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Ahmad SI, Hinshaw SP. A Qualitative Analysis of Perspectives on Self-directed Violence in a Prospective Longitudinal Study of Young Women With and Without Childhood ADHD. J Atten Disord 2024; 28:1255-1266. [PMID: 38294171 PMCID: PMC11168017 DOI: 10.1177/10870547231221729] [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: 02/01/2024]
Abstract
OBJECTIVE Non-suicidal self-directed violence (NSSDV) is a significant and growing youth public health crisis. Girls with ADHD are at increased risk of engaging in NSSDV, yet qualitative studies with this population-to better understand manifestations, motivations, and developmental course-are lacking. METHOD We conducted semi-structured, qualitative interviews with a sub-sample of 57 young women (32 with childhood ADHD, 25 neurotypical comparisons; mean age of 27 years, part of a larger prospective longitudinal study) regarding histories and manifestations of NSSDV. RESULTS Inductive and deductive analysis revealed several key themes, including self-perceived reasons for engaging in NSSDV (affect regulation, attention seeking, self-punishment, asserting control), impulsivity, secretiveness, and in some cases motivations for desistance. CONCLUSION Findings underscore the importance of early education and screening, especially among high-risk clinical populations. Increased resources and supports for professionals, parents, and peers are indicated, along with countering the persistent stigma associated with ADHD and NSSDV.
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Affiliation(s)
| | - Stephen P. Hinshaw
- University of California, San Francisco, USA
- University of California, Berkeley, USA
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2
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Townsend ML, Barr KR, Miller CE, Sanzone G. Self-harm and suicidal behaviors in children: perspectives of mental health clinicians. J Pediatr Psychol 2024:jsae044. [PMID: 38872281 DOI: 10.1093/jpepsy/jsae044] [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: 10/30/2023] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE Presentations for self-harm and suicidal behaviors are increasing in children and young people, although less is known about these presentations in children aged 12 years and under. This study aims to understand how mental health clinicians in public health services conceptualize, identify and respond to self-harm and suicidal behaviors in children. METHODS 26 mental health clinicians provided their perspectives through interviews or focus groups. Participant responses were analyzed using reflexive thematic analysis. RESULTS Mental health clinicians described how self-harm and suicidal behaviors may present differently in children compared with adolescents, particularly with the methods used. Using developmentally appropriate language and including parents or carers when screening for self-harm and suicidal behaviors was recommended by clinicians. The inclusion of parents or carers throughout the treatment process was important for clinicians, including helping parents understand their child's behavior and manage their own distress. Clinicians also highlighted the benefit of collaborating with schools to support children, yet noted primary school staff require training in responding to child self-harm and suicidal behavior. The limited services available for children 12 years and under including emergency care services, was identified as a problem. CONCLUSIONS Findings highlight the importance of timely assessment and interventions which include mental health and medical clinicians, parents, carers, and school staff to support children with self-harm and suicidal behaviors.
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Affiliation(s)
- Michelle L Townsend
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Karlen R Barr
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Caitlin E Miller
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Gillian Sanzone
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Goueslard K, Quantin C, Jollant F. Self-harm and suicide death in the three years following hospitalization for intentional self-harm in adolescents and young adults: A nationwide study. Psychiatry Res 2024; 334:115807. [PMID: 38387165 DOI: 10.1016/j.psychres.2024.115807] [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: 10/11/2023] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024]
Abstract
Self-harm is frequent in youths. This study aimed to assess the risk of self-harm and mortality over a three-year period following self-harm hospitalization. Data were extracted from national databases in France. All patients aged 12 to 24 years and hospitalized for self-harm in 2013-2014 were included and compared to age- and sex-matched individuals with no self-harm hospitalization during this period. Cox proportional hazards regression models were used. Overall, 34,533 individuals were hospitalized for self-harm in 2013-2014 (70.8 % females, 79.6 % self-poisoning), with a peak among females aged 14-16. Comparison with 103,599 matched controls showed significantly higher rates of past self-harm, somatic and psychiatric disorders, and dispensed drugs in youth hospitalized for self-harm. During follow-up, they significantly more often repeated self-harm (20.9 vs. 0.1 %), died from any cause (0.6 vs 0.03 %) and from suicide (0.2 vs 0.01 %), particularly during the first year. The choice of a violent self-harm means at inclusion increased the risk of suicide during follow-up. Psychiatric disorders were a significant risk factor for all outcomes. In conclusion, at least one in five youths will self-harm, and one in two hundred will die in the three years following hospitalization for self-harm. Reinforced follow-up care is necessary in this population.
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Affiliation(s)
- Karine Goueslard
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, France
| | - Catherine Quantin
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, France; Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, F21000 Dijon, France; Inserm, CESP, 94807, Villejuif, France
| | - Fabrice Jollant
- Department of psychiatry, Faculty of Medicine, Université Paris Saclay, Le Kremlin-Bicêtre, France; Department of psychiatry, Hôpital Bicêtre, APHP, Le Kremlin-Bicêtre, France; Department of psychiatry, CHU Nîmes, Nîmes, France; McGill Group for Suicide Studies, Department of psychiatry, McGill University, Montréal, Québec, Canada; Moods Research Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France.
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Dibaj IS, Tørmoen AJ, Klungsøyr O, Haga E, Mehlum L. Trajectories and Predictors of Change in Emotion Dysregulation and Deliberate Self-Harm Amongst Adolescents with Borderline Features. Clin Child Psychol Psychiatry 2024; 29:407-423. [PMID: 37220421 PMCID: PMC10945983 DOI: 10.1177/13591045231177374] [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: 05/25/2023]
Abstract
BACKGROUND Deliberate self-harm (DSH) and emotion dysregulation (ED) peaks in adolescence, and is associated with an increased risk of psychopathology, suicide and lower functioning in adulthood. DBT-A has been established as an effective treatment for reducing DSH, however less is known about changes in emotion dysregulation. This study aimed to identify baseline predictors of treatment response in outcome trajectories of DSH and emotion dysregulation. METHODS Response trajectories of DSH and ED were investigated using Latent Class Analysis on RCT data comparing DBT-A and EUC for 77 adolescents treated for deliberate self-harm and borderline traits. Logistic regression analysis was used to examine baseline predictors. RESULTS Two-class solutions were selected for both indicators, distinguishing between early and late responders in DSH, and responders and non-responders in ED. Higher levels of depression, shorter DSH histories and not receiving DBT-A predicted less favourable response in DSH, while DBT-A was the only predictor of treatment response in ED. CONCLUSIONS DBT-A was associated with a significantly faster reduction of deliberate self-harm in the short-term and improved emotion regulation in the long-term.
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Affiliation(s)
- Iselin Solerød Dibaj
- Institute of Clinical Medicine, University of Oslo, National Center for Suicide Research and Prevention, Oslo, Norway
| | - Anita Johanna Tørmoen
- Institute of Clinical Medicine, University of Oslo, National Center for Suicide Research and Prevention, Oslo, Norway
| | - Ole Klungsøyr
- Institute of Clinical Medicine, University of Oslo, National Center for Suicide Research and Prevention, Oslo, Norway
| | - Egil Haga
- Institute of Clinical Medicine, University of Oslo, National Center for Suicide Research and Prevention, Oslo, Norway
| | - Lars Mehlum
- Institute of Clinical Medicine, University of Oslo, National Center for Suicide Research and Prevention, Oslo, Norway
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Ying W, Shen Y, Ou J, Chen H, Jiang F, Yang F, Li J, Qian X, Luo W, Wang G, Dong H. Identifying clinical risk factors correlated with addictive features of non-suicidal self-injury among a consecutive psychiatric outpatient sample of adolescents and young adults. Eur Arch Psychiatry Clin Neurosci 2024; 274:291-300. [PMID: 37314538 DOI: 10.1007/s00406-023-01636-4] [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: 12/13/2022] [Accepted: 06/03/2023] [Indexed: 06/15/2023]
Abstract
Non-suicidal self-injury (NSSI) is an issue primarily of concern in adolescents and young adults. Recent literature suggests that persistent, repetitive, and uncontrollable NSSI can be conceptualized as a behavioral addiction. The study aimed to examine the prevalence of NSSI with addictive features and the association of this prevalence with demographic and clinical variables using a cross-sectional and case-control design. A total of 548 outpatients (12 to 22 years old) meeting the criteria for NSSI disorder of DSM-5 were enrolled and completed clinical interviews by 4 psychiatrists. NSSI with addictive features were determined by using a single-factor structure of addictive features items in the Ottawa self-injury inventory (OSI). Current suicidality, psychiatric diagnosis, the OSI, the revised Chinese Internet Addiction Scale, the Childhood Trauma Questionnaire, and the 20-item Toronto Alexithymia Scale were collected. Binary logistic regression analyses were used to explore associations between risk factors and NSSI with addictive features. This study was conducted from April 2021 to May 2022. The mean age of participants was 15.93 (SD = 2.56) years with 418 females (76.3%), and the prevalence of addictive NSSI was 57.5% (n = 315). Subjects with addictive NSSI had a higher lifetime prevalence of nicotine and alcohol use, a higher prevalence of current internet addiction, suicidality, and alexithymia, and were more likely to have physical abuse/neglect, emotional abuse, and sexual abuse than NSSI subjects without addictive features. Among participants with NSSI, the strongest predictors of addictive features of NSSI were female (OR = 2.405, 95% CI 1.512-3.824, p < 0.0001), alcohol use (OR = 2.179, 95% CI 1.378-3.446, p = 0.001), current suicidality (OR = 3.790, 95% CI 2.351-6.109, p < 0.0001), and psysical abuse in childhood (OR = 2.470, 95% CI 1.653-3.690, p < 0.0001). Nearly 3 out of 5 patients (12-22 years old) with NSSI met the criteria of NSSI with addictive features in this psychiatric outpatients sample. Our study demonstrated the importance of the necessity to regularly assess suicide risk, and alcohol use, as well as focus more on females and subjects who had physical abuse in childhood to prevent addictive NSSI.
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Affiliation(s)
- Wang Ying
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yidong Shen
- Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jianjun Ou
- Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hui Chen
- Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Furong Jiang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fangru Yang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianling Li
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao Qian
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenfeng Luo
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Gang Wang
- Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Huixi Dong
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Rizvi A, Usmani MA, Husain K, Yadava D. Emergency department visits for self-harm in the USA: Cross sectional study of National Hospital Ambulatory Medical Care Survey 2016-2020. Gen Hosp Psychiatry 2023; 84:258-259. [PMID: 37328361 DOI: 10.1016/j.genhosppsych.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Abid Rizvi
- Department of Behavioral medicine & Psychiatry, West Virginia University, Morgantown, 936 Sharpe hospital road Weston, WV 26452, USA.
| | | | - Karrar Husain
- Texas Tech University Health Science center, 800 W 4th Street, Odessa, TX 79763, USA
| | - Deep Yadava
- Department of Behavioral medicine & Psychiatry, West Virginia University, Morgantown, 936 Sharpe hospital road Weston, WV 26452, USA.
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Sorgi-Wilson KM, Cheung JC, Ciesinski NK, McCloskey MS. Cognition and Non-Suicidal Self-Injury: Exploring Relationships with Psychological Functions. Arch Suicide Res 2023; 27:1002-1018. [PMID: 35924878 PMCID: PMC9898468 DOI: 10.1080/13811118.2022.2106919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is strongly associated with difficulties in emotion regulation, but its relationships with maladaptive cognitive processes are less clear. METHOD The current study examined relationships between self-reported NSSI (presence, number of methods, frequency, recency, duration, functions) and negative cognitive processes (rumination, worry, self-criticism, perceived burdensomeness, thwarted belongingness) among 1,357 undergraduates. Cognition variables were submitted to exploratory factor analysis (EFA), and relationships were examined between the resulting factors and NSSI history (among the full sample) and NSSI severity and functions (among those with a history of NSSI). RESULTS The EFA derived two higher order cognitive factors: repetitive negative thinking (RNT) and negative self-perception (NSP). Both RNT and NSP were significantly higher among participants with than those without a history of NSSI. Among those with NSSI, NSP, but not RNT, was positively related to lifetime NSSI frequency and number of methods, as well as recency (presence in the past 12 months) and total duration (in years) of NSSI engagement. Moreover, RNT and NSP were positively associated with aggregate intrapersonal (but not interpersonal) functions of NSSI. The two cognitive factors demonstrated differential relationships with the individual intrapersonal NSSI functions. CONCLUSIONS Higher order categories of cognitive risk factors may have unique relationships with functions and severity of NSSI, with possible implications for more targeted approaches to risk assessment and intervention.HighlightsNegative thinking and self-perception were higher in people who engage in NSSI.Negative self-perception was associated with greater NSSI severity.Negative thinking and self-perception had different relations to NSSI functions.
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Hutsebaut J, Clarke SL, Chanen AM. The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence. Front Psychiatry 2023; 14:1130417. [PMID: 37229381 PMCID: PMC10203159 DOI: 10.3389/fpsyt.2023.1130417] [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: 12/23/2022] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Although national guidelines explicitly state that personality disorder can be diagnosed and treated in young people aged 12 to 18 years (adolescents), most clinicians remain hesitant. This creates a gap between science and practice, which we argue is largely motivated by moral reasons and, therefore, is best challenged by ethical arguments. We provide seven arguments in support of the notion that it is ethically right to diagnose and treat personality disorder when it occurs in adolescents. Central to these arguments is the scientific evidence that features of personality disorder are among the best predictors of a complex cluster of psychopathology leading to impairments in many areas of current and future mental, social and vocational functioning. We argue that intervention during adolescence and young adulthood is not only humane, but also critical for efforts to avert the longstanding psychosocial and health problems that seem refractory to treatment in adults with personality disorder. Moreover, we argue that regular services are often inadequately equipped to meet the needs of young people with personality disorder and that the common 'stepped-care' approach should be replaced by a 'staged-care' approach. Finally, we argue that early detection and intervention might have anti-stigmatizing effects, similar to other areas of healthcare in which stigmatizing labels have changed meaning when the conditions to which they refer have become more amenable to treatment.
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Affiliation(s)
- Joost Hutsebaut
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Viersprong Institute for the Study on Personality Disorders, Halsteren, Netherlands
| | - Sharon L. Clarke
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Viersprong Institute for the Study on Personality Disorders, Halsteren, Netherlands
| | - Andrew M. Chanen
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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