The Interactive Effects of Impulsivity and Negative Emotions on Adolescent Nonsuicidal Self-injury: A Latent Growth Curve Analysis

Co-developmental trajectories of suicidal ideation and non-suicidal self-injury among Chinese adolescents: Transdiagnostic predictors and association with suicide attempts

INTRODUCTION

Adolescent suicidal ideation (SI) and non-suicidal self-injury (NSSI) are crucial public health issues, yet their co-developmental trajectories during early adolescence and their associations with predictors and outcomes are unclear. This study aimed to (a) identify heterogeneous co-developmental trajectories of SI and NSSI, (b) explore associations between transdiagnostic predictors and trajectories, and (c) assess suicide attempt risk across trajectories.

METHODS

Four hundred fifty-three adolescents (Mage = 12.35 years, 48.3% boys) completed surveys at 6-month intervals across 2 years. At Time 1 (Nov 2020), participants completed surveys encompassing SI, and NSSI, along with family, peer, and individual predictors. Subsequent surveys (Times 2-4) measured SI and NSSI, with suicide attempts queried at Time 4.

RESULTS

Parallel process latent class growth models revealed three co-developmental groups (i.e., Stable low NSSI and SI; Moderate-NSSI and high-SI, parallel decreasing; High-NSSI and moderate-SI, parallel increasing). Multivariate logistic regression indicated that group membership was predicted by parental rejection, parental warmth, bullying victimization, depressive and anxiety symptoms, thwarted belongingness, and perceived burdensomeness. Adolescents in the "High-NSSI and moderate-SI, parallel increasing" group reported the highest suicide attempt frequency.

CONCLUSION

These findings underscore subgroup distinctions and transdiagnostic predictors in comprehending SI and NSSI progression, emphasizing the necessity of dynamic monitoring and tailored interventions for distinct subgroup characteristics.

Psychosocial factors affect the occurrence of nonsuicidal self-injury in adolescents with major depressive disorder through chain mediation

In the adolescent group, about half of adolescents with major depressive disorder (MDD) have NSSI. Psychosocial factors are associated with the development of NSSI. Clarifying the relationship between psychosocial factors and NSSI in adolescents with MDD can help us achieve early prevent. Demographic data, Hamilton Depression Scale-24 (HAMA24), childhood trauma questionnaire, emotional intelligence scale and interpersonal reactivity index were collected from 187 adolescents with MDD. Use ANOVA, Chi-square test, Binary Logistic Regression, Pearson correlation analysis, Mediation effect analysis and the Structural Equation Model for data analysis. The results of ANOVA showed that there was significant difference between the two groups in HAMD24 total score, impulsiveness, emotional intelligence, and empathy (p < 0.05). In the regression analysis, women, depression degree, motor impulsiveness (MI), personal distress (PD) and appraisal of other's emotions empathy were the risk factors for MDD adolescents to produce NSSI behavior. Among the indicators that were significantly related to MDD and NSSI, MI and PD mediate the relationship between MDD and NSSI. The structural equation model showed that MDD, PD and MI had a direct impact on NSSI, but PD and MI had multiple intermediary effected in the relationship between MDD and NSSI. Emotional intelligence, emotional neglect and cognitive impulsiveness indirectly affected the occurrence of NSSI behavior. Impulsiveness, personal distress, emotional neglect, and emotional intelligence are important risk factors that affect NSSI behavior in adolescents with MDD, and they affect the occurrence of NSSI in adolescents with MDD through chain mediation.

Dimensions of family stress and repetitive nonsuicidal self-injury in adolescence: Examining the interactive effects of impulsivity and emotion dysregulation

BACKGROUND

Repetitive non-suicidal self-injury (R-NSSI) in adolescence represents a significant risk factor for suicide. Although exposure to family stress is robustly associated with the risk of non-suicidal self-injury (NSSI), studies have not examined the potential mechanisms linking different forms of family stress and R-NSSI.

OBJECTIVE

This study examined how unique dimensions of family stress (threat and deprivation) relate to R-NSSI via interactions between impulsivity and emotion dysregulation.

PARTICIPANTS AND SETTING

The current sample included 3801 middle-school adolescents (42.2 % girls, Mage = 13.21 years).

METHODS

We conducted a two-wave study with 6-month intervals. Participants completed self-report measures assessing family stress, impulsivity, emotion dysregulation, and NSSI.

RESULTS

Moderate mediation analyses showed that threat was indirectly associated with NSSI frequency through the interaction of impulsivity and emotion dysregulation in the R-NSSI group and indirectly through impulsivity in the occasional NSSI (O-NSSI) group. Deprivation did not predict subsequent NSSI frequency in either group.

CONCLUSIONS

These findings lend empirical support to dimensional models of adversity and suggest that adolescents who experience threat-related family stress may have greater impulsivity and are more likely to report R-NSSI in the context of emotion dysregulation.

Distinct correlation network of clinical characteristics in suicide attempters having adolescent major depressive disorder with non-suicidal self-injury

Suicidal behavior and non-suicidal self-injury (NSSI) are common in adolescent patients with major depressive disorder (MDD). Thus, delineating the unique characteristics of suicide attempters having adolescent MDD with NSSI is important for suicide prediction in the clinical setting. Here, we performed psychological and biochemical assessments of 130 youths having MDD with NSSI. Participants were divided into two groups according to the presence/absence of suicide attempts (SAs). Our results demonstrated that the age of suicide attempters is lower than that of non-attempters in participants having adolescent MDD with NSSI; suicide attempters had higher Barratt Impulsiveness Scale (BIS-11) impulsivity scores and lower serum CRP and cortisol levels than those having MDD with NSSI alone, suggesting levels of cortisol and CRP were inversely correlated with SAs in patients with adolescent MDD with NSSI. Furthermore, multivariate regression analysis revealed that NSSI frequency in the last month and CRP levels were suicidal ideation predictors in adolescent MDD with NSSI, which may indicate that the increased frequency of NSSI behavior is a potential risk factor for suicide. Additionally, we explored the correlation between psychological and blood biochemical indicators to distinguish suicide attempters among participants having adolescent MDD with NSSI and identified a unique correlation network that could serve as a marker for suicide attempters. Our research data further suggested a complex correlation between the psychological and behavioral indicators of impulsivity and anger. Therefore, our study findings may provide clues to identify good clinical warning signs for SA in patients with adolescent MDD with NSSI.

Prevalence of engagement and frequency of non-suicidal self-injury behaviors in adolescence: an investigation of the longitudinal course and the role of temperamental effortful control

Non-suicidal self-injury (NSSI) is among the most frequent maladaptive behaviors reported in adolescence, with prevalence rates around 18-22% in community samples worldwide. The onset of NSSI typically occurs between early and middle adolescence, with a peak during middle adolescence (14-15 years) and a subsequent decline during late adolescence. This study investigated the growth curves of NSSI across four years during adolescence, analyzing simultaneously the probability of engagement in NSSI at least once (i.e., prevalence) and the frequency of engagement once initiated (i.e., severity). Furthermore, the study examined the predicting role of effortful control on NSSI over time (time-varying effects), net of other key risk factors for NSSI, such as anxiety-depression and bullying victimization. A sample of 430 Italian adolescents enrolled in Grade 9 at baseline was involved in the study. Based on the Latent Growth Curve Zero-inflated Poisson methodology, the results indicated a negative quadratic trend of both NSSI prevalence, with an increase between T1 and T3 followed by a decrease in the subsequent wave, and NSSI frequency once initiated, with a peak at T2 followed by a decline over time. The results also showed that adolescents who reported low effortful control abilities had a heightened probability of involvement in NSSI at each time point, whereas no significant association was found with NSSI frequency once initiated. Findings from this study offer important insights into the developmental course of NSSI and point out the need for future in-depth investigations of the mechanisms that might underlie NSSI prevalence and severity throughout adolescence.

Different profiles with multiple risk factors of nonsuicidal self-injury and their transitions during adolescence: A person-centered analysis

BACKGROUND

Nonsuicidal self-injury (NSSI) is a serious public health concern among adolescents. However, adolescents with different combinations of NSSI risk factors may constitute different subgroups that vary in subsequent risks of NSSI engagement, and the membership in these subgroups may change during early adolescence. Gender differences related to risk profiles and transition patterns may also exist. This study thus aimed to address these three questions.

METHODS

A total of 2,942 participants ranging from 12 to 17 years old (55.2% females; M_age = 14.60, SD = 1.21) completed a series of questionnaires about NSSI and its risk factors on three occasions, every six months. Latent profile and latent transition analyses were used to examine NSSI risk profiles (subgroups), their transition patterns, and gender differences.

RESULTS

Three distinct risk profiles were identified: Low-risk profile, Medium-risk profile, and High-risk profile. The profile membership was fairly stable over one year, and the shift across profiles represented a "resilient" pattern. Regarding gender differences, boys were less likely to be in either the Medium- or the High-risk groups, but more likely to transition from the Medium- to the Low-risk group, relative to girls.

LIMITATIONS

This study relied upon self-report measures. Additional research is needed to investigate the generalizability of the results to other populations, and to examine more predictors of class membership and transitions.

CONCLUSIONS

The results highlight the importance of considering subgroup differences in understanding NSSI risks. Differentiated interventions with multi-pronged approaches tailoring to different risk classes and gender groups may therefore prove more efficient and effective.

Nonsuicidal self-injury in undergraduate students with major depressive disorder: The role of psychosocial factors

BACKGROUND

Nonsuicidal self-injury (NSSI) is related to childhood abuse, family relationships, interpersonal relationships, personality, but the interaction between them is still unclear, and how they interact in major depressive disorder (MDD).

METHODS

Collected data from 444 undergraduate degree students with MDD participated. Used the Eysenck Personality Questionnaire, Childhood Trauma Questionnaire, Interpersonal Relationship Comprehensive Diagnostic Scale, and Family Assessment Device to assess the patients' psychosocial factors. NSSI behavior was assessed through interviews. Use the Chi-square test, Wilcoxon rank-sum test, Kruskal-Wallis H-test, Distance Correlation, Structural Equation Mode for data analysis.

RESULTS

Overall, 34.2% of patients with MDD had a history of NSSI. MDD patients with a history of NSSI had significant differences in psychoticism, neuroticism, emotional abuse, physical abuse, sexual abuse, emotional neglect, troubles in conversation, ability to make friends and family roles. Among these factors, psychoticism was most related to NSSI, and child abuse, interpersonal relationships and family roles played a variety of roles in mediating the relationship with NSSI.

CONCLUSIONS

Psychosocial factors affect the occurrence of NSSI through chain intermediary effects.

Resting state prefrontal cortex oxygenation in adolescent non-suicidal self-injury - A near-infrared spectroscopy study

•

Resting prefrontal cortex (PFC) oxygenation is decreased in adolescents with non-suicidal self-injury (NSSI) compared to healthy controls.

•

Lower PFC oxygenation (full sample) is associated with greater adverse childhood experiences and less health-related quality of life (HRQoL).

•

On the group-level, patients show no alterations of resting state functional connectivity within the PFC.

•

Among other clinical variables, increased PFC connectivity (full sample) is associated with greater borderline personality pathology.

Introduction

Neural alterations in limbic and prefrontal circuits in association with self-injurious behavior have been studied primarily in adult borderline personality disorder (BPD). In adolescent patients, research is still sparse. Here, we used resting functional near-infrared spectroscopy (NIRS) to examine oxygenation of the prefrontal cortex (PFC) and its association with symptom severity in adolescents engaging in non-suicidal self-injury (NSSI) and matched healthy controls (HC).

Methods

Adolescents (12–17 years) with recurrent episodes of NSSI (n = 170) and healthy controls (n = 43) performed a low-demanding resting-state vanilla baseline task. Mean oxygenation of the PFC and functional connectivity within the PFC, were measured using an 8-channel functional NIRS system (Octamon, Artinis, The Netherlands). Various clinical variables derived from diagnostic interviews and self-reports were included in statistical analyses to explore potential associations with PFC oxygenation and connectivity.

Results

Adolescents with NSSI showed significantly decreased PFC oxygenation compared to HC, as indexed by oxygenated hemoglobin. Lower PFC oxygenation was associated with greater adverse childhood experiences and less health-related quality of life (HRQoL). While there was no evidence for alterations in PFC connectivity in adolescents engaging in NSSI compared to HC, increased PFC connectivity in the full sample was associated with greater adverse childhood experience, greater BPD pathology, greater depression severity and psychological burden in general, as well as lower HRQoL.

Conclusion

This study is the first to examine PFC oxygenation using NIRS technology in adolescents engaging in NSSI. Overall, results indicate small effects not specific to NSSI. Clinical implications of these findings and recommendations for further research are discussed.

Mediating and moderating variables in the prediction of self-harm in young people: A systematic review of prospective longitudinal studies

BACKGROUND

Self-harm is widespread amongst young people. A growing body of research has explored factors that predict self-harm in young people, however, a systematic review of mediators and moderators of those factors has not yet been offered. This review aims to fill this gap by synthesising research about mediators and moderators of factors that prospectively predict self-harm in young people.

METHOD

A systematic review of research trials published up until 2018 was undertaken. Electronic databases Scopus (Elsevier), CINAHL, PsychINFO (EBSCO) and Medline were searched. Included studies utilised prospective longitudinal designs with participants aged 25 years or younger and self-harm outcome measures with published or reported psychometric properties. The aim of the review was to identify mediators and moderators of factors that predict self-harm in young people.

RESULTS

Of the 25 studies that met inclusion criteria, 22 reported at least one positive finding of a mediator or moderator. Specifically, 15 significant mediators and 20 significant moderators were identified in relation to a broad range of predictors of self-harm. Predictors were classified as adverse childhood experiences and parenting factors, psychological and psychiatric factors, social factors and intrapersonal factors. A number of potentially modifiable mediators and moderators were identified including interpersonal difficulties, impulsivity, self-esteem and self-compassion. Gender was the most commonly reported moderator.

LIMITATIONS

Included studies were assessed as limited by the heterogeneity of the mediators and moderators assessed, and by methodological factors including study durations, population characteristics, and the definition and assessment of self-harm. In addition, replication research was limited. Therefore it was difficult to integrate results and draw firm conclusions.

CONCLUSIONS

This review allowed us to explore diverse relationships between factors predictive of self-harm in young people and to identify a number of potentially modifiable mediators and moderators. Our findings have important implications for future research and treatment efforts as the identification of mediators and moderators is demonstrated to assist in identifying high risk individuals as well informing potential targets for treatment.

Impulsivity and Response Latency in Non-Suicidal Self-Injury: The Role of Negative Urgency in Emotion Regulation

Impulsivity is thought to be a contributing factor in non-suicidal self-injury (NSSI), yet the research is limited and inconsistent. In particular, little is known about how impulsivity is associated with response latency between initial urge and later self-injury, emotion regulation processes, or severity of NSSI. In this study, we tested group differences between participants with and without a history of NSSI on a questionnaire measure of impulsivity. In addition, we tested hypothesized correlations between impulsivity and relevant variables within the NSSI sample using questionnaires and self-reported response latency between urge and injury. Participants included 159 undergraduate students, 84 with an NSSI history and 75 without an NSSI history. Results indicated greater impulsivity on facets of Urgency and (lack of) Perseverance for the NSSI group. Within the NSSI sample, facets of impulsivity were associated with difficulties in emotion regulation and NSSI severity, but not response latency. In addition, response latency, a possible behavioral marker of impulsivity, was not associated with emotion regulation processes or NSSI frequency. These results suggest that higher scores on self-report measures of impulsivity, but not behavioral response latency measures, are associated with emotion regulation processes in individuals who self-injure.

Helping schools support caregivers of youth who self-injure: Considerations and recommendations

Non-suicidal self-injury (NSSI) is a significant international mental health concern, with consequences for not only youth who self-injure, but for their entire family system. Helping caregivers respond productively to their child’s self-injury is a vital part of effectively addressing NSSI. This paper will assist school-based mental health practitioners and other personnel support caregivers of youth who self-injure by reviewing current literature, highlighting common challenges faced by school-based professionals, and providing evidenced-informed recommendations for supporting caregivers of youth who self-injure. We posit that schools can best support caregivers by having clear and well-articulated self-injury protocols and by engaging caregivers early. Once engaged, helping caregivers to navigate first conversations, keep doors open, know what to expect, seek support for themselves and understand and address safety concerns will ultimately benefit youth who self-injure and the school systems that support them. We also review recommendations for working with youth whose caretakers are unwilling or unable to be engaged.

Understanding the Links Between Self-Report Emotional Intelligence and Suicide Risk: Does Psychological Distress Mediate This Relationship Across Time and Samples?

Objective: In the last decades, increasing attention has been paid to examining psychological resources that might contribute to our understanding of suicide risk. Although Emotional Intelligence (EI) is one dimension that has been linked with decreased suicidal ideation and behaviors, we detected several gaps in the literature in this area regarding the research designs and samples involved. In this research, we aimed to test a mediator model considering self-report EI, psychological distress and suicide risk across samples adopting both cross-sectional and prospective designs in two independent studies. Method: In Study 1, our purpose was to examine the potential role of psychological distress as a mediator in the relationship between self-report EI and suicide risk in a community sample comprised of 438 adults (270 women; mean age: 33.21 years). In Study 2, we sought to examine the proposed mediator model considering a 2-month prospective design in a sample of college students (n = 330 in T1; n = 311 in T2; 264 women; mean age: 22.22 years). Results: In Study 1, we found that psychological distress partially mediated the effect of self-report EI on suicide risk. More interestingly, findings from Study 2 showed that psychological distress fully mediated the relationship between self-report EI and suicide risk at Time 2. Conclusion: These results point out the role of psychological distress as a mediator in the association between self-report EI and suicide risk. These findings suggest an underlying process by which self-report EI may act as a protective factor against suicidal ideation and behaviors. In line with the limitations of our work, plausible avenues for future research and interventions are discussed.

Non-suicidal Self-Injury in Eating Disordered Patients: Associations with Heart Rate Variability and State-Trait Anxiety

Background: Non-suicidal self-injury (NSSI) is commonly present in individuals with eating disorders (EDs) and is often employed as a maladaptive emotion regulation strategy to avoid or abate negative emotions. One of the most prevalent negative emotions experienced by self-injurers is anxiety; however, this emotion has not been extensively studied in this population. Thus, the aim of our study was to investigate the influence of anxiety on NSSI in patients with ED from two different dimensions: state anxiety and trait anxiety.

Methods: The study comprised a total of 66 females: 12 ED patients with NSSI, 32 ED patients without a history of NSSI, and 22 healthy controls. State and trait anxiety were assessed by means of State-Trait Anxiety Inventory (STAI-S-T) and physiological data [i.e., heart rate variability (HRV)] were collected.

Results: STAI-trait scores were significantly higher in ED patients with NSSI than ED patients without NSSI. Furthermore, when conducting logistic regression analyses higher STAI-trait scores were associated with NSSI in ED patients. However, no differences in STAI-state scores and HRV were found between ED patients with and without NSSI.

Discussion: The present findings suggest that anxiety as a trait is associated with the use of maladaptive strategies (i.e., NSSI) in ED patients. These results uphold the need to target trait anxiety in ED treatment in order to prevent possible NSSI behaviors.

Non-suicidal Self-Injury in Eating Disordered Patients: Associations with Heart Rate Variability and State-Trait Anxiety

Background: Non-suicidal self-injury (NSSI) is commonly present in individuals with eating disorders (EDs) and is often employed as a maladaptive emotion regulation strategy to avoid or abate negative emotions. One of the most prevalent negative emotions experienced by self-injurers is anxiety; however, this emotion has not been extensively studied in this population. Thus, the aim of our study was to investigate the influence of anxiety on NSSI in patients with ED from two different dimensions: state anxiety and trait anxiety. Methods: The study comprised a total of 66 females: 12 ED patients with NSSI, 32 ED patients without a history of NSSI, and 22 healthy controls. State and trait anxiety were assessed by means of State-Trait Anxiety Inventory (STAI-S-T) and physiological data [i.e., heart rate variability (HRV)] were collected. Results: STAI-trait scores were significantly higher in ED patients with NSSI than ED patients without NSSI. Furthermore, when conducting logistic regression analyses higher STAI-trait scores were associated with NSSI in ED patients. However, no differences in STAI-state scores and HRV were found between ED patients with and without NSSI. Discussion: The present findings suggest that anxiety as a trait is associated with the use of maladaptive strategies (i.e., NSSI) in ED patients. These results uphold the need to target trait anxiety in ED treatment in order to prevent possible NSSI behaviors.