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Shen Y, Chen D, Guo J, Zheng Y, Zhang J, Zhan S, You J. Co-developmental trajectories of suicidal ideation and non-suicidal self-injury among Chinese adolescents: Transdiagnostic predictors and association with suicide attempts. Suicide Life Threat Behav 2024; 54:632-648. [PMID: 38529888 DOI: 10.1111/sltb.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/18/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
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.
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Affiliation(s)
- Yunhong Shen
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, China
| | - Danrui Chen
- Psychological Counseling Centre, Chang'an University, Xi'an, China
| | - Jiaqi Guo
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, China
| | - Yue Zheng
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, China
| | - Jiajing Zhang
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, China
| | - Shiting Zhan
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, China
| | - Jianing You
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University, Guangzhou, China
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Wang J, Han M, Xi Y, He X, Feng Y, Chen R. A longitudinal study of self-injurious thoughts and behaviors transitions and help-seeking intentions among young adults. Suicide Life Threat Behav 2024. [PMID: 38934487 DOI: 10.1111/sltb.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Engagement in self-injurious thoughts and behaviors (SITBs) is associated with low help-seeking intentions. Nevertheless, prior research has primarily relied on cross-sectional data, leaving uncertainties about the longitudinal dynamics between SITBs and help-seeking intentions. This study aims to investigate the longitudinal relationship between SITBs and help-seeking intentions for them. METHOD A one-year interval follow-up investigation was conducted among 1788 Chinese students (71.5% girls, Mage = 19.5). Changes in help-seeking intentions were initially analyzed among four SITBs transition groups. Subsequently, a cross-lagged model was employed to explore the possible bidirectional associations. RESULTS 232 participants (12.90%) experienced changes in SITBs, while 65 participants (3.60%) exhibited sustained SITBs between two measurement time points. Changes in help-seeking intentions varied across SITBs transition groups. Participants whose SITBs faded 1 year later showed a significant increase in help-seeking intentions, whereas those who experienced newly developed SITBs across two measurement time points demonstrated a significant decline. The cross-lagged analysis revealed that help-seeking intentions negatively predicted the subsequent risk of experiencing SITBs. CONCLUSIONS Greater help-seeking intentions predicted decreased SITBs 1 year later. Changes in help-seeking intentions serve as a valuable indicator for distinguishing between different types of SITBs transition. These findings underscore the importance of implementing prevention and intervention strategies targeted at enhancing help-seeking intentions to reduce SITBs.
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Affiliation(s)
- Juan Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Meng Han
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yingjun Xi
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiaoxiao He
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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Wang Q, Wen M, Fan S, Liu J, Wang X, Guo W, Hu J, Zhang J, Li B, Zhang L, Zhang Y, Li K. Attention-Dominated Cognitive Dysfunction May Be a Biological Marker for Distinguishing SA from SI in Adolescents: A Network Analysis Study Based on Adolescent Depression. Psychol Res Behav Manag 2024; 17:945-956. [PMID: 38464812 PMCID: PMC10924855 DOI: 10.2147/prbm.s448904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024] Open
Abstract
Objective Suicidal behavior is strongly correlated with depressive symptoms and the degree of suicidal ideation. Cognitive impairment may have varying degrees of influence on suicidal ideation (SI) and suicidal attempts (SA). The aim of this study was to identify the cognitive biomarkers that distinguish suicidal ideation from suicidal attempts in adolescents. Methods The cross-sectional sample comprised 54 adolescents with major depressive disorder (MDD) and 32 healthy controls (HC). The THINC-it was utilized to assess cognitive function of all the samples. Suicidal ideation was examined by the Positive and Negative Suicide Ideation Scale (PANSI). Based on the type of data, one-way ANOVA or Kruskal-Wallis was performed to investigate group differences. Bonferroni post-hoc analysis was employed for regulating type I error for pairwise comparisons. Network analysis was used to compare the networks associated with suicidal ideation, depression symptoms, and cognitive function between SA and SI. Results The depression symptoms (HAMD-17) (F=72.515, P<0.001) and suicidal ideation (PANSI) (F=267.952, P<0.001) in the SA were higher than those in the SI. Analysis of between-group differences showed SA performed worse in THINC-it, especially in "Spotter (SP)" (P=0.033), "Objective cognition score (OS)" (P=0.027) and "Composite score (CS)" (P=0.017). Compared with SI, network analysis revealed that SA had a unique network of cognitive function, depressive symptoms, and suicidal ideation. Nevertheless, both networks exhibit comparable performance concerning the node strength of cognitive function. Within their separate networks, the aspects of CS, OS, and SP have emerged as the three most crucial elements. Conclusion Adolescents with SI or SA exhibit a broad spectrum of cognitive impairments. Attention impairment can be beneficial in discerning between SI and SA. Future interventions for adolescent suicide can center on attention and the comprehensive cognitive ability that it represents.
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Affiliation(s)
- Qi Wang
- Clinical Medicine College, Hebei University, Hebei, People's Republic of China
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Min Wen
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Shaohang Fan
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Jinning Liu
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Xiaowen Wang
- Psychosomatic Medicine Department, Jiangxi Provincial People's Hospital, Nanchang, People's Republic of China
| | - Wentao Guo
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Jinyun Hu
- Psychiatric Department, The Second People's Hospital of Yuxi, Yunnan, People's Republic of China
| | - Jialan Zhang
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Bing Li
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
| | - Lili Zhang
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
| | - Yunshu Zhang
- Clinical Medicine College, Hebei University, Hebei, People's Republic of China
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
| | - Keqing Li
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
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Looijmans M, van Bergen D, Popma A, van Eijk N, Mérelle S, van Veen S, Hawton K, Gilissen R. The self-perceived needs of adolescents with suicidal behaviour: a scoping review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02342-1. [PMID: 38147110 DOI: 10.1007/s00787-023-02342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
Suicidal behaviour in adolescents is a major public health problem. Much research on this issue has focused on epidemiology and risk factors for suicidal behaviour, paying less attention to the self-perceived needs of adolescents. However, to increase engagement in suicide prevention, it is important to include the views of adolescents. A scoping review was performed to identify the available empirical study findings, of any study design, related to the self-perceived needs of adolescents with suicidal behaviour. The literature databases Medline, Embase, Psycinfo, CINAHL, ERIC, Scopus, and Web of Science were searched. Twenty-nine studies from 14 predominantly Anglo countries were included in the scoping review. The review showed that girls were overrepresented and that studies predominantly used qualitative approaches. The identified needs of adolescents with suicidal behaviour can broadly be grouped into needs related to the following areas: the importance of connecting with other people; adolescents' self-help strategies and personal growth after self-harm; mental healthcare; school or study programs; and needs related to society in relation to taboo on suicidal behaviour. Prevention of suicidal behaviour in adolescents will need to focus on development and strengthening of interventions fitting the needs of adolescents in these areas.
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Affiliation(s)
- Milou Looijmans
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands.
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Diana van Bergen
- Faculty of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | - Arne Popma
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nikki van Eijk
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands
| | - Saskia Mérelle
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands
| | - Sisco van Veen
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands
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Paladini G, Sciurpa E, Onorati R, Elhadidy HSMA, Giacomini G, Mamo C, Borraccino A. Gender and Age Influence on Emergency Department Visits for Non-Suicidal Self-Injuries in School Aged Children in Italy: An 11 Years Retrospective Cross-Sectional Study. Int J Public Health 2023; 68:1606370. [PMID: 38164389 PMCID: PMC10757917 DOI: 10.3389/ijph.2023.1606370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives: Non-suicidal self-injury (NSSI) poses a threat in developmental ages, yet there is a scarcity of studies on NSSI trends, especially those in emergency departments (ED). Methods: The aim of this cross-sectional study is to describe trends in ED visits for NSSI among young people aged between 5 and 19 years in Italy from 2011 to 2021 in Piedmont. From the ministerial ED discharge information system, all occurring NSSIs were identified by medical report and/or ICD9CM code and reported as a population rate and a visit rate on all ED requests. Results: The general rate of ED visits remained stable, with around 210,000 (55% males) visits each year, along the whole period from 2011 to 2019, then halved during 2020 and 2021. The NSSI population and visits rates increased from 2013, peaking in 2019 at a rate of around 25 and 23 NSSI visits (girls) and 76 and 69 NSSI (boys) per 100,000 ED visits. In 2020 and 2021, the rate of NSSI visits increased, particularly in girls and among older adolescents. Conclusion: The gradual increase of NSSI over the last decade is a rising public health issue, which deserves wider attention to ensure early detection and prevention.
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Affiliation(s)
- Giovanni Paladini
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Elena Sciurpa
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Roberta Onorati
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Grugliasco, Italy
| | | | - Gianmarco Giacomini
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Carlo Mamo
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Grugliasco, Italy
| | - Alberto Borraccino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
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Yan Y, Leong F, Song A, Goldman-Mellor S. Incidence and Correlates of Emergency Department Visits for Deliberate Self-Harm Among Asian American Youth. J Adolesc Health 2023; 72:510-518. [PMID: 36535866 PMCID: PMC10494551 DOI: 10.1016/j.jadohealth.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This study examined the epidemiology of self-harm emergency department (ED) visits among Asian American and Pacific Islander (AAPI) youth, and associated factors. METHODS We used California ED visit records in 2010 and 2011 to calculate incidence rates of self-harm ED visits for AAPI versus non-Hispanic White (NHW) patients aged 10-29 years. Demographic and clinical characteristics were compared for AAPI versus NHW patients presenting with self-harm. We used modified Poisson regression models to estimate the relative risk of recurrent ED self-harm visits for AAPI versus NHW patients and examined the association of insurance type and gender with recurrent self-harm among AAPIs. RESULTS Rates of self-harm ED visits for young AAPI patients were 38 and 26 per 100,000 among females and males, respectively. Although AAPI patients presenting with self-harm were equally or less likely than NHW patients to have comorbid psychological and substance use diagnoses at their index visit, they were 25% more likely to be admitted to hospital. However, they were 40% less likely to have a recurrent ED self-harm visit. Among AAPI patients, those who used Medicaid were significantly more likely than those with other insurance to be admitted as inpatients. DISCUSSION Young AAPI patients presenting to EDs with deliberate self-harm have different sociodemographic and clinical profiles compared to NHW patients. Our study also demonstrates significant heterogeneity in risk of recurrent self-harm by gender and insurance type among AAPI patients. This information may be useful for future intervention programs among self-harming AAPI youth.
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Affiliation(s)
- Yueqi Yan
- Health Sciences Research Institute, University of California, Merced, California
| | - Frederick Leong
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Anna Song
- Department of Psychological Science, University of California, Merced, California
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An Integrative Model of In-Hospital and Out-of-Hospital Nursing Care for Non-Suicidal Self-Injury: A Narrative Review. Brain Sci 2023; 13:brainsci13030466. [PMID: 36979278 PMCID: PMC10046685 DOI: 10.3390/brainsci13030466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Background: Non-suicidal self-injury (NSSI) refers to the intentional and repeated physical trauma of an individual without explicit suicidal intent, which has negative effects on the physical and mental well-being of an individual, especially for adolescents. Timely and accessible nursing care may play an important role in the survival and rehabilitation process of NSSI. Methods: In this review, we systematically discuss the nursing care of NSSI behavior and provide recommendations based on an integrated nursing model for NSSI management. Results: As reported in previous studies, a variety of factors can contribute to NSSI behavior, such as personality traits, current psychological status, history of mental illnesses, as well as family and social factors. In-hospital care is the most necessary and effective care during acute episodes of NSSI behavior. To effectively manage inpatients with NSSI behaviors, nurses should first understand the motivation of NSSI, and provide comprehensive and multi-level care through nurse-patient communication, individualized psychological care, and multidisciplinary cooperation with other professionals. While the purpose of out-of-hospital nursing is to reduce the frequency of NSSI behaviors by screening high-risk individuals, providing psychological support, promoting health education, and improving self-awareness. Conclusions: An integrative model of in-hospital and out-of-hospital nursing care can help improve the clinical management and long-term prognosis of patients with NSSI and minimize the risk of suicidal ideation or suicidal behavior.
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Lee KC, Huang R, Tal IR, Downs N, Zisook S. Comparison of Suicidal Ideation and Depressive Symptoms Between Medical and Pharmacy Students. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe8881. [PMID: 35470169 PMCID: PMC10159499 DOI: 10.5688/ajpe8881] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/08/2022] [Indexed: 05/06/2023]
Abstract
Objective. The purpose of the study was to compare suicidal ideation among medical and pharmacy students and characterize related symptoms.Methods. The authors conducted a cross-sectional, retrospective study to compare suicidal ideation among medical and pharmacy students at a single public university during 2009 to 2020. Respondents' voluntary and anonymous responses to the Interactive Screening Program (ISP) Stress and Depression Questionnaire are reported.Results. The authors analyzed responses from 619 medical and 214 pharmacy students collected over 11 academic years. There was no significant difference between medical and pharmacy students who endorsed suicidal ideation (13.5% vs 17.3%, respectively). The Patient Health Questionnaire-9 (PHQ-9) scores were significantly different between medical and pharmacy students, with more pharmacy students reporting moderate to severe depression (24.3% for medical vs 35.1% for pharmacy). Compared to medical students, more pharmacy students also endorsed anhedonia, a reduced capacity for pleasure (13.4% vs 24.3%, respectively), sleep problems (29.6% vs 42.6%, respectively), and fatigue (46% vs 64.4%, respectively). Pharmacy students also reported more intense affective states such as "feeling your life is too stressful" and "feeling intensely anxious or having anxiety attacks." Relationships and physical/mental health/substance abuse were common themes that emerged from the qualitative data.Conclusion. While there was no significant difference in suicidal ideation between pharmacy and medical students, the prevalence is alarming compared to the general population. More pharmacy students endorsed symptoms of depression and intense affective states that could impair functioning. Future studies may focus on mitigation strategies for suicidal ideation among health professions students.
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Affiliation(s)
- Kelly C Lee
- University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California
| | - Robin Huang
- VA Loma Linda Healthcare System, Loma Linda, California
| | - Ilanit R Tal
- University of California San Diego, School of Medicine, La Jolla, California
| | - Nancy Downs
- University of California San Diego, School of Medicine, La Jolla, California
| | - Sidney Zisook
- University of California San Diego, School of Medicine, La Jolla, California
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Gatta M, Raffagnato A, Angelico C, Benini E, Medda E, Fasolato R, Miscioscia M. Externalising Behaviours, Impulsivity, Alexithymia, and Emotional Dysregulation in Adolescents' Suicidality. CLINICAL NEUROPSYCHIATRY 2023; 20:17-28. [PMID: 36936619 PMCID: PMC10016105 DOI: 10.36131/cnfioritieditore20230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Objective suicide represents the second leading cause of death among adolescents (WHO, 2021). A deeper understanding of the characteristics that lead to it is crucial to increase the ability of clinicians in evaluating, treating, and preventing it. The objective of this study is to analyze the differences in impulsivity, externalizing behaviors, emotion dysregulation, and alexithymia between two groups of adolescents, the first presenting suicidal ideation (SI), the second presenting at least one suicide attempt (SA), in an ideation-to-action framework. Method we conducted a retrospective study with 190 adolescents (M= 14.5, SD age = 1.63; SI: n = 97, SA: n = 93). All were hospitalized in the Complex Operative Child Neuropsychiatry Hospital Unit (UOC-NPI) of the Hospital-University of Padua. Data were collected using the Youth Self-Report (YSR 11-18), Barratt's Impulsiveness Scale (BIS-11) and the Toronto Alexithymia Scale (TAS-20) questionnaires. Results the SA group obtained higher clinical scores in the YSR "rule-breaking behavior" and "conduct problems" scales, and in total TAS-20. Conclusions the role of externalizing problems and alexithymia could open new frontiers in the understanding of suicide. These new data could be useful for the implementation of early screening protocols and for directing clinical interventions, promoting greater emotion regulation and anger management skills among patients.
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Affiliation(s)
- Michela Gatta
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Caterina Angelico
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Elena Benini
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Erica Medda
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Rachele Fasolato
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
- Department of Developmental Psychology and Socialisation, University of Padua, 35131 Padua, Italy
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Xu H, Wang R, Li R, Jin Z, Wan Y, Tao F. Associations of Non-suicidal Self-Injury and Psychological Symptoms With Suicide Attempt in Adolescents: Are There Any Gender Differences? Front Psychiatry 2022; 13:894218. [PMID: 35795027 PMCID: PMC9251494 DOI: 10.3389/fpsyt.2022.894218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Huiqiong Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Rui Wang
- Department of Information Technology, Anqing Medical College, Anqing, China
| | - Ruoyu Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhengge Jin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Yuhui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
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11
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Abstract
We aimed to determine differences between adolescents with non-suicidal self-harm with and without a history of suicide attempt (SA). Sixty-eight adolescents with a mean age of 15.6 years (SD = 1.5) attending child and adolescent psychiatric outpatient clinics for repeated self-harm in Oslo, Norway, were included. A battery of instruments was used to assess sociodemographic information and psychopathology such as Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, emotional and behavioral problems, borderline symptoms, depression, hopelessness, suicidal ideation, and history of SA. Twenty-six participants (38.2%) reported a lifetime history of SA. Compared to the participants without a history of SA, those with an SA history had used a higher number of methods of self-harm and methods with higher lethality and had higher degrees of emotional and behavioral problems. They also scored higher in depressive symptoms, borderline pathology, emotional dysregulation, hopelessness, and suicidal ideation. History of SA was independently associated with perceived moderate to high risk of death on the most severe episode of self-harm (adjusted odds ratio [aOR], 15.93; 95% confidence interval [CI], 1.96-129.66), a longer duration (months) since self-harm debut (aOR, 1.07; 95% CI, 1.01-1.13), and suicidal ideation severity (aOR, 1.05; 95% CI, 1.01-1.11). Parental report of behavioral problems associated with SA suggested a strong association with externalizing problems. A combination of having a high level of psychopathology, externalizing problems, an extended history of self-harm behavior and use of more lethal self-harm methods seems to entail a significantly increased risk for making SAs among adolescents with non-suicidal self-harm. HIGHLIGHTSNon-suicidal self-harm (NSSH) with suicide attempt may be distinctive from NSSH without suicide attempt.Adolescents with NSSH with suicide attempt had relatively greater psychopathology.Protracted/lethal self-harm methods and externalizing problems indicate comorbidity.
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12
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Poudel A, Lamichhane A, Magar KR, Khanal GP. Non suicidal self injury and suicidal behavior among adolescents: co-occurrence and associated risk factors. BMC Psychiatry 2022; 22:96. [PMID: 35139825 PMCID: PMC8827284 DOI: 10.1186/s12888-022-03763-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and suicidal behavior (SB) are the major public health problems in adolescents. Despite the increased focus on these phenomena, there exist no reliable data in Nepal. This study aimed to determine the prevalence of NSSI and SB among adolescents. Furthermore the study identified the relationship between these two behaviors and assessed demographic, behavioral, and psychological risk factors of NSSI and SB in Nepalese adolescents in a representative sample of the general population. METHODS The study was conducted among 730 adolescents studying in grade 9 to 12 of public and private schools of Pokhara Metropolitan city, Nepal. Data were collected through self administered standard tools- Functional Assessment of Self Mutilation (FASM) tool, Suicidal Behaviors Questionnaire-Revised (SBQ-R), Rosenberg self-esteem scale (RSES) and Beck Depression Inventory (BDI). Descriptive statistical measures such as frequency, percentage, mean, standard deviation, range were used to assess demographic characteristics and adolescent's behavior regarding NSSI and suicide. For inferential analysis chi-square and one way ANOVA test was used. Furthermore, to determine the predictors of NSSI and SB, multiple logistic regression analysis was used. RESULTS Regarding behavioral characteristics, nearly half of the sample 327 (44.8%) reported a history of NSSI in past 1 year. Furthermore, 25.8% (n = 188) of the overall sample engaged in minor NSSI only and 3.42% (n = 25) engaged in at least one act of moderate/severe NSSI. The mean number of type of NSSI performed was 2.63 ± 1.71. The most common type of NSSI method used were picking at wound (27.3%), biting self (20.3%), pulling hair out (11.8%), cutting self (11.1%). Boys (52.6%) were more likely to be engaged in NSSI than girls (47.4%) (χ2 = 10.298, p = 0.002). Furthermore, among 730 adolescents who completed the SBQ-R questionnaire, 131 (17.9%) had suicidal behaviors (SB) (as defined by SBQ-R a total score ≥ 7). Regarding sex differences female were significantly higher in life time prevalence of suicidal behavior than male (χ2 = 30.26, p = 0.001). Simple Chi-square tests indicated that NSSI was significantly associated with SB (χ2 = 58.16, P < .001). Logistic regressions identified the four significant predictors of NSSI behavior: male, low-level of self-esteem (SE), moderate to severe form of depression and SB. Similarly, significant predictors of SB were: female, low-level of SE, moderate to severe form of depression and NSSI behavior. CONCLUSION The prevalence of both NSSI and SB is high in adolescents. Despite the differences between NSSI and SB a significant number of adolescents reported a history of both behaviors. Lower level of SE and moderate to severe depression were the significant predictors of both NSSI and SB. Furthermore, male and adolescents with the history of SB were at risk of NSSI behavior whereas female sex and adolescents with the history of NSSI were at risk of SB.
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Affiliation(s)
- Anju Poudel
- Tribhuvan University, Institute of Medicine, Pokhara Nursing Campus, Pokhara, Nepal.
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13
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Zhang Q, Zhao S, Liu Z, Luo B, Yang Y, Shi Y, Geng F, Xia L, Zhang K, Liu H. Association of thyroid-stimulating hormone and lipid levels with suicide attempts among adolescents with major depressive disorder in China. Front Psychiatry 2022; 13:1031945. [PMID: 36733417 PMCID: PMC9887045 DOI: 10.3389/fpsyt.2022.1031945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Evidence suggested that thyroid-stimulating hormone (TSH) and lipid levels were associated with major depressive disorder (MDD). However, its role in suicide attempts in adolescents with MDD was unclear. This investigation was to probe into the relationship between TSH, lipid levels, and attempted suicide in adolescents with MDD. METHODS A total of 179 adolescents with MDD were included from January 2021 to January 2022. Socio-demographic data and clinical data were obtained through self-made questionnaires. TSH and lipid levels were analyzed by a recognized laboratory. The Epidemiological Studies Depression Scale (CES-D) was used to assess the severity of depression. Questions about whether there was a behavior of suicide attempts were completed through conversation interviews. RESULTS Results showed that the CES-D total score, TSH, and low-density lipoprotein cholesterol (LDL-C) of suicide attempters were significantly higher than those of non-suicide attempters. Ordinary family relationships were more likely to attempt suicide than good family relationships. The CES-D total score, ordinary family relationships, TSH and LDL-C were still significant in binary logistic regression, with an adjusted odds ratio (OR) of 1.04, 3.42, 5.14, and 1.76, respectively. The area under the receiver operating characteristic (ROC) curve showed that the area under the ROC curve (AUC) ranged from 0.60 to 0.74. CONCLUSION Suicide attempts are common among adolescents with MDD and were associated with CES-D total score, ordinary family relationships, TSH, and LDL-C. Given the association between suicide attempts and TSH and LDL-C, the dynamic changes in TSH and LDL-C levels should be detected regularly.
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Affiliation(s)
- Qing Zhang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Shuyi Zhao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Zhichun Liu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Bei Luo
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yingying Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yudong Shi
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Feng Geng
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Kai Zhang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
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14
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Children and Adolescents' Psychological Well-Being Became Worse in Heavily Hit Chinese Provinces during the COVID-19 Epidemic. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6. [PMID: 34888418 PMCID: PMC8653505 DOI: 10.20900/jpbs.20210020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In light of the novel coronavirus’s (COVID-19’s) threat to public health worldwide, we sought to elucidate COVID-19’s impacts on the mental health of children and adolescents in China. Through online self-report questionnaires, we aimed to discover the psychological effects of the pandemic and its associated risk factors for developing mental health symptoms in young people. We disseminated a mental health survey through online social media, WeChat, and QQ in the five Chinese provinces with the most confirmed cases of COVID-19 during the late stage of the country-wide lockdown. We used a self-made questionnaire that queried children and adolescents aged 6 to 18 on demographic information, psychological status, and other lifestyle and COVID-related variables. A total of 17,740 children and adolescents with valid survey data participated in the study. 10,022 (56.5%), 11,611 (65.5%), 10,697 (60.3%), 6868 (38.7%), and 6225 (35.1%) participants presented, respectively, more depressive, anxious, compulsive, inattentive, and sleep-related problems compared to before the outbreak of COVID-19. High school students reported a greater change in depression and anxiety than did middle school and primary school students. Despite the fact that very few children (0.1%) or their family members (0.1%) contracted the virus in this study, the psychological impact of the pandemic was clearly profound. Fathers’ anxiety appeared to have the strongest influence on a children’s psychological symptoms, explaining about 33% of variation in the child’s overall symptoms. Other factors only explained less than 2% of the variance in symptoms once parents’ anxiety was accounted for. The spread of COVID-19 significantly influenced the psychological state of children and adolescents in participants’ view. It is clear that children and adolescents, particularly older adolescents, need mental health support during the pandemic. The risk factors we uncovered suggest that reducing fathers’ anxiety is particularly critical to addressing young people’s mental health disorders in this time.
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15
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Lee JY, Kim H, Kim SY, Kim JM, Shin IS, Kim SW. Non-suicidal self-injury is associated with psychotic like experiences, depression, and bullying in Korean adolescents. Early Interv Psychiatry 2021; 15:1696-1704. [PMID: 33461244 DOI: 10.1111/eip.13115] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
AIM Non-suicidal self-injury (NSSI) is common among adolescents, and several different factors can affect its prevalence. The present study examined the associated characteristics predicting NSSI among adolescents in South Korea. METHODS In total, 1674 high school students were recruited for a cross-sectional survey. They completed self-reported assessments, including the Deliberate Self-Harm Inventory (DSHI), the Center for Epidemiological Studies Depression Scale (CESD), the State-Trait Anxiety Inventory for Children (STAIC), and the Prodromal Questionnaire-16 (PQ-16), as well as their bullying experience. The NSSI group was defined as the sample group with at least one NSSI behaviour on the DSHI scale. A logistic regression analysis was performed using the NSSI group as the dependent variable. RESULTS The prevalence of NSSI was 28.3% (boys, 30.4%; girls, 24.4%) among adolescents. The most common type of NSSI behaviour among adolescents was interference with wound healing and sex differences in the method were examined. The CES-D, STAIC-trait, and PQ-16 scores were significantly higher and the RSES score was significantly lower in the NSSI group than those in the non-NSSI group. Participants' experience with bullying, such as being victims, bullies, bully-victims, and witness to bullying, were more likely to be in the NSSI group. In a logistic regression analysis, NSSI was significantly associated with male sex, low academic achievement, higher depression, psychotic-like experiences, being bullied, and witnessing bullying. CONCLUSION The results of this study suggest the need to identify and manage related psychologic factors in adolescents with NSSI, including psychotic-like symptoms.
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Affiliation(s)
- Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon-Young Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
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16
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Başgöze Z, Wiglesworth A, Carosella KA, Klimes-Dougan B, Cullen KR. Depression, Non-Suicidal Self-Injury, and Suicidality in Adolescents: Common and Distinct Precursors, Correlates, and Outcomes. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6:e210018. [PMID: 34734122 PMCID: PMC8562706 DOI: 10.20900/jpbs.20210018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Depression, non-suicidal self-injury (NSSI), and suicidal thoughts and behaviors (STB) often emerge during adolescence. Despite considerable overlap in clinical presentation, risk factors, and implicated neurobiology, there is also evidence for divergence in terms of precursors, correlates, and outcomes. The complex interrelationships amongst these three clinical domains require considering both shared and divergent patterns of risk for depression, NSSI, and STB; a clearer understanding of these developmental trajectories will be needed to guide optimization and tailoring of early interventions.
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Affiliation(s)
- Zeynep Başgöze
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Minneapolis, MN 55454, USA
| | - Andrea Wiglesworth
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | | | | | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Minneapolis, MN 55454, USA
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17
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Sellers CM, Díaz-Valdés A, Porter AC, Glenn CR, Miller AB, Battalen AW, O'Brien KHM. Nonsuicidal Self-injury, Suicide Planning, and Suicide Attempts Among High-risk Adolescents Prior to Psychiatric Hospitalization. Res Child Adolesc Psychopathol 2021; 49:1503-1511. [PMID: 34059987 DOI: 10.1007/s10802-021-00830-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to understand the trajectories of nonsuicidal self-injury (NSSI) and suicide plans (SP) in the 90 days prior to inpatient hospitalization, understand the role of NSSI and SP in predicting suicide attempts (SA) on a given day, and to test the interaction between NSSI and SP in predicting same-day SA. Participants included 69 adolescents (77% female, 65% white, 77% Non-Hispanic/Latinx, Mage = 15.77 SDage = 1.00) from an inpatient psychiatric unit. Past 90 day NSSI, SP, and SA were measured using the Columbia Suicide Severity Rating Scale and Timeline Follow Back. First, mixed effect models were conducted to assess trajectories of NSSI and SP leading up to inpatient hospitalization. The odds of NSSI remained relatively stable prior to hospitalization (OR = 1.01, 95% CI [1.00,1.02]). The odds of SP increased in the 90 days prior to hospitalization (OR = 1.04, 95% CI [1.02,1.05]) with each day associated with a 4% increase in the odds of making a SP. Second, random effect models were conducted to predict the odds of same-day SA from NSSI and SP. When adolescents endorsed either NSSI (OR = 2.99, p < .001) or a SP (OR = 77.13, p < .001) there was elevated odds of same-day SA. However, the presence of both NSSI and SP on a given day did not increase risk of SA on that same day. For this high-risk clinical sample of suicidal adolescents who drink alcohol, odds of SP increased in the days leading up to psychiatric hospitalization, but NSSI remained stable. On days when adolescents reported NSSI or SP, they had an increased odds of same-day SA. These results underscore the importance of frequent monitoring of NSSI and SP among high-risk adolescents who drink alcohol to prevent suicide attempts.
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Affiliation(s)
- Christina M Sellers
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, 02115, US. .,School of Social Work, College of Social Science, Policy, and Practice (CSSPP), Simmons University, Boston, MA, 02115, US.
| | - Antonia Díaz-Valdés
- Faculty of Humanities, Society and Health Research Center, Universidad Mayor, 7750000, Santiago, Chile
| | - Andrew C Porter
- Department of Psychology, University of Rochester, Rochester, NY, 14627, US
| | - Catherine R Glenn
- Department of Psychology, University of Rochester, Rochester, NY, 14627, US.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14627, US.,Department of Psychology, Old Dominion University, Norfolk, VA, 23529, US
| | - Adam Bryant Miller
- Department of Psychology and Neurosciences, The University of North Carolina At Chapel Hill, Chapel Hill, NC, 27599, Raleigh, US
| | | | - Kimberly H McManama O'Brien
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, 02115, US.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, US
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18
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White HV, Silamongkol T, Wiglesworth A, Labella MH, Goetz ER, Cullen KR, Klimes-Dougan B. Maternal Emotion Socialization of Adolescent Girls Engaging in Non-Suicidal Self-Injury. Res Child Adolesc Psychopathol 2021; 49:683-695. [PMID: 33521893 PMCID: PMC8443321 DOI: 10.1007/s10802-020-00758-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
Non-suicidal self injury (NSSI) is a transdiagnostic maladaptive behavior that is highly prevalent in adolescence. A greater understanding of the mechanisms leading to NSSI is needed to guide the development of prevention efforts. The current study examined the relationship between maternal socialization of emotions and NSSI behaviors in their children. Female adolescents (N = 90, 12-17 years old) who demonstrated a range of NSSI lifetime episodes from none to very frequent were included in this sample. Maternal responses to their children's displays of sadness, anger, and happiness were assessed. Principal components analysis was used to categorize items into supportive and unsupportive maternal emotion socialization responses for the three emotions. Adolescents whose mothers reported less supportive maternal responses to child's expressions of sadness and anger had more lifetime NSSI episodes. Many of these patterns remained when follow-up analyses considered an extreme group approach (e.g., high counts of NSSI versus no NSSI), when analyses focused on specific diagnostic subgroups (e.g., depression and anxiety), and to some extent (socialization of anger) when current NSSI was considered. While the cross-sectional study design prevents causal conclusions, transactional theories raise the possibility that mothers' emotion socialization may impact offspring NSSI and offspring engagement in NSSI may result in mothers altering their socialization practices to accommodate their child's unique needs. Future research should employ longitudinal methodology to examine the time course, consider the role of emotion regulation as an explanatory mechanism, and consider intervention methods that may teach effective emotion socialization for parents.
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Affiliation(s)
- Helen V White
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minnesota, USA
| | - Thanharat Silamongkol
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minnesota, USA
| | | | - Madelyn H Labella
- Department of Psychological and Brain Sciences, University of Delaware, Delaware, USA
| | - Emersyn R Goetz
- Department of Psychology, University of Minnesota, Minnesota, USA
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minnesota, USA
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19
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Sahasrabudhe SA, Silamongkol T, Park YW, Colette A, Eberly LE, Klimes-Dougan B, Coles LD, Cloyd JC, Öz G, Mueller BA, Kartha RV, Cullen KR. Identifying Biological Signatures of N-Acetylcysteine for Non-Suicidal Self-Injury in Adolescents and Young Adults. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6:e210007. [PMID: 34036177 PMCID: PMC8143039 DOI: 10.20900/jpbs.20210007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prevalence of non-suicidal self-injury (NSSI) is high in adolescents and young adults. However, there is a paucity of evidence-based treatments to address this clinical problem. An open-label, pilot study in the target population showed that treatment with oral N-acetylcysteine (NAC), a widely available dietary supplement, was associated with reduction in NSSI frequency. In preparation for a biologically informed design of an efficacy trial, a critical preliminary step is to clarify NAC's biological signatures, or measures of the mechanisms underlying its clinical effects. Toward that end, we propose a 2-stage project to investigate NAC's biological signatures (changes in glutathione (GSH) and/or glutamate (Glu)) in women with NSSI. The first stage; a double-blind randomized placebo-controlled study will focus on identifying the optimal dose to achieve meaningful change in GSH and Glu during short-term (4 weeks) NAC treatment in 36 women aged 16-24 years with NSSI. Go/No-go criteria to determine if the study will progress to the second stage include pre-specified changes in brain and blood measures of GSH. Changes in the brain GSH are measured through magnetic resonance spectroscopy (MRS). The dose for the stage 2 will be selected based on the biological changes and the tolerability observed in the stage 1. The stage 2 will seek to replicate the biological signature findings in an 8-week trial in a new patient cohort, and examine the relationships among biological signatures, NAC pharmacokinetics and clinical response. This 2-stage project is unique as it unifies clinical psychiatric measurements, quantitative MRS and pharmacological approaches in the first placebo-controlled clinical trial of NAC in young women with NSSI. TRIAL REGISTRATION The stage 1 trial protocol has been registered on https://clinicaltrials.gov/ with ClinicalTrials.gov ID "NCT04005053" (Registered on 02 July 2019. Available from: https://clinicaltrials.gov/ct2/show/NCT04005053).
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Affiliation(s)
- Siddhee A. Sahasrabudhe
- Center for Orphan Drug Research, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Thanharat Silamongkol
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN 55454, USA
| | - Young Woo Park
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alanna Colette
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN 55454, USA
| | - Lynn E. Eberly
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Bonnie Klimes-Dougan
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN 55455, USA
| | - Lisa D. Coles
- Center for Orphan Drug Research, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - James C. Cloyd
- Center for Orphan Drug Research, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Gülin Öz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Bryon A. Mueller
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN 55454, USA
| | - Reena V. Kartha
- Center for Orphan Drug Research, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN 55454, USA
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20
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Koposov R, Stickley A, Ruchkin V. Non-Suicidal Self-Injury Among Incarcerated Adolescents: Prevalence, Personality, and Psychiatric Comorbidity. Front Psychiatry 2021; 12:652004. [PMID: 34093271 PMCID: PMC8170036 DOI: 10.3389/fpsyt.2021.652004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Incarcerated adolescents represent a risk group for non-suicidal self-injury (NSSI), but research on this population has been limited and no studies have been conducted in Russia. To address this deficit, this study examined NSSI and the factors associated with it among youth in a juvenile correctional facility in Russia. Methods: NSSI and psychopathology were assessed using a psychiatric interview and self-report questionnaire in 368 incarcerated male adolescents aged 14-19 years (mean age 16.4 years, S.D. 0.9) from Northern Russia. Results: 18.2% (N = 67) of the study participants had a history of NSSI and also had higher rates of anxiety, post-traumatic stress disorder (PTSD), depression, community violence exposure and scored higher on most of the Youth Self-Report problem scales. In addition, 31.3% of the NSSI group reported previous suicidal ideation and had thought about a specific suicide method compared to 12.0% in the No-NSSI group. Adolescents with NSSI also differed significantly from the No-NSSI group on self-directedness (lower) and self-transcendence (higher) personality traits. Conclusion: NSSI is common in incarcerated adolescents in Russia and is associated with extensive psychiatric comorbidity, suicidal ideation and specific personality traits.
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Affiliation(s)
- Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Epidemiology and Modern Technologies of Vaccination, Institute of Professional Education, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Center of Neurology and Psychiatry, Kodaira, Japan.,Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Child Study Center, Yale School of Medicine, New Haven, CT, United States.,Säter Forensic Psychiatric Clinic, Säter, Sweden
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21
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Koenig J, Klier J, Parzer P, Santangelo P, Resch F, Ebner-Priemer U, Kaess M. High-frequency ecological momentary assessment of emotional and interpersonal states preceding and following self-injury in female adolescents. Eur Child Adolesc Psychiatry 2021; 30:1299-1308. [PMID: 32862250 PMCID: PMC8310834 DOI: 10.1007/s00787-020-01626-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/19/2020] [Indexed: 01/20/2023]
Abstract
Non-suicidal self-injury (NSSI) is a considerable health problem among adolescents. Affect regulation by means of self-injury may promote the maintenance of NSSI. However, existing findings have limited ecological validity. The present study aimed to assess emotional and interpersonal states preceding and following incidents of NSSI in female adolescents. Adolescents with NSSI-disorder completed ecological momentary assessments of affective and interpersonal states on an hourly basis for multiple days. Multilevel mixed-effect regression analyses were conducted to assess antecedences and consequences of acts of self-injury. Data from n = 73 female adolescents covering a total of 52 acts of self-injury were available for analyses. The urge to self-injure on the between subject-level and negative affect on the within-level were best predictors of self-injury. Surprisingly, self-injury increased negative affect and decreased feelings of attachment (mother only) in the following hour. In line with findings in adults, results illustrate the important association between negative affect and self-injury in female adolescents. However, the occurrence of NSSI itself was related to concurrent increases in negative affect, and even prospectively predicted a consecutive increase in negative affect. Therefore, improvements of negative affect following (or during) self-injury, as previously reported, are at best short-lived (< 1 h).
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Affiliation(s)
- Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ,Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julia Klier
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Philip Santangelo
- Chair of Applied Psychology/Mental mHealth Lab, Institute of Sport and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Ebner-Priemer
- Chair of Applied Psychology/Mental mHealth Lab, Institute of Sport and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. .,Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Wang L, Wu Q, Choi AWM. Negative Emotions as Risk Factors for Self-Directed Violence and Intimate Partner Violence in Chinese College Students. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:3886-3912. [PMID: 29294777 DOI: 10.1177/0886260517713225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this study, we examined the unique contributions of negative emotions (i.e., anger, depression, and shame) for two different types of self-directed violence (i.e., nonsuicidal self-injury [NSSI] and suicidality) and three different types of intimate partner violence perpetration (i.e., physical, sexual, and psychological violence) in a college sample. We investigated the moderating role of gender in any link between the negative emotions and the violent behaviors. We also examined an association between self-directed violence and intimate partner violence perpetration. We collected the survey data from a convenience sample of 752 Chinese college students (408 women and 344 men) ranging from 18 to 23 years of age. The questionnaires were filled out during class time. Analyses revealed that anger was associated with increased intimate partner physical, sexual, and psychological violence perpetration but not self-directed violence, underscoring its relevance for engaging in violence directed toward others. Our analyses also showed that, conversely, shame was associated with increased NSSI and suicidality but not intimate partner violence. Depression was associated with increased risk of engaging in self-directed violence as well as intimate partner physical and psychological violence. Moderation analysis showed that gender moderates the relationship of shame with NSSI. Women appear more susceptible to NSSI influenced by shame. Furthermore, the results found self-directed violence and intimate partner physical violence perpetration to be associated. The findings highlight the importance of targeting negative emotions in treatment with high-risk individuals. Integrated violence prevention programs would make it possible to treat co-occurring violence against self and intimate others in a more effective way.
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Affiliation(s)
- Ling Wang
- The University of Hong Kong, Pokfulam, Hong Kong
| | - Qinglu Wu
- The University of Hong Kong, Pokfulam, Hong Kong
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23
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Tang J, Ma Y, Lewis SP, Chen R, Clifford A, Ammerman BA, Gazimbi MM, Byrne A, Wu Y, Lu X, Chang H, Kang C, Tiemeier H, Yu Y. Association of Internet Addiction With Nonsuicidal Self-injury Among Adolescents in China. JAMA Netw Open 2020; 3:e206863. [PMID: 32496567 PMCID: PMC7273191 DOI: 10.1001/jamanetworkopen.2020.6863] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Both nonsuicidal self-injury (NSSI), defined as the direct, deliberate damage of one's body tissue without suicidal intent, and internet addiction among adolescents are public health concerns. However, the possible association of NSSI with internet addiction is not well understood. OBJECTIVE To examine the occurrence of internet addiction with NSSI and any sex differences among Chinese adolescents. DESIGN, SETTING, AND PARTICIPANTS A multicenter, cross-sectional, survey study was conducted from February 18 to October 15, 2015, among adolescents aged 11 to 20 years from 343 classes in 45 public high schools across 5 provinces of China. Data analysis was performed from August 1, 2018, to March 1, 2019. EXPOSURES Possible internet addiction and internet addiction. MAIN OUTCOMES AND MEASURES Less-frequent (1-4 times) NSSI and more-frequent (≥5 times) NSSI were surveyed using the Chinese version of the Functional Assessment of Self-Mutilation. RESULTS A total of 15 623 students (8043 male [51.5%] and 7580 female [48.5%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) participated. Of these, 4670 participants (29.9%) met the criteria for possible internet addiction and 509 participants (3.3%) met the criteria for internet addiction. A total of 2667 students (17.1%) engaged in less-frequent NSSI, while 1798 students (11.5%) engaged in more-frequent NSSI in the 12 months preceding the survey. Both possible internet addiction and internet addiction were associated with less-frequent or more-frequent NSSI. The adjusted odds ratios were 1.29 (95% CI, 1.17-1.42) for possible internet addiction and 1.41 (95% CI, 1.11-1.80) for internet addiction for less-frequent NSSI; for more-frequent NSSI, the adjusted odds ratios were 1.75 (95% CI, 1.56-1.96) for possible internet addiction and 2.66 (95% CI, 2.10-3.38) for internet addiction. These associations were similarly observed among age groups of 11 to 14, 15 to 17, and 18 to 20 years. No sex disparities were found in the associations of internet addiction with NSSI, except among adolescents aged 11 to 14 years, where the odds ratios for possible internet addiction with less-frequent NSSI were higher in male adolescents (1.53; 95% CI, 1.25-1.88) than female adolescents (1.13; 95% CI, 0.90-1.47). CONCLUSION AND RELEVANCE Internet addiction appears to be associated with NSSI, and the findings of this study suggest that the association was similar between male adolescents and female adolescents. These data suggest that evaluation of the risk of NSSI for adolescents in association with internet addiction may help health care professionals in developing preventive interventions for NSSI.
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Affiliation(s)
- Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, P. R. China
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Ying Ma
- Department of Child Healthcare, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, P. R. China
| | - Stephen P. Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Angela Clifford
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | | | - Marufu Martin Gazimbi
- Global Development Institute, ALB, University of Manchester, Manchester, United Kingdom
| | - Adrian Byrne
- School of Medicine, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Yu Wu
- Shenzhen Center for Disease Control and Prevention, Nanshan District, Shenzhen, P. R. China
| | - Xinchuan Lu
- Department of Child and Adolescent Psychiatry, Suzhou Guangji Hospital, Suzhou, P. R. China
| | - Hongjuan Chang
- Department of Maternal and Child Healthcare, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hankou District, Wuhan, P. R. China
| | - Chun Kang
- Department of Maternal and Child Healthcare, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hankou District, Wuhan, P. R. China
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Yizhen Yu
- Department of Maternal and Child Healthcare, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hankou District, Wuhan, P. R. China
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Cullen KR, Schreiner MW, Klimes-Dougan B, Eberly LE, LaRiviere L, Lim KO, Camchong J, Mueller BA. Neural correlates of clinical improvement in response to N-acetylcysteine in adolescents with non-suicidal self-injury. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109778. [PMID: 31682891 PMCID: PMC7058485 DOI: 10.1016/j.pnpbp.2019.109778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/05/2023]
Abstract
Non-suicidal self-injury (NSSI) is a serious clinical problem that is common in adolescents. Novel, biologically-informed approaches for treating NSSI in adolescents are needed to prevent negative outcomes such as chronic NSSI and future suicide attempts. N-acetylcysteine (NAC) has been used successfully to address other conditions that involve repetitive maladaptive behaviors and may have utility in addressing NSSI. This study explored neural circuit changes following an open-label, 8-week trial of NAC in female adolescents with NSSI. We measured whole-brain resting-state functional connectivity (RSFC) of the amygdala and the nucleus accumbens before and after treatment using resting-state functional neuroimaging. Usable neuroimaging data from both pre- and post-treatment were available for 18 participants. Reduction in NSSI frequency was associated with a decrease in left amygdala RSFC with right supplementary motor area (SMA), but with an increase in right amygdala RSFC with right inferior frontal cortex. For nucleus accumbens, a reduction in NSSI frequency was associated with a decrease in connectivity between right nucleus accumbens and left superior medial frontal cortex. We also report change in similar circuits accompanying clinical improvement in depression and global psychopathology measures. These preliminary findings suggest amygdala and nucleus accumbens-based circuits as potential treatment targets, and set the stage for future research designed to confirm these neural targets using randomized, placebo-controlled designs to confirm clinical efficacy and mechanisms of effect.
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Affiliation(s)
- Kathryn R. Cullen
- University of Minnesota, Medical School, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry
| | | | | | - Lynn E. Eberly
- University of Minnesota, School of Public Health, Division of Biostatistics
| | | | - Kelvin O. Lim
- University of Minnesota, Medical School, Department of Psychiatry and Behavioral Sciences
| | - Jazmin Camchong
- University of Minnesota, Medical School, Department of Psychiatry and Behavioral Sciences
| | - Bryon A. Mueller
- University of Minnesota, Medical School, Department of Psychiatry and Behavioral Sciences
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25
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Baer MM, Tull MT, Forbes CN, Richmond JR, Gratz KL. Methods Matter: Nonsuicidal Self-Injury in the Form of Cutting is Uniquely Associated with Suicide Attempt Severity in Patients with Substance Use Disorders. Suicide Life Threat Behav 2020; 50:397-407. [PMID: 31621951 PMCID: PMC7148192 DOI: 10.1111/sltb.12596] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the robust relation between nonsuicidal self-injury (NSSI) and suicidal behaviors, there is considerable heterogeneity in NSSI characteristics that may have implications for the strength of the NSSI-suicide attempt relation. Past research highlights the relevance of both more severe NSSI methods and NSSI in the form of cutting in particular to suicide attempts. To further explore the relations of specific NSSI methods to suicide attempts, this study examined relations between different NSSI methods (i.e., those involving cutting, burning, blunt force, or resulting in minor tissue damage) and both overall suicide attempts and two indicators of suicide attempt severity (attempts requiring medical attention and nonambivalent attempts) in 203 substance-dependent patients in residential treatment. METHOD Participants were administered questionnaires and semistructured interviews assessing the variables of interest. RESULTS Cutting was the only NSSI method to demonstrate significant relations with overall suicide attempts, nonambivalent suicide attempts, and suicide attempts requiring medical attention. Results remained when considering relevant covariates. CONCLUSION Results highlight an important link between NSSI methods involving cutting and suicide attempts among patients with substance use disorders. Findings also highlight the importance of more fine-grained characterizations of NSSI subgroups.
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Affiliation(s)
| | - Matthew T. Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA,Address correspondence to: Matthew T. Tull, Ph.D., Department of Psychology, Mail Stop 948, University of Toledo, 2801 West Bancroft Street, Toledo, Ohio 43606; Telephone: 419-530-4392; Fax: 419-530-8479;
| | | | | | - Kim L. Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
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26
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Zhao J, Chi Y, Ju Y, Liu X, Wang J, Liu X, Lew B, Siau CS, Jia C. Shame and Suicidal Ideation among Undergraduates in China: The Mediating Effect of Thwarted Belongingness and Perceived Burdensomeness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072360. [PMID: 32244371 PMCID: PMC7178018 DOI: 10.3390/ijerph17072360] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 01/26/2023]
Abstract
Undergraduate students with shame are more likely to experience suicidal ideation, but there remains a lack of research investigating the factors underlying this relationship. The interpersonal theory of suicide posits that suicidal ideation is influenced by the simultaneous presence of thwarted belongingness and perceived burdensomeness. We examined the prevalence of suicidal ideation among undergraduate students in China and examined the association between shame and suicidal ideation mediated by perceived burdensomeness and thwarted belongingness. A survey was conducted in July 2018 involving 2320 undergraduate students, and the twelve-month prevalence of suicidal ideation was 8.95%. Shame played a crucial role in predicting suicidal ideation, and the mediating effects of perceived burdensomeness and thwarted belongingness between shame and suicidal ideation were significant. Suicidal ideation is common among undergraduate students in China and merits greater attention. Shame, perceived burdensomeness, and thwarted belongingness may be important factors to assess among undergraduate students in suicide risk assessment and psychological intervention.
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Affiliation(s)
- Jingjing Zhao
- School of Marxism, Shandong University, Jinan 250012, China
| | - Yanna Chi
- School of Public Health, Shandong University, Jinan 250012, China
| | - Yanli Ju
- School of Public Health, Shandong University, Jinan 250012, China
| | - Xiyao Liu
- School of Public Health, Shandong University, Jinan 250012, China
| | - Jingjing Wang
- School of Public Health, Shandong University, Jinan 250012, China
| | - Xinglai Liu
- School of Public Health, Shandong University, Jinan 250012, China
| | - Bob Lew
- Department of Social Psychology, Putra University of Malaysia, Serdang 43400, Selangor Malaysia
| | - Ching Sin Siau
- Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur 56000, Malaysia
| | - Cunxian Jia
- School of Public Health, Shandong University, Jinan 250012, China
- Correspondence: ; Tel.: +86-0531-8838-2141-8803
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27
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Guo S, Yang Y, Liu F, Li F. The awareness rate of mental health knowledge Among Chinese adolescent: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19148. [PMID: 32049839 PMCID: PMC7035058 DOI: 10.1097/md.0000000000019148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mental health knowledge is an important part of mental health literacy, which is related to one's attitude and coping style when facing mental illness. The awareness rate of mental health knowledge among adolescents is an effective index to evaluate the effect of school mental health education, and the awareness rate of mental health knowledge among Chinese adolescents has not been effectively evaluated. METHODS Two electronic databases for English language and 3 electronic databases for Chinese language were searched for relevant studies. Meta-analysis was conducted to analyze the awareness rate among Chinese adolescents. The normal distribution test was conducted using 5 methods. Homogeneity test was conducted, and I > 50% indicates existence of heterogeneity and in this case, the random model was adopted; otherwise, we adopt the fixed model. Funnel plot and Egger test was used to confirm whether publication bias existed. RESULTS Seventeen studies were included in this study, comprising 22,164 students from different stages of education (10,437 senior middle-school students, 5589 junior middle-school students, and 6138 college students). The awareness rate of mental health knowledge among Chinese adolescents was only 66%; for university students and middle-school students, their awareness rate was 73% and 61%, respectively. The awareness rate among senior middle-school students was as low as that of junior middle-school students. The awareness rate among college students in developed regions was higher than that in developing regions. CONCLUSIONS The awareness rate of mental health knowledge among Chinese adolescents was lower than the goal set in the national mental health work plan. There are gaps in mental health education in different developed areas. The mental health education among adolescent in Chinese mainland needs to be further strengthened.
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Affiliation(s)
- Shengyu Guo
- Department of Economics and Management, Changsha University
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University
| | - Yan Yang
- Institute of Natural Resources and Conservation Lands, Hunan Academy of Forestry, Changsha, Hunan, China
| | - Feiyue Liu
- Department of Economics and Management, Changsha University
| | - Fuying Li
- Department of Economics and Management, Changsha University
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28
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Hooley JM, Fox KR, Boccagno C. Nonsuicidal Self-Injury: Diagnostic Challenges And Current Perspectives. Neuropsychiatr Dis Treat 2020; 16:101-112. [PMID: 32021203 PMCID: PMC6959491 DOI: 10.2147/ndt.s198806] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/15/2019] [Indexed: 11/23/2022] Open
Abstract
Nonsuicidal self-injury (NSSI) involves deliberate and intentional injury to body tissue that occurs in the absence of suicidal intent. Typical examples here might include self-cutting, burning, or self-hitting. Behavior of this kind is fundamentally unsettling as well as perplexing. It is also the case that self-harming behavior of any kind runs counter to a fundamental survival instinct. In the past, behaviors such as these were viewed as self-mutilation and considered to be a form of attenuated suicide. Much has changed over time, culminating in the entry of NSSI Disorder into DSM-5 as a condition in need of further study. In this review we describe the evolution of the NSSI construct and consider current issues in its diagnosis and assessment.
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Affiliation(s)
- Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, CO 80210, USA
| | - Chelsea Boccagno
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
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29
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Lim KS, Wong CH, McIntyre RS, Wang J, Zhang Z, Tran BX, Tan W, Ho CS, Ho RC. Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4581. [PMID: 31752375 PMCID: PMC6888476 DOI: 10.3390/ijerph16224581] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/03/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This meta-analysis aimed to estimate the global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents. METHODS A systematic search for relevant articles published between 1989 to 2018 was performed in multiple electronic databases. The aggregate 12-month and lifetime prevalence of suicidal behavior, deliberate self-harm, and non-suicidal self-injury were calculated based on the random-effects model. Subgroup analyses were performed to compare the prevalence according to school attendance and geographical regions. Results: A total of 686,672 children and adolescents were included. The aggregate lifetime and 12-month prevalence of suicide attempts was 6% (95% CI: 4.7-7.7%) and 4.5% (95% CI: 3.4-5.9%) respectively. The aggregate lifetime and 12-month prevalence of suicidal plan was 9.9% (95% CI: 5.5-17%) and 7.5% (95% CI: 4.5-12.1%) respectively. The aggregate lifetime and 12-month prevalence of suicidal ideation was 18% (95% CI: 14.2-22.7%) and 14.2% (95% CI: 11.6-17.3%) respectively. The aggregate lifetime and 12-month prevalence of non-suicidal self-injury was 22.1% (95% CI: 16.9-28.4%) and 19.5% (95% CI: 13.3-27.6%) respectively. The aggregate lifetime and 12-month prevalence of deliberate self-harm was 13.7% (95% CI: 11.0-17.0%) and 14.2% (95% CI: 10.1-19.5%) respectively. Subgroup analyses showed that full-time school attendance, non-Western countries, low and middle-income countries, and geographical locations might contribute to the higher aggregate prevalence of suicidal behaviors, deliberate self-harm, and non-suicidal self-injury. Conclusions: This meta-analysis found that non-suicidal self-injury, suicidal ideation, and deliberate self-harm were the three most common suicidal and self-harm behaviors in children and adolescents.
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Affiliation(s)
- Kim-San Lim
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (K.-S.L.); (R.C.H.)
| | - Celine H. Wong
- Division of Child and Adolescent Psychiatry, Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore;
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 1R8, Canada;
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Jiayun Wang
- Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China;
| | - Zhisong Zhang
- Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China;
| | - Bach X. Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Vietnam Young Physicians’ Association, Hanoi 100000, Vietnam
| | - Wanqiu Tan
- The China-Singapore (Chongqing) Demonstration Initiative on Strategic Connectivity Think Tank, Chongqing 400043, China;
| | - Cyrus S. Ho
- Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore;
| | - Roger C. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (K.-S.L.); (R.C.H.)
- Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China;
- Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119228, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam
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30
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Guedria-Tekari A, Missaoui S, Kalai W, Gaddour N, Gaha L. Suicidal ideation and suicide attempts among Tunisian adolescents: prevalence and associated factors. Pan Afr Med J 2019; 34:105. [PMID: 31998428 PMCID: PMC6961937 DOI: 10.11604/pamj.2019.34.105.19920] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/01/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Studies directed on suicidal behavior in North African adolescents are rare. This study was conducted to estimate the prevalence of suicidal thoughts and attempts among high school students in Tunisia and to determine factors associated with this suicidal behavior. Methods This is an analytical cross-sectional study composed of a population containing 821 high school students obtained through cluster sampling. The participants completed a pre-established form related to socio-demographic characteristics and anxiety symptoms, the Suicide Behavior Questionnaire-Revised, the Beck depression scale, and the Rosenberg self-esteem scale. Results The mean age of the adolescents was 17.7±0.97 years. Prevalence of suicidal behavior was 26.9% for brief passing suicidal thoughts, 9.6% for serious suicidal thoughts, and 7.3% for suicide attempts. Six determining factors of suicidal behavior were found: female gender (OR=2.56 (1.32-4.95); p= 0.005), personal history of depression (OR=2.29 (1.38-3.80); p=0.001), tobacco smoking (OR=3.59 (1.61-8.01); p=0.002), current depression symptoms (OR=5.50 (2.14-14.11); p<0.001), history of non-suicidal self-injurious behavior (OR= 3.16 (2.05-4.86); p<0.001), and low self-esteem (OR=2.74 (1.71-4.38); p<0.001). Conclusion Suicidal ideation and attempts are frequent among Tunisian adolescents and represent a serious public health problem. An urgent national prevention program is required.
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Affiliation(s)
- Asma Guedria-Tekari
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,University of Monastir, Monastir, Tunisia
| | - Sonia Missaoui
- Service de Pédopsychiatrie, CISSS de Lanaudière, Québec, Canada
| | | | - Naoufel Gaddour
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,University of Monastir, Monastir, Tunisia
| | - Lotfi Gaha
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,University of Monastir, Monastir, Tunisia
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31
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Izadi-Mazidi M, Yaghubi H, Mohammadkhani P, Hassanabadi H. Assessing the Functions of Non-Suicidal Self-Injury: Factor Analysis of Functional Assessment of Self-Mutilation among Adolescents. IRANIAN JOURNAL OF PSYCHIATRY 2019; 14:184-191. [PMID: 31598120 PMCID: PMC6778602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The aim of this cross sectional study was to assess the factor analysis of Functional Assessment of Self-Mutilation (FASM) among Iranian adolescents with non-suicidal self-injury. Method: In this study, 646 high school students, with the mean age of 16.55 ± 0.7, were selected using a multistage cluster sampling method; they completed FASM and the demographic form. Data were analyzed using the descriptive statistics, chi-square (χ2), independent sample t test, MANOVA, and confirmatory factor analyses (CFA). Results: Of the participants, 178 reported at least 1 episode of NSSI during the previous year. The mean age of the participants when they first harmed themselves was 14.64 (±1.71). Most of them reported to engage in NSSI impulsively (39.32%) and experienced little (31.5%) or moderate physical pain (31.5%) There were no significant differences between males and females in severity of NSSI, frequency of NSSI, thinking about NSSI prior to engaging in the act, and age of onset. The results of the confirmatory factor analysis supported the 4-factor model of NSSI functions suggested by Nock and Prinstine [Χ2/df = 1.84; RMSEA = 0.07; GFI = 0.82; AGFI = 0.77]. The most frequent function for engaging in NSSI was Automatic Negative Reinforcement. Conclusion: Findings of this study supported the structural validity of the FASM; thus, this tool can be useful in treatment and research contexts as a measure of NSSI functions. Moreover, this study found that adolescents engage in non-suicidal self-injury because of 4 distinct reinforcement processes. The study findings have important implications for the assessment and treatment of NSSI.
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Affiliation(s)
- Maryam Izadi-Mazidi
- Department of Clinical Psychology, School of Humanities, Shahed University, Tehran, Iran
| | - Hamid Yaghubi
- Department of Clinical Psychology, School of Humanities, Shahed University, Tehran, Iran.,Corresponding Author: Address: Department of Clinical Psychology, School of Humanities, Shahed University, Tehran, Iran. Postal Code: 3319118651. Tel: 98-9123105088,
| | - Pavaneh Mohammadkhani
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Hassanabadi
- Department of Educational Psychology, School of Psychology and Education, Kharazmi University, Tehran, Iran
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Küçük A, Çetinkaya S. İntihar amaçlı olmayan kendine zarar verme davranışı ve intihar ilişkisi; tanı, borderline kişilik bozukluğu ve mizaç ve karakter özelliklerinin rolü. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.466375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Daily intake of soft drinks is associated with symptoms of anxiety and depression in Chinese adolescents. Public Health Nutr 2019; 22:2553-2560. [PMID: 31097051 DOI: 10.1017/s1368980019001009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The association of soft drink consumption with mental problems in Asian adolescents has not been reported. The present study aimed to investigate the association of soft drink consumption and symptoms of anxiety and depression in adolescents in China. DESIGN A cross-sectional study to investigate the association of intake of soft drinks and sugars from soft drinks with symptoms of anxiety and depression measured by the two-item Generalized Anxiety Disorder (GAD-2) and the Patient Health Questionnaire (PHQ-2), respectively. SETTING A comprehensive university in Changsha, China. PARTICIPANTS Newly enrolled college students in 2017. RESULT In total, 8226 students completed the investigation and 8085 students with no systemic disorders were finally analysed. Students consuming soft drinks ≥7 times/week had significantly higher (mean difference; 95 % CI) GAD-2 (0·15; 0·07, 0·23) and PHQ-2 (0·27; 0·19, 0·35) scores compared with those barely consuming soft drinks, adjusted for demographic and behavioural factors. Those consuming >25 g sugar/d from soft drinks had significantly higher GAD-2 (0·11; 0·04, 0·18) and PHQ-2 (0·22; 0·15, 0·29) scores compared with non-consumers. The mediation effect of obesity in the associations was not clinically significant. CONCLUSIONS Adolescents consuming soft drinks ≥7 times/week, or >25 g sugar/d from soft drinks, had significantly higher levels of anxiety and depression. Dietary suggestion is needed to prevent anxiety and depression in adolescents.
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Westlund Schreiner M, Mueller BA, Klimes-Dougan B, Begnel ED, Fiecas M, Hill D, Lim KO, Cullen KR. White Matter Microstructure in Adolescents and Young Adults With Non-Suicidal Self-Injury. Front Psychiatry 2019; 10:1019. [PMID: 32038337 PMCID: PMC6992587 DOI: 10.3389/fpsyt.2019.01019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/23/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a growing public health concern that commonly begins in adolescence, and can persist into young adulthood. A promising approach for advancing our understanding of NSSI in youth is to examine white matter microstructure using diffusion magnetic resonance imaging (dMRI). METHOD The present study examined whole-brain group differences in structural connectivity (as measured by generalized fractional anisotropy [GFA]) between 28 female adolescents and young adults ages 13-21 years with NSSI and 22 age-matched healthy controls (HC). We also explored the association between clinical characteristics including NSSI severity and duration, impulsivity, emotion regulation and personality traits within the NSSI group and GFA of the uncinate fasciculus and cingulum. RESULTS Compared to the HC group, participants with NSSI had lower GFA in several white matter tracts, including the uncinate fasciculus, cingulum, bilateral superior and inferior longitudinal fasciculi, anterior thalamic radiation, callosal body, and corticospinal tract. When controlling for depressive symptoms, the NSSI group showed an association between NSSI duration (time since initiating NSSI behavior) and lower GFA in the left cingulum. Higher levels of attentional impulsivity were related to lower GFA in the left uncinate fasciculus within the NSSI group. CONCLUSIONS We found evidence suggesting widespread white matter microstructure deficits in adolescents and young adults with NSSI versus HC. We also report inverse associations between white matter integrity and clinical characteristics (duration of NSSI and attentional impulsivity). These white matter microstructural deficits may represent a possible neurobiologically-based vulnerability to developing maladaptive coping mechanisms, such as NSSI. Additionally, results suggest that this white matter disorganization may either worsen with prolonged engagement in NSSI or predict persistent NSSI; thereby highlighting the importance of early intervention targeting this behavior.
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Affiliation(s)
| | - Bryon A Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota College of Liberal Arts, Minneapolis, MN, United States
| | - Erin D Begnel
- Department of Psychology, University of Minnesota College of Liberal Arts, Minneapolis, MN, United States
| | - Mark Fiecas
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Dawson Hill
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Kelvin O Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
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Abstract
Recent studies have revealed a high rate of nonsuicidal self-injury (NSSI) behavior in Chinese students, but quantitative syntheses of pooled prevalence are sparse. There have been several NSSI prevalence meta-analyses in other populations. However, given the existence of cultural diversity, racial difference, educational system difference and so on, these results may not be ideal for Chinese populations. Furthermore, the above-mentioned meta-analyses did not include Chinese database which may have led to unintentional bias. Thus, we conducted this meta-analysis to estimate the prevalence of NSSI in Chinese middle-school students.The databases searched included PubMed, Embase, Web of Science, CBM (Chinese database), Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (Chinese database) and the Weipu database (Chinese database). The search terms included: self-injury/self-harm/self-abuse/nonsuicidal self-injury/deliberate self-harm, adolescen*/youth/teen/students, and China/Chinese. All relevant articles published between January 2000 to November 2017, in either Chinese or English, were included. Two investigators were engaged in this process, and any disagreements were settled by a third investigator. A random effects model was then used to calculate the pooled prevalence.A total of 420 studies with 160,348 participants were retrieved. The pooled prevalence was 22.37% (95% CI: 18.84%-25.70%). Substantial heterogeneity in prevalence estimates was revealed. Subgroup analyses showed that the pooled estimate of prevalence of life time NSSI was 14.5% (95%CI: 0.06%-22.7%), and 6-24 months NSSI was23.3% (95%CI: 20.5%-26.1%). The prevalence for males was 20.6% (95% CI: 16.1%-25.0%), and for females was 21.9% (95% CI: 17.6%-26.2%).The prevalence of NSSI in Chinese middle-school students is relatively high. More attention should be paid to the current situation.
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Tang F, Byrne M, Qin P. Psychological distress and risk for suicidal behavior among university students in contemporary China. J Affect Disord 2018; 228:101-108. [PMID: 29245090 DOI: 10.1016/j.jad.2017.12.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/25/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Psychological distress and suicidal behavior are important mental health problems among university students and warrant research to inform strategies for effective prevention in this young population. The present study aimed to assess psychological distress and suicidal behavior and to unravel their associations among university students. METHODS A total of 5972 undergraduate students, randomly selected from six universities in central China, comprised the sample. The Chinese version of the Symptom Checklist-90-revised (SCL-90-R) was used to assess various psychological symptoms. Logistic regression analysis was used to examine the relationship between psychological distress and risk for suicidal behavior. RESULTS 40.7% of the university students reported positive in a least one of the 9 psychological symptom dimensions assessed by the SCL-90-R. 7.6% of the students reported suicidal behavior in the previous twelve months. The risk of suicidal behavior was significantly associated with psychological symptoms of all types, but there were notable differences by sex. For male students, depression and phobic anxiety increased the risk of suicidal behavior. Meanwhile, depression and obsessive-compulsiveness were positively associated with suicidal behavior in female students. Furthermore, increasing risk of suicidal behavior was associated with increasing positive symptom total (PST) score and a statistically significant trend was observed. LIMITATIONS Data collected from a cross-sectional survey does not allow any examination of causal inference. CONCLUSIONS Psychological distress and suicidal behavior were both common among university students; and psychological distress was highly associated with suicidal behavior. The findings underscore the importance of mental health care for university students.
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Affiliation(s)
- Fang Tang
- Health Management Centre, Qianfoshan Hospital Affiliated to Shandong University, China; Centre for Suicide Prevention and Research, School of Public Health, Shandong University, China
| | - Majella Byrne
- PICuP Clinic, Maudsley Psychology Centre, South London and Maudsley NHS Foundation Trust, UK; Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, UK
| | - Ping Qin
- Centre for Suicide Prevention and Research, School of Public Health, Shandong University, China; National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.
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Cullen KR, Klimes-Dougan B, Schreiner MW, Carstedt P, Marka N, Nelson K, Miller MJ, Reigstad K, Westervelt A, Gunlicks-Stoessel M, Eberly LE. N-Acetylcysteine for Nonsuicidal Self-Injurious Behavior in Adolescents: An Open-Label Pilot Study. J Child Adolesc Psychopharmacol 2018; 28:136-144. [PMID: 29053023 PMCID: PMC5831760 DOI: 10.1089/cap.2017.0032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is common in adolescents and young adults, and few evidence-based treatments are available for this significant problem. N-acetylcysteine (NAC) is a widely available nutritional supplement that has been studied in some psychiatric disorders relevant to NSSI including mood and addictive disorders. This pilot study tested the use of NAC as a potential treatment for NSSI in youth. METHODS Thirty-five female adolescents and young adults with NSSI aged 13-21 years were enrolled in this study that had an open-label, single-arm study design. All participants were given oral NAC as follows: 600 mg twice daily (weeks 1-2), 1200 mg twice daily (weeks 3-4), and 1800 mg twice daily (weeks 5-8). Patients were seen every 2 weeks throughout the trial, at which time youth reported the frequency of NSSI episodes. Levels of depression, impulsivity, and global psychopathology were measured at baseline and at the end of the trial using the Beck Depression Inventory-II (BDI-II), Barratt Impulsivity Scale, and Symptoms Checklist-90 (SCL-90). RESULTS About two-thirds of the enrolled female youth completed the trial (24/35). NAC was generally well tolerated in this sample. NAC treatment was associated with a significant decrease in NSSI frequency at visit 6 and visit 8 compared to baseline. We also found that depression scores and global psychopathology scores (but not impulsivity scores) decreased after NAC treatment. Decrease in NSSI was not correlated with decrease in BDI-II or SCL-90 scores, suggesting these might be independent effects. CONCLUSION We provide preliminary evidence that NAC may have promise as a potential treatment option for adolescents with NSSI. The current results require follow-up with a randomized, placebo-controlled trial to confirm efficacy.
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Affiliation(s)
- Kathryn R. Cullen
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Bonnie Klimes-Dougan
- Psychology Department, College of Liberal Arts, University of Minnesota, Minneapolis, Minnesota
| | | | - Patricia Carstedt
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Nicholas Marka
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Katharine Nelson
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Michael J. Miller
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Kristina Reigstad
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Ana Westervelt
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, Minnesota
| | | | - Lynn E. Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Tang J, Li G, Chen B, Huang Z, Zhang Y, Chang H, Wu C, Ma X, Wang J, Yu Y. Prevalence of and risk factors for non-suicidal self-injury in rural China: Results from a nationwide survey in China. J Affect Disord 2018; 226:188-195. [PMID: 28988001 DOI: 10.1016/j.jad.2017.09.051] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 09/07/2017] [Accepted: 09/22/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a highly prevalent and serious public health problem among adolescents worldwide. However, to date there were no studies assessing the prevalence of NSSI defined by suggested DSM-5 criteria among Chinese adolescents. We aimed to conduct a nationwide survey to explore the prevalence of and risk factors for NSSI among school-based adolescents in rural China. METHODS A total sample of 15,623 adolescents in rural China were enrolled by using a multistage sampling method. Data was collected by self-report questionnaires including demographic characteristics, neglect, maltreatment, loneliness, resilience, social support and emotional management ability. NSSI was defined by suggested DSM-5 criteria, according to which the engagement in self-injury took place more than 5 times a year. Multinomial logistic regression models were used to estimate the association between risk factors and NSSI. RESULTS There were 12.2% of adolescents (n = 1908) met the suggested DSM-5 criteria. Approximately 29% reported a history of NSSI at least once during the last year. Significant differences were found in several demographic factors including gender, ethnicity, grade, and family structure between adolescents with and without experiencing NSSI. The top three NSSI behaviors among adolescents with NSSI experience were hitting self, pinching, and pulling hair, with a prevalence rate of 16.7%, 14.1% and 11.2%, respectively. Female, Han ethnicity, fathers' education level, neglect, maltreatment, loneliness, social support, suicidal behaviors and emotional management ability were significantly associated with NSSI by multivariate analysis. No significant relationship was found between resilience and risk of NSSI. LIMITATION The DSM-5 has proposed 6 groups of criteria for NSSI, we only used criteria on frequency given its more accepted feasibility and pragmatic application. Consequently, it may different from other prevalence that estimated by other criteria. CONCLUSION To the best of our knowledge, this is the first study reporting prevalence of NSSI defined by suggested DSM-5 criteria among adolescent in rural China. In comparison to finding from the similar samples of adolescents, Chinese rural adolescents seem to have a relative higher prevalence. The potential risk factors for NSSI include female, father's education, Han ethnicity, psychosocial factors and suicide behaviors. More evidence for further understanding of context of the occurrence, improving access to health care utilization, and identifying the role of psychosocial factors and family relationship, is needed for the prevention and management of NSSI.
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Affiliation(s)
- Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China; The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Guowei Li
- Department of Clinical Epidemiology & Biostatistics, St Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON L8S 4L8, United States.
| | - Baoxin Chen
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Zhijie Huang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Yanmei Zhang
- Department of Child & Women Health Care, School of Public Health, Tongji Medical University, Huazhong University of Science &Technology, Wuhan, China.
| | - Hongjuan Chang
- Department of Child & Women Health Care, School of Public Health, Tongji Medical University, Huazhong University of Science &Technology, Wuhan, China.
| | - Chunxia Wu
- Department of Child & Women Health Care, School of Public Health, Tongji Medical University, Huazhong University of Science &Technology, Wuhan, China.
| | - Xiaoguang Ma
- Department of Nutrition and Food Hygiene, Chronic Disease Research Institute, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Jiaji Wang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Yizhen Yu
- Department of Child & Women Health Care, School of Public Health, Tongji Medical University, Huazhong University of Science &Technology, Wuhan, China.
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Matney J, Westers NJ, Horton SE, King JD, Eaddy M, Emslie GJ, Kennard BD, Stewart SM. Frequency and Methods of Nonsuicidal Self-Injury in Relation to Acquired Capability for Suicide Among Adolescents. Arch Suicide Res 2018; 22:91-105. [PMID: 28121238 DOI: 10.1080/13811118.2017.1283266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this study was to test the Interpersonal Psychological Theory of Suicide (IPTS) proposal that the association of nonsuicidal self-injury (NSSI) with suicide attempt is mediated by acquired capability. Inpatient adolescents (n = 134) reported on suicide ideation and attempts, NSSI frequency and methods, depressive symptoms, and acquired capability for suicide. Consistent with the IPTS, both measures of NSSI were positively associated with acquired capability after accounting for depressive symptoms and past history of attempts. However, both NSSI measures explained independent variance in number of suicide attempts after controlling for suicide ideation and acquired capability. These findings contradict the IPTS and suggest that the role of NSSI in suicide attempt is mediated by variables external to the IPTS.
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Wang PW, Yen CF. Adolescent substance use behavior and suicidal behavior for boys and girls: a cross-sectional study by latent analysis approach. BMC Psychiatry 2017; 17:392. [PMID: 29216850 PMCID: PMC5721537 DOI: 10.1186/s12888-017-1546-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 11/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescent suicidal behavior may consist of different symptoms, including suicidal ideation, suicidal planning and suicidal attempts. Adolescent substance use behavior may contribute to adolescent suicidal behavior. However, research on the relationships between specific substance use and individual suicidal behavior is insufficient, as adolescents may not use only one substance or develop only one facet of suicidal behavior. Latent variables permit us to describe the relationships between clusters of related behaviors more accurately than studying the relationships between specific behaviors. Thus, the aim of this study was to explore how adolescent substance use behavior contributes to suicidal behavior using latent variables representing adolescent suicidal and substance use behaviors. METHOD A total of 13,985 adolescents were recruited using a stratified random sampling strategy. The participants indicated whether they had experienced suicidal ideation, planning and attempts and reported their cigarette, alcohol, ketamine and MDMA use during the past year. Latent analysis was used to examine the relationship between substance use and suicidal behavior. RESULTS Adolescents who used any one of the above substances exhibited more suicidal behavior. The results of latent variables analysis revealed that adolescent substance use contributed to suicidal behavior and that boys exhibited more severe substance use behavior than girls. However, there was no gender difference in the association between substance use and suicidal behavior. CONCLUSION Substance use behavior in adolescents is related to more suicidal behavior. In addition, the contribution of substance use to suicidal behavior does not differ between genders.
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Affiliation(s)
- Peng-Wei Wang
- 0000 0004 0620 9374grid.412027.2Department of Psychiatry, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 807 Taiwan ,0000 0000 9476 5696grid.412019.fDepartment of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan. .,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Schreiner MW, Klimes-Dougan B, Mueller BA, Eberly LE, Reigstad KM, Carstedt PA, Thomas KM, Hunt RH, Lim KO, Cullen KR. Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity. J Affect Disord 2017; 221. [PMID: 28628767 PMCID: PMC5555154 DOI: 10.1016/j.jad.2017.06.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a significant mental health problem among adolescents. Research is needed to clarify the neurobiology of NSSI and identify candidate neurobiological targets for interventions. Based on prior research implicating heightened negative affect and amygdala hyperactivity in NSSI, we pursued a systems approach to characterize amygdala functional connectivity networks during rest (resting-state functional connectivity [RSFC)]) and a task (task functional connectivity [TFC]) in adolescents with NSSI. METHOD We examined amygdala networks in female adolescents with NSSI and healthy controls (n = 45) using resting-state fMRI and a negative emotion face-matching fMRI task designed to activate the amygdala. Connectivity analyses included amygdala RSFC, amygdala TFC, and psychophysiological interactions (PPI) between amygdala connectivity and task conditions. RESULTS Compared to healthy controls, adolescents with NSSI showed atypical amygdala-frontal connectivity during rest and task; greater amygdala RSFC in supplementary motor area (SMA) and dorsal anterior cingulate; and differential amygdala-occipital connectivity between rest and task. After correcting for depression symptoms, amygdala-SMA RSFC abnormalities, among others, remained significant. LIMITATIONS This study's limitations include its cross-sectional design and its absence of a psychiatric control group. CONCLUSIONS Using a multi-modal approach, we identified widespread amygdala circuitry anomalies in adolescents with NSSI. While deficits in amygdala-frontal connectivity (driven by depression symptoms) replicates prior work in depression, hyperconnectivity between amygdala and SMA (independent of depression symptoms) has not been previously reported. This circuit may represent an important mechanism underlying the link between negative affect and habitual behaviors. These abnormalities may represent intervention targets for adolescents with NSSI.
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Affiliation(s)
| | | | - Bryon A. Mueller
- Department of Psychiatry, University of Minnesota Medical School
| | - Lynn E. Eberly
- Division of Biostatistics, University of Minnesota School of Public Health
| | | | | | - Kathleen M. Thomas
- Institute of Child Development, University of Minnesota College of Education and Human Development
| | - Ruskin H. Hunt
- Institute of Child Development, University of Minnesota College of Education and Human Development
| | - Kelvin O. Lim
- Department of Psychiatry, University of Minnesota Medical School
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Forrester RL, Slater H, Jomar K, Mitzman S, Taylor PJ. Self-esteem and non-suicidal self-injury in adulthood: A systematic review. J Affect Disord 2017. [PMID: 28647667 DOI: 10.1016/j.jad.2017.06.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a self-destructive act that represents a considerable burden on the individual and society. Low self-esteem may be a psychological variable that is related to NSSI. However, little is known about the nature of this relationship in adulthood. This systematic review therefore aimed to provide a synthesis of the available literature on the relationship between self-esteem and NSSI. METHODS Articles were independently identified and risk of bias assessed by two reviewers searching PsycINFO, CINAHL, Medline and Web of Science databases. Inclusion criteria were: (1) a mean sample age of eighteen years or over (2) full manuscripts available in English (3) assessment of NSSI (4) assessment(s) of self-esteem. A narrative synthesis of results was undertaken. A random-effects meta-analysis of differences in self-esteem between NSSI and non-NSSI groups was also undertaken. RESULTS Seventeen studies were identified and indicated a significant negative relationship between self-esteem and NSSI. The meta-analysis indicated lower self-esteem in those with experiences of NSSI versus those without, d = 0.59 - 1.17. Results suggested that although low self-esteem and NSSI are related in both clinical and non-clinical populations, there are a number of factors which also influence this relationship. LIMITATIONS The absence of longitudinal research is a major limitation of this literature. CONCLUSIONS It will be important for clinicians to consider the impact of self-esteem in those seeking support for NSSI. Further research should undertake longitudinal research to better understand the self-esteem and NSSI relationship.
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Affiliation(s)
- Rebecca L Forrester
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, England L69 3GB, United Kingdom.
| | - Hayley Slater
- Division of Health Research, University of Lancaster, Lancaster, England LA1 4YG, United Kingdom
| | - Khowla Jomar
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, England L69 3GB, United Kingdom
| | - Susan Mitzman
- Instiute of Learning and Teaching, University of Liverpool, Liverpool, England L69 3GB, United Kingdom
| | - Peter James Taylor
- Division of Psychology & Mental Health, University of Manchester, Manchester, England M13 9PL, United Kingdom
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Wang J, Xu Y, Guo L, Deng JX, Huang JH, Huang GL, Gao X, Wu H, Pan SY, Lu CY. The mediating effects of depressive symptoms and sleep quality on the relationship between the non-medical use of prescription drugs and suicidal behaviors among Chinese adolescents. Drug Alcohol Depend 2017. [PMID: 28624602 DOI: 10.1016/j.drugalcdep.2017.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The nature of the relationship between the non-medical use of prescription drugs (NMUPD) and suicide has not been clearly elucidated. Some studies have suggested that the relationship between substance use and suicidal ideation may be spurious and could be explained by other variables. METHODS A school-based cross-sectional study was performed in Guangzhou. A total of 5853 students completed questionnaires and were included in the study. NMUPD, alcohol use, illicit drug use, depressive symptoms, sleep quality, and suicidal behaviors were assessed. The mediating effects of depressive symptoms and sleep quality on the relationship between NMUPD and suicidal behaviors were examined using a structural equation model. RESULTS In the simple model without mediation, a positive relationship between NMUPD and suicidal behaviors in adolescents was found, which was independent of effects from the use of other substances. Both depressive symptoms and sleep quality were significant mediators of this relationship. CONCLUSION Public health and educational professionals should survey depressive symptoms and sleep quality and provide interventions when managing suicidal behaviors among adolescents engaging in NMUPD.
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Affiliation(s)
- Juan Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, China; School of Public Health, Guangzhou Medical University, China
| | - Yan Xu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, China; Centre for ADR Monitoring of Guangdong, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, China
| | | | | | | | - Xue Gao
- Centre for ADR Monitoring of Guangdong, China
| | - Hong Wu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, China
| | - Si-Yuan Pan
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, China
| | - Ci-Yong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, China.
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A comparative analysis of suicide attempts in left-behind children and non-left-behind children in rural China. PLoS One 2017; 12:e0178743. [PMID: 28594874 PMCID: PMC5464573 DOI: 10.1371/journal.pone.0178743] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 05/18/2017] [Indexed: 11/19/2022] Open
Abstract
To estimate the prevalence of suicide attempts and explore the shared and unique factors influencing suicide risk in left-behind children (LBC) and non-left-behind children (NLBC) in rural China, this study collected data using a multi-stage cluster random sampling method from 13,952 children including 6,034 LBC and 7,918 NLBC. Sociodemographic characteristics, suicide attempts, neglect and physical abuse, negative life events, and loneliness were measured by self-reported questionnaires. Data were analyzed using logistic regression models. Gender and mother's education level were unique influential factors for NLBC while family structure type was a unique influential factor for LBC. The study provides two novel findings regarding NLBC specifically: 1. Children with optimal family socioeconomic status are more likely to report suicide attempts (odds ratio OR = 1)than are those in the general children population, OR 0.52 (95% CI: 0.39-0.70), and 2. Children with higher mother's education level are subject to higher suicide rates in high school, OR 1.67 (95% CI: 1.13-2.46), and post-secondary education, OR 2.14 (95% CI: 1.37-3.37). The unique characteristics of LBC and NLBC in China suggest that investigating risk factors and determining the factors that might be targeted in intervention programs are urgently needed currently.
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Aggarwal S, Patton G, Reavley N, Sreenivasan SA, Berk M. Youth self-harm in low- and middle-income countries: Systematic review of the risk and protective factors. Int J Soc Psychiatry 2017; 63:359-375. [PMID: 28351292 DOI: 10.1177/0020764017700175] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Self-harm (defined here as an act of intentionally causing harm to own self, irrespective of the type, motive or suicidal intent) is one of the strongest antecedents of suicide in youth. While there have been a number of studies of youth self-harm in low- and middle-income countries (LMICs), there is currently no systematic review of studies of prevalence rates and risk and protective factors. AIM To systematically review the evidence relating to the prevalence rates and forms of self-harm in youth in LMICs and its relationship to family economic status, family functioning, relationship with the peer group, social relationships and academic performance. METHODS Electronic searches of three databases, MEDLINE, PsycINFO and Scopus, were performed. In total, 27 school-, community- and hospital-based studies evaluating self-harm in LMICs with youth focus (with participants between 12 and 25 years) were included. RESULTS The self-harm was divided into suicidal and non-suicidal depending on the nature of self-harm. The 12-month prevalence rates of non-suicidal self-harm varied from 15.5% to 31.3%, and the range of suicidal behaviour rates was from 3.2% to 4.7%. Banging and hitting were the most common in the community-based studies, followed by cutting, scratching and wound picking. Self-poisoning with pesticides was most commonly reported in hospital-based studies. Risk factors for self-harm were family conflict, peer groups with members indulging in self-harm, truancy and school absenteeism. Protective factors were having an understanding family, having friends and higher school competence. Risk factors for suicidal thoughts and attempts were lack of close friends and history of suicide by a friend. CONCLUSION The 12-month prevalence rates of youth self-harm in LMICs are comparable to high-income countries (HICs). The profile of risk and protective factors suggests that family-based interventions could be useful in treatment and prevention. Future studies should aim for greater consistency in assessment methods and the constructs under evaluation.
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Affiliation(s)
- Shilpa Aggarwal
- 1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - George Patton
- 2 Department of Pediatrics, Royal Children's Hospital, Parkville, VIC, Australia.,3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Nicola Reavley
- 3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | | | - Michael Berk
- 1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,4 Orygen: The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Multi-level Analysis of the Functioning of the Neurobiological Threat System in Adolescents: Implications for Suicide and Nonsuicidal Self-Injury. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0117-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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47
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Koenig J, Brunner R, Fischer-Waldschmidt G, Parzer P, Plener PL, Park J, Wasserman C, Carli V, Hoven CW, Sarchiapone M, Wasserman D, Resch F, Kaess M. Prospective risk for suicidal thoughts and behaviour in adolescents with onset, maintenance or cessation of direct self-injurious behaviour. Eur Child Adolesc Psychiatry 2017; 26:345-354. [PMID: 27558490 DOI: 10.1007/s00787-016-0896-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022]
Abstract
Direct self-injurious behaviour (D-SIB) is associated with suicidal behaviour and suicide risk. It is not known if D-SIB cessation reduces these risks. The aim of this study was to explore trajectories of D-SIB and their prospective influence on suicidal thoughts and behaviour during adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the Saving and Empowering Young Lives in Europe study were analysed. D-SIB and suicidal thoughts and behaviour were assessed at baseline (T0), 1- (T1) and 2-year follow-up (T2). Onset and maintenance of D-SIB between T0 and T1 were associated with a two to threefold increased odds ratio for suicidal thoughts and behaviour at T2. Suicidal thoughts and behaviour in those terminating D-SIB before T1 were similar compared to those with no life-time history of D-SIB. Late onset and maintenance of D-SIB prospectively indicate risk for suicidal thoughts and behaviour. This is the first study showing that D-SIB cessation reduces later risk for suicidal thoughts and behaviour in adolescence. Suicide prevention efforts should set one focus on reducing adolescent D-SIB.
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Affiliation(s)
- Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gloria Fischer-Waldschmidt
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - JiYeon Park
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Camilla Wasserman
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany.
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Buffering the effects of peer victimization on adolescent non-suicidal self-injury: The role of self-compassion and family cohesion. J Adolesc 2016; 53:107-115. [PMID: 27710776 DOI: 10.1016/j.adolescence.2016.09.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/22/2016] [Accepted: 09/16/2016] [Indexed: 11/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is a significant behavioral problem among adolescents all over the world. This study examined the longitudinal relationship between peer victimization and NSSI, as well as the buffering effects of self-compassion and family cohesion on this relationship. Data were collected at two time points from 525 secondary school students (226 girls; Mage = 12.97, SD = 1.02) in China. Results showed that peer victimization (marginally) significantly predicted NSSI over time even after controlling for Wave 1 NSSI. This association was weakened under the condition of high levels of self-compassion. Findings of this study emphasize the buffering effect of self-compassion in the relationship between peer victimization and NSSI, and are informative for prevention and intervention of this behavioral problem.
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Brackman EH, Morris BW, Andover MS. Predicting Risk for Suicide: A Preliminary Examination of Non-Suicidal Self-Injury and the Acquired Capability Construct in a College Sample. Arch Suicide Res 2016; 20:663-76. [PMID: 27007698 DOI: 10.1080/13811118.2016.1162247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The interpersonal psychological theory of suicide provides a useful framework for considering the relationship between non-suicidal self-injury and suicide. Researchers propose that NSSI increases acquired capability for suicide. We predicted that both NSSI frequency and the IPTS acquired capability construct (decreased fear of death and increased pain tolerance) would separately interact with suicidal ideation to predict suicide attempts. Undergraduate students (N = 113) completed self-report questionnaires, and a subsample (n = 66) also completed a pain sensitivity task. NSSI frequency significantly moderated the association between suicidal ideation and suicide attempts. However, in a separate model, acquired capability did not moderate this relationship. Our understanding of the relationship between suicidal ideation and suicidal behavior can be enhanced by factors associated with NSSI that are distinct from the acquired capability construct.
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Knorr AC, Tull MT, Anestis MD, Dixon-Gordon KL, Bennett MF, Gratz KL. The Interactive Effect of Major Depression and Nonsuicidal Self-Injury on Current Suicide Risk and Lifetime Suicide Attempts. Arch Suicide Res 2016; 20:539-52. [PMID: 26953789 PMCID: PMC5072359 DOI: 10.1080/13811118.2016.1158679] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED This study examined the main and interactive effects of MDD and lifetime nonsuicidal self-injury (NSSI) on current suicide risk and past suicide attempts. We predicted that individuals with a history of NSSI and current MDD would be at greater suicide risk than those with either risk factor alone. An interaction between lifetime MDD and NSSI was hypothesized for past suicide attempts. 204 substance dependent inpatients completed self-report measures and a diagnostic interview. Patients with both a history of NSSI and current MDD, relative to all other groups, had the greatest suicide risk. No support was found for the lifetime MDD by NSSI interaction. CONCLUSION Findings suggest the relevance of both NSSI and MDD in suicide risk.
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Affiliation(s)
- Anne C. Knorr
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael D. Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Mary F. Bennett
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
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