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

Prevalence and correlates of non-suicidal self-injury among patients with bipolar disorder: A multicenter study across China

BACKGROUND

Non-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies.

METHODS

NSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-) Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis.

RESULTS

The enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were "cutting" (41.2 %) and "hitting" (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05).

LIMITATIONS

As a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports.

CONCLUSION

Our study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.

Non-suicidal self-injury trajectories among adolescents during the COVID-19 pandemic: The role of parenting dimensions and stress reactions

BACKGROUND

The literature on the trajectories of NSSI behavior during the pandemic is scarce and mainly short-term. Furthermore, studies have not explored the buffering mechanisms that may have altered risk trajectories during this vulnerable period. This study aims to analyze the univariate change of NSSI during adolescence and to examine the alteration of the univariate growth due to the time-varying effect of COVID-19-related stress, parenting dimensions (i.e., positive and negative parenting), and their interaction.

METHODS

Participants included 830 Italian adolescents (44.2 % females; Mage = 14.52; SD = 0.80), who participated in at least one time point of data collection, from a three-wave longitudinal study (T1: from December 2019 to January 2020; T2: December 2020; T3: December 2021).

RESULTS

The Latent Growth Curve Analyses show a linear increase in NSSI over time. In regards to time-varying, at T1, the results highlight that higher levels of negative parenting are associated with higher levels of NSSI at the same time point. Instead, at T2, results show that pandemic stress is associated with higher levels of NSSI at T2. Regarding the interaction effect, positive parenting significantly buffered the effect of COVID-19 stress on NSSI at both T2 and T3.

LIMITATIONS

Only some dimensions of parenting style (i.e., positive and negative parenting) are included.

CONCLUSIONS

This study attempts to deepen the trajectory of NSSI behavior during the two years of the pandemic and examine the changes caused by the time-varying effects, thus providing suggestions for designing programs to prevent engagement in NSSI.

Peer Bullying and Psychiatric Diagnoses in Adolescents with Nonsuicidal Self-Injury

OBJECTIVES

The aim of this study was to determine the comorbid psychiatric diagnoses, peer bullying rates and NSSI characteristics in adolescents who engage in self-injuring behavior.

MATERIALS AND METHODS

This case-controlled cross-sectional study was conducted between 1 March 2020 and 1 May 2021 in the Child and Adolescent Psychiatry and Paediatrics outpatient clinic of a hospital in the Southeastern Anatolia region of Turkey. The data of 50 adolescents with NSSI and 60 adolescents without NSSI attending school were compared. The data in the study were obtained using sociodemographic form prepared by the researchers, the Affective Disorders and Schizophrenia Interview Schedule for School-Age Children-Present and Lifetime Version-Dsm-5, Peer Bullying Scale Adolescent Form and Self-Injurious Behaviour Assessment Inventory.

RESULTS

Fifty adolescents (70% female) with a mean age of 15.4 years (S.D. = 1.4) with NSSI were included as case group and 60 adolescents (66.7% female) with a mean age of 15.5 years (S.D. = 1.3) without NSSI were included as control group. Banging/hitting self was the most common NSSI method, while affect regulation was the most common function. In the case group, verbal, isolation and damage to belongings among the victim subtypes in the last year were found to be significantly higher than in the control group. It was found that there was a positive correlation between the variety of self-injury methods and bullying exposure scores in adolescents with NSSI. Depression disorders, anxiety disorders, oppositional defiant disorder, attention deficit hyperactivity disorder, conduct disorder, and post-traumatic stress disorder diagnoses were found to be more prevalent in the group with NSSI.

CONCLUSIONS

Based on the finding, it was found that psychiatric diagnoses are more common in adolescents with NSSI, peer bullying subtypes are seen at a higher rate, and as bullying scores increase, the variety of NSSI methods also increases. It is thought that providing psychiatric evaluation and treatment for adolescents with NSSI, establishing cooperation with school and family for peer bullying, developing preventive mental health policies and effective intervention programmes may be beneficial.

The impact of negative cognitive bias on NSSI: mediating non-adaptive cognitive emotion regulation strategies

BACKGROUND

Individuals may be more likely to engage in NSSI due to negative cognitive bias, while the use of negative emotional regulation mechanisms may further contribute to NSSI. Currently, there is a dearth of studies regarding the correlation among the three variables.

METHOD

The study employed convenience sampling to collect data via online platforms from a total of 572 college students in Harbin, Heilongjiang Province, China, over the period of January 2024 to February 2024. The questionnaires comprise the Non-Adaptive Cognitive Emotion Srategy Regulation Subscale, the Negative Cognitive Processing Bias Questionnaire, and the NSSI Questionnaire.

OUTCOME

Negative cognitive bias significantly and directly influences NSSI, as indicated by a beta coefficient of 0.3788 and a confidence interval of [0.2878, 0.4698]. The existence of negative cognitive bias significantly enhances the impact of non-adaptive cognitive emotion control approaches (β = 0.5613, CI [0.4808, 0.6418]). Non-adaptive cognitive emotion regulation strategies showed a significant effect on NSSI, as indicated by a beta coefficient of 0.2033 and a confidence interval of [0.0942, 0.3125]. The non-adaptive cognitive emotion control strategy serves as an intermediary between negative cognitive bias and NSSI, explaining 30.12% of the overall impact.

IN CONCLUSION

The results demonstrate that non-adaptive cognitive emotion regulation strategies play a partially moderating role in the relationship between negative cognitive bias and NSSI among nursing students. We emphasize the importance of non-adaptive cognitive emotion regulation strategies, negative cognitive biases, and NSSI among nursing students. In order to reduce the occurrence of NSSI, it is important for schools, families, and teachers to work together closely and implement a well-organized and efficient intervention to protect the mental well-being of nursing students.

The role of Theory of Mind in the transition towards suicidal attempts in youth NSSI: an exploratory pilot study

Non-suicidal self-injury (NSSI) can both precede and co-occur with suicidal attempts (SA). Underlying mechanisms/factors leading to the transition to SA in NSSI youths have been proposed (including the role of social cognition), despite they should be yet confirmed. Therefore, the study aims at exploring the role of the Theory of Mind in the differentiation of a sample of NSSI youngsters (aged 15-24) according to the presence of SA. We divided the sample into 4 groups using the Deliberate Self Harm Inventory (DSHI) and Columbia Suicide Severity Rating Scale (C-SSRS): control group (notNSSInotSA), NSSI without SA (NSSInotSA), NSSI with SA (NSSIplusSA), and SA without NSSI (SAonly). NSSIplusSA patients displayed higher Reading the Mind in the Eyes Test (RMET) scores (indicative of ToM abilities) than both the NSSInotSA (p=0.0016) and SAonly groups (p=0.0198), while SAonly patients showed lower RMET scores compared to the control group (p=0.0214). Multiple regression models used to differentiate NSSInotSA and NSSIplusSA found a significant association between RMET and LOSCS-CSC (Level Of Self-Criticism Scale-Comparative Self-Criticism) (pC=0.0802, pD=0.0016, pG=0.0053). Our findings supported the hypothesis that a hypertrophic affective ToM may possibly be associated with the occurrence of SA in youth NSSI. Further larger and longitudinal studies should confirm these preliminary findings, by exploring all social cognition dimensions.

"Swipe & slice": decoding digital struggles with non-suicidal self-injuries among youngsters

Introduction

Nonsuicidal-self-injury (NSSI)-related content recently emerged on social networking sites (SNS), despite its relationship with NSSI conducts is still unclear.

Methods

Hence, the current population-based cross-sectional study investigated the interplay between SNS use, NSSI content engagement, risky social media challenges (RSMCs), in a sample of 404 young adults (aged 18-24), focusing on the influence of problematic social media use (PSMU) and fear of missing out (FoMO).

Results

Around 51.5% of the samplewas engaged inNSSI-related contents on SNS, being mostly females (p<0.001), younger (p=0.005), transgender people and nonbinary people (p=0.030) and those who displayed higher PSMU (p<0.001) or FoMO (p=0.031). Around 66.2% of the sample currently practice NSSIs, predominantly among females (p<0.001), those using BeReal (p=0.012), actively looking for NSSIrelated contents on SNS (p<0.001) to be part of a group (p=0.0025) or learn how to practice NSSI (p=0.025). PSMU (p<0.001) and FoMO (p<0.001) emerged as significant predictors of NSSI content engagement, particularly among active seekers. NSSI conducts were significantly predicted by FoMO (p<0.001) and Snapchat (p=0.044), while negatively predicted by male sex (p<0.001), higher educational level (p=0.019) and age at which NSSI-related contents were firstly looked for (p=0.028).

Discussion

These findings underline the need to implement preventivepolicies and targeted interventions to monitor NSSI-related contents on SNS, the impact of PSMU and FoMO on NSSI, particularly among youngsters.

Understanding Comorbidity Between Non-Suicidal Self-Injury and Depressive Symptoms in a Clinical Sample of Adolescents: A Network Analysis

Background

Non-suicidal self-injury (NSSI) and depression often co-occur among adolescents with more severe clinical symptoms. This study examined the network structures of NSSI and depressive symptoms in adolescents.

Methods

Participants were recruited in the psychiatric outpatient clinics of three tertiary hospitals between April 10 and July 10, 2023. All participants been already found with self-injury behaviors in outpatient when enrolled. NSSI diagnostic criteria and Patient Health Questionnaire-9 (PHQ-9) were utilized to collect NSSI and depressive symptoms separately. We performed a network analysis to visualize the correlation between each symptom and to identify core and bridging symptoms in comorbidities.

Results

A total of 248 patients were enrolled in the study, with a mean age of 15.48 (SD = 1.62). Based on the PHQ-9 scores and grades, our results showed that the incidence of depression in adolescents with non-suicidal self-injury behavior was relatively high (N=235, 94.76%), with the majority having severe depression. The network analysis revealed that nodes D-6 "feeling bad, failing or letting yourself or your family down", D-1 "little interest or pleasure" and D-4 "feeling tired" were the most vital and most central symptoms. The most crucial bridging symptom is the node NSSI-8 "frequent thinking about self-injury", which connects the NSSI to the depression comorbid network.

Conclusion

This study offers a significant symptom-level conceptualization of the association between NSSI and depressive symptoms in a clinical sample of adolescents, which not only enhances our understanding of the comorbid but also identifies potential treatment targets to prevent and treat comorbidity between adolescent NSSI and depression.

Brain-gut axis mechanism of subthreshold nonsuicidal self-injury addictive features in adolescents

Nonsuicidal self-injury (NSSI) is associated with an increased risk of suicide. As the diagnostic criteria outlined in DSM-5 and other related clinical studies, a patient must have engaged in self-injurious behavior at least 5 times within the past year. However, patients with fewer than 5 self-injury behaviors should not be ignored. Our study included 46 adolescents aged 10-19 years with subthreshold NSSI (sNSSI), along with a control group of 50 healthy adolescents matched for age and other factors. We collected resting-state functional magnetic resonance imaging data and stool samples. The Ottawa Self-Injury Inventory and Deliberate Self-Harm Inventory were used to evaluate self-harm behaviors and addictive features. Local brain activity was assessed using fractional amplitude of low-frequency fluctuations (fALFF), and brain regions with abnormal fALFF were selected as seeds for whole-brain functional connectivity analysis. Stool samples were identified using 16S rDNA amplicon sequencing, and the LDA Effect Size method was used to explore significant differences between grouped samples. Mediation analysis was performed to investigate the brain-gut axis mechanisms of addictive features in sNSSI. We found that compared with healthy controls, sNSSI patients have abnormal fALFF in left thalamus and posterior cingulate cortex, dysconnectivities of left thalamus, and decreased Prevotellaceae. Our results suggested that addictive features of sNSSI may have a brain-gut mechanism. Furtherly, patients with 1-4 NSSI behaviors in the past year should have separate name for identification, such as "subthreshold NSSI".