Deliberate Self-harm in UK Dance Students: Prevalence, Predictors, and Prevention

自我伤害被定义为故意对自己造成伤害或痛苦的行为，是一个令人担忧的公共卫生问题。人口研究表明，在2000年至2014年期间，其患病率有所增加，16-24岁之间的女性中有五分之一报告她们有自残行为（Mcmanus et al.，2019年）。在临床样本中，自我伤害通常与心理健康状况共病，如焦虑症，包括创伤后应激障碍，物质使用障碍，饮食障碍和边缘型人格障碍（Cipriano，切拉，& Cotrufo，2017）。然而，尽管自残的流行率增加，但随后寻求帮助的行为并没有增加，其形式是自残者获得专业服务（Mcmanus等人，2019年）。因此，由于很大一部分自残的人没有在精神卫生服务中出现，因此使用非临床样本检查自残的患病率和预测因素至关重要。尽管研究强调相关精神健康问题的患病率增加，如饮食失调（Arcelus，Witcomb，& Mitchell，2013）和PTSD（Thomson & Jaque，S. 2015年）在舞者中，没有研究调查过这一人群的自我伤害。因此，该项目将是第一个调查英国舞者自我伤害的患病率和预测因素的项目。本项目将招募13-18岁的舞者，他们参加各种类型的职业或私人舞蹈培训。这一点尤其重要，因为青少年是自我伤害发生率最高的年龄组（Cipriano等人，2017），但不经常联系相关的医疗服务（Radez等人，2020年）。通过了解儿童和青少年心理健康服务之外的青少年人群中的自我伤害，有可能帮助制定以证据为基础的指导方针，以帮助更广泛地保护年轻人。在第一项研究中，自我报告问卷将用于调查英国青少年舞者自我伤害的患病率，人口统计学，保护和风险因素。此外，该研究还将研究舞者自我伤害与饮食或身体问题之间的关系。本研究亦将以量化的方法探讨舞者自我伤害的功能及自我伤害的方式;第二次研究则以质化的方法深入了解舞者自我伤害的原因及是否使用舞蹈特有的方式。通过使用访谈或焦点小组与舞蹈学生的风险和自我伤害的保护因素将获得更详细的了解。最后，对舞蹈教师的采访和焦点小组将探讨他们对自残的认识、经历和看法，并确定他们在支持自残学生方面可能存在的任何教育或培训需求。这个项目的一个重要方面是共同制作的元素。该项目的第三项研究将侧重于与舞蹈家、舞蹈教师和专家合作，创造传播这项研究的有意义的方式。知识到行动的框架（Field，Booth，Ilott，& Gerrish，2014）将用于指导这一阶段的知识转化过程。这项博士研究的首要目标是帮助为年轻舞者的心理健康制定保护指南，特别是与自我伤害有关的指南。所有研究结果将通过在相关科学期刊上发表的文章和会议报告进行正式交流。最后，通过与英国舞蹈协会直接合作，遵循知识到行动框架，任何结果都可以随时用于为舞蹈教师的实践和培训提供信息，并丰富健康舞者计划和国家舞蹈医学和科学研究所提供的指导。

Self-harm, defined as an act of deliberately inflicting harm or pain upon oneself, is an alarming public health concern. Population studies have demonstrated an increase in its prevalence between the years 2000 and 2014, with 1 in 5 females between the ages of 16-24 reporting that they have self-harmed (Mcmanus et al., 2019). In clinical samples, self-harm is often comorbid with mental health conditions such as, anxiety disorders, including PTSD, substance use disorders, eating disorders and borderline personality disorder (Cipriano, Cella, & Cotrufo, 2017). Nonetheless, despite the increase in the prevalence of self-harm, there has been no subsequent increase in help-seeking behaviours, in the form of accessing professional, services by those who self-harm (Mcmanus et al., 2019). Thereby, since a significant proportion of people who self-harm do not present in mental health services, it is vital to examine the prevalence and predictors of self-harm using non-clinical samples.Despite research highlighting the increased prevalence of related mental health problems such as eating disorders (Arcelus, Witcomb, & Mitchell, 2013) and PTSD (Thomson & Jaque, S. 2015) in dancers, no studies have investigated self-harm in this population. Thereby, this project will be the first to investigate the prevalence as well as predictors of self-harm in UK dancers. The present project will recruit 13-18-year old dancers who participate in vocational or private dance training across a variety of genres. This is particularly important as adolescents are the age group with the highest prevalence of self-harm (Cipriano et al., 2017) but do not often contact relevant healthcare services (Radez et al., 2020). By understanding self-harm in an adolescent population outside of Child and Adolescent Mental Health Services, it may be possible to help create evidence-based guidelines to aid in safeguarding young individuals more widely.The project will employ a mixed methods design. During the first study, self-report questionnaires will be used to investigate the prevalence, demographic, protective and risk factors for self-harm in adolescent UK dancers. Furthermore, the study will examine the relationship between self-harm and eating or body concerns in dancers. The function that self-harm serves for this group and the methods used to self-harm will also be explored using quantitative methods.During the second study, qualitative methods will be employed to gain a deeper understanding of the reasons why dancers self-harm and whether they use any dance-specific methods to do so. By using interviews or focus groups with dance students a more detailed understanding of risk and protective factors for self-harm will be obtained. Lastly, interviews and focus groups with dance teachers will explore their awareness, experiences and perceptions of self-harm as well as identify any educational or training needs they may have in supporting students who self-harm. An important aspect of this project is the element of co-production. The third study of this project will focus on collaboratively working with dancers, dance teachers and experts on creating meaningful ways of disseminating this research. The Knowledge to Action framework (Field, Booth, Ilott, & Gerrish, 2014) will be used to guide the knowledge translation process during this stage.An overarching aim of this PhD research will be to aid in creating safeguarding guidelines for young dancers' mental health, particularly in relation to self-harm. All findings will be formally communicated through publications in relevant scientific journals and conference presentations. Lastly, by directly collaborating with One Dance UK, following the Knowledge to Action framework, any results can be readily used to inform practice and training of dance teachers as well as enrich the Healthier Dancer Programme and the guidance offered by the National Institute of Dance Medicine and Science.