The Relationship Between Attachment and Self-Injurious Behaviors in the Child and Adolescent Population: A Systematic Review of the Literature

Childhood Predictors of Nonsuicidal Self-Injury in Adolescence: A Birth Cohort Study

OBJECTIVE

Nonsuicidal self-injury (NSSI) is rare in childhood but becomes prevalent in adolescence, which suggests that early intervention might be indicated. As childhood predictors of NSSI in adolescence are largely unknown, identifying these predictors was the aim of this study.

METHOD

In a birth cohort sample (n = 759) of Norwegian children, NSSI at 12, 14, or 16 years of age was regressed on predictors of NSSI at age 6 (parental factors: depression, parenting stress, negativity/hostility, emotional availability to the child; child factors: temperamental negative affectivity, emotion regulation, symptoms of emotional and behavioral disorders; external events: victimization from bullying, serious negative life events). Semistructured clinical interviews with adolescents and their parents were used to assess DSM-5-defined NSSI and NSSI disorder.

RESULTS

NSSI during the preceding 12 months at 12, 14, or 16 years of age was reported by 81 adolescents (10.0%, 95% CI 8.2-11.9), and NSSI disorder was reported by 20 adolescents (2.7%, 95% CI 1.9-3.8). In multivariable logistic regression analysis, female gender (odds ratio 11.6, 95% CI 4.0-33.5), parenting stress (odds ratio 4.8, 95% CI 1.4-16.5), and parental negativity/hostility (odds ratio 1.8, 95% CI 1.2-2.7) predicted NSSI, whereas child factors and external events were not predictive.

CONCLUSION

Parental factors when the child is 6 years of age-parenting stress and negativity/hostility toward the child-predict NSSI in adolescence. Universal and indicated programs targeting these aspects of parenting during childhood might reduce NSSI in adolescence.

PLAIN LANGUAGE SUMMARY

Almost 1 in 4 adolescents engage in deliberate self-harm without wanting to die from it. However, childhood predictors of nonsuicidal self-injury are largely unknown. This study from Norway followed 759 children from birth until adolescence. The authors found that children who perceived their parents as more negative and hostile at 6 years old were at increased risk of engaging in self-injury when they became adolescents. Children whose parents reported more stress in the parenting role were also at increased risk of engaging in self-harm during adolescence. The authors conclude alleviating parental stress and improving parent-child relations at an early age might decrease the risk of adolescent self-harm.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Risk and protective factors for self-harm in adolescents and young adults: An umbrella review of systematic reviews

We conducted an umbrella review to synthesise the evidence from systematic reviews and meta-analyses that examined the risk and protective factors for self-harm in young people. We searched six different databases and used the AMSTAR-2 checklist for quality assessment. The importance of each risk and protective factor was determined based on (1) the number of times it was identified by general reviews examining any risk or protective factor, and (2) the effect sizes from meta-analyses. There were 61 systematic reviews included in this review. The most frequently identified risk factors for self-harm in young people included childhood abuse, depression/anxiety, bullying, trauma, psychiatric illnesses, substance use/abuse, parental divorce, poor family relationships, lack of friends, and exposure to self-harm behaviour in others. The risk factors with the strongest evidence for an association with self-harm were behavioural disorders, personality disorders and depression or anxiety. There was a dearth of systematic reviews examining protective factors but good family/friend relationships were most frequently identified. There was also evidence to show that non-suicidal and suicidal self-harm shared many of the same risk factors. Clinicians and other professionals who work with young people should be particularly cognisant of the psychiatric and adverse life event risk factors as well as the substance use, education-related and individual-level (e.g. being LGB) risk factors for self-harm. Knowledge of risk factors for self-harm can potentially be used to inform the design and implementation of prevention measures and further research is needed on the protective factors for self-harm.

Childhood trauma as a mediator between attachment and recidivism risk: A study of Canadian offenders with mental disorders

The current study aimed to explore the relationships between attachment and childhood trauma on recidivism risk in a sample of Canadian offenders with mental disorder (OMDs). N = 56 OMDs completed the Adverse Childhood Experiences (ACE) questionnaire, a measure of adult attachment (Experiences in Close Relationships Scale), and interview to determine recidivism risk (Level of Service/Case Management Inventory; LS/CMI). The variables of interest had small to moderate correlations. Multivariable regression analysis found that ACE scores but not attachment insecurity were associated with LS/CMI scores. Mediation analyses demonstrated that ACE scores fully mediated the association between attachment anxiety and attachment avoidance and recidivism risk. Results demonstrate that as exposure to diverse ACEs increased so did the risk to recidivate and this exposure mediated the relationship between attachment insecurity and recidivism risk. This study highlights the necessity of addressing both attachment insecurity and the experience of ACE when providing psychiatric services to OMDs.

Effect of Mothers' Parental Bonding Style on Their Maternal Attachment

Purpose: This study was aimed to investigate the relationship between mothers’ parental bonding styles and their maternal attachment levels. Methods: This descriptive and cross-sectional study involved 216 mothers. The data were collected using the Personal Information Form, the Maternal Attachment Inventory (MAI), and the Parental Bonding Instrument (PBI). Results: The mean MAI score of the mothers was found to be 96.72 ± 8.75 which indicated a high level of maternal attachment. The mean score from the PBI-mother form was found to be 49.13 ± 14.60 and PBI-father form was 46.12 ±14.90 which indicated that the mothers had a positive bonding with their parents.The relationship between an individual’s maternal attachment was found to be positive, moderate, and significant to her own parental bonding. Parental bonding with mother and parental bonding with father explained 35% and 23% of the total variance found in maternal attachment, respectively. Conclusion: Mothers’ parental bonding showed an effect on their maternal attachment as well. The families and couples should be trained on how positive or negative bonding with their children can affect their life cycles and future lives.