Reciprocal Risk: the Longitudinal Relationship between Emotion Regulation and Non-suicidal Self-Injury in Adolescents

Gender-Specific Trajectories of Non-Suicidal Self-Injury among Adolescents: Predictive Roles of Distal and Proximal Risk Factors

Non-suicidal self-injury (NSSI) is considered a strong risk factor for suicide. Although NSSI is prevalent among adolescents and varies by gender, few studies have examined the gender-specific trajectory of NSSI and its predictors. This study examined the trajectory of NSSI among Chinese adolescent boys and girls separately, and the roles of distal (i.e., childhood maltreatment and its specific subtypes) and proximal risk factors (i.e., emotional dysregulation, peer victimization) on their trajectories. A total of 3290 Chinese adolescents (Mage = 13.08; SD = 0.84; 57.6% boys) participated in assessments at three time points. Latent class growth models identified three trajectories for boys: Low stable (92.5%), moderate increasing (5.0%) and high decreasing (2.5%). Four trajectories were identified for girls: Low stable (87.9%), moderate increasing (7.6%), high decreasing (3.0%) and high stable (1.5%). Multinomial logistic regression analyses revealed that both emotional dysregulation and emotional abuse predicted the trajectories of moderate increasing, high decreasing and high stable for girls, as well as predicted moderate increasing and high decreasing trajectories for boys. Peer victimization served as a significant risk factor predicting the moderate increasing and high decreasing trajectories only for girls, while overall childhood maltreatment was a remarkable predictor for the moderate increasing and high decreasing trajectories of boys. The findings highlighted the importance of gender differences in understanding the progression of NSSI and the key predictors, informing effective strategies for prevention and intervention.

Interrupting the Self-Harm Continuum

Background: Nonsuicidal self-injury (NSSI) has increased rapidly and is frequently linked to suicidal behavior; it has been argued that these behaviors are key points on a self-harm continuum. Aims: The current research explored self-harm and help-seeking behaviors, with the aim of identifying possibilities for prevention of further harm, including suicide. Methods: An online survey of 304 New Zealanders was undertaken, with the majority being aged under 25 and female. Results: Nearly half of the sample had engaged in self-harm and most of those had experienced suicidal thoughts; close to a quarter had made a suicide attempt. NSSI was used as a way of dealing with emotional distress. Very few sought help of any kind, especially professional support; of those who did seek professional support, most found it helpful but did not necessarily stop self-harming as a result. Limitations: Men are under-represented in the sample - though this is in accordance with the population of people who engage in NSSI. Conclusion: Many participants engaged in NSSI and also had suicidal thoughts using NSSI as an emotion regulation strategy; some participants appeared to use NSSI rather than attempting suicide. Given a link between NSSI and suicidal thoughts and behaviors, reluctance to seek help and on-going injurious behavior among some who do seek help, there is a need for increased identification and proactive support specifically focusing on improving emotion regulation and targeted at injurious behavior.

A Comparative Analysis of Emotional Regulation and Maladaptive Symptoms in Adolescents: Insights from Iran and Belgium

(1) Background: Emotional regulation is a critical determinant of adaptive functioning during adolescence, exerting a profound influence on psychological well-being. This study seeks to deepen our understanding of the intricate interplay between emotional regulation and maladaptive psychological symptoms, examining these dynamics through a cross-country comparison. (2) Methods: A total of 224 adolescents, aged 13 to 21 years, from both Iran and Belgium, participated in a cross-sectional comparative study. The study aimed to elucidate the relationship between emotional regulation and mental health functioning, assessing internalizing symptoms, externalizing symptoms, and self-injury. A demographic questionnaire, the Emotion Regulation Inventory, the Strengths and Difficulties Questionnaire, and the Self-Harm Inventory, were administered. Data analysis incorporated correlation assessments, multivariate analysis of variance, and structured equation modeling. (3) Results: The findings revealed a positive association between emotional dysregulation and psychological symptoms across the entire sample. Conversely, emotional suppression, more prevalent in Iran, showed no significant link with maladaptive symptoms but was associated with self-harm in the Belgian sample. Cultural disparities were evident, with internalizing problems more prevalent in Iran and externalizing issues more common in Belgium. (4) Conclusions: Emotional dysregulation emerged as a common factor compromising mental health. It emphasizes the necessity of considering cultural nuances when developing interventional and preventative programs and calls for further research in this field.

How do professionals and non-professionals respond to non-suicidal self-injury? Lived experiences of psychiatric outpatients in Singapore

BACKGROUND

For young people who engage in non-suicidal self-injury (NSSI), receiving negative responses to their NSSI can pose a barrier to future help-seeking. This qualitative study aimed to explore helpful and unhelpful ways in which professionals and non-professionals respond to NSSI, from the perspectives of individuals with lived experiences of NSSI.

METHODS

Semi-structured interviews were conducted with 20 outpatients (6 males, 14 females) aged 17 to 29 years from a tertiary psychiatric hospital in Singapore, who had reported engaging in NSSI behavior in an earlier study. The interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data.

RESULTS

Professionals' responses were organized into three main themes: 'prescribing solutions without understanding needs', 'disapproval or judgment', and 'helpful responses'. Non-professionals' responses were organized into four main themes: 'emotionally charged responses', 'avoidance and inaction', 'poor understanding of reasons for NSSI', and 'providing tangible support and acknowledging NSSI'. Participants also described how unhelpful responses negatively impacted their willingness to seek help.

CONCLUSIONS

Our findings provide a better understanding of responses to NSSI that are considered helpful and unhelpful, and can be used to improve existing guidelines on responding to NSSI.

Examining bidirectional relations between sleep problems and non-suicidal self-injury/suicidal behavior in adolescents: emotion regulation difficulties and externalizing problems as mediators

Based on previous empirical evidences and theoretical framework, sleep problems and non-suicidal self-injury (NSSI)/suicidal behavior may bidirectionally related to one another. However, this still needs to be examined through longitudinal research. Moreover, the mediating mechanisms accounting for their potential bidirectional relations have yet to be fully investigated. This study thus aimed to evaluate whether sleep problems and NSSI/suicidal behavior promoted each other directly or indirectly through the mediating roles of emotion regulation difficulties (ERD) and externalizing problems. A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82; Age range = 11-16 years old at T1) completed self-report measures on 3-time points across 1 year. Cross-lagged panel models were used to examine the focal longitudinal associations. Results revealed a predictive effect of sleep problems on NSSI and a positive bidirectional relation between sleep problems and suicidal behavior. Moreover, sleep problems exerted an indirect effect on NSSI through ERD, and vice versa. Additionally, both ERD and externalizing problems served as mediators in the pathway from suicidal behavior to sleep problems. This study disentangled the differential mediating roles of ERD and externalizing problems in the longitudinal associations between sleep problems and NSSI/suicidal behavior, which may help provide a more holistic theoretical framework through which to precisely identify key targets for early prevention and intervention of sleep problems and NSSI/suicidal behavior in adolescents.

Cognitive emotion regulation strategies among emerging adults with different self-harm histories

Background

Self-injurious behaviors have a high prevalence in emerging adulthood. People who engage in self-injury report more emotion regulation difficulties than their peers without self-injury. However, there is little research on how use of emotion regulation strategies varies over brief periods among emerging adults with differing self-harm histories. The current study examined variability in cognitive emotion regulation strategies between emerging adults with no self-harm, previous suicide attempts, or non-suicidal self-injury (NSSI).

Methods

Forty-one racially and ethnically diverse participants, ages 18-27, completed measures of cognitive emotion regulation once daily for one week.

Results

Data collected from 5 of these days were analyzed due to missing data on days 6 and 7. Growth curve analyses revealed differences in trajectories of rumination, acceptance, and catastrophizing, depending on self-harm histories. Specifically, participants with previous NSSI displayed increases in rumination, acceptance, and catastrophizing over time, compared to peers with a previous suicide attempt.

Limitations

The study design was limited by lack of assessment of self-harm during the daily diary, a limited assessment period of only one week, and distal time period of group classification.

Conclusions

These findings suggest that while emerging adults with NSSI histories use more emotion regulation strategies, they may need assistance in selecting when and how to use specific strategies.

A longitudinal investigation of non-suicidal self-injury persistence patterns, risk factors, and clinical outcomes during the college period

BACKGROUND

Although non-suicidal self-injury (NSSI) is known typically to begin in adolescence, longitudinal information is lacking about patterns, predictors, and clinical outcomes of NSSI persistence among emerging adults. The present study was designed to (1) estimate NSSI persistence during the college period, (2) identify risk factors and high-risk students for NSSI persistence patterns, and (3) evaluate the association with future mental disorders and suicidal thoughts and behaviors (STB).

METHODS

Using prospective cohorts from the Leuven College Surveys (n = 5915), part of the World Mental Health International College Student Initiative, web-based surveys assessed mental health and psychosocial problems at college entrance and three annual follow-up assessments.

RESULTS

Approximately one in five (20.4%) students reported lifetime NSSI at college entrance. NSSI persistence was estimated at 56.4%, with 15.6% reporting a high-frequency repetitive pattern (≥five times yearly). Many hypothesized risk factors were associated with repetitive NSSI persistence, with the most potent effects observed for pre-college NSSI characteristics. Multivariate models suggest that an intervention focusing on the 10-20% at the highest predicted risk could effectively reach 34.9-56.7% of students with high-frequency repetitive NSSI persistence (PPV = 81.8-93.4, AUC = 0.88-0.91). Repetitive NSSI persistence during the first two college years predicted 12-month mental disorders, role impairment, and STB during the third college year, including suicide attempts.

CONCLUSIONS

Most emerging adults with a history of NSSI report persistent self-injury during their college years. Web-based screening may be a promising approach for detecting students at risk for a highly persistent NSSI pattern characterized by subsequent adverse outcomes.

The Effect of Gender on Identification and Interpretation of Non-Suicidal Self-Injury

INTRODUCTION

Reported rates of non-suicidal self-injury (NSSI) differ by gender but may be under-reported and under-recognised in men. People engaging in NSSI rarely seek professional help without encouragement, so others play a key role in its identification and potential intervention. The current research investigated others' interpretations of NSSI, examining whether gender affects the likelihood of NSSI identification and views of how common and acceptable NSSI is.

METHOD

Participants (N = 429; 74.1% female, 23.3% male; please see below for further demographic information) responded to two vignettes describing a person self-injuring by punching a wall or by cutting themselves. The person's gender in each vignette was manipulated. Following each vignette, the participants rated the level to which they agreed the behaviour was common for the gender of the person described, as well as the level to which they agreed the behaviour was acceptable for the gender of the person described, on a 5-point Likert scale. Following both vignettes, participants were presented with a definition of NSSI and rated the level to which they agreed cutting and wall-punching were forms of NSSI on 5-point Likert scales. Independent-samples t tests and goodness of fit χ2 tests were conducted as appropriate.

RESULTS

Participants were more likely to identify wall-punching as common for men and cutting as common for women. However, there was no significant difference in whether wall-punching was identified as NSSI or considered to be an acceptable behaviour, regardless of the gender of the person engaging in it. That is, although research suggests that men are far more likely to engage in wall-punching as a form of NSSI than women, participants did not recognise this. Overall, the results indicated a gender-dependent difference in how acceptable and common NSSI is thought to be, but no noticeable difference in identification of a behaviour as NSSI. Wall-punching, typically a form of NSSI engaged in by males, tended not to be identified as such.

CONCLUSION

There is an effect of gender on how NSSI is interpreted, and it seems that men's NSSI is, and will continue to be, under-recognised. This has important implications for the treatment of men's NSSI, which is more likely to be seen as aggression and therefore deserving of punishment than an attempt at emotion regulation.

Self-, other-, and dual-harm during adolescence: a prospective-longitudinal study of childhood risk factors and early adult correlates

BACKGROUND

Little is known about the childhood antecedents and adult correlates of adolescent dual-harm (i.e. co-occurring self- and other-harm). We examine the longitudinal associations between (a) social and psychological risk factors in childhood and adolescent dual-harm and (b) adolescent dual-harm and social and mental health impairments in early adulthood.

METHODS

Participants (N = 1482) are from a prospective longitudinal community-representative study. Dual-, self-, and other-harm were self-reported at ages 13, 15, and 17. Social and psychological risk factors in childhood were assessed between 7 and 11; early adult correlates at age 20. Groups with dual-harm, self-harm only, other-harm only, and no harm were compared.

RESULTS

Between 13 and 17, 7.2% of adolescents reported dual-harm (self-harm only: 16.2%; other-harm only: 13.3%). Some childhood risk factors (e.g. sensation-seeking, parental divorce, victimization by peers) characterized all harm groups; others were common to the dual- and self-harm (anxiety/depressive symptoms, relational aggression) or dual- and other-harm groups only (low self-control, substance use, delinquency). Adolescents with dual-harm had reported more physical aggression and harsh parenting, and lower school bonding in childhood than any other group. In early adulthood, they reported more anxiety/depressive symptoms, psychopathy symptoms, homicidal ideations, delinquency, and victimization experiences than any other group.

CONCLUSIONS

Adolescent dual-harm follows psychological problems and social disconnection in childhood and signals risk of psychopathology and isolation in early adulthood. To curb the burden from dual-harm, interventions must target adolescents, families, peer networks, and school environments. Differentiating youth with dual-harm from those with single-harm is important for developing personalized treatments.

Emotion Regulation Difficulties, Family Functioning, and Well-Being Involved in Non-Suicidal Self-Injury and Suicidal Risk in Adolescents and Young People with Borderline Personality Traits

Individuals with a borderline personality disorder (BPD) or BPD traits usually have a lifetime history of harmful behaviors. Emotion regulation difficulties are a risk factor for suicide, whereas adequate family functioning and well-being play an important protective role. This study aims to determine the role of emotion regulation difficulties, well-being, and family functioning in the suicide risk and non-suicidal self-injury (NSSI) in adolescents and young people with BPD traits. From a sample of 285 young people, 103 (36.1%) had BPD traits (mean age = 16.82, SD = 2.71), and 68.93% were females. The results showed significant differences in personal and family variables according to the type of harmful behavior. Suicide attempts (SA) were mainly predicted by difficulties in impulse control, whereas NSSI was predicted by low family satisfaction. Programs designed to prevent SA and NSSI should consider individual differences, as well as the type of harmful behaviors exhibited.

Emotional dysregulation in childhood and disordered eating and self-harm in adolescence: prospective associations and mediating pathways

BACKGROUND

Emotional dysregulation may be a risk factor for disordered eating and self-harm in young people, but few prospective studies have assessed these associations long-term, or considered potential mediators. We examined prospective relationships between childhood emotional dysregulation and disordered eating and self-harm in adolescence; and social cognition, emotional recognition, and being bullied as mediators.

METHODS

We analysed Avon Longitudinal Study of Parents and Children data on 3,453 males and 3,481 females. We examined associations between emotional dysregulation at 7 years and any disordered eating and any self-harm at 16 years with probit regression models. We also assessed whether social cognition (7 years), emotional recognition (8 years) and bullying victimisation (11 years) mediated these relationships.

RESULTS

Emotional dysregulation at age 7 years was associated with disordered eating [fully adjusted probit B (95% CI) = 0.082 (0.029, 0.134)] and self-harm [fully adjusted probit B (95% CI) = 0.093 (0.036, 0.150)] at age 16 years. There was no evidence of sex interactions or difference in effects between self-harm and disordered eating. Mediation models found social cognition was a key pathway to disordered eating (females 51.2%; males 27.0% of total effect) and self-harm (females 15.7%; males 10.8% of total effect). Bullying victimisation was an important pathway to disordered eating (females 17.1%; males 10.0% of total effect), but only to self-harm in females (15.7% of total effect). Indirect effects were stronger for disordered eating than self-harm.

CONCLUSIONS

In males and females, emotional dysregulation in early childhood is associated with disordered eating and self-harm in adolescence and may be a useful target for prevention and treatment. Mediating pathways appeared to differ by sex and outcome, but social cognition was a key mediating pathway for both disordered eating and self-harm.

Emotional responding to overt and subtle social exclusion among young women who engage in non-suicidal self-injury

People who engage in non-suicidal self-injury (NSSI) consistently report greater emotion reactivity and dysregulation than their peers. However, evidence that these self-reports reflect an amplified emotional response under controlled conditions is limited. Here we test the effects of both subtle and overt social exclusion, to determine whether self-reported emotion dysregulation reflects responses to real-time emotional challenge for people who self-injure. We recruited 100 young women with past-year NSSI and 100 without NSSI to an online experiment. Participants took part in a baseline social inclusion ball-tossing game, followed by either an overt or subtle social exclusion ball-tossing game, while we measured negative mood and belongingness. Despite reporting greater emotion reactivity (d = 1.40) and dysregulation (d = 1.63) than controls, women with past-year NSSI showed no differences in negative mood or belongingness ratings in response to either overt or subtle social exclusion. Within the NSSI group, exploratory analyses found greater endorsement of intrapersonal functions predicted greater negative mood following social exclusion (β = 0.19). Given that amplified emotional responding is central to prominent theoretical models of NSSI, findings highlight the need to better understand the divergence in findings between self-reported emotion dysregulation and real-time emotional responding among people who self-injure.

Daily reciprocal relations between emotion dysregulation and non-suicidal self-injury among individuals with a history of sexual assault: The influence of posttraumatic stress symptoms

INTRODUCTION

Non-suicidal self-injury (NSSI) is a serious public health concern that can be understood within an emotion dysregulation framework. The current study adds to the literature by utilizing a micro-longitudinal design and novel statistical modeling to test reciprocal associations between emotion dysregulation and NSSI, as well as the potential moderating effect of posttraumatic stress symptoms (PTSS).

METHODS

Participants were 81 individuals with a history of sexual assault and NSSI (M_age  = 33.80; 67.9% women; 80.2% white) recruited from the community who self-reported on symptoms of emotion dysregulation and NSSI thoughts/behaviors once daily for 7 days. Average compliance rate was 72.8% (SD = 31.3%) and 34 participants (42.0%) endorsed NSSI thoughts/behaviors over the course of the study.

RESULTS

Findings revealed a significant positive effect of NSSI thoughts/behaviors on subsequent abilities to regulate negative emotions. Furthermore, while results did not detect a moderating influence of baseline PTSS on the relation between emotion dysregulation and NSSI thoughts/behaviors over time, individuals with higher baseline PTSS were found to experience heightened levels of NSSI thoughts/behaviors and emotion dysregulation on average.

CONCLUSION

Information from this study may be useful for future research and intervention development focused on the intersection of NSSI, PTSS, and emotion dysregulation.

Non-suicidal self-injury among first-year college students and its association with mental disorders: results from the World Mental Health International College Student (WMH-ICS) initiative

BACKGROUND

Although non-suicidal self-injury (NSSI) is an issue of major concern to colleges worldwide, we lack detailed information about the epidemiology of NSSI among college students. The objectives of this study were to present the first cross-national data on the prevalence of NSSI and NSSI disorder among first-year college students and its association with mental disorders.

METHODS

Data come from a survey of the entering class in 24 colleges across nine countries participating in the World Mental Health International College Student (WMH-ICS) initiative assessed in web-based self-report surveys (20 842 first-year students). Using retrospective age-of-onset reports, we investigated time-ordered associations between NSSI and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) mood (major depressive and bipolar disorder), anxiety (generalized anxiety and panic disorder), and substance use disorders (alcohol and drug use disorder).

RESULTS

NSSI lifetime and 12-month prevalence were 17.7% and 8.4%. A positive screen of 12-month DSM-5 NSSI disorder was 2.3%. Of those with lifetime NSSI, 59.6% met the criteria for at least one mental disorder. Temporally primary lifetime mental disorders predicted subsequent onset of NSSI [median odds ratio (OR) 2.4], but these primary lifetime disorders did not consistently predict 12-month NSSI among respondents with lifetime NSSI. Conversely, even after controlling for pre-existing mental disorders, NSSI consistently predicted later onset of mental disorders (median OR 1.8) as well as 12-month persistence of mental disorders among students with a generalized anxiety disorder (OR 1.6) and bipolar disorder (OR 4.6).

CONCLUSIONS

NSSI is common among first-year college students and is a behavioral marker of various common mental disorders.

Relationships between Outcome Expectancies and Non-Suicidal Self-Injury: Moderating Roles of Emotion Regulation Difficulties and Self-Efficacy to Resist Self-Injury

BACKGROUND

Non-suicidal self-injury (NSSI) is the deliberate damage of one's own body tissue in the absence of suicidal intent. Research suggests that individuals engage in NSSI as a means of regulating their emotions and that NSSI is associated with emotion regulation difficulties. There is also evidence supporting the role of outcome expectancies and self-efficacy to resist NSSI. However, it is unclear how these factors work together to explain NSSI.

OBJECTIVE

To explore whether the relationships between five NSSI-specific outcome expectancies and NSSI history are moderated by emotion regulation difficulties and self-efficacy to resist NSSI.

METHOD

1002 participants (Mage = 20.51, 72.5% female, 39.7% lifetime history of NSSI) completed an online survey including measures of NSSI history, outcome expectancies, self-efficacy to resist NSSI, and emotion regulation difficulties.

RESULTS

Emotion regulation difficulties were associated with NSSI, as was expecting NSSI to regulate affect. Conversely, expectations of communication and/or pain, as well as self-efficacy to resist NSSI were negatively associated with NSSI. Expectancies also interacted with both difficulties in emotion regulation and self-efficacy to resist NSSI in predicting self-injury. For example, the association between expectations of affect regulation and self-injury was weaker when associated with greater self-efficacy to resist NSSI.

CONCLUSION

These findings provide support for considering NSSI-specific cognitions in concert with emotion regulation when understanding NSSI.HighlightsOutcome expectancies can differentiate people based on NSSI history.Emotion regulation difficulties and self-efficacy to resist NSSI moderate the relationships between outcome expectancies and NSSI history.Emotion regulation difficulties and low self-efficacy to resist NSSI work together to predict NSSI history.

The prospective relation between borderline personality disorder symptoms and suicide risk: The mediating roles of emotion regulation difficulties and perceived burdensomeness

BACKGROUND

Despite the strong link between borderline personality disorder (BPD) symptoms and suicide risk, little is known about the mechanisms underlying this association. Theory-driven research clarifying the pathways through which BPD symptoms increase suicide risk over time is needed and may highlight relevant treatment targets for decreasing suicide risk among individuals with heightened BPD symptoms. This study examined the prospective relations among BPD symptoms, emotion regulation (ER) difficulties, perceived burdensomeness, thwarted belongingness, and suicide risk across five assessments over a 7-month period. Consistent with the interpersonal theory of suicide, we hypothesized that greater BPD symptoms would predict greater suicide risk over time via greater ER difficulties and, subsequently, greater perceived burdensomeness.

METHODS

A U.S. nationwide sample of 500 adults (47 % women; mean age = 40.0 ± 11.64) completed a prospective online study, including an initial assessment and four follow-up assessments over the next seven months.

RESULTS

Results revealed a significant indirect relation between BPD symptoms and greater suicide risk over time through greater ER difficulties and later perceived burdensomeness. Results also provided evidence for transactional relations between BPD symptoms and ER difficulties and suicide risk over time.

LIMITATIONS

All constructs were assessed via self-report questionnaire data. Our measure of suicide risk focuses on only suicidal ideation, plans, and impulses, and not suicide attempts or preparatory behaviors.

CONCLUSIONS

Results highlight both ER- and interpersonal-related factors as key mechanisms underlying suicide risk among community adults with BPD symptoms.

Sleep irregularity and nonsuicidal self-injurious urges and behaviors

STUDY OBJECTIVES

The objectives of this study were to examine the relationships between sleep regularity and nonsuicidal self-injury (NSSI), including lifetime NSSI history and daily NSSI urges.

METHODS

Undergraduate students (N = 119; 18-26 years), approximately half of whom endorsed a lifetime history of repetitive NSSI, completed a 10-day actigraphy and ecological momentary assessment (EMA) protocol. A Sleep Regularity Index was calculated for all participants using scored epoch by epoch data to capture rapid changes in sleep schedules. Participants responded to EMA prompts assessing NSSI urge severity and negative affect three times daily over the 10-day assessment period.

RESULTS

Results indicate that individuals with a repetitive NSSI history were more likely to experience sleep irregularity than those without a history of NSSI. Findings also suggest that sleep irregularity was associated with more intense urges to engage in NSSI on a daily basis, even after accounting for average daily sleep duration, sleep timing, negative affect, and NSSI history. Neither sleep duration nor sleep timing was associated with NSSI history nor daily NSSI urge intensity.

CONCLUSIONS

Findings suggest that sleep irregularity is linked with NSSI, including NSSI history and intensity of urges to engage in NSSI. The present study not only supports the growing evidence linking sleep disturbance with the risk for self-injury but also demonstrates this relationship using actigraphy and real-time assessments of NSSI urge severity. Findings highlight the importance of delineating the nuances in sleep irregularity that are proximally associated with NSSI risk and identifying targets for intervention.

The Mediating Role of Emotion Regulation on Self-harm among Gender Identity and Sexual Orientation Minority (LGBTQ+) Individuals

OBJECTIVE

The present study was conducted to (1) investigate the role of emotion regulation difficulties among self-harming Lesbian, Gay, Bisexual, Transgender, Queer, or Questioning (LGBTQ+) individuals and (2) to test for a mediating role of emotion regulation difficulties in self-harm among LGBTQ + individuals.

METHOD

This study investigated the relationship between LGBTQ + status, self-reported levels of emotion regulation difficulties, and self-harm in a community sample (N = 484, aged 16-63), using an online cross-sectional survey.

RESULTS

LGBTQ + individuals reported more emotion regulation difficulties and were almost seven times more likely to self-harm than non-LGBTQ + participants. Being an LGBTQ + participant was associated with greater self-harm frequency when controlling for age, income, and difficulties in emotion regulation. Emotion regulation difficulties mediated the association between LGBTQ + status and both self-harm status and frequency.

CONCLUSIONS

The present findings suggest that treating emotion regulation difficulties might reduce both the prevalence and lifetime frequency of self-harm episodes among gender identity and sexual orientation minority individuals. Targeting emotion regulation might be used as an early prevention strategy among LGBTQ + individuals who are at risk for self-harm. Further, enhancing emotion regulation skills among self-harming LGBTQ + individuals might replace maladaptive emotion regulation strategies with healthy alternatives, and can, therefore, foster resilience. HIGHLIGHTSLGBTQ + individuals are at high risk for self-harm.ER-mediated the association between LGBTQ + status and self-harm.Targeting emotion regulation in LGBTQ + people may help reduce self-harm.

Emotional Reactivity in Adolescents With Non-suicidal Self-injury and Its Predictors: A Longitudinal Study

BACKGROUND

The management of emergency presentations at child and adolescent psychiatric outpatient clinics, by children and adolescents with self-injurious thoughts and behaviors, represents very responsible tasks but also offers the opportunity for immediate interventions. The stability and degree of emotional reactivity (ER) is a significant psychopathological symptom for development and maintenance of self-injurious behavior, differentiating between those who have continued to injure themselves and those who have not. In general, the relationship between ER and self-injurious behavior has been shown to be bidirectional. However, the stability of ER over time, as well as important predictors for ER itself have not been investigated so far. Therefore, this present study aimed at investigating the stability of ER over time and the relationship between non-suicidal self-injury (NSSI) and ER. Reinforcement functions and several variables of psychological functioning were considered as possible influencing factors.

METHODS

As part of a longitudinal study, 97 adolescents aged 11-18 years who presented due to self-injurious thoughts or behaviors underwent standardized emergency management. This included a specified detailed psychiatric assessment at baseline (including the Emotion Reactivity Scale, ERS, and the Self-Injurious Thoughts and Behaviors Interview, SITBI) and treatment recommendations. These were followed by a catamnestic examination with two follow-up appointments. Changes over time in ER, NSSI, reinforcement functions of NSSI and general indicators of psychological functioning (General Severity Index, GSI) were examined and significant correlations were followed up by a linear-mixed effect model predicting the ERS score over time.

RESULTS

Data analysis revealed a statistically significant decrease in ERS scores and GSI over time. However, reinforcement functions for and the symptomatology of NSSI did not change. Furthermore, no predictive relationship from ER to NSSI could be identified. A linear-mixed effect model predicting the ERS identified the GSI, automatic positive reinforcement (as a reinforcement function for NSSI) and age as the only significant predictors.

CONCLUSION

Results demonstrate the importance of NSSI reinforcement functions for heightened emotional reactivity and emphasize their role as a point for therapeutic intervention by providing alternatives to NSSI and thereby possibly reducing emotional reactivity.

Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility

Although nonsuicidal self-injury (NSSI)-deliberate damaging of body tissue without suicidal intent-is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.

A Systematic Review on the Impact of Hot and Cool Executive Functions on Pediatric Injury Risks: a Meta-Analytic Structural Equation Modeling Approach

Injury is a leading cause of morbidity and mortality among children in the USA. Understanding the impact of executive functions (EFs) on the risk of injuries is crucial for developing effective interventions. However, literature has failed to examine the relationship between multiple EFs and injury domains. The present paper quantitatively synthesized research on cool and hot EFs and children's intentional and unintentional injury risks using a novel meta-analytic structural equation modeling (MASEM) approach. A systematic review was conducted in the following databases: PsycINFO, Scopus, SafetyLit, Cochrane Central, and PubMed (Medline). After screening titles, abstracts, and full texts, a total of 31 studies were eligible for the MASEM analysis. One-stage MASEM was conducted on six conceptualized path analysis models according to the complexity of exogenous and endogenous variables. The MASEM models suggested that hot and cool EFs were negatively associated with children's risk of injury or injury-related risk behaviors regardless of mean age and proportion of females. Among cool EF skills, inhibitory control, but not working memory or cognitive flexibility, was significantly associated with risks of unintentional injuries. Emotion regulation was the dominant hot EF skill examined in the literature and was found significantly associated with risks of non-suicidal self-injuries (NSSIs). EF has a significant impact on children's risk of both unintentional and intentional injuries. Future research should focus on the combined force of hot and cool EF on children's risks of injuries and injury-related risk behaviors.

Self-Critical and Self-Punishment Cognitions Differentiate Those With and Without a History of Nonsuicidal Self-Injury: An Ecological Momentary Assessment Study

The aim of this study was to examine trait, state, and temporal instability measures of self-critical and self-punishment cognitions to evaluate their respective roles in nonsuicidal self-injury (NSSI). Participants were university students with a history of NSSI (n = 64) and those with no history of NSSI (n = 59). At baseline, participants completed measures assessing history of NSSI behavior, as well as trait measures of self-criticism and self-punishment. After completion of baseline procedures, participants subsequently participated in a 10-day ecological momentary assessment protocol in which self-critical and self-punishment cognitions were assessed in real time three times daily. Employing bivariate and multivariate frameworks, our results demonstrate that both trait and state levels of self-critical and self-punishment cognitions robustly differentiate between young adults with and without a lifetime history of NSSI. The present results also confirm that the temporal instability of these cognitive states also meaningfully differentiate between groups, such that those who exhibit greater fluctuations in these cognitive states are more likely to have a history of NSSI. The current findings suggest that trait, state, and temporal instability of negative self-focused cognitions may be vulnerability factors for engagement in NSSI.

Stressful Experiences in University Predict Non-suicidal Self-Injury Through Emotional Reactivity

Theoretical perspectives on non-suicidal self-injury (NSSI; direct and deliberate self-injury without lethal intent such as self-cutting or hitting) have long underscored the affective regulating properties of NSSI. Less attention has been given to the processes through which individuals choose to engage in NSSI, specifically, to regulate their distress. In the present study, we tested one theoretical model in which recent stressful experiences facilitates NSSI through emotional reactivity. Further, we tested whether the indirect link between stressful experiences and NSSI was moderated by several NSSI specific risk factors (e.g., having friends who engage in NSSI). Given the widespread prevalence of NSSI among community-based samples of adolescents and emerging adults, we surveyed 1,125 emerging adults in first-year university at a large academic institution (72% female, Mage = 17.96, 25% with a recent history of NSSI at Time 1). Participants completed an online survey three times (assessments were 4 months apart), reporting on their recent stressful experiences in university, emotional reactivity, NSSI, as well as three NSSI specific risk factors (i.e., close friend engagement in NSSI, high self-disgust, and low fear of pain). As expected, path analysis revealed that there was a significant indirect effect of recent stressful experiences on NSSI engagement, through emotional reactivity. However, this effect was maintained across moderator analyses. These novel findings underscore the salient role of proximally occurring stressors in the prediction of NSSI among emerging adults in university, and can inform developing theoretical perspectives on NSSI.

Self-injury from early adolescence to early adulthood: age-related course, recurrence, and services use in males and females from the community

Adolescent self-injury is a widespread public health problem, but long-term longitudinal studies from European countries are rare. Self-injury in males and sex differences are poorly understood. This study describes the prevalence, frequency, age-related course, and recurrence of, and mental health services use related to adolescent self-injury. Data came from a Swiss prospective-longitudinal cohort study (N = 1482). Adolescents (52% male) reported frequency of self-injury and mental health services use (including reasons for and types of services use, hospitalizations) at ages 13, 15, 17, and 20. Between ages 13-20, 27% of adolescents reported self-injury at least once. In males, prevalence decreased from 12 to 5%; in females self-injury peaked at age 15 (16%) and then decreased (11% at age 20). In males, recurrence of self-injury increased after age 15 (from odds ratio [OR] < 3 to OR > 10); in females, recurrence was high from age 13 onwards (OR > 5). Predictors of recurrence included childhood/early adolescent internalizing symptoms and early self-injury onset. Typically, less than half of adolescents with self-injury used mental health services. Males with self-injury used services mainly for externalizing problems, learning difficulties, and attention/concentration problems; females for depression or self-injury, family problems, and victimization. Types of services used changed with age, and adolescents with self-injury had increased rates of hospitalization. There are notable sex differences in the longitudinal course of self-injury and reasons for related mental health services use. Treating early internalizing symptoms could be a promising target for preventing recurrent self-injury. Males are at particular risk of not receiving adequate treatment for self-injury.

Impact of the COVID-19 pandemic on students at elevated risk of self-injury: The importance of virtual and online resources

Non-suicidal self-injury (NSSI), which involves deliberate damage to body tissue without suicidal intent, has long been a concern for schools and school staff. Secondary schools are an ideal setting in which to identify, and appropriately refer, students who self-injure as well as implement evidence-based prevention and early intervention programs. However, in the context of the global COVID-19 pandemic, schools have been closed and students sent home to learn online. This may result in the exacerbation of existing anxieties and pose several new stressors that cumulatively may increase risk of NSSI. In this article, we draw on recent research and our collective experience working with schools, as well as digital mental health, to outline some of these potential stressors and offer resources for school staff to help students who are engaging in or at risk of NSSI.

Resilience mediates the association between school bullying victimization and self-harm in Chinese adolescents

OBJECTIVE

The association between school bullying and self-harm (SH) in adolescents has been extensively discussed. Nevertheless, little is known about the mechanism of this relationship, particularly the role of resilience. Our research aimed to explore and evaluate the potential moderation and mediation of resilience in the association between school bullying victimization and SH in a large sample of Chinese adolescents.

METHOD

We conducted a population-based cross-sectional survey of 3146 adolescents in southwest China. The data were collected by a self-administered questionnaire. Multivariate Logistic regression which incorporated the product term of bullying victimization and resilience was used to estimate the moderation of resilience. Mediation of resilience in bullying victimization and SH were evaluated by path model.

RESULTS

The prevalence of bullying involvement and SH were 13.13% (95% CI:9.31%-18.00%) and 47.0% (95% CI: 36.3%-58.0%), respectively. School bullying victimization was positively associated with SH. Resilience was a prominent mediator which accounted for 27.7% of the total association. Among all five dimensions of resilience, emotion regulation (30.90%), interpersonal assistance (24.78%), and family support (22.16%) showed the strongest mediation. Nevertheless, the moderation of resilience in this association was not statistically significant.

CONCLUSIONS

The findings of the present study suggest that resilience strengthening measures, particularly those aimed at improving emotion regulation ability and building social support could be effective in reducing school bullying victimization related SH behaviors among Chinese teenagers.

Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know

PURPOSE OF REVIEW

The current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research.

RECENT FINDINGS

While there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously. It is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.