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Fong ZH, Loh WNC, Fong YJ, Neo HLM, Chee TT. Parenting behaviors, parenting styles, and non-suicidal self-injury in young people: a systematic review. Clin Child Psychol Psychiatry 2022; 27:61-81. [PMID: 34866412 DOI: 10.1177/13591045211055071] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
UNLABELLED Non-suicidal self-injury (NSSI) is a worrying phenomenon that is prevalent among young people. Prior theorizing and empirical evidence suggest that parenting may play a role in the etiology of NSSI. Thus, we conducted a systematic review to examine the association between parenting behaviors and parenting styles with NSSI in young people. METHODS The following databases were searched for relevant articles in July 2020: PubMed, EMBASE, CINAHL Plus, and PsycINFO. Studies were included if they sampled young persons aged 10-25 years old with a history of NSSI, assessed parenting behavior or style, and tested associations between parenting and NSSI outcomes. RESULTS A total of 26 studies were included in this review. Among parenting behaviors, low parental support, high psychological control, and high reactive control were more consistently associated with NSSI. Conversely, the evidence for behavioral control is equivocal. There is some evidence that invalidating parenting is also associated with NSSI. CONCLUSION Consistent with the wider adolescent psychopathology literature, parenting that is perceived to be supportive, less psychologically controlling and reactive/punitive were less likely to be associated with NSSI. However, these results were largely based on child reports of parenting. Limitations and directions for future research are discussed.
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Affiliation(s)
- Zhi Hui Fong
- Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore
| | - Wan Ning Charisse Loh
- Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore
| | - Ying Jie Fong
- Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore
| | - Hui Ling Michelle Neo
- Department of Psychological Medicine, 59053National University Hospital, Singapore, Singapore
| | - Tji Tjian Chee
- Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, 59053National University Hospital, Singapore, Singapore
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Kruzan KP, Meyerhoff J, Biernesser C, Goldstein T, Reddy M, Mohr DC. Centering Lived Experience in Developing Digital Interventions for Suicide and Self-injurious Behaviors: User-Centered Design Approach. JMIR Ment Health 2021; 8:e31367. [PMID: 34951602 PMCID: PMC8742214 DOI: 10.2196/31367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/13/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of self-injurious thoughts and behaviors (SITB) signals a growing public health crisis. Despite a recognized need for improved and scalable interventions, the field of SITB intervention faces several challenges: existing interventions are often time and resource intensive, most individuals with SITB do not seek formal mental health care, and efficacious treatments are characterized by small effects. Combined, these challenges indicate a need for improved SITB interventions for individuals in formal treatment and those who are not treatment engaged but are at high risk of worsening mental health and future suicide attempts. OBJECTIVE We present a methodological approach and set of techniques that may address these challenges by centering the lived experience of individuals with SITB in the process of developing needed services: user-centered design (UCD). METHODS We highlight the value of UCD in the context of digital interventions for SITB by describing the UCD approach and explicating how it can be leveraged to include lived experience throughout the development and evaluation process. We provide a detailed case example highlighting 3 phases of the early development process that can be used to design an intervention that is engaging and meets end-user needs. In addition, we point to novel applications of UCD to complement new directions in SITB research. RESULTS In this paper, we offer a 2-pronged approach to meet these challenges. First, in terms of addressing access to effective interventions, digital interventions hold promise to extend the reach of evidence-based treatments outside of brick-and-mortar health care settings. Second, to address challenges related to treatment targets and engagement, we propose involving individuals with lived experience in the design and research process. CONCLUSIONS UCD offers a well-developed and systematic process to center the unique needs, preferences, and perceived barriers of individuals with lived SITB experience in the development and evaluation of digital interventions.
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Affiliation(s)
- Kaylee Payne Kruzan
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jonah Meyerhoff
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Candice Biernesser
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Tina Goldstein
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Madhu Reddy
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, CA, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Depresión, desregulación emocional y estrategias de afrontamiento en adolescentes con conductas de autolesión. ACTA COLOMBIANA DE PSICOLOGIA 2021. [DOI: 10.14718/acp.2022.25.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
En México, el estudio de la autolesión cuenta con pocas investigaciones, y menos si se trata de estudios que conformen posibles modelos explicativos. Teniendo esto en cuenta, en el presente trabajo se planteó como objetivo conocer la relación de la autolesión con la depresión, la desregulación emocional y los estilos de afrontamiento, con el fin de generar un modelo explicativo de la problemática. El estudio se realizó a partir de un diseño cuantitativo, transversal y con alcance explicativo, y se contó con una muestra de 5835 adolescentes (Medad = 11-15 años) inscritos en 62 secundarias públicas del estado de Sonora. Se realizaron regresiones logísticas para el análisis de los datos, y como resultado se encontró que, para los estudiantes con autolesión severa (3.54 %), el modelo explica el 61 % de la varianza en los datos (R2 de Nagelkerke = .61) y clasifica correctamente al 84.1 % de los participantes; mientras que, en la autolesión leve (5.29 %), el modelo explica el 72 % de la varianza en los datos (R2 de Nagelkerke = .72) y clasifica correctamente al 88.2 % de los estudiantes. Asimismo, las dimensiones de depresión mostraron el mayor nivel explicativo (cognitiva-afectiva, somática) y correlaciones positivas con la desregulación emocional y el estilo de afrontamiento de evitación, así como correlaciones negativas con el estilo de afrontamiento de aproximación. Al final se discute respecto a la importancia de las variables independientes para futuras investigaciones, y sobre los resultados anómalos y otros datos de interés.
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54
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Simone AC, Hamza CA. A longitudinal examination of predictors of nonsuicidal self-injury disclosures among university students. J Clin Psychol 2021; 77:2860-2877. [PMID: 34773410 DOI: 10.1002/jclp.23277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/08/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There is a paucity of longitudinal research on predictors of disclosures of nonsuicidal self-injury (NSSI) among emerging adults. However, understanding the factors that facilitate disclosure is critical, as disclosure may serve as a first step in accessing care. To address this gap, the present study examined predictors of prospective NSSI disclosures in a postsecondary student sample. METHODS A total of 475 university students with a history of NSSI (Mage = 17.96; 74.9% women) reported on several potential predictors of NSSI disclosure, and their disclosure history at baseline and 4- and 8-month follow-ups. RESULTS It was found that 22% of students reported disclosing NSSI during the first year of university; students who had previously disclosed, and who reported greater NSSI severity, were more likely to disclose over time. CONCLUSION Results of the present study suggest that disclosures often occur in the postsecondary context, and students who disclose NSSI may engage in more severe NSSI behaviours.
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Affiliation(s)
- Ariana C Simone
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Chloe A Hamza
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
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55
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Kaess M, Hooley JM, Klimes-Dougan B, Koenig J, Plener PL, Reichl C, Robinson K, Schmahl C, Sicorello M, Westlund Schreiner M, Cullen KR. Advancing a temporal framework for understanding the biology of nonsuicidal self- injury: An expert review. Neurosci Biobehav Rev 2021; 130:228-239. [PMID: 34450182 PMCID: PMC8783544 DOI: 10.1016/j.neubiorev.2021.08.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/17/2021] [Accepted: 08/21/2021] [Indexed: 11/04/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a serious clinical problem, particularly for adolescents and young adults. NSSI is a complex behavior that emerges through the intersecting effects of social, psychological, and biological mechanisms. Although the social and psychological contributions to risk for developing NSSI are relatively well understood and have guided the development of effective psychosocial treatments for self-injury, the biological mechanisms underlying NSSI have just begun to come to light. To evaluate and categorize the biological research conducted on the topic of NSSI, we propose a model that distinguishes between trait and state markers. According to this model, risk factors and mechanisms involved in NSSI can be distinguished into both trait and state factors. We review the existing evidence on distal biological traits (predictors) of NSSI, proximal biological traits (correlates) of NSSI, and biological states directly preceding or following NSSI. We conclude by providing recommendations for future research on the neurobiology of NSSI.
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Affiliation(s)
- Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Bonnie Klimes-Dougan
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kealagh Robinson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Maurizio Sicorello
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
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Mancinelli E, Sharka O, Lai T, Sgaravatti E, Salcuni S. Self-injury and Smartphone Addiction: Age and gender differences in a community sample of adolescents presenting self-injurious behavior. Health Psychol Open 2021; 8:20551029211038811. [PMID: 34659789 PMCID: PMC8512283 DOI: 10.1177/20551029211038811] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to identify the variables (i.e., internalizing, and externalizing problems, self-control, emotion dysregulation, and alexithymia) relevant for Smartphone Addiction and non-suicidal self-injury (NSSI), conceptualized as emotion-regulation strategies, also assessing age and gender differences. Based on power analysis, N = 78 Italian adolescents (11-19 years; Mage = 14.24; SD = 1.56; 73.1% females) were considered. Step-wise multivariate linear regressions evidence a mutual association between NSSI and Smartphone Addiction, particularly relevant in pre-adolescence. Low self-control is significantly associated with the Smartphone Addiction, while emotion dysregulation and alexithymia with NSSI. This study supports NSSI and Smartphone Addiction conceptualization as emotion-regulation strategies and the importance of prevention interventions.
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Affiliation(s)
- Elisa Mancinelli
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Ona Sharka
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | | | - Eleonora Sgaravatti
- The Net-ONLUS, Padua, Italy.,Complex Psychology Unit - Infancy, Adolescence and Family, USSL3, Via Piazzetta Unità d'Italia, Padua, Italy
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
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A Threshold Task to Determine Help-Seeking for Deliberate Self-Injury: a Proof of Concept Study. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09911-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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58
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He N, Xiang Y. How child maltreatment impacts internalized/externalized aggression among Chinese adolescents from perspectives of social comparison and the general aggression model. CHILD ABUSE & NEGLECT 2021; 117:105024. [PMID: 33905994 DOI: 10.1016/j.chiabu.2021.105024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Child maltreatment is believed to have a tight correlation with adolescent problem behaviors, and one of them is aggression. According to different attack targets, aggression can be divided into internalized aggression (attack oneself) and externalized aggression (attack others), both of which are negatively influenced by child maltreatment. However, little is known about the potential mechanisms of the effect from child maltreatment to internalized/externalized aggression. OBJECTIVE Based on the perspectives of social comparison and the general aggression model, the present study examined the mediating effects of benign envy, malicious envy and self-control between child maltreatment and internalized/externalized aggression. PARTICIPANTS AND SETTING 1951 adolescents (49 % girls, Mage = 12.93 years, SD = 2.54) from mainland China were recruited. METHODS Based on the retrospective self-reporting of five questionnaires, structural equation modeling and bootstrap estimation procedure were adopted to identify the mediating effects of benign envy, malicious envy and self-control. RESULTS The structural model fitted well [χ2 (178, 1951) = 1601.176, p < .001; RMSEA = 0.064; SRMR = 0.076; CFI = 0.913]. Benign envy (95 % CI [0.013, 0.002], [-0.040, -0.079]), malicious envy (95 % CI [0.044, 0.024], [0.363, 0.241]) and self-control (95 % CI [0.025, 0.005], [0.264, 0.166]) played a significant mediating role between child maltreatment and internalized/externalized aggression. CONCLUSION Benign envy, malicious envy and self-control played an important mediating role between child maltreatment and internalized/externalized aggression, which may provide a theoretical basis for future interventions to reduce adolescent problem behaviors, paying more attention to the improvement of emotion regulation and self-control.
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Affiliation(s)
- Nina He
- Department of Psychology, Hunan Normal University, Changsha, China; Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China
| | - Yanhui Xiang
- Department of Psychology, Hunan Normal University, Changsha, China; Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China.
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Sorgi KM, Ammerman BA, Cheung JC, Fahlgren MK, Puhalla AA, McCloskey MS. Relationships between Non-Suicidal Self-Injury and Other Maladaptive Behaviors: Beyond Difficulties in Emotion Regulation. Arch Suicide Res 2021; 25:530-551. [PMID: 31994980 DOI: 10.1080/13811118.2020.1715906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Non-suicidal self-injury (NSSI) co-occurs with both other maladaptive behaviors (e.g., aggression) and emotion dysregulation. However, the extent to which these maladaptive behaviors are linked to NSSI independent of emotion dysregulation is unclear. The present study examined relationships between NSSI and six other maladaptive behaviors among university undergraduates. When controlling for demographic variables, emotion dysregulation, and other maladaptive behaviors, binge eating, purging, illicit drug use, and physical aggression were each related to lifetime NSSI history and/or severity. No maladaptive behaviors were significantly related to the presence of current diagnostic-level NSSI in these multivariate analyses. Results suggest that some maladaptive behaviors may relate uniquely to NSSI risk independent of emotion dysregulation, highlighting the importance of considering such behaviors in self-injury assessment and treatment.
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Character configuration, major depressive episodes, and suicide-related ideation among Japanese undergraduates. PLoS One 2021; 16:e0251503. [PMID: 33979406 PMCID: PMC8115841 DOI: 10.1371/journal.pone.0251503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022] Open
Abstract
Aim To enable early identification of university students at high risk for suicide, we examined personality as a predictive factor for major depressive episodes and suicide-related ideation. Methods From 2011 to 2013, we administered the Patient Health Questionnaire-9 (PHQ-9) and the Temperament and Character Inventory (TCI) to 1,997 university students at enrollment (T1). We previously conducted a study using the same data set; this is a re-analysis of the dataset. To prevent contamination of data, participants diagnosed with a depressive episode were excluded at T1. Three years after enrollment (T2), we re-administered the PHQ-9 to the same students. We statistically compared TCI scores at T1 among depressive episode groups and suicide-related ideation groups. Two-way ANOVA and Cochran-Armitage trend tests were used to analyze the relationships between personality traits, depressive episodes, and suicide-related ideation. Results The PHQ-9 summary scores at baseline (T1) were 3.0 (±2.7), with female students scoring 4.6 (±2.9) and male students 2.9 (±2.6, p = 0.025). The major depressive episode group at T2 had lower self-directedness (SD) scores at T1 than the non-depressive episode control group. The suicide-related ideation (SI) group at T2 also had higher harm avoidance (HA), lower SD, and lower cooperativeness (C) scores than the non-SI group at T1. The Cochran-Armitage trend tests revealed significant associations between character configurations composed of SD and C, and both depressive episodes at T2 and SI at T2. Conclusion The temperament feature of high HA at baseline and character configurations of low SD and low C at baseline are the most contributory predictors for the novel development of depressive episodes and SI among Japanese university students.
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Gandhi A, Luyckx K, Adhikari A, Parmar D, De Sousa A, Shah N, Maitra S, Claes L. Nonsuicidal self-injury and identity formation in Indian clinical and nonclinical samples: A comparative study. Int J Soc Psychiatry 2021; 67:219-226. [PMID: 32686554 DOI: 10.1177/0020764020943618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is being increasingly identified as an important emerging mental health issue in the West. Yet, NSSI has not been adequately studied in clinical and nonclinical contexts in countries like India. AIM The aim of this study was to compare different features of NSSI between clinical and nonclinical samples in India. We also explored if the strength of the association between NSSI and disturbances in identity formation - a risk factor that can increase vulnerability to NSSI - was similar in the two samples mentioned above. METHOD For the clinical sample, data regarding NSSI and identity formation were collected from 100 psychiatric patients (47.0% females, mean age = 34.76 years, SD = 12.76, 17-70 years) from an outpatient/inpatient psychiatric department of a large tertiary hospital in Mumbai, India. Nonclinical data were collected from 120 young adults studying in a medical college in Mumbai, India (51.7% females, mean age = 19.7 years, SD = 2.16, 17-28 years). Information regarding NSSI and identity were collected using self-report questionnaires. RESULTS Lifetime prevalence of NSSI in the clinical and nonclinical samples was found to be around 17% and 21%, respectively. Although the prevalence of NSSI did not significantly differ between the two samples, some features of NSSI did differ between the two groups. Finally, multigroup Bayesian structural equation modeling indicated that irrespective of the type of the sample (i.e. clinical or nonclinical), consolidated and disturbed identity significantly (negative and positive, respectively) predicted lifetime NSSI. Additionally, the association between the aforementioned identity variables and NSSI did not significantly differ between the two samples. CONCLUSION The findings of these studies highlight the need for exploring issues related to identity formation in individuals who engage in NSSI irrespective of whether they suffer from a psychiatric disorder or not.
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Affiliation(s)
- Amarendra Gandhi
- Leuven Biostatistics and Statistical Bioinformatics Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Alka Adhikari
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Dhruv Parmar
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Nilesh Shah
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Shubhada Maitra
- Centre for Health and Mental Health, Tata Institute of Social Sciences, Mumbai, India
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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Talmon A, Ginzburg K. The Differential Role of Narcissism in the Relations Between Childhood Sexual Abuse, Dissociation, and Self-Harm. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP5320-NP5339. [PMID: 30226088 DOI: 10.1177/0886260518799450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Childhood sexual abuse (CSA) is considered a risk factor for self-harm behaviors. According to the anti-dissociation model of self-harm, the relation between CSA and self-harm is mediated by dissociation. However, inconclusive evidence supporting this model suggests that this association may be moderated by vulnerability factors. Grandiose and vulnerable narcissism represent distinct patterns of behaviors intended to deal with unmet needs of recognition. The aim of the study was to examine a model in which the relation between CSA and self-harm is mediated by dissociation, and the relation between dissociation and self-harm is moderated by grandiose narcissism and vulnerable narcissism. A battery of self-reported questionnaires including the Childhood Trauma Questionnaire, Dissociative Experiences Scale, Deliberate Self-Harm Inventory, and Brief-Pathological Narcissism Inventory were filled out by 766 college/university students. Results indicated that self-harm was related to CSA through the mediation of dissociation. Moreover, the analyses yielded significant interactions of both vulnerable and grandiose narcissism with dissociation in predicting self-harm; the relation between dissociation and self-harm was significant among individuals with high levels of vulnerable narcissism, as well as among individuals with low levels of grandiose narcissism. These findings support the anti-dissociation model of self-harm. The findings also highlight the complex and ambiguous role of narcissism in the long-term adjustment of CSA survivors.
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Cliffe B, Tingley J, Greenhalgh I, Stallard P. mHealth Interventions for Self-Harm: Scoping Review. J Med Internet Res 2021; 23:e25140. [PMID: 33929329 PMCID: PMC8122298 DOI: 10.2196/25140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/19/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Background Self-harm is a growing issue with increasing prevalence rates; however, individuals who self-harm do not often receive treatment. Mobile health (mHealth) interventions are a possible solution to some of the barriers that individuals face when seeking support, and they have also been found to be effective in improving mental health. Thus far, reviews of mHealth interventions for self-harm have been limited by study type. Therefore, we determined that a broader scoping review will provide a more exhaustive understanding of mHealth interventions for self-harm. Objective This scoping review aims to identify mHealth interventions for self-harm within the literature, understand the types and features of interventions that have been developed and evaluated, highlight research findings around mHealth interventions for self-harm, and determine what outcomes are typically used to assess the efficacy of interventions. Methods A search was conducted using Embase, PubMed, PsycINFO, PsycEXTRA, Web of Science, and the Cochrane Library. Studies were included if they described an mHealth intervention designed to have a direct (ie, if the intervention was designed for self-harm or for people who self-harm) or indirect (ie, if self-harm was measured as an outcome) treatment effect and if the paper was available in English. There were no exclusion criteria based on the study design. Results A total of 36 papers were included in the review, and most of them were randomized controlled trials published within the last 4 years. The interventions were mostly smartphone apps and calling or texting services, with 62% (21/34) having underlying therapeutic models to inform the intervention content. They were generally shown to be promising and appealing, but only 5 were widely available for use. Outcomes focused on a reduction of self-harm and suicidality, mood, and the users’ experiences of the intervention. Samples were typically nondiverse, and there was limited variety in the study designs and in the measurements of self-harm recovery. Conclusions Promising and appealing mHealth interventions have been developed but are not widely available. Research could benefit from greater diversity as well as a broader and more nuanced understanding of recovery from self-harm.
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Affiliation(s)
- Bethany Cliffe
- Department for Health, University of Bath, Bath, United Kingdom
| | - Jessica Tingley
- Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Bristol, United Kingdom
| | - Isobel Greenhalgh
- Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Bristol, United Kingdom
| | - Paul Stallard
- Department for Health, University of Bath, Bath, United Kingdom.,Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Bristol, United Kingdom
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Nagy LM, Shanahan ML, Baer RA. An experimental investigation of the effects of self-criticism and self-compassion on implicit associations with non-suicidal self-injury. Behav Res Ther 2021; 139:103819. [PMID: 33640591 DOI: 10.1016/j.brat.2021.103819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is the intentional destruction of bodily tissue in the absence of suicidal motives. Individuals who self-injure often report doing so in order to punish the self or express self-hatred. Self-criticism, or thoughts marked by shame, self-consciousness, and inferiority, is associated with higher rates of NSSI while self-compassion, or the tendency to be sympathetic and caring with oneself, is negatively associated with NSSI. The aim of the present study was to determine whether experimentally-induced self-criticism would increase and self-compassion would decrease implicit identification with NSSI. Participants were randomly assigned to either a self-criticism induction, a self-compassion induction, or a neutral, control condition and completed a measure of strength of the automatic associations that a person holds between themselves and self-harming behaviors before and after the experimental induction. Study hypotheses were partially supported. Results showed that participants in the self-criticism induction experienced an increase in their implicit associations with NSSI while implicit associations in the self-compassion condition did not significantly change. These results highlight the importance of self-criticism in NSSI. Future research should examine increases in self-criticism as a potential precursor of NSSI in longitudinal samples.
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Affiliation(s)
- Laura M Nagy
- Department of Psychology, University of Kentucky, United States.
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University, Purdue University Indianapolis, United States
| | - Ruth A Baer
- Department of Psychology, University of Kentucky, United States
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Wang Y, Lai J, Hu C, Meng H, Lyu D, Hu S. Non-suicidal self-harm is linked to suicidal thoughts in Chinese adolescents with mood disorders: a cross-sectional report. J Zhejiang Univ Sci B 2021; 22:233-240. [PMID: 33719228 DOI: 10.1631/jzus.b2000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yixin Wang
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Shanghai Pinghe Bilingual School, Shanghai 201206, China
| | - Jianbo Lai
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China.,Brain Research Institute of Zhejiang University, Hangzhou 310003, China.,Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China
| | - Chanchan Hu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China.,Brain Research Institute of Zhejiang University, Hangzhou 310003, China.,Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China
| | - Hongbo Meng
- Department of Rehabilitation, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Duo Lyu
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shaohua Hu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. .,The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China. .,Brain Research Institute of Zhejiang University, Hangzhou 310003, China. .,Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China.
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Warne N, Heron J, Mars B, Moran P, Stewart A, Munafò M, Biddle L, Skinner A, Gunnell D, Bould H. Comorbidity of self-harm and disordered eating in young people: Evidence from a UK population-based cohort. J Affect Disord 2021; 282:386-390. [PMID: 33421867 PMCID: PMC8150329 DOI: 10.1016/j.jad.2020.12.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Self-harm and eating disorders are often comorbid in clinical samples but their co-occurrence in the general population is unclear. Given that only a small proportion of individuals who self-harm or have disordered eating present to clinical services, and that both self-harm and eating disorders are associated with substantial morbidity and mortality, it is important to study these behaviours at a population level. METHODS We assessed the co-occurrence of self-harm and disordered eating behaviours in 3384 females and 2326 males from a UK population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants reported on their self-harm and disordered eating behaviours (fasting, purging, binge-eating and excessive exercise) in the last year via questionnaire at 16 and 24 years. At each age we assessed how many individuals who self-harm also reported disordered eating, and how many individuals with disordered eating also reported self-harm. RESULTS We found high comorbidity of self-harm and disordered eating. Almost two-thirds of 16-year-old females, and two-in-five 24-year old males who self-harmed also reported some form of disordered eating. Young people with disordered eating reported higher levels of self-harm at both ages compared to those without disordered eating. LIMITATIONS We were not able to measure whether participants identified their disordered eating as a method of self-harm. CONCLUSIONS Self-harm and disordered eating commonly co-occur in young people in the general population. It is important to screen for both sets of difficulties to provide appropriate treatment.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,Centre for Public Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK,NIHR Applied Research Collaboration (ARC) West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Anne Stewart
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Oxford UK
| | - Marcus Munafò
- NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK,School of Psychological Science, University of Bristol, Bristol, UK,MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK
| | - Lucy Biddle
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Applied Research Collaboration (ARC) West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andy Skinner
- School of Psychological Science, University of Bristol, Bristol, UK,MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK.
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Gandhi A, Luyckx K, Adhikari A, Parmar D, Desousa A, Shah N, Maitra S, Claes L. Non-suicidal self-injury and its association with identity formation in India and Belgium: A cross-cultural case-control study. Transcult Psychiatry 2021; 58:52-62. [PMID: 32873190 DOI: 10.1177/1363461520933759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to compare different features of Non-Suicidal Self-Injury (NSSI) in India and Belgium. We also explored whether the strength of the association between NSSI and disturbances in identity formation-a risk factor that can increase vulnerability to NSSI-was similar in young adults from India and Belgium. Data regarding NSSI and identity formation were collected from 182 young adults in India (56% females, mean age = 21.5 years, SD = 3.70, range = 17-38 years). The Belgian data used for matching were derived from four existing datasets. Of the 182 Indian cases, 138 cases could be matched with the Belgian sample on age, gender, and lifetime prevalence of NSSI. Lifetime prevalence of NSSI in the Indian sample was found to be around 21.4%, with higher prevalence in females than in males. Comparison of features of NSSI in India and Belgium indicated that the age of onset of NSSI was higher in the Indian sample (around 17 years) than the Belgian sample (around 15 years). Additionally, self-bruising behavior was more commonly reported in India and scratching/cutting was more often reported in Belgium. Finally, the Belgian sample reported intra-personal functions of NSSI more often than the Indian sample. Moderation analysis indicated that the associations between NSSI and identity confusion/integration were stronger in the Belgian sample compared to the Indian sample. Higher self-knowledge was protective against NSSI in both the Indian and the Belgian sample.
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Affiliation(s)
- Amarendra Gandhi
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Koen Luyckx
- Research Unit for School Psychology and Development in Context, KU Leuven, Leuven, Belgium UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Alka Adhikari
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Dhruv Parmar
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Avinash Desousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Nilesh Shah
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Shubhada Maitra
- School of Social Work, Tata Institute of Social Sciences, Mumbai, India
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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69
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Pfeifer JH, Allen NB. Puberty Initiates Cascading Relationships Between Neurodevelopmental, Social, and Internalizing Processes Across Adolescence. Biol Psychiatry 2021; 89:99-108. [PMID: 33334434 PMCID: PMC8494463 DOI: 10.1016/j.biopsych.2020.09.002] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022]
Abstract
Adolescence is a period of dramatic developmental transitions-from puberty-related changes in hormones, bodies, and brains to an increasingly complex social world. The concurrent increase in the onset of many mental disorders has prompted the search for key developmental processes that drive changes in risk for psychopathology during this period of life. Hormonal surges and consequent physical maturation linked to pubertal development in adolescence are thought to affect multiple aspects of brain development, social cognition, and peer relations, each of which have also demonstrated associations with risk for mood and anxiety disorders. These puberty-related effects may combine with other nonpubertal influences on brain maturation to transform adolescents' social perception and experiences, which in turn continue to shape both mental health and brain development through transactional processes. In this review, we focus on pubertal, neural, and social changes across the duration of adolescence that are known or thought to be related to adolescent-emergent disorders, specifically depression, anxiety, and deliberate self-harm (nonsuicidal self-injury). We propose a theoretical model in which social processes (both social cognition and peer relations) are critical to understanding the way in which pubertal development drives neural and psychological changes that produce potential mental health vulnerabilities, particularly (but not exclusively) in adolescent girls.
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Chen X, Zhou Y, Li L, Hou Y, Liu D, Yang X, Zhang X. Influential Factors of Non-suicidal Self-Injury in an Eastern Cultural Context: A Qualitative Study From the Perspective of School Mental Health Professionals. Front Psychiatry 2021; 12:681985. [PMID: 34650451 PMCID: PMC8505804 DOI: 10.3389/fpsyt.2021.681985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/31/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Adolescent non-suicidal self-injury (NSSI) is becoming a serious public health concern worldwide. In recent years, there has seen a significant increase in both the growth rate and cases of NSSI in Eastern countries, such as Japan, India, and China. In China, most schools have a mental health office that comprises mental health professionals (MHPs), who are the first to respond to student mental health problems, which include NSSI. MHPs possess comprehensive knowledge as well as unique insight into adolescent NSSI. However, very few studies on NSSI have incorporated their perspectives. In this work, we seek to add novel insight by conducting a study focusing on adolescent NSSI from the perspective of MHPs. Methods: We recruited a total of 24 MHPs from different schools using purposive sampling and conducted a semi-structured interview on NSSI-related issues. Each interview was voice recorded and lasted ~30 min. A thematic analysis was performed for the responses to study the most common and concerning issues underlying NSSI. Results: We extracted three major themes and eight sub-themes from the interview records, which included (1) the impact of Chinese culture on NSSI (sex-bias discrimination, overly high expectations, and inappropriate parenting style); (2) life events in school (internet use, academic pressure, and romantic relationships); and (3) opinions on the status quo of NSSI in China (ignorance and stigma). Conclusion: Results showed that culturally sensitive influential factors, such as sex-bias discrimination, the imposing of unrealistic expectations for personal achievement, and inappropriate parenting style, should be given more attention to prevent, assess, and intervene in NSSI. Emerging factors of modern society and adolescent lifestyles, such as academic pressure, internet use, and romantic relationships, should also be considered for treatments.
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Affiliation(s)
- Xiaoyu Chen
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ying Zhou
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Li Li
- Huangpu School, Shenzhen, China
| | - Yanfei Hou
- Department of Humanities and Mental Nursing, School of Nursing, Southern Medical University, Guangzhou, China
| | - Ding Liu
- College of Psychology, Shenzhen University, Shenzhen, China
| | - Xueling Yang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyuan Zhang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Escelsior A, Belvederi Murri M, Corsini GP, Serafini G, Aguglia A, Zampogna D, Cattedra S, Nebbia J, Trabucco A, Prestia D, Olcese M, Barletta E, Pereira da Silva B, Amore M. Cannabinoid use and self-injurious behaviours: A systematic review and meta-analysis. J Affect Disord 2021; 278:85-98. [PMID: 32956965 DOI: 10.1016/j.jad.2020.09.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increasing availability of high-potency cannabis-derived compounds and the use of synthetic cannabinoids may be responsible for severe side effects like cognitive impairment, psychosis or self-injurious behaviours (SIB). In particular, SIB like non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) raise growing concern as a possible consequence of cannabis use. However, the research to date has not addressed the relationship between cannabinoid use and SIB systematically. METHODS We conducted a systematic review on PubMed up to March 2020, using search terms related to cannabinoids and SIB. RESULTS The search yielded a total of 440 abstracts. Of those, 37 studies published between 1995 and 2020 were eligible for inclusion. Cannabinoid use was significantly associated with SIB at the cross-sectional (OR=1.569, 95%CI [1.167-2.108]) and longitudinal (OR=2.569, 95%CI [2.207-3.256]) level. Chronic use, presence of mental disorders, depressive symptoms, emotional dysregulation and impulsive traits might further increase the likelihood of self-harm in cannabis users. Synthetic cannabinoids may trigger highly destructive SIB mainly through the psychotomimetic properties of these compounds. CONCLUSION Cannabinoid use was associated with an increased prevalence of self-injury and may act as a causative factor with a duration-dependent manner. Emotional regulation and behavioural impulsivity functions might crucially moderate this association. Future studies should further investigate the mechanisms underlying this association, while exploring potential therapeutic applications of substances modulating the endocannabinoid system.
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Affiliation(s)
- Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Pietro Corsini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Domenico Zampogna
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Cattedra
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Jacopo Nebbia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alice Trabucco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Davide Prestia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Olcese
- Department of Educational Science - Psychology Unit, University of Genoa, Genoa, Italy
| | | | - Beatriz Pereira da Silva
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Kumar P, Patel V, Bhatt R, Raja H, Tiwari D, Vasavada D. Suicidal thoughts, suicidal attempts, and nonsuicidal self-injury among undergraduate health professionals. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2021. [DOI: 10.4103/amhs.amhs_321_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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73
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The Correlation between Oral Self-Harm and Ethnicity in Institutionalized Children. CHILDREN-BASEL 2020; 8:children8010002. [PMID: 33374663 PMCID: PMC7822475 DOI: 10.3390/children8010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 12/03/2022]
Abstract
Oral self-harm was described in institutionalized children who share a lack of emotional attention; frequently these children experience feelings such as neglect, loneliness, isolation or lack of connection with the world. The aim of our paper was to conduct a cross-sectional study in order to assess the prevalence of this behavior and its correlation with ethnicity among children from three institutions located in the central part of Romania. We examined 116 children from three ethnic groups, Romanians, Hungarians and local Roma population aged between 10–14 years old. The oral soft tissues were evaluated by one dentist who recorded the lesions of lips, buccal mucosa, commissures and tongue; data were statistically analyzed at a level of significance of p < 0.05. We found oral self-harm lesions in 18.1% participants, with statistically significant higher odds in girls (p = 0.03). The results showed an association between ethnicity and the development of these lesions (Chi-square p = 0.04). The most frequent lesions were located at oral commissures (35.48%), buccal mucosa (29.03%) and upper lip (19.36%). Oral self-harm lesions have a high incidence among institutionalized children in Romania. Identification of these cases in early stages is important, as these conditions are known to be aggravated during adolescence and adulthood.
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74
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Simone AC, Hamza CA. Examining the disclosure of nonsuicidal self-injury to informal and formal sources: A review of the literature. Clin Psychol Rev 2020; 82:101907. [DOI: 10.1016/j.cpr.2020.101907] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 11/27/2022]
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75
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Yang X, Xin M, Liu K, Böke BN. The impact of internet use frequency on non-suicidal self injurious behavior and suicidal ideation among Chinese adolescents: an empirical study based on gender perspective. BMC Public Health 2020; 20:1727. [PMID: 33198703 PMCID: PMC7670714 DOI: 10.1186/s12889-020-09866-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We attempted to find if there were gender differences in Non-suicidal self injurious (NSSI) behaviors and Suicidal ideation among Chinese adolescents, then analyze the impact of Internet use frequency on these variables among adolescents of different genders. METHODS Based on the data from 6 high-schools and 4 universities in 4 cities in China, the gender difference in NSSI behaviors and Suicidal ideation and their related factors were analyzed in the study. RESULTS Gender differences were found during different purposes of Internet use; There was no significant gender difference in NSSI behaviors among Chinese adolescents, yet females reported significantly higher intensity of suicidal ideation compared to males; Internet use frequency could explain the prevalence of NSSI behaviors and Suicidal ideation by gender, to some categories. CONCLUSIONS There were gender differences in Internet use frequency among adolescents; Gender difference of NSSI engagement among Chinese adolescents was not statistically significant; Females had higher suicidal ideation than males; the overuse of social softwares was found to be a risk factor to both NSSI engagements and suicidal ideations for both genders; males would engage less NSSI behaviors when they spent more time on knowledge sharing softwares while might have more suicidal ideation when they spent too much time on gaming.
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Affiliation(s)
- Xueyan Yang
- Institute for Population and Development Studies, Xi'an Jiaotong University, No.28, Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Moye Xin
- Institute for Population and Development Studies, Xi'an Jiaotong University, No.28, Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Kun Liu
- Institute for Population and Development Studies, Xi'an Jiaotong University, No.28, Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Bilun Naz Böke
- Human Development, McGill University, 3700 McTavish Street, Montreal, QC, H3A1Y2, Canada
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76
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Wallace GT, Conner BT, Shillington AM. Classification trees identify shared and distinct correlates of nonsuicidal self-injury and suicidal ideation across gender identities in emerging adults. Clin Psychol Psychother 2020; 28:682-693. [PMID: 33169471 DOI: 10.1002/cpp.2530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022]
Abstract
College students have an elevated risk for self-injurious thoughts and behaviours (SITBs), and there are robust differences in prevalence rates for SITBs across gender identities. Although numerous constructs have been implicated as risk factors, researchers have not significantly improved at predicting SITBs, possibly owing to constraints of confirmatory analyses. Classification trees are exploratory, person-centred analyses that enable joint examination of numerous correlates and their interactions. Thus, classification trees may discern previously unstudied risk factors and identify distinct subpopulations with elevated risk for SITBs. We tested classification trees that evaluated 298 potential correlates of nonsuicidal self-injury and suicidal ideation across self-identified women and men. Data came from 5,131 college students who completed the National College Health Assessment, which assesses a wide range of health-related constructs. Models produced parsimonious decision trees that accounted for a substantial amount of outcome variability (38.3-51.5%). Psychopathology, poorer psychological well-being, and other SITBs emerged as important correlates for all participants. Trauma, disordered eating, and heavy alcohol use were salient among women, whereas alcohol use norms were important correlates among men. Importantly, models identified several constructs that may be amenable to intervention. Results support the use of exploratory analyses to explicate heterogeneity among individuals who engage in SITBs and suggest that gender identity is an important moderator for certain risk factors.
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Affiliation(s)
- Gemma T Wallace
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Bradley T Conner
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Audrey M Shillington
- College of Health and Human Sciences, San José State University, San José, California, 95192, USA
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Gonçalves SF, Machado BC, Martins C, Brandão I, Roma torres A, Machado P. Dysregulated behaviours in bulimia nervosa—A case‐control study. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Carla Martins
- School of Psychology, University of Minho, Braga, Portugal,
| | - Isabel Brandão
- Psychiatry Department, Hospital of S.João, Porto, Portugal,
| | | | - Paulo Machado
- School of Psychology, University of Minho, Braga, Portugal,
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Edinger A, Fischer-Waldschmidt G, Parzer P, Brunner R, Resch F, Kaess M. The Impact of Adverse Childhood Experiences on Therapy Outcome in Adolescents Engaging in Nonsuicidal Self-Injury. Front Psychiatry 2020; 11:505661. [PMID: 33329074 PMCID: PMC7672012 DOI: 10.3389/fpsyt.2020.505661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Nonsuicidal self-injury (NSSI) is a prevalent and clinically significant behavior. There is a substantial association between adverse childhood experiences (ACEs) and NSSI. However, there are no studies investigating the impact of ACEs on NSSI treatment (psychotherapy) outcome. The aim of this secondary analysis of a randomized controlled trial (RCT) on psychotherapy of NSSI was to investigate the relationship between ACEs and treatment outcome in adolescents engaging in NSSI. Method: A sample of 74 adolescent outpatients engaging in repetitive NSSI (incidents on ≥ 5 days within the last 6 months) was recruited for a RCT. ACEs were assessed by the Childhood Experience of Care and Abuse (CECA) interview before treatment onset. Based on the CECA, participants were divided in two groups: with a history of ACEs (n = 30) and without a history of ACEs (n = 44). Frequencies of NSSI, depression, and suicide attempts as well as quality of life were measured at three points in time: before treatment onset (baseline; T0), 4 (T1), and 10 months (T2) after treatment onset. Results: Both participants with and without ACEs were able to reduce the frequency of NSSI significantly [χ2 (1) = 26.72; p < 0.001]. Surprisingly, participants with ACEs reached a significantly greater reduction in NSSI frequency within the past 6 months compared to participants without ACEs [χ2 (1) = 5.08; p = 0.024]. There were also substantial and similar improvements regarding depressive symptoms, suicide attempts and quality of life in both groups. Conclusion: ACEs seem to positively predict treatment response in psychotherapy for adolescent NSSI. This is contrary to prior research suggesting ACE as an unfavorable prognostic factor in the treatment of mental disorders. Clinical Trial Registration: Short term therapy in adolescents with self-destructive and risk-taking behaviors; http://www.drks.de; DRKS00003605.
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Affiliation(s)
- Alexandra Edinger
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gloria Fischer-Waldschmidt
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Clinic and Policlinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg District Hospital, Regensburg, Germany
| | - Franz Resch
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Maphisa JM, Mogotsi OP, Machola OK, Maswabi KM, Motsamai TB, Mosupiemang B. Psychiatric epidemiological survey of university students in Botswana: rationale and methods of the Youth Mental Health Study (YMHS). BMJ Open 2020; 10:e038175. [PMID: 33060084 PMCID: PMC7566732 DOI: 10.1136/bmjopen-2020-038175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND While the burden of disease attributable to mental disorders in low/middle-income countries (LMICs) is lower than high-income countries, there is recognition that the dearth of evidence from the LMICs may underestimate the actual prevalence and burden associated with mental disorders. Such is likely the case for Botswana where there has been no nationally representative data on the prevalence of symptoms of mental disorders or even a subgroup estimation of mental disorders in the country. Thus, the Youth Mental Health Study (YMHS) aims to estimate the prevalence and identify predictors of symptoms of mental disorders among university students in Botswana to add to the evidence and contribute to the country's health service planning. METHODS The YMHS is a cross-sectional study of youth (18-29 years) attending six large universities (accounting for nearly half of the tertiary student population) in Botswana. A stratified sampling procedure with proportionate allocation and selection is used to select a representative sample of 1308 participants. An online survey comprising of a battery of reliable and validated self-report measures of symptoms of mental disorders is used. A developmental psychopathology framework is used in identifying the risk factors of mental disorders. Participant recruitment will span over 4 months beginning in February 2020. ETHICS AND DISSEMINATION The study has received ethics approval from the University of Botswana Institutional Review Board, and the Ministry of Health and Wellness. Participants will be provided with feedback of their own results. Aggregated findings will be disseminated to stakeholders in the tertiary education and health sector in Botswana, and through peer-reviewed journals, conference presentations and the media.
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Affiliation(s)
- J Maphisa Maphisa
- Department of Psychology, University of Botswana, Gaborone, Botswana
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80
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Muller DL, Buser TJ, Farag MS, Buser JK. Experiences of Unintentionally Severe Harm During Nonsuicidal Self‐Injury Among College Students. JOURNAL OF COLLEGE COUNSELING 2020. [DOI: 10.1002/jocc.12168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Daniella L. Muller
- Department of Graduate Education, Leadership, and Counseling Rider University
| | - Trevor J. Buser
- Graduate School of Counseling and Psychology Naropa University
| | - Mena S. Farag
- Department of Graduate Education, Leadership, and Counseling Rider University
| | - Juleen K. Buser
- Department of Graduate Education, Leadership, and Counseling Rider University
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81
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Piccirillo ML, Burke TA, Moore-Berg SL, Alloy LB, Heimberg RG. Self-Stigma Toward Nonsuicidal Self-Injury: An Examination of Implicit and Explicit Attitudes. Suicide Life Threat Behav 2020; 50:1007-1024. [PMID: 32462657 PMCID: PMC11137797 DOI: 10.1111/sltb.12640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evidence suggests that individuals without a history of nonsuicidal self-injury (NSSI) are likely to view NSSI as a stigmatized behavior. However, there is limited evidence evaluating the presence of self-stigma among individuals who have engaged in NSSI. METHODS We recruited a university sample (n = 351) and employed implicit and explicit measures to examine the degree of stigmatization toward those with NSSI scarring, as compared to nonintentional disfigurement (i.e., accidental scarring) and to tattoos (i.e., a culturally sanctioned form of intentional tissue alteration). We examined the extent to which bias is related to indicators of NSSI severity among those with a history of NSSI. RESULTS We provide evidence that negative biases toward NSSI may represent the effects of self-stigma. However, findings suggest that biases were generally attenuated among participants with a history of NSSI as compared to those without. Participants who had lower levels of NSSI explicit bias were more likely to have a history of more severe engagement in NSSI; however, no significant relationships were found between implicit bias and NSSI severity indicators. CONCLUSIONS We present a theoretical rationale for attenuated biases among individuals with a history of NSSI and discuss implications of this research for NSSI recovery.
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Affiliation(s)
- Marilyn L Piccirillo
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Taylor A Burke
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Samantha L Moore-Berg
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, PA, USA
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McCarthy K. Resident assistant secondary trauma and burnout associated with student nonsuicidal self-injury. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:673-677. [PMID: 30908135 DOI: 10.1080/07448481.2019.1590374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/04/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
Objective: To determine whether or not encountering students struggling with nonsuicidal self-injury (NSSI) put resident assistants (RAs) at greater risk of burnout or secondary traumatic stress. Participants: One hundred and fifty-five RAs at three Midwest public university campuses between March and April 2016. Methods: RAs participated in an anonymous online survey that collected demographics, information on RAs' experiences and thoughts related to their work, RAs' exposure to NSSI struggle of a resident, and measurements of compassion satisfaction, burnout, and secondary traumatic stress. Results: RAs who encountered resident NSSI demonstrated significantly higher levels of burnout and secondary traumatic stress than RAs who did not encounter resident NSSI. Conclusion: College students struggle with NSSI can significantly affect the people around them. Residence life administration and college counseling centers should provide training, support, and supervision to RAs in a way that addresses and reduces the RAs' potential distress.
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83
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Bettis AH, Liu RT, Walsh BW, Klonsky ED. Treatments for Self-Injurious Thoughts and Behaviors in Youth: Progress and Challenges. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2020; 5:354-364. [PMID: 32923664 DOI: 10.1080/23794925.2020.1806759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Self-injurious thoughts and behaviors (SITBs) remain a common clinical problem in youth. This article reviews the state of knowledge regarding psychosocial treatments for SITBs in youth. Broadly speaking, psychosocial treatments that incorporate parents/family and that emphasize skills development (including emotion regulation and interpersonal skills) appear to produce the best outcomes. We also describe several challenges to the implementation of evidence-based psychotherapy, as well as potential solutions to these challenges, and provide an illustrative case example. Finally, because even evidence-based psychosocial treatments can take weeks to produce effects, increased attention has been given to biological approaches such as esketamine administration and transcranial direct current stimulation that have potential to yield rapid improvement for acute suicidal ideation, though evidence for the safety and efficacy of these approaches is in the early stages.
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Affiliation(s)
- Alexandra H Bettis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital; Department of Psychiatry, Harvard Medical School
| | - Barent W Walsh
- Executive Director Emeritus and Senior Clinical Consultant, Open Sky Community Services
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Holden RR, Lambert CE, La Rochelle M, Billet MI, Fekken GC. Invalidating childhood environments and nonsuicidal self-injury in university students: Depression and mental pain as potential mediators. J Clin Psychol 2020; 77:722-731. [PMID: 32880952 DOI: 10.1002/jclp.23052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/26/2020] [Accepted: 08/21/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the potential mediating effects of depression and psychache (i.e., extreme mental pain) on the relationship between parental invalidation and nonsuicidal self-injury (NSSI) in young adults. METHOD A sample of 2474 university students responded to previously validated measures of current NSSI, childhood parental invalidation, depression, and psychache. RESULTS Using a parallel mediation model, path analysis using structural equation modeling demonstrated full mediation by depression and psychache of the link between parental invalidation and NSSI. CONCLUSIONS Findings suggest that the association between invalidating childhood environments and NSSI has the potential to be mitigated by addressing issues of depression and psychache.
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85
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Agnafors S, Torgerson J, Rusner M, Kjellström AN. Injuries in children and adolescents with psychiatric disorders. BMC Public Health 2020; 20:1273. [PMID: 32838787 PMCID: PMC7445910 DOI: 10.1186/s12889-020-09283-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Unintentional injuries are a leading cause of morbidity and mortality in children of all ages. Prevention strategies require knowledge of risk factors, and behavior and psychiatric disorders have been suggested to influence the risk of injury during childhood. While externalizing disorders have been found to increase the risk for injuries, results are mixed regarding internalizing disorders, such as affective and anxiety conditions, and Autism Spectrum Disorders (ASD). There is a need for large scale studies relying on robust data sources. The aim of the present study was to examine the association between psychiatric disorders and injuries requiring medical attention, in a large population-based cohort of 350,000 children and adolescents in Sweden. METHODS Data were obtained from the regional health care database Vega. Psychiatric diagnoses and injury diagnoses obtained during 2014-2018 for individuals aged 0-17 years in 2016 were extracted. Descriptive statistics were used to examine differences in 5-year injury prevalence between children with and without different psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric diagnoses and injuries requiring medical attention. RESULTS The results show an increased risk for concurrent injuries in general, but the patterns vary by age and psychiatric disorder. Externalizing disorders and anxiety conditions were associated with concurrent injuries, while individuals with ASD had a lower risk for most injuries included. Affective disorders were associated with an increased risk for wounds, concussion, complications and poisoning, while the risk for fractures was decreased. Self-inflicted injury was more common in all psychiatric conditions investigated during adolescence, except for ASD. Children and adolescents with many types of psychiatric disorders were also at increased risk for a concurrent maltreatment diagnosis. CONCLUSIONS A general pattern of increased risk for concurrent injuries in children and adolescents with most psychiatric diagnoses was found, but the associations vary by age and type of psychiatric disorder. The results add to the literature on risk factors for injuries in children and adolescents, supporting diagnosis specific patterns. Several psychiatric diagnoses were associated with a marked increase in injury risk, indicating a high burden of disease for affected individuals.
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Affiliation(s)
- Sara Agnafors
- Division of Children's and Women's health, BKV, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden. .,Department of Research, Södra Älvsborgs Hospital, Borås, Sweden.
| | - Jarl Torgerson
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Rusner
- Department of Research, Södra Älvsborgs Hospital, Borås, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Norman Kjellström
- Department of Data Management and Analysis, Head Office, Region Västra Götaland, Skövde, Sweden
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86
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Mészáros G, Győri D, Horváth LO, Szentiványi D, Balázs J. Nonsuicidal Self-Injury: Its Associations With Pathological Internet Use and Psychopathology Among Adolescents. Front Psychiatry 2020; 11:814. [PMID: 32922320 PMCID: PMC7456921 DOI: 10.3389/fpsyt.2020.00814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/HYPOTHESES As risk factors for nonsuicidal self-injury (NSSI), most studies highlight the importance of internalising disorders, while only a few researches show the connection between externalising disorders and NSSI. Although some papers have introduced the idea that increasing prevalence rates of NSSI are connected to the broader use of the internet, associations between NSSI and pathological internet use (PIU) are understudied. According to our hypothesis, there is a connection between PIU and NSSI, but this is mediated by psychopathological factors from both internalising and externalising dimensions. METHODS In line with the dimensional approach of psychiatric disorders, participants (N = 363) were recruited from both clinical (N = 202 psychiatric inpatient) and nonclinical (N = 161 adolescents from secondary schools) settings. Measurements: Demographic Questionnaire; Strengths and Difficulties Questionnaire (SDQ); Deliberate Self-Harm Inventory (DSHI); Young Diagnostic Questionnaire for Internet Addiction (YDQ), Mini International Neuropsychiatric Interview Kid (M.I.N.I. Kid). RESULTS There was high NSSI frequency (39.9%-71% of them were girls) in our sample. NSSI was significantly more frequent among those who showed threshold symptoms on SDQ than in the subthreshold group [H(3) = 53.293, p <.001]. In the NSSI frequency, there was also a significant difference between 'normal' internet users and both 'maladaptive' and 'pathological' internet users [H(2) = 10.039, p <.05 p = .007]. According to the mediator models, the relationship between PIU and NSSI is not a direct association; it is mediated by all examined psychopathological factors (M.I.N.I. kid diagnoses) except for obsessive-compulsive disorder (OCD), alcohol abuse and dependence, and adjustment disorder. CONCLUSIONS We found a high frequency of NSSI. According to our results, PIU in itself is not a risk factor for NSSI but might become a risk factor in the presence of comorbid psychiatric disorders. All of these findings draw the attention of clinicians to the importance of careful screening of comorbid disorders with PIU.
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Affiliation(s)
- Gergely Mészáros
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Mental Health Sciences School of Ph.D., Semmelweis University, Budapest, Hungary
| | - Dora Győri
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Lili Olga Horváth
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dora Szentiványi
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Pedagogical Assistance Services, Budapest, Hungary
| | - Judit Balázs
- Mental Health Sciences School of Ph.D., Semmelweis University, Budapest, Hungary
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Bjørknes University College, Oslo, Norway
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Whitman MR, Kremyar AJ, Ben-Porath YS. Using the MMPI-2-RF to Assess Risk of Nonsuicidal Self-Injury among College Students. J Pers Assess 2020; 103:455-464. [PMID: 32783548 DOI: 10.1080/00223891.2020.1801701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nonsuicidal self-injury (NSSI), the deliberate destruction of one's own body tissue without suicidal intent, is a prevalent problem linked to adverse outcomes. Many assessment tools designed to assess for NSSI risk are limited by their behavioral focus, which does not cover the numerous affective, cognitive, and interpersonal correlates. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a widely used inventory of personality and psychopathology that assesses a range of empirical correlates of NSSI risk. The purpose of this study was to investigate the utility of the MMPI-2-RF for assessing these NSSI-related constructs. On the basis of a review of the literature and item content, we pre-identified MMPI-2-RF measures of constructs associated with NSSI risk. Correlations between scores on these scales and the number of methods of NSSI identified several meaningful results, including some small but consistent gender differences in these associations. Zero-inflated negative binomial regression analyses indicated that scores on some expected MMPI-2-RF scales independently predicted NSSI variability. Relative risk ratio analyses demonstrated the potential clinical utility of MMPI-2-RF scale scores for assessing risk of engagement in NSSI. These findings indicate that the MMPI-2-RF may be a useful tool for assessing risk for NSSI among college students.
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Affiliation(s)
- Megan R Whitman
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | - Andrew J Kremyar
- Department of Psychological Sciences, Kent State University, Kent, Ohio
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Hovrud L, Simons R, Simons J, Korkow J. Non-suicidal self-injury and bulimia: the role of emotion dysregulation and body dissatisfaction. Eat Weight Disord 2020; 25:1089-1097. [PMID: 31292855 PMCID: PMC7399667 DOI: 10.1007/s40519-019-00741-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/01/2019] [Accepted: 06/22/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Risk factors of negative affect, body dissatisfaction, distress tolerance, and negative urgency are independently associated with bulimia symptoms and non-suicidal self-injury (NSSI). However, relationships of these risk factors within comorbid presentations are not fully understood. The current study examined specific roles of these risk factors within this relationship. METHODS An at-risk community sample of young adults (N = 429) completed an online survey of negative affect, body dissatisfaction, distress tolerance, negative urgency, bulimia symptoms, and NSSI. RESULTS A hypothesized path model was a good fit to the data. Results indicated direct paths from body dissatisfaction, negative urgency, and distress tolerance to bulimia symptoms. Negative urgency, distress tolerance, and bulimia symptoms were directly associated with NSSI. Consistent with hypotheses, distress tolerance and negative urgency acted as vulnerability factors, increasing the strength of associations between bulimia symptoms and NSSI. Distress tolerance also strengthened associations between negative urgency and NSSI. In addition to the direct effect, negative urgency was indirectly associated with NSSI via body dissatisfaction bulimia. Hypothesized indirect effects through distress tolerance were not supported. CONCLUSIONS Results support etiological models of bulimia and NSSI, and suggest deficits in emotion regulation strengthen risk of comorbid presentations. Furthermore, individuals with greater impulsivity and difficulty tolerating distress are at increased risk of engaging in both bulimia behaviors and NSSI, providing targets for clinical intervention. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Lindsey Hovrud
- University of South Dakota, 414 E Clark St, South Dakota Union Building, Vermillion, SD, 57069, USA.
| | - Raluca Simons
- University of South Dakota, 414 E Clark St, South Dakota Union Building, Vermillion, SD, 57069, USA
| | - Jeffrey Simons
- University of South Dakota, 414 E Clark St, South Dakota Union Building, Vermillion, SD, 57069, USA
| | - John Korkow
- University of South Dakota, 414 E Clark St, South Dakota Union Building, Vermillion, SD, 57069, USA
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Oktan V. The roles of coping with stress and emotional regulation in predicting self-injurious behaviours among adolescents in Turkey. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2020. [DOI: 10.1080/03069885.2020.1792829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Vesile Oktan
- Department of Science Education, Fatih Faculty of Education, Karadeniz Technical University, Söğütlü, Trabzon, Turkey
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Nonsuicidal Self-Injury Among African American and Hispanic Adolescents and Young Adults: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:367-377. [PMID: 32671672 DOI: 10.1007/s11121-020-01147-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
While African American and Hispanic adolescents and young adults living in the USA are exposed to myriad stressors that may increase their risk for mental health difficulties, few studies have examined nonsuicidal self-injury (NSSI) among these youth. The purpose of this systematic review was to critically examine and synthesize current literature on NSSI among these understudied youth. Using multiple search terms related to NSSI, race/ethnicity, and developmental stage, electronic literature searches of PubMed, PsychINFO, and Google Scholar databases retrieved 3036 relevant articles published in the English language between 2000 and 2018; manual reference checks yielded an additional 17 articles. Ultimately, a total of 52 full-text studies were assessed for eligibility, and 15 articles were included in the present review. Although the majority of studies reported higher prevalence of NSSI among non-Hispanic White youth, evidence suggests that African American males are also at high risk of engaging in self-harm. Emotional dysregulation emerged as a common risk factor, while social support and feelings of connection were protective for some African American and Hispanic youth. Although racism and discrimination were not linked to NSSI in the reviewed studies, this remains an important area of future research for prevention and intervention efforts.
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91
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Childhood predictors and moderators of lifetime risk of self-harm in girls with and without attention-deficit/hyperactivity disorder. Dev Psychopathol 2020; 33:1351-1367. [DOI: 10.1017/s0954579420000553] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is associated with self-harm during adolescence and young adulthood, especially among females. Yet little is known about the developmental trajectories or childhood predictors/moderators of self-harm in women with and without childhood histories of ADHD. We characterized lifetime risk for nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA), comparing female participants with (n = 140) and without (n = 88) childhood ADHD. We examined theory-informed childhood predictors and moderators of lifetime risk via baseline measures from childhood. First, regarding developmental patterns, most females with positive histories of lifetime self-harm engaged in such behaviors in adolescence yet desisted by adulthood. Females with positive histories of self-harm by late adolescence emanated largely from the ADHD-C group. Second, we found that predictors of NSSI were early externalizing symptoms, overall executive functioning, and father's negative parenting; predictors of SI were adverse childhood experiences and low self-esteem; and predictors of SA were early externalizing symptoms, adverse childhood experiences, and low self-esteem. Third, receiver operating characteristics analyses helped to ascertain interactive sets of predictors. Findings indicate that pathways to self-harm are multifaceted for females with ADHD. Understanding early childhood predictors and moderators of self-harm can inform both risk assessment and intervention strategies.
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92
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Fulcher JA, Dunbar S, Orlando E, Woodruff SJ, Santarossa S. #selfharn on Instagram: understanding online communities surrounding non-suicidal self-injury through conversations and common properties among authors. Digit Health 2020; 6:2055207620922389. [PMID: 32426154 PMCID: PMC7218342 DOI: 10.1177/2055207620922389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives #selfharm has been blocked by Instagram, but manoeuvring hashtags (e.g. #selfharn) are beginning to appear in order for secret non-suicidal self-injury (NSSI) communities to communicate. The purpose of this study was to (a) determine the nature of the #selfharn conversation on Instagram, (b) analyze common properties of the visual content (i.e. images and videos; n = 93) tagged with #selfharn, and (c) discover what kind of environment the authors (n = 50) of #selfharn were creating. Methods A multi-method approach was utilized for this study. Netlytic was used to generate a text and content analysis to examine the authors’ captions and comments (n = 8772) associated with #selfharn (collected over a seven-day period). Results After removing #selfharn from the dataset, the text analysis revealed that #depression (n = 3081) and #suicide (n = 2270) were the most commonly used terms associated with #selfharn. Overall, 52% (n = 4386) of the popular words/phrases related with #selfharn posts were categorized as ‘bad feelings’. Through manual coding, it was determined that the majority of #selfharn visual content (n = 92; 99%) did not generate an advisory warning but did contain a wound (n = 70; 75%). The #selfharn author analysis suggests that most were women (n = 18; 36%) with a dark-coloured profile aesthetic (n = 37; 74%) determined by an overwhelming amount of grey, black, blue, red, or purple colours. Conclusion According to the text and content analyses, #selfharn on Instagram may be contributing negatively to an online community of mental-health issues. More resources should be provided by Instagram to those who are involved in the NSSI Instagram community.
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Affiliation(s)
- Jory A Fulcher
- Faculty of Human Kinetics, University of Windsor, Canada
| | - Sarah Dunbar
- Faculty of Human Kinetics, University of Windsor, Canada
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93
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Sarno I, Madeddu F, Gratz K. Self-injury, psychiatric symptoms, and defense mechanisms: Findings in an Italian nonclinical sample. Eur Psychiatry 2020; 25:136-45. [DOI: 10.1016/j.eurpsy.2009.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 05/26/2009] [Accepted: 05/27/2009] [Indexed: 11/25/2022] Open
Abstract
AbstractIntroductionThis study provides data on the rates, characteristics, and correlates of self-injury (SI) in an Italian nonclinical sample, a population previously unexamined within the SI literature. This study examined the associations between SI and defense mechanisms, as well as the differences between self-injurers (episodic and recurrent) and non self-injurers with regard to the severity and variety of their psychiatric symptoms and psychological distress.Materials and methodsFive hundred and seventy-eight university students (82.5% female; mean age = 22.3; S.D. = 3.4) were administered a battery of self-report questionnaires, including the “Deliberate Self Harm Inventory” for SI, the Response Evaluation Measure-71 for defense mechanisms, and the “Symptom Checklist-90-Revised” for psychological distress and psychiatric symptoms.ResultsOne hundred and nineteen participants (20.6%) reported having engaged in SI at least once during their lifetime. Individuals with recurrent SI (SI ≥ 5) reported significantly higher levels of all psychiatric symptoms and many maladaptive defense mechanisms than individuals without SI. Results also provided evidence for differences between individuals with recurrent and episodic SI.ConclusionResults suggest that recurrent self-injurers are distinguished from both episodic self-injurers and non self-injurers by their greater use of maladaptive defense mechanisms, rather than their lesser use of adaptive defenses. Further, results suggest that recurrent self-injurers differ from episodic self-injurers not in terms of the severity of their psychiatric symptoms, but the variety and number of these symptoms.
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94
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Rodav O, Levy S, Hamdan S. Clinical characteristics and functions of non-suicide self-injury in youth. Eur Psychiatry 2020; 29:503-8. [DOI: 10.1016/j.eurpsy.2014.02.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022] Open
Abstract
AbstractPurposeLittle is known about the clinical characteristics and motivations for engaging in non-suicide self-injury (NSSI) behaviors in adolescence. The aim of this study was to examine the prevalence, characteristics and functions of NSSI among adolescents in community settings, and to explore risk factors related to this behavior.Subjects and methodsTwo hundred and seventy-five adolescents aged 12 to 17 were recruited randomly from different High Schools in Israel. They completed self-report questionnaires assessing NSSI (Ottawa Self-Injury Inventory), depression (Children's Depression Inventory – CDI) and impulsivity (Barratt Impulsiveness Scale – BIS-II).ResultsIn the past year, 20.7% of the participants reported engaging NSSI at least once. Among them, 42.1% declared they are still engaging in NSSI at the present. Motives for NSSI were internal emotion regulation reasons, external emotion regulation reasons for social influences. In addition, the NSSI group reported significantly higher levels of depressive, impulsivity and suicidal ideations. Depressive symptoms were found as significant predictors of NSSI in the future.Discussion and conclusionsHigh rates of NSSI among community adolescents were found. Depression, impulsivity and suicidal ideation were found significantly related to NSSI. Mental health professionals in schools and in primary care should routinely assess NSSI among adolescents.
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95
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Bae Y, Seong Y, Kim SH, Kim S. Clinical Characteristics of Non-Suicidal Self-Injury and Suicide Attempts among Psychiatric Patients in Korea: A Retrospective Chart Review. Psychiatry Investig 2020; 17:320-330. [PMID: 32213802 PMCID: PMC7176559 DOI: 10.30773/pi.2019.0269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/06/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Limited data exist on non-suicidal self-injury (NSSI) and suicide attempts among psychiatric patients in Korea. In this study, we investigated the clinical characteristics of patients who engaged in NSSI and/or suicide attempts. METHODS We performed a retrospective medical chart review of patients with NSSI and/or suicide attempts at the psychiatric department of a university medical center in Seoul between 2017 and 2019. According to their history, patients were allocated to one of three groups: NSSI only, suicide attempts only and NSSI and suicide attempts group. Groups were compared based on sociodemographic characteristics and psychological assessments. RESULTS Overall, 80 patients with NSSI and/or suicide attempts were evaluated. Patients with NSSI and suicide attempts were more likely to be female than the other two groups. Patients with NSSI and suicide attempts were more likely to suffer from Cluster B personality disorder than the other groups. And patients with NSSI and suicide attempts scored significantly higher on novelty-seeking in TCI and RC8, RC9 in MMPI-2. CONCLUSION Patients with NSSI and/or suicide attempts were more likely to be female, younger, and showed higher levels of psychological disturbances. These findings highlight the importance of early detection and intervention for patients with NSSI.
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Affiliation(s)
- Yubeen Bae
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yoanna Seong
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sojung Kim
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Republic of Korea
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96
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Eddy LD, Eadeh HM, Breaux R, Langberg JM. Prevalence and predictors of suicidal ideation, plan, and attempts, in first-year college students with ADHD. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:313-319. [PMID: 30615588 PMCID: PMC6612472 DOI: 10.1080/07448481.2018.1549555] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/23/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
Objective. The present study evaluated the prevalence of past suicidal ideation (SI), plan, and attempt in college students with ADHD (N = 102) compared to a matched control (N = 102). Predictors of SI, plan, and attempts, were examined. Participants. Study participants were first year college students at a large Southeastern university who completed measures during August or September of 2014 or January of 2015. Methods. Measures were completed by first year students via an online survey. Results. Prevalence rates for SI and related behaviors were higher among the ADHD group than the matched control, with suicide attempts rates four times higher in the ADHD group (13.7% vs. 2.9%). Results showed that ADHD predicted rates of SI and suicide attempt accounting for depression and key demographic variables. Conclusions. Findings have implications for suicide risk assessments conducted with college students with ADHD.
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Affiliation(s)
- Laura D Eddy
- Department of Psychology, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Hana-May Eadeh
- Department of Psychology, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Rosanna Breaux
- Department of Psychology, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Joshua M Langberg
- Department of Psychology, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
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97
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Gonzalez-Blanks A, Bridgewater JM, Yates TM. Statistical Approaches for Highly Skewed Data: Evaluating Relations between Maltreatment and Young Adults' Non-Suicidal Self-injury. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 49:147-161. [PMID: 32077745 DOI: 10.1080/15374416.2020.1724543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Clinical phenomena often feature skewed distributions with an overabundance of zeros. Unfortunately, empirical methods for dealing with this violation of distributional assumptions underlying regression are typically discussed in statistical journals with limited translation to applied researchers. Therefore, this investigation compared statistical approaches for addressing highly skewed data as applied to the evaluation of relations between child maltreatment and non-suicidal self-injury (NSSI). Method: College students (N = 2,651; 64.2% female; 85.2% nonwhite) completed the Child Abuse and Trauma Scale and the Functional Assessment of Self-Mutilation. Statistical models were applied to cross-sectional data to provide illustrative comparisons across predictions to a) raw, highly skewed NSSI outcomes, b) natural log, square-root, and inverse NSSI transformations to reduce skew, c) zero-inflated Poisson (ZIP) and negative-binomial zero-inflated (NBZI) regression models to account for both disproportionate zeros and skewness in the NSSI data, and d) the skew-t distribution to model NSSI skewness. Results: Child maltreatment was significantly and positively related to NSSI frequency in the raw, transformation, and zero-inflated models, but this relation was negative in the skew-t model. Conclusions: These findings highlight the importance of using zero-inflated models rather than transformation approaches to address data skew. Moreover, whereas the skew-t distribution has been used to model skewed non-clinical data, this study suggests that the skew-t approach may not be well-suited to address skewed clinical data.
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Affiliation(s)
| | | | - Tuppett M Yates
- Department of Psychology, University of California, Riverside
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98
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Pollak OH, D'Angelo EJ, Cha CB. Does function predict persistence? Nonsuicidal self-injury among adolescents during and after hospitalization. Psychiatry Res 2020; 286:112839. [PMID: 32088507 DOI: 10.1016/j.psychres.2020.112839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 12/14/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a prevalent, concerning behavior among adolescents. Importantly, NSSI can serve a variety of functions. Some adolescents engage in NSSI to fulfill automatic or self-oriented functions (e.g., cutting to avoid internal negative states), whereas others engage in NSSI to serve social functions (e.g., cutting to communicate with others). This study tests whether self-reported reasons for engaging in NSSI, hereafter referred to as NSSI functions, predict NSSI thoughts and behaviors during and after hospitalization among adolescent psychiatric inpatients. Endorsement of both automatic and social NSSI functions, as well as positive and negative reinforcement subtypes, was assessed at hospital admission. Results showed that endorsement of overall automatic function predicted which adolescents engaged in NSSI behavior during hospitalization. Moreover, automatic and social functions showed distinct predictive patterns, such that automatic functions corresponded to greater likelihood of NSSI-related thoughts and behaviors whereas social functions mainly corresponded to reduced likelihood of NSSI-related outcomes. Of note, NSSI functions were less predictive of NSSI-related outcomes after hospital discharge. These findings suggest that identifying adolescent inpatients' reasons for NSSI engagement may meaningfully distinguish those at higher risk (and those at lower risk) of NSSI persistence during their hospital stay.
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Affiliation(s)
- Olivia H Pollak
- Department of Clinical Psychology, Teachers College, Columbia University, New York, USA
| | - Eugene J D'Angelo
- Department of Psychiatry, Boston Children's Hospital, Boston, Harvard Medical School, Boston, USA
| | - Christine B Cha
- Department of Clinical Psychology, Teachers College, Columbia University, New York, USA.
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99
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Invalidating Caregiving Environments, Specific Emotion Regulation Deficits, and Non-suicidal Self-injury. Child Psychiatry Hum Dev 2020; 51:39-47. [PMID: 31243625 DOI: 10.1007/s10578-019-00908-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the indirect effects of distinct aspects of invalidating caregiving environments (i.e., paternal maltreatment, maternal maltreatment, and perceived alienation) on non-suicidal self-injury (NSSI) via six specific emotion regulation difficulties. We hypothesized that specific emotion regulation deficits would mediate associations between invalidating environments and NSSI. Participants included 114 young adults (57 self-injurers; 57 age- and sex-matched comparison participants) aged 17-25 years. Three parallel mediation models tested hypotheses. Results showed that maternal maltreatment, paternal maltreatment, and perceived alienation indirectly predicted NSSI through poor emotional clarity. Maternal maltreatment uniquely predicted NSSI through limited access to regulation strategies. Lastly, maternal maltreatment and perceived alienation were both linked to greater difficulties engaging in goal-directed behavior during emotional upsets; however, contrary to hypotheses, this particular deficit was associated with decreased odds of engaging in NSSI. Findings illustrate how different aspects of invalidating environments and specific emotion regulation deficits may be implicated in NSSI engagement.
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100
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Parreco J, Sussman MS, Crandall M, Ebler DJ, Lee E, Namias N, Rattan R. Nationwide Outcomes and Risk Factors for Reinjury After Penetrating Trauma. J Surg Res 2020; 250:59-69. [PMID: 32018144 DOI: 10.1016/j.jss.2019.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/27/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have shown that a notable portion of patients who are readmitted for reinjury after penetrating trauma present to a different hospital. The purpose of this study was to identify the risk factors for reinjury after penetrating trauma including reinjury admissions to different hospitals. METHODS The 2010-2014 Nationwide Readmissions Database was queried for patients surviving penetrating trauma. E-codes identified patients subsequently admitted with a new diagnosis of blunt or penetrating trauma. Univariable analysis was performed using 44 injury, patient, and hospital characteristics. Multivariable logistic regression using significant variables identified risk factors for the outcomes of reinjury, different hospital readmission, and in-hospital mortality after reinjury. RESULTS There were 443,113 patients identified. The reinjury rate was 3.5%. Patients presented to a different hospital in 30.0% of reinjuries. Self-inflicted injuries had a higher risk of reinjury (odds ratio [OR]: 2.66, P < 0.05). Readmission to a different hospital increased risk of mortality (OR: 1.62, P < 0.05). Firearm injury on index admission increased risk of mortality after reinjury (OR: 1.94, P < 0.05). CONCLUSIONS This study represents the first national finding that one in three patients present to a different hospital for reinjury after penetrating trauma and have a higher risk of mortality due to this fragmentation of care. These findings have implications for quality and cost improvements by identifying areas to improve continuity of care and the implementation of penetrating injury prevention programs.
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Affiliation(s)
- Joshua Parreco
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Matthew S Sussman
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida.
| | - Marie Crandall
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - David J Ebler
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - Eugenia Lee
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Nicholas Namias
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Rishi Rattan
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
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