Non-suicidal self-injury (NSSI) among emerging adults: Sub-group profiles and their clinical relevance

Understanding the subtypes of non-suicidal self-injury: A new conceptual framework based on a systematic review

Non-suicidal self-injury (NSSI) is a significant public health problem, but there is no consistent evidence of its risk factors. One possibility is that there are subtypes NSSI that have different risk factors and clinical symptoms. In this review we evaluated the evidence of subtypes to determine if there were consistent subtypes of NSSI that emerged across studies. Four databases (Medline; Embase; PsycINFO; Web of Science) were searched to identify studies that used data-driven approaches and were published before November 9, 2022. There were 21 studies with 23 unique samples for review. Most of the included studies used NSSI symptoms or personal characteristics as the subtyping indicators, revealing 2-5 subtypes of NSSI. Variations in subtyping indicators, sample characteristics, and statistical methods may have contributed to the inconsistent number and characteristics of subtypes across studies. A new conceptual framework is proposed to integrate these diverse findings, highlighting the important roles of NSSI function and psychological pain in differentiating NSSI subtypes. This framework sheds light on the differences among self-injurers and offers insights for future endeavors to address the complexities of NSSI.

Positive effects of parent-child group emotional regulation and resilience training on nonsuicidal self-injury behavior in adolescents: a quasi-experimental study

Background

Nonsuicidal self-injury (NSSI) among adolescents is a growing global concern. However, effective interventions for treating NSSI are limited.

Method

A 36-week quasi-experimental study design of parent-child group resilience training (intervention group) for adolescents aged 12-17 years was used and compared with treatment-as-usual (control group). The primary endpoint was the frequency of NSSI assessed with the Ottawa Self-Injury Inventory (OSI), and the secondary endpoints were the levels of depression, hope, resilience, and family adaptability and cohesion as assessed by the 24-item Hamilton depression rating scale (HAMD-24), Herth Hope Scale (HHS), Connor-Davidson Resilience Scale (CD-RISC), and Family Adaptability and Cohesion Evaluation Scale, second edition (FACES-II-CV), respectively.

Result

A total of 118 participants completed the trial. Both groups showed a significant reduction in NSSI frequency after 12, 24, and 36 weeks of intervention (p< 0.05), although the intervention group did not differ significantly from the control group. After 12, 24, and 36 weeks of intervention, the CD-RISC, HHS, HAMD-24, and FACES-II-CV scores in the intervention and control groups improved over baseline (p< 0.05). Furthermore, the intervention group had higher scores on the CD-RISC, HHS, and FACES-II-CV and lower scores on the HAMD-24 than the control group after 12, 24, and 36 weeks of intervention (p  < 0.05).

Conclusion

Parent-child group emotional regulation and resilience training showed promise as treatment options for NSSI among adolescents, leading to increased hope, resilience, and improved family dynamics among NSSI teens. Moreover, NSSI frequency significantly decreased in the intervention group compared to baseline.

Identification and validation of KIF23 as a hypoxia-regulated lactate metabolism-related oncogene in uterine corpus endometrial carcinoma

AIMS

The "Warburg effect" has been developed from the discovery that hypoxia-inducible factor 1α (HIF-1α) could promote the conversion of pyruvate to lactate. However, no studies have linked hypoxia and lactate metabolism to uterine corpus endometrial carcinoma (UCEC).

MAIN METHODS

Sequencing and clinical data of patients with UCEC were extracted from The Cancer Genome Atlas (TCGA) database. Hypoxia-related lactate metabolism genes (HRLGs) were screened using Spearman's correlation analysis. A prognostic signature based on HRLGs was developed using the least absolute shrinkage and selection operator (LASSO) algorithm. A comprehensive analysis was conducted on the molecular features, immune environment, mutation patterns, and response to drugs between different risk groups. In vitro and in vivo experiments were performed to verify the function of KIF23.

KEY FINDINGS

A five HRLG-based prognostic signature was identified. The prognostic outcome was unfavorable for the high-risk subgroup. Observation of increased pathway activities associated with cell proliferation and DNA damage repair was noted in the high-risk subgroup. Additionally, notable correlations were observed between risk score and immune microenvironment, mutational features, and drug responsiveness. Further, we confirmed KIF23 as a novel oncogene in UCEC, whose silencing decreased proliferation and promoted apoptosis of cancer cells. KIF23 knockdown reduced tumor growth in nude mice. We demonstrated that KIF23 was upregulated under hypoxic stress in a HIF-1α dependent manner. Moreover, KIF23 regulated lactate dehydrogenase A expression.

SIGNIFICANCE

The developed HRLG-related signature was associated with prognosis, immune microenvironment, and drug sensitivity in UCEC. We also revealed KIF23 as a hypoxia-regulated lactate metabolism-related oncogene.

The Prediction Model of Non-Suicidal Self-Injury in Psychiatric Patients Using Decision Tree Analysis

PURPOSE

The prevalence rate of non-suicidal self-injury (NSSI) in the clinical population is higher than that in the community sample, necessitating the need to investigate the predicting factors of NSSI in this group. The present study aimed to develop a prediction model of NSSI among psychiatric patients in Korea.

MATERIALS AND METHODS

Decision tree analysis was conducted on a sample of 224 psychiatric patients. Emotion regulation strategies (rumination, cognitive reappraisal, and expressive suppression), impulsivity, problematic alcohol use, working memory, depressive mood, and gender were included in the model as predictors of NSSI.

RESULTS

Results indicated that rumination, problematic alcohol use, and working memory predicted lifetime NSSI engagement among psychiatric patients. The best predictor of lifetime NSSI engagement was rumination. Specifically, when the level of rumination was high, the level of working memory was lower, and the risk of NSSI was higher. In the case of low levels of rumination, the higher the level of problematic alcohol use, the higher the risk of NSSI. The highest prevalence of lifetime NSSI engagement was found in a subgroup of patients with high levels of rumination and low levels of working memory.

CONCLUSION

The major contribution of this study is finding a combination of factors to predict the high-risk group of NSSI among psychiatric patients in Korea. This study provides evidence on the effect of rumination, working memory, and problematic alcohol use on NSSI. It is suggested that clinicians and researchers should pay more attention to emotion regulation and related vulnerabilities in preventing and treating NSSI.

Function of Nonsuicidal Self-Injury Among Iranian University Students: A Factor Structure Analysis

Emerging non-Western studies indicate new patterns in the functionality of nonsuicidal self-injury (NSSI) warranting further investigation in different cultures. The current study aims to investigate the function (etiology and underlying mechanism) of NSSI among a sample of university students in Tehran, Iran, using the Inventory of Statements About Self-Injury (ISAS). The ISAS was administered to 63 students who self-injured (52.4% female; Mage = 22.15). An exploratory factor analysis using the Bayesian estimation method was conducted. A three-factor model of NSSI functions emerged including an intrapersonal factor representing within-self functions (e.g., self-punishment); a social identification factor consisting of functions establishing a sense of self/identity (e.g., peer bonding); and a communication factor representing an influencing/communicating functionality (e.g., marking distress). Intrapersonal and social identification factors were associated with greater severity of NSSI method and increased anxiety. Findings support the use of the ISAS among an Iranian sample and revealed additional patterns beyond the commonly referenced two-factor model (intrapersonal and interpersonal functions) in a culturally novel sample. The results are situated within the sample's sociocultural context.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSION

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

Development and validation of a prediction nomogram for non-suicidal self-injury in female patients with mood disorder

Background

Non-suicidal self-injury (NSSI) is a highly prevalent behavioral problem among people with mental disorders that can result in numerous adverse outcomes. The present study aimed to systematically analyze the risk factors associated with NSSI to investigate a predictive model for female patients with mood disorders.

Methods

A cross-sectional survey among 396 female patients was analyzed. All participants met the mood disorder diagnostic groups (F30-F39) based on the Diseases and Related Health Problems 10th Revision (ICD-10). The Chi-Squared Test, t-test, and the Wilcoxon Rank-Sum Test were used to assess the differences of demographic information and clinical characteristics between the two groups. Logistic LASSO Regression Analyses was then used to identify the risk factors of NSSI. A nomogram was further used to construct a prediction model.

Results

After LASSO regression selection, 6 variables remained significant predictors of NSSI. Psychotic symptom at first-episode (β = 0.59) and social dysfunction (β = 1.06) increased the risk of NSSI. Meanwhile, stable marital status (β = -0.48), later age of onset (β = -0.01), no depression at onset (β = -1.13), and timely hospitalizations (β = -0.10) can decrease the risk of NSSI. The C-index of the nomogram was 0.73 in the internal bootstrap validation sets, indicated that the nomogram had a good consistency.

Conclusion

Our findings suggest that the demographic information and clinical characteristics of NSSI can be used in a nomogram to predict the risk of NSSI in Chinese female patients with mood disorders.

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.

The Impact of Self-Consistency Congruence on Non-Suicidal Self-Injury in College Students: The Mediating Role of Negative Emotion and the Moderating Role of Gender

Non-suicidal self-injury (NSSI) can be defined as the deliberate destruction of body tissues to generate harm. College students have a higher incidence of NSSI. With the deepening of research on college students' NSSI, the connection between their self-consistency congruence and NSSI has drawn the attention of many scholars. The current study examined the association between self-concordance and NSSI, the mediating function of negative emotions, and the moderating role of gender. We surveyed 1020 college students from three universities in Jiangxi Province using a self-concordant scale, a NSSI questionnaire, and a negative emotion questionnaire. The results showed that self-concordance was negatively correlated with NSSI. There is an obvious negative connection between self-consistency congruence and negative emotions. There was a significant positive correlation between negative emotions and the NSSI scores. Negative emotions could mediate the association between self-consistency congruence and NSSI. Compared to males, females' self-concordant effects on negative emotions are easier to moderate.

A Person-Centered Approach to Adolescent Nonsuicidal Self-Injury: Predictors and Correlates in a Community Sample

Growing incidence of nonsuicidal self-injury (NSSI) and a lack of intensive examination of NSSI variability among adolescents justify identification of latent classes based on the endorsement of different NSSI behaviors. Latent class analysis was used to detect the heterogeneity of past month NSSI among 322 high school students (73.2% female). Two interpretable latent classes emerged. The Severe/Multimethod NSSI class (39%) engaged in almost all forms of NSSI with high intensity and motivated mainly for intrapersonal reasons. The results imply that compared to Mild/Moderate NSSI group (61%), the Severe class is at greater risk for poor mental health, which can exacerbate further NSSI acts. In school settings, identifying adolescents who are vulnerable for more severe NSSI can help to interrupt NSSI trajectories to emerging adulthood.

E-cigarettes and non-suicidal self-injury: Prevalence of risk behavior and variation by substance inhaled

BACKGROUND

Nicotine and cannabis inhalation through vaping or electronic delivery systems has surged among young adults in the United States, particularly during the coronavirus disease pandemic. Tobacco and marijuana use are associated with select adverse mental health outcomes, including symptoms of major depressive disorder and suicidal behaviors. Given the need for addiction specialists to treat problematic substance use with an integrated approach, the association between non-suicidal self-injury (NSSI) and use of e-cigarettes, tobacco, marijuana, and alcohol was examined among a diverse sample of college students.

METHODS

Healthy Minds Study data from 47,016 weighted observations, collected from college students in the 2018-2019 academic year, was used to explore associations between NSSI-related behaviors and past 30-day use of a vaping product (nicotine or marijuana). These relationships were assessed among those using vaping products only, and then among individuals using vaping products and alcohol, conventional cigarettes, and/or marijuana. Hierarchical logistic regression models estimating the relationship between vaping and NSSI were computed to adjust for the effects of demographic factors, symptomatology of psychiatric disorders, and concurrent use of other substances.

RESULTS

A fifth (22.9%) of respondents disclosed past 12-month NSSI; they were significantly more likely to screen positive for depression or anxiety compared to young adults without NSSI. Rates of using vaping products, conventional cigarettes, marijuana, or other substances were higher among students with NSSI even after controlling for potential cofounders. Additionally, students who used a THC-based liquid in their e-cigarettes were more likely to endorse NSSI in comparison to those who used "just flavoring." However, young adults who vaped were less likely to disclose frequent NSSI-related behaviors than their peers who did not vape.

CONCLUSIONS

These findings revealed an association between past 12-month NSSI and past 30-day vaping in a sample of young adults. Further surveillance among college populations and examination of potential sociodemographic confounders is necessary to confirm these findings and advance the substance use and addiction field.