Self-injurious behaviors in a college population

Invalidating Caregiving Environments, Specific Emotion Regulation Deficits, and Non-suicidal Self-injury

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.

Nationwide Outcomes and Risk Factors for Reinjury After Penetrating Trauma

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.

Cuestionario de Riesgo de Autolesión (CRA): propiedades psicométricas y resultados en una muestra de adolescentes

La autolesión tiene una alta frecuencia en adolescentes, por lo que son necesarios instrumentos adecuados para su medición y acciones preventivas. El objetivo de este estudio fue elaborar un instrumento válido y confiable que explorara la presencia de autolesión y aspectos muy poco abordados, como dificultad para dejar de lesionarse y el factor de riesgo denominado contagio social. De una muestra total (N = 629) no probabilística se obtuvo una muestra con distribución normal con N = 241 estudiantes de secundarias públicas del sur de la Ciudad de México, 89 hombres y 152 mujeres, con M = 12.37 años (DE = 2.28) y rango de 11-15 años. Los ítems del instrumento se elaboraron con base en la literatura y se sometieron a procedimientos de validación de contenido (evaluación de expertos), laboratorios cognoscitivos (para asegurar comprensión/significado de los ítems), validez de constructo, análisis factorial exploratorio (AFE) y confirmatorio (AFC), y consistencia interna (coeficientes alpha y omega). El AFC proyectó un modelo con tres factores (frecuencia, efecto adictivo y contagio social) con índices de bondad de ajuste adecuados y consistencia interna aceptable (alpha y omega = 0.94). Los resultados indican que el cuestionario es útil para evaluar aspectos relevantes de la autolesión; se discute la necesidad de complementar la información con entrevistas y de ahondar en el contagio social y la intención de autolesionarse.

Non-suicidal self-injury among male service members: Descriptive information and a preliminary examination of external correlates

Previous literature has identified nonsuicidal self-injury (NSSI) as a common and noteworthy behavior, particularly given its association with psychopathology and suicide. However, the research on NSSI among males has resulted in mixed findings. Additionally, few studies have examined NSSI among service members and only one study to date has examined NSSI specifically among male service members. The present study examined descriptive statistics and clinical correlates of NSSI among male service members. Results indicated that the most common method of NSSI among this group was burning oneself with a cigarette, followed closely by cutting, and burning oneself with a lighter. NSSI engagement was associated with common correlates of NSSI such as increased emotion dysregulation, depression, impulsivity, and capability for suicide as well as decreased distress tolerance and a greatly likelihood to have experienced recent suicidal ideation. NSSI was also associated with grit, narcissism, and masculinity, some of which may be particularly important and valued in military culture. Overall, results suggest important similarities and differences among NSSI in service members relative to previously studied samples. Future research should continue to examine NSSI among male service members to ensure treatments are effectively targeting and addressing aspects of the behavior.

The Emergency Assessment and Management of Non-Suicidal Self-Injury in Adolescents

Background and Goals:

Non-suicidal self-injury (NSSI) is a common presenting issue mental health providers experience in all levels of care from outpatient clinics to inpatient units. It is common among adolescents seen in emergency settings, either as a presenting problem or as a covert condition that may not be detected unless specifically assessed for. The presence of NSSI increases the risk of suicide. This article aims to help the clinician develop a better understanding of NSSI – what it may entail, the prevalence, and the motivations for why young people engage in it.

Methods:

We review the reasons adolescents injure themselves, the link between NSSI and psychiatric diagnoses and suicide, the assessment of NSSI, and treatment planning, with emphasis on ways to screen for NSSI and interventions that can be implemented in the Emergency Department. We illustrate the complexity of NSSI with the case of a young patient with a complex psychiatric history and an extensive history of self-injury.

Results and Discussion:

Despite the seeming intractability of NSSI, a number of evidencebased treatments exist. Treatment primarily involves specialized forms of psychotherapy, but interventions can be implemented in the ED that will reduce the immediate risk of NSSI while more definitive intervention is awaited.

Conclusion:

Mental health consultations in the ED should always include screening for NSSI. Mental health professionals in the ED can play an important role in the detection and treatment of this condition.

Understanding the Needs of Young People Who Engage in Self-Harm: A Qualitative Investigation

Self-harm is common and associated with adverse outcomes. Research about the risk factors for self-harm has informed the field with regard to clinical interventions that should be delivered for young people who engage in self-harm. Missing is an in-depth understanding of what the triggers of an urge to self-harm might be, including in young people being treated with a clinical intervention. Therefore, there is little knowledge about what techniques young people find helpful to deal with urges to self-harm when they occur. This qualitative study engaged seven young people with lived experience of self-harm in semi-structured interviews about the immediate triggers of the urge to self-harm, and helpful strategies to manage this urge. Thematic analysis using a general inductive approach revealed distressing emotions and a sense of isolation as key themes, with other triggers associated with their induction. Highlighted was the wide range of situations and emotions that can be triggering, such that a further key theme was the idiosyncratic nature of the self-help strategies young people found helpful. Interventions that are developed to support young people who self-harm must address this complexity and findings highlight the need for young people to maintain some autonomy and control while being supported to connect with others for support. This research adds to the literature on self-help strategies to support young people in moments when they are experiencing distressing emotions, feel isolated, and have an urge to self-harm providing important insight to the prevention and intervention for self-harm among young people.

Revista Digital Internacional de Psicología y Ciencia Social | Volumen 6 | Número 1 | Enero-Junio 2020 | Investigación y acción para el cambio social

El nombre del presente número es “La investigación para la acción y el cambio social”, decidimos titularlo de esa manera porque consideramos de fundamental interés destacar la importancia que ha adquirido el trabajo científico desarrollado por los profesionales de distintas disciplinas para favorecer a la población que atienden respectivamente, pues en los trabajos presentados se muestra una excelente articulación entre la teoría y la práctica, poniendo en evidencia que se parte de una concepción social y científica, holística, pluralista e igualitaria.

Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis

The current review presents a meta-analysis of the existing empirical literature on the prevalence of non-suicidal self-injury (NSSI) among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as on correlates of NSSI within sexual and gender minority populations. Eligible publications (n = 51) were identified through a systematic search of PsycINFO, MEDLINE, and Embase, supplemented by a search of references of prior reviews on this topic. NSSI prevalence rates were quite elevated among sexual (29.68% lifetime) and gender (46.65% lifetime) minority individuals compared to heterosexual and/or cisgender peers (14.57% lifetime), with transgender (46.65% lifetime) and bisexual (41.47% lifetime) individuals being at greatest risk. Even among these group findings, sexual minority youth emerged as an especially vulnerable population. Moreover, current evidence suggests these rates and differences between LGBT and heterosexual and/or cisgender peers have not declined over time. These findings may in some measure be due to the existence of LGBT-specific risk correlates combined with general risk correlates being more severe among sexual and gender minority populations. Additional research, particularly employing a longitudinal design, is needed in this area to advance efforts to reduce risk for NSSI among sexual and gender minority individuals.

Could affect regulation via vagal nerve self- stimulation be a maintaining factor in non-suicidal self-harm?

BACKGROUND

Non-suicidal self-injury (NSSI) is a serious and common phenomenon which has been linked with emotion or affect regulation. The capacity for top-down emotion regulation has also been linked to vagal tone. Vagal tone is known to be low in groups with a propensity to engage in NSSI.

HYPOTHESIS

Some forms of NSSI, both direct and indirect, may result in vagal stimulation. The resulting increase in vagal tone may be linked to activation of prefrontal areas and improved top-down emotion regulation. This may be a maintaining factor in NSSI.

EVALUATION

Cutting with the sight of blood, the use of ligatures, eating disorders and risky sexual behaviour, behaviours that could be considered direct or indirect forms of NSSI, are all plausible methods of vagal self-stimulation.

CONCLUSION

NSSI may increase vagal tone. This may result in improved top down emotion regulation and result in a calmer emotional state. These vagal effects may be important maintaining factors in self-harm. This has important implications for the study and possible management of a common and serious issue.

Examining Sexual Assault Victimization and Loneliness as Risk Factors Associated With Nonlethal Self-Harm Behaviors in Female College Students: Is It Important to Control for Concomitant Suicidal Behaviors (and Vice Versa)?

The present study examined sexual assault victimization and loneliness as predictors of self-harm behaviors in a sample of 224 female college students. Results from conducting regression analysis indicated that both sexual assault victimization and loneliness were unique and significant predictors of self-harm behaviors. This pattern remained even after controlling for concomitant suicidal behaviors. Interestingly, in a post hoc analysis predicting suicidal behaviors, it was found that loneliness, but not sexual assault victimization, was the only unique and significant predictor after controlling for self-harm behaviors. Some implications of the present findings for understanding self-harm behaviors in female college students and the importance of controlling for suicidal behaviors in studies of self-harm behaviors (and vice versa) are discussed.

Depressive symptoms and non-suicidal self-injury during adolescence: Latent patterns of short-term stability and change

INTRODUCTION

Depressive symptoms and non-suicidal self-injury not only increase in prevalence during adolescence, but they can also occur together. Both psychological problems seem to have similar precipitating conditions, suggesting they have transdiagnostic conditions-personal or contextual characteristics that contribute to co-occurrence. We sought to understand when these two problems co-occur and what is related to their co-occurrence.

METHODS

Using a pattern-centered approach and two waves of longitudinal data collected annually, we examined latent profiles of depressive symptoms and self-injury among a Swedish sample of adolescents aged 12 to 16 (M_ageT1 = 13.65 years, SD = 0.64), 53.7% boys and 47.3% girls. Most of the adolescents were Swedish (89%), with parents who were married or cohabitating (68%). We also examined the transitions between profiles over time.

RESULTS

Our results suggest that during this time frame, depressive symptoms and self-injury tend to emerge and stabilize or abate together. We also examined a broad array of predictors, including individual characteristics, emotion dysregulation, experiences with friends, parents' negative reactions to behavior, and school stress. The significant unique predictors suggest that adolescents who reported being subjected to relational aggression, having negative experiences while drinking, and low self-esteem had a greater probability of moving from moderate to high levels or maintaining high levels of depressive symptoms and self-injury, compared to adolescents classified in the other statuses.

CONCLUSIONS

Focusing on negative interpersonal experiences and selfesteem as transdiagnostic conditions may guide research and aid clinicians in supporting adolescents who feel depressed and engage in self-injury.

Are Tattoos an Indicator of Severity of Non-Suicidal Self-Injury Behavior in Adolescents?

OBJECTIVE

To compare adolescents with non-suicidal self-injury behavior and tattoos [NSSI (T+)] with another group with non-suicidal self-injury behavior without tattoos [NSSI (T-)].

METHODS

Adolescents (n=438) 42.6% males from the community (M=12.3, SD=1.3), completed the Self-Injury Schedule.

RESULTS

The lifetime prevalence of tattoos performed with the purpose to feel pain was 1.8%. Compared to the NSSI (T-) group, the NSSI (T+) group was significantly more likely to meet the DSM-5 frequency criteria of 5 self-injury events in 1 year, practice more than one method of self-injury, and topography, more suicidal intentionality, more negative thoughts and affective emotions before, during, and after self-injury and more academic and social dysfunction.

CONCLUSION

Adolescents from the community who practice tattooing to feel pain, show a distinct phenotype of NSSI. Health professionals and pediatricians should assess tattooing characteristics such as intention (to feel pain), frequency, and presence of non-suicidal self-injury behavior and suicide intentionality.

Effects of a Painful Stimulus on Stress Regulation in Male Patients With Borderline Personality Disorder: A Pilot Study

Pain processing in relation to stress has so far not been investigated in male patients with borderline personality disorder (BPD). This experimental pilot study examined 17 male BPD patients and 20 male healthy controls (HCs) to assess the effects of a pain stimulus on arousal, aggression, pain (ratings), and heart rate. At baseline, BPD patients showed significantly higher arousal and aggression; however, there was no significant difference in heart rate compared to the HC group. Following stress induction, a noninvasive mechanical pain stimulus was applied. No significant differences in pain ratings or heart rates were found between the groups. For arousal, a significantly stronger decrease was revealed in the BPD group compared to the HC group (t = 2.16, p = .038). Concerning aggression, the BPD group showed a significantly greater decrease after the pain stimulus than the HC group (t = 3.25, p = .002). This data showed that nonsuicidal self-injury can reduce arousal and aggression in male BPD.

Self-Harm and Suicide Among Children and Adolescents in Hong Kong: A Review of Prevalence, Risk Factors, and Prevention Strategies

This paper reviews the prevalence, risk factors, and effectiveness of prevention programs for self-harm and suicide among children and adolescents in Hong Kong. Youth suicide rates declined gradually over the past two decades, but it is alarming to see that self-harm, suicidal thoughts, and attempts are quite common among junior secondary students. Local studies identify psychopathology (especially depression) and family relationship issues as the most common risk factors of suicide and self-harm, and impulsive control issues are an additional factor contributing to self-harm. In the second part, this paper reviews the evidence for six types of universal and selective prevention strategies identified from local and overseas literature: (1) restriction of access to means of suicide; (2) guidelines for responsible media reporting of suicides; (3) provision of quality mental healthcare to at-risk populations; (4) school-based screening and prevention programs; (5) online prevention, monitoring, and support programs; and (6) life skills training programs. Research evidence supports that the provision of high-quality mental health services to at-risk populations and some school-based prevention programs (awareness and screening, and gatekeeper training) are effective in suicide prevention. Further research efforts are needed to verify the impact of the other four strategies. Practitioners could make better use of new prevention programs through the internet and instant messaging platforms, which have the potential to alter attitude toward suicide and self-harm as well as promoting help seeking behavior among young people.

Emotion Regulation Deficits and Nonsuicidal Self-Injury Prospectively Predict Suicide Ideation in Adolescents

BACKGROUND

The relationship between emotion regulation deficits and nonsuicidal self-injury (NSSI) is well established. Many studies have documented the strong relationship between NSSI and suicidal thoughts and behaviors. The relationship between emotion regulation deficits and suicide is less understood, but recent studies indicate a moderate association. This study aimed to examine the relationship between emotion regulation deficits, NSSI behavior, and suicide ideation in an unselected community sample of adolescents. It was expected that NSSI history would moderate the relationship between emotion regulation and future suicide ideation.

METHODS

Data were collected from 367 unselected, community adolescents (mean age = 13). Self-report questionnaires assessed NSSI behavior, emotion regulation deficits, and suicide ideation at two time points, 6 months apart.

RESULTS

After controlling for suicide ideation at baseline, emotion regulation deficits (experiential avoidance and interoceptive deficits) significantly predicted suicide ideation severity at follow-up, and interactions with NSSI engagement showed support for moderation.

CONCLUSIONS

Results of this study provide insight into the mechanisms of these relationships and have significant clinical implications for the identification of adolescents at risk for suicide behaviors.

Frustration with feeling: Latent classes of non-suicidal self-injury and emotion regulation difficulties

Although emotion regulation has been identified as a key function of non-suicidal self-injury (NSSI), it is unclear how specific indices of emotion regulation are associated with particular NSSI methods as markers of risk. This study used latent class analysis (LCA) to identify subgroups of individuals who engage in NSSI and their patterns of emotional regulation difficulties. Undergraduate students in the southeastern United States (N = 326) completed an online survey. LCA was used to identify subgroups of individuals engaging in NSSI and their associated emotion regulation difficulties. These subgroups were then compared across a variety of behavioral health outcomes (e.g. impulsive behavior, disordered eating, problematic alcohol use, suicide attempt history) to characterize specific risk profiles. The LCA revealed four subgroups who engage in NSSI and have specific emotion regulation difficulties. These subgroups were differentially associated with behavioral health outcomes, including suicide risk, disordered eating, and impulsive behavior. Results of this research could aid in clinical identification of at-risk individuals.

Personality, emotion-related variables, and media pressure predict eating disorders via disordered eating in Lebanese university students

PURPOSE

Disordered eating behaviors are on the rise among youth. The present study investigates psychosocial and weight-related variables as predictors of eating disorders (ED) through disordered eating (DE) dimensions (namely restrained, external, and emotional eating) in Lebanese university students.

METHODS

The sample consisted of 244 undergraduates (143 female) aged from 18 to 31 years (M = 20.06; SD = 1.67). Using path analysis, two statistical models were built separately with restrained and emotional eating as dependent variables, and all possible direct and indirect pathways were tested for mediating effects. The variables tested for were media influence, perfectionism, trait emotional intelligence, and the Big Five dimensions.

RESULTS

In the first model, media pressure, self-control, and extraversion predicted eating disorders via emotional eating. In the second model, media pressure and perfectionism predicted eating disorders via restrained eating.

DISCUSSION

Findings from this study provide an understanding of the dynamics between DE, ED, and key personality, emotion-related, and social factors in youth. Lastly, implications and recommendations for future studies are advanced.

Predicting status along the continuum of suicidal thoughts and behavior among those with a history of nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) and suicidal thoughts and behavior often co-occur, representing a growing public health concern. Despite extensive research examining suicidal thoughts and behavior among those who engage in NSSI, there is a lack of research investigating factors that, when considered together, can differentiate individuals along the continuum of suicidal thoughts and behavior (no history, suicidal ideation, suicide plan, suicide attempt). This study sought to address this question using a sample of 1178 college students with NSSI history (68.70% female). Discriminant function analysis was conducted including the following predictors: NSSI characteristics, negative affect difficulties, and behavioral and demographic risk factors for suicidal thoughts and behavior. Results suggest that self-disclosure of suicidal ideation, number of lifetime NSSI methods, NSSI frequency, depressive symptoms, and age most parsimoniously differentiate study groups. Those who use a greater number of NSSI methods and acts, paired with higher depressive symptoms and repeated self-disclosure of suicidal ideation are most likely to have a suicide attempt history; decreases in these variables suggest membership within less severe groups. Furthermore, older age may be related to greater suicidality. Findings suggest that the evaluation and co-occurrence of these variables may contribute to a more accurate suicide risk assessment.

Repeat Self-Inflicted Injury Among U.S. Youth in a Large Medical Claims Database

INTRODUCTION

This study describes characteristics of nonfatal self-inflicted injuries and incidence of repeat self-inflicted injuries among a large convenience sample of youth (aged 10-24 years) with Medicaid or commercial insurance.

METHODS

In 2018, Truven Health MarketScan medical claims data were used to identify youth with a self-inflicted injury in 2013 (or index self-inflicted injury) diagnosed in any inpatient or outpatient setting. Patients with 2 years of healthcare claims data (1 year before/after index self-inflicted injury) were assessed. Patient and injury characteristics, repeat self-inflicted injuries ≤1 year, time to repeat self-inflicted injury, and number of emergency department and urgent care facility visits per patient are reported. A regression model assessed factors associated with repeat self-inflicted injuries.

RESULTS

Among 4,681 self-inflicted injury patients, 70% were female. More than 71% of patients were treated for comorbidities (50% for depression) ≤1 year preceding the index self-inflicted injury. Poisoning was the most common index self-inflicted injury mechanism (60% of patients). Approximately 52% of patients had one or more emergency department visit and 1% had one or more urgent care facility visit, respectively, during the 2-year observation period. More than 11% of patients repeated self-inflicted injury ≤1 year (and 3% ≤7 days). Repeat self-inflicted injury was associated with younger patient age, being female, a self-inflicted injury event preceding the index self-inflicted injury, index self-inflicted injury treatment setting, and patient comorbidities.

CONCLUSIONS

Approximately one in ten youth repeated self-inflicted injury within 1 year and nearly half of youth with clinically treated self-inflicted injuries never received care in hospitals or emergency departments. Physicians and families should be aware of risk factors for repeat self-inflicted injury, including mental health comorbidities. Multilevel strategies are needed to prevent youth self-inflicted injuries.

Mental Health Experiences and Service Use Among Veterinary Medical Students

The mental health and wellness of veterinary students is an important contemporary focus of scholarship. Yet, to date, little empirical work has investigated mental health experiences and rates of mental health service use in large samples of veterinary students from multiple institutions. The purpose of this study is to explore the prevalence of mental health concerns among veterinary medical students, as well as rates of mental health service utilization, using validated measures and a large sample. Study participants were 573 veterinary medical students currently enrolled in accredited veterinary medical programs in the United States. Approximately one third of participants reported levels of depression or anxiety above the clinical cut-off, and a strong positive correlation was found between the two. Depression and anxiety were also associated with prior engagement in non-suicidal self-injury (NSSI), suicidal ideation, and prior suicide attempts. Nearly 80% of participants who scored above the clinical cut-off for depression or anxiety reported seeking some form of mental health services currently or in the past, and a majority reported having positive experiences with services. Results also indicated a higher than typical rate of NSSI among veterinary medical students. Implications for outreach, research, and education are discussed.

Resource Intensity for Children and Youth: The Development of an Algorithm to Identify High Service Users in Children's Mental Health

Children’s mental health care plays a vital role in many social, health care, and education systems, but there is evidence that appropriate targeting strategies are needed to allocate limited mental health care resources effectively. The aim of this study was to develop and validate a methodology for identifying children who require access to more intense facility-based or community resources. Ontario data based on the interRAI Child and Youth Mental Health instruments were analysed to identify predictors of service complexity in children’s mental health. The Resource Intensity for Children and Youth (RIChY) algorithm was a good predictor of service complexity in the derivation sample. The algorithm was validated with additional data from 61 agencies. The RIChY algorithm provides a psychometrically sound decision-support tool that may be used to inform the choices related to allocation of children’s mental health resources and prioritisation of clients needing community- and facility-based resources.

Self-Criticism as a Transdiagnostic Process in Nonsuicidal Self-Injury and Disordered Eating: Systematic Review and Meta-Analysis

Nonsuicidal self-injury (NSSI) and disordered eating (DE) are highly comorbid and may be regarded as belonging to a spectrum of self-harm behaviors. We investigated self-criticism as a transdiagnostic correlate of these behaviors, in keeping with etiological theories of both NSSI and DE. We reviewed the literature and meta-analyzed the relation of self-criticism to both NSSI (15 studies; 17 effect sizes) and DE (24 studies; 29 effect sizes). Results showed equivalent, moderate-to-large effects for the relation of self-criticism to NSSI (r = .38; CI: .29-.46) and DE (r = .40; CI: .34-.45). The relation of NSSI to self-criticism generalized across multiple potential moderators. DE behavior type moderated the relation of self-criticism to DE, with a stronger relation emerging for purging than restriction. Findings support self-criticism as a possible candidate for transdiagnostic pathways to self-harm.

Parent and peer relationships as longitudinal predictors of adolescent non-suicidal self-injury onset

BACKGROUND

Adolescence is characterized by developmental changes in social relationships, which may contribute to, or protect against, psychopathology and risky behaviors. Non-suicidal self-injury (NSSI) is one type of risky behavior that typically begins during adolescence and is associated with problems in relationships with family members and peers. Prior research on social factors in adolescent NSSI has been limited, however, by a narrow focus on specific interpersonal domains, cross-sectional methods, retrospective self-report of childhood experiences, and a failure to predict NSSI onset among as-yet-unaffected youth.

METHODS

We investigated these relationships in 2127 urban-living adolescent girls with no NSSI history at age 13, who were participating in a longitudinal cohort study (Pittsburgh Girls Study). We used discrete-time survival analyses to examine the contribution of time-varying interpersonal risk factors, assessed yearly at ages 13-16, to NSSI onset assessed in the following year (ages 14-17), controlling for relevant covariates, such as depression and race. We considered both behavioral indicators (parental discipline, positive parenting, parental monitoring, peer victimization), and cognitive/affective indicators (quality of attachment to parent, perceptions of peers, and perceptions of one's own social competence and worth in relation to peers) of interpersonal difficulties.

RESULTS

Parental harsh punishment, low parental monitoring, and poor quality of attachment to parent predicted increased odds of subsequent adolescent NSSI onset, whereas positive parenting behaviors reduced the odds of next year NSSI onset. Youth who reported more frequent peer victimization, poorer social self-worth and self-competence, and more negative perceptions of peers were also at increased risk of NSSI onset in the following year. When tested simultaneously, no single parenting variable showed a unique association with later NSSI onset; in contrast, peer victimization and poor social self-worth each predicted increased odds of later NSSI onset in an omnibus model of peer and parent relationship characteristics.

CONCLUSIONS

In this urban sample of adolescent girls, both peer and parent factors predicted new onset NSSI, although only peer factors were associated with subsequent NSSI in combined multivariate models. Results further suggest that both behavioral and cognitive/affective indicators of interpersonal problems predict NSSI onset. These findings highlight the relevance of family and peer relationships to NSSI onset, with implications for prevention of NSSI onset among at-risk youth.

Processes of Change and Nonsuicidal Self-Injury: A Qualitative Interview Study With Individuals at Various Stages of Change

Nonsuicidal self-injury (NSSI) is a pervasive and potentially lethal behavior that affects many youth and adolescents. Effective treatment and prevention efforts are critical but often lack a nuanced understanding of the behavior change process. To address this gap, this research employs a stage of change model to identify and understand the most salient and widespread processes that facilitate NSSI behavior change. Thirty-one semi-structured interviews were conducted with individuals with current or past self-injury. Individuals were recruited to represent all stages of change including those who have not thought about changing behavior to those who have been NSSI-free for years. We employ a directed content analysis to code for dimensions derived from the model and an inductive approach to surface more nuanced change levers. Four organizing dimensions emerged: relational, behavioral, self-knowledge, and barriers. Common change levers of value in clinical practice or in intervention modalities are discussed.

A longitudinal study investigating bidirectionality among nonsuicidal self-injury, self-criticism, and parental criticism

Previous research has indicated that both self-criticism and parental criticism may be associated with engagement in nonsuicidal self-injury (NSSI). However, much less is known about the temporal sequencing of these relationships (i.e., do self-criticism and parental criticism predict NSSI across time, or does NSSI predict self-criticism and parental criticism across time?). Undergraduate students (N = 1132; 70.5% female; M_age= 19.06) from a midsized Canadian university completed measures of NSSI, self-criticism, maternal criticism, and paternal criticism at two time points (one year apart). An autoregressive cross-lagged path analysis revealed that there was a significant unidirectional relationship between NSSI and self-criticism, such that greater NSSI frequency predicted greater self-criticism across time, but self-criticism did not predict greater NSSI frequency across time. In addition, both maternal and paternal criticism were not significantly associated with NSSI frequency when examining either direction of effects. Overall, our results challenge the notion that self-criticism is a risk factor for NSSI engagement, and instead, suggest that it may be a consequence of NSSI engagement. Intervention programs may benefit from recognizing that individuals who engage in NSSI may subsequently criticize themselves.

Nonsuicidal Self-Injury: Increased Prevalence in Engagement

While some suggest nonsuicidal self-injury (NSSI) is increasing, very little has been done systematically to explore this possibility. The current study employed three cohorts of freshman (total N = 949) from the same university across a period of 7 years to explore engagement in NSSI. Related intrapersonal factors were also examined. NSSI lifetime and current engagement use drastically increased across the three cohorts. Anxiety followed a similar trajectory as NSSI behaviors as increasing in reported levels, while depression and coping behaviors did not. Implications of these trends are discussed.

Preliminary evaluation of an intensive integrated individual and family therapy model for self-harming adolescents

BACKGROUND

To investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families.

METHODS

Forty-nine self-harming and/or suicidal adolescents, Mage = 14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress.

RESULTS

From pre- to post-assessment, the adolescents reported significant reductions of self-harm (p = .001, d = 0.54) and suicide attempts (p < .0001, d = 1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups.

CONCLUSIONS

The adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group.

TRIAL REGISTRATION

This study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593-31/5).

Stigma, gender dysphoria, and nonsuicidal self-injury in a community sample of transgender individuals

We investigated rates of nonsuicidal self-injury (NSSI) and correlates of past-year NSSI among transgender people to better understand factors contributing to this health disparity. A community-based sample of 332 transgender people participated in quantitative in-person interviews. The mean age of participants was 34.56 years (SD = 13.78, range = 16-87). The sample was evenly divided between transfeminine spectrum (50.3%) and transmasculine spectrum identities (49.7%) and was diverse in race/ethnicity. We evaluated associations between sociodemographic characteristics, stigma, hypothesized resilience factors, and identity variables with past-year NSSI. 53.3% of participants reported ever having self-injured in their lifetime. Past-year NSSI was reported by 22.3% of the sample and did not significantly differ based on gender identity. In logistic regression models, past-year NSSI was associated with younger age and felt stigma (perceived or anticipated rejection), but not enacted stigma (actual experiences of discrimination), and with gender dysphoria. Efforts to address the high rates of NSSI among transgender people should aim to reduce felt stigma and gender dysphoria, and promote transgender congruence. Future research using a developmental approach to assess variations in NSSI across the life course and in relation to transgender identity development may illuminate additional processes that affect NSSI in this population.

The role of online social networking on deliberate self-harm and suicidality in adolescents: A systematized review of literature

Social media use by minors has significantly increased and has been linked to depression and suicidality. Simultaneously, age-adjusted suicide rates have steadily increased over the past decade in the United States with suicide being the second most common cause of death in youth. Hence, the increase in suicide rate parallels the simultaneous increase in social media use. In addition, the rate of nonsuicidal self-injury ranges between 14% and 21% among young people. Evidence suggests that self-harming youth is more active on online social networks than youth who do not engage in self-harm behavior. The role of online social networking on deliberates self-harm and suicidality in adolescents with a focus on negative influence was assessed by conducting a systematized literature review. A literature search on "PubMed" and "Ovid Medline" using a combination of MeSH terms yielded nine articles for data extraction satisfying predefined inclusion/exclusion criteria. It was found that social networking websites are utilized by suicidal and self-harming youth as a medium to communicate with and to seek social support from other users. Online social networking also leads to increased exposure to and engagement in self-harm behavior due to users receiving negative messages promoting self-harm, emulating self-injurious behavior of others, and adopting self-harm practices from shared videos. Greater time spent on social networking websites led to higher psychological distress, an unmet need for mental health support, poor self-rated mental health, and increased suicidal ideation. In conclusion, greater time spent on online social networking promotes self-harm behavior and suicidal ideation in vulnerable adolescents.

Self-Injurious Thoughts and Behaviors May Be More Common and Severe Among People Identifying as a Sexual Minority

Research indicates that people who identify as a sexual minority are at higher risk of numerous negative outcomes, including self-injurious thoughts and behaviors (SITBs). The minority stress model proposes that people identifying as a sexual minority are at higher risk of these behaviors due to sexual orientation-specific stressors-however, it does not clarify whether SITBs will be more severe among these individuals. The present study tested whether SITBs are more common and more severe among people identifying as a sexual minority using several metrics, including frequency of SITB engagement, age of onset of SITB, desire to discontinue SITB engagement, and likelihood of future SITBs. Four independent research samples were used to test this model. Results were then combined and tested in an internal meta-analysis. Findings converge to indicate a longer and more severe course of SITB engagement among people identifying as a sexual minority. Future research is needed to replicate these findings and to advance the understanding of why this imbalance in risk and severity might exist, and how it can be prevented.

"Boy Crisis" or "Girl Risk"? The Gender Difference in Nonsuicidal Self-Injurious Behavior Among Middle-School Students in China and its Relationship to Gender Role Conflict and Violent Experiences

PURPOSE

We attempted to test if there were gender differences in nonsuicidal self-injurious (NSSI) behaviors among Chinese middle-school students, and analyze the impact of gender role conflict and violent experiences on these behaviors among middle-school students of different genders.

METHOD

Based on the survey data from seven middle schools in Xi'an region of China, the gender difference in NSSI behaviors and its associated factors were analyzed in this study.

RESULTS

There was no significant gender difference in NSSI behaviors among middle-school students; however, female middle-school students were more likely to experience gender role conflicts while male students were more likely to experience all kinds of violence earlier. Gender role conflicts and violent experiences can explain the prevalence of NSSI behaviors by gender, to some extent.

CONCLUSIONS

The hypothesis on gender patterns of "boy crisis" or "girl risk" on NSSI prevalence was not verified; however, a "girl risk" for gender role conflicts and a "boy crisis" in violent experiences were found. The gender role conflicts were significantly associated with NSSI prevalence among middle-school students to some extent; however, this relationship was adjusted by variables of violent experiences. The different variables of violent experiences were the important predictors of NSSI prevalence among male and female middle-school students with specific contents varying across genders.

Nonsuicidal self-injury and disordered eating: Differences in acquired capability and suicide attempt severity

Nonsuicidal self-injury (NSSI) and eating disorders are both strongly related to suicide behaviors, and both can be conceptualized as painful and provocative events that associate with acquired capability for suicide. Individuals who self-injure report greater acquired capability than those who do not engage in these behaviors, but results are mixed in eating disorder samples. Given that NSSI and disordered eating (DE) commonly co-occur, it is important to examine how acquired capability for suicide and suicide attempt severity may differ between individuals who engage in either, both, or neither of these behaviors. It was expected that individuals with both NSSI and DE would report the greatest acquired capability, assessed by fearlessness about death and fear about suicide, and suicide attempt severity, compared to NSSI only, DE only, and controls. In a sample of 1179 undergraduates, results indicated no differences on fearlessness about death, but the NSSI + DE group reported the lowest scores on fear of suicide and greatest suicide attempt severity compared to the other groups. Differences between fearlessness about death and fear about suicide are discussed, as well as the possible additive effect of engaging in both direct (NSSI) and indirect (DE) self-harm on fear about suicide and suicide risk.

Teenage Trauma Patients Are at Increased Risk for Readmission for Mental Diseases and Disorders

BACKGROUND

Most studies of readmission after trauma are limited to single institutions or single states. The purpose of this study was to determine the risk factors for readmission after trauma for mental illness including readmissions to different hospitals across the United States.

MATERIALS AND METHODS

The Nationwide Readmission Database for 2013 and 2014 was queried for all patients aged 13 to 64 y with a nonelective admission for trauma and a nonelective readmission within 30 d. Multivariable logistic regression was performed for readmission for mental diseases and disorders.

RESULTS

During the study period, 53,402 patients were readmitted within 30 d after trauma. The most common major diagnostic category on readmission was mental diseases and disorders (12.1%). The age group with the highest percentage of readmissions for mental diseases and disorders was 13 to 17 y (38%). On multivariable regression, the teenage group was also the most likely to be readmitted for mental diseases and disorders compared to 18-44 y (odds ratio [OR] 0.45, P < 0.01) and 45-64 y (OR 0.24, P < 0.01). Other high-risk comorbidities included HIV infection (OR 2.4, P < 0.01), psychosis (OR 2.2, P < 0.01), drug (OR 2.0, P < 0.01), and alcohol (OR 1.4, P < 0.01) abuse.

CONCLUSIONS

Teenage trauma patients are at increased risk for hospital readmission for mental illness. Efforts to reduce these admissions should be targeted toward individuals with high-risk comorbidities such as HIV infection, psychosis, and substance abuse.

Prediction of major depressive episodes and suicide-related ideation over a 3-year interval among Japanese undergraduates

Background

Suicide has been a leading cause of death among young adult populations in Japan. The aim of this study was to predict major depressive episodes (MDEs) and suicide-related ideation among university students using the Patient Health Questionnaire-9 (PHQ-9) and the Temperament and Character Inventory (TCI).

Methods

The subjects were 2194 university students who completed the PHQ-9 and TCI in the 1st year (T1) and the PHQ-9 in the 4th year (T2) of university. Multiple logistic regression analysis was performed to predict MDEs and suicide-related ideation at T2. Moreover, recursive partitioning analyses were conducted to reveal the future risk of MDEs and suicide-related ideation.

Results

The multiple logistic regression analyses of MDEs and suicide-related ideation at T2 revealed that depressive episodes, suicide-related ideation, and low self-directedness(SD) scores at T1 were significant predictors. The area under the curve of the model for MDEs was 0.858 and that for suicide-related ideation was 0.741. The recursive partitioning analyses revealed that a PHQ-9 summary score ≥15 at T1 predicted a high risk of MDEs at T2 and that both a PHQ-9 summary score ≥5 and a PHQ-9 #9 score ≥1 predicted a high risk of suicide-related ideation at T2.

Conclusions

MDEs, suicide-related ideation, and low SD scores are significant predictors of future MDEs and suicide-related ideation.

Non-Suicidal Self-Injury, Sexuality Concerns, and Emotion Regulation among Sexually Diverse Adolescents: A Multiple Mediation Analysis

Despite increasing interest in the prevalence and correlates of Non-Suicidal Self-Injury (NSSI) in adolescent populations, relatively few studies have examined NSSI among lesbian, gay and bisexual (LGB) adolescents. The current study explored sexuality concerns and elevated emotion dysregulation as potential mechanisms underlying the relationship between sexual orientation and elevated non-suicidal self-injury (NSSI). A community sample of 1,799 adolescents completed a questionnaire assessing NSSI, sexual orientation, sexuality concerns, and emotion regulation. Across the study, 20.6% of adolescents reported a history of NSSI. Adolescents who identify as "mostly heterosexual," "bisexual," and "mostly homosexual" were more likely to engage in NSSI than gay/lesbian, heterosexual, and asexual adolescents. Multiple mediation analysis showed that emotion regulation, but not sexuality concerns, mediated the relationship between sexual orientation and NSSI. The current study tested two theoretical pathways by which sexual orientation could predict NSSI engagement. Findings suggest that literature on general psychological processes, as well as group-specific minority stressors, can shed light on high rates of NSSI among LGB populations. Specifically, the challenges faced by LGB adolescents may undermine the development of emotion regulation. As such, this should be a key target of intervention with LGB adolescents engaging in NSSI.

Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students

Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the "Saving and Empowering Young Lives in Europe" (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE's Hungarian randomly selected high school sample (N = 995) was completed with a randomly selected vocational school sample (N = 140) in Budapest, Hungary. Participants aged 14⁻17 years completed the SEYLE project's self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ²(1) = 12.231, p< 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population.

What do young adolescents think about taking part in longitudinal self-harm research? Findings from a school-based study

BACKGROUND

Research about self-harm in adolescence is important given the high incidence in youth, and strong links to suicide and other poor outcomes. Clarifying the impact of involvement in school-based self-harm studies on young adolescents is an ethical priority given heightened risk at this developmental stage.

METHODS

Here, 594 school-based students aged mainly 13-14 years completed a survey on self-harm at baseline and again 12-weeks later. Change in mood following completion of each survey, ratings and thoughts about participation, and responses to a mood-mitigation activity were analysed using a multi-method approach.

RESULTS

Baseline participation had no overall impact on mood. However, boys and girls reacted differently to the survey depending on self-harm status. Having a history of self-harm had a negative impact on mood for girls, but a positive impact on mood for boys. In addition, participants rated the survey in mainly positive/neutral terms, and cited benefits including personal insight and altruism. At follow-up, there was a negative impact on mood following participation, but no significant effect of gender or self-harm status. Ratings at follow-up were mainly positive/neutral. Those who had self-harmed reported more positive and fewer negative ratings than at baseline: the opposite pattern of response was found for those who had not self-harmed. Mood-mitigation activities were endorsed.

CONCLUSIONS

Self-harm research with youth is feasible in school-settings. Most young people are happy to take part and cite important benefits. However, the impact of participation in research appears to vary according to gender, self-harm risk and method/time of assessment. The impact of repeated assessment requires clarification. Simple mood-elevation techniques may usefully help to mitigate distress.

Another look at impulsivity: Could impulsive behavior be strategic?

In the present article, we propose that impulsive behavior may be a response to certain needs or goals that people have in the moment and could therefore be strategic. We review briefly the dominant approaches and findings in the impulsivity literature. We then examine different behaviors that are typically considered impulsive such as delay discounting, risky sexual behavior, risk taking in the context of emotion dysregulation, and adolescent risk behavior and present evidence suggesting that they follow the general principles of goal pursuit. Specifically, they are (a) enacted when perceived as relevant to the individual's motivation; (b) less likely when alternative means to fulfill these goals are available; and (c) supported rather than reduced by sufficient executive control, a hallmark of goal pursuit. We do not argue that there is no impulsive behavior. Rather, we suggest that such behavior may represent individuals' attempts to fulfill current motivations or needs. This approach emphasizes the functionality and dynamism of the behavior, it provides a framework to explain the inconsistencies in the literature, it helps us to move away from pathologizing or moralizing the behavior, and it provides insights about potential strategies to mitigate the negative consequences of acting impulsively.

Identifying the relative importance of non-suicidal self-injury features in classifying suicidal ideation, plans, and behavior using exploratory data mining

Individuals with a history of non-suicidal self-injury (NSSI) are at alarmingly high risk for suicidal ideation (SI), planning (SP), and attempts (SA). Given these findings, research has begun to evaluate the features of this multi-faceted behavior that may be most important to assess when quantifying risk for SI, SP, and SA. However, no studies have examined the wide range of NSSI characteristics simultaneously when determining which NSSI features are most salient to suicide risk. The current study utilized three exploratory data mining techniques (elastic net regression, decision trees, random forests) to address these gaps in the literature. Undergraduates with a history of NSSI (N = 359) were administered measures assessing demographic variables, depression, and 58 NSSI characteristics (e.g., methods, frequency, functions, locations, scarring) as well as current SI, current SP, and SA history. Results suggested that depressive symptoms and the anti-suicide function of NSSI were the most important features for predicting SI and SP. The most important features in predicting SA were the anti-suicide function of NSSI, NSSI-related medical treatment, and NSSI scarring. Overall, results suggest that NSSI functions, scarring, and medical lethality may be more important to assess than commonly regarded NSSI severity indices when ascertaining suicide risk.