Prevalence and correlates of self-injury among university students

The underlying role of posttraumatic stress disorder symptoms in the association between intimate partner violence and deliberate self-harm among African American women

African American women are at heightened risk for intimate partner violence (IPV) and its negative consequences, including health-compromising behaviors. Deliberate self-harm (DSH) is one clinically-relevant behavior that has been understudied among African American women generally and those with exposure to IPV in particular. To date, no studies have examined factors that may account for the relationship between IPV and DSH. Therefore, the goal of the present study was to examine the intercorrelations among IPV (physical, psychological, and sexual), PTSD, and DSH history and versatility, and the potentially mediating role of PTSD symptoms in the IPV-DSH relation. Participants were 197 African American community women currently experiencing IPV. Sixty participants (31%) reported a history of DSH. Among participants who reported DSH, there was an average endorsement of 2.3 unique forms of deliberate self-harm (i.e., DSH versatility). Significant positive associations were detected among physical IPV severity, psychological IPV severity, PTSD symptom severity, and DSH history and versatility. PTSD symptom severity mediated the relationships between physical and psychological IPV severity and DSH history and versatility. Results highlight the relevance of PTSD symptoms to DSH and suggest that treatments targeting PTSD symptoms may be useful in reducing DSH among IPV-exposed African American women.

Differences between nonsuicidal self-injury and suicidal behavior in patients with eating disorders

Although it has been reported that 25% to 50% of patients with eating disorders engage in self-harming behaviors (SHBs), including nonsuicidal self-injury (NSSI) and suicidal behavior (SB), no study has investigated the psychological mechanisms underlying these SHBs or any differences that may exist between NSSI and SB. This study involved 76 female patients with eating disorders who were treated at the Kyoto University Hospital between July and August, 2010, who answered questionnaires about SHBs, eating attitudes, tendency to dissociate, and attachment style. Some of the participants (22.4%) had other psychiatric disorders in addition to eating disorders, including borderline personality disorder, dissociative disorder, and posttraumatic stress disorder. Of the participants without comorbidity, 23.7% had engaged in SHBs in the past 3 months. Participants with comorbidity tended to dissociate significantly more than participants without comorbidity. Logistic regression indicated that, in all participants, NSSI in the past 3 months was related to the tendency to dissociate and having a higher body mass index, whereas preoccupied attachment style was potentially related to recent SB. Specifically, among the participants without comorbidity, a sense of ineffectiveness and poor interoceptive awareness were related to recent NSSI, and severity of binge-eating was related to SB. In contrast, a history of NSSI in the patients with eating disorders without comorbidity was related to a sense of ineffectiveness. The results of our study suggest that it may be important to help patients with eating disorders recover their own sense of effectiveness as a possible way to reduce SHBs.

Impulsivity and nonsuicidal self-injury: A review and meta-analysis

Nonsuicidal self-injury (NSSI; direct self-injury without lethal intent) often is thought to be associated with impulse control problems. Recent research, however, offers conflicting results about whether impulsivity is a risk factor for NSSI engagement. To disentangle findings on the link between impulsivity and NSSI, an extensive review of the literature was conducted using several electronic databases (i.e., PsychInfo, PsychArticles, ERIC, CINAHL, and MEDLINE). In total, 27 studies that met the specific inclusion criteria were identified. Results of a meta-analysis revealed that individuals who engaged in NSSI self-reported greater impulsivity than individuals who did not engage in NSSI, and that this effect was most consistent for measures of negative urgency. In contrast, there was little evidence of an association between lab-based measures of impulsivity (e.g., Go/No-Go, Stop/Signal Task) and NSSI. Moreover, the link between impulsivity and NSSI found for self-report measures was sometimes eliminated when other risk factors for NSSI were controlled (e.g., abuse, depression, post-traumatic stress disorder). In addition to integrating findings, the present review provides several explanations for the discrepancies in findings between studies employing self-report versus lab-based measures of impulsivity. To conclude, several specific recommendations for future research directions to extend the literature on impulsivity and NSSI are offered.

Factors associated with current versus lifetime self-injury among high school and college students

We sought to identify factors associated with current versus lifetime nonsuicidal self-injury (NSSI) and factors that show consonant and distinct relationships with current NSSI for adolescents and young adults. Data came from a population-based survey of high school students (n = 9,985) and a national survey of college students (n = 7,801). Among both samples, factors associated with current NSSI included male gender, younger age, greater depressive symptoms, more hopelessness, and being the victim of a verbal or physical assault. For high school students, greater anxiety, and for college students, identifying as non-White, negative perceptions of one's weight, a same-sex sexual experience, and involvement in dating violence also distinguished the groups. Findings suggest that clinical and research assessments of lifetime NSSI might not extend to current behavior, and some differences exist in the factors associated with current behavior between adolescents and young adults. Clinical practice and prevention programming efforts should target certain intrapersonal and interpersonal factors associated with current NSSI among younger students during stressful transition periods in their lives, such as entering high school or college, when they might consider initiating or continuing this behavior.

Longitudinal effects of psychological symptoms on non-suicidal self-injury: a difference between adolescents and young adults in China

PURPOSE

Few longitudinal studies have examined the psychological symptoms that may lead to non-suicidal self-injury (NSSI) among Chinese adolescents and young adults. This study determined the predictive effects of psychological symptoms for NSSI during a 9-month follow-up period.

METHODS

Data from 17,622 students, 12-24 years of age, were analyzed in a cross-sectional fashion with respect to associations between psychological symptoms and NSSI. Follow-up surveys were performed 3, 6, and 9 months later. Incident cases of NSSI during follow-up were correlated with the psychological symptoms at baseline.

RESULTS

A total of 3,001 (17.0%) students reported that they had NSSI in the 12 months before the initial assessment. The total rate of NSSI revealed no statistically significant differences by gender, but marked differences between grades. The response rate 3, 6, and 9 months later was 91.8, 81.8, and 79.1%, respectively. Our cross-sectional study demonstrated statistically significant associations between emotional problems, conduct problems, social adaptation problems, psychological problems, and NSSI (P < 0.01). In the longitudinal study, emotional problems, conduct problems, social adaptation problems, and psychological problems at baseline had statistically significant associations with incident NSSI in follow-up involving the adolescents, while the association in young adults was attenuated after adjustment for confounding variables. Moreover, psychological symptoms at baseline showed a monotonic dose-response relationship with NSSI in follow-up involving adolescents.

CONCLUSIONS

The findings suggest that adolescents with psychological symptoms are a group with elevated risks for later NSSI. The prevention programs of NSSI should target attenuating the severity of psychological symptoms.

Sexual orientation and non-suicidal self-injury: a meta-analytic review

The aim of this study was to conduct the first meta-analysis comparing risk for NSSI between sexual minority and heterosexual persons. Eleven published and 4 unpublished studies were reviewed, describing associations between sexual orientation and NSSI in 7,147 sexual minority and 61,701 heterosexual participants. The overall weighted effect size for the relationship between sexual orientation and NSSI using a random-effects model was OR = 3.00 (95% CI = 2.46-3.66), indicating a medium-to-large effect. Sexual minority adolescents and bisexuals were found to be at particularly high-risk. These findings highlight the need to examine mechanisms linking sexual orientation and NSSI in future research. Building on these findings can add to understanding the associations between sexual orientation, NSSI, and suicidality, as well as prevention/intervention.

Levels of dissociation and nonsuicidal self-injury: a quartile risk model

Extant research indicates that dissociation may act as a risk factor for nonsuicidal self-injury (NSSI), but the data are mixed. In this study, 75 university and community females ages 18-35 were assessed for rates of normative, clinical, and severely clinical dissociation as well as for NSSI. Significant differences in normative dissociation were found between the control group and the group reporting a history of NSSI. In addition, normative dissociation--but not clinical or severely clinical dissociation--was found to be significantly associated with NSSI in this sample. Considering this finding in the context of the existing literature, we propose a quartile risk model of dissociation and NSSI as a new approach to the influences of levels of dissociation on NSSI risk.

Ethnic differences in prevalence and correlates of self-harm behaviors in a treatment-seeking sample of emerging adults

The present study examined differences between White and ethnic minority emerging adults in the prevalence of self-harm behaviors – i.e., non-suicidal self-injury (NSSI) and suicide attempts (SA) – and in well-documented risk (i.e., depressive symptoms, generalized anxiety symptoms, social anxiety symptoms, suicidal ideation (SI), substance use, abuse history) and protective factors (i.e., religiosity/spirituality, family support, friend support) associated with NSSI and SAs. Emerging adults (N=1156; 56% ethnic minority), ages 17–29 (M=22.3, S.D.=3.0), who were presented at a counseling center at a public university in the Northeastern U.S., completed a clinical interview and self-report symptom measures. Univariate and multivariate logistic regression models were used to examine the association between risk and protective factors in predicting history of NSSI-only, any SA, and no self-harm separately among White and ethnic minority individuals. Ethnic differences emerged in the prevalence and correlates of NSSI and SAs. Social anxiety was associated with SAs among White individuals but with NSSI among ethnic minority individuals. Substance use was a more relevant risk factor for White individuals, and friend support was a more relevant protective factor for ethnic minority individuals. These findings suggest differing vulnerabilities to NSSI and SAs between White and ethnic minority emerging adults.

Risk factors associated with self-injurious behavior among a national sample of undergraduate college students

OBJECTIVE

Nonsuicidal self-injury (NSSI) and suicidality among undergraduates represent important public health issues. This analysis identified risk factors that distinguished 3 groups, those who reported no history of self-harm; self-injury, but no suicide attempts (NSSI only); and self-injury and a suicide attempt (NSSI + SA) in the past year.

METHODS

Data came from 16,044 undergraduates who completed the Fall 2010 National College Health Assessment.

RESULTS

Over 3% of students reported NSSI, and one third of these individuals also attempted suicide. Factors that distinguished the NSSI only and NSSI + SA groups from the no self-harm group included current depressive symptoms, nonheterosexual orientation, an eating disorder/extreme weight control behavior, and diagnosis of an internalizing disorder. Factors that distinguished the NSSI + SA group from the NSSI only group were current depressive symptoms and diagnosis of an internalizing disorder.

CONCLUSIONS

Students experiencing mental health problems demonstrate increased risk for NSSI and/or suicidal behavior.

An Exploratory Study of the Nature and Extent of Nonsuicidal Self-Injury among College Women

This study assessed the extent and nature of nonsuicidal self-injury (NSSI) among 165 students attending an all-women’s college. Associations between NSSI behaviors and demographics, borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and attachment styles were investigated. Statistically significant relationships between the severity of NSSI and demographic characteristics and BPD and PTSD were explored using bivariate analysis. Within this population, presence of NSSI behavior was significantly associated with age, years in college, nonheterosexual orientation, BPD, PTSD, and preoccupied attachment styles. There were also marginally significant associations with race and financial status. Severity of NSSI behaviors was significantly associated with age, years in college, BPD pathology, and primary parent’s level of education. A logistic regression analysis was developed that predicted NSSI behavior with 67% accuracy based on these findings. This study has implications for clinical practice.

Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression

Published prevalence estimates of nonsuicidal self-injury (NSSI) among nonclinical samples are highly heterogeneous, raising concerns about their reliability and hindering attempts to explore the alleged increase in NSSI over time. Accordingly, the objectives of this study were to investigate the influence of methodological factors on heterogeneity in NSSI prevalence estimates, explore changes over time, and estimate overall international NSSI prevalence. Results showed that methodological factors contributed over half (51.6%) of the heterogeneity in prevalence estimates, and, after adjusting for these factors, NSSI prevalence did not increase over time. Overall, pooled NSSI prevalence was 17.2% among adolescents, 13.4% among young adults, and 5.5% among adults. Clearly, development of standardized methodology in NSSI research is crucial if accurate estimates are desired.

Meaning made of stress among veterans transitioning to college: examining unique associations with suicide risk and life-threatening behavior

Meaning made of stress has been shown to be a unique predictor of mental and physical health. In this study, we examined the unique associations between two facets of meaning made of stress (comprehensibility and footing in the world) and suicide risk and life-threatening behavior among military veterans who have transitioned to college were examined, controlling for demographic factors, religiousness, combat-related physical injury, combat exposure, depressive symptoms, and posttraumatic stress symptoms. Findings suggest that comprehensibility (having “made sense” of a stressor) is uniquely associated with lower suicide risk and a lower likelihood of driving under the influence of drugs or alcohol and engaging in self-mutilating behaviors.

Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: a comparative study of findings in 11 European countries

OBJECTIVES

To investigate the prevalence and associated psychosocial factors of occasional and repetitive direct self-injurious behavior (D-SIB), such as self-cutting, -burning, -biting, -hitting, and skin damage by other methods, in representative adolescent samples from 11 European countries.

METHODS

Cross-sectional assessment of adolescents was performed within the European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), which was conducted in 11 European countries. The representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9 ± 0.89) recruited from randomly selected schools. Frequency of D-SIB was assessed by a modified 6-item questionnaire based on previously used versions of the Deliberate Self-Harm Inventory (DSHI). In addition, a broad range of demographic, social, and psychological factors was assessed.

RESULTS

Overall lifetime prevalence of D-SIB was 27.6%; 19.7% reported occasional D-SIB and 7.8% repetitive D-SIB. Lifetime prevalence ranged from 17.1% to 38.6% across countries. Estonia, France, Germany, and Israel had the highest lifetime rates of D-SIB, while students from Hungary, Ireland, and Italy reported low rates. Suicidality as well as anxiety and depressive symptoms had the highest odds ratios for both occasional and repetitive D-SIB. There was a strong association of D-SIB with both psychopathology and risk-behaviors, including family related neglect and peer-related rejection/victimization. Associations between psychosocial variables and D-SIB were strongly influenced by both gender and country. Only a minor proportion of the adolescents who reported D-SIB ever received medical treatment.

CONCLUSION

These results suggest high lifetime prevalence of D-SIB in European adolescents. Prevalence as well as psychosocial correlates seems to be significantly influenced by both gender and country. These results support the need for a multidimensional approach to better understand the development of SIB and facilitate culturally adapted prevention/intervention.

Use of the cross-translational model to study self-injurious behavior in human and nonhuman primates

Nonsuicidal self-injurious behavior occurs in the general human population, particularly among teenagers and young adults. Some rhesus macaques also develop self-injurious behavior (SIB) as adolescents or young adults. In both of these cases, the development of harmful behaviors is idiopathic, only coming to the attention of physicians or veterinarians after the disorder is established. Thus, a combination of retrospective, statistical, and empirical procedures are used to understand this disorder. Here, we identify concordances between macaques and humans across five different levels of analysis-(1) form and prevalence, (2) etiology, (3) triggering events, (4) function/maintenance, and (5) therapeutic intervention-and show the value of the cross-translational model (macaques to humans and humans to macaques) in understanding this phenomenon. Substantial concordance is present with respect to the range of severity, the presence of early life stress exposure, and emotional dysregulation. In the macaque model, additional information is available on the hypothalamic-pituitary-adrenal axis stress response system, possible genetic involvement, and the immediate contextual situations that appear to trigger or exacerbate SIB episodes. In contrast, considerably more information is available from human studies on the effectiveness of various treatment regimens. Veterinarians have drawn on this information to explore these therapeutic interventions in monkeys. We expect that models of SIB will continue to have cross-translational impact as scientists and practitioners move from preclinical to clinical research and treatment.

Phenomenology of borderline personality disorder: the role of race and socioeconomic status

Little is known about racial differences in borderline personality disorder (BPD) that may influence etiology, phenomenology, and treatment of women with BPD. A total of 83 women with BPD participated in this cross-sectional study: n = 41 white and n = 42 African-American women. Structured interviews were used to assess Axis I and II disorders, and a series of interviews and questionnaires captured internalizing and externalizing symptoms. The white women with BPD reported more severe internalizing symptoms, whereas the African-American women reported more severe externalizing symptoms. Except for the association between race and number of suicide attempts, the relationship between race and internalizing/externalizing symptoms was mediated by socioeconomic status. In conclusion, African-American women with BPD may present with more severe symptoms of lack of anger control and fewer suicidal behaviors than those of white women with BPD, raising the possibility that they are misdiagnosed and receive treatments that are not optimal for BPD.

Assessing the prevalence of and factors associated with overweight, obesity, and binge eating as a function of ethnicity

OBJECTIVE

This study aimed to examine the prevalence of and factors associated with overweight, obesity, and binge eating as a function of ethnicity among a national sample of college students.

METHODS

Data were drawn from the 2010 Healthy Minds Study sample. Participants were 24,396 college students from 26 colleges and universities. This sample included 62 % females and a broad range of ethnic backgrounds; 30 % were overweight, 10 % were obese, and 7 % met criteria the for binge eating.

RESULTS

While African Americans reported the highest prevalence of overweight (49 %) and obesity (24 %), Arab-Americans reported the highest prevalence of binge eating (10 %). The factors associated with weight problems and binge eating differed by ethnicity.

CONCLUSIONS

Research is warranted to develop more culturally sensitive interventions to target those ethnic minorities at elevated risk. Further study of binge eating among Arab-Americans is particularly important, as the prevalence of this condition was higher among this group over any other.

Heterogeneity of interpersonal problems among depressed young adults: associations with substance abuse and pathological personality traits

This study extended previous theory and research on interpersonal heterogeneity in depression by identifying groups of depressed young adults who differ in their type and degree of interpersonal problems, and by examining patterns of pathological personality traits and alcohol abuse among these groups. We examined the interpersonal problems, personality traits, and alcohol-related problems of 172 college students with at least moderate levels of self-reported depression on the Patient Health Questionnaire (Spitzer, Kroenke, & Williams, 1999). Scores from the Inventory of Interpersonal Problems-Short Circumplex (Soldz, Budman, Demby, & Merry, 1995) were subjected to latent profile analysis, which classified individuals into 5 distinct groups defined by the types of interpersonal problems they experience (dominant, warm, submissive, cold, and undifferentiated). As hypothesized, groups did not differ in depression severity, but did show predicted patterns of differences on normative and maladaptive personality traits, as well as alcohol-related problems. The presence of clinically meaningful interpersonal heterogeneity in depression could have important implications for designing more individualized treatments and prevention efforts for depression that target diverse associated interpersonal problems.

Mental health in American colleges and universities: variation across student subgroups and across campuses

We estimated the prevalence and correlates of mental health problems among college students in the United States. In 2007 and 2009, we administered online surveys with brief mental health screens to random samples of students at 26 campuses nationwide. We used sample probability weights to adjust for survey nonresponse. A total of 14,175 students completed the survey, corresponding to a 44% participation rate. The prevalence of positive screens was 17.3% for depression, 4.1% for panic disorder, 7.0% for generalized anxiety, 6.3% for suicidal ideation, and 15.3% for nonsuicidal self-injury. Mental health problems were significantly associated with sex, race/ethnicity, religiosity, relationship status, living on campus, and financial situation. The prevalence of conditions varied substantially across the campuses, although campus-level variation was still a small proportion of overall variation in student mental health. The findings offer a starting point for identifying individual and contextual factors that may be useful to target in intervention strategies.

Adolescent nonsuicidal self-injury: the effects of personality traits, family relationships and maltreatment on the presence and severity of behaviours

Personality traits, family environment and maltreatment episodes are often associated with nonsuicidal self-injury (NSSI); however, research on these associations has shown mixed results. The aim of the present study was to clarify the effects of these factors on the presence and the severity of NSSI among a sample of Italian students who attended secondary schools (N = 267, mean age = 17.03 SD = 0.866). The results showed that personality traits, family environment and maltreatment differently predicted the presence and the severity of NSSI. Self-injurers were more impulsive and aggressive than non-self-injurers and reported poorer relationship quality with their mothers and more sexual and physical abuse episodes than non-self-injurers. Conversely, the frequency of NSSI behaviours was predicted by the presence of less impulsiveness, more anxiety and aggressiveness, poorer relationship quality with both parents and a lower degree of identification with the father. Finally, more frequent self-injurers also reported more sexual abuses and neglect episodes than less frequent self-injurers.

Exploring the relationship between posttraumatic stress disorder and deliberate self-harm: the moderating roles of borderline and avoidant personality disorders

Despite increasing evidence for an association between posttraumatic stress disorder (PTSD) and deliberate self-harm (DSH), few studies have examined the factors that moderate this association or the impact of co-occurring personality disorders among individuals with PTSD on DSH frequency. Given the high rates of co-occurrence between PTSD and two personality disorders of particular relevance to DSH, borderline personality disorder (BPD) and avoidant personality disorder (AVPD), this study examined the moderating role of these personality disorders in the association between PTSD and DSH frequency among a sample of substance use disorder patients (N=61). Patients completed structured clinical interviews assessing PTSD, BPD, and AVPD and a questionnaire assessing DSH. Results revealed more frequent DSH among patients with (vs. without) PTSD and provided evidence for the moderating role of AVPD in this association. Specifically, results revealed heightened levels of DSH only among PTSD patients with co-occurring AVPD. Findings are consistent with past research demonstrating that the presence of co-occurring AVPD among patients with other Axis I and II disorders is associated with worse outcomes, and highlight the importance of continuing to examine the moderating role of AVPD in the association between PTSD and a variety of health-risk behaviors.

Child maltreatment, subsequent non-suicidal self-injury and the mediating roles of dissociation, alexithymia and self-blame

OBJECTIVE

Although child maltreatment is associated with later non-suicidal self-injury (NSSI), the mechanism through which it might lead to NSSI is not well understood. The current retrospective case-control study examined associations between child maltreatment and later NSSI, and investigated the mediating roles of dissociation, alexithymia, and self-blame.

METHODS

Participants were 11,423 Australian adults (response rate 38.5%), randomly selected from the Australian Electronic White Pages, aged between 18 and 100 (M=52.11, SD=16.89), 62.2% female. Data were collected via telephone interviewing. Main outcome measures were reported history of child maltreatment (sexual abuse, physical abuse, neglect) and reported 12-month NSSI. Dissociation, alexithymia, and self-blame were examined as potential mediating variables in the relationship between child maltreatment and later NSSI. All analyses were conducted using logistic regression and adjusted for age and psychiatric diagnosis.

RESULTS

Results differed by gender. Compared to no child maltreatment, physical abuse (OR 2.75, 95% CI 1.68-4.51) and neglect (OR 2.56, 95% CI 1.65-3.99) independently increased the odds of NSSI among females. Physical abuse (OR 2.69, 95% CI 1.44-5.03) increased the odds of NSSI among males. Sexual abuse did not independently increase the odds of NSSI for males or females. For females, self-blame had the greatest effect on the child maltreatment-NSSI relationship (OR decreased by 14.6%, p<.000), although dissociation and alexithymia also partially mediated the relationship. For males, dissociation had the greatest effect (OR decreased by 12.9%, p=.003) with self-blame also having a relatively strong effect.

CONCLUSIONS

The results indicate that child maltreatment, and in particular, physical abuse, is strongly associated with the development of subsequent NSSI and may be partially mediated by dissociation, alexithymia, and self-blame for females and dissociation and self-blame for males. Altering attributional style (through cognitive therapy or emotion focussed therapy) and improving the capacity to regulate emotions (through dialectical behaviour therapy) may contribute to reduction or cessation of NSSI.

Self-harm and suicidal behaviors in Hong Kong adolescents: prevalence and psychosocial correlates

The present paper examined the prevalence and psychosocial correlates of adolescent deliberate self-harm (DSH) and suicidal behavior in a representative sample of 3,328 secondary school students in Hong Kong. With reference to the previous year, 32.7% of the students reported at least one form of DSH, 13.7% of the respondents had suicide thoughts, 4.9% devised specific suicidal plans, and 4.7% had actually attempted suicide. Adolescent girls had significantly higher rates of DSH and suicidal behavior than did adolescent boys. Having remarried parents was related to an increased likelihood of DSH and suicide. While high levels of family functioning, overall positive youth development, and academic and school performance predicted low rates of DSH and suicidal behavior, cognitive and behavioral competencies were unexpectedly found to be positively associated with DSH and suicidal behavior. Theoretical and practical implications of the findings are discussed.

Giving up self-injury: a comparison of everyday social and personal resources in past versus current self-injurers

Self-injury represents a common yet perplexing set of behaviors, considered difficult to treat. The current study aimed to identify social and personal resources that may aid in cessation of self-injury. A community sample of 312 participants completed an online questionnaire. In line with Brown and Williams ( 2007 ), we compared all self-injurers (current and past) (106, 34%) with those who had never self-injured (206, 66%), and then current (38, 12.2%) with past self-injurers (68, 21.8%). Overall, self-injurers reported significantly lower levels of perceived social support, social connectedness, resilience, self-esteem, and life satisfaction compared to those with no such history. Further analysis indicated that family support, self-esteem, resilience, and satisfaction with life were significantly better for past compared to current self-injurers (at the p < 0.01 level). Logistic regression suggested that self-injurers could be distinguished from non self-injurers on Self-esteem and Social Connectedness. A further logistic regression suggested that past self-injurers could be distinguished from current self-injurers by their level of Resilience. The research has important preventive and clinical implications.

Mental health service utilization among college students in the United States

We aimed to provide the most comprehensive picture, to date, of service utilization and help-seeking behavior for mental health problems among college students in the United States. We conducted online surveys in 2007 and 2009 of random samples of students in 26 campuses nationwide. Among students with an apparent mental health problem (32% of the weighted sample), 36% received any treatment in the previous year. The prevalence of psychotherapy and medication use was approximately equal. Treatment prevalence varied widely across campuses, with some campuses having prevalence 2 to 3 times higher than those of others. Apparent barriers to help-seeking included skepticism on treatment effectiveness and a general lack of perceived urgency. Overall, the findings indicate that help-seeking for mental health varies substantially across student characteristics and across campuses. Strategies to address the low prevalence of treatment will need to be responsive to this diversity.

Addressing mental health epidemic among university students via web-based, self-screening, and referral system: a preliminary study

The prevalence and severity of mental health problems in college and university communities are alarming. However, the majority of students with mental disorders do not seek help from professionals. To help students assess their mental conditions and encourage them to take an active role in seeking care, we developed a web-based self-screening, referral, and secure communication system and evaluated it at the University of Washington for 17 months. The system handled more than 1000 screenings during the study period. Of the subjects who used the system, 75% noted that the system helped them to make a decision to receive help from professionals. The system was able to provide outreach to students with mental health concerns effectively, allow them to self-screen their conditions, and encourage them to receive professional assistance. The system provided students with 24/7 web-based access to the clinic, and more than 50% of the system use was made during off-hours. The system was well received by patients, referral managers, and care providers, and it was transferred to the clinic for daily clinical use. We believe that a web-based system like ours could be used as one way to tackle the growing epidemic of mental health problems among college and university students.

Depression and suicide ideation among students accessing campus health care

Depression and suicide are of increasing concern on college campuses. This article presents data from the College Health Intervention Projects on the frequency of depression and suicide ideation among 1,622 college students who accessed primary care services in 4 university clinics in the Midwest, Northwest, and Canada. Students completed the Beck Depression Inventory and other measures related to exercise patterns, alcohol use, sensation seeking, and violence. The frequency of depression was similar for men (25%) and women (26%). Thought of suicide was higher for men (13%) than women (10%). Tobacco use, emotional abuse, and unwanted sexual encounters were all associated with screening positive for depression. "Days of exercise per week" was inversely associated with screening positive for depression. Because the majority of students access campus-based student health centers, medical providers can serve a key role in early identification and intervention. With every 4th student reporting symptoms of depression and every 10th student having suicidal thoughts, such interventions are needed.

Nonsuicidal self-injury in a college population: general trends and sex differences

OBJECTIVE

To describe basic nonsuicidal self-injury (NSSI) characteristics and to explore sex differences.

METHODS

A random sample from 8 universities were invited to participate in a Web-based survey in 2006-2007; 38.9% (n = 14,372) participated. Analysis assessed sex differences in NSSI prevalence, practices, severity, perceived dependency, and help-seeking; adjusted odds ratios for NSSI characteristics were calculated by sex status.

RESULTS

Lifetime NSSI prevalence rates averaged 15.3%. Females were more likely than males to self-injure because they were upset (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.3-2.1) or in hopes that someone would notice them (AOR = 1.6, 95% CI = 1.1-2.7). Males were 1.6 times (95% CI = 1.2-2.2) more likely to report anger and 4.0 times (95% CI = 2.3-6.8) more likely to report intoxication as an initiating factor. Sexual orientation predicted NSSI, particularly for women (Wald F = 8.81, p ≤ .000). Only 8.9% of the NSSI sample reported disclosing NSSI to a mental health professional.

CONCLUSIONS

NSSI is common in college populations but varies significantly by sex and sexual orientation. NSSI disclosure is low among both sexes.

Self-injurious behavior in adolescents

Janis Whitlock discusses the epidemiology and and care of adolescents undertaking nonsuicidal self-injury, also called “deliberate self-harm.”

Deliberate self-harm in Oxford University students, 1993-2005: a descriptive and case-control study

BACKGROUND

Deliberate self-harm (DSH; intentional self-poisoning or self-injury) is a major problem among young people and has been identified as one of the key mental health problems affecting students.

METHOD

Data on DSH presentations to the general hospital in Oxford by Oxford University students were analysed for the 12-year period from 1993 to 2005. The characteristics of the students with DSH were compared with those of age-matched DSH controls in the Oxford City area.

RESULTS

Problems with academic work, relationships with family, partners and friends were most likely to contribute to DSH episodes in students. Many experienced problems with psychiatric disorders and social isolation. The frequency of eating disorders was very high in students, and contributed to DSH significantly more often than in controls. Fewer students than controls self-poisoned in the DSH episode, fewer had personality disorder and fewer had problems with physical health, finance, housing and violence. Alcohol consumption in association with DSH and alcohol-related problems were common in both students and controls. Male students had significantly higher suicide intent than controls. Many students were referred to the university counselling service for follow-up, a resource not available to non-student controls.

CONCLUSIONS

Comparison of university students following DSH with age-matched controls has shown key differences in psychiatric characteristics, problems contributing to DSH and aftercare offered. These findings may help in the design of targeted self-harm prevention and management strategies for students.

The anxiogenic drug FG7142 increases self-injurious behavior in male rhesus monkeys (Macaca mulatta)

AIMS

Self-injurious behavior (SIB), which is deliberate infliction of self-injury without suicidal intent, is a significant human health problem. SIB is not unique to humans but is also manifested in a small percentage of captive macaques, typically as self-directed biting. Although the onset and maintenance of SIB have been linked to increased anxiety in both humans and nonhuman primates, no previous studies have directly tested the anxiety-SIB hypothesis. Here, we determined whether rhesus monkeys increase their self-directed biting following a challenge with the anxiogenic compound N-methyl-beta-carboline-3-carboxamide (FG7142).

MAIN METHODS

Ten rhesus monkeys (Macaca mulatta) with a veterinary record of self-wounding (SIB) as well as six age- and weight-matched non-wounding control monkeys were given intramuscular injections of 0.1, 0.3, or 1.0mg/kg FG7142. Behavior was observed following drug administration with special attention to displacement behaviors (scratching, self-grooming, and yawning), locomotor stereotypy, and self-directed biting. Plasma cortisol and ACTH were also measured as physiological indices of stress.

KEY FINDINGS

Self-directed biting rates dose-dependently increased in a subset of SIB monkeys, but did not change in control animals. Furthermore, administration of FG7142 led to an increase in scratching, yawning, and locomotor stereotypy in all monkeys, but did not affect the frequency self-grooming. Additionally, there was a dose-dependent increase in plasma cortisol concentrations, but not ACTH, in all animals.

SIGNIFICANCE

The present findings indicate that self-biting is anxiety-related in some but not all SIB monkeys, suggesting that this behavioral pathology is heterogeneous as has previously been suggested for SIB in humans.

Social support and mental health among college students

This study is the first, to our knowledge, to evaluate the relationship between mental health and social support in a large, random sample of college students. A Web-based survey was administered at a large, public university, with 1,378 students completing the measures in this analysis (response rate = 57%). The results support our hypothesis that students with characteristics differing from most other students, such as minority race or ethnicity, international status, and low socioeconomic status, are at greater risk of social isolation. In addition, the authors found that students with lower quality social support, as measured by the Multidimensional Scale of Perceived Social Support, were more likely to experience mental health problems, including a sixfold risk of depressive symptoms relative to students with high quality social support. These results may help administrators and health providers to identify more effectively the population of students at high risk for mental illness and develop effective interventions to address this significant and growing public health issue.

Persistence of mental health problems and needs in a college student population

BACKGROUND

Cross-sectional studies indicate a high prevalence of mental health problems among college students, but there are fewer longitudinal data on these problems and related help-seeking behavior.

METHODS

We conducted a baseline web-based survey of students attending a large public university in fall 2005 and a two-year follow-up survey in fall 2007. We used brief screening instruments to measure symptoms of mental disorders (anxiety, depression, eating disorders), as well as self-injury and suicidal ideation. We estimated the persistence of these mental health problems between the two time points, and determined to what extent students with mental health problems perceived a need for or used mental health services (medication or therapy). We conducted logistic regression analyses examining how baseline predictors were associated with mental health and help-seeking two years later.

RESULTS

Over half of students suffered from at least one mental health problem at baseline or follow-up. Among students with at least one mental health problem at baseline, 60% had at least one mental health problem two years later. Among students with a mental health problem at both time points, fewer than half received treatment between those time points.

LIMITATIONS

Mental health problems are based on self-report to brief screens, and the sample is from a single university.

CONCLUSIONS

These findings indicate that mental disorders are prevalent and persistent in a student population. While the majority of students with probable disorders are aware of the need for treatment, most of these students do not receive treatment, even over a two-year period.