Impact of Child/Adolescent Depression and Self Harm on Family Functioning Kathleen Ruiz University of Massachusetts Lowell Abstract This paper will examine several studies related to the impact of family functioning in adolescence who suffer from depression and as a result has engaged in self harm

Impact of Child/Adolescent Depression and Self Harm on Family Functioning
Kathleen Ruiz
University of Massachusetts Lowell

Abstract
This paper will examine several studies related to the impact of family functioning in adolescence who suffer from depression and as a result has engaged in self harm. Each study looks at the parent’s perspective on self harm after the fact. The results vary but it is evident that self harm can have extensive impacts on families and plays a major role in the reoccurrence of the behavior.

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Impact of Child/Adolescent Depression and Self Harm on Family Functioning
Are there significant impacts on the family system following a child’s self harm due to depression? Is there enough help out there to help parents support the child? Unless anyone has gone through it, I do not know if anyone realizes the impact a child’s self harm has on a family, especially the parents. According to the journal article, Self-Injury and Postvention: Responding to the Family in Crisis,”very little is known about the reactions of family regarding children who self-injure. The majority of the research that has been conducted on families of adolescents who self-injure has examined the family systemically but has not focused on the reactions of and impact on family members themselves.” (Trepal, Wester, ; Macdonald) Self harm is not the same as suicide. Parents react to their child’s self harm differently. Some may experience fear, some anger, and others downplay it all together. Either way, I do not think any of the “experiences” should be taken lightly. Three studies looked closely at the impacts.
Ferrey, et al. (2016) interviewed 37 parents of 35 young people who had self harmed. These parents explained their experiences with their child’s self harm. When choosing parents they sought a maximum variation in order to capture a wide range of experiences. The variations included gender, ethnicity, and geographical location. Through video or audio recordings the interviews were an average of 84 minutes beginning with an open ended section which the participant explained their experiences of caring for a young person who self harmed. They were then asked follow up questions to get more information about the participant’s story. Although the parents discovered their child’s self harm in different ways, through the interviews it was disclosed that many parents characterized their initial reaction as “shock and horror”. They describe considerable stress and anxiety caused by their child’s behavior. Many of them reported feeling shame, guilt, or embarrassment. It seems depression was common among the parents, which some was directly related to their child’s self harm. The study of Ferry, et al. (2016) also showed the negative impacts that it had on the relationships between family members, the impact on siblings, as well as on work and finances. The parents expressed that their emotional states and mental health were affected by the difficulty of making sense of the self harm. They worried about actions that may cause another episode of self harm. A common worry was that the self harm was a result of something they did or did not do as a parent and that they would be judged by others.
Oldershaw, et al. (2008) conducted a similar study where 12 parents were interviewed. The parents are main carers living with an adolescent between the ages of 13-18 years old who had been referred to a community child and adolescent mental health service (CAMHS). The semi structured interviews lasted about an hour. The topics were divided into four sections: history of self harm; personal experience; making sense of self harm and self help; and improvements and hopes for the future. The questions presented were broad and open ended. Interviews were conducted face to face at the CAMHS by a researcher who had no previous relationship with the participants. Once transcribed, individual summaries were sent to the participants to allow them to reflect on key points, give feedback, or expand. It was discovered that in the months leading up to the disclosure of self harm, parents had suspicion of the behavior by often noticing injuries. However, when confronted, the children denied harming themselves and made excuses about what happened. At that point, many parents admitted to trying to “wait and see” and “brushing it under the carpet”. They hoped the situation would resolve itself and they did not consider seeking professional help for their child. When asked about their personal opinions on the cause, they all responded by identifying problems they thought their child currently faced. The parents felt that the self harm served a purpose in their child’s life. Upon knowing about their child’s behavior, the parenting styles were changed. They described the feeling of “walking on eggshells” fearing that they may trigger an episode of self harm. Many found themselves constantly checking what their children were doing and increasing attention. They described the feeling of having to deny their own needs and the need of other children in the home. From the comments, the offer of continuous support is valued; not only for their child but for themselves as well.

The study conducted by Byrne, et al. (2008) were of parents and/or carers of young people what had engaged in deliberate self harm or had expressed suicidal ideation. The parents/carers were invited to a meeting which discussed setting up a support group which would be specific to their needs. Fifteen parents and ten caregivers attended the focus meeting. Through the analysis of the behavior the following themes emerged: support; emotions; parenting; family; psycho-education; managing self-harm; and other such as beliefs, school, and internet. The first concern of the participants was the need for support. They feel that with the support they will be able to cope with the impact the self harm had on their lives. As with the other studies, following their child’s self harm, the participants described feelings of guilt, isolation, fear, frustration, and a lack of confidence. Participants also described feeling of frustration and anger directed at their child’s behavior for disrupting the whole family. The other children in the house experienced feelings of abandonment. In looking at their parenting skills, the parents recognized that open communication was important to their child’s wellbeing. The study conducted by Byrne, et al. (2008) showed that the behavior did impact the whole family, disrupting family dynamics and family functioning. Deliberate self harm was clearly a deeply distressing experience for parents and/ or carers. The study found that open communication and family engagement protect against self harm.
When reviewing the three studies, in relation to the parent’s feelings of guilt there was an overall theme of an intense sense of isolation, anger, and embarrassment. All three also showed that there were many parents that had the desire to keep the child’s problems a secret. However, the thoughts of the future were hopeful. The common theme was “taking life one day at a time”. The parents described a sense of hope combined with an understanding that their child might be vulnerable to life’s difficulties. They understand that education on the behavior and support may contribute to the progress and well being of the child. Although the surveys were based on parents who came forward about their experiences, strong evidence of parental distress and family dysfunction show that there is limited published research pertaining to working with the parents and carers of young people who self-harm.

References

Byrne, S., Morgan, S., Fitzpatrick, C., Boylan, C., Crowley, S., Gahan, H., … Guerin, S.
(2008). Deliberate self-harm in children and adolescents: A qualitative study exploring the needs of parents and carers. Clinical Child Psychology and Psychiatry, 13(4), 493–504.

Ferrey, A. E., Hughes, N. D., Simkin, S., Locock, L., Stewart, A., Kapur, N., . . . Hawton,
K. (2016). Changes in parenting strategies after a young person’s self-harm: A qualitative study. Child and Adolescent Psychiatry and Mental Health, 10(1).

Oldershaw, A., Richards, C., Simic, M., & Schmidt, U. (2008). Parents’ perspectives on
adolescent self-harm: Qualitative study. British Journal of Psychiatry, 193(2), 140-144.

Trepal, H. C., Wester, K. L., ; Macdonald, C. A. (2006). Self-Injury and
Postvention: Responding to the Family in Crisis. The Family Journal,14(4)

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