1
|
Langjord T, Pedersen G, Bovim T, Bremer K, Christensen TB, Hove O, Kildahl AN, Mork E, Norheim AB, Ramleth RK, Romm KL, Siqveland J, Schønning T, Stänicke LI, Torgersen T, Pettersen MS, Tveit T, Urnes Ø, Walby FA, Kvarstein EH. Evaluation of health services and treatment alliance among extensively hospitalized patients due to severe self-harm - results from the Extreme Challenges project. Nord J Psychiatry 2024:1-12. [PMID: 39126325 DOI: 10.1080/08039488.2024.2376162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/23/2024] [Accepted: 06/30/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Extensive psychiatric hospitalization due to repeated severe self-harm (SH), is a poorly researched area, but a challenge within health services (HS). Recent studies have demonstrated high levels of involuntary treatment among patients with severe personality disorder (PD) and complex comorbidity. Keeping focus on extensively hospitalized SH patients, this study aimed to investigate patients' and clinicians' evaluation of HS and treatment alliance. METHOD A cross-sectional study with an inpatient sample (age >18 years) with frequent (>5) or long (>4 weeks) psychiatric hospital admissions last year due to SH or SA recruited from 12 hospitals across health regions (N = 42). Evaluation included patient and clinician report. RESULTS A minority of the patients (14%) were satisfied with HS before the current admission, 45% (patients) and 20% (clinicians) found the current admission helpful, and 46% (patients) and 14% (clinicians) worried about discharge. Treatment complaints were received in 38% of the cases. Outpatient mental HS were available after discharge for 68% and a majority of clinicians indicated satisfactory contact across HS. More intensive or specialized formats were unusual (structured outpatient treatment 35%, day treatment 21%, ambulatory services 32%, planned inpatient services 31%). Mutual problem understanding, aims, and confidence in therapists during the hospital stay were limited (patient-rated satisfactory mutual problem understanding: 39%, aims of stay: 50%, confidence: 50%). Patient and therapist alliance-ratings were in concordance for the majority. CONCLUSION The study highlights poor HS satisfaction, poor patient-therapist coherence, limited treatment alliance and limited follow-up in structured treatments addressing SH or intermediary supportive ambulatory/day/inpatient services.
Collapse
Affiliation(s)
- Tuva Langjord
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Geir Pedersen
- Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Tone Bovim
- Regional Centre - Violence, Trauma and Suicide Prevention, Oslo, Norway
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Kjetil Bremer
- Department for National and Regional Functions, National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Oddbjørn Hove
- Department of Research and Innovation, Helse Fonna Health Trust, Haugesund, Norway
| | - Arvid Nikolai Kildahl
- National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Nevsom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Erlend Mork
- Early Intervention in Psychosis Advisory Unit for Southeast Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Ruth-Kari Ramleth
- Department for Child and Adolescent Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for Southeast Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department for Research, Division of Mental Health and Addiction, Akershus University Hospital, Oslo, Norway
| | | | - Line Indrevoll Stänicke
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Child and Adolescent Psychiatry, Nic Waal Institute, Lovisenberg Hospital, Oslo, Norway
| | - Terje Torgersen
- Department of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona S Pettersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tone Tveit
- Division of Mental Health and Addiction, Bergen University Hospital, Bergen, Norway
| | - Øyvind Urnes
- Department for National and Regional Functions, National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elfrida Hartveit Kvarstein
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
2
|
Taylor PJ, Adeyemi I, Marlow K, Cottam S, Airnes Z, Hartley S, Howells V, Dunn BD, Elliott RA, Hann M, Latham C, Robinson C, Turpin C, Kellett S. The Relational Approach to Treating Self-Harm (RELATE): study protocol for a feasibility randomised controlled trial study of cognitive analytic therapy for adults who self-harm versus treatment at usual. Pilot Feasibility Stud 2024; 10:101. [PMID: 39026281 PMCID: PMC11256374 DOI: 10.1186/s40814-024-01526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Self-harm is a prevalent behaviour that has a major detrimental impact on a person's life. Psychological therapies have the potential to help, but evidence of effective interventions remains limited. Access and acceptability of interventions can also be a significant challenge, with individuals either being unable to access help or having to endure long waiting lists. Cognitive analytic therapy (CAT) is a time-limited and relationally-focused psychotherapy that may provide a valuable treatment option for people who self-harm. This protocol outlines the methodology for the first feasibility randomised controlled trial (RCT) of CAT for adults that self-harm. The trial will aim to determine the feasibility, acceptability and safety of undertaking larger-scale evaluations of CAT for self-harm within an RCT context. METHOD An RCT design with 1:1 allocation to CAT plus treatment as usual (TAU) or TAU alone. Participants will be adult outpatients with three or more instances of self-harm in the past year (target sample of n = 60). CAT will be 8 one-to-one weekly 60-min sessions plus a follow-up session up to 8 weeks after the last session. Assessments will occur at baseline, 12 weeks and 18 weeks after randomisation. Qualitative interviews with participants will gain insights into the feasibility and acceptability of CAT. Feasibility outcomes will be judged against progression criteria. DISCUSSION CAT may be an effective and accessible treatment option for people who self-harm, providing a more relationally orientated alternative to more behavioural therapies. The proposed feasibility RCT is an important first step in evaluating CAT as a treatment for self-harm. TRIAL REGISTRATION The trial was pre-registered (21/10/22) on ISR CTN (ISRCTN code: ISRCTN75661422).
Collapse
Affiliation(s)
- Peter James Taylor
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Isabel Adeyemi
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katie Marlow
- Rotherham, Doncaster, and South Humber NHS Foundation Trust, Doncaster, UK
| | - Sarah Cottam
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Zerena Airnes
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Victoria Howells
- Rotherham, Doncaster, and South Humber NHS Foundation Trust, Doncaster, UK
| | | | - Rachel A Elliott
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Mark Hann
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Cameron Latham
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Catherine Robinson
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Clive Turpin
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Stephen Kellett
- Rotherham, Doncaster, and South Humber NHS Foundation Trust, Doncaster, UK
| |
Collapse
|
3
|
Shen Z, Gao D, Lv X, Wang H, Yue W. A meta-analysis of the effects of ketamine on suicidal ideation in depression patients. Transl Psychiatry 2024; 14:248. [PMID: 38858391 PMCID: PMC11164699 DOI: 10.1038/s41398-024-02973-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/23/2024] [Accepted: 06/03/2024] [Indexed: 06/12/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- ZuoYao Shen
- The First Affiliated Hospital of Xinxiang Medical College Henan, Henan, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences (No.2018RU006), Beijing, China
| | - DaiQuan Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xue Lv
- The First Affiliated Hospital of Xinxiang Medical College Henan, Henan, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences (No.2018RU006), Beijing, China
| | - HongXing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - WeiHua Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China.
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
- Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences (No.2018RU006), Beijing, China.
| |
Collapse
|
4
|
Cheung JC, Sorgi-Wilson KM, Ciesinski NK, McCloskey MS. Examining the relationship between subtypes of rumination and non-suicidal self-injury: A meta-analytic review. Suicide Life Threat Behav 2024; 54:528-555. [PMID: 38411021 DOI: 10.1111/sltb.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior, often used to cope with intense negative affect. Rumination is an emotion regulation strategy that leads to fixation on and exacerbation of (typically) negative affective states. However, studies examining the relationship between rumination and NSSI have yielded mixed results, showing high degrees of heterogeneity. METHODS The present study conducted meta-analyses (k = 50) of the association between overall rumination and NSSI, and independent meta-analyses for each of four subtypes of rumination (general, depressive, brooding, reflection rumination). Potential moderators that may influence the magnitude of these relationships were also examined. RESULTS A small-to-moderate positive association between rumination and NSSI was found independent of rumination subtype. Moderating effects included NSSI outcome measure and study design for overall rumination and general rumination, respectively. Race was found to moderate the relationships between both brooding and depressive rumination and NSSI, though in inverse directions. An analysis of effect heterogeneity across studies suggested that undetected moderators may be present. CONCLUSION Results of this study support the relationships between rumination subtypes and NSSI and identify factors that may impact these relationships. Continued research is needed to understand this association, particularly in more varied subtypes of rumination and cognitive-affective moderators.
Collapse
Affiliation(s)
- Joey C Cheung
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Nicole K Ciesinski
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Michael S McCloskey
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Orsolini L, Corona D, Cervelli AL, Ribuoli E, Longo G, Volpe U. The role of Theory of Mind in the transition towards suicidal attempts in youth NSSI: an exploratory pilot study. Front Psychiatry 2024; 15:1403038. [PMID: 38873534 PMCID: PMC11170150 DOI: 10.3389/fpsyt.2024.1403038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 06/15/2024] Open
Abstract
Non-suicidal self-injury (NSSI) can both precede and co-occur with suicidal attempts (SA). Underlying mechanisms/factors leading to the transition to SA in NSSI youths have been proposed (including the role of social cognition), despite they should be yet confirmed. Therefore, the study aims at exploring the role of the Theory of Mind in the differentiation of a sample of NSSI youngsters (aged 15-24) according to the presence of SA. We divided the sample into 4 groups using the Deliberate Self Harm Inventory (DSHI) and Columbia Suicide Severity Rating Scale (C-SSRS): control group (notNSSInotSA), NSSI without SA (NSSInotSA), NSSI with SA (NSSIplusSA), and SA without NSSI (SAonly). NSSIplusSA patients displayed higher Reading the Mind in the Eyes Test (RMET) scores (indicative of ToM abilities) than both the NSSInotSA (p=0.0016) and SAonly groups (p=0.0198), while SAonly patients showed lower RMET scores compared to the control group (p=0.0214). Multiple regression models used to differentiate NSSInotSA and NSSIplusSA found a significant association between RMET and LOSCS-CSC (Level Of Self-Criticism Scale-Comparative Self-Criticism) (pC=0.0802, pD=0.0016, pG=0.0053). Our findings supported the hypothesis that a hypertrophic affective ToM may possibly be associated with the occurrence of SA in youth NSSI. Further larger and longitudinal studies should confirm these preliminary findings, by exploring all social cognition dimensions.
Collapse
|
6
|
Mirabella G, Mancini C, Pacifici S, Guerrini D, Terrinoni A. Enhanced reactive inhibition in adolescents with non-suicidal self-injury disorder. Dev Med Child Neurol 2024; 66:654-666. [PMID: 37899708 DOI: 10.1111/dmcn.15794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/08/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023]
Abstract
AIM To investigate whether the core of the pathophysiology underlying non-suicidal self-injury (NSSI) relates to poor impulse control due to impaired motor inhibition (i.e. the ability to inhibit a preplanned motor response). METHOD We conducted a case-control study to compare the proficiency of two domains of motor inhibition, that is, reactive and proactive inhibition, by giving the reaching arm version of the stop-signal task and a go-only task to 28 drug-naive adolescents with NSSI disorder (NSSID) (mean age [SD] 15 years 8 months [1 year 4 months]; three males and 25 females) and 28 typically developing adolescents (mean age 15 years 8 months [1 year 5 months]; three males and 25 females). RESULTS Reactive inhibition, as determined by the duration of the stop-signal reaction time, was enhanced in adolescents with NSSID compared to typically developing controls (194.2 [22.5 ms] vs 217.5 [17.3 ms], p < 0.001). By contrast, proactive inhibition was similar in both groups. Lastly, the level of impulsivity, assessed using the Barratt Impulsiveness Scale Version 11, did not differ between typically developing adolescents and adolescents with NSSID. However, adolescents with NSSID were more impulsive than controls in a subscale of the UPPS-P Impulsive Behavior Scale. INTERPRETATION NSSID is not driven by heightened motor impulsivity. Instead, adolescents with NSSID exhibited greater proficiency in reactive inhibition, a proxy for motor impulsivity. We suggest that the enhancement of reactive inhibition strengthens action control, allowing adolescents to suppress their self-protection instinct and perform NSSI behaviours.
Collapse
Affiliation(s)
- Giovanni Mirabella
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Neuromed, Pozzilli, Italy
| | - Christian Mancini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Susanna Pacifici
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Daiana Guerrini
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Arianna Terrinoni
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
7
|
Baizabal-Carvallo JF, Cavanna AE, Jankovic J. Tics emergencies and malignant tourette syndrome: Assessment and management. Neurosci Biobehav Rev 2024; 159:105609. [PMID: 38447821 DOI: 10.1016/j.neubiorev.2024.105609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/29/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
Tourette syndrome (TS) is a complex neurodevelopmental disorder characterized by the presence of tics, frequently accompanied by a variety of neuropsychiatric comorbidities. A subset of patients with TS present with severe and disabling symptoms, requiring prompt therapeutic intervention. Some of these manifestations may result in medical emergencies when severe motor or phonic tics lead to damage of anatomical structures closely related to the tic. Examples include myelopathy or radiculopathy following severe neck ("whiplash") jerks or a variety of self-inflicted injuries. In addition to self-aggression or, less commonly, allo-aggression, some patients exhibit highly inappropriate behavior, suicidal tendencies, and rage attacks which increase the burden of the disease and are important components of "malignant TS". This subset of TS is frequently associated with comorbid obsessive-compulsive disorder. Therapeutic measures include intensive behavioral therapy, optimization of oral pharmacotherapy, botulinum toxin injections, and deep brain stimulation.
Collapse
Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA; Department of Sciences and Engineering, University of Guanajuato, León, Mexico.
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom; School of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
8
|
Lindquist EG, West AE. What Do My (Online) Friends Think? A Topic Modeling Approach to Identifying Patterns of Response to Self-Injurious Behaviors on Reddit. Arch Suicide Res 2024; 28:537-553. [PMID: 36998237 DOI: 10.1080/13811118.2023.2193594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Approximately 17% of adolescents and young adults will engage in non-suicidal self-injury (NSSI) at least once in their lifetime, leading the World Health Organization to identify self-injury as one of the top five public health concerns for adolescents. Despite the widespread prevalence of this behavior, NSSI continues to be heavily stigmatized in both medical and community settings, deterring many engaged in NSSI from seeking informal support from friends and family as well as formal psychological or psychiatric treatment. In contrast to the low rates of in-person help-seeking for NSSI, online support groups are highly utilized by those engaged in NSSI. Thus, an empirical study of responses to frequent, voluntary disclosure of NSSI on social media is needed to better understand how these communities meet the needs of those who self-injure. METHOD The current project used latent Dirichlet allocation to identify frequent and favored themes in response to self-injury content in the largest self-injury group on Reddit (over 100,000 members). Reddit, the 9th most visited website in the world, is a chat-based social media platform that has 430+ million active users and billions of site visits, with current estimates suggesting that ∼63% of the U.S. population are Reddit users. RESULTS Identified themes included: (1) recovery encouragement; (2) provision of social and instrumental support; and (3) daily realities of living with NSSI. Responses that encouraged recovery received more upvotes on Reddit than any other type of comment. CONCLUSION These results can inform evidence-based, person-centered, dimensional treatments for NSSI.
Collapse
|
9
|
Ciesinski NK, Drabick DAG, Berman ME, McCloskey MS. Personality Disorder Symptoms in Intermittent Explosive Disorder: A Latent Class Analysis. J Pers Disord 2024; 38:34-52. [PMID: 38324246 DOI: 10.1521/pedi.2024.38.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Intermittent explosive disorder (IED) is characterized by recurrent reactive aggression. IED is associated with significant personality pathology that is suggestive of higher levels of general personality disorder (PD). However, little is known about how personality factors impact the severity and presentation of IED. The present study employed a latent class analysis to assess for distinct PD symptom classes within IED and to evaluate whether these classes differed in terms of severity and behavioral presentation. Statistical and clinical indicators revealed a four-class model, with latent classes distinguished primarily on general levels of PD symptoms (low, moderate, high). However, the two moderate PD symptom classes were distinguished from other classes on avoidant PD. In addition, classes differed in terms of severity and presentation, suggesting important implications for both general PD and avoidant PD comorbidity within IED. Results provide further insight into the heterogeneity within IED and suggest a more nuanced approach in treating this serious condition.
Collapse
Affiliation(s)
- Nicole K Ciesinski
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Deborah A G Drabick
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Mitchell E Berman
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi
| | - Michael S McCloskey
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
Hach I, Bertsch T, Nonell P. The prevalence of off-label use and supratherapeutic blood levels of outpatient psychotropic medication in suicidal adolescents. Front Psychiatry 2024; 14:1240681. [PMID: 38298931 PMCID: PMC10827976 DOI: 10.3389/fpsyt.2023.1240681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Adolescents with mental disorders show an increased risk of suicidal phenomena. Vice versa, suicidality is a serious adverse event of psychotropic drug therapy in adolescents. There are only a few new psychotropic agents approved for this young age group. We evaluated the (pre-pandemic) prevalence of off-label use as well as detailed blood concentrations of outpatient psychotropic medication and sex differences in a clinical population of suicidal adolescents. Methods The urine presence and serum levels of psychotropic substances of adolescents hospitalized due to their acute suicidality but without a known actual suicide attempt (i.e., no acute intoxication or serious self-injuries) were investigated routinely between 01.03.2017 and 31.01.2018. Urine (N = 205) and blood samples (N = 193) were taken at the beginning of closed inpatient admission, i.e., the results of the laboratory analysis reflect outpatient drug intake. The serum levels of psychopharmacological medication and OTC medication were measured. Results Our sample consists of 231 cases (boys: N = 54; girls: N = 177, ratio: 1:3.3), aged 12-17 years (average age: 15,4 years). The most prevalent psychiatric diagnoses were depressive episodes (54%) and adjustment disorders (25%), and girls were more often diagnosed with depressive disorders than boys (boy/girl ratio: 1:9.5, p < 0.0001). More than half of adolescents (56%) used at least one prescribed psychotropic drug at admission (24.8% ≥ two psychotropic drugs). Off-label use of second-generation antipsychotics was significantly more frequent than off-label use of antidepressants (85% vs. 31%, p < 0.01). Adolescents suffering from depressive disorders were significantly more often on-label treated than adolescents with neurotic or stress-related disorders (56% vs. 10%). Female cases with prescribed psychotropic drug use showed significantly more frequent supratherapeutic drug levels than male cases (5% vs. 27%, p < 0.05). Conclusion Female adolescents may have an increased risk of supratherapeutic blood levels, especially when outpatient prescribed psychotropic drugs are off-label used. Measurement of blood levels of outpatient-prescribed psychotropic drugs could be used to enhance the safety and efficacy of the individual psychopharmacological treatment of adolescent suicidal patients. There is an urgent need for more real-world evidence on the effective treatment of adolescents with psychotropic drugs.
Collapse
Affiliation(s)
- Isabel Hach
- Department of Education and Science, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Patrick Nonell
- Clinic of Child and Adolescent Psychiatry and Psychotherapy, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| |
Collapse
|
11
|
Worsley J, Young D, Harrison P, Corcoran R. Pilot Evaluation of a Remote Psychotherapy Service for Students Who Self-Harm: University-Community Outpatient Psychotherapy Engagement (U-COPE). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:103. [PMID: 38248564 PMCID: PMC10815049 DOI: 10.3390/ijerph21010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
Self-harm is becoming increasingly common in student populations. Brief psychological therapies might be helpful for those who have recently self-harmed. The current paper reports on an evaluation of a brief psychotherapy service delivered via remote means, namely University-Community Outpatient Psychotherapy Engagement (U-COPE). The service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help students who present with self-harm related difficulties. The primary aim was to understand students' and practitioners' experiences of a remote psychotherapy service. Semi-structured interviews were conducted with a total of nine participants (seven students and two practitioners). Interview data were analysed using thematic analysis. Analyses of the interviews across the stakeholders revealed three overarching themes: 'Accessibility'; 'Therapeutic experiences'; and 'Spaces and places of therapy'. Students appreciated the rapid access to intervention, especially as student services are typically characterised by long waiting lists. Despite the brief nature of the intervention, many students reported feeling a sense of control over the direction and pace of the therapeutic sessions, which is an important consideration for those who self-harm. The findings suggest that U-COPE may be helpful to students with difficulties related to self-harm. Further investigation of this brief intervention is warranted in order to ascertain whether U-COPE has a long-term impact on difficulties and distress-related behaviours.
Collapse
Affiliation(s)
- Joanne Worsley
- Department of Primary Care and Mental Health, University of Liverpool, Eleanor Rathbone Building, Liverpool L69 7ZA, UK;
| | - Danielle Young
- Department of Psychology, University of Liverpool, Liverpool L69 7ZA, UK;
| | - Paula Harrison
- Student Administration and Support, University of Liverpool, Liverpool L69 7XZ, UK;
| | - Rhiannon Corcoran
- Department of Primary Care and Mental Health, University of Liverpool, Eleanor Rathbone Building, Liverpool L69 7ZA, UK;
| |
Collapse
|
12
|
Valdivieso-Jiménez G, Pino-Zavaleta DA, Campos-Rodriguez SK, Ortiz-Saavedra B, Fernández MF, Benites-Zapata VA. Efficacy and Safety of Aripiprazole in Borderline Personality Disorder: A Systematic Review. Psychiatr Q 2023; 94:541-557. [PMID: 37566261 DOI: 10.1007/s11126-023-10045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
Aripiprazole is an atypical antipsychotic medication, and its use in treating borderline personality disorder (BPD) is debatable because it is not FDA-approved for treating BPD. This study aimed to investigate the efficacy and safety of aripiprazole in patients with BPD. On July 2, 2021, the protocol (CRD42021256647) was registered in PROSPERO. PubMed, Scopus, Web of Science, Ovid-Medline, Embase, PsycINFO, and Cochrane (CENTRAL) were searched without regard for language or publication date. We also searched trial registries on ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. Randomized clinical trials with adult patients diagnosed with BPD met the inclusion criteria. The Cochrane risk of bias for randomized trials (RoB-2) method was used to assess the quality of the included studies. We included two previously published randomized clinical trials. There were 76 patients with BPD, with 38, 12, and 26 assigned to the aripiprazole, olanzapine, and placebo groups, respectively. Most patients (88.16%) were females, with ages ranging from 22.1 to 28.14 yr. Aripiprazole has been proven to reduce anxiety, depression, anger, hostility, clinical severity, and obsessive-compulsive behavior, insecurity, melancholy, anxiety, aggressiveness/hostility, phobic anxiety, paranoid thinking, psychoticism, and somatization. The adverse effects were headache, insomnia, restlessness, tremor, and akathisia. The risk of bias was considerable in both trials, which is somewhat problematic considering that prejudice can lead to incorrect outcomes and conclusions. Aripiprazole has demonstrated encouraging outcomes in the treatment of patients with BPD. More randomized controlled studies are needed.
Collapse
Affiliation(s)
- Glauco Valdivieso-Jiménez
- Instituto Peruano para el Estudio y Abordaje Integral de la Personalidad, Personality Disorders, Calle Francia 329, Miraflores, Lima, 15074, Perú
| | - Dennis Anthony Pino-Zavaleta
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Calle Salaverry # 545, Trujillo, La Libertad, 13011, Perú
| | - Susan K Campos-Rodriguez
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Calle Salaverry # 545, Trujillo, La Libertad, 13011, Perú
| | - Brando Ortiz-Saavedra
- Universidad Nacional de San Agustín de Arequipa, Santa Catalina Nro. 117, Cercado, Arequipa, 04001, Perú
| | - María F Fernández
- Universidad Privada de Tacna, Capanique Campus, Av. Jorge Basadre Grohmann s/n Pocollay, Tacna, 23003, Perú
| | - Vicente Aleixandre Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Avenida La Fontana 750 La Molina, Lima, 15024, Perú.
| |
Collapse
|
13
|
Reichl C, Rockstroh F, Lerch S, Fischer-Waldschmidt G, Koenig J, Kaess M. Frequency and predictors of individual treatment outcomes (response, remission, exacerbation, and relapse) in clinical adolescents with nonsuicidal self-injury. Psychol Med 2023; 53:7636-7645. [PMID: 37282585 PMCID: PMC10755228 DOI: 10.1017/s0033291723001447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/23/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is prevalent in adolescent clinical samples. There is evidence that NSSI can be treated effectively but data on individual treatment outcomes is limited. The goal of this study was to examine response, remission, exacerbation, and relapse rates over one and two years, respectively, among a clinical sample of adolescents with NSSI. Furthermore, we aimed to identify clinically relevant predictors of NSSI trajectories. METHODS The sample consists of n = 203 adolescents (12-17 y., 94% female) from a specialized outpatient clinic for risk-taking and self-harming behavior with NSSI on at least five days in the six months before first assessment. Assessments were completed at baseline and one (FU1) and two (FU2) years later using structured clinical interviews and self-report questionnaires. RESULTS At FU1, 75% reported a reduction in NSSI frequency by at least 50% (treatment response); among those, one third (25% of the entire sample) achieved a remission (0 NSSI); an exacerbation (⩾50% more NSSI) was observed in 11% of patients. Of those in remission, 41% relapsed one year later. Predictors of non-response or non-remission were inpatient treatment and depressive symptoms. Adolescents with lower NSSI frequency at baseline had a higher risk of exacerbation. Due to limited sample size at FU2 no prediction model for relapse was established. CONCLUSIONS While most adolescents presenting with NSSI achieved significant improvement, more attention should be paid to the rather low rates of full remission. Prediction and early detection of individuals who deteriorate during or relapse after treatment is critical.
Collapse
Affiliation(s)
- Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franziska Rockstroh
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Gloria Fischer-Waldschmidt
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
14
|
Laura B, Maisto D, Pezzulo G. Modeling and controlling the body in maladaptive ways: an active inference perspective on non-suicidal self-injury behaviors. Neurosci Conscious 2023; 2023:niad025. [PMID: 38028726 PMCID: PMC10681710 DOI: 10.1093/nc/niad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/12/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
A significant number of persons engage in paradoxical behaviors, such as extreme food restriction (up to starvation) and non-suicidal self-injuries, especially during periods of rapid changes, such as adolescence. Here, we contextualize these and related paradoxical behavior within an active inference view of brain functions, which assumes that the brain forms predictive models of bodily variables, emotional experiences, and the embodied self and continuously strives to reduce the uncertainty of such models. We propose that not only in conditions of excessive or prolonged uncertainty, such as in clinical conditions, but also during pivotal periods of developmental transition, paradoxical behaviors might emerge as maladaptive strategies to reduce uncertainty-by "acting on the body"- soliciting salient perceptual and interoceptive sensations, such as pain or excessive levels of hunger. Although such strategies are maladaptive and run against our basic homeostatic imperatives, they might be functional not only to provide some short-term reward (e.g. relief from emotional distress)-as previously proposed-but also to reduce uncertainty and possibly to restore a coherent model of one's bodily experience and the self, affording greater confidence in who we are and what course of actions we should pursue.
Collapse
Affiliation(s)
- Barca Laura
- Institute of Cognitive Sciences and Technologies, National Research Council, Via San Martino della Battaglia 44, Rome 00185, Italy
| | - Domenico Maisto
- Institute of Cognitive Sciences and Technologies, National Research Council, Via San Martino della Battaglia 44, Rome 00185, Italy
| | - Giovani Pezzulo
- Institute of Cognitive Sciences and Technologies, National Research Council, Via San Martino della Battaglia 44, Rome 00185, Italy
| |
Collapse
|
15
|
Zinchuk M, Kustov G, Popova S, Mishin I, Voinova N, Gersamija A, Yakovlev A, Guekht A. Functions of nonsuicidal self-injurious behavior in Russian patients with suicidal ideation. Front Public Health 2023; 11:1270944. [PMID: 38026411 PMCID: PMC10660280 DOI: 10.3389/fpubh.2023.1270944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Nonsuicidal self-injurious behavior (NSSI) is an important risk factor for future suicide attempts. Previous research has identified a number of motivations for engaging in NSSI. The aim of the present study was to translate the Inventory of Statements About Self-Injury (ISAS) into Russian and then to evaluate its psychometric properties in a sample of patients with non-psychotic mental disorders and suicidal ideation (SI). Other aims were to determine the prevalence of specific NSSI functions in this population and to assess the relationship between different NSSI functions and clinical and psychological parameters. Participants and methods The study was conducted at the largest center for non-psychotic mental disorders in Moscow. All admitted patients with both NSSI and SI completed the Russian version of the ISAS-II, underwent the Self-Injurious Thoughts and Behaviors Interview, and completed the Personality Inventory for DSM-5 and ICD-11 Brief Form Plus-Modified, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Results A total of 614 patients were included in the study. 543 (88.4%) patients were assigned female at birth with a mean age of 24.86 (7.86) years. Factor analysis supported a two-factor structure (Intrapersonal and Interpersonal) of the Russian version of the ISAS-II, but in contrast to the original study, the "Marking distress" function loaded more strongly on the Interpersonal factor. In people with non-psychotic mental disorders and SI, Interpersonal functions of NSSI are associated with more severe depressive symptoms (r = 0.34), 12 months history of NSSI (r = 0.30), higher number of NSSI methods (r = 0.41), likelihood of future NSSI (r = 0.35) and psychoticism (r = 0.32). Conclusion The Russian version of the ISAS-II is a valid and reliable instrument for assessing NSSI functions in a population at high risk for suicide attempts. Interpersonal functions are associated with a number of unpleasant clinical and psychological features.
Collapse
Affiliation(s)
- Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Georgii Kustov
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Sofya Popova
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Ilya Mishin
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Nadezhda Voinova
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Anna Gersamija
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Alexander Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
16
|
Li X, Liu S, Tian Y, He J, Chen H, Ning M, Chen Z, Yang J, Li Y, Zhou J. Challenges for psychiatric nurses working with non-suicidal self-injury adolescents: a qualitative study. BMC Nurs 2023; 22:382. [PMID: 37833692 PMCID: PMC10571286 DOI: 10.1186/s12912-023-01542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Psychiatric nurses play a crucial role in treating and supporting adolescents with non-suicidal self-injury (NSSI) in China. However, few studies have explored their experiences and challenges. OBJECTIVES The aim of this qualitative study was to describe the challenges experienced by psychiatric nurses when working with adolescents having NSSI behaviors. METHODS This was a descriptive qualitative study using phenomenological approach. 18 psychiatric nurses from psychiatric wards were recruited from a tertiary hospital from Changsha, Hunan province, China. In-depth interview was performed for each participant collecting information about their feelings and experiences taking care of NSSI adolescents. ATLAS.ti 8 was used to enter data and perform thematic analysis following the six-phased process described by Braun and Clarke. RESULTS Two main themes and five sub-themes were summarized in this study. Nurses experienced both (1) Internal challenges (Lacking knowledge and skills to deal with NSSI adolescents and Feeling hard and stressful working with NSSI adolescents) and (2) External barriers (Unrealistic high expectations from family and schools, Uncooperative parents and Little help from communities and schools). CONCLUSIONS Psychiatric nurses had to face with their own negative feelings, insufficient knowledge and skills, alongside with pressures and little help from family, schools and communities when working with NSSI adolescents. Targeted training programs of treating NSSI adolescents and their supporting systems be performed in nurses, furthermore, family, schools and societies should also be raised.
Collapse
Affiliation(s)
- Xuting Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shiyan Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yusheng Tian
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Juan He
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hui Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Meng Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zengyu Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiaxin Yang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
17
|
Geng S, Wang L, Sun J, Xu M, Zhang L, Yi Z, Ji J, Zhang X. Risk factors and protective factors for nonsuicidal self-injury in adolescents: A hospital- and school-based case-control study. Clin Child Psychol Psychiatry 2023; 28:1321-1332. [PMID: 37038624 DOI: 10.1177/13591045231169087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Nonsuicidal Self-Injury (NSSI) in China has increasingly interested clinicians, although few studies have investigated its risk and protective factors. This study examined the risk factors of NSSI among Chinese adolescents. METHODS The researchers recruited adolescent participants with NSSI from a hospital outpatient clinic to form a case group and recruited adolescents without NSSI who provided informed consent from the school to form a control group. Participants completed a questionnaire, and data were analyzed using logistic regression. RESULTS A total of 138 cases and 276 controls participated in this study. Binary multivariate logistic regression analysis with adjusting for age and sex showed that domestic violence (OR = 8.615, 95%CI: 3.081-24.091), parental overconcern (OR = 6.995, 95%CI: 3.447-14.192), guilt (OR = 4.949, 95%CI: 2.227-10.996), and school bullying (OR = 21.676, 95%CI: 6.799-69.109) increased the risk of NSSI, while peer support (OR = 0.068, 95%CI: 0.030-0.150) and living in an urban environment (OR = 0.157, 95%CI: 0.056-0.437) decreased the risk of NSSI. CONCLUSION Some psychosocial factors were confirmed to be independent risk and protective factors for NSSI in this study. However, the clinical significance of the results needs to be interpreted with caution due to sample size limitations.
Collapse
Affiliation(s)
- Shuo Geng
- Department of Clinical Psychology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lin Wang
- Sleep Medicine Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jinping Sun
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingdong Xu
- Department of Clinical Psychology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Zhang
- Department of Psychology, Qingdao University, Qingdao, China
| | - Zhi Yi
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jun Ji
- College of Computer Science and Technology, Qingdao University, Qingdao, China
| | - Xu Zhang
- Department of Clinical Psychology, the Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
18
|
Hamza CA, Robinson K, Hasking PA, Heath NL, Lewis SP, Lloyd-Richardson E, Whitlock J, Wilson MS. Educational stakeholders' attitudes and knowledge about nonsuicidal self-injury among university students: A cross-national study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2140-2150. [PMID: 34380005 DOI: 10.1080/07448481.2021.1961782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a commonly occurring, yet historically poorly understood, mental health concern among post-secondary students. The present study sought to identify the current knowledge needs of university stakeholders to inform training efforts around effective NSSI response and student support on university campuses. Participants were 1,762 university students, staff, and student-staff (77% female) from seven universities in Canada, the USA, New Zealand, and Australia. Participants completed an online survey about their attitudes and knowledge of both general mental health and NSSI. University stakeholders reported significantly greater stigma toward NSSI than mental illness in general. Student-staff reported greater perceived knowledge and comfort, and demonstrated greater knowledge of NSSI, than students and staff. Findings underscore the need for additional training and resources to reduce stigma and increase knowledge about NSSI on university campuses internationally.
Collapse
Affiliation(s)
- Chloe A Hamza
- Applied Psychology and Human Development, University of Toronto Ontario Institute for Studies in Education, Toronto, Ontario, Canada
| | - Kealagh Robinson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Penny A Hasking
- Health Sciences, School of Psychology, Curtin University, Perth, Australia
| | - Nancy L Heath
- Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | | | - Janis Whitlock
- Family Life Development Center, Cornell University, Ithaca, New York, USA
| | - Marc S Wilson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| |
Collapse
|
19
|
Qu D, Wen X, Liu B, Zhang X, He Y, Chen D, Duan X, Yu J, Liu D, Zhang X, Ou J, Zhou J, Cui Z, An J, Wang Y, Zhou X, Yuan T, Tang J, Yue W, Chen R. Non-suicidal self-injury in Chinese population: a scoping review of prevalence, method, risk factors and preventive interventions. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100794. [PMID: 37693882 PMCID: PMC10485683 DOI: 10.1016/j.lanwpc.2023.100794] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/06/2023] [Accepted: 05/04/2023] [Indexed: 09/12/2023]
Abstract
Non-suicidal self-injury behavior (NSSI) is a serious public health concern that requires immediate attention. Despite the high prevalence of NSSI among the Chinese population, there is a significant gap in research on the comprehensive picture of this field. Therefore, a scoping review was conducted to investigate the prevalence, methods, risk factors, and preventive intervention programs related to NSSI in China. The review found that the estimated lifetime prevalence of NSSI among Chinese youth population is alarmingly high at 24.7% (N = 1,088,433). Common methods of NSSI include scratching, hitting, and biting. Additionally, the review synthesized 249 risk factors based on the biopsychosocial-ecological framework, highlighting the urgent need for intervention. However, only 12 empirical studies focus on NSSI prevention or intervention programs were included. These findings underscore the necessity for more clinical practices and larger studies to identify effective interventions and ultimately alleviate the burden of NSSI on the Chinese population. Funding This review was supported by Humanity and Social Science Youth foundation of Ministry of Education (22YJCZH018), Science and Technology Innovation 2030 (STI2030-Major Projects:2021ZD0200702), National Natural Science Foundation of China (81825009), and Shuimu Tsinghua Scholar. No funding agencies were involved in the data collection, data analysis, and writing of this paper.
Collapse
Affiliation(s)
- Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Xue Wen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Bowen Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Xuan Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuhao He
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Dongyang Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Xueer Duan
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jiaao Yu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Dongyu Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Xiaoqian Zhang
- Department of Psychiatry, Tsinghua University Yuquan Hospital, Beijing, China
| | - Jianjun Ou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Zaixu Cui
- Chinese Institute for Brain Research, Beijing, 102206, China
| | - Jing An
- Beijing Huilongguan Hospital, Beijing, China
- Peking University Huilongguan Clinical Medical School, Beijing, China
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tifei Yuan
- Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie Tang
- Department of Preventive, School of Public Health, Guangzhou Medical University, China
| | - Weihua Yue
- Chinese Institute for Brain Research, Beijing, 102206, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| |
Collapse
|
20
|
Rodante DE, Chiapella LC, Olivera Fedi R, Papávero EB, Lavoie KL, Daray FM. A randomized 3-month, parallel-group, controlled trial of CALMA m-health app as an adjunct to therapy to reduce suicidal and non-suicidal self-injurious behaviors in adolescents: study protocol. Front Psychiatry 2023; 14:1087097. [PMID: 37547219 PMCID: PMC10397405 DOI: 10.3389/fpsyt.2023.1087097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background Suicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth. Methods To test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period. Discussion This study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America. Clinical trial registration https://clinicaltrials.gov/, NCT05453370.
Collapse
Affiliation(s)
- Demián Emanuel Rodante
- Facultad de Medicina, Universidad de Buenos Aires, Instituto de Farmacología, Buenos Aires, Argentina
- “Dr. Braulio A. Moyano” Neuropsychiatric Hospital, Buenos Aires, Argentina
- FORO Foundation for Mental Health, Buenos Aires, Argentina
| | - Luciana Carla Chiapella
- Pharmacology Area, Faculty of Biochemical and Pharmaceutical Sciences, National University of Rosario, Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Ramiro Olivera Fedi
- Facultad de Medicina, Universidad de Buenos Aires, Instituto de Farmacología, Buenos Aires, Argentina
| | - Eliana Belén Papávero
- Facultad de Medicina, Universidad de Buenos Aires, Instituto de Farmacología, Buenos Aires, Argentina
- FORO Foundation for Mental Health, Buenos Aires, Argentina
- Pedro de Elizalde Children’s General Hospital, Buenos Aires, Argentina
| | - Kim L. Lavoie
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Federico Manuel Daray
- Facultad de Medicina, Universidad de Buenos Aires, Instituto de Farmacología, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| |
Collapse
|
21
|
Masland SR, Finch EF, Schnell SE. Effects of Group Psychotherapy for Nonsuicidal Self-Injury: A Meta-Analysis. Int J Group Psychother 2023; 73:183-201. [PMID: 38446601 DOI: 10.1080/00207284.2023.2191683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Nonsuicidal self-injury (NSSI) is prevalent and concerning among adolescents and adults. Although prior meta-analytic work has considered the efficacy of individual psychotherapy for reducing NSSI, the efficacy of group psychotherapy remains unclear. We conducted a systematic meta-analysis of group psychotherapy studies with NSSI measures. We identified a total of eight studies, including published articles (n = 6) or dissertations (n = 2) with 10 total effect sizes for group interventions. Overall, random-effects meta-analysis suggests that group psychotherapies have a significant small effect on NSSI. However, when corrected for publication bias, the effect is no longer significant. This meta-analysis cautiously suggests that group psychotherapies, which are cost-effective and efficient, hold promise for attenuating NSSI. The field would benefit from further study and treatment refinement, including consideration of what works for whom.
Collapse
|
22
|
Dai L, Zhang X, Yu R, Wang X, Deng F, Li X, Kuang L. Abnormal brain spontaneous activity in major depressive disorder adolescents with non-suicidal self injury and its changes after sertraline therapy. Front Psychiatry 2023; 14:1177227. [PMID: 37383613 PMCID: PMC10293671 DOI: 10.3389/fpsyt.2023.1177227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) commonly occurs among adolescents with major depressive disorder (MDD), causing adverse effects on the physical and mental health of the patients. However, the underlying neurobiological mechanism of NSSI in adolescents with MDD (nsMDDs) remains unclear, and there are still challenges in the treatment. Studies have suggested that sertraline administration could be an effective way for treatment. Methods To verify the effectiveness and to explore the neurobiological processes, we treated a group of adolescents with nsMDDs with sertraline in this study. The brain spontaneous activity alteration was then investigated in fifteen unmedicated first-episode adolescent nsMDDs versus twenty-two healthy controls through the resting-state functional magnetic resonance imaging. Besides the baseline scanning for all participants, the nsMDDs group was scanned again after eight weeks of sertraline therapy to examine the changes after treatment. Results At pre-treatment, whole brain analysis of mean amplitude of low-frequency fluctuation (mALFF) was performed to examine the neuronal spontaneous activity alteration, and increased mALFF was found in the superior occipital extending to lingual gyrus in adolescent nsMDDs compared with controls. Meanwhile, decreased mALFF was found in the medial superior frontal in adolescent nsMDDs compared with controls. Compared with the pre-treatment, the nsMDDs group was found to have a trend of, respectively, decreased and increased functional neuronal activity at the two brain areas after treatment through the region of interest analysis. Further, whole brain comparison of mALFF at pre-treatment and post-treatment showed significantly decreased spontaneous activity in the orbital middle frontal and lingual gyrus in adolescent nsMDDs after treatment. Also, depression severity was significantly decreased after treatment. Conclusion The abnormal functional neuronal activity found at frontal and occipital cortex implied cognitive and affective disturbances in adolescent nsMDDs. The trend of upregulation of frontal neuronal activity and downregulation of occipital neuronal activity after sertraline treatment indicated that the therapy could be effective in regulating the abnormality. Notably, the significantly decreased neuronal activity in the decision related orbital middle frontal and anxiety-depression related lingual gyrus could be suggestive of reduced NSSI in adolescent MDD after therapy.
Collapse
Affiliation(s)
- Linqi Dai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoliu Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Renqiang Yu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xingyu Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Deng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xue Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
23
|
Scheunemann J, Kühn S, Biedermann SV, Lipp M, Peth J, Gallinat J, Jelinek L. Implicit cognitions on self-injurious and suicidal behavior in borderline personality disorder. J Behav Ther Exp Psychiatry 2023; 79:101836. [PMID: 36709601 DOI: 10.1016/j.jbtep.2023.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Performance on implicit measures of suicidality has been associated with suicidal and nonsuicidal self-injury. Despite the high prevalence of self-harm in patients with borderline personality disorder (BPD), no previous study has assessed implicit measures in this patient group. METHODS Forty patients with BPD and 25 healthy controls completed three implicit association tests (IATs) (Death words - Me/Others words, Self-Harm pictures - Me/Others, and Self-Harm pictures - Good/Bad words) and a subliminal priming task (effect of the primes "dying"/"growing" on the categorization speed of positive/negative adjectives) as well as measures of psychopathology (suicidal ideation, previous nonsuicidal self-injury, borderline symptomatology, depression, and hopelessness). RESULTS Patients with BPD had higher scores on all three IATs than healthy controls. The subliminal priming procedure did not reveal group differences. Correlations between implicit measures and psychopathology among patients with BPD were mostly weak and nonsignificant with a few exceptions: Positive correlations were observed between IAT Self-Harm - Good/Bad and lifetime frequency of nonsuicidal self-injury, between IAT Self-Harm - Me/Others and depression, and between IAT Death - Me/Others and depression. Correlations between implicit measures were weak to moderate. LIMITATIONS The study was cross-sectional only, and the study had reduced power as the sample size was limited. CONCLUSIONS As expected, patients with BPD had higher scores than healthy controls on the IATs, which indicates higher implicit self-identification with self-harm and death as well as stronger implicit positive attitudes towards self-harm. The mostly weak correlations between implicit and explicit measures speak against the discriminative value of IATs in patients with BPD.
Collapse
Affiliation(s)
- Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany; Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Michael Lipp
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Judith Peth
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| |
Collapse
|
24
|
Yu W, Li S, Xiao W, Li X, Wang R, Liu J, Zhang S, Wan Y. Childhood maltreatment and non-suicidal self-injury among Chinese college students: The moderating roles of social phobia and perceived family economic status. CHILD ABUSE & NEGLECT 2023; 139:106113. [PMID: 36933367 DOI: 10.1016/j.chiabu.2023.106113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Non-suicidal self-injury is a heavy burden on affected college students with rippling effects throughout their lives. Childhood maltreatment is strongly associated with non-suicidal self-injury among college students. However, it remains unclear whether perceived family economic status and social phobia exert significant moderating effects on the relationship between childhood maltreatment and non-suicidal self-injury. OBJECTIVE This study aimed to identify the perceived family economic status and social phobia moderating the association between childhood maltreatment and non-suicidal self-injury. PARTICIPANTS AND SETTING This study used data (N = 5297) from two local medical colleges in Anhui province, China. METHODS Respondents completed questionnaires on childhood maltreatment, non-suicidal self-injury, social phobia and perceived family economic status online. Data were analyzed using Spearman's correlation followed by multiple moderation models. RESULTS The association between childhood maltreatment and non-suicidal self-injury was moderated by social phobia (β = 0.03, p < 0.05) and perceived family economic status (β = -0.30, p < 0.05). When considered together, both factors were found to play synergistic roles in the association between childhood maltreatment and non-suicidal self-injury in college students (β = 0.08, p < 0.001). CONCLUSION Our findings highlight that experience of childhood maltreatment, elevated social phobia, and low perceived family economic status increase the risk of non-suicidal self-injury. Future researches are recommended to conduct interventions from a more holistic perspective and integrate perceived family economic status as a relevant factor along with social phobia in coping with non-suicidal self-injury in college students.
Collapse
Affiliation(s)
- WeiQiang Yu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
| | - ShuQin Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
| | - Wan Xiao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
| | - Xin Li
- School of Clinical Medical, Anqing Medical College, Anhui, China
| | - Rui Wang
- Information Technology Office, Anqing Medical College, Anhui, China
| | - Jing Liu
- Department of Nursing, Faculty of Medicine, Union University of Huainan, Anhui, China
| | - Shichen Zhang
- Shool of Public Health and Health Management, Anhui Medical College, Anhui, China.
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
25
|
He H, Hong L, Jin W, Xu Y, Kang W, Liu J, Song J, Zheng T, Chen H, Zhao K. Heterogeneity of non-suicidal self-injury behavior in adolescents with depression: latent class analysis. BMC Psychiatry 2023; 23:301. [PMID: 37127584 PMCID: PMC10152699 DOI: 10.1186/s12888-023-04808-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/20/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) by adolescent patients with depression has become a serious public health problem. This cross-sectional study aims to identify subgroups of adolescents based on NSSI and explore the factors related to these subgroups. METHODS The study recruited 326 in- and out-patient adolescents (263 girls and 63 boys) aged 12 to 18 years (mean = 14.7, SD = 1.6) who had self-injured in the past year. Latent class indicators included 12 NSSI variables, as well as suicidal ideation. Logistic regression examined associations between identified classes and related factors. RESULTS In this study, two distinct subgroups were identified: a "high suicidal ideation NSSI group" (n = 129, 39.6%) and a "low suicidal ideation NSSI group" (n = 197, 60.4%). Depression (OR = 1.10; 95% CI, 1.05-1.16), female (OR = 2.01; 95% CI, 1.09-3.69), left-behind experience (OR = 2.08; 95% CI, 1.17-3.71), single-parent family (OR = 1.84; 95% CI, 1.11-3.04) and peer victimization (OR = 1.04; 95% CI, 1.02-1.05) increases the probability of belonging to the "high suicidal ideation NSSI group". A high level of perceived social support (OR = 0.99; 95% CI, 0.97-0.99) was a protective factor towards NSSI. CONCLUSIONS This study identifies two subgroups of NSSI and the factors associated with each subgroup. The early identification of high-risk groups for major NSSI in adolescents diagnosed with depression is possible due to the identification of correlating factors. Different treatment plans can be developed for different subtypes of NSSI to improve the effectiveness of prevention and intervention, promoting the healthy physical and mental development of adolescents with depression.
Collapse
Affiliation(s)
- He He
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Lan Hong
- The Third Hospital of QuZhou, Quzhou, 324003, China
| | - Wei Jin
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Yao Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Wei Kang
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Jie Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Jingyao Song
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Tiansheng Zheng
- The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Chen
- Department of Psychiatry, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- Lishui Second People's Hospital Affiliated to Wenzhou Medical University, Lishui, China.
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China.
| |
Collapse
|
26
|
O'Loghlen E, Galligan R, Grant S. The functions of binge eating scale (FBES): Development and preliminary psychometric validation. Appetite 2023; 183:106479. [PMID: 36736905 DOI: 10.1016/j.appet.2023.106479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Binge eating within binge-eating disorder (BED) is a behaviour widely understood as a response to dietary restraint and emotion dysregulation. However, qualitative literature suggests that a wider range of functions of binge eating exist, with associations between functions of binge eating and adverse childhood experiences highlighted across this research. The present study sought to develop a scale to measure a wide range of functions of binge eating within BED. A secondary aim was to examine the relationship between these functions and adverse childhood experiences (ACEs). METHOD The researchers developed an initial item pool for the Functions of Binge Eating Scale (FBES) and invited experts within the eating disorder (ED) field (n = 22) to review the items. The refined item pool was administered online to adults with self-reported binge eating symptoms (N = 882), along with related measures to establish scale validity. RESULTS Exploratory and confirmatory factor analyses produced an eight-factor structure (emotion regulation, hedonic hunger, compensatory eating, numbness/dissociation, emotion expression, self-punishment, control, self-protection). The scale demonstrated good internal reliability and adequate construct and predictive validity. Results also showed that functions theoretically related to childhood maltreatment were predicted by ACEs. DISCUSSION Findings extend our understanding of the range of functions of binge eating experienced in BED. Additionally, findings indicate that type of adverse childhood experience predicts functions of binge eating. Initial validation of the FBES suggests that functions of binge eating are wider than previously understood. Accordingly, clinicians are encouraged to explore and target more complex processes which might perpetuate binge-eating behaviour.
Collapse
Affiliation(s)
- Elyse O'Loghlen
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Roslyn Galligan
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Sharon Grant
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| |
Collapse
|
27
|
Taylor PJ, Duxbury P, Moorhouse J, Russell C, Pratt D, Parker S, Sutton C, Lobban F, Drake R, Eccles S, Ryder D, Patel R, Kimber E, Kerry E, Randles N, Kelly J, Palmier-Claus J. The Mental Imagery for Suicidality in Students Trial (MISST): study protocol for a feasibility randomised controlled trial of broad-minded affective coping (BMAC) plus risk assessment and signposting versus risk assessment and signposting alone. Pilot Feasibility Stud 2023; 9:43. [PMID: 36932430 PMCID: PMC10021063 DOI: 10.1186/s40814-023-01273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Going to university is an important milestone in many people's lives. It can also be a time of significant challenge and stress. There are growing concerns about mental health amongst student populations including suicide risk. Student mental health and counselling services have the potential to prevent suicide, but evidence-based therapies are required that fit these service contexts. The Broad-Minded Affective Coping intervention (BMAC) is a brief (6 sessions), positive imagery-based intervention that aims to enhance students access to past positive experiences and associated emotions and cognitions. Pilot data provides preliminary support for the BMAC for students struggling with suicidal thoughts and behaviours, but this intervention has not yet been evaluated in the context of a randomised controlled trial (RCT). The Mental Imagery for Suicidality in Students Trial (MISST) is a feasibility RCT that aims to determine the acceptability and feasibility of evaluating the BMAC as an intervention for university students at risk of suicide within a larger efficacy trial. Key feasibility uncertainties have been identified relating to recruitment, retention, and missing data. Intervention acceptability and safety will also be evaluated. METHOD MISST is a feasibility randomised controlled trial design, with 1:1 allocation to risk assessment and signposting plus BMAC or risk assessment and signposting alone. Participants will be university students who self-report experiences of suicidal ideation or behaviour in the past 3 months. Assessments take place at baseline, 8, 16, and 24 weeks. The target sample size is 66 participants. A subset of up to 20 participants will be invited to take part in semi-structured qualitative interviews to obtain further data concerning the acceptability of the intervention. DISCUSSION The BMAC intervention may provide an effective, brief talking therapy to help university students struggling with suicidal thoughts that could be readily implemented into university student counselling services. Depending on the results of MISST, the next step would be to undertake a larger-scale efficacy trial. TRIAL REGISTRATION The trial was preregistered (17 December 2021) on ISRCTN (ISRCTN13621293) and ClinicalTrials.gov (NCT05296538).
Collapse
Affiliation(s)
- Peter James Taylor
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Paula Duxbury
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jane Moorhouse
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Chloe Russell
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Dan Pratt
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK.,Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sophie Parker
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK.,Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Chris Sutton
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
| | - Fiona Lobban
- LA14YW, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Richard Drake
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Steve Eccles
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - David Ryder
- Division of Population Health, Health Services Research, and Primary Care, University of Manchester, Manchester, UK
| | - Rafeea Patel
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Eirian Kerry
- Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Nathan Randles
- School of Medicine, Keele University, Newcastle-Under-Lyme, UK
| | - James Kelly
- Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Doctorate in Clinical Psychology, Lancaster University, Lancaster, UK
| | - Jasper Palmier-Claus
- LA14YW, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK. .,Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK.
| |
Collapse
|
28
|
Internet based intervention (Emotion Regulation Individual Therapy for Adolescents) as add‐on to treatment as usual versus treatment as usual for non‐suicidal self‐injury in adolescent outpatients: The TEENS randomised feasibility trial. JCPP ADVANCES 2022. [DOI: 10.1002/jcv2.12115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
|
29
|
Psychotropic drugs for the treatment of non-suicidal self-injury in children and adolescents: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2022; 272:1559-1568. [PMID: 35174411 DOI: 10.1007/s00406-022-01385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
Non-suicidal self-injury (NSSI) in children and adolescents is a frequent phenomenon. NSSI at any time is a significant predictor of future NSSI but also, and more importantly, for suicide attempts. Less evidence is available for the impact, or more specifically, the therapeutic effect of psychotropic drugs on the emergence of NSSI in this population. The phenomenon is clinically highly relevant since adolescent psychiatric inpatients are often affected by NSSI and most of them are treated with psychotropic drugs. While previous reviews on NSSI comprised suicidal self-injury (SSI), this review aims at elucidating the potential impact of psychotropic drugs on the emergence of specifically NSSI in children and adolescents. Systematic searches of articles indexed electronically in PubMed, Embase and PsycInfo were conducted (PROSPERO CRD42020209505). Studies included in the quantitative synthesis were evaluated using the SIGN level of evidence rating. Meta-analyses were performed using RevMan (Version 5.4). 2227 records were identified through database searches. Two additional records were identified manually. In total, seven studies were included in qualitative and four studies in quantitative analyses. In a meta-analysis, selective serotonin reuptake inhibitors (SSRIs) were compared vs. control medication (placebo or serotonin-norepinephrine reuptake inhibitor) and here, no statistically significant difference between the groups could be observed regarding the frequency of NSSI events (Risk Ratio (RR) = 1.07, 95% confidence interval (CI) 0.60-1.91, p = 0.82, I2 = 12%). Evidence regarding the association of SSRI use and NSSI among children and adolescents is sparse and the impact of psychotropic drugs in general on NSSI rates in this population should be addressed in future clinical and observational studies.
Collapse
|
30
|
Abstract
Concerns have been raised about the impact of the COVID-19 pandemic on individuals with lived experience of nonsuicidal self-injury (NSSI). Yet, few efforts have explored this. Accordingly, using a mixed-methods approach, we sought to examine whether emerging adults who have self-injured experienced changes in NSSI urges and behavior during the pandemic and what may have accounted for these changes. To do so, university students with lived experience of NSSI completed online questions asking about NSSI and self-reported changes in urges and behavior since the onset of COVID-19. They then answered open-ended questions asking what contributed to these changes and how they have coped during this timeframe. Approximately 80% of participants reported no change or a decrease in NSSI urges and behavior. Participants discussed removal from stressors (e.g., social stress) that previously evoked NSSI, as well as having time for self-care and to develop resilience as accounting for this. Nevertheless, some participants reported challenges amid the pandemic (i.e., exacerbated stress, isolation); approximately one fifth of participants reported increases in NSSI urges and behavior. Our findings add to recent evidence that many individuals with prior mental health difficulties, including NSSI, can demonstrate resilience in the face of collective adversity. Research and clinician implications are discussed.
Collapse
|
31
|
Efficacy of psychotropic medications on suicide and self-injury: a meta-analysis of randomized controlled trials. Transl Psychiatry 2022; 12:400. [PMID: 36130938 PMCID: PMC9492722 DOI: 10.1038/s41398-022-02173-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
Using psychotropic medications to treat and prevent self-injurious thoughts and behaviors (SITBs) has become increasingly popular, but conclusive evidence supporting the efficacy this approach remains elusive. To empirically examine whether psychotropic medications are efficacious treatments for SITBs, the present meta-analysis comprehensively summarizes all published randomized controlled trials (RCTs) that have reported the causal effects of psychotropic medications on suicide and self-injury. A total of 251 papers from 718 unique RCTs were included. A frequentist pairwise approach was adopted for meta-analyses. Potential effect modifiers were examined via met regressions and potential biases were evaluated through sensitivity analyses. On average, medications yielded an 8% reduction in SITB frequency and a reduction of 0.2 standard deviations in symptoms and severity. Findings were largely consistent across potential effect modifiers, and significant evidence of publication bias was not detected. Only one medication class (i.e., antipsychotics) and two specific medications (i.e., citalopram, ketamine) produced larger-than-average treatment effects. Psychostimulants and typical antipsychotics may produce iatrogenic effects. Less than 4% of included studies required individuals to exhibit SITBs, and nearly half of analyzed effects were drawn from studies that excluded individuals on the basis of SITB risk. Taken together, findings suggest that psychotropic medications produce small treatment effects on SITBs; however, these findings should be considered in light of the methodological constraints of the existing literature, including the lack of studies intentionally including individuals with SITBs. It is critical for future RCTs to prioritize including individuals with existing SITBs to further clarify treatment effects in self-injurious and suicidal populations. Additional research is needed to better understand the treatment mechanisms of psychotropic medications and identify the causal processes underlying SITBs.
Collapse
|
32
|
Christoforou R, Ferreira N. The serial mediational role of attachment and emotion regulation in the relationship between early life adverse experiences and self-harm in a group of individuals engaging in self-harm who interact in self-harm focused online platforms. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Brañas MJAA, Croci MS, Murray GE, Choi-Kain LW. The Relationship Between Self-Harm and Suicide in Adolescents and Young Adults. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20220715-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
34
|
Guo J, Gao Q, Wu R, Ying J, You J. Parental Psychological Control, Parent-Related Loneliness, Depressive Symptoms, and Regulatory Emotional Self-Efficacy: A Moderated Serial Mediation Model of Nonsuicidal Self-Injury. Arch Suicide Res 2022; 26:1462-1477. [PMID: 34586982 DOI: 10.1080/13811118.2021.1922109] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Adolescent nonsuicidal self-injury (NSSI) has become an alarming public health concern. Parental psychological control has been identified as a risk factor for NSSI in some western samples. However, the relationship between parental psychological control and NSSI remains unclear among Chinese adolescents. Furthermore, little is known about how parental psychological control affects NSSI. This study aims to examine a moderated serial mediation model of NSSI, revealing the mediating and moderating mechanisms underlying the relationship between parental psychological control and NSSI. METHOD A total of 953 Chinese secondary school students (47.7% females, mean age = 12.53 years, SD = 0.63) completed questionnaires of NSSI, parental psychological control, parent-related loneliness, depressive symptoms, and regulatory emotional self-efficacy. RESULTS Parental psychological control was positively associated with NSSI. This association was mediated by parent-related loneliness and depressive symptoms independently. Also, it was serially mediated by parent-related loneliness and depressive symptoms. In addition, regulatory emotional self-efficacy moderated the indirect relationships between parental psychological control and NSSI. CONCLUSIONS Findings of this study shed light on how NSSI is affected by parental psychological control, parent-related loneliness, depressive symptoms, and regulatory emotional self-efficacy, and provide insights into the prevention and intervention measures targeting adolescent NSSI.HIGHLIGHTSParental psychological control was positively associated with NSSI.Parent-related loneliness and depressive symptoms independently and serially mediated the association between parental psychological control and NSSI.Regulatory emotional self-efficacy moderated the indirect relationships between parental psychological control and NSSI.
Collapse
|
35
|
Guo J, Ying J, Zhou X, Wang C, Lin N, You J. Double hurt: The impact of interpersonal-level stigma on nonsuicidal self-injury among lesbian, gay, and bisexual individuals. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
36
|
Calvo N, García-González S, Perez-Galbarro C, Regales-Peco C, Lugo-Marin J, Ramos-Quiroga JA, Ferrer M. Psychotherapeutic interventions specifically developed for NSSI in adolescence: A systematic review. Eur Neuropsychopharmacol 2022; 58:86-98. [PMID: 35325633 DOI: 10.1016/j.euroneuro.2022.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
Non-suicidal self-injury (NSSI) is a clinically significant behavior with high relevance and prevalence, especially affecting approximately 17-18% of the adolescent population worldwide. The aim of this study is to perform a systematic review to evaluate the effectiveness of the available Specific Psychotherapeutic Interventions (SPI) focused on the reduction of NSSI behaviors. A systematic review was performed analyzing PsychINFO, MEDLINE, Web of Science, PubMed and Cochrane CentralRegister of Controlled Trials to identify studies of interest from January 2010 to December 2020. According to PRISMA guidelines, only 13 studies were included in the review. Six SPI were found to specifically and significantly reduce NSSI in adolescents: Developmental Group Psychotherapy (DGP), Therapeutic Assessment (TA), Cutting Down Program (CDP), Emotional Regulation Individual Therapy for Adolescents (ERITA), Treatment for Self-Injurious Behaviors (T-SIB) and Intensive Contextual Treatment (ICT). Furthermore, relevant improvements in anxiety and depression symptoms were observed. The results of this review demonstrate the effectiveness of these interventions, mainly the CPD and T-SIB, which are the only SPI that have been studied using Randomized Controlled Trial (RCT). Considering the clinical relevance and associated functional impairment of NSSI, more research is needed to replicate the results and to increase knowledge about SPIs.
Collapse
Affiliation(s)
- Natalia Calvo
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Grup TLP Barcelona.
| | - Sara García-González
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Citlalli Perez-Galbarro
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Christina Regales-Peco
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Jorge Lugo-Marin
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Josep-Antoni Ramos-Quiroga
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Grup TLP Barcelona
| | - Marc Ferrer
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Grup TLP Barcelona
| |
Collapse
|
37
|
Johnson BN, McKernan LC, Bruehl S. A Theoretical Endogenous Opioid Neurobiological Framework for Co-occurring Pain, Trauma, and Non-suicidal Self-injury. Curr Pain Headache Rep 2022; 26:405-414. [PMID: 35380406 DOI: 10.1007/s11916-022-01043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Individuals with chronic pain are significantly more likely to have experienced overwhelming trauma early and often in key developmental years. There is increasing acknowledgment that childhood trauma disrupts how individuals process and cope with both physical and emotional pain. Emerging studies acknowledge elevated rates of non-suicidal self-injury (NSSI) in chronic pain populations. This review provides a theoretical framework to understand the relationship between NSSI behavior and pain experience in persons with chronic pain and childhood trauma histories. We discuss how NSSI may act to regulate neurobiological (e.g., endogenous opioid systems) and psychological (e.g., heightened negative affect and emotion dysregulation) systems affected by childhood trauma, leading to temporary pain relief and a cycle of negative reinforcement perpetuating NSSI. As these concepts are greatly understudied in pain populations, this review focuses on key areas relevant to chronic pain that may provide a testable, conceptual framework to support hypothesis generation, future empirical investigation, and intervention efforts. RECENT FINDINGS See Fig. 1. See Fig. 1.
Collapse
|
38
|
Zinchuk M, Beghi M, Beghi E, Bianchi E, Avedisova A, Yakovlev A, Guekht A. Non-Suicidal Self-Injury in Russian Patients with Suicidal Ideation. Arch Suicide Res 2022; 26:776-800. [PMID: 33108991 DOI: 10.1080/13811118.2020.1833801] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is recognized as a public health concern for its association with unfavorable outcomes, including suicidal behavior. The aim of this study is to identify factors associated with NSSI among patients with nonpsychotic mental disorders (NPMD) and suicidal ideation in Russia. METHODS A retrospective cohort study was conducted in the Moscow Research and Clinical Center for Neuropsychiatry between November 2017 and May 2019. The sample was composed of consecutive patients with lifetime suicidal ideation (from the Self-Injurious Thoughts and Behavior Interview) seen in the center's psychiatric ward for NPMD. The patients were divided into two groups: those with and without lifetime NSSI. Sociodemographic variables, psychiatric diagnosis, family history of mental disorders, history of physical or sexual abuse, sexual behavior, ad-hoc psychiatric treatments, suicidal ideation, plans, and gestures or attempts were investigated. RESULTS Six thousand, two hundred and four consecutive patients were screened for suicidal ideation. Out of a total of 361 patients (87.3% females) with suicidal ideation, 217 (60.1%) reported NSSI. Variables independently associated with NSSI included age <25 years (OR 6.0, CI 2.5-14.7), dissatisfaction with the perceived parenting style (OR 3.3, CI 1.5-7.4), bullying (OR 2.6, CI 1.0-6.5), severe body modifications (OR 11.9, CI 1.1-134.3), experience with illicit drugs (OR 4.4, CI 1.9-10.3), and eating disorders (OR 4.9, CI 2.0-11.8). LIMITATIONS Retrospective design, referral population, single center study, and exclusion of psychotic patients. CONCLUSIONS NSSI is associated with age <25 years old, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug-use, and lifetime eating disorders.HIGHLIGHTSNonsuicidal self-injury is a significant public health concern for its association with suicidal behavior.60.1% of Russian patients with non-psychotic mental disorders (NPMD) and suicidal ideation reported lifetime NSSI.NSSI in Russian patients with NPMD and suicidal ideation is associated with age less than 25 years, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug use, and lifetime eating disorders.
Collapse
|
39
|
Himelein-Wachowiak M, Giorgi S, Kwarteng A, Schriefer D, Smitterberg C, Yadeta K, Bragard E, Devoto A, Ungar L, Curtis B. Getting "clean" from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm. J Behav Addict 2022; 11:128-139. [PMID: 35312631 PMCID: PMC9109623 DOI: 10.1556/2006.2022.00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/21/2022] [Accepted: 02/27/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND & AIMS Previous studies have shown that nonsuicidal self-injury (NSSI) has addictive features, and an addiction model of NSSI has been considered. Addictive features have been associated with severity of NSSI and adverse psychological experiences. Yet, there is debate over the extent to which NSSI and substance use disorders (SUDs) are similar experientially. METHODS To evaluate the extent that people who self-injure experience NSSI like an addiction, we coded the posts of users of the subreddit r/selfharm (n = 500) for each of 11 DSM-5 SUD criteria adapted to NSSI. RESULTS A majority (76.8%) of users endorsed at least two adapted SUD criteria in their posts, indicative of mild, moderate, or severe addiction. The most frequently endorsed criteria were urges or cravings (67.6%), escalating severity or tolerance (46.7%), and NSSI that is particularly hazardous. User-level addictive features positively predicted number of methods used for NSSI, number of psychiatric disorders, and particularly hazardous NSSI, but not suicidality. We also observed frequent use of language and concepts common in SUD recovery circles like Alcoholics Anonymous. DISCUSSION & CONCLUSION Our findings support previous work describing the addiction potential of NSSI and associating addictive features with clinical severity. These results suggest that NSSI and SUD may share experiential similarities, which has implications for the treatment of NSSI. We also contribute to a growing body of work that uses social media as a window into the subjective experiences of stigmatized populations.
Collapse
Affiliation(s)
| | - Salvatore Giorgi
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA,Department of Computer and Information Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Kwarteng
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Destiny Schriefer
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Chase Smitterberg
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Kenna Yadeta
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Elise Bragard
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA,Department of Psychology, Fordham University, Bronx, NY, USA
| | - Amanda Devoto
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Lyle Ungar
- Department of Computer and Information Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Curtis
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA,Corresponding author. Biomedical Research Center, 251 Bayview Blvd. Suite 200, Baltimore, MD 21224, USA. Tel.:+ 443-740-2126. E-mail:
| |
Collapse
|
40
|
Goodman D, Pletch A, Paul P, Anderson E, Kverno K. Nonsuicidal Self-Injury: A Nurse-Led Quality Improvement Project to Address Self-Harm. J Psychosoc Nurs Ment Health Serv 2022; 60:7-10. [PMID: 35244492 DOI: 10.3928/02793695-20220208-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nonsuicidal self-injury (NSSI) behaviors, such as cutting, scratching, or more severe injuries, are frequently comorbid with neurodevelopmental, intellectual, trauma, personality, and major depressive disorders, complicating treatment and placing added care burdens on hospital nursing staff and advanced practice nurses. Although specific psychopharmacological treatment guidelines and approved medications for NSSI are non-existent, patients are treated with medications approved for co-morbid disorders and behavioral interventions targeting intrapersonal (poor emotional self-regulation) and interpersonal (communication of distress) functions. The current article describes a nurse-led quality improvement project, using the Plan-Do-Study-Act cycle, in a case example. Outcomes include improved staff competencies and policies, yet we remain challenged in implementing planned actions that add additional time burdens to already stretched care providers. [Journal of Psychosocial Nursing and Mental Health Services, 60(3), 7-10.].
Collapse
|
41
|
Rayner GC, Bowling G, Bluff L, Wright K, Ashworth‐Lord A, Laird C. A multi‐method evaluation of a compassion‐focused cognitive behavioural psychotherapy group for people who self‐harm. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gillian Clare Rayner
- Reader in Counselling & Psychotherapy, University of Central Lancashire (UCLan) Lancashire UK
| | - Gosia Bowling
- National Lead Emotional Wellbeing Nuffield Health Manchester UK
| | - Lisa Bluff
- Perinatal Mental Health Training Lead Greater Manchester Mental Health NHS Foundation Trust Manchester UK
| | - Karen Wright
- Professor of Nursing University of Central Lancashire (UCLan) Preston UK
| | | | - Catriona Laird
- Cognitive Behavioural Psychotherapist Greater Manchester Mental Health NHS Foundation Trust Manchester UK
| |
Collapse
|
42
|
Remission of Suicidal Ideation in Emotionally Unstable Personality Disorder with Flupenthixol. Case Rep Psychiatry 2022; 2022:7097189. [PMID: 35070463 PMCID: PMC8776478 DOI: 10.1155/2022/7097189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022] Open
Abstract
There are currently no licensed pharmacological treatments for Emotionally Unstable Personality Disorder. This case report describes a 50-year-old male who two years previously had been brought to the attention of psychiatric services following an overdose with intention to end his life. He was subsequently diagnosed with Emotionally Unstable Personality Disorder (EUPD) and, following further suicide attempts and trials of mainstream pharmacological treatments, responded to flupenthixol IM 20 mg fortnightly, experiencing complete remission from his suicidal ideation. Clinicians should be aware of EUPD presenting in later life and should consider the role of typical antipsychotics, including flupenthixol, in the treatment of suicidal ideation in patients with EUPD. Age-specific guidance on EUPD management would be of use to clinicians, especially in the management of older patients, as current guidance is based on findings within a narrow age group.
Collapse
|
43
|
Mirichlis S, Hasking P, Lewis SP, Boyes ME. Correlates of disclosure of non-suicidal self-injury amongst Australian university students. JOURNAL OF PUBLIC MENTAL HEALTH 2022. [DOI: 10.1108/jpmh-07-2021-0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Non-suicidal self-injury (NSSI) is associated with psychological disorders and suicidal thoughts and behaviours; disclosure of NSSI can serve as a catalyst for help-seeking and self-advocacy amongst people who have self-injured. This study aims to identify the socio-demographic, NSSI-related, socio-cognitive and socio-emotional correlates of NSSI disclosure. Given elevated rates of NSSI amongst university students, this study aimed to investigate these factors amongst this population.
Design/methodology/approach
Australian university students (n = 573) completed online surveys; 80.2% had previously disclosed self-injury.
Findings
NSSI disclosure was associated with having a mental illness diagnosis, intrapersonal NSSI functions, specifically marking distress and anti-dissociation, having physical scars from NSSI, greater perceived impact of NSSI, less expectation that NSSI would result in communication and greater social support from friends and significant others.
Originality/value
Expanding on previous works in the area, this study incorporated cognitions about NSSI. The ways in which individuals think about the noticeability and impact of their NSSI, and the potential to gain support, are associated with the decision to disclose self-injury. Addressing the way individuals with lived experience consolidate these considerations could facilitate their agency in whether to disclose their NSSI and highlight considerations for health-care professionals working with clients who have lived experience of NSSI.
Collapse
|
44
|
Kerkelä M, Gissler M, Veijola J. Association between participation to the Northern Finland Birth Cohort 1986 and mental disorders and suicidal behaviour. Epidemiol Health 2022; 44:e2022005. [PMID: 34990532 PMCID: PMC9016388 DOI: 10.4178/epih.e2022005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In prospective follow-up studies, participants are normally contacted during the follow-up period. Even though the idea is not to intervene, the studies conducted during follow-up may affect the target population. Our hypotheses were that participation in the prospective Northern Finland Birth Cohort 1986 study (NFBC 1986) increased the use of mental health services and reduced suicidal behaviour due to participation in follow-up studies. METHODS The NFBC 1986 study covered people with an expected date of birth between July 1985 and June 1986 in northern Finland (n=9,396). The participants of the NFBC 1986 were followed since the antenatal period with follow-ups including clinical examinations. The comparison cohort comprised people born in the same area in 1987 (n=8,959), who were not contacted. Registry data on psychiatric treatment, suicide attempts, and suicides were available. Crude risk ratios (RRs) and adjusted (for marital status and education) Mantel-Haenszel RRs were reported. RESULTS No increase in mental disorders were found in NFBC 1986 compared to comparison cohort. In the crude RR analysis of female participants, a lower risk for suicide attempts was found (RR, 0.67; 95% confidence interval, 0.49 to 0.92; p=0.011). CONCLUSIONS The results did not support our first hypothesis regarding the increased use of mental health services in the NFBC 1986 cohort. However, our second hypothesis gained some support as female participants of the NFBC 1986 had a lower risk of suicide attempts, although it was not due to a higher number of participants receiving psychiatric treatment.
Collapse
Affiliation(s)
- Martta Kerkelä
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki , Finland.,University of Turku, Research Centre for Child Psychiatry, Turku, Finland.,Academic Primary Health Care Centre, Region Stockholm, Sweden.,Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Juha Veijola
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Department of Psychiatry University Hospital of Oulu, Oulu, Finland.,Medical Research Center, University Hospital and University of Oulu, Oulu, Finland
| |
Collapse
|
45
|
Zhang JJ, Liu YD, Zhang H, Huang ZH, Wang F, Yang JJ, Wang SB, Jia FJ, Hou CL. Correlates of Non-suicidal Self-Injury in Adolescent Psychiatric Patients in China. Front Psychiatry 2022; 13:864150. [PMID: 35832596 PMCID: PMC9271878 DOI: 10.3389/fpsyt.2022.864150] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) has attracted more and more attention from schools, mental health workers and even the whole society in China. The aim of this study was to explore influencing factors and clinical characteristics of NSSI in adolescent psychiatric patients in China, and provide valuable information for the intervention and treatment of NSSI. METHODS The sample included 157 adolescents, 114 were female (72.6%), aged 12-18 years (M = 15.39, SD = 1.81). Assessments were performed using Childhood Trauma Questionnaire-Short Form, the Revised Olweus Bully/Victim Questionnaire, the modified version of Adolescents Self-Harm Scale, Montgomery-Asberg Depression Rating Scale, Brief Psychiatric Rating Scale, the Young Mania Rating Scale and the Mini International Neuropsychiatric Interview. Clinical characteristics were collected from electronic medical record system. RESULTS Adolescent patients with NSSI experienced more adverse life events including peer bullying, childhood trauma and romantic relationship trouble. They had more times of hospitalization, higher dosage of psychotic medication, and more severe depressive symptoms. CONCLUSIONS It is very necessary to evaluate negative life events, including childhood trauma, peer bullying etc., in adolescent patients with NSSI. It has important clinical implications for evaluating the risk factors of NSSI and giving effective intervention treatment. Timely and effective treatment of these patients' depressive symptoms will also contribute to the relief of NSSI.
Collapse
Affiliation(s)
- Ji-Jie Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yin-Du Liu
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Hua Zhang
- Dongying People's Hospital, Dongying, China
| | - Zhuo-Hui Huang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fei Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing-Jing Yang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fu-Jun Jia
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cai-Lan Hou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Cai-Lan Hou
| |
Collapse
|
46
|
Thai TT, Jones MK, Nguyen TP, Pham TV, Bui HHT, Kim LX, Nguyen TV. The Prevalence, Correlates and Functions of Non-Suicidal Self-Injury in Vietnamese Adolescents. Psychol Res Behav Manag 2021; 14:1915-1927. [PMID: 34866944 PMCID: PMC8636691 DOI: 10.2147/prbm.s339168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Research conducted across different countries has consistently identified non-suicidal self-injury (NSSI) to be a common and significant public health problem. This study examined the prevalence, associated factors and functions of NSSI, among a large sample of Vietnamese adolescents. Methods A total of 1316 high school students (15-18 years old, 63.3% female) across urban and suburban areas in Ho Chi Minh City, participated in this cross-sectional study. NSSI was assessed by the Functional Assessment of Self-Mutilation. Results Almost half (43.9%) of the adolescents engaged in at least one type of NSSI within the preceding 12-month period and more than one quarter (26.1%) engaged in multiple types of NSSI. Hitting self on purpose (23.1%), picking at a wound (17.0%), or biting self (16.7%) were the most frequent behaviours. Severe forms of NSSI such as scraping, burning or erasing skin were reported by 17.2%. The most common functions for NSSI were to stop bad feelings (56.0%), to punish self (48.7%), to get control of a situation (44.0%) and to feel relaxed (42.2%). Symptoms of depression, anxiety and stress were significant factors associated with NSSI, particularly for participants who engaged in moderate/severe NSSI and multiple types of NSSI. Conclusion High rates of NSSI were found in Vietnamese adolescents. There is a pressing need for the development and implementation of effective interventions to reduce NSSI. Strategies that promote positive mental health and reduce symptoms of depression, anxiety and stress as well as approaches that help adolescents manage their internal emotions are likely to be beneficial.
Collapse
Affiliation(s)
- Truc Thanh Thai
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City Vietnam
| | - Mairwen K Jones
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Thao Phuong Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City Vietnam
| | - Thao Van Pham
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City Vietnam
| | - Han Hy Thi Bui
- Woolcock Institute of Medical Research Vietnam, Ho Chi Minh City, Vietnam
| | - Loan Xuan Kim
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City Vietnam
| | - Tap Van Nguyen
- Department of Medicine and Pharmacy, Tra Vinh University, Tra Vinh, Vietnam
| |
Collapse
|
47
|
Cohen RL, Drewes JL, Queen SE, Freeman ZT, Pate KM, Adams RJ, Graham DR, Hutchinson EK. Elucidation of the Central Serotonin Metabolism Pathway in Rhesus Macaques ( Macaca mulatta) with Self-injurious Behavior. Comp Med 2021; 71:466-473. [PMID: 34794530 PMCID: PMC8715763 DOI: 10.30802/aalas-cm-21-000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/10/2021] [Accepted: 07/30/2021] [Indexed: 11/05/2022]
Abstract
Macaques with self-injurious behavior (SIB) have been used as a model of human SIB and have previously been shown to respond to treatments targeting enhancement of central serotonin signaling, whether by supplementation with tryptophan, or by inhibiting synaptic reuptake. Decreased serotonin signaling in the brain has also been implicated in many human psychopathologies including major depression disorder. A disturbance in tryptophan metabolism that moves away from the production of serotonin and toward the production of kynurenine has been proposed as a major etiological factor of depression. We hypothesized that in macaques with SIB, central tryptophan metabolism would be shifted toward kynurenine production, leading to lower central serotonin (5-hydroxytryptamine). We analyzed tryptophan metabolites in the cerebral spinal fluid (CSF) of macaques with and without SIB to determine whether and where tryptophan metabolism is altered in affected animals as compared with behaviorally normal controls. We found that macaques with SIB had lower CSF concentrations of serotonin than did behaviorally normal macaques, and that these deficits were inversely correlated with the severity of abnormal behavior. However, our results suggest that this decrease is not due to shifting of the tryptophan metabolic pathway toward kynurenine, as concentrations of kynurenine were also low. Concentrations of IL6 were elevated, suggesting central inflammation. Determining the mechanism by which serotonin function is altered in self-injurious macaques could shed light on novel therapies for SIB and other disorders of serotonin signaling.
Collapse
Key Words
- 3hk, 3-hydroxykynurenine
- 5hiaa, 5-hydroxyindoleacetic acid
- 5-ht, serotonin
- d, depression
- ido, indoleamine 2,3-dioxygenase enzyme
- mrm, multiple reaction monitoring
- nhps, nonhuman primates
- nsf, no significant findings
- ptsd, post-traumatic stress disorder
- tdo, sd, suicidal depression
- sib, self-injurious behavior
- tryptophan 2,3-dioxygenase enzyme
Collapse
Affiliation(s)
- Rachael L Cohen
- Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Julia L Drewes
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Suzanne E Queen
- Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Zachary T Freeman
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI
| | - Kelly Metcalf Pate
- Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, MD
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA
| | - Robert J Adams
- Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - David R Graham
- Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Eric K Hutchinson
- Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, MD;,
| |
Collapse
|
48
|
Bentley KH, Maimone JS, Kilbury EN, Tate MS, Wisniewski H, Levine MT, Roberg R, Torous JB, Nock MK, Kleiman EM. Practices for monitoring and responding to incoming data on self-injurious thoughts and behaviors in intensive longitudinal studies: A systematic review. Clin Psychol Rev 2021; 90:102098. [PMID: 34763126 PMCID: PMC8663717 DOI: 10.1016/j.cpr.2021.102098] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/27/2021] [Accepted: 10/25/2021] [Indexed: 02/03/2023]
Abstract
Advancements in the understanding and prevention of self-injurious thoughts and behaviors (SITBs) are urgently needed. Intensive longitudinal data collection methods-such as ecological momentary assessment-capture fine-grained, "real-world" information about SITBs as they occur and thus have the potential to narrow this gap. However, collecting real-time data on SITBs presents complex ethical and practical considerations, including about whether and how to monitor and respond to incoming information about SITBs from suicidal or self-injuring individuals during the study. We conducted a systematic review of protocols for monitoring and responding to incoming data in previous and ongoing intensive longitudinal studies of SITBs. Across the 61 included unique studies/samples, there was no clear most common approach to managing these ethical and safety considerations. For example, studies were fairly evenly split between either using automated notifications triggered by specific survey responses (e.g., indicating current suicide risk) or monitoring and intervening upon (generally with a phone-based risk assessment) incoming responses (36%), using both automated notifications and monitoring/intervening (35%), or neither using automated notifications nor monitoring/intervening (29%). Certain study characteristics appeared to influence the safety practices used. Future research that systematically evaluates optimal, feasible strategies for managing risk in real-time monitoring research on SITBs is needed.
Collapse
Affiliation(s)
- Kate H Bentley
- Massachusetts General Hospital, Department of Psychiatry, United States of America; Harvard Medical School, Department of Psychiatry, United States of America.
| | - Joseph S Maimone
- Massachusetts General Hospital, Department of Psychiatry, United States of America; Harvard University, Department of Psychology, United States of America
| | - Erin N Kilbury
- Massachusetts General Hospital, Department of Psychiatry, United States of America; Harvard University, Department of Psychology, United States of America
| | - Marshall S Tate
- Harvard University, Department of Psychology, United States of America
| | - Hannah Wisniewski
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Psychiatry and Division of Digital Psychiatry, United States of America
| | - M Taylor Levine
- Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Regina Roberg
- Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - John B Torous
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Psychiatry and Division of Digital Psychiatry, United States of America
| | - Matthew K Nock
- Massachusetts General Hospital, Department of Psychiatry, United States of America; Harvard University, Department of Psychology, United States of America
| | - Evan M Kleiman
- Rutgers University, Department of Psychology, United States of America
| |
Collapse
|
49
|
Abstract
Nonsuicidal self-injury (NSSI) is a common but poorly understood phenomenon in adolescents. This study examined the Sustained Threat domain in female adolescents with a continuum of NSSI severity (N = 142). Across NSSI lifetime frequency and NSSI severity groups (No + Mild NSSI, Moderate NSSI, Severe NSSI), we examined physiological, self-reported and observed stress during the Trier Social Stress Test; amygdala volume; amygdala responses to threat stimuli; and resting-state functional connectivity (RSFC) between amygdala and medial prefrontal cortex (mPFC). Severe NSSI showed a blunted pattern of cortisol response, despite elevated reported and observed stress during TSST. Severe NSSI showed lower amygdala-mPFC RSFC; follow-up analyses suggested that this was more pronounced in those with a history of suicide attempt for both moderate and severe NSSI. Moderate NSSI showed elevated right amygdala activation to threat; multiple regressions showed that, when considered together with low amygdala-mPFC RSFC, higher right but lower left amygdala activation predicted NSSI severity. Patterns of interrelationships among Sustained Threat measures varied substantially across NSSI severity groups, and further by suicide attempt history. Study limitations include the cross-sectional design, missing data, and sampling biases. Our findings highlight the value of multilevel approaches in understanding the complexity of neurobiological mechanisms in adolescent NSSI.
Collapse
|
50
|
Coleman SE, Dunlop BJ, Hartley S, Taylor PJ. The relationship between rumination and NSSI: A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:405-443. [PMID: 34806214 DOI: 10.1111/bjc.12350] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Rumination is a cognitive process that has been implicated in the onset and maintenance of a variety of psychological difficulties. The purpose of this review and meta-analysis was to examine the nature and strength of the relationship between rumination and non-suicidal self-injury (NSSI). METHODS The protocol for this review was pre-registered (CRD42019148186). A literature search of electronic databases PsycINFO, CINAHL, MEDLINE, and Web of Science was performed from the earliest date available to March 2020. Thirty-nine eligible papers were identified. An additional seven papers were identified from a search conducted in September 2021, resulting in a total of 46 papers. Separate meta-analyses were undertaken for NSSI frequency and NSSI history, with studies grouped by rumination type (depressive, transdiagnostic, anger, brooding, reflection, catastrophising, overall). Moderator analyses were also conducted along with a narrative synthesis of adjusted associations and longitudinal studies. RESULTS Rumination had a positive small association with NSSI frequency and a positive moderate association with NSSI history. The adjusted associations yielded mixed findings and most longitudinal research found rumination to be associated with prospective NSSI. LIMITATIONS Most included studies had a moderate risk of bias and used a student sample. A limitation of this review was that only English language papers were included. CONCLUSIONS Findings indicate that rumination is associated with NSSI, but more so the likelihood of engaging in NSSI overall than the frequency. Rumination-focused techniques for NSSI may therefore be of benefit. Further research is needed to understand this association, particularly with longitudinal studies that focus on state rumination rather than stable trait rumination. PRACTITIONER POINTS Rumination was found to have a small to moderate association with NSSI. Some individuals who engage in NSSI may benefit from psychological techniques that target rumination. Most of the studies included had a moderate risk of bias.
Collapse
Affiliation(s)
- Sophie E Coleman
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Brendan J Dunlop
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - Samantha Hartley
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK.,Pennine Care NHS Foundation Trust, Greater Manchester, UK
| | - Peter J Taylor
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK
| |
Collapse
|