The Association Between Masculinity and Nonsuicidal Self-Injury

When the time is right: Men's experiences of recovery in self-harm

Previous research has mainly focused on self-harm among women, defining what it is, what functions it has, how to manage and prevent self-harm, and how to recover from it. A recent review of the literature on self-harm among men concluded that research need to consider both clinical and personal aspects of recovery and pointed out the need to explore recovery from men's point of view. This study aimed to describe men's experiences of recovery in self-harm. Data were collected in Sweden in 2020 using semi-structured interviews. Eleven men who had recovered in self-harm were interviewed. Interviews were analysed using an abductive approach to qualitative content analysis. The analysis involved the application of an established framework for personal recovery in mental illness: connectedness, hope, identity, meaning, and empowerment (CHIME). The analysis identified one main theme: when the time is right, and five sub-themes: finding support in others; trusting that change is possible; getting to know yourself; reaching a new understanding; and developing new strategies to manage life. While the cessation of self-harm might both be a sign of and contribute to recovery, it is not the defining feature of recovery. Mental health professionals should be persistent in providing person-centred, recovery-oriented care for men who self-harm. The CHIME framework can be applied in the context of men's recovery in self-harm. This study is reported in accordance with the COREQ guidelines.

A Scoping Review on Gender/Sex Differences in COVID-19 Vaccine Intentions and Uptake in the United States

OBJECTIVE

To explore the empirical literature on gender/sex differences in vaccine acceptance among U.S.-based adults and adolescents in approximately the first 2 years of the pandemic.

DATA SOURCE

Embase, Medline, PsycINFO, EBSCO, CINAHL, Web of Science.

STUDY INCLUSION AND EXCLUSION CRITERIA

Peer-reviewed studies conducted in the U.S. with those aged 12 and older, published in English before January 12, 2022, examining the relationship between gender/sex on COVID-19 vaccine intentions and/or uptake.

DATA EXTRACTION

Three authors screened studies and extracted data.

DATA SYNTHESIS

Univariate and multivariate results are summarized.

RESULTS

A total of 53 studies met inclusion criteria (48 intentions, 7 uptake), using mostly cross-sectional designs (92.5%) and non-random sampling (83.0%). The majority of studies supported men's greater intentions to vaccinate compared to women, and men's greater vaccine uptake in univariate analyses, but most multivariate analyses supported no gender differences in uptake. Few studies examined gender beyond binary categories (women/men), highlighting a gap in the studies inclusive of transgender or gender-diverse populations in analyses.

CONCLUSION

Women may have been more hesitant to get the vaccine than men early in the pandemic, but these differences may not translate to actual behavior. Future research should include non-binary/transgender populations, explore the gender-specific reasons for hesitancy and differences by sub-populations, utilize more rigorous designs, and test gender-sensitive public health campaigns to mitigate vaccine concerns.

When Is Masculinity "Fragile"? An Expectancy-Discrepancy-Threat Model of Masculine Identity

ACADEMIC ABSTRACT

Manhood is a precarious social status. Under perceived gender identity threat, men are disproportionately likely to enact certain stereotype-consistent responses such as aggression to maintain their gender status. Yet less is known regarding individual variation in men's threat responsiveness-that is, the psychological conditions under which one's masculine identity is more or less "fragile." We propose a novel model of masculine identity whereby masculine norm expectancy generates discrepancy within the self to the extent that rigid norms are internalized as obligational (actual-ought discrepancy) versus aspirational (actual-ideal discrepancy), which predict extrinsic versus intrinsic motivations to reduce these discrepancies, respectively. Under threat, then, extrinsic motivations predict externalized responses (e.g., aggression), and intrinsic motivations elicit internalized responses (e.g., anxiety, shame, self-harm). We also consider the conditions under which masculinity may be less fragile-for example, in contexts with less rigid expectations and among men who reject expectations-as pathways to mitigate adverse masculinity threat-related outcomes.

PUBLIC ABSTRACT

In many cultures, men prove their manhood by engaging in behaviors that harm themselves and others (e.g., violence, sexism, homophobia), particularly people from marginalized groups. Yet less is known about why some men are more likely than others to enact these masculinity-proving behaviors. The goal of our model is to specify certain conditions under which masculinities become "fragile" and elicit these responses when under threat. We start by describing the rigid expectations men experience-for example, that they are strong and tough. We propose that these expectations cause men to experience different forms of discrepancy within themselves that produce corresponding motivations to reduce these discrepancies. Under threat, motivations driven by others' expectations elicit outward attempts to restore masculine status (e.g., aggression), whereas motivations driven by self-ideals cause internalized responses (e.g., shame, self-harm). We conclude by discussing how to reduce these discrepancies, such as mitigating the rigidity of and encouraging men's resistance to masculinity expectations.

The Effect of Gender on Identification and Interpretation of Non-Suicidal Self-Injury

INTRODUCTION

Reported rates of non-suicidal self-injury (NSSI) differ by gender but may be under-reported and under-recognised in men. People engaging in NSSI rarely seek professional help without encouragement, so others play a key role in its identification and potential intervention. The current research investigated others' interpretations of NSSI, examining whether gender affects the likelihood of NSSI identification and views of how common and acceptable NSSI is.

METHOD

Participants (N = 429; 74.1% female, 23.3% male; please see below for further demographic information) responded to two vignettes describing a person self-injuring by punching a wall or by cutting themselves. The person's gender in each vignette was manipulated. Following each vignette, the participants rated the level to which they agreed the behaviour was common for the gender of the person described, as well as the level to which they agreed the behaviour was acceptable for the gender of the person described, on a 5-point Likert scale. Following both vignettes, participants were presented with a definition of NSSI and rated the level to which they agreed cutting and wall-punching were forms of NSSI on 5-point Likert scales. Independent-samples t tests and goodness of fit χ2 tests were conducted as appropriate.

RESULTS

Participants were more likely to identify wall-punching as common for men and cutting as common for women. However, there was no significant difference in whether wall-punching was identified as NSSI or considered to be an acceptable behaviour, regardless of the gender of the person engaging in it. That is, although research suggests that men are far more likely to engage in wall-punching as a form of NSSI than women, participants did not recognise this. Overall, the results indicated a gender-dependent difference in how acceptable and common NSSI is thought to be, but no noticeable difference in identification of a behaviour as NSSI. Wall-punching, typically a form of NSSI engaged in by males, tended not to be identified as such.

CONCLUSION

There is an effect of gender on how NSSI is interpreted, and it seems that men's NSSI is, and will continue to be, under-recognised. This has important implications for the treatment of men's NSSI, which is more likely to be seen as aggression and therefore deserving of punishment than an attempt at emotion regulation.

The role of perceived social norms in non-suicidal self-injury and suicidality: A systematic scoping review

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for more nuanced, theory-based, investigations of how, when, where, why, and for whom, perceived norms have a causal role in NSSI and suicidality outcomes.

Nonsuicidal self-injury in veterans: Prevalence, clinical characteristics, and gender differences from a national cohort

Nonsuicidal self-injury (NSSI) is a robust predictor of suicidal thoughts and behaviors; however, while there are typically only small differences observed in the prevalence of NSSI between men and women, this condition has been largely overlooked and underestimated among men. Assessing NSSI methods more common in men may address misidentification as well as allow for more precise NSSI prevalence estimates. Survey data from a national sample of Gulf War I-Era veterans (N = 1063) was used to estimate the prevalence of NSSI and compare prevalence of NSSI methods between men and women veterans. Demographic and clinical correlates of NSSI engagement were also examined. The national lifetime prevalence rate of NSSI among Gulf War I-Era veterans was 22.40%, whereas the past year prevalence rate was 8.10%. In both men and women, wall/object punching was the most common NSSI method endorsed across the lifetime. Men had slightly higher overall NSSI prevalence rates compared with women. This study highlights the need to systematically assess NSSI, particularly among veterans, to better identify, and consequently treat, NSSI in men. This is the first available prevalence estimate of NSSI to include the assessment of wall/object punching in a national sample of adult veterans.

Men who self-harm-A scoping review of a complex phenomenon

BACKGROUND

To understand and care for men who self-harm, it is important that healthcare professionals have understanding of how and why men self-harm, men's experiences of self-harm and what can be done to hinder or prevent self-harm.

AIMS

The aim of this study was to synthesize the existing knowledge on men who self-harm, with a special emphasis on background, self-harming methods, experiences and reported therapeutic interventions and/or care approaches.

DESIGN

Scoping review of internationally published and grey literature, based on a methodological framework by Arksey and O'Malley.

DATA SOURCES

Systematic electronic database searches were conducted in CINAHL, MEDLINE (Ovid) and PsycINFO. From a total of 684 studies found, 24 studies met the inclusion criteria: full-text, published in English, peer-reviewed studies and grey literature including a focus on men who self-harm, men aged between 18 and 65 years, and published between 2010 and 2019.

RESULTS

Men's self-harm was understood as being related to mental disorders, a means of affect regulation, a loss of self-control, and a means of interpersonal communication. Self-harm can be a positive or negative experience, and there is a wide variety in the methods that men use to self-harm: sharp objects, injection, ingestion, without aids or riskful behaviour. Few studies reported on therapeutic interventions and/or care approaches for men who self-harm.

CONCLUSION

Men's self-harm should be understood as a complex, socially and culturally conditioned phenomenon and studied from a multitude of perspectives.

IMPACT

This scoping review concludes that self-harm among men should be understood as a complex, socially and culturally conditioned phenomenon. To empower men and support their recovery from self-harm, a person-centred approach should be incorporated into research on the subject and practice.

Self-injury from early adolescence to early adulthood: age-related course, recurrence, and services use in males and females from the community

Adolescent self-injury is a widespread public health problem, but long-term longitudinal studies from European countries are rare. Self-injury in males and sex differences are poorly understood. This study describes the prevalence, frequency, age-related course, and recurrence of, and mental health services use related to adolescent self-injury. Data came from a Swiss prospective-longitudinal cohort study (N = 1482). Adolescents (52% male) reported frequency of self-injury and mental health services use (including reasons for and types of services use, hospitalizations) at ages 13, 15, 17, and 20. Between ages 13-20, 27% of adolescents reported self-injury at least once. In males, prevalence decreased from 12 to 5%; in females self-injury peaked at age 15 (16%) and then decreased (11% at age 20). In males, recurrence of self-injury increased after age 15 (from odds ratio [OR] < 3 to OR > 10); in females, recurrence was high from age 13 onwards (OR > 5). Predictors of recurrence included childhood/early adolescent internalizing symptoms and early self-injury onset. Typically, less than half of adolescents with self-injury used mental health services. Males with self-injury used services mainly for externalizing problems, learning difficulties, and attention/concentration problems; females for depression or self-injury, family problems, and victimization. Types of services used changed with age, and adolescents with self-injury had increased rates of hospitalization. There are notable sex differences in the longitudinal course of self-injury and reasons for related mental health services use. Treating early internalizing symptoms could be a promising target for preventing recurrent self-injury. Males are at particular risk of not receiving adequate treatment for self-injury.

Non-suicidal self-injury among male service members: Descriptive information and a preliminary examination of external correlates

Previous literature has identified nonsuicidal self-injury (NSSI) as a common and noteworthy behavior, particularly given its association with psychopathology and suicide. However, the research on NSSI among males has resulted in mixed findings. Additionally, few studies have examined NSSI among service members and only one study to date has examined NSSI specifically among male service members. The present study examined descriptive statistics and clinical correlates of NSSI among male service members. Results indicated that the most common method of NSSI among this group was burning oneself with a cigarette, followed closely by cutting, and burning oneself with a lighter. NSSI engagement was associated with common correlates of NSSI such as increased emotion dysregulation, depression, impulsivity, and capability for suicide as well as decreased distress tolerance and a greatly likelihood to have experienced recent suicidal ideation. NSSI was also associated with grit, narcissism, and masculinity, some of which may be particularly important and valued in military culture. Overall, results suggest important similarities and differences among NSSI in service members relative to previously studied samples. Future research should continue to examine NSSI among male service members to ensure treatments are effectively targeting and addressing aspects of the behavior.

Peer victimization, depressive symptoms and non-suicidal self-injury behavior in Chinese migrant children: the roles of gender and stressful life events

Background

Non-suicidal self-injury (NSSI) has become a worldwide health concern, especially for the disadvantaged group such as Chinese rural-to-urban migrant children. Peer victimization is a risk factor for NSSI and is quite common among Chinese migrant children. However, few studies that focused on this group have paid attention to the relationship between peer victimization and NSSI. The current study addressed this gap in the literature by examining the mediating role of depressive symptoms and the moderating role of stressful life events in the relationship between peer victimization and NSSI in male and female migrant children.

Methods

A total of 650 migrant children completed self-report surveys that addressed peer victimization, NSSI, depressive symptoms, and stressful life events.

Results

Results showed that peer victimization was significantly related to NSSI for both migrant girls and boys. Depressive symptoms mediated the relationship between peer victimization and NSSI among girls, but not among boys. Additionally, stressful life events significantly moderated the relationships between depressive symptoms and NSSI and between peer victimization and NSSI among girls; higher levels of depressive symptoms or peer victimization coupled with more stressful life events related to a higher probability of NSSI. For boys, stressful life events moderated the relationship between peer victimization and NSSI; higher levels of peer victimization combined with increased NSSI behaviors among the boys who reported more stressful life events.

Conclusions

These findings contribute to the understanding of the mechanisms that inform the relationship between peer victimization and NSSI. Moreover, they indicate that future interventions can be enhanced by targeting depressive symptoms among girls and stressful life events among both girls and boys.

Experiences of transmasculine spectrum people who report nonsuicidal self-injury: A qualitative investigation

Transgender populations experience mental and physical health disparities compared to nontransgender populations, including nonsuicidal self-injury (NSSI). Guided by the minority stress theory and Nock's model of NSSI, this study explored perspectives of transmasculine spectrum people (i.e., people with a gender identity that is man, male, transgender man, genderqueer, or nonbinary and who were assigned female at birth) who engage in NSSI. Qualitative interviews were conducted with transmasculine spectrum people (N = 18) who reported a history of NSSI. Their mean age was 24.9 years old (SD = 5.43, range = 17-38). Participants reported that NSSI was influenced by a variety of factors including stress from gender nonconformity in childhood and adolescence. Stigma related to minority status and identity as well as proximal minority stress processes of concealment and expectations of rejection were identified as contributing to NSSI. Transgender identity development tasks such as coming out and identity exploration also appeared to affect NSSI. Finding a community of peers who engage in NSSI was helpful in mitigating social isolation, but at times reinforced NSSI. We discuss clinical implications at the individual and family levels. Interventions to reduce NSSI among transmasculine-spectrum people should include facilitating connections with gender minority peers and providing individual support and family interventions to facilitate transgender identity development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Mental Health Disparities Among Canadian Transgender Youth

PURPOSE

This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14-18 and 19-25).

METHODS

A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey.

RESULTS

Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups.

CONCLUSIONS

Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable.

Why sex and gender matter in implementation research

BACKGROUND

There has been a recent swell in activity by health research funding organizations and science journal editors to increase uptake of sex and gender considerations in study design, conduct and reporting in order to ensure that research results apply to everyone. However, examination of the implementation research literature reveals that attention to sex and gender has not yet infiltrated research methods in this field.

DISCUSSION

The rationale for routinely considering sex and gender in implementation research is multifold. Sex and gender are important in decision-making, communication, stakeholder engagement and preferences for the uptake of interventions. Gender roles, gender identity, gender relations, and institutionalized gender influence the way in which an implementation strategy works, for whom, under what circumstances and why. There is emerging evidence that programme theories may operate differently within and across sexes, genders and other intersectional characteristics under various circumstances. Furthermore, without proper study, implementation strategies may inadvertently exploit or ignore, rather than transform thinking about sex and gender-related factors. Techniques are described for measuring and analyzing sex and gender in implementation research using both quantitative and qualitative methods. The present paper describes the application of methods for integrating sex and gender in implementation research. Consistently asking critical questions about sex and gender will likely lead to the discovery of positive outcomes, as well as unintended consequences. The result has potential to strengthen both the practice and science of implementation, improve health outcomes and reduce gender inequities.