Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression

Prevalence of Adverse Childhood Experiences and Their Associations with Non-Suicidal Self-Injury Among Chinese Adolescents with Depression

The presence of adverse childhood experiences (ACEs) in adolescents diagnosed with depression has been associated with an extensive range of mental health issues, including non-suicidal self-injury (NSSI). However, there has been a dearth of research into the prevalence of ACEs and their associations with NSSI among depressed adolescent populations in China. This study aimed to investigate the prevalence of different types of ACEs and their associations with NSSI in depressed Chinese adolescents. Utilizing Chi-squared tests, latent class analysis (LCA), and multinomial logistic regression, the prevalence of different types of ACEs and their associations with NSSI were determined in a sample of 562 adolescents with depression. Among depressed adolescents. 92.9% of depressed adolescents reported ACEs, and the prevalence of emotional neglect, physical abuse, caregiver treated violently, and bullying was relatively high. ACEs, including sexual abuse (OR = 5.645), physical abuse (OR = 3.603), emotional neglect (OR = 3.096), emotional abuse (OR = 2.701), caregiver divorce/family separation (OR = 2.5), caregiver treated violently (OR = 2.221), and caregiver substance abuser (OR = 2.117), were associated with increased odds of exposure among depressed adolescents with NSSI. The high ACEs class (19%), the moderate ACEs class (40%), and the low ACEs class (41%) were identified as latent classes. NSSI was more prevalent in the high/moderate ACEs class compared to the low ACEs class, particularly in the high ACEs class. The situation of the prevalence of ACEs among adolescents with depression was unsatisfactory, and certain types of ACEs were associated with NSSI. Eliminating potential risk factors for NSSI requires the early prevention and targeted intervention of ACEs. Moreover, additional large-scale longitudinal studies are necessary to assess the different development trajectories associated with ACEs, such as the relationships between the different development periods of ACEs and NSSI, and to ensure the adoption of evidence-based prevention and intervention strategies.

The association between child maltreatment, cognitive reappraisal, negative coping styles, and non-suicidal self-injury in adolescents with major depressive disorder

BACKGROUND

Non-suicidal self-injury (NSSI) is a significant public health concern among adolescents with major depressive disorders (MDD). Although previous research has linked child maltreatment (CM) to NSSI, the precise mechanisms remain unclear. This study aims to investigate the association between CM, cognitive reappraisal (CR), negative coping styles (NC) and NSSI in adolescents with MDD, from the perspectives of both Latent Variable Theory and the Network Theory of Mental Disorder.

METHODS

A sample of 651 adolescents with MDD was recruited from January to December 2023. Data on CM, CR, NC, and NSSI were collected through paper-based self-reported questionnaires. Data analysis primarily involved structural equation modeling and network analysis.

RESULTS

The reporting rate of NSSI among adolescents with MDD was 48.2%. CM showed a significant positive correlation with NSSI. NSSI was affected by CM through three paths: the mediating role of CR, the mediating role of NC, and the chain mediating role of both CR and NC. Emotional abuse (EA) was the central node, while NSSI, EA, and "The urge to cry quietly when faced with troubles"(NC10) were the key bridge nodes.

CONCLUSIONS

This study is the first to use both structural equation modeling and network analysis to explore the explore the relationship between CM, CR, NC, and NSSI in adolescents with MDD, providing a theoretical basis for future early prevention and targeted interventions for adolescents with MDD.

A self-determination theory perspective on the relationship between emotion regulation styles, mindfulness facets, and well-being in adults with self-injury

BACKGROUND

The relevance of emotion regulation (ER) difficulties to nonsuicidal self-injury (NSSI; the deliberate destruction of one's bodily tissue without suicidal intent) has been repeatedly documented. Recently, specific mindfulness facets (i.e., awareness, nonjudging, describing) have been proposed as mechanisms that explain this relationship. The present study sought to extend this line of inquiry by exploring the mediating role of mindfulness facets in the relation between self-determination theory-based ER styles (i.e., integrative ER, suppressive ER, emotion dysregulation) and indices of positive and negative well-being (i.e., subjective vitality, NSSI difficulties), while controlling for gender, in adults with recent NSSI engagement.

METHODS

US adults with a history of more than one occurrence of NSSI within the last year (n = 222) completed online measures of ER styles, mindfulness facets, subjective vitality, and NSSI difficulties.

RESULTS

A mediation model indicated that the effects of ER styles on positive and negative well-being were explained by specific mindfulness facets (i.e., awareness, nonjudging, nonreactivity, describing).

CONCLUSIONS

The present study provides preliminary evidence that facets of dispositional mindfulness may be mechanisms through which ER styles impact positive and negative indices of well-being in adults with lived experience of NSSI.

Different self-damaging behaviours, similar motives? Testing measurement invariance of motives for nonsuicidal self-injury, disordered eating and substance misuse

OBJECTIVES

Theory and research suggest that distinct self-damaging behaviours (SDBs; e.g., nonsuicidal self-injury [NSSI], restrictive eating, binge eating, drug misuse, alcohol misuse) share similar motives. However, few studies have used a common self-report inventory to investigate the shared relevance and relative salience of motives for SDBs. Accordingly, the present study: (1) examined whether self-report scales assessing intrapersonal motives (i.e., relieving negative emotions, enhancing positive emotions, punishing oneself) and interpersonal motives (i.e., bonding with others, conforming with others, communicating distress, communicating strength, reducing demands) have invariant factor structures across SDBs; and (2) compared the salience of these motives across SDBs.

METHODS

1018 adults (54.6% men, Mage = 35.41 years) with a history of SDBs were allocated to the following groups: NSSI (n = 213), restrictive eating (n = 200), binge eating (n = 200), drug misuse (n = 200) or alcohol misuse (n = 205). Participants reported on their motives for engaging in their allocated SDB. Measurement invariance analyses compared the factor structures and latent means of the motive scales across SDBs.

RESULTS

The motive scales had comparable factor structures across SDBs. Intrapersonal motives were most strongly endorsed for NSSI and drug misuse. Interpersonal motives were most strongly endorsed for drug and alcohol misuse. All motives were least salient to restrictive eating.

CONCLUSIONS

Results suggest that common motives underlie distinct SDBs and that they can be adequately assessed using a single self-report inventory. However, certain motives are more relevant to some SDBs than others, with restrictive eating being the most motivationally distinct SDB. This knowledge can inform transdiagnostic models and interventions for SDBs.

Self-Compassion as a Mediator Linking Sleep Disturbances with Non-Suicidal Self-Injury: A Four-Wave, Cross-Lagged Study

Objective

This longitudinal study examined the reciprocal relationship between sleep disturbances with non-suicidal self-injury and whether self-compassion mediates these associations.

Methods

A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students at the baseline. This study spanned six waves with a six-month interval between each wave. Data from the last four waves were used because self-compassion or non-suicidal self-injury was not measured in the first two waves. The cross-lagged panel models were used to examine the longitudinal dynamic relationships between sleep disturbances, self-compassion, and non-suicidal self-injury.

Results

The results showed that all the auto-regressive paths were significant. For the cross-lagged paths, there was a reciprocal relation between sleep disturbances and self-compassion. Importantly, self-compassion played a longitudinal mediating role in the prediction from sleep disturbances to non-suicidal self-injury (indirect effect = 0.007 to 0.009, all p values < 0.001).

Conclusion

Psychological interventions targeting improved sleep quality and self-compassion may hold great promise for reducing the incidence of non-suicidal self-injury.

Depression fully mediates the effects of problematic internet use on nonsuicidal self-injury among adolescents during the COVID-19 outbreak

The outbreak of the coronavirus disease 2019 (COVID-19) pandemic threatened adolescents' mental health and livelihoods, which can worsen their non-suicidal self-injury (NSSI) behaviors. With the significant increase of total online time use, adolescents become more prone to problematic internet use (PIU). This study examined whether depression mediated the relationship between PIU and NSSI among adolescence during the COVID-19 outbreak. Constructed with a cross-sectional design during the COVID-19 outbreak in Taiwan, 1060 participants were drawn from junior high schools through stratified and cluster sampling, and completed a set of comprehensive surveys. The mediation model demonstrated a good fit to the data, GFI = .96, CFI = .97, NFI = .97, NNFI = .95, IFI = .97, and SRMR = .02. The overall fit of the mediational model was adequate. The path from PIU to depression, β = .41, p < .001, and the path from depression to NSSI, β = .40, p < .001, were both significant. Moreover, the effect of PIU to NSSI decreased from .23 (p < .001) to .05 (p = .099) when depression was incorporated into the analysis. Moreover, results in bootstrapping analysis displayed that the indirect effect (PIU on NSSI via depression) was statistically significant (p < .001) and the direct effect (PIU on NSSI) was statistically non-significant (p = .134). The full mediation model was confirmed. The findings of the structure equation modeling and bootstrap analysis showed that PIU significantly and positively predicted NSSI, and that depression fully mediated this relationship.

Internet-delivered emotion regulation therapy for adolescents engaging in non-suicidal self-injury and their parents: A qualitative, online focus group study

OBJECTIVES

We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI).

DESIGN

A qualitative study nested within a controlled feasibility trial.

METHODS

Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis.

RESULTS

Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents.

CONCLUSION

Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.

The mediating effects of school bullying victimization in the relationship between childhood trauma and NSSI among adolescents with mood disorders

BACKGROUND

Nonsuicidal self-injury (NSSI) is a serious problem in the adolescent population worldwide. Childhood trauma and bullying have been identified as risk factors for NSSI. We explored the relationships among Childhood trauma, Bullying victimization and the severity of NSSI behaviours, and test the effect of Bullying victimization in mediating the association between Childhood trauma and the NSSI behaviours.

METHODS

A total of 123 adolescents were recruited. They were diagnosed with depression or depressive episodes of bipolar disorder and had experienced NSSI in the last year. They were assessed using the Chinese version of the Childhood Trauma Questionnaire (CTQ-C), the Revised Olweus Bullying Victimization Questionnaire (OBVQ-R), and the Adolescent Self-Harm Questionnaire (ASHQ).

RESULTS

Females presented a significantly greater prevalence of sexual abuse and relationship bullying than boys. Individuals in the younger age group (10-14 years) presented a greater incidence of emotional neglect, verbal bullying, relationship bullying, and total bullying, and their NSSI score was also higher than that of those in the older age group (15-19 years). Only children show a greater prevalence of sexual abuse than nononly children. Single-parent families scored higher on emotional abuse, emotional neglect, physical neglect and physical bullying than two-parent families. There was a significant positive correlation between each dimension of childhood trauma and all the dimensions of bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. The mediating effects of bullying victimization on emotional abuse, physical abuse, emotional neglect and physical neglect were 14%, 21%, 20%, 13% and 20%, respectively.

CONCLUSION

There was a significant positive correlation between childhood trauma and bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. Bullying victimization played the partial mediating effects between Childhood trauma and NSSI.

Training approaches for the dissemination of clinical guidelines for NSSI: a quasi-experimental trial

BACKGROUND

Non-suicidal self-injury (NSSI) is of high clinical relevance due to its high prevalence and negative long-term implications. In 2016, the German consensus-based clinical guidelines for diagnostic, assessment and treatment of NSSI in childhood and adolescence were published. However, research indicates that clinical guidelines are often poorly implemented in clinical practice. One crucial part of this process is the training of healthcare professionals to transfer knowledge and capacities to bring guideline recommendations into clinical practice.

METHODS

The effect of three different dissemination strategies (printed educational material, e-learning, and blended-learning) on the NSSI guidelines´ recommendations was examined among 671 physicians and psychotherapists via an online-survey. The quasi-experimental study included three measurement points (before the training, after the training, 3-month follow-up) and mixed effects models were used to test for changes in knowledge, competences and attitudes toward NSSI and treatment. Moreover, the transfer of gained competences to practical work and user satisfaction were reviewed.

RESULTS

With all three training formats, the intended changes of the outcome variables could be observed. Hereby, the printed educational material condition showed the lowest improvement in the scores for the 'negative attitudes toward NSSI and those who self-injure'. The training effect remained stable throughout the follow-up measurement. The highest application rate of acquired intervention techniques in clinical practice was reported for the blended-learning condition. For all three training strategies, user satisfaction was high and evaluation of training quality was positive, with printed educational material receiving the lowest and blended-learning the highest evaluations.

CONCLUSIONS

In summary, all three training formats were perceived to be of high quality and seem to be suited to cover the needs of a heterogeneous group of physicians and psychotherapists. The choice of training method could be driven by considering which training goals are desired to be achieved and by the benefit-cost ratio allowing for tailored training approaches.

Risk Prediction Model for Non-Suicidal Self-Injury in Chinese Adolescents with Major Depressive Disorder Based on Machine Learning

Background

Non-suicidal self-injury (NSSI) is a significant social issue, especially among adolescents with major depressive disorder (MDD). This study aimed to construct a risk prediction model using machine learning (ML) algorithms, such as XGBoost and random forest, to identify interventions for healthcare professionals working with adolescents with MDD.

Methods

This study investigated 488 adolescents with MDD. Adolescents was randomly divided into 75% training set and 25% test set to testify the predictive value of risk prediction model. The prediction model was constructed using XGBoost and random forest algorithms. We evaluated the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, recall, F Score of the two models for comparing the performance of the two models.

Results

There were 161 (33.00%) participants having NSSI. Compared without NSSI, there were statistically significant differences in gender (P=0.035), age (P=0.036), depressive symptoms (P=0.042), sleep quality (P=0.030), dysfunctional attitudes (P=0.048), childhood trauma (P=0.046), interpersonal problems (P=0.047), psychoticism (P) (P=0.049), neuroticism (N) (P=0.044), punishing and Severe (F2) (P=0.045) and Overly-intervening and Protecting (M2) (P=0.047) with NSSI. The AUC values for random forest and XGBoost were 0.780 and 0.807, respectively. The top five most important risk predictors identified by both machine learning methods were dysfunctional attitude, childhood trauma, depressive symptoms, F2 and M2.

Conclusion

The study demonstrates the suitability of prediction models for predicting NSSI behavior in Chinese adolescents with MDD based on ML. This model improves the assessment of NSSI in adolescents with MDD by health care professionals working. This provides a foundation for focused prevention and interventions by health care professionals working with these adolescents.

An evaluation of emotion recognition, emotion reactivity, and emotion dysregulation as prospective predictors of 12-month trajectories of non-suicidal self-injury in an adolescent psychiatric inpatient sample

BACKGROUND

Little is known about trajectories of NSSI. We aimed to identify NSSI trajectories in adolescent psychiatric inpatients and emotional processes that differentiate between trajectories.

METHODS

Participants were 180 adolescents (71.7 % female; mean age of 14.89 years, SD = 1.35) from a psychiatric inpatient facility. NSSI was assessed at their index hospitalization, as well as 6, and 12 months after discharge. Emotion recognition, emotion reactivity, and emotion dysregulation were assessed at baseline. Latent class mixture modeling was used to identify different NSSI trajectories and ANOVAs were used to evaluate predictors of the trajectories.

RESULTS

Analyses yielded three NSSI trajectories. These included a stable low-frequency class (90.53 % of sample), a stable moderate-frequency class, and a class characterized by high-frequency NSSI at baseline but that largely resolves by 6-month follow-up. After adjustments for multiple comparisons were made, only emotion regulation at baseline differentiated between the trajectories, with greater overall emotion dysregulation and greater emotional non-acceptance (a facet of emotion dysregulation) characterizing the initially high-frequency class and the stable moderate-frequency class more than the stable low-frequency class (ps < .05). Difficulties engaging in goal-directed behavior when distressed characterized the stable moderate-frequency NSSI class more than the stable low-frequency class (p < .05). Limitations The study sample consists predominantly of female and White adolescents and thus may not generalize to other demographic groups.

CONCLUSIONS

The current findings suggest that interventions involving emotion regulation with adolescents who engage in NSSI would particularly benefit from a focus on increasing acceptance of emotional experiences.

National Trends in Emergency Department Visits for Suicide Attempts and Intentional Self-Harm

OBJECTIVE

This study estimated national annual trends and characteristics of emergency department visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020.

METHODS

Data were from the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national sample survey of emergency departments. Visits for suicide attempts and intentional self-harm were identified using discharge diagnosis codes (ICD-9-CM for 2011-2015; ICD-10-CM for 2016-2020) or reason-for-visit codes. The annual proportion of emergency department visits for suicide attempts and intentional self-harm was estimated.

RESULTS

The weighted number of emergency department visits for suicide attempts and intentional self-harm increased from 1.43 million, or 0.6% of total emergency department visits, in 2011-2012 to 5.37 million, or 2.1% of total emergency department visits in 2019-2020 (average annual percent change, 19.5%, 95% CI=16.9, 22.2). Visits per capita increased from 261 to 871 visits per 100,000 persons (average annual percent change, 18.8%, 95% CI=17.6, 20.0). The increase in visits was widely distributed across sociodemographic groups. While suicide attempt and intentional self-harm visits were most common among adolescents, adults age 65 or older demonstrated the largest increase (average annual percent change, 30.2%, 95% CI=28.5, 32.0). Drug-related diagnoses were the most common co-occurring diagnosis among suicide attempt and intentional self-harm visits. Despite the rise in emergency department visits for suicide attempts and intentional self-harm, less than 16% included an evaluation by a mental health professional.

CONCLUSIONS

A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita. These trends underscore an urgent need to improve the continuum of mental health care for individuals with suicidal symptoms.

Picturing self-harm: Investigating flash-forward mental imagery as a proximal and modifiable driver of non-suicidal self-injury

OBJECTIVES

Non-suicidal self-injury (NSSI) is theorized to be reinforced by its emotional consequences. Mental images of NSSI are commonly reported as occurring prior to NSSI. Based on the known functional properties of anticipatory mental imagery as an emotional and motivational amplifier, this study investigated whether NSSI mental imagery constitutes a proximal and dynamic mechanism underpinning NSSI risk.

METHOD

An intensive ecological momentary assessment (EMA) study was conducted to track the occurrence and characteristics of NSSI mental imagery alongside NSSI urge and behavior in naturalistic settings. A sample of N = 43 individuals aged 17 to 24 with a history of repetitive NSSI completed EMA surveys seven times a day for 14 days.

RESULTS

Mental preoccupation in the form of NSSI mental imagery-based flash-forwards to the actions, bodily sensations, and emotional benefits of NSSI was found to occur when NSSI urge was high but not when urge was low. Critically, objective cross-panel analyses showed that higher frequencies of NSSI imagery occurrence predicted greater future NSSI urge and increased likelihood of acting on urge, over and above current urge.

CONCLUSIONS

Mental imagery of NSSI is not simply an epiphenomenal by-product of NSSI urge and may constitute a dynamic and proximal novel intervention target.

Neural mechanism of non-adaptive cognitive emotion regulation in patients with non-suicidal self-injury

BACKGROUND

The incidence of non-suicidal self-injury (NSSI) has been on the rise in recent years. Studies have shown that people with NSSI have difficulties in emotion regulation and cognitive control. In addition, some studies have investigated the cognitive emotion regulation of people with NSSI which found that they have difficulties in cognitive emotion regulation, but there was a lack of research on cognitive emotion regulation strategies and related neural mechanisms.

METHODS

This study included 117 people with NSSI (age = 19.47 ± 5.13, male = 17) and 84 non-NSSI participants (age = 19.86 ± 4.14, male = 16). People with NSSI met the DSM-5 diagnostic criteria, and non-NSSI participants had no mental or physical disorders. The study collected all participants' data of Cognitive Emotion Regulation Questionnaire (CERQ) and functional magnetic resonance imaging (fMRI) to explore the differences in psychological performance and brain between two groups. Afterwards, Machine learning was used to select the found differential brain regions to obtain the highest correlation regions with NSSI. Then, Allen's Human Brain Atlas database was used to compare with the information on the abnormal brain regions of people with NSSI to find the genetic information related to NSSI. In addition, gene enrichment analysis was carried out to find the related pathways and specific cells that may have differences.

RESULTS

The differences between NSSI participants and non-NSSI participants were as follows: positive refocusing (t = -4.74, p < 0.01); refocusing on plans (t = -4.11, p < 0.01); positive reappraisal (t = -9.22, p < 0.01); self-blame (t = 6.30, p < 0.01); rumination (t = 3.64, p < 0.01); catastrophizing (t = 9.10, p < 0.01), and blaming others (t = 2.52, p < 0.01), the precentral gyrus (t = 6.04, pFDR < 0.05) and the rolandic operculum (t = -4.57, pFDR < 0.05). Rolandic operculum activity was negatively correlated with blaming others (r = -0.20, p < 0.05). Epigenetic results showed that excitatory neurons (p < 0.01) and inhibitory neurons (p < 0.01) were significant differences in two pathways, "trans-synaptic signaling" (p < -log108) and "modulation of chemical synaptic transmission" (p < -log108) in both cells.

CONCLUSIONS

People with NSSI are more inclined to adopt non-adaptive cognitive emotion regulation strategies. Rolandic operculum is also abnormally active. Abnormal changes in the rolandic operculum of them are associated with non-adaptive cognitive emotion regulation strategies. Changes in the excitatory and inhibitory neurons provide hints to explore the abnormalities of the neurological mechanisms at the cellular level of them. Trial registration number NCT04094623.

A Scoping Review of Digital-Based Intervention for Reducing Risk of Suicide Among Adults

Suicide is a serious public health problem, especially among adults. Risk factors for suicide include the presence of mental health disorders, history of previous suicide attempts; substance or alcohol use and lack of social support. The impact of suicide risk includes psychological loss, as well as the trauma and emotional stress that can be felt by the families and communities left behind. Digital interventions have emerged as a promising alternative for suicide risk prevention. Previous research has focused on the findings of various designs, which did not provide clear intervention information to inform the implementation of the intervention. This study aims to describe a digital intervention to reduce the risk of suicidal behavior in adults. The design used in this study was a scoping review. The authors conducted a literature search from the Scopus, PubMed, and CINAHL databases. Inclusion criteria in this study were articles discussing digital interventions aimed at preventing suicide risk in adult populations, English language, full-text, RCT or quasi-experiment design, and publication period of the last 10 years (2014-2024). The major keywords used in the article search were suicide prevention, digital intervention, and adults. Data extraction used manual table and data analysis used descriptive qualitative with a content approach. The results showed that there were 9 articles that discussed digital-based interventions to reduce suicide risk in adults. The various types of digital interventions used were smartphone apps, online learning modules, and game-based interventions. These interventions offer significant potential in reducing the risk of suicidal behavior in adults. Digital interventions have an important role in reducing the risk of suicidal behavior in adults by considering aspects of suitability to individual needs and understanding digital literacy. Then, the development of mental health services and public health policies presented needs to be done with collaboration between stakeholders in suicide prevention efforts.

The effectiveness of mindfulness-based intervention for psychological distress and emotion regulation in college students with non-suicidal self-injury

This study explored the effectiveness of a short-term mindfulness-based intervention (MBI) on psychological distress, mindfulness levels, emotion regulation, and impulsivity among college students with non-suicidal self-injury (NSSI). Participants completed four questionnaires, including the Five Facet Mindfulness Questionnaire, the Depression Anxiety Stress Scale, the Emotion Regulation Questionnaire, and the Brief Barratt Impulsivity Scale, and two behavioral tasks, including an emotion regulation task and a stop signal task (SST), at three time points. Compared with the healthy group, the NSSI group had a significantly greater level of psychological distress and a lower level of mindfulness. Compared with the NSSI control group and the healthy group, the NSSI MBI group had significantly increased mindfulness levels and decreased psychological distress after the intervention. In the NSSI MBI group, regardless of which emotion regulation strategy was adopted when viewing negative pictures, the intensity of negative emotions during the emotion regulation task was significantly reduced. Moreover, in the NSSI MBI group, the effectiveness of the MBI on the mindfulness level, stress level, and emotion regulation process was maintained at the follow-up. The present study provided empirical support that short-term MBI has the potential to help individuals with NSSI by enhancing their emotion regulation.

The role of testosterone and cortisol levels in nonsuicidal selfinjury in adolescents

INTRODUCTION

Nonsuicidal selfinjury (NSSI) is an important problem in adolescence, which is thought to serve several reinforcement functions (positive vs. negative, automatic vs. social). While the psychological mechanisms involved in NSSI are relatively well known, there is an important gap in the knowledge regarding the underlying biological mechanisms. This study examined the role of testosterone (T) and cortisol (C) in the frequency and reinforcement functions of NSSI.

METHODS

A total of 423 adolescents (age range = 13-17; 54.4% girls) from Basque Country (Spain) provided saliva samples to determine T and C levels and completed measures of NSSI 6 months later in 2017-2018.

RESULTS

The results showed that T but not C was significantly associated with higher NSSI frequency and the four types of NSSI functions. In addition, C moderated the predictive association between T and NSSI for automatic negative reinforcement, such that this association was significant only when C was high. Participant sex did not moderate any association between hormones and NSSI.

CONCLUSIONS

These preliminary results suggest that testosterone levels can affect NSSI behaviors in adolescence, thus helping to explain the increase in NSSI during this stage. Moreover, in situations in which NSSI serves to alleviate negative internal states, high levels of cortisol can be involved.

A systematic review of interpersonal processes and their measurement within experience sampling studies of self-injurious thoughts and behaviours

Self-injurious thoughts and behaviours (SITBs) are a leading cause of death, and interpersonal processes (IPs) appear to play a role in SITBs. This systematic review synthesises the literature on IPs and SITBs in daily life and addresses four critical questions: (1) Which IPs have been assessed and how, (2) How are differences in IPs between individuals associated with SITBs?, (3) How are differences in IPs within individuals associated with SITBs? and (4) Do IPs relate differently to self-injurious thoughts than behaviours? Our review followed PRISMA guidelines and eligible literature was screened until 25 April 2024. We identified 58 Experience Sampling studies (32.76% daily-diary studies) of which most focused on IPs from major SITBs theories (e.g., thwarted belongingness) but largely used inconsistent operationalizations. Results from 39 studies investigating within-person associations were mixed. Based on 26 studies, whether differences in IPs between individuals relate to SITBs remains unclear. Three studies have investigated whether IPs relate to the transition from thoughts to behaviours, but temporal models are needed to draw firm conclusions. Studies investigating IPs and SITBs in daily life are largely inconclusive. Psychometrically validated measures are warranted, and future daily-life studies would benefit from drawing on ideation-to-action frameworks.

Nonsuicidal Self-Injury in Adolescent and Emerging Adult Childhood Cancer Survivors: A First Exploration

Purpose: This study examines nonsuicidal self-injury (NSSI) in adolescent and emerging adult survivors of childhood cancer, aiming to gain a first understanding of the phenomenon, its relation to general and cancer-specific functioning, and the stability of NSSI engagement over time. Methods: Dutch-speaking survivors (n = 125, age range = 14-25 years) participated in the first three annual waves of the Longitudinal Identity Study of Childhood Cancer Survivors study. Descriptive characteristics of lifetime NSSI were calculated. Multivariate analysis of variance (MANOVA) and χ2-analyses were performed to examine differences in demographic and clinical characteristics between survivors with and without lifetime NSSI. To assess differences in general and cancer-specific functioning between survivors with and without lifetime NSSI, two MANOVA analyses were performed. Finally, prevalence rates of current NSSI across the three waves were calculated, followed by χ2-analyses to explore differences in current NSSI over time. Results: The prevalence and characteristics of lifetime NSSI engagement resembled those in the general population. Although demographic and clinical characteristics were unrelated to NSSI engagement, several meaningful differences were found in both general and cancer-specific functioning between survivors with and without NSSI. Survivors with lifetime NSSI experienced more depressive symptoms and difficulties with identity formation (i.e., lower levels of identity synthesis and higher levels of identity confusion). In addition, they experienced more post-traumatic stress symptoms and cancer-related worries, and identified less as a "cancer patient." Conclusions: This study provides a first understanding of NSSI engagement in survivors of childhood cancer, mapping the characteristics of NSSI and its associations with both general and cancer-specific functioning.

Quantifying the Importance of Non-Suicidal Self-Injury Characteristics in Predicting Different Clinical Outcomes: Using Random Forest Model

Existing research on non-suicidal self-injury (NSSI) among adolescents has primarily concentrated on general risk factors, leaving a significant gap in understanding the specific NSSI characteristics that predict diverse psychopathological outcomes. This study aims to address this gap by using Random Forests to discern the significant predictors of different clinical outcomes. The study tracked 348 adolescents (64.7% girls; mean age = 13.31, SD = 0.91) over 6 months. Initially, 46 characteristics of NSSI were evaluated for their potential to predict the repetition of NSSI, as well as depression, anxiety, and suicidal risks at a follow-up (T2). The findings revealed distinct predictors for each psychopathology. Specifically, psychological pain was identified as a significant predictor for depression, anxiety, and suicidal risks, while the perceived effectiveness of NSSI was crucial in forecasting its repetition. These findings imply that it is feasible to identify high-risk individuals by assessing key NSSI characteristics, and also highlight the importance of considering diverse NSSI characteristics when working with self-injurers.

A longitudinal investigation of university adjustment among students with and without a history of non-suicidal self-injury

OBJECTIVE

The present study explored differences in four domains of university adjustment (i.e. personal-emotional, social, academic, and institutional attachment) among students with and without a history of engaging in non-suicidal self-injury (NSSI) and examined the independent influence of NSSI on university adjustment.

PARTICIPANTS AND METHODS

Participants were 231 students from a large Canadian university who completed an online survey during their first and second year of university examining their perceived stress, perceived social support, coping self-efficacy, and university adjustment.

RESULTS

Relative to students who never engaged in NSSI, those who did reported lower levels of university adjustment across domains. However, NSSI was not a significant predictor of university adjustment after accounting for perceived stress, perceived social support, and coping self-efficacy.

CONCLUSIONS

This study provides preliminary evidence that engaging in NSSI may not confer additional risk for university adjustment, as students' psychological resources appear to be stronger determinants of adjustment.

A Daily Diary Study of the Relation between Stress and Nonsuicidal Self-Injury and the Moderating Role of Emotion Dysregulation in Emerging Adulthood

Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18-25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, Mage = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12-14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable.

An Investigation of the Mediating Roles of Emotion Regulation Difficulties, Distress Tolerance, Self-Compassion, and Self-Disgust in the Association Between Childhood Trauma and Nonsuicidal Self-Injury

OBJECTIVE

Childhood maltreatment has been associated as a risk factor with the development of nonsuicidal self-injury (NSSI), with difficulty in emotion regulation explaining the association. However, little is known about the potential factors that make some individuals with maltreatment history more vulnerable to difficulties in emotion regulation and, in turn, engage in NSSI. The current study aimed to examine the roles of distress tolerance, self-compassion, and self-disgust in the association between childhood maltreatment types and emotion regulation difficulty, which was expected to predict NSSI.

METHOD

The sample included 397 university students between the ages of 18 and 30. Participants completed self-report scales assessing childhood maltreatment, emotion regulation difficulty, distress tolerance, self-compassion, self-disgust, and NSSI using the paper-pencil and online methods. The mediation model suggested for the association between childhood maltreatment types and NSSI was tested using path analysis.

RESULTS

Low distress tolerance, low self-compassion, high self-disgust, and resulting high emotion regulation difficulty mediated the indirect effect of emotional neglect on NSSI.

CONCLUSION

The current study sheds light on various factors in the development and maintenance of NSSI and reveals three developmental pathways from emotional neglect in childhood to engaging in NSSI.HIGHLIGHTSEmotional neglect may be a distal risk factor for nonsuicidal self-injury (NSSI).Low distress tolerance and self-compassion and high self-disgust may increase the risk of NSSI.Emotion regulation difficulty may make people engage in NSSI to regulate emotions.

Longitudinal Associations Between Nonsuicidal Self-Injury, Depressive Symptoms, Hopelessness, and Emotional Dysregulation in Adolescents

Nonsuicidal self-injury (NSSI) in adolescents has been associated with increased depressive symptomatology, hopelessness, and emotional dysregulation; however, few studies have examined longitudinal associations between NSSI and these problems. This study examines the longitudinal relationships among these variables in community adolescents and whether the pattern of relationships varies between boys and girls. The participants were 785 adolescents (57.1% girls) aged 13 to 18 years (M = 15.64; SD = 1.08) who completed self-reported measures of NSSI, depression, hopelessness, and emotional dysregulation at least once at two moments separated by 1 year. The longitudinal model was tested through structural equation modeling and multiple group analysis. NSSI predicted increased depressive symptoms, hopelessness, and emotional dysregulation; depressive symptoms predicted NSSI; hopelessness predicted depressive symptoms; and emotional dysregulation predicted depressive symptoms and hopelessness. The pattern was similar for girls and boys, although girls scored higher on all variables. The results underscore the important bidirectional associations between NSSI and other risk factors throughout adolescence. These findings will support prevention and interventions for NSSI and internalizing symptoms in adolescents in school and clinical settings.

A Qualitative Analysis of Perspectives on Self-directed Violence in a Prospective Longitudinal Study of Young Women With and Without Childhood ADHD

OBJECTIVE

Non-suicidal self-directed violence (NSSDV) is a significant and growing youth public health crisis. Girls with ADHD are at increased risk of engaging in NSSDV, yet qualitative studies with this population-to better understand manifestations, motivations, and developmental course-are lacking.

METHOD

We conducted semi-structured, qualitative interviews with a sub-sample of 57 young women (32 with childhood ADHD, 25 neurotypical comparisons; mean age of 27 years, part of a larger prospective longitudinal study) regarding histories and manifestations of NSSDV.

RESULTS

Inductive and deductive analysis revealed several key themes, including self-perceived reasons for engaging in NSSDV (affect regulation, attention seeking, self-punishment, asserting control), impulsivity, secretiveness, and in some cases motivations for desistance.

CONCLUSION

Findings underscore the importance of early education and screening, especially among high-risk clinical populations. Increased resources and supports for professionals, parents, and peers are indicated, along with countering the persistent stigma associated with ADHD and NSSDV.

Developmental trajectories of non-suicidal self-injury in adolescence: The effect of social support and socioeconomic status

BACKGROUND

Non-suicidal self-injury (NSSI) in early adolescence has been amply documented. However, there has been little research on the progression of NSSI over time. Most studies have focused on the risk factors for NSSI, with less attention devoted to understanding the role of protective factors. This paper aimed to expand existing knowledge about the development of NSSI, with an emphasis on the impacts of protective factors such as social support and socioeconomic status (SES).

METHODS

A total of 436 adolescents completed self-report surveys that addressed social support including friend, family, and teacher support, objective and subjective SES, and NSSI at three different points in time for 2 years.

RESULTS

Latent growth curve analyses revealed that NSSI increased across early adolescence to mid-adolescence. Support from friends and family negatively predicted adolescents' initial NSSI level. Furthermore, subjective SES negatively predicted the rate of NSSI.

CONCLUSIONS

These findings contribute to an understanding of the influences of both social support and SES on NSSI over time. NSSI interventions and education should include considerations of both the value of support from friends and family as well as subjective SES.

Nonsuicidal self-injury among Chinese university students during the post-COVID-19 era: analysis of sex differences and the impact of gender role conflict

Background

Global centers of epidemic prevention and control have entered a new stage of normalization, namely, the "post-COVID-19 era." During the post-COVID-19 era, which is characterized by the time period following that with the most serious medical consequences, the psychosocial consequences of the COVID-19 pandemic began to receive worldwide attention, especially the degree of psychological distress it caused.

Aim

This study explored the differential impact of gender role conflict on Chinese university students' engagement in nonsuicidal self-injury (NSSI) as a function of biological sex following the global COVID-19 pandemic.

Methods

Participants were 1,600 university students in northwestern China (M age = 21.3 years; 50.8% women) who completed online measures of demographic variables (including biological sex, gender role conflict, and NSSI engagement).

Results

Women reported significantly more gender role conflicts than men did, while engagement in NSSI was significantly more prevalent among men than women. A total of 262 men reported engaging in at least one NSSI behavior, resulting in a prevalence rate of 33.25%. In comparison, a total of 106 individuals reported engaging in at least one NSSI behavior, resulting in a prevalence rate of 13.05% among women. Gender role conflict was found to significantly predict university students' NSSI engagement, regardless of biological sex.

Conclusion

This is the first empirical study to identify sex differences in both gender role conflict and engagement in NSSI among university students in Northwestern China during the post-COVID-19 era. In addition, the present study is the first to demonstrate how gender role conflict predicts engagement in NSSI across sexes. These findings will inform the literature on gender role conflict and NSSI, particularly the close relationship between gender role conflict and engagement in NSSI among Chinese university students, and they emphasize the need for continued efforts to explore NSSI cross-culturally.

Cognitive Phenotype Shifts in Risk Taking: Interplay of Nonsuicidal Self-Injury Behaviors and Intensified Depression

BACKGROUND

Nonsuicidal self-injury (NSSI) behavior is significantly prevalent in both adolescents and psychiatric populations, particularly in individuals with major depressive disorder. NSSI can be considered a result of risky decision making in response to negative emotions, where individuals choose self-harm over other less harmful alternatives, suggesting a potential decision-making deficit in those engaging in NSSI. This study delves into the complex relationship between NSSI and depression severity in decision making and its cognitive underpinnings.

METHODS

We assessed decision behaviors in 57 patients with major depressive disorder and NSSI, 42 patients with major depressive disorder without NSSI, and 142 healthy control participants using the Balloon Analog Risk Task, which involves risk taking, learning, and exploration in uncertain scenarios. Using computational modeling, we dissected the nuanced cognitive dimensions influencing decision behaviors. A novel statistical method was developed to elucidate interaction effects between NSSI and depression severity.

RESULTS

Contrary to common perceptions, we found that individuals with NSSI behaviors were typically more risk averse. There was also a complex interaction between NSSI and depression severity in shaping risk-taking behaviors. As depressive symptoms intensified, the individuals with NSSI began to perceive less risk and behave more randomly.

CONCLUSIONS

This research provides new insights into the cognitive aspects of NSSI and depression, highlighting the importance of considering the influence of comorbid mental disorders when investigating the cognitive underpinnings of such behaviors, especially in the context of prevalent cross-diagnostic phenomena such as NSSI behaviors.

A meta-analysis of the effects of ketamine on suicidal ideation in depression patients

The treatment of suicidal ideation in patients with depression has been a major problem faced by psychiatric and emergency departments, and reasonable drug selection is particularly important. Ketamine has been shown to reduce suicidal ideation rapidly, but the strength of the effect is unclear and there is little evidence-based medical evidence to support this. We systematically searched all articles published on PubMed, Cochrane Library, Web of Science, CNKI and EMBASE. Stata 15 and R 4.1.3 were used for meta-analysis, and odds ratios were calculated in fixed effects or random effects models based on the heterogeneity test results. Our search resulted in 505 articles; we analyzed 14 studies, which included 1,380 participants. The 14 studies included 10 randomized controlled trial (RCT) studies and 4 single-arm studies. Our study suggests that, ketamine has a significant therapeutic effect on suicidal ideation throughout the treatment cycle. We performed network meta-analyses(NMA) and pairwise meta-analyses to compare the efficacy of ketamine in the reduction of suicidal ideation. There was a significant reduction in suicidal ideation within the first day after treatment (NMA ketamine day1 RR = 10.02, 95%CI = 4.24 to 23.68). In repeated treatment, the degree of recovery of suicidal ideation after the last dose was significantly greater than that after the first dose (RR = 0.56, 95%CI = 0.51 to 0.62). Recovery of suicidal ideation was also significantly better in the treatment end point than in the placebo group at the same time point (NMA ketamine day26 RR = 4.29, 95%CI = 1.41 to 13.08). This is the first network meta-analysis to demonstrate the role of ketamine in the alleviation of suicidal ideation. Our network meta-analysis also compared the effects of different drugs at different time points, which was not done in previous studies. This is of great reference significance for future drug research andrational drug use.

Negative self-perceptions and severity of NSSI: Testing the benefits and barriers model

Nonsuicidal self-injury (NSSI) is theorized to be caused by negative associations with the self, including low self-esteem, but the mechanisms explaining why low self-esteem is related to more severe NSSI are unclear. The current study aimed to address this limitation by evaluating a mediation model, proposing that low self-esteem would relate to more severe NSSI through increasing self-punishment motivations. Data came from 468 undergraduate students with a history of NSSI who completed an online survey measuring NSSI characteristics and functions, self-esteem, and self-punishment motivations for NSSI. Mediation was tested using a structural equation model using bootstrapped 95% percentile-corrected confidence intervals in which NSSI severity was modeled as a latent variable composed of NSSI frequency, recency, and versatility of methods. The total model was significant and the indirect effect of self-esteem on NSSI severity through self-punishment motives was significant. Self-esteem also retained significant direct effects on NSSI severity, indicating partial mediation. These results provide support for the benefits and barriers model of NSSI, suggesting that negative self-views increase risk for more severe NSSI through self-punishment motivations. Clinical interventions that emphasize self-compassion and focus on modifying self-punishment motivations may help reduce NSSI behavior.

The relationship between borderline personality disorder and self-injurious/suicidal behaviors in adolescents and young adults: A protocol for systematic review and meta-analysis

Background & Aims

Borderline personality disorder (BPD) is a common psychiatric disorder associated with a high risk of suicide attempts, death by suicide, and non-suicidal self-injury (NSSI). A systematic and comprehensive understanding of the link between BPD and suicide and self-injury in adolescents and young adults is crucial for effective public health prevention strategies. This protocol outlines our approach to summarize the evidence on the association between BPD diagnosis and self-injurious/suicidal behaviors including death by suicide, nonfatal suicide attempts, NSSI, and self-harm behavior through a systematic review and meta-analysis.

Methods

The protocol is registered (PROSPERO: CRD42022363329) and developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)-2015 statement. We will conduct a comprehensive literature search using electronic databases including MEDLINE, EMBASE, SCOPUS, Web of Science, CINHAL, and PsycINFO. The review will include studies that meet the specific inclusion criteria and will be searched using multiple databases A meta-analysis will be conducted using a fixed-effects or random-effects approach based on the level of heterogeneity. Subgroup analysis and meta-regression will be performed if necessary.

Conclusion

This study is unique, as it is the first of its kind to systematically review and analyze the existing literature on this topic. The results of this study will provide important evidence on the magnitude of this relationship overall and in different subgroups, which can be used to inform the development of effective prevention and treatment strategies.

The impact of negative cognitive bias on NSSI: mediating non-adaptive cognitive emotion regulation strategies

BACKGROUND

Individuals may be more likely to engage in NSSI due to negative cognitive bias, while the use of negative emotional regulation mechanisms may further contribute to NSSI. Currently, there is a dearth of studies regarding the correlation among the three variables.

METHOD

The study employed convenience sampling to collect data via online platforms from a total of 572 college students in Harbin, Heilongjiang Province, China, over the period of January 2024 to February 2024. The questionnaires comprise the Non-Adaptive Cognitive Emotion Srategy Regulation Subscale, the Negative Cognitive Processing Bias Questionnaire, and the NSSI Questionnaire.

OUTCOME

Negative cognitive bias significantly and directly influences NSSI, as indicated by a beta coefficient of 0.3788 and a confidence interval of [0.2878, 0.4698]. The existence of negative cognitive bias significantly enhances the impact of non-adaptive cognitive emotion control approaches (β = 0.5613, CI [0.4808, 0.6418]). Non-adaptive cognitive emotion regulation strategies showed a significant effect on NSSI, as indicated by a beta coefficient of 0.2033 and a confidence interval of [0.0942, 0.3125]. The non-adaptive cognitive emotion control strategy serves as an intermediary between negative cognitive bias and NSSI, explaining 30.12% of the overall impact.

IN CONCLUSION

The results demonstrate that non-adaptive cognitive emotion regulation strategies play a partially moderating role in the relationship between negative cognitive bias and NSSI among nursing students. We emphasize the importance of non-adaptive cognitive emotion regulation strategies, negative cognitive biases, and NSSI among nursing students. In order to reduce the occurrence of NSSI, it is important for schools, families, and teachers to work together closely and implement a well-organized and efficient intervention to protect the mental well-being of nursing students.

Early maladaptive schemas, distress tolerance and self-injury in Iranian adolescents: serial mediation model of transdiagnostic factors

BACKGROUND

Non-suicidal self-injury (NSSI) is prevalent behaviour among adolescents. Although there are different etiological models of NSSI, there is a general lack of evidence-based, comprehensive and transdiagnostic models of NSSI in adolescents.

AIMS

The aim of this study was to investigate a model of transdiagnostic factors of NSSI in adolescents, testing a serial mediation model of the relationship between early maladaptive schemas (EMS), distress tolerance and NSSI through experiential avoidance and rumination.

METHOD

A community sample was identified of 1014 adolescents aged 13-17, of whom 425 had a history of NSSI. A serial mediation path analytic method was utilised to examine the relationships between NSSI and its associated functions as criterion variables, EMS and distress tolerance as predictors, experiential avoidance as the first mediator and rumination as the second mediator.

RESULTS

The path analytic model fit indices were good (X2/d.f. = 2.25, goodness of fit index = 0.98, normed fit index = 0.97, comparative fit index = 0.98, root mean square error of approximation = 0.054, standardised root mean squared residual = 0.028). Rumination significantly mediated the relationship between schemas of 'vulnerability to harm', 'emotional deprivation', 'social isolation', 'insufficient self-control', and NSSI frequency and intrapersonal functions. In serial fashion, experiential avoidance mediated the role of rumination in the relationship between social isolation, and insufficient self-control and NSSI frequency and intrapersonal functions. All indirect effects were significant.

CONCLUSIONS

Key indirect effects were found linking maladaptive schemas and distress tolerance to NSSI frequency, and NSSI intrapersonal functions via experiential avoidance and rumination. Thus, it is important to address these transdiagnostic factors with particular emphasis on the sequential mediating role of experiential avoidance and rumination in conceptualisation and therapeutic interventions for NSSI.

Non-suicidal self-injury in trichotillomania and skin picking disorder

BACKGROUND

Trichotillomania and skin picking disorder have been characterized as body-focused repetitive behavior (BFRB) disorders (i.e., repetitive self-grooming behaviors that involve biting, pulling, picking, or scraping one's own hair, skin, lips, cheeks, or nails). Trichotillomania and skin picking disorder have also historically been classified, by some, as types of compulsive self-injury as they involve repetitive hair pulling and skin picking, respectively. The question of the relationship of these disorders to more conventional forms of self-injury such as cutting or self-burning remains incompletely investigated. The objective of this study was to examine the relationship of these two disorders with non-suicidal self-injury (NSSI).

METHODS

Adults with trichotillomania (n = 93) and skin picking (n = 105) or both (n = 82) were recruited from the general population using advertisements and online support groups and completed an online survey. Participants completed self-report instruments to characterize clinical profiles and associated characteristics. In addition, each participant completed a mental health history questionnaire.

RESULTS

Of the 280 adults with BFRB disorders, 141 (50.1%) reported a history of self-injury independent of hair pulling and skin picking. Participants with a history of self-injury reported significantly worse pulling and picking symptoms (p < .001) and were significantly more likely to have co-occurring alcohol problems (p < .001), borderline personality disorder (p < .001), buying disorder (p < .001), gambling disorder (p < .001), compulsive sex behavior (p < 001), and binge eating disorder (p = .041).

CONCLUSIONS

NSSI appears common in trichotillomania and skin picking disorder and may be part of a larger constellation of behaviors associated with impulse control or reward-related dysfunction.

Borderline personality traits mediate the relationship between negative life events and nonsuicidal self-injury in a clinical sample with youth depression

BACKGROUND

Borderline personality traits play a significant role in nonsuicidal self-injury (NSSI), particularly in depressed youths. NSSI is also highly correlated with negative life events. This research aimed to explore the connections between negative life events, borderline personality traits, and NSSI.

METHODS

The study included 338 depressed youth aged 13 to 25 years. Self-reported measures and clinical interviews were utilized to evaluate the depressive symptoms, borderline personality traits, negative life events, and NSSI behaviours of these participants. Identifying variables linked to NSSI was the aim of our analysis, and we also conducted a mediation analysis to look into the influence of borderline traits on the connection between negative life events and NSSI.

RESULTS

Of the 338 depressed youth, approximately 59.47% (201/338) displayed NSSI, which was associated with greater clinical severity. Borderline traits had an independent influence on NSSI and it partially explained the connection between negative life events and NSSI, even when accounting for depression symptoms. Depressed youth who were more vulnerable to NSSI behaviours often experienced negative life events such as interpersonal relationships, academic pressure, being punished, and loss.

CONCLUSIONS

Our research suggests that depressed youth who experience more negative life events are more likely to experience NSSI, and negative life events indirectly influence nonsuicidal self-injury through borderline personality traits. Implementing interventions focused on mitigating borderline symptoms could be a promising therapeutic approach for addressing NSSI in young people.

Prevalence and associated risk factors for suicidal ideation, non-suicidal self-injury and suicide attempt among male construction workers in Ireland

BACKGROUND

Suicide among male construction workers are reported to be disproportionally high compared to the working age population. However, there is minimal understanding of the prevalence and associated factors for suicidal ideation, non-suicidal self-injury, and suicide attempt among this occupational group globally.

METHODS

A cross-sectional study was conducted on a large sample of male construction workers in Ireland (n = 1,585). We investigated the prevalence of suicidal ideation, non-suicidal self-injury and suicide attempts and sociodemographic, occupational, and mental health factors associated with these three outcomes. Multivariable Poisson regression was performed to estimate the prevalence rate ratio of suicidal ideation (model 1 primary outcome), while multivariable logistic regression was used to estimate the odds ratio of non-suicidal self-injury (model 2 primary outcome), and suicide attempt (model 3 primary outcome).

RESULTS

The lifetime prevalence rate for suicidal ideation was 22%, 6% for non-suicidal self-injury, and 6% for suicide attempt. In univariate modelling, socio-demographic and occupation-specific factors associated with the three outcomes included younger age (suicidal ideation and non-suicidal self-injury), not being in a relationship (suicide attempt) and working 35-44 h per week (suicidal ideation and suicide attempt). The mental health factors generalized anxiety disorder, depression, and suicide bereavement were significantly associated with increased risk of the three outcomes. In fully adjusted multivariable models, increasing severity of generalized anxiety disorder and depression were associated with an increased prevalence rate ratio of suicidal ideation, and a higher odds ratio of non-suicidal self-injury and suicide attempt.

CONCLUSION

Suicidal ideation, non-suicidal self-injury and suicide attempt are significant issues for male construction workers that require specific attention. Findings highlight a need to support younger male construction workers and those bereaved by suicide. They also highlight the need for the early detection and treatment of generalized anxiety disorder and depression in order to intervene in, and potentially prevent, suicidality among male construction workers.

Adolescent Nonsuicidal Self-Injury and Suicidality: A Latent Class Analysis and Associations with Clinical Characteristics in an At-Risk Cohort

Nonsuicidal self-injury (NSSI) is frequently encountered in adolescents, but its predictive value for suicidality or other clinical characteristics is challenging due to its heterogeneous nature. This study used latent class analysis to identify subgroups of NSSI and compared these on sociodemographic characteristics, adverse outcomes and protective factors. The study included 966 high-risk adolescents, Mage 14.9 y, SD 0.9 y, 51.8% female. Four classes emerged: (1) "Low NSSI-Low suicidality", (2) "Moderate NSSI-Low suicidality", (3) "Moderate NSSI-High suicidality", and (4) "High NSSI-High suicidality". Girls predominated in the high suicidality classes. Generally, Class 4 had the poorest outcomes: more internalizing and externalizing problems, less social support from friends and families and worst self-esteem. These findings emphasize the need for interventions tailored to specific phenotypes of adolescents engaging in NSSI.

Unveiling convergent and divergent intrinsic brain network alternations in depressed adolescents engaged in non-suicidal self-injurious behaviors with and without suicide attempts

AIMS

Limited understanding exists regarding the neurobiological mechanisms underlying non-suicidal self-injury (NSSI) and suicide attempts (SA) in depressed adolescents. The maturation of brain network is crucial during adolescence, yet the abnormal alternations in depressed adolescents with NSSI or NSSI+SA remain poorly understood.

METHODS

Resting-state functional magnetic resonance imaging data were collected from 114 depressed adolescents, classified into three groups: clinical control (non-self-harm), NSSI only, and NSSI+SA based on self-harm history. The alternations of resting-state functional connectivity (RSFC) were identified through support vector machine-based classification.

RESULTS

Convergent alterations in NSSI and NSSI+SA predominantly centered on the inter-network RSFC between the Limbic network and the three core neurocognitive networks (SalVAttn, Control, and Default networks). Divergent alterations in the NSSI+SA group primarily focused on the Visual, Limbic, and Subcortical networks. Additionally, the severity of depressive symptoms only showed a significant correlation with altered RSFCs between Limbic and DorsAttn or Visual networks, strengthening the fact that increased depression severity alone does not fully explain observed FC alternations in the NSSI+SA group.

CONCLUSION

Convergent alterations suggest a shared neurobiological mechanism along the self-destructiveness continuum. Divergent alterations may indicate biomarkers differentiating risk for SA, informing neurobiologically guided interventions.

Prediction of non-suicidal self-injury in adolescents at the family level using regression methods and machine learning

BACKGROUND

Adolescent non-suicidal self-injury (NSSI) is a major public health issue. Family factors are significantly associated with NSSI in adolescents, while studies on forecasting NSSI at the family level are still limited. In addition to regression methods, machine learning (ML) techniques have been recommended to improve the accuracy of family-level risk prediction for NSSI.

METHODS

Using a dataset of 7967 students and their primary caregivers from a cross-sectional study, logistic regression model and random forest model were used to test the forecasting accuracy of NSSI predictions at the family level. Cross-validation was used to assess model prediction performance, including the area under the receiver operator curve (AUC), precision, Brier score, accuracy, sensitivity, specificity, positive predictive value and negative predictive value.

RESULTS

The top three important family-related predictors within the random forest algorithm included family function (importance:42.66), family conflict (importance:42.18), and parental depression (importance:27.21). The most significant family-related risk predictors and protective predictors identified by the logistic regression model were family history of mental illness (OR:2.25) and help-seeking behaviors of mental distress from parents (OR:0.65), respectively. The AUCs of the two models, logistic regression and random forest, were 0.852 and 0.835, respectively.

LIMITATIONS

The key limitation is that this cross-sectional survey only enabled the authors to examine predictors that were considered to be proximal rather than distal.

CONCLUSIONS

These findings highlight the significance of family-related factors in forecasting NSSI in adolescents. Combining both conventional statistical methods and ML methods to improve risk assessment of NSSI at the family level deserves attention.

A Brief Cognitive Analytic Therapy-Informed Approach for Young People That Have Self-Injured (CATCH-Y): A Case Series

BACKGROUND

Non-suicidal self-injury (NSSI) presents an increasingly prevalent problem for young people; however, there remains a scarce evidence base for effective, scalable treatments for adolescents. This study aimed to assess the feasibility and acceptability of a brief, cognitive analytic therapy (CAT)-informed intervention for young people who engage in NSSI (CATCH-Y).

METHODS

A case series design recruited 13 young people who met the inclusion and exclusion criteria to participate in the five-session intervention. Eligible participants were aged 13-17 years (M = 15.15, SD = 1.28) and had engaged in NSSI at least once in the previous 6 months. Feasibility and acceptability were measured via recruitment, retention, qualitative feedback and missing data. The secondary outcome measures of personal recovery and motivation were administered pre- and post-assessment, with measures of depressive symptoms and urges to self-injure.

RESULTS

The intervention was found to be largely feasible and acceptable with high rates of recruitment, retention and pre-/post-assessment data completeness. Measures showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although results were mixed. Completion rates for remote assessments were low.

CONCLUSIONS

The findings of this study support further evaluation of the CATCH-Y intervention on a larger scale. In-person assessments may be preferable to remote to ensure good completion rates.

Development and validation of the self-injury stigma scale

Non-suicidal self-injury is a prevalent and concerning behavior. Negative beliefs and stereotypes about NSSI are associated with negative outcomes, and negative, self-referential beliefs (e.g., self-stigmatizing beliefs) related to engagement in NSSI may be particularly harmful. Despite this, there is no validated measure specifically designed to assess for NSSI self-stigma. As this significantly hinders the ability to understand and quantify the effect of NSSI self-stigma, this study sought to validate the newly developed Self-Injury Stigma Scale (SISS). It was hypothesized the SISS would follow a four-factor structure that parallels a widely cited theoretical model of stigma. It was also hypothesized measures of shame and help-seeking self-stigma would be moderately, negatively, correlated with the SISS subscales, supporting the measure's validity. Participants from Study 1 were college students (n = 264, 65.8% female) with at least one lifetime NSSI act. A series of factor analytic models revealed a one-factor structure for the Application of Stigma subscale (i.e., third step of the four-step model). As this was the only SISS subscale to achieve an appropriate model fit, this scale alone was retained as the final SISS. The factor structure was tested via confirmatory factor analysis on a second sample (i.e., community participants with at least one past month of NSSI act; n = 240, 41.3% female). An acceptable fit on most, but not all, indices was reached. Convergent and discriminant validity were supported. The SISS retrospectively predicted past 3 month NSSI frequency and method versatility, and lifetime NSSI versatility, but not lifetime NSSI frequency or disclosure. Thus, the clinical utility of the SISS was partially supported. Findings offering evidence in favor of the SISS's appropriateness and utility as a measure of self-stigma of NSSI. Future work using this measure has the potential to clarify the risk associated with NSSI self-stigma and inform behavioral interventions.

Is a smartphone application (BlueIce) acceptable and safe for university students who self-harm: an open study

BACKGROUND

Many university students self-harm but few receive support. Smartphone apps have been identified as acceptable sources of support for students who self-harm, but the use of supportive self-harm apps is yet to be explored in this population.

OBJECTIVE

This study sought to explore the acceptability and safety of a specific app (BlueIce) for university students who self-harm.

METHODS

This was an exploratory, mixed methods study with 15 university students attending university well-being services with self-harming thoughts and/or behaviours. BlueIce was offered alongside the face-to-face support provided by the well-being service. Self-harming thoughts and behaviours, coping self-efficacy, and symptoms of anxiety and depression were measured before and after using BlueIce for 6 weeks. Follow-up interviews were also undertaken to explore how students perceived BlueIce in more depth.

RESULTS

Following app use, there were statistically significant reductions in symptoms of anxiety (baseline M 12.47, SD 4.42; follow-up M 10, SD 4.16) t(14)=2.26, p=0.040, d=0.58 and depression (baseline M 16.5, SD 5.17, follow-up M 12.27, SD 3.66) t(13)=5.50, p<0.001, d=1.47. Qualitative findings showed participants found BlueIce to be acceptable, safe and helpful, and reported that they were more able to cope with difficult feelings and better understand their self-harm triggers following use of the app.

CONCLUSION

BlueIce was an acceptable, safe and helpful source of support for university students struggling with self-harm thoughts and/or behaviours. This builds on previous findings with adolescents and suggests that BlueIce could be a particularly acceptable and helpful resource for university students.

Predictors of non-suicidal self-injury in adolescents with depressive disorder: the role of alexithymia, childhood trauma, and body investment

Purpose

This study analyzes the relationship of alexithymia, childhood trauma, and body investment to non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder and whether they have predictive and diagnostic value for non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder.

Patients and methods

A total of 225 patients with a diagnosis of adolescent depressive disorder were included in the study and were divided into two groups according to the DSM-5 criteria: 98 cases without NSSI and 127 cases with NSSI. Compare the demographic data, 24-item Hamilton Depression Scale (HAMD-24), 20-item Toronto Alexithymia Scale (TAS-20), Childhood Trauma Questionnaire-Short Form (CTQ-SF), and Body Investment Scale (BIS) scores between two groups. Binary logistic regression was used to analyze the independent risk factors contributing to NSSI behaviors in adolescents with depression, and establish four predictive models. Based on the models' predictive probability, the ROC curves were plotted to calculate the value of the predictive diagnostic effect.

Results

The group without NSSI had lower scores than the group with NSSI on HAMD-24 total score, TAS-20 total score, difficulty identifying feelings, difficulty describing feelings, and externally focused thinking, as well as lower scores on CTQ-SF total score, physical neglect, emotional neglect, physical abuse, and emotional abuse. In contrast, the BIS total score, body image feelings and attitudes, body care, and body protection factor scores were higher for the group without NSSI. The BIS body care factor score and the CTQ-SF emotional abuse factor score were significantly linked with adolescents diagnosed with depressive disorder who exhibited NSSI behaviors. These results provide a good diagnostic model for adolescents with depressive disorder.

Conclusion

Low levels of body care and childhood emotional abuse may independently contribute to the implementation of NSSI in adolescents with depressive disorder. Body investment and childhood trauma are valuable in diagnosing and predicting NSSI behaviors and should be considered as potentially important factors in clinical treatment.

Analyzing Co-Occurrence of Non-Suicidal Self-Injury With Suicidal Ideation and Related Factors Among Adolescents in Jeju Island

Objectives

Non-suicidal self-injury (NSSI) and suicidal behavior, including suicidal ideation (SI) and suicide attempts, are important predictors of suicide in adolescents. This study aimed to investigate the associations between NSSI, SI, NSSI+SI, mental health problems, and family factors in Korean adolescents in Jeju Island, with an emphasis on key findings.

Methods

A total of 561 adolescents completed self-report questionnaires regarding demographics, NSSI, SI, suicidal behavior, perceived family functioning, and mental health problems, which were assessed using Center for Epidemiological Studies Depression Scale for Children, Screen for Children Anxiety-Related Disorders (SCARED), and Youth Self-Report (YSR). Data were analyzed using descriptive statistics, one-way analysis of variance, chi-square test, post-hoc analyses, and multivariate logistic regression.

Results

In this study, 22.3% of adolescents reported either NSSI or SI, with 5.5% reporting NSSI and 20.7% reporting SI. Combined (NSSI+SI) group showed a significantly higher SCARED score, anxiety/depression, thought problems, attention problem, and rule breaking on YSR than did the SI only group. Higher level of depression and anxiety were significantly associated with NSSI and SI. Female sex and perceived family dissatisfaction were significantly associated factors for SI, but not for NSSI in multivariate logistic regression.

Conclusion

This study provides insights into the clinical characteristics and associated factors among adolescents with NSSI, SI, and NSSI+SI in Jeju Island. Identifying these results can inform the development of targeted prevention and intervention strategies to mitigate the negative consequences of these behaviors and contribute to a better understanding of the role of family in this context.

Association between positive youth development and non-suicidal self-injury: A longitudinal survey of children and adolescents in southwest China, 2019-21

BACKGROUND

Non-suicidal self-injury (NSSI) could lead to serious problems (exp. suicidal attempts) among children and adolescents. Positive youth development (PYD) focuses on comprehensive development instead of a single problem. This study aims to explore the longitudinal relationship between NSSI and PYD among Chinese children and adolescents.

METHODS

The longitudinal study used the three-wave dataset from the Chengdu Positive Child Development (CPCD) in southwest China between 2019 and 2021, including 10,370 participants. The parallel process Latent Growth Curve Model (LGCM) was utilized to analyze the relationship between PYD and NSSI across time.

RESULTS

The study results demonstrated that the initial level of NSSI is negatively associated with the initial value (β = -0.730, p < 0.01) and the growth rate (β = -0.012, p < 0.01) of PYD, and the development rate of the two variables are negatively related to each other(β = -0.120, p < 0.01).

LIMITATIONS

The specific relationships between PYD attributes and NSSI should be explored in the future. And the cultural variation among countries deserves more research. Moreover, the dynamic cohort research leads to a relatively high loss of participants.

CONCLUSIONS

PYD and NSSI are closely associated among children and adolescents. Instead of playing a protective role, PYD tends to be predicted by NSSI behaviors over time.

A pilot study examining hemomania behaviors in psychiatry outpatients engaged with nonsuicidal self-injury

BACKGROUND

This study aims to conduct the first-ever evaluation of our previously proposed behaviors of "hemomania" in individuals engaged with nonsuicidal self-injury (NSSI).

METHODS

The study encompassed 130 outpatients engaged with NSSI who applied at the psychiatry outpatient clinic. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, while psychiatric diagnoses were evaluated using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Subsequently, participants completed the Depression Anxiety Stress Scale-21 and Short Form of Barratt Impulsiveness Scale.

RESULTS

The prevalence of at least one hemomania behavior including seeing blood, tasting blood, bloodletting, and blood-drinking was observed to be 43.1% in individuals with NSSI. When participants were divided into two groups, individuals with hemomania exhibited: (1) a higher incidence of psychiatric comorbidities, increased suicide attempts, and more severe symptoms of depression, anxiety, stress, and impulsivity, (2) higher comorbidity rates of borderline personality disorder, body-focused repetitive behaviors, and dissociative disorders, and (3) elevated frequencies of certain NSSI behaviors, including cutting, biting, needle-ticking, and carving, compared to those without.

CONCLUSION

Hemomania could be considered a specific impulse control disorder, characterized by heightened impulsivity and a persistent urge to obtain one's own blood. However, further studies are needed to validate this hypothesis.

A comparison of retrospectively reported and ecological momentary assessment-reported perceived social support in predicting ecological momentary assessment-reported non-suicidal self-injury

INTRODUCTION

Non-suicidal self-injury (NSSI) urges and behaviors are associated with lower perceived social support and related constructs (e.g., perceived rejection). However, no studies have examined the concordance of retrospective (baseline) and ecological momentary assessment (EMA) perceived social support assessments. Retrospective and EMA reports are often only weakly to moderately correlated; measurement approaches may, therefore, impact observed associations between variables. We tested whether average EMA-reported perceived emotional social support uniquely predicts EMA-reported NSSI urges and behaviors above baseline-reported retrospective self-report of perceived emotional social support alone.

METHODS

93 young adults (ages 18-34) with past-month NSSI urges or behaviors and lifetime NSSI behaviors completed a semi-structured interview, self-report surveys, and a 2-week EMA protocol.

RESULTS

Baseline- and EMA-reported perceived emotional social support were positively correlated (Kendall's tau-b = 0.51). Average EMA-reported social support was uniquely associated with EMA-reported NSSI urges but not NSSI behaviors.

CONCLUSIONS

EMA-reported perceived emotional social support captured information not represented by baseline reports alone, but improvement in model fit was modest. EMA-reported social support may further improve the estimation of EMA-reported NSSI urges if modeled as a proximal predictor of NSSI. Further work is needed to clarify temporal directions between social support and NSSI urges. Limitations are discussed.

Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis

INTRODUCTION

Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes).

METHODS

Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes.

RESULTS

Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24).

CONCLUSION

Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed.

Diurnal variation of cardiac autonomic activity in adolescent non-suicidal self-injury

Heart rate (HR) and vagally mediated heart rate variability (HRV) are two distinct biomarkers of cardiac autonomic activity. Decreased cardiac vagal activity (or decreased HRV) in particular has been linked with impairments in the functional flexibility of the central autonomic network (CAN), resulting in impaired stress and emotion regulatory capacities. Decreased HRV is widely used as trait marker of psychopathology. Repetitive engagement in non-suicidal self-injury (NSSI) in adolescence correlates with both deficits in stress and emotion regulation, as well as decreased HRV. Existing research has, however, focused on short-term recordings of HR and HRV under resting and phasic conditions. In this study, we examined whether diurnal variation of cardiac autonomic activity, indexed by cosinor parameters of HR and HRV derived from 48 h of ambulatory ECG recording under natural conditions over a weekend, are altered in female adolescents with NSSI disorder compared to controls (HC; N = 30 per study group). Several important confounds, including physical activity, were controlled for. Female adolescents with NSSI show higher rhythm-adjusted 24 h mean levels and greater respective amplitude of HR, as well as lower rhythm-adjusted 24 h mean levels and smaller respective amplitude of HRV. Peak levels in both HR and HRV in the NSSI group were reached approximately 1 h later compared to HC. Severity of exposure to early life maltreatment might be linked with altered amplitudes of 24 h HR and HRV. Diurnal rhythms of cardiac autonomic activity might hold promise as objective indicators of disordered stress and emotion regulation in developmental psychopathology, and as such should be investigated in future studies with rigorous assessment and control of potential confounds.