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Li Q, Song K, Feng T, Zhang J, Fang X. Machine learning identifies different related factors associated with depression and suicidal ideation in Chinese children and adolescents. J Affect Disord 2024; 361:24-35. [PMID: 38844165 DOI: 10.1016/j.jad.2024.06.006] [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: 11/13/2023] [Revised: 04/04/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Depression and suicidal ideation often co-occur in children and adolescents, yet they possess distinct characteristics. This study sought to identify the different related factors associated with depression and suicidal ideation. METHODS A nationwide cross-sectional survey collected data from Chinese children and adolescents aged 8 to 18 (N = 160,962; 48.91 % girls). The survey included inquiries about demographics, depression, suicidal ideation, anxiety, perceived stress, academic burnout, internet addiction, non-suicidal self-injury, bullying, and being bullied. Fifteen machine learning algorithms were conducted to identify the different related factors associated with depression and suicidal ideation. Additionally, we conducted external validation on an independent sample of 1,812,889 children and adolescents. RESULTS Our findings revealed seven related factors linked to depression and six associated with suicidal ideation, with average accuracy rates of 86.86 % and 85.82 %, respectively. For depression, the most influential factors were anxiety, perceived stress, academic burnout, internet addiction, non-suicidal self-injury, experience of bullying, and age. Similarly, anxiety, non-suicidal self-injury, perceived stress, internet addiction, academic burnout, and age emerged as paramount factors for suicidal ideation. Moreover, these related factors showed notable variations in their predictive capacities for depression and suicidal ideation across different subgroups. CONCLUSION Anxiety emerged as the predominant shared factor for both depression and suicidal ideation, whereas the other related factors displayed distinct predictive patterns for each condition. These findings highlight the critical need for tailored strategies from public mental health service providers and policymakers to address the pressing concerns of depression and suicidal ideation.
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Affiliation(s)
- Qingyin Li
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Kunru Song
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Tao Feng
- Beijing Mind Data & Analysis Technology Co. Ltd, Beijing, China
| | - Jintao Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
| | - Xiaoyi Fang
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China; State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
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Bilello D, Townsend E, Broome MR, Armstrong G, Burnett Heyes S. Friendships and peer relationships and self-harm ideation and behaviour among young people: a systematic review and narrative synthesis. Lancet Psychiatry 2024; 11:633-657. [PMID: 39025094 DOI: 10.1016/s2215-0366(24)00170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/03/2024] [Accepted: 05/20/2024] [Indexed: 07/20/2024]
Abstract
Friendships and peer relationships have an important role in the experience of self-harm ideation and behaviour in young people, yet they typically remain overlooked. This systematic review and narrative synthesis explores the extant literature on this topic to identify important relationships between these constructs. We did a keyword search of peer-reviewed empirical articles relating to friendships and peer relationships and self-harm ideation and behaviour in young people (aged 11-25 years). We identified 90 articles with evidence primarily from adolescents aged 11-18 years, including mixed genders and a majority of White individuals. Findings highlight substantive relationships between the key constructs, showing that: characteristics of friends and peers, including their self-harm ideation and behaviour, relate to and predict ego self-harm ideation and behaviour; friends and peers are important sources of support; and evidence on causal mechanisms is scarce but highlights potential peer selection and influence processes. Studies of the friends and peers of young people with self-harm ideation and behaviour highlight that: friends' attitudes to self-harm and suicide influence their responses to peers with self-harm ideation and behaviour; and friends who are bereaved and friend supporters experience negative outcomes such as symptoms of depression, anxiety, PTSD, and grief, alongside difficult emotions. Despite substantial heterogeneity across samples, study designs, and definition or measurement of the primary constructs, this work presents an initial step in organising a complex literature on a crucially important topic, which can help to inform future research and evidence-based interventions.
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Affiliation(s)
- Delfina Bilello
- School of Psychology and Institute for Mental Health, University of Birmingham, Birmingham, UK; Self-Harm Research Group, University of Nottingham, Nottingham, UK.
| | - Ellen Townsend
- Self-Harm Research Group, University of Nottingham, Nottingham, UK
| | - Matthew R Broome
- School of Psychology and Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Stephanie Burnett Heyes
- School of Psychology and Institute for Mental Health, University of Birmingham, Birmingham, UK
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3
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Liu L, Wang W. Suicide attempts of friends and family during adolescence and long-term suicidal ideation and attempts: Findings from the 25-year Add Health study. J Affect Disord 2024; 358:377-382. [PMID: 38735584 DOI: 10.1016/j.jad.2024.05.053] [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: 01/28/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Suicide is a significant global public health concern. However, previous studies have predominantly focused on individual-level risk factors. Against this backdrop, microsystem suicide propinquity, which encompasses suicidal thoughts and behaviors (STB) within families and peer groups, is significant in elucidating the development and perpetuation of STB in adolescents. METHODS This study utilized data from the National Longitudinal Study of Adolescent to Adult Health (Add Health, 1994-2018). Adolescents who reported instances of suicide attempts among their friends and family members during Wave 1 were selected (N = 4826). Generalized estimation equations (GEE) and structural equation models (SEM) were employed. RESULTS GEE analyses indicated that individuals with friends who had attempted suicide exhibited higher risks for suicidal ideation (OR [95 % CI] = 2.57 [2.13, 3.11]) and suicide attempts (OR [95 % CI] = 2.47 [1.78, 3.42]). Also, individuals with family members who had attempted suicide exhibited higher risks for suicidal ideation (OR [95 % CI] = 2.37 [1.62, 3.46]) and attempts (OR [95 % CI] = 2.27 [1.17, 4.41]). However, friends' and family members' suicide attempts failed to show significant interactive effect. Besides, SEM analyses indicated that friends' and family members' suicide attempts were associated with one's long-term suicidal ideation and attempts via depressive symptoms. CONCLUSION Suicide attempts of friends and family during adolescence were long-term risk factors for suicidal ideation and attempts from adolescence to young adulthood. Moreover, depressive symptoms served as long-term mechanisms in these associations.
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Affiliation(s)
- Luming Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Wenchao Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China; Department of Psychology, Faculty of Arts and Sciences, Beijing Normal University, Zhuhai 519087, China.
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Ahmad SI, Hinshaw SP. A Qualitative Analysis of Perspectives on Self-directed Violence in a Prospective Longitudinal Study of Young Women With and Without Childhood ADHD. J Atten Disord 2024; 28:1255-1266. [PMID: 38294171 PMCID: PMC11168017 DOI: 10.1177/10870547231221729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Non-suicidal self-directed violence (NSSDV) is a significant and growing youth public health crisis. Girls with ADHD are at increased risk of engaging in NSSDV, yet qualitative studies with this population-to better understand manifestations, motivations, and developmental course-are lacking. METHOD We conducted semi-structured, qualitative interviews with a sub-sample of 57 young women (32 with childhood ADHD, 25 neurotypical comparisons; mean age of 27 years, part of a larger prospective longitudinal study) regarding histories and manifestations of NSSDV. RESULTS Inductive and deductive analysis revealed several key themes, including self-perceived reasons for engaging in NSSDV (affect regulation, attention seeking, self-punishment, asserting control), impulsivity, secretiveness, and in some cases motivations for desistance. CONCLUSION Findings underscore the importance of early education and screening, especially among high-risk clinical populations. Increased resources and supports for professionals, parents, and peers are indicated, along with countering the persistent stigma associated with ADHD and NSSDV.
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Affiliation(s)
| | - Stephen P. Hinshaw
- University of California, San Francisco, USA
- University of California, Berkeley, USA
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Moloney F, Amini J, Sinyor M, Schaffer A, Lanctôt KL, Mitchell RHB. Sex Differences in the Global Prevalence of Nonsuicidal Self-Injury in Adolescents: A Meta-Analysis. JAMA Netw Open 2024; 7:e2415436. [PMID: 38874927 PMCID: PMC11179134 DOI: 10.1001/jamanetworkopen.2024.15436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/20/2024] [Indexed: 06/15/2024] Open
Abstract
Importance Nonsuicidal self-injury (NSSI) is a strong predictor of suicide attempts. The prevalence of NSSI has been increasing among female adolescents in North America and Europe, but less is known about trends in other geographical regions. Objective To examine sex differences in the prevalence of NSSI among adolescents within and between geographical regions. Data Sources MEDLINE and PsycINFO were searched using the keywords adolescents, self-injury, sex factors, and synonyms for articles published in English between January 1, 2000, and May 10, 2022. Study Selection Studies were included if they presented original data (any study design), included adolescents aged 10 to 19 years, reported results stratified by sex, and explicitly defined self-injury as behaviors occurring without suicidal intent. Data Extraction and Synthesis This meta-analysis was registered with PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were assessed for quality by 2 independent coders (F.M. and J.A.). A random-effects model was used to calculate prevalence. Data were analyzed from July 2022 to April 2023. Main Outcomes and Measures The prevalence of NSSI in male and female adolescents within and between regions was the main outcome. Odds ratios (OR) with 95% CIs were calculated for community samples. Results Eight hundred and two studies were screened, and 38 were included (266 491 participants). Across 17 countries, the pooled prevalence of NSSI was 17.7% (female:male OR, 1.60; 95% CI, 1.29-1.98). NSSI was twice as prevalent among female adolescents compared with male adolescents in North America (OR, 2.49; 95% CI, 2.16-2.86) and Europe (OR, 2.08; 95% CI, 1.69-2.58), but not in Asia (OR, 1.00; 95% CI, 0.71-1.41). Conclusions and Relevance In this meta-analysis of sex differences in global prevalence of NSSI, the female predominance of NSSI observed among adolescents in North America and Europe aligned with rising rates of suicide in these populations. The comparable prevalence of NSSI among male and female adolescents in Asia also aligned with the lower male-to-female suicide ratio compared with other countries. More research is needed to characterize regional (and potentially cultural) sex differences among adolescents with NSSI to prevent and treat the behavior and to understand the possible interplay with corresponding regional trends in suicide.
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Affiliation(s)
- Fiona Moloney
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jasmine Amini
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rachel H B Mitchell
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Li J, Gao Y, Liu J, Liu X, Wang H. Impacts of difficulties with emotion regulation on the longitudinal relationship between peer victimization and changes in adolescent nonsuicidal self-injury. J Adolesc 2024; 96:350-359. [PMID: 38017669 DOI: 10.1002/jad.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/30/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Research has found that peer victimization is associated with adolescent nonsuicidal self-injury (NSSI) behavior; however, most of these studies ignored the association between these constructs at the within-person level. Additionally, the association between peer victimization and NSSI may vary among adolescents with different personal characteristics. With a longitudinal design, this study investigated whether and how emotion regulation (ER) difficulties moderate the relationship between peer victimization and changes in NSSI, with particular attention given to the unique moderating role of different dimensions of ER difficulties. METHODS The study sample comprised 3,561 adolescents aged between 10 and 17 years old (Mage = 13.22, SD = 0.85; 56.9% males). Self-report assessments were administered in December 2021 and June 2022 in Shanxi province, China. RESULTS The latent change score model showed that the adolescent NSSI increased during our assessments, with peer victimization as a significant predictor. ER difficulties moderated the association between peer victimization and NSSI changes, but interestingly, in an unexpected pattern. Specifically, peer victimization significantly predicted NSSI changes among adolescents with low ER difficulties but not for those with high ER difficulties. Moreover, among the multiple dimensions of ER difficulties, only nonacceptance of emotional responses and limited access to emotion regulation strategies interacted with peer victimization to predict NSSI changes and showed interaction patterns similar to those at the overall level of ER difficulties. CONCLUSIONS The current study revealed the moderating role of ER difficulties in the relationship between peer victimization and changes in NSSI. These findings provide intervention implications for adolescents who engage in NSSI.
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Affiliation(s)
- Jinwen Li
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yemiao Gao
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jinmeng Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xia Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Hui Wang
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
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Clayton MG, Pollak OH, Prinstein MJ. Why Suicide? Suicide Propinquity and Adolescent Risk for Suicidal Thoughts and Behaviors. Clin Child Fam Psychol Rev 2023; 26:904-918. [PMID: 37801188 DOI: 10.1007/s10567-023-00456-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/07/2023]
Abstract
Suicide represents an international public health concern, and for adolescents aged 14 to 18 in the United States, is the third leading cause of death (Centers for Disease Control and Prevention. 2021 Youth Risk Behavior Survey Data. Available at: www.cdc.gov/yrbs . Accessed on August 30, 2023.). In response to this alarming rate, as well as the relative lack of meaningful progress in the prediction and prevention of suicidal thoughts and behaviors (STB) over the past decades (see Franklin et al., 2017), recent reviews of the suicide literature have advocated for the adoption of novel frameworks and theoretical reexamination of the processes that confer risk for suicide. Currently, the majority of suicide theories emphasize distal factors associated with suicide risk, but these factors also generalize to other types of psychopathology and do not answer the fundamental question of "why suicide?" vs. other maladaptive outcomes. In an effort to address this gap and build off existing theoretical and empirical science from various disciplines, the current theoretical paper will explore the concept of suicide propinquity, the degree of closeness and identification with STB, as a potential moderator of the link between psychological distress and suicide. Specifically, this paper: (1) provides context within the existing theories of suicide, highlighting gaps that might otherwise be explained by propinquity; (2) discusses historical and scientific evidence of suicide phenomena that support the existence of propinquity; (3) explores potential processes of how propinquity may confer risk for STB in adolescence; and (4) suggests future directions for research to examine adolescent suicide from a propinquity perspective.
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Affiliation(s)
- Matthew G Clayton
- Department of Psychology and Neuroscience, University of North Carolina, Davie Hall, Campus, Box 3270, Chapel Hill, NC, USA.
| | - Olivia H Pollak
- Department of Psychology and Neuroscience, University of North Carolina, Davie Hall, Campus, Box 3270, Chapel Hill, NC, USA
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, University of North Carolina, Davie Hall, Campus, Box 3270, Chapel Hill, NC, USA
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Pitman A, Lowther M, Pike A, Davies J, de Cates A, Buckman JEJ, Robinson O. The influence of peer non-suicidal self-harm on young adults' urges to self-harm: experimental study. Acta Neuropsychiatr 2023:1-13. [PMID: 38012834 DOI: 10.1017/neu.2023.51] [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] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To test the hypothesis that exposure to peer self-harm induces adolescents' urges to self-harm and that this is influenced by individual suggestibility. METHODS We recruited 97 UK-based adults aged 18-25 years with a recent history of self-harm, measuring baseline suggestibility (Resistance to Peer Influence; RPI) and perceived ability to control urges to self-harm (using an adapted item from the Self-Efficacy to Resist Suicidal Action scale; SEASA) before and after two self-harm vignettes featuring named peers from the participant's social network (to simulate exposure to peer non-suicidal self-harm) and after a wash-out exposure. We used paired t-tests to compare mean SEASA scores pre- and post-exposure, and linear regression to test for an association between RPI and change in SEASA scores pre- and post-exposure. RESULTS Perceived ability to control urges to self-harm was significantly reduced following exposure to peer self-harm (t(96) = 4.02, p < 0.001, mean difference = 0.61; 95% CI = 0.31, 0.91), but was not significantly different from baseline after exposure to a wash-out. We found no association between suggestibility and change in urges to self-harm after exposure to peer self-harm. CONCLUSION Our findings support social influences on self-harm in a sample of young adults, regardless of their individual degree of suggestibility.
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Affiliation(s)
- Alexandra Pitman
- Division of Psychiatry, UCL, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | - Alexandra Pike
- UCL Institute of Cognitive Neuroscience, London, UK
- Department of Psychology and York Biomedical Research Institute, University of York, York, UK
| | - Jessica Davies
- Division of Psychiatry, UCL, London, UK
- St Andrew's Healthcare, Birmingham, UK
- Centre for Applied Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Angharad de Cates
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Littlemore Mental Health Centre, Oxford, UK
| | - Joshua E J Buckman
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
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Pollak OH, Kwon SJ, Jorgensen NA, Lindquist KA, Telzer EH, Prinstein MJ. Neural Reactivity to Social Punishment Predicts Future Engagement in Nonsuicidal Self-injury Among Peer-Rejected Adolescents. Biol Psychiatry 2023; 94:40-49. [PMID: 36411092 DOI: 10.1016/j.biopsych.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rates of nonsuicidal self-injury (NSSI) increase dramatically in adolescence. Affective reactivity and adverse social experiences have been linked to NSSI, but less is known about whether these factors may separately or interactively predict NSSI, especially longitudinally. This study combined functional magnetic resonance imaging and a sociometric measure to test whether a combination of neural (e.g., amygdala) reactivity to social punishment and peer-nominated peer acceptance/rejection predicts NSSI longitudinally in adolescence. Amygdala reactivity was examined as a potential neural marker of affective reactivity to social punishment, which may heighten NSSI risk in contexts of social adversity. METHODS One hundred twenty-five adolescents (63 female) completed a social incentive delay task during neuroimaging and school-based peer nominations to measure peer acceptance/rejection. NSSI engagement was assessed at baseline and 1-year follow-up. RESULTS Greater amygdala reactivity to social punishment predicted greater NSSI engagement 1 year later among adolescents with high peer rejection. This effect for the amygdala was specific to social punishment (vs. reward) and held when controlling for biological sex and pubertal development. Exploratory analyses found that ventral striatum reactivity to social reward and punishment similarly interacted with peer rejection to predict NSSI but that amygdala connectivity with salience network regions did not. CONCLUSIONS Amygdala reactivity to social punishment, in combination with high peer rejection, may increase NSSI risk in adolescence, possibly via heightened affective reactivity to adverse social experiences. Objective measures of neurobiological and social risk factors may improve prediction of NSSI, while therapeutic approaches that target affective reactivity and increase prosocial skills may protect against NSSI in adolescence.
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Affiliation(s)
- Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Seh-Joo Kwon
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nathan A Jorgensen
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kristen A Lindquist
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eva H Telzer
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Masland SR, Finch EF, Schnell SE. Effects of Group Psychotherapy for Nonsuicidal Self-Injury: A Meta-Analysis. Int J Group Psychother 2023; 73:183-201. [PMID: 38446601 DOI: 10.1080/00207284.2023.2191683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Nonsuicidal self-injury (NSSI) is prevalent and concerning among adolescents and adults. Although prior meta-analytic work has considered the efficacy of individual psychotherapy for reducing NSSI, the efficacy of group psychotherapy remains unclear. We conducted a systematic meta-analysis of group psychotherapy studies with NSSI measures. We identified a total of eight studies, including published articles (n = 6) or dissertations (n = 2) with 10 total effect sizes for group interventions. Overall, random-effects meta-analysis suggests that group psychotherapies have a significant small effect on NSSI. However, when corrected for publication bias, the effect is no longer significant. This meta-analysis cautiously suggests that group psychotherapies, which are cost-effective and efficient, hold promise for attenuating NSSI. The field would benefit from further study and treatment refinement, including consideration of what works for whom.
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Liu W, Hu Z, Liu Z, Zhang F, Ding Y, Shui Y, Yang Z, Cheng W. Age- and sex-dependent increase in self-harm among adolescents with mental health problems in East China during COVID-19 related society-wide isolation. Front Public Health 2023; 11:1129123. [PMID: 36969633 PMCID: PMC10036048 DOI: 10.3389/fpubh.2023.1129123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectiveThe COVID-19 pandemic has raised concerns about child and adolescent mental health issues, such as self-harm. The impact of society-wide isolation on self-harming behaviors among adolescents in China is unclear. In addition, adolescents of different ages and sexes have varying abilities to cope with environmental changes. However, these differences are rarely considered in self-harm studies. We aimed to characterize the age- and sex-dependent effects of COVID-19-related society-wide isolation on self-harm among adolescents in East China.MethodsWe collected 63,877 medical records of children and adolescents aged 8–18 who had an initial visit to Shanghai Mental Health Center in China between 2017 and 2021 and charted annual self-harm rates for each age and sex. Using interrupted time series analysis, we modeled global and seasonal trends and the effect of COVID-19-related society-wide isolation on self-harm rates.ResultsFemales aged 10–17 and males aged 13–16 exhibited significantly increasing trends in self-harm rate (pfdr < 0.05) in the past 5 years. Eleven-year-old females in 2020 showed a self-harm rate (37.30%) that exceeded the peak among all ages in 2019 (age 13, 36.38%). The COVID-19-related society-wide isolation elevated self-harm rates in female patients aged 12 [RR 1.45 (95% CI 1.19–1.77); pfdr = 0.0031] and 13 years [RR 1.33 (95% CI 1.15–1.5); pfdr = 0.0031], while males were less affected. Further, females with emotional disorders dominated the increased self-harm rates.ConclusionSociety-wide isolation has had a significant impact on early adolescent females in East China, especially for those with emotional disturbances, and has brought forward the peak in adolescent self-harm rates. This study calls for attention to the risk of self-harm in early adolescents.
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Affiliation(s)
- Wenjing Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhishan Hu
- Laboratory of Psychological Heath and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Zhang
- Department of Psychological Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Ding
- Laboratory of Psychological Heath and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Shui
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi Yang
- Laboratory of Psychological Heath and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Zhi Yang
| | - Wenhong Cheng
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychological Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wenhong Cheng
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Rajhvajn Bulat L, Sušac N, Ajduković M. Predicting prolonged non-suicidal self-injury behaviour and suicidal ideations in adolescence - the role of personal and environmental factors. CURRENT PSYCHOLOGY 2023; 43:1-12. [PMID: 36855643 PMCID: PMC9951151 DOI: 10.1007/s12144-023-04404-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
Suicide is one of the leading causes of death among adolescents and repetitional suicidal ideations (SI) and non-suicidal self-injury (NSSI) often precede it. In order to improve recognition of youth who are at high risk of suicide, current study aims to identify which individual variables (personality, self-concept and adverse childhood experiences - ACE) predict prolonged NSSI and SI from middle to late adolescence. A 3-year longitudinal study was conducted with 1101 Croatian adolescents (aged 15-17). 181 students (72.4% females) reported either NSSI or SI or both in T1 and were included in all waves of the study. Analyses are focused on differentiation between adolescents who continue with NSSI/SI and those who stop with it in a 3-year period. Results showed that adolescents with prolonged NSSI/SI had more ACE, especially domestic violence, worse family financial status, higher neuroticism and lower results on self-concept variables. The prediction model of classification of those who have prolonged NSSI or SI was better for SI than NSSI, with predictors explaining 31% of variation in SI. Adolescents who experienced more ACE and report more neuroticism have a higher chance of prolonged SI, while youth who perceive better family financial status and have better relationships with parents have a greater chance to stop with it. For NSSI only neuroticism was a significant predictor. Considering significant variables which could predict prolonged NSSI and/or SI, data presented in this paper have both scientific and practical contribution in understanding, treating and preventing adolescents' mental health problems.
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Affiliation(s)
- Linda Rajhvajn Bulat
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
| | - Nika Sušac
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
| | - Marina Ajduković
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
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13
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Vafaei T, Samavi SA, Whisenhunt JL, Najarpourian S. An investigation of self-injury in female adolescents: a qualitative study. QUALITY & QUANTITY 2023; 57:1-24. [PMID: 36816810 PMCID: PMC9923642 DOI: 10.1007/s11135-023-01632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
This study aimed to investigate the phenomenon of self-injury among female adolescents. The research was qualitative, and the sampling method was purposive non-random; the sample size was 20 Iranian girl adolescents aged 13-15 years who had experienced non-suicidal self-injury. Data were collected through semi-structured interviews. The data analysis process was performed during three coding steps (open, axial, selective), through which the basic codes and categories were identified. Study results indicate that the main factors in adolescents' self-injury were individual or psychological (thoughts, emotions, and behaviors) and social (peers, family, communication with different gender, communication with others, media/cyberspace, school, and economic). In the former, the role of emotions was remarkable, while in the latter, the family played a key role. Further, results revealed that communication within the family was an important motivating and sustentative factor in adolescents' self-injury. The results can help counselors in working with adolescents who self-injure; results can also be used in the development and implementation of treatment plans.
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Affiliation(s)
- Tayebeh Vafaei
- Department of Counseling, University of Hormozgan, Bandar Abbas, Iran
| | | | - Julia L. Whisenhunt
- Department of Counseling, Higher Education, and Speech-Language Pathology, University of West Georgia, Carrollton, GA USA
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14
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De Luca L, Giletta M, Nocentini A, Menesini E. Non-Suicidal Self-Injury in Adolescence: The Role of Pre-Existing Vulnerabilities and COVID-19-Related Stress. J Youth Adolesc 2022; 51:2383-2395. [PMID: 35986870 PMCID: PMC9392436 DOI: 10.1007/s10964-022-01669-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Abstract
For many adolescents, the COVID-19 pandemic represents a uniquely challenging period, and concerns have been raised about whether COVID-19-related stress may increase the risk for self-injurious behaviors among adolescents. This study examined the impact of pre-existing vulnerabilities on the occurrence and frequency of Non-Suicidal Self-Injury (NSSI) through COVID-19-related stress, and whether the impact of COVID-19-related stress on NSSI was buffered by the perceived social support during the pandemic. Participants were 1061 adolescents (52.40% females; Mage = 15.49 years, SD = 0.76) from a two-wave longitudinal study, which included assessments before the COVID-19 onset and one year later the declaration of the pandemic. Path analyses showed that adolescents with a prior history of NSSI, higher levels of internalizing symptoms, and poor regulatory emotional self-efficacy before the COVID-19 pandemic reported higher levels of COVID-19-related stress which in turn increased their risk to engage in NSSI. Besides, the findings did not support the role of social support as a moderator of the association between COVID-19 related stress and the occurrence/frequency of NSSI. These findings suggest that enhanced stress perception may serve as a key pathway for the continuation and development of NSSI among vulnerable adolescents facing adverse life events.
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Affiliation(s)
- Lisa De Luca
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy.
| | - Matteo Giletta
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Annalaura Nocentini
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Ersilia Menesini
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
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15
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Wei C, Li Z, Ma T, Jiang X, Yu C, Xu Q. Stressful life events and non-suicidal self-injury among Chinese adolescents: A moderated mediation model of depression and resilience. Front Public Health 2022; 10:944726. [PMID: 35991060 PMCID: PMC9387939 DOI: 10.3389/fpubh.2022.944726] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Stressful life events are associated with an increased risk of non-suicidal self-injury (NSSI) in adolescence, but the mechanisms explaining this association are unclear. Based on the experiential avoidance model of NSSI, and the protective factor model of resilience, the current study tested depression as a mediator and resilience as a moderator of this association. Chinese adolescents (N = 643; Mage = 15.91; 52.10 % female), anonymously completed self-report measures in classrooms. Results showed that stressful life events was linked to adolescent NSSI in part because of adolescent depression, and resilience was a protective factor that buffered this effect. These findings can inspire practitioners to pay attention to the interaction of risk factors and protective factors when providing prevention and intervention for adolescent NSSI.
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Affiliation(s)
- Chang Wei
- Research Center for Rural Educational and Cultural Development of Key Research Base of Humanities and Social Sciences in Hubei Province, School of Education, Hubei University of Science and Technology, Xianning, China
- School of Psychology, South China Normal University, Guangzhou, China
| | - Zhiyong Li
- College of Education Science, Hubei Normal University, Huangshi, China
| | - Tao Ma
- School of Psychology, South China Normal University, Guangzhou, China
| | - Xiaxia Jiang
- Research Center for Rural Educational and Cultural Development of Key Research Base of Humanities and Social Sciences in Hubei Province, School of Education, Hubei University of Science and Technology, Xianning, China
- School of Psychology, Central China Normal University, Wuhan, China
- *Correspondence: Xiaxia Jiang
| | - Chengfu Yu
- School of Education, Guangzhou University, Guangzhou, China
| | - Qian Xu
- Research Center for Rural Educational and Cultural Development of Key Research Base of Humanities and Social Sciences in Hubei Province, School of Education, Hubei University of Science and Technology, Xianning, China
- Qian Xu
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16
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Meinhardt I, Cuthbert S, Gibson K, Fortune S, Hetrick SE. Young people and adult stakeholders' reflections on how school staff should support students who self-harm: A qualitative study. J Adolesc 2022; 94:969-980. [PMID: 35880459 DOI: 10.1002/jad.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Self-harm is a significant public health issue affecting school communities, students, and families. The school is an ideal environment for early intervention and prevention. This study aimed to explore the views of young people and stakeholders on how school staff should support students who self-harm in the context of developing accessible and acceptable guidelines. METHODS The study was nested within a larger Delphi study conducted in New Zealand. Two panels were asked to provide reflection in open text boxes in two questionnaires on how school staff can support students who self-harm. The youth panel included 22 participants between 16 and 25 years, and 81.8% identified as female and 18.3% as male. The stakeholder panel (e.g., school staff) included 27 participants over 25 years, and 63.0% identified as female, and 37.0% as male. The data were analyzed using thematic analysis to identify key themes. RESULTS Eight themes were identified; (1) an approach that prioritizes trust, (2) an approach that recognizes students' agency, (3) an individually tailored approach, (4) a whole-school approach, (5) an approach that recognizes role boundaries, (6) an approach that prioritizes safety, (7) a nonpunitive approach, and (8) an appropriately-resourced approach. CONCLUSION The eight themes identified highlighted ineffective practices in response to self-harm in schools. The eight themes provide solutions to these practices. Our findings highlighted four recommendations that address ineffective management approaches in response to students who self-harm. These recommendations included using a student-centered approach, a whole-school approach, avoiding punitive approaches, and providing adequate resourcing to schools.
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Affiliation(s)
- Inge Meinhardt
- School of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Sasha Cuthbert
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kerry Gibson
- School of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Sarah Fortune
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychological Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Sarah Elisabeth Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,A Better Start, E Tipu E Rea (Grant Number 15-02688), National Science Challenge, Auckland, New Zealand.,Centre of Excellence in Youth Mental Health, The Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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17
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Wilkinson PO, Qiu T, Jesmont C, Neufeld SAS, Kaur SP, Jones PB, Goodyer IM. Age and gender effects on non-suicidal self-injury, and their interplay with psychological distress. J Affect Disord 2022; 306:240-245. [PMID: 35304237 DOI: 10.1016/j.jad.2022.03.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/31/2021] [Accepted: 03/10/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION NSSI (non-suicidal self-injury) is an important public health issue, with high prevalence and associations with future mental illness and suicide. To date, no large single study has tested age and gender effects on NSSI and their interplay with psychological distress. METHOD NSSI and psychological distress were ascertained by questionnaire in a community study of 2368 young people aged 14-25; proportions at each age and of each gender were approximately equal. RESULTS There was a significant quadratic interaction between age and gender on last month NSSI prevalence (p = 0.025): NSSI was more common in females ages 16-19, but there were no significant gender differences at younger/older ages. General distress partially mediated the effects of age and gender on NSSI. The association between general distress and NSSI was not significantly moderated by age, gender nor their interactions. CONCLUSIONS Gender difference in NSSI is not a static gap, but evolves across time, widening in mid-adolescence and disappearing by early adulthood. Part of the reason for that gender gap being present at those ages is the increase levels of distress in young women at those ages. There was no evidence that the effects of general distress on NSSI differed by age/gender.
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Affiliation(s)
| | - Tianyou Qiu
- Department of Psychiatry, University of Cambridge, UK; University of British Columbia, Canada
| | - Ceit Jesmont
- Department of Psychiatry, University of Cambridge, UK; North West School of Paediatrics, UK
| | | | - Sahaj P Kaur
- Department of Psychiatry, University of Cambridge, UK; Medway NHS Foundation Trust, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK
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18
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Recent exposure to others’ confided suicidal thoughts and risk of self-harm and suicidality among adolescents. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03123-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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What is Known About the Role of Friendship in Adolescent Self-Harm? A Review and Thematic Synthesis. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Non-Suicidal Self-Injury Among Adolescents: A Structural Model with Socioecological Connectedness, Bullying Victimization, and Depression. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01319-6. [PMID: 35178654 DOI: 10.1007/s10578-022-01319-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/03/2022]
Abstract
The objective was to examine the associations of socioecological connectedness with bullying victimization and depressive symptoms in early adolescence and with non-suicidal self-injury (NSSI) in mid-adolescence, and how these might differ between genders. Diverse adolescents (N = 4115; 49.1% girls) in the 7th grade reported on connections with parents/family, peers, school, and neighborhood, as well as bullying victimization and depressive symptoms, and NSSI in 10th grade (Me = 16.1 years). Structural equation modeling with WSLMV indicated that the lower likelihood of NSSI in 10th grade was associated with higher perceptions of connections between adolescents and their families, both directly as well as indirectly through reduced bully victimization and depressive symptoms three years earlier. Higher school connectedness was indirectly associated with the lower likelihood of NSSI through bullying victimization and depressive symptoms. Paths to NSSI varied for girls and boys. Results advance the understanding of developmental pathways leading to NSSI in adolescent girls and boys.
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21
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Nilsson M, Lundh L, Westling S. Childhood maltreatment and self-hatred as distinguishing characteristics of psychiatric patients with self-harm: A comparison with clinical and healthy controls. Clin Psychol Psychother 2022; 29:1778-1789. [PMID: 35467060 PMCID: PMC9790602 DOI: 10.1002/cpp.2744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Deliberate self-harm (DSH) is common in clinical populations. Childhood maltreatment (CM) and attitudes both towards oneself and towards DSH may be of importance for the development of DSH. This study aimed to test whether patients with DSH report more CM, more negative attitudes towards oneself and more positive attitudes towards DSH than a clinical and a healthy comparison group, and whether the effects of CM are mediated by negative attitudes towards oneself. METHOD Females with DSH and psychiatric disorders (n = 34), females without DSH but with psychiatric disorders (n = 31) and healthy female individuals (n = 29) were compared regarding DSH, CM, attitudes towards the self and attitudes towards self-harm. RESULTS Females with DSH reported more emotional abuse and more self-hatred as compared to both comparison groups. The effect of emotional abuse was mediated by self-hatred. The DSH-group had significantly more positive attitudes towards DSH than the healthy comparison group. CONCLUSION Self-hatred and CM in the form of emotional abuse may be distinguishing characteristics of female patients with DSH in psychiatric settings. The present results are compatible with the hypothesis that emotional abuse leads to DSH via self-hatred, but the cross-sectional nature of the study precludes any causal conclusions. The clinical utility of the results is discussed.
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Affiliation(s)
- Magnus Nilsson
- Department of Clinical Sciences, PsychiatryLund UniversityLundSweden
| | | | - Sofie Westling
- Clinical Psychiatric Research CenterRegion SkåneLundSweden
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22
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Hall S, Melia Y. I Just Pulled Myself Together and Realised I had to be Responsible: Adolescents' Experiences of Having a Friend Who Self-Harms. CHILD & YOUTH CARE FORUM 2022; 51:291-311. [PMID: 34131376 PMCID: PMC8191706 DOI: 10.1007/s10566-021-09629-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
Background Self-harm usually begins during adolescence and adolescents that self-harm most commonly confide in friends, yet to date, there is little research from the friend's perspective. Objective This qualitative study explores adolescents' experiences of what it is like to have a friend who self-harms by cutting and what this experience means for friendship, the wider peer group and psychological well-being. Methods Semi-structured interviews were conducted face-to-face with a community sample of eight females aged between 13 and 18 years, living in England. Interpretative Phenomenological Analysis was used to analyse the data. Results Four superordinate themes emerged: desperately searching for meaning, I will be there at all costs, too hot to handle and identification. Adolescents were concerned about escalations in their friends' behaviours and felt a sense of duty to help, but the majority experienced a dilemma as to whether to disclose to others and all reported some form of distress. Conclusions The results highlight the important, yet complex nature of friendship in this context. Friends play a key role in supporting adolescents who self-harm but need greater support managing this role and the effects. Schools/colleges should educate young people about self-harm to increase their knowledge and skills in relation to supporting a friend with this issue. Furthermore, they should promote environments for talking about mental health openly to give young people increased opportunities for help-seeking.
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Affiliation(s)
- Sarah Hall
- Clinical Psychologist, The Darwin Centre, Queens Road, Stoke-on-Trent, ST4 7LF UK
| | - Yvonne Melia
- Clinical Psychologist, The Science Centre, Staffordshire University Doctorate in Clinical Psychology, Leek Road, Stoke-on-Trent, ST4 2RU UK
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23
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Yang SY, Lee D, Jeong H, Cho Y, Ahn JE, Hong KS, Baek JH. Comparison of Patterns of Non-suicidal Self-Injury and Emotion Dysregulation Across Mood Disorder Subtypes. Front Psychiatry 2022; 13:757933. [PMID: 35633812 PMCID: PMC9133457 DOI: 10.3389/fpsyt.2022.757933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Non-suicidal self-injury (NSSI) is frequently encountered in patients with mood disorders. Emotion dysregulation (ED), frequently observed in mood disorders, could be a major mediating factor in NSSI. The aim of this study was to explore differences in NSSI behavior and ED across mood disorder subtypes. The relationships between childhood trauma and NSSI and ED were also explored. METHODS A total of 191 patients with mood disorders were included in this study. The patterns of NSSI behavior and ED across patients with bipolar I disorder (BD-I), bipolar II disorder (BD-II), and major depressive disorder (MDD) were compared. RESULTS More than half (54%) of the subjects experienced NSSI. Patients with BD-II and MDD engaged in NSSI behavior more frequently than those diagnosed with BD-I. NSSI behaviors in patients with BD-II most commonly included cutting, whereas hitting behaviors were most common among other groups. Patients with BD-II and MDD reported more severe ED than those with BD-I. In the case of childhood trauma, those with BD-II and MDD reported greater emotional neglect than those with BD-I. Structural equation modeling revealed that ED mediated the association between childhood trauma and NSSI. CONCLUSION BD-I was associated with less frequent NSSI behavior and less severe ED than BD-II and MDD. ED mediated the association between childhood trauma and NSSI. Promoting emotion regulation strategies could prevent NSSI behavior in patients with mood disorders.
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Affiliation(s)
- So Yung Yang
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea.,Institute of Behavioral Sciences in Medicine, College of Medicine, Yonsei University, Seoul, South Korea
| | - Dongbin Lee
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Hyewon Jeong
- Center for Clinical Research, Samsung Biomedical Research Institute (SBRI), Seoul, South Korea
| | - Yunji Cho
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Jae Eun Ahn
- Center for Clinical Research, Samsung Biomedical Research Institute (SBRI), Seoul, South Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.,School of Medicine, Sungkyunkwan University, Suwon, South Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.,School of Medicine, Sungkyunkwan University, Suwon, South Korea
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24
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Reinhardt M, Kökönyei G, Rice KG, Drubina B, Urbán R. Functions of nonsuicidal self-injury in a Hungarian community adolescent sample: a psychometric investigation. BMC Psychiatry 2021; 21:618. [PMID: 34886827 PMCID: PMC8662905 DOI: 10.1186/s12888-021-03613-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/15/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The Inventory of Statements About Self-Injury (ISAS) is a psychometrically valid tool to evaluate the motives of nonsuicidal self-injury (NSSI), but there are a few studies that test gender differences in the factor structure of the measurement. However, several differences across gender were identified in NSSI (e.g., in prevalence, methods, functions). Therefore, our study focused on further analyses of the dimensionality of the ISAS functions. METHODS Among Hungarian adolescents with a history of NSSI (N = 418; 70.6% girls; mean age was 16.86, SD = 1.45), confirmatory factor analysis and exploratory structural equation modeling frameworks were used to test the factor structure of the ISAS part II. RESULTS Results support the two-factor structure of the questionnaire. Intrapersonal and interpersonal motivation factors emerged in the whole sample, but this factor structure varied across gender. Among girls, intrapersonal motivation of NSSI was associated with higher loneliness, more inflexible emotion regulation, and a more pronounced level of internalizing and externalizing mental illness symptoms. CONCLUSIONS Our findings provide sufficiently solid arguments for the need to examine NSSI functionality separately for adolescent girls and boys because there were clear gender differences in the motives underlying NSSI. In addition, precise scanning of patterns of NSSI functions may further help us to identify the most at-risk adolescents regarding self-injury.
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Affiliation(s)
- Melinda Reinhardt
- Department of Personality and Health Psychology, Institute of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
- Child and Adolescent Psychiatry, 14th District Medical Center, Budapest, Hungary.
| | - Gyöngyi Kökönyei
- Department of Personality and Health Psychology, Institute of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis 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, USA
| | - Boglárka Drubina
- Department of Personality and Health Psychology, Institute of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Róbert Urbán
- Department of Personality and Health Psychology, Institute of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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25
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Understanding Perceptions of Nonsuicidal Self-Injury: Descriptive and Injunctive Norms. Psychiatr Q 2021; 92:1657-1671. [PMID: 34169388 DOI: 10.1007/s11126-021-09933-8] [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] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a major public health concern. Web-based personalized feedback interventions (PFIs) may be a cost-effective and efficient way to treat NSSI. In order to develop a PFI, it is imperative to assess descriptive and injunctive norms. The current study examines descriptive and injunctive norms of NSSI within college students and adults in the community, comparing how perceived norms may differ for those who do or do not engage in NSSI. Study 1 calculated percentages of NSSI behavior within the student sample. Study 2 then examined perceived descriptive and injunctive norms between those with and without history of NSSI in both samples. Study 1 indicated that 19% of undergraduate students had histories of NSSI. Additionally, there was a general tendency to overestimate the percentage of people who engage in NSSI and the number of times a typical person engages in NSSI. Finally, those who engaged in NSSI believed that most people do not understand why individuals engage in NSSI; comparatively, the majority of people without history of NSSI still indicated that they understand why others would engage in NSSI. These research findings may be utilized in a PFI to reduce shame and NSSI behavior.
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Laursen B, Veenstra R. Toward understanding the functions of peer influence: A summary and synthesis of recent empirical research. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2021; 31:889-907. [PMID: 34820944 PMCID: PMC8630732 DOI: 10.1111/jora.12606] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 05/20/2023]
Abstract
Compelling evidence demonstrates that peer influence is a pervasive force during adolescence, one that shapes adaptive and maladaptive attitudes and behaviors. This literature review focuses on factors that make adolescence a period of special vulnerability to peer influence. Herein, we advance the Influence-Compatibility Model, which integrates converging views about early adolescence as a period of increased conformity with evidence that peer influence functions to increase affiliate similarity. Together, these developmental forces smooth the establishment of friendships and integration into the peer group, promote interpersonal and intragroup compatibility, and eliminate differences that might result in social exclusion.
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27
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Kahn GD, Rabinowitz JA, Stuart EA, Wilcox HC. Prospective examination of self-harm up to three years after contact with Child Protective Services (CPS). Int J Inj Contr Saf Promot 2021; 29:15-22. [PMID: 34663166 DOI: 10.1080/17457300.2021.1993266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined the prevalence and correlates of self-harm among adolescents in the three years following an investigation by U.S. Child Protective Services (CPS) into alleged child maltreatment. Participants (N = 1573, 47% Male, 45% White) were drawn from the National Survey of Child and Adolescent Well-Being, cohort II. Self-harm was assessed at the conclusion of the CPS investigation, and at 18- and 36-months follow-up. Descriptive statistics and multivariable logistic regression were used to assess differences in self-harm over time by demographic characteristics, maltreatment type, and out-of-home placement. The prevalence of self-harm among older adolescents (15-17 years) remained stable at ∼10%, while among younger adolescents (11-14 years), it declined from 13% to 3.5%. Approximately 4.5% of youth reported self-harm at multiple survey waves. Native American and Asian/Pacific Islander youth were five times more likely to report repeated self-harm. Further research is warranted to understand this heightened risk.
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Affiliation(s)
- Geoffrey D Kahn
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Deviant Peer Affiliation and Non-Suicidal Self-Injury among Chinese Adolescents: Depression as a Mediator and Sensation Seeking as a Moderator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168355. [PMID: 34444105 PMCID: PMC8391377 DOI: 10.3390/ijerph18168355] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022]
Abstract
Non-suicidal self-injury (NSSI) is an emerging health problem among adolescents. Although previous studies have shown that deviant peer affiliation is an important risk factor for this behavior, the reasons for this relationship are unclear. Based on the integrated theoretical model of the development and maintenance of NSSI and the social development model of delinquency prevention, this study tested whether depression mediated the relationship between deviant peer affiliation and NSSI and whether this mediating effect was moderated by sensation seeking. A sample of 854 Chinese adolescents (31.50% male; Mage = 16.35; SD = 1.15) anonymously completed questionnaires on the study variables. Results of regression-based analyses showed that depression mediated the association between deviant peer affiliation and NSSI, and this effect was stronger among adolescents who reported high sensation seeking. The results demonstrate the role of individual differences in the link between affiliation with deviant peers and NSSI, and have implications for preventing and treating this risky behavior.
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Hennings J. Das Verstärkermodell der Suizidalität: Chronische Suizidalität bei der Borderline-Persönlichkeitsstörung verstehen und behandeln. VERHALTENSTHERAPIE 2021. [DOI: 10.1159/000518239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Trotz großer Fortschritte in der evidenzbasierten Psychotherapie wird unser Versorgungssystem durch chronisch suizidale Patienten mit einer Borderline-Persönlichkeitsstörung (BPS) weiterhin stark herausgefordert. Die BPS ist mit einem hohen Suizidrisiko von 5–10% sowie einem hohen Selbstverletzungsrisiko von bis zu 80% behaftet. Therapeuten wie Angehörige fühlen sich oft überfordert und hilflos, wenn sie mit der Suizidalität der Patienten konfrontiert sind. Immer wieder kommt es so zu Therapieabbrüchen, Vorstellungen in Notaufnahmen oder akut-psychiatrischen Einweisungen. Bei der nichtsuizidalen Selbstverletzung (NSSV) – einem Verhaltensmuster, das gehäuft zusammen mit chronischer Suizidalität bei BPS auftritt – tragen Verstärkermechanismen (z.B. Nachlassen von Anspannung) dazu bei, dass sich Borderline-Patienten trotz längerfristig unangenehmen Folgen immer wieder selbst verletzen. Die Motive für NSSV und suizidales Verhalten können sehr unterschiedlich sein. Es spricht jedoch einiges dafür, dass die zugrunde liegenden Mechanismen ähnlich sind und sich hieraus wichtige therapeutische Interventionsmöglichkeiten ableiten lassen. In dieser Übersichtsarbeit werden die Hintergründe und Unterschiede von NSSV, Suizidideationen sowie Suizidversuchen bei chronisch suizidalen Borderline-Patienten dargestellt. Neuere Erkenntnisse der modernen Neuro- und Verhaltenswissenschaft werden in ein Verstärkermodell der Suizidalität integriert, von dem verhaltenstherapeutische Interventionen abgeleitet werden, die Therapeuten in ihrer Arbeit mit chronisch suizidalen Patienten unterstützen können.
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30
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Associations Between Adolescent Depression and Self-Harm Behaviors and Screen Media Use in a Nationally Representative Time-Diary Study. Res Child Adolesc Psychopathol 2021; 49:1623-1634. [PMID: 34297316 DOI: 10.1007/s10802-021-00832-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 12/28/2022]
Abstract
Screen media use is associated with mental health problems among adolescents. However, few studies have examined screen media use using contemporaneous time diaries (rather than retrospective reports), compared associations across specific screen media activities or by gender, or examined associations with self-harm behaviors. Participants were 13- to 15-year-old adolescents completing time diaries (n = 4,252) for one weekday and one weekend day in the 2015 administration of the Millennium Cohort Study, a nationally representative birth cohort study of UK adolescents. Participants also completed a measure of depressive symptoms and reported whether they had engaged in self-harm in the last year. Girls who spent 2 + hrs/day, compared to < 2 h/day, on digital media were more likely to self-harm (for social media use, adjusted relative risk [ARR] for self-harm = 1.46, 95% CI = 1.17, 1.82; for internet use, ARR = 1.80 [1.20, 2.70]). Girls spending more time on digital media were also more likely to be depressed (for social media, ARR = 1.29 [1.03, 1.63]; for internet use, ARR = 1.75 [1.19, 2.59]). Associations with gaming, texting/e-mailing, and TV/video watching among girls were mostly not significant. Associations for boys were mostly not significant. Girls who use digital media (especially social media and the internet) more hrs/day are more likely to have clinically significant levels of depressive symptoms and prior history of self-harm, though gaming, texting/e-mailing, and TV/video watching showed few associations. Screen media use was mostly not significantly associated with self-harm or depression among boys.
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Peer Influence during Adolescence: The Moderating Role of Parental Support. CHILDREN-BASEL 2021; 8:children8040306. [PMID: 33920622 PMCID: PMC8074199 DOI: 10.3390/children8040306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/03/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022]
Abstract
Although many studies show that peers influence the development of adolescent internalizing and externalizing difficulties, few have considered both internalizing and externalizing difficulties in the same study, and fewer have considered the contributions of parents. Using a longitudinal sample of 385 adolescents, the contributions of best friends' internalizing and externalizing difficulties (as assessed in Grade 6; G6: Mage = 13.64 years; 53% female; 40% ethnic or racial minority) were examined as they predicted subsequent adolescent internalizing and externalizing difficulties (at G8); in addition, the moderating role of both maternal and paternal support (at G6) was explored. Structural equation modelling revealed that best friend internalizing difficulties predicted decreases, but that best friend externalizing difficulties predicted increases in adolescents' externalizing difficulties over time. Significant interactions involving both maternal and paternal support revealed that the negative impact of a G6 best friend having internalizing problems on later G8 adolescent externalizing problems was stronger at low levels of maternal and paternal support. The findings highlight the complex, and interactive, influences of friends and parents on the development of internalizing and externalizing symptomatology during adolescence, and underscore the importance of targeting both sources of social influence in research and clinical work.
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32
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Carosella KA, Wiglesworth A, Silamongkol T, Tavares N, Falke CA, Fiecas MB, Cullen KR, Klimes-Dougan B. Non-suicidal self-injury in the context of COVID-19: The importance of psychosocial factors for female adolescents. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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33
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Wang Y, Lai J, Hu C, Meng H, Lyu D, Hu S. Non-suicidal self-harm is linked to suicidal thoughts in Chinese adolescents with mood disorders: a cross-sectional report. J Zhejiang Univ Sci B 2021; 22:233-240. [PMID: 33719228 DOI: 10.1631/jzus.b2000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yixin Wang
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Shanghai Pinghe Bilingual School, Shanghai 201206, China
| | - Jianbo Lai
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China.,Brain Research Institute of Zhejiang University, Hangzhou 310003, China.,Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China
| | - Chanchan Hu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China.,Brain Research Institute of Zhejiang University, Hangzhou 310003, China.,Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China
| | - Hongbo Meng
- Department of Rehabilitation, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Duo Lyu
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shaohua Hu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. .,The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China. .,Brain Research Institute of Zhejiang University, Hangzhou 310003, China. .,Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China.
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Rodríguez-Blanco L, Carballo-Belloso JJ, de León S, Baca-García E. A longitudinal study of adolescents engaged in Non-Suicidal Self Injury (NSSI): clinical follow-up from adolescence to young adulthood. Psychiatry Res 2021; 297:113711. [PMID: 33486275 DOI: 10.1016/j.psychres.2021.113711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
The main aim of the current study is to examine the demographic and clinical factors that predict a continuity of the use of Mental Health Services (MHS) in adulthood by subjects who have engaged in non-suicidal-self-injury behaviors (NSSI) and have been followed in MHS in their teen years. A cohort of 147 participants was selected from an original sample of 267 adolescent patients recruited from the Child and Adolescent Outpatient Psychiatric Services. Patients were divided into two groups: those who had engaged in NSSI (NSSI-group), and those who had not (non-NSSI-group). Rate of use of MHS in adulthood was calculated for both groups and univariate analyses and binary logistic regression analysis were applied. In the NSSI-group, two factors appeared to influence a continuity of the use of MHS in adulthood. Prosocial behavior was associated with a greater use of MHS in adulthood whereas behavioral problems were associated with less use. Only prosocial behavior was maintained in the regression model as a predictor. Our findings could have implications for clinical practice with NSSI patients and highlight the importance of working on specific areas that could prevent treatment abandonment in the transition from adolescence to adulthood.
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Affiliation(s)
- Lucía Rodríguez-Blanco
- Psychiatry Department, General Hospital of Villalba Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Collado Villalba. Madrid, Spain; Psychiatry Department, Autonomous University of Madrid. 4, Arzobispo Morcillo, 28029. Madrid, Spain.
| | - Juan Jose Carballo-Belloso
- Child and Adolescent Psychiatry Department, Universitary Hospital Gregorio Marañón. 46, Dr. Esquerdo, 28007. Madrid, Spain; CIBERSAM, Carlos III Institute of Health. Madrid, Spain 3-5, Monforte de Lemos, 28029. Madrid, Spain
| | - Santiago de León
- Signal Theory and Communications Department. Carlos III University. 30, Universiy Avenue, 28911. Leganés. Madrid
| | - Enrique Baca-García
- Psychiatry Department, General Hospital of Villalba Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Collado Villalba. Madrid, Spain; Psychiatry Department, Autonomous University of Madrid. 4, Arzobispo Morcillo, 28029. Madrid, Spain; CIBERSAM, Carlos III Institute of Health. Madrid, Spain 3-5, Monforte de Lemos, 28029. Madrid, Spain; Psychiatry Department, University Hospital Jiménez Díaz Foundationt. 2, Reyes Católicos Avenue, 28040. Madrid, Spain; Psychiatry Department, University Hospital Rey Juan Carlos. Gladiolo, s/n, 28933. Mostoles, Spain; Psychiatry Department, University Hospital Infanta Elena. 21, Reyes Católicos Avenue, 28342. Valdemoro, Spain; Psychiatry Department, Catholic University of the Maule. San Miguel Avenue, 3605. Talca, Chile; Psychiatry Department, University Hospital of Nimes, 4, Rue du Professeur Robert Debré, 30029. Nîmes, Francia
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35
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Morthorst B, Rubæk L, Lindschou J, Jakobsen JC, Gluud C, Bjureberg J, Hellner C, Møhl B, Pagsberg AK. An internet-based emotion regulation intervention versus no intervention for nonsuicidal self-injury in adolescents: study protocol for a feasibility trial. Pilot Feasibility Stud 2021; 7:44. [PMID: 33549128 PMCID: PMC7866693 DOI: 10.1186/s40814-021-00785-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) has gained increased attention in recent years due to increased prevalence, especially among adolescents. Evidence-based interventions for NSSI are sparse. Emotion regulation individual therapy for adolescents (ERITA) is an online intervention that needs investigation. Non-randomised studies suggest ERITA improves emotion regulations skills and reduces NSSI frequency. Before conducting a large pragmatic randomised clinical trial, we aim to investigate the feasibility of ERITA in Denmark. METHODS A randomised, parallel group feasibility trial comparing ERITA as add on to treatment as usual versus treatment as usual in 30 adolescents age 13-17 years with recurrent NSSI referred to outpatient clinics in The Child and Adolescent Mental Health Services in the Capital Region of Denmark. Feasibility outcomes are (1) completion of follow-up, (2) the fraction of eligible participants who consent to inclusion and randomisation and (3) compliance with the intervention. Clinical outcomes such as self-injury frequency and the ability to regulate emotions will be investigated exploratorily. DISCUSSION Internet-based interventions are assumed to be appealing to adolescents by being easily accessible and easy to navigate by tech natives. Disclosure of self-injury behaviour may be facilitated by an online intervention. The evidence for self-injury specific treatment needs to be extended but prior to a large clinical trial, the feasibility of methods and procedures must be assessed. TRIAL REGISTRATION ClinicalTrials.Gov Identifier: NCT04243603 .
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Affiliation(s)
- Britt Morthorst
- Research Unit, Child and Adolescent Mental Health Services, The Capital Region of Denmark, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark
| | - Lotte Rubæk
- Team of Self-Injury, Child and Adolescent Mental Health Services, The Capital Region of Denmark, Lersøpark allé 107, 2100 Copenhagen Ø, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholms läns sjukvårdsområde (SLSO), Sachsgatan 10, 118 61 Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholms läns sjukvårdsområde (SLSO), Sachsgatan 10, 118 61 Stockholm, Sweden
| | - Bo Møhl
- Department of Communication and Psychology, Aalborg University, Teglgårds Plads 1 (Nordkraft), 9200 Aalborg, Denmark
| | - Anne Katrine Pagsberg
- Research Unit, Child and Adolescent Mental Health Services, The Capital Region of Denmark, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark
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36
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Nesi J, Burke TA, Lawrence HR, MacPherson HA, Spirito A, Wolff JC. Online Self-Injury Activities among Psychiatrically Hospitalized Adolescents: Prevalence, Functions, and Perceived Consequences. Res Child Adolesc Psychopathol 2021; 49:519-531. [PMID: 33404950 PMCID: PMC7988289 DOI: 10.1007/s10802-020-00734-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 12/28/2022]
Abstract
The majority of adolescents with psychiatric disorders use social media, engaging in a range of online activities that may confer both risks and benefits. Very little work, however, has examined engagement in online activities related to self-injury among these youth, such as posting about self-injury, viewing self-injury related content, or messaging about self-injury with online or offline friends. This study examined the frequency and types of online self-injury activities in which adolescents engage, perceived functions that these activities serve, and associated risk for self-injurious thoughts and behaviors (SITBs). Participants were 589 psychiatrically-hospitalized adolescents (Mage = 14.88), who completed self-report measures assessing online self-injury activities, perceived functions and consequences of these activities, and SITBs. Results indicated that 43.3% of the sample had engaged in online self-injury activities, that the majority (74.8%) used social networking sites (e.g., Snapchat, Instagram) to do so, and that these activities were significantly more common among sexual and gender minority youth. Adolescents who talked about self-injury with friends met online were more likely to report a history of suicide attempt(s). A latent profile analysis revealed three distinct subgroups of youth based on their perceived functions of engaging in online self-injury activities. Subgroups reporting higher levels of engagement for purposes of identity exploration, self-expression, and aiding recovery were at heightened risk for negative perceived consequences of these activities and reported greater suicidal ideation severity. Findings offer new insights for identifying youth who may be at heightened risk for SITBs in the context of social media use.
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Affiliation(s)
- Jacqueline Nesi
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, RI, Providence, USA.
- Bradley Hasbro Research Center, Rhode Island Hospital, Providence, RI, USA.
| | - Taylor A Burke
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, RI, Providence, USA
- Bradley Hasbro Research Center, Rhode Island Hospital, Providence, RI, USA
| | - Hannah R Lawrence
- McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Heather A MacPherson
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, RI, Providence, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Anthony Spirito
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, RI, Providence, USA
| | - Jennifer C Wolff
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, RI, Providence, USA
- Bradley Hasbro Research Center, Rhode Island Hospital, Providence, RI, USA
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Kandsperger S, Jarvers I, Ecker A, Schleicher D, Madurkay J, Otto A, Brunner R. Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service. Front Psychiatry 2021; 12:634346. [PMID: 34177642 PMCID: PMC8221288 DOI: 10.3389/fpsyt.2021.634346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/17/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers. Methods: A consecutive sample of 86 adolescents aged 11-18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents. Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI. Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.
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Affiliation(s)
- Stephanie Kandsperger
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Irina Jarvers
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Angelika Ecker
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Daniel Schleicher
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Joseph Madurkay
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Alexandra Otto
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
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38
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Syed S, Kingsbury M, Bennett K, Manion I, Colman I. Adolescents' knowledge of a peer's non-suicidal self-injury and own non-suicidal self-injury and suicidality. Acta Psychiatr Scand 2020; 142:366-373. [PMID: 32885408 DOI: 10.1111/acps.13229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Some research suggests that suicidal ideation and attempt among adolescents may be contagious - that is adolescents who are exposed to peers' suicidal behaviour are more likely to experience suicidal ideation or attempt suicide themselves. Less is known about the potential contagion effect of non-suicidal self-injury (NSSI). Our objective was to determine whether knowledge of a friend's NSSI is associated with adolescent's own non-suicidal self-injury and suicidal behaviours. METHODS Data from 1483 youth ages 14-17 years were obtained from the 2014 Ontario Child Health Study, a cross-sectional population-based survey of children and adolescents in Ontario, Canada. Logistic regression models were used to examine associations between knowledge of a friend's NSSI and adolescents' own self-reported self-injurious and suicidal behaviours. Interactions with gender, age group and presence of a mental disorder were investigated. RESULTS Knowledge of a friend's non-suicidal self-injury was significantly associated with the adolescent's own non-suicidal self-injury (OR = 2.03, 95% CI 1.05-3.90), suicidal ideation (OR = 3.08, 95% CI 1.50-6.30) and suicide attempt (OR = 2.87, 95% CI 1.20-6.87). CONCLUSION These findings suggest an apparent contagion effect for non-suicidal self-injury. Awareness of a friend's self-injurious behaviours is associated with an adolescent's own self-injury and suicidality. Interventions aimed at preventing NSSI and suicidality should consider prevention of possible contagion at the school and/or community level.
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Affiliation(s)
- S Syed
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - M Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - K Bennett
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics) and the Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - I Manion
- University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - I Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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39
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Stanton J, Thomas DR, Jarbin M, MacKay P. Self-determination theory in acute child and adolescent mental health inpatient care. A qualitative exploratory study. PLoS One 2020; 15:e0239815. [PMID: 33064721 PMCID: PMC7567378 DOI: 10.1371/journal.pone.0239815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction There is a dearth of research to guide acute adolescent mental health inpatient care. Self-determination Theory provides evidence that meeting needs for relatedness, autonomy and competence is likely to increase wellbeing and intrinsic motivation. These needs may be able to be met in the inpatient environment. Method This qualitative study aimed to explore young people’s experience of acute mental health inpatient care with particular attention to meeting of these three needs. Fifteen young people were interviewed. The importance of relatedness with staff, other young people and families was identified. Results Relatedness with staff and peers were valued parts of admission. Some young people describe enhanced relatedness with family. They described loss of autonomy as a negative experience but appreciated opportunities to be involved in choices around their care and having more freedom. Coming into hospital was associated with loss of competence but they described building competence during the admission. Engaging in activities was experienced positively and appeared to enhance meeting of all three needs. Meeting of the three needs was associated with an experience of increased safety. Conclusions Engaging young people in activities with a focus on relatedness, autonomy and competence may have specific therapeutic potential. Autonomy, experience of competence and connection with staff may enhance safety more effectively than physical containment. Peer contact may have untapped therapeutic value we understand little of. This study supports the value of Self-determination Theory as a guide day to day inpatient care to meet the needs of adolescents for relatedness, autonomy and competence.
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Affiliation(s)
- Josephine Stanton
- Child and Family Unit, Auckland District Health Board, Auckland, New Zealand
| | - David R Thomas
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Maarten Jarbin
- Faculty of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Pauline MacKay
- Child and Family Unit, Auckland District Health Board, Auckland, New Zealand
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McCarthy K. Resident assistant secondary trauma and burnout associated with student nonsuicidal self-injury. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:673-677. [PMID: 30908135 DOI: 10.1080/07448481.2019.1590374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/04/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
Objective: To determine whether or not encountering students struggling with nonsuicidal self-injury (NSSI) put resident assistants (RAs) at greater risk of burnout or secondary traumatic stress. Participants: One hundred and fifty-five RAs at three Midwest public university campuses between March and April 2016. Methods: RAs participated in an anonymous online survey that collected demographics, information on RAs' experiences and thoughts related to their work, RAs' exposure to NSSI struggle of a resident, and measurements of compassion satisfaction, burnout, and secondary traumatic stress. Results: RAs who encountered resident NSSI demonstrated significantly higher levels of burnout and secondary traumatic stress than RAs who did not encounter resident NSSI. Conclusion: College students struggle with NSSI can significantly affect the people around them. Residence life administration and college counseling centers should provide training, support, and supervision to RAs in a way that addresses and reduces the RAs' potential distress.
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Bresin K. Toward a unifying theory of dysregulated behaviors. Clin Psychol Rev 2020; 80:101885. [PMID: 32615400 DOI: 10.1016/j.cpr.2020.101885] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
Dysregulated behaviors, defined as active behaviors that have short-term benefits but cause serious recurrent long-term distress or impairment to the individual and/or those around them, include behaviors such as suicidal and nonsuicidal self-injury, aggression, and substance use. These behaviors are common and costly to the individual, their friends and family, and society. Despite similar etiological models and interventions, dysregulated behaviors have largely been studied in isolation from one another. The goals of this paper were to a) define dysregulated behaviors as a coherent class of behaviors, b) review the prevalence and consequences of dysregulated behaviors, c) outline how dysregulated behaviors fit into current models of psychopathology, and d) describe the key questions to be addressed by future research in this area. It is argued that integrating across theories of discrete dysregulated behaviors can help provide aid in the development of etiological models, which in turn can improve prevention and intervention for dysregulated behaviors.
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Affiliation(s)
- Konrad Bresin
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA 30302-5010, USA.
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The Role of Social Support in the Association between Childhood Adversity and Adolescent Self-injury and Suicide: Findings from a Statewide Sample of High School Students. J Youth Adolesc 2020; 49:1195-1208. [DOI: 10.1007/s10964-020-01235-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/27/2020] [Indexed: 12/28/2022]
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Hennings JM. Function and Psychotherapy of Chronic Suicidality in Borderline Personality Disorder: Using the Reinforcement Model of Suicidality. Front Psychiatry 2020; 11:199. [PMID: 32256412 PMCID: PMC7093558 DOI: 10.3389/fpsyt.2020.00199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/02/2020] [Indexed: 12/12/2022] Open
Abstract
Although great advancements in evidence-based therapies, chronic suicidal patients with borderline personality disorder (BPD) still challenge our mental health system. While BPD patients continue suffering from distress and aversive emotions, therapists and relatives feel often stunned and helpless when confronted with suicidality resulting in interruption of therapies, repeated presentations to emergency rooms and referrals to hospitals. Reviewing the current knowledge of the functions and background of non-suicidal self-injury, we learned that reinforcement mechanisms play an important role to understand why individuals act in deliberate self-mutilation. While individual motives for non-suicidal self-injury and suicidal behavior including suicidal ideations can differ, the principle mechanisms appear to be transferrable. Elucidating the individual motives and function of suicidal behavior is an important therapeutic step, giving us access to very central maladaptive schemes and false believes that we need to address in order to reduce chronic suicidality in BPD patients. This Perspective article aims to give a better idea of what is behind and what are the differences between non-suicidal self-injury, suicidal ideations and suicide attempts. It further integrates recent developments of behavioral science in a reinforcement model of suicidality that can provide therapists a practical armamentarium in their work with chronic suicidal clients.
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Affiliation(s)
- Johannes M. Hennings
- Department of Dialectical Behavioral Therapy, kbo-Isar-Amper-Klinikum Munich-East, Munich, Germany
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Schwartz-Mette RA, Lawrence HR. Peer Socialization of Non-Suicidal Self-Injury in Adolescents' Close Friendships. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:1851-1862. [PMID: 31209626 PMCID: PMC6812616 DOI: 10.1007/s10802-019-00569-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-suicidal self-injury (NSSI), or self-harming behavior without intent to die (Nock Current Directions in Psychological Science, 18, 78-83, 2009), is associated with distress and impairment across domains, including increased risk for suicidality (Kiekens et al. Journal of Affective Disorders, 239, 171-179, 2018). In adolescence, prevalence of NSSI is high (Swannell et al. Suicide and Life-threatening Behavior, 44, 273-303, 2014), and peer influence regarding NSSI is thought to be strong (Brechwald and Prinstein Journal of Research on Adolescence, 21, 166-79, 2011). Although concern regarding "clusters" of NSSI has long been documented, peer socialization of NSSI in adolescence is understudied. This paper tests peer influence on NSSI frequency within adolescent friendship dyads. Emotion regulation difficulties and friendship quality were evaluated as factors that may influence susceptibility to peer influence effects. Adolescents (N = 196, M age = 15.68, 69.9% female, 87.6% White) nested within 93 friendship dyads reported on their own NSSI frequency, difficulties in emotion regulation, and friendship quality at three time points spaced 3 months apart. Cross-lagged Actor-Partner Interdependence Models examined peer influence effects over time. Friends' Time 1 frequency of NSSI uniquely predicted adolescents' own NSSI frequency over 3 and 6 months, controlling for initial similarity among friends as well as individual risk factors for NSSI. Peer influence effects were strongest in adolescents with higher levels of emotion regulation difficulty but did not vary as a function of friendship quality. Friends' NSSI frequency is a significant and unique predictor of increases in adolescents' own NSSI frequency over time. Implications for interventions that leverage the important developmental context of peer relationships are discussed.
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Affiliation(s)
| | - Hannah R Lawrence
- Department of Psychology, University of Maine, 301 Little Hall, Orono, ME, 04469, USA
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Pediatric Nonsuicidal Self-Injury: A Call to Action for Inpatient Staff Training. J Psychiatr Pract 2019; 25:395-401. [PMID: 31505528 DOI: 10.1097/pra.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The rising prevalence of nonsuicidal self-injury (NSSI) in pediatric populations along with the recent inclusion of NSSI as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have increased the focus on the assessment and treatment of NSSI among youth. Despite the frequent occurrence of NSSI in inpatient psychiatric treatment settings, there are no empirically based assessment protocols to guide clinical staff. This article presents findings from a needs assessment conducted with staff at a state-run child and adolescent inpatient treatment facility. The purpose was to assess the need for formalized NSSI training among staff. A questionnaire was developed to evaluate whether staff had received formal training in NSSI assessment and treatment as well as typical practice responses to patients engaging in NSSI behaviors. The questionnaire also evaluated staff comfort and confidence in their knowledge and skills concerning the assessment and treatment of NSSI among children and adolescents. Respondents were 126 clinical staff, most of whom were nursing staff. Only a minority of staff reported having received formal NSSI training, and a third of respondents indicated that they do not typically assess for NSSI at all. Although a substantial percentage of clinical staff self-reported comfort and confidence with assessing and treating NSSI, fewer than 10% demonstrated accurate skill. Formal training in NSSI is associated with positive outcomes for both patients and staff in general healthcare settings. These findings suggest that similar training for staff on pediatric inpatient psychiatric units will likely foster comfort, confidence, and accuracy, thereby improving outcomes for children and adolescents engaging in NSSI behaviors.
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Martínez-Ferrer B, Stattin H. Self-harm, depressive mood, and belonging to a subculture in adolescence. J Adolesc 2019; 76:12-19. [PMID: 31404687 DOI: 10.1016/j.adolescence.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Belén Martínez-Ferrer
- Faculty of Social Sciences, University Pablo Olavide, Ctra, Utrera, km.1, 41013, Spain.
| | - Håkan Stattin
- Department of Psychology, Uppsala University, Sweden.
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Tilton-Weaver L, Marshall SK, Svensson Y. Depressive symptoms and non-suicidal self-injury during adolescence: Latent patterns of short-term stability and change. J Adolesc 2019; 75:163-174. [PMID: 31400556 DOI: 10.1016/j.adolescence.2019.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Depressive symptoms and non-suicidal self-injury not only increase in prevalence during adolescence, but they can also occur together. Both psychological problems seem to have similar precipitating conditions, suggesting they have transdiagnostic conditions-personal or contextual characteristics that contribute to co-occurrence. We sought to understand when these two problems co-occur and what is related to their co-occurrence. METHODS Using a pattern-centered approach and two waves of longitudinal data collected annually, we examined latent profiles of depressive symptoms and self-injury among a Swedish sample of adolescents aged 12 to 16 (MageT1 = 13.65 years, SD = 0.64), 53.7% boys and 47.3% girls. Most of the adolescents were Swedish (89%), with parents who were married or cohabitating (68%). We also examined the transitions between profiles over time. RESULTS Our results suggest that during this time frame, depressive symptoms and self-injury tend to emerge and stabilize or abate together. We also examined a broad array of predictors, including individual characteristics, emotion dysregulation, experiences with friends, parents' negative reactions to behavior, and school stress. The significant unique predictors suggest that adolescents who reported being subjected to relational aggression, having negative experiences while drinking, and low self-esteem had a greater probability of moving from moderate to high levels or maintaining high levels of depressive symptoms and self-injury, compared to adolescents classified in the other statuses. CONCLUSIONS Focusing on negative interpersonal experiences and selfesteem as transdiagnostic conditions may guide research and aid clinicians in supporting adolescents who feel depressed and engage in self-injury.
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Frijters P, Islam A, Lalji C, Pakrashi D. Roommate effects in health outcomes. HEALTH ECONOMICS 2019; 28:998-1034. [PMID: 31310423 DOI: 10.1002/hec.3901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 09/25/2018] [Accepted: 05/10/2019] [Indexed: 06/10/2023]
Abstract
We use randomized roommate assignment in dormitories in a college in Kolkata in India to examine peer effects in weight gains among roommates. We use administrative data on weight, height, and test scores of students at the time of college admission and then survey these students at the end of their first and second years in college. We do not find any significant roommate specific peer effect in weight gain. Our results rather suggest that an obese roommate reduces the probability that the other roommates become obese in subsequent years. We examine potential mechanism using survey data on students' eating habits, smoking, exercise, and sleeping patterns. We find that obese roommates sleep longer, which in turn improves the sleep pattern of others, which might explain the weak negative effect of obese roommates on the weight of others in the same room.
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Affiliation(s)
- Paul Frijters
- Centre for Economic Performance, London School of Economics, London, UK
| | - Asad Islam
- Department of Economics, Monash University, Melbourne, Victoria, Australia
| | - Chitwan Lalji
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - Debayan Pakrashi
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kanpur, India
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Abdelraheem M, McAloon J, Shand F. Mediating and moderating variables in the prediction of self-harm in young people: A systematic review of prospective longitudinal studies. J Affect Disord 2019; 246:14-28. [PMID: 30572208 DOI: 10.1016/j.jad.2018.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/03/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Self-harm is widespread amongst young people. A growing body of research has explored factors that predict self-harm in young people, however, a systematic review of mediators and moderators of those factors has not yet been offered. This review aims to fill this gap by synthesising research about mediators and moderators of factors that prospectively predict self-harm in young people. METHOD A systematic review of research trials published up until 2018 was undertaken. Electronic databases Scopus (Elsevier), CINAHL, PsychINFO (EBSCO) and Medline were searched. Included studies utilised prospective longitudinal designs with participants aged 25 years or younger and self-harm outcome measures with published or reported psychometric properties. The aim of the review was to identify mediators and moderators of factors that predict self-harm in young people. RESULTS Of the 25 studies that met inclusion criteria, 22 reported at least one positive finding of a mediator or moderator. Specifically, 15 significant mediators and 20 significant moderators were identified in relation to a broad range of predictors of self-harm. Predictors were classified as adverse childhood experiences and parenting factors, psychological and psychiatric factors, social factors and intrapersonal factors. A number of potentially modifiable mediators and moderators were identified including interpersonal difficulties, impulsivity, self-esteem and self-compassion. Gender was the most commonly reported moderator. LIMITATIONS Included studies were assessed as limited by the heterogeneity of the mediators and moderators assessed, and by methodological factors including study durations, population characteristics, and the definition and assessment of self-harm. In addition, replication research was limited. Therefore it was difficult to integrate results and draw firm conclusions. CONCLUSIONS This review allowed us to explore diverse relationships between factors predictive of self-harm in young people and to identify a number of potentially modifiable mediators and moderators. Our findings have important implications for future research and treatment efforts as the identification of mediators and moderators is demonstrated to assist in identifying high risk individuals as well informing potential targets for treatment.
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Affiliation(s)
- Mona Abdelraheem
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Ultimo, NSW, Australia
| | - John McAloon
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Ultimo, NSW, Australia.
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
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50
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Miranda-Mendizabal A, Castellví P, Parés-Badell O, Alayo I, Almenara J, Alonso I, Blasco MJ, Cebrià A, Gabilondo A, Gili M, Lagares C, Piqueras JA, Rodríguez-Jiménez T, Rodríguez-Marín J, Roca M, Soto-Sanz V, Vilagut G, Alonso J. Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. Int J Public Health 2019; 64:265-283. [PMID: 30635683 PMCID: PMC6439147 DOI: 10.1007/s00038-018-1196-1] [Citation(s) in RCA: 344] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To assess the association between gender and suicide attempt/death and identify gender-specific risk/protective factors in adolescents/young adults. METHODS Systematic review (5 databases until January 2017). Population-based longitudinal studies considering non-clinical populations, aged 12-26 years, assessing associations between gender and suicide attempts/death, or evaluating their gender risk/protective factors, were included. Random effect meta-analyses were performed. RESULTS Sixty-seven studies were included. Females presented higher risk of suicide attempt (OR 1.96, 95% CI 1.54-2.50), and males for suicide death (HR 2.50, 95% CI 1.8-3.6). Common risk factors of suicidal behaviors for both genders are previous mental or substance abuse disorder and exposure to interpersonal violence. Female-specific risk factors for suicide attempts are eating disorder, posttraumatic stress disorder, bipolar disorder, being victim of dating violence, depressive symptoms, interpersonal problems and previous abortion. Male-specific risk factors for suicide attempt are disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend's suicidal behavior, and access to means. Male-specific risk factors for suicide death are drug abuse, externalizing disorders, and access to means. For females, no risk factors for suicide death were studied. CONCLUSIONS More evidence about female-specific risk/protective factors of suicide death, for adolescent/young adults, is needed.
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Affiliation(s)
- Andrea Miranda-Mendizabal
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Pere Castellví
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- Department of Psychology, Jaen University, Jaén, Spain
| | - Oleguer Parés-Badell
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Itxaso Alayo
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José Almenara
- Preventive Medicine Area and Public Health, University of Cádiz, Cádiz, Spain
| | | | - Maria Jesús Blasco
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Annabel Cebrià
- Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - Andrea Gabilondo
- Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, San Sebastian, Spain
- Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute, San Sebastian, Spain
| | - Margalida Gili
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain
- Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain
| | - Carolina Lagares
- Department of Statistics and Operative Research, University of Cádiz, Cádiz, Spain
| | | | | | | | - Miquel Roca
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain
- Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain
| | - Victoria Soto-Sanz
- Department of Health Psychology, Miguel Hernandez University of Elche, Elche, Spain
| | - Gemma Vilagut
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Alonso
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain.
- Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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