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Cheng J, Guan M, Peng C, Hu J, Rong F, Wang Y, Zhang N, Xu Z, Yu Y. Self-injury and suicidal ideation among Chinese adolescents involved in different subtypes of aggression: The role of gender. J Affect Disord 2024; 355:371-377. [PMID: 38537758 DOI: 10.1016/j.jad.2024.03.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Although aggression associated self-injury and suicidal ideation, but the specific impact of different subtypes of aggression is unclear. Therefore, the current study aims to quantify the associations between five subtypes of aggression, self-injury, and suicidal ideation in Chinese adolescents. METHOD A total of 18,532 students were recruited in grades 7 to 12 using a stratified cluster sampling across five representative provinces in China. The Functional Assessment of Self-Mutilation (CH-FASM) and Buss and Warren's Aggression Questionnaire (BWAQ) assess self-injury and aggression, respectively. RESULTS During the last year, the proportion of self-injury, suicidal ideation, and self-injury plus suicidal ideation (SSI) were 13.4 %, 10.0 %, 12.4 %, respectively. Multivariate logistic regression indicated that hostility was associated with self-injury-only (OR = 1.033, 95 % CI = 1.021-1.044), suicidal ideation-only (OR = 1.075, 95 % CI = 1.061-1.088), and SSI (OR = 1.100, 95 % CI = 1.087-1.114) (all P < 0.001) across five subtypes of aggression. In gender stratification, physical aggression was risk factor for self-injury-only, suicidal ideation-only, and SSI (OR = 1.028, 95 % CI = 1.018-1.037, P < 0.001) in females. While anger was association with self-injury-only and suicidal ideation-only in males (P < 0.05). LIMITATIONS This study was a cross-sectional design and self-reported questionnaire. CONCLUSION Hostility is a strong predictor of self-injury and suicidal ideation across five subtypes of aggression. There are gender differences in relationships. Prevention programs for adolescents' self-injury and suicidal ideation should consider different subtypes of aggression and gender differences.
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Affiliation(s)
- Junhan Cheng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meiqi Guan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chang Peng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fajuan Rong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nan Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zixuan Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yizhen Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Kostic J, Žikić O, Djordjević V, Ristić A, Krivokapić Ž. Nonsuicidal Self-Injury and Suicidal Beliefs in Adolescent Inpatient. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:796. [PMID: 38792979 PMCID: PMC11122763 DOI: 10.3390/medicina60050796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Although nonsuicidal self-injury (NSSI), by definition, excludes suicidal intent, numerous studies show associations between NSSI and suicidal phenomena in clinical and outpatient adolescent samples. Given the growing interest in the relationship between NSSI and suicidal phenomena, the present study aimed to investigate the relationship between NSSI and suicidal beliefs in adolescent psychiatric inpatients. Materials and Methods: The study sample included 50 adolescent inpatients at a specialized facility, with a mean age of 15.44 ± 1.39, who fulfilled DSM-5 criteria for NSSI. For study purposes, we use the Ottawa Self-Injury Inventory (OSI) and Brief Suicide Cognitions Scale (B-SCS). Statistical data processing was performed in the R software 4.3.0 (R Core Team, Vienna, Austria). Results: Of all NSSI functions, the Internal ER function score was the highest (18.72 ± 7.08), followed by External ER (8.10 ± 3.11), Social Influence (5.88 ± 5.37), and Sensation Seeking (3.44 ± 2.98). The mean Craving (C) score was 14.06 ± 7.51. The mean value of the B-SCS score was 19.54 ± 5.24. It was found that the B-SCS score is significantly related to Internal ER (r = 0.441, p < 0.001) and Craving (r = 0.297, p = 0.036). The multivariable model shows that internal ER function and participants' age are significantly related to the B-SCS score. Conclusion: Despite the limitations of the study, it is emphasized that cognitions occurring across the fluid suicidal belief system alone do not fully capture the complexity of suicide, but assessing the suicidal belief system in NSSI inpatient adolescents could nevertheless provide helpful information for identifying individuals who may have an elevated vulnerability to experiencing suicidal ideas and behaviors over time.
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Affiliation(s)
- Jelena Kostic
- Medical College, University of Niš, 18000 Niš, Serbia
- Mental Health Protection University Clinical Centre Niš, 18000 Niš, Serbia
| | - Olivera Žikić
- Medical College, University of Niš, 18000 Niš, Serbia
- Mental Health Protection University Clinical Centre Niš, 18000 Niš, Serbia
| | - Vladimir Djordjević
- Medical College, University of Niš, 18000 Niš, Serbia
- Mental Health Protection University Clinical Centre Niš, 18000 Niš, Serbia
| | - Aleksandra Ristić
- Mental Health Protection University Clinical Centre Niš, 18000 Niš, Serbia
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Wang Z, Li D, Chen Y, Tao Z, Jiang L, He X, Zhang W. Understanding the subtypes of non-suicidal self-injury: A new conceptual framework based on a systematic review. Psychiatry Res 2024; 334:115816. [PMID: 38412712 DOI: 10.1016/j.psychres.2024.115816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
Non-suicidal self-injury (NSSI) is a significant public health problem, but there is no consistent evidence of its risk factors. One possibility is that there are subtypes NSSI that have different risk factors and clinical symptoms. In this review we evaluated the evidence of subtypes to determine if there were consistent subtypes of NSSI that emerged across studies. Four databases (Medline; Embase; PsycINFO; Web of Science) were searched to identify studies that used data-driven approaches and were published before November 9, 2022. There were 21 studies with 23 unique samples for review. Most of the included studies used NSSI symptoms or personal characteristics as the subtyping indicators, revealing 2-5 subtypes of NSSI. Variations in subtyping indicators, sample characteristics, and statistical methods may have contributed to the inconsistent number and characteristics of subtypes across studies. A new conceptual framework is proposed to integrate these diverse findings, highlighting the important roles of NSSI function and psychological pain in differentiating NSSI subtypes. This framework sheds light on the differences among self-injurers and offers insights for future endeavors to address the complexities of NSSI.
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Affiliation(s)
- Zhenhai Wang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Dongjie Li
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Yanrong Chen
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Zhiyuan Tao
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Liyun Jiang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Xu He
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Wei Zhang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China.
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4
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Reinhardt M, Rice KG, Horváth Z. Non-suicidal self-injury motivations in the light of self-harm severity indicators and psychopathology in a clinical adolescent sample. Front Psychiatry 2022; 13:1046576. [PMID: 36532173 PMCID: PMC9751932 DOI: 10.3389/fpsyt.2022.1046576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Adolescents with psychiatric problems are also considered a vulnerable population in terms of non-suicidal self-injury (NSSI). In the current study, we examined the associations of interpersonal and intrapersonal NSSI motivations with several NSSI severity indicators and psychopathological characteristics. Materials and methods In a cross-sectional research design, 158 adolescents (83.5% girls; mean age = 16.10 years; SD = 1.49) who have received inpatient or outpatient psychiatric treatment completed the Inventory of Statements About Self-Injury, the Strengths and Difficulties Questionnaire, and the Self-Critical Rumination Scale. Results More than two-thirds of the sample (75.3%; n = 119) reported at least one episode of NSSI in their life, and 45.38% (n = 54) have engaged in NSSI in the past month (current self-injury). The results indicated that only intrapersonal NSSI functions were linked to NSSI severity indicators (current and repetitive NSSI, versatility), interpersonal functions were not. Furthermore, a number of psychopathological features (co-occurring mental disorders, presence of a mood disorder, more internalizing mental illness symptoms, and more pronounced self-critical rumination) were associated with engaging in NSSI for intrapersonal reasons. We also identified other differences within the specific intrapersonal NSSI motivations. It should be highlighted that the anti-suicide function of NSSI behaved in exactly the opposite way as the other intrapersonal motivations. Discussion All this points to the fact that in clinical settings, detailed assessment of NSSI motivations and severity indicators can help to develop a more effective treatment plan.
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Affiliation(s)
- Melinda Reinhardt
- Department of Clinical Psychology and Addiction, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Kenneth G. Rice
- Center for the Study of Stress, Trauma, and Resilience, Department of Counseling and Psychological Services, Georgia State University, Atlanta, GA, United States
| | - Zsolt Horváth
- Department of Personality and Health Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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Wang K, He Q, Zhu X, Hu Y, Yao Y, Hommel B, Beste C, Liu J, Yang Y, Zhang W. Smaller putamen volumes are associated with greater problems in external emotional regulation in depressed adolescents with nonsuicidal self-injury. J Psychiatr Res 2022; 155:338-346. [PMID: 36179414 DOI: 10.1016/j.jpsychires.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/17/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
The functions of nonsuicidal self-injury (NSSI) consist of social and emotional aspects (Social influence, Sensation seeking, Internal and External emotion regulation). Previous studies have indicated that dysfunction in reward-related brain structures especially the striatum might drive this habitual behavior. However, no studies to date have investigated the associations between striatum and different functions for adolescents engaging in NSSI behaviors. Here, we recruited 35 depressed adolescents with recent NSSI behaviors and 36 healthy controls and acquired structural brain images, depressive symptoms, social, academic and family environments assessments, in addition to NSSI functions in patients only. Subcortical volumes and cortical thickness were estimated with FreeSurfer. Mixed linear regressions were performed to examine associations between striatal structures (caudate, putamen, nucleus accumbens, pallidum) and NSSI functions, with age, sex, total intracranial volume, hemisphere and depression severity included as covariates. Effect of environmental factors and potential associations with cortical thickness and other subcortical volumes were also tested. We found that, among the four functions, external emotional regulation represented the main function for NSSI engagement. Increased external emotion regulation was significantly associated with smaller putamen volume. No environmental factors biased the association with putamen. No associations with other cortical or subcortical regions were observed. Our findings suggested that smaller putamen might be a biomarker of NSSI engagement for depressed adolescents when they regulated frustrated or angry emotions. The results have potentially clinical implications in early identification and brain intervention of NSSI in youth.
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Affiliation(s)
- Kangcheng Wang
- School of Psychology, Shandong Normal University, Jinan, 250358, China
| | - Qiang He
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xingxing Zhu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Yufei Hu
- School of Psychology, Shandong Normal University, Jinan, 250358, China
| | - Yuan Yao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Bernhard Hommel
- School of Psychology, Shandong Normal University, Jinan, 250358, China; Cognitive Psychology Unit, & Leiden Institute for Brain & Cognition, Institute of Psychology, Leiden University, Netherlands; Department of Child and Adolescent Psychiatry, TU Dresden, Germany
| | - Christian Beste
- School of Psychology, Shandong Normal University, Jinan, 250358, China; Department of Child and Adolescent Psychiatry, TU Dresden, Germany; University Neuropsychology Center, TU Dresden, Germany
| | - Jintong Liu
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; Childhood Psychiatry Unit, Shandong Mental Health Center, Jinan, 250014, China
| | - Ying Yang
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; Childhood Psychiatry Unit, Shandong Mental Health Center, Jinan, 250014, China.
| | - Wenxin Zhang
- School of Psychology, Shandong Normal University, Jinan, 250358, China.
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Yin L, Song TH, Wei YY, Zhang LG, Zhou SJ, Yu JJ, Zhang LY, Li HJ, Chen JX. Relationship Between Affective Temperaments and Suicide Risk in Patients With First-Onset Major Depressive Disorder. Front Psychiatry 2022; 13:893195. [PMID: 35747102 PMCID: PMC9211372 DOI: 10.3389/fpsyt.2022.893195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background People may endorse suicidal behavior during a major depressive episode. Affective temperaments may play a role in this risk. We explored the relationship between affective temperaments and suicide and identified some traits that can predict suicide risk in depression. Materials and Methods We analyzed the results of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) in 284 participants recruited from a psychiatric clinic and the community in Beijing and compared the subscale scores (temperaments of cyclothymic, dysthymic, anxious, irritable, and hyperthymic) among major depressive disorders (MDDs) vs. the general population as well as depressive patients with vs. without suicide risk, using Student's test, chi-square test, rank-sum test, and multivariable regression modeling. Results The incidence of suicidal risk in depressive subjects was 47.62% (80/168). Being unmarried (p < 0.001), unemployed (p = 0.007), and temperaments of dysthymic, cyclothymic, anxious, and irritable scores (all p < 0.001) were significantly more prevalent in patients with depression than in the general population. Young age (p < 0.001), female sex (p = 0.037), unmarried (p = 0.001), more severe depression (p < 0.001), and dysthymic, anxious, and cyclothymic temperament (all p < 0.05) were significantly more prevalent in patients with depressive disorder than those without suicide risk. The logistic regression analysis showed that younger age (odds ratio [OR] = 0.937, 95% CI 0.905∼0.970), female sex (OR = 2.606, 95% CI 1.142∼5.948), more severe depression (OR = 1.145, 95% CI 1.063∼1.234), cyclothymic temperament (OR = 1.275, 95% CI 1.102∼1.475), and dysthymic temperament (OR = 1.265, 95% CI 1.037∼1.542) were all independently associated with high suicidal risk in patients with first-onset major depression (p < 0.05). Conclusion Temperament traits differ between the general population and people suffering from MDD. Subjects with MDD who have much more severe depressive symptoms and a cyclothymic or dysthymic temperament were at a high risk of suicide.
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Affiliation(s)
- Lu Yin
- Beijing Hui-Long-Guan Hospital, Peking University Hui-Long-Guan Clinical Medical School, Beijing, China
| | - Tian-He Song
- Department of Psychology, Chengde Medical University, Hebei, China
| | - Yan-Yan Wei
- Beijing Hui-Long-Guan Hospital, Peking University Hui-Long-Guan Clinical Medical School, Beijing, China
| | - Li-Gang Zhang
- Beijing Hui-Long-Guan Hospital, Peking University Hui-Long-Guan Clinical Medical School, Beijing, China
| | - Shuang-Jiang Zhou
- Beijing Hui-Long-Guan Hospital, Peking University Hui-Long-Guan Clinical Medical School, Beijing, China
| | - Jian-Jin Yu
- Beijing Hui-Long-Guan Hospital, Peking University Hui-Long-Guan Clinical Medical School, Beijing, China
| | - Li-Ye Zhang
- Beijing Hui-Long-Guan Hospital, Peking University Hui-Long-Guan Clinical Medical School, Beijing, China
| | - Hong-Juan Li
- Beijing Hui-Long-Guan Hospital, Peking University Hui-Long-Guan Clinical Medical School, Beijing, China
| | - Jing-Xu Chen
- Beijing Hui-Long-Guan Hospital, Peking University Hui-Long-Guan Clinical Medical School, Beijing, China
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Himelein-Wachowiak M, Giorgi S, Kwarteng A, Schriefer D, Smitterberg C, Yadeta K, Bragard E, Devoto A, Ungar L, Curtis B. Getting "clean" from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm. J Behav Addict 2022; 11:128-139. [PMID: 35312631 PMCID: PMC9109623 DOI: 10.1556/2006.2022.00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/21/2022] [Accepted: 02/27/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND & AIMS Previous studies have shown that nonsuicidal self-injury (NSSI) has addictive features, and an addiction model of NSSI has been considered. Addictive features have been associated with severity of NSSI and adverse psychological experiences. Yet, there is debate over the extent to which NSSI and substance use disorders (SUDs) are similar experientially. METHODS To evaluate the extent that people who self-injure experience NSSI like an addiction, we coded the posts of users of the subreddit r/selfharm (n = 500) for each of 11 DSM-5 SUD criteria adapted to NSSI. RESULTS A majority (76.8%) of users endorsed at least two adapted SUD criteria in their posts, indicative of mild, moderate, or severe addiction. The most frequently endorsed criteria were urges or cravings (67.6%), escalating severity or tolerance (46.7%), and NSSI that is particularly hazardous. User-level addictive features positively predicted number of methods used for NSSI, number of psychiatric disorders, and particularly hazardous NSSI, but not suicidality. We also observed frequent use of language and concepts common in SUD recovery circles like Alcoholics Anonymous. DISCUSSION & CONCLUSION Our findings support previous work describing the addiction potential of NSSI and associating addictive features with clinical severity. These results suggest that NSSI and SUD may share experiential similarities, which has implications for the treatment of NSSI. We also contribute to a growing body of work that uses social media as a window into the subjective experiences of stigmatized populations.
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Affiliation(s)
| | - Salvatore Giorgi
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA,Department of Computer and Information Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Kwarteng
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Destiny Schriefer
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Chase Smitterberg
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Kenna Yadeta
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Elise Bragard
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA,Department of Psychology, Fordham University, Bronx, NY, USA
| | - Amanda Devoto
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Lyle Ungar
- Department of Computer and Information Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Curtis
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA,Corresponding author. Biomedical Research Center, 251 Bayview Blvd. Suite 200, Baltimore, MD 21224, USA. Tel.:+ 443-740-2126. E-mail:
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Pritchard TR, Fedchenko CA, Lewis SP. Self-Injury Is My Drug: The Functions of Describing Nonsuicidal Self-Injury as an Addiction. J Nerv Ment Dis 2021; 209:628-635. [PMID: 33958550 DOI: 10.1097/nmd.0000000000001359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Adolescents and emerging adults who engage in nonsuicidal self-injury (NSSI) often participate in online activity regarding their self-injury. Of particular importance are the potential benefits and risks associated with online NSSI activity, including how individuals describe their NSSI experiences. One way that individuals describe these experiences is by discussing NSSI as an addiction. Accordingly, we used thematic analysis to explore why individuals may use addiction references to describe their NSSI experiences. To do this, we examined 71 posts from a popular NSSI social network. Four themes emerged: difficulty inherent in stopping, authentication, warn others, and communicate the plight of the behavior. Findings highlight a number of avenues for research as well as implications for clinicians working with clients who self-injure perceive NSSI as an addiction. Mental health professionals can leverage their understanding of clients' perceptions of NSSI to better serve this population.
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Masi G, Lupetti I, D’Acunto G, Milone A, Fabiani D, Madonia U, Berloffa S, Lenzi F, Mucci M. A Comparison between Severe Suicidality and Nonsuicidal Self-Injury Behaviors in Bipolar Adolescents Referred to a Psychiatric Emergency Unit. Brain Sci 2021; 11:brainsci11060790. [PMID: 34203874 PMCID: PMC8232570 DOI: 10.3390/brainsci11060790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Severe suicide ideation or attempts and non-suicidal self-injury (NSSI) present both differences and relevant overlaps, including frequent co-occurrence and shared risk factors. Specific categorical diagnoses, namely bipolar disorder (BD), may affect clinical features and natural histories of suicidal or not suicidal self-harm behaviour. Our study aimed to compare suicidality (severe suicidal ideation or suicidal attempts) and NSSI in referred bipolar adolescents. Methods: The sample included 95 bipolar adolescents (32 males, 63 females) aged 11 to 18 years. Thirty adolescents with suicide attempts/suicidal ideation and BD (SASIB) were compared with structured measures to 35 adolescents with NSSI and BD, without suicidal ideation or attempts (NSSIB), and to 30 adolescents with BD, without suicidal ideation or attempts or NSSI (CB). Results: Compared to CB, suicidality and NSSI were both associated with female sex, borderline personality disorder and self-reported internalizing disorders, anxiety/depression and thought disorders. The NSSI were specifically associated with somatic problems. Severe suicidal ideation and suicide attempts were associated with adverse life events, immigration, bullying, eating disorders, social problems, depressive feelings, performance and social anxiety, and feelings of rejection. Conclusions: Both shared and differential features between suicidal and not suicidal adolescents may represent possible targets for diagnostic and preventative interventions.
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10
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Gyori D, Balazs J. Nonsuicidal Self-Injury and Perfectionism: A Systematic Review. Front Psychiatry 2021; 12:691147. [PMID: 34305684 PMCID: PMC8293614 DOI: 10.3389/fpsyt.2021.691147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nonsuicidal self-injury (NSSI) and perfectionism mean a huge concern related to mental health and psychopathology. Recently, there has been a growing interest in research on the exploration of the association of perfectionism and NSSI, but till today there is no systematic review has been prepared in this topic. Aims: Therefore, we performed a systematic literature review of published studies that investigated the association between NSSI and perfectionism. Methods: The systematic search was made on PubMed, OVID Medline, PsychInfo, Scopus, and Web of Science. The search terms were ("nonsuicidal self-injury" OR "nonsuicidal self-injury" OR NSSI OR "self-injury" OR "self-injurious behavior" OR SIB OR "self-harm" OR "deliberate self-harm" OR DSH) AND (perfectionism). The inclusion criteria were as follows: written in English; reported empirical data; used validated self-report measures; investigated the association of nonsuicidal self-injury and perfectionism. There were no restrictions on participants regarding age, gender, race or ethnicity. Exclusion criteria: not written in English; was a review/meta-analysis; measured suicide behavior; measured self-injury irrespective of motivation or suicidal intent; was not about the association between nonsuicidal self-injury and perfectionism. Results: After the screening process, 15 studies were included in our systematic review. The majority of studies (12) were published in the last 10 years. Nine (60%) recruited participants from community samples, four (26.7%) from clinical populations, and two (13.3%) both from community and clinical participants. Fourteen (93.3%) of the studies were cross-sectional studies, and one study contained a longitudinal investigation. The majority of studies included only or mainly female participants (62.3-87.2%) and two studies contained a balanced male-female ratio population. Fourteen (93.3%) studies from the 15 studies found a significant positive association between NSSI and perfectionism. Limitations: The heterogeneity of used instruments makes it difficult to compare the results of involved studies. Only two studies investigated populations with balanced gender ratios. Only two studies examined both clinical and community populations. Clinical investigations enrolled mainly eating-disordered (ED) patients. Conclusions: The results of the current systematic review highlight the role of perfectionism in NSSI engagement. This systematic review may help the development of effective prevention initiatives and treatment strategies.
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Affiliation(s)
- Dora Gyori
- Doctoral School of Psychology, Eotvos Lorand University, Budapest, Hungary.,Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary.,Department of Psychology, Bjørknes University College, Oslo, Norway
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Bohaterewicz B, Nowicka M, Sobczak AM, Plewka AA, Gaszczyk P, Marek T. Clinical and Psychosocial Characteristics of Adolescent Pediatric Patients Hospitalized after Different Types of Suicidal Behaviors-A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155568. [PMID: 32752251 PMCID: PMC7432877 DOI: 10.3390/ijerph17155568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 01/30/2023]
Abstract
The objective of this study was to examine the clinical characteristics of adolescents hospitalized after a suicide attempt or instrumental suicide-related behavior. Participants included thirty-six adolescents from the pediatric unit of a Polish hospital who made a nonfatal suicide attempt (SAA) or engaged in instrumental suicide-related behavior (IBA), as well as a general population sample (GPS). Psychosocial features were measured using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Suicide Behaviors Questionnaire–Revised (SBQ-R), the Psychache Scale (TPS), the State–Trait Anxiety Inventory (STAI), the Center of Epidemiological Studies Depression Scale for Children (CES-DC), and the Prodromal Questionnaire (PQ-16). The SAA group scored significantly higher than the IBA group and the GPS in modules related to irritability and anhedonia, voice hallucinations and delusions, suicidal acts, thoughts and ideation, and medical lethality. Additionally, the SAA scored higher on the SBQ-R and PQ-16 compared to the IBA group and the GPS. Although anxiety, mental pain, and depressive symptoms could not independently distinguish between the SAA and IBA groups, psychotic symptoms were more frequently present within the SAA group. The above symptoms may be important to consider when screening for suicide risk in the general population.
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Affiliation(s)
- Bartosz Bohaterewicz
- Department of Psychology of Individual Differences, Psychological Diagnosis, and Psychometrics, Institute of Psychology, University of Social Sciences and Humanities, 03-815 Warsaw, Poland; (B.B.); (M.N.); (A.A.P.)
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, 31-007 Cracow, Poland;
| | - Magdalena Nowicka
- Department of Psychology of Individual Differences, Psychological Diagnosis, and Psychometrics, Institute of Psychology, University of Social Sciences and Humanities, 03-815 Warsaw, Poland; (B.B.); (M.N.); (A.A.P.)
| | - Anna M. Sobczak
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, 31-007 Cracow, Poland;
- Correspondence:
| | - Aleksandra A. Plewka
- Department of Psychology of Individual Differences, Psychological Diagnosis, and Psychometrics, Institute of Psychology, University of Social Sciences and Humanities, 03-815 Warsaw, Poland; (B.B.); (M.N.); (A.A.P.)
| | - Patrycia Gaszczyk
- Department of Psychology, University of Essex, Colchester CO4 3SQ, UK;
| | - Tadeusz Marek
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, 31-007 Cracow, Poland;
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12
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Zhang F, Cloutier PF, Yang H, Liu W, Cheng W, Xiao Z. Non-suicidal self-injury in Shanghai inner bound middle school students. Gen Psychiatr 2019; 32:e100083. [PMID: 31552387 PMCID: PMC6738666 DOI: 10.1136/gpsych-2019-100083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 12/18/2022] Open
Abstract
Background Non-suicidal self-injury (NSSI) behaviour is very common among adolescents. Its prevalence and behavioural characteristics may vary according to regional and cultural differences. Investigation of NSSI locations and diagnosis of adolescents with NSSI are relatively lacking in China. Aims The study objective was to determine the prevalence and features of NSSI among middle school students in Shanghai. Methods The participants were from grade 6 to 8 selected from three junior schools in Jing’an District. Consenting students completed the Ottawa Self-Injury Inventory to determine the prevalence and characteristics of NSSI. Those who indicated NSSI within the past month were administered the Mini-International Neuropsychiatric Interview for Children and Adolescents to assess for emotional disorders. Result The result shows 510 participants (21.7%; mean age 13.51 (0.97) years old; 56.7% female) reported at least one instance of NSSI during the previous 12 months. NSSI was significantly more common in girls than boys (24.9% vs 18.5%; χ2=14.03, p=0.00). Commonly reported reasons for NSSI were for internal and external emotion regulation (87.9%, 82.3%) and social influence (57.8%). Anxiety disorders were the most common (28.9%) disorder associated with NSSI. Conclusion The rate of NSSI of middle school students in Shanghai inner bound is similar to those reported in North American and European youth. It is essential that school mental health professionals are aware of how to manage NSSI within the school setting.
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Affiliation(s)
- Fang Zhang
- Department of Medical psychology, Shanghai General hospital, Medical School of Shang Hai Jiaotong University, Shanghai, China
| | | | - Hongmei Yang
- Shanghai Jing'an Education College, Shanghai, China
| | - Wenjing Liu
- Shanghai Mental Health Center, Medical School of Shang Hai Jiaotong University, Shanghai, China
| | - Wenhong Cheng
- Department of Medical psychology, Shanghai General hospital, Medical School of Shang Hai Jiaotong University, Shanghai, China.,Shanghai Mental Health Center, Medical School of Shang Hai Jiaotong University, Shanghai, China
| | - Zeping Xiao
- Shanghai Mental Health Center, Medical School of Shang Hai Jiaotong University, Shanghai, China
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13
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Solís-Bravo MA, Flores-Rodríguez Y, Tapia-Guillen LG, Gatica-Hernández A, Guzmán-Reséndiz M, Salinas-Torres LA, Vargas-Rizo TL, Albores-Gallo L. Are Tattoos an Indicator of Severity of Non-Suicidal Self-Injury Behavior in Adolescents? Psychiatry Investig 2019; 16:504-512. [PMID: 31352732 PMCID: PMC6664213 DOI: 10.30773/pi.2019.03.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/17/2018] [Accepted: 03/06/2019] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Marco Antonio Solís-Bravo
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Clinical and Community Epidemiology in Child and Adolescent Psychiatry, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Yassel Flores-Rodríguez
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Hospital Psiquiátrico “Dr. Samuel Ramírez Moreno”, Mexico State, Mexico
| | - Liliana Guadalupe Tapia-Guillen
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Clinical and Community Epidemiology in Child and Adolescent Psychiatry, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Aymara Gatica-Hernández
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Instituto Nacional de Psiquiatría “Dr. Ramón de la Fuente Muñiz”, Mexico City, Mexico
| | - Miriam Guzmán-Reséndiz
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Hospital General “Dr. Ruben Leñero”, Mexico City, Mexico
| | - Luis Alberto Salinas-Torres
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- CECOSAM Cuauhtémoc, Mexico City, Mexico
| | | | - Lilia Albores-Gallo
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Clinical and Community Epidemiology in Child and Adolescent Psychiatry, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
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14
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Thornton VJ, Asanbe CB, Denton EGD. Clinical risk factors among youth at high risk for suicide in South Africa and Guyana. Depress Anxiety 2019; 36:423-432. [PMID: 30900366 DOI: 10.1002/da.22889] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 12/21/2018] [Accepted: 02/25/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Suicide is the second leading cause of death among youth worldwide, but low- and middle-income countries (LMICs) account for 78% of all suicides. The LMICs South Africa and Guyana rank high in the global suicide rates. To better understand and prevent suicide among the youth, the present study targets youths at high risk for suicide, in an LMIC, to contextually and representatively identify clinical risk factors for suicide. METHODS One hundred-ninety youths, aged 11-21, separated from biological parents at the time of assessment, in South Africa and Guyana, were administered the Child Behavior Checklist and Behavior Assessment System for Children to assess clinical symptoms. The youths were asked about current suicide ideation and previous attempt(s). Self-report responses to clinical items yielded scale scores for depression, social stress, atypicality, somatization, anxiety, and ADHD. Using an integrative data analytic technique, clinical scale scores were standardized and used to predict suicidal behaviors in a binary logistic regression analysis. RESULTS Approximately 22% of Black South African youths and 60% of Guyanese youths endorsed suicide ideation and attempt or suicide attempt only. In fully adjusted analyses, the odds of atypicality and somatization were 1.96 and 1.67 times greater among the youths who endorsed suicidal ideation when compared with those who did not (p < .04). Youth social stress was significantly associated with the suicide attempt, controlling for model covariates (odds ratio [OR], 1.88, p = .05). Gender moderated the effect of somatization on youth suicide. CONCLUSION Our results contextualize how social stress, atypicality, and somatization relate to LMIC youth suicide. Further study on high-risk samples will contribute to generalizable suicide-prevention models.
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Affiliation(s)
- Veronica J Thornton
- Department of Human Development and Family Studies, The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Comfort B Asanbe
- Department of Psychology, City University of New York College of Staten Island, Staten Island, New York
| | - Ellen-Ge D Denton
- Department of Psychology, City University of New York College of Staten Island, Staten Island, New York
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15
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James K, Stewart D. Blurred Boundaries – A Qualitative Study of How Acts of Self-Harm and Attempted Suicide Are Defined by Mental Health Practitioners. CRISIS 2018; 39:247-254. [DOI: 10.1027/0227-5910/a000491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: There is no commonly accepted definition of the term self-harm, and there is an ongoing debate about whether or not it should include acts of attempted suicide. The use of this language in clinical practice has not previously been explored. Aims: To investigate if, and how, practitioners distinguish between acts of self-harm and attempted suicide, and present any implications for practice. Method: We conducted semistructured interviews with a random sample of 18 frontline practitioners from 10 mental health wards and completed a thematic analysis of interview data. Results: Most participants described self-harm and attempted suicide as distinct behaviors. Characteristics of the act, disclosures of intent, and the level of distress observed were commonly used to differentiate between self-harm and attempted suicide. Very few participants believed that people who self-harm may also feel suicidal. Practitioners confidently described two different behaviors, yet self-harm and attempted suicide were often conflated, revealing the challenges and complexities associated with the separation of these acts in clinical practice. Limitations: Clinicians working in other settings or disciplines may have different views. Participants' accounts may not be an accurate representation of what happens in practice. Conclusion: This study adds to a body of evidence which argues against the dichotomous separation of these behaviors into acts of suicidal and nonsuicidal self-harm.Our findings suggest there is no common understanding of the boundaries between self-harm and attempted suicide among frontline clinicians. The language currently used, and consequent practice, particularly with regard to risk assessment, is problematic. Efforts should be made to operationalize terms around suicidal behavior and to incorporate these into training for clinical staff.
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Affiliation(s)
- Karen James
- Kingston University and St. George’s University of London, Joint Faculty of Health, Social Care and Education, London, UK
| | - Duncan Stewart
- Kingston University and St. George’s University of London, Joint Faculty of Health, Social Care and Education, London, UK
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16
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The functions and addictive features of non-suicidal self-injury: A confirmatory factor analysis of the Ottawa self-injury inventory in a university sample. Psychiatry Res 2018; 264:316-321. [PMID: 29665561 DOI: 10.1016/j.psychres.2018.04.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/31/2018] [Accepted: 04/06/2018] [Indexed: 11/21/2022]
Abstract
The Ottawa Self-Injury Inventory (OSI) is a comprehensive self-report measure of non-suicidal self-injury (NSSI). In an effort to build on past research and further validate the OSI, this study presents a confirmatory factor analysis of the OSI's subscales measuring the functions and addictive features of NSSI using a university sample. Participants were 316 university students aged 17-25 years (84.8% female) who had engaged in NSSI at least once in their lifetime. Consistent with past research, results confirmed the four-factor structure of the Functions items (Internal Emotion Regulation, Social Influence, External Emotion Regulation, Sensation Seeking), as well as the single-factor structure of Addictive Features items. Correlations calculated between the obtained factors and indicators of NSSI severity revealed that higher endorsement of NSSI's Internal Emotion Regulation functions, External Emotion Regulation functions, and Addictive Features were associated with more frequent lifetime NSSI, recent (past 6 months) NSSI, and greater distress regarding NSSI urges; greater endorsement of NSSI's Sensation Seeking functions was also linked with more frequent lifetime NSSI. Results provide further support for the OSI's psychometric properties in a university sample, and offer additional evidence for links between specific NSSI functions and addictive features and more severe manifestations of the behavior.
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17
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Balázs J, Győri D, Horváth LO, Mészáros G, Szentiványi D. Attention-deficit hyperactivity disorder and nonsuicidal self-injury in a clinical sample of adolescents: the role of comorbidities and gender. BMC Psychiatry 2018; 18:34. [PMID: 29409473 PMCID: PMC5801900 DOI: 10.1186/s12888-018-1620-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/28/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the possible association between attention-deficit hyperactivity disorder (ADHD) and non-suicidal self-injury (NSSI) with special focus on the role of comorbidities and gender in a clinical sample of adolescents with both a dimensional and a categorical approach to psychopathology. METHODS Using a structured interview, the Mini International Neuropsychiatric Interview Kid and a self-rated questionnaire, the Deliberate Self-Harm Inventory, the authors examined 202 inpatient adolescents (aged: 13-18 years) in the Vadaskert Child and Adolescent Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary. Descriptive statistics, Mann-Whitney U test, chi-square test and mediator model were used. RESULTS Fifty-two adolescents met full criteria for ADHD and a further 77 showed symptoms of ADHD at the subthreshold level. From the 52 adolescents diagnosed with ADHD, 35 (67.30%) had NSSI, of whom there were significantly more girls than boys, boys: n = 10 (28.60%), girls: n = 25 (71.40%) ((χ2(1) = 10.643 p < .001 ϕ = .452). Multiple mediation analyses resulted in a moderated mediation model in which the relationship between symptoms of ADHD and the prevalence of current NSSI was fully mediated by the symptoms of comorbid conditions in both sex. Significant mediators were the symptoms of affective and psychotic disorders and suicidality in both sexes and the symptoms of alcohol abuse/dependence disorders in girls. CONCLUSIONS ADHD symptoms are associated with an increased risk of NSSI in adolescents, especially in the case of girls. Our findings suggest that clinicians should routinely screen for the symptoms of ADHD and comorbidity, with a special focus on the symptoms of affective disorders and alcohol abuse/dependence psychotic symptoms to prevent NSSI.
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Affiliation(s)
- Judit Balázs
- Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064, Hungary. .,Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary.
| | - Dóra Győri
- 0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064 Hungary
| | - Lili Olga Horváth
- 0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064 Hungary ,0000 0001 2294 6276grid.5591.8Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Gergely Mészáros
- Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary ,0000 0001 0942 9821grid.11804.3cSemmelweis University, School of Ph.D. Studies, Budapest, Hungary
| | - Dóra Szentiványi
- 0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064 Hungary ,0000 0001 2294 6276grid.5591.8Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
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18
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Roley-Roberts ME, Zielinski MJ, Hurtado G, Hovey JD, Elhai JD. Functions of Nonsuicidal Self-Injury Are Differentially Associated with Suicide Ideation and Past Attempts among Childhood Trauma Survivors. Suicide Life Threat Behav 2017; 47:450-460. [PMID: 27767234 DOI: 10.1111/sltb.12306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Abstract
Research into factors for suicide has revealed relations between trauma exposure and suicidality (e.g., Bridge, Goldstein, & Brent, ; Joiner, Sachs-Ericson, Wingate, Brown, Anestis, & Selby, ) wherein painful and provocative experiences (e.g., nonsuicidal self-injury [NSSI]) are an important link (e.g., Van Orden, Witte, Cukrowicz, Braithwaite, Selby, & Joiner, ; Smith, ). No prior research has assessed the relationship between functions of NSSI and suicidality among childhood trauma survivors. Participants who endorsed childhood trauma exposure (N = 121; Mage = 18.69, range 18-22) completed measures of posttraumatic stress disorder (PTSD) symptoms, NSSI, and suicidality. Multiple regressions assessing whether the four functions of NSSI predicted suicide ideation and past attempts after controlling for PTSD symptom severity found that only social negative reinforcement was associated with SI (β = .304, SE = .243, t = 2.23, p = .028), while only automatic negative reinforcement was associated with past attempts (β = .470, SE = .066, t = 2.25, p = .028). Findings highlight the importance of assessing NSSI functions when assessing suicidality among trauma survivors.
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Affiliation(s)
- Michelle E Roley-Roberts
- The Ohio State University Wexner Medical Center, Columbus, OH, USA.,University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Melissa J Zielinski
- Psychoiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gabriela Hurtado
- Eating Recovery Center, Austin, TX, USA.,University of Toledo, Toledo, OH, USA
| | - Joseph D Hovey
- Psychology, University of Texas - Rio Grande Valley, Edinburg, TX, USA
| | - Jon D Elhai
- Psychology, University of Toledo, Toledo, OH, USA
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19
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Meszaros G, Horvath LO, Balazs J. Self-injury and externalizing pathology: a systematic literature review. BMC Psychiatry 2017; 17:160. [PMID: 28468644 PMCID: PMC5415783 DOI: 10.1186/s12888-017-1326-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/24/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND During the last decade there is a growing scientific interest in nonsuicidal self-injury (NSSI). The aim of the current paper was to review systematically the literature with a special focus on the associations between self-injurious behaviours and externalizing psychopathology. An additional aim was to review terminology and measurements of self-injurious behaviour and the connection between self-injurious behaviours and suicide in the included publications. METHODS A systematic literature search was conducted on 31st December 2016 in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with two categories of search terms (1. nonsuicidal self-injury, non-suicidal self-injury, NSSI, self-injurious behaviour, SIB, deliberate self-harm, DSH, self-injury; 2. externalizing disorder, attention deficit hyperactivity disorder, ADHD, conduct disorder, CD, oppositional defiant disorder, OD, ODD). RESULTS Finally 35 papers were included. Eleven different terms were found for describing self-injurious behaviours and 20 methods for measuring it. NSSI has the clearest definition. All the examined externalizing psychopathologies had strong associations with self-injurious behaviours according to: higher prevalence rates in externalizing groups than in control groups, higher externalizing scores on the externalizing scales of questionnaires, higher symptom severity in self-injurious groups. Eight studies investigated the relationship between suicide and self-injurious behaviours and found high overlap between the two phenomena and similar risk factors. CONCLUSIONS Based on the current findings the association between externalizing psychopathology and self-injurious behaviours has been proven by the scientific literature. Similarly to other reviews on self-injurious behaviours the confusion in terminology and methodology was noticed. NSSI is suggested for use as a distinct term. Further studies should investigate the role of comorbid conditions in NSSI, especially when internalizing and externalizing pathologies are both presented.
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Affiliation(s)
- Gergely Meszaros
- Semmelweis University, Mental Health Sciences School Of Ph.D., Üllői út 26, Budapest, 1085, Hungary. .,Vadaskert Child Psychiatry Hospital and Outpatient Clinic, Lipótmezei út 1-5, Budapest, 1021, Hungary.
| | - Lili Olga Horvath
- 0000 0001 2294 6276grid.5591.8Doctoral School of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, Hungary ,0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, Hungary
| | - Judit Balazs
- Vadaskert Child Psychiatry Hospital and Outpatient Clinic, Lipótmezei út 1-5, Budapest, 1021 Hungary ,0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, Hungary
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20
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Stewart JG, Esposito EC, Glenn CR, Gilman SE, Pridgen B, Gold J, Auerbach RP. Adolescent self-injurers: Comparing non-ideators, suicide ideators, and suicide attempters. J Psychiatr Res 2017; 84:105-112. [PMID: 27716512 PMCID: PMC5204373 DOI: 10.1016/j.jpsychires.2016.09.031] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/03/2016] [Accepted: 09/29/2016] [Indexed: 11/26/2022]
Abstract
Adolescent non-suicidal self-injury (NSSI) and suicidality are serious health concerns; however, factors that contribute to the transition from NSSI to suicide ideation and suicide attempts are unclear. To address this gap, we investigated whether demographic characteristics, child maltreatment, and psychiatric factors are associated with the level suicidality among adolescents with a history of self-injury. Participants were three groups of adolescent inpatient self-injurers (n = 397, 317 female), aged 13-18 years (M = 15.44, SD = 1.36): (a) non-ideators (n = 96; no current suicide ideation and no lifetime suicide attempts), (b) suicide ideators (n = 149; current ideation and no lifetime attempts), and (c) suicide attempters (n = 152; current ideation and at least one lifetime attempt). Participants completed interviews assessing psychiatric diagnoses, suicidality, and NSSI characteristics, as well as questionnaires on childhood trauma, psychiatric symptoms, and risky behavior engagement. Depression severity was associated with greater odds being a suicide ideator (p < 0.001, OR = 1.04) and an attempter (p < 0.001, OR = 1.05) compared to a non-ideator. Suicide attempters used more NSSI methods and reported greater risky behavior engagement than non-ideators (p = 0.03, OR = 1.29 and p = 0.03, OR = 1.06, respectively) and ideators (p = 0.015, OR = 1.25 and p = 0.04, OR = 1.05, respectively); attempters used more severe NSSI methods (e.g., burning). Our results identify a wide range of risk markers for increasing lethality in a sample at high risk for suicide mortality; future research is needed to refine risk assessments for adolescent self-injurers and determine the clinical utility of using risk markers for screening and intervention.
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Affiliation(s)
- Jeremy G. Stewart
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA, Corresponding author. McLean Hospital, 115 Mill Street, Mailstop 331, de Marneffe Building, Room 239, Belmont, MA 02478-9106, USA. (J.G. Stewart)
| | - Erika C. Esposito
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA
| | - Catherine R. Glenn
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, USA
| | - Stephen E. Gilman
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA, Department of Social and Behavioral Sciences and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Bryan Pridgen
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA
| | - Joseph Gold
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA
| | - Randy P. Auerbach
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA
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Maciejewski DF, Renteria ME, Abdellaoui A, Medland SE, Few LR, Gordon SD, Madden PAF, Montgomery G, Trull TJ, Heath AC, Statham DJ, Martin NG, Zietsch BP, Verweij KJH. The Association of Genetic Predisposition to Depressive Symptoms with Non-suicidal and Suicidal Self-Injuries. Behav Genet 2016; 47:3-10. [PMID: 27590903 PMCID: PMC5222948 DOI: 10.1007/s10519-016-9809-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022]
Abstract
Non-suicidal and suicidal self-injury are very destructive, yet surprisingly common behaviours. Depressed mood is a major risk factor for non-suicidal self-injury (NSSI), suicidal ideation and suicide attempts. We conducted a genetic risk prediction study to examine the polygenic overlap of depressive symptoms with lifetime NSSI, suicidal ideation, and suicide attempts in a sample of 6237 Australian adult twins and their family members (3740 females, mean age = 42.4 years). Polygenic risk scores for depressive symptoms significantly predicted suicidal ideation, and some predictive ability was found for suicide attempts; the polygenic risk scores explained a significant amount of variance in suicidal ideation (lowest p = 0.008, explained variance ranging from 0.10 to 0.16 %) and, less consistently, in suicide attempts (lowest p = 0.04, explained variance ranging from 0.12 to 0.23 %). Polygenic risk scores did not significantly predict NSSI. Results highlight that individuals genetically predisposed to depression are also more likely to experience suicidal ideation/behaviour, whereas we found no evidence that this is also the case for NSSI.
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Affiliation(s)
- Dominique F Maciejewski
- Department of Clinical Developmental Psychology and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, 1081 BT, Amsterdam, The Netherlands
| | - Miguel E Renteria
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Abdel Abdellaoui
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Sarah E Medland
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Lauren R Few
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Scott D Gordon
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Grant Montgomery
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Dixie J Statham
- Faculty of Arts and Social Sciences, University of Sunshine Coast, Sippy Downs, QLD, 4556, Australia
| | - Nicholas G Martin
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Brendan P Zietsch
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
- School of Psychology, University of Queensland, St. Lucia, Brisbane, QLD, 4029, Australia
| | - Karin J H Verweij
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
- School of Psychology, University of Queensland, St. Lucia, Brisbane, QLD, 4029, Australia.
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Freeman KR, James S, Klein KP, Mayo D, Montgomery S. Outpatient Dialectical Behavior Therapy for Adolescents Engaged in Deliberate Self-Harm: Conceptual and Methodological Considerations. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2016; 33:123-135. [PMID: 26985126 PMCID: PMC4789287 DOI: 10.1007/s10560-015-0412-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The current review examines conceptual and methodological issues related to the use of dialectical behavior therapy for adolescents (DBT-A) in treating youth who engage in deliberate self-harm. A comprehensive review of the literature identified six studies appropriate for the review. Results indicated several inconsistencies and limitations across studies including the mixing of various forms of self-harm; variations in diagnostic inclusion/exclusion criteria, insufficient use of standardized self-harm outcome measures, variable lengths and intensity of provided treatment, and inadequate attention paid to DBT adherence. Each of these areas is reviewed along with a discussion of ways to improve the quality of future research.
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Affiliation(s)
- Kimberly R. Freeman
- Department of Social Work and Social Ecology, Loma Linda University, 1898 Business Center Drive, San Bernardino, CA 92408, USA
| | - Sigrid James
- Department of Social Work and Social Ecology, Loma Linda University, 1898 Business Center Drive, San Bernardino, CA 92408, USA
| | - Keith P. Klein
- Department of Social Work and Social Ecology, Loma Linda University, 1898 Business Center Drive, San Bernardino, CA 92408, USA
| | - Danessa Mayo
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Loma Linda, CA 92350, USA
| | - Susanne Montgomery
- Department of Social Work and Social Ecology, Loma Linda University, 1898 Business Center Drive, San Bernardino, CA 92408, USA
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23
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Orlando CM, Broman-Fulks JJ, Whitlock JL, Curtin L, Michael KD. Nonsuicidal Self-Injury and Suicidal Self-Injury: A Taxometric Investigation. Behav Ther 2015; 46:824-33. [PMID: 26520224 DOI: 10.1016/j.beth.2015.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 11/17/2022]
Abstract
The present research examined the latent structure of self-injurious behavior (SIB) to determine whether suicidal self-injury (SSI) and nonsuicidal self-injury (NSSI) reflect categorically distinct types of SIB or dimensional variations of the same construct. Participants consisted of 1,525 female undergraduates across several universities in the United States who completed the Survey of College Mental Health and Well Being and endorsed a history of SIB. Empirically derived indicators representing intent to die, suicidal history, frequency of SIB, severity of SIB, and number of methods of SIB were submitted to three mathematically independent taxometric procedures. Results of multiple consistency tests converged to indicate that the latent structure of SIB is continuous, with individuals who engage in SSI and NSSI differing in degree rather than kind. The implications of these dimensional findings for the theoretical conceptualization, assessment, and treatment of SIB are discussed.
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24
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Rawlings J, Shevlin M, Corcoran R, Morriss R, Taylor PJ. Out of the blue: Untangling the association between impulsivity and planning in self-harm. J Affect Disord 2015; 184:29-35. [PMID: 26070044 DOI: 10.1016/j.jad.2015.05.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Planned and unplanned acts of self-harm may have distinct clinical and psychological correlates. Trait impulsivity is one factor that might be expected to determine whether self-harm is planned. Research so far has focussed on suicide attempts and little is known about how individuals engaging in planned and unplanned acts of self-harm differ. The aim of the current study was to examine how individuals who report planned self-harm, unplanned self-harm, and no self-harm differ in terms of impulsivity and affective symptoms (depression, anxiety, and activated mood). METHOD An online survey of University students (n = 1350) was undertaken including measures of impulsivity, affective symptoms and self-harm. Analyses made use of a multinomial logistic regression model with affective and cognitive forms of impulsivity estimated as latent variables. RESULTS Trait affective impulsivity, but not cognitive, was a general risk factor for whether self-harm occurred. There was no evidence of differences between planned and unplanned self-harm. Affective symptoms of depression and anxiety mediated the relationship between affective impulsivity and self-harm. LIMITATIONS The study was cross-sectional, relied on a student sample which may not generalise to other populations. CONCLUSIONS Trait affective impulsivity is associated with self-harm but it appears to be mediated by depression and anxiety symptoms. The exact relationships between trait affective impulsivity, depression, anxiety and self-harm require further longitudinal research in clinical populations but might lead to improved risk assessment and new therapeutic approaches to self-harm.
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Affiliation(s)
- Jodie Rawlings
- School of Psychology, University of Exeter, United Kingdom
| | - Mark Shevlin
- School of Psychology, University of Ulster, United Kingdom
| | - Rhiannon Corcoran
- Institute of Psychology, Health & Society, University of Liverpool, United Kingdom
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, United Kingdom
| | - Peter James Taylor
- Institute of Psychology, Health & Society, University of Liverpool, United Kingdom.
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25
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Abstract
Abstract. Nonsuicidal self-injury (NSSI) is a prevalent, pervasive, clinically significant behavior in adolescents, frequently associated with serious social, physical, and psychological consequences. It is characterized by high comorbidity with various disorders. Therefore, NSSI has been included as a research diagnosis in the Diagnostic and statistical manual of mental disorders (5th ed., American Psychiatric Association (APA; 2013) ; DSM-5; Section 3), as a condition requiring further study for possible future official adoption. This is a positive step toward providing researchers with a uniform definition and criteria. This state-of-the-art article gives an overview of prevalence rates, comorbidity, clinical correlates, functions, and risk factors as well as treatment and dealing with adolescents with NSSI and their Internet activities. Furthermore, the association and differences between NSSI and suicidality as well as borderline personality disorder are reviewed. The article concludes with future directions for research, for example, the dimensional approach to classification of the Research Domain Criteria project.
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Affiliation(s)
- Tina In-Albon
- University of Koblenz-Landau, Clinical Child and Adolescent Psychology and Psychotherapy, Landau, Germany
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26
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Testing an equifinality model of nonsuicidal self-injury among early adolescent girls. Dev Psychopathol 2015; 26:851-62. [PMID: 25047303 DOI: 10.1017/s0954579414000431] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a common behavior among females that has been shown to confer risk for continued self-injury and suicidal attempts. NSSI can be viewed conceptually as behavior that is pathognomonic with aggression and/or depression. Empirical research on concurrent correlates supports this concept: numerous and diverse factors are shown to be significantly associated with self-harm, including depression, emotion dysregulation, impulsivity, and aggression and other conduct problems, as well as environmental stressors such as bullying, harsh parenting, and negative life events. In the present study, we test hypotheses regarding developmental precursors (measured from ages 8 to 12 years) to NSSI in young adolescent girls (ages 13-14 years), specifically whether aggression, depression, and environmental stressors distinguish girls with and without self-harm, and whether there is evidence for multiple developmental pathways to NSSI. Data were derived from the longitudinal Pittsburgh Girls Study. In this community sample of girls, the prevalence of NSSI at ages 13 or 14 years of age was 6.0%. Initial levels in dimensions measured within the depression, aggression, and environmental stressor domains accounted for variance in NSSI in early adolescence. Changes over time in relational aggression and assertiveness were also significantly associated with risk for NSSI. To a large extent, adolescent NSSI was predicted by psychological deficits and stress exposure that began early in childhood. Risk indices were calculated using the 85th or 15th percentile. Close to 80% of girls who engaged in NSSI during adolescence were identified by at least one risk domain in childhood. A sizable proportion of adolescent girls who later engaged in NSSI had childhood risk scores in all three domains; the remaining girls with adolescent NSSI were relatively evenly distributed across the other risk domain profiles. The observation that multiple pathways to NSSI exist suggests that deficits underlying the behavior may vary and require different modes of prevention.
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27
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Hamza CA, Willoughby T, Heffer T. Impulsivity and nonsuicidal self-injury: A review and meta-analysis. Clin Psychol Rev 2015; 38:13-24. [PMID: 25779460 DOI: 10.1016/j.cpr.2015.02.010] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/11/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Chloe A Hamza
- Department of Psychology, Brock University, 500 Glenridge Avenue, St. Catharines, Ontario L2S 3A1, Canada.
| | - Teena Willoughby
- Department of Psychology, Brock University, 500 Glenridge Avenue, St. Catharines, Ontario L2S 3A1, Canada.
| | - Taylor Heffer
- Department of Psychology, Brock University, 500 Glenridge Avenue, St. Catharines, Ontario L2S 3A1, Canada.
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28
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Tapola V, Wahlström J, Kuittinen M, Lappalainen R. The co-occurrence of nonsuicidal and suicidal self-injurious acts in adult women: A pilot study of similarities and differences. NORDIC PSYCHOLOGY 2015. [DOI: 10.1080/19012276.2014.997784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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KIM KERRIL, GALVAN THANIA, PUZIA MEGANE, CUSHMAN GRACEK, SEYMOUR KARENE, VANMALI ROSHANI, JONES RICHARDN, SPIRITO ANTHONY, DICKSTEIN DANIELP. Psychiatric and self-injury profiles of adolescent suicide attempters versus adolescents engaged in nonsuicidal self-injury. Suicide Life Threat Behav 2015; 45:37-50. [PMID: 25060743 PMCID: PMC6538394 DOI: 10.1111/sltb.12110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/20/2014] [Indexed: 11/26/2022]
Abstract
To better delineate the unique correlates of self-injurious behaviors (SIB), psychiatric profiles of mutually exclusive groups of adolescents who made a suicide attempt (SA) versus those engaged in nonsuicidal self-injury (NSSI) were examined. Contrary to hypotheses, the NSSI group endorsed earlier onsets of SIB and suicidal ideation (SI), as well as higher rates of depression and anxiety compared with their SA counterparts. Future work is warranted to understand the role of SI, including duration of SI and anxiety in the development of NSSI, and to identify risk and resiliency factors useful in predicting an adolescent's SIB status.
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Affiliation(s)
- KERRI L. KIM
- Bradley Hospital’s Pediatric, Mood, Imaging and NeuroDevelopment (PediMIND) Program, Alpert Medical School of Brown University, Providence, RI, USA
| | - THANIA GALVAN
- Bradley Hospital’s Pediatric, Mood, Imaging and NeuroDevelopment (PediMIND) Program, Alpert Medical School of Brown University, Providence, RI, USA
| | - MEGAN E. PUZIA
- Bradley Hospital’s Pediatric, Mood, Imaging and NeuroDevelopment (PediMIND) Program, Alpert Medical School of Brown University, Providence, RI, USA
| | - GRACE K. CUSHMAN
- Bradley Hospital’s Pediatric, Mood, Imaging and NeuroDevelopment (PediMIND) Program, Alpert Medical School of Brown University, Providence, RI, USA
| | - KAREN E. SEYMOUR
- Bradley Hospital’s Pediatric, Mood, Imaging and NeuroDevelopment (PediMIND) Program, Alpert Medical School of Brown University, Providence, RI, USA
| | - ROSHANI VANMALI
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - RICHARD N. JONES
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA, and Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - ANTHONY SPIRITO
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - DANIEL P. DICKSTEIN
- Bradley Hospital’s Pediatric, Mood, Imaging and NeuroDevelopment (PediMIND) Program, Alpert Medical School of Brown University, Providence, RI, USA
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30
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Ford JD, Gómez JM. The relationship of psychological trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-injury and suicidality: a review. J Trauma Dissociation 2015; 16:232-71. [PMID: 25758363 DOI: 10.1080/15299732.2015.989563] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.
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Affiliation(s)
- Julian D Ford
- a Department of Psychiatry , University of Connecticut School of Medicine , Farmington , Connecticut , USA
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31
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Jenkins AL, Singer J, Conner BT, Calhoun S, Diamond G. Risk for suicidal ideation and attempt among a primary care sample of adolescents engaging in nonsuicidal self-injury. Suicide Life Threat Behav 2014; 44:616-28. [PMID: 24720472 DOI: 10.1111/sltb.12094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 01/10/2014] [Indexed: 11/28/2022]
Abstract
One in five adolescents in the United States has engaged in nonsuicidal self-injury (NSSI), one in eight have had serious thoughts of suicide, and one in 25 have attempted suicide. Research suggests that NSSI may increase risk for suicide attempt, yet little is known about the relationship between NSSI and suicidal ideation or attempts. In a primary care setting, 1,561 youth aged 14-24 years completed a brief, comprehensive, mental health screen as part of a routine well visit to determine which factors were most likely to predict suicidal ideation and attempt among youth engaging in NSSI. Results of recursive partitioning revealed that current depression and history of alcohol use best differentiated youth engaging in NSSI with low versus high risk for suicidal ideation and attempts. This simple algorithm is presented as a clinical screening tool that might aid medical providers in determining which youth would benefit from more intensive assessment and intervention.
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32
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Baus N, Fischer-Kern M, Naderer A, Klein J, Doering S, Pastner B, Leithner-Dziubas K, Plener PL, Kapusta ND. Personality organization in borderline patients with a history of suicide attempts. Psychiatry Res 2014; 218:129-33. [PMID: 24746393 DOI: 10.1016/j.psychres.2014.03.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Abstract
Suicide attempts (SA) are common in patients with Borderline Personality Disorder (BPD). Recent studies focus on aspects of personality associated with risk for SA such as deficits in affect regulation including impulse control and aggression. The current study examines associations of dysfunctional personality organization, psychiatric comorbidities as well as non-suicidal self-injury (NSSI) with SA in a sample of 68 BPD outpatients. Patients with a history of SA yielded higher scores in personality domains of aggression, especially self-directed aggression. Further, a history of SA was associated with a worse general level of personality organization and a higher prevalence rate of NSSI and substance abuse disorder. The results demonstrate that SA in BPD patients might be regarded as a manifestation of impaired personality functioning rather than mere state variables and symptoms. Moreover, these findings might have implications for indication, treatment, and prognosis of Borderline Personality Disorder.
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Affiliation(s)
- Nicole Baus
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria.
| | - Melitta Fischer-Kern
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria
| | - Andrea Naderer
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria
| | - Jakob Klein
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria
| | - Barbara Pastner
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria
| | | | - Paul L Plener
- Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany
| | - Nestor D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria
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33
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Victor SE, Klonsky ED. Correlates of suicide attempts among self-injurers: A meta-analysis. Clin Psychol Rev 2014; 34:282-97. [DOI: 10.1016/j.cpr.2014.03.005] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/11/2014] [Accepted: 03/25/2014] [Indexed: 12/27/2022]
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34
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Leong CH, Wu AMS, Poon MMY. Measurement of perceived functions of non-suicidal self-injury for Chinese adolescents. Arch Suicide Res 2014; 18:193-212. [PMID: 24568552 DOI: 10.1080/13811118.2013.824828] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Due to the lack of validated assessment tools for motives of non-suicidal self-injury behaviors in the Chinese contexts, this study aims to evaluate the psychometric properties of the Chinese version of the Functional Assessment of Self-Mutilation (C-FASM). A total of 345 secondary school students (mean age = 11.41 years), who reported non-suicidal self-injury in the past year, voluntarily participated in the questionnaire survey. Confirmatory factor analysis results supported a second-order model of 4 motivational factors. The overall scale scores had significant correlations with depression, anxiety, impulsiveness, self-esteem, social support, and suicidal ideation. The internal consistency of the scale was also satisfactory. The C-FASM is a valid and reliable instrument for assessing non-suicidal self-injury among nonclinical Chinese adolescents.
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35
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Proposed Diagnostic Criteria for the DSM-5 of Nonsuicidal Self-Injury in Female Adolescents: Diagnostic and Clinical Correlates. PSYCHIATRY JOURNAL 2013. [PMID: 24236273 DOI: 10.1155/2013/159208.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nonsuicidal self-injury (NSSI) is included as conditions for further study in the DSM-5. Therefore, it is necessary to investigate the proposed diagnostic criteria and the diagnostic and clinical correlates for the validity of a diagnostic entity. The authors investigated the characteristics of NSSI disorder and the proposed diagnostic criteria. A sample of 73 female inpatient adolescents and 37 nonclinical adolescents (aged 13 to 19 years) was recruited. Patients were classified into 4 groups (adolescents with NSSI disorder, adolescents with NSSI without impairment/distress, clinical controls without NSSI, and nonclinical controls). Adolescents were compared on self-reported psychopathology and diagnostic cooccurrences. Results indicate that adolescents with NSSI disorder have a higher level of impairment than adolescents with other mental disorders without NSSI. Most common comorbid diagnoses were major depression, social phobia, and PTSD. There was some overlap of adolescents with NSSI disorder and suicidal behaviour and borderline personality disorder, but there were also important differences. Results further suggest that the proposed DSM-5 diagnostic criteria for NSSI are useful and necessary. In conclusion, NSSI is a highly impairing disorder characterized by high comorbidity with various disorders, providing further evidence that NSSI should be a distinct diagnostic entity.
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36
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Loh C, Teo YW, Lim L. Deliberate self-harm in adolescent psychiatric outpatients in Singapore: prevalence and associated risk factors. Singapore Med J 2013; 54:491-5. [DOI: 10.11622/smedj.2013170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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37
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Adolescent non-suicidal self-injury (NSSI) in German-speaking countries: comparing prevalence rates from three community samples. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1439-45. [PMID: 23292435 DOI: 10.1007/s00127-012-0645-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Non-suicidal self-injury (NSSI) has been recognized as a significant mental health problem in adolescence with high prevalence rates. To date, there are few studies that compare rates of adolescent NSSI between different countries. Thus far no prevalence rates of adolescent NSSI have been reported for Austrian or Swiss community samples. METHODS This study aimed to assess and compare rates of adolescent NSSI in school samples from Austria, Germany and Switzerland using the same assessment instrument (Ottawa Self-Injury Inventory; OSI). RESULTS Within these countries, 6-month prevalence rates between 7.6 and 14.6% were found, with rates showing significant differences between countries (χ² = 16.54, p = 0.02). CONCLUSIONS These results demonstrate with some variability the significant rates of NSSI in youth in a cross-country study.
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38
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Proposed Diagnostic Criteria for the DSM-5 of Nonsuicidal Self-Injury in Female Adolescents: Diagnostic and Clinical Correlates. PSYCHIATRY JOURNAL 2013; 2013:159208. [PMID: 24236273 PMCID: PMC3820093 DOI: 10.1155/2013/159208] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 07/08/2013] [Indexed: 01/22/2023]
Abstract
Nonsuicidal self-injury (NSSI) is included as conditions for further study in the DSM-5. Therefore, it is necessary to investigate the proposed diagnostic criteria and the diagnostic and clinical correlates for the validity of a diagnostic entity. The authors investigated the characteristics of NSSI disorder and the proposed diagnostic criteria. A sample of 73 female inpatient adolescents and 37 nonclinical adolescents (aged 13 to 19 years) was recruited. Patients were classified into 4 groups (adolescents with NSSI disorder, adolescents with NSSI without impairment/distress, clinical controls without NSSI, and nonclinical controls). Adolescents were compared on self-reported psychopathology and diagnostic cooccurrences. Results indicate that adolescents with NSSI disorder have a higher level of impairment than adolescents with other mental disorders without NSSI. Most common comorbid diagnoses were major depression, social phobia, and PTSD. There was some overlap of adolescents with NSSI disorder and suicidal behaviour and borderline personality disorder, but there were also important differences. Results further suggest that the proposed DSM-5 diagnostic criteria for NSSI are useful and necessary. In conclusion, NSSI is a highly impairing disorder characterized by high comorbidity with various disorders, providing further evidence that NSSI should be a distinct diagnostic entity.
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Dinya E, Csorba J, Suli A, Grosz Z. Behaviour profile of Hungarian adolescent outpatients with a dual diagnosis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1574-1580. [PMID: 22537855 DOI: 10.1016/j.ridd.2012.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 05/31/2023]
Abstract
The behaviour dimensions of 244 Hungarian adolescent psychiatric outpatients with a dual diagnosis (intellectual disability and psychiatric diagnosis) were examined by means of the adapted version of the Behaviour Problem Inventory (BPI, Rojahn, Matson, Lott, Esbensen, & Smalls, 2001). Four IQ subgroups were created: borderline, mild, moderate and profound ID subsamples. Significantly higher means were found in the self-injury/stereotyped behaviour/summarized scale categories both in the frequency and severity of symptoms in the more disabled groups against the samples having milder IQ impairment. Adolescents with a dual diagnosis showed much higher BPI scale means than an adult residential ID sample. ADHD and emotional disorders were the most frequent psychiatric diagnostic comorbidities of ID (20.67% and 11.73%). Academic achievement disorder, depression and psychosis had low occurrences (3.35, 2.23 and 1.17%, respectively) but showed convergency with other authors' data. The comorbid emotional disorders may create challenges for the care of the mildly intellectually disabled group.
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Affiliation(s)
- Elek Dinya
- Department of Health Informatics and Education, Semmelweis University, Budapest, Hungary.
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Hamza CA, Stewart SL, Willoughby T. Examining the link between nonsuicidal self-injury and suicidal behavior: a review of the literature and an integrated model. Clin Psychol Rev 2012; 32:482-95. [PMID: 22717336 DOI: 10.1016/j.cpr.2012.05.003] [Citation(s) in RCA: 395] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 04/26/2012] [Accepted: 05/03/2012] [Indexed: 11/25/2022]
Abstract
Self-injurious behaviors (SIB) refer to behaviors that cause direct and deliberate harm to oneself, including nonsuicidal self-injury (NSSI), suicidal behaviors, and suicide. Although in recent research, NSSI and suicidal behavior have been differentiated by intention, frequency, and lethality of behavior, researchers have also shown that these two types of self-injurious behavior often co-occur. Despite the co-occurrence of NSSI and suicidal behavior, however, little attention has been given as to why these self-injurious behaviors may be linked. Several authors have suggested that NSSI is a risk factor for suicidal behavior, but no comprehensive review of the literature on NSSI and suicidal behavior has been provided. To address this gap in the literature, we conducted an extensive review of the research on NSSI and suicidal behavior among adolescents and adults. First, we summarize several studies that specifically examined the association between NSSI and suicidal behavior. Next, three theories that have been proposed to account for the link between NSSI and suicidal behavior are described, and the empirical support for each theory is critically examined. Finally, an integrated model is introduced and several recommendations for future research are provided to extend theory development.
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Affiliation(s)
- Chloe A Hamza
- Department of Psychology, Brock University, 500 Glenridge Avenue, St. Catharines, Ontario, Canada, L2S3A1.
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[Assessment of suicidal ideation in adolescents: comparison of two instruments]. Prax Kinderpsychol Kinderpsychiatr 2012; 61:4-15. [PMID: 22400375 DOI: 10.13109/prkk.2012.61.1.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Standardized instruments are crucial for a valid assessment of suicidal behavior. In questionnaire assessments the wording of questions can influence the results. In this study we compared the congruence of the Self-Harm Behavior Questionnaire (SHBQ) and the Ottawa Self-Injury Inventory (OSI) as measures of prevalence of suicidal ideation in an adolescent sample (n = 665, mean age: 14.8, SD: 0.66). We found a life-time prevalence of 36.4 % in the SHBQ and a one-year-prevalence of 27.8 % in the OSI. There was good agreement between the two instruments in terms of the prevalence of suicidal ideation and the association with suicide attempts. The observed rates are comparable with other studies in adolescents; differences arise with varying study designs.
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Swahn MH, Ali B, Bossarte RM, Van Dulmen M, Crosby A, Jones AC, Schinka KC. Self-harm and suicide attempts among high-risk, urban youth in the U.S.: shared and unique risk and protective factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:178-91. [PMID: 22470286 PMCID: PMC3315085 DOI: 10.3390/ijerph9010178] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 12/13/2011] [Accepted: 01/05/2012] [Indexed: 11/16/2022]
Abstract
The extent to which self-harm and suicidal behavior overlap in community samples of vulnerable youth is not well known. Secondary analyses were conducted of the “linkages study” (N = 4,131), a cross-sectional survey of students enrolled in grades 7, 9, 11/12 in a high-risk community in the U.S. in 2004. Analyses were conducted to determine the risk and protective factors (i.e., academic grades, binge drinking, illicit drug use, weapon carrying, child maltreatment, social support, depression, impulsivity, self-efficacy, parental support, and parental monitoring) associated with both self-harm and suicide attempt. Findings show that 7.5% of participants reported both self-harm and suicide attempt, 2.2% of participants reported suicide attempt only, and 12.4% of participants reported self-harm only. Shared risk factors for co-occurring self-harm and suicide attempt include depression, binge drinking, weapon carrying, child maltreatment, and impulsivity. There were also important differences by sex, grade level, and race/ethnicity that should be considered for future research. The findings show that there is significant overlap in the modifiable risk factors associated with self-harm and suicide attempt that can be targeted for future research and prevention strategies.
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Affiliation(s)
- Monica H. Swahn
- Institute of Public Health, Georgia State University, 50 Decatur Street Southeast, Atlanta, GA 30303, USA;
- Author to whom correspondence should be addressed; ; Tel.: +1-404-413-1148
| | - Bina Ali
- Institute of Public Health, Georgia State University, 50 Decatur Street Southeast, Atlanta, GA 30303, USA;
| | - Robert M. Bossarte
- Department of Psychiatry, University of Rochester, 400 Fort Hill Avenue, Canandaigua, Rochester, NY 14424, USA;
| | - Manfred Van Dulmen
- Department of Psychology, Kent State University, 800 East Summit Street, Kent, OH 44242, USA; (M.V.D.); (K.C.S.)
| | - Alex Crosby
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA;
| | - Angela C. Jones
- Department of Psychology, John Carroll University, 20700 North Park Boulevard, University Height, OH 44118, USA;
| | - Katherine C. Schinka
- Department of Psychology, Kent State University, 800 East Summit Street, Kent, OH 44242, USA; (M.V.D.); (K.C.S.)
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de Kloet L, Starling J, Hainsworth C, Berntsen E, Chapman L, Hancock K. Risk factors for self-harm in children and adolescents admitted to a mental health inpatient unit. Aust N Z J Psychiatry 2011; 45:749-55. [PMID: 21827346 DOI: 10.3109/00048674.2011.595682] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to identify risk factors for self-harm for children and adolescents in a mental health inpatient unit. METHODS A retrospective file audit of patient files over three years (2006-2009) was conducted to determine risk factors associated with self-harm in children and adolescents admitted to a mental health unit. A checklist of potential factors was based on risk factors found in a review of the literature including demographic information, diagnosis, home situation, environmental stressors, childhood trauma and previous mental health care. The study compared those who self-harmed with a control group who did not self-harm. RESULTS There were 150 patients who self-harmed (mean age 14 years) and 56 patients who did not self-harm with a mean age of 13 years. Several factors were identified that increased the likelihood of self-harm, including a diagnosis of depression, female gender, increasing age, being Australian-born, living with a step parent, not having received previous mental health care, having a history of trauma, and having other stressors including problems within the family. CONCLUSIONS While increasing age, female gender, a history of trauma and a diagnosis of depression are well known as risk factors for self-harm, this study confirms that family factors, in particular living with a step parent, significantly add to the risk. Child and adolescent services should be aware of the increased risk of self-harm in young people with mental health problems who live in blended families. Treatment approaches need to involve parents as well as the child or young person.
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Affiliation(s)
- Liselotte de Kloet
- Walker Unit, Concord Centre for Mental Health, Hospital Road, Concord West, New South Wales 2138, Australia
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Csorba J, Radvanyi K, Regenyi E, Dinya E. A study of behaviour profiles among intellectually disabled people in residential care in Hungary. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1757-1763. [PMID: 21530162 DOI: 10.1016/j.ridd.2011.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 03/01/2011] [Accepted: 03/02/2011] [Indexed: 05/30/2023]
Abstract
The authors investigated the behavioural dimensions of 269 intellectually disabled (ID) people in residential care in specialized institutions in Tolna county (South-West Hungary) with the aim of screening the frequency and severity of the relevant behavioural symptoms associated with intellectual disability and depending on the level of intellectual impairment. Only 120 residents had an International Classification of Disease (ICD) diagnosis of "mental retardation (MR)" and a valid IQ grading either by means of the Hungarian standard version of the HAWIK or by the coloured Raven test. 4 IQ groups were created: borderline (B), mild (MID), moderate (MOD) and profound (PID) intellectual disability subgroups. The Hungarian pilot version of the Behaviour Problem Inventory (BPI) was used. seventy-two percent of the residents displayed behavioural problems. All scale score means exhibited an enhancing tendency with IQ loss, as both frequency and Seventy increased linearly towards the more severe groups, but significantly only in the category of stereotyped behaviour. The authors focussed on problems of patient recruitment and discussed the measurement of behavioural and other psychiatric symptoms when researchers reported on the increased occurrence of behaviour and psychiatric symptoms in ID populations.
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Affiliation(s)
- Janos Csorba
- Department of Special Needs Education Pathology, Eotvos Lorand University of Sciences (ELTE), Barczi Gusztav Faculty of Special Needs Education, Budapest, Hungary.
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Greydanus DE, Apple RW. The relationship between deliberate self-harm behavior, body dissatisfaction, and suicide in adolescents: current concepts. J Multidiscip Healthc 2011; 4:183-9. [PMID: 21811385 PMCID: PMC3141836 DOI: 10.2147/jmdh.s11569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Deliberate self-harm (DSH) is a common though often hidden condition in children and adolescents that may result in suicide. This discussion covers several aspects of DSH including its prevalence, etiology, and management. The relationships of DSH to body dissatisfaction and suicide are specifically considered. Even though most cases of DSH do not end in overt suicide, DSH reflects that potential underlying psychological pathophysiology, and likelihood of eventual death from self-murder, cannot always be predicted or prevented. It is important to take all acts of DSH as serious, and to offer comprehensive management to prevent future acts of DSH and potential suicide.
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Affiliation(s)
- Donald E Greydanus
- Pediatrics and Human Development; College of Human Medicine, Michigan State University, East Lansing, MI, USA
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MacLaren VV, Best LA. Nonsuicidal self-injury, potentially addictive behaviors, and the Five Factor Model in undergraduates. PERSONALITY AND INDIVIDUAL DIFFERENCES 2010. [DOI: 10.1016/j.paid.2010.05.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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