Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents

Gender-specific factors of suicidal ideation among high school students in Yunnan province, China: A machine learning approach

BACKGROUND

Suicidal ideation (SI) assumes a pivotal role in predicting suicidal behaviors. The incidence of SI among high (junior and senior) school students is significantly higher than that of other age groups. The aim of this study is to explore the gender differences in SI among high school students in Yunnan Province.

METHOD

A total of 6180 students in grades 7-12 in Yunnan province, China from May 2021 to May 2022 participated in this survey. Univariate analysis was employed to describe the influencing factors of male and female students' SI. Subsequently, data were stratified by gender. Adopting machine learning technique, including Least Absolute Shrinkage and Selection Operator (Lasso) and Boruta algorithm, and logistic regression model to estimate the direction and effect magnitude of the influencing factors.

RESULTS

The prevalence of SI was significantly higher for females (31.34 %) than males (16.73 %). The logistic regression model was established using the variables screened by Boruta algorithm, indicated that anxiety, depression, suffering emotion abuse or emotion neglect in childhood, non-suicidal self-injury, evening chronotype are common risk factors for SI in male and female students. Notably, female students who exhibited aggressive behavior, have experienced bullying, and were in the junior high school learning stage were more likely to report SI than their male counterparts.

CONCLUSIONS

Females showed more vulnerability to SI than males especially among females in junior high school, reporting aggressive behavior and bullying experiences. Tailored prevention strategies, informed by these gender-related distinctions, should be developed and implemented.

Prevalence of Adverse Childhood Experiences and Their Associations with Non-Suicidal Self-Injury Among Chinese Adolescents with Depression

The presence of adverse childhood experiences (ACEs) in adolescents diagnosed with depression has been associated with an extensive range of mental health issues, including non-suicidal self-injury (NSSI). However, there has been a dearth of research into the prevalence of ACEs and their associations with NSSI among depressed adolescent populations in China. This study aimed to investigate the prevalence of different types of ACEs and their associations with NSSI in depressed Chinese adolescents. Utilizing Chi-squared tests, latent class analysis (LCA), and multinomial logistic regression, the prevalence of different types of ACEs and their associations with NSSI were determined in a sample of 562 adolescents with depression. Among depressed adolescents. 92.9% of depressed adolescents reported ACEs, and the prevalence of emotional neglect, physical abuse, caregiver treated violently, and bullying was relatively high. ACEs, including sexual abuse (OR = 5.645), physical abuse (OR = 3.603), emotional neglect (OR = 3.096), emotional abuse (OR = 2.701), caregiver divorce/family separation (OR = 2.5), caregiver treated violently (OR = 2.221), and caregiver substance abuser (OR = 2.117), were associated with increased odds of exposure among depressed adolescents with NSSI. The high ACEs class (19%), the moderate ACEs class (40%), and the low ACEs class (41%) were identified as latent classes. NSSI was more prevalent in the high/moderate ACEs class compared to the low ACEs class, particularly in the high ACEs class. The situation of the prevalence of ACEs among adolescents with depression was unsatisfactory, and certain types of ACEs were associated with NSSI. Eliminating potential risk factors for NSSI requires the early prevention and targeted intervention of ACEs. Moreover, additional large-scale longitudinal studies are necessary to assess the different development trajectories associated with ACEs, such as the relationships between the different development periods of ACEs and NSSI, and to ensure the adoption of evidence-based prevention and intervention strategies.

Association of conventional and electronic cigarette use with suicidality in Chinese adolescents: The moderating effect of sex and school type

BACKGROUND

To estimate the prevalence of lifetime e-cigarette use and explore the association between lifetime conventional and electronic cigarette use with suicidality among Chinese adolescents, focusing on sex and school-type differences.

METHODS

A total of 22,509 students from 432 classes in 80 schools were recruited in Guangdong Province using a multistage, stratified cluster, random sampling method in 2021. Self-report questionnaires were used to collect information. Multivariable logistic regression models were performed and stratification analysis was conducted. All analyses were weighted and adjusted for the complex survey design.

RESULTS

The weighted prevalence of lifetime e-cigarette use among adolescents in Guangdong Province was 8.7 % (4.3 % were dual users and 4.4 % were e-cigarette-only users) and 2.6 % were conventional-cigarette-only users. Lifetime e-cigarette-only users (AOR [Adjusted OR] =1.46, 95 % CI = 1.21-1.76), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.58-2.46) and dual users (AOR = 1.67, 95 % CI = 1.38-2.02) were at a higher risk of suicidal ideation than non-users. Lifetime e-cigarette-only users (AOR = 2.03, 95 % CI = 1.53-2.70), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.42-2.73), and dual users (AOR = 2.76, 95 % CI = 2.10-3.61) had a significantly higher risk of suicide attempts than non-users. After further analysis stratified by sex and school type, the associations of lifetime cigarette use patterns with suicidality slightly varied.

LIMITATION

The cross-sectional study design and self-report information.

CONCLUSION

The prevalence of e-cigarettes among Chinese adolescents is concerning. Lifetime conventional and e-cigarette use were associated with suicidality among Chinese adolescents, with sex and school type moderating these associations. Targeted measures to restrict cigarette use, including new tobacco product (e-cigarette) use, among adolescents are warranted.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

A cross-sectional study of non-suicidal self-injury in adolescent depression: association with demographic characteristics and physiological indicators

Introduction

Non-suicidal self-injury (NSSI) is a prevalent concern among adolescents with depression, yet its relationship with demographic characteristics and physiological indicators remains underexplored. This study aimed to investigate these relationships among inpatient adolescents aged 13 to 18 at a hospital affiliated with Guizhou Medical University.

Methods

A cross-sectional study was conducted involving 222 adolescent inpatients diagnosed with depression. Data on NSSI occurrence, demographic variables (gender, only-child status, age), and physiological indicators (ALT, TSH, FT4, PLR, TG, HDLC, LDLC, FT3, NLR, MLR) were collected and analyzed. Statistical analyses, including correlations and group comparisons, were performed to assess the associations between NSSI and these factors.

Results

The prevalence of NSSI among the participants was 40.5%. Significant correlations were found between NSSI and several demographic and physiological factors. Specifically, NSSI was significantly associated with female gender, non-only-child status, younger age, lower ALT levels, higher TSH levels, lower FT4 levels, and higher PLR values. However, no significant differences were observed in TG, HDLC, LDLC, FT3, NLR, or MLR between the NSSI and non-NSSI groups.

Discussion

The findings highlight distinct demographic and physiological profiles associated with NSSI among adolescents with depression. The prevalence rate of NSSI underscores its significance as a behavioral manifestation in this population. Further research should explore the underlying mechanisms linking these factors to better inform targeted interventions and treatment strategies for adolescents experiencing NSSI in the context of depression.

Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships

BACKGROUND

Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation.

METHODS

The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships.

RESULTS

The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation.

CONCLUSIONS

Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

Developmental trajectories of non-suicidal self-injury in adolescence: The effect of social support and socioeconomic status

BACKGROUND

Non-suicidal self-injury (NSSI) in early adolescence has been amply documented. However, there has been little research on the progression of NSSI over time. Most studies have focused on the risk factors for NSSI, with less attention devoted to understanding the role of protective factors. This paper aimed to expand existing knowledge about the development of NSSI, with an emphasis on the impacts of protective factors such as social support and socioeconomic status (SES).

METHODS

A total of 436 adolescents completed self-report surveys that addressed social support including friend, family, and teacher support, objective and subjective SES, and NSSI at three different points in time for 2 years.

RESULTS

Latent growth curve analyses revealed that NSSI increased across early adolescence to mid-adolescence. Support from friends and family negatively predicted adolescents' initial NSSI level. Furthermore, subjective SES negatively predicted the rate of NSSI.

CONCLUSIONS

These findings contribute to an understanding of the influences of both social support and SES on NSSI over time. NSSI interventions and education should include considerations of both the value of support from friends and family as well as subjective SES.

Association between negative life events through mental health and non-suicidal self-injury with young adults: evidence for sex moderate correlation

BACKGROUND

Non-suicidal self-injury (NSSI) has exhibited an increasing trend in recent years and is now globally recognized as a major public health problem among adolescents and young adults. Negative life events (NLEs) are positively associated with NSSI. We sought to explore (1) whether sex plays a role in the risk of NLEs leading to NSSI and (2) the role played by mental health (MH).

METHODS

We adopted a multi-stage cluster sampling method to select college students across four grades from May to June 2022. Generalized linear models were used to evaluate the relationships between NLEs, sex, MH and NSSI, presented as incidence-rate ratios (RRs) with 95% confidence intervals (CIs). We examined the complex relationship between these variables using the PROCESS method for moderation analysis.

RESULTS

Following the exclusion of data that did not meet the study requirements, data from 3,578 students (mean age: 20.53 [± 1.65] years) were included. Poisson regression results indicate that high-level NLEs (RR = 0.110, 95%CI: 0.047-0.173) are associated with increased NSSI. Furthermore, interaction effects were observed among sex, NLEs and NSSI. MH and sex moderated the relationship between NLEs and NSSI.

CONCLUSION

Identifying risk factors for NSSI is also important when exploring the interaction between NLEs and MH given the potential for NSSI to significantly increase the risk of later psychopathological symptoms and substance abuse problems. In addition, the significance of sex differences in risk factors for NSSI should be determined. This study evaluated how the impact of NLEs on NSSI can be reduced among adolescents from multiple perspectives.

Adverse childhood experiences and deviant peer affiliation among Chinese delinquent adolescents: the role of relative deprivation and age

Background

Deviant peer affiliation is considered a potential risk factor for adolescent delinquency. Due to the serious situation of adolescent delinquency in China, it is necessary to investigate the mechanisms by which adolescents associate with deviant peers.

Objectives

The purpose of this study was to examine the association between adverse childhood experiences (ACEs) and deviant peer affiliation, the mediating effect of relative deprivation, and the moderating effect of age in a sample of Chinese delinquent adolescents.

Methods

Five hundred and forty-two Special School students aged 11-18 years were interviewed and completed questionnaires, including demographics, adverse childhood experiences, deviant peer affiliation, and relative deprivation.

Results

(1) After controlling for gender, adverse childhood experiences and deviant peer affiliation were significantly and positively associated among delinquent adolescents. (2) The effect of ACEs on deviant peer affiliation was mediated by relative deprivation. (3) Age played a moderating role not only in the relationship between ACEs and relative deprivation, but also in the indirect relationship in which ACEs influence deviant peer affiliation through relative deprivation; specifically, the indirect effect of ACEs influencing deviant peer affiliation through relative deprivation was stronger in early adolescence compared with late adolescence.

Conclusion

Overall, early ACEs play an important role in deviant peer affiliation among delinquent adolescents and relative deprivation is an important mediating variable. The results of the present study emphasize the importance of cognitive interventions for delinquent adolescents who experience ACEs in early adolescence, which may be instructive for the prevention of adolescent delinquency.

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.

Prevalence of unhealthy behaviors and their associations with non-suicidal self-injury, suicidal ideation and suicide attempt among Chinese adolescents

BACKGROUND

Unhealthy lifestyle behaviors among adolescents have emerged as a significant public health concern worldwide, however, there is little investigation on the impact of unhealthy behaviors on non-suicidal self-injury (NSSI), suicidal ideation (SI) and suicide attempt (SA). This study aimed to investigate the prevalence of seven unhealthy behaviors as well as their associations with NSSI, SI and SA, and to explore whether the aforementioned associations differ across sex.

METHODS

A total of 74,152 adolescents were included in this study via a multi-stage, stratified cluster, random sampling method in 2021. Information about unhealthy behaviors (insufficient physical activity, current smoking, current drinking, excessive screen time, long homework time, insufficient sleep and unhealthy BMI), NSSI, SI, SA and other demographics was collected. Sampling weights were used to estimate the prevalence, and the weighted logistic regression models were performed. Stratified analyses by sex and sensitive analyses were conducted.

RESULTS

Overview, the weighted prevalence of adolescents had more than five unhealthy behaviors were 5.2%, with boys showing a higher prevalence than girls (6.5% vs.3.8%). Current smoking, current drinking, excessive screen use, long homework time, insufficient sleep, and unhealthy BMI were significantly associated with NSSI, SI and SA. Moreover, adolescents with high lifestyle risk scores were associated with an increased risk of NSSI (5-7 vs. 0: OR 6.38, 95% CI 5.24-7.77), SI (5-7 vs. 0: OR 7.67, 95% CI 6.35-9.25), and SA (5-7 vs. 0: OR 9.57, 95% CI 6.95-13.17). Significant sex differences were found in the associations of unhealthy behaviors with NSSI, SI and SA.

CONCLUSION

Unhealthy behaviors are quite common among Chinese adolescents. Adolescents with multiple unhealthy behaviors are associated with increased risks of NSSI, SI, and SA. The implementation of school and family-based interventions to promote healthy lifestyles is recommended as a preventive measure against self-injurious behavior and suicidality in adolescents.

Childhood maltreatment and suicidal ideation among Chinese adolescents: Moderated mediation effect of perceived social support and maladaptive cognitive emotion regulation strategies

BACKGROUND

Although previous studies have shown that childhood maltreatment is a risk factor for adolescent suicidal ideation, less is known about the mediating and moderating mechanisms underlying this association.

OBJECTIVE

The current study aimed to investigate the relationship between childhood maltreatment and suicidal ideation among adolescents, as well as the mediating role of maladaptive cognitive emotion regulation strategies (maladaptive CERSs) and the moderating role of perceived social support.

METHODS

In a cross-sectional design, 4005 adolescents (Mage = 14.24 years, SD = 1.53; 49.0 % males) completed self-report questionnaires regarding childhood maltreatment, maladaptive CERSs, perceived social support and suicidal ideation, along with their basic information.

RESULTS

After controlling for gender, family location, family structure, and depression, childhood maltreatment was positively related to adolescent suicidal ideation, and maladaptive CERSs were found to mediate this association. Moderated mediation analyses revealed that perceived social support buffered the associations between maladaptive CERSs and adolescent suicidal ideation.

CONCLUSIONS

The findings assist in understanding the mechanisms of maladaptive CERSs and perceived social support in the relationship between childhood maltreatment and suicidal ideation and can provide new perspectives for researchers designing interventions for suicidal ideation.

Outcomes of adverse childhood experience during late adolescence: Evidence from college and community samples

Scant studies have investigated adverse childhood experience (ACE) outcomes and mastery during adolescence in different cultural contexts. This cross-sectional study examines the impact of ACEs on subjective well-being, health complaints, and healthcare utilization during late adolescence, including the mediating role of the sense of mastery in the Saudi context. Adolescents (N = 396) aged 17-21 years were recruited via convenience sampling from colleges and local communities from two regions in Saudi Arabia. Data were collected using a paper-pencil anonymous survey and analyzed using path analysis. Of the sample, 85.5% experienced at least one ACE. ACEs had a direct effect on subjective well-being (p = 0.034), health complaints (p < 0.001), healthcare utilization (p < 0.001), and sense of mastery (p < 0.001). Sense of mastery had an effect on subjective well-being (p < 0.001) and health complaints (p < 0.001), but not on healthcare utilization (p = 0.436). Sense of mastery partially mediated the relationship between ACEs and subjective well-being (p = 0.034) and health complaints (p < 0.001), but not healthcare utilization (p = 0.438). ACEs have detrimental effects on adolescent health. Attention should be paid to primary prevention and early detection to avoid further harm, and interventions that address the role of the sense of mastery should be developed for adolescents.

Mobile phone addiction and suicide behaviors among Chinese adolescents: The mediation of poor sleep quality

Background and aims

Mobile phone addiction (MPA) is emerging among adolescents, especially during the COVID-19 pandemic. Nevertheless, there is a dearth of knowledge regarding the correlation between MPA and suicide behaviors and its mechanism. The objective of the current study is exploring the direct effect of MPA on suicide behaviors and the indirect effect through poor sleep quality.

Methods

A total of 18,900 Chinese adolescents aged 12 to 18 were recruited via a multi-stage cluster sampling method.

Results

The prevalence of MPA and poor sleep quality was 26.2 and 23.1%, respectively. During the past year, 24.4% participants were involved in suicide behaviors. Specifically, suicide ideators, suicide planners, and suicide attempters were 10.7, 8.4, and 5.3%, respectively. Particularly, rural females had the highest prevalence of suicide behaviors, MPA, and poor sleep quality. Logistic regression analysis showed that MPA was significantly associated with suicide ideators (OR = 1.22, 95% CI: 1.09-1.37, p < 0.001) and planners (OR = 1.18, 95% CI: 1.04-1.34, p < 0.05), but not for suicide attempters (p > 0.05). Structural equation modelling demonstrated that MPA had direct effect on suicide behaviors (β = 0.145, 95% CI = 0.127-0.160), and poor sleep quality partially mediated the relationship (the mediating ratio was 46.7%). The mediating ratio of poor sleep quality was the highest in urban males.

Conclusions

MPA has both direct and indirect effects on suicide behaviors. For suicide prevention, limited mobile phone use and improvement sleep quality may be practical for adolescents. Additionally, more efforts of intervention could give priority to rural girls.

Understanding the Impact of Adverse Childhood Experiences on Non-suicidal Self-Injury in Youth: A Systematic Review

Objective

Non-suicidal self-injury (NSSI), defined as a deliberate destruction of one's own body without a suicidal intent, is a global public health issue. Adverse childhood events (ACEs) have been shown to be associated with various mental illnesses; however, to date the impact of such events on NSSI in youth has not been reviewed.

Methods

We conducted a systematic review, searched 5 databases for published articles evaluating ACE and NSSI in youth less than or equal to 21 years of age. After screening 247 articles, we included 21 unique articles in this systematic review.

Results

Increasing ACE score, physical, sexual or emotional abuse, parental neglect and substance use, parental separation or dysfunctional family, and death of a close family member had statistically significant correlation with NSSI.

Conclusion

Non-suicidal self-injury is an impairing diagnosis with far reaching psychiatric manifestations and repercussions. Practitioners having high clinical suspicion for ACEs in youth with NSSI must intervene early by administering the ACEs questionnaire. Effective treatment of NSSI in those with ACEs with psychotherapy significantly improves outcomes and prevents suicide in youth.

Adverse childhood experiences and human immunodeficiency virus testing among adults with human immunodeficiency virus risk behaviours

Adverse childhood experiences (ACEs) have been associated with poor HIV testing in adulthood yet, they have not been extensively described in those at increased risk for HIV. Cross-sectional analysis data (n = 204,231) on ACEs and HIV testing were obtained from the 2019-2020 Behavioural Risk Factor Surveillance Survey. Weighted logistic regression models were used to access the association of ACEs exposure, ACEs score, and ACEs type with HIV testing among adults with HIV risk behaviours, and stratified analysis was also performed to examine gender differences. The results indicated the overall rate of HIV testing was 38.8% and was higher among those with HIV risk behaviours (64.6%) than those without (37.2%). In populations with HIV risk behaviours, the negative association of HIV testing with ACEs exposure, ACEs score, and ACEs type was identified. Relative to those without ACEs, adults who were exposed to ACEs might decrease the rate of HIV testing, participants with ≥4 ACEs scores were less likely to have HIV testing, and childhood exposure to sexual abuse had the greatest impact on HIV testing. For both males and females, childhood exposure to ACEs was associated with lower odds of HIV testing and ACEs score ≥4 had the most robust associations with HIV testing. For males, those who experienced witnessed domestic violence had the lowest odds of HIV testing but the odds of engaging in HIV testing for females were the lowest among those who experienced childhood sexual abuse.

Trauma-Informed Approach to Qualitative Interviewing in Non-Suicidal Self-Injury Research

Non-suicidal self-injury (NSSI) is recognized as a public health concern owing to its chronic nature, association with suicide risk, and its growing prevalence rates across the globe. Including individuals living with NSSI in research is crucial as it offers opportunities to give primacy to participant voices and insights, further guiding therapeutic interventions. Research has established an association between history of traumatic events and adverse childhood experiences with subsequent risk of NSSI. When planning a qualitative research study with individuals with potential trauma history, researchers need to be aware of and sensitive to potential re-traumatization and distressing emotions that participants may experience during interviews, as well as complex trauma reactions that may affect individuals after study participation. The article emphasizes that researchers be cognizant of the multifaceted nature of trauma and how it can impact individuals and communities and be sensitive in their approach to interviewing vulnerable groups such as individuals with experiences of NSSI. The authors propose adopting a trauma-informed approach to ethically plan and conduct qualitative interviews exploring NSSI experiences. Trauma-informed recommendations for preparing and carrying out specific steps during different stages of NSSI interviews are detailed.

Brief Report: The Association of Adverse Childhood Experiences and Suicide-Related Behaviors Among 10th-Grade Secondary School Students

The association between adverse childhood experiences and suicide-related behaviors (SRB) of adolescents has been widely studied in Western high-income countries, but not yet in Latin America. The aim of this study was to determine this association and to explore a dose-response relationship between adverse childhood experiences and SRB in Chile. We conducted a cross-sectional survey to assess adverse childhood experiences up to 1 year prior to the survey and SRB (suicide ideation and attempts) in a sample of secondary school students. Multilevel and multivariable logistic regressions were run with SRB as dependent and adverse childhood experiences as independent variables, adjusted by self-esteem, general mental health, friend and parental support, and the age at onset of cannabis and alcohol use. We included 7,458 adolescents (48.7% girls), mean age = 16.0 (SD = 0.7), and found a prevalence of 78.1% for at least one adverse childhood experience. The 6-month prevalence of suicidal ideation was 18.1% (95% confidence interval [CI]: 17.2%-19.0%), and the prevalence of suicide attempts was 5.0% (95% CI: 4.6-5.6). Among all adverse childhood experiences, only sexual abuse was a risk factor for both SRB. We also found an independent effect of the total number of adverse childhood experiences on suicidal ideation (p < .001) and on suicide attempts (p < .001). Additionally, ages at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively. This is the first study exploring the influence of adverse childhood experiences on suicide-related behaviors in adolescents from Latin America.HIGHLIGHTSSexual abuse is associated with suicidal ideation and suicide attempts in 10th-grade secondary school studentsThere is a dose-response effect between adverse childhood experiences and suicide-related behaviorAges at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively.

School connectedness and psychological resilience as mediators in the relationship between childhood abuse and suicidal ideation among Chinese adolescents

Background: Suicide among adolescents is a huge public health concern around the world. Although childhood abuse has been established as a substantial risk factor for suicide behaviours, potential mediators in this relationship remain unclear.Objective: This study aimed to examine the mediating roles of school connectedness and psychological resilience in the association between childhood abuse and suicidal ideation among Chinese high school students.Methods: The sample involved 1607 adolescents from four high schools in Central China. Structural equation modelling (SEM) was conducted to investigate the mediation effects of school connectedness and psychological resilience on the relationship between childhood abuse and suicidal ideation.Results: The prevalence of suicidal ideation during the past week was 21.9%. Childhood abuse was positively related to the development of suicidal ideation directly and indirectly through school connectedness and psychological resilience. School connectedness and psychological resilience were also partial mediators of all three types of childhood abuse (emotional abuse, physical abuse and sexual abuse) when the types were examined separately.Conclusions: Suicidal ideation was widespread among Chinese high school students. Psychological resilience and school connectedness could attenuate the detrimental impact of childhood abuse on suicidal ideation. Findings underscore the improvement of psychological resilience and the connection to the school would be beneficial to suicide prevention among Chinese adolescents with childhood abuse.

Role of polygenic risk scores in the association between chronotype and health risk behaviors

BACKGROUND

This study explores the association between chronotypes and adolescent health risk behaviors (HRBs) by testing how genetic background moderates these associations and clarifies the influence of chronotypes and polygenic risk score (PRS) on adolescent HRBs.

METHODS

Using VOS-viewer software to select the corresponding data, this study used knowledge domain mapping to identify and develop the research direction with respect to adolescent risk factor type. Next, DNA samples from 264 students were collected for low-depth whole-genome sequencing. The sequencing detected HRB risk loci, 49 single nucleotide polymorphisms based to significant SNP. Subsequently, PRSs were assessed and divided into low, moderate, and high genetic risk according to the tertiles and chronotypes and interaction models were constructed to evaluate the association of interaction effect and clustering of adolescent HRBs. The chronotypes and the association between CLOCK-PRS and HRBs were examined to explore the association between chronotypes and mental health and circadian CLOCK-PRS and HRBs.

RESULTS

Four prominent areas were displayed by clustering information fields in network and density visualization modes in VOS-viewer. The total score of evening chronotypes correlated with high-level clustering of HRBs in adolescents, co-occurrence, and mental health, and the difference was statistically significant. After controlling covariates, the results remained consistent. Three-way interactions between chronotype, age, and mental health were observed, and the differences were statistically significant. CLOCK-PRS was constructed to identify genetic susceptibility to the clustering of HRBs. The interaction of evening chronotypes and high genetic risk CLOCK-PRS was positively correlated with high-level clustering of HRBs and HRB co-occurrence in adolescents, and the difference was statistically significant. The interaction between the sub-dimensions of evening chronotypes and the high genetic CLOCK-PRS risk correlated with the outcome of the clustering of HRBs and HRB co-occurrence.

CONCLUSIONS

The interaction of PRS and chronotype and the HRBs in adolescents appear to have an association, and the three-way interaction between the CLOCK-PRS, chronotype, and mental health plays important roles for HRBs in adolescents.

Maladaptive cognitive regulation moderates the mediating role of emotion dysregulation on the association between psychosocial factors and non-suicidal self-injury in depression

Introduction

Non-suicidal self-injury (NSSI) is highly prevalent in depression, and is associated with psychosocial factors, emotion dysregulation, and strategies of cognitive emotion regulation. However, the internal combination and interactions of these risk factors in depression remain unclear.

Methods

Data from 122 patients with depression, including 56 with NSSI and 66 without NSSI, were analyzed. Self-rating scales were used to assess psychosocial factors, emotion dysregulation, and cognitive regulation strategies. Sparse partial least squares discriminant analysis (sPLS-DA) was employed to explore internal combinations in each profile. A moderated mediation model was applied to examine their interactional relationship.

Results

The results identified an NSSI-related psychosocial profile characterized by high neuroticism, childhood trauma, poor family functioning, and low psychological resilience. Emotion dysregulation, including high levels of alexithymia, anhedonia, and emotion regulation difficulties, mediated the association between this psychosocial profile and NSSI. The mediated effect was further moderated by maladaptive cognitive regulation strategies.

Limitations

Lack of sufficient information on NSSI frequency and severity. Relatively small sample size for discussing the impact of gender and age of depressive patients with NSSI.

Conclusion

These findings hold important implications for the prevention, treatment, and rehabilitation of NSSI.

Reciprocal associations between early maladaptive schemas and depression in adolescence: long-term effects of childhood abuse and neglect

BACKGROUND

Adolescent depression has grown to be a major social concern in China. During the coronavirus pandemic, the incidence of depression among Chinese adolescents increased substantially. More research is required to inform the prevention and intervention of adolescent depression in China. Depression is associated with Early Maladaptive Schemas (EMSs). Childhood abuse and neglect are distal antecedents of adolescent depression. It is not known how depression and EMSs interact in adolescence and how childhood abuse and neglect contribute to this relationship. This study aimed to examine the reciprocal relationships between depression and EMSs, as well as the long-term effects of childhood abuse and neglect on depression and EMSs during adolescence. The work also investigates gender differences in these mechanisms.

METHODS

Using a two-wave longitudinal design, we recruited 3,485 Chinese adolescents (Mage = 13.2; 43.2% females) from three Shanxi Province, China middle schools. All participants completed self-report questionnaires addressing childhood abuse and neglect, depression, and EMSs. Structural equation models examined reciprocal relationships between depression and EMS, as well as the effect of childhood abuse and neglect on depression and EMSs. Multi-group analysis addressed gender differences.

RESULTS

Results indicated that greater depression predicted more EMSs measured later, but EMSs did not predict subsequent depression. Childhood abuse and neglect had different effects on depression and EMSs during adolescence. Specifically, exposure to childhood abuse related to more severe depression and EMSs in adolescence and contributed to the perpetuation of EMSs by increasing depression. Exposure to childhood neglect showed a direct effect on depression and indirectly reinforced subsequent EMSs through depression. There were no gender differences.

CONCLUSION

These findings contribute to a better understanding of the emergence and course of depression in early adolescence, suggesting that childhood abuse and neglect are critical early risk factors. Additionally, depression plays a key role in promoting schema perpetuation among adolescents exposed to childhood maltreatment, providing important implications for relevant prevention and intervention in early adolescence.

A Child-Parent Dyad Study on Adolescent Paranoia and the Influence of Adverse Life Events, Bullying, Parenting Stress, and Family Support

BACKGROUND

Paranoid beliefs commonly occur in the general adolescent population. Exposure to adverse life events (ALEs) and/or bullying are important environmental risk factors. The extent to which others, especially parents, are available to help a young person cope with stressful situations may offset this risk.

STUDY DESIGN

A cross-sectional adolescent-parent dyad design (n = 142 pairs) was used to test whether an adolescent's perception of being supported by their family, and/or the parent's perception of stress and burden in their parenting role, moderated the association between environmental risk and adolescent paranoid beliefs.

STUDY RESULTS

Moderation analysis indicated that ALEs were significantly associated with adolescent paranoid beliefs when parents reported high stress and burden in their parenting role. Conversely, at low and moderate levels of parental stress, ALEs were unrelated to paranoid beliefs. Bullying was strongly associated with paranoia, with no moderation effects. The adolescent's perception of support within their family had no moderating effects.

CONCLUSIONS

Findings indicate that the focus of prevention should be shifted beyond just families of adolescents who are experiencing psychosis and/or have high "at-risk" profiles, to families of adolescents exposed to ALEs. Targeted support for parents to help reduce parental stress and burden, and help foster protective family environments even in the face of ALEs, is an important avenue for reducing the risk of paranoid beliefs in adolescents. Further research is required to better understand how to offset the deleterious effect of bullying on paranoid beliefs in adolescents.

Negative Parenting Styles and Psychological Crisis in Adolescents: Testing a Moderated Mediating Model of School Connectedness and Self-Esteem

Little is known about how rejecting and controlling parenting styles may influence adolescent psychological crisis and what conditions may buffer the detrimental effects of psychological crisis. By integrating multiple theories, this study investigated self-esteem as an underlying mediator and school connectedness as a potential moderator to explain the link between negative parenting and the two psychological crises among Chinese adolescents. In this study, the questionnaire method is adopted to examine the combined mechanism of rejecting parenting style and controlling parenting style on the psychological crisis of adolescents. In total, 1863 adolescents were involved in this study, ranging from 13 to 17 years old. The results showed that both the rejecting parenting style and the controlling parenting style can significantly and positively predict the level of psychological crisis of adolescents, but the predictive power of the rejecting parenting style was stronger. Self-esteem partially mediates the relationship between rejecting parenting style, controlling parenting style, and psychological crisis. School connectedness moderates both the effects of rejecting parenting styles on self-esteem and the effects of self-esteem on the psychological crisis. This study identifies the internal mechanisms by which negative parenting styles affect adolescents' psychological crisis, and reveals the mediating and moderating roles of self-esteem and school connectedness, providing additional explanatory paths for the mechanisms of adolescents' psychological crisis.

Adverse Childhood Experiences and alcohol use among U.S.-born and immigrant Latinx youth: the roles of social support and stress hormones

The biobehavioral correlates of Adverse Childhood Experiences (ACEs) among Latinx youth have been strikingly understudied. The purpose of this study was to 1) examine the effects of T-ACEs (e.g., maltreatment, family dysfunction) and E-ACEs (e.g., family deportation, community violence) in alcohol use, 2) test whether social support moderated these associations and 3) explore whether ACEs and alcohol use were related via adrenocortical hormones (i.e., cortisol, dehydroepiandrosterone [DHEA]). A total of 100 Latinx youth, between the ages of 13 and 19, participated in this study (53% female). Community samples of United States (U.S.)-born (N = 54) and immigrant Latinx (N = 46) youth provided morning saliva samples and completed self-report questionnaires. Results highlighted that for immigrant youth, social support buffered the effects of E-ACEs on alcohol use, F(9,89)= 3.34, p = .01, R2 = .25. Although our mediation hypothesis was not supported, the direct effects of T-ACEs (β = .25, t (94) = 2.21, p = .03) and E-ACES (β = -.24, t (94) = -2.23, p = .03) on DHEA were significant for the entire sample. Preventing maltreatment and reducing community-level adversities seem critical for optimal child development, as exposure to these may increase alcohol use risk and affect HPA Axis functioning. Increasing extrafamilial support may be particularly salient for immigrant Latinx youth, as many experience extended immigration-related periods of separation from family members.

Immediate and longer-term changes in mental health of children with parent-child separation experiences during the COVID-19 pandemic

BACKGROUND

The psychological impact of the COVID-19 pandemic has been understudied among vulnerable populations. This study aimed to examine the immediate and longer-term changes in the mental health of children with parent-child separation experiences during the COVID-19 pandemic, and identify potential buffering opportunities for mental health.

METHODS

This longitudinal cohort study used data from 723 rural Chinese children who provided data before (Oct. 2019) the COVID-19 pandemic and during the following 2 years. Changes in the probability of depressive symptoms, anxiety symptoms, non-suicide self-injurious (NSSI), suicidal ideation, suicide plan, and suicide attempt were tested across four waves using generalized estimating models (GEE).

RESULTS

Compared with children who never experienced parent-child separation, children persistently separated from parents since birth experienced greater deterioration in all mental health in the 2-year follow-up (average change: depressive symptoms: β = 0.59, 95% CI [0.26, 0.93]; anxiety symptoms: β = 0.45, 95% CI [0.10, 0.81]; NSSI: β = 0.66, 95% CI [0.31, 1.01]; suicide ideation: β = 0.67, 95% CI [0.38, 0.96]; suicide plan: β = 0.77, 95% CI [0.38, 1.15]; suicide attempt: β = 1.12, 95% CI [0.63, 1.62]). However, children with childhood separation from their parents but reunited with them during the transition to adolescence showed similar even lower changes to counterparts who never experienced parent-child separation (all ps > 0.05).

CONCLUSION

These results indicating improvements in supportiveness of the caregiving environment during the transition to adolescence may provide the opportunity to buffer the adverse impact of COVID-19 on mental health. Translating such knowledge to inform intervention and prevention strategies for youths exposed to adversity is a critical goal for the field.

Prevalence and associated factors of internet addiction among Chinese adolescents: association with childhood trauma

Introduction

Internet addiction (IA) is common among adolescents and may have severe consequences. This study aimed to investigate the prevalence and factors associated with IA among middle school students of Hunan Province, China. Relevance between IA and childhood trauma was also explored.

Methods

One thousand six hundred ten students were enrolled in this cross-sectional study. Data collected included demographics; internet addiction (revised-Chen internet addiction scale); childhood trauma (CTQ-SF); depression, anxiety, and stress symptoms (DASS-21); suicidal behaviors, as well as non-suicidal self-injury (NSSI). Cramer's V analysis, univariable logistic regression and multivariable logistic regression were used for associations and identifying independent relevance of IA, respectively.

Results

The prevalence of IA was 12.8%. Cramer's V analysis showed that IA was associated with emotional abuse, emotional and physical neglect, NSSI, suicidal behaviors, stress, anxiety and depressive symptoms, physical disorder history. Regression analysis showed that IA was independently associated with emotional neglect (OR = 3.062, 95% CI: 2.083, 4.501, p < 0.001); physical neglect (OR = 2.328; 95% CI: 1.590, 3.409, p < 0.001); depressive symptoms (OR = 2.218, 95% CI: 1.467, 3.353, p < 0.001) nationality (OR = 1.888, 95% CI: 1.034, 3.447, p = 0.006) and age (OR = 1.253, 95% CI: 1.066, 1.471, p = 0.006).

Discussion

IA is common among middle school students. Attention should be paid to students with childhood trauma since they have a higher risk for IA, which may increase the risk for suicidal behaviors.

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.

The prevalence of self-injury in adolescence: a systematic review and meta-analysis

In the past 10 years, there has been a growing interest in self-injurious behavior (SIB) among adolescents. The lifetime prevalence of SIB is between 16 and 22% in community sample with females more likely to engage in SIB. There are conflicting results about the global distribution of the prevalence of SIB and whether the SIB has increased in the 21st century. Our aim in the current study was to conduct a systematic search of and meta-analysis on the prevalence of SIB in adolescents over the past 5 years' worth of published papers and to examine gender, continental, and year differences. We conducted a systematic search in June 2020 of six databases (PubMed, Scopus, Web of Science, OVID Medline, PsycINFO, EBSCO) with three main search terms: "self-injurious behavior," "prevalence," and "adolescence." Article inclusion criteria were (a) written in English; (b) published between January 1, 2015, and June 18, 2020; and (c) focused on a community sample. Titles and abstracts of the articles were screened first. Then, the relevant full texts were read, and those that met the inclusion criteria were collected. We used Comprehensive Meta-Analysis software was used to conduct the analyses. After the screening process 97, articles were included in the meta-analysis. The age of the samples ranged from 11.00 to 18.53 years. The overall average prevalence of nonsuicidal self-injury in the studies was 16%. There was a significant gender difference: females reported a higher prevalence than males (19.4% and 12.9%, respectively). A significantly higher prevalence was found among Asian articles than those from other continents (19.5% and 14.7%, respectively). The prevalence of SIB did not change significantly between 2013 and 2018. The current research draws attention to the high prevalence of SIB among adolescents, especially among females and those living in Asia. It is important to address this behavior, both in terms of prevention and intervention.

Sexual and gender minority adverse childhood experiences (SGM-ACEs), perceived social support, and adult mental health

BACKGROUND

Building on decades of research into the long-term developmental impacts of adverse childhood experiences (ACEs), researchers have called for expanding the ACEs framework to include experiences specific to minoritized identities. Recent empirical research has led to the development of a measure of sexual and gender minority adverse childhood experiences (SGM-ACEs). Within the SGM-specific ACEs framework, research on the long-term impact to adult mental health and the role of perceived social support are not well studied.

OBJECTIVE

The purpose of this paper was two-fold. First, examine whether SGM-ACEs adversely impact mental health in SGM adults. Second, examine the role of perceived social support in the association between SGM-ACEs and adult mental health.

PARTICIPANTS AND SETTING

Data were collected using a multifaceted sampling strategy. In total, 1819 self-identified SGM Texans completed an online survey inquiring about ACEs, SGM-ACEs, mental health, and demographic characteristics.

RESULTS

We estimated two competing structural equation models (SEM) examining the associations between SGM-ACEs and anxiety and depressive symptoms, and whether perceived social support may moderate or mediate his association. While both models demonstrated that SGM-ACEs were significantly associated with higher anxiety and depressive symptoms. However, we found more support for the mediation model such that SGM-ACEs had direct effects on anxiety and depressive symptoms, and an indirect effect on anxiety symptoms through family support.

CONCLUSIONS

Our findings confirmed that exposure to SGM-ACE is associated with poorer adult mental health. Additionally, SGM-ACEs exposure undermines SGM individuals' perceptions of family support, which increases symptoms of anxiety.

The relationship between childhood traumatic experience and suicidal tendency in non-suicidal self-injury behavior patients

BACKGROUND

Individuals with non-suicidal self-injury (NSSI) behavior are usually prone to repeated, intentional, direct harm to their own bodies that is not allowed by society without suicidal ideation. Under this behavior guidance, childhood traumatic experience may easily cause a series of psychological comorbidity symptoms, such as anxiety and depression, finally leading to a suicidal tendency.

METHODS

A total of 311 adolescent NSSI behavioral patients were recruited at the Ningbo Kangning hospital, Zhejiang Province according to the DSM-5 diagnostic criteria. Demographic data, childhood abuse and neglect, internet addiction, self-esteem, anxiety, and suicidal tendency were evaluated. A structural equation model with a path induction mechanism was constructed to evaluate the relationship between distal and proximal factors related to suicidal tendencies due to childhood traumatic experiences in NSSI behavioral individuals.

RESULTS

Among the 311 subjects included in the survey, 250 (80.39%) suffered traumatic experiences, such as emotional abuse/physical abuse/sexual abuse/emotional neglect or physical neglect in their childhood, 303 (97.43%) had suicidal ideation, 271 (87.14%) showed the total score of self-esteem, 148 (47.59%) had different degrees of Internet addiction tendency, and 286 (91.96%) showed obvious anxiety. The established path model fit well (GFI = 0.996, RMSEA = 0.03), and the model showed that self-esteem, anxiety, and childhood traumatic experience had standardized coefficients of -0.235 (z = -4.742, p < 0.01), 0.322 (z = 6.296, p < 0.01), 0.205 (z = 4.047, p < 0.01), respectively, with suicidal ideation path, suggesting that self-esteem, Internet addiction, and anxiety showed significant mediating effects in the process of childhood traumatic experience affecting suicidal ideation.

CONCLUSION

In the context of childhood traumatic experience, it is often accompanied by a series of regulatory behaviors such as Internet addiction, self-esteem, and so on, which finally leads to anxiety, mental symptoms, and even suicidal tendencies. The results provide effective support for the structural equation modeling to evaluate the multi-level influence of NSSI behavior individuals and emphasize that childhood familial factors may lead to psychiatric comorbidity symptoms and suicidal behavior.

Adverse childhood experiences, mental health, and social functioning: A scoping review of the literature

BACKGROUND

Adverse childhood experiences (ACEs) negatively impact people's physical and mental health and social functioning. Research literature focuses on the impact of ACEs on physical and mental health, yet to our knowledge, no study has examined the literature on ACEs, mental health, and social functioning outcomes.

OBJECTIVE

To map how ACEs, mental health, and social functioning outcomes have been defined, assessed, and studied in the empirical literature and identify gaps in the current research which need further investigation.

METHODS

A scoping review methodology following a five-step framework was implemented. Four databases were searched CINAHL, Ovid (Medline, Embase) and PsycInfo. The analysis involved both numerical and a narrative synthesis in line with the framework.

RESULTS

Fifty-eight studies were included in the analysis, and three key issues were identified a) the limitations of research samples to date, b) the choice of outcome measures for ACEs, social and mental health outcomes, and c) the limitations of current study designs.

CONCLUSION

The review demonstrates variability in the documentation of participant characteristics and inconsistencies in the definitions and applications of ACEs, social and mental health and related measurements. There is also a lack of longitudinal and experimental study designs, studies on severe mental illness, and studies including minority groups, adolescents, and older adults with mental health problems. Existing research is highly variable methodologically and limits our broader understanding of the relationships between ACEs, mental health, and social functioning outcomes. Future research should implement robust methodologies to provide evidence that could be used for developing evidence-based interventions.

Association of parent-child relationship quality and problematic mobile phone use with non-suicidal self-injury among adolescents

BACKGROUND

Non-suicidal self-injury behavior (NSSI) is a common mental health threat among adolescents. Poor parent-child relationship (PCR) and problematic mobile phone use (PMPU) are risk factors for NSSI. We aimed to explore the impact of PCR quality, PMPU, and their interaction effects on NSSI among adolescents in China, as well as the sex difference.

METHOD

A survey was conducted among school students in 4 provinces in China between 2017 and 2018. The study included 14,500 valid participants. The students' general demographic characteristics was collected, and further data on PCR quality, PMPU, and NSSI were obtained through self-rated questionnaire. Chi-square test, binomial logistic regression models, and the Andersson Excel were used for data analysis.

RESULTS

The 12-month prevalence of NSSI was 27.3%. Lower PCR quality and PMPU were significantly associated with NSSI, respectively. The low PCR + yes PMPU group had the greatest association with NSSI, followed by the high PCR + yes PMPU group, low PCR + no PMPU group. Moreover, in low father-child relationship + yes PMPU group, females had a higher risk of NSSI than males; in high mother-child relationship + yes PMPU group, females had a higher risk of NSSI than males. Additive interaction analysis indicated that mother-child relationship quality and PMPU were associated with increased risks of NSSI, in the subgroup of males.

CONCLUSIONS

The findings underline the importance of simultaneously studying the quality of PCR and PMPU for a comprehensive understanding of NSSI behavior, and especially highlights the significance of maternal relationship quality.

Risk factors, theoretical models, and biological mechanisms of nonsuicidal self-injury: a brief review

Nonsuicidal self-injury (NSSI) refers to the direct, deliberate infliction of harm to one's body tissue without the intention to die. The prevalence of NSSI has increased significantly globally in recent years and has become an important public health problem affecting the health of people, especially adolescents. The occurrence of NSSI in adolescents is the result of the interaction of different factors. Many scholars have proposed various theoretical models to explain the mechanism of NSSI behavior based on previous research on the influencing factors of NSSI. Moreover, advances have been made in genetic and neuroimaging mechanisms related to NSSI. Understanding the genetic and neuroimaging mechanisms of NSSI is important for both describing and treating the disorder. This literature review discusses the progress made on the risk factors, theoretical models, and biological mechanisms of NSSI.

Psychosocial predictors of persistent suicidal ideation among Chinese adolescents: A longitudinal study

BACKGROUND

Suicide is the fourth leading cause of death among adolescents. Studies have shown that persistent suicidal ideation has a more important effect on suicidal behavior. The objective of this study was to identify predictors of persistent suicidal ideation.

METHODS

Data were collected from 4225 Chinese middle and high school students. These adolescents were assessed for suicidal ideation at baseline and the second year. We used multinomial logistic regression (n = 4171) for the predictive effect of these factors on persistent suicidal ideation. We controlled for gender, residence, clinical diagnosis, clinical diagnosis family, suicide planning, and suicide attempts.

RESULTS

Depressive symptoms are essential in predicting persistent suicidal ideation (OR = 14.0; p < 0.001). Persistent suicidal ideation was predicted by sleep disorders, such as poor sleep quality (OR = 2.3; p = 0.008), difficulty falling asleep (OR = 2.4; p = 0.005), frequently midnight awakening (OR = 1.9; p = 0.044), and frequent nightmares (OR = 2.1; p = 0.040). There was a significant association between concern with persistent ideation and parental-peer alienation (OR for father, 1.9[p = 0.024]; OR for mother, 3.1[p < 0.001]; OR for peer, 2.3[p = 0.003]).

LIMITATIONS

All measures are based on self-report rather than objective assessment or clinical diagnostic assessment.

CONCLUSIONS

Persistent suicidal ideation had a more important role in influencing suicide planning and attempt. Interventions targeting sleep disorders and attention to attachments in the home and school are particularly important in preventing persistent suicidal ideation in adolescents.

The psychosocial consequences of covid-19 in adolescents with nonsuicidal self-injury

BACKGROUND

Young people have been especially affected by the psychosocial consequences of the covid-19 pandemic. Covid-19 has potentially also been more stressful for vulnerable groups with mental health problems.

METHODS

In this cross-sectional study, the psychosocial effects of covid-19 in a vulnerable group of adolescents with nonsuicidal self-injury (NSSI) from a sample of 1602 Swedish high-school students were examined. Data were collected in 2020 and 2021. First, adolescents with and without NSSI were compared on how they perceived the psychosocial impact of covid-19, and second, a hierarchical multiple regression analysis was used to examine whether lifetime NSSI experience was associated with perceived psychosocial consequences of covid-19, when demographic variables and symptoms of mental health problems were controlled for. Interaction effects were also examined.

RESULTS

Significantly more individuals with NSSI reported being burdened by covid-19 compared to those without NSSI. When demographic variables and mental health symptoms were controlled for, adding NSSI experience did not, however, increase the amount of variance explained in the model. The total model explained 23.2% of the variance in perceived psychosocial impact of covid-19. Perceiving the family's financial situation as poor and neither good nor bad, studying a theoretical high school program, symptoms of depression and difficulties with emotion regulation were significantly associated with perceived negative psychosocial impact of the covid-19 pandemic. There was a significant interaction effect between NSSI experience and depressive symptoms. The effect of NSSI experience was larger when depressive symptoms were lower.

CONCLUSIONS

Lifetime NSSI experience in itself was not associated with psychosocial covid-19 consequences when other variables were controlled for, whereas symptoms of depression and difficulties with emotion regulation were. Results imply that vulnerable adolescents with mental health symptoms need special attention and access to mental health support in order to prevent further stress and worsening of mental health symptoms in the wake of the covid-19 pandemic.

Exploring associations of adverse childhood experiences with patterns of 11 health risk behaviors in Chinese adolescents: focus on gender differences

PURPOSE

Adolescents exposed to adverse childhood experiences (ACEs) are at increased risk for health-compromising behaviors. However, few studies have investigated how ACEs correlate with patterns of health risk behaviors (HRBs) during adolescence, a crucial developmental period. The aim was to extend the current knowledge about the relationship between ACEs and HRB patterns among adolescents, and to explore gender differences.

METHODS

A multi-centered population-based survey was conducted in 24 middle schools in three provinces across China between 2020 and 2021. A total of 16,853 adolescents effectively completed anonymous questionnaires covering exposure to eight ACE categories and 11 HRBs. Clusters were identified using latent class analysis. Logistic regression models were utilized to test the association between them.

RESULTS

There were four classes of HRB patterns: "Low all" (58.35%), "Unhealthy lifestyle" (18.23%), "Self-harm" (18.42%), and "High all" (5.0%). There were significant differences between HRB patterns in terms of the different numbers and types of ACEs in three logistic regression models. Specifically, compared to "Low all," different types of ACEs were positively associated with the three other HRB patterns, and there were significant trends toward increase in the three latent classes of HRBs with higher ACEs. In general, females with ACEs had a higher risk of "High all" except sexual abuse than males.

CONCLUSION

Our study comprehensively considers the association between ACEs and aggregation categories of HRBs. The results support efforts to improve clinical healthcare, and future work may explore protective factors based on individual, family, and peer education to mitigate the negative trajectory of ACEs.

Rural-urban differences in prevalence and correlates of suicidal ideation in adolescent patients with depression in a large sample of Chinese

BACKGROUND

Suicidal ideation (SI) is severe comorbidity of depression that has been extensively studied in the past. Residence differences between SI have rarely been systematically studied, especially in parental rearing behavior. This large-scale explored the residence differences in the prevalence and correlation of SI adolescent patients with depression.

METHODS

A total of 1417 patients with depression were recruited, and their demographic data and clinical data were collected. The Children's Depression Inventory (CDI) and the Egna Minnen Beträffande Uppfostran (EMBU) scale were used to assess depression, and parental rearing behavior, respectively.

RESULTS

The prevalence of suicidal ideation was higher in urban patients than in rural patients (43.7 % vs.37.7 %, P < 0.05). Patients with SI scored higher on total CDI scores, parental punishment, parental rejection, and paternal overprotection compared to their respective patients without SI. In the urban group, patients with SI had lower parental emotional warmth scores and higher parental intervention scores compared to patients without SI. Logistic regression analysis showed that total CDI score, gender, alcohol consumption, father's emotional warmth, father's rejection, and mother's intervention were significantly associated with SI in urban patients (P < 0.05); total CDI score and mother's rejection were significantly associated with SI in rural patients (P < 0.05).

LIMITATIONS

No causal relationship could be drawn due to the cross-sectional design.

CONCLUSIONS

The results of this study showed significant residential differences in risk and associated factors for SI among adolescents with depression. Focusing on the parenting styles of adolescent patients can help with the early identification and intervention of SI.

Prevalence and predictors of benevolent childhood experiences among a representative sample of young people

Emerging research evidence suggests that benevolent childhood experiences (BCEs) may partly explain more favourable mental health outcomes among individuals affected by adverse childhood experiences (ACEs). However, much of this research has focused on adult populations. Consequently, this study sought to provide the first rigorous assessment of the prevalence and predictors of BCEs using a nationally representative sample of young people from Northern Ireland (NI). Participants were 11-19-years-olds (N = 1293) who participated in the NI Youth Wellbeing Prevalence Survey (NI-YWS, 2020). Prevalence rates, gender differences and predictors of BCEs were investigated. Results revealed how most of the sample experienced multiple BCEs (95%, n = 1084), with females reporting higher levels of BCEs. Significant positive predictors of BCEs were female gender, parental education, living with both biological parents, and living in areas with lower deprivation, while significant negative predictors of BCEs included family being in receipt of social welfare and older age. Overall, this study highlights how BCEs are common, while the identification of factors associated with likelihood of having positive experiences during early development provides novel insights into those young people who may be at greater risk for maladaptive psychological outcomes.

Co-occurrence patterns of adverse childhood experiences and their associations with non-suicidal self-injury and suicidal behaviors and gender difference among middle school students: A three-city survey in China

BACKGROUND

Previous research has found increasing evidence of adverse childhood experiences (ACEs) leading to non-suicidal self-injury (NSSI) and suicidal behaviors. Most studies have focused on a certain type or timing of ACEs or the patterns of multiple types; however, few of them have examined the patterns of ACEs combined types and timing and the gender differences in the association between ACEs and self-harming behaviors.

METHODS

A cross-sectional survey was conducted in three Chinese cities from November 2020 to May 2021. We asked 16,853 middle school students to anonymously complete a questionnaire to provide the details of their own ACEs and NSSI or suicidal behaviors.

RESULTS

Latent class analysis identified four classes: high ACEs (10 %), high abuse/neglect (20.3 %), moderate ACEs (26.7 %) and low ACEs (43 %). Logistic regression models demonstrated that students in the high ACEs, high abuse/neglect and moderate ACEs subgroups were more likely to engage in NSSI and suicidal behaviors than students with low ACEs. Compared with boys, girls had a higher probability of engaging in NSSI and suicidal behaviors when exposed to the same level of ACEs.

CONCLUSION

Co-occurrence of ACEs is associated with high risk of NSSI and suicidal behaviors. Our findings recognized the most dangerous patterns and latent class membership, which supply the evidence for policy makers to adopt preventive measures to protect high-risk individuals. Strategies to relieve the impact of ACEs, especially on girls, need to be considered comprehensively.

LIMITATIONS

The study was limited by cross-sectional design, as causality could not be confirmed. In addition, because our survey was retrospective, potential recall bias can not be ignored.

The Latent Class Analysis of Adverse Childhood Experiences among Chinese Children and Early Adolescents in Rural Areas and Their Association with Depression and Suicidal Ideation

Exposure to adverse childhood experiences (ACEs) is a global public health concern that is detrimental to the psychological outcomes of Chinese children in rural areas due to the lack of public awareness of ACEs and mental health resources. The objective of this study was to identify the patterns of ACEs and the impact of ACE patterns on depression and suicidal ideation among 4683 students (mean age = 10.08 years, SD = 0.99; 48.17% female students) from 63 elementary schools in rural areas in Guizhou Province, China. Latent class analysis was conducted to identify the best class pattern. A three-step approach was undertaken to explore the association between the class patterns and demographic covariates and depression and suicidal thoughts. An overall three-class pattern of ACEs was identified, which was: (1) high ACEs, (2) high verbal abuse and emotional neglect and low household dysfunction, and (3) low ACEs. The results also showed that children in the high ACEs class tended to show higher depression rates and more frequent suicidal ideation across the three groups. Being female and younger and having a lower socioeconomic status were risk factors. Our study identified a class pattern that was not found in previous research, which is high verbal abuse and emotional neglect and low household dysfunction.

Childhood Adversity and Risky Behaviors among Chinese Rural Young Adults: The Mediation Effect of Perceived Stress and Moderation Effect of Social Support

Research has documented that adverse childhood experiences (ACEs) significantly impact young people's risky behaviors. Yet, few studies have explored if individuals' perceived stress mediates the association between ACEs and risky behaviors; also if social support moderates the pathways from ACEs to risky behaviors through perceived stress. This study aimed to assess the mediation effect of perceived stress and the moderation effect of social support in the study of ACEs and risky behaviors. This study sample includes 1091 Chinese rural young people. A web-based survey was used to assess demographic information, ACEs, perceived stress, social support, and seven types of risky behaviors. Multivariate regression models were run to test associations between ACEs and different risky behaviors while controlling for confounding variables. The mediation model (Model 4) and the moderated mediation model (Model 58) were also performed using the PROCESS macro. Multivariate regression results showed that, with increasing ACEs values, there was an increased likelihood of all risky behaviors. The moderated mediation analysis confirmed that perceived stress mediated the linkage between ACEs and risky behaviors. However, no significant moderating effect of social support was found. The study findings indicate that ACEs, risky behaviors, and perceived stress are significant public health problems among rural Chinese young people. Culturally appropriate prevention and intervention programs and services need to be implemented to address these issues and promote rural Chinese young people's wellbeing and development.

Sleep duration trajectory during the transition to adolescence and subsequent risk of non-suicidal self-harm

Non-suicidal self-harm (NSSH) and chronic insufficient sleep are both major health problems during the transition from childhood to adolescence. We examined to identify sleep duration trajectories from childhood to adolescence and their associations with subsequent risk of NSSH. A cohort of children around the period of pubertal onset (7-9 years old) were followed from 2013 over 6 years. Group-based trajectory modeling was recruited to identify sleep duration trajectories derived from 5 repeated measures. Association between sleep duration trajectories with the risk of NSSH was examined using multivariate logistic regression model. Nonlinear dose-response associations between sleep duration and NSSH risk were also assessed using restricted cubic spline models. Of the 1973 participants included in the study (mean ± SD, 8.1 ± 0.9 years age at baseline, 41.1% female). Three sleep duration trajectories were identified: persistent sleeping ≥ 8 h/day (27.7%), moderately decreasing (60.8%) and rapidly decreasing (11.5%) sleep duration groups. After multivariable adjustment for covariates, compared with the persistent sleeping ≥ 8 h/day group, the odds ratio of NSSH was 2.58 (95% CI 1.92, 3.45) for the moderately decreasing group, and 4.16 (2.86, 6.04) for rapidly decreasing group. In dose-response analysis, sleep duration was associated with NSSH risk in a non-linear fashion (χ² = 25.16, P_nonlinearity < 0.001). When compared with the reference (sleep duration = 8 h), the ORs (95% CI) for NSSH risks were 3.20 (1.93, 5.29), 2.37 (1.64, 3.41), 1.75 (1.39, 2.20) and 1.30 (1.18, 1.44) for sleep duration at 4 to 7 h, respectively. Also, we found sleep duration at 9 h [0.82 (0.75, 0.89)] and at 10 h [0.72 (0.57, 0.91)] significantly associated with decreased risk of NSSH. Longitudinal sleep duration patterns may assist in identification of adolescents at greatest risk of NSSH in the future, which could lead to improved targeting of prevention and intervention strategies. The findings also highlight a non-linear relationship between sleep duration and NSSH during the transition to adolescence.

Factors associated with single and multiple suicide attempts in adolescents attending school in Argentina: national cross-sectional survey in 2018

BACKGROUND

Factors associated with single suicide attempts (SSA) and multiple suicide attempts (MSA) may differ.

AIMS

The study aimed to assess the factors associated with MSA in adolescents with a history of suicide attempts during the past 12 months in Argentina.

METHOD

National cross-sectional data from the Global School-based Student Health Survey in Argentina in 2018 were analysed. Students who reported having a history of suicide attempts in the past 12 months were included in the final sample (n = 8507). Students with MSA were compared with students with an SSA through multiple logistic regression.

RESULTS

In a subsample of adolescents attending school (mean age 14.8 years, s.d. = 1.3), 59.4% had an SSA and 40.6% had MSA in the past 12 months. In the final adjusted logistic regression model, compared with participants with SSA, both male and female students with MSA more frequently had no close friends, reported feeling more lonely and had more anxiety-induced sleep disturbances. Furthermore, among female participants, having been physically attacked, having participated in physical fights, low parental support, current tobacco use and lifetime amphetamine use were associated with MSA. Among male students, multiple sexual partners were associated with MSA. Furthermore, among both boys and girls, compared with participants without psychosocial distress, participants with one, two, three or more psychosocial distress factors had higher odds of MSA. Compared with students with one or two social or environmental risk factors, students with seven or eight social or environmental risk factors had higher odds of MSA; compared with students who had zero or one health risk behaviours, students with six or more health risk behaviours had higher odds of MSA.

CONCLUSIONS

Psychosocial distress (anxiety-induced sleep disturbance, having no close friends and loneliness) increased the odds of MSA among both sexes. The odds of MSA were increased by interpersonal violence, low parental support and substance use among girls, and by having multiple sexual partners among boys. This suggests the potential relevance of these variables in identifying multiple suicide attempters among adolescents attending school in Argentina.

Associations of Non-suicidal Self-Injury and Psychological Symptoms With Suicide Attempt in Adolescents: Are There Any Gender Differences?

Background

Psychological symptoms and non-suicidal self-injury (NSSI) are independently associated with suicide attempts (SA). Yet, no study has tested the interaction effects between NSSI and psychological symptoms on SA in community adolescent populations, or examined whether the interaction varies by gender. We sought to examine the interaction effects of NSSI and psychological symptoms on SA in adolescents and explore gender differences.

Methods

A school-based health survey in 3 provinces in China was conducted between 2013-2014. 14,820 students aged 10-20 years completed standard questionnaires, to record the details of various psychological symptoms, SA and NSSI.

Results

Psychological symptoms and NSSI were independently associated with a higher likelihood of SA in both boys and girls (p < 0.001). Adolescents with psychological, conduct or social adaptation symptoms without concurrent NSSI, were twice as likely to report SA (corresponding RORs were 1.80, 1.80 and 2.16, respectively; p < 0.01) than those who reported NSSI. Male adolescents with psychological, emotional, conduct or social adaptation symptoms had a higher risk of SA in the non-NSSI group than the NSSI group (corresponding RORs were 2.85, 2.26, 2.30 and 3.01 respectively; p < 0.01). While in girls, only adolescents with social adaptation symptoms had a higher risk of SA in the non-NSSI group than NSSI group (corresponding RORs was 1.71, p < 0.05). In the non-NSSI group, boys reporting psychological symptoms exhibited a higher likelihood of a SA than their female counterparts.

Conclusion

Psychological symptoms and NSSI are independently associated with an increased risk of SA in adolescents. However, to some extent, NSSI may reduce the risk of SA among individuals with psychological symptoms, especially in boys.

Profiles of adverse childhood experiences and protective resources on high-risk behaviors and physical and mental disorders: Findings from a national survey

BACKGROUND

Adverse childhood experiences (ACE) vary across culture and their heterogenous impact on health outcomes is understudied. The present population-based study determined latent classes of adverse childhood experiences, examined socio-demographic variations between identified classes, and elucidated the interactions between class membership and protective resources (i.e., positive mental health and perceived social support) on high-risk behaviors (i.e., smoking, binge drinking, and suicidality), chronic physical disorders, and mental disorders.

METHODS

A total of 4441 adult Singapore residents were recruited from the community. Lifetime mental disorders and suicidality were assessed on structured clinical interviews by trained interviewers, while chronic physical disorders, smoking, binge drinking, ACE, perceived social support, and positive mental health were self-reported.

RESULTS

Latent class analysis identified three distinct profiles; a multiple adversities class endorsing elevated levels of abuse and violence (6.1%), an emotionally neglected and bullied class (7.6%), and a low adversities class (86.2%). The multiple adversities class was associated with younger age, female gender, lower education status, more high-risk behaviors (e.g. binge drinking and suicidality), and physical/mental disorders. A three-way interaction was observed between ACE profiles, social support, and positive mental health on suicidality; high social support and positive mental health reduced the risk of suicidality in the multiple adversities class.

LIMITATIONS

Results may not be generalizable beyond the Singapore population due to cultural factors.

CONCLUSIONS

Clinical assessment should adopt a person-centered approach to identify profiles of ACE and determine their interactions with protective resources on high-risk behaviors and physical/mental disorders; patient-tailored treatment may subsequently build upon these profiles.

Risk factors for non-suicidal self-injury (NSSI) in adolescents: A meta-analysis

BACKGROUND

Non-suicidal self-injury (NSSI) in adolescents is a significant mental health problem around the world. Here, we performed a meta-analysis to systematically delineate the risk factors for NSSI.

METHOD

We searched Medline, Embase, Web of Science and Cochrane for relevant articles and abstracts published prior to 12 November 2021. Pooled odds ratios (ORs) and 95% confident intervals (CIs) were used to assess various risk factors, and publication bias was assessed by Egger's test, the trim and fill method and meta-regression. This study is registered with PROSPERO, CRD42021265885.

RESULTS

A total of 25 articles were eventually included in the analysis. Eighty risk factors were identified and classified into 7 categories: mental disorders (ORs, 1·89; 95% CI, 1·60-2·24), bullying (ORs, 1·98; 95% CI, 1·32-2·95), low health literacy (ORs, 2·20; 95% CI, 1·63-2·96), problem behaviours (ORs, 2·36; 95% CI, 2·00-2·77), adverse childhood experiences (ORs, 2·49; 95% CI, 1·85-3.34), physical symptoms (ORs, 2·85; 95% CI, 1·36-5·97) and the female gender (ORs, 2·89; 95% CI, 2·43-3·43). The range of heterogeneity (I²) was from 20·3% to 99·2%.

CONCLUSION

This meta-analysis found that mental disorders, low health literacy, adverse childhood experiences, bullying, problem behaviours, the female gender and physical symptoms appear to be risk factors for NSSI.

Borderline personality traits mediate the relationship between low perceived social support and non-suicidal self-injury in a clinical sample of adolescents

BACKGROUND

Non-suicidal self-injury (NSSI) is a serious public health concern among adolescents, especially in clinical settings. Social support plays a critical role in the onset and maintenance of NSSI in adolescence. NSSI is closely associated with borderline personality disorder (BPD), yet no previous work has analyzed the mediating role of borderline traits in the relationship between perceived social support (PSS) and NSSI. This study aimed to address this gap.

METHODS

Participants were 228 adolescent patients (12 to 18 years old), who completed a clinical interview and self-report measures of BPD-traits, current psychological distress, emotion dysregulation and PSS. They were grouped based on the presence (vs. absence) of NSSI. Univariate and multivariate logistic regression analyses were used to identify risk factors of NSSI, and a mediation analysis was conducted to examine the intermediary role of borderline traits in the relationship between PSS and NSSI.

RESULTS

NSSI was highly prevalent in our sample (58%) and was associated with higher clinical severity. Low PSS predicted NSSI in univariate, but not multivariate regression. Mediation analyses showed that borderline traits fully accounted for the relationship between low PSS and NSSI, even when controlling for current psychological distress and gender.

LIMITATIONS

Cross-sectional design through self-report assessment.

CONCLUSIONS

Findings suggest that adolescents with low PSS are especially vulnerable for developing NSSI due to elevated BPD traits. In clinical settings, interventions aimed to reduce borderline symptoms may be a promising treatment option for adolescents with NSSI and low PSS.