A cross-cultural study of self-harm comparing the UK and Thailand

Anupansupsai, Rungarun (2019) A cross-cultural study of self-harm comparing the UK and Thailand. PhD thesis, University of Nottingham.

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Self-harm is a serious public health concern with a large academic literature. Though different cultures have reported different self-harm prevalence, there is limited literature focusing on cultural influences on self-harm. To broaden our understanding, this thesis investigated the differences in self-harm comparing the United Kingdom and Thailand. Thailand is a growing economy, in which self-harm is increasing, but has a culture of mindfulness which has been found to manage mental health problems in other societies.

This thesis compromises three studies (Chapters Three, Four, and Five): the first examined the differences in the characteristics of self-harm in the UK and Thailand, the second examined the differences between various subgroups of self-harm, and the third develops and assesses a guideline for self-harm early intervention for Thai clinicians. The first two studies were conducted quantitatively using the same online survey. The third followed the Delphi method, and included a feasibility study to validate the acceptability of the guideline.

Chapter Three revealed that the prevalence, methods, frequency, number of methods, and motives of self-harm were significantly different between the UK and Thailand. In both cultures, the most common motive was the “cry of pain” (to get relief from a terrible state of mind), the age of onset was in adolescence, and not seeking help was reported at similar rates in both cultures. The lifetime self-harm prevalence was lower in Thailand than in the UK (16.8% vs. 36.7%). Culture affected the methods of self-harm; cutting was the most common method in the UK, whereas punching was the most common in Thailand. Skin injury and drug consumption were not as common in Thailand as in the UK. British people reported a higher frequency of self-harm and higher number of self-harm methods than Thai people, and “cry for help” motives were more common in Thailand than in the UK.

Despite cultural differences, interactions of culture and self-harm on risk factors were not significant, and risk factors for self-harm were similar across both societies. Being British, female gender, non-heterosexuality, unemployment, chronic physical illness, psychiatric service history, drug consumption, and exposure to the self-harm of others were all associated with self-harm. Emotionality, Negative Urgency, Difficulties in Emotion Regulation, Rumination, Depression, and Anxiety showed positive associations with self-harm, whereas Extraversion and all scales of Mindfulness (except Observing) showed negative associations. However, only female gender, non-heterosexuality, chronic physical illness, psychiatric service history, drug consumption, Non-reactivity Mindfulness, and Depression were associated with self-harm in a multivariate logistic regression.

Chapter Four examined the differences between subgroups of self-harm (recency, frequency, and motivation), comparing the UK and Thailand. No interactions between culture and subgroups on psychosocial factors and psychological characteristics were significant. The findings also revealed that almost all psychosocial factors were comparable between subgroups; only culture distinguished repetitive from occasional self-harm, and only having psychiatric service history distinguished recent from past self-harm. However, several psychological characteristics distinguished between all subgroups. The recent self-harm group reported higher scores on Goal DER (Difficulties in Emotion Regulation), Strategies DER, Negative Urgency, and Depression, and lower scores on Awareness Mindfulness, Non-reactivity Mindfulness, and Extraversion. The repetitive self-harm group reported lower scores on Agreeableness and Extraversion, and higher scores on Goal DER, Strategies DER, Depression, and Anxiety. The Motivation to die group reported higher scores for Depression, Brooding Rumination, Negative Urgency, Goal DER, Strategies DER, and Impulsive DER, and lower scores for Awareness Mindfulness, and Extraversion. In addition, more severe subgroups indicated more adverse psychological problems in their histories than less severe subgroups.

Chapter Five revealed that the guideline for self-harm early intervention developed from these results for Thai clinicians was feasible when implemented in a healthcare service. The guideline was of good quality (clear, concise, and comprehensive, with an attractive design) and Thai clinicians who worked in hospitals reported that the guideline was acceptable, practical, effective, and user-friendly. However, the guideline may require adaption to be more suitable for healthcare settings lacking emergency units or inpatient wards.

The findings of this research suggest that clinicians should consider the influence of cultural differences and self-harm characteristics of subgroups when providing appropriate treatment for patients who self-harm. This research recommends implementing the guideline for self-harm early intervention to improve clinical services for these patients in Thailand.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Egan, Vincent
Schroder, Thomas
Keywords: Cross-cultural study, Self-harm, Personality, Impulsivity, Emotion regulation, Mindfulness, Rumination, Guideline, Early Intervention
Subjects: W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 59160
Depositing User: Anupansupsai, Rungarun
Date Deposited: 16 Jun 2021 08:31
Last Modified: 16 Jun 2021 13:36
URI: https://eprints.nottingham.ac.uk/id/eprint/59160

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