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DSH among Māori
As for suicide, there are distinct disparities for Māori youth. In the Youth 2000 survey 2,325 of the 9,699 participants identified as Māori (AHRG, 2004). Māori adolescents were more likely to have thought about suicide (17.4% vs.12.4%), made plans related to suicide (11.1% vs. 7.4%) and acted on these thoughts (6.9% vs. 3.6%) than non-Māori (AHRG, 2004). Among hospitalisations for DSH in NZ Māori females had consistently higher rates of hospitalisation than all other groups. Māori males had higher rates o hospitalisation than non- Māori males. Māori females aged between 15 and 24 years old had the highest rate of hospitalisations for DSH in 2006 (SPINZ, 2008). In 2007 there were 75.3 Māori intentional selfharm hospitalisations per 100,000 people in 2007, compared to 61.6 per 100,000 for the non- Māori population. The DSH hospitalisations show no downward trend for Māori since 1996; in comparison, DSH hospitalisation rates for non-Māori have dropped markedly.
Risk Factors for DSH and Suicide
A large amount of literature exists on the risk factors for suicide and DSH and many different factors are said to increase the risk for both. A risk factor is said to be “a characteristic, variable, or hazard that increases the likelihood of development of an adverse outcome, which is measurable and which precedes the outcome” (Moscicki, 1997, p. 500). Some studies have found adolescents who engage in DSH are often unable to identify precipitating factors or give reasons for their behaviours (Beautrais, Joyce, & Mulder, 1996; Hawton et al., 1982; Kienhorst, de Wilde, Diekstra, & Wolters, 1995). Nevertheless, understanding risk factors is desirable to ensure effective treatment and prevention strategies for adolescents.
Family history and parental mental health
Having a family history of suicidal behaviours is associated with an increased risk of suicide and DSH (Beautrais, 2000a; Carr, 1999; Fortune et al., 2005). This may come about because of social learning factors, such as modelling of poor emotional regulation and distress tolerance skills, and an altered tolerance to DSH, as well as possible genetic factors. Studies suggest that the rate of suicide and DSH is increased among adolescents who have been exposed to parental psychopathology, including depression, substance abuse disorders and antisocial behaviours (Beautrais, 2000a; Carr, 1999; Fortune et al., 2005). It has been suggested that families with parental psychopathology are characterised by high levels of conflict and low levels of communication and cohesion (Garber, Little, Hilsman & Weaver, 1998) which have also been linked with increased DSH. As mentioned above, this may be a result of social learning and the modelling of maladaptive behaviours and coping strategies (Carr, 1999).
Family problems
There is a well recognised association between family dysfunction and adolescent DSH (Agerbo, Nordentoft, & Mortensen, 2002; Miller, King, Shain, & Naylor, 1992; Sim, Adrian, Zeman, Cassano & Friedrich, 2009; Spirito, Brown, Overholser, & Fritz, 1989). A chaotic early environment is said to predispose individuals to psychological problems later in life (Carr, 1999). More specifically, conflict between parents and adolescents is a significant risk factor for suicide and DSH (Brent, Baugher, Bridge, Chen, & Chiappetta, 1999). This view is supported by an Australian study which found more dysfunction in families of adolescents who engaged in DSH compared with those who did not (Tulloch, Blizzard & Pinkus, 1997). This study also found a strong association between inadequate parent-child communication and adolescent DSH. There is also recent evidence to suggest that rejection from parents affects adolescents more negatively than problems in peer relationships, and is more powerfully associated with suicidal behaviours than peer relationship difficulties (Fotti, Katz, Afifi, & Cox, 2006).
CHAPTER ONE Introduction: Te Whakatuwheratanga
Kaupapa Māori Research
Understanding DSH and Suicide
Prevalence and Incidence of DSH and Suicide
Risk Factors of DSH and Suicide
Protective Factors
Cultural Factors and Māori Specific Risk Factors
A Predictive Model of Risk Factors for DSH and Suicide
Psychological Explanations of DSH
Motives for DSH
Impact of DSH on Families
Interventions for DSH Behaviours
Aims of the Study
CHAPTER TWO Method: Te Tukanga
Methodology
The Setting
Participants
Procedure
Data Analysis
CHAPTER THREE Analysis of Whānau Intiews
Whānau Ideas Regarding the Motives for DSH
The Impact of DSH on Whānau
Needs of Whānau Following the DSH of their Young Person
CHAPTER FOUR Analysis of Key Informant Interviews
Key Informant Ideas Regarding the Motives for DSH
Key Informants Ideas Regarding the Impact of DSH on Whānau
Key Informants Ideas Regarding the Needs of Whānau Following DSH
CHAPTER FIVE Discussion: Te Whakamutunga
Summary of analyses
Comparison between Māori and non-Māori
Implications
Limitations of the study
Directions for Future research
GLOSSARY
REFERENCES
APPENDICES
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