Prevalence and Function of Non-Suicidal Self-Injury (NSSI) in a Community Sample of Adolescents, Using Suggested DSM-5 Criteria for a Potential NSSI Disorder

Role of sleep problem on suicidal behaviour and non-suicidal self-injury among adolescents in Pokhara, Nepal

INTRODUCTION

Sleep is a fundamental human requirement, considered one of the major contributing factors to physical and mental health, especially among adolescents. Poor quality sleep has many potential consequences including non-suicidal self-injury (NSSI), suicidal thoughts or behaviour and complete suicide. The NSSI and suicidal behaviour are increasing in Nepal. Thus, this study aimed to assess the role of sleep problem on suicidal behaviour and non-suicidal self-injury among adolescents in Pokhara metropolitan, Nepal.

METHODS

A cross-sectional analytical study was conducted among 673 adolescents using a multistage cluster sampling technique from private and public schools in Pokhara Metropolitan. Self-administered questionnaire was used for data collection. Collected data was entered and managed in EpiData (version 3.1) and analysed in IBM SPSS (version 23). Binary logistic regression was used to identify the association of sleep problem with NSSI and suicidal behaviour.

RESULTS

The study found that sleep problem (65.2%, 439), suicidal behaviour (18.6%, 125) and NSSI (57.9%, 390) were prevalent among adolescents in study setting. The presence of sleep problem significantly influenced the suicidal behavior (AOR = 3.88, 95% CI = 2.27-6.63) alongside the sex of student (AOR = 1.96, 95% CI = 1.28-3.00), adolescents from family having monthly income less than NPR 40,000 (AOR = 1.97 95% CI = 1.16-3.35) and private schools students (AOR = 2.99, 95% CI = 1.84-4.86). Likewise, sleep problem was also associated with non-suicidal self-injury (AOR = 3.24, 95% CI = 2.26-4.65), in addition to attending private school (AOR = 2.52, 95% CI = 1.71-3.72).

CONCLUSION

This study concludes that sleep problem is prevalent among the adolescents and increase the risk of NSSI and suicidal behaviour. Therefore, parents and teachers need to assess their conditions and help them maintain sound sleep. Additionally, suicide prevention strategies need to be adopted to mitigate further risk.

A multi-modal assessment of self-knowledge in adolescents with non-suicidal self-injury: a research domains criteria (RDoC) study

BACKGROUND

Adolescence is a critical period for brain development, consolidation of self-understanding, and onset of non-suicidal self-injury (NSSI). This study evaluated the RDoC (Research Domain Criteria) sub-construct of Self-Knowledge in relation to adolescent NSSI using multiple units of analysis.

METHODS

One hundred and sixty-four adolescents assigned female at birth (AFAB), ages 12-16 years with and without a history of NSSI entered a study involving clinical assessment and magnetic resonance imaging (MRI), including structural, resting-state functional MRI (fMRI), and fMRI during a self-evaluation task. For imaging analyses, we used an a priori defined Self Network (anterior cingulate, orbitofrontal, and posterior cingulate cortices; precuneus). We first examined interrelationships among multi-level Self variables. We then evaluated the individual relationships between NSSI severity and multi-level Self variables (self-report, behavior, multi-modal brain Self Network measures), then conducted model testing and multiple regression to test how Self variables (together) predicted NSSI severity.

RESULTS

Cross-correlations revealed key links between self-reported global self-worth and self-evaluation task behavior. Individually, greater NSSI severity correlated with lower global self-worth, more frequent and faster negative self-evaluations, lower anterior Self Network activation during self-evaluation, and lower anterior and posterior Self Network resting-state connectivity. Multiple regression analysis revealed the model including multi-level Self variables explained NSSI better than a covariate-only model; the strongest predictive variables included self-worth, self-evaluation task behavior, and resting-state connectivity.

CONCLUSIONS

Disruptions in Self-Knowledge across multiple levels of analysis relate to NSSI in adolescents. Findings suggest potential neurobiological treatment targets, potentially enhancing neuroplasticity in Self systems to facilitate greater flexibility (more frequently positive) of self-views in AFAB adolescents.

Similarities and differences in the functions of non-suicidal self-injury (NSSI) across gender non-conforming and cisgender young adults

BACKGROUND

Non-suicidal self-injury (NSSI) can be motivated by a broad range of functions and many individuals report multiple reasons for self-injuring. Most NSSI research has involved predominantly female samples and few studies have examined gender similarities and differences in function endorsement.

METHODS

We characterise the prevalence and versatility of NSSI functions within a gender-diverse online sample of cisgender women (cis-women; n = 280), cisgender men (cis-men; n = 176), and transgender, non-binary, and other gender non-conforming young adults (TGNC; n = 80) age 18-30 (M = 23.73, SD = 3.55). The Ottawa Self-Injury Inventory (OSI-F) assessed 24 intrapersonal and social functions across nine domains: affect regulation, self-punishment, anti-dissociation, anti-suicide, sensation seeking, sexuality, interpersonal influence, and body image.

RESULTS

TGNC participants and cis-women were significantly more likely to report intrapersonally motivated NSSI and greater function versatility than cis-men. Low mood, emotional distress, suicidality, and trauma symptomology appeared to contribute to gender differences in function endorsement. Gender similarities also emerged; across groups, intrapersonal functions were substantially more common than social functions, and the most endorsed domains were affect regulation and self-punishment. No domains were gender specific.

LIMITATIONS

The OSI-F was developed from majority female samples and may not adequately capture the experiences of other gender groups.

CONCLUSIONS

Interventions which reduce distress and strengthen emotion regulation are likely to benefit individuals who self-injure regardless of gender. However, most individuals report multiple NSSI functions and person-centred interventions which address this complexity are needed. Future research should develop gender-informed treatment models which consider the unique experiences of TGNC individuals and cis-men who self-injure.

Non-suicidal self-injury among youth students during COVID-19 pandemic: the role of psychological factors in Jingzhou, China

Objective

This study aimed to explore the impact of the COVID-19 pandemic on non-suicidal self-injury (NSSI) among youth students, and the mediating role of psychological factors in the relationship between the COVID-19 pandemic and NSSI.

Method

An online survey was conducted at junior and senior high schools, as well as universities located in Jingzhou, Hubei Province, China between June 2021 and January 2022. The COVID-19 Impact Index was constructed using multiple correspondence analysis (MCA) method. The bootstrapping method was used for mediation analysis.

Results

A total of 16025 youth participated in the study and 12507 youth (78.1%) finished the questionnaires. The COVID-19 Impact Index had a significantly positive effect on NSSI (r=0.16, p<0.001). The mediation analysis results showed that the COVID-19 Impact Index had a significant indirect effect on youth' NSSI (β=0.0918, 95% CI [0.0788, 0.1048]), and this indirect effect was mainly achieved through affecting youth' anxiety, depression and post-traumatic stress disorder (PTSD). The mediation effect of anxiety on NSSI was 0.0584, the direct effect was 0.0334, and the mediation proportion was 63.6%. The mediation effect of depression on NSSI was 0.0668, the direct effect was 0.0250, and the mediation proportion was 72.8%. The mediation effect of PTSD on NSSI was 0.0640, the direct effect was 0.0278, and the mediation proportion was 69.7%. All the mediation effects, direct effects and total effects were statistically significant (p<0.001).

Conclusion

The higher the impact of the COVID-19 Impact Index, the higher the prevalence of NSSI among youth students. Anxiety, depression and PTSD had mediated the relationship between the COVID-19 Impact Index and NSSI. It is suggested that specific health policies, mental health services and interventions should be developed to reduce the NSSI and improve mental health status among youth students during the COVID-19 pandemic.

Self-Compassion as a Mediator Linking Sleep Disturbances with Non-Suicidal Self-Injury: A Four-Wave, Cross-Lagged Study

Objective

This longitudinal study examined the reciprocal relationship between sleep disturbances with non-suicidal self-injury and whether self-compassion mediates these associations.

Methods

A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students at the baseline. This study spanned six waves with a six-month interval between each wave. Data from the last four waves were used because self-compassion or non-suicidal self-injury was not measured in the first two waves. The cross-lagged panel models were used to examine the longitudinal dynamic relationships between sleep disturbances, self-compassion, and non-suicidal self-injury.

Results

The results showed that all the auto-regressive paths were significant. For the cross-lagged paths, there was a reciprocal relation between sleep disturbances and self-compassion. Importantly, self-compassion played a longitudinal mediating role in the prediction from sleep disturbances to non-suicidal self-injury (indirect effect = 0.007 to 0.009, all p values < 0.001).

Conclusion

Psychological interventions targeting improved sleep quality and self-compassion may hold great promise for reducing the incidence of non-suicidal self-injury.

The role of testosterone and cortisol levels in nonsuicidal selfinjury in adolescents

INTRODUCTION

Nonsuicidal selfinjury (NSSI) is an important problem in adolescence, which is thought to serve several reinforcement functions (positive vs. negative, automatic vs. social). While the psychological mechanisms involved in NSSI are relatively well known, there is an important gap in the knowledge regarding the underlying biological mechanisms. This study examined the role of testosterone (T) and cortisol (C) in the frequency and reinforcement functions of NSSI.

METHODS

A total of 423 adolescents (age range = 13-17; 54.4% girls) from Basque Country (Spain) provided saliva samples to determine T and C levels and completed measures of NSSI 6 months later in 2017-2018.

RESULTS

The results showed that T but not C was significantly associated with higher NSSI frequency and the four types of NSSI functions. In addition, C moderated the predictive association between T and NSSI for automatic negative reinforcement, such that this association was significant only when C was high. Participant sex did not moderate any association between hormones and NSSI.

CONCLUSIONS

These preliminary results suggest that testosterone levels can affect NSSI behaviors in adolescence, thus helping to explain the increase in NSSI during this stage. Moreover, in situations in which NSSI serves to alleviate negative internal states, high levels of cortisol can be involved.

Sex Differences in the Global Prevalence of Nonsuicidal Self-Injury in Adolescents: A Meta-Analysis

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.

The Impact of Recent Life Events, Internalizing Symptoms, and Emotion Regulation on the Severity of Non-Suicidal Self-Injury in Adolescents: A Mediation Analysis

Background

Previous studies have demonstrated a strong association between recent stressful life events and non-suicidal self-injury (NSSI) among adolescents. Internalizing symptoms and difficulty in emotion regulation (DER) may mediate this relationship. This study aimed to investigate the relationship between recent stressful life events and NSSI severity in adolescents and the potential moderating role of internalizing symptoms and DER.

Methods

A total of 224 adolescent inpatients (78.6% female) participated in the study, with an age range of 12-18 years old. Data on recent stressful life events, internalizing symptoms, DER, and NSSI behaviors were collected using a clinician-rated questionnaire. A structural equation model was used to test the hypothesized model.

Results

The rate of NSSI reporting among adolescents in the past 12 months was 65.18%. Recent stressful life events were found to be directly associated with NSSI severity (β = 0.128, P = 0.023). A chain-mediating effect between recent stressful life events and NSSI was also confirmed (β = 0.034, P = 0.023), with DER and internalizing symptoms playing a chain-mediating role and DER having a significantly indirect association with NSSI through internalizing symptoms.

Conclusion

Recent stressful life events appear to play a role in the etiology of NSSI, particularly punishment and interpersonal relationship events that warrant special attention. DER and internalizing symptoms play a chain-mediating role in the relationship between life events and NSSI. Reducing recent stressful life events, screening for internalizing symptoms, and improving emotion regulation may decrease NSSI behavior among adolescents.

IL-6 predicts non-suicidal self-injury over 3 months in high-risk adolescents

BACKGROUND

Suicide is the second leading cause of death in 12- to 17-year-old adolescents in the USA. Research on biological mechanisms contributing to self-harm risk that could be targeted in treatment could help to prevent suicide and self-harm episodes.

AIMS

We aimed to evaluate whether markers of inflammation, interleukin-6 (IL-6) and C-reactive protein (CRP), predict self-harm over 3 months within a sample selected for elevated suicide/self-harm risk at project entry.

METHOD

Fifty-one adolescents aged 12-19 years selected for elevated suicide/self-harm risk completed three clinical interviews about suicide attempts and non-suicidal self-injury, 3 months apart. At baseline and 3 months, youth also provided blood samples, from which we assayed levels of IL-6 and CRP.

RESULTS

Using generalised mixed models, we found that greater levels of IL-6 predicted more self-harm episodes (odds ratio [OR] = 3.3, 95% CI: 1.1, 10.0) and specifically, non-suicidal self-injury (OR = 3.5, 95% CI: 1.1, 11.2), over 3 months.

CONCLUSIONS

The study findings increase our understanding of whether and how inflammation may be implicated in risk of self-harm. IL-6 may be a viable biological marker of short-term risk for self-harm.

Measurement and stratification of nonsuicidal self-injury in adolescents

BACKGROUND

Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI.

METHODS

The performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures.

RESULTS

A total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures.

CONCLUSIONS

When investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.

Examining the Presence, Frequency, and Associated Characteristics of Nonsuicidal Self-Injury by Proxy: Initial Validation of the Nonsuicidal Self-Injury by Proxy Questionnaire (NSSIBPQ)

Nonsuicidal self-injury (NSSI) by proxy is the intentional destruction of one's own body tissue through the elicitation of another being's actions. Despite its clinical relevance, research on NSSI by proxy is limited and there are no available measures of this behavior. This research aimed to characterize NSSI by proxy among young adults and provide preliminary data on the validity of a new self-report measure, the NSSI by Proxy Questionnaire (NSSIBPQ). Two nationwide community samples of young adults (one general community sample and one with a history of traditional NSSI and suicidality) completed online studies. NSSI by proxy was reported by 18% of the general community sample and 45% of the self-injuring sample. Findings support the clinical relevance of NSSI by proxy and its potential to meet criteria for an NSSI disorder diagnosis. Results also provide preliminary support for the internal consistency and convergent, discriminant, and concurrent validity of the NSSIBPQ.

Online and school bullying roles: are bully-victims more vulnerable in nonsuicidal self-injury and in psychological symptoms than bullies and victims?

BACKGROUND

Bullying leads to adverse mental health outcomes and it has also been linked to nonsuicidal self-injury (NSSI) in community adolescents. It is not clear whether different roles of bullying (bully, victim, bully-victim) are associated with NSSI, furthermore the same associations in cyberbullying are even less investigated.

METHODS

The aim of the current study was to test whether students involved in school or online bullying differed from their not involved peers and from each other in psychological symptoms (externalizing and internalizing problems) and in NSSI severity (number of episodes, number of methods). Furthermore, mediation models were tested to explore the possible role of externalizing and internalizing problems in the association of school and online bullying roles with NSSI. In our study, 1011 high school students (66.07% girls; n = 668), aged between 14 and 20 years (Mage = 16.81; SD = 1.41) participated.

RESULTS

Lifetime prevalence of at least one episode of NSSI was 41.05% (n = 415). Students involved in bullying used more methods of NSSI than not involved adolescents. In general, victim status was associated mostly with internalizing symptoms, while bully role was more strongly associated with externalizing problems. Bully-victims status was associated with both types of psychological problems, but this group did not show a significantly elevated NSSI severity compared to other bullying roles. Externalizing and internalizing problems mediated the relationship between bullying roles and NSSI with different paths at different roles, especially in case of current NSSI that happened in the previous month.

CONCLUSIONS

Results highlight that students involved in bullying are more vulnerable to NSSI and to psychological symptoms compared to their peers who are not involved in bullying. It is suggested that bullying roles, especially bully-victim status, need to be identified in school and online settings and thus special attention should be addressed to them to reduce psychological symptoms and NSSI, for example by enhancing adaptive coping skills.

Role of Developmental Timing of Childhood Adversity in Nonsuicidal Self-Injury Persistence or Desistance

Given the high prevalence of nonsuicidal self-injury (NSSI), scientific interest is on the rise, yet its developmental course remains understudied. Factors that may influence NSSI behavior are also unclear, although early research describes it as a maladaptive form of emotion regulation. In a college student sample (N = 507), the current study examines the extent that developmental timing of, and cumulative exposure to, potentially traumatic events (PTEs) accounts for variance in NSSI frequency, duration, and desistance, as well as the role that emotion regulation difficulties (ERD) play. Of 507 participants, 411 endorsed PTE exposure and were categorized into developmental groups based on age of initial PTE exposure, with the hypothesis that initial exposure during early childhood and adolescence may represent particularly sensitive risk periods. Results revealed that cumulative PTE exposure was significantly positively associated with shorter NSSI desistance, whereas ERD were significantly negatively associated with shorter NSSI desistance. However, the interaction between cumulative PTE exposure, when coupled with current ERD significantly moderated (i.e., strengthened) the path between cumulative PTE exposure and NSSI desistance. When examined individually, this interaction was only significant for the early childhood group, suggesting that the effects of PTE exposure on NSSI persistence may vary not only as a function of emotion regulation capacities but also when in the developmental course initial PTE exposure occurs. These findings contribute to our understanding of the role of PTE and timing, as well as ERD, in predicting NSSI behavior, and can inform programs and policies to prevent and curtail self-harm.

A preliminary investigation into cortical structural alterations in adolescents with nonsuicidal self-injury

The structural neural correlates underlying youth nonsuicidal self-injury (NSSI) warrant further exploration. Few studies have explored the association between NSSI and brain structure in adolescence, and no studies have investigated differences in the relation between age and brain structure in youth with NSSI. This preliminary investigation examined associations between NSSI history, age, and cortical structure using magnetic resonance imaging in adolescent girls (N=100, Mage=13.4 years) at increased risk for psychopathology. We conducted whole-brain analyses to investigate the associations between age and cortical structure, NSSI history and cortical structure, and NSSI history as a moderator of the association between age and cortical structure. Results suggested that age was associated with less cortical thickness and surface area in the left and right prefrontal, temporal, and parietal cortex. NSSI history was associated with less left insula and left inferior parietal cortex cortical surface area. Among adolescents with NSSI history, older age predicted greater left inferior parietal cortex surface area and was not associated with left precentral cortex surface area. Among adolescents without NSSI history, older age predicted smaller surface areas as expected with the typical trajectory of neurodevelopment. Overall, our results suggest differences in cortical surface area development in adolescents with NSSI history.

School-based self-harm prevention programs: A systematic review with implications for international implementation

Both self-harm and suicidal behaviors have been targeted through school-based prevention programs, many of which have been developed in the United States. The aims of this systematic review were to assess effects of school-based prevention programs on suicide and self-harm and to evaluate whether they are fit to the exporting culture. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our inclusion criteria, structured according to population/problem, intervention, control/comparison, outome, were: children and youth up to 19 years of age, school-based programs at universal, selective or indicated levels compared with teaching as usual or with other programs, and outcomes of suicide or self-harm measured at least 10 weeks after intervention. Studies without a control group or using non-behavioral outcomes were excluded. A comprehensive and systematic literature search was conducted from the 1990s to March 2022. Risk for bias was assessed with checklists adapted from the Cochrane Risk of Bias (ROB) tool. A total of 1,801 abstracts were retrieved. Five studies fulfilled our inclusion criteria, but one had high risk for bias. Confidence in the evidence for effect was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Studies included in this review were evaluated with respect to applicability in the context of international export. Only two school-based programs demonstrated efficacy in preventing suicidal behaviors. Although implementation of evidence-based interventions is a crucial next step, further replication with simultaneous attention to dissemination and implementation issues are called for. Funding and registration: conducted on assignment by the Swedish government. The protocol is available at the SBU website in Swedish.

The Association between Nonsuicidal Self-Injury and Perfectionism in Adolescence: The Role of Mental Disorders

Previous evidence has drawn attention to the fact that maladaptive perfectionism is a risk factor for engagement in nonsuicidal self-injury (NSSI). Until now, few studies have examined this topic, especially among community adolescents. The aim of this study was to explore the relationship between perfectionism dimensions and NSSI functions to examine the potential mediating effect of mental disorders. Altogether, 146 Hungarian community adolescents (ages 13-18 years) were involved. All participants completed the Hungarian adaptation of the Inventory of Statements about Self-Injury (ISAS), the Frost Multidimensional Perfectionism Scale (FMPS), and the Mini International Neuropsychiatric Interview Kid. To analyse the interrelationships among NSSI, perfectionism, and mental disorders, we conducted regression and network analysis. Of the 146 adolescents, 90 (61.64%, girls: 71.11%) engaged in NSSI. The Concern over Mistakes and Doubts about Action scales of the FMPS significantly and positively predicted both NSSI intrapersonal and interpersonal motivation, with comparable effect sizes, and this association was fully mediated by anxiety disorders. There was a significant direct negative relationship between the FMPS Organisation dimension and both main NSSI functions. This study draws attention to an increasing trend and the extremely high NSSI prevalence rate among community adolescents. Adolescents with perfectionistic concerns are at heightened risk for anxiety disorders, which can increase their vulnerability to NSSI engagement.

Physiological response to pain in female adolescents with nonsuicidal self-injury as a function of severity

BACKGROUND

Preliminary evidence indicates altered hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) response to experimental pain in individuals with nonsuicidal self-injury (NSSI). This study investigated effects of NSSI severity and severity of psychopathology on the HPA axis and ANS response to pain.

METHODS

N = 164 adolescents with NSSI and n = 45 healthy controls received heat pain stimulation. Salivary cortisol, α-amylase and blood pressure were repeatedly assessed before and after painful stimulation. Heart rate (HR) and heart rate variability (HRV) were assessed continuously. NSSI severity and comorbid psychopathology were derived from diagnostic assessments. Main and interaction effects of time of measurement and NSSI severity, adjusted for severity of adverse childhood experiences, borderline personality disorder and depression, on HPA axis and ANS response to pain were examined using regression analyses.

RESULTS

Increasing NSSI severity predicted an increasing cortisol response (χ2(3) = 12.09, p = .007) to pain. After adjusting for comorbid psychopathology, greater NSSI severity predicted decreased α-amylase levels following pain (χ2(3) = 10.47, p = .015), and decreased HR (χ2(2) = 8.53, p = .014) and increased HRV(χ2(2) = 13.43, p = .001) response to pain.

LIMITATIONS

Future research should implement several NSSI severity indicators, potentially revealing complex associations with the physiological response to pain. Assessing physiological responses to pain in NSSI in a naturalistic setting presents a promising avenue for future research in NSI.

CONCLUSIONS

Findings indicate an increased pain-related HPA axis response and an ANS response characterized by reduced sympathetic and increased parasympathetic activity associated with NSSI severity. Results support claims for dimensional approaches to NSSI and its related psychopathology alongside shared, underlying neurobiological correlates.

Developmental pathways of repetitive non-suicidal self-injury: predictors in adolescence and psychological outcomes in young adulthood

BACKGROUND

Much longitudinal research has been carried out on non-suicidal self-injury (NSSI) during the last decades, but there still is a lack of studies of the individual developmental pathways of NSSI from adolescence into young adulthood. The aim of the present study was to investigate individual developmental pathways of repetitive non-suicidal self-injury (repNSSI) from adolescence into young adulthood, including adolescent predictors and psychological outcomes in young adulthood. Three developmental pathways were targeted: stable adolescence-limited repNSSI; repNSSI prolonged into young adulthood; and late-onset repNSSI; with no repNSSI as comparison.

METHODS

Data were taken from a cohort of compulsory school students (N = 1064) in grades 7-8 in a Swedish municipality. The cohort was followed longitudinally, and this study included all individuals (n = 475) with NSSI data from three waves: T1 (when they were 13-15 years old); T2 (one year later); and T3 (ten years later). RepNSSI was operationalized as self-reports of at least 5 instances of NSSI during the past six/twelve months.

RESULTS

The two pathways that involved stable repNSSI were observed significantly more often than expected by chance, with the strongest overrepresentation for the Prolonged RepNSSI pathway. Still, most adolescents who engaged in stable repNSSI stopped this before reaching young adulthood. Those who stopped did not, however, show a significantly better psychological adjustment in young adulthood than those who continued. Compared to participants with no repNSSI, participants who had stopped still reported significantly more stress, anxiety, and emotional dysregulation. As to the prediction of late onset NSSI, the findings were less robust, but sporadic NSSI at T1 and poor sleep at T2 were significant predictors, whereas depressive symptoms fell just short of significance at both timepoints.

CONCLUSIONS

The present results indicate that among adolescents who engage in stable adolescent repNSSI (1) significantly more individuals than expected by chance still engage in repNSSI ten years later, and (2) those who stop engaging in repNSSI do not show significantly better psychological adjustment than those who still engage in it. The present findings also indicate that late onset of repNSSI as reported in young adulthood to some extent is predictable from symptom measures ten years earlier.

A Multilevel Examination of Cognitive Control in Adolescents With Nonsuicidal Self-injury

Background

Nonsuicidal self-injury (NSSI), a transdiagnostic behavior, often emerges during adolescence. This study used the Research Domain Criteria approach to examine cognitive control (CC) with a focus on response inhibition and urgency relative to NSSI severity in adolescents.

Methods

One hundred thirty-eight adolescents, assigned female sex at birth, with a continuum of NSSI severity completed negative and positive urgency measurements (self-report), an emotional Go/NoGo task within negative and positive contexts (behavioral), and structural and functional imaging during resting state and task (brain metrics). Cortical thickness, subcortical volume, resting-state functional connectivity, and task activation focused on an a priori-defined CC network. Eighty-four participants had all these main measures. Correlations and stepwise model selection followed by multiple regression were used to examine the association between NSSI severity and multiunit CC measurements.

Results

Higher NSSI severity correlated with higher negative urgency and lower accuracy during positive no-inhibition (Go). Brain NSSI severity correlates varied across modalities and valence. For right medial prefrontal cortex and right caudate, higher NSSI severity correlated with greater negative but lower positive inhibition (NoGo) activation. The opposite pattern was observed for the right dorsolateral prefrontal cortex. Higher NSSI severity correlated with lower left dorsal anterior cingulate cortex (ACC) negative inhibition activation and thicker left dorsal ACC, yet it was correlated with higher right rostral ACC positive inhibition activation and thinner right rostral ACC, as well as lower CC network resting-state functional connectivity.

Conclusions

Findings revealed multifaceted signatures of NSSI severity across CC units of analysis, confirming the relevance of this domain in adolescent NSSI and illustrating how multimodal approaches can shed light on psychopathology.

Early maladaptive schemas are associated with self-injury thoughts and behavior in adolescents

BACKGROUND

Early maladaptive schemas (EMSs) and self-harm have been firmly linked in adults, but research on these associations in adolescents remains scarce. Additionally, the links between EMSs and functions of self-injury has not been previously studied in this age group. Thus, the aim of the present study was to investigate the associations of EMSs with self-harm thoughts and behavior, as well as with self-harm functions, among adolescents in specialized health care.

METHODS

The participants were recruited from first-visit 12-22-year-old adolescent patients entering specialized mental health care or pediatric care. For 118 participants, complete data were available for the Young Schema Questionnaire Short Form 2-Extended (YSQ) when entering care and the Ottawa Self-Injury Inventory Functions scale (OSI-F) one year later. YSQ was used to measure the participants' EMSs and OSI-F their self-harm thoughts and behavior. The associations of EMSs and self-harm were investigated in three groups: no self-harm, self-harm thoughts only, and both self-harm thoughts and behavior. The associations of EMSs with self-injury behavior functions were assessed in four categories: Internal Emotional Regulation, External Emotional Regulation, Social Influence, and Sensation Seeking. Additionally, EMSs' associations with addictive features of self-injury behavior were assessed. The magnitudes of effect sizes of differences between the self-harm groups were evaluated with Cliff's Delta. The associations of EMSs with self-injury functions were analyzed with general linear modeling and with self-injury addictive features using logistic regression.

RESULTS

The differences between the self-harm groups were significant for the majority of the EMSs. The stronger the EMSs were, the more severe the manifestations of self-harm. The effect sizes ranged from small to large depending on the EMS. Considering self-injury functions, Internal Emotional Regulation was associated with Self-Sacrifice EMS (p = 0.021), and External Emotional Regulation both with Abandonment (p = 0.040) and Unrelenting Standards (p = 0.012) EMSs. Being addicted to self-injury was associated with Abandonment (p = 0.043) and Dependence (p = 0.025) EMSs.

CONCLUSIONS

The present study shows that significant associations between EMSs and both self-harm thoughts and behavior exist also in adolescents. Stronger EMSs are linked to more severe self-harm. Knowledge of these associations may help to improve the understanding and treatment of adolescents suffering from self-harm.

Current status of nonsuicidal injuries and associated factors among junior high school students in Hainan Province, China: a cross-sectional study

BACKGROUND

To summarize the general status of nonsuicidal self-injury (NSSI) behaviour and the characteristics of junior high school students and to determine the risk factors associated with NSSI behaviour.

METHODS

Five middle schools in the rural and urban areas of Hainan Province were randomly selected for this cross-sectional study, and junior high school students were administered questionnaires, including the General Sociodemographic Questionnaire, Ottawa Self-Injury Scale, Anxiety Self-Rating Scale, Depression Self-Rating Scale, Adolescent Lifestyle Scale, and Parenting Style Scale.

RESULTS

The NSSI rate among junior high school students in Hainan Province was 28.9%, with a higher prevalence among girls than boys (P < 0.05). The age range was 11-16 years, with a mean age of 13.08 ± 0.911 years. The most common form of self-injury was scratching/bruising, followed by hitting oneself, pulling out hair, biting, head banging, and cutting. The NSSI methods of scratching/bruising, hitting oneself and cutting more commonly occurred in girls than boys (P < 0.05). The most common sites of self-injury were the face, scalp, lips, forearm/elbow, axilla/wrist, hands/fingers, and thighs/knees. Significant differences were observed in the distribution of self-injury sites (nose, lips, genitals, and axillae/wrists) between the two genders (p < 0.05). The most important motivation for undertaking NSSI behaviours was to release negative emotions. The risk factors affecting NSSI behaviours were female gender (OR = 1.793), depression (OR = 1.961), anxiety (OR = 1.495), interpersonal relationship factors (OR = 1.099), academic stress factors (OR = 1.062), maternal emotional warmth (OR = 0.97), and maternal overinterference (OR = 1.036).

CONCLUSIONS

The NSSI rate among junior high school students in Hainan was 28.9%, affecting girls more than boys. The form and site of self-injury between boys and girls were significantly different. The motivation for committing self-injurious behaviours was mainly to regulate bad emotions. Risk factors for NSSI behaviours included female gender, anxiety, depression, interpersonal relationship factors, academic stress factors, and maternal emotional overinterference, while maternal emotional warmth was a protective factor.

Association between life events, anxiety, depression and non-suicidal self-injury behavior in Chinese psychiatric adolescent inpatients: a cross-sectional study

Background

Non-suicidal self-injury (NSSI) is a major public health concern among adolescents. Further research is needed into contributors to this behavior, in particular among adolescents with psychiatric disorders. The aim of the present study was to explore the impact of life events and emotional stress on NSSI among hospitalized psychiatric adolescents.

Methods

In this cross-sectional study, 505 Chinese psychiatric adolescent inpatients 10-19  years old completed questionnaires about sociodemographic characteristics and NSSI as well as the Adolescent Self-Rating Life Events Checklist (ASLEC), the State-Trait Anxiety Inventory Form Y, and the Center for Epidemiological Studies Depression Scale. Chi-square test was used to compare the incidence of NSSI in psychiatric adolescent patients with different sociodemographic. T-test was used to compare the total scores and dimension scores of the ASLEC, STAI-Y, and CES-D between the NSSI group and the non-NSSI group. A binary logistic regression model was built to explore the relationships among sociodemographic characteristics, questionnaire scores and NSSI.

Results

Most psychiatric adolescent inpatients (393, 77.8%) reported NSSI behavior. The higher risk for NSSI was observed among female (odds ratio [OR] 2.665, 95% confidence interval [CI] 1.575-4.510), younger adolescents (10-14 years; OR 2.021, 95% CI 1.258-3.245), with a suicide history (OR 2.479, 95% CI 1.549-3.967), or with depression symptom (OR 3.217, 95% CI 1.572-6.582) and those with higher scores of ASLEC (OR 1.019, 95% CI 1.010-1.029).

Conclusion

Our study in China is one of the first to apply to adolescent inpatients the diagnostic criteria of NSSI in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders. Our analysis suggests that NSSI prevalence is disturbingly high among adolescents with mental illness in China. A better understanding of contributing factors, especially negative life events and negative emotions, may guide interventions that can reduce its prevalence.

Sleep problems mediate the influence of childhood emotional maltreatment on adolescent non-suicidal self-injury: The moderating effect of rumination

BACKGROUND

Non-suicidal self-injury (NSSI) is a highly serious public health problem among adolescents in China, and childhood emotional maltreatment has been found to be a risk factor for NSSI.

OBJECTIVE

Little is known about the longitudinal association between childhood emotional maltreatment and NSSI as well as its underlying mediating and moderating mechanisms. Thus, we hypothesized whether sleep problems mediated the association between childhood emotional maltreatment and NSSI, and whether this indirect effect was moderated by rumination.

PARTICIPANTS AND SETTING

A total of 1987 Chinese adolescents (56.1 % males; ages 10 to 14, M = 12.32, SD = 0.53) completed self-report questionnaires regarding childhood emotional maltreatment, sleep problems, rumination non-suicidal self-injury (NSSI) in three waves.

METHODS

Structural equation model was used to test a moderated mediation model, with gender, age and socioeconomic status and baseline measures as covariates.

RESULTS

Childhood emotional maltreatment was significantly associated with NSSI, and this association was mediated by sleep problems. Moderated mediation analyses revealed that rumination intensified the relation between childhood emotional maltreatment and sleep problems as well as the relation between sleep problems and NSSI.

CONCLUSIONS

Findings of this study demonstrate a relationship among childhood emotional maltreatment, sleep problems, rumination and NSSI. Interventions that target sleep problems and rumination may be beneficial for reducing NSSI for at-risk adolescents.

Negative and Positive Emotional Reactivity in Women With and Without a History of Self-Injury

In trying to better understand why certain individuals self-injure, researchers have proposed high emotional reactivity for negative emotions may influence vulnerabilities and predispose individuals to react to stressful situations in a dysregulated manner, thus engaging in non-suicidal self-injury (NSSI). However, the role of emotional reactivity for positive emotions in those with a history of NSSI is still unclear. Thus, the present study sought to examine group differences in the reactivity of (a) negative and (b) positive emotions in young adults with and without a history of NSSI engagement, and (c) to evaluate whether the reactivity of positive emotions could predict NSSI engagement when controlling for reactivity of negative emotions. The sample consisted of 96 female students who reported engaging in NSSI within the past 2 years (M_age = 20.28 years, SD = 1.65) and an age-matched female comparison group with no NSSI history (M_age = 20.43 years, SD = 1.76). Results from separate MANOVAs indicated individuals with a history of NSSI reported higher negative reactivity across all aspects (emotional intensity, sensitivity, and persistence) than the comparison group, Wilk's λ = .86, F (3,188) = 10.65, p < .001, partial η² = .145; however, no significant differences emerged for positive reactivity, Wilk's λ = .99, F (3,188) = 0.52, p = .669. Moreover, a logistic regression revealed that persistence of negative emotions was the only significant predictor of NSSI, Wald χ² (1) = 4.54, p = .03. The present results highlight the importance of the persistence of negative emotions for individuals who engage in NSSI. Furthermore, the current study provides the first suggestion of no significant differences in positive emotional reactivity between individuals with and without NSSI; underlining the importance of focusing on negative emotional reactivity in clinical practice as well as using positive emotions to "undo" the effect of negative emotions.

Symptomatic, Alexithymic, and Suicidality-Related Features in Groups of Adolescent Self-Harmers: A Case-Control Study

Non-suicidal self-injury (NSSI) is an increasing phenomenon among both clinical and nonclinical adolescent groups and is associated with several psychopathological symptoms, in addition to being one of the main risk factors for suicidality. Nevertheless, differences between clinical and nonclinical samples of self-harmers in symptom dimensions, alexithymia, suicidality, and NSSI-related variables are still scarcely investigated. The current study aimed to fill this gap by enrolling a sample of Italian girls (age range: 12-19 years) that included 63 self-harmers admitted to mental health outpatient services (clinical group), 44 self-harmers without admission to mental health services (subclinical group), and 231 individuals without an NSSI history (control group). Questionnaires investigating psychopathological symptoms, alexithymia, and NSSI-related variables were administered. The results highlighted that all symptom-related variables and alexithymic traits were more severe in the NSSI groups than in the control group; in particular, self-depreciation, anxiety, psychoticism, and pathological interpersonal relationships were distinguished between the clinical and subclinical groups. Compared to the subclinical group, the clinical group was characterized by higher NSSI frequency, NSSI disclosure, self-punishment as the main reason for engagement in NSSI, and suicidal ideation. These findings were then discussed in terms of clinical practice and primary and secondary prevention in the adolescent population.

Non-suicidal self-injury in a college sample: Intrapersonal and family factors

Objective: Adolescents and young adults are at risk for non-suicidal self-injury (NSSI) and suicidal behavior. This study examined intrapersonal (depressive symptoms, self-criticism) and family (perceived family functioning, parenting style, parental attachment) factors associated with reported history of NSSI in a college sample. Method: Participants included 111 undergraduate students (M_age = 20.2) from a private, nonprofit university. Data were collected via online survey. Hierarchical logistic regression analysis was conducted. Results: The final model was statically significant, Nagelkerke R² = .40, suggesting a robust association between the predictors and history of NSSI. Self-criticism and unhealthy family functioning were significant predictors of NSSI behaviors after controlling for study variables and demographic characteristics. Reported history of engaging in NSSI was positively correlated with parent alienation, unhealthy family functioning, self-criticizing behaviors, and depressive symptoms. Conclusion: College mental health providers should be familiar with risk factors of NSSI as well as strategies to address self-criticism.

The Association Between Atypical Speech Development and Adolescent Self-Harm

BACKGROUND

Adolescent self-harm is a major public health issue internationally. Various factors associated with adolescent self-harm have been identified, including being bullied and experiencing mental health problems. Stuttering and speech sound disorder are associated with both of these factors. It was hypothesized that both stuttering and speech sound disorder would be associated with self-harm. This is the first study to explore the relationship between communication disorders and adolescent self-harm.

METHOD

Secondary analysis of a large, longitudinal, prospective, community sample, the Avon Longitudinal Study of Parents and Children, was carried out. Clinicians identified children who stuttered or exhibited speech sound disorder at the age of 8 years. When the cohort members were 16 years old, they were asked to complete a questionnaire about self-harm. Multinomial logistic regression was used to examine the associations between stuttering and speech sound disorder and the self-harm outcomes, adjusting for other relevant factors.

RESULTS

Of 3,824 participants with data for both speech status and self-harm, 94 (2.5%; 95% confidence interval [CI; 2.0, 3.0]) stuttered at 8 years of age and 127 (3.3%; 95% CI [2.8, 3.9]) displayed speech sound disorder. Speech sound disorder at the age of 8 years was associated with self-harm with suicidal intent in both unadjusted and adjusted models. Differences between the adjusted and unadjusted models were small, suggesting that speech sound disorder is largely an independent risk factor for self-harm with suicidal intent. Stuttering at the age of 8 years was not associated with adolescent self-harm, and there was no association between speech sound disorder and self-harm without suicidal intent.

CONCLUSION

Compared with individuals without speech sound disorder, adolescents with speech sound disorder at the age of 8 years have twice the risk of reporting self-harm with suicidal intent, even when other important predictors are taken into account.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22573030.

The Association of Borderline Personality Features and Self-Injury Among Adolescents with Non-Suicidal Self-Injury: The Mediating Role of Alexithymia

Introduction

Non-suicidal self-injury (NSSI) is becoming an increasingly prevalent phenomenon among adolescents, endangering their health. The aims of this study were to 1) explore the associations between borderline personality features, alexithymia and NSSI and 2) examine if alexithymia mediates the relationships between borderline personality features and both the severity of NSSI and the various functions that maintain NSSI in adolescents.

Methods

This cross-sectional study recruited 1779 outpatient and inpatient aged 12-18 years from psychiatric hospitals. All adolescents completed a structured four-part questionnaire including demographic items, the Chinese version of the Functional Assessment of Self-Mutilation, the Borderline Personality Features Scale for Children and the Toronto Alexithymia Scale.

Results

The structural equation modelling results indicated that alexithymia partially mediated the associations between borderline personality features and both the severity of NSSI and the emotion regulation function of NSSI (B = 0.058 and 0.099, both p < 0.001), after controlling for age and sex.

Discussion

These findings suggest that alexithymia may play a role in the mechanism and treatment of NSSI among adolescents with borderline personality features. Further longitudinal studies are essential to validate these findings.

Heterogeneity of non-suicidal self-injury behavior in adolescents with depression: latent class analysis

BACKGROUND

Non-suicidal self-injury (NSSI) by adolescent patients with depression has become a serious public health problem. This cross-sectional study aims to identify subgroups of adolescents based on NSSI and explore the factors related to these subgroups.

METHODS

The study recruited 326 in- and out-patient adolescents (263 girls and 63 boys) aged 12 to 18 years (mean = 14.7, SD = 1.6) who had self-injured in the past year. Latent class indicators included 12 NSSI variables, as well as suicidal ideation. Logistic regression examined associations between identified classes and related factors.

RESULTS

In this study, two distinct subgroups were identified: a "high suicidal ideation NSSI group" (n = 129, 39.6%) and a "low suicidal ideation NSSI group" (n = 197, 60.4%). Depression (OR = 1.10; 95% CI, 1.05-1.16), female (OR = 2.01; 95% CI, 1.09-3.69), left-behind experience (OR = 2.08; 95% CI, 1.17-3.71), single-parent family (OR = 1.84; 95% CI, 1.11-3.04) and peer victimization (OR = 1.04; 95% CI, 1.02-1.05) increases the probability of belonging to the "high suicidal ideation NSSI group". A high level of perceived social support (OR = 0.99; 95% CI, 0.97-0.99) was a protective factor towards NSSI.

CONCLUSIONS

This study identifies two subgroups of NSSI and the factors associated with each subgroup. The early identification of high-risk groups for major NSSI in adolescents diagnosed with depression is possible due to the identification of correlating factors. Different treatment plans can be developed for different subtypes of NSSI to improve the effectiveness of prevention and intervention, promoting the healthy physical and mental development of adolescents with depression.

The psychosocial consequences of covid-19 in adolescents with nonsuicidal self-injury

BACKGROUND

Young people have been especially affected by the psychosocial consequences of the covid-19 pandemic. Covid-19 has potentially also been more stressful for vulnerable groups with mental health problems.

METHODS

In this cross-sectional study, the psychosocial effects of covid-19 in a vulnerable group of adolescents with nonsuicidal self-injury (NSSI) from a sample of 1602 Swedish high-school students were examined. Data were collected in 2020 and 2021. First, adolescents with and without NSSI were compared on how they perceived the psychosocial impact of covid-19, and second, a hierarchical multiple regression analysis was used to examine whether lifetime NSSI experience was associated with perceived psychosocial consequences of covid-19, when demographic variables and symptoms of mental health problems were controlled for. Interaction effects were also examined.

RESULTS

Significantly more individuals with NSSI reported being burdened by covid-19 compared to those without NSSI. When demographic variables and mental health symptoms were controlled for, adding NSSI experience did not, however, increase the amount of variance explained in the model. The total model explained 23.2% of the variance in perceived psychosocial impact of covid-19. Perceiving the family's financial situation as poor and neither good nor bad, studying a theoretical high school program, symptoms of depression and difficulties with emotion regulation were significantly associated with perceived negative psychosocial impact of the covid-19 pandemic. There was a significant interaction effect between NSSI experience and depressive symptoms. The effect of NSSI experience was larger when depressive symptoms were lower.

CONCLUSIONS

Lifetime NSSI experience in itself was not associated with psychosocial covid-19 consequences when other variables were controlled for, whereas symptoms of depression and difficulties with emotion regulation were. Results imply that vulnerable adolescents with mental health symptoms need special attention and access to mental health support in order to prevent further stress and worsening of mental health symptoms in the wake of the covid-19 pandemic.

Do Cortisol and Dehydroepiandrosterone Influence Motivational Factors for Non-Suicidal Self-Injury in Female Adolescents?

Non-suicidal self-injury (NSSI) is a significant public health issue that particularly affects female adolescents usually emerging during puberty, with a subsequent reduction and even remission in the phenomenon later in life. The dysregulation of the hormonal stress response, particularly cortisol and dehydroepiandrosterone sulfate (DHEA-S), whose levels increase markedly during pubertal adrenarche, has been associated with the development and maintenance of a wide range of emotional disorders. Our study aims to investigate whether different cortisol-DHEA-S response patterns could be associated with the main motivational moderators to engage NSSI as well as with urgency and motivation to stop NSSI in a sample of female adolescents. We found significant correlations between stress hormones and several factors that support and sustain NSSI, specifically: cortisol levels and distressing/upsetting urge (r = 0.39 and a p = 8.94 × 10^-3) and sensation seeking (r = -0.32 and a p = 0.04), as well as cortisol/DHEA-s ratio and external emotion regulation (r = 0.40 and a p = 0.01) and desire to stop NSSI (r = 0.40 and a p = 0.01). Cortisol and DHEA-S may play a role in NSSI through the regulation of stress responses and affective states. Such results could have implications for the development of new and improved treatment and prevention plans for NSSI.

Peer Victimization and Adolescent Non-Suicidal Self-Injury: The Mediating Role of Alienation and Moderating Role of Mindfulness

Peer victimization and non-suicidal self-injury (NSSI) are two major public health problems, with the former being associated with outward attack and the latter characterizing inward attack. Peer victimization has been shown to be associated with adolescents' NSSI. However, less is known about the mechanism underlying the association. Based on the experiential avoidance model of NSSI, this study tested whether the sense of alienation mediated the association between peer victimization and NSSI, and whether this process was weakened by mindfulness. A total of 1,574 Chinese adolescents (51.1% girls; ages 12-16 years) completed questionnaires concerning NSSI, peer victimization, alienation, and mindfulness. Regression-based analyses indicated that peer victimization predicted adolescents' NSSI through the indirect effect of alienation, and mindfulness weakened this indirect effect. These findings suggest that victimized adolescents may injure themselves as an emotion regulation strategy. The results highlight the importance to implement programs aimed to improve the school climate to reduce the risk of adolescent NSSI. Furthermore, we underscore the need to include emotion-regulation training (e.g., mindful practice) into bully intervention programs to prevent NSSI.

Development and validation of a prediction nomogram for non-suicidal self-injury in female patients with mood disorder

Background

Non-suicidal self-injury (NSSI) is a highly prevalent behavioral problem among people with mental disorders that can result in numerous adverse outcomes. The present study aimed to systematically analyze the risk factors associated with NSSI to investigate a predictive model for female patients with mood disorders.

Methods

A cross-sectional survey among 396 female patients was analyzed. All participants met the mood disorder diagnostic groups (F30-F39) based on the Diseases and Related Health Problems 10th Revision (ICD-10). The Chi-Squared Test, t-test, and the Wilcoxon Rank-Sum Test were used to assess the differences of demographic information and clinical characteristics between the two groups. Logistic LASSO Regression Analyses was then used to identify the risk factors of NSSI. A nomogram was further used to construct a prediction model.

Results

After LASSO regression selection, 6 variables remained significant predictors of NSSI. Psychotic symptom at first-episode (β = 0.59) and social dysfunction (β = 1.06) increased the risk of NSSI. Meanwhile, stable marital status (β = -0.48), later age of onset (β = -0.01), no depression at onset (β = -1.13), and timely hospitalizations (β = -0.10) can decrease the risk of NSSI. The C-index of the nomogram was 0.73 in the internal bootstrap validation sets, indicated that the nomogram had a good consistency.

Conclusion

Our findings suggest that the demographic information and clinical characteristics of NSSI can be used in a nomogram to predict the risk of NSSI in Chinese female patients with mood disorders.

Psychotropic drugs for the treatment of non-suicidal self-injury in children and adolescents: a systematic review and meta-analysis

Non-suicidal self-injury (NSSI) in children and adolescents is a frequent phenomenon. NSSI at any time is a significant predictor of future NSSI but also, and more importantly, for suicide attempts. Less evidence is available for the impact, or more specifically, the therapeutic effect of psychotropic drugs on the emergence of NSSI in this population. The phenomenon is clinically highly relevant since adolescent psychiatric inpatients are often affected by NSSI and most of them are treated with psychotropic drugs. While previous reviews on NSSI comprised suicidal self-injury (SSI), this review aims at elucidating the potential impact of psychotropic drugs on the emergence of specifically NSSI in children and adolescents. Systematic searches of articles indexed electronically in PubMed, Embase and PsycInfo were conducted (PROSPERO CRD42020209505). Studies included in the quantitative synthesis were evaluated using the SIGN level of evidence rating. Meta-analyses were performed using RevMan (Version 5.4). 2227 records were identified through database searches. Two additional records were identified manually. In total, seven studies were included in qualitative and four studies in quantitative analyses. In a meta-analysis, selective serotonin reuptake inhibitors (SSRIs) were compared vs. control medication (placebo or serotonin-norepinephrine reuptake inhibitor) and here, no statistically significant difference between the groups could be observed regarding the frequency of NSSI events (Risk Ratio (RR) = 1.07, 95% confidence interval (CI) 0.60-1.91, p = 0.82, I² = 12%). Evidence regarding the association of SSRI use and NSSI among children and adolescents is sparse and the impact of psychotropic drugs in general on NSSI rates in this population should be addressed in future clinical and observational studies.

Non-suicidal self-injury motivations in the light of self-harm severity indicators and psychopathology in a clinical adolescent sample

Introduction

Adolescents with psychiatric problems are also considered a vulnerable population in terms of non-suicidal self-injury (NSSI). In the current study, we examined the associations of interpersonal and intrapersonal NSSI motivations with several NSSI severity indicators and psychopathological characteristics.

Materials and methods

In a cross-sectional research design, 158 adolescents (83.5% girls; mean age = 16.10 years; SD = 1.49) who have received inpatient or outpatient psychiatric treatment completed the Inventory of Statements About Self-Injury, the Strengths and Difficulties Questionnaire, and the Self-Critical Rumination Scale.

Results

More than two-thirds of the sample (75.3%; n = 119) reported at least one episode of NSSI in their life, and 45.38% (n = 54) have engaged in NSSI in the past month (current self-injury). The results indicated that only intrapersonal NSSI functions were linked to NSSI severity indicators (current and repetitive NSSI, versatility), interpersonal functions were not. Furthermore, a number of psychopathological features (co-occurring mental disorders, presence of a mood disorder, more internalizing mental illness symptoms, and more pronounced self-critical rumination) were associated with engaging in NSSI for intrapersonal reasons. We also identified other differences within the specific intrapersonal NSSI motivations. It should be highlighted that the anti-suicide function of NSSI behaved in exactly the opposite way as the other intrapersonal motivations.

Discussion

All this points to the fact that in clinical settings, detailed assessment of NSSI motivations and severity indicators can help to develop a more effective treatment plan.

Trajectories of nonsuicidal self‐injury during adolescence

OBJECTIVE

Although nonsuicidal self-injury is a public health concern, there is little information on how it changes across adolescence or what contributes to stability or change. We aimed to identify trajectories of stability and change in self-injury from ages 13 to 17 years, and to identify interpersonal and intrapersonal correlates that differentiate between trajectories of stability and change.

METHOD

We used five annual waves of cohort-sequential data, targeting 7th and 8th graders attending all public schools in three municipalities in central Sweden. The data were gathered via questionnaires, using a multi-item measure of non-suicidal self-injury and assessing negative experiences at home, in school, with peers, and in romantic settings, as well as intrapersonal issues (internalizing symptoms and difficulties with emotional, and behavioral regulation). The analytic sample was 3195 adolescents (51.7% boys, 48.3% girls; ages 12-16 years at T1, M = 13.61; SD = 0.66), most of whom were born in Sweden (88.6%) to at least one parent of Swedish origin (77.4%).

RESULTS

Latent growth curve modeling revealed three self-injury trajectories: a stable-low, a low-increasing, and an increasing-decreasing trajectory. Adolescents in the stable-low class reported the best overall adjustment at ages 13 and 16. Comparatively, adolescents in the other two classes reported similar levels of difficulty interpersonally and intrapersonally. Where they differed, the increase-decrease class fared worse than the low-increasing class.

CONCLUSIONS

This study suggests the need to frame self-injury as having multiple directions of development during adolescence and develop theory that aligns with differential patterns of self-injury development.

Effects of childhood trauma on nonsuicidal self-injury in adolescent patients with bipolar II depression

OBJECTIVE

This study was performed to explore the effect of childhood trauma on nonsuicidal self-injury (NSSI) in adolescents with bipolar II (BD II) depression.

METHODS

Based on the diagnostic criteria of the DSM-5 and structured interviews to assess the presence or absence of NSSI, 184 adolescent patients with BD II depression were divided into the NSSI (n = 112) and non-NSSI (n = 72) groups. The Adolescent Nonsuicidal Self-Injury Assessment Questionnaire (ANSAQ), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Toronto Alexithymia Scale (TAS-20), Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA) were used to assess the subjects.

RESULT

The CTQ-SF, HAMD, HAMA, and TAS-20 scores were significantly higher in the NSSI group than in the non-NSSI group (p &lt; .01). Logistic regression analysis showed emotional abuse (p = .028, OR = 1.14, 95% CI = 1.01-1.28) and age of onset (p = .009) as risk factors for NSSI. Adolescents with onset age 12-13 years (OR = 6.30, 95% CI = 1.72-23.10) and 14-15 years (OR = 2.24, 95% CI = 1.04-4.84) had a higher risk of self-injury relative to adolescents aged 16-18 years.

CONCLUSION

Childhood trauma and alexithymia were important influencing factors in adolescent patients with BD II depression. Emotional abuse and age of onset as risk factors for NSSI, and difficulties in emotion recognition were positively associated with the patients' NSSI.

Social Support and Nonsuicidal Self-injury among adolescent Psychiatric Inpatients

Cross-sectional studies and prospective studies with long follow-up periods (e.g., years) have shown that lower levels of social support are associated with nonsuicidal self-injury (NSSI) among adolescents. This study examined how short-term changes in social support may contribute to NSSI behavior and whether different sources of support (e.g., friends, family members) provide differential protective effects against NSSI. We examined fluctuations in NSSI and social support perceived from multiple sources among a sample of 118 high-risk adolescents hospitalized for serious self-harm risk. Participants provided daily reports of social support and any self-injurious behavior for the duration of their inpatient treatment (721 total observations, average observations per participant = 6.11). Multi-level models were used to assess variability in social support and how these fluctuations relate to whether or not an individual engages in NSSI. Over one-third of participants reported engaging in NSSI at least once during inpatient hospitalization and self-reported social support varied within person across sources of support (ICC range = 0.68-0.81). Support perceived from family members and inpatient unit staff was inversely associated with NSSI, but no relationship was found between NSSI and support from other patients on the unit or friends outside of the unit. These findings suggest that the protective effects of social support for NSSI vary over short periods of time and that support perceived from adults is particularly relevant among this high-risk clinical sample. This study represents an important step in identifying risk factors to improve the detection and prevention of NSSI among adolescent inpatients.

Childhood symptoms of attention-deficit/hyperactivity disorder and borderline personality disorder

OBJECTIVE

Childhood attention-deficit /hyperactivity disorder (ADHD) is known to be associated with adult Borderline Personality Disorder (BPD). We investigated if any of the subdimensions of childhood ADHD, that is, impulsivity, inattention, or hyperactivity was more prominent in this association.

METHODS

In a nation-wide cohort (N = 13,330), we utilized parent reported symptoms of childhood ADHD and clinically ascertained adult BPD diagnoses. The summed total scores of ADHD symptoms and its three subdimensions were used and standardized for effect size comparison. Associations were analyzed using Cox regression with sex and birth-year adjustments. Secondary outcomes were BPD-associated traits (i.e., self-harm and substance use) analyzed using logistic- and linear regression respectively.

RESULTS

ADHD symptom severity was positively associated with BPD with a hazard ratio (HR) of 1.47 (95% confidence interval [CI]: 1.22-1.79) per standard deviation increase in total ADHD symptoms. Impulsivity was the most prominent subdimension with the only statistically significant association when analyzed in a model mutually adjusted for all ADHD subdimensions-HR for inattention: 1.15 (95% CI: 0.85-1.55), hyperactivity: 0.94 (95% CI: 0.69-1.26), impulsivity: 1.46 (95% CI: 1.12-1.91). In secondary analyses, weak positive associations were seen between total ADHD symptom score and self-harm and substance use. In analyses by subdimensions of ADHD, associations were weak and most prominent for inattention in the model with self-harm.

CONCLUSION

Childhood ADHD symptoms were associated with subsequent development of BPD diagnosis and appeared to be driven primarily by impulsivity. Our findings are important for understanding the association between childhood symptoms of ADHD and subsequent BPD.

Childhood maltreatment and self-hatred as distinguishing characteristics of psychiatric patients with self-harm: A comparison with clinical and healthy controls

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.

Tumor markers and depression scores are predictive of non-suicidal self-injury behaviors among adolescents with depressive disorder: A retrospective study

Background

Non-suicidal self-injury (NSSI) is an important risk factor for suicide in adolescents with depressive disorders; therefore, it is important to predict NSSI occurrence as early as possible. Disturbances in biological rhythms are characteristic manifestations of depressive disorders and can lead to immune dysfunction, leading to changes in tumor markers. This study aimed to produce an index that utilizes tumor markers to predict NSSI behaviors among adolescents with depressive disorders.

Methods

A total of 120 hospitalized adolescent patients with depressive disorders aged 14–24 years were included in this study. Participants were divided into NSSI and non-NSSI groups based on self-reports using the Ottawa Self-Injury Inventory. Demographics, tumor marker concentrations, other peripheral blood indices, Hamilton Depression Rating Scale (HDRS) scores, and Hamilton Anxiety Rating Scale (HAMA) scores were compared between the two groups. Logistic regression analysis was conducted to develop a joint index, and a receiver operating characteristic (ROC) curve was created to predict NSSI behaviors among adolescents with depressive disorders.

Results

Compared with the non-NSSI group, the NSSI group had significantly higher insight, retardation, insomnia, hopelessness, psychiatric anxiety, total HDRS and HAMA scores, and significantly higher levels of cancer antigen 125 (CA-125), cancer antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA). In addition, a joint index was developed by combining CA-125, CA19-9, CEA, HDRS total score, HAMA total score and age using multiple logistic regression to predict NSSI behaviors. The area under the curve was 0.831, with a sensitivity and specificity of 0.734 and 0.891, respectively.

Conclusion

A combination of depression score, tumor marker levels, and age can identify NSSI behaviors among adolescents with depressive disorders.

Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: A meta-analysis

Background

Adolescents with immature mind and unstable emotional control are high-risk groups of non-suicidal self-injury (NSSI) behavior. We meta-analyzed the global prevalence of NSSI and prevalence of NSSI characteristics in a non-clinical sample of adolescents between 2010 and 2021.

Methods

A systematic search for relevant articles published from January 1, 2010 to June 30, 2021 was performed within the scholarly database search engines of CBM, CNKI, VIP, Wanfang, PubMed, Web of Science, PsycINFO, and Embase. Eligibility criteria were as follows: provided cross-sectional data on the prevalence of NSSI; the subjects were non-clinical sample adolescents; and a clear definition of NSSI was reported. We used the following definiton of NSSI as our standard: the deliberate, self-inflicted destruction of body tissue, such as cutting, burning, and biting, without attempted suicide. The quality evaluation tool for cross-sectional studies recommended by the JBI was used. The global prevalence of NSSI was calculated based on the random-effects model by Comprehensive Meta-analysis version 3.0. Subgroup analyses were performed to compare the prevalence according to sex, living place, smoking or drinking history, and family structure.

Results

Sixty-two studies involving 264,638 adolescents were included. The aggregate prevalence of NSSI among a non-clinical sample of adolescents was similar between over a lifetime (22.0%, 95% CI 17.9-26.6) and during a 12-month period (23.2%, 95% CI 20.2-26.5). Repetitive NSSI was more common than episodic NSSI (20.3% vs. 8.3%) but the frequency of mild injury (12.6%) was similar to that of moderate injury (11.6%). Multiple-method NSSI occurred slightly more often compared than one-method NSSI (16.0% vs. 11.1%). The top three types of NSSI in adolescents were banging/hitting (12.0%, 95% CI 8.9-15.9), pinching (10.0%, 95% CI 6.7-14.8), and pulling hair (9.8%, 95% CI 8.3-11.5), and the least common type was swallowing drugs/toxic substances/chemicals (1.0%, 95% CI 0.5-2.2). Subgroup analyses showed that being female, smoking, drinking, having siblings, and belonging to a single-parent family may be linked to higher prevalence of NSSI.

Conclusion

This meta-analysis found a high prevalence of NSSI in non-clinical sample of adolescents, but there are some changes in severity, methods, and reasons. Based on the current evidence, adolescents in modern society are more inclined to implement NSSI behavior by a variety of ways, which usually are repetitive, and moderate and severe injuries are gradually increasing. It is also worth noting that adolescents with siblings or in single-parent families are relatively more likely to implement NSSI behavior due to maladjustment to the new family model. Future research needs to continue to elucidate the features and risk factors of NSSI so as to intervene in a targeted way.

Limitation

The limitation of this study is that the heterogeneity among the included studies is not low, and it is mainly related to Chinese and English studies. The results of this study should be used with caution.

Systematic review registration

[www.crd.york.ac.uk/prospero/], identifier [CRD42022283217].

Emotional Dysregulation and Trauma Symptoms Mediate the Relationship Between Childhood Abuse and Nonsuicidal Self-Injury in Adolescents

Background

Nonsuicidal self-injury (NSSI) is common in adolescents. Emotion dysregulation has been identified as a core mechanism in the development and maintenance of NSSI and it is therefore an important target when addressing NSSI. The pathogenic connection between different kinds of childhood abuse, difficulties in emotion regulation and NSSI needs further investigation. The objective of this study was to examine whether difficulties with emotion regulation and trauma symptoms, separately and together, mediate the relationships between sexual, physical and emotional abuse and NSSI.

Method

Cross-sectional data was collected from 3,169 adolescent high-school students aged 16-19 years (M = 18.12, SD = 0.45). Data from self-reported experiences of childhood abuse, current difficulties with emotion regulation (measured with the Difficulties with Emotion Regulation Scale, DERS-16) and trauma symptoms (measured with the Trauma Symptom Checklist for Children, TSCC), and NSSI were collected. Structural Equation Modeling (SEM) was used to test the proposed relationships between variables.

Results

The prevalence of life-time NSSI was 27.4%. Prevalence of reported childhood abuse was 9.2, 17.5, and 18.0% for sexual, physical, and emotional abuse, respectively. Childhood abuse, difficulties with emotion regulation and trauma symptoms exhibited significant positive associations with NSSI in adolescents. Emotional dysregulation and trauma symptoms were both found to mediate the relationship between childhood abuse and NSSI. Latent variable models were found to fit data well.

Conclusion

Results indicate that increased levels of emotional dysregulation and trauma symptoms in relation to childhood abuse contribute to the increased risk of NSSI. Further, results point to some aspects of emotional dysregulation and trauma symptoms being more important in this regard. Clinical implications are discussed.

Self-referential processing in individuals with nonsuicidal self-injury: An fMRI study

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Individuals with NSSI rated negative adjectives as more relevant.

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Altered self-referential processing in NSSI related to temporoparietal and subcortical areas.

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Brain activity in inferior parietal lobe related to ‘nonsuicidality’ in people with NSSI.

Nonsuicidal self-injury (NSSI) is associated with considerable deficits in managing negative self-directed internal experiences. The present study explores the neurophysiological correlates of self-referential processing in individuals with NSSI. A total of 26 individuals with NSSI (≥5 episodes of NSSI behavior in the past year, without suicide attempts) and 35 age-, sex-, education-, and intelligence quotient (IQ)-matched controls participated in this study. Participants underwent fMRI scanning as they performed a personal relevance rating task, which required them to evaluate the personal relevance of emotional words. As predicted, we found that individuals engaging in NSSI tended to rate negative adjectives as more relevant and positive adjectives as less relevant. An analysis of functional neuroimaging data showed that the NSSI group had increased activity relative to the control group in the inferior parietal lobe, inferior temporal gyrus, calcarine, insula, and thalamus in response to positive adjectives. The NSSI group also demonstrated greater activation in the calcarine and reduced activation in the inferior frontal gyrus in response to negative self-referential stimuli compared with the control group. In addition, increased right inferior parietal lobe activity during positive self-referential processing was correlated with reduced suicidal ideation in the NSSI group. Our study provides neural evidence for self-referential processing bias in individuals with NSSI and highlights the need for further research to clarify the pathophysiological features that are specific to NSSI.

Peripheral and neural correlates of self-harm in children and adolescents: a scoping review

BACKGROUND

Self-harm in children and adolescents is difficult to treat. Peripheral and neural correlates of self-harm could lead to biomarkers to guide precision care. We therefore conducted a scoping review of research on peripheral and neural correlates of self-harm in this age group.

METHODS

PubMed and Embase databases were searched from January 1980-May 2020, seeking English language peer-reviewed studies about peripheral and neural correlates of self-harm, defined as completed suicide, suicide attempts, suicidal ideation, or non-suicidal self-injury (NSSI) in subjects, birth to 19 years of age. Studies were excluded if only investigating self-harm in persons with intellectual or developmental disability syndromes. A blinded multi-stage assessment process by pairs of co-authors selected final studies for review. Risk of bias estimates were done on final studies.

RESULTS

We screened 5537 unduplicated abstracts, leading to the identification of 79 eligible studies in 76 papers. Of these, 48 investigated peripheral correlates and 31 examined neural correlates. Suicidality was the focus in 2/3 of the studies, with NSSI and any type of self-harm (subjects recruited with suicidality, NSSI, or both) investigated in the remaining studies. All studies used observational designs (primarily case-control), most used convenience samples of adolescent patients which were predominately female and half of which were recruited based on a disorder. Over a quarter of the specific correlates were investigated with only one study. Inter-study agreement on findings from specific correlates with more than one study was often low. Estimates of Good for risk of bias were assigned to 37% of the studies and the majority were rated as Fair.

CONCLUSIONS

Research on peripheral and neural correlates of self-harm is not sufficiently mature to identify potential biomarkers. Conflicting findings were reported for many of the correlates studied. Methodological problems may have produced biased findings and results are mainly generalizable to patients and girls. We provide recommendations to improve future peripheral and neural correlate research in children and adolescents, ages 3-19 years, with self-harm.

The Psychosocial Correlates of Non-suicidal Self-Injury Within a Sample of Adolescents With Mood Disorder

Background

According to the integrated theoretical model, adolescents' behaviors were the outcome of the complex interplay between multiple levels. Non-suicidal self-injury (NSSI) is a serious and high prevalent problem among adolescents with mood disorders. However, a systematic perspective on psychosocial correlates among Chinese clinical adolescents is still rare.

Method

The impact of several factors at the individual (i.e., sex, age, self-esteem, and psychological distress), family (i.e., family structure, family income, and family support), and social level (i.e., living environment, peer support, and teacher support) on the frequency of NSSI behaviors were investigated in the current study. This research included 621 Chinese adolescents with mood disorders from 20 hospitals.

Results

Three-steps hierarchical regression analyses indicated that lower levels of psychological distress and higher levels of self-esteem were most associated with less frequency of NSSI behaviors. In addition, family support was negatively associated with the frequency of NSSI behaviors. After controlling the factors at individual and family levels, no significant association was found between the factors at the social level and the frequency of NSSI behaviors.

Conclusion

These findings provide preliminary support for the notion that adolescent self-esteem and family support may effectively shield them from problematic behavior; nevertheless, adolescents suffering from more emotional pain can be even riskier. Thus, further intervention strategies should consider the non-independence of individual capacities, co-combinatory effects of mood disorder, and family environment in treating those vulnerable Chinese adolescents.

Pituitary volume in adolescents with non-suicidal self-injury: Preliminary evidence for alterations in pituitary maturation

BACKGROUND

Non-suicidal self-injury (NSSI), typically observed in the context of various mental disorders, represents a highly prevalent and serious problem among adolescents. Based on studies linking NSSI with stress, alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning have been suggested to contribute to the development and maintenance of this behavior. While research has mainly focused on cortisol - the main hormonal output of this system - to our knowledge, no study has examined pituitary gland volume (PGV) - an alternative approach of assessing HPA axis functionality that is less state-dependent - in adolescents engaging in NSSI.

METHODS

Magnetic Resonance Imaging (MRI) was performed among n = 35 adolescents (aged 12-17 years) fulfilling the diagnostic criteria for NSSI disorder according to DSM-5 and n = 31 age-matched healthy controls; PGV was obtained by manual tracing. To test for group differences - our primary aim - a hierarchical linear regression model was computed, controlling for several potential confounding variables. Since adolescence reflects a time period for significant brain development - including changes in PGV - we also tested for an age-dependent group effect. In a second step, we aimed to investigate whether differences in PGV are accounted for by the experience of childhood adversity or psychopathology. Finally, following an exploratory approach, the dimensional association between PGV and various clinical characteristics (e.g., frequency of NSSI) were explored.

RESULTS

No evidence was found for overall volumetric differences between healthy control participants and adolescents engaging in NSSI (p > 0.05) - recognizing that small effect size differences could not be detected in the present study - but group membership significantly interacted with age in predicting PGV (p = 0.02). Particularly, while PGV increased linearly with age in healthy controls (B = 61.39, SE = 14.94, p < 0.01), no corresponding association was found in NSSI patients (B = 16.83, SE = 12.20, p = 0.17). PGV was not related to adverse experiences during childhood and none of the clinical characteristics (e.g., frequency of NSSI) significantly correlated with PGV (p > 0.05).

CONCLUSION

These results provide preliminary evidence for alterations in pituitary maturation in adolescents engaging in NSSI, although replication in longitudinal studies with larger samples is warranted.

Different Ways to Drown Out the Pain: A Meta-Analysis of the Association Between Nonsuicidal Self-Injury and Alcohol Use

OBJECTIVE

There is a significant overlap in the motivations for nonsuicidal self-injury (NSSI) and alcohol use. Moreover, several theories would predict that more frequent alcohol use is likely associated with more NSSI engagement. Still, the size and direction of this association has not been well documented in the literature.

METHOD

To address this gap, the goal of this article was to conduct a meta-analysis of the relation between alcohol use and NSSI.

RESULTS

Across 57 samples and 141,669 participants, we found that there was a significant positive association between NSSI and alcohol use, odds ratio = 1.78, 95% confidence interval [1.53, 2.07], k = 64, m = 52. Moderator analyses found that this effect was stronger for younger samples and samples with more severe alcohol use problems.

CONCLUSIONS

These results help establish a link between NSSI and alcohol use. Implications and future directions for NSSI research and intervention are discussed.HighlightsThere are several reasons to think that NSSI and alcohol use are linked.No reviews or meta-analyses have been conducted.We found a significant and small effect linking greater NSSI with greater alcohol use.

Affective states and nonsuicidal self-injury (NSSI): Results from an ecological momentary assessment study of veterans with NSSI disorder

BACKGROUND

The affective states most strongly associated with nonsuicidal self-injury (NSSI) remain poorly understood, particularly among veterans. This study used ecological momentary assessment (EMA) to examine relationships between affect ratings and NSSI urges and behaviors among veterans with NSSI disorder.

METHODS

Participants (N = 40) completed EMA entries via mobile phone for 28 days (3722 total entries). Entries included intensity ratings for five basic affective states, as well as NSSI urges and behaviors, during the past 4 hours.

RESULTS

Bivariate analyses indicated that each affect variable was significantly associated with both NSSI urges and behaviors. Angry/hostile and sad were most strongly associated with both NSSI urges and behaviors. A multivariate regression revealed that angry/hostile, disgusted with self, and happy (inversely related) were contemporaneously (within the same period) associated with NSSI behaviors, whereas all five basic affective states were contemporaneously associated with NSSI urges. In a lagged model, angry/hostile and sad were associated with subsequent NSSI urges but not behaviors.

CONCLUSIONS

Findings highlight the relevance of particular affective states to NSSI and the potential utility of targeting anger in treatments for NSSI among veterans. There is a need for future EMA research study to further investigate temporal relationships between these variables.

Post-injury outcomes of children with behavioral health disorders

BACKGROUND

The impact of Behavioral Health Disorders (BHDs) on pediatric injury is poorly understood. We investigated the relationship between BHDs and outcomes following pediatric trauma.

METHODS

We analyzed injured children (age 5-15) from 2014 to 2016 using the Pediatric Trauma Quality Improvement Program. The primary outcome was in-hospital mortality. Univariable and multivariable analyses compared children with and without a comorbid BHD.

RESULTS

Of 69,305 injured children, 3,448 (5%) had a BHD. These 3,448 children had a median of 1 [IQR: 1, 1] BHD diagnosis: ADHD (n = 2491), major psychiatric disorder (n = 1037), drug use disorder (n = 250), and alcohol use disorder (n = 29). A higher proportion of injured children with BHDs suffered intentional and penetrating injury. Firearm injuries were more common for BHD patients (3% vs 1%, p<0.001). Children with BHDs were more likely to have an ISS>25 compared to children without (5% vs 3%, p<0.001). While median LOS was longer for BHD patients (2 [1, 3] vs 2 [1, 4], p<0.001), mortality was similar (1% vs 1%, p = 0.76) and complications were less frequent (7% vs 8%, p = 0.002). BHD was associated with lower risk of mortality (OR 0.45, 95%CI [0.30, 0.69]) after controlling for age, sex, race, trauma type, and injury intent and severity.

CONCLUSION

Children with BHDs experienced lower in-hospital mortality risk after traumatic injury despite more severe injury upon presentation. Intentional and penetrating injuries are particularly concerning, and future work should assess prevention efforts in this vulnerable group.