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Wu Y, Zhang Y, Wang C, Huang B. A meta-analysis on the lifetime and period prevalence of self-injury among adolescents with depression. Front Public Health 2024; 12:1434958. [PMID: 39145175 PMCID: PMC11322151 DOI: 10.3389/fpubh.2024.1434958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/18/2024] [Indexed: 08/16/2024] Open
Abstract
Background Adolescents are vulnerable to mental disorders due to physiological, psychosocial, and cognitive changes during this critical developmental stage. Depression, in particular, can lead to high-risk behaviors such as self-injury (SI) and suicide. This study aims to estimate the pooled prevalence of SI behaviors among adolescents with depression. Materials and methods We systematically searched databases including EMBASE, Scopus, PubMed, and Web of Sciences for relevant articles published on adolescents with depression from January 1, 2000, to January 1, 2024. The quality assessment of the studies was conducted using the Joanna Briggs Institute (JBI) criteria. The global prevalence of SI was calculated based on a random effects model using Stata software version 17. Results Our analysis included 29 studies involving 12,934 adolescents. The lifetime prevalence of SI was 52% (95% Confidence Interval [CI]: 41-64), while the period prevalence was 57% (95% CI: 49-64). Notably, a significant relationship was observed between the prevalence of SI and the year of publication of articles (p = 0.002). Furthermore, publication bias was not significant for both lifetime prevalence (p = 0.281) and period prevalence (0.358). Conclusion The prevalence of self-injurious behaviors in adolescents with depression is alarmingly high, with more than half of adolescents having engaged in these high-risk behaviors during their lifetime or within the last year. Given the associated risk of suicide, it is crucial to identify individuals at risk and provide timely interventions.
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Affiliation(s)
- Yanli Wu
- Emergency Department, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yanhong Zhang
- Nursing Department, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chengzhen Wang
- Emergency Department, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Beibei Huang
- Emergency Department, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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2
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Yang J, Zhao Y. Examining bidirectional relations between sleep problems and non-suicidal self-injury/suicidal behavior in adolescents: emotion regulation difficulties and externalizing problems as mediators. Eur Child Adolesc Psychiatry 2024; 33:2397-2411. [PMID: 38150149 DOI: 10.1007/s00787-023-02334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023]
Abstract
Based on previous empirical evidences and theoretical framework, sleep problems and non-suicidal self-injury (NSSI)/suicidal behavior may bidirectionally related to one another. However, this still needs to be examined through longitudinal research. Moreover, the mediating mechanisms accounting for their potential bidirectional relations have yet to be fully investigated. This study thus aimed to evaluate whether sleep problems and NSSI/suicidal behavior promoted each other directly or indirectly through the mediating roles of emotion regulation difficulties (ERD) and externalizing problems. A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82; Age range = 11-16 years old at T1) completed self-report measures on 3-time points across 1 year. Cross-lagged panel models were used to examine the focal longitudinal associations. Results revealed a predictive effect of sleep problems on NSSI and a positive bidirectional relation between sleep problems and suicidal behavior. Moreover, sleep problems exerted an indirect effect on NSSI through ERD, and vice versa. Additionally, both ERD and externalizing problems served as mediators in the pathway from suicidal behavior to sleep problems. This study disentangled the differential mediating roles of ERD and externalizing problems in the longitudinal associations between sleep problems and NSSI/suicidal behavior, which may help provide a more holistic theoretical framework through which to precisely identify key targets for early prevention and intervention of sleep problems and NSSI/suicidal behavior in adolescents.
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Affiliation(s)
- Jiaping Yang
- Department of Psychology, Guangzhou University, 230 Wai Huan Xi Rd, 510006, Guangzhou, China.
| | - Yinqiu Zhao
- School of Psychology, South China Normal University, 510631, Guangzhou, People's Republic of China
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3
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Curtis C. Interrupting the Self-Harm Continuum. CRISIS 2024; 45:210-216. [PMID: 38229543 DOI: 10.1027/0227-5910/a000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Background: Nonsuicidal self-injury (NSSI) has increased rapidly and is frequently linked to suicidal behavior; it has been argued that these behaviors are key points on a self-harm continuum. Aims: The current research explored self-harm and help-seeking behaviors, with the aim of identifying possibilities for prevention of further harm, including suicide. Methods: An online survey of 304 New Zealanders was undertaken, with the majority being aged under 25 and female. Results: Nearly half of the sample had engaged in self-harm and most of those had experienced suicidal thoughts; close to a quarter had made a suicide attempt. NSSI was used as a way of dealing with emotional distress. Very few sought help of any kind, especially professional support; of those who did seek professional support, most found it helpful but did not necessarily stop self-harming as a result. Limitations: Men are under-represented in the sample - though this is in accordance with the population of people who engage in NSSI. Conclusion: Many participants engaged in NSSI and also had suicidal thoughts using NSSI as an emotion regulation strategy; some participants appeared to use NSSI rather than attempting suicide. Given a link between NSSI and suicidal thoughts and behaviors, reluctance to seek help and on-going injurious behavior among some who do seek help, there is a need for increased identification and proactive support specifically focusing on improving emotion regulation and targeted at injurious behavior.
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Affiliation(s)
- Cate Curtis
- School of Psychology, University of Waikato, New Zealand
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4
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Evseev VD, Bokhan NA, Mandel AI, Kadochnikova SV. [Prevalence and risk factors of non-suicidal self-injury behavior]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:13-19. [PMID: 38465806 DOI: 10.17116/jnevro202412402113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The prevalence of non-suicidal self-injury (NSSI) behavior in adolescents has increased significantly in the early 21st century. The phenomenon of NSSI behavior has become one of the key health problems in the field of adolescent psychiatry and psychology over the past decade worldwide. However, the social characteristics and factors influencing NSSI are very different in different regions of the world. Studies of self-harming behavior indicate that the upward trend is almost equally relevant for developing and developed countries. To date, the methodological basis for the diagnosis of NSSI has not been sufficiently developed in the Russian Federation, there are only some studies of NSSI both from an empirical perspective and in the context of the search for risk factors, causes and functions, models of comorbidity with mental disorders.
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Affiliation(s)
- V D Evseev
- Mental Health Research Institute - Tomsk National Research Medical Center Russian Academy of Sciences, Tomsk, Russia
| | - N A Bokhan
- Mental Health Research Institute - Tomsk National Research Medical Center Russian Academy of Sciences, Tomsk, Russia
- Siberian State Medical University, Tomsk, Russia
| | - A I Mandel
- Mental Health Research Institute - Tomsk National Research Medical Center Russian Academy of Sciences, Tomsk, Russia
| | - S V Kadochnikova
- Siberian State Medical University, Tomsk, Russia
- Tomsk Clinical Psychiatric Hospital, Tomsk, Russia
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Dierickx S, Claes L, Buelens T, Smits D, Kiekens G. DSM-5 non-suicidal self-injury disorder in a community sample: comparing NSSI engagement, recency and severity among emerging adults. Front Psychiatry 2023; 14:1251514. [PMID: 38144473 PMCID: PMC10748385 DOI: 10.3389/fpsyt.2023.1251514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Up to one in five emerging adults engage in non-suicidal self-injury (NSSI). Providing a better understanding of factors that differentiate between who engages in lifetime NSSI and who is more likely to engage in recent and clinically severe NSSI can provide meaningful information for prevention and intervention of NSSI. The present study (n = 669) considered NSSI lifetime engagement (no prior history of NSSI vs. lifetime NSSI), recency [past NSSI (>12 months ago) vs. recent (≤12-month) NSSI], and clinical severity among those with recent NSSI (subthreshold vs. DSM-5 NSSI disorder). The prevalence of NSSI disorder was 8.4% in emerging adults aged 18 to 26 years old. Higher anxiety levels were related to NSSI engagement, but only depressive symptoms and NSSI versatility were consistently associated with more recent NSSI and NSSI disorder. A stepped-care approach may be required in addressing NSSI among emerging adults.
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Affiliation(s)
- Serafine Dierickx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Expertise Unit Resilient People, University Colleges Leuven-Limburg, Leuven, Belgium
| | - Laurence Claes
- Expertise Unit Resilient People, University Colleges Leuven-Limburg, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Tinne Buelens
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Dirk Smits
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Department, Odisee University of Applied Sciences, Brussel, Belgium
| | - Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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6
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Chen Y, Fu W, Ji S, Zhang W, Sun L, Yang T, He K, Zhou Y. Relationship between borderline personality features, emotion regulation, and non-suicidal self-injury in depressed adolescents: a cross-sectional study. BMC Psychiatry 2023; 23:293. [PMID: 37118709 PMCID: PMC10148398 DOI: 10.1186/s12888-023-04800-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is common among adolescents and has been linked to mental disorders and suicide in addition to physical injuries. According to the empirical avoidance model, adolescents with NSSI have stronger emotional affect and poorer emotional regulation than those without NSSI, and these constitute core features of borderline personality disorder (BPD). The relationship between borderline personality features, emotional regulation, and NSSI in the population is unclear. This study explored these associations to provide a theoretical basis for the treatment of NSSI in the future. METHODS Depressed adolescents (n = 1192) were evaluated using Chinese versions of the Function Assessment of Self-mutilation Scale, Emotional Regulation Questionnaire for Children and Adolescents, and Borderline Personality Features Scale for Children. RESULTS The majority of depressed adolescents (71.3%, 850/1192) had demonstrated NSSI in the past year, with cutting or scratching being the most common form (57.4%). Pearson correlation analysis with NSSI as a fixed factor (NSSI = 1, no NSSI = 2) revealed a negative correlation between NSSI and borderline personality features (r = -0.314, P < 0.01) but a positive correlation between NSSI and emotional regulation capacity (r = 0.159, P < 0.01), which was positively correlated with the expression suppression dimension (r = 0.079, p < 0.01); however, there was no significant correlation between the cognitive reappraisal dimension and expression suppression (r = 0.022, p > 0.05). The occurrence of NSSI was also positively correlated with borderline personality features in general (r = 0.314, p < 0.01). These results were statistically significant. Emotional regulation played a mediating role between borderline personality traits and NSSI in adolescents with depression (effect value = 0.151). CONCLUSION Borderline personality features and emotional regulation ability were significantly correlated with NSSI in depressed adolescents. Borderline personality symptoms not only directly influenced NSSI risk in adolescents with depression, but also indirectly influenced NSSI risk through emotional regulation.
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Affiliation(s)
- Yang Chen
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China
| | - Wenxian Fu
- Anhui Mental Health Center, Hefei, 230022, China
| | - Sifan Ji
- Anhui Mental Health Center, Hefei, 230022, China
| | - Wei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
| | - Lingmin Sun
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
| | - Tingting Yang
- Psychological counseling department, Hefei Fourth People's Hospital, Anhui, 230000, China
| | - Kongliang He
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China.
- Psychological counseling department, Hefei Fourth People's Hospital, Anhui, 230000, China.
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China.
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An Integrative Model of In-Hospital and Out-of-Hospital Nursing Care for Non-Suicidal Self-Injury: A Narrative Review. Brain Sci 2023; 13:brainsci13030466. [PMID: 36979278 PMCID: PMC10046685 DOI: 10.3390/brainsci13030466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
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.
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8
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Yao Z, Pang L, Xie J, Shi S, Ouyang M. The relationship between social anxiety and self-injury of junior high school students: Mediation by intolerance of uncertainty and moderation by self-esteem. Front Public Health 2023; 11:1046729. [PMID: 36969616 PMCID: PMC10034106 DOI: 10.3389/fpubh.2023.1046729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectiveThe problem of adolescents' self-injury has gradually attracted social attention, however, a lack of research exists on the internal mechanism between social anxiety and self-injury. This study explored the relationship between social anxiety and self-injury in Chinese junior high school students.MethodAn adolescent self-injury questionnaire, social anxiety scale, intolerance of uncertainty questionnaire and self-injury questionnaire were used to survey 614 junior high school students.ResultsThe results showed that: (1) social anxiety had a significant positive predictive effect on self-injury; (2) intolerance of uncertainty had a significant mediating effect between social anxiety and self-injury; and (3) self-esteem had a significant moderating effect on the mediating effect of intolerance of uncertainty.ConclusionThe study suggested that social anxiety in junior high school students has an impact on self-injury through mediation of intolerance of uncertainty and modulation of self-esteem.
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Affiliation(s)
- Zhendong Yao
- Normal College, Hunan University of Arts and Science, Changde, China
| | - Lu Pang
- School of Preschool Education, Hunan College for Preschool Education, Changde, China
| | - Jin Xie
- Mental Health Service Center, Huanghuai University, Zhumadian, China
| | - Seqin Shi
- No. 1 Middle School of Loudi, Loudi, China
| | - Min Ouyang
- Students Affairs Department, Xiangnan University, Chenzhou, China
- College of Educational Science and Law, Xiangnan University, Chenzhou, China
- *Correspondence: Min Ouyang
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9
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Medina-Mora ME, Genis-Mendoza AD, Villatoro Velázquez JA, Bustos-Gamiño M, Bautista CF, Camarena B, Martínez-Magaña JJ, Nicolini H. The Prevalence of Symptomatology and Risk Factors in Mental Health in Mexico: The 2016-17 ENCODAT Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3109. [PMID: 36833803 PMCID: PMC9961066 DOI: 10.3390/ijerph20043109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
There is little recent information about the prevalence of symptomatology of mental health disorders in representative population samples in Mexico. To determine the prevalence of mental health symptoms in Mexico and its comorbidity with tobacco, alcohol, and drug use disorder (SUD), we used the 2016-17 National Survey of Drug, Alcohol, and Tobacco Use (Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco, ENCODAT 2016-2017). The data were collected from households using a cross-sectional, stratified, multistage design, with a confidence level of 90% and a response rate of 73.6%. The final sample included 56,877 completed interviews of individuals aged 12-65, with a subsample of 13,130 who answered the section on mental health. Symptoms of mania and hypomania (7.9%), depression (6.4%), and post-traumatic stress (5.7%) were the three main problems reported. Of this subsample, 56.7% reported using a legal or illegal drug without SUD, 5.4% reported SUD at one time on alcohol, 0.8% on tobacco, and 1.3% on medical or illegal drugs, 15.9% reported symptoms related to mental health, and 2.9% comorbidity. The prevalence found is consistent with those reported in previous studies, except for an increase in post-traumatic stress, which is consistent with the country's increase in trauma.
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Affiliation(s)
- María Elena Medina-Mora
- Global Studies Seminar, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City 04510, Mexico
- Director, School of Psychology, National Autonomous University of Mexico (UNAM), Mexico City 04510, Mexico
- Centro de Investigación en Salud Mental Global INPRFM UNAM, Mexico City 04510, Mexico
| | - Alma Delia Genis-Mendoza
- Psychiatric and Neurodegenerative Disease Genomics Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City 14610, Mexico
- Juan N. Navarro Children’s Psychiatric Hospital, Psychiatric Care Services, Mexico City 14080, Mexico
| | - Jorge Ameth Villatoro Velázquez
- Global Studies Seminar, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City 04510, Mexico
- Data Analysis and Survey Unit, Ramón de la Fuente Muñiz National Institute of Psychiatry (INPRFM), Mexico City 14370, Mexico
| | - Marycarmen Bustos-Gamiño
- Data Analysis and Survey Unit, Ramón de la Fuente Muñiz National Institute of Psychiatry (INPRFM), Mexico City 14370, Mexico
| | - Clara Fleiz Bautista
- Global Studies Seminar, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City 04510, Mexico
- Data Analysis and Survey Unit, Ramón de la Fuente Muñiz National Institute of Psychiatry (INPRFM), Mexico City 14370, Mexico
| | - Beatriz Camarena
- Department of Pharmacogenetics, Ramón de la Fuente Muñiz National Institute of Psychiatry (INPRFM), Mexico City 14370, Mexico
| | - José Jaime Martínez-Magaña
- Psychiatric and Neurodegenerative Disease Genomics Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City 14610, Mexico
| | - Humberto Nicolini
- Psychiatric and Neurodegenerative Disease Genomics Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City 14610, Mexico
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Kiekens G, Hasking P, Bruffaerts R, Alonso J, Auerbach RP, Bantjes J, Benjet C, Boyes M, Chiu WT, Claes L, Cuijpers P, Ebert DD, Mak A, Mortier P, O’Neill S, Sampson NA, Stein DJ, Vilagut G, Nock MK, Kessler RC. Non-suicidal self-injury among first-year college students and its association with mental disorders: results from the World Mental Health International College Student (WMH-ICS) initiative. Psychol Med 2023; 53:875-886. [PMID: 34140062 PMCID: PMC8683565 DOI: 10.1017/s0033291721002245] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although non-suicidal self-injury (NSSI) is an issue of major concern to colleges worldwide, we lack detailed information about the epidemiology of NSSI among college students. The objectives of this study were to present the first cross-national data on the prevalence of NSSI and NSSI disorder among first-year college students and its association with mental disorders. METHODS Data come from a survey of the entering class in 24 colleges across nine countries participating in the World Mental Health International College Student (WMH-ICS) initiative assessed in web-based self-report surveys (20 842 first-year students). Using retrospective age-of-onset reports, we investigated time-ordered associations between NSSI and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) mood (major depressive and bipolar disorder), anxiety (generalized anxiety and panic disorder), and substance use disorders (alcohol and drug use disorder). RESULTS NSSI lifetime and 12-month prevalence were 17.7% and 8.4%. A positive screen of 12-month DSM-5 NSSI disorder was 2.3%. Of those with lifetime NSSI, 59.6% met the criteria for at least one mental disorder. Temporally primary lifetime mental disorders predicted subsequent onset of NSSI [median odds ratio (OR) 2.4], but these primary lifetime disorders did not consistently predict 12-month NSSI among respondents with lifetime NSSI. Conversely, even after controlling for pre-existing mental disorders, NSSI consistently predicted later onset of mental disorders (median OR 1.8) as well as 12-month persistence of mental disorders among students with a generalized anxiety disorder (OR 1.6) and bipolar disorder (OR 4.6). CONCLUSIONS NSSI is common among first-year college students and is a behavioral marker of various common mental disorders.
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Affiliation(s)
- Glenn Kiekens
- Center for Public Health Psychiatry, KU Leuven, Belgium
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Penelope Hasking
- School of Population Health, Curtin University, Perth, Australia
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, KU Leuven, Belgium
- Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
- Pompeu Fabra University, Barcelona, Spain
| | | | - Jason Bantjes
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences Stellenbosch University, South Africa
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Mark Boyes
- School of Population Health, Curtin University, Perth, Australia
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David D. Ebert
- Department for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University Munich, Germany
| | - Arthur Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Philippe Mortier
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Siobhan O’Neill
- School of Biomedical Sciences, Ulster University, Derry-Londonderry, Northern Ireland
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Gemma Vilagut
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Köllensperger E, Walter C, Germann G, Engel H, Reichenberger M. [Scars from Nonsuicidal Self-Injury - What Plastic Surgery Can Do]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 51:10-18. [PMID: 35023757 DOI: 10.1024/1422-4917/a000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Scars from Nonsuicidal Self-Injury - What Plastic Surgery Can Do Abstract. Objective: Nonsuicidal self-injury (NSSI) can induce characteristic scar patterns indicating the origin of these scars. This frequently results in the stigmatization of the involved patients with far-reaching consequences for their daily routine and quality of life. Despite patients being highly interested in scar correction, the potential of surgical therapy to alleviate NSSI-prone behavior and its help in destigmatizing surgical corrections and esthetic improvements in these situations are not well-known. Method: Over a period of 5 years, we analyzed 600 patients requesting NSSI scar treatment in our outpatient clinic. We collected data on the motivation for a scar correction, on the maturity of the scars, the involved body parts, and potential prior scar treatments as well as the amount, localization, and type of performed surgical procedures in our institution. Results: Stigmatization (57 %) and limitations in choice of clothing (18 %) were the most frequent reasons given for scar correction. We performed 358 dermabrasions and 55 serial excisions on these patients, nine combinations of both, and 13 other procedures. Conclusions: Plastic surgery offers multiple possibilities to reduce the stigmatization of patients with NSSI scars, who should thus be informed early about their choices.
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Affiliation(s)
- Eva Köllensperger
- ETHIANUM - Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin, Heidelberg, Deutschland
| | - Clara Walter
- ETHIANUM - Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin, Heidelberg, Deutschland
| | - Günter Germann
- ETHIANUM - Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin, Heidelberg, Deutschland
| | - Holger Engel
- ETHIANUM - Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin, Heidelberg, Deutschland
| | - Matthias Reichenberger
- ETHIANUM - Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin, Heidelberg, Deutschland
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Yu L, Zhao J, Zhao T, Xiao Y, Ou Q, He J, Luo J, Zhong Y, Cen Y, Luo W, Yang J, Deng Y, Zhang J, Luo J. Multicenter analysis on the non-suicidal self-injury behaviors and related influencing factors-A case study of left-behind children in northeastern Sichuan. J Affect Disord 2023; 320:161-168. [PMID: 36162662 DOI: 10.1016/j.jad.2022.09.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Few studies have been conducted focusing on the non-suicidal self-injury (NSSI) incidence rate and influencing factors among left-behind children in northeastern Sichuan, China. In this study, we investigated the incidence rate of the NSSI behaviors, levels of anxiety and depression in left-behind children in northeastern Sichuan, and relevant sociodemographic factors. METHODS The NSSI behaviors were identified using the Ottawa Self-injury Inventory (Chinese version). Its incidence rate and related influencing factors were evaluated by Cluster sampling; the Depression Anxiety Stress Scale-21 Items (DASS-21) was adopted to assess the levels of anxiety, depression, and stress. RESULTS A total of 9450 adolescents met the inclusion criteria, including 543 with NSSI behaviors, and the prevalence of NSSI was 5.7 %. There were 3596 left-behind children, and 243 of them had NSSI behaviors, the NSSI incidence in left-behind children was 6.8 %. There were 5854 non-left-behind children, and the NSSI incidence in non-left-behind children was 5.1 %. Left-behind children's NSSI behaviors were remarkably correlated with five risk factors: being female (OR = 2.411, 95%CI = 1.773-3.279), parents' divorce (OR = 1.742, 95%CI = 1.262-2.404), elder age (OR = 1.120, 95%CI = 1.028-1.219), severe depression (OR = 1.212, 95%CI = 1.148-1.281), and high anxiety (OR = 1.170, 95%CI = 1.093-1.251). LIMITATIONS This is a cross-sectional study, we cannot probe into the causality between NSSI behaviors and corresponding risk factors. Reporting and recalling biases may be unavoidable as questionnaires are performed by self-rating scales and retrospective reports. CONCLUSION The NSSI behaviors are common in left-behind children in northeastern Sichuan. This study proposes that prevention and intervention measures are necessary for the healthy growth of such children.
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Affiliation(s)
- Ling Yu
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; School of Psychiatry, North Sichuan Medical College, Nanchong, China; Department of Psychiatry, Nanchong Psychosomatic Hospital, Nanchong, China
| | - Jiayu Zhao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ting Zhao
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - Yun Xiao
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - Qin Ou
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - JinLong He
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - Jing Luo
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - Yunling Zhong
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - Yu Cen
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - Wenxiu Luo
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - JiaMing Yang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ya Deng
- Department of Basic Medicine, Dazhou Vocational College of Chinese Medicine, Dazhou, China
| | - Jiazhu Zhang
- Nanyang Centre for Public Administration, Nanyang Technological University, Singapore
| | - Jiaming Luo
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; School of Psychiatry, North Sichuan Medical College, Nanchong, China.
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Chartrand H, Tefft B, Sareen J, Hiebert-Murphy D, Katz LY, Klonsky ED, Wang Y, Kim H, Bolton JM. A Longitudinal Study of Correlates, Discharge Disposition, and Rate of Re-presentation to Emergency Services of Adults who Engage in Non-suicidal Self-injury. Arch Suicide Res 2022; 26:1141-1158. [PMID: 33306000 DOI: 10.1080/13811118.2020.1856259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In DSM-5, non-suicidal self-injury (NSSI) and suicide attempts (SA) are classified as distinct disorders in the section of conditions for further study. However, some have questioned the validity of distinguishing NSSI from SA. The objective of this study was to longitudinally examine the correlates, discharge disposition, and rate of re-presentation to emergency services of adults who engaged in NSSI and compare them to (a) adults who engage in SA and (b) adults with no self-harm or suicidal ideation (SI). METHOD Data came from 4,772 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Winnipeg, Canada between January 2009 and June 2012. Chart reviews were conducted for all presentations with NSSI (n = 158), and a sample of those with SA (n = 172) and no SH or SI (n = 173). RESULTS Among the adults who returned to emergency services, those who originally presented with SA re-presented significantly sooner than those who presented with NSSI. (χ2(1) = 7.457, p = 0.006). Those who originally presented with NSSI that returned to hospital did not return with repeat NSSI, but instead the majority re-presented with suicidal thoughts and SA. Further, those who re-presented with NSSI and SA were less likely to be hospitalized or to receive a referral to mental health services, and more likely to be discharged to usual care at time of initial presentation. CONCLUSIONS Overall, these findings indicate a trajectory of escalation of self-harm behavior for certain people who engage in NSSI, especially those who re-present to emergency services.HIGHLIGHTSA quarter of people with self-harm re-present to emergency services within four-and-a-half years.Those with suicide attempts re-presented significantly sooner than non-suicidal self-injury.There is a need for increased interventions in emergency services for those with self-harm.
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Liu J, Gao Y, Wang H, Liu X. Emotional Reactivity and Inhibitory Control in Nonsuicidal Self-Injury Adolescence: Divergence Between Positive and Negative Emotions. J Youth Adolesc 2022; 51:1720-1732. [PMID: 35523926 DOI: 10.1007/s10964-022-01618-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/11/2022] [Indexed: 12/01/2022]
Abstract
Nonsuicidal self-injury (NSSI) is prevalent in adolescents and is often linked to emotion dysregulation. However, it remains unknown which specific processes of emotion regulation and under what emotional context these processes are related to the risk for NSSI in samples of community-based adolescents. This study used two laboratory tasks to examine whether adolescents with a history of NSSI displayed difficulties in emotional reactivity and inhibitory control in response to negative and positive emotions. In Study 1, adolescents with/without a history of NSSI (N = 64; MAge = 13.45 ± 0.50; 53% female) completed a picture perception task in which they were asked to judge the valence and arousal of images. In Study 2, adolescents with/without a history of NSSI (N = 74; MAge = 13.49 ± 0.80; 50% female) were given a two-choice emotional oddball task that required them to differentially respond to frequent stimuli (images of an object) and infrequent stimuli (affective images). The results showed that adolescents with a history of NSSI showed decreased emotional sensitivity and lower levels of inhibitory control in response to images depicting negative emotional content but not to those depicting positive emotional content. Furthermore, affective inhibitory control problems were significantly positively related to the severity of NSSI, especially in the context of negative emotions. These findings suggest that there is a divergence between positive and negative emotions in both emotional reactivity and affective inhibitory control processes on NSSI. Specifically, relative to adolescents with no history of NSSI, adolescents with a history of NSSI showed lower emotional awareness and behavioral inhibitory control when processing negative emotions, but these distinctions were not found in contexts involving positive emotions. Additionally, the results suggest that affective inhibitory control deficits specific for negative emotions may result in vulnerability to increased NSSI severity.
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Affiliation(s)
- Jinmeng Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yemiao Gao
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Hui Wang
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xia Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China.
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Köllensperger E, Walter C, Germann G, Engel H, Reichenberger M. [Non-suicidal self-injurious Behaviour: Insights into a littleknown Patient Population in Plastic Surgery]. HANDCHIR MIKROCHIR P 2022; 54:112-118. [PMID: 35419781 DOI: 10.1055/a-1759-3068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Despite its high prevalence in adolescents and young adults, non-suicidal self-injury (NSSI) is poorly known and understood in areas other than psychiatry. Due to this lack of knowledge, affected patients often face a lack of understanding as well as rejection and discrimination when seeking help from medical professionals. This not only hampers a lasting improvement of NSSI and the development of a trustful physician-patient relationship but may also lead to traumatisation of affected patients. Based on our patients' data, this article aims to inform interested plastic surgeons about NSSI and thus to support the treatment of affected patients. PATIENTS AND METHODS 600 patients with scars from NSSI presenting to our outpatient clinic for the first time during the past five years were enrolled in this study. Extensive data collected during the first contact was analysed and compared with the current literature. RESULTS 95 % of the patients were female; 5 % were male. On average, patients presented 8.4 years after the last NSSI event and with a mean age of 26 years. NSSI scars were most often located on the left forearm (48 %), followed by both forearms (40 %), the left upper arm (20 %), both upper arms (15 %) and both thighs (14 %). In 57 % of patients, scars were only present on one side. A mean of 380 cm2 of the body surface was affected by NSSI scars. 47 % of patients reported having at least one additional diagnosis, with thyroid dysfunction and depression being the most common. 21 % of patients had ongoing psychiatric or psychological therapy at the time of their first consultation in our clinic. CONCLUSION Our data provides first insight into a large population of NSSI patients seeking treatment options for their NSSI-associated scars in a plastic surgery outpatient clinic. Most patients were female with scars located on their forearms. A mean of more than 8 years had passed between their last NSSI and their first presentation to our clinic. Our findings offer a data-based approach to a group of patients with a disease pattern that is largely misunderstood in surgical disciplines and needs more attention, especially in the light of its high prevalence and life-long consequences.
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Affiliation(s)
- Eva Köllensperger
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
| | - Clara Walter
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
| | - Günter Germann
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
| | - Holger Engel
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
| | - Matthias Reichenberger
- ETHIANUM Klinik für Plastische Chirurgie, Ästhetik und Rekonstruktion, Wirbelsäulenchirurgie, Handchirurgie, Orthopädie und Präventive Medizin
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Abstract
Co-occurrence of nonsuicidal self-injury (NSSI) and suicide attempts (SA) might occur because they share common risk factors, or alternatively because one leads to the other. Using search terms salient to NSSI and SA, we screened 555 studies to identify 17 that presented temporal data about NSSI and SA. Much of the evidence indicates that NSSI predates SA, especially among females and individuals with depressive symptoms, or diagnosed with borderline personality disorder or mood disorders. However, in some studies, associated risk factors likely accounted for the effect. Greater NSSI frequency to a threshold increases risk for later SA. Findings suggest that the behaviors have common predisposing factors, but that there is also a potent gateway effect whereby NSSI precedes SA.
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Wang X, Huang X, Huang X, Zhao W. Parents' lived experience of adolescents' repeated non-suicidal self-injury in China: a qualitative study. BMC Psychiatry 2022; 22:70. [PMID: 35090423 PMCID: PMC8796418 DOI: 10.1186/s12888-022-03715-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/11/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The prevalence of non-suicidal self-injury (NSSI) is high among adolescents. Parents have significant impact on the development of NSSI. Many quantitative studies have demonstrated the relationship between parental factors such as parenting behaviors and adolescents' NSSI. However, few studies have explored parents' responses and adolescent-parent reciprocal interaction during repeated NSSI. This study aimed to explore parents' cognition, behaviors and adolescent-parent reciprocal interaction during repeated NSSI. METHODS This is a phenomenological study. By purposive sampling, 24 parents of adolescents with repeated NSSI were recruited from a child and adolescent psychiatric ward in a mental health center in Chengdu, China. Semi-structured interviews were conducted and audio-recorded. Audio-recordings were transcribed verbatim and analyzed using thematic analysis. FINDINGS Three themes were identified: parents' attribution, perceptions and coping behaviors of NSSI. Chronic stress of adolescents and triggers of NSSI were associated with parental expectations. Parents initially perceived NSSI as a manifestation of puberty, a way of making needs met or a coping strategy of negative emotions, and gradually realized that it was a condition requiring psychological assistance. Parents' coping behaviors of NSSI were divided into 4 stages, namely denial, dissuasion, reflection and adaptation, and working as a team. To be more specific, parents' coping strategies at dissuasion stage included criticizing and conciliating, while those at reflection and adaptation stage included neglecting, avoiding conflicts and increasing control. CONCLUSIONS These findings suggest that adjusting parents' expectation and negative perceptions of NSSI is beneficial to reduce adolescent-parent conflict and adolescents' inner conflict and prevent NSSI. Furthermore, it's necessary to publicize NSSI related knowledge to promote the early detection and treatment of NSSI.
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Affiliation(s)
- Xu Wang
- grid.13291.380000 0001 0807 1581Mental Health Center of West China Hospital, Sichuan University, No. 28 South Dianxin Street, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581West China School of Nursing, Sichuan University, Chengdu, China
| | - Xuehua Huang
- Mental Health Center of West China Hospital, Sichuan University, No. 28 South Dianxin Street, Chengdu, 610041, China.
| | - Xia Huang
- grid.13291.380000 0001 0807 1581Mental Health Center of West China Hospital, Sichuan University, No. 28 South Dianxin Street, Chengdu, 610041 China
| | - Wenting Zhao
- grid.13291.380000 0001 0807 1581West China School of Nursing, Sichuan University, Chengdu, China
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Cayubit RFO, Dimaculangan DMH, Lim SMG, Sanchez GMJB, Pazcoguin JMA, Reyes MES. Social networking and depressive symptom: Predictors of non-suicidal self-injury among adolescents. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02541-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ye Z, Xiong F, Li W. A meta-analysis of co-occurrence of non-suicidal self-injury and suicide attempt: Implications for clinical intervention and future diagnosis. Front Psychiatry 2022; 13:976217. [PMID: 36032240 PMCID: PMC9411747 DOI: 10.3389/fpsyt.2022.976217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and suicide attempt (SA) are risk behaviors that lead to physical injury and even death in individuals, and are a very powerful risk factor when both occur together, with individuals presenting with more severe psychological and behavioral problems. Due to the different demographic characteristics of different study subjects, an overall understanding of the incidence and occurrence of this co-occurrence is lacking to clarify the focus of clinical interventions and future research directions. METHODS A systematic search was conducted for relevant studies in English and Chinese that reported data on co-occurring non-suicidal self-injury and suicide attempts as of May 2022. The incidence of co-occurrence of non-suicidal self-injury and suicide attempt (NSSI + SA) was calculated using Stata version 16.0 software based on a random-effects model, and the differences in incidence in different populations were compared by subgroups of age group, comorbidity, and time of occurrence. The study was written in strict accordance with PRISMA norms and registration was completed on the PROSPERO platform (CRD42022329095). RESULTS A total of 37 studies (139,573 individuals) were included for meta-analysis, and the combined incidence of non-suicidal self-injury and suicide attempt co-occurrence was 9.6%. Among different groups, the prevalence of NSSI + SA was 10, 11, 6, and 26% in adolescents and young adults, adults, the general population, and people with mental illness, respectively, and the co-occurrence of NSSI + SA within 12 months was 17%. CONCLUSION There is a significant group with a history of both non-suicidal self-injury and suicide attempts and presenting with more severe symptoms clinically. Targeted prevention and intervention are urgently needed, but the direction of intervention needs further research on the occurrence trajectory of this co-occurrence. SYSTEMATIC REVIEW REGISTRATION http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42022329095, identifier: CRD42022329095.
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Affiliation(s)
- Zhiyu Ye
- School of Education Research, China University of Geosciences, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Fang Xiong
- School of Education Research, China University of Geosciences, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Wentian Li
- Wuhan Mental Health Centre, Wuhan, China
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Nonsuicidal Self-Injury on Instagram: Examining Hashtag Trends. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2021. [DOI: 10.1007/s10447-021-09451-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Uncovering the Mystery of Non-Suicidal Self-Injury Among Selected Filipino Adolescents: A Grounded Theory Approach. PSYCHOLOGICAL STUDIES 2021. [DOI: 10.1007/s12646-021-00619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wang L, Liu J, Yang Y, Zou H. Prevalence and risk factors for non-suicidal self-injury among patients with depression or bipolar disorder in China. BMC Psychiatry 2021; 21:389. [PMID: 34348675 PMCID: PMC8335871 DOI: 10.1186/s12888-021-03392-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 07/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUNDS Non-suicidal self-injury is a serious health problem among patients with depression or bipolar disorder. However, few studies within the Chinese context have investigated the prevalence of NSSI and its risk factors in above populations. The purpose of this study was to investigate the prevalence of non-suicidal self-injury and its risk factors in patients with depression or bipolar disorder in China. METHODS The final sample comprised of 394 inpatients(Mage = 29.71; SDage = 11.95) with depression or bipolar disorder from two psychiatric hospitals in Beijing, China. A General Demographic Data Form, the Non-suicidal Self-injury Questionnaire(NSSI-Q), Impulsivity Item and the Adverse Childhood Experiences-International Questionnaire(ACE-IQ) were completed by all patients. RESULTS Of the 394 patients examined, 245(62.2%) of this sample reported NSSI in past year. Of the 245 patients with NSSI, 135(55.1%) were diagnosed with depression and 110(44.9%) were diagnosed with bipolar disorder. The most common methods of NSSI for female was "pinching"(23.1%) and "scratching"(22.8%), while for male it was "hiting hard objects"(12.7%). By multivariate regression analysis, young age, unemployment, a higher monthly family income, single, impulsivity, long duration of illness and ACEs were risk factors for NSSI in patients with depression and bipolar disorder(P<0.05). CONCLUSIONS Our study points to the fact that there was an unfortunate message about the prevalence of NSSI among patients with depression or bipolar disorder in China. It is necessary not only to raise the awareness of NSSI in families and society, but also to formulate targeted assessment and intervention. Moreover, future research should not only focus on individuals being hospitalized, but should be representative of individuals treated at home or in the community because there are no national statistics on NSSI among such patients in China.
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Affiliation(s)
- Lu Wang
- grid.186775.a0000 0000 9490 772XSchool of Nursing, Anhui Medical University, No.69 Mei Shan Road, Shu Shan District, Hefei, 230031 Anhui Province China
| | - Jun Liu
- Department of Nursing, Beijing An Ding Hospital, 5 Ankang Lane, Xicheng District, Beijing, 100088 China
| | - Yuan Yang
- Department of Nursing, Beijing An Ding Hospital, 5 Ankang Lane, Xicheng District, Beijing, 100088 China
| | - Haiou Zou
- School of Nursing, Peking Union Medical College, Badachu Road, Shijingshan District, Beijing, 100144, China.
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Costa RPDO, Peixoto ALRP, Lucas CCA, Falcão DN, Farias JTDS, Viana LFP, Pereira MADA, Sandes MLB, Lopes TB, Mousinho KC, Trindade-Filho EM. Profile of non-suicidal self-injury in adolescents: interface with impulsiveness and loneliness. J Pediatr (Rio J) 2021; 97:184-190. [PMID: 32151605 PMCID: PMC9432040 DOI: 10.1016/j.jped.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 12/20/2019] [Accepted: 01/12/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Comprehend the profile and prevalence of non-suicidal self-injury (NSSI) in adolescents and its association with impulsiveness and loneliness. METHODS Cross-sectional study carried out in 2017 in Maceió-Alagoas, Northeast Brazil, in the households of 505 adolescents aged 12-17 years, using a sample stratified and randomized by gender and neighborhood. The following instruments were used: a sociodemographic questionnaire, Brazilian version of Functional Assessment of Self-Mutilation (FASM), the Brazilian Barratt Impulsiveness Scale (BIS-11), and the Brazilian Loneliness Scale (UCLA-BR). RESULTS A prevalence of 6.53% was found for non-suicidal self-injury disorder (DSM-5). Significant differences ( p ≤ 0.05) were observed regarding: the most frequently used forms of NSSI were the items "cut oneself" and "scratch oneself"; engaging in three or more different forms of self-injurious behavior (66.67%) and, reporting as reasons, "to relieve feelings of emptiness or indifference" and "to stop bad feelings/sensations." Significance was also related to the sociodemographic profile: 72.73% were females and 63.54% had family income below one minimum wage. Individuals with self-injurious behavior also had higher impulsiveness and loneliness scores (p ≤ 0.05). CONCLUSIONS The study identified a direct association between NSSI and impulsiveness and loneliness among adolescents, being more prevalent in females and in young individuals with socioeconomic vulnerability. The data provide support for improving public health policies, aimed at education, prevention, and treatment of adolescents with NSSI.
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Robinson K, Garisch JA, Wilson MS. Nonsuicidal self-injury thoughts and behavioural characteristics: Associations with suicidal thoughts and behaviours among community adolescents. J Affect Disord 2021; 282:1247-1254. [PMID: 33601703 DOI: 10.1016/j.jad.2020.12.201] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/15/2020] [Accepted: 12/31/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND We consider whether nonsuicidal self-injury (NSSI) thoughts - in the absence of any NSSI behaviour - are associated with suicidal thoughts and behaviours among adolescents, before examining whether characteristics of NSSI behaviour are associated with greater suicidal thoughts and behaviours. METHODS Adolescents (n = 2,057, M age =15.56) recruited from secondary schools reported their lifetime history of NSSI, suicidal thoughts and behaviours, NSSI characteristics, and NSSI functions. Receiver Operating Characteristic analysis test whether NSSI status and characteristics of NSSI behaviour are diagnostic of clinically elevated suicidal thoughts and behaviours (a score of 7 or higher on the Suicide Behaviours Questionnaire-Revised). Regression models test whether NSSI functions predict greater suicidality. RESULTS Adolescents with NSSI thoughts and those with NSSI behaviour were more likely to report lifetime suicidal ideation and past-year suicide plan(s) than adolescents with no history of NSSI. In addition, adolescents with a history of NSSI were more likely to report a lifetime history of suicide attempt(s) as well as past-year suicide attempt(s) than adolescents with no history of NSSI. A greater number of NSSI methods, requiring medical assistance for NSSI injuries, and engaging in NSSI for self-punishment, anti-suicide, and sensation-seeking functions were associated with greater severity of suicidal thoughts and behaviours. LIMITATIONS Data are cross-sectional, limiting inferences about causality. CONCLUSIONS Findings emphasize the importance of NSSI thoughts and characteristics of NSSI behaviour in understanding the complex relationship between NSSI and suicidal thoughts and behaviours among adolescents.
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Affiliation(s)
- Kealagh Robinson
- School of Psychology, Victoria University of Wellington, New Zealand
| | - Jessica A Garisch
- School of Psychology, Victoria University of Wellington, New Zealand; Child and Adolescent Mental Health Service, Capital and Coast District Health Board, New Zealand
| | - Marc S Wilson
- School of Psychology, Victoria University of Wellington, New Zealand
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Voss C, Hoyer J, Venz J, Pieper L, Beesdo-Baum K. Non-suicidal self-injury and its co-occurrence with suicidal behavior: An epidemiological-study among adolescents and young adults. Acta Psychiatr Scand 2020; 142:496-508. [PMID: 32979220 DOI: 10.1111/acps.13237] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/13/2020] [Accepted: 09/17/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) comprising thoughts and behaviors is common and often co-occurring with suicidal behavior like ideation, plan, and attempt. As limited data are available for adolescents and young adults, this study aims to present prevalence estimates for lifetime NSSI, its co-occurrence with suicidal behavior, conditional probabilities and their association with socio-demographic characteristics, severity characteristics of suicidal behavior, and health service utilization. METHOD The epidemiological Behavior and Mind Health (BeMIND) study assessed in 2015/16 a random-community sample of N = 1180 aged 14-21 years from Dresden, Germany, regarding lifetime NSSI via self-administered questionnaire and suicidal behaviors via standardized interview. RESULTS Any lifetime NSSI was reported by 19.3% (thoughts: 18.0%, behaviors: 13.6%) of the sample with higher prevalence in females (OR = 2.7, 95% CI 1.9-3.8, P < 0.001). Lifetime prevalence of co-occurring NSSI and suicidal behavior was 7.7%. Females had a 3.3- to 8.8-fold odds of co-occurrence than males. Among those with any NSSI, 39.6% endorsed suicidal behavior, and 66.3% of those with any suicidal behavior reported NSSI. 42.3% of those with any NSSI reported to have used mental healthcare services at any time during their life with higher rates in those with co-occurring suicidal behavior (62.3%). CONCLUSION Non-suicidal self-injury and co-occurring suicidal behavior is common in adolescents and young adults-especially females. The limited utilization of mental healthcare services underpins the need for improving recognition of NSSI and suicidal behavior as well as the accessibility of mental healthcare services during adolescence and emerging adulthood.
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Affiliation(s)
- C Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Hoyer
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J Venz
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - L Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - K Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
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26
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Marin S, Hajizadeh M, Sahebihagh MH, Nemati H, Ataeiasl M, Anbarlouei M, Pashapour H, Mahmoodi M, Mohammadpoorasl A. Epidemiology and Determinants of Self-Injury Among High School Students in Iran: a Longitudinal Study. Psychiatr Q 2020; 91:1407-1413. [PMID: 32418140 DOI: 10.1007/s11126-020-09764-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Non-suicidal self-injury (NSSI) among adolescents is a major health concern globally. The epidemiology and determinant of NSSI have not been studied extensively in Iran. Thus, this longitudinal study sought to investigate the prevalence, incidence and contributing factors of NSSI among adolescents in Iran. This study was conducted at high school students aged 14-18 years old in the metropolitan city of Tabriz, located in north western Iran. Data were collected from 6229 10th-grade students at two time-points, with 12 months interval in October and November 2017 and 2018. A self-administered questionnaire was used to collect information on demographic, NSSI and cigarette and hookah smoking from the study participants. The results showed that lifetime prevalence of NSSI among students was 6.2% (95% confidence interval [CI]: 5.7 to 6.9) at the first assessment. Scratching and hair pulling were the most and least common methods of self-injury, respectively. Over the one year, 206 students (3.6% CI 95%: 3.1-4.1) reported the onset of NSSI. Tobacco smoking and previous year average grade were related to the incidence of NSSI. Although gender was significantly associated with the prevalence of NSSI, the relationship between gender and incidence of NSSI was not significant. Although the prevalence of NSSI was low among adolescents, the incidence rate was considerable. Further studies are required to understand the risk factors of NSSI in Iran.
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Affiliation(s)
- Soudabeh Marin
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Mohammad Hassan Sahebihagh
- Tabriz Health Services Management Research Center, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Nemati
- Department of Community Health Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Ataeiasl
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Anbarlouei
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Pashapour
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahbobeh Mahmoodi
- Department of Community Health Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asghar Mohammadpoorasl
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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27
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Gonzalez-Blanks A, Bridgewater JM, Yates TM. Statistical Approaches for Highly Skewed Data: Evaluating Relations between Maltreatment and Young Adults' Non-Suicidal Self-injury. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 49:147-161. [PMID: 32077745 DOI: 10.1080/15374416.2020.1724543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Clinical phenomena often feature skewed distributions with an overabundance of zeros. Unfortunately, empirical methods for dealing with this violation of distributional assumptions underlying regression are typically discussed in statistical journals with limited translation to applied researchers. Therefore, this investigation compared statistical approaches for addressing highly skewed data as applied to the evaluation of relations between child maltreatment and non-suicidal self-injury (NSSI). Method: College students (N = 2,651; 64.2% female; 85.2% nonwhite) completed the Child Abuse and Trauma Scale and the Functional Assessment of Self-Mutilation. Statistical models were applied to cross-sectional data to provide illustrative comparisons across predictions to a) raw, highly skewed NSSI outcomes, b) natural log, square-root, and inverse NSSI transformations to reduce skew, c) zero-inflated Poisson (ZIP) and negative-binomial zero-inflated (NBZI) regression models to account for both disproportionate zeros and skewness in the NSSI data, and d) the skew-t distribution to model NSSI skewness. Results: Child maltreatment was significantly and positively related to NSSI frequency in the raw, transformation, and zero-inflated models, but this relation was negative in the skew-t model. Conclusions: These findings highlight the importance of using zero-inflated models rather than transformation approaches to address data skew. Moreover, whereas the skew-t distribution has been used to model skewed non-clinical data, this study suggests that the skew-t approach may not be well-suited to address skewed clinical data.
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Affiliation(s)
| | | | - Tuppett M Yates
- Department of Psychology, University of California, Riverside
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28
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Buelens T, Luyckx K, Kiekens G, Gandhi A, Muehlenkamp JJ, Claes L. Investigating the DSM-5 criteria for non-suicidal self-injury disorder in a community sample of adolescents. J Affect Disord 2020; 260:314-322. [PMID: 31521868 DOI: 10.1016/j.jad.2019.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/11/2019] [Accepted: 09/01/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a serious public health concern in adolescents. In 2013, DSM-5 recognized NSSI as a distinct clinical phenomenon and made a call for more systematic research by including Non-Suicidal Self-Injury-Disorder (NSSI-D) as a condition requiring further research. Yet, few studies have examined the prevalence of NSSI-D in adolescents using the exact DSM-5 criteria. Additionally, the few studies available criticised several of the proposed diagnostic criteria and pointed out that more research is needed. METHODS Therefore, we examined prevalence rates of NSSI-D and investigated the four most controversial criteria (i.e., criteria A, B/C, and E) in a large community sample of adolescents (N = 2,130; 54% female; Mage = 15, SD = 1.81). RESULTS Our results show an overall NSSI-D prevalence rate of 7.6%, with significantly more girls (11.7%) than boys (2.9%) meeting the diagnosis. The prevalence of NSSI-D dropped to 5.5% when an alternative criterion A (i.e., ≥10 days of NSSI in the past year) was implemented. In our sample, 87% and 99% of adolescents with lifetime NSSI met criteria B and C, which clearly questions the clinical utility of these criteria for the DSM-5 diagnosis of NSSI-D. Importantly, however, although criterion E received relatively low endorsement, it significantly distinguished adolescents with and without NSSI-D from one another. LIMITATIONS AND CONCLUSION Although our conclusions are restricted by the cross-sectional nature of our study, these findings show that NSSI-D is common in community adolescents and offer new insights in the endorsement and clinical utility of specific NSSI-D criteria.
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Affiliation(s)
- Tinne Buelens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium.
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Glenn Kiekens
- Centre for Public Health Psychiatry, KU Leuven, Leuven, Belgium
| | - Amarendra Gandhi
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium
| | | | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium; Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
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29
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Zetterqvist M, Perini I, Mayo LM, Gustafsson PA. Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index. Front Psychiatry 2020; 11:8. [PMID: 32116833 PMCID: PMC7034359 DOI: 10.3389/fpsyt.2020.00008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study, especially in adolescent and clinical populations where it is particularly prevalent and studies are limited. Twenty-nine clinical self-injuring adolescents were included in the study. The Clinical Assessment of Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess prevalence of NSSID. The NSSID diagnosis criteria were met by 62.1% of adolescents. The impairment or distress criterion was least often met. Criteria B and C (assessing reasons for NSSI and cognitions/emotions prior to NSSI) were confirmed by 96-100% of all participants. Adolescents with NSSI in this clinical sample had several comorbidities and high levels of psychopathology. NSSID occurred both in combination with and independently of borderline personality disorder traits as well as suicide plans and attempts. Those with NSSID had a significantly higher cutting frequency than those not meeting full NSSID criteria. Other NSSI characteristics, comorbidity, psychopathology, and trauma experiences did not differ between groups. CANDI was a feasible tool to assess NSSID in adolescents. It is important to use structured measures to assess the validity of the NSSID diagnosis across development in both community and clinical samples. The clinical utility of the NSSID diagnosis is discussed.
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Affiliation(s)
- Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - Irene Perini
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Leah M Mayo
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per A Gustafsson
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
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30
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Lim KS, Wong CH, McIntyre RS, Wang J, Zhang Z, Tran BX, Tan W, Ho CS, Ho RC. Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4581. [PMID: 31752375 PMCID: PMC6888476 DOI: 10.3390/ijerph16224581] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/03/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This meta-analysis aimed to estimate the global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents. METHODS A systematic search for relevant articles published between 1989 to 2018 was performed in multiple electronic databases. The aggregate 12-month and lifetime prevalence of suicidal behavior, deliberate self-harm, and non-suicidal self-injury were calculated based on the random-effects model. Subgroup analyses were performed to compare the prevalence according to school attendance and geographical regions. Results: A total of 686,672 children and adolescents were included. The aggregate lifetime and 12-month prevalence of suicide attempts was 6% (95% CI: 4.7-7.7%) and 4.5% (95% CI: 3.4-5.9%) respectively. The aggregate lifetime and 12-month prevalence of suicidal plan was 9.9% (95% CI: 5.5-17%) and 7.5% (95% CI: 4.5-12.1%) respectively. The aggregate lifetime and 12-month prevalence of suicidal ideation was 18% (95% CI: 14.2-22.7%) and 14.2% (95% CI: 11.6-17.3%) respectively. The aggregate lifetime and 12-month prevalence of non-suicidal self-injury was 22.1% (95% CI: 16.9-28.4%) and 19.5% (95% CI: 13.3-27.6%) respectively. The aggregate lifetime and 12-month prevalence of deliberate self-harm was 13.7% (95% CI: 11.0-17.0%) and 14.2% (95% CI: 10.1-19.5%) respectively. Subgroup analyses showed that full-time school attendance, non-Western countries, low and middle-income countries, and geographical locations might contribute to the higher aggregate prevalence of suicidal behaviors, deliberate self-harm, and non-suicidal self-injury. Conclusions: This meta-analysis found that non-suicidal self-injury, suicidal ideation, and deliberate self-harm were the three most common suicidal and self-harm behaviors in children and adolescents.
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Affiliation(s)
- Kim-San Lim
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (K.-S.L.); (R.C.H.)
| | - Celine H. Wong
- Division of Child and Adolescent Psychiatry, Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore;
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 1R8, Canada;
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Jiayun Wang
- Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China;
| | - Zhisong Zhang
- Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China;
| | - Bach X. Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Vietnam Young Physicians’ Association, Hanoi 100000, Vietnam
| | - Wanqiu Tan
- The China-Singapore (Chongqing) Demonstration Initiative on Strategic Connectivity Think Tank, Chongqing 400043, China;
| | - Cyrus S. Ho
- Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore;
| | - Roger C. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (K.-S.L.); (R.C.H.)
- Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China;
- Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119228, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam
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31
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Chávez-Flores YV, Hidalgo-Rasmussen CA, Yanez-Peñúñuri LY. Assessment tools of non-suicidal self-injury in adolescents 1990-2016: a systematic review. CIENCIA & SAUDE COLETIVA 2019; 24:2871-2882. [PMID: 31389535 DOI: 10.1590/1413-81232018248.18502017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Yolanda Viridiana Chávez-Flores
- Escuela de Ciencias de la Salud Valle de las Palmas, Universidad Autónoma de Baja California. Calzada Universidad 14418, Parque Industrial Internacional. 22427 Tijuana B.C. México.
| | - Carlos Alejandro Hidalgo-Rasmussen
- Centro de Investigación en Riesgos y Calidad de Vida, Departamento de Promoción, Preservación y Desarrollo de la Salud, Universidad de Guadalajara. Centro de Estudios Avanzados, Universidad de Playa Ancha. Cd. Guzman Jalisco Mexico
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32
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Williams KA, Lee EJ. Challenges of conducting qualitative research of non-suicidal self-injury in South Korea: An international nursing research collaboration. Arch Psychiatr Nurs 2019; 33:358-363. [PMID: 31280780 DOI: 10.1016/j.apnu.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/21/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
Abstract
Understanding non-suicidal self-injury in foreign countries considering their cultural context requires collaboration among international researchers. Through an international collaborative approach, gaps in cultural views can be closed, thereby increasing the understanding of non-suicidal self-injury at a global level. The aim of this article was to illustrate the methodological and ethical challenges of an international collaboration that occurred during a qualitative study with South Korean young adults and the corresponding strategies that were implemented. It is hoped that the dissemination of these strategies and lessons learned can assist other researchers as they pursue international collaborative research.
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Affiliation(s)
- Kimberly A Williams
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, South Korea.
| | - Eun Jin Lee
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, South Korea.
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33
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Solís-Bravo MA, Flores-Rodríguez Y, Tapia-Guillen LG, Gatica-Hernández A, Guzmán-Reséndiz M, Salinas-Torres LA, Vargas-Rizo TL, Albores-Gallo L. Are Tattoos an Indicator of Severity of Non-Suicidal Self-Injury Behavior in Adolescents? Psychiatry Investig 2019; 16:504-512. [PMID: 31352732 PMCID: PMC6664213 DOI: 10.30773/pi.2019.03.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/17/2018] [Accepted: 03/06/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare adolescents with non-suicidal self-injury behavior and tattoos [NSSI (T+)] with another group with non-suicidal self-injury behavior without tattoos [NSSI (T-)]. METHODS Adolescents (n=438) 42.6% males from the community (M=12.3, SD=1.3), completed the Self-Injury Schedule. RESULTS The lifetime prevalence of tattoos performed with the purpose to feel pain was 1.8%. Compared to the NSSI (T-) group, the NSSI (T+) group was significantly more likely to meet the DSM-5 frequency criteria of 5 self-injury events in 1 year, practice more than one method of self-injury, and topography, more suicidal intentionality, more negative thoughts and affective emotions before, during, and after self-injury and more academic and social dysfunction. CONCLUSION Adolescents from the community who practice tattooing to feel pain, show a distinct phenotype of NSSI. Health professionals and pediatricians should assess tattooing characteristics such as intention (to feel pain), frequency, and presence of non-suicidal self-injury behavior and suicide intentionality.
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Affiliation(s)
- Marco Antonio Solís-Bravo
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Clinical and Community Epidemiology in Child and Adolescent Psychiatry, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Yassel Flores-Rodríguez
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Hospital Psiquiátrico “Dr. Samuel Ramírez Moreno”, Mexico State, Mexico
| | - Liliana Guadalupe Tapia-Guillen
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Clinical and Community Epidemiology in Child and Adolescent Psychiatry, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Aymara Gatica-Hernández
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Instituto Nacional de Psiquiatría “Dr. Ramón de la Fuente Muñiz”, Mexico City, Mexico
| | - Miriam Guzmán-Reséndiz
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Hospital General “Dr. Ruben Leñero”, Mexico City, Mexico
| | - Luis Alberto Salinas-Torres
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- CECOSAM Cuauhtémoc, Mexico City, Mexico
| | | | - Lilia Albores-Gallo
- Hospital Psiquiátrico Infantil “Dr. Juan N. Navarro”, Mexico City, Mexico
- Clinical and Community Epidemiology in Child and Adolescent Psychiatry, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
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Favril L. Non-suicidal self-injury and co-occurring suicide attempt in male prisoners. Psychiatry Res 2019; 276:196-202. [PMID: 31102884 DOI: 10.1016/j.psychres.2019.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/29/2022]
Abstract
High rates of non-suicidal self-injury (NSSI) and suicide attempts (SA) are well documented in prisoners, however, few studies examined their co-occurrence in this high-risk population. Study participants were 1203 adult men randomly selected from 15 Belgian prisons, representing 12% of the national male prison population. Lifetime prevalence rates for NSSI and SA are 17% and 20% respectively, with half (55%) of self-injurers reporting a SA history. Bivariate analyses show that NSSI and SA are significantly related to one another, and many risk factors are common to both. Multivariate analysis comparing prisoners who engaged in NSSI with (n = 109) and without (n = 90) co-occurring SA indicates that suicidal ideation is the strongest independent correlate of SA among self-injurers. Additionally, relative to those with a history of NSSI only, prisoners with co-occurring NSSI and SA are significantly more likely to be violent offenders, being prescribed psychotropic medication, and report a psychiatric diagnosis; suggesting that they constitute a more clinically severe subgroup. Collectively, these findings highlight the marked overlap between NSSI and SA in prisoners, both in terms of prevalence and correlates, with suicidal ideation being an important predictor of suicide risk among self-injurers.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium.
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35
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Kiekens G, Hasking P, Boyes M, Claes L, Mortier P, Auerbach RP, Cuijpers P, Demyttenaere K, Green JG, Kessler RC, Myin-Germeys I, Nock MK, Bruffaerts R. The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors. J Affect Disord 2018; 239:171-179. [PMID: 30014957 DOI: 10.1016/j.jad.2018.06.033] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/23/2018] [Accepted: 06/12/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Theoretical and empirical literature suggests that non-suicidal self-injury (NSSI) is an important correlate of suicide risk. The present study was designed to evaluate: (a) whether NSSI is associated with increased odds of subsequent onsets of suicidal thoughts and behaviors (STB) independent of common mental disorders, (b) whether NSSI is associated with increased risk of transitioning from suicide ideation to attempt, and (c) which NSSI characteristics are associated with STB after NSSI. METHOD Using discrete-time survival models, based on retrospective age of onset reports from college students (n = 6,393, 56.8% female), we examined associations of temporally prior NSSI with subsequent STB (i.e., suicide ideation, plan, and attempt) controlling mental disorders (i.e., MDD, Broad Mania, GAD, Panic Disorder, and risk for Alcohol Dependence). NSSI characteristics associated with subsequent STB were examined using logistic regressions. RESULTS NSSI was associated with increased odds of subsequent suicide ideation (OR = 2.8), plan (OR = 3.0), and attempt (OR = 5.5) in models that controlled for the distribution of mental disorders. Further analyses revealed that NSSI was associated with increased risk of transitioning to a plan among those with ideation, as well as attempt among those with a plan (ORs = 1.7-2.1). Several NSSI characteristics (e.g., automatic positive reinforcement, earlier onset NSSI) were associated with increased odds of experiencing STB. LIMITATIONS Surveys relied on self-report, and thus, there is the potential for recall bias. CONCLUSIONS This study provides support for the conceptualization of NSSI as a risk factor for STB. Investigation of the underlying pathways accounting for these time-ordered associations is an important avenue for future research.
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Affiliation(s)
- G Kiekens
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium; School of Psychology, Curtin University, Perth, Australia.
| | - P Hasking
- School of Psychology, Curtin University, Perth, Australia
| | - M Boyes
- School of Psychology, Curtin University, Perth, Australia
| | - L Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - P Mortier
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium
| | - R P Auerbach
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - K Demyttenaere
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium
| | - J G Green
- School of Education, Boston University, Boston, MA, USA
| | - R C Kessler
- Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, MA, USA
| | - I Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - M K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - R Bruffaerts
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium; Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, USA
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Kiekens G, Hasking P, Claes L, Mortier P, Auerbach RP, Boyes M, Cuijpers P, Demyttenaere K, Green JG, Kessler RC, Nock MK, Bruffaerts R. The DSM-5 nonsuicidal self-injury disorder among incoming college students: Prevalence and associations with 12-month mental disorders and suicidal thoughts and behaviors. Depress Anxiety 2018; 35:629-637. [PMID: 29697881 DOI: 10.1002/da.22754] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/19/2018] [Accepted: 03/08/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Approximately one in five college students report a history of nonsuicidal self-injury. However, it is unclear how many students meet criteria for the recently proposed DSM-5 nonsuicidal self-injury disorder (NSSI-D). In this study, we used full NSSI-D criteria to identify those students most in need of clinical care. METHODS Using data from the Leuven College Surveys (n = 4,565), we examined the 12-month prevalence of DSM-5 NSSI-D in a large and representative sample of incoming college students. We also explored the optimal frequency threshold as a function of interference in functioning due to NSSI, and examined comorbidity patterns with other 12-month mental disorders (i.e., major depressive disorder, broad mania, generalized anxiety disorder, panic disorder, and alcohol dependence) and suicidal thoughts and behaviors (STB). RESULTS Twelve-month NSSI-D prevalence was 0.8% and more common among females (1.1%) than males (0.4%). The proposed 5+ diagnostic threshold was confirmed as yielding highest discrimination between threshold and subthreshold cases in terms of distress or disability due to NSSI. A dose-response relationship was observed for NSSI recency-severity (i.e., 12-month NSSI-D, subthreshold 12-month NSSI-D, past NSSI, no history of NSSI) with number of 12-month mental disorders and STB. NSSI-D occurred without comorbid disorders for one in five individuals, and remained associated with severe role impairment when controlling for the number of comorbid disorders. CONCLUSIONS These findings offer preliminary evidence that DSM-5 NSSI-D is uncommon among incoming college students, but may help to improve the deployment of targeted resource allocation to those most in need of services. More work examining the validity of NSSI-D is required.
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Affiliation(s)
- Glenn Kiekens
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.,School of Psychology, Curtin University, Perth, Australia
| | | | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | | | - Randy P Auerbach
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mark Boyes
- School of Psychology, Curtin University, Perth, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Ronald C Kessler
- Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.,Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, USA
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