Literature Review

Topic: Social work pertaining to social issues on suicide and self-harm in Singapore

Suicide and self-harm cases in Singapore have rapidly increased in the last decade with the most affected groups being the younger generation. An article published in Singapore by The Straits Times newspaper on 28th December 2015 revealed that more young people were engaging in self-harm and suicidal attempts by cutting themselves on their arms and legs to cope with emotional stress and frustrations. Self-harming and suicide cases have therefore become a significant clinical problem in Singapore with the Ministry of Social and Family development raising concerns over the rapid increase of self-harm and suicide-related behaviour in the country. Various biosocial models of self-harmful behavior as well as incorporating family processes and social support networks have been made help in the promotion of social cohesion and identification with societal values as well as in enhancement of mental health and prevention of suicide cases. However, the role social workers work despite their significant contribution in reducing suicide and self-harm cases has been ignored. This essay, therefore, provides a review of journal articles on social work about social issues in suicide and self-harm in Singapore. It will also give a self-reflection of the findings and their applicability in addressing the social problem in Singapore.  

The literature review will be built upon by conducting an intensive investigation of social work and its contribution through social workers to the study of suicide and suicide-related behaviour to provide an understanding with the importance of social work and its participation in prevention, assessment and treatment of suicide cases. The review will be done on 20 journals within a time frame of the last five years.

Relations between self-harm and suicidal behaviour in adolescence; in their journal review, Salome, Hirsch, Chang & Jeglicet, (2016) conducted a study to establish the relationship between self-harm or non-suicidal self-injurious behaviour and suicidal behaviour. Their findings had that there are specific relational and shared risk factors such as mental or cognitive disorders, depression, family dysfunction and substance abuse among the young groups which triggered self-harm behaviour among the younger generation. Their findings also showed that there was a correlation between self-harming behavior and suicidal behavior. Self-harming was found to be a more significant risk factor predictive of subsequent suicidal behavior.

Metasynthesis of Youth suicidal behavior: perspectives of youth; parents and Healthcare Professionals: this journal review was done by Jonathan et al. (2015) and attempted to provide an understanding of youth suicidal behavior. The journal engaged in a study that involved the youths, parents and health professionals who provided different perspectives on suicidal behavior. In their findings, they established that suicidal and self-harming behavior correlated with relational experience, individual experience as well as with social and cultural background. The feeling of difference and rejection as well as changes in the relational distance between the parents and the youths were found to be critical relational risk factors enhancing suicidal behavior and self-harm amongst the children in their journal of mental health (Davis, Weiss, Tull & Gratz, 2017, p. 46). On the other hand, personal distress and lack of self-control were found to be critical individual experience risk factors while failure to fit into social groups and meet its values was among the forefront societal and cultural experience risk factors.

Relations between self-harm and suicidal behavior in adolescence

Suicide risk in Tran’s population: in their journal of counseling psychology, Tebbe and Moradi, (2016), provided an understanding of mortal dangers in Tran’s community. In their findings, they identified that minority stressors such as depression, social support and drug abuse are significant risk factors enhancing suicidal and self-harm behaviour. They recognized the need for social work professionals to develop strategies aimed at controlling these risk factors and improve the development of better mental health care and reduce suicidal cases.

Non-suicidal self-injury and suicidal thoughts and behaviors: in their journal of consulting and clinical psychology, Chu et al. (2018) provided an understanding of the interpersonal theory of variables among military service members and veterans. They argued that self-harm behaviors had become a robust correlate of suicidal thoughts behavior not only to the young generation but also to adults in military service. According to the interpersonal theory of suicide, they identified that thwarted belongingness and perceived burdensomeness correlated with suicide attempts by the military members who had a high capability for suicide.

Suicidal ideation in Transgender people: Testa et al. (2017) in their journal of abnormal psychology explained how gender minority stress and interpersonal theory risk factors enhance the rapid growth of suicidal and self-harm behavior in the society. It calls for the need of social work and their professionals to understand the various interpersonal lethal risk factors as well as the gender minority stress risk factors such as depression and rejection especially to young female adults as key to the fight and prevention of suicidal cases.

Help-seeking behavior and adolescent self-harm: in their journal of Psychiatry, Rowe et al. (2014) provided an understanding of the relationship between help-seeking initiatives and increased self-harm amongst the young groups. They also aimed at identifying the available sources of support for those who seek help and the possible barriers to help-seeking. In their findings, they established that half of their sample did not find for any assistance while a minority of them sought help from friends and family. It was also identified that many adolescents used social media as a tool for disclosure while the barrier to seeking help was determined to be the fear of an adverse reaction such as stigmatization. Few facilitators of help-seeking were identified which shows that the society has not embraced the role of social work and their professionals in helping the adolescents with self-harm behavior to avoid suicidal cases (Houben et al. 2017, p. 26).

Metasynthesis of Youth suicidal behavior: perspectives of youth; parents and Healthcare Professionals

Therapeutic interventions for suicide attempts and self-harm in adolescents: in their journal of Psychiatry, Ougrin, Tranah, Stahn, Moran & Asarnow, (2015) explored the various intervention mechanisms which can be used to help in reducing suicidal cases amongst the young people. They argued that despite the efforts made to understand the relationship between self-harm and suicidal attempts in adolescents, there is a need for pharmacological, social and psychological therapeutic interventions which will involve the efforts of different social work groups working with health care professionals to help address this issue which has become a significant health crisis in the modern society.

Non-suicidal self-injury on Trans people; in their journal of sexual medicine, Claes et al. (2015) investigated the prevalence of self-harm behavior in Tran’s people and the association with intra and interpersonal problems. Their findings had that; there was a high prevalence of self-harm and suicidal attempts in men compared to the efforts of women. Men experienced more psychological and interpersonal problems and also established that there was perceived less social support in the fight against suicide and self-harm behavior.

The mental health of transgender Youth: in their journal of adolescent health, Connolly, Zerros, Barone, Johnson & Joseph, (2016) investigated the mental health risk factors contributing to suicidal and self-harm attempts amongst transgender youths and their peers. Their findings had that; transgender youths experienced higher risks of depression, suicidality and self-harm compared to their peers. They argued that the provision of gender affirming therapy as well as the supportive social transition in childhood had a direct correlation with improved psychological functioning among the adolescents and gender variant children. The ideas of Bouman et al. also supported the findings. 2018 in their journal of transgenderism.

Youth self-harm in low and middle-income countries: Aggarwal, Patton, Reavley, Sreenivasan & Berk, (2017) in their international journal of social psychiatry investigated the prevalence of self-harm and its relationship to family economic status, family functionality and social relationships. Their findings had that the risk factors of self-harm and suicidal attempts such as depression were higher in families of low economic status and in families where there were distances in social relationships. Divorce cases and family abuse also were prevalent in patients who had attempted self-harm and suicide.

Exposure to and searching for information about suicide and self-harm on the internet: in their journal of affective disorders, Mars et al. (2015) investigated the potential impact of the internet on self-harm and suicidal behavior in young people. They established that the internet had been used by young people to search for information about suicide as well as in discussing self-harming and suicidal feelings. They also determined that a significant proportion of the sample accessed the sites offering help, support and advice as compared to the websites providing information on self-harm and suicidal attempts. The ideas of Castellví et al. (2017) also supported these findings in their journal of affective disorders.

Suicide risk in Tran’s population

Integration of Safety Program to Suicide attempts: Asarnow, Berk, Hughes & Anderson, (2015) in their journal of clinical child and adolescent psychology investigated the impact of integrating a safety program to reduce suicidal effort amongst the young people. Their findings had that, developing a help and safety program had a significant improvement on measures of suicidal behavior, hopelessness, youth and parent depression as well as on social adjustments.

Non-suicidal self-injury in an adolescent population in Singapore: in their journal of clinical child psychology and psychiatry, Tan, Rehfue, Suarez & Parks, (2014) evaluated the correlation between parental invalidation and depression leading to self-harm for Singaporean adolescent groups. In their findings, they established that there was a moderate but positive correlation between the level of parental invalidation and self-harm, as well as on the academic performance of their children and hence increased suicidal and self-harm attempts (Cha et al. 2018, p. 14).  

The function of non-suicidal self-injury in Singapore adolescents: Ong, Tan & Liang, (2017) in their journal of psychiatry investigated the roles of self-harm and implications for possible interventions. Their findings had that the most commonly endorsed function of self-harm in the individual functional assessment was automatic negative reinforcement in the society as well as negative social reinforcement where depression was identified as a significant disorder. They argued that there is a need for psychological interventions in an attempt to improve the prevention measures for self-harm and suicidal attempts.

Associations between self-harm and first onset suicidal thoughts and behavior: in their journal of affective disorder, Kiekens et al. (2018) investigated the relationship between the onset of suicidal thoughts or self-harm behavior and suicidal attempts. Their findings had that, the first onset of suicidal or self-harm thoughts or what they referred to as suicidal ideation had a significant correlation with attempted suicide and that such ideas acted as the most significant risks for those with deadly intent.

A personal reflection on the literature review and applicability in social work on suicide cases in Singapore

The literature review has provided various insights into the prevalence of suicidal and self-harm risk factors amongst the adolescent population. It has also pointed out the causes of suicide are complex and multi-faceted. Despite the efforts made to understand the various risk factors and their relationship to suicidal attempts and self-harm, most of the authors have emphasized on the importance of social intervention in the fight and prevention of suicidal attempts. Among the sources of help where those affected have sourced help include family members and peer groups without the involvement of social work professionals who play a significant role in their engagement with patients of attempted suicide and various youth groups. They have therefore emphasized the importance of social work in understanding, evaluation and prevention of social issues concerning self-harm and suicidal attempts in Singapore.

Non-suicidal self-injury and suicidal thoughts and behaviors

For instance, in the United States, social workers are the largest occupational group of mental health professionals indicating their relevance and contribution in helping the youth overcome suicidal and self-harm attempts. Most social workers or professionals work with health care professionals and therefore engage more with the young people experiencing mental disorders, depression, family dysfunctions or facing rejection in their peer groups in society. The Samaritans group in Singapore, for instance, has helped in engaging youths through social media and collecting reports on self-harm and suicidal attempts and therefore providing an opportunity to the government as well as the family and society to develop inclusive social programs that will help in understanding the issues faced by young people and those with suicidal intents.

Conclusion

Despite the increasing concerns of adolescent self-harm and suicidal attempts in Singapore, the ministry of social and family development is keen on partnering with various stakeholders in fighting this issues that have become a critical health concern. Despite the knowledge of the essential factors for suicidal behavior in youth which has increased in the recent past, this study has shown the increasing need for integration of social work strategies and efforts through social work professionals in helping the society to educate the youths on dangers of self-harm and above all understanding the risk factors influencing their suicidal attempts in order to help them overcome them. These will, therefore, call on the efforts of the parents, the youths, a single entity cannot solve the government and the society at large as the problem.

References

Aggarwal, S., Patton, G., Reavley, N., Sreenivasan, S. A., & Berk, M. (2017). Youth self-harm in low-and middle-income countries: systematic review of the risk and protective factors. International journal of social psychiatry, 63(4), 359-375.

Asarnow, J. R., Berk, M., Hughes, J. L., & Anderson, N. L. (2015). The SAFETY Program: a treatment-development trial of a cognitive-behavioral family treatment for adolescent suicide attempters. Journal of Clinical Child & Adolescent Psychology, 44(1), 194-203.

Bouman, W. P., Claes, L., Brewin, N., Crawford, J. R., Millet, N., Fernandez-Aranda, F., & Arcelus, J. (2017). Transgender and anxiety: A comparative study between transgender people and the general population. International Journal of Transgenderism, 18(1), 16-26.

Castellví, P., Lucas-Romero, E., Miranda-Mendizábal, A., Parés-Badell, O., Almenara, J., Alonso, I., … & Lagares, C. (2017). Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: a systematic review with meta-analysis. Journal of affective disorders, 215, 37-48.

Suicidal ideation in Transgender people

Cha, C. B., Franz, P. J., M. Guzmán, E., Glenn, C. R., Kleiman, E. M., & Nock, M. K. (2018). Annual Research Review: Suicide among youth–epidemiology, (potential) etiology, and treatment. Journal of child psychology and psychiatry, 59(4), 460-482.pp. 6-18.

Chu, C., Hom, M. A., Stanley, I. H., Gai, A. R., Nock, M. K., Gutierrez, P. M., & Joiner, T. E. (2018). Non-suicidal self-injury and suicidal thoughts and behaviors: A study of the explanatory roles of the interpersonal theory variables among military service members and veterans. Journal of consulting and clinical psychology, 86(1), 56.

Claes, L., Bouman, W. P., Witcomb, G., Thurston, M., Fernandez?Aranda, F., & Arcelus, J. (2015). Non?Suicidal Self?Injury in trans people: Associations with psychological symptoms, victimization, interpersonal functioning, and perceived social support. The journal of sexual medicine, 12(1), 168-179.

Connolly, M. D., Zervos, M. J., Barone II, C. J., Johnson, C. C., & Joseph, C. L. (2016). The mental health of transgender youth: advances in understanding. Journal of Adolescent Health, 59(5), 489-495.

Davis, L. T., Weiss, N. H., Tull, M. T., & Gratz, K. L. (2017). The relation of protective factors to deliberate self-harm among African-American adults: moderating roles of gender and sexual orientation identity. Journal of Mental Health, 26(4), 351-358.pp. 46. 

Houben, M., Claes, L., Vansteelandt, K., Berens, A., Sleuwaegen, E., & Kuppens, P. (2017). The emotion regulation function of nonsuicidal self-injury: A momentary assessment study in inpatients with borderline personality disorder features. Journal of abnormal psychology, 126(1). 26.

Kiekens, G., Hasking, P., Boyes, M., Claes, L., Mortier, P., Auerbach, R. P., … & Myin-Germeys, I. (2018). The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors. Journal of affective disorders, 239, 171-179.

Lachal J, Orri M, Sibeoni J, Moro MR, Revah-Levy A. Metasynthesis of youth suicidal behaviours: perspectives of youth, parents, and health care professionals. PloS One. 2015;10(5):e0127359. pmid:26001066

Mars, B., Heron, J., Biddle, L., Donovan, J. L., Holley, R., Piper, M., … & Gunnell, D. (2015). Exposure to, and searching for, information about suicide and self-harm on the Internet: Prevalence and predictors in a population based cohort of young adults. Journal of affective disorders, 185, 239-245.

Ong, S. H., Tan, A. C. Y., & Liang, W. Z. (2017). Functions of nonsuicidal self-injury in Singapore adolescents: Implications for intervention. Asian journal of psychiatry, 28, 47-50.

Ougrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015). Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 54(2), 97-107.

Rowe, S. L., French, R. S., Henderson, C., Ougrin, D., Slade, M., & Moran, P. (2014). Help-seeking behaviour and adolescent self-harm: a systematic review. Australian & New Zealand Journal of Psychiatry, 48(12), 1083-1095.

Salome G, K. L., Hirsch, J. K., Chang, E. C., & Jeglic, E. L. (2017). Non-Suicidal Self-Injury and Suicidal Behavior in a Diverse Sample: The Moderating Role of Social Problem-Solving Ability. International Journal of Mental Health and Addiction, 15(3), 471-484.

Tan, A. C., Rehfuss, M. C., Suarez, E. C., & Parks-Savage, A. (2014). Nonsuicidal self-injury in an adolescent population in Singapore. Journal of Clinical child psychology and psychiatry, 19(1), 58-76.

Tebbe, E. A., & Moradi, B. (2016). Suicide risk in trans populations: An application of minority stress theory. Journal of Counseling Psychology, 63(5), 520.

Testa, R. J., Michaels, M. S., Bliss, W., Rogers, M. L., Balsam, K. F., & Joiner, T. (2017). Suicidal ideation in transgender people: Gender minority stress and interpersonal theory factors. Journal of abnormal psychology, 126(1), 125.