Friendships and self-harm in young people: an exploration of lived experience and social mechanisms

Bilello, Delfina ORCID: 0000-0003-0475-7492 (2024). Friendships and self-harm in young people: an exploration of lived experience and social mechanisms. University of Birmingham. Ph.D.

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Abstract

Self-harm, or intentional self-injury and self-poisoning regardless of intent, is a key health concern among young people (NICE, 2023). Self-harm is intrinsically tied to its social context, of which friendships are an important aspect. Our understanding of social and friendship aspects of self-harm in young people is fragmented. Historically, the role, influence and impact of friends has been explored either as a source of risk for self-harm or protective factor, while the experiences of friends have rarely been considered. Friendships are reciprocal and mutual relationships in which friends influence one another, and should be studied accordingly. The present thesis considers the perspectives of young people who self-harm and friends of young people who self-harm, thereby extending our understanding of friendships in the context of self-harm from multiple perspectives.

Four studies were conducted for the present thesis using a sequential mixed-methods multi-informant approach. Chapter 3 presents a novel overview of existing knowledge around the relationship between friendships and self-harm in young people (11-25 years old) through a systematic review and narrative synthesis of the literature on a) young people who self-harm and b) friends of young people who self-harm. Chapter 4 presents a qualitative study of the experiences of young people who self-harmed in adolescence, with a particular emphasis on the importance, role and influence of friendships in their experiences of self-harm. Qualitative Chapter 5 focuses on the experiences of friends of young people who self-harmed during adolescence, highlighting their processes of sense-making, the importance and consequences of their supportive role for themselves, their friend and the friendship. Chapter 6 is a quantitative social network study which gathered longitudinal, temporally high-resolution data from a social network of adolescents to investigate causal relationships between supportive peer interactions and daily mood.

Overall, findings in this thesis enhance our understanding of the interrelated and complex nature of friendship and self-harm experiences, and their contribution to distinct outcomes among young people who self-harm and friends of young people who self-harm. Evidence suggests that young people who self-harm may be exposed to friends’ negative influence, yet they may also rely on friends for support. Friends hold a unique position and role as supporters, yet this may come at a personal cost. Self-harm represents a unique experience impacting friendships, whereby these acquire distinct meanings, characteristics and dynamics. Finally, the complex nature of peer social support is a key finding from the present thesis, emerging as a conduit for both protective and risk effects occurring at the individual, friend and friendship level. The evidence generated in this thesis proposes the careful integration of adolescent friends and friendships in self-harm research and intervention development. The developmental and potential clinical relevance of adolescent peer support in self-harm calls for expanding research in this direction.

Type of Work:	Thesis (Doctorates > Ph.D.)
Award Type:	Doctorates > Ph.D.
Supervisor(s):	Supervisor(s) Email ORCID Burnett Heyes, Stephanie UNSPECIFIED orcid.org/0000-0002-9049-9559 Townsend, Ellen UNSPECIFIED orcid.org/0000-0002-4677-5958 Broome, Matthew UNSPECIFIED orcid.org/0000-0002-6963-8884
Licence:	All rights reserved
College/Faculty:	Colleges > College of Life & Environmental Sciences
School or Department:	School of Psychology
Funders:	Economic and Social Research Council
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
URI:	http://etheses.bham.ac.uk/id/eprint/15078

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