1
|
Liu H, Lan Z, Huang X, Wang Q, Deng F, Li J. The mediating effect of bullying on parental-peer support matching and NSSI behaviour among adolescents. BMC Public Health 2024; 24:1775. [PMID: 38961448 PMCID: PMC11223308 DOI: 10.1186/s12889-024-19309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Being subjected to bullying is a significant risk factor for non-suicidal self-injury (NSSI) among adolescents. Parental support, peer support, and social connectedness play protective roles in mitigating NSSI in this population. However, the precise impact of the combined effects of parental and peer support on bullying and NSSI requires further investigation. METHODS This study employed the Child and Adolescent Social Support Scale, Delaware Bullying Victimisation Scale, Social Connectedness Scale, and the Ottawa Self-Injury Inventory to survey 1277 Chinese adolescents. Polynomial regression analysis and response surface analysis were applied to examine the mediating role of bullying and social connectedness in the relationship between parental and peer support matching and NSSI. RESULTS The results indicate that parental support (r = 0.287, P < 0.001), peer support (r = 0.288, P < 0.001), and social connectedness (r = 0.401, P < 0.001) were protective factors against NSSI in adolescents. Conversely, bullying (r = 0.425, P < 0.001) acts as a risk factor for NSSI in this population. Adolescents with low parental and peer support experienced more bullying than those with high parental and peer support, while those with low parental but high peer support experienced less bullying than those with high parental but low peer support (R^2 = 0.1371, P < 0.001). Social connectedness moderated the effect between bullying and NSSI in this model (β = 0.006, P < 0.001). LIMITATIONS Due to the under-representation of participants and lack of longitudinal data support, the explanatory power of causality between variables was limited. Future studies should include national samples and incorporate longitudinal studies to enhance the generalisability and robustness of the findings. CONCLUSION This study reveals the influence mechanism of parental and peer support matching experienced by adolescents on bullying and NSSI and the moderating role of social connectedness. These findings enrich the developmental theory of adolescent NSSI and provide reference for the prevention and intervention of adolescent NSSI behaviour.
Collapse
Affiliation(s)
- Huaqiang Liu
- School of Law and Public Administration, Yibin University, Yibin, 644000, China
| | - Zhensong Lan
- School of Public Administration, Hechi University, No. 42, Longjiang Road, Yizhou, Guangxi, 546300, China.
| | - Xuefang Huang
- School of Teacher Education, Hechi University, Yizhou, 546300, China
| | - Qing Wang
- College of Humanities, Jiangxi University of Finance and Economics, Nanchang, 330013, China
| | - Fafang Deng
- School of Public Administration, Hechi University, No. 42, Longjiang Road, Yizhou, Guangxi, 546300, China
| | - Juchao Li
- School of Economics and Management, Beijing University of Technology, Beijing, 100124, China
| |
Collapse
|
2
|
Streeto C, Phillips KE. Compassion Satisfaction and Burnout Are Related to Psychiatric Nurses' Antipathy Towards Nonsuicidal Self-Injury (NSSI). J Am Psychiatr Nurses Assoc 2024; 30:663-668. [PMID: 35941763 DOI: 10.1177/10783903221116132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Many psychiatric patients engage in nonsuicidal self-injury (NSSI). Despite this, studies show that psychiatric nurses display a stigma toward patients who engage in self-harm, often due to the fact that nurses report a lack of understanding about the behavior. In addition, nurses can struggle with professional quality of life (ProQOL). The purpose of this study was to provide an educational intervention on NSSI and measure its effects on antipathy as well as to determine if ProQOL has an impact on overall antipathy. METHODS A sample of psychiatric nurses was recruited and randomly assigned to either the educational intervention or control group. Both groups took the Self-Harm Antipathy Scale (SHAS) and ProQOL-V; the intervention group was asked to repeat the SHAS immediately following an educational video, and the control was asked to repeat the SHAS at least 2 weeks later. Qualitative data were also collected. RESULTS The ProQOL-V CS subscale and pretest SHAS total scores (n = 23, r = -0.432, p = .039) and SHAS Needs Function (NF) (n = 23, r = -0.454, p = .029) showed a significant moderate negative correlation. There was also a significant moderate positive correlation between the ProQOL-V Burnout subscale and SHAS NF pretest scores (n = 23, r = 0.483, r = 0.02). CONCLUSIONS A relationship between high compassion satisfaction and low antipathy, as well as between high burnout and high antipathy, particularly in the area of understanding the reasons patients self-harm (NF) was found. Educating nurses on the reasons for NSSI may reduce their antipathy. It may also be beneficial to support nurses to prevent burnout.
Collapse
Affiliation(s)
- Courtney Streeto
- Courtney Streeto, DNP, APRN, Generations Psychiatry Services, Branford, CT, USA
| | - Kathryn E Phillips
- Kathryn E. Phillips, PhD, APRN, Fairfield University, Fairfield, CT, USA
| |
Collapse
|
3
|
Sigurvinsdottir R, Gisladottir B, Asgeirsdottir BB, Sigfusdottir ID. Sexual Attraction and Non-Suicidal Self-Harm: The Role of Stressors and Psychological Mediators. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1293-1306. [PMID: 38347324 DOI: 10.1007/s10508-023-02792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 03/22/2024]
Abstract
Non-suicidal self-harm (NSSH) is a serious concern for the well-being of youth. Stressors relate to greater NSSH risk, such as being non-heterosexual in a heteronormative society. Other stressors may include traumatic experiences. These relationships may be mediated by psychological factors (depressed mood, anxiety, anger, and self-esteem) as well as contextual factors (support from parents and peers). The purpose of this study was to examine NSHH ideation and behavior among Icelandic youth, as well as relationships with stressors and mediators. Students in Icelandic high schools (N = 8921, 50.8% female) completed an in-class survey in the year 2016. Results showed an elevated risk of NSSH ideation and behavior among bisexual and homosexual youth. Mediation analyses showed that, for girls, being bisexual related to greater NSSH ideation and behavior, and these relationships were mediated by depressed mood, anger, and self-esteem, as well as by support from parents and peers. For boys, however, both homosexual and bisexual attraction related to greater risk for NSSH ideation and behavior, which was mediated by depressed mood, anger, and self-esteem. These results suggest that NSSH risk factors vary by gender and, therefore, they may benefit from different interventions to stop and prevent this behavior. This is the first study of its kind in Iceland, where sexual minority stress may need further study within the Nordic context.
Collapse
Affiliation(s)
| | | | | | - Inga Dora Sigfusdottir
- Department of Psychology, Reykjavik University, Menntavegur 1, 102, Reykjavik, Iceland
- Icelandic Centre for Social Research and Analysis, Reykjavik, Iceland
- Teachers College, Columbia University, New York, NY, USA
| |
Collapse
|
4
|
Stafström M, Raninen J. Trends in alcohol-related harm among Swedish youth: Do in-patient care registry data match drinking trends? Drug Alcohol Rev 2024; 43:625-632. [PMID: 38018667 DOI: 10.1111/dar.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Youth drinking has been declining in Sweden since the year 2000. There is a paucity of studies examining trends in alcohol-related harm during this period. The overall aim of the present study is to examine how trends in alcohol-related harm match trends in drinking among Swedish youths during 2000-2021. METHODS Measures of alcohol use were obtained from national school surveys. Prevalence rates of any alcohol use and heavy episodic drinking were used. Alcohol-related harm indicators were obtained from registry information from the National Board of Health and Welfare. Annual trends in harm indicators were tested with linear regression models and correlations between alcohol use and alcohol-related harm indicators were assessed using Pearson's correlation on annual data. RESULTS Statistically significant negative trends were observed for all alcohol-related harm indicators for the period 2000-2021. Significant correlations were found for both measures of alcohol use and all alcohol-related harm indicators. DISCUSSION AND CONCLUSIONS The levels of alcohol-related harm have declined among youths in Sweden during the period 2000-2021. The trends in harm seem to reflect the decline in youth drinking that has occurred during the same period.
Collapse
Affiliation(s)
- Martin Stafström
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jonas Raninen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| |
Collapse
|
5
|
Reichl C, Rockstroh F, Lerch S, Fischer-Waldschmidt G, Koenig J, Kaess M. Frequency and predictors of individual treatment outcomes (response, remission, exacerbation, and relapse) in clinical adolescents with nonsuicidal self-injury. Psychol Med 2023; 53:7636-7645. [PMID: 37282585 PMCID: PMC10755228 DOI: 10.1017/s0033291723001447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/23/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023]
Abstract
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.
Collapse
Affiliation(s)
- Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franziska Rockstroh
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Gloria Fischer-Waldschmidt
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
6
|
Hedén L, Jonsson LS, Fredlund C. The Connection Between Sex as Self-Injury and Sexual Violence. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3531-3540. [PMID: 37640887 PMCID: PMC10703980 DOI: 10.1007/s10508-023-02669-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a suggested diagnosis recognized by DSM-5 as in need of further research. Recent studies conclude that sex as self-injury (SASI) and NSSI share similar functions, such as being used as emotional regulation. SASI has been associated with earlier sexual abuse, but the understanding of the association between sexual violence and SASI is still limited. The aim of this study was to further investigate the connection between sexual violence and the experience of SASI. How could SASI be related to sexual violence? The study used a qualitative design and was based on an anonymous questionnaire published on the websites of Swedish NGOs, providing help and support to women and youths, such as those in women's shelters. In total, 139 informants with a mean age of 27.9 years (range 15-64 years) were included in the study. Three main themes were found: (1) Normalization of sexual violence and a shift in boundaries could be seen as consequences of earlier experiences of sexual violence leading to SASI; (2) SASI could escalate into sexual violence through increased need of emotional regulation, increased risk-taking, and risk of victimization; (3) SASI could be used to regain control of re-experiences, the body, sexuality, and shame after sexual abuse. In conclusion, a complex connection was identified whereby SASI could escalate into sexual violence, and earlier experiences of sexual violence could lead to SASI in a vicious loop. Hence, SASI should be seen as a risk factor for further victimization and sexual abuse.
Collapse
Affiliation(s)
- Ludwig Hedén
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Linda S Jonsson
- Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Cecilia Fredlund
- Department of Psychiatry in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83, Linköping, Sweden.
| |
Collapse
|
7
|
Laporte N, Ozolins A, Westling S, Westrin Å, Wallinius M. Adverse childhood experiences as a risk factor for non-suicidal self-injury and suicide attempts in forensic psychiatric patients. BMC Psychiatry 2023; 23:238. [PMID: 37038150 PMCID: PMC10084684 DOI: 10.1186/s12888-023-04724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Exposure to adverse childhood experiences (ACE) have been found to have profound negative consequences on an individuals' health. Non-suicidal self-injury (NSSI) is a clinically complex and serious global health issue and is closely related to suicide attempts. Previous research has found associations between ACE and NSSI and suicide attempts in clinical samples. However, this association has to our knowledge not been studied to this extent in a sample of forensic psychiatric patients. The aim of this study was therefore to describe the prevalence of adverse childhood experiences (ACE) and their associations with non-suicidal self-injury (NSSI) and/or suicide attempts in forensic psychiatric patients. METHODS The current study is a cross-sectional study of a consecutive cohort of 98 forensic psychiatric patients (86.7% male) in Sweden. We invited 184 patients with a predicted stay of > 8 weeks who had been cleared for participation by their treating psychiatrist. Of these, 83 declined and 98 eligible patients provided informed consent. Information on ACE, NSSI, and suicide attempts derived from files, self-reports (Childhood Trauma Questionnaire-Short Form; CTQ-SF), and interviews were compared separately among participants with and without NSSI or suicide attempts using t-tests. The dose-response association between ACE and NSSI/suicide attempts was analysed using binary logistic regression. RESULTS In file reviews, 57.2% of participants reported physical abuse, 20% sexual abuse, and 43% repeated bullying by peers during childhood. NSSI and suicide attempts were associated significantly with CTQ-SF total scores, with medium effect sizes (d = .60 to .63, p < .01), and strongly with several CTQ-SF subscales. Parental substance abuse was also associated with NSSI (p = .006, OR = 3.23; 95% confidence interval [CI] = 1.36 to 7.66) and suicide attempts (p = .018, OR = 2.75; 95% CI = 1.18 to 6.42). Each additional ACE factor predicted an increased probability of NSSI (p = .016, OR = 1.29; CI = 1.04 to 1.59) but not of suicide attempts. When anxiety and depressive disorders were included in the model, ACE remained a significant predictor of NSSI. CONCLUSIONS We report extensive ACE, from both files and self-reports. When comparing groups, correlations were found between ACE and NSSI, and ACE and suicide attempts among forensic psychiatric patients. ACE seem to predict NSSI but not suicide attempts in this group, even when controlling for affective and anxiety disorders. Early ACE among forensic psychiatric patients, especially physical and emotional abuse and parental substance abuse, have important impacts on self-harming behaviours that must be acknowledged both by the institutions that meet them as children and in their later assessment and treatment.
Collapse
Affiliation(s)
- Natalie Laporte
- Evidence-based forensic psychiatry, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden.
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden.
| | - Andrejs Ozolins
- Department of Psychology, Linnaeus University, Växjö, Sweden
| | - Sofie Westling
- Department of Clinical Sciences Malmö, Psychiatry, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Sweden
| | - Märta Wallinius
- Evidence-based forensic psychiatry, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| |
Collapse
|
8
|
Vafaei T, Samavi SA, Whisenhunt JL, Najarpourian S. An investigation of self-injury in female adolescents: a qualitative study. QUALITY & QUANTITY 2023; 57:1-24. [PMID: 36816810 PMCID: PMC9923642 DOI: 10.1007/s11135-023-01632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
This study aimed to investigate the phenomenon of self-injury among female adolescents. The research was qualitative, and the sampling method was purposive non-random; the sample size was 20 Iranian girl adolescents aged 13-15 years who had experienced non-suicidal self-injury. Data were collected through semi-structured interviews. The data analysis process was performed during three coding steps (open, axial, selective), through which the basic codes and categories were identified. Study results indicate that the main factors in adolescents' self-injury were individual or psychological (thoughts, emotions, and behaviors) and social (peers, family, communication with different gender, communication with others, media/cyberspace, school, and economic). In the former, the role of emotions was remarkable, while in the latter, the family played a key role. Further, results revealed that communication within the family was an important motivating and sustentative factor in adolescents' self-injury. The results can help counselors in working with adolescents who self-injure; results can also be used in the development and implementation of treatment plans.
Collapse
Affiliation(s)
- Tayebeh Vafaei
- Department of Counseling, University of Hormozgan, Bandar Abbas, Iran
| | | | - Julia L. Whisenhunt
- Department of Counseling, Higher Education, and Speech-Language Pathology, University of West Georgia, Carrollton, GA USA
| | | |
Collapse
|
9
|
Farajzadeh N, Sadeghzadeh N. NSSI questionnaires revisited: A data mining approach to shorten the NSSI questionnaires. PLoS One 2023; 18:e0284588. [PMID: 37083960 PMCID: PMC10121061 DOI: 10.1371/journal.pone.0284588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/02/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Non-suicidal self-injury (NSSI) is a psychological disorder that the sufferer consciously damages their body tissues, often too severe that requires intensive care medicine. As some individuals hide their NSSI behaviors, other people can only identify them if they catch them while injuring, or via dedicated questionnaires. However, questionnaires are long and tedious to answer, thus the answers might be inconsistent. Hence, in this study for the first time, we abstracted a larger questionnaire (of 662 items in total) to own only 22 items (questions) via data mining techniques. Then, we trained several machine learning algorithms to classify individuals based on their answers into two classes. METHODS Data from 277 previously-questioned participants is used in several data mining methods to select features (questions) that highly represent NSSI, then 245 different people were asked to participate in an online test to validate those features via machine learning methods. RESULTS The highest accuracy and F1 score of the selected features-via the Genetics algorithm-are 80.0% and 74.8% respectively for a Random Forest algorithm. Cronbach's alpha of the online test (validation on the selected features) is 0.82. Moreover, results suggest that an MLP can classify participants into two classes of NSSI Positive and NSSI Negative with 83.6% accuracy and 83.7% F1-score based on the answers to only 22 questions. CONCLUSION While previously psychologists used many combined questionnaires to see whether someone is involved in NSSI, via various data mining methods, the present study showed that only 22 questions are enough to predict if someone is involved or not. Then different machine learning algorithms were utilized to classify participants based on their NSSI behaviors, among which, an MLP with 10 hidden layers had the best performance.
Collapse
Affiliation(s)
- Nacer Farajzadeh
- Faculty of Information Technology and Computer Engineering, Azarbaijan Shahid Madani University, Tabriz, Iran
- Artificial Intelligence and Machine Learning Research Laboratory, Azarbaijan Shahid Madani University, Tabriz, Iran
| | - Nima Sadeghzadeh
- Faculty of Information Technology and Computer Engineering, Azarbaijan Shahid Madani University, Tabriz, Iran
- Artificial Intelligence and Machine Learning Research Laboratory, Azarbaijan Shahid Madani University, Tabriz, Iran
| |
Collapse
|
10
|
Li Y, He K, Xue C, Li C, Gu C. 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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11898. [PMID: 36231200 PMCID: PMC9564789 DOI: 10.3390/ijerph191911898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Yang Li
- Mental Health Education Center and Education Development Research Institute, Nanchang University, Nanchang 330038, China
- School of Psychology, Central China Normal University, Wuhan 430000, China
| | - Keke He
- Mental Health Education Center and Education Development Research Institute, Nanchang University, Nanchang 330038, China
| | - Changfeng Xue
- Mental Health Education Center and Education Development Research Institute, Nanchang University, Nanchang 330038, China
| | - Chun Li
- Department of Preschool Education, Qingdao University, Qingdao 266000, China
| | - Chuanhua Gu
- School of Psychology, Central China Normal University, Wuhan 430000, China
| |
Collapse
|
11
|
Zhao Y, D Dela Rosa R, Zhang Q, Zhao W, Xu H, Wang R, Ma L. Lived experiences of parents providing care to young people who self-harm: a protocol for a meta-aggregative synthesis of qualitative studie. BMJ Open 2022; 12:e065489. [PMID: 36038177 PMCID: PMC9438063 DOI: 10.1136/bmjopen-2022-065489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The self-harm of young people can cause tremendous distress to their parents/carers and impair parents' ability to provide care. At the same time, parents play an essential role in supporting their child during the management and treatment of self-harm. The synthesis of evidence about parental experiences and needs can inform mental health practice and the development of interventions to provide better care to young people who self-harm and their parents. METHODS AND ANALYSIS A comprehensive search will be conducted across several information sources, including multiple electronic databases (eg, PubMed, Embase, CINAHL, PsycINFO, ProQuest, CNKI, Wanfang, VIP and SinoMed), grey literature, the websites of specific organisations and hand-searched reference lists of all the relevant studies. Qualitative studies published in English or Chinese and focusing on the lived experiences of parents whose child self-harms will be included. Two reviewers will independently screen all the retrieved articles according to the flow diagram proposed by PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two independent reviewers will then appraise the methodological quality of all the included articles using the JBI (Joanna Briggs Institute) critical appraisal checklist for qualitative research. The meta-aggregation approach will be used to synthesise the findings of the included qualitative studies, and the level of confidence in the synthesised findings will be assessed using the Confidence in the Qualitative synthesised finding approach. ETHICS AND DISSEMINATION No additional ethical clearance is required since this review is a secondary analysis of published primary studies. The findings will be disseminated through publication in a peer-reviewed journal and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021265525.
Collapse
Affiliation(s)
- Yanli Zhao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | | | - Qiushi Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Zhao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hui Xu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Rui Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ling Ma
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
12
|
Schwartz-Lifshitz M, Ben-Dor DH, Bustan Y, Zalsman G, Gothelf D, Weizman A, Barzilay R. Phenotypic Characterization of Youth Admitted To Acute Psychiatric Inpatient Unit Following Self-Harm Behavior. Arch Suicide Res 2022; 26:1186-1197. [PMID: 33403931 PMCID: PMC9534345 DOI: 10.1080/13811118.2020.1865223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Deliberate self-harm (DSH) is a major health concern among adolescents, and is often associated with the need for inpatient psychiatric hospitalization. The aim of this study was to identify clinical and demographic characteristics associated with DSH behavior among adolescents admitted to an acute psychiatric inpatient unit. METHOD We retrospectively analyzed data from the electronic medical records of consecutive admittances to a single acute adolescent inpatient unit (n = 703, mean age 15.2). We compared inpatients with DSH to inpatients without DSH and further compared within the DSH group based on the presence of suicidal intent. RESULTS Compared to Non-DSH inpatients (n = 497), youths admitted following DSH (n = 206) were more likely to be female (OR = 2.6, 95%CI 1.7-4), currently in depressive exacerbation (OR = 2.4, 95%CI 1.6-3.6), with concurrent suicidal ideation (OR = 3.9, 95%CI 2.5-5.9), and history of alcohol use (OR = 5.6, 95%CI 3.2-9.5). Within DSH youths, no significant clinical differences were identified between those admitted following a suicide attempt (n = 102) compared to non-suicidal-self-injury (n = 104), who were generally younger. CONCLUSIONS Findings suggest that early detection and intervention of DSH and depressive crisis is warranted, regardless of the self-harm subtype.HIGHLIGHTSDeliberate self-harm is common among adolescent psychiatric inpatients.Adolescent inpatients with deliberate self-harm are predominantly females with concurrent depression and suicidal ideation.We did not detect significant clinical and demographic differences between self-harmers with or without suicidal intent.
Collapse
|
13
|
Ekanem OJ, Woods P. Effectiveness of Nonsuicidal Self-Injury Interventions among Incarcerated Women in Correctional Facilities and Secure Settings: An Integrative Review. Issues Ment Health Nurs 2022; 43:220-238. [PMID: 34499564 DOI: 10.1080/01612840.2021.1967532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Nonsuicidal self-injury (NSSI) is prevalent among incarcerated women in correctional facilities. This poses a challenge in selecting appropriate intervention. This integrative review aimed to identify effective interventions for managing NSSI among incarcerated women. Whittemore and Knafl's framework for integrative reviews was used, and eight databases were searched with 11 papers meeting the inclusion criteria. Six interventions for NSSI for incarcerated women were identified as promising in reducing the rate of NSSI. Data did not support the effectiveness of gender-specific interventions for incarcerated women. There is a need for further research to identify appropriate interventions to target NSSI among incarcerated women.
Collapse
Affiliation(s)
| | - Phil Woods
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
14
|
Sørensen JØ, Rasmussen A, Roesbjerg T, Verhulst FC, Pagsberg AK. Suicidality and self-injury with selective serotonin reuptake inhibitors in youth: Occurrence, predictors and timing. Acta Psychiatr Scand 2022; 145:209-222. [PMID: 34374070 PMCID: PMC9292826 DOI: 10.1111/acps.13360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Meta-analyses have established a heightened risk of suicidality for youth treated with selective serotonin reuptake inhibitors (SSRIs). The present study investigates the risk and possible predictors of suicidality and non-suicidal self-injury (NSSI) associated with SSRI treatment in a clinical sample of children and adolescents. METHODS An observational, longitudinal, retrospective study using a within-subject study design including in- and outpatients aged 0-17 years treated with SSRIs. Data were obtained from digital medical records and prescription software. RESULTS N = 365 patients were included (64.1% female), mean (SD) age 14.5 (2.04) years, with primary depression, anxiety or obsessive-compulsive disorder. No suicides occurred. When comparing the 6-week period immediately prior to versus following SSRI initiation, the patient proportion with broadly defined suicidality decreased (38.5% vs. 24.2%, p < 0.001) while the proportion with suicide attempts was stable (2.8% vs. 2.8%, p = 1.000). The proportion with NSSI decreased statistically non-significantly (12.4% vs. 8.4%, p = 0.067). Results from individually standardized observation periods were similar; however, the proportion with suicide attempts decreased statistically non-significantly and the proportion with NSSI decreased significantly. Suicidality during SSRI treatment was associated with previous suicidality (OR[CI] = 6.0 [2.4-14.8], p < 0.001), depression as indication for SSRI treatment (OR[CI] = 2.1 [1.2-3.7], p = 0.01), female sex (OR[CI] = 2.1 [1.1-4.1], p = 0.02) and previous NSSI (OR[CI] = 2.0 [1.2-3.5], p = 0.01). CONCLUSION Suicidality was common in youth treated with SSRIs. The patient proportion with overall suicidality decreased, and the proportion with attempted suicide was stable in the weeks following SSRI initiation. Previous suicidality, depression, female sex and previous NSSI are important predictors for suicidality during SSRI treatment in youth.
Collapse
Affiliation(s)
- Johanne Østerby Sørensen
- Child and Adolescent Mental Health CenterMental Health ServicesCapital Region of DenmarkHellerupDenmark
| | - Annette Rasmussen
- Child and Adolescent Mental Health CenterMental Health ServicesCapital Region of DenmarkHellerupDenmark
| | - Troels Roesbjerg
- Mental Health ServicesCapital Region of DenmarkCopenhagen ØDenmark
| | - Frank C. Verhulst
- Child and Adolescent Mental Health CenterMental Health ServicesCapital Region of DenmarkHellerupDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health CenterMental Health ServicesCapital Region of DenmarkHellerupDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
15
|
Wong SL, Chung MC. The subjective experience of non-suicidal self-injury among female Chinese university students. Nord J Psychiatry 2022; 76:18-28. [PMID: 34061715 DOI: 10.1080/08039488.2021.1929461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the subjective experience of non-suicidal self-injury (NSSI) among female Chinese university students in Hong Kong. DESIGN Interpretative phenomenological analysis was used. METHODS Seven female students participated in the study, two engaged in biting and scratching, and three in cutting. RESULTS The majority of them indicated negative attitudes towards NSSI and saw no particular meaning attached to it. However, they all persisted with their behaviours, which suggested that they were unable to stop. Students found themselves in a paradoxical situation whereby although they saw no real benefit of NSSI, they still engaged in it to cope with distress. Feelings characterised by this distress were about entrapment and issues with academia, intimacy, loneliness, insecurity, negative self-worth, regulating distressing emotions, increasing positive physical sensations, healing oneself, and feeling alive. CONCLUSIONS The experience of hurting themselves persistently for these female students symbolised their struggle with academic or relationship difficulties, self-acceptance, emotional regulation and survival without self-injury.
Collapse
Affiliation(s)
- Siu Ling Wong
- Student Affairs Office, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Man Cheung Chung
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
16
|
Lee JY, Kim H, Kim SY, Kim JM, Shin IS, Kim SW. Non-suicidal self-injury is associated with psychotic like experiences, depression, and bullying in Korean adolescents. Early Interv Psychiatry 2021; 15:1696-1704. [PMID: 33461244 DOI: 10.1111/eip.13115] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
AIM Non-suicidal self-injury (NSSI) is common among adolescents, and several different factors can affect its prevalence. The present study examined the associated characteristics predicting NSSI among adolescents in South Korea. METHODS In total, 1674 high school students were recruited for a cross-sectional survey. They completed self-reported assessments, including the Deliberate Self-Harm Inventory (DSHI), the Center for Epidemiological Studies Depression Scale (CESD), the State-Trait Anxiety Inventory for Children (STAIC), and the Prodromal Questionnaire-16 (PQ-16), as well as their bullying experience. The NSSI group was defined as the sample group with at least one NSSI behaviour on the DSHI scale. A logistic regression analysis was performed using the NSSI group as the dependent variable. RESULTS The prevalence of NSSI was 28.3% (boys, 30.4%; girls, 24.4%) among adolescents. The most common type of NSSI behaviour among adolescents was interference with wound healing and sex differences in the method were examined. The CES-D, STAIC-trait, and PQ-16 scores were significantly higher and the RSES score was significantly lower in the NSSI group than those in the non-NSSI group. Participants' experience with bullying, such as being victims, bullies, bully-victims, and witness to bullying, were more likely to be in the NSSI group. In a logistic regression analysis, NSSI was significantly associated with male sex, low academic achievement, higher depression, psychotic-like experiences, being bullied, and witnessing bullying. CONCLUSION The results of this study suggest the need to identify and manage related psychologic factors in adolescents with NSSI, including psychotic-like symptoms.
Collapse
Affiliation(s)
- Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon-Young Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| |
Collapse
|
17
|
Kearns JC, Brown SL, Cero I, Gorman KR, Nock MK, Keane TM, Marx BP. Temporal sequences of suicidal and nonsuicidal self-injurious thoughts and behaviors among inpatient and community-residing military veterans. J Affect Disord 2021; 294:430-440. [PMID: 34320450 PMCID: PMC10910846 DOI: 10.1016/j.jad.2021.07.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 06/18/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) are major health concerns among military veterans yet little is known about the temporal relations among these outcomes. This study examined the temporal relations between suicidal and nonsuicidal SITBs among higher-risk veterans. Specifically, we identified when SITBs emerged and evaluated the role of nonsuicidal self-injury (NSSI) in the medical lethality of suicide attempts (SA), relative risk, and survival time of suicidal SITBs (i.e., suicide ideation [SI], suicide plan, SA). METHOD Cross-sectional data were collected from two samples examining suicide risk among veterans receiving inpatient psychiatric care (n = 157) and community-residing veterans with current depression and/or past month SI (n = 200). Participants completed an interview to assess SITBs. RESULTS SITBs emerged between ages 14-28 years with behaviors emerging, on average, earlier among inpatient veterans. The time lag between SITBs was not significantly different between groups. Inpatient veterans had a significantly shorter time lag from SI to SA. NSSI history predicted an increase in relative risk for all suicidal SITBs and shorter survival time. There was no association between NSSI history and medical lethality of the most serious SA for both groups. LIMITATIONS Limitations included use of cross-sectional, retrospective self-report with age-of-onset endorsed in years and not all SITBs were assessed (e.g., passive SI). CONCLUSIONS Veterans with a NSSI history are at high risk for suicidal SITBs and have a shorter survival time. Results showed thoughts (i.e., NSSI thoughts, SI) emerged before behavior (i.e., NSSI, SA) and NSSI emerged before SA.
Collapse
Affiliation(s)
- Jaclyn C Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA; VA Boston Healthcare System, Boston, MA, USA
| | - Sarah L Brown
- VA Boston Healthcare System, Boston, MA, USA; Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Ian Cero
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kaitlyn R Gorman
- VA Boston Healthcare System, Boston, MA, USA; University of Massachusetts - Boston, Boston, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Terence M Keane
- VA Boston Healthcare System, Boston, MA, USA; National Center for PTSD, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Brian P Marx
- VA Boston Healthcare System, Boston, MA, USA; National Center for PTSD, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
| |
Collapse
|
18
|
Nonsuicidal Self-Injury on Instagram: Examining Hashtag Trends. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2021. [DOI: 10.1007/s10447-021-09451-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
19
|
Victor SE, Brown SL, Scott LN. Prospective and Concurrent Affective Dynamics in Self-Injurious Thoughts and Behaviors: An Examination in Young Adult Women. Behav Ther 2021; 52:1158-1170. [PMID: 34452670 PMCID: PMC8403235 DOI: 10.1016/j.beth.2021.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
Affective dynamics, assessed using ecological momentary assessment (EMA), provide a nuanced understanding of within-person fluctuations of negative affect (NA) and positive affect (PA) in daily life. NA and PA dynamics have been associated with psychopathology and response to psychological treatments. NA and PA dynamics have been rarely studied concurrently in association with self-injurious thoughts and behaviors (SITB), transdiagnostic difficulties encountered regularly in clinical and community settings. Here we present EMA data from a large, diverse sample of young adult women with high rates of SITB to examine NA and PA dynamics (mean intensity, variability, and inertia). Specifically, we considered the prospective associations between past-year suicidal thoughts and past-year nonsuicidal self-injury and affective dynamics, as well as the concurrent associations between affective dynamics, EMA-reported suicidal thoughts, and EMA-reported urges for nonsuicidal self-injury. Results demonstrate that elevated mean NA and NA variability are robustly associated with all types of SITB assessed prospectively or concurrently. Interestingly, these associations were weakest for past-year nonsuicidal self-injurious behaviors, relative to past-year and concurrent suicidal or nonsuicidal self-injurious thoughts. Past-year suicidal thoughts further predicted increased NA inertia. Decreased PA inertia was associated with past-year nonsuicidal self-injury behavior, as well as concurrent EMA suicidal thoughts. We found no associations (prospective or concurrent) between SITB and mean PA intensity or PA variability. These results highlight the importance of understanding affective processes to develop real-world interventions to prevent nonsuicidal self-injury and suicidal behavior in daily life.
Collapse
|
20
|
McPhillips R, Nafees S, Elahi A, Batool S, Krishna M, Krayer A, Huxley P, Chaudhry N, Robinson C. Knowledge, attitudes and experiences of self-harm and suicide in low-income and middle-income countries: protocol for a systematic review. BMJ Open 2021; 11:e041645. [PMID: 34158289 PMCID: PMC8220466 DOI: 10.1136/bmjopen-2020-041645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Over 800 000 people die due to suicide each year and suicide presents a huge psychological, economic and social burden for individuals, communities and countries as a whole. Low-income and middle-income countries (LMICs) are disproportionately affected by suicide. The strongest risk factor for suicide is a previous suicide attempt, and other types of self-harm have been found to be robust predictors of suicidal behaviour. An approach that brings together multiple sectors, including education, labour, business, law, politics and the media is crucial to tackling suicide and self-harm. The WHO highlights that evaluations of the knowledge and attitudes that priority groups, not only healthcare staff, have of mental health and suicidal behaviour are key to suicide prevention strategies. The aim of this systematic review is to examine the knowledge, attitudes and experiences different stakeholders in LMICs have of self-harm and suicide. METHODS AND ANALYSIS MEDLINE, Embase, PsycINFO, CINAHL, BNI, Social Sciences and Cochrane Library will be searched. Reviewers working independently of each other will screen search results, select studies for inclusion, extract and check extracted data, and rate the quality of the studies using the Strengthening the Reporting of Observational studies in Epidemiology and Critical Appraisals Skills Programme checklists. In anticipation of heterogeneity, a narrative synthesis of quantitative studies will be provided and metaethnography will be used to synthesise qualitative studies. ETHICS AND DISSEMINATION Ethical approval is not required. A report will be provided for the funding body, and the systematic review will be submitted for publication in a high-impact, peer-reviewed, open access journal. Results will also be disseminated at conferences, seminars, congresses and symposia, and to relevant stakeholders. PROSPERO REGISTRATION NUMBER CRD42019135323.
Collapse
Affiliation(s)
| | - Sadia Nafees
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Anam Elahi
- Social Care and Society, The University of Manchester, Manchester, UK
| | - Saqba Batool
- Social Care and Society, The University of Manchester, Manchester, UK
| | - Murali Krishna
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Anne Krayer
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Peter Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Nasim Chaudhry
- Research and Development, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | |
Collapse
|
21
|
Prediction of suicidal ideation and attempt in 9 and 10 year-old children using transdiagnostic risk features. PLoS One 2021; 16:e0252114. [PMID: 34033672 PMCID: PMC8148349 DOI: 10.1371/journal.pone.0252114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
The objective of the current study was to build predictive models for suicidal ideation in a sample of children aged 9–10 using features previously implicated in risk among older adolescent and adult populations. This case-control analysis utilized baseline data from the Adolescent Brain and Cognitive Development (ABCD) Study, collected from 21 research sites across the United States (N = 11,369). Several regression and ensemble learning models were compared on their ability to classify individuals with suicidal ideation and/or attempt from healthy controls, as assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia–Present and Lifetime Version. When comparing control participants (mean age: 9.92±0.62 years; 4944 girls [49%]) to participants with suicidal ideation (mean age: 9.89±0.63 years; 451 girls [40%]), both logistic regression with feature selection and elastic net without feature selection predicted suicidal ideation with an AUC of 0.70 (CI 95%: 0.70–0.71). The random forest with feature selection trained to predict suicidal ideation predicted a holdout set of children with a history of suicidal ideation and attempt (mean age: 9.96±0.62 years; 79 girls [41%]) from controls with an AUC of 0.77 (CI 95%: 0.76–0.77). Important features from these models included feelings of loneliness and worthlessness, impulsivity, prodromal psychosis symptoms, and behavioral problems. This investigation provided an unprecedented opportunity to identify suicide risk in youth. The use of machine learning to examine a large number of predictors spanning a variety of domains provides novel insight into transdiagnostic factors important for risk classification.
Collapse
|
22
|
Leone C, Galosi S, Mollica C, Fortunato M, Possidente C, Milone V, Misuraca S, Berillo L, Truini A, Cruccu G, Ferrara M, Terrinoni A. Dissecting pain processing in adolescents with Non-Suicidal Self Injury: Could suicide risk lurk among the electrodes? Eur J Pain 2021; 25:1815-1828. [PMID: 33982830 PMCID: PMC8453562 DOI: 10.1002/ejp.1793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/01/2021] [Accepted: 05/02/2021] [Indexed: 12/13/2022]
Abstract
Background Although non‐suicidal self‐injury (NSSI) disorder is highly prevalent in adolescents, its relationship with pain system function and suicidality is still controversial. The present study was designed to assess the function of the nociceptive afferent pathways and the endogenous pain modulation in adolescent patients with NSSI and to longitudinally register any suicide attempt, describe its frequency and find a possible association between suicide, neurophysiological measures and psychological measures. Methods We enrolled 30 adolescents suffering from NSSI and 20 age‐ and gender‐matched healthy controls. Patients underwent a comprehensive psychological evaluation. Each participant underwent thermal pain thresholds of the quantitative sensory testing, laser‐evoked potential recording to study the ascending nociceptive pathway and the conditioned pain modulation testing to test the endogenous pain modulation. Results We found that patients with NSSI had a reduced amplitude of the N2 component of laser‐evoked potentials and an abnormal conditioned pain modulation. The amplitude of the N2 was associated with suicidal risk. Conclusions The deficit of the endogenous pain modulation likely depends on a saturation due to continuous pain solicitation. The strong association of a reduced amplitude of the N2 component with suicide suggests that it may serve as a possible biomarker in self‐harming adolescents. Significance The present study identifies the N2 component of laser‐evoked potentials as a possible neurophysiological biomarker of suicidal risk in patients with non‐suicidal self‐injury, therefore, raising the possibility for a non‐invasive test to identify subjects at higher risk of suicide among self‐harming patients.
Collapse
Affiliation(s)
- Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Serena Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Cristina Mollica
- Department of Methods and Models for Economics, Territory and Finance, Sapienza University, Rome, Italy
| | - Mattia Fortunato
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | - Valeria Milone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Sofia Misuraca
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Luana Berillo
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Mauro Ferrara
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | |
Collapse
|
23
|
Daukantaitė D, Lundh LG, Wångby-Lundh M, Claréus B, Bjärehed J, Zhou Y, Liljedahl SI. What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up. Eur Child Adolesc Psychiatry 2021; 30:475-492. [PMID: 32318877 PMCID: PMC8019412 DOI: 10.1007/s00787-020-01533-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/08/2020] [Indexed: 01/07/2023]
Abstract
This study examined the longitudinal associations between non-suicidal self-injury (NSSI) in early adolescence and various positive and negative aspects of mental health in young adulthood. The participants were a cohort of regular school students (n = 1064) in grades 7-8 from a Swedish municipality. Nine hundred and ninety-one of these completed an 11-page questionnaire (T1: Mage = 13.7; 50.3% girls); 1 year later, 984 students completed the questionnaire again (T2: Mage = 14.8; 51.1% girls); and 10 years later, 557 took part (T3: Mage = 25.3; 59.2% women). The prevalence of any NSSI (≥ 1 instance) decreased from about 40% in adolescence to 18.7% in young adulthood, while the prevalence of repetitive NSSI (≥ 5 instances) decreased from about 18 to 10%. Compared to individuals who reported no NSSI as adolescents, and controlling for gender and psychological difficulties in adolescence, adolescents with stable repetitive NSSI (i.e., repetitive NSSI at both T1 and T2) showed significantly higher levels of stress, anxiety, NSSI, and difficulties in emotion regulation 10 years later. Even infrequent and unstable repetitive NSSI in adolescence was associated with negative outcomes in young adulthood. These results suggest that stable repetitive NSSI in adolescence is a strong risk factor for mental health problems in young adulthood and that occasional engagement in NSSI in adolescence is an indicator of vulnerability for poorer mental health in young adulthood.
Collapse
Affiliation(s)
- Daiva Daukantaitė
- Department of Psychology, Lund University, Box 213, 221 00, Lund, Sweden.
| | - Lars-Gunnar Lundh
- Department of Psychology, Lund University, Box 213, 221 00, Lund, Sweden
| | | | - Benjamin Claréus
- Department of Psychology, Lund University, Box 213, 221 00, Lund, Sweden
| | - Jonas Bjärehed
- Department of Psychology, Lund University, Box 213, 221 00, Lund, Sweden
| | - Ya Zhou
- Department of Psychology, Lund University, Box 213, 221 00, Lund, Sweden
| | - Sophie I Liljedahl
- Department of Psychology, Lund University, Box 213, 221 00, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| |
Collapse
|
24
|
Voss C, Hoyer J, Venz J, Pieper L, Beesdo-Baum K. Non-suicidal self-injury and its co-occurrence with suicidal behavior: An epidemiological-study among adolescents and young adults. Acta Psychiatr Scand 2020; 142:496-508. [PMID: 32979220 DOI: 10.1111/acps.13237] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/13/2020] [Accepted: 09/17/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) comprising thoughts and behaviors is common and often co-occurring with suicidal behavior like ideation, plan, and attempt. As limited data are available for adolescents and young adults, this study aims to present prevalence estimates for lifetime NSSI, its co-occurrence with suicidal behavior, conditional probabilities and their association with socio-demographic characteristics, severity characteristics of suicidal behavior, and health service utilization. METHOD The epidemiological Behavior and Mind Health (BeMIND) study assessed in 2015/16 a random-community sample of N = 1180 aged 14-21 years from Dresden, Germany, regarding lifetime NSSI via self-administered questionnaire and suicidal behaviors via standardized interview. RESULTS Any lifetime NSSI was reported by 19.3% (thoughts: 18.0%, behaviors: 13.6%) of the sample with higher prevalence in females (OR = 2.7, 95% CI 1.9-3.8, P < 0.001). Lifetime prevalence of co-occurring NSSI and suicidal behavior was 7.7%. Females had a 3.3- to 8.8-fold odds of co-occurrence than males. Among those with any NSSI, 39.6% endorsed suicidal behavior, and 66.3% of those with any suicidal behavior reported NSSI. 42.3% of those with any NSSI reported to have used mental healthcare services at any time during their life with higher rates in those with co-occurring suicidal behavior (62.3%). CONCLUSION Non-suicidal self-injury and co-occurring suicidal behavior is common in adolescents and young adults-especially females. The limited utilization of mental healthcare services underpins the need for improving recognition of NSSI and suicidal behavior as well as the accessibility of mental healthcare services during adolescence and emerging adulthood.
Collapse
Affiliation(s)
- C Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Hoyer
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J Venz
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - L Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - K Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
25
|
Bout A, Kettani N, Berhili N, Aarab C, Rammouz I, Aalouane R. Les conduites d’automutilation non suicidaires dans une population recrutée pendant une hospitalisation en psychiatrie : À propos de 100 patients. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
26
|
Gratz KL, Spitzen TL, Tull MT. Expanding our understanding of the relationship between nonsuicidal self-injury and suicide attempts: The roles of emotion regulation self-efficacy and the acquired capability for suicide. J Clin Psychol 2020; 76:1653-1667. [PMID: 32227691 PMCID: PMC7723229 DOI: 10.1002/jclp.22950] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although past literature has emphasized the role of acquired capability in the relationship between nonsuicidal self-injury (NSSI) and suicide attempts, support for the indirect relationship of NSSI to suicide attempts through acquired capability is limited. Thus, research examining other factors that may underlie this relationship is needed. Across two studies, this research examined the indirect relationships of NSSI frequency to suicide attempts through both acquired capability and emotion regulation self-efficacy (ERSE). METHOD Two large samples of adults (one nationwide community sample and one clinical sample of patients with substance use disorders) completed questionnaires and/or interviews. RESULTS Results revealed significant indirect relationships of NSSI frequency to lifetime suicide attempts through ERSE, but not acquired capability, within both samples. CONCLUSIONS Results highlight the relevance of ERSE to both suicide attempts and the NSSI-suicide attempt relationship, and suggest the potential utility of interventions aimed at increasing ERSE among individuals with repeated NSSI.
Collapse
|
27
|
Fredlund C, Wadsby M, Jonsson LS. Motives and Manifestations of Sex as Self-Injury. JOURNAL OF SEX RESEARCH 2020; 57:897-905. [PMID: 31725334 DOI: 10.1080/00224499.2019.1689377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To view destructive sexual behaviors as a form of self-injury is a new concept in the research field that needs further exploration and conceptualization. The aim of this study was to explore experiences of sex as self-injury to identify motives and manifestations of the behavior. An anonymous self-selected open-ended questionnaire was used for the study, and qualitative content analysis was used to identify patterns and themes in the text. A total of 199 informants participated in the study (M = 27.9, SD = 9.3 years), all of whom were recruited via a range of websites of Swedish nongovernmental organizations. Sex as self-injury was described as voluntary exposure to sexual situations including psychological and/or physical harm. Affect regulation and receiving positive or negative confirmation emerged as important motives for the behavior. Respondents described sex as self-injury as difficult to stop when it felt compulsive and addictive, with ever-higher risk-taking and self-harming described. Our findings indicate that sex as self-injury often includes deliberate sexual violence, and is similar to other self-injurious behaviors, including non-suicidal self-injury. Sex as self-injury needs to be addressed in healthcare, such as in psychiatry and gynecology departments, to prevent further traumatization.
Collapse
Affiliation(s)
- Cecilia Fredlund
- Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University
| | - Marie Wadsby
- Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University
| | - Linda S Jonsson
- Barnafrid, Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University
| |
Collapse
|
28
|
Abstract
Suicide is the second leading cause of death among adolescents worldwide, yet adequate mental health services for children and adolescents are lacking across the globe. Likewise, youth who engage in non-suicidal self-injury (NSSI) are at heightened risk for suicide, but few pediatric settings have established protocols for screening and responding to youth who engage in NSSI and/or endorse thoughts of suicide. In this article, we highlight similarities and differences of managing suicide and NSSI across cultures, including persisting stigma associated with youth at risk for self-harm. We summarize current guidelines for screening youth at risk for suicide and NSSI across services, consider the use of online and telehealth services, and offer recommendations for a multidisciplinary approach to treating youth who engage in self-harming behaviors as well as how healthcare professionals can communicate with each other using common, non-stigmatizing language. We conclude with a discussion of future policy recommendations and areas for research.
Collapse
Affiliation(s)
- Nicholas J Westers
- Department of Psychiatry, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, USA
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria
| |
Collapse
|
29
|
Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Res 2020; 288:112920. [PMID: 32279008 DOI: 10.1016/j.psychres.2020.112920] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI). METHODS A literature search was conducted for original articles examining the general and psychiatric populations. RESULTS There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts. CONCLUSION The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.
Collapse
|
30
|
Mathew AS, Davine TP, Snorrason I, Houghton DC, Woods DW, Lee HJ. Body-focused repetitive behaviors and non-suicidal self-injury: A comparison of clinical characteristics and symptom features. J Psychiatr Res 2020; 124:115-122. [PMID: 32135390 DOI: 10.1016/j.jpsychires.2020.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
Body-focused repetitive behaviors (BFRBs) and non-suicidal self-injury (NSSI) are recognized as distinct categories in the DSM-5. However, definitions and assessment of NSSI sometimes encompasses behaviors similar to BFRBs, and little data exist about their clinical differences. The current study examined clinical characteristics and symptom features associated with NSSI vs. BFRBs. The current sample included 1523 individuals who endorsed moderate to severe NSSI (n = 165) or BFRBs: hair pulling group (n = 102), skin picking group (n = 216), nail picking group (n = 253), nail biting group (n = 487), and cheek biting group (n = 300). Responders were asked to complete questionnaires on clinical features relevant for BFRBs and NSSI. NSSI and BFRBs had significant differences on several clinical features. Individuals in the NSSI group were more likely than individuals with BFRBs to report engaging in the behavior for social-affective reasons (i.e., to get out of doing something, or receive attention from others). Individuals in the NSSI group were also more likely to engage in the behavior to regulate tension and feelings of emptiness, and to experience relief during the act. In contrast, individuals in the BFRB groups were more likely to engage in the behavior automatically without reflective awareness, to reduce boredom, or to fix appearance. The NSSI group obtained significantly higher scores on questionnaires assessing stress, anxiety, depression, and harm avoidance. Overall, the results showed several notable differences between NSSI and BFRBs that are consistent with clinical literature and definitions of these problems in the DSM-5.
Collapse
Affiliation(s)
- Abel S Mathew
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Taylor P Davine
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | | | - David C Houghton
- Department of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, USA.
| |
Collapse
|
31
|
Vine V, Victor SE, Mohr H, Byrd AL, Stepp SD. Adolescent suicide risk and experiences of dissociation in daily life. Psychiatry Res 2020; 287:112870. [PMID: 32171125 PMCID: PMC7983062 DOI: 10.1016/j.psychres.2020.112870] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Abstract
Dissociation is associated with risk for suicide in adults, but this link is not well studied in adolescents, in spite of their marked suicide risk. This study assessed adolescents' dissociative experiences in daily life and evaluated the association between dissociative experiences and suicide risk, including the independence of this relationship from related affective and clinical states and demographic characteristics. Clinically referred early adolescents (N = 162; aged 11-13) were assessed via multi-informant clinical interview, questionnaires, and 4-day ecological momentary assessment protocol. Adolescents were classified as being at elevated suicide risk using multi-informant, multi-method reports of suicide risk behavior and/or at elevated proximal risk using the 4-day EMA only. Suicide risk was associated with daily dissociative experiences, and this relationship was independent of daily negative and positive affect and co-occurring borderline personality symptoms. Gender differences emerged, such that the relationship between daily dissociative experiences and suicide risk was only significant in adolescent girls. Overall, findings suggest dissociation may be independently relevant to adolescent suicide risk, above and beyond effects of psychopathology and affective disturbance, and especially in girls. Daily dissociative experiences may help understand and detect suicide risk among early adolescents and warrant further research.
Collapse
Affiliation(s)
- Vera Vine
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
| | - Sarah E Victor
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Harmony Mohr
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Amy L Byrd
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| |
Collapse
|
32
|
Sarno I, Madeddu F, Gratz K. Self-injury, psychiatric symptoms, and defense mechanisms: Findings in an Italian nonclinical sample. Eur Psychiatry 2020; 25:136-45. [DOI: 10.1016/j.eurpsy.2009.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 05/26/2009] [Accepted: 05/27/2009] [Indexed: 11/25/2022] Open
Abstract
AbstractIntroductionThis study provides data on the rates, characteristics, and correlates of self-injury (SI) in an Italian nonclinical sample, a population previously unexamined within the SI literature. This study examined the associations between SI and defense mechanisms, as well as the differences between self-injurers (episodic and recurrent) and non self-injurers with regard to the severity and variety of their psychiatric symptoms and psychological distress.Materials and methodsFive hundred and seventy-eight university students (82.5% female; mean age = 22.3; S.D. = 3.4) were administered a battery of self-report questionnaires, including the “Deliberate Self Harm Inventory” for SI, the Response Evaluation Measure-71 for defense mechanisms, and the “Symptom Checklist-90-Revised” for psychological distress and psychiatric symptoms.ResultsOne hundred and nineteen participants (20.6%) reported having engaged in SI at least once during their lifetime. Individuals with recurrent SI (SI ≥ 5) reported significantly higher levels of all psychiatric symptoms and many maladaptive defense mechanisms than individuals without SI. Results also provided evidence for differences between individuals with recurrent and episodic SI.ConclusionResults suggest that recurrent self-injurers are distinguished from both episodic self-injurers and non self-injurers by their greater use of maladaptive defense mechanisms, rather than their lesser use of adaptive defenses. Further, results suggest that recurrent self-injurers differ from episodic self-injurers not in terms of the severity of their psychiatric symptoms, but the variety and number of these symptoms.
Collapse
|
33
|
Ali A, Azam M, Mattiullah J. Physical Exercise as Medicine for Self-Injurious Behavior. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200302-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
34
|
Hambleton AL, Hanstock TL, Halpin S, Dempsey C. Initiation, meaning and cessation of self-harm: Australian adults’ retrospective reflections and advice to adolescents who currently self-harm. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1737509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ashlea L. Hambleton
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| | - Tanya L. Hanstock
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| | - Sean Halpin
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| | - Caitlin Dempsey
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| |
Collapse
|
35
|
DeVille DC, Whalen D, Breslin FJ, Morris AS, Khalsa SS, Paulus MP, Barch DM. Prevalence and Family-Related Factors Associated With Suicidal Ideation, Suicide Attempts, and Self-injury in Children Aged 9 to 10 Years. JAMA Netw Open 2020; 3:e1920956. [PMID: 32031652 PMCID: PMC7261143 DOI: 10.1001/jamanetworkopen.2019.20956] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although suicide is a leading cause of death for children in the United States, and the rate of suicide in childhood has steadily increased, little is known about suicidal ideation and behaviors in children. OBJECTIVE To assess the overall prevalence of suicidal ideation, suicide attempts, and nonsuicidal self-injury, as well as family-related factors associated with suicidality and self-injury among preadolescent children. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study using retrospective analysis of the baseline sample from the Adolescent Brain Cognitive Development (ABCD) study. This multicenter investigation used an epidemiologically informed school-based recruitment strategy, with consideration of the demographic composition of the 21 ABCD sites and the United States as a whole. The sample included children aged 9 to 10 years and their caregivers. MAIN OUTCOMES AND MEASURES Lifetime suicidal ideation, suicide attempts, and nonsuicidal self-injury as reported by children and their caregivers in a computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia. RESULTS A total of 11 814 children aged 9 to 10 years (47.8% girls; 52.0% white) and their caregivers were included. After poststratification sociodemographic weighting, the approximate prevalence rates were 6.4% (95% CI, 5.7%-7.3%) for lifetime history of passive suicidal ideation; 4.4% (95% CI, 3.9%-5.0%) for nonspecific active suicidal ideation; 2.4% (95% CI, 2.1%-2.7%) for active ideation with method, intent, or plan; 1.3% (95% CI, 1.0%-1.6%) for suicide attempts; and 9.1% (95% CI, 8.1-10.3) for nonsuicidal self-injury. After covarying by sex, family history, internalizing and externalizing problems, and relevant psychosocial variables, high family conflict was significantly associated with suicidal ideation (odds ratio [OR], 1.12; 95% CI, 1.07-1.16) and nonsuicidal self-injury (OR, 1.09; 95% CI, 1.05-1.14), and low parental monitoring was significantly associated with ideation (OR, 0.97; 95% CI, 0.95-0.98), attempts (OR, 0.91; 95% CI, 0.86-0.97), and nonsuicidal self-injury (OR, 0.95; 95% CI, 0.93-0.98); these findings were consistent after internal replication. Most of children's reports of suicidality and self-injury were either unknown or not reported by their caregivers. CONCLUSIONS AND RELEVANCE This study demonstrates the association of family factors, including high family conflict and low parental monitoring, with suicidality and self-injury in children. Future research and ongoing prevention and intervention efforts may benefit from the examination of family factors.
Collapse
Affiliation(s)
- Danielle C DeVille
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Diana Whalen
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, Missouri
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
- Department of Radiology, Washington University in St Louis, St Louis, Missouri
| | | | - Amanda S Morris
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Department of Human Development and Family Science, Oklahoma State University, Tulsa
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, Missouri
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
- Department of Radiology, Washington University in St Louis, St Louis, Missouri
| |
Collapse
|
36
|
Abstract
Self-harm has become one of the leading causes of mortality in developed countries. The overall rate for suicide in Canada is 11.3 per 100,000 according to Statistics Canada in 2015. Between 2000 and 2007 the lowest rates of suicide in Canada were in Ontario, one of the most urbanized regions in Canada. However, the interaction between land use, landscape and self-harm has not been significantly studied for urban cores. It is thus of relevance to understand the impacts of land-use and landscape on suicidal behavior. This paper takes a spatial analytical approach to assess the occurrence of self-harm along one of the densest urban cores in the country: Toronto. Individual self-harm data was gathered by the National Ambulatory Care System (NACRS) and geocoded into census tract divisions. Toronto’s urban landscape is quantified at spatial level through the calculation of its land use at different levels: (i) land use type, (ii) sprawl metrics relating to (a) dispersion and (b) sprawl/mix incidence; (iii) fragmentation metrics of (a) urban fragmentation and (b) density and (iv) demographics of (a) income and (b) age. A stepwise regression is built to understand the most influential factors leading to self-harm from this selection generating an explanatory model.
Collapse
|
37
|
Buelens T, Luyckx K, Kiekens G, Gandhi A, Muehlenkamp JJ, Claes L. Investigating the DSM-5 criteria for non-suicidal self-injury disorder in a community sample of adolescents. J Affect Disord 2020; 260:314-322. [PMID: 31521868 DOI: 10.1016/j.jad.2019.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/11/2019] [Accepted: 09/01/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a serious public health concern in adolescents. In 2013, DSM-5 recognized NSSI as a distinct clinical phenomenon and made a call for more systematic research by including Non-Suicidal Self-Injury-Disorder (NSSI-D) as a condition requiring further research. Yet, few studies have examined the prevalence of NSSI-D in adolescents using the exact DSM-5 criteria. Additionally, the few studies available criticised several of the proposed diagnostic criteria and pointed out that more research is needed. METHODS Therefore, we examined prevalence rates of NSSI-D and investigated the four most controversial criteria (i.e., criteria A, B/C, and E) in a large community sample of adolescents (N = 2,130; 54% female; Mage = 15, SD = 1.81). RESULTS Our results show an overall NSSI-D prevalence rate of 7.6%, with significantly more girls (11.7%) than boys (2.9%) meeting the diagnosis. The prevalence of NSSI-D dropped to 5.5% when an alternative criterion A (i.e., ≥10 days of NSSI in the past year) was implemented. In our sample, 87% and 99% of adolescents with lifetime NSSI met criteria B and C, which clearly questions the clinical utility of these criteria for the DSM-5 diagnosis of NSSI-D. Importantly, however, although criterion E received relatively low endorsement, it significantly distinguished adolescents with and without NSSI-D from one another. LIMITATIONS AND CONCLUSION Although our conclusions are restricted by the cross-sectional nature of our study, these findings show that NSSI-D is common in community adolescents and offer new insights in the endorsement and clinical utility of specific NSSI-D criteria.
Collapse
Affiliation(s)
- Tinne Buelens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium.
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Glenn Kiekens
- Centre for Public Health Psychiatry, KU Leuven, Leuven, Belgium
| | - Amarendra Gandhi
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium
| | | | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3720, 3000 Leuven, Belgium; Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| |
Collapse
|
38
|
Zetterqvist M, Perini I, Mayo LM, Gustafsson PA. Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index. Front Psychiatry 2020; 11:8. [PMID: 32116833 PMCID: PMC7034359 DOI: 10.3389/fpsyt.2020.00008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study, especially in adolescent and clinical populations where it is particularly prevalent and studies are limited. Twenty-nine clinical self-injuring adolescents were included in the study. The Clinical Assessment of Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess prevalence of NSSID. The NSSID diagnosis criteria were met by 62.1% of adolescents. The impairment or distress criterion was least often met. Criteria B and C (assessing reasons for NSSI and cognitions/emotions prior to NSSI) were confirmed by 96-100% of all participants. Adolescents with NSSI in this clinical sample had several comorbidities and high levels of psychopathology. NSSID occurred both in combination with and independently of borderline personality disorder traits as well as suicide plans and attempts. Those with NSSID had a significantly higher cutting frequency than those not meeting full NSSID criteria. Other NSSI characteristics, comorbidity, psychopathology, and trauma experiences did not differ between groups. CANDI was a feasible tool to assess NSSID in adolescents. It is important to use structured measures to assess the validity of the NSSID diagnosis across development in both community and clinical samples. The clinical utility of the NSSID diagnosis is discussed.
Collapse
Affiliation(s)
- Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - Irene Perini
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Leah M Mayo
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per A Gustafsson
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| |
Collapse
|
39
|
Hooley JM, Fox KR, Boccagno C. Nonsuicidal Self-Injury: Diagnostic Challenges And Current Perspectives. Neuropsychiatr Dis Treat 2020; 16:101-112. [PMID: 32021203 PMCID: PMC6959491 DOI: 10.2147/ndt.s198806] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/15/2019] [Indexed: 11/23/2022] Open
Abstract
Nonsuicidal self-injury (NSSI) involves deliberate and intentional injury to body tissue that occurs in the absence of suicidal intent. Typical examples here might include self-cutting, burning, or self-hitting. Behavior of this kind is fundamentally unsettling as well as perplexing. It is also the case that self-harming behavior of any kind runs counter to a fundamental survival instinct. In the past, behaviors such as these were viewed as self-mutilation and considered to be a form of attenuated suicide. Much has changed over time, culminating in the entry of NSSI Disorder into DSM-5 as a condition in need of further study. In this review we describe the evolution of the NSSI construct and consider current issues in its diagnosis and assessment.
Collapse
Affiliation(s)
- Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, CO 80210, USA
| | - Chelsea Boccagno
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
| |
Collapse
|
40
|
Laghi F, Cerutti R, Terrinoni A, Lonigro A, Pongetti A, Ferrara M, Fantini F. Evaluation of the “Reading the Mind in the Eyes Test” with Non-Suicidal Self-Injury (NSSI) adolescents: A pilot study. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00505-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
41
|
Harris IM, Beese S, Moore D. Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools. BMJ Open 2019; 9:e029311. [PMID: 31494608 PMCID: PMC6731844 DOI: 10.1136/bmjopen-2019-029311] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE This systematic review aimed to evaluate the ability of risk tools to predict the future episodes of suicide/self-harm in adolescents. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL and PsycINFO were searched from inception to 3 March 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Cohort studies, case-control studies and randomised controlled trials of adolescents aged 10-25 who had undergone risk assessment in a clinical setting following an episode of self-harm were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were grouped by tool and narrative synthesis undertaken, with studies appraised using a checklist combining the QUIPS (Quality In Prognosis Studies) and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tools. RESULTS Of the 17 137 articles initially identified, 11 studies evaluating 10 separate tools were included. The studies varied in setting, population and outcome measure. The majority of the studies were rated as having an unclear risk of bias, and meta-analysis was not possible due to high variability between studies.The ability of the tools to correctly identify those adolescents going on to make a self-harm/suicide attempt ranged from 27% (95% CI 10.7% to 50.2%) to 95.8% (95% CI 78.9% to 99.9%). A variety of metrics were provided for 1-10 points increases in various tools, for example, odds and HRs. CONCLUSIONS This systematic review is the first to explore the use of assessment tools in adolescents. The predictive ability of these tools varies greatly. No single tool is suitable for predicting a higher risk of suicide or self-harm in adolescent populations. PROSPERO REGISTRATION NUMBER CRD42017058686.
Collapse
Affiliation(s)
| | - Sophie Beese
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
42
|
Klimes-Dougan B, Begnel E, Almy B, Thai M, Schreiner MW, Cullen KR. Hypothalamic-pituitary-adrenal axis dysregulation in depressed adolescents with non-suicidal self-injury. Psychoneuroendocrinology 2019; 102:216-224. [PMID: 30590339 DOI: 10.1016/j.psyneuen.2018.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is characterized by causing harm to one's own body without the intent of suicide. While major depressive disorder (MDD) has been associated with elevated cortisol (at least in some subgroups), prior studies in NSSI have suggested that NSSI is associated with blunted reactivity to stress of the hypothalamic-pituitary-adrenal (HPA) axis, possibly consistent with an allostatic load model. The present study used a multi-level approach to examine salivary cortisol in the context of a social stressor in 162 adolescents (ages 12 to 19 years old) with MDD with a history of repeated engagement in NSSI (MDD/NSSI) versus MDD without repeated NSSI (MDD), and healthy controls (HC). Observed (expressed) and self-reported (experienced) ratings of stress were also obtained during the social stress paradigm. The results showed that MDD/NSSI exhibited lower salivary cortisol levels and differed in cortisol trajectories in the context of a social stressor compared to HC and MDD. Observed stress, but not self-reported stress, during the social stress paradigm was greater for the MDD/NSSI than HC. Follow-up analyses suggested the possibility that this pattern of lower cortisol for those who engage in NSSI was present in females and males, and was more pronounced in those with repeated NSSI (but not subthreshold NSSI) and those with a history of NSSI and suicide attempts. Overall, these findings add to the prior literature and begin to show a consistent pattern for how stress is processed in atypical ways for those who engage in repeated NSSI. Importantly, these results suggest that some of the heterogeneity across adolescent depression may be better represented by these underlying biological processes, perhaps even representing subgroups that will benefit from different types of intervention. Hypothalamic-Pituitary-Adrenal Axis Dysregulation in Depressed Adolescents with Non-Suicidal Self-Injury.
Collapse
Affiliation(s)
- Bonnie Klimes-Dougan
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | - Erin Begnel
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | - Brandon Almy
- Institute of Child Development, College of Education and Human Development, University of Minnesota, Twin Cities, United States.
| | - Michelle Thai
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | | | - Kathryn R Cullen
- Psychiatry Department, School of Medicine, University of Minnesota, Twin Cities, United States.
| |
Collapse
|
43
|
Richmond-Rakerd LS, Trull TJ, Gizer IR, McLaughlin K, Scheiderer EM, Nelson EC, Agrawal A, Lynskey MT, Madden PA, Heath AC, Statham DJ, Martin NG. Common genetic contributions to high-risk trauma exposure and self-injurious thoughts and behaviors. Psychol Med 2019; 49:421-430. [PMID: 29729685 PMCID: PMC7410360 DOI: 10.1017/s0033291718001034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prior research has documented shared heritable contributions to non-suicidal self-injury (NSSI) and suicidal ideation (SI) as well as NSSI and suicide attempt (SA). In addition, trauma exposure has been implicated in risk for NSSI and suicide. Genetically informative studies are needed to determine common sources of liability to all three self-injurious thoughts and behaviors, and to clarify the nature of their associations with traumatic experiences. METHODS Multivariate biometric modeling was conducted using data from 9526 twins [59% female, mean age = 31.7 years (range 24-42)] from two cohorts of the Australian Twin Registry, some of whom also participated in the Childhood Trauma Study and the Nicotine Addiction Genetics Project. RESULTS The prevalences of high-risk trauma exposure (HRT), NSSI, SI, and SA were 24.4, 5.6, 27.1, and 4.6%, respectively. All phenotypes were moderately to highly correlated. Genetic influences on self-injurious thoughts and behaviors and HRT were significant and highly correlated among men [rG = 0.59, 95% confidence interval (CI) (0.37-0.81)] and women [rG = 0.56 (0.49-0.63)]. Unique environmental influences were modestly correlated in women [rE = 0.23 (0.01-0.45)], suggesting that high-risk trauma may confer some direct risk for self-injurious thoughts and behaviors among females. CONCLUSIONS Individuals engaging in NSSI are at increased risk for suicide, and common heritable factors contribute to these associations. Preventing trauma exposure may help to mitigate risk for self-harm and suicide, either directly or indirectly via reductions in liability to psychopathology more broadly. In addition, targeting pre-existing vulnerability factors could significantly reduce risk for life-threatening behaviors among those who have experienced trauma.
Collapse
Affiliation(s)
- Leah S. Richmond-Rakerd
- Dept. of Psychology & Neuroscience, Duke University
- Dept. of Psychological Sciences, University of Missouri
| | | | - Ian R. Gizer
- Dept. of Psychological Sciences, University of Missouri
| | | | - Emily M. Scheiderer
- Dept. of Psychological Sciences, University of Missouri
- Dept. of Clinical and Counselling Psychology, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK
| | | | - Arpana Agrawal
- Dept. of Psychiatry, Washington University School of Medicine
| | - Michael T. Lynskey
- Dept. of Psychiatry, Washington University School of Medicine
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England
| | | | - Andrew C. Heath
- Dept. of Psychiatry, Washington University School of Medicine
| | | | | |
Collapse
|
44
|
Concannon E, Carr S, Doherty A, McInerney SJ, Birrane J, Kearney L, Hussey AJ, Potter SM, Kelly JL, McInerney NM. Referral of patients to plastic surgeons following self-harm: Opportunities for suicide prevention. J Plast Reconstr Aesthet Surg 2018; 72:491-497. [PMID: 30509737 DOI: 10.1016/j.bjps.2018.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/28/2018] [Indexed: 11/28/2022]
Abstract
Self-harm is a common source of referral to plastic and hand surgery services. Appropriate management of these patients is complex and includes the need for close liaison with mental health services. Self-harm is the single biggest risk factor for completed suicide, thereby increasing the risk by a factor of 66.1 This study aimed to analyse the clinical pathway and demographics of patients referred to plastic surgeons following self-harm. This 6-year retrospective series included patients referred to plastic surgeons following self-harm within the Galway University Hospital group. Patients were identified through the Hospital inpatient enquiry system, cross-referenced with data from the National Suicide Research Foundation. Data collected included demographics, psychiatric history, details of self-harm injury, admission pathway and operative intervention. Forty-nine patients were referred to plastic surgery services during the study period, accounting for 61 individual presentations. The male-to-female ratio was 26 (53%) to 23 (47%). Mean age was 40 years (range 21-95 years). Alcohol or illicit substance use was recorded in 17 of 61 (28%) presentations. Mortality from suicide occurred in 4 patients (8%). Mental health assessment was not carried out in 9 presentations (15%). Documentation of need for close or one-to-one observation was made in 11 cases (20%) and was not referred to in 43 cases (83%) following mental health assessment. This study demonstrates significant diversity in the management of this vulnerable patient group and may inform development of referral pathways to improve the safety of transfer, surgical admission and discharge of patients following self-harm, in consultation with mental health services.
Collapse
Affiliation(s)
- E Concannon
- Department of Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland.
| | - S Carr
- Department of Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| | - A Doherty
- Department of Psychiatry, Galway University Hospitals, Galway, Ireland
| | - S J McInerney
- Department of Psychiatry, St Michaels Hospital, Toronto and University of Toronto, Canada
| | - J Birrane
- Department of Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| | - L Kearney
- Department of Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| | - A J Hussey
- Department of Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| | - S M Potter
- Department of Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| | - J L Kelly
- Department of Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| | - N M McInerney
- Department of Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| |
Collapse
|
45
|
Keel PK, Jean Forney K, Buchman-Schmitt JM, Kennedy GA, Joiner TE. Examining the link between weight suppression and non-suicidal self-injurious behaviors. Eat Behav 2018; 30:66-71. [PMID: 29885591 DOI: 10.1016/j.eatbeh.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 04/13/2018] [Accepted: 06/01/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Given the negative consequences of excess weight, a large portion of the US population is seeking to obtain and maintain weight loss. Weight Suppression (WS) represents the difference between previous highest adult weight and current weight and may have negative psychological consequences. The current study examined the link between WS and lifetime non-suicidal self-injurious (NSSI) behavior and explored indirect effects in this link using survey data in two large samples. METHODS Sample 1 included 1011 college students (67% female, mean age = 19 years); Sample 2 included 2461 participants from an epidemiological study (68% female, mean age = 34 years). Models of direct and indirect effects were tested in MPlus using bootstrapping. RESULTS As hypothesized, greater WS was associated with increased likelihood of lifetime NSSI in both samples (OR = 1.05 and 1.02). In both samples, significant indirect effects of drive for thinness (Total R2 = 0.06 and 0.09) and depressive symptoms (Total R2 = 0.13 and 0.29) accounted for this association. Alternative models in which the indirect effect of WS was tested in associations between drive for thinness or depressive symptoms and NSSI were not supported. CONCLUSION Results suggest that the link between WS and lifetime NSSI may be accounted for by eating or mood-related pathology. Future research should test whether addressing associated eating and mood problems would eliminate the link between WS and NSSI as a means for reducing suicide risk.
Collapse
Affiliation(s)
- Pamela K Keel
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA.
| | - K Jean Forney
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA.
| | | | - Grace A Kennedy
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA.
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA.
| |
Collapse
|
46
|
James K, Stewart D. Blurred Boundaries – A Qualitative Study of How Acts of Self-Harm and Attempted Suicide Are Defined by Mental Health Practitioners. CRISIS 2018; 39:247-254. [DOI: 10.1027/0227-5910/a000491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: There is no commonly accepted definition of the term self-harm, and there is an ongoing debate about whether or not it should include acts of attempted suicide. The use of this language in clinical practice has not previously been explored. Aims: To investigate if, and how, practitioners distinguish between acts of self-harm and attempted suicide, and present any implications for practice. Method: We conducted semistructured interviews with a random sample of 18 frontline practitioners from 10 mental health wards and completed a thematic analysis of interview data. Results: Most participants described self-harm and attempted suicide as distinct behaviors. Characteristics of the act, disclosures of intent, and the level of distress observed were commonly used to differentiate between self-harm and attempted suicide. Very few participants believed that people who self-harm may also feel suicidal. Practitioners confidently described two different behaviors, yet self-harm and attempted suicide were often conflated, revealing the challenges and complexities associated with the separation of these acts in clinical practice. Limitations: Clinicians working in other settings or disciplines may have different views. Participants' accounts may not be an accurate representation of what happens in practice. Conclusion: This study adds to a body of evidence which argues against the dichotomous separation of these behaviors into acts of suicidal and nonsuicidal self-harm.Our findings suggest there is no common understanding of the boundaries between self-harm and attempted suicide among frontline clinicians. The language currently used, and consequent practice, particularly with regard to risk assessment, is problematic. Efforts should be made to operationalize terms around suicidal behavior and to incorporate these into training for clinical staff.
Collapse
Affiliation(s)
- Karen James
- Kingston University and St. George’s University of London, Joint Faculty of Health, Social Care and Education, London, UK
| | - Duncan Stewart
- Kingston University and St. George’s University of London, Joint Faculty of Health, Social Care and Education, London, UK
| |
Collapse
|
47
|
Volitional determinants of self-harm behaviour and suicidal risk in persons with borderline personality disorder. EUROPEAN JOURNAL OF PSYCHIATRY 2018. [DOI: 10.1016/j.ejpsy.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
48
|
Valencia-Agudo F, Burcher GC, Ezpeleta L, Kramer T. Nonsuicidal self-injury in community adolescents: A systematic review of prospective predictors, mediators and moderators. J Adolesc 2018. [PMID: 29522914 DOI: 10.1016/j.adolescence.2018.02.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nonsuicidal self-injury (NSSI) usually starts during adolescence and is associated with an array of psychological and psychiatric symptoms and future suicide attempts. The aim of this study is to determine prospective predictors, mediators and moderators of NSSI in adolescent community samples in order to target prevention and treatment strategies. Two team members searched online databases independently. Thirty-nine studies were included in the review. Several variables were seen to prospectively predict NSSI: female gender, family-related variables, peer victimisation, depression, previous NSSI and self-concept. Few studies analysed mediators and moderators. Low self-concept was highlighted as a relevant moderator in the relationship between intra/interpersonal variables and NSSI. Implications of these findings are discussed. The considerable heterogeneity between studies posed a limitation to determine robust predictors of NSSI. Further prospective studies using standardised measures of predictors and outcomes are needed to ascertain the most at risk individuals and develop prevention strategies.
Collapse
Affiliation(s)
- Fatima Valencia-Agudo
- Clinical and Health Psychology Department, Autonomous University of Barcelona, Facultat de Psicologia UAB, Departament de Psicologia Clínica i de la Salut, Edifici B1, Campus de la Universitat Autònoma de Barcelona, Carrer de Ca n'Altayó, s/n, 08193, Bellaterra, Barcelona, Spain; Centre for Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK.
| | - Georgina Corbet Burcher
- Centre for Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Lourdes Ezpeleta
- Clinical and Health Psychology Department, Autonomous University of Barcelona, Facultat de Psicologia UAB, Departament de Psicologia Clínica i de la Salut, Edifici B1, Campus de la Universitat Autònoma de Barcelona, Carrer de Ca n'Altayó, s/n, 08193, Bellaterra, Barcelona, Spain
| | - Tami Kramer
- Centre for Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| |
Collapse
|
49
|
Abstract
Few studies have examined associations between pathological narcissism and self-harm, but those that do indicate that narcissistic vulnerability (not narcissistic grandiosity) relates to self-harm. The current study extends this literature by investigating how facets of pathological narcissism assessed by the Pathological Narcissism Inventory relate to specific nonsuicidal self-injury (NSSI) behaviors assessed by the Inventory of Statements About Self-Injury using statistical models appropriate for non-normally distributed count data. In a sample of 1,023 undergraduate students, results revealed that facets of both narcissistic vulnerability and narcissistic grandiosity were differentially related to the endorsement and frequency of specific NSSI behaviors and higher-order latent NSSI factors (repetitive and impulsive), even after accounting for levels of borderline pathology. The clinical implications of these results are discussed.
Collapse
Affiliation(s)
- Sindes Dawood
- Pennsylvania State University, University Park, Pennsylvania
| | | | | | - Aaron L Pincus
- Pennsylvania State University, University Park, Pennsylvania
| |
Collapse
|
50
|
Liu ZZ, Chen H, Bo QG, Chen RH, Li FW, Lv L, Jia CX, Liu X. Psychological and behavioral characteristics of suicide attempts and non-suicidal self-injury in Chinese adolescents. J Affect Disord 2018; 226:287-293. [PMID: 29024902 DOI: 10.1016/j.jad.2017.10.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/24/2017] [Accepted: 10/01/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Suicide attempts (SA) and non-suicidal self-injury (NSSI) are prevalent in adolescents and important risk factors of suicide death. Both SA and NSSI are associated with multiple psychosocial, behavioral, biological and genetic factors. This study examined similarities and differences in psychological vulnerability and internalizing and externalizing problems between adolescents with SA and NSSI. METHODS Participants consisted of 11,831 students and had a mean age of 14.97 (SD = 1.46) years. Students completed a structured questionnaire to report their demographic information, psychological characteristics, internalizing and externalizing problems, SA and NSSI. Based on the history of NSSI and SA in the last year, the sample was divided into four groups: non-self-harm (NSH), NSSI only, SA only, and NSSI+SA. Multivariate analyses of covariance and post-hoc pairwise comparisons were performed for multiple comparisons. RESULTS Compared with NSH group, adolescents with either NSSI or SA scored significantly higher on trait anger, impulsiveness, hopelessness, internalizing and externalizing problems. NSSI+SA group and SA only group scored significantly higher than NSSI only group but both did not score significantly different on most psychological and behavioral variables. LIMITATIONS Limitations include reliance on self-reported measures and cross-sectional survey. CONCLUSIONS Psychological and behavioral profiles between adolescents with SA and NSSI are similar but are more severe in suicide attempters. The findings highlight the necessity of assessing psychological and behavioral problems for prevention and early intervention of adolescent self-harm.
Collapse
Affiliation(s)
- Zhen-Zhen Liu
- Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Jinan 250012, China
| | - Hua Chen
- Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Jinan 250012, China
| | - Qi-Gui Bo
- Centers for Disease Control and Prevention of Lijin County, Lijin 257400, China
| | - Ren-Hong Chen
- Centers for Disease Control and Prevention of Yanggu County, Yanggu 252300, China
| | - Feng-Wen Li
- Centers for Disease Control and Prevention of Zoucheng City, Zoucheng 273500, China
| | - Lei Lv
- Education bureau of Yanggu County, Yanggu 252300, China
| | - Cun-Xian Jia
- Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Jinan 250012, China.
| | - Xianchen Liu
- Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Jinan 250012, China; School of Psychology, South China Normal University, Shipai, Guangzhou 510631, China; The University of Tennessee Health Science Center, Memphis, TN 38163, United States.
| |
Collapse
|