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Min J, Hein KE, Medlin AR, Mullins-Sweatt SN. Prevalence rate trends of borderline personality disorder symptoms and self-injurious behaviors in college students from 2017 to 2021. Psychiatry Res 2023; 329:115526. [PMID: 37839319 DOI: 10.1016/j.psychres.2023.115526] [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: 07/14/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
The current study examines the prevalence rates of borderline personality disorder (BPD) symptoms and nonsuicidal self-injury (NSSI) behaviors amongst college students over a five-year period, including pre- and during the COVID pandemic. Online prescreener surveys were completed by undergraduate students (n = 12,756) attending a large Southern Plains University every semester from Spring of 2017 to Spring of 2021. The percentage of students with NSSI history and significant BPD symptoms were visualized by semester to examine trends over time. A series of logistic regressions and negative binomial regressions were conducted on NSSI history and BPD symptoms to examine whether the endorsement rates have been increasing over time and to compare before and during COVID pandemic. There was an increasing trend of NSSI rates and significant BPD symptoms over time for all sexes. Furthermore, there was a steeper increase in BPD symptoms specifically in female students over the last five years. Additionally, there was a significant increase in odds of elevated BPD symptoms and NSSI behaviors in the college students enrolled during the COVID pandemic compared with pre-COVID. Overall, there has been an increasing trend in BPD symptoms and NSSI rates over the last few years, including during the COVID pandemic.
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Affiliation(s)
- Jiwon Min
- Department of Psychology, Oklahoma State University, Stillwater, USA.
| | - Katherine E Hein
- Department of Psychology, Oklahoma State University, Stillwater, USA
| | - Austin R Medlin
- Department of Health & Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
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Wang LJZ, Lan Y, Liu SJ, Yan WS. Impact of the COVID-19 and psychological risk factors on non-suicidal self-injury behavior among high school students: a one-year follow-up study. BMC Psychiatry 2023; 23:512. [PMID: 37452290 PMCID: PMC10349405 DOI: 10.1186/s12888-023-05021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Non-suicidal self-injury (NSSI) behavior is a severe public health issue in adolescents. This study investigated the possible impact of the coronavirus disease 2019 (COVID-19) and analyzed psychological risk factors on adolescent NSSI. METHODS A one-year follow-up study was conducted in September 2019 (Time 1) and September 2020 (Time 2) among 3588 high school students. The completed follow-up participants (N = 2527) were classified into no NSSI (negative at both time points), emerging NSSI (negative at Time 1 but positive at Time 2), and sustained NSSI (positive at both time points) subgroups according to their NSSI behaviors before and during the COVID-19 pandemic. Perceived family functioning, perceived school climate, negative life events, personality traits (neuroticism, impulsivity, and self-control) were assessed using self-report scales. RESULTS The data indicated an increase (10.3%) in the incidence of NSSI. Compared to no NSSI subjects, the emerging NSSI and sustained NSSI subgroups had lower perceived family functioning, higher neuroticism, higher impulse-system but lower self-control scores, and more negative life events. Logistic regressions revealed that after controlling for demographics, neuroticism and impulse-system levels at Time 1 positively predicted emerging NSSI behavior, and similarly, higher neuroticism and impulsivity and lower self-control at Time 1 predicted sustained NSSI behavior. CONCLUSIONS These findings highlighted the aggravated impact of the COVID-19 on NSSI, and suggested that individual neuroticism, impulsivity, and self-control traits might be crucial for the development of NSSI behavior among adolescent students.
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Affiliation(s)
- Lu-Jiao-Zi Wang
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Yan Lan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Su-Jiao Liu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Wan-Sen Yan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China.
- Guizhou Research Institute for Health Development, Guizhou Medical University, Guiyang, China.
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Kang L, Wang W, Zhang N, Nie Z, Gong Q, Yao L, Tu N, Feng H, Zong X, Bai H, Wang G, Bu L, Wang F, Liu Z. Superior temporal gyrus and cerebellar loops predict nonsuicidal self-injury in major depressive disorder patients by multimodal neuroimaging. Transl Psychiatry 2022; 12:474. [PMID: 36357369 PMCID: PMC9649804 DOI: 10.1038/s41398-022-02235-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022] Open
Abstract
In major depressive disorder (MDD) patients, nonsuicidal self-injury (NSSI) is a common comorbidity, and it is important to clarify the underlying neurobiology. Here, we investigated the association of NSSI with brain function and structure in MDD patients. A total of 260 MDD patients and 132 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging and three-dimensional T1-weighted structural scans. NSSI behaviour was assessed through interviews. Voxel-based morphometry analysis (VBM), regional homogeneity analysis (ReHo), functional connectome topology properties and network-based statistics were used to detect the differences in neuroimaging characteristics. Finally, the random forest method was used to evaluate whether these factors could predict NSSI in MDD. Compared with HCs, MDD patients with a history of NSSI showed significant right putamen grey matter volume (GMV), right superior orbital frontal cortex ReHo, left pallidum degree centrality, and putamen-centre function network differences. Compared to MDD subjects without NSSI, those with past NSSI showed significant right superior temporal gyrus (STG) GMV, right lingual gyrus ReHo, sigma and global efficiency, and cerebellum-centre function network differences. The right STG GMV and cerebellum-centre function network were more important than other factors in predicting NSSI behaviour in MDD. MDD patients with a history of NSSI have dysregulated spontaneous brain activity and structure in regions related to emotions, pain regulation, and the somatosensory system. Importantly, right STG GMV and cerebellar loops may play important roles in NSSI in MDD patients.
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Affiliation(s)
- Lijun Kang
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Wang
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Nan Zhang
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhaowen Nie
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Gong
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihua Yao
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ning Tu
- grid.412632.00000 0004 1758 2270PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongyan Feng
- grid.412632.00000 0004 1758 2270PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofen Zong
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hanping Bai
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihong Bu
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China. .,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China.
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China. .,Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China.
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Riva A, Pigni M, Bomba M, Nacinovich R. Adolescents with anorexia nervosa with or without non-suicidal self-injury: clinical and psychopathological features. Eat Weight Disord 2022; 27:1729-1737. [PMID: 34585367 DOI: 10.1007/s40519-021-01311-4] [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: 03/13/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. METHODS The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. RESULTS AN + NSSI group showed higher prevalence of binging-purging-type AN (p < .001), and mean higher age (p = .008) and Body Mass Index (BMI) (p = .002) than AN without NSSI group. Concerning psychological scales, AN + NSSI group showed higher scores in mostly of the sub-scale of the test Eating Disorders Inventory-3, higher scores at the scale for depression (p < 0.001) and higher scores at the three indexes of Symptom Checklist 90-Revised test, Global Severity Index (p < 0.001), Positive Symptoms total (p = .003) and Positive Symptom Distress Index (p < 0.001). No differences emerged at Children's Global Assessment Scale and at scale for evaluation of alexithymia. Regression analyses showed that a diagnosis of binging-purging-type AN (p = .001) predicts NSSI. CONCLUSION Results suggest that adolescents with AN and NSSI show peculiar clinical features with higher prevalence of binging-purging-type AN and more severe psychopathological traits than adolescents with AN without NSSI. LEVEL OF EVIDENCE Level III: Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Maria Pigni
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Monica Bomba
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
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Modrego Pardo I, Gómez Balaguer M, Hurtado Murillo F, Cuñat Navarro E, Solá Izquierdo E, Morillas Ariño C. Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain. ENDOCRINOL DIAB NUTR 2021; 68:338-345. [PMID: 34556264 DOI: 10.1016/j.endien.2020.04.009] [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: 01/24/2020] [Accepted: 04/21/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.
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Affiliation(s)
- Inés Modrego Pardo
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, Spain.
| | - Marcelino Gómez Balaguer
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Felipe Hurtado Murillo
- Centro de Salud Sexual y Reproductiva, Unidad de Identidad de Género, Centro de Salud Arabista Ambrosio Huici, Valencia, Spain
| | - Enrique Cuñat Navarro
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Eva Solá Izquierdo
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Carlos Morillas Ariño
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, Spain
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Modrego Pardo I, Gómez Balaguer M, Hurtado Murillo F, Cuñat Navarro E, Solá Izquierdo E, Morillas Ariño C. Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2021; 68:338-345. [PMID: 32950440 DOI: 10.1016/j.endinu.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.
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Affiliation(s)
- Inés Modrego Pardo
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, España.
| | - Marcelino Gómez Balaguer
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, España
| | - Felipe Hurtado Murillo
- Centro de Salud Sexual y Reproductiva, Unidad de Identidad de Género, Centro de Salud Arabista Ambrosio Huici, Valencia, España
| | - Enrique Cuñat Navarro
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, España
| | - Eva Solá Izquierdo
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, España
| | - Carlos Morillas Ariño
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género, Hospital Universitario Dr. Peset, Valencia, España
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The Role of Psychological Factors in Non-suicidal Self-injury of Female Adolescents. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2021. [DOI: 10.5812/ijpbs.101562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Non-suicidal self-injury (NSSI) is defined as inflicting damage to one’s own body. It begins in adolescence and tends to become chronic. Objectives: Considering the high prevalence and chronicity of NSSI among girls, the present study aimed to investigate the factors affecting the prevalence of NSSI in female adolescents from their perspective. Methods: The participants consisted of 604 female high-school students in Saveh, aged 14 - 17 years (14.29 ± 1.11), who were selected via random cluster sampling from November 2018 to January 2019. They answered six questionnaires, including the Inventory of Statements About Self-injury (ISAS), Ways of Coping questionnaire (WCQ), Child Abuse Self-report scale (CASRS), Family Emotional Involvement and Criticism scale (FEICS), Emotion Reactivity scale (ERS), and Aggression questionnaire (AQ). Data were analyzed using logistic regression analysis. Results: The predictor variables of child abuse, emotion reactivity, perceived parental criticism, family emotional involvement, and problem- and emotion-focused coping styles could successfully distinguish NSSI individuals from those without NSSI (P < 0.05). There were no significant differences between minor and moderate groups. Conclusions: Family emotional support is a protective factor, while criticism, child abuse, and emotion-focused coping style are risk factors for NSSI.
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Gargiulo A. Narratives of Self-Harm at School: Identifying Trajectories of Intervention in Educational Contexts. EUROPES JOURNAL OF PSYCHOLOGY 2020; 16:95-111. [PMID: 33680172 PMCID: PMC7913034 DOI: 10.5964/ejop.v16i1.1883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022]
Abstract
Recent studies have shown that self-harming behaviour is increasingly widespread among adolescents, in particular at school. However, educational institutions perceive themselves unable to cope with the phenomenon, searching for protocols and guidelines to improve its management. Considering schools as useful contexts for intercepting the young malaise, this study aims at exploring the main meanings of self-harming behaviours made within the educational cultural contexts starting from the student’s narrations, in order to understand the possible trajectories of practice. In two high schools we have collected 96 narratives of self-harm written by adolescents (mean age 14; 74% females), who have been engaged in non-suicidal self-injury once in their life. The analysis of the narratives, produced with the help of a software for the automatic qualitative analysis of texts, has allowed to identify four prevalent themes organized into three sense vectors. The findings highlighted significant gender differences in the representation of the experience of self-harm between males and females, as well as the importance of meaningful relationships developed in familiar and educational contexts, which may allow the help seeking process. The emerging of culturally-shared meanings among adolescents within the investigated contexts may allow to think about possible protocols of preventive and clinical practices in schools.
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Affiliation(s)
- Anna Gargiulo
- Department of Humanities, University of Naples Federico II, Naples, Italy
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Lim KS, Wong CH, McIntyre RS, Wang J, Zhang Z, Tran BX, Tan W, Ho CS, Ho RC. Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224581. [PMID: 31752375 PMCID: PMC6888476 DOI: 10.3390/ijerph16224581] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/03/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This meta-analysis aimed to estimate the global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents. METHODS A systematic search for relevant articles published between 1989 to 2018 was performed in multiple electronic databases. The aggregate 12-month and lifetime prevalence of suicidal behavior, deliberate self-harm, and non-suicidal self-injury were calculated based on the random-effects model. Subgroup analyses were performed to compare the prevalence according to school attendance and geographical regions. Results: A total of 686,672 children and adolescents were included. The aggregate lifetime and 12-month prevalence of suicide attempts was 6% (95% CI: 4.7-7.7%) and 4.5% (95% CI: 3.4-5.9%) respectively. The aggregate lifetime and 12-month prevalence of suicidal plan was 9.9% (95% CI: 5.5-17%) and 7.5% (95% CI: 4.5-12.1%) respectively. The aggregate lifetime and 12-month prevalence of suicidal ideation was 18% (95% CI: 14.2-22.7%) and 14.2% (95% CI: 11.6-17.3%) respectively. The aggregate lifetime and 12-month prevalence of non-suicidal self-injury was 22.1% (95% CI: 16.9-28.4%) and 19.5% (95% CI: 13.3-27.6%) respectively. The aggregate lifetime and 12-month prevalence of deliberate self-harm was 13.7% (95% CI: 11.0-17.0%) and 14.2% (95% CI: 10.1-19.5%) respectively. Subgroup analyses showed that full-time school attendance, non-Western countries, low and middle-income countries, and geographical locations might contribute to the higher aggregate prevalence of suicidal behaviors, deliberate self-harm, and non-suicidal self-injury. Conclusions: This meta-analysis found that non-suicidal self-injury, suicidal ideation, and deliberate self-harm were the three most common suicidal and self-harm behaviors in children and adolescents.
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Affiliation(s)
- Kim-San Lim
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (K.-S.L.); (R.C.H.)
| | - Celine H. Wong
- Division of Child and Adolescent Psychiatry, Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore;
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 1R8, Canada;
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Jiayun Wang
- Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China;
- Correspondence:
| | - Zhisong Zhang
- Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China;
| | - Bach X. Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Vietnam Young Physicians’ Association, Hanoi 100000, Vietnam
| | - Wanqiu Tan
- The China-Singapore (Chongqing) Demonstration Initiative on Strategic Connectivity Think Tank, Chongqing 400043, China;
| | - Cyrus S. Ho
- Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore;
| | - Roger C. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (K.-S.L.); (R.C.H.)
- Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China;
- Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119228, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam
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Chang EC, Schaffer MR, Novak CJ, Ablow DB, Gregory AE, Chang OD, Lucas AG, Hirsch JK. Sexual assault history and self-destructive behaviors in women college students: Testing the perniciousness of perfectionism in predicting non-suicidal self-injury and suicidal behaviors. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2019.05.021] [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: 10/26/2022]
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11
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Slavin-Stewart C, Boylan K, Burke JD. Subgroups of Adolescent Girls With Borderline Personality Disorder Symptoms. J Pers Disord 2018; 32:636-653. [PMID: 28926303 DOI: 10.1521/pedi_2017_31_317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to determine whether borderline personality disorder (BPD) can be differentiated from other disorders in a clinical sample of adolescent girls. Participants (N = 75) were grouped based on the pattern of BPD symptom endorsement using a latent class analysis. Four latent classes were identified. The most impaired class endorsed seven BPD symptoms and an average of three comorbid disorders. An intermediate class endorsed three BPD symptoms and had the highest prevalence of PTSD (41.7%). A third class reported two BPD symptoms and had a high prevalence of anxiety disorders (62%). The fourth class had no BPD symptoms and, on average, one comorbid disorder. Only a small subset of these teenage girls met criteria for BPD, and they had distinct and severe impairment. The results suggest the modest likelihood of a BPD diagnosis in clinical samples of teenage girls, and to also be vigilant for PTSD.
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Affiliation(s)
| | | | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut
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Sharp C, Steinberg L, Michonski J, Kalpakci A, Fowler C, Frueh BC, Fonagy P. DSM Borderline Criterion Function Across Age-Groups: A Cross-Sectional Mixed-Method Study. Assessment 2018; 26:1014-1029. [PMID: 30003799 DOI: 10.1177/1073191118786587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) Section II criteria for borderline personality disorder (BPD) lack developmental operationalization. The aim of the current study was to evaluate whether DSM criteria operate similarly across adolescents and adults to determine if developmental adjustment for DSM criteria was needed. Three age cohorts were recruited: adolescents (ages 12-17 years; n = 484), young adults (ages 18-25 years; n = 442), and adults (ages ≥26 years; n = 953). The Child Interview for DSM-IV BPD and the Structured Clinical Interview for DSM-IV Axis II disorders were administered to adolescents and adults, respectively. Item response theory methods were used to evaluate differential item (or criterion) functioning (DIF) of BPD criteria across adolescents and adults. Qualitative analyses were then used to evaluate the potential sources of DIF. Item response theory results demonstrated DIF across adolescents and adults for all DSM BPD criteria. Qualitative analyses suggested that the source of DIF was most likely due to rater/interviewer bias. Results furthermore suggested that behavioral criteria may represent the heterotypic features of BPD, while intra- and interpersonal criteria represent the homotypic features of the disorder. The article concludes with recommendations for developmentally informed guidelines for the assessment of BPD.
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Affiliation(s)
- Carla Sharp
- 1 University of Houston, Houston, TX, USA.,2 The Menninger Clinic, Houston, TX, USA
| | | | - Jared Michonski
- 3 Evidence-Based Treatment Centers of Seattle, Seattle, WA, USA
| | | | - Chris Fowler
- 2 The Menninger Clinic, Houston, TX, USA.,4 Houston Methodist Hospital, Houston, TX, USA
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13
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Abstract
The majority of non-suicidal self-injury (NSSI) research has used self- or clinician-rated measures of behavior which (a) are subject to reporting biases, or (b) have limited use in experimental designs that could illuminate causal relationships. Laboratory-based behavioral tasks have therefore been developed to assess NSSI-related behaviors more directly. We reviewed the behavioral methods that have been developed to assess NSSI tendencies or behaviors over the past 30 years. Several categories of laboratory analogues were identified: NSSI-related stimuli (e.g., NSSI pictures, implicit association tasks, guided imagery), experimenter administered pain stimuli (e.g., cold, heat, pressure, shock, and blade), and self-selected pain stimuli (e.g., cold and shock). These behavioral methods assess various aspects of NSSI and all have distinct advantages and shortcomings. Overall, these approaches have made significant contributions to the field complementing self- and clinician-ratings.
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14
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Cullen KR, Klimes-Dougan B, Schreiner MW, Carstedt P, Marka N, Nelson K, Miller MJ, Reigstad K, Westervelt A, Gunlicks-Stoessel M, Eberly LE. N-Acetylcysteine for Nonsuicidal Self-Injurious Behavior in Adolescents: An Open-Label Pilot Study. J Child Adolesc Psychopharmacol 2018; 28:136-144. [PMID: 29053023 PMCID: PMC5831760 DOI: 10.1089/cap.2017.0032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is common in adolescents and young adults, and few evidence-based treatments are available for this significant problem. N-acetylcysteine (NAC) is a widely available nutritional supplement that has been studied in some psychiatric disorders relevant to NSSI including mood and addictive disorders. This pilot study tested the use of NAC as a potential treatment for NSSI in youth. METHODS Thirty-five female adolescents and young adults with NSSI aged 13-21 years were enrolled in this study that had an open-label, single-arm study design. All participants were given oral NAC as follows: 600 mg twice daily (weeks 1-2), 1200 mg twice daily (weeks 3-4), and 1800 mg twice daily (weeks 5-8). Patients were seen every 2 weeks throughout the trial, at which time youth reported the frequency of NSSI episodes. Levels of depression, impulsivity, and global psychopathology were measured at baseline and at the end of the trial using the Beck Depression Inventory-II (BDI-II), Barratt Impulsivity Scale, and Symptoms Checklist-90 (SCL-90). RESULTS About two-thirds of the enrolled female youth completed the trial (24/35). NAC was generally well tolerated in this sample. NAC treatment was associated with a significant decrease in NSSI frequency at visit 6 and visit 8 compared to baseline. We also found that depression scores and global psychopathology scores (but not impulsivity scores) decreased after NAC treatment. Decrease in NSSI was not correlated with decrease in BDI-II or SCL-90 scores, suggesting these might be independent effects. CONCLUSION We provide preliminary evidence that NAC may have promise as a potential treatment option for adolescents with NSSI. The current results require follow-up with a randomized, placebo-controlled trial to confirm efficacy.
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Affiliation(s)
- Kathryn R. Cullen
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Bonnie Klimes-Dougan
- Psychology Department, College of Liberal Arts, University of Minnesota, Minneapolis, Minnesota
| | | | - Patricia Carstedt
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Nicholas Marka
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Katharine Nelson
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Michael J. Miller
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Kristina Reigstad
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Ana Westervelt
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | | | - Lynn E. Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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15
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Ammerman BA, Olino TM, Coccaro EF, McCloskey MS. Predicting Nonsuicidal Self-Injury in Borderline Personality Disorder Using Ecological Momentary Assessment. J Pers Disord 2017; 31:844-855. [PMID: 28072044 DOI: 10.1521/pedi_2017_31_278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is a highly comorbid disorder, and these comorbidities increase the impairment associated with BPD. For example, depression, which occurs in the majority of individuals with BPD, increases the likelihood of an individual with BPD to engage in nonsuicidal self-injury (NSSI). Little research, however, has investigated potential mechanisms of NSSI engagement in this population. The current study aimed to fill this gap by examining momentary experiences, levels of distress tolerance, and NSSI among 51 individuals meeting current diagnostic criteria for BPD and a comorbid depressive disorder. Using data from an ecological momentary assessment across 7 days, it was found that daily urges to hurt oneself and impulsive urges, but not daily negative affect or aggressive urges, predicted NSSI occurrence. Furthermore, low levels of distress tolerance was a stronger predictor of NSSI behavior than daily experiences. These findings have important implications with regard to state versus trait dispositions in NSSI engagement among those with BPD and depression.
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16
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Kelada L, Hasking P, Melvin G, Whitlock J, Baetens I. “I Do Want to Stop, At Least I Think I Do”: An International Comparison of Recovery From Nonsuicidal Self-Injury Among Young People. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558416684954] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Phenomenological and cultural understandings of recovery from the perspective of individuals who engage in nonsuicidal self-injury (NSSI) are rare. The primary study objective was to understand similarities across three samples in (a) how young people define recovery from NSSI and (b) what they consider helpful approaches taken by parents and professionals to assist their recovery. Using a cross-national sample of young people ( n = 98) from Australia ( n = 48), Belgium ( n = 25) and the United States ( n = 25), we assessed their perspectives on NSSI. Consistent across all samples, young people defined recovery as no longer having the urge to self-injure when distressed, often displayed ambivalence about recovery, and reported it was helpful when parents and professionals were calm and understanding. Acceptance of recovery as a process involving relapses may need to be emphasized in NSSI treatment, to ease the pressure young people often place on themselves to stop the behavior outright.
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17
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Mojtabai R, Olfson M, Han B. National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults. Pediatrics 2016; 138:peds.2016-1878. [PMID: 27940701 PMCID: PMC5127071 DOI: 10.1542/peds.2016-1878] [Citation(s) in RCA: 747] [Impact Index Per Article: 93.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study examined national trends in 12-month prevalence of major depressive episodes (MDEs) in adolescents and young adults overall and in different sociodemographic groups, as well as trends in depression treatment between 2005 and 2014. METHODS Data were drawn from the National Surveys on Drug Use and Health for 2005 to 2014, which are annual cross-sectional surveys of the US general population. Participants included 172 495 adolescents aged 12 to 17 and 178 755 adults aged 18 to 25. Time trends in 12-month prevalence of MDEs were examined overall and in different subgroups, as were time trends in the use of treatment services. RESULTS The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents. CONCLUSIONS The prevalence of depression in adolescents and young adults has increased in recent years. In the context of little change in mental health treatments, trends in prevalence translate into a growing number of young people with untreated depression. The findings call for renewed efforts to expand service capacity to best meet the mental health care needs of this age group.
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Affiliation(s)
- Ramin Mojtabai
- Departments of Mental Health, Bloomberg School of Public Health, and .,Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University;,New York State Psychiatric Institute, New York, New York; and
| | - Beth Han
- Substance Abuse and Mental Health Services Administration, Rockville, Maryland
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18
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Ammerman BA, Brown S. The Mediating Role of Self-Criticism in the Relationship between Parental Expressed Emotion and NSSI. CURRENT PSYCHOLOGY 2016; 37:325-333. [PMID: 29651223 DOI: 10.1007/s12144-016-9516-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Nonsuicidal self-injury (NSSI) is found at high rates among adolescents and young adults and is associated with many negative consequences, warranting additional research. Two factors that may contribute to NSSI during this time period are one's levels of self-criticism and perceptions of their parental relationships; however, these relationships have received limited attention. The purpose of this current study was to address this gap in the literature. Adolescents and young adults (n=294) completed measures of perceived parental expressed emotion, self-criticism, and NSSI. Participants with a history of NSSI reported perceiving their parents as providing less emotional support, inducing more irritation, being more intrusive, and expressing more criticism compared to those without a history of NSSI. These individuals also endorsed greater self-criticism. Further, self-criticism mediated the relationship between perceived parental expressed emotion and NSSI occurrence, such that those with higher reported self-criticism and greater perceived parental expressed emotion were more likely to engage in NSSI.
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19
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Plener PL, Allroggen M, Kapusta ND, Brähler E, Fegert JM, Groschwitz RC. The prevalence of Nonsuicidal Self-Injury (NSSI) in a representative sample of the German population. BMC Psychiatry 2016; 16:353. [PMID: 27760537 PMCID: PMC5069807 DOI: 10.1186/s12888-016-1060-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 10/04/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a proposed new "condition for further study" in the DSM-5. To date no prevalence data has been available on this diagnostic entity from a representative sample of the general population. METHODS A representative sample of the German population (N = 2509, mean age = 48.8 years, SD = 18.1, female 55.4 %) completed the NSSI section of the German version of the Self-Injurious Thoughts and Behaviors Interview (SITBI-G). RESULTS A history of NSSI at least once during lifetime was reported by 3.1 % of all participants, with higher lifetime prevalence rates in younger age groups. DSM-5 NSSI disorder criteria were met by 0.3 %. The most common function of NSSI was automatic negative reinforcement (e.g. to alleviate negative feelings). CONCLUSIONS To the best of our knowledge, this is the first study reporting rates for the proposed NSSI category in DSM-5 from a representative sample of the general population. In comparison to findings from community samples of adolescents, adults seem to have lower lifetime prevalence rates of NSSI, thus making it necessary to emphasize prevention and treatment efforts in younger age groups.
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Affiliation(s)
- Paul L. Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
| | - Marc Allroggen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
| | - Nestor D. Kapusta
- Department for Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, Universität Leipzig, Leipzig, Germany ,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
| | - Rebecca C. Groschwitz
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
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Functions of nonsuicidal self-injury (NSSI): Cross-sectional associations with NSSI duration and longitudinal changes over time and following treatment. Psychiatry Res 2016; 241:83-90. [PMID: 27156029 DOI: 10.1016/j.psychres.2016.04.083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 11/24/2022]
Abstract
In this study, we sought to clarify if and how the functions of nonsuicidal self-injury (NSSI) relate to duration of NSSI or change over time. To accomplish this aim, we analyzed data obtained from routine clinical evaluations completed within a specialized acute-care treatment program for NSSI. Specifically, we examined how functions of NSSI vary between patients by duration of NSSI, how functions changed within patients over time, and how changes in NSSI functions related to treatment outcomes. Neither internal nor social functions were associated with NSSI duration between patients after controlling for relevant covariates. For patients completing two admissions assessments, internal and social functions decreased similarly over time, although the decrease in internal functions was no longer significant after controlling for decreases in NSSI urges. For patients who completed admissions and discharge assessments, internal and social functions decreased over the course of treatment, with larger decreases in internal functions. Decreases in both types of functions related to improved treatment outcomes. In conclusion, our results suggest that NSSI functions are generally stable across time, although decreases in NSSI functions may relate to clinical improvement.
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21
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Kelada L, Hasking P, Melvin G. The Relationship Between Nonsuicidal Self-Injury and Family Functioning: Adolescent and Parent Perspectives. JOURNAL OF MARITAL AND FAMILY THERAPY 2016; 42:536-49. [PMID: 26725333 DOI: 10.1111/jmft.12150] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
We explored parent and adolescent reports of family functioning, how this differed if the parent was aware that their child self-injured, and how parental awareness of self-injury was related to self-injury frequency, self-injury severity, and help seeking. Participants were 117 parent-adolescent dyads, in 23 of which the adolescent self-injured. Adolescents who self-injured reported poorer family functioning than their parents, but parents who did not know about their child's self-injury reported similar functioning to parents whose children did not self-injure. Parents were more likely to know that their child self-injured when the behavior was severe and frequent. Help-seeking was more likely when parents knew about self-injury. Family-based interventions which emphasize perspective-taking could be used to effectively treat self-injury.
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22
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De Riggi ME, Moumne S, Heath NL, Lewis SP. Non-Suicidal Self-Injury in Our Schools: A Review and Research-Informed Guidelines for School Mental Health Professionals. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2016. [DOI: 10.1177/0829573516645563] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Non-suicidal self-injury (NSSI), the immediate and deliberate destruction of one’s own body tissue, without suicidal intent, and not for purposes that are socially accepted, is a critical concern for youth in schools. Despite significant scholarly advances and increasing clinical awareness of NSSI, many school mental health professionals (MHPs) continue to report feeling ill equipped to support students who self-injure, and emphasize a need for formal education about NSSI and its management in schools. Thus, the first part of this article summarizes current NSSI research on prevalence, age of onset, gender differences, functions, risk factors, and associations with suicide. Emerging from this review, the second part offers research-informed recommendations for MHPs managing NSSI in schools, including guidelines for (a) identifying students at elevated risk of self-injury, (b) developing a protocol for school personnel’s initial response to student self-injury, (c) first-level assessment of NSSI, and (d) managing critical issues related to NSSI contagion and online activity.
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23
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Abstract
For too long, medical/psychiatric and psychological studies, with focus on emotional sensitivity, personality traits, and correlation with psychopathology, have dominated research on self-injuring acts. The phenomenon thus has been defined as a predominantly medical issue. However, a large body of community prevalence studies show self-injuring acts to be a common phenomenon in society, and most of those who self-injure are unknown in psychiatric or other clinical settings. This article describes and analyzes the medicalization of self-injuring acts and argues a need to move research on self-injuring acts out of the medical paradigm. There is a need to explicitly explore the impact of social, cultural, structural, and gendered factors surrounding and influencing self-injuring acts. A non-medical approach, beyond the limits of the medical perspective, would feed research forward and create a more nuanced view on this widespread social phenomenon.
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24
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Gholamrezaei M, De Stefano J, Heath NL. Nonsuicidal self-injury across cultures and ethnic and racial minorities: A review. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2015; 52:316-326. [PMID: 26644040 DOI: 10.1002/ijop.12230] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/01/2015] [Indexed: 11/08/2022]
Abstract
The field of nonsuicidal self-injury (NSSI) is dominated by research conducted with Caucasian-majority samples in Western countries such as United States, Canada, Australia and European countries. This article critically reviewed the empirical research on NSSI in non-Western countries and among ethnic/racial minority individuals who live in the West to give voice to and understand the patterns of NSSI among individuals who do not fall within the dominant Caucasian majority. The study found both similarities and differences between Western and non-Western data in terms of characteristics and functions of NSSI. Differences in gender patterns in regards to prevalence of NSSI and methods used as well as presence of a more relational functionality of NSSI rather than emotion regulation functionality were two points of divergence in the findings of these studies. In addition, the findings seem to indicate that the role of ethnicity/race is mediated by important factors such as socioeconomic status (SES) and gender. Existing gaps in the literature and suggestions for further research are discussed.
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Affiliation(s)
- Maryam Gholamrezaei
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Jack De Stefano
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Nancy L Heath
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
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25
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Dickstein DP, Puzia ME, Cushman GK, Weissman AB, Wegbreit E, Kim KL, Nock MK, Spirito A. Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury. J Child Psychol Psychiatry 2015; 56:1127-36. [PMID: 25677262 DOI: 10.1111/jcpp.12385] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide is among the most important mental health issues affecting adolescents today despite much research on its detection and prevention. Beyond suicide attempts (SAs), clinicians are increasingly confronted with another, potentially related problem: non-suicidal self-injury (NSSI)-defined as the deliberate destruction of body tissue without intent to die. NSSI may increase risk for making an SA by sevenfold, but many studies examining this link have involved youths engaging in both NSSI and SAs. Thus, there is a need to compare homogeneous groups of adolescents engaged in NSSI-only or SA-only, but not both, to advance what is known about each form of self-harm. The self-injurious implicit association task (SI-IAT) is a particularly important computerized behavioral task to study such adolescents because the SI-IAT provides objective behavioral data about problems for which people may lack insight or be motivated to conceal, such as SAs and NSSI. METHODS We evaluated implicit associations with cutting and death/suicide using the computerized SI-IAT in three mutually exclusive groups: (1) adolescents who made an SA but had never engaged in NSSI (n = 47); (2) adolescents who engaged in NSSI but had never made an SA (n = 46); and (3) typically developing control (TDC) adolescents without history of psychiatric problems (n = 43). RESULTS Nonsuicidal self-injury participants had stronger identification with cutting versus no cutting than either SA or TDC participants. Contrary to our hypothesis, NSSI participants had stronger identification with suicide/death versus life than either SA or TDC participants. CONCLUSIONS Strong implicit attitudes towards suicide/death among adolescents with NSSI without a prior SA suggest that clinicians should not dismiss NSSI as not serious. Further work is required to elucidate the mechanism by which youths engaged in NSSI acquire these stronger identifications and make a first-time SA to develop novel treatment and prevention strategies blocking this transformation, ultimately reducing youth suicide.
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Affiliation(s)
- Daniel P Dickstein
- PediMIND Program, Bradley Hospital, East Providence, RI, USA.,Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA
| | - Megan E Puzia
- PediMIND Program, Bradley Hospital, East Providence, RI, USA.,Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA
| | - Grace K Cushman
- PediMIND Program, Bradley Hospital, East Providence, RI, USA.,Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA
| | - Alexandra B Weissman
- PediMIND Program, Bradley Hospital, East Providence, RI, USA.,Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA
| | - Ezra Wegbreit
- PediMIND Program, Bradley Hospital, East Providence, RI, USA.,Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA
| | - Kerri L Kim
- PediMIND Program, Bradley Hospital, East Providence, RI, USA.,Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Anthony Spirito
- Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA
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26
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Hanania JW, Heath NL, Emery AA, Toste JR, Daoud FA. Non-Suicidal Self-Injury among Adolescents in Amman, Jordan. Arch Suicide Res 2015; 19:260-74. [PMID: 25058810 DOI: 10.1080/13811118.2014.915778] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
While previous research has demonstrated cross-national differences in non-suicidal self-injury (NSSI), most studies to date have taken place in North America. The present study investigated the prevalence and characteristics of NSSI in a sample of 952 Jordanian adolescents (49.8% female) between the ages of 11-19 years. Participants completed a screening measure to assess occurrence of NSSI and its characteristics. Results indicate an overall lifetime prevalence of 22.6% (n = 215), with significantly more males (26.98%, n = 129) than females (18.14%, n = 86) reporting having engaged in NSSI at least once in their lifetime. This study provides empirical evidence that adolescent engagement in NSSI occurs at similar prevalence levels in Jordan, relative to North American samples, whereas gender comparisons of prevalence and characteristics revealed several differences.
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Affiliation(s)
- Joan W Hanania
- a Department of Counseling and Clinical Psychology , Columbia University-Teachers College , New York , NY , USA
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27
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Non-suicidal self-injury in adolescence: a longitudinal study of the relationship between NSSI, psychological distress and perceived parenting. J Adolesc 2014; 37:817-26. [PMID: 25086458 DOI: 10.1016/j.adolescence.2014.05.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 05/23/2014] [Accepted: 05/25/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The present study investigates whether either adolescents' psychological distress and/or perceived parenting predicted the occurrence of NSSI. Furthermore, the consequences of NSSI are examined in a three-wave longitudinal study. DESIGN The sample at time 1 (age 12) consisted of 1396 adolescent reports and 1438 parent reports. At time 2 (age 13), 827 adolescent reports and 936 parent reports were obtained. Time 3 (age 14) included 754 adolescent reports and 790 parent reports. Psychological distress of adolescents was measured using the Strengths and Difficulties Questionnaire. Perceived parenting behaviors were examined by the Parental Behavior Scale and the Psychological Control Scale. RESULTS A total of 10% of the adolescents engaged in NSSI at least once before age 15. Higher psychological distress of adolescents at time 1 was associated with the presence of NSSI at time 2 or 3. The association between psychological distress at time 1 and perception of decreased parental rule setting at time 3 was mediated by the presence of NSSI at time 2. CONCLUSIONS The present study showed that psychological distress at age 12 predicts NSSI over time and that parental awareness of NSSI changes the perception of parenting behaviors.
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28
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Swannell SV, Martin GE, Page A, Hasking P, St John NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav 2014; 44:273-303. [PMID: 24422986 DOI: 10.1111/sltb.12070] [Citation(s) in RCA: 822] [Impact Index Per Article: 82.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/28/2013] [Indexed: 12/13/2022]
Abstract
Published prevalence estimates of nonsuicidal self-injury (NSSI) among nonclinical samples are highly heterogeneous, raising concerns about their reliability and hindering attempts to explore the alleged increase in NSSI over time. Accordingly, the objectives of this study were to investigate the influence of methodological factors on heterogeneity in NSSI prevalence estimates, explore changes over time, and estimate overall international NSSI prevalence. Results showed that methodological factors contributed over half (51.6%) of the heterogeneity in prevalence estimates, and, after adjusting for these factors, NSSI prevalence did not increase over time. Overall, pooled NSSI prevalence was 17.2% among adolescents, 13.4% among young adults, and 5.5% among adults. Clearly, development of standardized methodology in NSSI research is crucial if accurate estimates are desired.
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Affiliation(s)
- Sarah V Swannell
- School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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Abstract
Nonsuicidal self-injury (NSSI) has a high prevalence among the general undergraduate population, but as yet, no study has investigated the rate of NSSI among medical students despite the high levels of depression and suicidal ideation found in this population. Our study aimed to estimate the prevalence of NSSI and suicide attempts in German medical students and explore the associations between these behaviors and the five major personality traits. Seven hundred fourteen medical students (67% women; age range, 18-35 years; mean age, 23.1 years) participated in an online survey. We report a lifetime prevalence of 14.3% for NSSI and 1.5% for suicide attempt. The students with NSSI showed higher levels of neuroticism and openness to experience but lower levels of conscientiousness and extraversion on the NEO Five-Factor Inventory. Our results are in line with previous research from other countries regarding the prevalence of NSSI among students and its association with personality.
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Liang S, Yan J, Zhang T, Zhu C, Situ M, Du N, Fu X, Huang Y. Differences between non-suicidal self injury and suicide attempt in Chinese adolescents. Asian J Psychiatr 2014; 8:76-83. [PMID: 24655633 DOI: 10.1016/j.ajp.2013.11.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/22/2013] [Accepted: 11/23/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE Self-harm behaviors are predominant health risks among adolescents. This study aimed to elucidate the lifetime prevalence and differences in social psychological factors between non-suicidal self-injury (NSSI) and suicide attempt (SA) among Chinese adolescents. METHOD Data were collected from 2131 middle school students with a mean age of 13.92 (SD 1.63) years (49.1% girls). Participants were asked to self-report NSSI and SA over their lifetime. Post hoc tests pairwise comparisons and multinomial logistic regression analyses were conducted to investigate differences and similarities between subjects with NSSI and attempted suicide. RESULTS The prevalence of lifetime NSSI and SA endorsed by the participants were 23.2% and 3.2%, respectively, and the co-occurrence of these two behaviors (NSSI+SA) was reported to 2.3%. Boys were comparable with girls in the prevalence rate of NSSI, but not in the rate of SA. It revealed that single-child was not the risk factor for self-harm behavior in Mainland China, but lower higher family cohesion and adaptability. Factors that distinguished the NSSI+SA group from the NSSI only group were female gender, lower grade, impulsivity, health risk behaviors and family cohesion. Being female gender, single-parent family, depressive symptoms and impulsivity were factors differentiating attempted suicide from NSSI. CONCLUSIONS Our findings suggest that Chinese adolescents engaging both in NSSI and SA had severe suicidal attempts and were different from those who engaged in NSSI alone.
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Affiliation(s)
- Sugai Liang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yan
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Zhang
- College of Public Health, Sichuan University, Chengdu 610041, China
| | - Cuizhen Zhu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Minging Situ
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Du
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueyin Fu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Leong CH, Wu AMS, Poon MMY. Measurement of perceived functions of non-suicidal self-injury for Chinese adolescents. Arch Suicide Res 2014; 18:193-212. [PMID: 24568552 DOI: 10.1080/13811118.2013.824828] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Due to the lack of validated assessment tools for motives of non-suicidal self-injury behaviors in the Chinese contexts, this study aims to evaluate the psychometric properties of the Chinese version of the Functional Assessment of Self-Mutilation (C-FASM). A total of 345 secondary school students (mean age = 11.41 years), who reported non-suicidal self-injury in the past year, voluntarily participated in the questionnaire survey. Confirmatory factor analysis results supported a second-order model of 4 motivational factors. The overall scale scores had significant correlations with depression, anxiety, impulsiveness, self-esteem, social support, and suicidal ideation. The internal consistency of the scale was also satisfactory. The C-FASM is a valid and reliable instrument for assessing non-suicidal self-injury among nonclinical Chinese adolescents.
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Predictors of Onset for Non-suicidal Self-injury Within a School-Based Sample of Adolescents. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2013; 15:850-9. [DOI: 10.1007/s11121-013-0412-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sornberger MJ, Heath NL, Toste JR, McLouth R. Nonsuicidal self-injury and gender: patterns of prevalence, methods, and locations among adolescents. Suicide Life Threat Behav 2012; 42:266-78. [PMID: 22435988 DOI: 10.1111/j.1943-278x.2012.0088.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Nonsuicidal self-injury (NSSI) among adolescents is a growing concern. However, little is known about gender and features of this behavior. Gender differences in NSSI among a sample of 7,126 adolescents were investigated, 1,774 of whom reported having engaged in NSSI. Gender differences in prevalence, method, and location of NSSI were examined. Findings revealed that females reported higher rates of NSSI, more cutting and scratching, and more injuries to arms and legs than their male counterparts. Males reported more burning and hitting-type behavior, as well as injuries to the chest, face, or genitals. This highlights an interesting pattern of NSSI, which future research should consider to accurately examine NSSI in females and males.
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Muehlenkamp JJ, Claes L, Havertape L, Plener PL. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health 2012; 6:10. [PMID: 22462815 PMCID: PMC3348041 DOI: 10.1186/1753-2000-6-10] [Citation(s) in RCA: 558] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/30/2012] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND The behaviours of non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research. METHODS We conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe. RESULTS Fifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3) and DSH (16.1% SD = 11.6) studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization. CONCLUSION NSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.
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Affiliation(s)
- Jennifer J Muehlenkamp
- Department of Psychology, University of Wisconsin, UW-Eau Claire, 105 Garfield Ave, Eau Claire, WI 54702, USA
| | - Laurence Claes
- Department of Psychology, Katholieke Universiteit Leuven, Tiensestraat 102, 3000 Leuven, Belgium
| | - Lindsey Havertape
- Department of Psychology, University of Wisconsin, UW-Eau Claire, 105 Garfield Ave, Eau Claire, WI 54702, USA
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
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LUNDH LARSGUNNAR, WÅNGBY-LUNDH MARGIT, BJÄREHED JONAS. Deliberate self-harm and psychological problems in young adolescents: Evidence of a bidirectional relationship in girls. Scand J Psychol 2011; 52:476-83. [DOI: 10.1111/j.1467-9450.2011.00894.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lundh LG, Wångby-Lundh M, Paaske M, Ingesson S, Bjärehed J. Depressive symptoms and deliberate self-harm in a community sample of adolescents: a prospective study. DEPRESSION RESEARCH AND TREATMENT 2010; 2011:935871. [PMID: 21234107 PMCID: PMC3014680 DOI: 10.1155/2011/935871] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/11/2010] [Accepted: 10/19/2010] [Indexed: 12/02/2022]
Abstract
The associations between depressive symptoms and deliberate self-harm were studied by means of a 2-wave longitudinal design in a community sample of 1052 young adolescents, with longitudinal data for 83.6% of the sample. Evidence was found for a bidirectional relationship in girls, with depressive symptoms being a risk factor for increased self-harm one year later and self-harm a risk factor for increased depressive symptoms. Cluster analysis of profiles of depressive symptoms led to the identification of two clusters with clear depressive profiles (one severe, the other mild/moderate) which were both characterized by an overrepresentation of girls and elevated levels of self-harm. Clusters with more circumscribed problems were also identified; of these, significantly increased levels of self-harm were found in a cluster characterized by negative self-image and in a cluster characterized by dysphoric relations to parents. It is suggested that self-harm serves more to regulate negative self-related feelings than sadness.
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Affiliation(s)
- Lars-Gunnar Lundh
- Department of Psychology, Lund University, Box 213, 221 00 Lund, Sweden
| | | | - My Paaske
- Department of Psychology, Lund University, Box 213, 221 00 Lund, Sweden
| | - Stina Ingesson
- Department of Psychology, Lund University, Box 213, 221 00 Lund, Sweden
| | - Jonas Bjärehed
- Department of Psychology, Lund University, Box 213, 221 00 Lund, Sweden
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Muehlenkamp JJ, Walsh BW, McDade M. Preventing non-suicidal self-injury in adolescents: the signs of self-injury program. J Youth Adolesc 2009; 39:306-14. [PMID: 19756992 DOI: 10.1007/s10964-009-9450-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 09/03/2009] [Indexed: 12/01/2022]
Abstract
Non-suicidal self-injury (NSSI) continues to be a problem among youth and there is a great need for programming aimed at reducing NSSI in adolescents. The signs of self-injury program is the first known NSSI school-based prevention program for adolescents that attempts to increase knowledge, improve help-seeking attitudes and behaviors, and decrease acts of NSSI. A total of five schools implemented the program in selected classrooms (n = 274 adolescents; 51.5% female, mean age = 16.07 years) that consisted of predominantly Caucasian (73%) adolescents. Researchers collected pre-post evaluation surveys of the program and feasibility interviews were conducted with the school guidance personnel who ran the program. Results indicated the prevention program did not produce iatrogenic effects, increased accurate knowledge and improved help-seeking attitudes and intentions among students. No significant changes were found in regards to self-reported formal help-seeking actions. Feasibility responses indicate the program is user-friendly and well received by school personnel. The data offer preliminary evidence that the program may be an effective prevention program for schools.
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Affiliation(s)
- Jennifer J Muehlenkamp
- Department of Psychology, 227 Hibbard Hall, University of Wisconsin-Eau Claire, Eau Claire, WI, 54702-4004, USA.
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