More than just enduring − Mental health and well-being among Swedish young adults who ceased self-injuring since adolescence

Abstract: Non-suicidal self-injury (NSSI) is an umbrella term for non-lethal behaviours that are unlikely to be intended as suicidal, such as cutting, hitting, or burning oneself. The aims of this dissertation were to investigate i) the mental health and well-being of Swedish young adults who have ceased engaging in NSSI since adolescence, and ii) the psychosocial conditions that facilitate NSSI cessation and psychological growth during this period. This thesis utilizes data from a longitudinal Swedish project called Självkänsla Och Livssituation. The project encompassed all grade 7 and grade 8 regular school students in a Swedish municipality. Participants answered questionnaires in 2007 (T1: N = 992, mean age = 13.73) and 2008 (T2: N = 987, mean age = 14.78) and were asked to do so again 10 years later, in 2017 (T3: N = 557, mean age = 25.33). Eleven participants who reported to have ceased self-injuring since adolescence were also interviewed in 2018 about their experiences using a semi-structured protocol. In relation to the first aim, Paper I indicated that reporting to have engaged in NSSI at T1 or T2 was associated with mental health problems (i.e., depression, anxiety, and stress) and difficulties regulating emotion at T3. This relationship was especially prominent if repetitive NSSI (≥5 instances) was reported at both T1 and T2. Paper II showed that more young adults reported ceasing repetitive NSSI rather than continuing it; however, no significant differences in reported mental health problems, well-being (i.e., life satisfaction and flourishing), resilience, or emotion regulation were found between participants who ceased (defined as ≥5 instances at T1 and T2, but not at T3) and those who continued to self-injure repetitively (defined as ≥5 instances at T1, T2, and T3). However, Paper IV and some extended analyses that utilized an alternative definition of these engagement patterns indicated that young adults who had fully ceased NSSI since adolescence (i.e., ≥5 instances at T1 or T2, 0 at T3) reported higher resilience and flourishing than did those who continued to injure repetitively (i.e., ≥5 instances at T1 or T2 and T3). In relation to the second aim, in neither Paper II nor the Extended analyses could the continuation or cessation of repetitive NSSI be reliably predicted from adolescent psychosocial functioning. The interviews analysed narratively for Paper III suggested that most young adults described that their lives had improved since adolescence. This positive change was initiated at a pivotal event that enabled the participants to sense agency in their lives. Sensing agency made it easier to cope with adversity by means other than NSSI, and subsequent positive life changes expanded this sense of agency and facilitated and sustained a sense of growth. Paper IV found that reporting repetitive NSSI at T1/T2 was associated with retrospective recall of more negative life events during both adolescence and later in life. However, positive life events and especially having reached an important life goal 1 to In conclusion, distress related to past and recent mental health problems and experiences of adversity can persist among young adults who have ceased NSSI since adolescence. At the same time, their resilience and well-being improved relative to those who continued NSSI, a change that could be enabled through sensing agency and experiencing positive life events. For young adults with lived experience of NSSI, such experiences may help them see life as more than just something that needs to be endured.