Clinical characteristics and functions of non-suicide self-injury in youth

Fundamentals of Nonsuicidal Self-Injury in Pediatric Patients

Nonsuicidal self-injury (NSSI) is deliberate self-inflicted injury to one's own body without suicidal intent. There is a high prevalence of NSSI among adolescents, especially in adolescents with history of adverse childhood events and intense reactive emotions. Pediatricians are commonly the first point of contact for adolescents and preadolescents with mental health concerns, and knowledge of how to elicit and respond to reports of NSSI are critical in identifying, supporting, and making appropriate referrals to behavioral health providers. Appropriate referrals include a psychiatric assessment by a child and adolescent psychiatrist and licensed therapist. Therapy targets NSSI by identifying the function of the behavior for the patient and finding ways to obtain that function safely using coping skills. Pediatricians should consider their role in setting the tone for families to engage in productive mental health treatment, with the goal of having the adolescent and caregiver work collaboratively to use healthy coping skills. [Pediatr Ann. 2024;53(8):e280-e282.].

Parental attachment and childhood trauma in adolescents engaged in non-suicidal self-injury

AIM

In this study, it was aimed to compare parental attachment and childhood traumas in adolescents with NSSI with healthy peers.

METHODS

Fifty adolescents aged 14-18 years with lifetime NSSI and 56 healthy peers were included in the study. Inventory of Statements About Self-injury (ISAS), The Parental Bonding Instrument (PBI) and Child Trauma Questionnaire (CTQ-28) scales were used.

RESULTS

Eighty-two percentage of the NSSI group and 70% of the control group were girls. The mean age was 15.6 ± 1.1 years in the NSSI group and 15.3 ± 0.9 years in the control group. There was no significant difference between the groups in terms of age and gender. The NSSI group had more negative scores than the control group in terms of childhood traumas and attachment characteristics to both mother and father. The analyses showed that mother PBI care/control and sexual abuse score had a relationship with both ISAS Autonomic Functions and ISAS Social Functions scores.

CONCLUSIONS

These results suggest that secure attachment with the mother may be protective for both the autonomic and social functions of the NSSI. Therefore, interventions for dysfunctional parental attachment may prevent the development of NSSI.

Mediating role of anxiety and impulsivity in the association between child maltreatment and lifetime non-suicidal self-injury with and without suicidal self-injury

BACKGROUND

Child maltreatment can increase the risk of lifetime non-suicidal self-injury (NSSI) and suicidal self-injury (SSI), but there is limited knowledge regarding the differences of potentially psychological mechanisms between NSSI with and without SSI.

METHODS

Participants, 3918 community-based Chinese young men aged 18-34 years in Chengdu, were included in this study. We investigated the association between depression, anxiety, psychosis, child maltreatment, adulthood traumatic events, impulsivity, alcohol dependence, drug abuse, and lifetime of NSSI among participants with and without SSI. Parallel mediation analysis was utilized to explore the mediators for the relation between child maltreatment and NSSI.

RESULTS

The prevalence of lifetime NSSI was 6.1 % (95 % CI: 5.4 %-6.9 %) among young men. Anxiety and impulsivity partially mediated the effect of child maltreatment on NSSI either with (indirect effect: 51.2 %) or without SSI (indirect effect: 34.3 %). Depression was independently and significantly associated with only NSSI but not with NSSI+SSI. Alcohol dependence and psychosis were independently and significantly associated with NSSI+SSI and mediated the effect of child maltreatment on NSSI+SSI.

LIMITATIONS

The cross-sectional survey data limits the robustness of the proof to the causal relationships.

CONCLUSIONS

Anxiety and impulsivity are associated with NSSI either with or without SSI and partially mediate the effect of child maltreatment on NSSI. Depression is associated with only NSSI, while alcohol dependence and psychosis are only associated with NSSI+SSI. It could be crucial to improve treatment and recovery of alcohol dependence and psychosis for preventing young men engaged in NSSI from attempting SSI.

A study of the interactive mediating effect of ADHD and NSSI caused by co-disease mechanisms in males and females

Background

Non-suicidal self-injury (NSSI), of which the predisposing factors are complex and diverse, profoundly affects the physical and mental health of young people. Therefore, this work established an NSSI intermediary network model considering the interaction of multiple factors. A mediating effect between attention-deficit/hyperactivity disorder (ADHD) and NSSI, considering the influence of comorbidities, such as depression, anxiety, and impulsive personality, was proposed based on sex differences.

Methods

A total of 2,689 middle school students in Ningbo City, Zhejiang Province, China, were randomly sampled and participated in this study. Data regarding their demographic characteristics, attention deficit, hyperactivity/impulsivity, NSSI, anxiety, depression, internet addiction, and other comorbid symptoms were collected and analyzed. After initially screening the data, variables were assessed for significance using a single-factor inter-group difference analytic method, and a binary logistic regression analysis was performed. The intermediary effect of factors influencing NSSI in males and females was also analyzed.

Results

The overall NSSI rate was 15.16%. The results showed that the impact of individual impulsivity characteristics (impulsiveness, the ADHD with hyperactivity/impulsivity subtype) on NSSI behavior was not significant (regression results, P > 0.05). The degree of association between ADHD with attention deficit and ADHD with comprehension deficit subtypes, and other comorbid symptoms (depression, anxiety, and internet addiction disorder) and NSSI, with odds ratios (ORs) of 7.6/6.42/436.68/3.82/1.86, and 95% bootstrap confidence intervals (CIs) of 4.64, 12.87/3.46, 12.67/137.42, 2659.13/2.32, 6.37/1.31, 2.82, respectively. The results also showed significant effects of ADHD subtypes on comorbid symptoms and the path effects of NSSI (P < 0.01). Among them, the mediating effect was the strongest when anxiety was the mediating variable, and the mediating effect of girls was higher than that of boys.

Conclusion

The results of this work demonstrated the influence of ADHD symptoms on NSSI behavior. Among patients with ADHD, patients with subtypes with obvious attention deficit characteristics were more likely to exhibit NSSI behavior, whereas the hyperactive impulse subtype had no direct impact on NSSI. We conclude that adolescent impulsivity may not be directly related to NSSI behavior and that impulsive characteristics jointly affect NSSI behavior through a series of NSSI comorbid symptoms. Notably, the probability of symptom onset and the degree of comorbidity was significantly higher in girls than in boys of the same age, and girls were more prone to NSSI behavior. These findings provide effective theoretical support for the prevention and treatment of adolescent NSSI behavior.

Beyond the Surface: Teachers' Perceptions and Experiences in Cases of Non-Suicidal Self-Injury Among High School Students

Non-suicidal self-injury (NNSI) among adolescents is a significant concern. This study aimed to explore teachers' perceptions and experiences in cases of NSSI among their students. This qualitative-phenomenological study used in-depth, semi-structured interviews conducted with 27 teachers from high-schools in Israel. Thematic analysis was used to identify patterns and themes. Theme 1 highlighted the emotional impact of discovering self-injury incidents, including panic, confusion, and helplessness. Theme 2 focused on teachers' limited professional support and their need for training and guidance. Theme 3 explored teachers' desire to help students and their strategies for building connections and providing empathy, sometimes despite emotional detachment. Theme 4 emphasized the importance of involving parents and the need for effective communication. This study emphasizes the importance of providing teachers comprehensive training to address NSSI effectively. These findings provide a better understanding of teachers' experiences and underscore the need for enhanced support systems.

The development of Non-Suicidal Self-Injury (NSSI) during adolescence: A systematic review and Bayesian meta-analysis

BACKGROUND

Despite a surge in research on self-injury in the last decade, a summary of research findings about the development of Non-Suicidal Self-Injury (NSSI) over time in community youth samples is not yet present in the scientific literature. This study aims to summarize the empirical literature on this topic, examining both the occurrence (Study 1) and frequency (Study 2) of NSSI over time, and for this reason, a Systematic Review and Bayesian Meta-Analysis were conducted.

METHODS

Following the PRISMA guidelines, the longitudinal studies included in the systematic review consisted of 41 papers (Study 1 = 16; Study 2 = 25). Only studies with available data were included in the meta-analysis (Study 1 = 12; Study 2 = 11).

RESULTS

First, the findings highlight limits related to methodological aspects, the design of the studies, and the availability of data. Meta-analytic results shows that across development, the frequency (i.e., not the occurrence) of NSSI increases for the group of younger adolescents, remains stable in the group of middle adolescents, and it decreases for older adolescents.

LIMITATIONS

This study highlights some limitations that can be summarized in three different macro categories: the first refers to methodological aspects (e.g., the lifetime prevalence of NSSI), the second to the design of the studies (e.g., not homogeneous cohort; short-term covered), and the third to the availability of data.

CONCLUSIONS

The current meta-analysis tries to shed light on the longitudinal research on NSSI behavior and how this behavior develops in terms of both occurrence and frequency, providing practical and methodological indications for future research.

The relationship between depressive mood and non-suicidal self-injury among secondary vocational school students: the moderating role of borderline personality disorder tendencies

Background

Non-suicidal self-injury (NSSI) has become an important public health issue of global concern, often occurring in adolescents, and depressive mood is closely related to NSSI. In addition, NSSI is considered a symptom of borderline personality disorder. It has been found that adolescents in secondary vocational schools are more vulnerable to behavior and emotional disorders than those in general high schools. This study investigated the risk factors associated with NSSI affecting secondary vocational school students and analyzed the role of borderline personality disorder tendencies in promoting the occurrence of NSSI among students with depressive moods.

Methods

A total of 1,848 Chinese secondary vocational students completed a self-report questionnaire. The homemade NSSI behavior questionnaire, Patient Health Questionnaire-9 and Personality Diagnostic Questionnaire-4 were used in this survey. Binary logistic regression and PROCESS software analysis were used to explore the influencing factors associated with NSSI and to test for moderating effects.

Results

Female (OR = 3.412, 95% CI 2.301-5.060), drinking history (OR = 2.007, 95% CI 1.383-2.911), history of suicidal death exposure (OR = 3.161, 95% CI 1.999-4.999), depressive mood (OR = 2.436, 95% CI 1.668-3.558) and borderline personality disorder tendencies (OR = 2.558, 95% CI = 1.764-3.711) were independent risk factors for NSSI. Borderline personality disorder tendencies (B = 0.047, p = 0.000) moderated the relationship between depressive mood and NSSI. The stronger the borderline personality tendencies, the more NSSI behavior occurred when they were depressive.

Conclusions

Borderline personality disorder tendencies in secondary vocational school adolescents significantly enhance the association of depressive mood with NSSI. There is a moderating role for borderline personality disorder tendencies in depressive mood and NSSI.

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.

The Characteristics and Influencing Factors of Nonsuicidal Self-Injury of Adolescents With Depressive Disorder in China: A Meta-analysis

ABSTRACT

This study is a systematic review of characteristics and influencing factors of nonsuicidal self-injury behavior among adolescents with depressive disorder in China. PubMed, CNKI, WanFang Database, and VIP were searched for studies. Meta-analysis was performed using RevMan 5.1 software. Nineteen studies involving 707 subjects were included in the meta-analysis. Age, gender, only child or not, and residence were included in the analysis, of which age (I2 = 0%, p = 0.42) and residence (I2 = 0%, p = 0.84) were analyzed by fixed-effects model; gender (I2 = 75%, p = 0.003) and only child or not (I2 = 50%, p = 0.140) were analyzed by random-effects model. The evidence shows that, according to the common self-injury mode and location, the nonsuicidal self-injury behavior of young people with depressive disorder aged 15-18 years is paid attention to and guided, so as to achieve early detection and early diagnosis and treatment, and reduce the occurrence of serious harm.

An Integrative Model of In-Hospital and Out-of-Hospital Nursing Care for Non-Suicidal Self-Injury: A Narrative Review

Background: Non-suicidal self-injury (NSSI) refers to the intentional and repeated physical trauma of an individual without explicit suicidal intent, which has negative effects on the physical and mental well-being of an individual, especially for adolescents. Timely and accessible nursing care may play an important role in the survival and rehabilitation process of NSSI. Methods: In this review, we systematically discuss the nursing care of NSSI behavior and provide recommendations based on an integrated nursing model for NSSI management. Results: As reported in previous studies, a variety of factors can contribute to NSSI behavior, such as personality traits, current psychological status, history of mental illnesses, as well as family and social factors. In-hospital care is the most necessary and effective care during acute episodes of NSSI behavior. To effectively manage inpatients with NSSI behaviors, nurses should first understand the motivation of NSSI, and provide comprehensive and multi-level care through nurse-patient communication, individualized psychological care, and multidisciplinary cooperation with other professionals. While the purpose of out-of-hospital nursing is to reduce the frequency of NSSI behaviors by screening high-risk individuals, providing psychological support, promoting health education, and improving self-awareness. Conclusions: An integrative model of in-hospital and out-of-hospital nursing care can help improve the clinical management and long-term prognosis of patients with NSSI and minimize the risk of suicidal ideation or suicidal behavior.

Reciprocal associations between peer problems and non-suicidal self-injury throughout adolescence

BACKGROUND

Peer problems have emerged as important predictors of Non-Suicidal Self-Injury (NSSI) development during adolescence. However, the possibility that adolescents who engage in NSSI may, in turn, be at increased risk for experiencing difficulties with their peers has rarely been examined. This study investigated the reciprocal associations between peer problems (e.g. peer victimization, friendship stress and loneliness) and NSSI throughout adolescence, distinguishing between- and within-person effects.

METHOD

Participants were 866 adolescents (54.5% females; M_age  = 13.12 years, SD = 0.78), who took part in six waves of data collection. Adolescents completed self-report measures of NSSI, friendship stress and loneliness and they took part in a peer nomination procedure to assess peer victimization. Random Intercept Cross-Lagged Panel Models (RI-CLPMs) were used to estimate within-person cross-lagged effects between each peer problem and NSSI from Grade 7 to 12.

RESULTS

After accounting for between-person associations between peer problems and NSSI, results indicated that higher-than-usual levels of NSSI predicted higher-than-usual levels of adolescents' own friendship stress, loneliness and peer victimization at the subsequent time point. Yet, sensitivity analyses revealed that most of these effects were strongly attenuated and explained by within-person fluctuations in depressive symptoms. No within-person cross-lagged effects from peer problems to NSSI were found.

CONCLUSIONS

Findings highlight that the associations between peer problems (i.e. friendship stress, loneliness) and NSSI may be largely explained by shared underlying factors; yet, some evidence also suggests that NSSI engagement may increase adolescents' risk to experience difficulties in the relationships with their peers, in part via increases in depressive symptoms.

Smaller putamen volumes are associated with greater problems in external emotional regulation in depressed adolescents with nonsuicidal self-injury

The functions of nonsuicidal self-injury (NSSI) consist of social and emotional aspects (Social influence, Sensation seeking, Internal and External emotion regulation). Previous studies have indicated that dysfunction in reward-related brain structures especially the striatum might drive this habitual behavior. However, no studies to date have investigated the associations between striatum and different functions for adolescents engaging in NSSI behaviors. Here, we recruited 35 depressed adolescents with recent NSSI behaviors and 36 healthy controls and acquired structural brain images, depressive symptoms, social, academic and family environments assessments, in addition to NSSI functions in patients only. Subcortical volumes and cortical thickness were estimated with FreeSurfer. Mixed linear regressions were performed to examine associations between striatal structures (caudate, putamen, nucleus accumbens, pallidum) and NSSI functions, with age, sex, total intracranial volume, hemisphere and depression severity included as covariates. Effect of environmental factors and potential associations with cortical thickness and other subcortical volumes were also tested. We found that, among the four functions, external emotional regulation represented the main function for NSSI engagement. Increased external emotion regulation was significantly associated with smaller putamen volume. No environmental factors biased the association with putamen. No associations with other cortical or subcortical regions were observed. Our findings suggested that smaller putamen might be a biomarker of NSSI engagement for depressed adolescents when they regulated frustrated or angry emotions. The results have potentially clinical implications in early identification and brain intervention of NSSI in youth.

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].

Psycho-Behavioral Profiles of Pediatric Inpatients with Past and Recent Onset of Nonsuicidal Self-Injury: A Cluster Analysis Approach

Few studies have focused on the persistence of nonsuicidal self-injury (NSSI) over time in developmental age. This study aimed to define the psycho-behavioral profiles of young inpatients according to past or recent NSSI onset (i.e., NSSI for more or less than one year, respectively), and identify possible risk factors for maintaining NSSI over time. A total of 118 Italian NSSI inpatients aged 9–17 were involved. The Youth Self-Report (YSR) was administered. K-means cluster analyses were conducted using the YSR affective disorders, social competencies, and social problems scales as clustering variables. A binomial logistic regression was run to clarify which of these variables discriminate between the past and recent NSSI onset groups. Chi-square tests were performed to pinpoint the variables associated with long-standing NSSI. The final cluster solution displayed four psycho-behavioral profiles; a greater number of inpatients with recent NSSI onset was found in the clusters characterized by scarce social competencies. Affective disorders and social competencies were significant predictors, and higher scores on both scales were more likely in the past NSSI onset group. School problems and alcohol/substance use were related to long-standing NSSI. Therefore, a lack of social skills may be involved in recent NSSI onset, while affective disorders and other problem behaviors may dictate the continuation of NSSI over time.

Depressive symptoms mediate the association between maternal authoritarian parenting and non-suicidal self-injury among Chinese adolescents

BACKGROUND

Non-suicidal self-injury (NSSI) is a significant public health concern. Authoritarian parenting is a common parenting style in China. Authoritarian parenting is associated with NSSI in adolescents. Little is known about the mechanism underlying this association. This study was to investigate the mediating effect of depressive symptoms on the association between maternal authoritarian parenting and NSSI among Chinese adolescents.

METHODS

A total of 7072 adolescents who participated in the 1-year follow-up of Shandong Adolescent Behavior & Health Cohort (SABHC) were included for the analysis. A self-administered questionnaire was used to assess authoritarian parenting, depressive symptoms, non-suicidal self-injury, and family demographics in November-December in 2015. One year later, a follow-up survey was carried out to assess participants' depressive symptoms and NSSI.

RESULTS

Of the sample, mean age was 14.58 (SD = 1.46) and 3536 (50%) were female at baseline. 19.4% adolescents reported having ever NSSI over the past 12 months at baseline, and 8.8% reported having ever NSSI at 1-year follow-up. The association of maternal authoritarian parenting with subsequent NSSI was at least partially mediated by depressive symptoms. Mediation analyses showed that effect size was 0.194 in the entire sample, 0.192 in females and 0.193 in males, respectively.

LIMITATION

All variables were measured based on self-report.

CONCLUSIONS

Maternal authoritarian parenting style is a significant predictor of NSSI and its association with NSSI is partially mediated by depressive symptoms among Chinese adolescents. It may be important to intervene poor parenting styles and depression to reduce the risk of NSSI in Chinese adolescents.

Alexithymia and Psychopathological Manifestations Centered on the Body: Somatization and Self-Harm

The present study aimed to investigate alexithymia and psychopathological manifestations centered on the body in a sample of adolescents with somatizing and/or self-harming issues to analyze the phenomenon of NSSI linked to Somatic Symptom Disorders (SSD). A sample of 184 adolescents between 12 and 19 years of age, was divided into three groups, one with NSSI (n = 49) and the second group with SSD (n = 57), comparing them with a third group of adolescents with SSD and NSSI (n = 78) to investigate their differences and similarities in psychopathological correlates and to analyze the mediation role of alexithymia and emotional dysregulation in NSSI and SSD related to internalizing problems. The battery of tests included the Toronto Alexithymia Scale (TAS-20) and the Youth Self-Report 11–18 (YSR). The NSSI + SSD group scored higher than the other two groups on all the YSR scales. The affective syndromes were the only clinical condition that discriminated between the three groups. On all the other syndrome scales, the NSSI + SSD group differed from the other two groups, while there were no differences between the NSSI group and the SSD group. The NSSI + SSD group revealed a more severely deficient emotional self-regulation. Difficulty identifying feelings was a trait shared by adolescents with SSD and those engaging in NSSI, a more complex overall alexithymia profile was associated with the combination of self-harming behavior and somatization. Alexithymia and emotional dysregulation played a mediating role in the relationship between internalizing problems and somatization. We did not find a mediating role in alexithymia and emotional dysregulation in the relationship between internalizing problems and self-injurious behavior. The combination of NSSI and SSD gave rise to more severe psychopathological correlates, clinical levels of alexithymia, and more severe deficient emotional self-regulation. Results of mediation role indicated a link between alexithymia, emotional dysregulation, and somatization.

Prospective Pathways From Impulsivity to Non-Suicidal Self-Injury Among Youth

Non-suicidal self-injury (NSSI) is a common behavior, particularly among adolescents and young adults. Impulsivity has been implicated as an important factor associated with NSSI, however prospective longitudinal research is lacking. Moreover, the relationship between impulsivity and other risk factors for NSSI is unclear. By examining longitudinal models including impulsivity, attachment, and distress we hope to elucidate the nature of the association between impulsivity and NSSI. 1,686 community-recruited young people (ages 14-25) with no NSSI in the past year were followed up for one year, completing self-report measures of the above factors. Impulsivity independently predicted new onset of NSSI over and above other risk factors, indicating heightened impulsivity is a prospective risk factor for NSSI. Psychological distress mediated the parenting-NSSI association.

Risk factors for non-suicidal self-injury (NSSI) in adolescents: A meta-analysis

BACKGROUND

Non-suicidal self-injury (NSSI) in adolescents is a significant mental health problem around the world. Here, we performed a meta-analysis to systematically delineate the risk factors for NSSI.

METHOD

We searched Medline, Embase, Web of Science and Cochrane for relevant articles and abstracts published prior to 12 November 2021. Pooled odds ratios (ORs) and 95% confident intervals (CIs) were used to assess various risk factors, and publication bias was assessed by Egger's test, the trim and fill method and meta-regression. This study is registered with PROSPERO, CRD42021265885.

RESULTS

A total of 25 articles were eventually included in the analysis. Eighty risk factors were identified and classified into 7 categories: mental disorders (ORs, 1·89; 95% CI, 1·60-2·24), bullying (ORs, 1·98; 95% CI, 1·32-2·95), low health literacy (ORs, 2·20; 95% CI, 1·63-2·96), problem behaviours (ORs, 2·36; 95% CI, 2·00-2·77), adverse childhood experiences (ORs, 2·49; 95% CI, 1·85-3.34), physical symptoms (ORs, 2·85; 95% CI, 1·36-5·97) and the female gender (ORs, 2·89; 95% CI, 2·43-3·43). The range of heterogeneity (I²) was from 20·3% to 99·2%.

CONCLUSION

This meta-analysis found that mental disorders, low health literacy, adverse childhood experiences, bullying, problem behaviours, the female gender and physical symptoms appear to be risk factors for NSSI.

Non suicidal self injury and suicidal behavior among adolescents: co-occurrence and associated risk factors

BACKGROUND

Non-suicidal self-injury (NSSI) and suicidal behavior (SB) are the major public health problems in adolescents. Despite the increased focus on these phenomena, there exist no reliable data in Nepal. This study aimed to determine the prevalence of NSSI and SB among adolescents. Furthermore the study identified the relationship between these two behaviors and assessed demographic, behavioral, and psychological risk factors of NSSI and SB in Nepalese adolescents in a representative sample of the general population.

METHODS

The study was conducted among 730 adolescents studying in grade 9 to 12 of public and private schools of Pokhara Metropolitan city, Nepal. Data were collected through self administered standard tools- Functional Assessment of Self Mutilation (FASM) tool, Suicidal Behaviors Questionnaire-Revised (SBQ-R), Rosenberg self-esteem scale (RSES) and Beck Depression Inventory (BDI). Descriptive statistical measures such as frequency, percentage, mean, standard deviation, range were used to assess demographic characteristics and adolescent's behavior regarding NSSI and suicide. For inferential analysis chi-square and one way ANOVA test was used. Furthermore, to determine the predictors of NSSI and SB, multiple logistic regression analysis was used.

RESULTS

Regarding behavioral characteristics, nearly half of the sample 327 (44.8%) reported a history of NSSI in past 1 year. Furthermore, 25.8% (n = 188) of the overall sample engaged in minor NSSI only and 3.42% (n = 25) engaged in at least one act of moderate/severe NSSI. The mean number of type of NSSI performed was 2.63 ± 1.71. The most common type of NSSI method used were picking at wound (27.3%), biting self (20.3%), pulling hair out (11.8%), cutting self (11.1%). Boys (52.6%) were more likely to be engaged in NSSI than girls (47.4%) (χ²  =  10.298, p  =  0.002). Furthermore, among 730 adolescents who completed the SBQ-R questionnaire, 131 (17.9%) had suicidal behaviors (SB) (as defined by SBQ-R a total score ≥ 7). Regarding sex differences female were significantly higher in life time prevalence of suicidal behavior than male (χ² = 30.26, p = 0.001). Simple Chi-square tests indicated that NSSI was significantly associated with SB (χ² = 58.16, P < .001). Logistic regressions identified the four significant predictors of NSSI behavior: male, low-level of self-esteem (SE), moderate to severe form of depression and SB. Similarly, significant predictors of SB were: female, low-level of SE, moderate to severe form of depression and NSSI behavior.

CONCLUSION

The prevalence of both NSSI and SB is high in adolescents. Despite the differences between NSSI and SB a significant number of adolescents reported a history of both behaviors. Lower level of SE and moderate to severe depression were the significant predictors of both NSSI and SB. Furthermore, male and adolescents with the history of SB were at risk of NSSI behavior whereas female sex and adolescents with the history of NSSI were at risk of SB.

The subjective experience of non-suicidal self-injury among female Chinese university students

OBJECTIVE

The purpose of this study was to explore the subjective experience of non-suicidal self-injury (NSSI) among female Chinese university students in Hong Kong.

DESIGN

Interpretative phenomenological analysis was used.

METHODS

Seven female students participated in the study, two engaged in biting and scratching, and three in cutting.

RESULTS

The majority of them indicated negative attitudes towards NSSI and saw no particular meaning attached to it. However, they all persisted with their behaviours, which suggested that they were unable to stop. Students found themselves in a paradoxical situation whereby although they saw no real benefit of NSSI, they still engaged in it to cope with distress. Feelings characterised by this distress were about entrapment and issues with academia, intimacy, loneliness, insecurity, negative self-worth, regulating distressing emotions, increasing positive physical sensations, healing oneself, and feeling alive.

CONCLUSIONS

The experience of hurting themselves persistently for these female students symbolised their struggle with academic or relationship difficulties, self-acceptance, emotional regulation and survival without self-injury.

The relationship between non-suicidal self-injury, identity conflict, and risky behavior among Druze adolescents

OBJECTIVES

This study aimed to explore the prevalence of non-suicidal self-injury (NSSI) among Druze adolescents in Israel, an ethnic minority, and examine the influence of identity conflict, depression, and performance of risky behaviors on such adolescents' engagement in NSSI. This investigation is important because little is known about NSSI among adolescents from ethnic minorities.

METHODS

Overall, 290 Druze adolescents aged 16-18 (mean = 16.26, standard deviation = 0.9) years (63.9% female) participated in this study. They were recruited through snowball sampling from three Druze schools that agreed to participate in the study. All participants completed self-report measures for NSSI, depression, anxiety, engagement in risky behaviors, emotion regulation, sleep problems, and identity integration.

RESULTS

Almost 20% of the total sample engaged in NSSI. Those who engaged in NSSI reported more significant depression, anxiety, sleep problems, and engagement in risky behaviors when compared with those who did not engage in NSSI. Moreover, those who engaged in NSSI reported experiencing a higher level of identity conflict. Further analysis revealed an indirect effect of identity conflict on NSSI through engagement in risky behaviors.

CONCLUSIONS

This study's findings clarify the prevalence of NSSI among Druze adolescents, as well as contributing factors, and also highlights the importance of developing interventions that specifically target this unique ethnic group.

Non-suicidal Self-Injury Among Adolescents From Diverse Ethnocultural Groups in Israel: The Association With Sleep Problems and Internet Addiction

OBJECTIVES

Although Non-suicidal Self-Injury (NSSI) has received more attention in recent years, most of these studies focused on samples from North American and European countries; consequently, little is known about its patterns and frequency in other cultures as well as its relation to sleep problems and internet addiction. As one of the few studies that aim to fill this gap, the current study examined the prevalence, characteristics, and types of NSSI behaviors among adolescents from diverse ethnocultural groups.

METHODS

A sample of 642 adolescents, aged 12-18 years, were randomly recruited from different middle and high schools in Israel, employing a snowball sampling technique. The sample included the following: 50% Jews and 34.7% Muslims born in Israel, 9.7% immigrants from the former Soviet Union (FSU), and 4.4% immigrants from Ethiopia. The participants completed self-report questionnaires that assessed their NSSI, sleep problems, internet addictions, and depressive symptoms.

RESULTS

Almost one-third of the sample had engaged in NSSI, while 6% frequently injured themselves. More than half of the FSU immigrants and one-third of the Muslim participants indicated that they engaged in NSSI. These two population groups also exhibited severe depressive symptoms, sleep problems, and internet addictions. The most parsimonious correlations with NSSI included being male, an immigrant/Muslim minority who exhibited severe depressive symptoms and internet addictions.

CONCLUSIONS

These results emphasize the need for routine NSSI assessments to prevent long-term sequelae, including any forms of suicidal thoughts and behaviors and adult borderline personality disorder (BPD). Primary preventive programs that include adaptive coping skills may eliminate the social contagion effect of NSSI.

Non-Suicidal Self-Injury: An Observational Study in a Sample of Adolescents and Young Adults

Non-Suicidal Self-Injury (NSSI) is the self-inflicted destruction of body tissues without suicidal intent with a prevalence of 1.5% to 6.7% in the youth population. At present, it is not clear which emotional and behavioral components are specifically associated with it. Therefore, we studied NSSI in a clinical sample of youth using the Ottawa Self-injury Inventory and the Barratt Impulsiveness Scale 11. The Mann-Whitney test was used to compare the numerical responses provided to the tests. We found 54 patients with NSSI, with a mean age of 17 years. Scores were analyzed in the total sample and in four subgroups. In the total sample, Internal Emotion and External Emotion Regulation, Craving, Non-Planning and Total Impulsivity were significantly associated with NSSI. There were statistically significant differences in Craving between patients with multiple NSSI episodes, suicide attempts and multiple injury modes and patients of other corresponding subgroups, in Internal Emotion Regulation, Sensation Seeking and Motor Impulsivity between NSSI patients with suicide attempts and no suicide attempts, and in Cognitive Impulsivity between NSSI patients with multiple injury modes and one injury mode. It is necessary to carefully evaluate the components underlying NSSI in order to activate personalized treatment options.

Early maladaptive schemas in young people who self-injure

BACKGROUND

There is emerging evidence that early maladaptive schemas (EMS) may be a cognitive vulnerability factor in nonsuicidal self-injury (NSSI). The current study sought to examine the relationship between EMS and NSSI history, and whether this is moderated by gender, in a community youth sample.

METHOD

Participants were 403 Australian secondary and university students aged between 16 and 25 years, who completed a survey of NSSI history, EMS, and general emotional distress.

RESULTS

Logistic regression analysis indicated that being female, depression, and EMS scores were useful for differentiating between youth reporting NSSI history and those who did not. High levels of Defectiveness/Shame and Abandonment/Instability schema scores, and low levels of Emotional Inhibition schema scores, were associated with NSSI history. Gender did not moderate the relationships between these EMS scores and NSSI history.

CONCLUSIONS

Present results suggest that aspects of the schema domain of Disconnection and Rejection are important for identifying NSSI history beyond young people's emotional distress. This provides researchers and clinicians with an opportunity to better target key EMS, especially beliefs about self-defectiveness and feelings of shame, that may be driving the regulatory function of self-injury among youth.

Thoughts and beliefs about nonsuicidal self-injury: An application of social cognitive theory

According to Social Cognitive Theory, the anticipated consequences of a behavior (outcome expectancies), coupled with our belief in our ability to successfully perform the behavior (self-efficacy), determine the likelihood of engagement in a behavior. We explored whether the relationship between nonsuicidal self-injury outcome expectancies and self-injury was moderated by self-efficacy to resist nonsuicidal self-injury. Participants: Five hundred and sixteen college students aged 18-26 years (M = 20.60, SD = 1.86). Methods: Self-report measures were completed online. Results: The relationship between expecting self-injury would result in pain or emotion regulation and engaging in self-injury was moderated by a belief in the ability to resist self-injury. People who had never self-injured were more likely to believe that self-injury would cause physical pain and believe they could resist self-injury. A belief in the ability to resist self-injury countered expectations that self-injury would result in emotion regulation. Conclusion: Results may inform college-based prevention and intervention efforts.

Non-Suicidal Self-Injury Among Incarcerated Adolescents: Prevalence, Personality, and Psychiatric Comorbidity

Introduction: Incarcerated adolescents represent a risk group for non-suicidal self-injury (NSSI), but research on this population has been limited and no studies have been conducted in Russia. To address this deficit, this study examined NSSI and the factors associated with it among youth in a juvenile correctional facility in Russia. Methods: NSSI and psychopathology were assessed using a psychiatric interview and self-report questionnaire in 368 incarcerated male adolescents aged 14-19 years (mean age 16.4 years, S.D. 0.9) from Northern Russia. Results: 18.2% (N = 67) of the study participants had a history of NSSI and also had higher rates of anxiety, post-traumatic stress disorder (PTSD), depression, community violence exposure and scored higher on most of the Youth Self-Report problem scales. In addition, 31.3% of the NSSI group reported previous suicidal ideation and had thought about a specific suicide method compared to 12.0% in the No-NSSI group. Adolescents with NSSI also differed significantly from the No-NSSI group on self-directedness (lower) and self-transcendence (higher) personality traits. Conclusion: NSSI is common in incarcerated adolescents in Russia and is associated with extensive psychiatric comorbidity, suicidal ideation and specific personality traits.

Depression as a mediator between frequent nightmares and non-suicidal self-injury among adolescents: a 3-wave longitudinal model

BACKGROUND

Frequent nightmares and depression are associated with non-suicidal self-injury (NSSI) in adolescents. Little is known about the mediating role of depression in the nightmare-NSSI link. This study explores the longitudinal mediating effect of depression on the relationship between frequent nightmares and NSSI as well as the moderating effect of gender using a three-wave longitudinal design.

METHODS

Participants were adolescents from the Shandong Adolescent Behavior and Health Cohort who were surveyed at baseline, 1 year later, and 2 years later. A self-administered questionnaire was used to measure nightmare frequency, depression, and NSSI. Structural equation modeling and multiple-group analysis were used to test the mediating effect of depression and the moderating effect of gender. Covariates included demographics and earlier measures of depression and NSSI.

RESULTS

Among 6995 participants, 3399 (48.6%) were females, mean age was 14.86 (SD = 1.50) years at baseline. Frequent nightmares had a significant mediation effect on NSSI through depression (B_ab = 0.06, 95% CI = 0.02-0.10) after controlling for demographics and earlier measures of depression and NSSI. Gender had no significant moderating effect on the nightmare-NSSI association.

LIMITATIONS

All data were collected by self-report.

CONCLUSIONS

The association between frequent nightmares and NSSI in adolescents was partially mediated by depression. Frequent nightmares and depression should be assessed and treated to prevent self-harm in adolescents.

Automutilação em adolescentes: revisão integrativa da literatura

Resumo Trata-se de uma revisão integrativa da literatura acerca dos conhecimentos produzidos pela comunidade científica sobre automutilação em adolescentes no período de janeiro de 2012 a junho de 2017. A busca foi realizada nas bases de dados SCIELO e Portal CAPES, em português, inglês e espanhol com amostra final de 71 artigos. Este estudo mostrou grande número de publicações a nível internacional, com destaque para artigos epidemiológicos e fragilidade na publicação de estudos de intervenção que investiguem a eficácia de terapias e programas de prevenção.

Injuries in children and adolescents with psychiatric disorders

BACKGROUND

Unintentional injuries are a leading cause of morbidity and mortality in children of all ages. Prevention strategies require knowledge of risk factors, and behavior and psychiatric disorders have been suggested to influence the risk of injury during childhood. While externalizing disorders have been found to increase the risk for injuries, results are mixed regarding internalizing disorders, such as affective and anxiety conditions, and Autism Spectrum Disorders (ASD). There is a need for large scale studies relying on robust data sources. The aim of the present study was to examine the association between psychiatric disorders and injuries requiring medical attention, in a large population-based cohort of 350,000 children and adolescents in Sweden.

METHODS

Data were obtained from the regional health care database Vega. Psychiatric diagnoses and injury diagnoses obtained during 2014-2018 for individuals aged 0-17 years in 2016 were extracted. Descriptive statistics were used to examine differences in 5-year injury prevalence between children with and without different psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric diagnoses and injuries requiring medical attention.

RESULTS

The results show an increased risk for concurrent injuries in general, but the patterns vary by age and psychiatric disorder. Externalizing disorders and anxiety conditions were associated with concurrent injuries, while individuals with ASD had a lower risk for most injuries included. Affective disorders were associated with an increased risk for wounds, concussion, complications and poisoning, while the risk for fractures was decreased. Self-inflicted injury was more common in all psychiatric conditions investigated during adolescence, except for ASD. Children and adolescents with many types of psychiatric disorders were also at increased risk for a concurrent maltreatment diagnosis.

CONCLUSIONS

A general pattern of increased risk for concurrent injuries in children and adolescents with most psychiatric diagnoses was found, but the associations vary by age and type of psychiatric disorder. The results add to the literature on risk factors for injuries in children and adolescents, supporting diagnosis specific patterns. Several psychiatric diagnoses were associated with a marked increase in injury risk, indicating a high burden of disease for affected individuals.

Using the Body When There Are No Words for Feelings: Alexithymia and Somatization in Self-Harming Adolescents

The present case-control study aimed to investigate the relationship between alexithymia and somatic complaints in the psychopathological setting of non-suicidal self-injury (NSSI). A clinical sample of 134 adolescents (115 females; 85.5%) from 12 to 18 years old engaging in NSSI was compared with a control group of 243 high-school students (157 females; 64.6%) from 13 to 18 years old. Data were collected using two questionnaires: The Youth Self-Report 11-18 and the 20 Toronto Alexithymia Scale. In both cases and controls, the presence of somatization and alexithymia was associated with more severe psychopathological problems. Analyses were conducted to explore the association between somatic disorders and alexithymia. In the clinical group, somatic complaints were reported by 95.9% of alexithymic individuals, whereas only 44.3% of alexithymic adolescents reported somatic complaints. A one-way relationship emerged between somatization and alexithymia: while alexithymia would seem to be a factor associated with self-injury, somatic disorders were strongly associated with alexithymia, but not necessarily with self-injury. Among the self-harming adolescents, those with both alexithymia and somatization had a more severe psychopathological picture than the individuals with alexithymia but no somatization. This would suggest that, in the setting of NSSI, greater difficulty with identifying feelings is associated with somatization, and alexithymia would be an attribute common to self-harming behavior and somatization, both of which are characterized by the body being used to express psychological and emotional problems. Future research could further investigate alexithymia in self-harming individuals, in relation to any presence or absence of somatic disorders, with longitudinal assessments on any differences in their manifestation of self-injury and its psychopathological correlates.

Assessment tools of non-suicidal self-injury in adolescents 1990-2016: a systematic review

The purpose of this systematic review was to identify the instruments created or adapted to assess non-suicidal self-injury (NSSI) among adolescents. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) methodology was used. Two individual reviewers analyzed the psychometric properties of instruments published in English or Spanish from 1990 to 2016 considering standardized quality criteria. The PsycINFO, PubMed, ISI Web of Knowledge, Scopus, SciELO, ScienceDirect, and EBSCO databases were consulted. Eighteen studies that created or adapted 11 instruments were selected. Most were developed in the United States or Canada, and none were developed in Latin America. Several studies presented no evidence of the psychometric properties of their instruments. Seven of the 18 studies obtained at least one positive score. The Alexian Brothers Urge to Self-Injure Scale (ABUSI) and the Impulse, Self-harm, and Suicide Ideation Questionnaire for Adolescents (ISSIQ-A) obtained the highest positive scores. The limitation of this study is that only seven databases were employed for the literature search in English and Spanish. The reporting of the psychometric properties of NSSI instruments among adolescents should be improved, and adaptations to Latin American countries should be developed for international comparisons.

Nonsuicidal self-injury among adolescents in south-east Serbia

Background

Nonsuicidal self-injury (NSSI) refers to the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. The aim of this study was to explore the variety of self-injury behaviors as well as the function of NSSI among adolescents in South-East Serbia.

Methods

The study included 50 adolescents of both sexes, aged 13–18 years, who had deliberately engaged in self-injury at least once. A general socio-demographic questionnaire and the Inventory of Statements About Self-Injury (ISAS) were used in the study.

Results

The average age of the respondents was 15 (1.17); the most common NSSI methods were cutting (60%), followed by biting and severe scratching (14%); the average age of onset was 14.12 (0.77); the majority confirmed experiencing pain during self-injury (42%); the respondents more commonly performed NSSI when they were alone (68,0%); in 90% of the cases, the time elapsed between sensing the urge to self-injury and acting on it was less than 1 h; the majority of the respondents stated that they did not want to stop self-injuring (56%). In terms of the NSSI function, the obtained scores were the highest for affect regulation 3.36 (1.47), self-punishment 1.90 (1.39) and marking distress 1.72 (1.26). In terms of gender, there was a statistically significant difference for the antidissociation (P = .043), interpersonal influence (P = .004) and revenge (P = .019).

Conclusion

The results may have practical implications when it comes to taking preventive and therapeutic measures in the vulnerable adolescent population.

Non-suicidal Self-Injury in Clinical Practice

Background: Non-suicidal self-injury (NSSI) among adolescents is a major public health concern and a common problem in clinical practice. The aim of this study was to examine different aspects of NSSI in a high-risk adolescent sample in clinical practice in association with personality disorders, symptoms, and coping skills to enhance the understanding of NSSI and improve treatment interventions.

Methods: In a sample of 140 adolescent inpatients treated for personality disorders, assessments were performed pre-treatment and post-treatment using a questionnaire on NSSI developed for clinical practice, the Structured Clinical Interview for DSM personality disorders, the Symptom Check List 90, and the Cognitive Emotion Regulation Questionnaire.

Results: NSSI was common (66.4%) among the inpatient adolescents. Of those without NSSI behaviour (n = 47), 10 (21.3%) started NSSI during treatment. NSSI was related to number of personality disorders and not to one specific. Participants who experienced NSSI (n = 93) reported significantly more symptoms and the negative coping strategy self-blame. They scored lower on the positive coping strategies of refocusing and reappraisal.

Conclusion: NSSI in adolescent clinical practice is common, not exclusive to borderline personality disorder and could be contagious. Reducing self-blame and enhancing positive refocusing and positive reappraisal seem important treatment targets.

Nonsuicidal self-injury among adolescents and young adults with prolonged exposure to violence: The effect of post-traumatic stress symptoms

Less is known about nonsuicidal self-injury (NSSI) among adolescents and young adults living in areas under prolonged political violence. This study aims to explore the frequencies of NSSI as well as the severity of post-traumatic stress symptoms (PTSS), depression, anxiety, and sleep problems among 889 Palestinian adolescents and young adults. The participants completed self-report questionnaires assessing NSSI, PTSS, depression, anxiety symptoms, and sleep difficulties. The results found that 13.8% of the total sample are frequently engaging in some form of NSSI behavior. Moreover, 43.1% exhibited severe symptoms of PTSD, and almost one-third of the sample reported severe symptoms of depression (30.1%); more than two-thirds of the sample (68.4%) experience sleep difficulties. Those who engage in NSSI were found to be at higher risk for sleep problems, depression, and PTSS. Avoidance/numbing, as well as hyperarousal symptoms clusters of PTSS, were significantly associated with NSSI above and beyond depressive symptoms. These results suggest that NSSI is frequently a sequelae of prolonged exposure to trauma and violence, and highlight the importance of routine assessment of this behavior. It is crucial to be familiar with the association between PTSS, sleep difficulties, and NSSI in a clinical setting to implement programs focusing on preventing these domains.

A meta-analysis of the prevalence of different functions of non-suicidal self-injury

BACKGROUND

A broad variety of different functions can underlie acts of Non-suicidal self-injury (NSSI). Whilst research so far has identified many of the commonly reported functions, no reliable estimates of prevalence currently exist for these different NSSI functions. Understanding the prevalence of NSSI functions represents a key to better understanding the phenomenology of NSSI and addressing the differing needs of the NSSI population. We conducted a systematic review and meta-analysis of the prevalence of NSSI functions in community and clinical samples.

METHOD

A literature search of electronic databases PsycINFO, Medline, and Web of Science from date of inception to March 2017 was undertaken. A pre-specified framework for categorising different functions of NSSI was used to collate data from across studies. A random-effects meta-analysis of prevalence was then undertaken on these data.

RESULTS

Intrapersonal functions (66-81%), and especially those concerning emotion regulation were most commonly reported by individuals who engage in NSSI (63-78%). Interpersonal functions (e.g., expressing distress) were less common (33-56%).

LIMITATIONS

The review was limited to English-language articles. Reviewed articles were inconsistent in their measurement of NSSI. Inconsistency within pooled prevalence estimates was high when moderators were not accounted for.

CONCLUSIONS

Findings indicate that intrapersonal functions of NSSI are most common and are present for the majority of participants. This finding supports dominant emotion-regulation models of NSSI, and the use of interventions that work to improve emotion-regulation ability. However, interpersonal functions remain endorsed by a substantial portion of participants.

Thoughts, images, and appraisals associated with acting and not acting on the urge to self-injure

OBJECTIVES

The aim of this study was to examine the frequency, content, and appraisals of thoughts and images occurring during urges to engage in non-suicidal self-injury (NSSI).

METHOD

Undergraduates (N = 154) with a history of NSSI completed an online survey of their thoughts, images, and appraisals when they acted on urges to engage in NSSI as well as when they resisted urges to self-injure.

RESULTS

Most (>90%) participants reported experiencing both thoughts and images during urges to engage in NSSI. During urges that resulted in self-injury, self-critical and hopeless thoughts were most distressing, and thoughts about relief from emotional distress were most comforting. Images of the anticipated injury were most common. During urges that did not result in self-injury themes of the futility of NSSI, positive self-talk, and the impact on others were most common. Images were most frequently of the negative impact on self and others, and the anticipated injury. Appraisals encouraging NSSI occurred when individuals did and did not act on their urges, but concurrent strong discouraging appraisals appeared to be protective on occasions when urges did not result in self-injury.

LIMITATIONS

Retrospective self-report was used to assess cognitive content. Generalisability of findings to non-student samples needs to be assessed.

CONCLUSIONS

Findings from this study may inform comprehensive assessment of thoughts and images associated with urges to engage in NSSI. NSSI interventions may need to promote thoughts, imagery and appraisals that discourage NSSI whilst simultaneously modifying cognitions that encourage NSSI.

Association of Self-reported Impulsivity to Nonsuicidal Self-Injury, Suicidality, and Mortality in Adolescent Psychiatric Inpatients

This study examines the association of self-reported impulsivity to nonsuicidal self-injury, suicidal ideation, suicide attempts, and completed suicides in a clinical sample of 508 Finnish adolescents (aged 12-17) treated in psychiatric inpatient care between April 2001 and March 2006. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime interview was used to gather information on psychiatric disorders, impulsivity, and suicidality of the adolescents. Mortality data were obtained from the national cause of death register. In adolescent girls, impulsivity was significantly associated with suicidal ideation and attempts and completed suicides in adolescent boys. Of adolescent boys with impulsivity, 10.4% had died by suicide during the follow-up time. For preventive purposes, health care professionals are encouraged asked adolescents targeted questions about impulsivity and to consider the associated risk of suicidality identified in this study.

Impulsivity and self-harm in adolescence: a systematic review

Research supports an association between impulsivity and self-harm, yet inconsistencies in methodology across studies have complicated understanding of this relationship. This systematic review examines the association between impulsivity and self-harm in community-based adolescents aged 11-25 years and aims to integrate findings according to differing concepts and methods. Electronic searches of EMBASE, MEDLINE, PsychINFO, CINAHL, PubMed and The Cochrane Library, and manual searches of reference lists of relevant reviews identified 4496 articles published up to July 2015, of which 28 met inclusion criteria. Twenty-four of the studies reported an association between broadly specified impulsivity and self-harm. However, findings varied according to the conception and measurement of impulsivity and the precision with which self-harm behaviours were specified. Specifically, lifetime non-suicidal self-injury was most consistently associated with mood-based impulsivity-related traits. However, cognitive facets of impulsivity (relating to difficulties maintaining focus or acting without forethought) differentiated current self-harm from past self-harm. These facets also distinguished those with thoughts of self-harm (ideation) from those who acted on thoughts (enaction). The findings suggested that mood-based impulsivity is related to the initiation of self-harm, while cognitive facets of impulsivity are associated with the maintenance of self-harm. In addition, behavioural impulsivity is most relevant to self-harm under conditions of negative affect. Collectively, the findings indicate that distinct impulsivity facets confer unique risks across the life-course of self-harm. From a clinical perspective, the review suggests that interventions focusing on reducing rash reactivity to emotions or improving self-regulation and decision making may offer most benefit in supporting those who self-harm.

Biting myself so I don't bite the dust: prevalence and predictors of deliberate self-harm and suicide ideation in Azorean youths

Objective:

To characterize non-suicidal self-injury (NSSI) behaviors, methods, and functions as well as suicide ideation in the adolescent population of a Portuguese community in São Miguel Island, Azores. Increasing rates of NSSI behaviors among adolescents have been observed globally, while suicidal behavior has been pointed as a major cause of death during adolescence.

Methods:

A sample of 1,763 adolescents, aged 14 to 22, was randomly drawn from public and private schools and administered a set of self-report questionnaires. Descriptive and regression analyses were used to look for specific relationships and predictors of NSSI and suicide ideation in this isolated community.

Results:

Approximately 30% of youths reported at least one NSSI behavior, a rate that is twice as high as most studies carried out in mainland Portugal and in other European countries. Biting oneself was the most frequent form of NSSI, and NSSI behaviors served predominantly automatic reinforcement purposes (i.e., regulation of disruptive emotional states). NSSI and suicide ideation encompassed different distal and proximal risk factors.

Conclusions:

Exploring and characterizing these phenomena is necessary to provide a better understanding, enhance current conceptualizations, and guide the development of more effective prevention and intervention strategies in youths.

Psychological characteristics of self-harming behavior in Korean adolescents

Recently, self-injury is drawing the attention of researchers and clinicians. The purpose of this study was to investigate the prevalence and psychological characteristics of adolescents who engage in self-harm and to examine the risk factors for engaging in this harmful behavior among Korean mid-adolescents. Participants were 784 adolescents aged 13-15 years. They completed self-report questionnaires that assessed (1) Non-Suicidal Self-Injury: the Self-Harm Questionnaire, Toronto Alexithymia Scale; (2) depression: Children's Depression Inventory; (3) adolescent-parent relationship: Parental Bonding Instrument; (4) peer attachment: Inventory of Parent and Peer Attachment; and (5) academic stress. Overall, 12.4% (n=97) of participants reported engaging in self-destructive behavior at least once in their lives. The primary reason for engaging in self-harm was to regulate negative emotions such as anger and sadness. As expected, the self-harm group showed statistically significant higher levels of academic stress, alexithymia, depression, and poor relationships with their parents and peers. Stepwise multiple regression analysis showed that alexithymia, depression, and peer relations were significant predictors of self-harming behavior. Given that the primary reason for engaging in self-harm is to cope with negative emotions, mental health professionals in school settings should regularly evaluate self-injurious behavior and provide prevention programs for adolescents at risk.

Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a serious and prevalent problem within the adolescent population. NSSI is associated with a variety of psychiatric diagnoses and behavioral concerns. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, has recognized NSSI as its own separate diagnosis. Although there are unique differences between NSSI and suicidal behaviors, a link exists between these behaviors. It is crucial that pediatric nurse practitioners who provide care for adolescents possess a thorough understanding of NSSI. In this continuing education article, NSSI will be discussed in terms of epidemiology, diagnosis and co-morbidity, risk factors, relationship with suicidal behaviors, and implications for practice.

Risk-factor differences for nonsuicidal self-injury and suicide attempts in Mexican psychiatric patients

BACKGROUND

The present study compared sociodemographic characteristics, comorbidities with substance use, and impulsivity features in three groups of psychiatric patients - suicide attempters, nonsuicidal self-injury, and nonsuicidal without self-injury - to determine the predictive factors for nonsuicidal self-injury or suicide behavior.

PATIENTS AND METHODS

Demographic features and self-reported substance use were assessed in 384 Mexican psychiatric patients. Impulsivity features were evaluated using the Plutchik Impulsivity Scale. Comparison analyses between groups were performed and a logistic regression model used to determine the factors associated with nonsuicidal with self-injury behavior and suicidal behavior.

RESULTS

Different predictive factors were observed for nonsuicidal self-injury and suicidal behavior. Females were more likely to present nonsuicidal self-injury behaviors (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.18-0.93; P=0.03). For suicide attempters, the factors associated were younger age (OR 0.89, 95% CI 0.85-0.93; P<0.001), less than 6 years of schooling (OR 0.2, 95% CI 0.06-0.6; P=0.004), and higher impulsivity traits, such as self-control (OR 1.19, 95% CI 1.03-1.36; P=0.01), planning of future actions (OR 0.79, 95% CI 0.66-0.95; P=0.01), and physiological behavior (OR 1.34, 95% CI 1.01-1.78; P=0.03).

CONCLUSION

Our results show that in a Mexican population, impulsivity features are predictors for suicide attempts, but not for self-injury. Other factors related to sociocultural background and individual features (such as personality) may be involved in this behavioral distinction, and should be studied in future research aimed at better understanding of both self-harmful behaviors.

Alexithymia, impulsiveness, and psychopathology in nonsuicidal self-injured adolescents

INTRODUCTION

Nonsuicidal self-injury (NSSI) is a multifaceted phenomenon and a major health issue among adolescents. A better understanding of self-injury comorbidities is crucial to improve our ability to assess, treat, and prevent NSSI.

PURPOSE

This study aimed at analyzing some of the psychobehavioral correlates of NSSI: psychological problems, alexithymia, impulsiveness, and sociorelational aspects.

PATIENTS AND METHODS

This was a case-control study. The clinical sample (n=33) included adolescents attending our unit for NSSI and other issues; the controls (n=79) were high-school students. Data were collected using six questionnaires: Youth Self-Report, Barratt's Impulsiveness Scale, Toronto Alexithymia Scale, Children's Depression Inventory, Symptom Checklist-90-R, and Child Behavior Checklist.

RESULTS

Cases scored significantly higher in all questionnaires. Habitual self-injurers scored higher on impulsiveness and alexithymia. The gesture's repetition seems relevant to the global clinical picture: habitual self-injurers appear more likely to seek help from the sociosanitary services. We found a difference between the self-injurers' and their parents' awareness of the disorder.

CONCLUSION

Habitual self-injurers show signs of having difficulty with assessing the consequences of their actions (nonplanning impulsiveness) and the inability to manage their feelings. Given the significantly higher scores found for cases than for controls on all the psychopathological scales, NSSI can be seen as a cross-category psychiatric disorder, supporting the Diagnostic and Statistical Manual of Mental Disorders decision to include it as a pathological entity in its own right.

Examining Accumulated Emotional Traits in Suicide Blogs With an Emotion Topic Model

Suicide has been a major cause of death throughout the world. Recent studies have proved a reliable connection between the emotional traits and suicide. However, detection and prevention of suicide are mostly carried out in the clinical centers, which limit the effective treatments to a restricted group of people. To assist detecting suicide risks among the public, we propose a novel method by exploring the accumulated emotional information from people's daily writings (i.e., Blogs), and examining these emotional traits that are predictive of suicidal behaviors. A complex emotion topic model is employed to detect the underlying emotions and emotion-related topics in the Blog streams, based on eight basic emotion categories and five levels of emotion intensities. Since suicide is caused through an accumulative process, we propose three accumulative emotional traits, i.e., accumulation, covariance, and transition of the consecutive Blog emotions, and employ a generalized linear regression algorithm to examine the relationship between emotional traits and suicide risk. Our experiment results suggest that the emotion transition trait turns to be more discriminative of the suicide risk, and that the combination of three traits in linear regression would generate even more discriminative predictions. A classification of the suicide and nonsuicide Blog articles in our additional experiment verifies this result. Finally, we conduct a case study of the most commonly mentioned emotion-related topics in the suicidal Blogs, to further understand the association between emotions and thoughts for these authors.

Impulsivity and nonsuicidal self-injury: A review and meta-analysis

Nonsuicidal self-injury (NSSI; direct self-injury without lethal intent) often is thought to be associated with impulse control problems. Recent research, however, offers conflicting results about whether impulsivity is a risk factor for NSSI engagement. To disentangle findings on the link between impulsivity and NSSI, an extensive review of the literature was conducted using several electronic databases (i.e., PsychInfo, PsychArticles, ERIC, CINAHL, and MEDLINE). In total, 27 studies that met the specific inclusion criteria were identified. Results of a meta-analysis revealed that individuals who engaged in NSSI self-reported greater impulsivity than individuals who did not engage in NSSI, and that this effect was most consistent for measures of negative urgency. In contrast, there was little evidence of an association between lab-based measures of impulsivity (e.g., Go/No-Go, Stop/Signal Task) and NSSI. Moreover, the link between impulsivity and NSSI found for self-report measures was sometimes eliminated when other risk factors for NSSI were controlled (e.g., abuse, depression, post-traumatic stress disorder). In addition to integrating findings, the present review provides several explanations for the discrepancies in findings between studies employing self-report versus lab-based measures of impulsivity. To conclude, several specific recommendations for future research directions to extend the literature on impulsivity and NSSI are offered.