Non-Suicidal self-injury and suicide in depressed Adolescents: Impact of peer victimization and bullying

Cumulative ecological risk and nonsuicidal self-injury in adolescents: The mediation of depression and the moderation of impulsiveness

BACKGROUND

This study is based on the biosocial model of nonsuicidal self-injury (NSSI), to explore the effects of cumulative ecological risk on adolescents' NSSI, the mediating effect of depression between cumulative ecological risk and adolescents' NSSI, and the moderating role of impulsiveness in this mediating pathway.

METHODS

A total of 16 508 adolescents, with 7903 males (47.9%), participated in the study and completed the Cumulative Ecological Risk Questionnaire, the Short Form of the Center for Epidemiological Studies Depression Scale, the Impulsiveness assessment, and the Nonsuicidal Self-Injury Scale.

RESULTS

(1) There was a significant positive correlation between cumulative ecological risk, depression, impulsiveness, and NSSI; (2) cumulative ecological risk significantly predicted adolescents' NSSI; (3) depression had a mediating effect between cumulative ecological risk and adolescents' NSSI; and (4) impulsiveness moderated both the effects of cumulative ecological risk on adolescents' depression and NSSI and the effects of depression on NSSI in adolescents.

CONCLUSIONS

Impulsiveness and depression are risk factors for adolescent NSSI and play a crucial role between cumulative ecological risk and NSSI in adolescents.

The Effect of Teacher Discrimination Behavior on Adolescent Suicidal Ideation: A Cross-Sectional Survey

Introduction

 Suicidal ideation and suicidal behavior, as the most severe psychological and behavioral problems among adolescents, bring not only significant damage to individual social functioning but also cause enormous economic and social pressure, which will ultimately be detrimental to social development and social stability. This paper aimed to explore the potential relationship between teacher discrimination behavior, peer bullying victimization, anxiety disorders, and adolescent suicidal ideation based on the Vulnerability-Stress Model.

Methods

 From September to November 2022, our research team surveyed 21,017 junior high school students from 12 secondary schools in ten cities in China. Mplus 8.3 software was used to analyze the pathways of teacher discrimination behavior on adolescent suicidal ideation.

Results

 The results showed that teacher preference had a significant negative effect on suicidal ideation, and teacher prejudice significantly positively affected suicidal ideation. Mediation test results indicated that there were significant independent mediating effects of peer bullying victimization and anxiety disorders between teacher discrimination behavior and adolescents' suicidal ideation, as well as significant chain mediating effects.

Conclusion

 Secondary school teachers should improve their self-quality and pay more attention to adolescents' suicidal ideation. Teachers are expected to put love into their education, respect and trust each student, and attend to their emotional needs unbiasedly. Educators should develop targeted prevention and intervention measures according to the actual situation of school bullying and also strengthen adolescents' life-value education to improve the psychological quality of adolescents and create a healthy campus atmosphere.

Neural Reactivity to Social Punishment Predicts Future Engagement in Nonsuicidal Self-injury Among Peer-Rejected Adolescents

BACKGROUND

Rates of nonsuicidal self-injury (NSSI) increase dramatically in adolescence. Affective reactivity and adverse social experiences have been linked to NSSI, but less is known about whether these factors may separately or interactively predict NSSI, especially longitudinally. This study combined functional magnetic resonance imaging and a sociometric measure to test whether a combination of neural (e.g., amygdala) reactivity to social punishment and peer-nominated peer acceptance/rejection predicts NSSI longitudinally in adolescence. Amygdala reactivity was examined as a potential neural marker of affective reactivity to social punishment, which may heighten NSSI risk in contexts of social adversity.

METHODS

One hundred twenty-five adolescents (63 female) completed a social incentive delay task during neuroimaging and school-based peer nominations to measure peer acceptance/rejection. NSSI engagement was assessed at baseline and 1-year follow-up.

RESULTS

Greater amygdala reactivity to social punishment predicted greater NSSI engagement 1 year later among adolescents with high peer rejection. This effect for the amygdala was specific to social punishment (vs. reward) and held when controlling for biological sex and pubertal development. Exploratory analyses found that ventral striatum reactivity to social reward and punishment similarly interacted with peer rejection to predict NSSI but that amygdala connectivity with salience network regions did not.

CONCLUSIONS

Amygdala reactivity to social punishment, in combination with high peer rejection, may increase NSSI risk in adolescence, possibly via heightened affective reactivity to adverse social experiences. Objective measures of neurobiological and social risk factors may improve prediction of NSSI, while therapeutic approaches that target affective reactivity and increase prosocial skills may protect against NSSI in adolescence.

Childhood trauma, peer victimization, and non-suicidal self-injury among Chinese adolescents: a latent variable mediation analysis

BACKGROUND

Childhood and peer experiences can influence adolescents' perceptions of interpersonal relationships, which can, in turn, influence their emotional states and behavior patterns. Non-suicidal self-injury (NSSI) is now a common problem behavior among adolescents. The present study examined the role of childhood trauma and peer victimization in adolescents' NSSI.

METHODS

A cross-sectional survey was conducted among 1783 adolescents (1464 girls and 318 boys) in the psychiatric outpatient clinics or wards of 14 psychiatric hospitals or general hospitals in nine provinces in China. Data were collected using the Multidimensional Peer Victimization Scale (MPVS), Short-form Childhood Trauma Questionnaire(CTQ-SF), and Functional Assessment of Self-Mutilation (FASM). Structural equation modeling (SEM) with latent variables was used to demonstrate the mediating role of peer victimization in the association between childhoodtrauma and NSSI.

RESULTS

The SEM analysis demonstrated that peer victimization plays a partial mediating role in the relationship between childhood trauma and NSSI. In addition, several covariates (such as age, gender, education level, and place of residence) effectively regulated the relationship between peer victimization and NSSI.

CONCLUSION

In future studies of NSSI among Chinese adolescents, attention should be paid to the roles of childhood trauma and peer bullying; there is a temporal sequence between these two variables and, to some extent, childhood trauma can have an impact on bullying during adolescence which, in turn, influences NSSI behavior.

Applying the interpersonal-psychological theory of suicide to inform the association between bullying victimization and suicidal ideation in college students

Objective: Victims of bullying are at increased risk for suicidal ideation. The purpose of the current study is to examine the impact of bullying victimization in childhood on college student's current report of suicidal ideation through two mechanisms derived from the interpersonal-psychological theory of suicide. Participants: Our sample consists of 304 undergraduate college students from a large, southeastern university. Methods: We employed a cross-sectional design with self-report surveys to examine the indirect effects of childhood bullying victimization frequency on suicidal ideation through thwarted belongingness and perceived burdensomeness. Results: The association between bullying victimization and suicidal ideation was explained by perceived burdensomeness, but not thwarted belongingness. Conclusions: Bullying victimization in childhood may have distal effects on suicidal ideation through influencing perceptions of worthlessness and self-hatred. Interventions in college settings that address the impact of bullying victimization on perceived burdensomeness may reduce potential for suicidal ideation among college students.

A cross-sectional study of non-suicidal self-injury in a Chinese adolescent inpatient cohort

Background

Non-suicidal self-injury (NSSI) is a significant predictor of completed suicide and is increasingly recognized as a serious public health concern. Multiple factors, including social, familial, mental, and genetic factors could influence the occurrence of this behavior. Identifying the early risk factors is important for screening and preventing this behavior.

Methods

Here, we recruited a total of 742 adolescent inpatient participants from a mental health center and conducted a series of diagnostic interviews and questionnaires to assess NSSI behavior and other events. Bivariate analysis was used to detect differences between groups in NSSI and non-NSSI. Then, binary logistic regression was fitted to identify predictors of NSSI as a function of these questionnaire scores.

Results

Of the 742 adolescents examined, a total of 382 (51.5%) participants engaged in NSSI. Bivariate analysis showed that age, gender, depression, anxiety, insomnia, and childhood trauma was significantly associated with NSSI. Logistic regression results suggested that females had 2.43 higher odds of engaging in NSSI when compared to their male counterparts (OR = 3.43, 95%CI = 2.09-5.74, p = 1.70 × 10^-6). Depression was a primary risk predictor for NSSI with each additional increase in symptoms of depression increasing the odds of engaging in NSSI by 18% (OR = 1.18, 95%CI = 1.12-1.25, p = 2.25 × 10^-8).

Conclusion

More than half of the adolescent inpatients with psychiatric disorders have NSSI experience. Depression and gender were the risk factors for NSSI. Age at a specific range had a high prevalence of NSSI.

Risk factors, theoretical models, and biological mechanisms of nonsuicidal self-injury: a brief review

Nonsuicidal self-injury (NSSI) refers to the direct, deliberate infliction of harm to one's body tissue without the intention to die. The prevalence of NSSI has increased significantly globally in recent years and has become an important public health problem affecting the health of people, especially adolescents. The occurrence of NSSI in adolescents is the result of the interaction of different factors. Many scholars have proposed various theoretical models to explain the mechanism of NSSI behavior based on previous research on the influencing factors of NSSI. Moreover, advances have been made in genetic and neuroimaging mechanisms related to NSSI. Understanding the genetic and neuroimaging mechanisms of NSSI is important for both describing and treating the disorder. This literature review discusses the progress made on the risk factors, theoretical models, and biological mechanisms of NSSI.

Heterogeneity of non-suicidal self-injury behavior in adolescents with depression: latent class analysis

BACKGROUND

Non-suicidal self-injury (NSSI) by adolescent patients with depression has become a serious public health problem. This cross-sectional study aims to identify subgroups of adolescents based on NSSI and explore the factors related to these subgroups.

METHODS

The study recruited 326 in- and out-patient adolescents (263 girls and 63 boys) aged 12 to 18 years (mean = 14.7, SD = 1.6) who had self-injured in the past year. Latent class indicators included 12 NSSI variables, as well as suicidal ideation. Logistic regression examined associations between identified classes and related factors.

RESULTS

In this study, two distinct subgroups were identified: a "high suicidal ideation NSSI group" (n = 129, 39.6%) and a "low suicidal ideation NSSI group" (n = 197, 60.4%). Depression (OR = 1.10; 95% CI, 1.05-1.16), female (OR = 2.01; 95% CI, 1.09-3.69), left-behind experience (OR = 2.08; 95% CI, 1.17-3.71), single-parent family (OR = 1.84; 95% CI, 1.11-3.04) and peer victimization (OR = 1.04; 95% CI, 1.02-1.05) increases the probability of belonging to the "high suicidal ideation NSSI group". A high level of perceived social support (OR = 0.99; 95% CI, 0.97-0.99) was a protective factor towards NSSI.

CONCLUSIONS

This study identifies two subgroups of NSSI and the factors associated with each subgroup. The early identification of high-risk groups for major NSSI in adolescents diagnosed with depression is possible due to the identification of correlating factors. Different treatment plans can be developed for different subtypes of NSSI to improve the effectiveness of prevention and intervention, promoting the healthy physical and mental development of adolescents with depression.

Associations of bullying perpetration and peer victimization subtypes with preadolescent's suicidality, non-suicidal self-injury, neurocognition, and brain development

BACKGROUND

Although both peer victimization and bullying perpetration negatively impact preadolescents' development, the underlying neurobiological mechanism of this adverse relationship remains unclear. Besides, the specific psycho-cognitive patterns of different bullying subtypes also need further exploration, warranting large-scale studies on both general bullying and specific bullying subtypes.

METHODS

We adopted a retrospective methodology by utilizing the data from the Adolescent Brain and Cognitive Development^SM Study (ABCD Study®) cohort collected between July 2018 and January 2021. Participants were preadolescents aged from 10 to 13 years. The main purpose of our study is to examine the associations of general and specific peer victimization/bullying perpetration with preadolescents' (1) suicidality and non-suicidal self-injury; (2) executive function and memory, including attention inhibition, processing speed, emotion working memory, and episodic memory; (3) brain structure abnormalities; and (4) brain network disturbances. Age, sex, race/ethnicity, body mass index (BMI), socioeconomic status (SES), and data acquisition site were included as covariates.

RESULTS

A total of 5819 participants aged from 10 to 13 years were included in this study. Higher risks of suicide ideation, suicide attempt, and non-suicidal self-injury were found to be associated with both bullying perpetration/peer victimization and their subtypes (i.e., overt, relational, and reputational). Meanwhile, poor episodic memory was shown to be associated with general victimization. As for perpetration, across all four tasks, significant positive associations of relational perpetration with executive function and episodic memory consistently manifested, yet opposite patterns were shown in overt perpetration. Notably, distinct psycho-cognitive patterns were shown among different subtypes. Additionally, victimization was associated with structural brain abnormalities in the bilateral paracentral and posterior cingulate cortex. Furthermore, victimization was associated with brain network disturbances between default mode network and dorsal attention network, between default mode network and fronto-parietal network, and ventral attention network related connectivities, including default mode network, dorsal attention network, cingulo-opercular network, cingulo-parietal network, and sensorimotor hand network. Perpetration was also associated with brain network disturbances between the attention network and the sensorimotor hand network.

CONCLUSIONS

Our findings offered new evidence for the literature landscape by emphasizing the associations of bullying experiences with preadolescents' clinical characteristics and cognitive functions, while distinctive psycho-cognitive patterns were shown among different subtypes. Additionally, there is evidence that these associations are related to neurocognitive brain networks involved in attention control and episodic retrieval. Given our findings, future interventions targeting ameliorating the deleterious effect of bullying experiences on preadolescents should consider their subtypes and utilize an ecosystemic approach involving all responsible parties.

Peer Victimization and Adolescent Non-Suicidal Self-Injury: The Mediating Role of Alienation and Moderating Role of Mindfulness

Peer victimization and non-suicidal self-injury (NSSI) are two major public health problems, with the former being associated with outward attack and the latter characterizing inward attack. Peer victimization has been shown to be associated with adolescents' NSSI. However, less is known about the mechanism underlying the association. Based on the experiential avoidance model of NSSI, this study tested whether the sense of alienation mediated the association between peer victimization and NSSI, and whether this process was weakened by mindfulness. A total of 1,574 Chinese adolescents (51.1% girls; ages 12-16 years) completed questionnaires concerning NSSI, peer victimization, alienation, and mindfulness. Regression-based analyses indicated that peer victimization predicted adolescents' NSSI through the indirect effect of alienation, and mindfulness weakened this indirect effect. These findings suggest that victimized adolescents may injure themselves as an emotion regulation strategy. The results highlight the importance to implement programs aimed to improve the school climate to reduce the risk of adolescent NSSI. Furthermore, we underscore the need to include emotion-regulation training (e.g., mindful practice) into bully intervention programs to prevent NSSI.

Influence of academic stress and school bullying on self-harm behaviors among Chinese middle school students: The mediation effect of depression and anxiety

Objective

The purpose of this study was to explore the relationship between academic stress, school bullying and self-harm behaviors among Chinese middle school students and to further explore the impact of anxiety and depression on this relationship.

Methods

The students (aged 12-16 years) in a middle school in Changsha city were invited to respond to a questionnaire through an online platform. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess the severity of anxiety and depressive symptoms, respectively. The experience of being bullied, academic stress, and self-harm behaviors were assessed using several questions on the basis of previous studies.

Results

A total of 1,313 middle school students completed the study, and 3.40% and 4.10% of them reported suicide attempts (SAs) and non-suicidal self-injury (NSSI), respectively. Univariate logistic regression analysis revealed that anxiety symptoms (OR = 1.23, 95% CI: 1.18-1.28; OR = 1.25, 95% CI: 1.19-1.31), depressive symptoms (OR = 1.20, 95% CI: 1.16-1.25; OR = 1.26, 95% CI: 1.20-1.31), school bullying (OR = 3.8, 95% CI: 2.11-6.89; OR = 2.76, 95% CI: 1.39-5.47), and academic stress (OR = 2.20, 95% CI: 1.27-3.80; OR = 3.80, 95% CI: 1.20-7.25) were common factors of NSSI and SAs. In addition, depressive symptoms showed a mediating effect on the association of school bullying and academic stress with SAs or NSSI, and anxiety symptoms showed a mediating effect on the association of school bullying and academic stress with NSSI only.

Conclusion

Appropriate strategies are needed to reduce academic pressure and prevent school bullying. Meanwhile, negative emotions such as depression and anxiety should be evaluated and intervened in to prevent self-harm behaviors among middle school students.

The Relationship Between Bullying Victimization and Perpetration and Non-suicidal Self-injury: A Systematic Review

Experience of bullying may be a significant risk factor for non-suicidal self-injury (NSSI). This study had three aims: to systematically investigate the association between bullying and NSSI, analyze the possible mechanisms underlying the two phenomena, and evaluate any differences between bullying victimization and bullying perpetration with respect to NSSI. A systematic search about the association between bullying victimization and perpetration and NSSI was conducted using specific databases (PubMed, Scopus, Science Direct). The following keywords were used in all database searches: "bullying" AND "NSSI" OR "peer victimization" and NSSI. The searches in PubMed, Scopus and Science Direct revealed a total of 88 articles about bullying or peer victimization and NSSI. However, only 29 met our inclusion criteria and were used for the present review. Overall, all studies examined victimization; four studies also evaluated the effects of perpetration and one included bully-victims. According to the main findings, both being a victim of bullying and perpetrating bullying may increase the risk of adverse psychological outcomes in terms of NSSI and suicidality in the short and the long run. To the best of our knowledge, this is the first review to systematically evaluate the relation between bullying victimization/perpetration and NSSI. The main results support a positive association. Future research should evaluate the possible role of specific mediators/moderators of the association between experience of bullying and NSSI.

High-risk group and functional subtypes of non-suicidal self-injury in young adults with mental disorders

BACKGROUND

Identifying high-risk groups of non-suicidal self-injury (NSSI) with multiple risk factors and different functional subtypes contribute to implementing person-centered interventions.

METHODS

We investigated NSSI profiles among a sample of 258 psychiatric inpatients aged 18-25 years. All participants completed well-validated measures of internal personal and external environmental characteristics. One-hundred and ninety patients reported a lifetime history of NSSI and completed an additional NSSI assessment. A k-means cluster analysis was conducted to extract characteristics of risk factors and functional subtypes. Independent sample t-test, analysis of variance and χ ² test were used to test the difference of demographic statistical factors, risk factors and functional scores among groups with different frequency of NSSI.

RESULTS

The clustering of risk factors analyses supported 4-clusters. The proportion of repeat NSSI patients was the highest (67.1%) in the group with unfavorable personal and unfavorable environmental characteristics. Functional subtype clustering analyses supported 5-clusters. Among patients with repeated NSSI, those with depression were mainly accompanied by the "Sensation Seeking" subtype (39.7%), bipolar disorder mainly supported the "Anti-suicide" subtype (37.9%), and eating disorders were mostly "Social Influence" subtype (33.3%). There was an interaction between functional subtypes and mental disorders.

LIMITATIONS

All participants were in treatment in a psychiatric service and the results may not be generalizable to a community sample. The data included retrospective self-report which may be inaccurate due to recall bias.

CONCLUSION

It is necessary to identify high-risk groups of NSSI who with unfavorable personal and environmental characteristics and clinical interventions need to consider the heterogeneity of patients' functional subtypes of NSSI.

Bullying victimization and suicide attempts among adolescents in 41 low- and middle-income countries: Roles of sleep deprivation and body mass

Background

Suicide is the fourth leading cause of death for adolescents, and globally, over 75% of completed suicides occur in low- and middle-income countries (LMICs). Bullying has been proven to be closely related to suicide attempts. However, further understanding of the mechanisms underlying the relationship between bullying and adolescents' suicide attempts is urgently needed.

Methods

We used data from the Global School-based Student Health Survey (GSHS) (2010-2017) from 41 LMICs or regions. This study was based on questions assessing bullying victimization, suicide attempts, sleep deprivation, and body mass. Chi-square tests were used to explore the correlations among the main variables. The mediating role of sleep deprivation and the moderating role of body mass index (BMI) were analyzed using PROCESS.

Results

The results showed a positive association between bullying victimization and suicide attempts. Sleep deprivation partially mediated the relationship between the frequency of being bullied and suicide attempts. In addition, sleep deprivation played a full or partial mediating role in the relationship between different types of bullying and suicide attempts. BMI moderated the relationships between the frequency of being bullied and suicide attempts, between being made fun of about one's body and sleep deprivation, and between sleep deprivation and suicide attempts.

Conclusion

Being bullied has a positive effect on suicide attempts, which is mediated by sleep deprivation and moderated by body mass. The results of this study are consistent with the stress-diathesis model of suicide, suggesting that being bullied is one of the stressors of suicide in adolescents, while sleep deprivation and body mass are susceptibility diatheses of suicide. The results are conducive to identifying adolescents at a high risk of suicide, suggesting that there is a need to pay more attention to bullied adolescents, especially their sleep quality and body mass, and design effective intervention measures to improve the current situation of adolescent suicide in LMICs.

The Influence of Cyberbullying on Nonsuicidal Self-Injury and Suicidal Thoughts and Behavior in a Psychiatric Adolescent Sample

Cyberbullying is a well-established risk factor for suicidal thoughts and behavior in adolescents. However, research examining the differential influence of different forms of cyberbullying on suicidality is limited. This exploratory study investigated the association between cyberbullying and self-injurious thoughts and behaviors separately. Specifically, the study sought to examine how being the subject of online rumors, illicit photographs, and threatening messages related to nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempt (SA) history in an adolescent psychiatric sample (n = 64). The findings demonstrated that endorsement of any form of cyberbullying was significantly associated with NSSI. Further, victims of online rumors were over fifteen times more likely to engage in NSSI, and all participants who reported involvement in illicit photographs endorsed NSSI. Additionally, participants who endorsed involvement in an online rumor were nearly seventeen times more likely to report SA history. The forms of cyberbullying assessed were not significantly associated with SI.

Association between school bullying victimization and self-harm in a sample of Chinese children and adolescents: The mediating role of perceived social support

Background

Studies indicated that bullying victimization (BV) is an important risk factor for self-harm in children and adolescents. However, it is unclear whether perceived social support significantly mediates this association. This study aimed to examine the association between BV and self-harm, with a particular focus on the mediating role of perceived social support.

Methods

A population-based cross-sectional study of 4,627 Chinese students aged from 10 to 17 years was conducted in southwestern China Yunnan province. A two-stage simple random cluster sampling method was used to choose study subjects. The adjusted associations between school BV, perceived social support, and self-harm were examined by using the multivariate logistic regression models. The mediation of perceived social support in the association between BV and self-harm was evaluated by using a path model.

Results

After controlling potential covariates, BV was associated with a prevalence of increased self-harm, with an adjusted odds ratio of 1.90 (95% CI: 1.57, 2.32). Among all sources of perceived social support, only parental support played a prominent mediating role in the association between BV and self-harm, accounting for 20.73% of the explained variance. The mediation of parental support was comparable between boys and girls. As for different types of bullying victimization, path analyses indicated that only the association between physical victimization and self-harm was significantly mediated by parental support.

Conclusion

Our study results highlighted the promising interventional benefit of parental support in BV-associated self-harm risk for children and adolescents. For victims of bullying, especially physical bullying, promoting parental support might be effective in reducing self-harm risk. Longitudinal studies are warranted to further corroborate these findings.

The effects of peer bullying and poverty on suicidality in Chinese left behind adolescents: The mediating role of psychotic-like experiences

AIM

This study investigated the influence of childhood adversity, such as peer bullying and socioeconomic status, on the suicidal behaviour of left-behind Chinese adolescents to determine whether psychotic-like experiences (PLEs) mediated the associations between these childhood adversities and suicidality; suicidal ideation (serious thoughts about taking one's own life), suicide plans, and suicide attempts.

METHODS

A representative group of rural adolescents (n = 3346) was recruited from 16 rural high schools in China. Suicidality was assessed using the suicide module from the Mini International Neuropsychiatric Interview Kid. Participants also completed questionnaires on bullying, socioeconomic status, left-behind characteristics, and PLEs. Structural equation modelling was then employed to explore the relationships between these variables.

RESULTS

Peer bullying, poverty, and left-behind status were all found to significantly increase adolescent suicide risk, the relationships between which were mediated by PLEs. Peer bullying was found to play the most significant role in the PLEs and suicidality, with the risk of suicide increasing with the length of time a child had been left behind.

CONCLUSION

Adverse life events can lead to a high risk of PLEs, which in turn can increase the risk of suicide. These results could assist in identifying individuals at risk of suicidality and the design of appropriate interventions. The results also highlighted the role PLEs play in suicidality and highlighted the need for further research in this area.

Patterns of psychological pain and self-harm behaviors in adolescents

BACKGROUND

The study examined the role of campus stressors and psychological pain on non-suicidal self-injury (NSSI) and suicide attempt (SA).

METHODS

Specific patterns of co-occurring psychological pain, campus stressors, and self-harm behaviors were identified by latent profile analysis, and their odds ratios (ORs) on NSSI and SA were analyzed in cross-sectional study and 2-year follow-up study. Structural Equation Model was used to explore indirect effect of campus stressors on SA and NSSI via different components of psychological pain.

RESULTS

Three classes were identified as low-risk class (68.58%) with low endorsements on the three measures, moderate-risk class (26.52%) with the elevated academic stressors, high levels of painful feelings, and high probabilities on NSSI; and high-risk class (4.90%) with the elevated combined stressors, high levels of pain avoidance, and high probabilities on SA. Compared to the moderate-risk class, adolescents in the high-risk class had a 4.97 OR of reporting NSSI, 17.98 OR of reporting SA. Pain avoidance class at baseline reported a higher probability in SA class (OR = 224.00) in a 2-year study.

CONCLUSIONS

Painful feelings might be shared psychosocial correlates for NSSI and SA. However, pain avoidance may play a role in distinguishing SA from NSSI, which shed light on the intervention of adolescents who engage in self-harm behaviors.

Race and Depressive Symptoms are Associated with the Prevalence of Adolescent Suicide Attempts in Hawai'i, Youth Risk Behavior Survey 2015-2017

Suicide is death caused by injuring oneself with the intent to die. According to the 2017 National Vital Statistics report, suicide was the second leading cause of death for adolescents 10-24 years old, accounting for 19.2% of deaths in that age group. Aggregated 2015-2017 Hawai'i Youth Risk Behavior Survey (YRBS) data from 12 120 respondents were analyzed. Multivariate logistic regression modeling for complex survey procedure was created using predicted marginals to estimate crude and adjusted prevalence ratios for suicide attempts. After adjusting for race, depressive symptoms, bullying, illicit drug use, alcohol use, and self-harm, youth who experienced bullying (adjusted prevalence ratio=1.75; 95% confidence interval: 1.44-2.12), used illicit drugs (1.89; 1.54-2.31), those with one-time self-harm (2.87; 2.04-4.04), or repeated self-harm (5.31; 4.28-6.60) were more likely to have suicide attempts. Race by depressive symptoms interaction was significant (P <.01), demonstrating the heterogeneity of the stratum-specific measures of association. When depressive symptoms were present, youth who are Native Hawaiian (2.64; 1.68-4.15), Japanese (2.39; 1.44-3.95), other Pacific Islander (2.04; 1.29-3.21), Filipino (1.77; 1.21-2.59), and those who do not describe as only one race/ethnicity (1.74; 1.16-2.62) were more likely to have suicide attempts compared to White. When depressive symptoms were not present, other Pacific Islanders (4.05; 1.69-9.67), Hispanics/Latinos (3.37; 1.10-10.30), Native Hawaiians (3.03; 1.23-7.45), and other race groups (2.03; 1.03-4.00) were more likely to have suicide attempts compared to White. These results demonstrated the importance of screening for depressive symptoms and other risk factors to prevent suicide attempts in adolescents.

Cyberbullying victimization and nonsuicidal self-injury in adolescents: Testing a moderated mediating model of emotion reactivity and dispositional mindfulness

BACKGROUND

Little is known about how cyberbullying victimization may influence adolescent nonsuicidal self-injury (NSSI) and what conditions may buffer the detrimental effects of cyberbullying victimization. By integrating multiple theories, this study investigated emotion reactivity as an underlying mediator and mindfulness as a potential moderator to explain the link between cyberbullying victimization and NSSI among Chinese adolescents.

METHOD

A total of 2,523 participants with an age range of 11 to 16 years old (Mage = 13.22, SD = 1.60, 48.4% girls) completed assessments.

RESULTS

After controlling SES, age, gender, traditional bullying victimization, and child maltreatment, latent moderated structural equation modeling revealed that emotion reactivity mediated the association between cyberbullying victimization and NSSI. In addition, dispositional mindfulness was found to buffer the relation between cyberbullying victimization and NSSI, but not the relation between cyberbullying victimization and emotion reactivity.

LIMITATIONS

This study was cross-sectional in nature and relied exclusively upon self-report measures.

CONCLUSIONS

The findings provide researchers and practitioners with a deeper understanding of the relation between cyberbullying victimization and NSSI among adolescents and its underlying mechanism. Suggested intervention and prevention strategies include helping youth reduce emotion reactivity to break the cyberbullying victimization to NSSI cycle and to enhance youths' mindfulness to buffer against the ill effects of cyberbullying victimization.

The consequences of cyberbullying and traditional bullying victimization among adolescents: Gender differences in psychological symptoms, self-harm and suicidality

This study aimed to examine the effects of different types of bullying victimization (direct, relational, and cyber) on psychological symptoms, self-harm, and suicidality (including suicidal ideation and attempts) among adolescents, and to explore whether these effects may vary by gender. The data were obtained from a cross-sectional study of adolescents (n = 11,248, 46.7% females) with a mean age of 13.83 years from grade 5 to 12 in Henan, China. A series of binary logistic regression models were conducted to estimate the associations between different types of bullying victimization and psychological symptoms, self-harm, suicidal ideation, and suicidal attempts, after adjusting for demographic covariates. All three types of bullying victimization were significantly associated with psychological symptoms, self-harm, suicidal ideation, and suicidal attempts. Adolescents who suffered from cyberbullying victimization were more likely to commit self-harm and suicidal attempts as compared to direct and relational victimization. Female adolescents who suffered from relational bullying tend to have a higher risk of suicidal attempts than male adolescents. The current study demonstrated the negative effect of bullying victimization on adolescents' adverse psychological outcomes and gender difference need to be taken into account in developing targeted intervention strategies to address bullying victimization.

Forgiveness and Loneliness in Peer-Victimized Adolescents

The purpose of the present study was to analyze the relationships between forgiveness, motivations for revenge, avoidance, and benevolence; loneliness, emotional loneliness and positive subjective evaluation of the social network; and peer victimization in schools, relational, overt physical, and overt verbal, based on gender. A battery of instruments was administered to 617 Spanish students (50.7% boys and 49.3% girls), aged between 10 and 16 years (M = 13.04 years, SD = 1.80 years) from primary and secondary education. A multivariate analysis of variance and a multiple block regression for data analysis was used. Study results revealed that the most victimized students showed greater motivation for revenge and avoidance, as well as a greater perception of emotional loneliness and less positive subjective evaluation of their social network. In addition, the findings obtained in the regression analysis (stepwise) indicated that being a boy between 11 and 13 years old and having a high level of emotional loneliness and high avoidance motivation were the most important predictors of peer victimization. Finally, the findings and their possible implications in the design of intervention projects that encourage forgiveness in interpersonal conflicts and integration in social networks as preventive strategies of peer victimization were discussed.

Is It Possible to Measure the Role of the Bystander and the Victim of Bullying in Children? Construct Validity of Two Brief Pictorial Scales With IRT and CFA Models

The study's objective was to develop and validate the psychometric properties of two brief pictorial scales to evaluate the roles of bystanders and victims of bullying. A sample of 910 students was considered (49.6%, boys; 50.4%, girls) between the ages of 7 and 13 (M = 10, SD = 1.4). Both instruments present nine pictorial items representing two dimensions: physical bullying (items 1 to 4) and psychological bullying (items 5 to 9). An additional measure of anxiety was used to assess convergent validity. The Confirmatory Factorial Analysis shows that the two-dimensional oblique model, physical bullying and psychological bullying, presents a better fit to the bystander scale data (RMSEA = .040; CFI = .984; SRMR = .033) and in the victim scale (RMSEA = .051; CFI = .978; SRMR = .040) in comparison to other competitor models. From the perspective of the Item Response Theory (IRT), it was found that the items adequately discriminate the levels of the latent variable; therefore, items 1 (physical bullying) and 7 (psychological bullying) are the most accurate on the bystander scale, and items 3 (physical bullying) and 7 (psychological bullying), on the victim scale. It was also found that the degree of difficulty on both scales is lower for the psychological bullying dimension than for the physical bullying dimension. Both instruments demonstrated good psychometric properties; therefore, they can detect school bullying in classrooms.

Bullying perpetration and victimization in elementary school students diagnosed with attention-deficit/hyperactivity disorder

Previous research has found that attention-deficit/hyperactivity disorder (ADHD) in children is related to bullying perpetration. This study examined the correlation between ADHD and bullying perpetration, and aimed to identify which factors, including bullying victimization, predicted bullying. Forty-nine elementary school students, aged 6-12, participated voluntarily in a comparative study between children with ADHD and non-ADHD control children; none of them had previously undergone psychiatric treatment. Both parents' and participants' social demographic information (gender, age) and clinical variables were obtained from self-report questionnaires. The participants' bullying victimization experience, impulsivity, and parents' history of ADHD had significant relationships with bullying. The status of ADHD and other self-reported scales had no significant relationships with bullying. The association between bullying victimization and bullying perpetration was notable among all factors examined. This was consistent with the claims of prior studies that past victimization led to perpetration of bullying. Therefore, it seems that when treating victims of bullying, care should be taken, through proper intervention, to ensure the incident is neither repeated nor replicated. Characteristics associated with ADHD, including impulsivity and parents' history of ADHD, were significantly related to bullying. However, we could not confirm our hypothesis that ADHD itself might be associated with bullying behavior.

Prevalence and Correlates of Mental Health Problems among Chinese Adolescents with Frequent Peer Victimization Experiences

This study investigated the prevalence and correlates of mental health outcomes, particularly depression, anxiety, and insomnia, in adolescents with frequent peer victimization experiences (FPVEs). In this cross-sectional study, 490 adolescents reported having FPVEs (prevalence, 4.2%; mean age, 13.40 ± 1.38 years old; 52.2% male) completed a series of surveys to evaluate their demographic factors and mental health status. The results showed that the prevalence of depression, anxiety, and insomnia were 50.3%, 33.8%, and 40.2%, respectively. Older age, being female, being left behind, and more adverse childhood experiences were correlated with more symptoms of depression, anxiety, and insomnia among adolescents with FPVEs. At the same time, social support and self-compassion were good for ameliorating these mental health problems. Implications for intervention programs designed to improve the mental health of adolescents with FPVEs were also discussed.

The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents-A Network Approach

Although earlier research has highlighted that psychiatric disorders significantly impair patients' quality of life (QoL), few studies have examined the relationship between nonsuicidal self-injury (NSSI) and QoL. Our aim was to investigate whether QoL mediates the mental disorder-NSSI relationship, and to study the QoL ratings agreement of self and parents in a clinical population of adolescents. We involved 202 adolescents from Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, aged 13-18 years. All participants completed the Deliberate Self-Harm Inventory, Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen, and the Mini International Neuropsychiatric Interview Kid. To map the interrelationship between the NSSI, mental disorders, and QoL dimensions, Mixed Graphical Models were estimated. Adolescents with a history of NSSI rated their QoL to be significantly lower than adolescents without NSSI. Self and parents' QoL ratings are closer in the NSSI sample than in the no-NSSI sample. Among all QoL dimensions, only family problems had a direct significant association with NSSI engagement. Our results highlight that, contrary to our hypothesis, the presence of mental disorders mediates the relationship between most QoL dimensions and the occurrence of NSSI. Our results draw attention to the potential causal effect of environmental factors (e.g., peer problems) on mental disorders that, in turn, result in NSSI. The present paper highlights the importance of network modelling in clinical research.

Neural Correlates Associated With Suicide and Nonsuicidal Self-injury in Youth

There is no definitive neural marker of suicidal thoughts and behaviors (STBs) or nonsuicidal self-injury (NSSI), and relative to adults, research in youth is more limited. This comprehensive review focuses on magnetic resonance imaging studies reporting structural and functional neural correlates of STBs and NSSI in youth to 1) elucidate shared and independent neural alternations, 2) clarify how developmental processes may interact with neural alterations to confer risk, and 3) provide recommendations based on convergence across studies. Forty-seven articles were reviewed (STBs = 27; NSSI = 20), and notably, 63% of STB articles and 45% of NSSI articles were published in the previous 3 years. Structural magnetic resonance imaging research suggests reduced volume in the ventral prefrontal and orbitofrontal cortices among youth reporting STBs, and there is reduced anterior cingulate cortex volume related to STBs and NSSI. With regard to functional alterations, blunted striatal activation may characterize STB and NSSI youth, and there is reduced frontolimbic task-based connectivity in suicide ideators and attempters. Resting-state functional connectivity findings highlight reduced positive connectivity between the default mode network and salience network in attempters and show that self-injurers exhibit frontolimbic alterations. Together, suicidal and nonsuicidal behaviors are related to top-down and bottom-up neural alterations, which may compromise approach, avoidance, and regulatory systems. Future longitudinal research with larger and well-characterized samples, especially those integrating ambulatory stress assessments, will be well positioned to identify novel targets that may improve early identification and treatment for youth with STBs and NSSI.

Bullying Experiences and Nonsuicidal Self-injury among Chinese Adolescents: A Longitudinal Moderated Mediation Model

Bullying experiences play an important role in non-suicidal self-injury (NSSI). However, little is known about how and in what conditions different bullying experiences (i.e., experiences of being pure bullies, pure victims, and bully-victims) may influence NSSI. Guided by the transactional model of development and the integrated model of NSSI, the current study investigated two potential mediators (i.e., peer acceptance and depressive symptoms) and one potential moderator (i.e., psychological resilience) of the relations between different bullying experiences and NSSI. Participants were 812 Chinese adolescents (43% female; Mage at Wave 1 = 13.15 years) from a two-wave longitudinal study with data spanning 1 year. The results show that all three types of bullying experiences can relate to a higher likelihood of NSSI through two indirect pathways: (a) lower peer acceptance to more depressive symptoms, or (b) more depressive symptoms. These indirect effects were weaker for adolescents with higher (versus lower) levels of psychological resilience. Moreover, when bully-victims were distinguished from pure bullies and pure victims and the unique effects for all three groups were tested, the direct and indirect effects were most evident among bully-victims. These findings imply that it is necessary to distinguish bully-victims from pure bullies and pure victims. The results indicate that NSSI may be effectively reduced if interventions focus on promoting peer acceptance and reducing adolescent depressive symptoms, particularly for bully-victims with lower levels of psychological resilience.

Suicidality Among Children and Youth With and Without Autism Spectrum Disorder: A Systematic Review of Existing Risk Assessment Tools

Individuals with autism are at heightened risk for experiencing suicidality compared to those without autism. Despite this, it is unknown what tools are used to assess suicide risk in research and clinical practice among children and youth with autism. This systematic review examined tools commonly used to measure suicidality in children and youth with and without autism spectrum disorder. Four databases were searched. We identified five tools (C-SSRS, PSS, SITBI, SIQ-JR, BSS) commonly used with youth in the general population; however, we did not identify any tools that were commonly used autistic children and youth. Results highlight the lack of available tools utilized to measure suicidality in autistic children and youth. We propose a framework to facilitate research to fill this gap.

Social rejection, popularity, peer victimization, and self-injurious thoughts and behaviors among adolescents: A systematic review and meta-analysis

Self-injurious thoughts and behaviors (SITBs) are significant public health problems in adolescence. The current article provides a comprehensive systematic review examining the relationship between events leading to perceived low relational evaluation (e.g. social rejection) and SITBs among adolescents. Theoretical work posits that low relational evaluation is experienced as psychologically painful, a known correlate of SITBs. Therefore, events leading to low relational evaluation may be particularly informative in understanding the context of SITBs. The current review examines how experiences of low relational evaluation that are hypothesized to elicit psychological pain, such as social rejection, low popularity, and peer victimization are related to engagement in SITBs in adolescence. A total of 56 articles meeting inclusion criteria were identified. The hypothesis of an association between indicators of low relational evaluation and SITBs was generally supported throughout the literature, with more consistency found among studies examining suicidal ideation specifically. However, interpretation of the findings is constrained by various methodological limitations of studies. The present review concludes with a theoretical conceptualization of the relationship between perceived relational value and SITBs, leveraging social and evolutionary psychological theory, to guide future research into this topic.

Study Protocol for Teen Inflammation Glutamate Emotion Research (TIGER)

This article provides an overview of the study protocol for the Teen Inflammation Glutamate Emotion Research (TIGER) project, a longitudinal study in which we plan to recruit 60 depressed adolescents (ages 13–18 years) and 30 psychiatrically healthy controls in order to examine the inflammatory and glutamatergic pathways that contribute to the recurrence of depression in adolescents. TIGER is the first study to examine the effects of peripheral inflammation on neurodevelopmental trajectories by assessing changes in cortical glutamate in depressed adolescents. Here, we describe the scientific rationale, design, and methods for the TIGER project. This article is intended to serve as an introduction to this project and to provide details for investigators who may be seeking to replicate or extend these methods for other related research endeavors.

Life Stress and Suicide in Adolescents

Stress exposure is central to theories of suicide. To advance understanding of the relation between stress and suicide, we examined whether specific, theoretically-pertinent life stressors were differentially related to suicidal thinking versus suicidal behaviors among hospitalized adolescents. Participants were 197 (144 female) adolescents aged 13 to 19 years old (M = 15.61, SD = 1.48) recruited from an acute residential psychiatric treatment program. Participants were categorized into mutually exclusive groups: psychiatric controls (n = 38) with no lifetime history of suicide ideation or suicide attempts, suicide ideators (n = 99) with current ideation and no lifetime attempts, and suicide attempters (n = 60) with a lifetime history of suicide ideation and at least one attempt in the past month. Adolescents completed the Stress and Adversity Inventory for Adolescents (Adolescent STRAIN), which assessed life events and chronic difficulties occurring in five social-psychological categories: Interpersonal Loss, Physical Danger, Humiliation, Entrapment, and Role Change/Disruption. Additionally, they completed a structured interview and symptom questionnaires to capture concurrent psychopathology. Controlling for demographic and clinical covariates, only Interpersonal Loss events distinguished attempters from psychiatric controls (OR = 2.27) and ideators (OR = 1.49); no events or difficulties differentiated ideators from controls. These effects persisted when analyses were restricted to single attempters and when events following the most recent attempt were excluded. The findings elucidate potential social-environmental triggers of suicide. Ultimately, this may improve the identification of ideators most likely to make an attempt, enabling the deployment of targeted early interventions.

The Association of Bullying and Suicidality: Does it Affect the Pediatric Population?

Over the last few years, bullying has been identified as one of the significant issues in the pediatric population. Reports also found that bullied youth have a higher risk of developing suicidality. Although preventable, suicide remains the leading cause of death in young people. This literature review aims to establish the association of bullying and the suicidality of the pediatric group (0-18 years of age). A PubMed search was conducted to find studies associating bullying and suicidality in the pediatric population. MeSH keyword strategy, along with subheadings, was used to retrieve appropriate literature. A total of 42 articles were included after the careful examination and application of exclusion and inclusion criteria. This study showed a strong association between bullying and suicidality, albeit the presence of some contradictory ideas.

Research on the Relationships between Psychological Problems and School Bullying and Non-Suicidal Self-Injury among Rural Primary and Middle School Students in Developing Areas of China

(1) Purpose: To analyze the role of psychological problems in connection with school bullying and non-suicidal self-injury (NSSI) among rural primary and middle school students in developing areas of China. (2) Methods: A multi-stage, stratified, cluster random sampling method was used to select 2284 rural primary and middle school students in Jiangxi Province for study. Questionnaires regarding the health risk behaviors of children in developing areas were left behind at primary and middle schools, and they were later collected and analyzed by using the mental health diagnostic monitoring scale for Chinese primary and middle school students. Pearson correlation, logistic regression, and bootstrap tests were conducted to analyze the association between psychological problems, school bullying, and NSSI. (3) Results: The incidence of NSSI in rural primary and middle school students in Jiangxi Province was 14.84%. Compared with other children with behavioral problems, those who had experienced school bullying and had mild/severe psychological problems were more likely to have engaged in NSSI behaviors (p < 0.001). Psychological problems have a mediating effect between school bullying and NSSI, which accounted for 12.96% of the total effect. (4) Conclusion: Psychological problems are likely an effect modifier in the connection between school bullying and NSSI behaviors. Therefore, effectively targeting psychological problems in rural primary and middle school students in Jiangxi Province may help prevent and control NSSI behaviors in students who have experienced school bullying.

Correlations between Quality of Life, School Bullying, and Suicide in Adolescents with Attention-Deficit Hyperactivity Disorder

Although adolescents with attention-deficit hyperactivity disorder (ADHD) have a higher risk of suicidality and more problems related to school bullying, and quality of life (QoL) is reportedly associated with school bullying, suicide, and ADHD, no study has examined their correlation. This study examined the complex relationships between QoL, school bullying, suicide, and ADHD symptoms. A total of 203 adolescents with ADHD aged between 12 and 18 years were recruited. School bullying and QoL were examined using the Chinese version of the School Bullying Experience Questionnaire and the Taiwanese Quality of Life Questionnaire for Adolescents. Network model analysis was conducted to graphically present their relationships. We identified triangular correlations between school bullying, QoL, and suicidality, indicating possible pathways from school bullying to suicidality, and the originating or mediating roles of personal competence and psychological well-being. Furthermore, the ADHD symptoms of inattention and hyperactivity/impulsivity may differentially regulate these pathways. Longitudinal studies are warranted to confirm these findings.

Maternal Awareness of Adolescent Bullying Victimization in a Low-Income Context

Background:

Adolescents and parents often disagree about the perception of bullying victimization since adults tend to underestimate its occurrence.

Objective:

This study identifies factors that can influence maternal perception of bullying victimization experienced by her son/daughter in the past 12 months.

Methods:

This cross-sectional study involved a representative sample of in-school adolescents (n=669, 11-15-years) living in Itaboraí city, Brazil (mean age±SE: 13.01±0.07 years; 51.7% females). A 3-stage probabilistic sampling procedure (random selection of census units, eligible households and target child) generated sampling weights. Trained lay interviewers individually applied semi-structured questionnaires to mothers and adolescents in the households. Multivariable logistic regression analysis examined factors potentially influencing maternal perception of bullying victimization experienced by her son/daughter: adolescent gender and age, adolescent self-perceived bullying victimization, exposure to severe physical punishment by parents, internalizing/externalizing behaviour problems identified by the Youth Self-Report/YSR, maternal education and maternal anxiety/depression identified by the 20-item Self-Reporting Questionnaire/SRQ-20.

Results:

Univariable logistic regression analysis identified a strong association between adolescent self-perceived bullying victimization and maternal perception of bullying victimization experienced by her son/daughter. Multivariable models showed that adolescent perception influenced maternal perception when adolescents had no clinical internalizing behaviour problems and when mothers had higher education.

Conclusion:

Anxious/depressive adolescents may hide victimization incidents, while those with no problems probably reveal these incidents to the mother. Considering that maternal low education is an indicator of low socioeconomic status, which is associated with multiple stressors, less educated mothers may be more likely to interpret these incidents as a common part of growing-up.

Statistical Approaches for Highly Skewed Data: Evaluating Relations between Maltreatment and Young Adults' Non-Suicidal Self-injury

Objective: Clinical phenomena often feature skewed distributions with an overabundance of zeros. Unfortunately, empirical methods for dealing with this violation of distributional assumptions underlying regression are typically discussed in statistical journals with limited translation to applied researchers. Therefore, this investigation compared statistical approaches for addressing highly skewed data as applied to the evaluation of relations between child maltreatment and non-suicidal self-injury (NSSI). Method: College students (N = 2,651; 64.2% female; 85.2% nonwhite) completed the Child Abuse and Trauma Scale and the Functional Assessment of Self-Mutilation. Statistical models were applied to cross-sectional data to provide illustrative comparisons across predictions to a) raw, highly skewed NSSI outcomes, b) natural log, square-root, and inverse NSSI transformations to reduce skew, c) zero-inflated Poisson (ZIP) and negative-binomial zero-inflated (NBZI) regression models to account for both disproportionate zeros and skewness in the NSSI data, and d) the skew-t distribution to model NSSI skewness. Results: Child maltreatment was significantly and positively related to NSSI frequency in the raw, transformation, and zero-inflated models, but this relation was negative in the skew-t model. Conclusions: These findings highlight the importance of using zero-inflated models rather than transformation approaches to address data skew. Moreover, whereas the skew-t distribution has been used to model skewed non-clinical data, this study suggests that the skew-t approach may not be well-suited to address skewed clinical data.

Self-Harm, Suicidal Ideation, and Suicide Attempts in Chinese Adolescents Involved in Different Sub-types of Bullying: A Cross-Sectional Study

Background: Bullying tends to peak during adolescence, and it is an important risk factor of self-harm and suicide. However, research on the specific effect of different sub-types of bullying is limited. Objective: The purpose of this study is to examine the associations between four common forms of bullying (verbal, physical, relational, and cyber) and self-harm, suicidal ideation (SI), and suicide attempts (SA). Method: This was a cross-sectional study of a sample including 4,241 Chinese students (55.8% boys) aged 11 to 18 years. Bullying involvement, self-harm, SI, and SA were measured via The Juvenile Campus Violence Questionnaire (JCVQ). The association was examined through multinomial logistic regression analysis, adjusted for demographic characteristics and psychological distress. Results: Bullying victimization and perpetration were reported by 18.0 and 10.7% of participants. The prevalence of self-harm, SI, and SA were 11.8, 11.8, and 7.1%, respectively. Relational bullying victimization and perpetration were significantly associated with SI only, SI plus self-harm, and SA. Physical bullying victimization and perpetration were risk factors of self-harm only and SA. Verbal victimization was significantly associated with SI only. Cyber perpetration was a risk factor of SA. Conclusions: The findings highlight the different effects of sub-types of bullying on self-harm and suicidal risk. Anti-bullying intervention and suicide prevention efforts should be prior to adolescents who are involved in physical and relational bullying.

Comportamento suicida e estratégias de prevenção sob a ótica de professores

RESUMO Objetivo Analisar conhecimentos sobre comportamento suicida e estratégias de prevenção adotadas por professores do ensino fundamental. Método Estudo qualitativo, apoiado na pesquisa-ação, realizado em escola pública do município de Teresina, Piauí, Brasil. Participaram nove professores de ensino fundamental. Realizaram-se três encontros, uma reunião de negociação e dois seminários temáticos. Os discursos foram submetidos à análise temática. Resultados O conhecimento dos professores acerca do comportamento suicida envolveu identificação dos sinais de alerta, tendo a automutilação como atitude suicida mais recorrente. Como estratégias apontaram a necessidade de prevenção por meio da identificação do aluno em risco, da observação, do diálogo, do monitoramento e utilização de redes de apoio. Os desafios elencados pelos professores foram a inabilidade na identificação e associação dos sinais de alerta com o comportamento suicida, a dificuldade na abordagem do aluno em crise, a ausência de equipe de saúde mental nas escolas e de temas transversais nos currículos escolares. Conclusão e implicações para a prática Observa-se a necessidade de ações voltadas para a capacitação desses profissionais, tendo em vista sua posição privilegiada para promoção de ambientes saudáveis, bem como para prevenção e identificação dos adolescentes em risco, com manejo adequado e encaminhamento compartilhado aos serviços de saúde.

Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis

OBJECTIVE

This meta-analysis aimed to estimate the global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents.

METHODS

A systematic search for relevant articles published between 1989 to 2018 was performed in multiple electronic databases. The aggregate 12-month and lifetime prevalence of suicidal behavior, deliberate self-harm, and non-suicidal self-injury were calculated based on the random-effects model. Subgroup analyses were performed to compare the prevalence according to school attendance and geographical regions. Results: A total of 686,672 children and adolescents were included. The aggregate lifetime and 12-month prevalence of suicide attempts was 6% (95% CI: 4.7-7.7%) and 4.5% (95% CI: 3.4-5.9%) respectively. The aggregate lifetime and 12-month prevalence of suicidal plan was 9.9% (95% CI: 5.5-17%) and 7.5% (95% CI: 4.5-12.1%) respectively. The aggregate lifetime and 12-month prevalence of suicidal ideation was 18% (95% CI: 14.2-22.7%) and 14.2% (95% CI: 11.6-17.3%) respectively. The aggregate lifetime and 12-month prevalence of non-suicidal self-injury was 22.1% (95% CI: 16.9-28.4%) and 19.5% (95% CI: 13.3-27.6%) respectively. The aggregate lifetime and 12-month prevalence of deliberate self-harm was 13.7% (95% CI: 11.0-17.0%) and 14.2% (95% CI: 10.1-19.5%) respectively. Subgroup analyses showed that full-time school attendance, non-Western countries, low and middle-income countries, and geographical locations might contribute to the higher aggregate prevalence of suicidal behaviors, deliberate self-harm, and non-suicidal self-injury. Conclusions: This meta-analysis found that non-suicidal self-injury, suicidal ideation, and deliberate self-harm were the three most common suicidal and self-harm behaviors in children and adolescents.

Neurocognitive Processes Implicated in Adolescent Suicidal Thoughts and Behaviors: Applying an RDoC Framework for Conceptualizing Risk

Purpose of Review

Identifying risk factors for STBs during adolescence is essential for suicide prevention. In this review, we employ the Research Domain Criteria (RDoC) framework to synthesize studies on key neurocognitive processes-cognitive control, reward responsiveness/valuation, and negative urgency-relevant to adolescent STBs.

Recent Findings

Within subdomains of Cognitive Control, studies of inhibition/suppression and updating/maintenance were mixed, while response selection (i.e., decision-making) deficits were consistently associated with suicide attempts. Fewer studies, by comparison, have probed the Positive Valence Systems. Relative to healthy controls, adolescents with prior STBs may show a blunted neural response to rewards and value rewards less, but findings require replication. Finally, negative urgency, which may span subdomains within both Cognitive Control and the Positive Valence Systems, was associated with recent suicide attempts in the only study to directly test this association.

Summary

Few studies have examined neurocognitive functioning in relation to adolescent STBs, despite the relevance of this research to detecting suicide risk. We recommend that future studies incorporate developmental contexts relevant to both neurocognitive processes and STBs.Broadly, cognitive control is associated with activation of the prefrontal cortex (PFC) and its interaction with other brain areas (e.g., reward and motor regions) [32]. Functional magnetic resonance imaging (fMRI) studies using emotional stimuli have provided evidence of abnormalities in neural regions supporting cognitive control among youth with STBs. [33] computed neural activation corresponding to viewing angry faces (relative to a fixation cross) in a sample of depressed youth. They found that, relative to non-attempters, attempters had: (a) increased activation in the right anterior gyrus and dorsolateral PFC and (b) reduced functional connectivity between the anterior cingulate gyrus and bilateral insulae. Relatedly, youth with bipolar disorder and a history of suicide attempts showed reduced functional connectivity between the amygdala and the left ventral PFC while viewing emotional (happy, fearful) and neutral faces compared to patient non-attempters [34]. The findings indicate that attempters may have problems regulating and appropriately deploying attention, as well as planning and executing behavioral responses, in emotional contexts.