Non-Suicidal Self-Injury among Adolescents in Amman, Jordan

Sex Differences in the Global Prevalence of Nonsuicidal Self-Injury in Adolescents: A Meta-Analysis

Importance

Nonsuicidal self-injury (NSSI) is a strong predictor of suicide attempts. The prevalence of NSSI has been increasing among female adolescents in North America and Europe, but less is known about trends in other geographical regions.

Objective

To examine sex differences in the prevalence of NSSI among adolescents within and between geographical regions.

Data Sources

MEDLINE and PsycINFO were searched using the keywords adolescents, self-injury, sex factors, and synonyms for articles published in English between January 1, 2000, and May 10, 2022.

Study Selection

Studies were included if they presented original data (any study design), included adolescents aged 10 to 19 years, reported results stratified by sex, and explicitly defined self-injury as behaviors occurring without suicidal intent.

Data Extraction and Synthesis

This meta-analysis was registered with PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were assessed for quality by 2 independent coders (F.M. and J.A.). A random-effects model was used to calculate prevalence. Data were analyzed from July 2022 to April 2023.

Main Outcomes and Measures

The prevalence of NSSI in male and female adolescents within and between regions was the main outcome. Odds ratios (OR) with 95% CIs were calculated for community samples.

Results

Eight hundred and two studies were screened, and 38 were included (266 491 participants). Across 17 countries, the pooled prevalence of NSSI was 17.7% (female:male OR, 1.60; 95% CI, 1.29-1.98). NSSI was twice as prevalent among female adolescents compared with male adolescents in North America (OR, 2.49; 95% CI, 2.16-2.86) and Europe (OR, 2.08; 95% CI, 1.69-2.58), but not in Asia (OR, 1.00; 95% CI, 0.71-1.41).

Conclusions and Relevance

In this meta-analysis of sex differences in global prevalence of NSSI, the female predominance of NSSI observed among adolescents in North America and Europe aligned with rising rates of suicide in these populations. The comparable prevalence of NSSI among male and female adolescents in Asia also aligned with the lower male-to-female suicide ratio compared with other countries. More research is needed to characterize regional (and potentially cultural) sex differences among adolescents with NSSI to prevent and treat the behavior and to understand the possible interplay with corresponding regional trends in suicide.

Self-harm behaviors and their intentions: a cross-cultural analysis

BACKGROUND

Self-harm behaviors (performed with either lethal and non-lethal intentions) are common, especially among individuals suffering from mood disorders, and the reasons individuals self-harm vary both by person and by the type of behavior. Understanding these variations may help clinicians determine levels of risk more accurately.

AIMS

To understand whether culture and gender are associated with the likelihood of engaging in specific self-harm behaviors and whether the intention (lethal, ambivalent, non-lethal) of these behaviors vary with culture and gender.

METHODS

2826 individuals took part in an international multilingual online depression/suicidality screening study and reported at least one instance of self-harm in the past year. Participants were grouped into six broad cultural categories (Latin America, South Asia, Russian, Western English, Chinese, Arab).

RESULTS

3-way (culture x gender x intent) interactions were observed for several self-harm behaviors (overdosing, self-burning, asphyxiating, poisoning, and jumping from heights), suggesting that individuals engage in each of these behaviors with different intentions depending on gender and culture. Cultures and genders likewise differed in the likelihood of engaging in several self-harm behaviors.

CONCLUSIONS

Clinicians should consider culture and gender when assessing for suicide risk, as similar self-harming behaviors may reflect different intentions depending on an individual's culture and gender.

The development of Non-Suicidal Self-Injury (NSSI) during adolescence: A systematic review and Bayesian meta-analysis

BACKGROUND

Despite a surge in research on self-injury in the last decade, a summary of research findings about the development of Non-Suicidal Self-Injury (NSSI) over time in community youth samples is not yet present in the scientific literature. This study aims to summarize the empirical literature on this topic, examining both the occurrence (Study 1) and frequency (Study 2) of NSSI over time, and for this reason, a Systematic Review and Bayesian Meta-Analysis were conducted.

METHODS

Following the PRISMA guidelines, the longitudinal studies included in the systematic review consisted of 41 papers (Study 1 = 16; Study 2 = 25). Only studies with available data were included in the meta-analysis (Study 1 = 12; Study 2 = 11).

RESULTS

First, the findings highlight limits related to methodological aspects, the design of the studies, and the availability of data. Meta-analytic results shows that across development, the frequency (i.e., not the occurrence) of NSSI increases for the group of younger adolescents, remains stable in the group of middle adolescents, and it decreases for older adolescents.

LIMITATIONS

This study highlights some limitations that can be summarized in three different macro categories: the first refers to methodological aspects (e.g., the lifetime prevalence of NSSI), the second to the design of the studies (e.g., not homogeneous cohort; short-term covered), and the third to the availability of data.

CONCLUSIONS

The current meta-analysis tries to shed light on the longitudinal research on NSSI behavior and how this behavior develops in terms of both occurrence and frequency, providing practical and methodological indications for future research.

The prevalence of self-injury in adolescence: a systematic review and meta-analysis

In the past 10 years, there has been a growing interest in self-injurious behavior (SIB) among adolescents. The lifetime prevalence of SIB is between 16 and 22% in community sample with females more likely to engage in SIB. There are conflicting results about the global distribution of the prevalence of SIB and whether the SIB has increased in the 21st century. Our aim in the current study was to conduct a systematic search of and meta-analysis on the prevalence of SIB in adolescents over the past 5 years' worth of published papers and to examine gender, continental, and year differences. We conducted a systematic search in June 2020 of six databases (PubMed, Scopus, Web of Science, OVID Medline, PsycINFO, EBSCO) with three main search terms: "self-injurious behavior," "prevalence," and "adolescence." Article inclusion criteria were (a) written in English; (b) published between January 1, 2015, and June 18, 2020; and (c) focused on a community sample. Titles and abstracts of the articles were screened first. Then, the relevant full texts were read, and those that met the inclusion criteria were collected. We used Comprehensive Meta-Analysis software was used to conduct the analyses. After the screening process 97, articles were included in the meta-analysis. The age of the samples ranged from 11.00 to 18.53 years. The overall average prevalence of nonsuicidal self-injury in the studies was 16%. There was a significant gender difference: females reported a higher prevalence than males (19.4% and 12.9%, respectively). A significantly higher prevalence was found among Asian articles than those from other continents (19.5% and 14.7%, respectively). The prevalence of SIB did not change significantly between 2013 and 2018. The current research draws attention to the high prevalence of SIB among adolescents, especially among females and those living in Asia. It is important to address this behavior, both in terms of prevention and intervention.

Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: A meta-analysis

Background

Adolescents with immature mind and unstable emotional control are high-risk groups of non-suicidal self-injury (NSSI) behavior. We meta-analyzed the global prevalence of NSSI and prevalence of NSSI characteristics in a non-clinical sample of adolescents between 2010 and 2021.

Methods

A systematic search for relevant articles published from January 1, 2010 to June 30, 2021 was performed within the scholarly database search engines of CBM, CNKI, VIP, Wanfang, PubMed, Web of Science, PsycINFO, and Embase. Eligibility criteria were as follows: provided cross-sectional data on the prevalence of NSSI; the subjects were non-clinical sample adolescents; and a clear definition of NSSI was reported. We used the following definiton of NSSI as our standard: the deliberate, self-inflicted destruction of body tissue, such as cutting, burning, and biting, without attempted suicide. The quality evaluation tool for cross-sectional studies recommended by the JBI was used. The global prevalence of NSSI was calculated based on the random-effects model by Comprehensive Meta-analysis version 3.0. Subgroup analyses were performed to compare the prevalence according to sex, living place, smoking or drinking history, and family structure.

Results

Sixty-two studies involving 264,638 adolescents were included. The aggregate prevalence of NSSI among a non-clinical sample of adolescents was similar between over a lifetime (22.0%, 95% CI 17.9-26.6) and during a 12-month period (23.2%, 95% CI 20.2-26.5). Repetitive NSSI was more common than episodic NSSI (20.3% vs. 8.3%) but the frequency of mild injury (12.6%) was similar to that of moderate injury (11.6%). Multiple-method NSSI occurred slightly more often compared than one-method NSSI (16.0% vs. 11.1%). The top three types of NSSI in adolescents were banging/hitting (12.0%, 95% CI 8.9-15.9), pinching (10.0%, 95% CI 6.7-14.8), and pulling hair (9.8%, 95% CI 8.3-11.5), and the least common type was swallowing drugs/toxic substances/chemicals (1.0%, 95% CI 0.5-2.2). Subgroup analyses showed that being female, smoking, drinking, having siblings, and belonging to a single-parent family may be linked to higher prevalence of NSSI.

Conclusion

This meta-analysis found a high prevalence of NSSI in non-clinical sample of adolescents, but there are some changes in severity, methods, and reasons. Based on the current evidence, adolescents in modern society are more inclined to implement NSSI behavior by a variety of ways, which usually are repetitive, and moderate and severe injuries are gradually increasing. It is also worth noting that adolescents with siblings or in single-parent families are relatively more likely to implement NSSI behavior due to maladjustment to the new family model. Future research needs to continue to elucidate the features and risk factors of NSSI so as to intervene in a targeted way.

Limitation

The limitation of this study is that the heterogeneity among the included studies is not low, and it is mainly related to Chinese and English studies. The results of this study should be used with caution.

Systematic review registration

[www.crd.york.ac.uk/prospero/], identifier [CRD42022283217].

Is self-harm among orthodontic patients related to dislike of dentofacial features and oral health-related quality of life?

OBJECTIVES

To investigate the relationship between self-reported self-harm and dislike of dentofacial features and oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

Anonymous, self-reporting questionnaires were completed by 699 school children (aged 13-14 years), representing over 1% of the age group in Amman, Jordan. Participants were invited from 23 randomly selected schools in 10 educational directorates. OHRQoL was assessed using the Child Perception Questionnaire (CPQ 11-14). Self-harm was assessed using a constructed self-reporting questionnaire. The relationship between OHRQoL and self-harm was assessed and significant findings were identified at probability of α = 0.05.

RESULTS

Over one-quarter of schoolchildren (26.9%, n = 88) admitted self-harming behavior. Self-harm was reported to be due to dislike of dentofacial appearance among 12.9% of participants (n = 90). Higher CPQ 11-14 total scores and individual dimension scores were associated with the presence of self-harm (P < .001). High self-harm incidence was reported among participants who had dentofacial features that affected appearance (P < .001). Among subjects admitting self-harm, the frequency of self-harming behavior ranged from once to over 10 times per year.

CONCLUSIONS

Significant relationships were found between self-harm and dislike of dentofacial features and OHRQoL.

Non-suicidal Self-Injury Among Adolescents From Diverse Ethnocultural Groups in Israel: The Association With Sleep Problems and Internet Addiction

OBJECTIVES

Although Non-suicidal Self-Injury (NSSI) has received more attention in recent years, most of these studies focused on samples from North American and European countries; consequently, little is known about its patterns and frequency in other cultures as well as its relation to sleep problems and internet addiction. As one of the few studies that aim to fill this gap, the current study examined the prevalence, characteristics, and types of NSSI behaviors among adolescents from diverse ethnocultural groups.

METHODS

A sample of 642 adolescents, aged 12-18 years, were randomly recruited from different middle and high schools in Israel, employing a snowball sampling technique. The sample included the following: 50% Jews and 34.7% Muslims born in Israel, 9.7% immigrants from the former Soviet Union (FSU), and 4.4% immigrants from Ethiopia. The participants completed self-report questionnaires that assessed their NSSI, sleep problems, internet addictions, and depressive symptoms.

RESULTS

Almost one-third of the sample had engaged in NSSI, while 6% frequently injured themselves. More than half of the FSU immigrants and one-third of the Muslim participants indicated that they engaged in NSSI. These two population groups also exhibited severe depressive symptoms, sleep problems, and internet addictions. The most parsimonious correlations with NSSI included being male, an immigrant/Muslim minority who exhibited severe depressive symptoms and internet addictions.

CONCLUSIONS

These results emphasize the need for routine NSSI assessments to prevent long-term sequelae, including any forms of suicidal thoughts and behaviors and adult borderline personality disorder (BPD). Primary preventive programs that include adaptive coping skills may eliminate the social contagion effect of NSSI.

Characterization of suicide attempts and self-harm by adolescents and adults notified in Santa Catarina, Brazil, 2014-2018

OBJECTIVE

To characterize adolescent and adult suicide attempts and self-harm reported in Santa Catarina, Brazil, from 2014 to 2018.

METHODS

This was a cross-sectional descriptive study with data from the Notifiable Health Conditions Information System. The sociodemographic, clinical and type of self-inflicted violence characteristics among adolescents and adults were compared.

RESULTS

Among the 8,859 notifications analyzed, suicide attempts predominated in relation to self-mutilation; self-inflected violence was more frequent in females, those of white skin color and with mental disorders; it occurred more at home, in both age groups. Among adolescents, repeated self-mutilation (83.3%) stood out, while among adults, repeated suicide attempts (50.6%) and suspected alcohol use (18.3%) at the time of violence stood out.

CONCLUSION

We identified high prevalence of attempted suicide among adolescents and adults; the characteristics of violence were similar between the age groups analyzed.

Non-Suicidal Self-Injury: An Observational Study in a Sample of Adolescents and Young Adults

Non-Suicidal Self-Injury (NSSI) is the self-inflicted destruction of body tissues without suicidal intent with a prevalence of 1.5% to 6.7% in the youth population. At present, it is not clear which emotional and behavioral components are specifically associated with it. Therefore, we studied NSSI in a clinical sample of youth using the Ottawa Self-injury Inventory and the Barratt Impulsiveness Scale 11. The Mann-Whitney test was used to compare the numerical responses provided to the tests. We found 54 patients with NSSI, with a mean age of 17 years. Scores were analyzed in the total sample and in four subgroups. In the total sample, Internal Emotion and External Emotion Regulation, Craving, Non-Planning and Total Impulsivity were significantly associated with NSSI. There were statistically significant differences in Craving between patients with multiple NSSI episodes, suicide attempts and multiple injury modes and patients of other corresponding subgroups, in Internal Emotion Regulation, Sensation Seeking and Motor Impulsivity between NSSI patients with suicide attempts and no suicide attempts, and in Cognitive Impulsivity between NSSI patients with multiple injury modes and one injury mode. It is necessary to carefully evaluate the components underlying NSSI in order to activate personalized treatment options.

Non-suicidal self-injury in Shanghai inner bound middle school students

Background

Non-suicidal self-injury (NSSI) behaviour is very common among adolescents. Its prevalence and behavioural characteristics may vary according to regional and cultural differences. Investigation of NSSI locations and diagnosis of adolescents with NSSI are relatively lacking in China.

Aims

The study objective was to determine the prevalence and features of NSSI among middle school students in Shanghai.

Methods

The participants were from grade 6 to 8 selected from three junior schools in Jing’an District. Consenting students completed the Ottawa Self-Injury Inventory to determine the prevalence and characteristics of NSSI. Those who indicated NSSI within the past month were administered the Mini-International Neuropsychiatric Interview for Children and Adolescents to assess for emotional disorders.

Result

The result shows 510 participants (21.7%; mean age 13.51 (0.97) years old; 56.7% female) reported at least one instance of NSSI during the previous 12 months. NSSI was significantly more common in girls than boys (24.9% vs 18.5%; χ²=14.03, p=0.00). Commonly reported reasons for NSSI were for internal and external emotion regulation (87.9%, 82.3%) and social influence (57.8%). Anxiety disorders were the most common (28.9%) disorder associated with NSSI.

Conclusion

The rate of NSSI of middle school students in Shanghai inner bound is similar to those reported in North American and European youth. It is essential that school mental health professionals are aware of how to manage NSSI within the school setting.

Conducting research on nonsuicidal self-injury in schools: Ethical considerations and recommendations

Research on nonsuicidal self-injury (NSSI) has grown significantly over the last 15 years, with much of this work focused on factors that initiate and maintain NSSI among school-aged youth. Although this work is important, it does raise several ethical concerns. In this article we outline key ethical issues underlying NSSI research in schools and offer recommendations for conducting ethically sound and productive research in this area. Ethical concerns addressed include: 1) recruitment of minors to research; 2) disclosure and confidentiality; 3) the risk of iatrogenic effects; 4) duty of care; 5) engaging schools in research; and 6) safety of the researchers. In each area, we offer recommendations to assist researchers, ethics committees, and schools in working together to conduct ethical NSSI research, further our understanding of NSSI, and address and respond to these behaviors in schools.

Prevalence and Characteristics of Self-Harm in Adolescents: Meta-Analyses of Community-Based Studies 1990-2015

OBJECTIVE

To provide meta-analytic estimates of self-harm from all community-based studies of adolescents from 1990 through 2015, estimates of suicidal risk, and characteristics including age profile, frequency, types, seeking help, and reasons.

METHOD

Databases, bibliographies, and the internet were searched for cross-sectional and cohort studies of 12- to 18-year-olds. Meta-analytic estimates of the prevalence and characteristics of self-harm, risk of suicidal behaviors, and rates comparing different methods were calculated.

RESULTS

One hundred seventy-two datasets reporting self-harm in 597,548 participants from 41 countries were included. Overall lifetime prevalence was 16.9% (95% CI 15.1-18.9), with rates increasing to 2015. Girls were more likely to self-harm (risk ratio 1.72, 95% CI 1.57-1.88). The mean age of starting self-harm was 13 years, with 47% reporting only 1 or 2 episodes and cutting being the most common type (45%). The most frequent reason was relief from thoughts or feelings. Slightly more than half sought help, but for most this was from a friend. Suicidal ideation (risk ratio 4.97) and attempts (risk ratio 9.14) were significantly higher in adolescents who self-harmed, but this was higher with more frequent self-harm. Methodologic factors also were associated with higher rates of self-harm.

CONCLUSION

Interventions that can lower suicidal risk should be made available to adolescents who self-harm frequently as soon as possible. Preventative interventions that help adolescents deal with negative feelings should be instituted at the onset of puberty. Because friends are frequently asked for support, interventions also should be developed for peer groups.

“I Do Want to Stop, At Least I Think I Do”: An International Comparison of Recovery From Nonsuicidal Self-Injury Among Young People

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.

Beyond medicalization: Self-injuring acts revisited

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.