Table_7_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 online using Indicator Wave Analysis.DOCX

BackgroundSelf-harm is complex, multifaceted, and dynamic, typically starts in adolescence, and is prevalent in young people. A novel research tool (the Card Sort Task for Self-harm; CaTS) offers a systematic approach to understanding this complexity by charting the dynamic interplay between multidimensional factors in the build-up to self-harm. Sequential analysis of CaTS has revealed differences in key factors between the first and the most recent episode of self-harm in adolescence. Rates of self-harm typically decline post-adolescence, but self-harm can continue into adulthood. A comparison between factors linked to self-harm in young people vs. adults will inform an understanding of how risk unfolds over time and clarify age-specific points for intervention. A pilot online adaptation (CaTS-online) and a new method (Indicator Wave Analysis; IWA) were used to assess key factors in the build-up to self-harm.
MethodsCommunity-based young people (n = 66; 18–25 years, M = 21.4; SD = 1.8) and adults (n = 43; 26–57 years, M = 35; SD = 8.8) completed CaTS-online, documenting thoughts, feelings, events, and behaviours over a 6-month timeline for the first ever and most recent self-harm. A notable interdependence between factors and time points was identified using IWA.
ResultsPositive emotion at and immediately after self-harm exceeded the threshold for both groups for both episodes. Feeling better following self-harm was more pronounced for the first-ever episodes. Impulsivity was an important immediate antecedent to self-harm for both groups at both episodes but most markedly for young people. Acquired capability was notable for adults’ most recent episodes, suggesting this develops over time. Burdensomeness was only more notable for adults and occurred 1 week prior to a recent episode. Both groups revealed patterns of accessing support that were helpful and unhelpful.
ConclusionCommonalities and differences in the temporal organisation of factors leading to and following self-harm were identified in young people and adult pathways which shed light on age-specific factors and possible points of intervention. This has implications for clinical support and services around approaches to positive feelings after self-harm (especially for first-ever self-harm), feeling of burdensomeness, impulsivity, and acquired capability leading up to self-harm. Support is provided for card-sort approaches that enable the investigation of the complex and dynamic nature of pathways to self-harm.

研究背景
自伤是一种多维度且具有动态性的复杂行为，通常始发于青少年时期，在青年群体中高发。本研究开发的新型研究工具——自伤分类卡片任务（Card Sort Task for Self-harm, CaTS），通过绘制自伤发生前多维因素间的动态交互关系图谱，为解析自伤的复杂性提供了系统化路径。针对CaTS的序列分析已揭示，青少年群体首次与最近一次自伤事件的关键影响因素存在差异。自伤发生率通常在青少年期后下降，但自伤行为可持续至成年阶段。对比青年与成年群体中与自伤相关的影响因素，有助于理解风险随时间的演变轨迹，并明确针对性的干预节点。本研究采用线上试点改编版工具（CaTS线上版）与新型分析方法——指标波浪分析（Indicator Wave Analysis, IWA），对自伤发生前的关键影响因素进行评估。
研究方法
本研究招募社区群体中的青年（n=66，年龄18~25岁，M=21.4，SD=1.8）与成人（n=43，年龄26~57岁，M=35，SD=8.8），让其完成CaTS线上版任务，记录首次与最近一次自伤事件前后6个月内的想法、感受、事件与行为。通过IWA分析，研究人员发现各影响因素与时间节点间存在显著的交互关联。
研究结果
在自伤发生时及发生后即刻，两个群体的两次自伤事件对应的积极情绪水平均超出阈值。首次自伤事件后，个体感受到的情绪改善程度更为显著。冲动性是两个群体两次自伤事件的重要即时前驱因素，但对青年群体的影响最为显著。获得性能力在成年群体最近一次自伤事件中表现显著，提示该因素随时间推移逐渐形成。累赘感仅在成年群体中更为突出，且通常出现在最近一次自伤事件的1周前。两个群体均呈现出对支持资源的获取模式，其中部分支持具有帮助性，部分则无实际助益。
研究结论
本研究明确了青年与成年群体在自伤发生前后的影响因素时间组织模式上的共性与差异，为识别年龄特异性影响因素及潜在干预节点提供了依据。该研究结果对临床支持与服务具有指导意义，涉及自伤后积极情绪的干预（尤其针对首次自伤）、累赘感、冲动性以及自伤前的获得性能力等方向。本研究支持采用分类卡片法，以探究自伤路径的复杂动态特性。