Is the end in the beginning? Child maltreatment increases the risk of non-suicidal self-injury and suicide attempts through impaired personality functioning

Antecedents and risk factors for borderline personality disorder: Etiopathogenic models based on a multi-level meta-analysis

BACKGROUND

Empirically-based developmental psychopathology approach identified three domains involved in the emergence of borderline personality disorder (BPD): i) underlying liabilities to develop psychopathology (i.e., early patterns of internalizing and externalizing manifestations); ii) invalidating relational experiences (e.g., childhood traumatic experiences, maladaptive parenting, problematic peer relationships); iii) regulatory mechanisms of emotions and behaviors. Nevertheless, no studies have quantitatively summarized empirical findings concerning how and to what extent these domains might be temporally associated to the emergence of BPD features from adolescence to adulthood.

METHODS

The current multi-level meta-analysis included 106 studies (N = 86,871 participants) assessing the role of previously mentioned antecedents and risk factors for BPD.

RESULTS

The analysis showed moderate effect sizes capturing temporal associations between early internalizing/externalizing psychopathological manifestations, different invalidating relational experiences, emotion/behavior regulation processes with later BPD features. The effect sizes of these domains were not statistically different from each other.

CONCLUSION

This evidence supports a transactional developmental model of BPD. Consistently, the emergence of BPD could be viewed in the light of dynamic interplays between an underlying liability to psychopathology and invalidating relational experiences across different stages of development, which are progressively reinforced through increasing alterations of emotion and behavior regulation mechanisms.

Progress in understanding personality functioning in light of the DSM-5 and ICD-11

Updates regarding the dimensional model of personality disorder in the DSM-5 and ICD-11 have stimulated interest in the concept of personality functioning (PF). A growing number of literature has demonstrated the extensive empirical basis, validated evaluation tools, and clinical utility of the concept of PF. The concept of PF provides a construct for the diagnosis and evaluation of personality disorders. As a trans-diagnostic factor, PF is of great significance in the etiology and development of many mental and physical conditions. PF can be improved per se, primarily through psychotherapy. The evaluation and treatment of low PF should be considered in all relevant cases. The current study aims to provide a comprehensive review of the concept, pathogenesis, measurement, prevalence, psychopathological significance, as well as intervention for disordered PF.

Childhood maltreatment, peer victimization, borderline personality feature, suicidal risk in adolescents: Direct and indirect associations among developmental trajectories

INTRODUCTION

Childhood maltreatment, peer victimization, and borderline personality traits have all been shown to be linked to suicidal risk. However, there remains a need to illuminate the possible direct and indirect pathways among them from a developmental perspective that could serve as intervention targets. This study thus aimed to investigate the direct and indirect relationships among developmental trajectories of childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk in adolescents.

METHODS

A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82) in junior middle schools completed self-report measures on three-time points across 1 year. Latent growth curve modeling was used to evaluate the direct and indirect relationships among the developmental trajectories of the aforementioned study variables.

RESULTS

The developmental trajectories of childhood maltreatment, peer victimization, and borderline personality feature were positively and directly related to the developmental trajectory of suicidal risk; and the developmental trajectories of childhood maltreatment, peer victimization were indirectly related to the developmental trajectory of suicidal risk through the mediating effect of the developmental trajectory of borderline personality feature.

CONCLUSIONS

The findings elucidated the direct and indirect longitudinal relationships among childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk, highlighting that interventions should target childhood maltreatment, peer victimization, and borderline personality feature to decrease suicidal risk in adolescents with a developmental perspective.

A powerful safety net: Social support moderates the association of quality of life deficits with suicidal ideation in long-term childhood cancer survivors

OBJECTIVES

Cancer survivors are at risk for suicidality. We aimed to expand the knowledge about protective factors and their interplay with risk factors by testing social support as a modifier of the association of Quality of Life (QoL) deficits with suicidal ideation.

RESEARCH APPROACH

We surveyed N = 633 childhood cancer survivors (CCS) using validated questionnaires (EORTC Core Quality of Life questionnaire QLQ-C30, Patient Health Questionnaire PHQ-9). The interaction of QoL and social support was investigated using multiple linear regression analysis.

FINDINGS

CCS reporting suicide attempts and current suicidal ideation (SI) had lower QoL. CCS with SI reported less social support. QoL and social support were independently associated with SI and interacted: among CCS with less social support, low QoL was more strongly associated with SI.

CONCLUSION

The results highlight the need for interdisciplinary survivorship care, and to focus on risk and protective factors to strengthen suicide prevention.

Inpatients with a history of suicide attempts in routine clinical care exhibit specific characteristics regarding sociodemographics, life events, personality, and symptom burden

Research indicates that patients with a lifetime history of suicide attempts are particularly burdened. However, investigations of their characteristics and comparisons with other patients are scarce. This study aimed to fill this research gap, using routine clinical data and guided by theoretical models. Data of N = 706 patients (54.4% women) was collected at the psychosomatic inpatient/day-clinic unit of a German university clinic. It comprised sociodemographic data and information about previous experiences (e.g., childhood abuse and neglect), symptom measures (e.g., the PHQ-9) and individual differences (e.g., the level of personality functioning assessed with the OPD-SQS). Groups were compared using independent t-tests or χ2-tests. Of the total sample, 118 patients (16.7%) reported suicide attempts. Those with a history of suicide attempts were more likely to have a migration background and a lower level of education, smoke (heavily) and use illegal substances. They reported lower levels of personality functioning, more current symptoms and traumatic previous experiences of abuse and neglect. Screening for previous suicidal behavior as well as associated factors can yield valuable information for clinical practice. Many group differences map onto previously observed specific risk factors for suicidal behavior, supporting the conceptual models and underscoring their relevance among clinical populations as well.

Risk factors of suicide re-attempt: A two-year prospective study

BACKGROUND

History of suicide attempt (SA) is the strongest predictor of a new SA and suicide. It is primordial to identify additional risk factors of suicide re-attempt. The aim of this study was to identify risk factors of suicide re-attempt in patients with recent SA followed for 2 years.

METHODS

In this multicentric cohort of adult inpatients, the median of the index SA before inclusion was 10 days. Clinicians assessed a large panel of psychological dimensions using validated tools. Occurrence of a new SA or death by suicide during the follow-up was recorded. A cluster analysis was used to identify the dimensions that best characterized the population and a variable "number of personality traits" was created that included the three most representative traits: anxiety, anger, and anxious lability. Risk factors of re-attempt were assessed with adjusted Cox regression models.

RESULTS

Among the 379 patients included, 100 (26.4 %) re-attempted suicide and 6 (1.6 %) died by suicide. The two major risk factors of suicide re-attempt were no history of violent SA and presenting two or three personality traits among trait anxiety, anger and anxious lability.

LIMITATIONS

It was impossible to know if treatment change during follow-up occur before or after the re-attempt.

DISCUSSION

One of the most important predictors of re-attempt in suicide attempters with mood disorders, was the presence of three personality traits (anger, anxiety, and anxious lability). Clinicians should provide close monitoring to patients presenting these traits and proposed treatments specifically targeting these dimensions, especially anxiety.

Association between negative life events through mental health and non-suicidal self-injury with young adults: evidence for sex moderate correlation

BACKGROUND

Non-suicidal self-injury (NSSI) has exhibited an increasing trend in recent years and is now globally recognized as a major public health problem among adolescents and young adults. Negative life events (NLEs) are positively associated with NSSI. We sought to explore (1) whether sex plays a role in the risk of NLEs leading to NSSI and (2) the role played by mental health (MH).

METHODS

We adopted a multi-stage cluster sampling method to select college students across four grades from May to June 2022. Generalized linear models were used to evaluate the relationships between NLEs, sex, MH and NSSI, presented as incidence-rate ratios (RRs) with 95% confidence intervals (CIs). We examined the complex relationship between these variables using the PROCESS method for moderation analysis.

RESULTS

Following the exclusion of data that did not meet the study requirements, data from 3,578 students (mean age: 20.53 [± 1.65] years) were included. Poisson regression results indicate that high-level NLEs (RR = 0.110, 95%CI: 0.047-0.173) are associated with increased NSSI. Furthermore, interaction effects were observed among sex, NLEs and NSSI. MH and sex moderated the relationship between NLEs and NSSI.

CONCLUSION

Identifying risk factors for NSSI is also important when exploring the interaction between NLEs and MH given the potential for NSSI to significantly increase the risk of later psychopathological symptoms and substance abuse problems. In addition, the significance of sex differences in risk factors for NSSI should be determined. This study evaluated how the impact of NLEs on NSSI can be reduced among adolescents from multiple perspectives.

Associations between emotional maltreatment, depression and self-harm among Chinese adolescents: A three-wave longitudinal mediation model

BACKGROUND

Self-harm seriously endangers adolescents' physical and mental health. However, the longitudinal mechanism of self-harm is not yet clear.

OBJECTIVE

This study explored the inconsistent relationships between two types of emotional maltreatment and self-harm across three waves, regarding depression as a potential mediator and gender as a moderator of these associations.

PARTICIPANTS AND SETTING

A sample of 588 Chinese adolescents (Mage at T1 = 12.79 years) in a middle school completed the assessment of demographic information, emotional maltreatment, depression and self-harm within one year.

METHODS

Path analysis models were created to estimate the relationship of emotional maltreatment with self-harm and the mediating effect of depression. A multi-group analysis was applied to investigate the moderating effect of gender.

RESULTS

There existed positive associations between emotional abuse at T1 and self-harm at T2 and T3 (β = 0.12, SE = 0.05, p = 0.006; β = 0.09, SE = 0.05, p = 0.054), and the mediating effect of emotional abuse at T1 on self-harm at T3 via depression at T2 was significant (Indirect effect = 0.05, SE = 0.02, 95 % CI [0.02, 0.08]). Multi-group analysis of gender revealed no significant differences in the cross-lagged pathways, but there were stronger links for girls than boys among self-harm at T1, T2, and T3 (p < 0.001).

CONCLUSIONS

Emotional abuse but not emotional neglect could significantly predict self-harm. Furthermore, depression played a mediating role in the longitudinal relationship between emotional abuse and self-harm. Girls who had high levels of self-harm at a previous time point were more inclined than boys to harm themselves at a subsequent time point. These findings provide a different perspective to develop effective prevention and intervention measures.

The familial transmission of suicide and non-suicidal self-injury in different income levels in town

BACKGROUND

Prior researches have established that suicide and non-suicidal self-injury (NSSI) exhibit familial transmission patterns. However, the extent to which these patterns vary across different income levels remains unclear, as well as the specific factors that influence them. This study aimed to explore these questions.

METHODS

We analyzed data from 13,988 parent-child pairs in Chongqing, China, where the children were aged from 7 to 12 years old. Six income levels were considered, and the children's depression and anxiety symptoms were assessed using standardized scales (the Center for Epidemiological Studies Depression Scale for Children, [CES-DC], and the Screen for Child Anxiety Related Emotional Disorders [SCARED], respectively). Binary logistic regression analysis was employed to examine the transmission of suicide and NSSI across different income levels.

RESULTS

Familial transmission of suicide was significant difference in all income levels except the highest, while familial transmission of NSSI was significant difference in all income levels except the lowest. Notably, in both low- and high-income levels, suicide and NSSI transmissions primarily occurred among male children, mothers with higher education, and children who spent long time with their mothers. Additionally, the transmissions were mediated partially or entirely by children's depression and anxiety symptoms.

LIMITATIONS

Future studies should investigate the separate effects of fathers' and mothers' suicide and NSSI histories on familial transmission patterns.

CONCLUSION

The familial transmissions of suicide and NSSI exhibited distinct patterns across different income levels.

Suicidal ideation in patients with diabetes and childhood abuse - The mediating role of personality functioning: Results of a German representative population-based study

AIMS

Suicidal ideation (SID) in patients with diabetes mellitus is increasingly acknowledged. Still, the underlying mechanisms are unclear. We examined SID prevalences in patients with diabetes, its association with different types of abuse, and a mediating effect of personality functioning.

METHODS

In a representative population sample (N = 2,515), diabetes, SID, abuse (ICAST-R), personality functioning (OPD-SQS), and depression/anxiety (PHQ-4) were assessed by self-report. Statistical analyses comprised Chi2-Tests, logistic regression and mediation analyses.

RESULTS

The prevalence of SID (21.8 %) was three fold higher in patients with diabetes compared to the general population. Abuse further increased the likelihood to report SID in diabetes patients (sexual: 48.1 % vs. 18.2 %; χ2(1) = 12.233, p <.001; emotional: 35.7 % vs. 15.7 %; χ2(1) = 10.892, p <.001). A dose-response relationship between the number of abuse experiences and SID was observed (one abuse experience: OR = 1.138, 95 %-CI [0.433, 2.990], p =.793, >2 abuse experiences: OR = 2.693, 95 %-CI [1.278, 5.675], p =.009). Impaired personality functioning had an indirect effect on the association between emotional abuse and SID (b = 0.25, 95 %-CI [0.037, 0.551]).

CONCLUSIONS

Diabetes patients experience increased SID prevalences, especially those with emotional or sexual abuse. In individuals with a history of emotional abuse, impaired personality functioning partly explained SID and should therefore be considered and addressed in this patient group.

Childhood Maltreatment and Non-Suicidal Self-Injury in Adolescents: Testing a Moderated Mediating Model

There is a wealth of evidence to suggest that childhood maltreatment is a major risk factor contributing to non-suicidal self-injury (NSSI) among adolescents. However, how and under what conditions childhood maltreatment is related to NSSI remains largely unclear. This study examined the indirect effect of depressive symptoms in the relation between childhood maltreatment and non-suicidal self-injury, as well as the moderating role of cognitive reappraisal and emotion reactivity in those associations. A sample of 1,984 Chinese adolescents (Mage = 12.84, SD = 1.27, 47.9% girls) completed self-report questionnaires. The results of path analysis showed that childhood maltreatment was significantly related to NSSI and that depressive symptoms play an indirect effect in the relation between them. Cognitive reappraisal mitigated the effect of childhood maltreatment on depressive symptoms, and emotion reactivity strengthened the effect of depressive symptoms on non-suicidal self-injury. The results further showed that the indirect effect of depressive symptoms was more prominent for youths with lower levels of cognitive reappraisal and greater emotion reactivity. Interventions that enhance cognitive reappraisal and reduce emotion reactivity may interrupt the pathway from childhood maltreatment to NSSI via depressive symptoms.

Measuring personality functioning with the 12-item version of the OPD-Structure Questionnaire (OPD-SQS): reliability, factor structure, validity, and measurement invariance in the general population

Background

The assessment of personality functioning is at the core of current dimensional models of personality disorders. A variety of measures from different clinical and research traditions aim to assess basic psychological capacities regarding the self and others. While some instruments have shown reliability and validity in clinical or other selected samples, much less is known about their performance in the general population.

Methods

In three samples representative of the German adult population with a total of 7,256 participants, levels of personality functioning were measured with the short 12-item version of the Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQS). We addressed questions of factor structure, reliability, validity, factorial invariance, and provide norm values.

Results

Confirmatory factor analysis indicated a satisfactory to good model fit. OPD-SQS models were mostly unaffected by variables such as gender, age, or measurement time. As expected, personality functioning was associated with general psychopathology as well as indices of occupational functioning.

Conclusion

The OPD-SQS is a viable measure to assess personality functioning in the general population.

Operationalized Psychodynamic Diagnostic of Adolescents in Light of the New ICD-11 Model of Personality Functioning: Personality Structure, Psychodynamic Conflicts, and Mental Health Problems

The International Classification of Diseases and Related Health Problems, 11th Revision introduced a fully dimensional approach to personality disorders which conceptionally converges with the long-standing psychodynamic understanding of psychopathology through underlying intra- and interpersonal impairments. In this study, the diagnostic contributions of the two psychodynamic concepts of personality structure and psychodynamic conflicts were investigated through the comparison of self-report data of 189 adolescents with mental health problems and 321 mentally healthy controls. The study results reveal that adolescents with mental health problems show significantly higher impairments in all four domains of personality structure and significantly higher levels of several psychodynamic conflicts. Further, adolescents with different mental health problems significantly differ regarding the impairments in the personality structure domains and several levels of psychodynamic conflicts. While higher structural impairments are shown in adolescents with eating and anxiety disorders, higher levels of the passive self-worth conflict persist in adolescents with depressive disorders, and higher levels of the passive identity conflict are affecting adolescents with eating disorders. The findings suggest that a standardized diagnostic assessment of personality structure and psychodynamic conflicts in adolescent patients could contribute to a deeper understanding of mental health problems and appropriate treatment planning through the detection of underlying intra- and interpersonal impairments.

Suicide attempts due to child abuse: A perspective into the Nepalese legal framework and societal norms

Children who experience violence are more prone to develop high-risk behaviour, mental illness and anxiety disorder. Nepalese law is against any form of physical violence but corporal punishment by parents on children continues in patriarchal Nepalese society. We describe a case of a young boy who attempted suicide twice due to maltreatment and discuss the legal and social issues involved.

Social and demographic characteristics of child maltreatment fatalities among children ages 5-17 years

BACKGROUND

While risk factors have been identified among infants and young children, less is known about child maltreatment fatalities among older children.

OBJECTIVES

To describe the social and demographic characteristics of children where abuse or neglect was determined to cause or contribute to their death, compare characteristics and circumstances of the deaths by cause and manner of death and type of maltreatment, and explore the role of abuse and neglect in child suicides.

PARTICIPANTS AND SETTING

Secondary analysis of deaths due to child abuse or neglect among children ages 5-17 years old occurring during 2009-2018 and documented in the National Fatality Review-Case Reporting System.

METHODS

Child, family, and social characteristics were compared by child age (5-10 years vs. 11-17 year-olds), and by cause and manner of death. Frequencies and proportions were reported and compared using chi-square statistics.

RESULTS

1478 maltreatment-related deaths were identified. Higher proportions of older children were non-Hispanic white, had a history of chronic disease or disability, had problems in school, and had a history of mental health issues. Forty-three percent of the maltreatment deaths were due to homicide and 10 % by suicide. Higher proportions (65 %) of younger children (5-10 years old) died by homicide, compared to older children (35 % among ages 11-17y). While 58 % of deaths overall were related to neglect, 68 % of deaths in older children were related to neglect, including 80 % of suicides.

CONCLUSIONS

The causes of child maltreatment deaths among children 5-17y vary by age. Child neglect caused and/or contributed to most child suicides.

Measuring Impairments of Mentalization with the 15-Item Mentalization Questionnaire (MZQ) and Introducing the MZQ-6 Short Scale: Reliability, Validity and Norm Values Based on a Representative Sample of the German Population

Deficits in mentalization are indicated by impaired emotional awareness and self-reflectiveness, and are associated with various mental disorders. However, there is a lack of validated research instruments. In this study, the psychometric properties of the Mentalization Questionnaire (MZQ) were evaluated in a representative German population sample with n = 2487 participants. Analyses included evaluation of the MZQs acceptance, reliability, and validity. Factorial validity was established with exploratory (EFA) and confirmatory factor analyses (CFA) after the dataset was randomly split. Dimensionality was evaluated with a bi-factor model. For convergent validity, correlations with the OPD SQS, PHQ-4, and POMS were calculated. While acceptance was good, internal consistencies (ω = 0.65-0.79) and factor structure of the original four subscales were not acceptable (TLI = 0.87, CFI = 0.91, RMSEA = 0.071). EFA indicated a 3-factor solution, which was not confirmed by CFA (TLI = 0.89, CFI = 0.91, RMSEA = 0.073). Correlations between subscales and bi-factor analyses indicated an underlying general factor (TLI = 0.94, CFI = 0.96, RMSEA = 0.053). A shortened 6-item version was comparable to the original scale. Age and sex-specific representative norm-values are presented. The MZQ is a feasible, reliable and valid self-report instrument to measure representations of inner mental states. However, when applied to non-clinical samples, the total score of the MZQ should be used.