Non suicidal self injury and suicidal behavior among adolescents: co-occurrence and associated risk factors

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

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

Sex Differences in the Global Prevalence of Nonsuicidal Self-Injury in Adolescents: A Meta-Analysis

Importance

Nonsuicidal self-injury (NSSI) is a strong predictor of suicide attempts. The prevalence of NSSI has been increasing among female adolescents in North America and Europe, but less is known about trends in other geographical regions.

Objective

To examine sex differences in the prevalence of NSSI among adolescents within and between geographical regions.

Data Sources

MEDLINE and PsycINFO were searched using the keywords adolescents, self-injury, sex factors, and synonyms for articles published in English between January 1, 2000, and May 10, 2022.

Study Selection

Studies were included if they presented original data (any study design), included adolescents aged 10 to 19 years, reported results stratified by sex, and explicitly defined self-injury as behaviors occurring without suicidal intent.

Data Extraction and Synthesis

This meta-analysis was registered with PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were assessed for quality by 2 independent coders (F.M. and J.A.). A random-effects model was used to calculate prevalence. Data were analyzed from July 2022 to April 2023.

Main Outcomes and Measures

The prevalence of NSSI in male and female adolescents within and between regions was the main outcome. Odds ratios (OR) with 95% CIs were calculated for community samples.

Results

Eight hundred and two studies were screened, and 38 were included (266 491 participants). Across 17 countries, the pooled prevalence of NSSI was 17.7% (female:male OR, 1.60; 95% CI, 1.29-1.98). NSSI was twice as prevalent among female adolescents compared with male adolescents in North America (OR, 2.49; 95% CI, 2.16-2.86) and Europe (OR, 2.08; 95% CI, 1.69-2.58), but not in Asia (OR, 1.00; 95% CI, 0.71-1.41).

Conclusions and Relevance

In this meta-analysis of sex differences in global prevalence of NSSI, the female predominance of NSSI observed among adolescents in North America and Europe aligned with rising rates of suicide in these populations. The comparable prevalence of NSSI among male and female adolescents in Asia also aligned with the lower male-to-female suicide ratio compared with other countries. More research is needed to characterize regional (and potentially cultural) sex differences among adolescents with NSSI to prevent and treat the behavior and to understand the possible interplay with corresponding regional trends in suicide.

The role of Theory of Mind in the transition towards suicidal attempts in youth NSSI: an exploratory pilot study

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.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Objectives

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

Methods

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

Results

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

Conclusion

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

Factors and pathways of non-suicidal self-injury in children: insights from computational causal analysis

Background

Non-suicidal self-injury (NSSI) has become a significant public health issue, especially prevalent among adolescents. The complexity and multifactorial nature of NSSI necessitate a comprehensive understanding of its underlying causal factors. This research leverages the causal discovery methodology to explore these causal associations in children.

Methods

An observational dataset was scrutinized using the causal discovery method, particularly employing the constraint-based approach. By integrating machine learning and causal inference techniques, the study aimed to determine direct causal relationships associated with NSSI. The robustness of the causal relationships was evaluated using three methods to construct and validate it: the PC (Peter and Clark) method, Fast Causal Inference (FCI) method, and the GAE (Graphical Autoencoder) method.

Results

Analysis identified nine nodes with direct causal relationships to NSSI, including life satisfaction, depression, family dysfunction, sugary beverage consumption, PYD (positive youth development), internet addiction, COVID-19 related PTSD, academic anxiety, and sleep duration. Four principal causal pathways were identified, highlighting the roles of lockdown-induced lifestyle changes, screen time, positive adolescent development, and family dynamics in influencing NSSI risk.

Conclusions

An in-depth analysis of the factors leading to Non-Suicidal Self-Injury (NSSI), highlighting the intricate connections among individual, family, and pandemic-related influences. The results, derived from computational causal analysis, underscore the critical need for targeted interventions that tackle these diverse causative factors.

Associations Among Psychological Resilience, Self-Esteem, Social Support, and Non-Suicidal Self-Injury Behaviors in Adolescents Receiving Inpatient Psychiatric Care

PURPOSE

To explore associations among psychological resilience, self-esteem, social support, and non-suicidal self-injury (NSSI) behaviors in adolescents receiving inpatient psychiatric care.

METHOD

In this cross-sectional study, 505 Chinese adolescents (aged 10 to 19 years) receiving inpatient psychiatric care completed a general characteristics questionnaire, the Psychological Resilience Scale (PRS), Self-Esteem Scale (SES), and Child and Adolescent Social Support Scale (CASSS). Statistical tests were used to compare NSSI incidence, scale scores, and factors influencing NSSI.

RESULTS

The incidence rate of NSSI was 77.82% (n = 393). Total and dimension scores on the PRS, SES, and CASSS in the NSSI group were significantly lower than those in the non-NSSI group (p < 0.01). Binary logistic multifactorial regression analysis showed that participants who were female and aged 10 to 14 years were more prone to NSSI behavior (p < 0.05). Having close friends, high parental expectations, and moderate to high self-esteem were protective factors for NSSI behavior (p < 0.05).

CONCLUSION

Nursing personnel should prioritize enhancing psychological resilience, self-esteem, and social support in adolescents receiving inpatient psychiatric care to mitigate the risk of NSSI and ensure the safety of hospitalized individuals. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Testing Suicide Ideation-to-Action Theory Differences Among Those With Nonsuicidal Self-Injury

OBJECTIVE

Individuals with recent nonsuicidal self-injury (NSSI) are at elevated risk for suicide but our understanding of the factors that impact the emergence of suicidal ideation and/or suicide attempts in this group is limited. The current study aimed to evaluate whether the processes identified by existing ideation-to-action theories of suicide apply within this subgroup.

METHOD

A sample of 362 university students (77.9% female, 88.5% White) who reported past year engagement in NSSI completed an anonymous online questionnaire assessing past year NSSI, suicidal ideation, and suicide attempts as well as hopelessness, interpersonal, and acquired capability/volitional variables. Participants were divided into NSSI only (controls), NSSI + Ideation, and NSSI + Suicide Attempt groups.

RESULTS

A one-way ANOVA evaluated group differences on the theoretical factors. There were significant differences between NSSI controls and both the ideation and attempt groups, who did not differ from each other, on hopelessness and interpersonal factors. No significant differences were observed across groups for the volitional factors except for impulsivity, which differed between the NSSI controls and ideation group.

CONCLUSION

Results suggest suicide ideation-to-action theories may have applicability to understanding the presence of suicide ideation among those with NSSI but may lack specificity for understanding risk for suicide attempts.

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

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

Beyond the Surface: Teachers' Perceptions and Experiences in Cases of Non-Suicidal Self-Injury Among High School Students

Non-suicidal self-injury (NNSI) among adolescents is a significant concern. This study aimed to explore teachers' perceptions and experiences in cases of NSSI among their students. This qualitative-phenomenological study used in-depth, semi-structured interviews conducted with 27 teachers from high-schools in Israel. Thematic analysis was used to identify patterns and themes. Theme 1 highlighted the emotional impact of discovering self-injury incidents, including panic, confusion, and helplessness. Theme 2 focused on teachers' limited professional support and their need for training and guidance. Theme 3 explored teachers' desire to help students and their strategies for building connections and providing empathy, sometimes despite emotional detachment. Theme 4 emphasized the importance of involving parents and the need for effective communication. This study emphasizes the importance of providing teachers comprehensive training to address NSSI effectively. These findings provide a better understanding of teachers' experiences and underscore the need for enhanced support systems.

Understanding Comorbidity Between Non-Suicidal Self-Injury and Depressive Symptoms in a Clinical Sample of Adolescents: A Network Analysis

Background

Non-suicidal self-injury (NSSI) and depression often co-occur among adolescents with more severe clinical symptoms. This study examined the network structures of NSSI and depressive symptoms in adolescents.

Methods

Participants were recruited in the psychiatric outpatient clinics of three tertiary hospitals between April 10 and July 10, 2023. All participants been already found with self-injury behaviors in outpatient when enrolled. NSSI diagnostic criteria and Patient Health Questionnaire-9 (PHQ-9) were utilized to collect NSSI and depressive symptoms separately. We performed a network analysis to visualize the correlation between each symptom and to identify core and bridging symptoms in comorbidities.

Results

A total of 248 patients were enrolled in the study, with a mean age of 15.48 (SD = 1.62). Based on the PHQ-9 scores and grades, our results showed that the incidence of depression in adolescents with non-suicidal self-injury behavior was relatively high (N=235, 94.76%), with the majority having severe depression. The network analysis revealed that nodes D-6 "feeling bad, failing or letting yourself or your family down", D-1 "little interest or pleasure" and D-4 "feeling tired" were the most vital and most central symptoms. The most crucial bridging symptom is the node NSSI-8 "frequent thinking about self-injury", which connects the NSSI to the depression comorbid network.

Conclusion

This study offers a significant symptom-level conceptualization of the association between NSSI and depressive symptoms in a clinical sample of adolescents, which not only enhances our understanding of the comorbid but also identifies potential treatment targets to prevent and treat comorbidity between adolescent NSSI and depression.

Distress tolerance and lifetime frequency of non-suicidal self-injury (NSSI): A systematic review and meta-analysis

NSSI has recently been recognized as a significant health issue given its documented association with psychopathology and across a broad spectrum of psychiatric disorders. It has been found that individuals experiencing heightened emotions, which is referred to as an emotional cascade, are more likely to engage in self-injury behaviour due to low levels of distress tolerance (DT). The current meta-analysis using PRISMA guidelines sought to quantify the strength of the association between DT and lifetime frequency of NSSI using 22 eligible studies (N = 14,588; F = 60.7%; age = 23.35 ± 7.30), mainly from the United States. The correlation between emotional DT and NSSI was a small negative correlation (r = -.14), and it was non-significant for behavioural DT and NSSI (r = .02). Also, the effect-size was significant for studies that used interview-based measure of NSSI (r = -.24), and it was non-significant when self-report measures of NSSI (r = -.11) utilized. The association between DT and NSSI was significant and negative across the general population (r = -.47), university students (r = -.17), and inpatients (r = -.27); surprisingly, it was significant and positive among adolescents or high school students (r = .17). The observed effect-sizes were independent of publication year, mean age and its standard deviation, study quality, female proportion, DT, NSSI measures reliability, and clinical status. Future studies on NSSI should consider DT as a spectrum from distress intolerance to distress over-tolerance, given that it seems it has different functions when different samples (e.g., adolescents) are studied.

Efficiency of psychological interventions in the prevention of suicidal behavior and self-injury in penitentiary population: A systematic review

INTRODUCTION

Suicidal behavior is an important public health problem, with a high prevalence in penitentiary context. Nowadays, there is a wide variety of specific treatment programs, aimed to prevent suicidal and self-injurious behavior in incarcerated people. These programs show relative efficiency depending on the model of the psychological intervention applied. This systematic review evaluates the efficiency of suicidal and self-injurious behavior prevention programs in prisons.

METHOD

Empirical studies, evaluating prevention programs for suicidal and self-injurious behavior in penitentiary context were considered for inclusion. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) directives were followed. Studies from 1990 to 2022 were reviewed, based on the review developed by Winicov (2019) that covered the time lapse between 1990 and 2015. Articles from 2015 to 2022 were located by database research (EBSCOHost, ScienceDirect, PubMed & ProQuest).

RESULTS

44,050 potential studies were identified. Eighteen were included in this systematic review (9 studies by Winicov, 2019). 14 studies showed efficacy of intervention programs on self-injury behavior. The use of Cognitive Behavioral Therapy (CBT) reduced suicidal ideation. In addition, positive results were observed in 3 studies using third-generation therapies as an intervention.

CONCLUSIONS

Suicidal and self-injurious behavior in prison shows lower levels of incidence when specific treatment programs are applied. It's crucial to increase the evaluation in relation to the implementation of new treatment models (i.e., Dialectical Behavior Therapy - DBT, Acceptance and Commitment Therapy - ACT, Mindfulness, Functional Analytic Psychotherapy - FAP) as to better orientate prevention strategies. Further research is needed in gender sensitive interventions.

Perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers: a qualitative study

Background

The prevalence of non-suicidal self-injury among adolescents has increased over the years. Most parents, however, are poorly informed and confused about this behavior. Sharing caretaking experiences with parents in similar situations seems to be beneficial. Nevertheless, few researchers have explored the views of parents who share their caretaking experiences with peers.

Aim

This study aimed to investigate the perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers as well as the motivations for and barriers to this behavior.

Methods

This qualitative study adopted a purposive sampling method. Participants (16 mothers and 2 fathers) were recruited from the mental health center of a tertiary hospital in Chengdu, Sichuan, China. A total of 18 semistructured face-to-face individual interviews were conducted. All interviews were audio-recorded and analyzed thematically using NVivo 11.

Results

Three themes and nine subthemes were identified: (1) sharable caretaking experiences: reflection and transformation, self-emotional management, and diversified support; (2) motivations for sharing: empathy, reciprocity, and meaning; and (3) barriers to sharing: inadequate knowledge, low self-identity, and concerns for children.

Conclusion

Parents accumulate a wealth of experience during their long-term care of adolescents with repeated non-suicidal self-injury. Although most parents are willing to share their caretaking experiences with peers, there are several barriers. Therefore, in order to increase parents' motivation to share, psychological education is necessary.

Prevalence, correlates and common methods of non-suicidal self-injury in South Asia: a systematic review

INTRODUCTION

The dynamics of self-harm vary substantially around the world, yet it is severely under-researched outside of a small number of high-income 'Western' countries. South Asia is disproportionately impacted by suicide, yet we know less about non-suicidal self-injury (NSSI) in the region.

OBJECTIVE

To review and summarise evidence on the prevalence, correlates and common methods of NSSI in South Asia.

METHODS

We searched Medline, Embase and PsycINFO for the period 1 January 2000 to 31 August 2023, for peer-reviewed observational studies. A total of 11 studies from eight South Asian countries that reported prevalence and/or correlates of NSSI were included in this review. We assessed the quality of the studies using the Study Quality Assessment Tools for Observational Cohort and Cross-Sectional Studies. We used meta-regression to describe the sources of heterogeneity. Abstracted data were summarised using thematic synthesis.

RESULTS

For non-clinical populations, the 12-month prevalence of NSSI ranged from 3.2% to 44.8%, and the lifetime prevalence ranged from 21% to 33%. For clinical populations, the 12-month prevalence of NSSI ranged from 5% to 16.4%, while the lifetime prevalence ranged from 2% to 27%. Male sex, unemployment, financial stress, history of suicidal behaviour and depression were associated with a higher risk of NSSI. Better access to counselling services, higher self-esteem and self-knowledge were associated with a lower risk of NSSI.

CONCLUSION

The burden of NSSI in South Asia appears to be high in both clinical and non-clinical populations. Further research, especially with general population samples, is needed to build evidence on the epidemiology, context and meaning of NSSI in South Asia to inform the design of context-specific interventions.

PROSPERO REGISTRATION NUMBER

CRD42022342536.

The relationship between depressive mood and non-suicidal self-injury among secondary vocational school students: the moderating role of borderline personality disorder tendencies

Background

Non-suicidal self-injury (NSSI) has become an important public health issue of global concern, often occurring in adolescents, and depressive mood is closely related to NSSI. In addition, NSSI is considered a symptom of borderline personality disorder. It has been found that adolescents in secondary vocational schools are more vulnerable to behavior and emotional disorders than those in general high schools. This study investigated the risk factors associated with NSSI affecting secondary vocational school students and analyzed the role of borderline personality disorder tendencies in promoting the occurrence of NSSI among students with depressive moods.

Methods

A total of 1,848 Chinese secondary vocational students completed a self-report questionnaire. The homemade NSSI behavior questionnaire, Patient Health Questionnaire-9 and Personality Diagnostic Questionnaire-4 were used in this survey. Binary logistic regression and PROCESS software analysis were used to explore the influencing factors associated with NSSI and to test for moderating effects.

Results

Female (OR = 3.412, 95% CI 2.301-5.060), drinking history (OR = 2.007, 95% CI 1.383-2.911), history of suicidal death exposure (OR = 3.161, 95% CI 1.999-4.999), depressive mood (OR = 2.436, 95% CI 1.668-3.558) and borderline personality disorder tendencies (OR = 2.558, 95% CI = 1.764-3.711) were independent risk factors for NSSI. Borderline personality disorder tendencies (B = 0.047, p = 0.000) moderated the relationship between depressive mood and NSSI. The stronger the borderline personality tendencies, the more NSSI behavior occurred when they were depressive.

Conclusions

Borderline personality disorder tendencies in secondary vocational school adolescents significantly enhance the association of depressive mood with NSSI. There is a moderating role for borderline personality disorder tendencies in depressive mood and NSSI.

Relations of Childhood Trauma and Emotional Dysregulation with Suicide Ideation and Suicidal Behaviour Severity in a Clinical Sample of Depressive Female Adolescents

Objective: This study aimed to explore the aspects of emotional dysregulation (ED) and childhood trauma (CT) which are associated with suicide ideation (SI) and suicidal behaviour (SB) severity in depressive female adolescents who previously attempted suicide. Method : In this cross-sectional study, we evaluated SI and SB severity. The Columbia-Suicide Severity Rating Scale (C-SSRS) was administered to 80 depressive female patients who had suicide attempts within the last month. Current suicide ideation (C-SI) and total score (C-TS), lifetime- suicide ideation (L-SI), and total score (L-TS) were obtained with the C-SSRS. Patients were recruited from five different provinces in Turkey. Additionally, the patients completed the Difficulties in Emotion Regulation Scale (DERS), Childhood Trauma Questionnaire (CTQ), and Beck Depression Inventory (BDI). The Pearson correlation test and a multiple linear regression analysis were used to determine variables predictive of suicide scores. Results: The results of multiple linear regression analysis indicated that the BDI and DERS - total scores explained 35% (adjusted R) of the variance in C-SI ((F (2;67) = 19.61, P < 0.001). C-TS was explained by 'BDI,' 'emotional neglect' and 'DERS impulse' (38% (adjusted R) (F (3;66) = 15.15, P < 0.001). L-SI was only associated with DERS strategies (explains 13% (adjusted R) of the variance in L-SI (F (1;68) = 10.411, P = 0.02). Concerning the C-SSRS L-TS, the DERS impulse and CTQ total accounted for 24% (adjusted R) of the variance (F (2;67) = 10.620, P < 0.001). Conclusion: The results of our study suggest that adolescents who have experienced emotional neglect and depressive symptoms are more at risk for suicidal ideation and behaviour. In addition, depressed adolescents who show impulsive behaviours and restricted emotional strategies are also at risk. Identifying neglected depressed adolescents and teaching impulse control and effective emotional strategies is important for the prevention of suicidal behaviours and thoughts.

Non-suicidal self-injury in Chinese college students with elevated autistic traits: Associations with anxiety, rumination and experiential avoidance

Although existing studies have proved that autistic traits (AT) may have relations to non-suicidal self-injury (NSSI) behaviors, its associations with anxiety, rumination and experiential avoidance (EA) are still unclear. The current study, based on a sample of 1317 Chinese college students, explored the associations between AT, anxiety and NSSI, and the possible modulating roles of rumination and EA in these associations. The results shows that 1) a total of 334 (25.36%) students reported a history of NSSI and 30 (2.28%) students were categorized as high AT; 2) Students with high AT reported higher rates of NSSI than those with low AT (36.67% vs. 25.10%); 3) AT, anxiety, rumination and EA have positive relations with NSSI; 4) AT predicted NSSI indirectly through anxiety; 5) Rumination and EA significantly moderated the effects of AT on NSSI via anxiety. In conclusion, this study confirms the indirect effect of AT on NSSI through anxiety in Chinese college students, and further clarifies the reinforcing effects of rumination and EA on the associations between AT, anxiety and NSSI. These findings suggest that developing adaptive emotion-regulating strategies and positive coping styles might promote the prevention and treatment of NSSI behaviors among autistic individuals.

Non-suicidal self-injury and suicidal ideation among Chinese college students of childhood emotional abuse: associations with rumination, experiential avoidance, and depression

Background

Prior studies have proved the relationships between childhood emotional abuse (CEA) histories and suicidal thoughts or behaviors in adulthood, however, how emotion regulation strategies work as the mediating mechanism is necessary to be investigated. This study aimed to further verify the impacts of rumination, experiential avoidance (EA) and depression on the associations between CEA and non-suicidal self-injury (NSSI) and suicidal ideation (SI) on a sample of Chinese college students.

Methods

The Childhood Emotional Abuse Questionnaire, the Non-Suicidal Self-Injury Questionnaire, the Symptom Checklist, the Ruminative Response Scale, the Acceptance and Action Questionnaire-II and the Zung Self-Rating Depression Scale were completed by 1,317 college students.

Results

The rates of NSSI and SI of students with CEA experiences were 31.70 and 7.90% respectively, both higher than those without such experiences. The mediating roles of rumination, EA and depression between CEA and NSSI and SI were significant (p < 0.01).

Conclusion

The current study shed light on the linking roles of rumination, EA and depression in the relations between CEA and NSSI and SI. It is suggested that developing adaptive emotion-regulating strategies may be helpful to the intervention of suicidal thoughts or behaviors among individuals with CEA experiences.

Non-suicidal self-injury in Chinese population: a scoping review of prevalence, method, risk factors and preventive interventions

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.

Firearms Availability Among High-School Age Youth With Recent Depression or Suicidality

BACKGROUND AND OBJECTIVES

Limiting firearm access is essential to decreasing teen suicide. Previous efforts have focused on household firearms; however, less is known about firearm access and possession among teens at increased suicide risk. Our objective was to estimate prevalence of firearm possession and access among high school-aged teens with recent depression and/or lifetime history of suicidality (DLHS).

METHODS

We conducted a probability-based, cross-sectional Web survey of 1914 parent-teen dyads between June 24, 2020, and July 22, 2020, with data weighted to generate a nationally representative sample of US teenagers (aged 14-18). Logistic regression analyses examined the difference between teens with and without DLHS for: (1) personal firearm possession, (2) perceived firearm access, and (3) method of firearm attainment.

RESULTS

Among high school-aged teens, 22.6% (95% confidence interval [CI], 19.4-25.8) reported DLHS, 11.5% (95% CI, 8.7-14.3) reported personal firearm possession, and 44.2% (95% CI, 40.2-48.2) endorsed firearm access. Teens experiencing DLHS had increased perceived access (adjusted odds ratio, 1.56; 95% CI, 1.07-2.28) compared with non-DLHS peers. There was no association between DLHS and personal firearm possession (adjusted odds ratio, 0.97; 95% CI, 0.47-2.00). Among teens reporting firearm possession, those with DLHS were more likely to have acquired it by buying/trading for it (odds ratio, 5.66; 95% CI, 1.17-27.37) and less likely receiving it as a gift (odds ratio, 0.06; 95% CI, 0.01-0.36).

CONCLUSIONS

High school-aged teens experiencing DLHS have higher perceived firearm access compared with lower-risk peers. Providers should speak directly to high school-aged teens at increased suicide risk about firearm access, in addition to counseling parents.

Nonsuicidal Self-Injury

ABSTRACT

Nonsuicidal self-injury (NSSI) is an area of growing concern for the health care community, as evidenced by its identification as a Healthy People 2030 objective and as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In the past, nurses may have identified patients who cut or harmed themselves as having suicidal intent, yet NSSI is increasingly recognized and investigated as a separate disorder. This article provides an overview of NSSI, including information about risk factors, clinical assessment, and preventive efforts.

The role of depressive symptoms and social support in the association of internet addiction with non-suicidal self-injury among adolescents: a cohort study in China

BACKGROUND

Both internet addiction (IA) and non-suicidal self-injury (NSSI) are major public health concerns among adolescents, however, the association between IA and NSSI was not well understood. We aimed to investigate the association between IA and NSSI within a cohort study, and explore the mediated effect of depressive symptoms and the moderating effect of social support in the association.

METHODS

A total of 1530 adolescents aged 11-14 years who completed both the baseline (T1) and 14-month follow-up (T2) survey of the Chinese Adolescent Health Growth Cohort were included for the current analysis. IA, NSSI, depressive symptoms and social support were measured at T1; depressive symptoms and NSSI were measured again at T2. Structural equation models were employed to estimate the mediated effect of depressive symptoms and the moderating effect of social support in the association between IA and NSSI at T2.

RESULTS

IA was independently associated with an increased risk of NSSI at T2, with the total effect of 0.113 (95%CI 0.055-0.174). Depressive symptoms mediated the association between IA and NSSI at T2, and social support moderated the indirect but not the direct effect of IA on NSSI at T2. Sex differences were found on the mediated effect of depressive symptoms and the moderated mediation effect of social support.

CONCLUSIONS

Interventions that target adolescents' NSSI who also struggle with IA may need to focus on reducing depressive symptoms and elevating social support.

Menstrual pain mediated the association between daytime sleepiness and suicidal risk: A prospective study

BACKGROUND

Adolescents with daytime sleepiness have been demonstrated to have a higher level of suicidal risk than those without. Currently, few studies had examined the pathway from daytime sleepiness to suicidal risk among female adolescents. This study aimed to explore the association among menstrual pain, daytime sleepiness, and suicidal risk among female adolescents in China.

METHODS

Of 7072 adolescents who participated in the follow-up survey of Shandong Adolescents Behavior & Health Cohort (SABHC), 3001 were female adolescents who had begun to menstruate and included for the analysis. A structured self-administrated questionnaire was used to measure menstrual pain, daytime sleepiness, suicidal risk and demographic characteristics. Participants were first surveyed in November-December 2015 and resurveyed 1 year later.

RESULTS

Of 3001 participants, 11.43 % had suicidal risk, 79.8 % experienced menstrual pain. Cross-lagged analysis showed that there was cause-and-effect relationship between menstrual pain and daytime sleepiness. Moderate (OR = 1.79, 95%CI: 1.22-2.63) and severe (OR = 2.73, 95%CI: 1.80-4.12) menstrual pain (follow-up) were associated with suicidal risk (follow-up). Daytime sleepiness (baseline: OR = 1.04, 95%CI: 1.02-1.06, follow-up: OR = 1.07, 95%CI: 1.05-1.09) had effects on suicidal risk (follow-up). Mediation analysis showed that menstrual pain played a partially mediating role between daytime sleepiness and suicidal risk, with the indirect effect being 0.002 (95%CI: 0.001-0.004).

LIMITATIONS

All data were self-reported.

CONCLUSIONS

Menstrual pain and daytime sleepiness had effects on each other, and they both were the risk factors of suicidal risk. Among female adolescents, the association between daytime sleepiness and suicidal risk could be partially mediated by menstrual pain. Releasing the menstrual pain of female adolescents with daytime sleepiness could reduce their suicidal risk.

Multifaceted risk for non-suicidal self-injury only versus suicide attempt in a population-based cohort of adults

BACKGROUND

Non-suicidal self-injury and suicide attempt represent significant public health concerns. While these outcomes are related, there is prior evidence that their etiology does not entirely overlap. Efforts to directly differentiate risk across outcomes are uncommon, particularly among older, population-based cohorts.

METHODS

This research has been conducted using the UK Biobank. Data on individuals' self-reported history of non-suicidal self-injury only versus suicide attempt (maximum N = 6643) were analyzed. Applying LASSO and standard logistic regression, participants reporting one of these outcomes were assessed for differences across a range of sociodemographic, behavioral, and environmental features.

RESULTS

Sociodemographic features most strongly differentiated between the outcomes of non-suicidal self-injury only versus suicide attempt. Specifically, Black individuals were more likely to report a suicide attempt, as were those of mixed race, those endorsing higher levels of depressive symptoms or trauma history, and those who had experienced financial problems (odds ratios 1.02-3.92). Those more likely to engage in non-suicidal self-injury only were younger, female, had higher levels of education, those who resided with a partner, and those who had a recently injured relative.

LIMITATIONS

Differences in timing across correlates and outcomes preclude the ability to establish causal pathways.

CONCLUSIONS

The factors identified in the current study as differentially associated with non-suicidal self-injury only versus suicide attempt provide further evidence of at least partially distinct correlates, and warrant follow-up in independent samples to investigate causality.

Prevalence of Depression in School-Going Adolescents and Its Impact on Scholastic Performance: A Cross-Sectional Study

BACKGROUND

Adolescents are more prone to depression, which needs early identification.

AIM

The aim of the study is to assess the prevalence of depression in school-going adolescents and its association with their scholastic performance.

MATERIALS AND METHODS

This questionnaire-based cross-sectional study was conducted on 473 students, among whom 271 girls and 202 boys with an age group of 12-17 years, who were selected through simple random sampling from four high schools located in and around Kolar city, Karnataka, India, from January 2023 to March 2023, were included in the study after obtaining three informed consents from adolescents. A questionnaire was given to all the study participants, and the depression was assessed according to the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) score. The severity of depression among the children was assessed by the Patient Health Questionnaire-A (PHQ-A). Further, these children were assessed for their scholastic performance based on their final examination scores. The data were entered into an Excel sheet, and statistical analysis was performed.

RESULTS

A total of 473 subjects were included in the present study; 177 had depression, which represents 37% of the total population. According to PHQ-A, 31% had mild depression, 5% had moderate depression, and 1% had severe depression. The association between depression and scholastic performance was not significant.

CONCLUSION

In the current study sample, depression was found to be mild to moderate, which reflects the overall performance of adolescents. All students were treated accordingly. Hence, active measures are to be initiated to prevent depression.

Age- and sex-dependent increase in self-harm among adolescents with mental health problems in East China during COVID-19 related society-wide isolation

Objective

The COVID-19 pandemic has raised concerns about child and adolescent mental health issues, such as self-harm. The impact of society-wide isolation on self-harming behaviors among adolescents in China is unclear. In addition, adolescents of different ages and sexes have varying abilities to cope with environmental changes. However, these differences are rarely considered in self-harm studies. We aimed to characterize the age- and sex-dependent effects of COVID-19-related society-wide isolation on self-harm among adolescents in East China.

Methods

We collected 63,877 medical records of children and adolescents aged 8–18 who had an initial visit to Shanghai Mental Health Center in China between 2017 and 2021 and charted annual self-harm rates for each age and sex. Using interrupted time series analysis, we modeled global and seasonal trends and the effect of COVID-19-related society-wide isolation on self-harm rates.

Results

Females aged 10–17 and males aged 13–16 exhibited significantly increasing trends in self-harm rate (pfdr &lt; 0.05) in the past 5 years. Eleven-year-old females in 2020 showed a self-harm rate (37.30%) that exceeded the peak among all ages in 2019 (age 13, 36.38%). The COVID-19-related society-wide isolation elevated self-harm rates in female patients aged 12 [RR 1.45 (95% CI 1.19–1.77); pfdr = 0.0031] and 13 years [RR 1.33 (95% CI 1.15–1.5); pfdr = 0.0031], while males were less affected. Further, females with emotional disorders dominated the increased self-harm rates.

Conclusion

Society-wide isolation has had a significant impact on early adolescent females in East China, especially for those with emotional disturbances, and has brought forward the peak in adolescent self-harm rates. This study calls for attention to the risk of self-harm in early adolescents.

The relationship between negative life events and non-suicidal self-injury (NSSI) among Chinese junior high school students: the mediating role of emotions

BACKGROUND

Adolescent non-suicidal self-injury (NSSI) is common and adolescence is the most common period of first self-injury, and the occurrence of NSSI is influenced by negative life events and emotional symptoms. The mediating role of emotional symptoms in the interaction between negative life events and NSSI has not been carefully investigated yet.

METHODS

For middle school students in three schools in a Chinese province, the Adolescents Self-Harm Scale was used to investigate NSSI, the Adolescent Self-Rating Life Events Check List was used to investigate adolescent negative life events, and the Self-Rating Anxiety Scale and Self-Rating Depression Scale were used to assess their emotional symptoms. After the description of general data and the test for differences between groups, the relationship between negative life events, emotional symptoms and NSSI was analyzed using Pearson correlation analysis. Structural equation modeling was used to analyze the mediating role of emotions in negative life events and NSSI.

RESULTS

A total of 2376 junior high school students completed this survey, which revealed an annual NSSI prevalence of 37.1% (n = 881) and a higher prevalence of NSSI among girls and rural adolescents. Among adolescents who developed NSSI, 67.4% (N = 594) used multiple means of self-injury. The most common means of self-injury was hair pulling (51.0%), and the most common NSSI purpose and external factors/events were venting bad emotions or feelings (57.5%) and poor academic performance (44.9%), respectively. Negative life events, emotional symptoms and NSSI were positively associated (P < 0.05). Structural equation modeling with negative life events, emotional symptoms and NSSI as variables showed that the model-fit index matched the data well, with RMSEA = 0.073, AGFI = 0.945, GFI = 0.980, CFI = 0.985, NFI = 0.982, TLI = 0.968, IFI = 0.985, and negative life events, emotional symptoms (anxiety, depression) and NSSI all had direct effects with standardized path coefficients of 0.16, 0.19, and 0.23, respectively, with negative life events playing an indirect role in NSSI through emotional symptoms and emotional symptoms playing an incomplete mediating role in negative life events and NSSI.

CONCLUSION

The prevalence of NSSI was higher among Chinese junior high school students. Both negative life events and emotional symptoms were direct risk factors for NSSI. In addition, negative life events were also indirect risk factors for NSSI, and emotional symptoms played an incomplete mediating role in the relationship between the effects of negative life events and NSSI. This indicates that the combination of reducing the frequency of negative life events while maintaining individual emotional stability during adolescent development can effectively reduce the prevalence of NSSI in adolescents.

Emotional Reactivity and Inhibitory Control in Nonsuicidal Self-Injury Adolescence: Divergence Between Positive and Negative Emotions

Nonsuicidal self-injury (NSSI) is prevalent in adolescents and is often linked to emotion dysregulation. However, it remains unknown which specific processes of emotion regulation and under what emotional context these processes are related to the risk for NSSI in samples of community-based adolescents. This study used two laboratory tasks to examine whether adolescents with a history of NSSI displayed difficulties in emotional reactivity and inhibitory control in response to negative and positive emotions. In Study 1, adolescents with/without a history of NSSI (N = 64; M_Age = 13.45 ± 0.50; 53% female) completed a picture perception task in which they were asked to judge the valence and arousal of images. In Study 2, adolescents with/without a history of NSSI (N = 74; M_Age = 13.49 ± 0.80; 50% female) were given a two-choice emotional oddball task that required them to differentially respond to frequent stimuli (images of an object) and infrequent stimuli (affective images). The results showed that adolescents with a history of NSSI showed decreased emotional sensitivity and lower levels of inhibitory control in response to images depicting negative emotional content but not to those depicting positive emotional content. Furthermore, affective inhibitory control problems were significantly positively related to the severity of NSSI, especially in the context of negative emotions. These findings suggest that there is a divergence between positive and negative emotions in both emotional reactivity and affective inhibitory control processes on NSSI. Specifically, relative to adolescents with no history of NSSI, adolescents with a history of NSSI showed lower emotional awareness and behavioral inhibitory control when processing negative emotions, but these distinctions were not found in contexts involving positive emotions. Additionally, the results suggest that affective inhibitory control deficits specific for negative emotions may result in vulnerability to increased NSSI severity.

Prevenção da autolesão não suicida: construção e validação de material educativo

Resumo Objetivo: elaborar e validar um material educativo para fortalecer a assistência em saúde aos adolescentes sobre a autolesão não suicida. Método: pesquisa metodológica delineada em três etapas: (1) construção do material a partir de estudo misto sobre necessidades ligadas à temática por meio das redes sociais e uma revisão guarda-chuva sobre a assistência relacionada à autolesão não suicida; (2) validação com 10 especialistas em saúde mental e/ou violência autoprovocada selecionados pela Plataforma Lattes; (3) avaliação pelo público-alvo, sendo convidados profissionais de saúde, sem restrição de formação. A coleta dos dados de validação e avaliação foi realizada por um questionário sociodemográfico e o Suitability Assessment of Materials for evaluation of health-related information for adults. Foi empregada a estatística descritiva, índice de validade de conteúdo e o teste AC1 de Gwet. Resultados: o material obteve boa aceitação geral e confiabilidade na validação pelos especialistas (AC1=0,633; p=0,0000) e na avaliação pelo público-alvo (AC1=0,716; p=0,0000). Todos os profissionais apontaram a contribuição pessoal e potencial educativo do material. Conclusão: destaca-se a construção de material educativo embasado em ciência para o fortalecimento da assistência aos adolescentes com autolesão não suicida.

Prevención de las autolesiones no suicidas: construcción y validación de material educativo

Resumen Objetivo: elaborar y validar un material educativo para fortalecer la asistencia en salud a los adolescentes sobre la autolesión no suicida. Método: investigación metodológica delineada en tres etapas: (1) Construcción del material a partir de un estudio mixto sobre las necesidades vinculadas al tema por medio de las redes sociales y una revisión paraguas sobre la asistencia relacionada con la autolesión no suicida; (2) validación con 10 especialistas en salud mental y/o violencia autoprovocada seleccionados por la Plataforma Lattes; (3) Evaluación por parte del público objetivo, siendo invitados profesionales de salud, sin restricción de formación. La recolección de los datos de validación y evaluación fue realizada por un cuestionario sociodemográfico y el Suitability Assessment of Materials for evaluation of health-related information for adults. Se empleó la estadística descriptiva, el índice de validez de contenido y el test AC1 de Gwet. Resultados: el material obtuvo una buena aceptación general y confiabilidad en la validación por parte de los especialistas (AC1=0,633; p = 0,0000) y en la evaluación por el público objetivo (AC1 = 0,716; p=0,0000). Todos los profesionales señalaron la contribución personal y el potencial educativo del material. Conclusión: se destaca la construcción de material educativo basado en ciencia para fortalecer la asistencia a los adolescentes con autolesión no suicida.

Prevention of non-suicidal self-injury: construction and validation of educational material

Objective:

to develop and validate educational material to strengthen adolescent health care on non-suicidal self-injury.

Method:

methodological research designed in three stages: (1) construction of the material based on a mixed study on needs related to the theme through social networks and an umbrella review on health care related to non-suicidal self-injury; (2) validation with 10 experts in mental health and/or self-inflicted violence selected through the Lattes Platform; (3) evaluation by the target public, with health professionals being invited, without restriction of training. Validation and evaluation data were collected by using a sociodemographic questionnaire and the Suitability Assessment of Materials for evaluation of health-related information for adults. We used descriptive statistics, content validity index, and Gwet’s AC1 test.

Results:

the material obtained good general acceptance and reliability in the validation by the experts (AC1= 0.633; p=0.0000) and in the evaluation by the target public (AC1=0.716; p=0.0000). All professionals pointed out the personal contribution and educational potential of the material.

Conclusion:

we highlight the construction of science-based educational material to strengthen the health care for adolescents with non-suicidal self-injury.