leading up to and after self-harm episodes in adults and young people? 2. Do items at time points leading up to and after self-harm differ between adults and young people? 3. Do items at time points leading up to and after self-harm differ between the first ever and most recent episode of self-harm for adults and young people?