Childhood maltreatment and impulsivity as predictors of interpersonal violence, self-injury and suicide attempts: A national study

Childhood maltreatment and suicide attempts in major depression and bipolar disorders in South Korea: A prospective nationwide cohort study

BACKGROUND

Childhood maltreatment (CM) is prevalent among patients with mood disorders and considered an important risk factor for suicide in the general population. Despite mood disorders being implicated in up to 60 % of completed suicides, the predictive role of CM on suicide attempt (SA) among early mood disorder patients remains poorly understood.

METHODS

We enrolled 480 participants diagnosed with early-onset major depressive disorder (MDD), bipolar I disorder (BD I), and bipolar II disorder (BD II). Over an average of 60 weeks, participants underwent follow-up assessments at 12-week intervals. Using multivariate logistic regression, we examined the association between CM and SA history at baseline. Further, the Cox proportional hazard model assessed the predictive role of childhood maltreatment in SA during follow-up.

RESULTS

At baseline, 38 % of the total participants reported SA history, with a follow-up prevalence of 10 %. Childhood maltreatment was significantly associated with past SAs and was a robust predictor of future SA, adjusting for relevant clinical risk factors. Emotional abuse and sexual abuse related to SA history, and physical abuse increased future SA risk.

LIMITATIONS

Potential biases in reporting SA and childhood maltreatment, along with unexplored factors such as additional environmental and familial risks, may affect the study's findings.

CONCLUSIONS

Childhood maltreatment emerged as a robust predictor of SA among early-onset mood disorder patients. Systematic evaluation of CM early in the clinical process may be crucial for effective risk management. Additionally, our findings highlight the importance of implementing proactive interventions for CM to prevent the onset of adverse psychological trajectories.

Correlations between non-suicidal self-injury and problematic internet use among Chinese adolescents: a systematic review and meta-analysis

Background

Non-Suicidal Self-Injury (NSSI) has continued to be a major issue for public health worldwide, especially among teenagers. Studies have found a certain correlation between NSSI and Problematic Internet Use (PIU). However, this relationship is still unclear among Chinese adolescents, a specific population. Hence, a meta-analysis was carried out on observational studies to explore the connection between NSSI and PIU in Chinese teenagers, aiming to provide more clarity on the correlation.

Methods

To identify the link between NSSI and PIU, we scoured seven digital repositories until November 16, 2023. Employing a random-effects meta-analysis framework, we delved into the association between NSSI and PIU. Additionally, we carried out subgroup evaluations to scrutinize variables including geographical location, age demographics, research methodology, diagnostic instruments, gender, and variables controlled for confounding, like symptoms of depression. For amalgamating data, STATA software (version 16) was deployed.

Results

In this analysis, we included 15 research papers encompassing a collective sample of 137,166 individuals. Our findings revealed a significant positive association between NSSI and PIU within the adolescent population in China, with an Odds Ratio (OR) of 2.02 and a 95% Confidence Interval (CI) ranging from 1.73 to 2.37. Notably, this correlation was markedly stronger in specific subgroups: adolescents from China's Western regions exhibited an OR of 4.22 (95% CI: 3.44, 5.18); middle school attendees had an OR of 2.09 (95% CI: 1.92, 2.28); those diagnosed with concurrent depression disorders showed an OR of 2.32 (95% CI: 1.98, 2.73); and female adolescents demonstrated an OR of 2.49 (95% CI: 2.26, 2.75), highlighting the nuanced dynamics of this relationship.

Conclusion

This meta-analysis indicates that PIU among adolescents is associated with an increased risk of NSSI. Our findings underscore the importance of targeting specific populations, including those in the western region of China, middle school students, adolescents with comorbid depression disorders, and female adolescents, who may be at higher risk of PIU and subsequently NSSI. These results emphasize the need for tailored interventions and preventive strategies to address these intertwined issues effectively.

Systematic review registration

PROSPERO, identifier CRD42024496579.

Incidence and correlates of suicide attempts in adolescents with major depressive versus bipolar disorders: A cross-sectional study

BACKGROUND

Major depressive disorders (MDD) and bipolar disorders (BD) are the most common psychiatric diagnoses of suicide attempts (SA) in adolescents. However, little is known regarding the differences in incidence and clinical-related features of SA between these two disorders. The study aims to examine the SA incidence and related factors in adolescents with MDD versus BD.

METHOD

A retrospective survey was conducted in outpatients. SA incidence, demographic characteristics and substance use history were collected. Symptom Checklist-90 was used to measure the severity of symptoms. The Revised Chinese internet addiction scale and Barratt Impulsiveness Scale-11 were utilized to assess the presence of internet addiction and impulsiveness. The Childhood Trauma Questionnaire was used to measure childhood maltreatment subtypes.

RESULTS

295 MDD and 205 BD adolescents were recruited. The incidence of SA for MDD and BD were 52.5 % and 56.4 %, respectively. BD adolescents who attempted suicide showed worse symptoms, higher rates of nicotine and alcohol use, higher motor and non-planning impulsivity, and a more childhood physical abuse proportion than MDD adolescents with SA. Physical abuse in childhood was found to be associated with SA in both disorders (OR = 1.998 for MDD; OR = 2.275 for BD), while higher anxiety (OR = 1.705), and alcohol use (OR = 2.094) were only associated with SA in MDD.

LIMITATIONS

Retrospective, cross-sectional design cannot draw causality, and biases in self-report measurements cannot be ignored.

CONCLUSIONS

The findings revealed some difference between BD and MDD for adolescents with SA, and it emphasize significance of prompt identification and exact distinction between BD and MDD in adolescents.

Sleep and circadian rhythms in adolescents with attempted suicide

Sleep and circadian rhythm disorders are very common in adolescents and have been linked to suicidal ideation. However, little is known about adolescent sleep before a suicide attempt (SA). The objectives of this study were to compare the sleep of adolescents aged 13 to 18 over a period of 4 weeks before a SA compared to a non-SA group, then to analyze the association between sleep, support social and well-being based on information from validated questionnaires. In 2015, 250 adolescents were included, 55 were recruited the day after a SA in French hospitals (before SA evaluations were retrospective). Logistic regression analyzes showed that during school days, bedtime was equivalent in both groups, but sleep onset latency was significantly longer in SA (86 min vs. 52 min, p = 0.016), and wake-up time was earlier (6 h 22 vs. 6 h 47, p = 0.002), resulting in a shorter total sleep time of 44 min (OR = 0.76, CI 95% [0.61-0.93]) the month preceding SA. Adolescents with longer sleep time performed better on perceived psychological well-being (p = 0.005), relationship with parents (p = 0.011) and school environment (p < 0.001). Results indicate a significant change in the quantity and quality of adolescents' subjective sleep in the 4 weeks preceding SA requiring objective measures to study the predictive properties of sleep in SA.

The relationship between mobile phone addiction and non-suicidal self-injury: Findings from six universities in Shaanxi province, China

BACKGROUND

Although the development and application of mobile phones have changed various aspects of people's lives, excessive use of mobile phones has also raised physical and mental health concerns. However, the relationship between mobile phone addiction (MPA) and non-suicidal self-injury (NSSI) is unclear.

METHODS

A cross-sectional study was conducted (2022) among students from six universities to assess the relationship between MPA and NSSI. A Mobile Phone Addiction Tendency Scale (MPATS) was used to assess MPA, while NSSI was assessed via The Ottawa Self-Injury Inventory. Binary logistic regression models were used to assess the relationship between MPA and NSSI.

RESULTS

A total of 18,723 college students (6531 males [34.9 %] and 12,192 females [65.1 %]) were included in the final analyses. The prevalence of NSSI during the past 12 months was 6.5 %. Furthermore, 5553 participants (29.7 %) met the MPA criteria (MPATS score ≥ 48), and the average MPATS score was 39.5 ± 13.0. MPA was associated with increased odds of NSSI after adjusting for socio-demographic characteristics, health-related characteristics, and relevant psychosocial variables (OR, 1.29; 95 % CI, 1.13-1.46). Moreover, gender did not affect the association of MPA and MPATS score with NSSI (P for interaction>0.05). The restricted cubic splines regression showed that a monotonically increasing risk of NSSI was associated with increasing MPATS score (P for non-linearity = 0.474).

CONCLUSIONS

MPA is associated with increased odds of NSSI among college students, indicating that early examination, prevention, and intervention for MPA may prevent and control NSSI.

Mediating role of anxiety and impulsivity in the association between child maltreatment and lifetime non-suicidal self-injury with and without suicidal self-injury

BACKGROUND

Child maltreatment can increase the risk of lifetime non-suicidal self-injury (NSSI) and suicidal self-injury (SSI), but there is limited knowledge regarding the differences of potentially psychological mechanisms between NSSI with and without SSI.

METHODS

Participants, 3918 community-based Chinese young men aged 18-34 years in Chengdu, were included in this study. We investigated the association between depression, anxiety, psychosis, child maltreatment, adulthood traumatic events, impulsivity, alcohol dependence, drug abuse, and lifetime of NSSI among participants with and without SSI. Parallel mediation analysis was utilized to explore the mediators for the relation between child maltreatment and NSSI.

RESULTS

The prevalence of lifetime NSSI was 6.1 % (95 % CI: 5.4 %-6.9 %) among young men. Anxiety and impulsivity partially mediated the effect of child maltreatment on NSSI either with (indirect effect: 51.2 %) or without SSI (indirect effect: 34.3 %). Depression was independently and significantly associated with only NSSI but not with NSSI+SSI. Alcohol dependence and psychosis were independently and significantly associated with NSSI+SSI and mediated the effect of child maltreatment on NSSI+SSI.

LIMITATIONS

The cross-sectional survey data limits the robustness of the proof to the causal relationships.

CONCLUSIONS

Anxiety and impulsivity are associated with NSSI either with or without SSI and partially mediate the effect of child maltreatment on NSSI. Depression is associated with only NSSI, while alcohol dependence and psychosis are only associated with NSSI+SSI. It could be crucial to improve treatment and recovery of alcohol dependence and psychosis for preventing young men engaged in NSSI from attempting SSI.

Self-harm and interpersonal violence due to high temperature from the global burden of disease study 2019: A 30-year assessment

BACKGROUND

The impact of global warming on health due to climate change is increasingly studied, but the global burden of self-harm and interpersonal violence attributable to high temperature is still limited. This study aimed to systematically assess the burden of self-harm and interpersonal violence attributable to high temperature globally or by region and climate zone from 1990 to 2019.

METHODS

We obtained the global, regional, and national deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized disability-adjusted life year rates (ASDR) of self-harm and interpersonal violence due to high temperature from 1990 to 2019 through the Global Burden of Disease Study (GBD) 2019. The burden of self-harm and interpersonal violence due to high temperature was estimated by age, sex, climate zone, the socio-demographic index (SDI), and the healthcare access and quality index (HAQ). Average annual percentage changes (AAPCs) in ASMR and ASDR were calculated for 1990-2019 using the Joinpoint model.

RESULTS

From 1990 to 2019, the global deaths and DALYs related to self-harm and interpersonal violence due to high temperature increased from 20,002 (95% UI, 9243 to 41,928) and 1,107,216 (95% UI, 512,062 to 2,319,477) to 26,459 (95% UI, 13,574 to 47,265) and 1,382,487 (95% UI, 722,060 to 2,474,441), respectively. However, the ASMR and ASDR showed varying degrees of decreasing trends, with decreases of 13.36% and 12.66%, respectively. The ASMR was high and declining in low and low-middle SDI regions, particularly in tropical and subtropical regions. In addition, SDI and HAQ index were negatively correlated with ASMR in 204 countries and regions.

CONCLUSIONS

The global burden of self-harm and interpersonal violence attributed to high temperature has decreased over the past 30 years, but the number of deaths and DALYs continues to rise. Climate change continues to make heat stress a significant risk factor for self-harm and interpersonal violence worldwide.

The mediating role of impulsivity between sleep quality and suicidal ideation in adolescent population: a multicenter cross-sectional study in the northeastern Sichuan, China

Introduction

Suicidal ideation is a critical early stage in the progression towards suicidal be havior. Prior research has established links between sleep quality, impulsivity, and suicidal tendencies, yet the interaction among these factors has been less explored. This study aims to explore the mediating role of impulsivity in the relationship between sleep quality and suicidal ideation in adolescents.

Methods

Employing a cross-sectional study design, 6,974 questionnaires were distributed,including the Socio-demographic Characteristics Questionnaire, Barratt Impulsiveness Scale, the Positive and Negative Suicide Ideation Inventory,and the Pittsburgh Sleep Quality Index Scale. The participants were high school and middle school students from 33 schools in northeastern Sichuan, China, selected through random cluster sampling.

Results

Of these 6,786 questionnaires were analyzed. The participant distribution included 47.2% male and 52.8% female students, with 68.3% from junior schools and 31.7% from senior schools. The prevalence of suicidal ideation was found to be 13.6%. The analysis, which involved correlation analysis and the construction of a structural equation model, revealed that sleep quality had a significant positive effect on impulsivity (β:0.289,p < 0.05), and impulsivity, in turn, had a positive impact on suicidal ideation (β:0.355,p < 0.05).Moreover, sleep quality was directly linked to suicidal ideation (β:0.208,p < 0.05). Thus, sleep quality affects suicidal ideation both directly and indirectly through impulsivity.

Discussion

The results of this study suggest that both sleep quality and impulsivity are significant direct influencers of suicidal ideation among adolescents in the region studied, with impulsivity also playing an indirect role in the relationship between sleep quality and suicidal ideation.

Frequency and predictors of individual treatment outcomes (response, remission, exacerbation, and relapse) in clinical adolescents with nonsuicidal self-injury

BACKGROUND

Nonsuicidal self-injury (NSSI) is prevalent in adolescent clinical samples. There is evidence that NSSI can be treated effectively but data on individual treatment outcomes is limited. The goal of this study was to examine response, remission, exacerbation, and relapse rates over one and two years, respectively, among a clinical sample of adolescents with NSSI. Furthermore, we aimed to identify clinically relevant predictors of NSSI trajectories.

METHODS

The sample consists of n = 203 adolescents (12-17 y., 94% female) from a specialized outpatient clinic for risk-taking and self-harming behavior with NSSI on at least five days in the six months before first assessment. Assessments were completed at baseline and one (FU1) and two (FU2) years later using structured clinical interviews and self-report questionnaires.

RESULTS

At FU1, 75% reported a reduction in NSSI frequency by at least 50% (treatment response); among those, one third (25% of the entire sample) achieved a remission (0 NSSI); an exacerbation (⩾50% more NSSI) was observed in 11% of patients. Of those in remission, 41% relapsed one year later. Predictors of non-response or non-remission were inpatient treatment and depressive symptoms. Adolescents with lower NSSI frequency at baseline had a higher risk of exacerbation. Due to limited sample size at FU2 no prediction model for relapse was established.

CONCLUSIONS

While most adolescents presenting with NSSI achieved significant improvement, more attention should be paid to the rather low rates of full remission. Prediction and early detection of individuals who deteriorate during or relapse after treatment is critical.

Purpose maintained: Adverse childhood experiences and meaning in life

OBJECTIVE

Three studies examined the relationship between adverse childhood experiences and meaning in life, focusing on the facets of meaning-coherence, significance, and purpose.

METHOD

In Study 1 (N = 1804), college students rated adverse childhood experiences, global meaning in life, and its facets. In Study 2 (N = 822), noncollege adults rated childhood trauma, meaning in life facets, attachment style, mood, and neuroticism. In Study 3 (N = 380) college students wrote about a positive and negative childhood memory, rating the facets of meaning immediately after each writing task.

RESULTS

In Studies 1-2, at the level of zero-order correlations, adverse childhood experiences related negatively to coherence, significance, and purpose. Controlling for the other facets, adverse childhood experiences remained negatively related to coherence and significance but were unrelated to purpose. Negative relationships between adverse childhood experiences and coherence and significance maintained controlling for covariates (Study 2). In Study 3, the predicted 3-way interaction showed that after recalling a negative childhood memory, adverse childhood experiences predicted lower significance and coherence but higher purpose.

CONCLUSIONS

Adverse childhood experiences consistently predict lower feelings of coherence and significance but, accounting for these associations, are unrelated to purpose. Purpose may represent a motivational strength emerging out of childhood adversity.

Association of two variable number of tandem repeats in the monoamine oxidase A gene promoter with suicide completion: The present study and meta-analysis

BACKGROUND

One potential cause of suicide is serotonergic dysfunction. Sex differences have been reported to modulate the effects of serotonergic polymorphisms. Monoamine oxidase A (MAOA) is an enzyme that degrades serotonin and is located on the X chromosome. A previous study indicated that the upstream (u) variable number of tandem repeat (VNTR) in the MAOA gene promoter may be associated with suicide. However, a meta-analysis showed that this polymorphism may not be related to suicide. According to a recent study, compared with the uVNTR, the distal (d)VNTR and the haplotypes of the two VNTRs modulate MAOA expression.

METHODS

We examined the two VNTRs in the MAOA gene promoter in 1007 subjects who committed suicide and 844 healthy controls. We analyzed the two VNTRs using fluorescence-based polymerase chain reaction assays. We conducted a meta-analysis for the two VNTRs to update it.

RESULTS

Our results demonstrated that neither the genotype-based associations nor allele/haplotype frequencies of the two VNTRs were significantly associated with suicide. In the meta-analysis, we did not indicate relationships between uVNTR and suicide nor did we identify articles analyzing dVNTR in suicide.

CONCLUSION

Overall, we did not find a relationship between the two VNTRs in the MAOA promoter and suicide completion; thus, warranting further studies are required.

A Longitudinal Examination of Recent Posttraumatic Stress Symptoms and Nonsuicidal Self-Injury among University Students

Nonsuicidal self-injury is a burgeoning mental health concern amongst post-secondary students. In the present study, the link between posttraumatic stress symptoms (PTSS) and nonsuicidal self-injury (NSSI) was examined among post-secondary students over time, while accounting for the role of co-occurring depressive symptoms. Participants were 841 first-year university students with self-reported lifetime histories of trauma who reported on traumatic experiences, PTSS, depressive symptoms, and NSSI at three time points over the course of their first year of university. This study also included exploratory correlational analyses of the relation among PTSS and motivations for NSSI engagement. As expected, PTSS predicted NSSI engagement among students within and across time, though effects were small. The strongest correlations were among PTSS and engaging in NSSI for the purposes of fulfilling self-punishment desires and anti-dissociation (e.g., to reduce feelings of numbness). This study provides further support for theories underscoring NSSI as a means of coping with intra- and interpersonal distress among post-secondary students experiencing stressful life events, such as trauma.

Impact of lithium on mortality among older adults with major psychiatric disorders: A 5-year prospective multicenter study

OBJECTIVE

Prior studies report conflicting results about the association between lithium use and all-cause mortality. In addition, data are scarce on this association among older adults with psychiatric disorders. In this report, we sought to examine the associations of lithium use with all-cause mortality and specific causes of death (i.e., due to cardiovascular disorder, non-cardiovascular disease, accident, or suicide) among older adults with psychiatric disorders during a 5-year follow-up period.

METHODS

In this observational epidemiological study, we used data from 561 patients belonging to a Cohort of individuals with Schizophrenia or Affective disorders aged 55-years or more (CSA). Patients taking lithium at baseline were first compared to patients not taking lithium, and then to patients taking (i) antiepileptics and (ii) atypical antipsychotics in sensitivity analyses. Analyses were adjusted for socio-demographic (e.g., age, gender), clinical characteristics (e.g., psychiatric diagnosis, cognitive functioning), and other psychotropic medications (e.g. benzodiazepines).

RESULTS

There was no significant association between lithium use and all-cause mortality [AOR=1.12; 95%CI=0.45-2.79; p=0.810] or disease-related mortality [AOR=1.37; 95%CI=0.51-3.65; p=0.530]. None of the 44 patients taking lithium died from suicide, whereas 4.0% (N=16) of patients not receiving lithium did.

CONCLUSION

These findings suggest that lithium may not be associated with all-cause or disease-related mortality and might be associated with reduced risk of suicide in this population. They argue against the underuse of lithium as compared with antiepileptics and atypical antipsychotics among older adults with mood disorders.

Non-suicidal self-injury and suicidal ideation among Chinese college students of childhood emotional abuse: associations with rumination, experiential avoidance, and depression

Background

Prior studies have proved the relationships between childhood emotional abuse (CEA) histories and suicidal thoughts or behaviors in adulthood, however, how emotion regulation strategies work as the mediating mechanism is necessary to be investigated. This study aimed to further verify the impacts of rumination, experiential avoidance (EA) and depression on the associations between CEA and non-suicidal self-injury (NSSI) and suicidal ideation (SI) on a sample of Chinese college students.

Methods

The Childhood Emotional Abuse Questionnaire, the Non-Suicidal Self-Injury Questionnaire, the Symptom Checklist, the Ruminative Response Scale, the Acceptance and Action Questionnaire-II and the Zung Self-Rating Depression Scale were completed by 1,317 college students.

Results

The rates of NSSI and SI of students with CEA experiences were 31.70 and 7.90% respectively, both higher than those without such experiences. The mediating roles of rumination, EA and depression between CEA and NSSI and SI were significant (p < 0.01).

Conclusion

The current study shed light on the linking roles of rumination, EA and depression in the relations between CEA and NSSI and SI. It is suggested that developing adaptive emotion-regulating strategies may be helpful to the intervention of suicidal thoughts or behaviors among individuals with CEA experiences.

Violence and Suicidal/Nonsuicidal Self-Injury Among Adolescents Undergoing Residential Treatment: An Examination of the Predictive Validity of the SAVRY, START:AV, and VRS-YV

Using a retrospective study design, predictive validity of the Structured Assessment of Violence Risk in Youth, Short-Term Assessment of Risk and Treatability: Adolescent Version (START: AV), and the Violence Risk Scale-Youth Version (VRS-YV) was examined among 87 adolescents referred to a residential treatment program. With few exceptions, moderate to high accuracy was achieved for the three measures in predicting violence and suicidal/nonsuicidal self-injury occurring during the adolescents' time in treatment. Accuracy of the measures peaked within 90 days for violence and gradually increased over the 180-day follow-up for suicidal/nonsuicidal self-injury. Dynamic factors were more predictive of repeated events involving violence relative to static/historical factors, whereas only factors from the START: AV were predictive of repeated events involving suicidal/nonsuicidal self-injury. These results emphasize the need for further examining the risk of adverse outcomes beyond violence among adolescents.

The relationship between child maltreatment and social anxiety: A meta-analysis

BACKGROUND

Globally, child maltreatment has become a serious problem, affecting individuals' physical and mental health. This meta-analysis aimed to explore the association between child maltreatment and social anxiety.

METHODS

MEDLINE, PsycINFO, EMBASE, Scopus, and Web of Science were searched for articles published by October 2021. Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate the quality of studies. Maltreatment type, sample setting, age, country and measurement instruments were analyzed as moderators.

RESULTS

Twenty-nine studies met the inclusion criteria. Child maltreatment was positively correlated with social anxiety (r = 0.201, 95 % CI [0.171, 0.230]). The moderating effect of maltreatment subtypes was significant whether divided into three types (Q_b = 12.152, p = .002), or five types (Q_b = 11.574, p = .021). Specifically, emotional maltreatment (r = 0.251, 95 % CI [0.201, 0.298]) had a stronger relationship with social anxiety than physical (r = 0.138, 95 % CI [0.085, 0.191]; Q_b = 9.312, p = .002) and sexual maltreatment (r = 0.153, 95 % CI [0.108, 0.197]; Q_b = 9.197, p = .002). However, there was no significant difference in the effect size between physical and sexual maltreatment (Q_b = 0.096, p = .757). Other variables (age, sample setting and country) were not significant moderators.

LIMITATIONS

Only twenty-nine studies were included, and there was high heterogeneity among the studies, the interpretation of the results should be cautious.

CONCLUSIONS

This meta-analysis confirmed the relationship between child maltreatment and social anxiety, especially highlight the harmfulness of emotional maltreatment.

History of abuse is associated with thoughts of harm among patients with pain after accounting for depressive symptoms

INTRODUCTION

Screening for depressive symptoms is often the first step to understanding risk for thoughts of harm among patients with pain. Pain characteristics and history of abuse are also associated with thoughts of harm; however, little is known about these associations after accounting for depressive symptoms. This study examined the association between pain characteristics and history of abuse with thoughts of harm among pain patients with moderate to severe and low to mild depressive symptoms.

METHODS

We conducted a cross-sectional analysis of patients (n=7510) who presented to a tertiary-care, outpatient pain clinic.

RESULTS

Abuse history was significantly associated with increased odds of reporting thoughts of harm for both patients with moderate to severe depressive symptoms as well as low to mild depressive symptoms. Abuse did not modify the association between any of the pain characteristics and thoughts of harm.

DISCUSSION

Our results highlight the importance of abuse history in assessing thoughts of harm. Although we are unable to infer causality due to the cross-sectional design, this study highlights the importance of screening for abuse history when assessing for suicidal and homicidal ideation.

Parental neglect, anxious attachment, perceived social support, and mental health among Chinese college students with left-behind experience: A longitudinal study

The harm of childhood parental neglect to emerging adults' maladjustment has garnered empirical support. For college students who have left-behind experience (LBE), this relationship is rarely discussed and the psychological process underlying this relationship is not well understood. Using a longitudinal study and guided by the Risky Families model, this study aimed to explore the mediating roles of anxious attachment and perceived social support in the link between parental neglect and maladjustment of LBE college students. We used two-wave longitudinal data, with a time lag of 3 months, collected among Chinese college students with LBE in Chongqing (N = 391). The results revealed that parental neglect in wave one was positively associated with maladjustment (depression, anxiety, and stress) in wave two. Anxious attachment and perceived social support in wave two separately mediated the relationship between parental neglect in wave one and maladjustment in wave two. Anxious attachment and perceived social support in wave two only sequentially mediated the pathway from parental neglect to later depression. These findings emphasize the importance of anxious attachment and social support in resilience and have significant implications for LBE college students' social work practice in China.

You Hurt Me, so I Hurt Myself and Others: How Does Childhood Emotional Maltreatment Affect Adolescent Violent Behavior and Suicidal Ideation?

Violent behavior and suicidal ideation are two major public health problems, with the former representing outward attack and the latter characterizing inward attack. The effects of emotional maltreatment in childhood will continue into adolescence. This study explores the impact of childhood emotional maltreatment on adolescent violent behavior/suicidal ideation and its mechanism. Participants were 3,600 adolescents (average age is 16.21 ± 0.99) from the middle east of China. They completed questionnaires measuring emotional maltreatment in childhood, deviant peer affiliation, depression, violent behavior, and suicidal ideation in adolescence. After controlling for demographic variables, we found that deviant peer affiliation and depression mediated between childhood emotional maltreatment and adolescent violent behavior/suicidal ideation. Multi-group analysis results showed that males' deviant peer affiliation would contribute to their violent behaviors. Among female groups, deviant peer affiliation and depression were risk factors for violent behavior and suicidal ideation. a) cross-sectional design was used in this study; b) all the measures were self-reported. Preventing emotional maltreatment in childhood can help reduce violent behavior and suicidal ideation by reducing deviant peer affiliation and depression in adolescence. Males who experienced emotional maltreatment in childhood are more likely to show violent behaviors shaped by external factors such as deviant peer affiliation. In contrast, females' interpersonal orientation and internalizing factors both influence their external and internal aggressive behaviors.

Childhood emotional abuse and motor impulsiveness among male violent inmates with antisocial personality disorder

This study aimed to explore the relationship among childhood maltreatment, impulsiveness and antisocial personality through a questionnaire survey of violent male inmates. We found that the scores of inmates with Antisocial Personality Disorder (ASPD) in Childhood Trauma Questionnaire-28 item Short Form (CTQ-SF) and Barratt Impulsive Scale-11 (BIS-11) were higher than those in the Non-Antisocial personality group, and there was a significant correlation between the scores of CTQ-SF and BIS-11. We found that the interaction between impulsivity and childhood abuse predicts ASPD levels. Moreover, motor and non-planning impulsiveness played important roles in the observed differences in antisocial personality scores among the inmates who had experienced childhood maltreatment; motor impulsiveness was mainly related to emotional abuse, physical abuse, and sexual abuse, while non-planning impulsiveness was mainly related to emotional neglect and physical neglect. These findings suggest that identifying and providing timely intervention for inmates with high impulsiveness who experienced maltreatment in childhood may also contribute to the prevention of violent behavior and to better prison management.

Reseach progress in dual harm

Growing evidence supports an association between self-harm and aggression, and the two behaviors frequently co-occur. The co-occurrence of self-harm and aggression is termed as dual harm. Existing evidence reveals that rather than a simple co-occurrence of self-harm and aggression, dual-harm may be an independent behavior different from a sole harm behavior. Identification of characteristics and influencing factors for dual harm may help develop effective prevention strategies for the affected population. A review of the literature yields a high incidence of dual harm among the clinical and forensic populations. Individuals with dual harm engage in an earlier, more frequent, and a wider range of harmful behaviors, with the increased use of lethal methods. Common factors that affect dual harm include childhood adversities, emotional dysregulation, personality traits, mental disorders, and biological factors. A comprehensive theory to explain dual harm is still not available. Currently, two main theories for explaining mechanism of dual harm are the two-stage model of countervailing forces and the cognitive-emotional model. An in-depth exploration of characteristics, influencing factors, and theories for dual harm is of great importance for the prevention of dual harm.

Impulsivity, impulsive aggression and borderline personality features among violent spouses

Objective

Spousal violence in Pakistan is under researched but still not considered as a public health problem. The current study is intended to analyze the association between multiple measures of impulsivity, impulsive aggression, and borderline personality feature among violent spouses as well as to find out the moderating role of impulsive aggression between spousal violence and borderline personality features.

Methods

A cross-sectional survey research design was used for conducting the research. The sample of 300 spouses, experiencing intimate partner relationships, was taken from different cities of the Hazara division through purposive sampling.

Results

Present study demonstrated a significant positive correlation of spousal violence with impulsivity (r = .708∗∗, P < .001), impulsive aggression (r = .176∗∗, P < .001), and borderline personality features (r = .605∗∗, P < .001), while impulsivity was negatively correlated with impulsive aggression (r = -.018, P < .01). Impulsive aggression moderates the relationship between spousal violence and borderline personality features. The results showed that male and female spouses were found equally impulsive and impulsively aggressive. Likewise, impulsivity, impulsive aggression, and borderline personality features were found significant predictors of violence F = (3, 296) = 106. 67, P < .001.

Conclusion

Current research offers some important insights and consequences for physicians and practitioners who interact with individuals who have experienced violence. These results have significant therapeutic implications for the treatment of violent couples.

Roles of Psychological Distress and Social Support in the Relationship Between Childhood Maltreatment and Perceived Needs for Mental Health Care

Childhood maltreatment is a major public health issue worldwide. It increases a range of health-risk behaviors, psychological and physical problems, which are associated with an increased need for mental health services in adulthood. Identification of mediating factors in the relationship between maltreatment and seeking mental health care may help attenuate the negative consequences of childhood maltreatment and promote more appropriate treatment. This study aims to examine whether the relationship between childhood maltreatment and perceived need for mental health care is mediated by psychological distress and/or moderated by social support. Data from the Canadian Community Health Survey-Mental Health 2012 are analyzed. A total of 8,993 participants, who had complete information on childhood maltreatment and diagnoses of mental disorders or psychological distress, are included in this study. Structural equation modeling and the PROCESS macro were used to identify relationships among childhood maltreatment, perceived needs for mental health care, and psychological distress. Hierarchical linear regression was then used to verify the moderated mediation model. We found that psychological distress partially mediated the effect of childhood maltreatment on perceived needs for mental health care in adulthood. Social support played an important role in terms of moderating the relationship between maltreatment and perceived needs for care. For those with a history of childhood maltreatment, those who perceived a low level of social support were more likely to have higher levels of psychological distress and perceived need for mental health care. This is the first study to identify the separate and combined roles of psychological distress and social support in the relationship between childhood maltreatment and perceived need for mental health care. Selective prevention strategies should focus on social support to improve mental health services among people with a history of childhood maltreatment.

Psychiatric symptoms and mortality in older adults with major psychiatric disorders: results from a multicenter study

Prior research suggests that certain psychiatric symptoms could be associated with increased risk of death. However, it remains unclear whether this association could rely on all or specific symptoms. In this report, we used data from a multicenter 5-year prospective study (N = 641) of older adults with an ICD-10 diagnosis of schizophrenia, bipolar disorder or major depressive disorder, recruited from French community psychiatric departments. We used a latent variable approach to disentangle the effects shared by all psychiatric symptoms (i.e., general psychopathology factor) and those specific to individual psychiatric symptoms, while adjusting for sociodemographic and clinical factors. Psychiatric symptoms were assessed face-to-face by psychiatrists trained to semi-structured interviews using the Brief Psychiatric Rating Scale (BPRS). Among older adults with major psychiatric disorders, we found that all psychiatric symptoms were associated with increased mortality, and that their effect on the 5-year mortality were exerted mostly through a general psychopathology dimension (β = 0.13, SE = 0.05, p < 0.05). No BPRS item or lower order factor had a significant effect on mortality beyond and above the effect of the general psychopathology factor. Greater number of medical conditions, older age, male sex, and being hospitalized or institutionalized at baseline were significantly associated with this risk beyond the effect of the general psychopathology factor. Since psychiatric symptoms may affect mortality mainly through a general psychopathology dimension, biological and psychological mechanisms underlying this dimension should be considered as promising targets for interventions to decrease excess mortality of older individuals with psychiatric disorders.

Validity and reliability: The psychometric properties of the Persian version of Short Form of the Impulsiveness Questionnaire UPPS-P in Iran

BACKGROUND

Impulsiveness is a multidimensional and multifaceted construct that plays an important role in understanding various psychopathology and problematic behavior. It is necessary to study the psychometric properties of instruments in the new culture before its scientific application, and it also contributes to external validity. The current study was conducted to determine the psychometric properties of the Persian version of Short Form of the Impulsiveness Questionnaire UPPS-P (SUPPS-P) in a sample of male soldiers serving in the military service.

MATERIALS AND METHODS

The present research design is cross-sectional in 2019-2020. The Iranian version of the SUPPS-P was prepared across forwarding translation, reconciliation, and back-translation. The research sample included 254 soldiers who were selected via convenience sampling method and completed a set of scales, including the SUPPS-P scales, short-form self-compassion scale, McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Cognitive Flexibility Inventory (CFI), Perth Alexithymia Questionnaire (PAQ), and the Deliberate Self-harm Inventory (DSHI). The construct validity of SUPPS-P scale was measured using confirmatory factor analysis and convergent and divergent validity. For reliability, Cronbach's alpha and test-retest reliability (with 2 weeks interval) were used. Data were analyzed using LISREL software (version 8.8) and SPSS version 22.

RESULTS

The results showed that the SUPPS-P scale is a reliable and valid scale with acceptable internal consistency and acceptable test-retest reliability among soldiers. In terms of convergent validity, SUPPS-P showed a significant positive correlation with measures of MSI-BPD, PERS, and DSHI. SUPPS-P showed a negative correlation with self-compassion and cognitive flexibility, thus demonstrated a good divergent validity. The results of this study also provide support for the five-factor model of the SUPPS-P scale.

CONCLUSION

The SUPPS-P instrument showed acceptable validity and reliability and could be useful in assessing impulsivity in Iranian society. The SUPPS-P scale shows notable promise as a measure for use in impulsivity research and clinical settings.

Contributing factors to heterogeneity in the timing of the onset of major depressive episode: Results from a national study

INTRODUCTION

It remains unclear whether specific clinical factors contribute to heterogeneity in the timing of the onset of major depression.

METHODS

Using a nationally representative US adult sample, the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions, we compared the characteristics of 5 different groups of patients defined by their age at onset: (i) before 18 years, (ii) between 18 and 34 years, (iii) between 35 and 44 years, (iv) between 45 and 59 years, and (v) 60 years or older. Specifically, we examined parental history of psychiatric disorders, history of childhood maltreatment experiences, sociodemographic characteristics, lifetime psychiatric disorders, and psychiatric disorders that occurred before the first major depressive episode (MDE).

RESULTS

Compared with first MDE occurring between 18 and 34 years, first MDE before 18 years was more strongly associated with childhood maltreatment and family history of psychiatric disorders, and less strongly linked to prior lifetime psychiatric disorders, whereas first MDE occurring at 60 years and older was more strongly associated with widowhood and a prior lifetime history of generalized anxiety disorder.

LIMITATIONS

Associations found cannot be interpzreted as causal relationships due to study design and the risk of recall bias.

CONCLUSION

Our results suggest substantial age differences in risk factors for first MDE. Improving early detection and treatment of major depression and other psychiatric disorders, and preventing childhood maltreatment may have broad benefits to reduce the burden of MDE at all ages.

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

BACKGROUND

Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders.

METHODS

We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors.

RESULTS

Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged.

CONCLUSIONS

Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.

Patterns of Child Maltreatment and the Development of Conflictual Emerging Adult Romantic Relationships: An Examination of Mechanisms and Gender Moderation

Individuals who experienced child maltreatment are at heightened risk for involvement in conflictual romantic relationships. The aim of this study was to examine the effect of patterns of child maltreatment on the development of maladaptive romantic relationships in emerging adulthood (EA), as well as to determine whether childhood physical aggression and disinhibition mediate this risk. Utilizing a longitudinal sample of emerging adult participants (N = 398 emerging adults; M_age = 19.67 years) who took part in a summer research camp as children (M_age = 11.27 years), we employed a combination of person-centered and variable-centered methods to test study aims. Significant differences in child behavior and developmental pathways emerged not only between those who experienced maltreatment and those who did not, but also among maltreated individuals with different constellations of maltreatment experiences. Specifically, childhood aggression was a robust mechanism underlying the risk associated with chronic/multi-subtype maltreatment, and the risk associated with neglect only, for involvement in dysfunctional EA romantic relationships. Together, these findings highlight the utility of person-centered methods for conceptualizing maltreatment, identify childhood aggression as a pathway of risk, and the underscore the criticality of prevention and early intervention to interrupt the intergenerational transmission of high conflict and aggression within families.

Mediation of Internet addiction on association between childhood maltreatment and suicidal behaviours among Chinese adolescents

Aims

The associations between suicidal behaviours and childhood maltreatment (CM), as well as Internet addiction (IA) have been extensively examined. However, few studies pay attention to different types of CM and all stages of suicidality, including suicidal ideation (SI), suicidal plans (SP) and suicidal attempts (SA). Moreover, little is known regarding the mediation of IA on the relationship between CM and suicidal behaviours. The study aims to explore the direct effect of CM and IA on three stages of suicidal behaviours, and the indirect effect of CM on suicidality via IA.

Methods

A total of 16 130 high-school students aged 12–18 were recruited using a stratified cluster sampling strategy across five representative provinces in China. Relevant information was collected by a self-administered anonymous questionnaire. Multinomial logistic regression analysis and structural equation model were used to examine the associations.

Results

During the last year, 16.0% of participants reported suicidal behaviours. Specifically, 7.9% reported SI only, 4.6% reported SP but no SA, and 3.5% reported SA. The prevalence of neglect, physical abuse and IA in moderate to severe were 28.9, 19.9 and 33.1%, respectively. After controlling for demographic characteristics and confounding factors, such as loneliness, psychological resilience, and social support, moderate and severe neglect, physical abuse and IA were associated with an increased risk of SI, SP and SA (p < 0.01). The total effect of neglect and physical abuse on suicidal behaviours were 0.152 and 0.172, respectively (p < 0.001). The mediation proportion of IA on the association between neglect and suicidal behaviours, as well as physical abuse and suicidal behaviours were 22.4 and 18.0%, respectively.

Conclusions

CM and IA are independently associated with suicidal behaviours among Chinese adolescents. Moreover, IA plays a mediating role on the relationship between CM and suicidality. Targeted interventions for adolescents’ suicidal behaviours should focus on those who have experience of CM and IA.

Pituitary volume in people with chronic schizophrenia: Clarifying the roles of serious violence and childhood maltreatment

Aberrations in stress-linked hypothalamic-pituitary-adrenal axis function have been independently associated with schizophrenia, antisocial behaviour and childhood maltreatment. In this study, we examined pituitary volume (PV) in relation to childhood maltreatment (physical abuse, sexual abuse, neglect) in men (i) with schizophrenia and a history of serious violence (n = 13), (ii) with schizophrenia but without a history of serious violence (n = 15), (iii) with antisocial personality disorder (ASPD) and a history of serious violence (n = 13), and (iv) healthy participants without a history of violence (n = 15). All participants underwent whole-brain magnetic resonance imaging. Experiences of childhood maltreatment were rated based on interviews (for all), and case history and clinical/forensic records (for patients only). There was a trend for smaller PV, on average, in schizophrenia patients (regardless of a history of violence), compared to the healthy group and the ASPD group; other group differences in PV were non-significant. Sexual abuse ratings correlated negatively with PVs in ASPD participants, but no significant association between childhood maltreatment and PV was found in schizophrenia participants. Our findings are consistent with previous evidence of smaller-than-normal PV in chronic schizophrenia patients, and suggest that illness-related influences may mask the possible sexual abuse-smaller PV association, seen here in ASPD, in this population.

Prevalence and risk factors for non-suicidal self-injury among patients with depression or bipolar disorder in China

BACKGROUNDS

Non-suicidal self-injury is a serious health problem among patients with depression or bipolar disorder. However, few studies within the Chinese context have investigated the prevalence of NSSI and its risk factors in above populations. The purpose of this study was to investigate the prevalence of non-suicidal self-injury and its risk factors in patients with depression or bipolar disorder in China.

METHODS

The final sample comprised of 394 inpatients(M_age = 29.71; SD_age = 11.95) with depression or bipolar disorder from two psychiatric hospitals in Beijing, China. A General Demographic Data Form, the Non-suicidal Self-injury Questionnaire(NSSI-Q), Impulsivity Item and the Adverse Childhood Experiences-International Questionnaire(ACE-IQ) were completed by all patients.

RESULTS

Of the 394 patients examined, 245(62.2%) of this sample reported NSSI in past year. Of the 245 patients with NSSI, 135(55.1%) were diagnosed with depression and 110(44.9%) were diagnosed with bipolar disorder. The most common methods of NSSI for female was "pinching"(23.1%) and "scratching"(22.8%), while for male it was "hiting hard objects"(12.7%). By multivariate regression analysis, young age, unemployment, a higher monthly family income, single, impulsivity, long duration of illness and ACEs were risk factors for NSSI in patients with depression and bipolar disorder(P<0.05).

CONCLUSIONS

Our study points to the fact that there was an unfortunate message about the prevalence of NSSI among patients with depression or bipolar disorder in China. It is necessary not only to raise the awareness of NSSI in families and society, but also to formulate targeted assessment and intervention. Moreover, future research should not only focus on individuals being hospitalized, but should be representative of individuals treated at home or in the community because there are no national statistics on NSSI among such patients in China.

A comprehensive model of predictors of quality of life in older adults with schizophrenia: results from the CSA study

BACKGROUND

Numerous factors are known to influence quality of life of adults with schizophrenia. However, little is known regarding the potential predictors of quality of life in the increasing population of older adults with schizophrenia. The main objective of the present study was to propose a comprehensive model of quality of life in this specific population.

METHODS

Data were derived from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) study, a large (N = 353) multicenter sample of older adults with schizophrenia or schizoaffective disorder recruited from French community mental-health teams. We used structural equation modeling to simultaneously examine the effects of six broad groups of clinical factors previously identified as potential predictors of quality of life in this population, including (1) severity of general psychopathology, (2) severity of depression, (3) severity of cognitive impairment, (4) psychotropic medications, (5) general medical conditions and (6) sociodemographic characteristics.

RESULTS

General psychopathology symptoms, and in particular negative and depressive symptoms, cognitive impairment, reduced overall functioning and low education were significantly and independently associated with diminished quality of life (all p < 0.05). Greater number of medical conditions and greater number of antipsychotics were also independently and negatively associated with quality of life, although these associations did not reach statistical significance in sensitivity analyses, possibly due to limited statistical power.

CONCLUSION

Several domains are implicated in quality of life among older adults with schizophrenia. Interventions targeting these factors may help improve importantly quality of life of this vulnerable population.

Sleep complaints are associated with increased suicide risk independently of psychiatric disorders: results from a national 3-year prospective study

Prior research suggests that sleep disturbances are associated with increased risk of suicide. However, sleep disturbances are associated with a wide range of psychiatric disorders, and it is unknown whether this association is independent of psychopathology. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of three sleep complaints (i.e., trouble falling asleep, early morning awakening, and hypersomnia) on the 3-year occurrence of attempting suicide. Because psychiatric disorders increase the risk of suicide attempt almost exclusively through a general psychopathology factor representing their shared effect, covariates included that factor, prior history of suicide attempt, and a wide range of sociodemographic and clinical characteristics. The 3-year prevalence rate of suicide attempt was 0.6% (n = 241). Compared with participants who did not attempt suicide between the two waves, those who did reported significantly more frequently having trouble falling asleep (44.6% vs. 16.6%), early morning awakening (38.9% vs. 12.7%), and hypersomnia (35.0% vs. 10.7%). Following adjustments, effects of sleep complaints on this risk were significant and exerted almost exclusively through a general sleep complaints factor representing the shared effect across all sleep complaints. There were no residual associations of any individual sleep complaint with attempting suicide above that association. Sleep complaints are associated with an increased risk of attempting suicide independently of psychopathology, and should be included in suicide risk assessments as these symptoms may provide targets for reducing the risks of suicidal behaviors.

Association of Borderline Personality Disorder Criteria With Suicide Attempts Among US Adults

IMPORTANCE

Rates of suicide are increasing. Although borderline personality disorder (BPD) and other psychiatric disorders are associated with suicide, there is a dearth of epidemiological research on associations between BPD and suicide attempts (SAs). Delineating the SA risk associated with BPD and its specific criteria in a nationally representative sample of individuals could inform recognition and intervention efforts for SAs.

OBJECTIVE

To examine the association of a BPD diagnosis and specific BPD criteria with SAs in US adults.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study analyzed data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), a psychiatric epidemiological survey of noninstitutionalized US adults aged 18 or older conducted from April 2012 to June 2013. Eligible adults were randomly selected from households within census-defined counties or groups of counties. Data were analyzed from December 2020 to January 2021.

MAIN OUTCOMES AND MEASURES

Prevalence of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) psychiatric and personality disorders, BPD and its specific criteria, SAs, and adverse childhood experiences (ACEs), as assessed by structured diagnostic or clinical interviews; prevalence is expressed as weighted means. Multivariable-adjusted logistic regression was used to compare the risk of lifetime and past-year SAs by BPD diagnosis and by each specific BPD criterion. Analyses were adjusted for demographic and clinical factors, including psychiatric comorbidity, age at BPD onset, and ACEs.

RESULTS

Of 36 309 respondents, 20 442 (56.3%) were women and 52.9% were non-Hispanic White; the mean (SD) age was 45.6 (17.5) years. The prevalence (SE) of lifetime and past-year SAs among participants with a lifetime diagnosis of BPD based on original NESARC-III diagnostic codes was 22.7% (0.8%) (adjusted odds ratio [AOR], 8.40; 95% CI, 7.53-9.37) and 2.1% (0.2%) (AOR, 11.77; 95% CI, 7.86-17.62), respectively. With use of diagnostic codes requiring 5 BPD criteria to meet social-occupational dysfunction, prevalence (SE) of lifetime and past-year SAs was 30.4% (1.1%) (AOR, 9.15; 95% CI, 7.99-10.47) and 3.2% (0.4%) (AOR, 11.42; 95% CI, 7.71-16.91), respectively. After excluding the BPD criterion of self-injurious behavior (to eliminate criterion overlap), the prevalence (SE) of lifetime and past-year SAs was 28.1% (1.1%) (AOR, 7.61; 95% CI, 6.67-8.69) and 3.0% (0.4%) (AOR, 9.83; 95% CI, 6.63-14.55), respectively. In analyses adjusting for sociodemographic variables, psychiatric disorders, age at BPD onset, and ACEs, BPD diagnosis and specific BPD criteria of self-injurious behaviors and chronic feelings of emptiness were significantly associated with increased odds of lifetime SAs (BPD diagnosis: AOR, 2.10; 95% CI, 1.79-2.45; self-injurious behaviors: AOR, 24.28; 95 CI, 16.83-32.03; feelings of emptiness: AOR, 1.58; 95% CI, 1.16-2.14) and past-year SAs (BPD diagnosis: AOR, 11.42; 95% CI, 7.71-16.91; self-injurious behaviors: AOR, 19.32; 95% CI, 5.22-71.58; feelings of emptiness: AOR, 1.99; 95% CI, 1.08-3.66). In analysis with BPD criteria simultaneously entered (excluding self-injurious behavior), chronic feelings of emptiness were significantly associated with increased odds of lifetime SAs (AOR, 1.66; 95% CI, 1.23-2.24) and past-year SAs (AOR, 2.45; 95% CI, 1.18-5.08).

CONCLUSIONS AND RELEVANCE

In a national sample of adults, after adjusting for demographic and clinical variables, a BPD diagnosis and the specific BPD criteria of self-injurious behaviors and chronic emptiness were significantly associated with increased SA risk. Although BPD is a complex heterogeneous diagnosis, the results of this study suggest that the criteria of self-injurious behaviors and chronic feelings of emptiness should be routinely considered in suicide risk assessment.

Cerebrospinal fluid levels of monoamines among suicide attempters: A systematic review and random-effects meta-analysis

BACKGROUND

It remains unclear whether the dopaminergic and noradrenergic systems may be implied in suicide attempt risk. In addition, although the serotonergic system has been extensively studied, no formal meta-analysis has been performed to examine its association with suicide attempt.

METHODS

Using PRISMA methodology, we performed a systematic literature review and random-effects meta-analyses of the differences in cerebrospinal fluid (CSF) levels of 5-HIAA, HVA and MHPG between suicide attempters and individuals who never attempted suicide.

RESULTS

We identified 30 studies including 937 suicide attempters and 1128 non-attempters; 29 of them measured CSF levels of 5-HIAA, 22 measured CSF levels of HVA and 14 measured CSF levels of MHPG. CSF levels of 5-HIAA and HVA were significantly lower in suicide attempters than in non-attempters [SMD = -0.43 (95% CI: -0.71 to -0.15; p < 0.01) and SMD = -0.45 (95% CI: -0.72 to -0.19; p < 0.01), respectively]. We did not find a significant association between CSF MHPG levels and suicide attempt.

LIMITATIONS

Our analyses relied on a limited number of studies of good quality and most studies included small sample sizes.

CONCLUSION

Both serotonin and dopamine systems may play a role in suicide attempt risk. Our findings suggest that a silo approach to biomarkers should be phased out in favor of the study of multiple systems in parallel and in the same populations to progress in the identification of the biological components independently associated with suicide risk, with the goal of identifying new treatment targets and improving suicide risk prediction.

"How many times did I not want to live a life because of him": the complex connections between child sexual abuse, disclosure, and self-injurious thoughts and behaviors

BACKGROUND

Meta-analyses have confirmed an association between child sexual abuse (CSA) and non-suicidal and suicidal self-injurious thoughts and behaviors (SITB), yet the mechanisms linking these factors are, to date, poorly understood. The goal of the current study is to explore one potential influencing factor acting in the association between CSA and SITB, which is the disclosure experience. Disclosure has been identified as a prominent factor in the healing process of survivors, with a lack of support following disclosures heightening negative outcomes. Exploring the impact of CSA disclosure on SITB is necessary to build effective prevention and intervention strategies.

METHODS

This qualitative study is part of a larger initiative spanning diverse research sites in Canada and in Ireland and aiming to lend voice to young people who were sexually abused in childhood/adolescence. Participants were recruited from community-based sexual abuse/assault agencies, hospital-based specialized clinics and child advocacy centres. The Long Interview Method, based on a branch of phenomenology, was used to guide research design and data collection. The current thematic analysis, informed by a stress-diathesis model, is based on a sample comprised of 21 ethnically diverse youth aged 15 to 25 who self-reported a sexual abuse experience in their childhood or teenage years and who, as part of the interview on their disclosure processes, revealed past or current SITB.

RESULTS

The thematic analysis led to the identification of four main themes that both confirmed past research and conceptual models on SITB, and provided new insights. Participants perceived a clear link between their CSA experience and SITB and other mental health issues. They offered their views on the meanings of SITB for CSA victims: to cope with abuse; to end the abuse; to express self-hatred and loneliness; and to let people know about their suffering. They described how negative disclosure experiences led to more nonsuicidal and suicidal SITB. Yet, participants also revealed that receiving support for their SITB created opportunities for CSA disclosure and support.

CONCLUSIONS

This study showed complex connections between CSA experiences, disclosure and nonsuicidal and suicidal SITB. Understanding the reciprocal influences between SITB, CSA disclosure and help-seeking could better equip mental health professionals and caregivers to provide support and foster healing and recovery in CSA victims.

Distinguishing prisoners who think about suicide from those who attempt suicide

BACKGROUND

Many people who consider suicide do not translate these intentions into action. Although prisoners constitute a particularly high-risk group for suicide, little is known about the factors that distinguish those who think about suicide from those who attempt suicide.

METHODS

Participants were 1326 adult offenders (1203 men) randomly selected from 15 Belgian prisons, representing 14% of the national prison population. Multivariate regression analysis compared prisoners who attempted suicide (n = 277) with those who thought about suicide but never made an attempt (n = 312) on a range of established risk factors.

RESULTS

Among the 589 participants reporting a lifetime history of suicidal ideation (44% of the total sample), almost half (47%) had made a suicide attempt. Relative to those who only thought about suicide, participants who attempted suicide were more likely to be violent offenders (aOR 2.33, 95% CI 1.49-3.62) and have a history of non-suicidal self-injury (aOR 3.19, 95% CI 2.09-4.86). The presence of self-reported mental disorder diagnosis (aOR = 2.84, 95% CI 1.91-4.24) and illicit substance abuse (aOR = 2.01, 95% CI 1.24-3.28) also independently differentiated prisoners who attempted v. considered suicide.

CONCLUSION

This study provides preliminary evidence that behavioural and mental health factors are implicated in the transition from thoughts to acts of suicide in prisoners. Prospective studies are warranted to explore whether these risk factors predict progression from ideation to action over time.

Adverse Childhood Experiences and Risk of Subsequently Engaging in Self-Harm and Violence towards Other People-"Dual Harm"

The etiology of “dual harm” (the co-occurrence of self-harm and externalized violence in the same individual) is under-researched. Risk factors have mostly been investigated for each behavior separately. We aimed to examine adversities experienced between birth and age 15 years among adolescents and young adults with histories of self-harm and violent criminality, with a specific focus on dual harm. Three nested case-control studies were delineated using national interlinked Danish registers; 58,409 cases in total aged 15–35 were identified: 28,956 with a history of violent criminality (but not self-harm), 25,826 with a history of self-harm (but not violent criminality), and 3987 with dual-harm history. Each case was matched by date of birth and gender to 20 controls who had not engaged in either behavior. We estimated exposure prevalence for cases versus controls for each of the three behavior groups, and incidence rate ratios (IRRs). Experiencing five or more childhood adversities was more prevalent among individuals with dual-harm history (19.3%; 95% CI 18.0, 20.8%) versus self-harm (10.9%; 10.5, 11.3%) and violence (11.4%; 11.0%, 11.8%) histories. The highest IRRs for dual harm were linked with parental unemployment (5.15; 95% CI 4.71, 5.64), parental hospitalization following self-harm (4.91; 4.40, 5.48) or assault (5.90; 5.07, 6.86), and parental violent criminality (6.11; 5.57, 6.70). Growing up in environments that are characterized by poverty, violence, and substance misuse, and experiencing multiple adversities in childhood, appear to be especially strongly linked with elevated dual-harm risk. These novel findings indicate potential etiologic pathways to dual harm.

What Differentiates Prisoners Who Attempt Suicide from Those Who Experience Suicidal Ideation? A Nationally Representative Study

OBJECTIVE

Many people who think about suicide do not engage in suicidal behavior. Identifying risk factors implicated in the process of behavioral enaction is crucial for suicide prevention, particularly in high-risk groups such as prisoners.

METHOD

Cross-sectional data were drawn from a nationally representative sample of 17,891 prisoners (79% men) in the United States. We compared prisoners who attempted suicide (attempters; n = 2,496) with those who thought about suicide but never made an attempt (ideators; n = 1,716) on a range of established risk factors.

RESULTS

More than half (59%) of participants who experienced suicidal ideation had also attempted suicide. Violent offending, trauma, brain injury, alcohol abuse, and certain mental disorders distinguished attempters from ideators.

CONCLUSION

Our results fit within recent ideation-to-action theories that emphasize the role of a capability for suicide in the transition from thoughts to acts of suicide.

Psychiatric symptoms and quality of life in older adults with schizophrenia spectrum disorder: results from a multicenter study

The severity of psychopathology has a strong negative impact on quality of life (QoL) among older adults with schizophrenia spectrum disorder. However, because these subjects generally experience multiple psychiatric symptoms, it remains unclear whether decreased QoL in this population is due to specific symptoms (e.g., hallucinations), specific dimensions of psychopathology (e.g., negative symptoms), a general psychopathology dimension representing the shared effect across all psychiatric symptoms, or a combination of these explanations. Data were derived from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) study, a large (N = 353) multicenter sample of older adults with schizophrenia spectrum disorder recruited from French public-sector psychiatric departments. We used structural equation modeling to examine the shared and specific effects of psychiatric symptoms on QoL, while adjusting for sociodemographic characteristics, general medical conditions, global cognitive functioning and psychotropic medications. Psychiatric symptoms and QoL were assessed face-to-face by psychiatrists using the Brief Psychiatric Rating Scale (BPRS) and the Quality of Life Scale (QLS). Among older adults with schizophrenia spectrum disorder, effects of psychiatric symptoms on QoL were exerted mostly through a general psychopathology dimension (β = - 0.43, p < 0.01). Negative symptom dimension had an additional negative effect on QoL beyond the effect of that factor (β = - 0.28, p < 0.01). Because psychiatric symptoms affect QoL mainly through two dimensions of psychopathology, i.e., a general psychopathology dimension and a negative symptom dimension, mechanisms underlying those dimensions should be considered as promising targets for therapeutic interventions to substantially improve quality of life of this vulnerable population.

Prediction of attempted suicide in men and women with crack-cocaine use disorder in Brazil

Background

Suicide is a severe health problem, with high rates in individuals with addiction. Considering the lack of studies exploring suicide predictors in this population, we aimed to investigate factors associated with attempted suicide in inpatients diagnosed with cocaine use disorder using two analytical approaches.

Methods

This is a cross-sectional study using a secondary database with 247 men and 442 women hospitalized for cocaine use disorder. Clinical assessment included the Addiction Severity Index, the Childhood Trauma Questionnaire, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, totalling 58 variables. Descriptive Poisson regression and predictive Random Forest algorithm were used complementarily to estimate prevalence ratios and to build prediction models, respectively. All analyses were stratified by gender.

Results

The prevalence of attempted suicide was 34% for men and 50% for women. In both genders, depression (PR_M = 1.56, PR_W = 1.27) and hallucinations (PR_M = 1.80, PR_W = 1.39) were factors associated with attempted suicide. Other specific factors were found for men and women, such as childhood trauma, aggression, and drug use severity. The men's predictive model had prediction statistics of AUC = 0.68, Acc. = 0.66, Sens. = 0.82, Spec. = 0.50, PPV = 0.47 and NPV = 0.84. This model identified several variables as important predictors, mainly related to drug use severity. The women's model had higher predictive power (AUC = 0.73 and all other statistics were equal to 0.71) and was parsimonious.

Conclusions

Our findings indicate that attempted suicide is associated with depression, hallucinations and childhood trauma in both genders. Also, it suggests that severity of drug use may be a moderator between predictors and suicide among men, while psychiatric issues shown to be more important for women.

Effects of depression and cognitive impairment on quality of life in older adults with schizophrenia spectrum disorder: Results from a multicenter study

BACKGROUND

Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder.

METHODS

We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder.

RESULTS

Depression and cognitive impairment were positively associated (r = 0.24, p < 0.01) and both independently and negatively impacted on QoL (standardized β = -0.41 and β = -0.32, both p < 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively.

LIMITATIONS

Because of the cross-sectional design of this study, measures of association do not imply causal associations.

CONCLUSIONS

Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.

Shared and specific associations of substance use disorders on adverse outcomes: A national prospective study

BACKGROUND AND AIMS

Substance use disorders (SUD) frequently co-occur and are associated with numerous adverse outcomes and lower quality of life. The goal of this study was to examine whether the associations of SUD with adverse outcomes occur through a shared liability or are disorder-specific even after taking into account their frequent co-occurrence.

BASIC PROCEDURES

Data were drawn from the National Epidemiological Survey on Alcohol and Related Conditions. The association between nine SUDs assessed at Wave 1 (2001-2002) and a broad range of outcomes (divorce/separation, violence, unemployment, financial crisis, legal problems, problems with a neighbor, friend, or relative, and quality of life) at Wave 2 (2005-2005) were estimated separately and simultaneously using a latent variable model to account for their co-occurrence and identify potential disorder-specific effects.

MAIN FINDINGS

SUD at Wave 1 were associated with increased prevalence of all adverse outcomes at Wave 2 (p < .05). With the exception of nicotine dependence and tranquilizer use disorder, we found no specific associations of any SUD with any adverse outcome. Rather, associations occurred primarily through the latent variable representing the shared effects of the different SUDs.

CONCLUSIONS AND RELEVANCE

Our findings underscore the importance of adopting dimensional approaches to model the co-occurrence of SUD. Because SUD increases the risk of adverse outcomes mainly through a general predisposition representing mechanisms shared across SUD rather than through drug-specific mechanisms, this dimension should be considered as a therapeutic target to substantially advance prevention of adverse outcomes caused by SUD.