Family Responses to Youth Who Have Engaged in Deliberate Self-Harm: A Qualitative Constructive Grounded Theory Study in Sri Lanka

Main Article Content

Susantha Rasnayake
Pavel Navrátil
Praveeni Senanayake

Abstract

Like in the global context, suicide and deliberate self-harm (DSH) among youth are critical public health concerns in Sri Lanka. However, studies have mainly focused on the risk factors of suicide and deliberate self-harm with limited attention to examining the family responses to youth who have engaged in deliberate self-harm, which is vital in developing aftercare plans for prevention. This study, derived from the constructive grounded theory methodology and thematic analysis, aimed to explore how the immediate family responds to youth who engage in deliberate self-harm. A total of 40 qualitative interviews, 20 with affected youth and 20 with their family members, were analyzed. This qualitative analysis derived four themes: (1) the family’s aftercare role, (2) family accusation and reduced conversation, (3) recalling of unpleasant memories on occasions, and (4) withdrawal of family support. Findings revealed that though family plays a vital caregiver role, negative responses of the family would buffer the psychosocial well-being of the affected youth in the post-discharged period, informing us of the importance of the family’s role in helping the affected young people following deliberate self-harm. Thus, health professionals, social workers, and social service providers can contribute to minimizing the family’s negative responses through enhancing family relationships and psychoeducation.

Article Details

How to Cite
Rasnayake, S., Navrátil, P. ., & Senanayake, P. . (2025). Family Responses to Youth Who Have Engaged in Deliberate Self-Harm: A Qualitative Constructive Grounded Theory Study in Sri Lanka. Journal of Population and Social Studies [JPSS], 33(.), 784–802. Retrieved from https://so03.tci-thaijo.org/index.php/jpss/article/view/275526
Section
Research Articles
Author Biography

Susantha Rasnayake, Department of Sociology, University of Peradeniya, Sri Lanka

Corresponding author

References

• Abeyasekera, A. L. (2019). Embodied shame and gendered demeanours in young women in Sri Lanka. Feminism & Psychology, 29(2), 157–176. https://doi.org/10.1177/0959353518803976

• Andriessen, K., Draper, B., Dudley, M., & Mitchell, P. B. (2015). Bereavement after suicide: Disentangling clues to better help bereaved adolescents [Editorial]. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 36(5), 299–303. https://doi.org/10.1027/0227-5910/a000339

• Beautrais, A. L., Wells, J. E., McGee, M. A., & Oakley Browne, M. A. (2006). Suicidal behaviour in Te Rau Hinengaro: The New Zealand Mental Health Survey. Australian & New Zealand Journal of Psychiatry, 40(10), 896–904. https://doi.org/10.1080/j.1440-1614.2006.01909.x

• Brent, D. A., McMakin, D. L., Kennard, B. D., Goldstein, T. R., Mayes, T. L., & Douaihy, A. B. (2013). Protecting adolescents from self-harm: A critical review of intervention studies. Journal of the American Academy of Child and Adolescent Psychiatry, 52(12), 1260-1271. https://doi.org/10.1016/j.jaac.2013.09.009

• Buckmaster, R., Guerin, S., O’Leary, T., & McNulty, M. (2021). Exploration of family dynamics in adults who self-harm: A multi-perspective approach. Journal of Family Therapy, 43(4), 665-686. https://doi.org/10.1111/1467-6427.12314

• Byrne, S., Morgan, S., Fitzpatrick, C., Boylan, C., Crowley, S., Gahan, H., Howley, J., Staunton, D., & 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, 493–504. https://doi.org/10.1177/1359104508096

• Carmichael, T., & Cunningham, N. (2017). Theoretical data collection and data analysis with gerunds in a constructivist grounded theory study. Electronic Journal of Business Research Methods, 15(2), 59–73. https://academic-publishing.org/index.php/ejbrm/article/view/1357

• Charmaz, K. (2008). Constructionism and grounded theory. In J. A. Holstein & J. F. Gubrium (Eds.), Handbook of Constructionist Research (pp. 397–412). The Guilford Press.

• Charmaz, K. (2014). Constructing grounded theory. In R. Barbour (Ed.), Introducing qualitative methods (2nd ed.). SAGE Publications Inc.

• De Leo, D., Burgis, S., Bertolote, J. M., Kerkhof, A. J. F. M., & Bille-Brahe, U. (2006). Definitions of suicidal behavior: Lessons learned from the WHO/EURO Multicentre Study. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 27(1), 4–15. https://doi.org/10.1027/0227-5910.27.1.4

• De Silva, V. A., Senanayake, S. M., Dias, P., & Hanwella, R. (2012). From pesticides to medicinal drugs: Time series analyses of methods of self-harm in Sri Lanka. Bulletin of the World Health Organization, 90(1), 40–46. https://www.scielosp.org/pdf/bwho/2012.v90n1/40-46/en

• Ferrey, A. E., Hughes, N. D., Simkin, S., Locock, L., Stewart, A., Kapur, N., Gunnell, D., & Hawton, K. (2016a). Changes in parenting strategies after a young person’s self-harm: A qualitative study. Child and Adolescent Psychiatry and Mental Health, 10, Article 20. https://doi.org/10.1186/s13034-016-0110-y

• Ferrey, A. E., Hughes, N. D., Simkin, S., Locock, L., Stewart, A., Kapur, N., Gunnell, D., & Hawton, K. (2016b). The impact of self-harm by young people on parents and families: A qualitative study. BMJ Open, 6, Article e009631. https://doi.org/10.1136/bmjopen-2015-009631

• Gould, M., Shaffer, D., & Greenberg, T. (2003). The epidemiology of youth suicide. In R. King & A. Apter (Eds.), Suicide in Children and Adolescents (Cambridge Child and Adolescent Psychiatry, pp. 1–40). Cambridge University Press.

• Gouveia-Pereira, M., Abreu, S., & Martins, S. (2014). How do families of adolescents with suicidal ideation behave? Developmental Psychology, 27(1), 171–178. https://doi.org/10.1590/S0102-79722014000100019

• Hewamanne, S. (2010). Suicide narratives and in-between identities among Sri Lanka’s factory workers. Ethnology, 49(1), 1–22. https://ethnology.pitt.edu/ojs/Ethnology/article/view/6075

• King, C. A., & Merchant, C. R. (2012). Social and interpersonal factors relating to adolescent suicidality: A review of the literature. Archives of Suicide Research, 12(2), 181–196. https://doi.org/10.1080/13811110802101203

• Knipe, D. W., Bandara, P., Senarathna, L., Kidger, J., López-López, J., & Rajapakse, T. (2019). Childhood adversity and deliberate self-poisoning in Sri Lanka: A protocol for a hospital-based case-control study. BMJ Open, 9(8), Article e027766. https://doi.org/10.1136/bmjopen-2018-027766

• Knipe, D. W., Gunnell, D., Pearson, M., Jayamanne, S., Pieris, R., Priyadarshana, C., Weerasinghe, M., Hawton, K., Konradsen, F., Eddleston, M., & Metcalfe, C. (2018). Attempted suicide in Sri Lanka: An epidemiological study of household and community factors. Journal of Affective Disorders, 232, 177–184. https://doi.org/10.1016/j.jad.2018.01.028

• Krug, E. G., Mercy, J. A., Dahlberg, L. L., & Zwi, A. B. (2002). The world report on violence and health. Lancet, 360(9339), 1083–1088. https://doi.org/10.1016/S0140-6736(02)11133-0

• Lindgren, B.-M., Åström, S., & Graneheim, U. H. (2010). Held to ransom: Parents of self-harming adults describe their lived experience of professional care and caregivers. International Journal of Qualitative Studies on Health and Well-Being, 5(3), Article 5482. https://doi.org/10.3402/qhw.v5i3.5482

• Logan, E. L., Thornton, J. A., & Breen, L. J. (2018). What determines supportive behaviors following bereavement? A systematic review and call to action. Death Studies, 42(2), 104–114. https://doi.org/10.1080/07481187.2017.1329760

• Marecek, J., & Senadheera, C. (2012). ‘I drank it to put an end to me’: Narrating girls’ suicide and self-harm in Sri Lanka. Contributions to Indian Sociology, 46(1–2), 53–82. https://doi.org/10.1177/006996671104600204

• Marecek, J., & Senadheera, C. (2023). Gendered antecedents and consequences of young women’s suicidal acts in Sri Lanka. International Journal of Environmental Research and Public Health, 20(4), Article 2885. https://doi.org/10.3390/ijerph20042885

• McKinnon, B., Gariépy, G., Sentenac, M., & Elgar, F. J. (2016). Adolescent suicidal behaviours in 32 low- and middle-income countries. Bulletin of the World Health Organization, 94(5), 340–350. https://doi.org/10.2471/BLT.15.163295

• Michelson, D., & Bhugra, D. (2012). Family environment, expressed emotion, and adolescent self-harm: A review of conceptual, empirical, cross-cultural, and clinical perspectives. International Review of Psychiatry, 24(2), 106–114. https://doi.org/10.3109/09540261.2012.657613

• Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent nonsuicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6(10), Article 10. https://doi.org/10.1186/1753-2000-6-10

• Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiological Review, 30, 133–154. https://doi.org/10.1093/epirev/mxn002

• Obeyesekere, G. (1984). The cult of the goddess Pattini. The University of Chicago Press.

• Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia–Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168, 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704

• Pushpakumara, P. H. G. J., Thennakoon, S. U. B., Rajapakse, T. N., Abeysinghe, R., & Dawson, A. H. (2018). A prospective study of repetition of self-harm following deliberate self-poisoning in rural Sri Lanka. PLOS ONE, 12, Article e0199486. https://doi.org/10.1371/journal.pone.0199486

• Rajapakse, T., Griffiths, K. M., Christensen, H., & Cotton, S. A. (2014). Comparison of non-fatal self-poisoning among males and females in Sri Lanka. BMC Psychiatry, 14, Article 221. https://doi.org/10.1186/s12888-014-0221-z

• Rajapakse, T. N., & Tennakoon, S. U. B. (2016). Gender differences in suicide in Sri Lanka – What does it tell us? Ceylon Medical Journal, 61, 139–141. https://doi.org/10.4038/cmj.v61i4.8377

• Sørensen, J. B., Agampodi, T., Sørensen, B. R., Siribaddana, S., Konradsen, F., & Rheinländer, T. (2017). ‘We lost because of his drunkenness’: The social processes linking alcohol use to self-harm in the context of daily life stress in marriages and intimate relationships in rural Sri Lanka. BMJ Global Health, 2(4), Article e000462. https://doi.org/10.1136/bmjgh-2017-000462

• Sørensen, J. B., Pearson, M., Andersen, M. W., Weerasinghe, M., Rathnaweera, M., Rathnapala, D. G. C., Eddleston, M., & Konradsen, F. (2019). Self-harm and suicide coverage in Sri Lankan newspapers: An analysis of the compliance with recommended guidelines. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 40(1), 54–61. https://doi.org/10.1027/0227-5910/a000534

• Sri Lanka Medical Association (SLMA). (2019, December). Suicide prevention in Sri Lanka: Recommendations for action. https://slma.lk/wp-content/uploads/2020/10/Suicide-Prevention-in-Sri-Lanka-Recommendations-for-Action-final.pdf

• Standley, J. C. (2020). Expanding our paradigms: Intersectional and socioecological approaches to suicide prevention. Death Studies, 46(1), 224–232. https://doi.org/10.1080/07481187.2020.1725934

• Sweeney, M. M. (2007). Stepfather families and the emotional well-being of adolescents. Journal of Health and Social Behavior, 48(1), 33–49. https://doi.org/10.1177/002214650704800103

• Wagner, B. M. (2009). Suicidal behavior in children and adolescents. Yale University Press.

• Wagner, B. M., Aiken, C., Mullaley, P. M., & Tobin, J. J. (2000). Parents’ reactions to adolescents’ suicide attempts. Journal of the American Academy of Child and Adolescent Psychiatry, 39(4), 429–436. https://doi.org/10.1097/00004583-200004000-00011

• Whittall, J., Sumner, A., Ravindran, A. V., Rodrigo, A., & Walker, Z. J. (2018). Evaluating sociodemographic and psychiatric contributors to suicide in Sri Lanka: An ecological survey. International Journal of Noncommunicable Diseases, 3(2), 49–55. https://www.ijncd.org/text.asp?2018/3/2/49/235212

• Widger, T. (2014, May 28). Suicide in Sri Lanka: Understanding the crisis. Forum for Suicide and Culture Research. https://suicideandculture.wordpress.com/2014/05/28/suicide-in-sri-lanka-understanding-the-crisis/

• Widger, T. (2015). Suicide in Sri Lanka: The anthropology of an epidemic. Routledge.

• World Health Organization. (2014). Preventing suicide: A global imperative. https://iris.who.int/handle/10665/131056

• World Health Organization. (2019). Suicide in the world: The global health estimates. https://apps.who.int/iris/bitstream/handle/10665/326948/WHO-MSD-MER-19.3-eng.pdf

• World Health Organization. (2021, July 16). Suicide rate estimates, crude, 15–19 years: Estimates by country [Data set]. https://apps.who.int/gho/data/node.main.MHSUICIDE1519?lang=en

• Xing, X.-Y., Tao, F.-B., Wan, Y.-H., Xing, C., Qi, X.-Y., Hao, J.-H., Su, P.-Y., Pan, H.-F., & Huang, L. (2010). Family factors associated with suicide attempts among Chinese adolescent students: A national cross-sectional survey. Journal of Adolescent Health, 46(6), 592–599. https://doi.org/10.1016/j.jadohealth.2009.12.006

• Zaborskis, A., Sirvyte, D., & Zemaitiene, N. (2016). Prevalence and familial predictors of suicidal behaviour among adolescents in Lithuania: A cross-sectional survey 2014. BMC Public Health, 16(554), Article 554. https://doi.org/10.1186/s12889-016-3211-x