Functions of nonsuicidal self-injury (NSSI): Cross-sectional associations with NSSI duration and longitudinal changes over time and following treatment

A self-determination theory perspective on the relationship between emotion regulation styles, mindfulness facets, and well-being in adults with self-injury

BACKGROUND

The relevance of emotion regulation (ER) difficulties to nonsuicidal self-injury (NSSI; the deliberate destruction of one's bodily tissue without suicidal intent) has been repeatedly documented. Recently, specific mindfulness facets (i.e., awareness, nonjudging, describing) have been proposed as mechanisms that explain this relationship. The present study sought to extend this line of inquiry by exploring the mediating role of mindfulness facets in the relation between self-determination theory-based ER styles (i.e., integrative ER, suppressive ER, emotion dysregulation) and indices of positive and negative well-being (i.e., subjective vitality, NSSI difficulties), while controlling for gender, in adults with recent NSSI engagement.

METHODS

US adults with a history of more than one occurrence of NSSI within the last year (n = 222) completed online measures of ER styles, mindfulness facets, subjective vitality, and NSSI difficulties.

RESULTS

A mediation model indicated that the effects of ER styles on positive and negative well-being were explained by specific mindfulness facets (i.e., awareness, nonjudging, nonreactivity, describing).

CONCLUSIONS

The present study provides preliminary evidence that facets of dispositional mindfulness may be mechanisms through which ER styles impact positive and negative indices of well-being in adults with lived experience of NSSI.

Typologies of Non-Suicidal Self-Injury Functions and Clinical Correlates Among Inpatient Youth

This study identified typologies of specific non-suicidal self-injury (NSSI) functions among youth admitted for psychiatric hospitalization and investigated clinically relevant correlates. Inpatient youth (n = 68) aged 10-17 years reported on their reasons to engage in NSSI, frequency and severity of NSSI, and symptoms of borderline personality disorder (BPD). A latent class analysis using youth's specific NSSI functions as indicators found two NSSI function typologies, which were differentially associated with clinical correlates. The Multiple Functions class (n = 28) endorsed to "feel something," "punish self," "escape feelings," "relieve anxiety," "stop feeling self-hatred," "stop feeling angry," "show much they are hurting," and "create a hurt that can be soothed." Conversely, the Single/Avoidant Function class (n = 40) endorsed one primary function-i.e., to "escape feelings." Youth in the Multiple Functions class reported significantly more frequent self-injury and greater BPD symptomology. The present study illustrates the importance of examining constellations of specific NSSI functions in inpatient care settings, given their unique associations with NSSI frequency and features of BPD. These findings could inform targeted psychological screening and, in turn, guide the implementation of interventions for elevated NSSI frequency and BPD symptomology among inpatient youth, based on NSSI functions endorsed.

A Qualitative Analysis of Perspectives on Self-directed Violence in a Prospective Longitudinal Study of Young Women With and Without Childhood ADHD

OBJECTIVE

Non-suicidal self-directed violence (NSSDV) is a significant and growing youth public health crisis. Girls with ADHD are at increased risk of engaging in NSSDV, yet qualitative studies with this population-to better understand manifestations, motivations, and developmental course-are lacking.

METHOD

We conducted semi-structured, qualitative interviews with a sub-sample of 57 young women (32 with childhood ADHD, 25 neurotypical comparisons; mean age of 27 years, part of a larger prospective longitudinal study) regarding histories and manifestations of NSSDV.

RESULTS

Inductive and deductive analysis revealed several key themes, including self-perceived reasons for engaging in NSSDV (affect regulation, attention seeking, self-punishment, asserting control), impulsivity, secretiveness, and in some cases motivations for desistance.

CONCLUSION

Findings underscore the importance of early education and screening, especially among high-risk clinical populations. Increased resources and supports for professionals, parents, and peers are indicated, along with countering the persistent stigma associated with ADHD and NSSDV.

The Association of Borderline Personality Features and Self-Injury Among Adolescents with Non-Suicidal Self-Injury: The Mediating Role of Alexithymia

Introduction

Non-suicidal self-injury (NSSI) is becoming an increasingly prevalent phenomenon among adolescents, endangering their health. The aims of this study were to 1) explore the associations between borderline personality features, alexithymia and NSSI and 2) examine if alexithymia mediates the relationships between borderline personality features and both the severity of NSSI and the various functions that maintain NSSI in adolescents.

Methods

This cross-sectional study recruited 1779 outpatient and inpatient aged 12-18 years from psychiatric hospitals. All adolescents completed a structured four-part questionnaire including demographic items, the Chinese version of the Functional Assessment of Self-Mutilation, the Borderline Personality Features Scale for Children and the Toronto Alexithymia Scale.

Results

The structural equation modelling results indicated that alexithymia partially mediated the associations between borderline personality features and both the severity of NSSI and the emotion regulation function of NSSI (B = 0.058 and 0.099, both p < 0.001), after controlling for age and sex.

Discussion

These findings suggest that alexithymia may play a role in the mechanism and treatment of NSSI among adolescents with borderline personality features. Further longitudinal studies are essential to validate these findings.

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

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

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

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

Adolescents With Non-Suicidal Self-Harm-Who Among Them Has Attempted Suicide?

We aimed to determine differences between adolescents with non-suicidal self-harm with and without a history of suicide attempt (SA). Sixty-eight adolescents with a mean age of 15.6 years (SD = 1.5) attending child and adolescent psychiatric outpatient clinics for repeated self-harm in Oslo, Norway, were included. A battery of instruments was used to assess sociodemographic information and psychopathology such as Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, emotional and behavioral problems, borderline symptoms, depression, hopelessness, suicidal ideation, and history of SA. Twenty-six participants (38.2%) reported a lifetime history of SA. Compared to the participants without a history of SA, those with an SA history had used a higher number of methods of self-harm and methods with higher lethality and had higher degrees of emotional and behavioral problems. They also scored higher in depressive symptoms, borderline pathology, emotional dysregulation, hopelessness, and suicidal ideation. History of SA was independently associated with perceived moderate to high risk of death on the most severe episode of self-harm (adjusted odds ratio [aOR], 15.93; 95% confidence interval [CI], 1.96-129.66), a longer duration (months) since self-harm debut (aOR, 1.07; 95% CI, 1.01-1.13), and suicidal ideation severity (aOR, 1.05; 95% CI, 1.01-1.11). Parental report of behavioral problems associated with SA suggested a strong association with externalizing problems. A combination of having a high level of psychopathology, externalizing problems, an extended history of self-harm behavior and use of more lethal self-harm methods seems to entail a significantly increased risk for making SAs among adolescents with non-suicidal self-harm. HIGHLIGHTSNon-suicidal self-harm (NSSH) with suicide attempt may be distinctive from NSSH without suicide attempt.Adolescents with NSSH with suicide attempt had relatively greater psychopathology.Protracted/lethal self-harm methods and externalizing problems indicate comorbidity.

What's Different About Those Who Have Ceased Self-Injury? Comparison Between Current and Lifetime Nonsuicidal Self-Injury

OBJECTIVE

The current study aimed to investigate the sociodemographic and psychological variables as well as the function of NSSI related to the cessation of NSSI by analyzing the difference between those currently engaged in nonsuicidal self-injury (NSSI) and those who have stopped NSSI behaviors.

METHODS

A total of 490 adults with a history of NSSI (359 females) were assigned to one of two groups: NSSI engagement within the last 12 months or "current NSSI" (n = 402) vs. no episode of NSSI in the previous 12 months or "lifetime NSSI" (n = 88).

RESULTS

There were no significant group differences in sex or socioeconomic status, while individuals with current NSSI were slightly younger than those who had ceased NSSI behavior. Regarding the functions of NSSI, the current NSSI group endorsed more intrapersonal functions. Moreover, the participants who had ceased NSSI behavior reported significantly less perceived stress, dysfunctional attitudes, alexithymia, emotion reactivity, and suicidal ideation. On the other hand, the lifetime NSSI group showed greater psychological resources such as self-esteem, distress tolerance, and resilience.

CONCLUSIONS

We revealed apparent differences in NSSI functions, clinical symptoms, and psychological resources depending on the maintenance and cessation of NSSI. This study highlights the need for a better understanding of the factors that stop as well as those that continue NSSI behaviors. HIGHLIGHTSThe lifetime NSSI group reported less intrapersonal NSSI functions.The current NSSI group suffered from more clinical symptoms.Individuals who ceased NSSI had more psychological resources.

Evaluating the Effectiveness of a Brief Mindfulness Activity in University Students With Non-Suicidal Self-Injury Engagement

Current theoretical frameworks posit that engagement in non-suicidal self-injury (NSSI) is due to an inability to regulate one's emotions. In turn, mindfulness-based interventions have been shown to enhance emotion regulatory processes in those who engage in NSSI.

OBJECTIVE

The purpose of the present study was to determine whether a brief mindfulness activity was differentially effective at increasing state mindfulness and decreasing stress following a stress induction task in university students with versus without a history of NSSI engagement.

METHOD

The sample consisted of two groups of participants who identified as women: participants with a history of NSSI engagement (NSSI; n = 57; M_age=20.09, SD = 2.05) and participants without (no-NSSI; n = 87; M_age=20.22, SD = 1.94). All participants were asked to complete pre-intervention measures of state mindfulness and stress and were randomly assigned to either a mindfulness activity (body scan) or control task condition. Following the completion of their respective activities, a Stroop stress induction task was conducted and participants completed post-intervention measures of state mindfulness and stress.

RESULTS

Two 3-way mixed ANOVAs (Time X NSSI status X Condition) were conducted and revealed significant time by condition interactions for both state mindfulness, Wilk's Λ = .93, F(1, 140) = 10.70, p = .001, η_p² = .07, and stress, Wilk's Λ = .97, F(1, 140) = 4.21, p = .04, η_p² = .03. As such, both groups (NSSI/no-NSSI) demonstrated similar increases in state mindfulness and decreases in stress in response to the brief mindfulness activity following the stress induction. Implications for future research and practice will be discussed.HIGHLIGHTSThe brief mindfulness activity effectively increased state mindfulness.The brief mindfulness activity effectively decreased stress.Benefits were experienced similarly among both groups (NSSI/no-NSSI).

Is age of self-harm onset associated with increased frequency of non-suicidal self-injury and suicide attempts in adolescent outpatients?

BACKGROUND

Self-harm in adolescents is an increasing public health concern and an important risk factor for suicide. We aimed to examine how age of self-harm onset in adolescents was associated with frequency of subsequent suicidal and non-suicidal self-harm (NSSI) episodes, and how age of onset and duration of self-harm may influence the frequency of self-harm.

METHODS

Data from 103 adolescents with recurrent self-harm recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports, and analysed with negative binomial and hurdle models.

RESULTS

A lower age of self-harm onset and a longer duration of self-harm were both significantly associated with increased frequency of subsequent episodes of NSSI and risk of a first suicide attempt. There was an increase in repeated suicide attempts when the age of onset of self-harm decreased and the duration increased, and dramatically more for long duration of NSSI before first suicide attempt.

CONCLUSION

Initiating self-harm behaviour at the youngest age had the highest risk of increased frequency of NSSI and suicide attempts. Longer duration of self-harm behaviour increased this risk. This underlines the importance of early identification of self-harm behaviour in adolescents, and the use of effective interventions.

Variability in the Functions of Nonsuicidal Self-Injury: Evidence From Three Real-Time Monitoring Studies

Despite functional models of nonsuicidal self-injury (NSSI) helping to explain why people engage in this perplexing behavior, we still lack an understanding of some of the key properties of NSSI functions. Here, we address three unanswered questions about NSSI functions: how much do distinct NSSI functions (1) vary between people over time, (2) vary within people over time, and (3) simultaneously co-occur over time? Data were drawn from three ecological momentary assessment (EMA) studies of self-injurious adult psychiatric outpatients (n = 7), community-based adolescents (n = 15), and community-based adults (n = 9). Across the three studies, there was a total of 271 NSSI episodes (all with corresponding functions captured by EMA). The vast majority (27 of 31; 87%) of participants exhibited unique patterns of NSSI functions during the monitoring periods, indicating high variability between people. The vast majority (26 of 31; 84%) of participants also showed changes in NSSI functions over time, indicating high variability within people. Although it was most common for only one function to be reported for a given NSSI episode, participants endorsed more than one function for 22% to 43% of NSSI episodes, indicating that different functions did simultaneously co-occur. These results underscore that reinforcement processes for NSSI differ from person-to-person, and are both time-varying and multifaceted, which has implications for personalized assessment and treatment of this clinical phenomenon.

Intrapersonal and Interpersonal Functions as Pathways to Future Self-Harm Repetition and Suicide Attempts

Background: Research has identified functions of non-suicidal self-harm/self-injury (NSSH) but whether functions change over time, from adolescence to early adulthood, or predict the continuation of the behavior prospectively remains unclear. This study aimed to prospectively explore whether intrapersonal and interpersonal NSSH functions in adolescence predict repetition of self-harm (regardless of suicidal intent) and incident suicide attempts in early adulthood.

Methods: Participants were 528 individuals with NSSH at age 16 years from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in the UK. Descriptive statistics were used to explore changes in functions over time from age 16 to 21, and logistic regression used to examine associations between NSSH functions and repeat self-harm and suicide attempts at age 21, 24, and 25 years.

Findings: The majority of 16-year-olds with NSSH endorsed intrapersonal (e.g., affect regulatory) functions only (73% at 16 years and 64% at 21 years). Just under half of adolescents (42%) and three quarters of 21 years olds reported more than one function simultaneously. A greater number of intrapersonal functions at 16 years independently predicted future repetition of self-harm at ages 21–25 years, over and above interpersonal functions (OR = 1.46, 95% CI 1.06–2.01). Interpersonal functions during adolescence did not predict repeat self-harm or suicide attempts in adulthood.

Discussion: Our findings suggest that intrapersonal but not interpersonal NSSH functions are a prospective risk factor for future self-harm and might also predict incident suicide attempts. The results highlight the central role of underlying affective difficulties and motivations in self-harm maintenance.

Stressful Experiences in University Predict Non-suicidal Self-Injury Through Emotional Reactivity

Theoretical perspectives on non-suicidal self-injury (NSSI; direct and deliberate self-injury without lethal intent such as self-cutting or hitting) have long underscored the affective regulating properties of NSSI. Less attention has been given to the processes through which individuals choose to engage in NSSI, specifically, to regulate their distress. In the present study, we tested one theoretical model in which recent stressful experiences facilitates NSSI through emotional reactivity. Further, we tested whether the indirect link between stressful experiences and NSSI was moderated by several NSSI specific risk factors (e.g., having friends who engage in NSSI). Given the widespread prevalence of NSSI among community-based samples of adolescents and emerging adults, we surveyed 1,125 emerging adults in first-year university at a large academic institution (72% female, Mage = 17.96, 25% with a recent history of NSSI at Time 1). Participants completed an online survey three times (assessments were 4 months apart), reporting on their recent stressful experiences in university, emotional reactivity, NSSI, as well as three NSSI specific risk factors (i.e., close friend engagement in NSSI, high self-disgust, and low fear of pain). As expected, path analysis revealed that there was a significant indirect effect of recent stressful experiences on NSSI engagement, through emotional reactivity. However, this effect was maintained across moderator analyses. These novel findings underscore the salient role of proximally occurring stressors in the prediction of NSSI among emerging adults in university, and can inform developing theoretical perspectives on NSSI.

Prevalence and Risk Factors for Nonsuicidal Self-Injury in Transgender and Gender-Expansive Youth at a Rural Gender Wellness Clinic

Purpose: Transgender and gender-expansive (TGE) populations are at increased risk for nonsuicidal self-injury (NSSI). Rural TGE populations are understudied and underserved in terms of mental health services. The purpose of this study was to determine lifetime prevalence of NSSI among TGE youth at a rural gender wellness clinic and identify demographic and clinical characteristics associated with NSSI. Methods: The Gender Wellness Center Pediatric Patient Registry, a comprehensive database of 185 TGE youth ≤25 years of age, provided an estimate of the lifetime prevalence of NSSI. Univariate logistic regression models were utilized to test associations between patient demographic and clinical characteristics and NSSI. Variables that met the threshold for significance in the univariate analyses (p<0.05) were entered into a multivariate logistic regression model. All statistical analyses were conducted in SAS v.9.4. Results: Prevalence of NSSI in the sample was 36.8% (n=68). In unadjusted logistic regression models, risk factors for NSSI included female assigned sex at birth, transmasculine spectrum gender identity, history of mood disorder, history of suicidal ideation (SI) or attempt, and history of abuse (p<0.05). In the adjusted model, variables significantly associated with NSSI included female assigned sex at birth, history of mood disorder, and history of SI or attempt. Conclusion: NSSI was highly prevalent in this sample of rural TGE youth, confirming the need for screening and early interventions that target the unique vulnerabilities of TGE youth. The complex interplay of sex assigned at birth, mood disorders, and NSSI requires further research.

Does function predict persistence? Nonsuicidal self-injury among adolescents during and after hospitalization

Nonsuicidal self-injury (NSSI) is a prevalent, concerning behavior among adolescents. Importantly, NSSI can serve a variety of functions. Some adolescents engage in NSSI to fulfill automatic or self-oriented functions (e.g., cutting to avoid internal negative states), whereas others engage in NSSI to serve social functions (e.g., cutting to communicate with others). This study tests whether self-reported reasons for engaging in NSSI, hereafter referred to as NSSI functions, predict NSSI thoughts and behaviors during and after hospitalization among adolescent psychiatric inpatients. Endorsement of both automatic and social NSSI functions, as well as positive and negative reinforcement subtypes, was assessed at hospital admission. Results showed that endorsement of overall automatic function predicted which adolescents engaged in NSSI behavior during hospitalization. Moreover, automatic and social functions showed distinct predictive patterns, such that automatic functions corresponded to greater likelihood of NSSI-related thoughts and behaviors whereas social functions mainly corresponded to reduced likelihood of NSSI-related outcomes. Of note, NSSI functions were less predictive of NSSI-related outcomes after hospital discharge. These findings suggest that identifying adolescent inpatients' reasons for NSSI engagement may meaningfully distinguish those at higher risk (and those at lower risk) of NSSI persistence during their hospital stay.

One-Year Consistency in Lifetime Frequency Estimates and Functions of Non-Suicidal Self-Injury in a Clinical Sample

Non-suicidal self-injury (NSSI), the direct, deliberate destruction of one's own bodily tissue in the absence of an intent to die, is frequently used for evaluating treatment in clinical care. One instrument for assessing NSSI is the Inventory of Statements About Self-Injury (ISAS). The ISAS is a self-rating measure examining the lifetime frequencies of NSSI behaviors and further exploring NSSI functions. The study aimed to examine the consistency of self-reported lifetime NSSI frequencies and functions (via the ISAS) in a clinical sample of individuals with current self-harm and/or recurrent suicidal behaviors over one year. Fifty-two individuals (84.6% women) completed the ISAS three times over 1 year. We found relatively good test-retest stability for most NSSI behaviors and functions, but the correlation coefficients and frequencies of NSSI behaviors varied substantially. Approximately, 50% of participants reported lower lifetime frequencies of NSSI behaviors at the later time points, with approximately 20% reporting a significant reduction in their lifetime frequencies over one year. This unexpected finding raises concerns about the accuracy of reporting lifetime NSSI frequencies among individuals with multiple psychiatric diagnoses and extensive NSSI behaviors across their lives. Further research is needed to determine more reliable ways of collecting data on the lifetime frequency of NSSI in clinical samples and the accuracy of lifetime NSSI frequency estimates in general.

Clinical and personality characteristics of adolescents with anorexia nervosa with or without non-suicidal self-injurious behavior

PURPOSE

About one-fifth of patients with anorexia nervosa (AN) engage in non-suicidal self-injury (NSSI). This study examined clinical and temperament profile of female adolescents with both disorders (AN+NSSI) as compared with peers with AN only.

METHODS

A consecutive sample of 73 female adolescents with AN (mean age: 13.77 years), who had been admitted to inpatient or day-hospital services, received clinical, cognitive, and temperament/character evaluations. Of them, 32 met DSM-5 criteria also for NSSI. Assessments included demographics, standard nutrition parameters, Youth Self-Report (YSR), Wechsler Intelligence Scale for Children IV (WISC-IV), Temperament and Character Inventory (TCI), and Global Assessment of Functioning (GAF).

RESULTS

No differences were detected between AN+NSSI and AN in demographics, body mass index, or age at onset of AN. AN+NSSI had higher rate of binging and purging, higher YSR scores for both internalizing and externalizing psychopathology, lower total IQ, and lower Self-directedness and Cooperativeness scores.

CONCLUSIONS

These data suggest that adolescents with AN+NSSI have psychopathological, cognitive and overall character features that differ from patients with AN only. These characteristics may have implications for treatment and outcome.

Function and progression of non-suicidal self-injury and relationship with suicide attempts: A qualitative investigation with an adolescent clinical sample

AIM

To investigate the function and progression of non-suicidal self-injury (NSSI) and its relationship with suicide attempts.

METHOD

Qualitative in-depth interviews were conducted with 15 adolescents psychiatrically hospitalized following a suicide attempt who reported NSSI. Applied thematic analysis was used to identify and examine themes from the interview data.

RESULTS

Thematic analysis revealed that the primary function of NSSI was relief from emotional pain, though the function often changed over time. NSSI was often not directly related to patients' suicide attempts, yet risk of suicidal behavior seemed to increase once NSSI lost its effectiveness, and suicide became the only option.

CONCLUSION

Clinicians need to understand and monitor the functions of NSSI, and its relationship with suicidality, to prevent suicide attempts among adolescents.

Self-injury Age of Onset: A Risk Factor for NSSI Severity and Suicidal Behavior

This study replicates and extends prior work by examining how age of Non Suicidal Self-Injury (NSSI) onset relates to NSSI severity, suicidal behavior, perceived recovery from NSSI, and protective factors of life satisfaction, resilience, and subjective happiness. University students who reported engaging in NSSI within the past year (n = 644) completed on-line questionnaires assessing NSSI characteristics, suicidal behavior, and protective factors. Participants who began self-injuring at or before age 12 reported significantly more lifetime acts of NSSI, greater method versatility, and medically severe NSSI than those who began NSSI at older ages (17 years). Those with a typical age of onset (13-16 years) did not differ from the younger age group on method versatility, medical severity, past year frequency, or perceived recovery but did differ from those with an older age of onset. The proportion of individuals reporting suicide attempts significantly increased as the age of onset became younger. No age of onset group differences were observed on the protective factors. The age at which one begins NSSI appears to be a risk factor for increasingly severe NSSI and potential suicidal behavior. Early detection and intervention is important for reducing the negative consequences of engaging in NSSI.

Starting from scratch: prevalence, methods, and functions of non-suicidal self-injury among refugee minors in Belgium

BACKGROUND

As many refugee minors have gone/go through stressful life experiences and uncertainty, one might expect mental health issues, including self-injury. However, literature on non-suicidal self-injury (NSSI) in refugee minors is scarce. This study explores the prevalence, methods, and functions of NSSI in refugee minors in Belgium, and compares research results to the existing literature on NSSI in Western adolescents.

METHODS

Data were obtained from 121 refugee minors (mean age = 16.12, SD = 1.23; range 14-18 years) through schools located in the Flemish and Brussels-Capital regions of Belgium. The sample consists of 39.7% girls and 60.3% boys. Self-report questionnaires were used to explore socio-economic data, NSSI behaviour (e.g. The Brief Non-Suicidal Self-injury Assessment Tool; BNNSI-AT) and emotional and behavioural difficulties (The Strengths and Difficulties Questionnaire; SDQ). Non-parametric Chi square tests were used for statistical comparisons of the obtained data as well as independent-sample t-tests and Fisher's exact tests.

RESULTS

Results show a lifetime NSSI prevalence rate of 17.4%. Being accompanied or not, having both parents around, or living in an asylum centre did not influence NSSI prevalence. An average of 2.65 methods of NSSI was applied (SD = 2.50; range 1-9). The mean number of functions per person was six (SD = 4.97, range 0-16), with automatic functions reported the most. The data do point towards a greater psychological strain, with 68.4% reporting more than five acts of NSSI. Results of the SDQ's Total Difficulties Scale and, more specifically, of the Emotional Problems, Conduct Problems, Peer Problems and Impact Scales indicate a substantial risk of clinically significant problems within the NSSI group. The Peer Problems and Impact Scales also point towards a high risk for suicidality amongst self-injuring refugees.

CONCLUSIONS

Prevalence rates, methods and functions are comparable to Western samples. However, the higher incidence of the NSSI and the results on the SDQ also emphasise the vulnerability of refugee minors.

Perceived effectiveness of NSSI in achieving functions on severity and suicide risk

Nonsuicidal self-injury (NSSI) continues to be a psychiatric problem for youth and young adults, and is a robust risk factor for suicidal thoughts and behaviors. Research has established that NSSI is motivated by intrapersonal and interpersonal functions; however, research on the perceived effectiveness of NSSI for achieving the desired functions is lacking. In the current study, it was expected that using NSSI to achieve intrapersonal functions would be rated as more effective than interpersonal functions, and that perceived effectiveness of NSSI would be differentially related to NSSI severity and suicide risk outcomes. In a sample of 264 adults with lifetime NSSI history (over 70% past year), intrapersonal functions were endorsed more than interpersonal functions, and were rated as significantly more effective. Overall, perceived effectiveness of NSSI for intrapersonal functions was significantly and positively predictive of NSSI severity, while interpersonal functions were significantly and negatively related. Perceived effectiveness of NSSI for intrapersonal functions, but not interpersonal functions, were significantly predictive of more frequent and intense suicide ideation and greater likelihood of suicide plans and attempts. Results highlight the importance of assessing the perceived effectiveness of NSSI for specific functions in identifying individuals at risk for more severe NSSI and suicide.