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Ashworth E, Thompson J, Saini P. "It's like an epidemic, we don't know what to do": The perceived need for and benefits of a suicide prevention programme in UK schools. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2024; 94:824-838. [PMID: 38514453 DOI: 10.1111/bjep.12683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Despite emerging evidence for the effectiveness of school-based suicide prevention programmes worldwide, there are few being implemented in the United Kingdom, and their social validity (i.e., the feasibility, acceptability, and utility) is not yet known. AIMS We aimed to conduct a scoping study to determine: (1) the social validity and potential benefits of school-based suicide prevention interventions, (2) the perceived need for such interventions, and (3) barriers and facilitators to implementation. SAMPLE AND METHODS A total of 46 participants took part. Semi-structured interviews were conducted with mental health professionals (N = 8), school staff (N = 8), and parents whose children had experienced suicidal ideation/behaviours (N = 3) in England. Focus groups were also completed with children and young people (N = 27) aged 15-18 across three state secondary schools. Data were analysed using thematic framework analysis. RESULTS Three themes were identified: (1) the need for and importance of suicide prevention in children and young people, (2) schools as a setting for delivery, and (3) key components of suicide prevention programmes. CONCLUSIONS Participants overwhelmingly agreed that there is a need for a greater and more consistent emphasis on school-based suicide prevention. School appears to be an acceptable location for suicide prevention, and participants felt discussions about suicide should begin at the start of secondary school. However, there are potential barriers that need to be considered, including tailoring for neurodiversity, challenging cultural/family beliefs and stigma, managing personal experiences of suicidal thoughts or previous bereavement from suicide, and a lack of existing training for school staff.
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Affiliation(s)
- Emma Ashworth
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Joniece Thompson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Pooja Saini
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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Sun T, Liu J, Wang H, Yang BX, Liu Z, Liu J, Wan Z, Li Y, Xie X, Li X, Gong X, Cai Z. Risk Prediction Model for Non-Suicidal Self-Injury in Chinese Adolescents with Major Depressive Disorder Based on Machine Learning. Neuropsychiatr Dis Treat 2024; 20:1539-1551. [PMID: 39139655 PMCID: PMC11319100 DOI: 10.2147/ndt.s460021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024] Open
Abstract
Background Non-suicidal self-injury (NSSI) is a significant social issue, especially among adolescents with major depressive disorder (MDD). This study aimed to construct a risk prediction model using machine learning (ML) algorithms, such as XGBoost and random forest, to identify interventions for healthcare professionals working with adolescents with MDD. Methods This study investigated 488 adolescents with MDD. Adolescents was randomly divided into 75% training set and 25% test set to testify the predictive value of risk prediction model. The prediction model was constructed using XGBoost and random forest algorithms. We evaluated the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, recall, F Score of the two models for comparing the performance of the two models. Results There were 161 (33.00%) participants having NSSI. Compared without NSSI, there were statistically significant differences in gender (P=0.035), age (P=0.036), depressive symptoms (P=0.042), sleep quality (P=0.030), dysfunctional attitudes (P=0.048), childhood trauma (P=0.046), interpersonal problems (P=0.047), psychoticism (P) (P=0.049), neuroticism (N) (P=0.044), punishing and Severe (F2) (P=0.045) and Overly-intervening and Protecting (M2) (P=0.047) with NSSI. The AUC values for random forest and XGBoost were 0.780 and 0.807, respectively. The top five most important risk predictors identified by both machine learning methods were dysfunctional attitude, childhood trauma, depressive symptoms, F2 and M2. Conclusion The study demonstrates the suitability of prediction models for predicting NSSI behavior in Chinese adolescents with MDD based on ML. This model improves the assessment of NSSI in adolescents with MDD by health care professionals working. This provides a foundation for focused prevention and interventions by health care professionals working with these adolescents.
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Affiliation(s)
- Ting Sun
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Health Science Center, Yangtze University, Jingzhou, People’s Republic of China
| | - Jingfang Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Hui Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Bing Xiang Yang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- School of Nursing, Wuhan University, Wuhan, People’s Republic of China
- Population and Health Research Center, Wuhan University, Wuhan, People’s Republic of China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Jie Liu
- Anesthesiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Zhiying Wan
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Yinglin Li
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Xiangying Xie
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Xiaofen Li
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Xuan Gong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Zhongxiang Cai
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
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Ashworth E, McCarthy M, Wynne S, Robinson J, McKay S, Lane S, Richardson G, Boardman N, Henderson K, Crosbie V, Humphrey N, York S, Michail M, Hart D, Clacy D, Jalota M, Saini P. Study protocol for the Multimodal Approach to Preventing Suicide in Schools (MAPSS) project: A regionally based feasibility trial of an integrated response to suicide risk among UK secondary school pupils. PLoS One 2024; 19:e0302873. [PMID: 39058694 PMCID: PMC11280149 DOI: 10.1371/journal.pone.0302873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/30/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Suicide is the leading cause of death of children and young people under 35 in the UK, and suicide rates are rising in this age group. Schools are considered an appropriate and logical setting for youth suicide prevention activities, with universal, selective, and indicated approaches all demonstrating efficacy. Given that international best practice recommends suicide prevention programmes combine these approaches, and that to date this has not been done in school settings in the UK, this study aims to evaluate the feasibility of delivering a suicide prevention programme incorporating universal, selective, and indicated components in UK schools. METHODS This study is a feasibility cluster-randomised controlled trial (RCT) of an adapted version of the Multimodal Approach to Preventing Suicide in Schools (MAPSS) programme. The programme, initially developed in Australia, involves delivering universal psychoeducation to all pupils, screening them for suicide risk, and delivering Internet-based Cognitive Behavioural Therapy (Reframe IT-UK) to those students identified as being at high-risk for suicide. The programme will be trialled in six secondary schools in Northwest England and will target Year 10 students (14- and 15-year-olds). The primary aims are to assess: 1) the acceptability and safety of delivering MAPSS in a school setting in the UK; 2) the social validity of the MAPSS programme; and 3) the feasibility of delivering a large-scale, appropriately powered, cluster-RCT and economic evaluation of this intervention in the future. Secondary aims are to assess changes over time in mental health and wellbeing outcomes. DISCUSSION This study is the first to evaluate a suicide prevention programme comprising universal, selective, and indicated components in UK schools. If the programme is found to be feasible, it could be more widely tested in schools and may ultimately lead to reduced rates of suicide and suicidal behaviour in young people.
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Affiliation(s)
- Emma Ashworth
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Molly McCarthy
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Sio Wynne
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jo Robinson
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Samuel McKay
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Steven Lane
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, United Kingdom
| | - Neil Boardman
- Champs Public Health Collaborative, Cheshire and Merseyside, United Kingdom
| | | | - Vivienne Crosbie
- Child and Adolescent Mental Health Services, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Neil Humphrey
- Manchester Institute of Education, University of Manchester, Manchester, United Kingdom
| | - Sian York
- Calderstones School, Liverpool, United Kingdom
| | - Maria Michail
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Damian Hart
- Merseyside Youth Association, Liverpool, United Kingdom
| | | | | | - Pooja Saini
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
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Haasz M, Betz ME, Ambroggio L, Cafferty R, King CA, Wong S, Leonard J, Brooks-Russell A, Sigel E. Acceptability and feasibility of video-based firearm safety education in a Colorado emergency department for caregivers of adolescents in firearm-owning households. Inj Prev 2024:ip-2023-045204. [PMID: 39053924 DOI: 10.1136/ip-2023-045204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Easy firearm access increases injury risk among adolescents. We evaluated the acceptability and feasibility of improving knowledge of a 3 min safe firearm storage education video in the paediatric emergency department. METHODS We conducted a single-centre block trial in a large paediatric emergency department (August 2020-2022). Participants were caregivers of adolescents (10-17 years) in firearm-owning households. First block participants (control) completed a baseline survey about child safety behaviours (including firearms). Second block participants (intervention) completed a baseline survey, watched the safe firearm storage video and evaluated acceptability. Participants completed a 3-month follow-up survey about firearm safety behaviours and knowledge recall. Demographic and clinical variables were compared between the intervention and control groups using Fisher's exact and χ2 tests. McNemar's test was used to compare firearm storage behaviours at the initial and 3-month visit within each group. RESULTS Research staff approached 1264 caregivers; 371 consented to participate (29.4%) and 144 (38.8%) endorsed firearm ownership. There were 95 participants in the control group and 62 in the intervention group. Follow-up was lower in the intervention group (53.7% vs 37.1%, p=0.04). Among participants viewing the video, 80.3% liked the video and 50.0% felt they learnt something new from the video. CONCLUSIONS Video-based firearm education in a paediatric emergency department is acceptable among a population of caregivers of adolescents with household firearms. This is a higher-risk group that may uniquely benefit from consistent education in the paediatric emergency department. Further study with larger populations is needed to evaluate intervention effectiveness. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov (NCT05168878).
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Affiliation(s)
- Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lilliam Ambroggio
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rachel Cafferty
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cheryl A King
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shale Wong
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jan Leonard
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadephia, Philadelphia, Pennsylvania, USA
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric Sigel
- Department of Pediatrics, Section of Adolescent Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Kim S, Park J, Lee H, Lee H, Woo S, Kwon R, Kim S, Koyanagi A, Smith L, Rahmati M, Fond G, Boyer L, Kang J, Lee JH, Oh J, Yon DK. Global public concern of childhood and adolescence suicide: a new perspective and new strategies for suicide prevention in the post-pandemic era. World J Pediatr 2024:10.1007/s12519-024-00828-9. [PMID: 39008157 DOI: 10.1007/s12519-024-00828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Suicide is the second leading cause of death in young people worldwide and is responsible for about 52,000 deaths annually in children and adolescents aged 5-19 years. Familial, social, psychological, and behavioral factors play important roles in suicide risk. As traumatic events such as the COVID-19 pandemic may contribute to suicidal behaviors in young people, there is a need to understand the current status of suicide in adolescents, including its epidemiology, associated factors, the influence of the pandemic, and management initiatives. DATA SOURCES We investigated global and regional suicide mortality rates among children and adolescents aged 5-19 years using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The suicide mortality rates from 1990 to 2019 were examined in 204 countries and territories across six World Health Organization (WHO) regions. Additionally, we utilized electronic databases, including PubMed/MEDLINE and Scopus, and employed various combinations of terms such as "suicide", "adolescents", "youth", "children", "risk factors", "COVID-19 pandemic", "prevention", and "intervention" to provide a narrative review on suicide within the pediatric population in the post-pandemic era. RESULTS Despite the decreasing trend in the global suicide mortality rate from 1990 to 2019, it remains high. The mortality rates from suicide by firearms or any other specified means were both greater in males. Additionally, Southeast Asia had the highest suicide rate among the six WHO regions. The COVID-19 pandemic seems to contribute to suicide risk in young people; thus, there is still a strong need to revisit appropriate management for suicidal children and adolescents during the pandemic. CONCLUSIONS The current narrative review integrates up-to-date knowledge on suicide epidemiology and the effects of the COVID-19 pandemic, risk factors, and intervention strategies. Although numerous studies have characterized trends in suicide among young people during the pre-pandemic era, further studies are required to investigate suicide during the pandemic and new strategies for suicide prevention in the post-pandemic era. It is necessary to identify effective prevention strategies targeting young people, particularly those at high risk, and successful treatment for individuals already manifesting suicidal behaviors. Care for suicidal children and adolescents should be improved with parental, school, community, and clinical involvement.
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Affiliation(s)
- Soeun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-e-Asr University of Rafsanjan, Rafsanjan, Iran
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Jiseung Kang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Jun Hyuk Lee
- Health and Human Science, University of Southern California, Los Angeles, CA, USA
| | - Jiyeon Oh
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
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Falcó R, Santana-Monagas E, Moreno-Amador B, Piqueras JA, Marzo JC. Suicidal Risk During Adolescence: Could Covitality Be Part of the Solution? Arch Suicide Res 2024; 28:948-963. [PMID: 37847011 DOI: 10.1080/13811118.2023.2262553] [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] [Indexed: 10/18/2023]
Abstract
OBJECTIVE The covitality model suggests that the co-disposition and synergy of core psychosocial assets (i.e., covitality) buffer the negative impact of stressful events and prevent the emergence of mental health problems during adolescence. At this stage of development, suicide already constitutes the leading cause of unnatural death in Europe. The present study aimed to examine how covitality relates to bidimensional mental health status (i.e., psychopathology and subjective well-being) and suicidal risk. METHOD Participants were 5,296 Spanish students ages 12 to 18 years (Mage ± SD = 14.19 ± 1.53), 50.2% male. RESULTS In a structural equation mediational model, covitality acted as a powerful shield of psychosocial strengths against suicidality, via an indirect effect entirely mediated by its impact on bidimensional mental health. The total variance in suicidal risk explained by the set of independent variables was 61.8%, while the total variance of psychopathology and subjective well-being explained by covitality was 54.1% and 75.6%, respectively. CONCLUSIONS These preliminary findings highlight the need for further study of covitality as a defense strategy against adolescent suicide. HIGHLIGHTSCovitality promote subjective well-being and prevent psychopathological symptoms.These self-perceived psychosocial strengths do not have direct effect on suicidality.Covitality is related to lower suicidal risk through indirect mechanisms: via bidimensional approach to mental health status (BMH).
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Tran T, Nguyen H, Shochet I, Nguyen N, La N, Wurfl A, Orr J, Nguyen H, Stocker R, Fisher J. Coping Self-Efficacy and Thoughts of Self-Harm Among Adolescents in Vietnam: A Longitudinal Study. Arch Suicide Res 2024; 28:1022-1034. [PMID: 37837377 DOI: 10.1080/13811118.2023.2265444] [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] [Indexed: 10/16/2023]
Abstract
We aimed to determine the effect of coping self-efficacy on thoughts of self-harm among adolescents attending high school in Hanoi, Vietnam. Longitudinal data were collected using the Center for Epidemiologic Studies Depression Scale Revised and the Coping Self-Efficacy Scale among 552 Year 10 students. The prevalence of thoughts of death and/or self-injury on at least 1 day in the past week was 16.9% at baseline and 14.5% at 8-month follow-up. When baseline coping self-efficacy was greater by one standard deviation, the odds of having thoughts of self-harm at follow-up were reduced by 42%. Our findings suggest that school-based programs that aim to strengthen coping strategies may be useful in preventing self-harm among adolescents.
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Goreis A, Pfeffer B, Hajek Gross C, Klinger D, Oehlke SM, Zesch H, Claes L, Plener PL, Kothgassner OD. Attentional Biases and Nonsuicidal Self-Injury Urges in Adolescents. JAMA Netw Open 2024; 7:e2422892. [PMID: 39023890 PMCID: PMC11258595 DOI: 10.1001/jamanetworkopen.2024.22892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/19/2024] [Indexed: 07/20/2024] Open
Abstract
Importance Nonsuicidal self-injury (NSSI) is a significant clinical concern among adolescents. Exposure to NSSI-related content on social media platforms has been suspected to potentially act as a trigger for NSSI. Objective To use free-viewing eye-tracking and dot-probe paradigms to examine attentional bias and psychophysiological responses to NSSI-related pictorial and textual stimuli in adolescents with and without a history of NSSI. Design, Setting, and Participants From June 2022 to April 2023, adolescent participants in Vienna, Austria with and without a history of NSSI were exposed to NSSI-related stimuli in this nonrandomized controlled trial. Data were analyzed from December 2023 to January 2024. Exposure Exposure to NSSI-related stimuli. Main Outcomes and Measures During both tasks, subjective arousal, NSSI urges, and autonomic nervous system activity were assessed. Results A total of 50 adolescents in 2 groups, 25 who engaged in NSSI (mean [SD] age 15.86 [1.14] years; 19 female participants [76%]) and 25 who did not (mean [SD] age 16.40 [1.71] years; 19 female participants [76%]) were included. Adolescents with a history of NSSI-but not those without a history of NSSI-showed a clear attentional bias toward NSSI-related images during eye-tracking, as indicated by increased initial fixations (500 ms stimulus presentation mean difference, 28.64%; 95% CI, 18.31%-38.98%; P < .001; 1000 ms stimulus presentation mean difference, 18.50%; 95% CI, 9.05%-27.95%; P < .001) and longer fixation durations (500 ms mean difference, 29.51 ms; 95% CI, 4.3-54.72 ms; P < .001; 1000 ms mean difference, 39.83 ms; 95% CI, 6.90-72.76 ms; P < .001), regardless of stimulus duration. This bias was associated with a heightened urge to engage in NSSI (d = 1.22; 95% CI, 0.69-1.73; P < .001), a trend not seen in adolescents without a history of NSSI. Similarly, in the dot-probe task, only the NSSI group showed an attentional bias toward NSSI images but not toward trauma images, emphasizing the specificity of their attentional bias. Physiological measures revealed no significant differences, suggesting that viewing NSSI images is not associated with increased autonomic arousal. Textual NSSI content did not provoke an attentional bias or heighten NSSI urges in either group. Conclusions and Relevance In this nonrandomized controlled trial of 50 adolescents, results highlighted a specific attentional bias toward NSSI-related pictorial stimuli in adolescents with a history of NSSI, particularly a difficulty in disengaging from NSSI images. These findings contribute to understanding maladaptive information processing in NSSI and suggest implications for clinical management and cognitive models addressing NSSI triggers. Trial Registration German Clinical Trials Register identifier: DRKS00025905.
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Affiliation(s)
- Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Bettina Pfeffer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Carola Hajek Gross
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Diana Klinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Sofia M. Oehlke
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Heidi Zesch
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Laurence Claes
- Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
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Schiff SJ, Meza J, Bath E, Lee SS. Commercially Sexually Exploited Adolescent Girls: The Association Between Externalizing Disorders and Parental Incarceration with Suicide Attempts. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01730-1. [PMID: 38935209 DOI: 10.1007/s10578-024-01730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
Commercial sexual exploitation (CSE) is a significant public health concern disproportionately affecting ethnoracially minoritized girls. Despite strong associations of CSE with suicide attempts, little is known about correlates of suicide among girls with CSE histories. Elevated rates of externalizing disorders (i.e., attention-deficit/hyperactivity disorder [ADHD], disruptive behavior disorders [DBD], conduct disorder [CD]) were observed among CSE youth, particularly in ethnoracially minoritized samples. Youth with CSE histories are frequently affected by parental incarceration, which is correlated with risk for suicide attempts. We tested cross-sectional simultaneous associations of externalizing disorders and parental incarceration with number of suicide attempts among 360 ethnoracially diverse girls affected by CSE (Mean age = 18.86). ADHD, DBD, and maternal incarceration were positively associated with number of suicide attempts. Findings implicate clinical/familial correlates of suicide attempts in this marginalized group, suggesting early suicide prevention efforts may improve traction on this problem by focusing on individual and family level factors.
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Affiliation(s)
- Sara J Schiff
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Franz Hall, Los Angeles, CA, 90095-1563, USA.
| | - Jocelyn Meza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Eraka Bath
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steve S Lee
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Franz Hall, Los Angeles, CA, 90095-1563, USA
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Richardson R, Connell T, Foster M, Blamires J, Keshoor S, Moir C, Zeng IS. Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review with Meta-Analysis. J Youth Adolesc 2024; 53:1301-1322. [PMID: 38564099 PMCID: PMC11045640 DOI: 10.1007/s10964-024-01969-w] [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] [Received: 08/28/2023] [Accepted: 03/02/2024] [Indexed: 04/04/2024]
Abstract
Suicide remains the second most common cause of death in young people aged 10-24 years and is a growing concern globally. The literature reports a vast number of factors that can predispose an adolescent to suicidality at an individual, relational, community, or societal level. There is limited high-level research identifying and understanding these risk and protective factors of adolescent suicidality. The present study used an umbrella review and meta-analysis to synthesize evidence from the review literature in the past 20 years on risk and protective factors of self-harm and suicidality (behavior and ideation) in adolescents. The umbrella review included 33 quantitative reviews with 1149 individual studies on suicidality and self-harm. Based on the data synthesis, it compared the public health impact of exposure on the population of the identified exposure. Bullying victimization was the most attributed environmental exposure for suicidality. The other identified significant school and individual factors were sleeping disturbance, school absenteeism, and exposure to antidepressants. Several significant vulnerable young populations were identified with significantly higher prevalence of suicidality, including lesbian, gay, bisexual, transgender, queer (or questioning) youth and those with mental health disorders, problem behaviors, previous suicidality, self-harm, and gender (female). A person-centered approach emphasizing connectedness and bully-free school environments should be a priority focus for schools, health professionals, and public health policymakers.
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Affiliation(s)
- Rebecca Richardson
- Faculty of Health and Environmental Science, Research Office, Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
- Faculty of Culture and Society, School of Social Sciences and Public Policy, Auckland University of Technology, Auckland, New Zealand
| | - Tanya Connell
- Faculty of Health and Environmental Science, School of Nursing, Auckland University of Technology, Auckland, New Zealand
| | - Mandie Foster
- Faculty of Health and Environmental Science, School of Nursing, Auckland University of Technology, Auckland, New Zealand
- School of Midwifery and Nursing, Edith Cowan University, Perth, WA, Australia
| | - Julie Blamires
- Faculty of Health and Environmental Science, School of Nursing, Auckland University of Technology, Auckland, New Zealand
| | - Smita Keshoor
- Faculty of Health and Environmental Science, School of Oral Health, Auckland University of Technology, Auckland, New Zealand
| | - Chris Moir
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Irene Suilan Zeng
- Faculty of Health and Environmental Science, Research Office, Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand.
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11
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Zhou R, Foo JC, Nishida A, Ogawa S, Togo F, Sasaki T. Longitudinal relationships of psychotic-like experiences with suicidal ideation and self-harm in adolescents. Eur Child Adolesc Psychiatry 2024; 33:1977-1985. [PMID: 37740799 PMCID: PMC11211151 DOI: 10.1007/s00787-023-02299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023]
Abstract
Research in adolescents suggests associations between psychotic-like experiences (PLEs) and self-injurious thoughts and behaviors (SITBs), but insights into their temporal relationship, which may inform prediction, have been limited. Psychological distress (PD; symptoms of depression and anxiety) has been related to both PLEs and SITBs, and may modulate this relationship. Given that PLEs have been linked to the development of several mental disorders, and the relationships between SITBs and suicide, it is important to better understand their relationship. The present study sought to investigate these factors using a longitudinal school-based design. Adolescents (n = 1685, ages 12-18) completed annual self-report assessments (6 time points) on PLEs, SITBs (suicidal ideation (SI) and self-harm (SH)), as well as PD. The longitudinal associations between PLEs and SITBs were analyzed, employing two cross-lagged panel models (CLPMs), with and without adjustment for PD. Unadjusted CLPMs revealed significant bidirectional temporal associations between PLEs and SITBs (both SI and SH), suggesting that PLEs both predicted and were predicted by SITBs. When adjusting for PD, the effect of SI on PLEs remained significant, but not PLEs on SI; bidirectional associations between PLEs and SH also remained significant. A bidirectional longitudinal relationship where both PLEs and SITBs can precede (and perhaps predict) each other was suggested in adolescents. PD may play a particular role in situations where PLEs are followed by SI. Heightened awareness about relationships between these phenotypes may be an important step toward facilitating timely interventions for both mental disorders and suicide.
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Affiliation(s)
- Rui Zhou
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Jerome Clifford Foo
- Institute for Psychopharmacology, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry, College of Health Sciences, University of Alberta, Edmonton, Canada
| | - Asuka Nishida
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Sayoko Ogawa
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Fumiharu Togo
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
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12
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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Technical Report. Pediatrics 2024; 153:e2024066327. [PMID: 38646698 DOI: 10.1542/peds.2024-066327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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13
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Haw R, Marsden M, Hartley S, Turpin C, Taylor PJ. A Brief Cognitive Analytic Therapy-Informed Approach for Young People That Have Self-Injured (CATCH-Y): A Case Series. Clin Psychol Psychother 2024; 31:e2976. [PMID: 38757462 DOI: 10.1002/cpp.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) presents an increasingly prevalent problem for young people; however, there remains a scarce evidence base for effective, scalable treatments for adolescents. This study aimed to assess the feasibility and acceptability of a brief, cognitive analytic therapy (CAT)-informed intervention for young people who engage in NSSI (CATCH-Y). METHODS A case series design recruited 13 young people who met the inclusion and exclusion criteria to participate in the five-session intervention. Eligible participants were aged 13-17 years (M = 15.15, SD = 1.28) and had engaged in NSSI at least once in the previous 6 months. Feasibility and acceptability were measured via recruitment, retention, qualitative feedback and missing data. The secondary outcome measures of personal recovery and motivation were administered pre- and post-assessment, with measures of depressive symptoms and urges to self-injure. RESULTS The intervention was found to be largely feasible and acceptable with high rates of recruitment, retention and pre-/post-assessment data completeness. Measures showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although results were mixed. Completion rates for remote assessments were low. CONCLUSIONS The findings of this study support further evaluation of the CATCH-Y intervention on a larger scale. In-person assessments may be preferable to remote to ensure good completion rates.
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Affiliation(s)
- R Haw
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Specialist Perinatal Service, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - M Marsden
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Aquarius Ward, South West London and St. George's Mental Health NHS Trust, London, UK
| | - S Hartley
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Tameside and Glossop CAMHS, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - C Turpin
- Specialist Psychotherapy Service, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - P J Taylor
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Howlader S, Abedin S, Rahman MM. Social support, distress, stress, anxiety, and depression as predictors of suicidal thoughts among selected university students in Bangladesh. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002924. [PMID: 38626087 PMCID: PMC11020522 DOI: 10.1371/journal.pgph.0002924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/15/2024] [Indexed: 04/18/2024]
Abstract
This study examines the association of perceived social support with suicidal thoughts among a young adult sample of university students and estimates the degree to which perceived stress, distress, anxiety, and depression may explain the association. A cross-sectional survey was conducted from June to September 2022 among 642 students, selected using the probability proportional to size procedure, at a large university in Bangladesh. We used the Multidimensional Scale of Perceived Social Support (MSPSS) to measure support. The Impact of Events Scale-Revised (IES-R), the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorders (GAD-7) scale, and the Patient Health Questionnaire (PHQ-9) were used to assess distress, stress, anxiety, and depression. The association between social support and suicidal thoughts was examined using multivariable logistic regression models. Mediation analyses were carried out using the Karlson, Holm, and Breen (KHB) method. We found that perceived social support was associated with lower odds of suicidal thoughts after controlling for other variables (adjusted odds ratio = 0.94; 95% confidence interval = 0.92-0.96). Mediation analysis showed that, after adjusting for potential confounders, the mediating effects among the total effect of perceived social support on suicidal thoughts were 56.1%, 20.8%, 22.5%, 38.8%, and 50.9% for all mental disorders together and four specific adverse mental health outcomes, i.e., perceived distress, stress, anxiety, and depression, respectively. This study demonstrates that perceived social support reduces the likelihood of suicidal thoughts among university students, and mental disorders have a partial mediating effect on the association. Suicide prevention and mental health promotion efforts among university students should consider encouraging students to build and strengthen a strong social support network.
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Affiliation(s)
- Sihab Howlader
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Sumaiya Abedin
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Mosfequr Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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15
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Goñi-Sarriés A, Pírez G, Yárnoz-Goñi N, Lahortiga-Ramos F, Iruin Á, Díez-Suárez A, Zorrilla I, Morata-Sampaio L, Oliver MJ, González-Pinto A, Sánchez-Villegas A. SESSAMO, follow-up of secondary students to assess mental health and obesity: a cohort study. GACETA SANITARIA 2024; 38:102385. [PMID: 38613905 DOI: 10.1016/j.gaceta.2024.102385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/19/2023] [Accepted: 02/01/2024] [Indexed: 04/15/2024]
Abstract
During last decades, a departure from health-related lifestyles has been observed among adolescents. Evidence reports that healthy lifestyles could be predictors of better mental health status. The aims of the SESSAMO Project are: 1) to assess the association between lifestyles and physical and mental health; 2) to assess how self-concept and stressful life events can modulate these associations; and 3) to establish the role of social determinants in the lifestyle and in adolescents' health. The SESSAMO Project is a prospective cohort carried out in Spain. Students aged 14-16 years (2nd-4th ESO) and their parents are invited to participate. Baseline data are collected through on-line, validated, self-administered questionnaires through a digital platform. Information on lifestyles, stressful life events and self-concept are collected. Screening of depression, anxiety, eating disorders, suicide risk, psychotic experiences and COVID impact is assessed. Every three years, up to age of 25, participants will be contacted again to update relevant information.
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Affiliation(s)
- Adriana Goñi-Sarriés
- Red de Salud Mental de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Guillermo Pírez
- Servicio de Psiquiatría, Complejo Hospitalario Universitario Insular-Materno Infantil, Servicio Canario de la Salud, Las Palmas de Gran Canaria, Spain
| | - Nora Yárnoz-Goñi
- Servicio de Psiquiatría, Hospital Clínico Universitario Lozano Blesa, Servicio Aragonés de Salud, Zaragoza, Spain
| | - Francisca Lahortiga-Ramos
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain; Departamento de Psiquiatría y Psicología Médica, Universidad de Navarra, Pamplona, Spain
| | - Álvaro Iruin
- Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; Red de Salud Mental de Gipuzkoa, Osakidetza, Spain
| | - Azucena Díez-Suárez
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain; Unidad de Psiquiatría Infantil y Adolescente, Departamento de Psiquiatría y Psicología Médica, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Leticia Morata-Sampaio
- Departamento de Psicología y Sociología, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - M Jesús Oliver
- Research Institute of Biomedical and Health Sciencies, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Almudena Sánchez-Villegas
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Spain; Institute for Innovation & Sustainable Development in Food Chain, Universidad Pública de Navarra, Pamplona, Spain.
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16
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Brager-Larsen A, Zeiner P, Mehlum L. DSM-5 Non-Suicidal Self-Injury Disorder in a Clinical Sample of Adolescents with Recurrent Self-Harm Behavior. Arch Suicide Res 2024; 28:523-536. [PMID: 37506259 DOI: 10.1080/13811118.2023.2192767] [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] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Non-suicidal self-injury disorder (NSSID) is a new diagnosis proposed in DSM-5 with a need of further study, especially in adolescent clinical populations where non-suicidal self-injury (NSSI) is particularly prevalent. We aimed to study characteristics of NSSID and estimate an optimal cutoff frequency level of NSSI behavior. METHODS Data were collected from 103 outpatient adolescents (ages 12-18) with recurrent self-harm behavior. RESULTS Adolescents with NSSID reported significantly more frequent NSSI behavior and suicide attempts than adolescents without NSSID. Frequency of NSSI, global functioning, depressive symptoms, number of self-harm methods and anxiety symptoms best discriminated between adolescents with and without NSSID. An optimal cutoff level for a diagnosis of NSSID was found to be ≥15 days with NSSI during the last year, which led to a reduction in the rate of adolescents diagnosed with NSSID from 54% to 46%. CONCLUSION This study shows that NSSID is a highly impairing disorder characterized by high risk of multiple NSSI and suicide attempts, decreased functioning and other associated psychiatric disorders. Clinical awareness of these risks are important to ensure early detection and treatment. Future prospective longitudinal studies are needed to further validate the characteristics of the NSSID diagnosis and its clinical utility.
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17
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Hajek Gross C, Oehlke SM, Prillinger K, Goreis A, Plener PL, Kothgassner OD. Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis. Suicide Life Threat Behav 2024; 54:317-337. [PMID: 38279664 DOI: 10.1111/sltb.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). METHODS Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes. RESULTS Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24). CONCLUSION Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed.
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Affiliation(s)
- Carola Hajek Gross
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Sofia-Marie Oehlke
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
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18
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Pears KC, Tiberio SS, Kim HK. Reducing Suicidal Ideation in Preadolescents With a History of Foster Care by Promoting School Readiness in Early Childhood. CHILD MALTREATMENT 2024; 29:165-175. [PMID: 35835729 DOI: 10.1177/10775595221115209] [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: 06/15/2023]
Abstract
Preadolescents with a history of foster care placement report suicidal ideation (SI) at higher rates than their peers, which increases their risk for suicide attempts in adolescence. Despite these increased risks, few interventions have been shown to reduce SI in these youth. This study examined the main and mediated long-term effects of a program to increase school readiness in children in foster care at age 5 years on SI when the children were ages 9-11 years, 4-6 years after the intervention ended. Children who received the intervention were less likely to report SI, although the difference did not reach statistical significance. The intervention reduced SI indirectly through its positive effect on children's self-esteem at age 9 years. Implications for programming to reduce SI and subsequent suicide attempts in youth with a history of foster care are discussed.
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Affiliation(s)
- Katherine C Pears
- Oregon Social Learning Center, Eugene, OR, USA
- OSLC Developments, Inc, Eugene, OR, USA
| | | | - Hyoun K Kim
- Department of Child & Family Studies, Yonsei University, Seodaemun-gu, Korea
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19
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Badger K, Baez Caraballo P, Gibbs A, Messina L, Halpern M, Amesty S. Thoughts of self-harm in adolescents: Relationship with violence in the Dominican Republic. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002711. [PMID: 38190375 PMCID: PMC10773958 DOI: 10.1371/journal.pgph.0002711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
Violence against adolescents is a pressing health problem with long-term implications for future physical and mental well-being, such as thoughts of self-harm, which have been associated with suicidal ideation and completion. However, much of the research has been conducted only in high-income countries. This study aimed to examine the correlation between violence against adolescents and self-harm thoughts in La Romana, Dominican Republic (DR). Cross-sectional survey data was collected at a community-based clinic from participants aged 13-20. Participants were recruited through the clinic's adolescent program and peer referral, and verbal consent was obtained. A survey solicited information about each participant's demographics, experiences with violence, and thoughts of harm to self or others. The survey was completed by 49 adolescents. The mean age was 16.78 (SD 2.34); 65% were female. We performed t-tests and Fisher's exact to investigate the relationship between demographics, reported violence experiences and having self-harm thoughts. About half (45%) had experienced physical violence, 76% had experienced emotional violence, and 12% had experienced sexual violence. The most common perpetrators of physical and emotional violence were classmates (12% and 24%), and the most common perpetrator of sexual violence was an ex-partner (4.1%). Ten participants (20.4%) had thought about harming themselves. Self-harm thoughts were significantly associated with being female (p = 0.025), employed (p = 0.05), and to a higher number of experiences of physical (0.029) and sexual violence (p = 0.023). The results of this study suggest a high prevalence of both violence and self-harm thoughts in adolescents in the DR. Interventions that address physical and sexual violence against adolescents may be particularly important. Particular attention should also be paid to screening for self-harm thoughts in female-identifying adolescents. Further research is needed to better understand the relationship between violence and self-harm thoughts in adolescents in the DR.
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Affiliation(s)
- Kelsey Badger
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
- Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, California, United States of America
| | | | | | - Luz Messina
- Clínica de Familia, La Romana, Dominican Republic
| | - Mina Halpern
- Clínica de Familia, La Romana, Dominican Republic
| | - Silvia Amesty
- Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- Columbia University Mailman School of Public Health, New York, New York, United States of America
- Department of Medical Humanities and Ethics, Columbia University Irving Medical Center, New York, New York, United States of America
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20
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Babajani F, Salari N, Hosseinian-Far A, Abdoli N, Mosafer H, Heidarian P, Mohammadi M. Prevalence of suicide attempts across the African continent: A systematic review and meta-analysis. Asian J Psychiatr 2024; 91:103878. [PMID: 38142521 DOI: 10.1016/j.ajp.2023.103878] [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: 09/15/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Over 700,000 people worldwide lose their lives through suicide every year. The prevalence of suicide has increased, especially in low- and middle-income countries such as many African countries. For every fatal suicidal attempt, there are approximately 20 other non-fatal suicide attempts within the population. The purpose of this study is to investigate the prevalence of attempts of suicides in the African continent through a systematic review and meta-analysis. METHODS To identify relevant sources, the PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar repositories and databases were systematically searched without a lower time limit and until July 2023. The heterogeneity of the studies was checked with the I2 index, and accordingly random effects model was adopted to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v.2). RESULTS In the review of 48 studies with a sample size of 244,701 people, the prevalence of suicide attempts in Africa was found to be 9.9% (95%CI: 8.5%-11.6%). With the increase in the year of study, the prevalence of suicide attempt in the African continent increases. Also, with the increase in the sample size, the prevalence of suicide attempts in Africa decreases. The suicide attempt prevalence among African men and woman slightly differed with 7.6% and 8.2%, respectively. CONCLUSION Suicide attempt is an important public health concern in Africa. The findings of this study are important not only for African health policy making, but also to contribute to the accuracy of global estimates with respect to suicide attempts.
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Affiliation(s)
- Fateme Babajani
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Nasrin Abdoli
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hadis Mosafer
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pegah Heidarian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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21
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Hua LL, Lee J, Rahmandar MH, Sigel EJ. Suicide and Suicide Risk in Adolescents. Pediatrics 2024; 153:e2023064800. [PMID: 38073403 DOI: 10.1542/peds.2023-064800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/02/2024] Open
Abstract
Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue, with a recent declaration of a National State of Emergency in Children's Mental Health by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association. This clinical report is an update to the previous American Academy of Pediatrics clinical report, "Suicide and Suicide Attempts in Adolescents." Because pediatricians and pediatric health care providers are at the front line of care for adolescents amid a child and adolescent mental health crisis, and because of the chronic and severe shortage of mental health specialists, it is important that pediatric health care providers become facile with recognizing risk factors associated with suicidality and at-risk populations, screening and further assessment of suicidality as indicated, and evidence-based interventions for patients with suicidal ideation and associated behaviors. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available.
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Affiliation(s)
- Liwei L Hua
- Division of Integrated Behavioral Health, South Bend Clinic, South Bend, Indiana
| | - Janet Lee
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Maria H Rahmandar
- Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric J Sigel
- Department of Pediatrics, University of Colorado School of Medicine, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado
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McEvoy D, Brannigan R, Cooke L, Butler E, Walsh C, Arensman E, Clarke M. Risk and protective factors for self-harm in adolescents and young adults: An umbrella review of systematic reviews. J Psychiatr Res 2023; 168:353-380. [PMID: 37972513 DOI: 10.1016/j.jpsychires.2023.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/13/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
We conducted an umbrella review to synthesise the evidence from systematic reviews and meta-analyses that examined the risk and protective factors for self-harm in young people. We searched six different databases and used the AMSTAR-2 checklist for quality assessment. The importance of each risk and protective factor was determined based on (1) the number of times it was identified by general reviews examining any risk or protective factor, and (2) the effect sizes from meta-analyses. There were 61 systematic reviews included in this review. The most frequently identified risk factors for self-harm in young people included childhood abuse, depression/anxiety, bullying, trauma, psychiatric illnesses, substance use/abuse, parental divorce, poor family relationships, lack of friends, and exposure to self-harm behaviour in others. The risk factors with the strongest evidence for an association with self-harm were behavioural disorders, personality disorders and depression or anxiety. There was a dearth of systematic reviews examining protective factors but good family/friend relationships were most frequently identified. There was also evidence to show that non-suicidal and suicidal self-harm shared many of the same risk factors. Clinicians and other professionals who work with young people should be particularly cognisant of the psychiatric and adverse life event risk factors as well as the substance use, education-related and individual-level (e.g. being LGB) risk factors for self-harm. Knowledge of risk factors for self-harm can potentially be used to inform the design and implementation of prevention measures and further research is needed on the protective factors for self-harm.
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Affiliation(s)
- David McEvoy
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland.
| | - Ross Brannigan
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland.
| | - Lorcan Cooke
- School of Medicine, Royal College of Surgeons Ireland (RCSI), Dublin, 2, Ireland.
| | - Emma Butler
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland.
| | - Cathal Walsh
- Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Ella Arensman
- School of Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Ireland; National Suicide Research Foundation (NSRF), Western Gateway Building, University College Cork, Ireland.
| | - Mary Clarke
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
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23
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Wiglesworth A, Butts J, Carosella KA, Mirza S, Papke V, Bendezú JJ, Klimes-Dougan B, Cullen KR. Stress system concordance as a predictor of longitudinal patterns of resilience in adolescence. Dev Psychopathol 2023; 35:2384-2401. [PMID: 37434505 PMCID: PMC10784418 DOI: 10.1017/s0954579423000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
Resilience promotes positive adaptation to challenges and may facilitate recovery for adolescents experiencing psychopathology. This work examined concordance across the experience, expression, and physiological response to stress as a protective factor that may predict longitudinal patterns of psychopathology and well-being that mark resilience. Adolescents aged 14-17 at recruitment (oversampled for histories of non-suicidal self-injury; NSSI) were part of a three-wave (T1, T2, T3) longitudinal study. Multi-trajectory modeling produced four distinct profiles of stress experience, expression, and physiology at T1 (High-High-High, Low-Low-Low, High-Low-Moderate, and High-High-Low, respectively). Linear mixed-effect regressions modeled whether the profiles predicted depressive symptoms, suicide ideation, NSSI engagement, positive affect, satisfaction with life, and self-worth over time. Broadly, concordant stress response profiles (Low-Low-Low, High-High-High) were associated with resilient-like patterns of psychopathology and well-being over time. Adolescents with a concordant High-High-High stress response profile showed a trend of greater reduction in depressive symptoms (B = 0.71, p = 0.052), as well as increased global self-worth (B = -0.88, p = 0.055), from T2 to T3 compared to the discordant High-High-Low profile. Concordance across multi-level stress responses may be protective and promote future resilience, whereas blunted physiological responses in the presence of high perceived and expressed stress may indicate poorer outcomes over time.
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Affiliation(s)
| | - Jessica Butts
- Public Health, Division of Biostatistics, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Salahudeen Mirza
- Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Victoria Papke
- Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | | | - Kathryn R Cullen
- Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
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24
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Reichl C, Rockstroh F, Lerch S, Fischer-Waldschmidt G, Koenig J, Kaess M. Frequency and predictors of individual treatment outcomes (response, remission, exacerbation, and relapse) in clinical adolescents with nonsuicidal self-injury. Psychol Med 2023; 53:7636-7645. [PMID: 37282585 PMCID: PMC10755228 DOI: 10.1017/s0033291723001447] [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: 10/13/2022] [Revised: 03/23/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is prevalent in adolescent clinical samples. There is evidence that NSSI can be treated effectively but data on individual treatment outcomes is limited. The goal of this study was to examine response, remission, exacerbation, and relapse rates over one and two years, respectively, among a clinical sample of adolescents with NSSI. Furthermore, we aimed to identify clinically relevant predictors of NSSI trajectories. METHODS The sample consists of n = 203 adolescents (12-17 y., 94% female) from a specialized outpatient clinic for risk-taking and self-harming behavior with NSSI on at least five days in the six months before first assessment. Assessments were completed at baseline and one (FU1) and two (FU2) years later using structured clinical interviews and self-report questionnaires. RESULTS At FU1, 75% reported a reduction in NSSI frequency by at least 50% (treatment response); among those, one third (25% of the entire sample) achieved a remission (0 NSSI); an exacerbation (⩾50% more NSSI) was observed in 11% of patients. Of those in remission, 41% relapsed one year later. Predictors of non-response or non-remission were inpatient treatment and depressive symptoms. Adolescents with lower NSSI frequency at baseline had a higher risk of exacerbation. Due to limited sample size at FU2 no prediction model for relapse was established. CONCLUSIONS While most adolescents presenting with NSSI achieved significant improvement, more attention should be paid to the rather low rates of full remission. Prediction and early detection of individuals who deteriorate during or relapse after treatment is critical.
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Affiliation(s)
- Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franziska Rockstroh
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Gloria Fischer-Waldschmidt
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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25
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Gordon K, Warne N, Heron J, von Gontard A, Joinson C. Continence Problems and Mental Health in Adolescents from a UK Cohort. Eur Urol 2023; 84:463-470. [PMID: 37248139 DOI: 10.1016/j.eururo.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/12/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Adolescents with continence problems experience unique threats to their psychological well-being, but long-term mental health sequelae are unknown. OBJECTIVE To examine prospective relationships between incontinence/lower urinary tract symptoms (LUTS) and mental health problems in young people. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study of young people (n = 7332: 3639 males and 3693 females) from a population-based sample was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We estimated the association between incontinence/LUTS and mental health outcomes using multivariable regression models adjusted for sex, socioeconomic position, developmental level, intelligence quotient, stressful life events, maternal psychopathology, body mass index, and emotional/behavioural problems. RESULTS AND LIMITATIONS Daytime wetting and voiding postponement showed the greatest number of associations with mental health problems. All incontinence subtypes/LUTS were associated with increased odds of generalised anxiety disorder (eg, odds ratio for daytime wetting = 3.01, 95% confidence interval [1.78, 5.09], p < 0.001) and/or higher anxiety scores. There was also evidence of associations with common mental disorder (eg, voiding postponement: 1.88 [1.46, 2.41], p < 0.001), depression (eg, urgency: 1.94 [1.19, 3.14], p = 0.008), depressive symptoms (eg, daytime wetting: 1.70 [1.13, 2.56], p = 0.01), self-harm thoughts (eg, voiding postponement: 1.52 [1.16, 1.99], p = 0.003), and disordered eating (eg, nocturia 1.72 [1.27, 2.34], p = 0.001). We are unable to generalise our results to minority ethnic groups, less affluent populations, and non-UK samples. CONCLUSIONS Young people with incontinence/LUTS are at an increased risk of mental health problems. Further research is needed to establish the direction of causality. PATIENT SUMMARY We looked at the association between continence problems and mental health outcomes in young people from a large population-based cohort. Young people with continence problems at the age of 14 yr were more likely to suffer from a range of mental health problems at the age of 18 yr, including common mental disorder, depression, anxiety, self-harm thoughts, and disordered eating. Paediatric continence clinics should address the mental health needs of young people and provide clear and effective care pathways to child and adolescent mental health services.
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Affiliation(s)
- Katie Gordon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Naomi Warne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alexander von Gontard
- Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland; Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Carol Joinson
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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26
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Srivastava A, Hall WJ, Krueger EA, Goldbach JT. Sexual Identity Fluidity and Depressive Symptoms: Findings From a National Longitudinal Study of Sexual Minority Adolescents. J Adolesc Health 2023; 73:873-879. [PMID: 37530683 PMCID: PMC10592473 DOI: 10.1016/j.jadohealth.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/25/2023] [Accepted: 06/09/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Sexual minority adolescents (SMAs) consistently report elevated risk of mental health symptoms, including depression. Sexual identities may change over time (referred as sexual identity fluidity), particularly during adolescence. This study examined the effect of sexual identity fluidity on depressive symptoms over time. METHODS National longitudinal data were analyzed from SMAs aged 14-17 years (N = 1,077) in the adolescent stress experiences over time study during an 18-month period. Multigroup time-varying covariate latent growth models were employed to examine the effect of sexual identity fluidity on depressive symptoms. RESULTS In the sample, 40% of SMAs reported at least 1 change in sexual identity during an 18-month period. Cisgender females reported sexual identity fluidity at a higher rate than their male counterparts (46.9% vs. 26.6%, respectively). In our first model (total sample), a change in sexual identity was associated with reporting fewer depressive symptoms (b = -0.591, p = .004). In our multigroup model (by sex assigned at birth), a change in sexual identity was significantly associated with reporting fewer depressive symptoms among cisgender females (b = -0.591, p < .01). However, there was no significant effect found among cisgender males. The models controlled for age and race or ethnicity. DISCUSSION The results add to the limited knowledge on the complex relationship between sexual identity fluidity and mental health risks over time among adolescents. Our results indicate that sexual identity development and change processes differ between cisgender females and males. The nuances associated with these sexual identity processes need further investigation.
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Affiliation(s)
- Ankur Srivastava
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, North Carolina.
| | - William J Hall
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, North Carolina
| | - Evan A Krueger
- Tulane University, School of Social Work, Los Angeles, California
| | - Jeremy T Goldbach
- Washington University in St. Louis, Brown School of Social Work, St. Louis, Missouri
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27
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Steare T, Gutiérrez Muñoz C, Sullivan A, Lewis G. The association between academic pressure and adolescent mental health problems: A systematic review. J Affect Disord 2023; 339:302-317. [PMID: 37437728 DOI: 10.1016/j.jad.2023.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/06/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Academic pressure is a potential contributor to adolescent mental health problems, but international evidence on this association has never been synthesised. METHODS We conducted the first systematic review of the association between academic pressure and adolescent depression, anxiety, self-harm, suicidality, suicide attempts and suicide. We searched MEDLINE, PsycINFO, ERIC and Web of Science (core collection) up to November 24, 2022, for studies of school-going children or adolescents, which measured academic pressure or timing within the school year as the exposure and depression, anxiety, self-harm, or suicidal ideation, attempts or suicide as outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool. We used narrative synthesis to summarise the evidence. The review was prospectively registered with PROSPERO (CRD42021232702). RESULTS We included 52 studies. Most studies assessed mixed anxiety and depressive symptoms (n = 20) or depressive symptoms (n = 19). Forty-eight studies found evidence of a positive association between academic pressure or timing within the school year and at least one mental health outcome. LIMITATIONS Most studies were cross-sectional (n = 39), adjusted for a narrow range of confounders or had other limitations which limited the strength of causal inferences. CONCLUSIONS We found evidence that academic pressure is a potential candidate for public health interventions which could prevent adolescent mental health problems. Large population-based cohort studies are needed to investigate whether academic pressure is a causal risk factor that should be targeted in school- and policy-based interventions. FUNDING UCL Health of the Public; Wellcome Institutional Strategic Support Fund.
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Affiliation(s)
- Thomas Steare
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK.
| | | | - Alice Sullivan
- Centre for Longitudinal Studies (UCL Institute of Education), University College London, London, UK
| | - Gemma Lewis
- Division of Psychiatry, University College London, London, UK
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28
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Al-Dajani N, Czyz EK, Eisenberg D, Zheng K, King CA. A latent profile analysis of at-risk first-year undergraduate students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37722880 PMCID: PMC10947455 DOI: 10.1080/07448481.2023.2252909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/20/2023] [Indexed: 09/20/2023]
Abstract
Objective: We examined whether meaningful subgroups of self-injurious behaviors (SIBs) would emerge within a pool of first-year college students already deemed at elevated risk. Participants: First-year undergraduates (N = 1,068) recruited in 2015-2018 Fall terms. Methods: Past-year nonsuicidal self-injury (NSSI) frequency, past-year number of NSSI methods used, lifetime suicide attempt (SA) history, and recency of SA were included in a latent profile analysis. Results: Four subgroups emerged: low SIB (n = 558, 52%), high NSSI only (n = 182, 17%), high SIB (n = 141, 13%), and high SA only (n = 187, 18%). Students in the high SIB group reported higher levels of suicidal ideation at baseline and follow-up in comparison to all groups. Those in the high NSSI only or high SIB groups had relatively higher levels of NSSI at baseline and follow-up. Conclusions: Findings highlight the amount of heterogeneity within a high-risk group, along with the importance of considering distal and proximal SIBs in university screening efforts.
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Affiliation(s)
| | - Ewa K. Czyz
- Department of Psychiatry, University of Michigan
| | - Daniel Eisenberg
- Department of Health Management and Policy, School of Public Health, University of Michigan
| | - Kai Zheng
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine
| | - Cheryl A. King
- Department of Psychiatry, University of Michigan
- Depression Center, University of Michigan
- Injury Prevention Center, University of Michigan
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29
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He X, Yang P, Yu Q, Yang B. Correlations between negative life events and suicidal ideation among Chinese adolescents: a meta-analysis. Front Psychiatry 2023; 14:1201786. [PMID: 37779616 PMCID: PMC10539609 DOI: 10.3389/fpsyt.2023.1201786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background Suicide ideation (SI) has become a serious social issue worldwide, and research has found a certain correlation between negative life events (NLE) and SI. Nevertheless, this relationship is still not clear among Chinese adolescents, a special population. Hence, this investigation performed a meta-analysis of observational research on the correlation between NLE and SI among adolescents in China, to further clarify the association. Methods We performed an extensive search on seven electronic databases starting from their establishment until March 10, 2023. The research mainly focused on cross-sectional studies conducted on samples of Chinese adolescents. To examine the association between NLE and SI, a meta-analysis model using random effects was utilized. To investigate moderating factors such as age, region, assessment tools for SI, and year of publication, subgroup and meta-regression analyses were performed. The AHRQ evaluated the quality of the study. The synthesis of data was conducted utilizing STATA software (version 16). Results Ultimately, a total of 30 cross-sectional studies were selected for this analysis, including 39,602 individuals in the participant sample. The results showed that NLE was moderately positively correlated with SI among Chinese adolescents (r = 0.29, 95% CI: 0.26, 0.32). In addition, this relationship was moderated by regional differences and the measurement tool used for SI. Studies conducted in Western China showed a higher correlation coefficient than those conducted in Eastern and Central China. Moreover, research conducted with the SSIOSS demonstrated a stronger correlation coefficient compared to studies utilizing the BSI-CV or other assessment instruments. Conclusion This meta-analysis indicates that NLE is linked to SI in Chinese teenagers, especially those residing in Western regions of China. Identifying and intervening in NLE and associated risk factors are crucial to prevent suicide within this demographic.
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Affiliation(s)
- Xubin He
- Chongqing Mental Health Center, Chongqing, China
| | - Ping Yang
- Chongqing Mental Health Center, Chongqing, China
| | - Qinyao Yu
- Chongqing Medical School, Chongqing, China
| | - Bo Yang
- Chongqing Mental Health Center, Chongqing, China
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30
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Florindo Salvador V, Gouveia-Pereira M, Simões B, Duarte E. Young adults who self-harm: Barriers to and facilitators of seeking help. Psychiatry Res 2023; 327:115390. [PMID: 37574602 DOI: 10.1016/j.psychres.2023.115390] [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: 12/17/2022] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023]
Abstract
In Portugal, the lifetime prevalence of DSH in adolescents is situated between 16% and 35% (Duarte et al., 2020a; Gouveia-Pereira et al., 2016). Help-seeking is an important facilitator to stop these behaviors, although it is known that most individuals who engage in self-harm do not ask for help (Rowe et al., 2014). Study one (n = 222) examines the differences between two groups of young adults with a history of deliberate self-harm (participants who asked for help and participants who did not ask for help) regarding these behaviors' severity and diversity, suicidal ideation, and family conflicts. Participants completed a self-report questionnaire which included an open-ended question focused on the reasons that may or may not contribute for seeking help. Significant differences between the two groups were found for all variables and are further discussed, followed by a qualitative analysis concerning the help-seeking motives. Study two (n = 110) used a self-report questionnaire to analyze the expectations of young adults with a history of deliberate self-harm concerning their social support network and the role of healthcare workers when they asked or thought about asking for help. These expectations included contents related with problem-solving, confidentiality, understanding and trust, support, and unburdening. Identifying facilitators and barriers to help-seeking can be a relevant step in planning and managing interventions within deliberate self-harm. Future directions and limitations are discussed.
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Affiliation(s)
- Vanessa Florindo Salvador
- Applied Psychology Research Center Capabilities and Inclusion (APPsyCI), ISPA, Instituto Universitário, Lisbon, Portugal.
| | - Maria Gouveia-Pereira
- Applied Psychology Research Center Capabilities and Inclusion (APPsyCI), ISPA, Instituto Universitário, Lisbon, Portugal
| | | | - Eva Duarte
- Applied Psychology Research Center Capabilities and Inclusion (APPsyCI), ISPA, Instituto Universitário, Lisbon, Portugal
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31
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Fedina L, Moss L, Rousson AN, Smith ME, Bright C, Herrenkohl TI, DeVylder J. Effects of Neighborhood Disconnection on Psychological Distress and Suicide Risk Associated with Interpersonal Violence Within Racial Groups. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:681-697. [PMID: 37593058 PMCID: PMC10427586 DOI: 10.1007/s40653-023-00532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 08/19/2023]
Abstract
Negative mental health outcomes have been associated with adverse childhood experiences (ACEs) and intimate partner violence (IPV); however, few studies have identified risk and protective factors across levels of the social ecology that mitigate the onset of psychological distress and suicide risk associated with trauma. This study examines the relationship between ACEs, IPV, and mental health (i.e., psychological distress, suicidal ideation, and suicide attempts) within racial sub-populations of Black American, Latinx, and White adults. An online, cross-section survey was administered to a general population sample of adults in Baltimore and New York City. ACEs, IPV, and mental health outcomes were assessed within racial sub-populations of Black American (N = 390), Latinx (N = 178), and White (N = 339) adults, while accounting for within-group demographic differences. Moderating effects of social support and neighborhood disconnection on the relationship between ACEs, IPV, and mental health outcomes were also assessed. IPV was associated with psychological distress and suicidal ideation for Black and Latinx adults, but not for White adults. ACEs were associated with increased psychological distress for all three groups, and increased odds for suicidal ideation among Black and Latinx adults.. A significant negative interaction effect for neighborhood disconnection was found in the relationship between ACEs and psychological distress for Black adults. Findings highlight the significant mental health burdens of ACEs and IPV within racial and ethnic groups. Neighborhood disconnection may exacerbate psychological distress associated with ACEs among populations most impacted by interpersonal violence and mental health inequalities.
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Affiliation(s)
- Lisa Fedina
- School of Social Work, University of Michigan, 1080 S. University Ave, Ann Arbor, MI 48105 USA
| | - Lolita Moss
- School of Social Work, University of Michigan, 1080 S. University Ave, Ann Arbor, MI 48105 USA
| | | | | | | | - Todd I. Herrenkohl
- School of Social Work, University of Michigan, 1080 S. University Ave, Ann Arbor, MI 48105 USA
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, NY USA
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32
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Morales-Rodríguez FM, Martínez-Ramón JP, Giménez-Lozano JM, Morales Rodríguez AM. Suicide Risk Analysis and Psycho-Emotional Risk Factors Using an Artificial Neural Network System. Healthcare (Basel) 2023; 11:2337. [PMID: 37628534 PMCID: PMC10454187 DOI: 10.3390/healthcare11162337] [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: 07/03/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Suicidal behavior among young people has become an increasingly relevant topic after the COVID-19 pandemic and constitutes a public health problem. This study aimed to examine the variables associated with suicide risk and determine their predictive capacity. The specific objectives were: (1) to analyze the relationship between suicide risk and model variables and (2) to design an artificial neural network (ANN) with predictive capacity for suicide risk. The sample comprised 337 youths aged 18-33 years. An ex post facto design was used. The results showed that emotional attention, followed by problem solving and perfectionism, were variables that contributed the most to the ANN's predictive capacity. The ANN achieved a hit rate of 85.7%, which is much higher than chance, and with only 14.3% of incorrect cases. This study extracted relevant information on suicide risk and the related risk and protective factors via artificial intelligence. These data will be useful for diagnosis as well as for psycho-educational guidance and prevention. This study was one of the first to apply this innovative methodology based on an ANN design to study these variables.
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Affiliation(s)
| | - Juan Pedro Martínez-Ramón
- Department of Evolutionary and Educational Psychology, Faculty of Psychology and Speech Therapy, Campus Regional Excellence Mare Nostrum, University of Murcia, 30100 Murcia, Spain;
| | - José Miguel Giménez-Lozano
- Department of Educational and Developmental Psychology, Faculty of Psychology, University of Granada, 18011 Granada, Spain;
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Muehlenkamp JJ, Brausch AM, Littlefield A. Concurrent changes in nonsuicidal self-injury and suicide thoughts and behaviors. Psychol Med 2023; 53:4898-4903. [PMID: 35768888 PMCID: PMC9800642 DOI: 10.1017/s0033291722001763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is a risk factor for suicide, yet how changes in NSSI engagement relate to suicide ideation, planning, and attempts remains largely unknown. The current study aims to fill this gap by examining how changes in NSSI frequency over time related to concurrent changes in suicide thoughts and behaviors. METHODS Data came from a sample of 403 self-injuring young adults who completed assessments of NSSI and suicide thoughts and behaviors at baseline, 6, and 12 months. Bivariate latent growth modeling, adjusting for covariates of lifetime NSSI frequency and treatment status, was used to examine the extent to which changes in NSSI frequency related to suicide ideation and suicide planning. RESULTS The frequency of NSSI declined across the study period. The slopes of NSSI and suicide ideation were significantly correlated, suggesting individuals with sharper declines in NSSI across time also showed sharper declines in suicide ideation. The intercepts between NSSI and suicide planning were significantly correlated, suggesting those with high NSSI frequency at baseline tended to report higher suicide planning across time. After covariate adjustment, the intercept of suicide planning marginally (p = 0.08) correlated with the slope of NSSI, tentatively suggesting that those who had less reductions in NSSI tended to have higher frequencies of suicide planning. CONCLUSION These results provide new evidence that changes in NSSI are related to subsequent changes in suicide thoughts and behaviors. Monitoring suicide risk among those with NSSI is important and treatment aiming to reduce NSSI may also reduce suicide risk.
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Affiliation(s)
- Jennifer J Muehlenkamp
- Department of Psychology, University of Wisconsin-Eau Claire, 105 Garfield Ave, Eau Claire, WI 54701, USA
| | - Amy M Brausch
- Department of Psychological Sciences, Western Kentucky University, 1906 College Heights Blvd, Bowling Green, KY 42101, USA
| | - Andrew Littlefield
- Department of Psychological Sciences, Texas Tech University, Box 42051, Lubbock, TX 79409-2051, USA
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Rockstroh F, Edinger A, Josi J, Brunner R, Resch F, Kaess M. Brief Psychotherapeutic Intervention Compared with Treatment as Usual for Adolescents with Nonsuicidal Self-Injury: Outcomes over a 2-4-Year Follow-Up. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:243-254. [PMID: 37487473 PMCID: PMC10568598 DOI: 10.1159/000531092] [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: 12/19/2022] [Accepted: 05/11/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The "Cutting Down Programme" (CDP), a brief psychotherapeutic intervention for treating nonsuicidal self-injury (NSSI) in adolescents, was comparable to high-quality treatment as usual (TAU) in a previous randomized controlled trial (RCT). OBJECTIVE The aim of the study was to evaluate the long-term outcomes of the CDP over up to 4 years. METHODS Assessments of NSSI, suicide attempts, borderline personality disorder (BPD), depression, and quality of life took place 2 to 4 years (T3) after enrollment in a RCT. The evolution of NSSI, suicide attempts, depression, and quality of life was analyzed using (generalized) linear mixed-effects models. Ordered logistic regression was used for analyzing BPD diagnoses. Data from T0, T2, and T3 are reported. RESULTS Out of 74 patients, 70 (95%) were included in the T3 assessment. The frequency of NSSI events alongside with suicide attempts and depression further decreased between T2 and T3 and BPD between T0 and T3 in both groups. Quality of life remained stable in both groups between T2 and T3. Both groups received substantial but comparable additional treatment between T2 and T3. More treatment sessions during the follow-up period were linked to larger improvements of NSSI. CONCLUSIONS The CDP was found to be as effective as TAU in promoting recovery from NSSI and comorbid symptoms in the long term. Results suggest that treatment effects from a brief psychotherapeutic intervention may endure and even further improve after completion of the program. However, additional treatment seems to improve chances for recovery independent from CDP versus TAU.
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Affiliation(s)
- Franziska Rockstroh
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Alexandra Edinger
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Academy for Psychotherapy, SRH University Heidelberg, Heidelberg, Germany
| | - Johannes Josi
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Romuald Brunner
- Clinic and Policlinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Franz Resch
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Polskaya NA, Basova AY, Razvaliaeva AY, Yakubovskaya DK, Vlasova NV, Abramova AA. Non-suicidal self-injuries and suicide risk in adolescent girls with eating disorders: associations with weight control, body mass index, and interpersonal sensitivity. CONSORTIUM PSYCHIATRICUM 2023; 4:65-77. [PMID: 38250646 PMCID: PMC10795949 DOI: 10.17816/cp6803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/19/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) are associated with a risk of premature death, as well as suicidal and self-injurious behavior. A low or high body mass index (BMI) and weight control behavior can also have an impact on self-injurious and suicidal behavior. While some studies show that interpersonal sensitivity is a risk factor for EDs, affective disorders, and self-injurious behavior, in-depth studies of these issues have not been done. AIM The present study investigates how self-injurious and suicidal behavior relate to weight control behavior, BMI, and interpersonal sensitivity in adolescent girls from a clinical population with diagnosed EDs compared with adolescent girls from the general population. METHODS The main group was comprised of 31 girls with a diagnosis of ED (as the main diagnosis or co-occurring with affective disorders, M=151.13 years), being treated in in the Eating Disorder Clinic of the Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva. The comparison group consisted of 27 adolescent girls recruited from Proton Educational Center (M=15.511.09 years). The measures included a qualitative survey that yielded data on weight control behavior, and self-injurious behavior, a Blitz questionnaire probing the suicide risk (used only in the main group), and the Interpersonal Sensitivity Measure. Height and weight data were also recorded for BMI calculation. RESULTS The qualitative analysis of weight control behavior yielded the following results: purging behavior, restrictive behavior, and corrective behavior. Participants in the main group used purging and restrictive behavior more often, whereas participants in the comparison group used strategies associated with a healthy lifestyle. The main group and participants who practiced purging and restrictive weight control in the overall sample had the smallest BMI. Self-injurious behavior was approximately evenly distributed both amongst the main and comparison groups. Self-cutting was the most prevalent type of self-injury. In the main group, self-injury was associated with a smaller BMI, while in the comparison group it was associated with an increase in the fear of rejection and overall interpersonal sensitivity. Based on the assessment of the suicide risk, six participants in the main group were deemed high-risk; they also displayed increased fear of rejection, dependence on the assessments of others, and overall interpersonal sensitivity. All girls in the suicide risk subgroup had non-suicidal self-injuries. CONCLUSION The results of our study broaden our understanding of the risk factors of suicidal and self-injurious behavior in adolescent girls with EDs and reveal the characteristics of the type of weight control behavior used by this group in comparison with adolescent girls in the general population. Girls with EDs who were considered at the risk of committing suicide demonstrated high interpersonal sensitivity, which provides a rationale for further studying the general interpersonal mechanisms that underlie the pathogenesis of EDs, as well as that of self-injurious and suicidal behavior.
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Affiliation(s)
- Natalia A. Polskaya
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
- Moscow State University of Psychology & Education
| | - Anna Y. Basova
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
- Pirogov Russian National Research Medical University
| | | | - Daria K. Yakubovskaya
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
| | | | - Anna A. Abramova
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
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Wong SMY, Ip CH, Hui CLM, Suen YN, Wong CSM, Chang WC, Chan SKW, Lee EHM, Lui SSY, Chan KT, Wong MTH, Chen EYH. Prevalence and correlates of suicidal behaviours in a representative epidemiological youth sample in Hong Kong: the significance of suicide-related rumination, family functioning, and ongoing population-level stressors. Psychol Med 2023; 53:4603-4613. [PMID: 35650661 PMCID: PMC10388322 DOI: 10.1017/s0033291722001519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Young people are most vulnerable to suicidal behaviours but least likely to seek help. A more elaborate study of the intrinsic and extrinsic correlates of suicidal ideation and behaviours particularly amid ongoing population-level stressors and the identification of less stigmatising markers in representative youth populations is essential. METHODS Participants (n = 2540, aged 15-25) were consecutively recruited from an ongoing large-scale household-based epidemiological youth mental health study in Hong Kong between September 2019 and 2021. Lifetime and 12-month prevalence of suicidal ideation, plan, and attempt were assessed, alongside suicide-related rumination, hopelessness and neuroticism, personal and population-level stressors, family functioning, cognitive ability, lifetime non-suicidal self-harm, 12-month major depressive disorder (MDD), and alcohol use. RESULTS The 12-month prevalence of suicidal ideation, ideation-only (no plan or attempt), plan, and attempt was 20.0, 15.4, 4.6, and 1.3%, respectively. Importantly, multivariable logistic regression findings revealed that suicide-related rumination was the only factor associated with all four suicidal outcomes (all p < 0.01). Among those with suicidal ideation (two-stage approach), intrinsic factors, including suicide-related rumination, poorer cognitive ability, and 12-month MDE, were specifically associated with suicide plan, while extrinsic factors, including coronavirus disease 2019 (COVID-19) stressors, poorer family functioning, and personal life stressors, as well as non-suicidal self-harm, were specifically associated with suicide attempt. CONCLUSIONS Suicide-related rumination, population-level COVID-19 stressors, and poorer family functioning may be important less-stigmatising markers for youth suicidal risks. The respective roles played by not only intrinsic but also extrinsic factors in suicide plan and attempt using a two-stage approach should be considered in future preventative intervention work.
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Affiliation(s)
- Stephanie M. Y. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Charlie H. Ip
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy L. M. Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Y. N. Suen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Corine S. M. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - W. C. Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Sherry K. W. Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin H. M. Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Simon S. Y. Lui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - K. T. Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michael T. H. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Y. H. Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Zhang B, Zhang W, Sun L, Jiang C, Zhou Y, He K. Relationship between alexithymia, loneliness, resilience and non-suicidal self-injury in adolescents with depression: a multi-center study. BMC Psychiatry 2023; 23:445. [PMID: 37337144 DOI: 10.1186/s12888-023-04938-y] [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: 02/08/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) behaviors are prevalent in adolescents and have adverse effects on physical and mental health. However, little is known about the relationship between NSSI and alexithymia, or the underlying mechanisms that could explain this relationship. This study aimed to elucidate the current status of NSSI in adolescent depression, and analyze the relationship between alexithymia, loneliness, resilience, and adolescent depression with NSSI, so as to provide a theoretical basis for psychotherapeutic interventions. METHOD The study sample involved inpatients and outpatients from 12 hospitals across China and adolescents with depression who met the DSM-5 diagnostic criteria for depression episode. The following scales were used: The Functional Assessment of Self-Mutilation, Toronto Alexithymia Scale, UCLA Loneliness Scale, and Connor Davidson Resilience Scale. RESULTS The detection rate of NSSI in adolescents with depression from 2021.01.01-2022.01.01 was 76.06% (1782/2343). Spearman's correlation analysis revealed a significant correlation between alexithymia, loneliness, resilience and NSSI in depressed adolescents, and the results of the non-parametric test showed that the differences between the two groups for each factor were statistically significant. Binary logistic regression results showed that alexithymia (B = 0.023, p = 0.003, OR = 1.023, 95% CI: 1.008-1.038) and depression (B = 0.045, p < 0.001, OR = 1.046, 95% CI: 1.026-1.066) are risk factors for NSSI, resilience (B = - 0.052, p < 0.001, OR = 0.949, 95% CI: 0.935 - 0.964) is a protective factor for NSSI. Alexithymia directly predicted NSSI and also indirectly influenced NSSI through the mediated effect of resilience. Loneliness moderates the first half of the path of this mediated model. CONCLUSION The present study confirms a moderated mediation effect: Alexithymia can have an impact on NSSI behaviors in depressed adolescents through the mediating role of resilience. Loneliness, as a moderating variable, moderated the first half of the pathway of the mediating model. We discuss perspectives for future research and interventions based on the findings of the study.
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Affiliation(s)
- Bing Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Mental Health Center, 230022, Hefei, China
- Hefei Fourth People's Hospital, Hefei, China
| | - Wei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Mental Health Center, 230022, Hefei, China
- Hefei Fourth People's Hospital, Hefei, China
| | - Lingmin Sun
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Mental Health Center, 230022, Hefei, China
- Hefei Fourth People's Hospital, Hefei, China
| | - Cheng Jiang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
| | - Yongjie Zhou
- Shenzhen Kangning Hospital, Shenzhen, China.
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China.
| | - Kongliang He
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China.
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China.
- Anhui Mental Health Center, 230022, Hefei, China.
- Hefei Fourth People's Hospital, Hefei, China.
- Psychological counseling department, Hefei Fourth People's Hospital, Anhui, 230000, China.
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Yue Y, Wang Y, Yang R, Zhu F, Yang X, Lu X, Zhu P, Wu Z, Li Z, Zhao X, Du X. Gender difference in the associations of childhood maltreatment and non-suicidal self-injury among adolescents with mood disorders. Front Psychiatry 2023; 14:1162450. [PMID: 37304441 PMCID: PMC10248456 DOI: 10.3389/fpsyt.2023.1162450] [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: 02/09/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) is a common feature among adolescents with mood disorders. Although childhood maltreatment has shown to be associated with non-suicidal self-injury (NSSI), previous studies have yielded mixed results in terms of different subtypes of childhood maltreatment and only few studies have investigated the effects of gender. The present cross-sectional study investigated effects of different types of childhood maltreatment on NSSI, as well as the role of gender in these effects. Methods In this cross-sectional study, a total of 142 Chinese adolescent inpatients with mood disorders (37 males and 105 females) were consecutively recruited within a psychiatric hospital. Demographic and clinical characteristics were collected. Participants were administered the Childhood Trauma Questionnaire (CTQ), the Functional Assessment of Self-Mutilation (FASM). Results 76.8% of the sample reported engaging NSSI in the previous 12 months. Female participants were more likely to engage in NSSI than males (p < 0.001). Participants in the NSSI group reported significantly more experiences of emotional abuse (p < 0.001) and emotional neglect (p = 0.005). With regards to gender differences, female participants who have experienced emotional abuse were more likely to engage in NSSI (p = 0.03). Conclusion As a whole, NSSI represents a frequent phenomenon among adolescent clinical populations and females were more likely to engage in NSSI than males. NSSI was significantly related to experiences of childhood maltreatment and specifically related to emotional abuse and emotional neglect over and above other types of childhood maltreatment. Females were more sensitive to emotional abuse than males. Our study highlights the importance of screening for subtypes of childhood maltreatment as well as considering the effects of gender.
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Affiliation(s)
- Yan Yue
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Yi Wang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ruchang Yang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Feng Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xuna Yang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xinchuan Lu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ping Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhengyan Wu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
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Yong N, Luo J, Luo JM, Yao YS, Wu J, Yang H, Li JD, Yang S, Leng YY, Zheng HC, Fan Y, Hu YD, Ma J, Tan YW, Pan JY. Non-suicidal self-injury and professional psychological help-seeking among Chinese left-behind children: prevalence and influencing factors. BMC Psychiatry 2023; 23:291. [PMID: 37101196 PMCID: PMC10134637 DOI: 10.1186/s12888-023-04801-0] [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: 11/24/2022] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a risk factor for suicide. This study aimed to investigate the prevalence of NSSI and professional psychological help-seeking status and influencing factors among left-behind children (LBC) in China. METHODS We implemented a population-based cross-sectional study in participants aged 10-18 years. Sociodemographic characteristics, NSSI, help-seeking status and coping style were measured by self-reported questionnaires. A total of 16,866 valid questionnaires were collected, including 6096 LBC. Binary logistic regression models were used to analyze the factors influencing NSSI and professional psychological help-seeking. RESULTS The incidence of NSSI among LBC was 4.6%, significantly higher than that of non-left-behind children (NLBC). This incidence was higher among girls. Moreover, 53.9% of LBC with NSSI did not receive any treatment and only 22.0% sought professional psychological help. LBC often adopt emotion-oriented coping styles, specifically, those with NSSI. LBC with NSSI who seek professional help tend to adopt problem-oriented coping styles. Logistic regression analysis revealed that girls, learning stage, single-parent, remarried families, patience, and emotional venting were risk factors for NSSI in LBC, while problem-solving and social support seeking were protective factors. Moreover, problem-solving was also a predictor for seeking professional psychological help, patience will prevent it. LIMITATIONS This was an online survey. CONCLUSIONS The prevalence of NSSI in LBC is high. Gender, grade, family structure, and coping style affect the occurrence of NSSI among LBC. Only a few LBC with NSSI seek professional psychological help, while the coping style will affect the help-seeking behavior.
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Affiliation(s)
- Na Yong
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
- Department of Child and Adolescent Psychology, Nanchong Psychosomatic Hospital, Nanchong, Sichuan, China
| | - Jing Luo
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jia-Ming Luo
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China.
| | - Yi-Song Yao
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jing Wu
- Mental Health Center, Southwest Petroleum University, Nanchong, Sichuan, China
| | - Han Yang
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jing-Dan Li
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Shuang Yang
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yuan-Yuan Leng
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hong-Chuan Zheng
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yang Fan
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ying-Dan Hu
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jin Ma
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ya-Wen Tan
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ji-Yang Pan
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
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Wang D, Ma Z, Fan Y, Chen H, Liu W, Zhang Y, Zeng H, Fan F. Associations Between Family Function and Non-suicidal Self-injury Among Chinese Urban Adolescents with and Without Parental Migration. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01528-7. [PMID: 37043049 DOI: 10.1007/s10578-023-01528-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/13/2023]
Abstract
The study aims to explore the effect of family function on non-suicidal self-injury (NSSI) among Chinese urban adolescents with and without parental migration. Between April 21st to May 12th, 2021, adolescents were recruited from Shenzhen city of Guangdong province, China (n = 124,357). Of all the participants, 22,855 (18.4%) were left-behind children (LBC). Family function, NSSI, depression, and socio-demographic characteristics were assessed using a series of self-reported questionnaires. Urban LBC had a higher NSSI frequency, while a lower level of family function than non-LBC. After controlling for confounders, parental migration was significantly associated with NSSI, and family dysfunction was a robust risk factor for NSSI as well. The protective effect of family function on NSSI of LBC was stronger than non-LBC. This implies that children with higher levels of family function tend to exhibit a lower frequency of NSSI, especially in those with parental migration. In practice, adolescents' NSSI prevention and intervention strategies should focus on improving family function.
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Affiliation(s)
- Dongfang Wang
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Zijuan Ma
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Yunge Fan
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Huilin Chen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Wenxu Liu
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Yifan Zhang
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Huijun Zeng
- Shenzhen Bao'an Institute of Education Sciences, Shenzhen, China
| | - Fang Fan
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China.
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Ohlis A, Bjureberg J, Ojala O, Kerj E, Hallek C, Fruzzetti AE, Hellner C. Experiences of dialectical behaviour therapy for adolescents: A qualitative analysis. Psychol Psychother 2023; 96:410-425. [PMID: 36756991 DOI: 10.1111/papt.12447] [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: 05/03/2022] [Revised: 12/14/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To explore how former patients in dialectical behaviour therapy for adolescents (DBT-A) experience their treatment, and specifically if there were aspects of the treatment that they retrospectively identify as particularly meaningful, helpful or unhelpful. DESIGN From a larger sample of 75 former DBT-A patients 19 were selected for a qualitative semi-structured interview study. METHODS Young adults (N = 19; 18 females, one male), who as adolescents had been enrolled in DBT-A due to self-harming behaviours and features of borderline personality disorder, were interviewed up to 8 years (median 6.0; min 1.3; max 8.2) after end of treatment, at mean age 23 years (SD 2.5). Reflexive thematic analysis was implemented. RESULTS Six key themes were revealed; (1) The need to be seen, listened to and believed in, (2) the importance of teamwork between patient and therapist, (3) the value of group and structure, (4) therapy as lifesaving and life-changing, (5) the risks of feeling misplaced and (6) the risks of abrupt endings. CONCLUSION A trusting relationship with the therapist promoted commitment and motivation for treatment. This relationship was facilitated by the therapist showing explicit care and belief in the patient's own competence in changing their destructive behaviours. Meeting peers in group skill training offered a salient form of validation and was reported to be of particular value. The format of meeting peers and the importance of the dialectical therapeutic stance need to be studied further. Not all youth experienced DBT-A as suitable and the need for sufficient treatment dose was emphasized.
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Affiliation(s)
- Anna Ohlis
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Psychology, Stanford University, Stanford, California, USA
| | - Olivia Ojala
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Emme Kerj
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Camilla Hallek
- DBT-unit, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alan E Fruzzetti
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Clara Hellner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Zhao L, Zhou D, Hu J, He X, Peng X, Ma L, Liu X, Tao W, Chen R, Jiang Z, Zhang C, Liao J, Xiang J, Zeng Q, Dai L, Zhang Q, Hong S, Wang W, Kuang L. Changes in microstates of first-episode untreated nonsuicidal self-injury adolescents exposed to negative emotional stimuli and after receiving rTMS intervention. Front Psychiatry 2023; 14:1151114. [PMID: 37181884 PMCID: PMC10172670 DOI: 10.3389/fpsyt.2023.1151114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background Nonsuicidal self-injury (NSSI) is a common mental health threat in adolescents, peaking in adolescence with a lifetime prevalence of ~17%-60%, making it a high-risk risk factor for suicide. In this study, we compared changes in microstate parameters in depressed adolescents with NSSI, depressed adolescents, and healthy adolescents during exposure to negative emotional stimuli, and further explored the improvement of clinical symptoms and the effect of microstate parameters of repetitive transcranial magnetic stimulation (rTMS) in depressed adolescents with NSSI, and more evidence was provided for potential mechanisms and treatment optimization for the occurrence of NSSI behaviors in adolescents. Methods Sixty-six patients with major depressive disorder (MDD) exhibiting NSSI behavior (MDD + NSSI group), 52 patients with MDD (MDD group), and 20 healthy subjects (HC group) were recruited to perform neutral and negative emotional stimulation task. The age range of all subjects was 12-17 years. All participants completed the Hamilton Depression Scale, the Patient Health Questionnaire-9, the Ottawa Self-Injury Scale and a self-administered questionnaire to collect demographic information. We provided two different treatments to 66 MDD adolescents with NSSI; 31 patients received medication and completed post-treatment scale assessments and EEG acquisitions, and 21 patients received medication combined with rTMS and completed post-treatment scale assessments and EEG acquisitions. Multichannel EEG was recorded continuously from 64 scalp electrodes using the Curry 8 system. EEG signal preprocessing and analysis was performed offline, using the EEGLAB toolbox in MATLAB. Use the Microstate Analysis Toolbox in EEGLAB for segmentation and computation of microstates, and calculate a topographic map of the microstate segmentation of the EEG signal for a single subject in each dataset, and four parameters were obtained for each microstate classification: global explained variance (GEV), mean duration (Duration), average number of occurrences per second (Occurrence), and average percentage of total analysis time occupied (Coverage), which were then statistically analyzed. Results Our results indicate that MDD adolescents with NSSI exhibit abnormalities in MS 3, MS 4, and MS 6 parameters when exposed to negative emotional stimuli compared to MDD adolescents and healthy adolescents. The results also showed that medication combined with rTMS treatment improved depressive symptoms and NSSI performance more significantly in MDD adolescents with NSSI compared to medication treatment, and affected MS 1, MS 2, and MS 4 parameters in MDD adolescents with NSSI, providing microstate evidence for the moderating effect of rTMS. Conclusion MDD adolescents with NSSI showed abnormal changes in several microstate parameters when receiving negative emotional stimuli, and compared to those not receiving rTMS treatment, MDD adolescents with NSSI treated with rTMS showed more significant improvements in depressive symptoms and NSSI performance, as well as improvements in EEG microstate abnormalities.
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Affiliation(s)
- Lin Zhao
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongdong Zhou
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Jinhui Hu
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoqing He
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Peng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingli Ma
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyi Liu
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Wanqing Tao
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Ran Chen
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenghao Jiang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Chenyu Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Liao
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaojiao Xiang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Zeng
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Linxi Dai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Hong
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wo Wang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Li Kuang,
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Patra BN, Sen MS, Sagar R, Bhargava R. Deliberate self-harm in adolescents: A review of literature. Ind Psychiatry J 2023; 32:9-14. [PMID: 37274564 PMCID: PMC10236686 DOI: 10.4103/ipj.ipj_215_21] [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: 10/14/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/11/2022] Open
Abstract
Deliberate self-harm is a rising epidemic in the youth. This review examined the different self-harm behavior, approach to treatment, and the implication of such behaviors in the adolescent population in the academic literature. Using the PubMed database, we searched for specific terms related to different self-harm behaviors in Adolescents. The bibliography of the articles found relevant for the review was also screened. Each study's findings were taken with reference to our topic and findings were summarized. After reviewing the literature, we found that the prevalence of suicidal attempts was as high as 18% in the past year While the nonsuicidal attempts were as high as 31%. Risk factors associated with higher levels of suicide were bullying, loneliness and anxiety, tobacco and alcohol use, and weak family and social relationships. While the factors playing a protective role are being connected to school, having good social support, and attending school. There are very few studies focused on interventions related to suicide prevention in Adolescent and postvention programs. Out of the evidence available, the interventions are not focused on the target individuals and lack replicability. Self-harm is a major public health concern which needs to be understood holistically. The interventions aimed at preventing and managing self-harm behavior still need to be more targeted and precise. Other targets may include interventions suited to different phases of development, stopping the progression of the behavior to adulthood, including the varied population in such intervention, etc.
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Affiliation(s)
- Bichitra Nanda Patra
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mahadev Singh Sen
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Bhargava
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Kaufman EA, Clerke AS, Meddaoui B. Translating core intervention strategies into action: Interpersonal validation among self-injuring adolescents and their mothers. J Clin Psychol 2023; 79:105-125. [PMID: 35611597 DOI: 10.1002/jclp.23393] [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: 07/24/2021] [Revised: 01/27/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Most evidence-supported treatments for psychiatric problems teach clients skills to incorporate into their daily lives. Yet little research rigorously examines the extent to which individuals absorb these strategies and can competently apply them outside of the therapeutic relationship. OBJECTIVES The current study examined the degree to which self-injuring adolescents and their mothers (n = 30 dyads) and typical control mother-daughter dyads (n = 30) were able to utilize a multicomponent interpersonal validation-oriented skill from dialectical behavior therapy, after a single teaching. We also aimed to assess whether variance in Gentle, Interested, Validate, and Easy (GIVE) skill practice was associated with a physiological index of emotion regulation (respiratory sinus arrhythmia [RSA]). METHOD An observational coding system was developed to measure skill-related behavior across four key domains (be[ing] gentle, act[ing] interested, validation, and us[ing] an easy manner; GIVE) and applied during two family conflict discussions (pre- and postskills training). Mother and adolescent RSA data were collected at rest and across discussion tasks. RESULTS Behavioral indicators of skill use improved pre-to-post skills training across the entire sample, except in one GIVE domain (easy manner). Self-injuring youth and their mothers demonstrated greater improvements than control dyads with respect to being gentle. RSA reactivity scores predicted behavioral validation, such that higher RSA was associated with higher validation scores. CONCLUSIONS As a field, we currently have a limited understanding of how intervention skills are used, and what factors predict effective skill application. Results suggest self-injuring adolescents and their mothers can learn and improve on most aspects of a core intervention strategy after a single teaching and that better physiological regulation during conflict is associated with more validating behaviors.
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Affiliation(s)
- Erin A Kaufman
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - Alexa S Clerke
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - Brianna Meddaoui
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
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Gómez-Peresmitré G, Platas-Acevedo RS, León-Hernández R, Pineda-García G, Guzmán-Saldaña R. Psychometric Assessment of an Online Self-Test Measuring Risky Eating Behavior, Depression, Social Anxiety, and Self-Injury in Mexican Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:399. [PMID: 36612722 PMCID: PMC9819483 DOI: 10.3390/ijerph20010399] [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: 11/07/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
The objective of this study was to evaluate the validity and reliability of OTESSED, an online test for the self-detection and prevention of risk factors for eating disorders and related problems, such as depression, social anxiety, and self-injury, in samples of male and female adolescents. Participants formed a non-probability sample of N = 577 high school students. The mean ages of boys and girls were the same (Mage = 15.61; SD = 0.73). Among the main results, scales of depression, self-injury, social anxiety, and risky eating behavior (REB) with construct validity (CFA) were obtained. The first two showed the same structure (two factors per sex), with an appropriate reliability omega value (0.92), and a similar percentage of explained variance (≥50). The REB scale presented two factors for boys and three for girls, with an appropriate omega value (0.88) and explained variance percentage (0.56). The instrument validation process was completed, meeting the discriminant validity criterion for each scale of the OTESSED.
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Affiliation(s)
- Gilda Gómez-Peresmitré
- Faculty of Psychology, The National Autonomous University of Mexico, Av. Universidad 3004 Col Copilco-Universidad, Alcaldía Coyoacán, Mexico City C.P. 04510, Mexico
| | - Romana Silvia Platas-Acevedo
- Faculty of Psychology, The National Autonomous University of Mexico, Av. Universidad 3004 Col Copilco-Universidad, Alcaldía Coyoacán, Mexico City C.P. 04510, Mexico
| | - Rodrigo León-Hernández
- National Council of Science and Technology, Avenida Insurgentes Sur 1582, Crédito Constructor, Ciudad de México C.P. 03940, Mexico
| | - Gisela Pineda-García
- Faculty of Medicine and Psychology, Autonomous University of Baja California, Cal. University 14418, International Industrial Park, Tijuana C.P. 22390, Mexico
| | - Rebeca Guzmán-Saldaña
- Institute of Health Sciences, Autonomous University of the State of Hidalgo, Camino a Tilcuautla s/n Pueblo San Juan Tilcuautla, Hidalgo C.P. 42160, Mexico
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Ojala O, Kuja-Halkola R, Bjureberg J, Ohlis A, Cederlöf M, Norén Selinus E, Lichtenstein P, Larsson H, Lundström S, Hellner C. Associations of impulsivity, hyperactivity, and inattention with nonsuicidal self-injury and suicidal behavior: longitudinal cohort study following children at risk for neurodevelopmental disorders into mid-adolescence. BMC Psychiatry 2022; 22:679. [PMID: 36329415 PMCID: PMC9635086 DOI: 10.1186/s12888-022-04311-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The knowledge of how the separate Attention-Deficit/Hyperactivity Disorder (ADHD) subdimensions (impulsivity, hyperactivity, and inattention) are associated with nonsuicidal self-injury (NSSI) and suicidal behavior (SB) is limited. The objective of this study was to investigate the associations of childhood ADHD subdimensions with NSSI and SB in children at risk of neurodevelopmental disorders (NDDs; including ADHD). METHODS The sample (N = 391) included twin pairs where at least one twin screened positive for at least one NDD or common comorbidity at age 9 or 12. Data on ADHD subdimensions was collected through a telephone interview with a caregiver/legal guardian at age 9 or 12, and data on NSSI and SB was collected through an in-person clinical assessment at age 15. The associations between the ADHD subdimensions and NSSI or SB were tested in three different models: (1) univariable, (2) together with the other ADHD subdimensions, and (3) in a confounder-adjusted model including other NDD symptoms in addition to ADHD subdimensions, for NSSI and SB separately. RESULTS A total of 32 (8.2%) adolescents reported life-time engagement of NSSI, and 18 (4.6%) SB. Childhood impulsivity was associated with SB and childhood inattention with NSSI, in all models. Hyperactivity was not meaningfully associated with any of the outcomes. CONCLUSION Impulsivity and inattention, but not hyperactivity, may be of particular importance in understanding SB and NSSI. Brief screening for impulsivity and inattention in childhood could facilitate detection of children vulnerable to NSSI and SB and indicate valuable information for preventive and intervention strategies.
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Affiliation(s)
- Olivia Ojala
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Anna Ohlis
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Cederlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Eva Norén Selinus
- Region Vastmanland - Uppsala University, Centre for Clinical Research, Vastmanland Hospital, Vasteras, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Centre for Ethics, Law and Mental health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden
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Karvonen M, Karukivi M, Kronström K, Kaltiala R. The nature of co-morbid psychopathology in adolescents with gender dysphoria. Psychiatry Res 2022; 317:114896. [PMID: 37732850 DOI: 10.1016/j.psychres.2022.114896] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 10/31/2022]
Abstract
Gender-referred adolescents (GR) have been reported to present with considerable psychiatric symptomatology compared to their age-peers. There is, however, little research on how they compare to adolescents referred due to mental health problems (MHR). We set out to compare psychopathology in adolescents referred to our specialized gender identity unit (n = 84) and adolescents referred to a general adolescent psychiatric clinic (n = 293) in a university hospital setting in Finland. Of the GR adolescents, 40.9% had not received any psychiatric diagnosis during adolescence. Eating disorders were less common in the GR than in the MHR group, but otherwise the prevalences of disorders did not differ statistically significantly. At the symptom level, the GR adolescents displayed significantly more suicidal ideation and talk and less alcohol abuse and eating disorder symptoms than did the MHR adolescents, but otherwise their symptom profiles were comparable. Additionally, the GR adolescents had significantly fewer total externalizing symptoms than did the MHR adolescents. Adolescents seeking gender affirming treatments present with psychiatric symptoms and disorders comparable to those seen among adolescent psychiatric patients. Medical gender affirming care may not be a sufficient intervention for treating psychiatric comorbidities of adolescents with gender dysphoria.
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Affiliation(s)
- M Karvonen
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland.
| | - M Karukivi
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - K Kronström
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - R Kaltiala
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Vanha Vaasa Hospital, Vaasa, Finland
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Bazzano AN, Sun Y, Chavez-Gray V, Akintimehin T, Gustat J, Barrera D, Roi C. Effect of Yoga and Mindfulness Intervention on Symptoms of Anxiety and Depression in Young Adolescents Attending Middle School: A Pragmatic Community-Based Cluster Randomized Controlled Trial in a Racially Diverse Urban Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12076. [PMID: 36231378 PMCID: PMC9564597 DOI: 10.3390/ijerph191912076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Mental health conditions in childhood and adolescence are increasing in the U.S. population and require early intervention, as highlighted by a recent Surgeon General's Advisory on Protecting Youth Mental Health. These health issues, which have been exacerbated by the COVID-19 pandemic, impair functioning, and may lead to longer term reductions in quality of life. Young adolescents are likely to experience stressors including academic pressure, feelings of loneliness and isolation, and excessive exposure to social media, all of which have been made worse by the pandemic and associated disruptions. Universal preventive programs at school serve as an important strategy for equipping youth with coping skills to address current and future social and emotional challenges. Yoga and mindfulness programs have emerged as a promising preventive approach for schools and have proven feasible and acceptable. The current study evaluated a universal, school-based mindfulness and yoga program among youth aged 11-14 in a racially diverse, urban setting in the United States. Outcomes of interest included symptoms of anxiety and depression. Anxiety and depression symptoms decreased in the intervention group, although these differences were not statistically significant. In the control group, anxiety symptoms decreased but depression symptoms increased. The resulting time effect indicated a significant decrease in anxiety symptoms, while the time by group effect revealed a strong trend in depression symptoms. Future research should investigate the utility of yoga and mindfulness interventions for early adolescents in a larger population, and the differences in intervention effect among subgroups, with attention to longer term outcomes.
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Affiliation(s)
- Alessandra N. Bazzano
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Yaoyao Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
| | - Vaughne Chavez-Gray
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Temitope Akintimehin
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Jeanette Gustat
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Denise Barrera
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Cody Roi
- Department of Child and Adolescent Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
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Zhu X, Griffiths H, Eisner M, Hepp U, Ribeaud D, Murray AL. Developmental Relations Between Bullying Victimization and Suicidal Ideation in Middle Adolescence and Emerging Adulthood: Do Internalizing Problems and Substance Use Mediate Their Links? J Youth Adolesc 2022; 51:1745-1759. [PMID: 35568749 PMCID: PMC9279233 DOI: 10.1007/s10964-022-01630-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/05/2022] [Indexed: 02/06/2023]
Abstract
Previous research has suggested that bullying victimization is associated with higher suicidal risk among young people; however, the mechanisms underlying this relation have not been well examined. The current study aimed to illuminate the developmental links between bullying victimization and suicidal ideation by examining the mediating roles of depressive symptoms, anxiety symptoms, and substance use. The study sample consisted of n = 1465 participants (51.7% male) from the normative z-proso study. Using random intercept cross-lagged panel models and three waves of longitudinal data (ages 15, 17, and 20), the hypothesized mediation effects at the within-person level were tested while partialling out between-person confounds. The results suggested that, at the within-person level, bullying victimization did not predict subsequent suicidal ideation via depressive symptoms, anxiety symptoms, or substance use. However, age 15 bullying victimization predicted within-person increases in age 17 depressive symptoms and suicidal ideation. In addition, depressive symptoms at age 15 and tobacco and cannabis use at age 17 were associated with within-person increases in bullying victimization at ages 17 and 20, respectively. The results also indicated that cannabis use and suicidal ideation were positively and reciprocally related over time. Future studies collecting data at multiple timescales are needed to understand proximal and longer-term mechanisms underlying the relation between bullying victimization and suicidality.
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Affiliation(s)
- Xinxin Zhu
- Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - Helen Griffiths
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK
| | - Manuel Eisner
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur-Zurcher Unterland, Winterthur, Switzerland
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
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Vidal-Arenas V, Bravo AJ, Ortet-Walker J, Ortet G, Mezquita L, Ibáñez MI, Cross-cultural Addictions Study Team. Neuroticism, rumination, depression and suicidal ideation: A moderated serial mediation model across four countries. Int J Clin Health Psychol 2022; 22:100325. [PMID: 35950010 PMCID: PMC9343412 DOI: 10.1016/j.ijchp.2022.100325] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background/objective Research has highlighted the role of neuroticism, rumination, and depression in predicting suicidal thoughts, but studies on how these variables interplay are scarce. The aims of the present study were to test a model in which emotional stability (i.e., low neuroticism) would act as an antecedent and moderator of rumination and depressed mood in the prediction of suicidal ideation (i.e., moderated serial-mediation), and to explore their replicability across four countries and sex, among college students as an at-risk-group for suicide. Method Participants were 3482 undergraduates from U.S, Spain, Argentina, and the Netherlands. Path analysis and multi-group analysis were conducted. Results Emotional stability was indirectly linked to suicidal ideation via rumination and depressed mood. Moreover, emotional stability moderated the associations between rumination and depressed mood, and between depressed mood and suicidal ideation. Findings were consistent in males and females, and across countries studied. Discussion Regardless of sex and country, people with low emotional stability reported higher levels of rumination, which in turn was associated with more depressed mood, and these were associated with higher reports of suicidal thoughts. This cascade of psychological risk factors for suicidal ideation seems to be more harmful in people who endorse low levels of emotional stability.
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