Self-harm reasons, goal achievement, and prediction of future self-harm intent

Association of Social Media Use and High-Risk Behaviors in Adolescents: Cross-Sectional Study

BACKGROUND

Previous studies have demonstrated the prevalence of social media use and identified the presence of high-risk behaviors among adolescents, including self-harm and sharing of sexually explicit messages.

OBJECTIVE

This study aimed to identify patterns in the amount of time spent on social media by adolescents who engage in high-risk behavior and the extent to which they use social media as a platform for sharing such behaviors.

METHODS

This was a descriptive cross-sectional study of 179 adolescents seen in a pediatric clinic at an urban medical center. We used an anonymous self-report survey to obtain demographic characteristics, rates of self-harm thoughts and behaviors, sharing of sexually explicit messages, and social media use as determined by total hours spent on social media per day and the number of applications used.

RESULTS

Most adolescents reported spending 3 to 5 hours on social media each day and using 3 or more social media applications. Almost 1 in 8 (22/179, 12.3%) adolescents self-reported having ever engaged in self-injury with a mean age of onset of 11.8 years. Over a quarter (49/179, 27.4%) of adolescents reported sharing sexually explicit messages. Relative risk of engaging in self-injury and or sharing sexually explicit messages increased with the use of 4 or more social media applications (1.66; CI 1.11-2.48).

CONCLUSIONS

Results show a relationship between the number of social media applications used and increased rates of high-risk behaviors. We identified relevant risk factors that clinicians can use to screen for high-risk behavior and parents can monitor to encourage education about healthy online practices.

Stressful Life Events as a Predictor for Nonsuicidal Self-Injury in Southern Chinese Adolescence: A Cross-Sectional Study

Stressful life events have been implicated in the etiology of kinds of psychopathology related to nonsuicidal self-injury (NSSI); however, few studies have examined the association between NSSI and stressful life events directly in Chinese school adolescents. In this study, we aim to estimate the prevalence rate of NSSI and examine its association with stressful life events in Southern Chinese adolescents. A total sample of 4405 students with age ranged from 10 to 22 years was randomly selected from 12 schools in 3 cities of Guangdong Province, China. NSSI, stressful life events, self-esteem, emotional management, and coping methods were measured by structured questionnaires. Multinomial logistic regression was used to examine the association of NSSI with stressful life events. Results showed the 1 year self-reported NSSI was 29.2%, with 22.6% engaged in "minor" NSSI (including hitting self, pulling hair, biting self, inserting objects under nails or skin, picking at a wound) and 6.6% in "moderate/sever" NSSI (including cutting/carving, burning, self-tattooing, scraping, and erasing skin). Self-hitting (15.9%), pulling hair out (10.9%), and self-inserting objects under nails or skin picking areas to dram blood (18.3%) were the most frequent types of NSSI among adolescents. Results also showed that "Minor NSSI" was associated with stressful life events on interpersonal, loss and health adaption, and "moderate/severe NSSI" was associated with life events on interpersonal, health adaption in Southern Chinese adolescents, even after adjusted for sex, age, residence, self-esteem, coping style, and emotional management. Results further suggested stressful life events were significantly associated with less risk of NSSI in those who had good emotional management ability.

The functions of nonsuicidal self-injury: converging evidence for a two-factor structure

Research has identified more than a dozen functions of non-suicidal self-injury (NSI), but the conceptual and empirical overlap among these functions remains unclear. The present study examined the structure of NSI functions in two large samples of patients receiving acute-care treatment for NSI. Two different measures of NSI functions were utilized to maximize generalizability of findings: one sample (n = 946) was administered the Inventory of Statements About Self-injury (ISAS; Klonsky and Glenn in J Psychopathol Behav Assess 31:215-219, 2009), and a second sample (n = 211) was administered the Functional Assessment of Self-Mutilation (FASM; Lloyd et al. in Self-mutilation in a community sample of adolescents: descriptive characteristics and provisional prevalence rates. Poster session at the annual meeting of the Society for Behavioral Medicine, New Orleans, LA, 1997). Exploratory factor analyses revealed that both measures exhibited a robust two-factor structure: one factor represented Intrapersonal functions, such as affect regulation and anti-dissociation, and a second factor represented Social functions, such as interpersonal influence and peer bonding. In support of the two-factor structure's construct validity, the factors exhibited a pattern of correlations with indicators of NSI severity that was consistent with past research and theory. Findings have important implications for theory, research, and treatment. In particular, the two-factor framework should guide clinical assessment, as well as future research on the implications of NSI functions for course, prognosis, treatment, and suicide risk.

Neuroimaging the temporal dynamics of human avoidance to sustained threat

Many forms of human psychopathology are characterized by sustained negative emotional responses to threat and chronic behavioral avoidance, implicating avoidance as a potential transdiagnostic factor. Evidence from both nonhuman neurophysiological and human neuroimaging studies suggests a distributed frontal-limbic-striatal brain network supports avoidance. However, our understanding of the temporal dynamics of the network to sustained threat that prompts sustained avoidance is limited. To address this issue, 17 adults were given extensive training on a modified free-operant avoidance task in which button pressing avoided money loss during a sustained threat period. Subsequently, subjects underwent functional magnetic resonance imaging while completing the avoidance task. In our regions of interest, we observed phasic, rather than sustained, activation during sustained threat in dorsolateral and inferior frontal regions, anterior and dorsal cingulate, ventral striatum and regions associated with emotion, including the amygdala, insula, substantia nigra and bed nucleus of the stria terminalis complex. Moreover, trait levels of experiential avoidance were negatively correlated with insula, hippocampal and amygdala activation. These findings suggest knowledge that one can consistently avoid aversive outcomes is not associated with decreased threat-related responses and that individuals with greater experiential avoidance exhibit reduced reactivity to initial threat. Implications for understanding brain mechanisms supporting human avoidance and psychological theories of avoidance are discussed.

Human avoidance and approach learning: evidence for overlapping neural systems and experiential avoidance modulation of avoidance neurocircuitry

Adaptive functioning is thought to reflect a balance between approach and avoidance neural systems with imbalances often producing pathological forms of avoidance. Yet little evidence is available in healthy adults demonstrating a balance between approach and avoidance neural systems and modulation in avoidance neurocircuitry by vulnerability factors for avoidance. Consequently, we used functional magnetic resonance imaging (fMRI) to compare changes in brain activation associated with human avoidance and approach learning and modulation of avoidance neurocircuitry by experiential avoidance. fMRI tracked trial-by-trial increases in activation while adults learned through trial and error an avoidance response that prevented money loss and an approach response that produced money gain. Avoidance and approach cues elicited similar experience-dependent increases in activation in a fronto-limbic-striatal network. Positive and negative reinforcing outcomes (i.e., money gain and avoidance of loss) also elicited similar increases in activation in frontal and striatal regions. Finally, increased experiential avoidance and self-punishment coping was associated with decreased activation in medial/superior frontal regions, anterior cingulate, amygdala and hippocampus. These findings suggest avoidance and approach learning recruit a similar fronto-limbic-striatal network in healthy adults. Increased experiential avoidance also appears to be associated with reduced frontal and limbic reactivity in avoidance, establishing an important link between maladaptive avoidance coping and altered responses in avoidance neurocircuitry.