Relations between Nonsuicidal Self-Injury and Suicidal Behavior in Adolescence: A Systematic Review

Adolescent Nonsuicidal Self-Injury and Suicidality: A Latent Class Analysis and Associations with Clinical Characteristics in an At-Risk Cohort

Nonsuicidal self-injury (NSSI) is frequently encountered in adolescents, but its predictive value for suicidality or other clinical characteristics is challenging due to its heterogeneous nature. This study used latent class analysis to identify subgroups of NSSI and compared these on sociodemographic characteristics, adverse outcomes and protective factors. The study included 966 high-risk adolescents, Mage 14.9 y, SD 0.9 y, 51.8% female. Four classes emerged: (1) "Low NSSI-Low suicidality", (2) "Moderate NSSI-Low suicidality", (3) "Moderate NSSI-High suicidality", and (4) "High NSSI-High suicidality". Girls predominated in the high suicidality classes. Generally, Class 4 had the poorest outcomes: more internalizing and externalizing problems, less social support from friends and families and worst self-esteem. These findings emphasize the need for interventions tailored to specific phenotypes of adolescents engaging in NSSI.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

Interrupting the Self-Harm Continuum

Background: Nonsuicidal self-injury (NSSI) has increased rapidly and is frequently linked to suicidal behavior; it has been argued that these behaviors are key points on a self-harm continuum. Aims: The current research explored self-harm and help-seeking behaviors, with the aim of identifying possibilities for prevention of further harm, including suicide. Methods: An online survey of 304 New Zealanders was undertaken, with the majority being aged under 25 and female. Results: Nearly half of the sample had engaged in self-harm and most of those had experienced suicidal thoughts; close to a quarter had made a suicide attempt. NSSI was used as a way of dealing with emotional distress. Very few sought help of any kind, especially professional support; of those who did seek professional support, most found it helpful but did not necessarily stop self-harming as a result. Limitations: Men are under-represented in the sample - though this is in accordance with the population of people who engage in NSSI. Conclusion: Many participants engaged in NSSI and also had suicidal thoughts using NSSI as an emotion regulation strategy; some participants appeared to use NSSI rather than attempting suicide. Given a link between NSSI and suicidal thoughts and behaviors, reluctance to seek help and on-going injurious behavior among some who do seek help, there is a need for increased identification and proactive support specifically focusing on improving emotion regulation and targeted at injurious behavior.

Suicide and suicidality in Australian Defence Force veterans: A systematic scoping review

OBJECTIVE

Increased suicidality and suicide deaths among veterans of the Australian Defence Force have gained recent prominence. A systematic scoping review was conducted to identify, summarise and synthesise the existing literature relating to Australian veteran suicide and suicidality, with the objective of identifying future research priorities.

METHODS

We conducted a PRISMA-compliant systematic search on PubMed/MEDLINE, Embase and CINAHL databases for all manuscripts reporting primary data on suicide and suicidality in Australian veterans. The search was supplemented by grey literature and a search of reference lists. Manuscripts of any study type, published in the English language since the Vietnam era, were eligible for inclusion.

RESULTS

A total of 26 articles and reports, utilising a variety of mostly quantitative approaches, were included in the review. Findings, especially in larger and more recent studies, indicate increased suicidality in the veteran population. Suicide deaths appeared to increase with transition out of the military. Mental illness was identified as an important risk factor for suicide and suicidality. Current service was identified as a protective factor against suicide. There was mixed evidence regarding the impact of operational deployment on suicide and suicidality.

CONCLUSIONS

Gaps were identified in relation to the relative contributions to risk from transition, the various psychosocial correlates (for example, relationships, finances, employment), pre-service factors and the extent to which these are causal or mediating in nature. A better understanding of health service utilisation would also aid in targeting preventive efforts. Future research in these areas is warranted.

Suicide risk in patients with a current depressive episode during the COVID-19 pandemic

Introduction

The prevalence of major depressive disorder (MDD) increased during the COVID-19 pandemic. Data on suicidality in these patients during the pandemic period remain scarce. The aim of the study was to determine the prevalence and variables associated with serious suicide risk in Russian inpatients with MDD during the COVID-19 pandemic.

Methods

A cross-sectional cohort study with consecutive sampling was conducted from January 1, 2021 to December 31, 2021. All patients completed the Mini International Neuropsychiatric Interview (M.I.N.I.) (including the suicidality module), the Beck Depression Inventory, and the State-Trait Anxiety Inventory, and underwent a semi-structured interview to collect relevant demographic and clinical data. Effect sizes for all independent variables and covariates were calculated using partial eta-squared (ηp2).

Results

Of the 6757 patients with non-psychotic mental disorders assessed, 1605 (23.7%) had MDD confirmed by the M.I.N.I., of whom 17.8% were at serious risk for suicide according to the M.I.N.I. suicidality module. Factors independently associated with serious suicide risk in Russian inpatients with MDD during the pandemic were younger age (ηp2 = 0.021), greater severity of depression (0.038), higher state anxiety (0.003), and nonsuicidal self-injury (NSSI) (0.066). The same variables, except for state anxiety, were independently associated with suicide risk in the subgroup of MDD patients previously infected with SARS-CoV2.

Conclusion

In the COVID-19 pandemic, the proportion of patients with MDD at serious risk of suicide was similar to pre-pandemic data. No associations were found between suicidality in patients with MDD and COVID-related factors. Younger age, greater severity of depression, and especially NSSI were the most significant risk factors for suicide in patients with MDD during the COVID-19 pandemic.

Identifying high-risk subgroups for self-harm in adolescents and young adults: A longitudinal latent class analysis of risk factors

BACKGROUND

Self-harm is a major public health concern in young people and is governed by a complex interaction of different risk factors. While many studies have identified these risk factors, less is known about how they tend to co-occur together.

METHODS

A latent class analysis was conducted using risk factors for self-harm from two waves at ages 13 and 17 from the Growing Up in Ireland (GUI) study their associations with self-harm were examined longitudinally at ages 17 and 20, respectively.

RESULTS

At age 13, there was a 'peer problems' group with higher probabilities of bullying, being unpopular and internalising problems and a 'school and substance use problems' group with higher probabilities of substance use, truancy or excessive absence from school and violence. Both of these two groups had over a two-fold risk of self-harm at age 17 in comparison to the low risk factor group. At age 17, there was a group with depression that was diagnosed by a medical professional with the highest relative risk (RR:13.9 (95 % CI 10.2-19.0)) of self-harm at age 20. Two other groups with undiagnosed depression had high probabilities of being bullied, and either high or low probabilities of substance use that had a 9.4 (95 % CI 6.8-13.1) and 7.4 (95 % CI 5.5-10.0) relative risk of self-harm at age 20, respectively.

CONCLUSIONS

Identifying hidden sub-groups using risk factors for self-harm in young people can inform potential public health interventions by clinicians and other professionals who work with young people.

Association between positive youth development and non-suicidal self-injury: A longitudinal survey of children and adolescents in southwest China, 2019-21

BACKGROUND

Non-suicidal self-injury (NSSI) could lead to serious problems (exp. suicidal attempts) among children and adolescents. Positive youth development (PYD) focuses on comprehensive development instead of a single problem. This study aims to explore the longitudinal relationship between NSSI and PYD among Chinese children and adolescents.

METHODS

The longitudinal study used the three-wave dataset from the Chengdu Positive Child Development (CPCD) in southwest China between 2019 and 2021, including 10,370 participants. The parallel process Latent Growth Curve Model (LGCM) was utilized to analyze the relationship between PYD and NSSI across time.

RESULTS

The study results demonstrated that the initial level of NSSI is negatively associated with the initial value (β = -0.730, p < 0.01) and the growth rate (β = -0.012, p < 0.01) of PYD, and the development rate of the two variables are negatively related to each other(β = -0.120, p < 0.01).

LIMITATIONS

The specific relationships between PYD attributes and NSSI should be explored in the future. And the cultural variation among countries deserves more research. Moreover, the dynamic cohort research leads to a relatively high loss of participants.

CONCLUSIONS

PYD and NSSI are closely associated among children and adolescents. Instead of playing a protective role, PYD tends to be predicted by NSSI behaviors over time.

How to survive the long night? Longitudinal relationship between sleep problems and suicidal behavior among adolescents: The serial mediating roles of negative emotion, self-control, and nonsuicidal self-injury

OBJECTIVE

Sleep problems are a significant risk factor for identifying and preventing suicidal involvement among adolescents. However, there is limited evidence to assess the underlying mechanisms between them. This study investigated the longitudinal relationship between sleep problems and suicidal behavior and examined whether this relationship was moderated by negative emotions, low self-control, and nonsuicidal self-injury (NSSI).

METHODS

From December 2020 onward, we assessed 1214 Chinese secondary school adolescents (60.7% were boys, aged 13-19 years) three times, 6 months apart.

RESULTS

In the direct effects model, sleep problems were found to have a positive impact on adolescent suicidal behavior. In the indirect effects model, we observed that sleep problems were associated with an elevated risk of suicidal behavior through several pathways: one-mediator path of negative emotions, low self-control, and NSSI, respectively; two-mediator path of negative emotions via low self-control, negative emotions via NSSI, and low self-control via NSSI, and three-mediator path from negative emotions to NSSI via low self-control.

CONCLUSIONS

This longitudinal study provides evidence that sleep problems in adolescents may increase suicidal behavior by exacerbating negative emotions, weakening self-control, and promoting NSSI. The findings suggest sleep problems should be addressed in suicide prevention and intervention efforts for adolescents.

Understanding the impact of children's and young people's self-harm on parental well-being: a systematic literature review of qualitative and quantitative findings

BACKGROUND

Self-harm in children and young people is increasing. Parents are vital in supporting young people; however, parents may experience distress linked to the self-harm. Previous reviews have highlighted the emotional impact and need for information and support, however, have not elucidated the relationships between these themes, nor examined the quantitative data examining parents' well-being.

METHODS

We conducted a mixed methods review, with qualitative meta-synthesis focusing on links between themes and quantitative synthesis of parental well-being findings, including pooled means. PsycInfo, Medline, EMBASE, AMED, CINHAL and Web of Science were searched to identify relevant records. References of included studies were also searched. Every abstract was screened by two authors. Data were extracted by one author and checked by another.

RESULTS

We identified 39 reports of 32 studies: 16 with qualitative data and 17 with quantitative data (one had both). Qualitative findings showed how parents' emotions were associated to their knowledge and beliefs about self-harm. Parents' emotions often evidenced the need to self-care, but emotions of guilt reduced engagement in self-care. How parents supported their young person was linked to their knowledge, and the management of their own emotions, and influenced if they could engage in self-care. Quantitative findings were mixed, however suggested poor general mental health amongst these parents.

CONCLUSIONS

Further good quality quantitative studies are needed, with measurement of psychological mechanisms that may underpin parental distress. Current evidence supports peer-support and interventions that go beyond information provision to address the connected factors of knowledge, emotion, self-care, and parenting behaviours.

Characteristics and Functions of Non-Suicidal Self-Injury That Inform Suicide Risk

OBJECTIVE

Although non-suicidal self-injury (i.e., NSSI) has been suggested as a robust risk factor of suicide, NSSI related information that is most related to suicide risk remains unclear. Commonly studied NSSI characteristics are its frequency and the number of methods endorsed. However, it may not be merely how frequent or how many different methods that matters, but "why," which alludes to the importance of NSSI functions (or why individuals engage in NSSI). Thus, this study examined how the interactions between NSSI characteristics and functions are associated with suicide risk.

METHODS

Undergraduate students (n = 820) with a lifetime history of NSSI, filled out self-report measures on NSSI and suicide risk. A hierarchical regression analysis was conducted to examine the moderation effects between four 2-way interactions (i.e., method X intrapersonal; method X interpersonal; frequency X intrapersonal; frequency X interpersonal) on suicide risk.

RESULTS

Main effects of all four independent variables were statistically significant. In terms of interactions, the intrapersonal function moderated both the effects of NSSI frequency and methods on suicide risk, whereas the interpersonal function moderated the effects of NSSI frequency on suicide risk.

CONCLUSION

Our results highlight that some NSSI related information than others are more indicative of suicide risk. In particular, the combination of NSSI functions, along with its frequency and number of methods, holds promise when assessing for current and lifetime suicidal thoughts and behaviors.

Non-suicidal Self-injurious Thoughts and Behaviors Among Adolescent Inpatients

Non-suicidal self-injury (NSSI) is a serious public health concern that typically onsets during early adolescence. Adolescents (N = 980, ages 12-19 years) admitted for acute, residential psychiatric treatment completed baseline clinical interviews assessing mental disorders and questionnaires measuring demographics, early life adversity, and symptom severity. Prevalence rates of NSSI for lifetime (thoughts: 78%; behaviors: 72%), past year (thoughts: 74%; behaviors: 65%), and past month (thoughts: 68%; behaviors: 51%) were high. Although effect sizes were modest, the presence of a lifetime depressive disorder, sexual abuse, and comorbidity (i.e., three or more current disorders) were significant correlates of experiencing NSSI thoughts and behaviors. Furthermore, lifetime depressive disorder, current anxiety disorder, and comorbidity were associated with a greater odds of persistent NSSI thoughts and/or behaviors. Longitudinal studies are needed to determine whether targeting these factors reduces the persistence of NSSI thoughts and behaviors.

Whole-brain structural and functional neuroimaging of individuals who attempted suicide and people who did not: A systematic review and exploratory coordinate-based meta-analysis

Suicide is the cause of death of approximately 800,000 people a year. Despite the relevance of this behaviour, risk assessment tools rely on clinician experience and subjective ratings. Given that previous suicide attempts are the single strongest predictors of future attempts, we designed a systematic review and coordinate-based meta-analysis to demonstrate whether neuroimaging features can help distinguish individuals who attempted suicide from subjects who did not. Out of 5,659 publications from PubMed, Scopus, and Web of Science, we summarised 102 experiments and meta-analysed 23 of them. A cluster in the right superior temporal gyrus, a region implicated in emotional processing, might be functionally hyperactive in individuals who attempted suicide. No statistically significant differences in brain morphometry were evidenced. Furthermore, we used JuSpace to show that this cluster is enriched in 5-HT1A heteroreceptors in the general population. This exploratory meta-analysis provides a putative neural substrate linked to previous suicide attempts. Heterogeneity in the analytical techniques and weak or absent power analysis of the studies included in this review currently limit the applicability of the findings, the replication of which should be prioritised.

How do professionals and non-professionals respond to non-suicidal self-injury? Lived experiences of psychiatric outpatients in Singapore

BACKGROUND

For young people who engage in non-suicidal self-injury (NSSI), receiving negative responses to their NSSI can pose a barrier to future help-seeking. This qualitative study aimed to explore helpful and unhelpful ways in which professionals and non-professionals respond to NSSI, from the perspectives of individuals with lived experiences of NSSI.

METHODS

Semi-structured interviews were conducted with 20 outpatients (6 males, 14 females) aged 17 to 29 years from a tertiary psychiatric hospital in Singapore, who had reported engaging in NSSI behavior in an earlier study. The interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data.

RESULTS

Professionals' responses were organized into three main themes: 'prescribing solutions without understanding needs', 'disapproval or judgment', and 'helpful responses'. Non-professionals' responses were organized into four main themes: 'emotionally charged responses', 'avoidance and inaction', 'poor understanding of reasons for NSSI', and 'providing tangible support and acknowledging NSSI'. Participants also described how unhelpful responses negatively impacted their willingness to seek help.

CONCLUSIONS

Our findings provide a better understanding of responses to NSSI that are considered helpful and unhelpful, and can be used to improve existing guidelines on responding to NSSI.

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

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

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

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.

Risk and protective factors for self-harm in adolescents and young adults: An umbrella review of systematic reviews

We conducted an umbrella review to synthesise the evidence from systematic reviews and meta-analyses that examined the risk and protective factors for self-harm in young people. We searched six different databases and used the AMSTAR-2 checklist for quality assessment. The importance of each risk and protective factor was determined based on (1) the number of times it was identified by general reviews examining any risk or protective factor, and (2) the effect sizes from meta-analyses. There were 61 systematic reviews included in this review. The most frequently identified risk factors for self-harm in young people included childhood abuse, depression/anxiety, bullying, trauma, psychiatric illnesses, substance use/abuse, parental divorce, poor family relationships, lack of friends, and exposure to self-harm behaviour in others. The risk factors with the strongest evidence for an association with self-harm were behavioural disorders, personality disorders and depression or anxiety. There was a dearth of systematic reviews examining protective factors but good family/friend relationships were most frequently identified. There was also evidence to show that non-suicidal and suicidal self-harm shared many of the same risk factors. Clinicians and other professionals who work with young people should be particularly cognisant of the psychiatric and adverse life event risk factors as well as the substance use, education-related and individual-level (e.g. being LGB) risk factors for self-harm. Knowledge of risk factors for self-harm can potentially be used to inform the design and implementation of prevention measures and further research is needed on the protective factors for self-harm.

Suicidal Ideation and Non-Suicidal Self-Injury Following Early Childhood Psychotic Experiences in Preadolescent Children at Familial High Risk of Schizophrenia or Bipolar Disorder-The Danish High Risk and Resilience Study, VIA 11

BACKGROUND AND HYPOTHESIS

Suicide is a leading cause of death in youth and is often preceded by suicidal ideation (SI) and non-suicidal self-injury (NSSI). Identifying early markers of risk for SI and NSSI could improve timely identification of at-risk individuals.

STUDY DESIGN

Children (mean age 11.9, SD 0.2) at familial high risk of schizophrenia (N = 171), or bipolar disorder (N = 104), and controls (N = 174) were assessed for psychotic experiences (PE), SI, NSSI, and Axis I mental disorders in face-to-face interviews in early and middle childhood (age 7 and 11).

STUDY RESULTS

Having 2 types of early childhood PE predicted middle childhood SI after accounting for previous SI, NSSI, and mental disorders (OR 2.8, 95% CI 1.1-6.9; P = .03). Two PE predicted NSSI (OR 3.0, 95% CI 1.2-7.7; P = .02) in excess of previous SI, NSSI, mental disorders, and familial risk. Persistent and incident PE predicted SI (OR 3.2, 95% CI, 1.1-8.8; P = .03; OR 3.8, 95% CI, 1.3-11.5; P = .02) in the fully adjusted model. Nineteen percent of children with persistent PE reported middle childhood SI vs 3.8% of those who never reported PE. In children with early childhood mental disorders, those who reported 2 PE had 4.4-fold increased odds of later SI (95% CI, 1.2-16.7; P = .03) after adjustments. PE were nondifferentially associated with outcomes across familial risk groups.

CONCLUSIONS

Early childhood PE index elevated risk for subsequent SI and NSSI beyond what can be attributed to presence of mental disorders. Mental health screenings and clinical assessments should include early childhood PE.

Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States

BACKGROUND

Suicide is among the top three causes of adolescent mortality. There is a scarcity of research examining cannabis use and suicidal behavior in adolescents.

OBJECTIVES

To determine the association between cannabis use disorder (CUD) and suicide attempt/self-harm in a hospitalized sample of adolescents.

METHODS

We conducted a cross-sectional observation study using data from the Nationwide Inpatient Sample collected over four years from January 1, 2016, through December 31, 2019. We included adolescents aged 10-19 hospitalized during the above period (N = 807,105). The primary outcome was suicide attempt/self-harm and the main predictor was CUD. The International Classification of Diseases Tenth Revision (ICD 10) diagnostic codes was used to identify a diagnosis of CUD, suicide attempt/self-harm, and other diagnoses included in the analyses. Adolescents diagnosed with CUD (n = 53,751) were compared to adolescents without CUD (n = 753,354). Univariate and multivariate logistic regressions were conducted to determine the association between CUD and suicide attempts/self-harm.

RESULTS

807,105 adolescent hospitalizations were analyzed, of which 6.9% had CUD. Adolescents with CUD were more likely to be older (17 years vs. 15 years), female (52% vs. 48%), have depression (44% vs. 17%), anxiety (32% vs. 13%), an eating disorder (1.9% vs. 1.2%), ADHD (16.3% vs. 9.1%), Conduct Disorder (4.1% vs. 1.3%), Alcohol Use Disorder (11.9% vs. 0.8%), Nicotine Use Disorder (31.1% vs. 4.1%), Cocaine Use Disorder (5.4% vs. 0.2%), Stimulant Use Disorder (0.8% vs. 0.4%) and report suicide attempts/self-harm (2.8% vs. 0.9%) [all ps<0.001]. After adjusting for potential confounders, CUD was associated with a higher risk of suicide attempts/self-harm (OR = 1.4, 95% CI 1.3-1.6, p <0.001). Post-hoc analyses showed the presence of depression moderated the association between CUD and suicide attempts/self-harm in that adolescents with CUD and depression had 2.4 times the odds of suicide attempt/self-harm compared to those with CUD but no depression after controlling for potential confounders (p<0.001).

CONCLUSIONS

Our study provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk. Identifying high-risk adolescents in inpatient settings provides an opportunity for intervention.

[Adolescents' Experiences of Non-Suicidal Self-Injury: An Interpretative Phenomenological Analysis Stud]

PURPOSE

This qualitative study used interpretative phenomenological analysis and photovoice methods to explore the meaning of non-suicidal self-injury experienced by adolescents.

METHODS

Participants were adolescents enrolled in middle and high schools in Gyeonggi-do and Jeollabuk-do who were selected through snowball sampling. Six participants had repeatedly engaged in self-injurious behavior for over a year. Data were collected through in-depth interviews and the photovoice method between November 2020 and July 2021. The collected data were analyzed using six steps of interpretative phenomenological analysis.

RESULTS

The results yielded 5 main themes and 18 subthemes. The main themes were 'a silent cry to an indifferent world', 'a heartache that one endures with scars', 'an inescapable cycle', 'filling the space in one's heart', and 'healing the wounds'. The study findings revealed that the self-injurious behavior of adolescents began as a consequence of feeling lost and struggling with conflicts at home and school, which helped them relieve tension and pain. Nonetheless, inflicting self-injury only left signs of regret and remorse, which became a trace that the participants wanted to hide. However, the wounds healed after receiving attention and support from others. They were determined to stop engaging in repeated self-injurious behaviors and made efforts to do so.

CONCLUSION

This study can be used as a basis for the development of educational programs to prevent non-suicidal self-injury in adolescents. Additionally, it can inform nursing interventions that focus on building support systems to help adolescents who attempt self-injury.

A qualitative study on lived experience of self-harm in South Asians in the UK: From reasons to recovery

OBJECTIVES

Self-harm rates and clinical presentations differ by ethnicity. South Asian women are at risk of self-harm. Previous research suggested investigating individuals' experiences with self-harm with qualitative studies in developing self-harm prevention strategies. This research aims to explore self-harm experiences among South Asians in the United Kingdom.

DESIGN

Qualitative study.

METHODS

Participants were recruited via third-sector organizations and online platforms. Semi-structured interviews were conducted with 11 South Asian individuals with a history of self-harm living in the United Kingdom. The data were analysed based on a reflective thematic analysis approach.

RESULTS

Results revealed four main themes: (1) reasons for self-harm; (2) recovery journey; (3) culture and mental health; and (4) the transition to suicidal thoughts and behaviours. Reasons for self-harm included negative life circumstances, social life difficulties, challenges faced during COVID-19 and mental health problems. Participants described their recovery journey by acknowledging the role of professional help, self-care, psychoeducation and personal growth, improving social relationships, and faith and spirituality. Cultural factors included generational differences and stigma. Culturally adapted psychological interventions were perceived as promising. The reported transition from self-harm to suicidal behaviours was linked to experiencing major stressful life events and the use of severe methods of self-harm.

CONCLUSIONS

The findings suggest that socio-cultural factors impact mental health and recovery processes among South Asians. Mental health services should consider improving culturally sensitive clinical practices in responding to self-harm among South Asian communities.

Suicidal Ideation in American Indian and Alaskan Native College-Attending Students

INTRODUCTION

Despite being at the highest risk of suicide, American Indian/Alaskan Native (AIAN)-emerging adults are underrepresented in mental health research. There is great diversity in individual and community experiences and access within AIAN-identifying individuals, prompting the need for research on risk and protective factors of suicidality within AIAN-emerging adults.

METHODS

Data from AIAN-identifying emerging adults (mean age = 24.4 years) collected between 2017 and 2020 (n=2,551) were drawn from the Healthy Minds Study, a national annual panel study on mental/behavioral health within higher education settings. Multivariate logistic regressions (conducted in 2022) were used to evaluate the risk and protective factors associated with suicidality (ideation, planning, attempt) by gender (male, female, trans/gender nonbinary).

RESULTS

Suicidal ideation rates were high; over 1 in 5 AIAN-emerging adults reported ideation, 1 in 10 reported planning, and 3% reported attempt in the previous year. AIANs identifying as a gender minority (trans/nonbinary) were 3 times more likely to report suicidality across event type. Across all gender identities, suicidality was significantly associated with nonsuicidal self-injury and self-perceived need for help; flourishing was predictive of lower odds of suicidality event for male- and female-identifying AIAN students.

CONCLUSIONS

Suicidality is high for AIAN college-attending students, particularly for gender minority-identifying students. Embracing a strength-based approach to highlight student awareness of mental health services is critical. Future research should examine the protective factors as well as community and structural factors that might provide meaningful support within and outside of university contexts for students facing individual, relational, or challenges within their communities.

Sleep problems mediate the influence of childhood emotional maltreatment on adolescent non-suicidal self-injury: The moderating effect of rumination

BACKGROUND

Non-suicidal self-injury (NSSI) is a highly serious public health problem among adolescents in China, and childhood emotional maltreatment has been found to be a risk factor for NSSI.

OBJECTIVE

Little is known about the longitudinal association between childhood emotional maltreatment and NSSI as well as its underlying mediating and moderating mechanisms. Thus, we hypothesized whether sleep problems mediated the association between childhood emotional maltreatment and NSSI, and whether this indirect effect was moderated by rumination.

PARTICIPANTS AND SETTING

A total of 1987 Chinese adolescents (56.1 % males; ages 10 to 14, M = 12.32, SD = 0.53) completed self-report questionnaires regarding childhood emotional maltreatment, sleep problems, rumination non-suicidal self-injury (NSSI) in three waves.

METHODS

Structural equation model was used to test a moderated mediation model, with gender, age and socioeconomic status and baseline measures as covariates.

RESULTS

Childhood emotional maltreatment was significantly associated with NSSI, and this association was mediated by sleep problems. Moderated mediation analyses revealed that rumination intensified the relation between childhood emotional maltreatment and sleep problems as well as the relation between sleep problems and NSSI.

CONCLUSIONS

Findings of this study demonstrate a relationship among childhood emotional maltreatment, sleep problems, rumination and NSSI. Interventions that target sleep problems and rumination may be beneficial for reducing NSSI for at-risk adolescents.

Subcortical volume analysis in non-suicidal self-injury adolescents: A pilot study

Given the high prevalence of non-suicidal self-injury (NSSI) among teenagers worldwide, the underlying mechanisms promoting such behavior must be urgently investigated. This study aimed to investigate neurobiological changes in the regional brain in adolescents with NSSI by comparing the volumes of the subcortical structures of 23 female adolescents with NSSI and 23 healthy controls with no history of psychiatric diagnosis or treatment. The NSSI group comprised those who underwent inpatient treatment for non-suicidal self-harm behavior at the Department of Psychiatry at Daegu Catholic University Hospital from July 1, 2018, to December 31, 2018. The control group comprised healthy adolescents from the community. We compared differences in the volume of the bilateral thalamus, caudate, putamen, hippocampus, and amygdala. All statistical analyses were conducted using SPSS Statistics Version 25. The NSSI group exhibited decreased subcortical volume in the left amygdala and marginally decreased subcortical volume in the left thalamus. Our results provide important clues about adolescent NSSI's underlying biology. Analysis of subcortical volumes between the NSSI and normal groups revealed subcortical volume differences in the left amygdala and thalamus, part of the core cerebral regions responsible for emotional processing and regulation, which may help explain the neurobiological mechanism of NSSI.

Understanding self-harm and suicidal behaviours in South Asian communities in the UK: systematic review and meta-synthesis

BACKGROUND

Previous findings have indicated that self-harm and suicide are associated with different rates, and different risk and protective factors in South Asian people compared with White people in the UK. Substantial qualitative research has explored experiences of self-harm and suicide in South Asian people.

AIMS

The study aims to review the existing qualitative evidence on self-harm and suicidal behaviours in South Asian communities in the UK.

METHOD

Systematic searches were conducted on Medline, EMBASE, PsycINFO, CINAHL, Open Dissertations and the British Library Ethos databases. We selected qualitative studies from both journals and grey literature that included South Asian participants who were resident in the UK and presented perceptions or experiences of self-harm and/or suicidal behaviour. Analysis was undertaken based on the meta-ethnographic approach.

RESULTS

Fifteen studies were included in the analysis. Experience of self-harm was discussed based on three aspects: behind self-harm, functions of self-harm and recovery from self-harm. 'Behind self-harm' refers to factors associated with self-harm and suicide. 'Functions of self-harm' captures the meaning attributed to self-harm and suicide. 'Recovery from self-harm' encapsulates personal and professional help, and practical suggestions for the improvement of mental health services.

CONCLUSIONS

Although some similarities with the majority White population were present, there were also crucial differences that need consideration when shaping health policies, improving access to health services and developing culturally sensitive psychosocial interventions for self-harm and suicide specific to South Asian communities in the UK.

Non-suicidal self-injury and professional psychological help-seeking among Chinese left-behind children: prevalence and influencing factors

BACKGROUND

Non-suicidal self-injury (NSSI) is a risk factor for suicide. This study aimed to investigate the prevalence of NSSI and professional psychological help-seeking status and influencing factors among left-behind children (LBC) in China.

METHODS

We implemented a population-based cross-sectional study in participants aged 10-18 years. Sociodemographic characteristics, NSSI, help-seeking status and coping style were measured by self-reported questionnaires. A total of 16,866 valid questionnaires were collected, including 6096 LBC. Binary logistic regression models were used to analyze the factors influencing NSSI and professional psychological help-seeking.

RESULTS

The incidence of NSSI among LBC was 4.6%, significantly higher than that of non-left-behind children (NLBC). This incidence was higher among girls. Moreover, 53.9% of LBC with NSSI did not receive any treatment and only 22.0% sought professional psychological help. LBC often adopt emotion-oriented coping styles, specifically, those with NSSI. LBC with NSSI who seek professional help tend to adopt problem-oriented coping styles. Logistic regression analysis revealed that girls, learning stage, single-parent, remarried families, patience, and emotional venting were risk factors for NSSI in LBC, while problem-solving and social support seeking were protective factors. Moreover, problem-solving was also a predictor for seeking professional psychological help, patience will prevent it.

LIMITATIONS

This was an online survey.

CONCLUSIONS

The prevalence of NSSI in LBC is high. Gender, grade, family structure, and coping style affect the occurrence of NSSI among LBC. Only a few LBC with NSSI seek professional psychological help, while the coping style will affect the help-seeking behavior.

Self-Harm Behaviors, Suicide Attempts, and Suicidal Ideation in a Clinical Sample of Children and Adolescents with Psychiatric Disorders

Suicidal ideation and self-harm behaviors have been found to be important risk factors for suicide. The aim of this study was to explore the rates of psychiatric disorders among different groups of patients with suicidal ideation, suicide attempts, and non-suicidal self-harm behaviors and to identify the associated socio-demographic and clinical variables. We conducted a cross-sectional study with emergency-admitted patients presenting with non-suicidal self-harm behaviors, suicide attempts, or suicidal ideation to the emergency room of the Child and Adolescent Psychiatry Clinic in Cluj-Napoca, Romania. Data were collected from the patients' charts using a questionnaire that contained socio-demographic and clinical variables. A total of 95 patients aged between 6 and 18 years were included in the study. Ingesting medication and cutting were the most frequently used methods to attempt suicide. Depression and mixed affective and conduct disorders were the diagnoses most commonly associated with suicidal behavior. Girls with depressive symptoms were more probable to have suicide attempts than boys, and girls with depressive symptoms and behavioral problems registered more self-harm behaviors. Further research should systematically examine the relationship between self-harm behaviors and suicide attempts and the profile of patients at risk of future suicide attempts.

Efficacy of psychotherapeutic interventions for non-suicidal self-injury in adolescent population: Systematic review and meta-analysis

Non-suicidal self-injury (NSSI) is the deliberate and self-inflicted damage to body tissue in the absence of fatal intent, and has become a serious health problem among adolescents. The aim of this study was to evaluate the efficacy of treatment for NSSI in this population through a systematic revision and meta-analysis (PROSPERO ID: 252355). Studies with therapies that reduced NSSI were included. The search was performed in the Medline, APA PsycINFO and PubPsych databases. The synthesis of measures for the main outcome (NSSI reduction) and for secondary outcomes (global functioning change and depressive symptomatology reduction) was performed using a random effects model. The search identified a total of 1881 studies. The systematic review included five studies and the meta-analysis four studies. The summary effect estimate for the standardized mean difference in NSSI was -0.53 (95% CI: -0.82, -0.25), in global functioning it was 0.62 (95% CI: 0.34, 0.91), and in depressive symptomatology it was -0.59 (95% CI: -0.82, -0.36). The certainty of the evidence using the GRADE method is low. We conclude that therapies specifically aimed at reducing NSSI are effective in reducing both NSSI and depressive symptoms while increasing global functioning.

A retrospective cohort study comparing the social, familial and clinical characteristics of adolescents admitted to a French Emergency Department in suicidal crisis before and during the COVID-19 pandemic

The social turmoil resulting from the COVID19 pandemic has come with an increase in the incidence of suicidal crises among adolescents and in particular an increase of suicidal attempts in most Western societies. Monthly prevalence of suicidal attempts in adolescents was doubled or tripled during winter 2021 in France. This study proposes to describe the youths in suicidal crisis admitted to a French hospital during the pandemic according to their sociodemographic, familial, and clinical characteristics as well as to compare them to the adolescents who were presenting the same symptoms the years preceding the pandemic. A retrospective cohort of 332 participants was divided in two groups. The adolescents admitted during the pandemic were more frequently girls, with less familial and personal history of psychiatric care, less depressive disorders, and they were more frequently referred to psychological outpatient care than to psychiatric outpatient care. These results strengthen the hypothesis that the increase in adolescents' suicidal crisis could be an expression of the social suffering more than a result of an increase in adolescents' psychiatric disorders.

Association Between Internet Searches Related to Suicide/Self-Harm and Adolescent Suicide Death in South Korea, 2016–2020: Data Analysis Study (Preprint)

BACKGROUND

Previous studies have investigated the association between suicide and internet search volumes of terms related to suicide or self-harm. However, the results varied by people's age, period, and country, and no study has exclusively investigated suicide or self-harm rates among adolescents.

OBJECTIVE

This study aims to determine the association between the internet search volumes of terms related to suicide/self-harm and the number of suicides among South Korean adolescents. We investigated gender differences in this association and the time lag between the internet search volumes of the terms and the connected suicide deaths.

METHODS

We selected 26 search terms related to suicide and self-harm among South Korean adolescents, and the search volumes of these terms for adolescents aged 13-18 years were obtained from the leading internet search engine in South Korea (Naver Datalab). A data set was constructed by combining data from Naver Datalab and the number of suicide deaths of adolescents on a daily basis from January 1, 2016, to December 31, 2020. Spearman rank correlation and multivariate Poisson regression analyses were performed to identify the association between the search volumes of the terms and the suicide deaths during that period. The time lag between suicide death and the increasing trend in the search volumes of the related terms was estimated from the cross-correlation coefficients.

RESULTS

Significant correlations were observed within the search volumes of the 26 terms related to suicide/self-harm. The internet search volumes of several terms were associated with the number of suicide deaths among South Korean adolescents, and this association differed by gender. The search volume for "dropout" showed a statistically significant correlation with the number of suicides in all adolescent population groups. The correlation between the internet search volume for "dropout" and the connected suicide deaths was the strongest for a time lag of 0 days. In females, self-harm and academic score showed significant associations with suicide deaths, but academic score showed a negative correlation, and the time lags with the strongest correlations were 0 and -11 days, respectively. In the total population, self-harm and suicide method were associated with the number of suicides, and the time lags with the strongest correlations were +7 and 0 days, respectively.

CONCLUSIONS

This study identifies a correlation between suicides and internet search volumes related to suicide/self-harm among South Korean adolescents, but the relatively weak correlation (incidence rate ratio 0.990-1.068) should be interpreted with caution.

[Polymorphisms of OPRM1, OPRK1, DCC genes and non-suicidal self-injuries in adults]

OBJECTIVE

To investigate the associations of OPRM1 gene rs179971, OPRK1 gene rs6473797 and DCC gene rs8084280 polymorphisms with non-suicidal self-injury (NSSI) characteristics and motivations in adults.

MATERIAL AND METHODS

A pilot sample included 28 adult patients with history of NSSI (89.3% (n=25) women, median age (Q1-Q3) - 23 (21.25-25) years). Most patients (78.6%, n=20) had a diagnosis of bipolar disorder. NSSI characteristics and motivations were assessed using the Inventory of Statements about Self-Injury (ISAS) scale. The Childhood Trauma Questionnaire (CTQ) was used to control for childhood trauma - one of the most important environmental factors associated with NSSI. The Baratt Impulsivity Scale (BIS) and the Buss-Perry Aggression Questionnaire (BPAQ) were also used to assess impulsivity and aggression, respectively. RT-PCR was used for genotyping, a genetic effect was assessed using the dominant model. Mann-Whitney U-test, Pearson χ2-test and multiple linear regression were used for statistical analysis.

RESULTS

Carriers of the minor G allele of OPRM1 gene rs1779971 had a higher level of aggression assessed by BPAQ (p=0.02). The minor C allele of OPRK1 gene rs6473797 was associated with an increase of the subjective importance of «Affect regulation» (B=2.23; CI 95% [0.39-4.06]; p=0.022) and «Anti-dissociation» (B=3.31; CI 95% [0.18-6.44]; p=0.039) motivations, whereas the minor T allele of DCC gene rs8084280, on the contrary, was associated with a decrease of the importance of «Affect regulation» (B=-1.74; CI 95% [-3.30 - -0.18]; p=0.032). Moreover, this effect was found after adjusting for diagnosis, sex, age, and the presence of childhood trauma.

CONCLUSIONS

To our knowledge, this is the first study on the association of genetic markers with NSSI motivations. The results of this pilot study demonstrate that OPRK1 and DCC gene polymorphisms can determine differences in motivations for self-harm, however, these results require confirmation in large samples.

User profiles of electronic ecological momentary assessment in outpatient child and adolescent mental health services

INTRODUCTION

Electronic ecological momentary assessment (EMA) can provide precise information regarding day-to-day functioning of patients overcoming some of the limitations of usual clinical evaluation; however adherence to this methodology might be a major threat. Research and application of EMA concerning clinical settings remains scant. Our goal was to study the user profiles of EMA in a clinical sample of adolescents.

MATERIAL AND METHODS

209 adolescents following an outpatient mental health treatment accepted to use EMA. They were evaluated in different sociodemographic and clinical variables as well as the use that they made of EMA.

RESULTS

39.7% of patients were considered users and 60.3% non-active users. Certain self-harm behaviours were more common in the group of active users, while hyperkinetic disorders were more common in the group of non-active users. A regression analysis revealed that non-suicidal self-injury (OR=2.99) and hyperkinetic disorders (OR=0.51) were related to the use of EMA.

CONCLUSION

This preliminary study adds novel and promising information about EMA use in clinical practice. Adolescents with self-harm behaviours EMA seem more prone to use this tool. Our study provides support for actively monitoring self-harm behaviours with EMA. Future studies might consider a comprehensive analysis of adherence and EMA data collection.

Identifying and Managing Suicidality in Children and Adolescents with Chronic Pain: Evidence-Based Treatment Strategies

Children and adolescents with chronic pain are at an increased risk of suicidality. This narrative review article aims to inform clinical practice in the assessment and management of suicidality in youth with chronic pain. The article begins with a survey of the background and prevalence of youth with chronic pain. A review of the current evidence behind the increased risk of suicidality in youth with chronic pain follows. Contextualization of this data with general tenets of child and adolescent suicide risk and risk assessment is provided. Suicidology theory including the interpersonal theory of suicide is overviewed to help clinicians to conceptualize the reviewed data. Guiding parameters for the suicide risk assessment and management planning is presented. Concluding recommendations are made to guide clinical practice in the assessment and management of suicidality in youth with chronic pain.

Non-suicidal self-injury motivations in the light of self-harm severity indicators and psychopathology in a clinical adolescent sample

Introduction

Adolescents with psychiatric problems are also considered a vulnerable population in terms of non-suicidal self-injury (NSSI). In the current study, we examined the associations of interpersonal and intrapersonal NSSI motivations with several NSSI severity indicators and psychopathological characteristics.

Materials and methods

In a cross-sectional research design, 158 adolescents (83.5% girls; mean age = 16.10 years; SD = 1.49) who have received inpatient or outpatient psychiatric treatment completed the Inventory of Statements About Self-Injury, the Strengths and Difficulties Questionnaire, and the Self-Critical Rumination Scale.

Results

More than two-thirds of the sample (75.3%; n = 119) reported at least one episode of NSSI in their life, and 45.38% (n = 54) have engaged in NSSI in the past month (current self-injury). The results indicated that only intrapersonal NSSI functions were linked to NSSI severity indicators (current and repetitive NSSI, versatility), interpersonal functions were not. Furthermore, a number of psychopathological features (co-occurring mental disorders, presence of a mood disorder, more internalizing mental illness symptoms, and more pronounced self-critical rumination) were associated with engaging in NSSI for intrapersonal reasons. We also identified other differences within the specific intrapersonal NSSI motivations. It should be highlighted that the anti-suicide function of NSSI behaved in exactly the opposite way as the other intrapersonal motivations.

Discussion

All this points to the fact that in clinical settings, detailed assessment of NSSI motivations and severity indicators can help to develop a more effective treatment plan.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Typologies of Non-Suicidal Self-Injury Functions and Clinical Correlates Among Inpatient Youth

This study identified typologies of specific non-suicidal self-injury (NSSI) functions among youth admitted for psychiatric hospitalization and investigated clinically relevant correlates. Inpatient youth (n = 68) aged 10-17 years reported on their reasons to engage in NSSI, frequency and severity of NSSI, and symptoms of borderline personality disorder (BPD). A latent class analysis using youth's specific NSSI functions as indicators found two NSSI function typologies, which were differentially associated with clinical correlates. The Multiple Functions class (n = 28) endorsed to "feel something," "punish self," "escape feelings," "relieve anxiety," "stop feeling self-hatred," "stop feeling angry," "show much they are hurting," and "create a hurt that can be soothed." Conversely, the Single/Avoidant Function class (n = 40) endorsed one primary function-i.e., to "escape feelings." Youth in the Multiple Functions class reported significantly more frequent self-injury and greater BPD symptomology. The present study illustrates the importance of examining constellations of specific NSSI functions in inpatient care settings, given their unique associations with NSSI frequency and features of BPD. These findings could inform targeted psychological screening and, in turn, guide the implementation of interventions for elevated NSSI frequency and BPD symptomology among inpatient youth, based on NSSI functions endorsed.

A Pre-Adolescent and Adolescent Clinical Sample Study about Suicidal Ideation, Suicide Attempt, and Self-Harming

Suicide is the second cause of death among adolescents, and nonsuicidal self-injury (NSSI) is one of the main risk factors for suicidal behavior. However, the possible variables specifically associated with suicidal ideation and suicide attempt, as well as the psychopathological characteristics linked to the concomitant presence of suicidal ideation/attempt and NSSI are still under-investigated in youth. The current study aimed to address these issues in a sample of 174 young Italian inpatients (M_age = 14.3 years ± 1.93, 78.2% girls). Sociodemographic and clinical variables were assessed through psycho-diagnostic interviews and ad hoc questionnaires. A binomial logistic regression was performed to identify the predictors of suicidal ideation and suicide attempt. Then, Kruskal-Wallis tests were run to analyze the psychopathological differences between patients with suicidal ideation and suicide attempt considering the coexistence of NSSI. The results highlighted that previous access to child mental health services and general psychopathological problems significantly predicted suicidal ideation, while previous hospitalizations, borderline personality functioning, and affective disorders significantly predicted suicide attempt. In general, inpatients with also NSSI reported higher levels of internalizing, somatic and total problems, impulsiveness, alexithymia, and emotional dysregulation. The clinical implications of our findings in terms of primary and secondary preventive programs are discussed.

The Association Between Problematic Use of Alcohol and Drugs and Repeat Self-Harm and Suicidal Ideation

Aims: We investigated the association between problematic use of alcohol and/or drugs (PUAD) and the incidence, urgency, and mode of discharge for a subsequent episode of self-harm (SH) or suicidal ideation (SI). Methods: This was a retrospective population-based cohort study of individuals admitted to hospital for an index episode of SH/SI (2010-2014) using linked data from hospital admissions and emergency department (ED) presentations. The outcome variables were (1) subsequent presentation to the ED for SH/SI, (2) triage category, and (3) mode of departure. Key predictors were PUAD. Results: In total, 23,007 individuals were admitted to hospital for an index SH/SI, of whom 8% had a subsequent presentation to an ED for SH/SI within a year. The odds of subsequent presentation was increased in those with problematic alcohol use (AOR 1.62, 95% CI 1.36, 1.92), drug use (AOR 1.28, 95% CI 1.07, 1.53), and mental health diagnoses (AOR 1.63, 95% CI 1.44, 1.85). Those with problematic alcohol use were more likely to be assigned to the most urgent triage categories (AOR 1.84, 95% CI 1.32, 2.56). Limitations: Defining SH and PUAD using administrative data is challenging, and the true prevalence is likely to be underestimated. Conclusion: The findings underscore the importance of drug health intervention as a key component of self-harm prevention.

Psychosocial Factors and Sociodemographic Characteristics Associated with Suicidality Risk in Chilean Adolescents

Background: Suicidality in adolescents is a growing concern and is currently a public health issue in Chile and the world. Objective: To determine the association between the risk of suicidality with self-harm, sociodemographic parameters (that is, gender and type of school), psychosocial variables, and social and family support in Chilean adolescents. Methods: In a cross-sectional study, 829 (377, 45.5% girls) children/adolescents between 10 and 19 years of age participated. Suicidality, self-esteem, health-related quality of life (HRQoL), and social support perception were evaluated by standard, validated questionnaires. The presence of self-harm, dating violence, and family dysfunction was also evaluated through a self-report survey. Results: Suicidality risk was related to low self-esteem (OR = 9.73; 95%; CI = 6.62−14.28; p < 0.001), low HRQoL (OR = 5.0; 95%; CI = 3.51−7.13; p < 0.001), low social support (OR; 3.38, 95%; CI; 2.48−4.6; p < 0.001), and self-harm (OR = 8.03; 95%; CI = 5.69−11.33; p < 0.001). In family terms, suicidality risk was associated with exposure to physical (OR = 2.47, 95%CI; 1.69−3.6; p < 0.001) and psychological (OR = 1.78, 95; 1.33−2.39; p < 0.001) aggression between parents, and with considering their family dysfunctional (OR = 2.41 95%; CI = 1.69−3.41; p < 0.001). Finally, suicidality was associated with feeling mistreated by a boyfriend/girlfriend (OR = 2.18; 95% CI = 1.19−3.98; p = 0.011). Conclusion: Suicidality was associated with self-harm, low social, psychological and family well-being, and/or feeling mistreated by a boyfriend/girlfriend.

Adverse clinical outcomes among youths with nonsuicidal self-injury and suicide attempts: a longitudinal cohort study

BACKGROUND

More knowledge about risks of clinical outcomes associated with nonsuicidal self-injury (NSSI) and suicide attempts (SAs) is needed to inform risk assessment and intervention.

METHODS

Longitudinal cohort study based on 1,855 youths was clinically assessed for NSSI and SA, and followed up (from December, 2011 to December 2013) for the outcomes; diagnosed self-injury, alcohol/substance use disorder, and psychiatric inpatient care data derived from Swedish registers. Hazard ratios (HRs) and 95% confidence intervals (CIs) of the outcomes were estimated with Cox regressions, and additionally adjusted for the potential effect of sex and the number of clinical assessments. NSSI and SA were treated as time-varying covariates.

RESULTS

Youths with NSSI had elevated risks of all outcomes, compared with youths without NSSI or SA; the HR was 2.3, 95% confidence interval [1.6, 3.4] for self-injury, 1.4 [0.9, 2.1] for alcohol/substance use disorder, and 1.3 [1.0, 1.7] for psychiatric inpatient care. Youths with SA displayed higher risks for the outcomes than the NSSI group; the HR was 5.5 [2.4, 12.6] for self-injury, 2.0 [0.9, 4.4] for alcohol/substance use disorder, and 2.6 [1.5, 4.5] for psychiatric inpatient care. Youths with both NSSI and SA showed similar risks as youths with SA; HR 4.1 [2.0, 8.3] for self-injury, 2.0 [1.1, 4.1] for alcohol/substance use disorder, but a higher risk of psychiatric inpatient care; HR 5.0 [3.1, 7.9]. All results remained virtually unchanged in the adjusted analyses.

CONCLUSIONS

Youths with NSSI and/or SA had higher risks for subsequent adverse clinical outcomes. These excess risks were more pronounced among youths with SA and youths with both NSSI and SA, and the risk for psychiatric inpatient care was particularly high in youths with both NSSI and SA. Our findings suggest that early interventions for youths with NSSI or SA should not exclusively focus on suicide prevention, but also consider the risk of subsequent alcohol/substance use disorder.

Analgesic Effect of Alcohol Mediates the Association between Alcohol Intoxication and Deliberate Self-Harm

We examined whether the analgesic effect of alcohol mediates the association between alcohol and deliberate self-harm (DSH) using data from a larger study on alcohol effects. Men (n = 106) and women (n = 104) low-risk alcohol drinkers (ages M = 26.00, SD = 6.98) recruited from the community who had no suicide attempt or episode of deliberate self-harm within the past year were randomly assigned to either a placebo drink condition or a drink calibrated to reach approximately .050%, .075%, or .100% blood alcohol concentration. Notable within-condition BAC variability, as well as overlap between conditions, suggested that BAC would be a more accurate indicator of intoxication compared to condition assignment. Pain tolerance was assessed by increasingly intense 1-s shocks delivered via fingertip electrodes. Self-reported pain associated with the pain tolerance index was also examined. A laboratory task of DSH, the Self-Aggression Paradigm, was then completed, with DSH operationalized as the number of self-administered shocks the participant was led to believe were twice the intensity of his or her pain tolerance and could cause "minor tissue damage that would quickly heal." A negative binomial parallel mediational model for count data revealed that pain tolerance, but not self-report pain, mediated the effect of alcohol on DSH. As such, the current study provides preliminary experimental evidence that the analgesic effect of alcohol is partially responsible for link between alcohol intoxication and deliberate self-harm.

Alexithymia and Psychopathological Manifestations Centered on the Body: Somatization and Self-Harm

The present study aimed to investigate alexithymia and psychopathological manifestations centered on the body in a sample of adolescents with somatizing and/or self-harming issues to analyze the phenomenon of NSSI linked to Somatic Symptom Disorders (SSD). A sample of 184 adolescents between 12 and 19 years of age, was divided into three groups, one with NSSI (n = 49) and the second group with SSD (n = 57), comparing them with a third group of adolescents with SSD and NSSI (n = 78) to investigate their differences and similarities in psychopathological correlates and to analyze the mediation role of alexithymia and emotional dysregulation in NSSI and SSD related to internalizing problems. The battery of tests included the Toronto Alexithymia Scale (TAS-20) and the Youth Self-Report 11–18 (YSR). The NSSI + SSD group scored higher than the other two groups on all the YSR scales. The affective syndromes were the only clinical condition that discriminated between the three groups. On all the other syndrome scales, the NSSI + SSD group differed from the other two groups, while there were no differences between the NSSI group and the SSD group. The NSSI + SSD group revealed a more severely deficient emotional self-regulation. Difficulty identifying feelings was a trait shared by adolescents with SSD and those engaging in NSSI, a more complex overall alexithymia profile was associated with the combination of self-harming behavior and somatization. Alexithymia and emotional dysregulation played a mediating role in the relationship between internalizing problems and somatization. We did not find a mediating role in alexithymia and emotional dysregulation in the relationship between internalizing problems and self-injurious behavior. The combination of NSSI and SSD gave rise to more severe psychopathological correlates, clinical levels of alexithymia, and more severe deficient emotional self-regulation. Results of mediation role indicated a link between alexithymia, emotional dysregulation, and somatization.

Non-Suicidal Self-Injury in Russian Patients with Suicidal Ideation

BACKGROUND

Nonsuicidal self-injury (NSSI) is recognized as a public health concern for its association with unfavorable outcomes, including suicidal behavior. The aim of this study is to identify factors associated with NSSI among patients with nonpsychotic mental disorders (NPMD) and suicidal ideation in Russia.

METHODS

A retrospective cohort study was conducted in the Moscow Research and Clinical Center for Neuropsychiatry between November 2017 and May 2019. The sample was composed of consecutive patients with lifetime suicidal ideation (from the Self-Injurious Thoughts and Behavior Interview) seen in the center's psychiatric ward for NPMD. The patients were divided into two groups: those with and without lifetime NSSI. Sociodemographic variables, psychiatric diagnosis, family history of mental disorders, history of physical or sexual abuse, sexual behavior, ad-hoc psychiatric treatments, suicidal ideation, plans, and gestures or attempts were investigated.

RESULTS

Six thousand, two hundred and four consecutive patients were screened for suicidal ideation. Out of a total of 361 patients (87.3% females) with suicidal ideation, 217 (60.1%) reported NSSI. Variables independently associated with NSSI included age <25 years (OR 6.0, CI 2.5-14.7), dissatisfaction with the perceived parenting style (OR 3.3, CI 1.5-7.4), bullying (OR 2.6, CI 1.0-6.5), severe body modifications (OR 11.9, CI 1.1-134.3), experience with illicit drugs (OR 4.4, CI 1.9-10.3), and eating disorders (OR 4.9, CI 2.0-11.8).

LIMITATIONS

Retrospective design, referral population, single center study, and exclusion of psychotic patients.

CONCLUSIONS

NSSI is associated with age <25 years old, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug-use, and lifetime eating disorders.HIGHLIGHTSNonsuicidal self-injury is a significant public health concern for its association with suicidal behavior.60.1% of Russian patients with non-psychotic mental disorders (NPMD) and suicidal ideation reported lifetime NSSI.NSSI in Russian patients with NPMD and suicidal ideation is associated with age less than 25 years, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug use, and lifetime eating disorders.

Development and validation of the Self-Harm Screening Inventory (SHSI) for adolescents

Despite the rapidly increasing rate of non-suicidal self-injury (NSSI) among adolescents, there is a dearth of culturally appropriate psychological measures screening for NSSI among the adolescents in the Asian countries. This study aimed to develop and validate the Self-Harm Screening Inventory (SHSI), a culturally sensitive and suitable scale for screening adolescents for NSSI. In total, 514 Korean adolescents (aged 12–16 years) were recruited nationwide. All participants gave informed consent and completed the online self-report measures on NSSI, depression, anxiety, and self-esteem. Thereafter, preliminary items were developed through a series of steps: literature review, ratings of experts on self-harm and suicide, and statistical analyses. Ten of the 20 preliminary items were eliminated after exploratory factor analysis due to low endorsement and factor loading (less than .70). The final version of the SHSI comprised 10 binary items relating to self-harm behaviors within the past year (e.g., cut my body with sharp objects, hit my body). A confirmatory factor analysis supported a one-factor structure, as hypothesized. The one-factor model had a good model fit (x²(35) = 84.958, p < .001, RMSEA = .053, CFI = .981, TLI = .975, SRMR = .124). The SHSI also had good internal consistency (Cronbach’s alpha = .795) and 4-week test-retest reliability (r = .786, p < .01). The SHSI had high correlations with another self-harm related scale, the Self-Harm Inventory (r = .773, p < .01), and moderate correlations with the Child Depression Inventory (r = .484, p < .01) and Revised Children’s Manifest Anxiety Scale (r = .433, p < .01). Additionally, the SHSI was negatively correlated with the Rosenberg Self-Esteem Scale (r = -.399, p < .01). The findings indicate that the SHSI is a reliable and valid measure for the screening of self-harm behaviors among adolescents.

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

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.

Assessing Clinical Features of Adolescents Suffering from Depression Who Engage in Non-Suicidal Self-Injury

Depressive disorders (DDs) and non-suicidal self-injury (NSSI) are important juvenile mental health issues, showing alarming increasing rates. They frequently co-occur, mainly among adolescents, increasing the suicide risk. We aimed to compare the clinical features of two groups of adolescents with DDs, differed by their engagement or not in NSSI (“DD + NSSI” and “DD”). We hypothesized that NSSI would characterize particularly severe forms of DDs suitable for becoming specific phenotypes of adolescent depression. We enrolled 56 adolescents (11–17 years) diagnosed with a DD according to the DSM-5 criteria. They were assessed for NSSI endorsement (Ottawa Self-Injury Inventory), depressive symptoms (Children’s Depression Inventory 2), emotional dysregulation (Difficulties in Emotional Regulation Scale), and anxiety symptoms (Screen for Child Anxiety-Related Emotional Disorders). The two groups accounted for 31 (“DD + NSSI”) and 25 (“DD”) individuals. The “DD + NSSI” group had significantly higher suicidal ideation (p 0.0039), emotional dysregulation (p 0.0092), depressive symptoms (p 0.0138), and anxiety symptoms (p 0.0153) than the “DD” group. NSSI seemed to characterize more severe phenotypes of adolescent depression, applying for a potential role as a “specifier” of DDs, describing relevant information for their management. Further studies are needed to support this hypothesis and its potential opportunities for prevention and treatment.

The psychological characteristics and risk factors of suicidal attempt among mood disorders adolescents accompany with non-suicidal self-injury: A multi-center study

BACKGROUND

Identifying the risk factors of suicide attempts(SA) in adolescents with mood disorders(MD) who engage in non-suicidal self-injury(NSSI) is of great significance for suicide prevention. The aim of the present study was to explore the psychological characteristics and risk factors of SA among MD adolescents engaged in NSSI.

METHODS

We recruited MD outpatients accompany with NSSI aged 12-18 years. SA, NSSI methods and function, suicidal ideation(SI), psychological distress(PD), self-esteem, stress mindset and perceived social support were assessed by valid scales. Classification and regression tree analysis (CART) was employed to explore the characteristics and risk factors of SA among MD adolescent with NSSI.

RESULTS

We included 658 participants in this study. Of 58.1% participants reported SA during the past 12 months. Compared with the adolescents without SA, the attempters used more different NSSI methods and reported more frequent NSSI. SA, SI, PD, self-esteem and amount of thinking time before engaging in self-injury were risk factors of SA among MD adolescents. Interactions between the four risk factors resulted in varying degrees of risk of SA. Compared to adolescents with the characteristics of low level of SI - little consideration before self-injury, adolescents who having multiple characteristics of the high level of SI -high level of PD - low self-esteem were associated with a 15.1-fold increased risk of SA(P < 0.001), and those with the characteristics of high SI - deliberated before engaging in self-injury were associated with a 28.1-fold increased risk of attempted suicide(P < 0.001).

CONCLUSIONS

Our findings identify multiple correlates for SA in MD adolescents accompany with NSSI, including SI, PD, self-esteem and deliberate time they thought before self-injury, which may contribute to the development of suicidal behaviors in an interactive manner.