Research

Reflecting on asking about self-harm for the first time

By Abigail Paterson.

I recently completed the data collection for the first study in my PhD and when I did, I realised that this also signalled the end of my first study which asked participants about their self-harm behaviour. It was two big milestones for me in my PhD and before I begin data analysis (another milestone for another day) I took some time to reflect on my experience and realised I had learned a lot asking about self-harm for the first time. My PhD is primarily testing if implementation intentions [1] can reduce self-harm behaviour and evaluating the effects of various variables on the effectiveness of this intervention (for example volitional moderators within the Integrated Motivational-Volitional Model of Suicide [2]. As self-harm (self-poisoning or self-injury irrespective of the motivation [3]) is the behaviour of interest I realised there may be other early career researchers recruiting a sample of people who have engaged in self-harm, for the first time. I have learned a lot, but I have chosen to focus on two areas: my initial worries and recruitment.

The first thought I had when looking back over my first study was about the initial worries I had. I found myself asking a lot of questions including: “Am I going to upset someone?”; “Am I going to unintentionally cause harm?”; and “Have I considered everything?”. Guidance to answer each of these issues was sought from my supervisors and resources including the Code of Human Research Ethics [4]. I am going to take each question in turn and hopefully reassure you that it’s ok to ask these questions and that asking these questions can help shape your research to be the best it can be (which I believe was the case for my first study). I remember vividly asking myself, “Am I going to upset someone?”. Self-harm is a personal and sensitive topic and there is a chance that someone will not like your research. There are many possible reasons for why this may be and each one is understandable (e.g., feelings of shame/guilt following self-harm, stigma or not feeling ready to share their experience). On a related note, I received a negative response during the data collection phase of my first study. One of the best pieces of advice my supervisors gave me was not to view it as a personal attack and rather to view it was a learning opportunity as academia is not an easy world to be in. Having these types of experiences with your supervisors there to support you is the best time for them! When I was informed that a negative response had been made, I did the following: I took time to reflect on what the issue was and I considered how I could amend the study to address the individual’s feedback. I made a minor amendment to my study with support from my supervisors and university ethics committee and the study progressed.

“Am I unintentionally going to cause harm?” was another question I worried about. This can be a scary question to ask yourself, but I hope I can reassure you that research which asks about self-harm is supported and has not been found to cause self-harm [5]. If your type of study is relatively new (such as mine) you can include an appropriate measure to check further distress is not caused. For example, in my first study I included a measure of depression and anxiety to check that by delivering an intervention designed to reduce self-harm behaviour did not cause an increase in either of these outcomes.

Another question I remember feeling stressed about was, “Have I considered everything?”.  As an early career researcher, you will do your best to consider everything but there is no perfect study (some more wise words from my supervisors during my first study). I remember spending a lot of time comparing measures, considering ethical issues and evaluating the length of the questionnaire. When you are trying to “consider everything” an important balance to strike is addressing your research aims and participant burden. If I had sent out the first draft of my questionnaire although it would have measured a wide range of variables about a population which is hard to access it would have had a huge drop-out rate due to the length. It is especially important not to overburden your participants. I found it easier to simplify my questionnaire by looking at my research questions and identifying which measures were answering them specifically. Any other measures you can remove and remember them for the future! An extra design feature, if it is your first time collecting data from a sample of people who have engaged in self-harm, is to include support group contact information at every step of my research (i.e., the participant information sheets and debrief forms). This is something I would definitely recommend as it helped me feel reassured in regard to the participants mental health and wellbeing.

The second thought I had when looking back over my first study was about recruitment. This was the first study I had done where I felt the real challenge of recruiting participants. In general, recruitment for an intervention study means you are relying on participants to complete a questionnaire at two different time points and understandably not everyone will want to complete a second questionnaire (hello attrition!) but adding a behaviour which is of a personal and sensitive nature can add an extra layer of difficulty during recruitment. I managed to recruit the sample size needed to conduct my data analyses and the main reason I think this was achieved was by using social media as my main source of recruitment. I had access to Facebook, Twitter and Reddit throughout my first study and each had its benefits. Facebook and Reddit are particularly useful for groups, but please make sure you contact the moderators and tell them about your research. It is important they are so fully informed about what is being promoted on their page. Twitter and Facebook are also great for sharing your research widely (the retweet button will become your best friend when advertising on twitter!). There is a large academic network on Twitter and supporting each other by sharing each other’s research is something I cannot recommend enough as their help makes a difference. I would like to add that another member of the netECR community has provided a great read about online recruitment and some helpful tips which I would recommend you read if you plan on recruiting online [6].

Overall, when I reflected on the experience of asking about self-harm for the first time, the initial worries and recruitment were the two key points that came to mind. Both have taught me a lot as an early career researcher and, although it was hard at times, I see them now as invaluable learning opportunities.

References

[1] Gollwitzer, P (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54(7), 493-503. https://doi.org/10.1037/0003-066X.54.7.493

[2] O’Connor, R., & Kirtley, O. (2018). The integrated motivational-volitional model of suicidal behaviour. Philosophical transactions of the Royal Society of London. Series B, Biological Sciences, 373(1754). https://doi.org/10.1098/rstb.2017.0268

[3] Hawton, K., Harriss, L., Hall, S., Simkin. S., Bale, E., & Bond, A. (2003). Deliberate self-harm in Oxford, 1999-2000: a time of change in patient characteristics. Psychological medicine, 33, 987-995.  https://doi.org/10.1017/S0033291703007943

[4] British Psychological Society (2014). Code of Human Research Ethics. https://www.bps.org.uk/sites/bps.org.uk/files/Policy/Policy%20-%20Files/BPS%20Code%20of%20Human%20Research%20Ethics.pdf

[5] DeCou, C. R. & Schumann, M. E. (2017), On the iatrogenic risk of assessing suicidality: A meta-analysis. Suicide and Life Threatening Behavior 48(5) 531-543. https://doi.org/10.1111/sltb.12368

[6] Pendrous, R. (2019, September 9). Experiences of online recruitment for suicide research: Some best practice recommendations. https://netecr.org/2019/09/09/online-recruitment/


Abigail Paterson (@abigailzp) is a PhD student at the University of Strathclyde.

 

 

 

*Featuring Photo by Kelly Sikkema on Unsplash

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