Four Distinct Subgroups of Self-Injurious Behavior among Chinese Adolescents: Findings from a Latent Class Analysis

Utilizing social determinants of health to identify most vulnerable neighborhoods-Latent class analysis and GIS map

OBJECTIVES

Public Health officials are often challenged to effectively allocate limited resources. Social determinants of health (SDOH) may cluster in areas to cause unique profiles related to various adverse life events. The authors use the framework of unintended teen pregnancies to illustrate how to identify the most vulnerable neighborhoods.

METHODS

This study used data from the U.S. American Community Survey, Princeton Eviction Lab, and Connecticut Office of Vital Records. Census tracts are small statistical subdivisions of a county. Latent class analysis (LCA) was employed to separate the 832 Connecticut census tracts into four distinct latent classes based on SDOH, and GIS mapping was utilized to visualize the distribution of the most vulnerable neighborhoods. GEE Poisson regression model was used to assess whether latent classes were related to the outcome. Data were analyzed in May 2021.

RESULTS

LCA's results showed that class 1 (non-minority non-disadvantaged tracts) had the least diversity and lowest poverty of the four classes. Compared to class 1, class 2 (minority non-disadvantaged tracts) had more households with no health insurance and with single parents; and class 3 (non-minority disadvantaged tracts) had more households with no vehicle available, that had moved from another place in the past year, were low income, and living in renter-occupied housing. Class 4 (minority disadvantaged tracts) had the lowest socioeconomic characteristics.

CONCLUSIONS

LCA can identify unique profiles for neighborhoods vulnerable to adverse events, setting up the potential for differential intervention strategies for communities with varying risk profiles. Our approach may be generalizable to other areas or other programs.

KEY MESSAGES

What is already known on this topic Public health practitioners struggle to develop interventions that are universally effective. The teen birth rates vary tremendously by race and ethnicity. Unplanned teen pregnancy rates are related to multiple social determinants and behaviors. Latent class analysis has been applied successfully to address public health problems. What this study adds While it is the pregnancy that is not planned rather than the birth, access to pregnancy intention data is not available resulting in a dependency on teen birth data for developing public health strategies. Using teen birth rates to identify at-risk neighborhoods will not directly represent the teens at risk for pregnancy but rather those who delivered a live birth. Since teen birth rates often fluctuate due to small numbers, especially for small neighborhoods, LCA may avoid some of the limitations associated with direct rate comparisons. The authors illustrate how practitioners can use publicly available SDOH from the Census Bureau to identify distinct SDOH profiles for teen births at the census tract level. How this study might affect research, practice or policy These profiles of classes that are at heightened risk potentially can be used to tailor intervention plans for reducing unintended teen pregnancy. The approach may be adapted to other programs and other states to prioritize the allocation of limited resources.

Nonsuicidal self-injury methods among U.S. Veterans: Latent class analysis and associations with psychosocial outcomes

Nonsuicidal self-injury (NSSI) is a debilitating concern among U.S. veterans, with wall/object-punching commonly endorsed as an NSSI method. We examined how this behavior relates to other NSSI methods and psychosocial outcomes. We conducted a latent class analysis (LCA) of NSSI methods among 1,138 Gulf War Era veterans, (77.9% male), 21.7% of whom endorsed lifetime NSSI. We categorized classes based on their associations with age, sex, combat and military sexual assault exposure, then examined the association of class membership with psychosocial indicators. LCA results supported four classes: 1) High punching/banging NSSI (2.5%); 2) Multimethod NSSI methods (6.3%); 3) High-risk, multimethod NSSI (3.1%); and 4) Low-risk NSSI (88.1%). Psychosocial indicators (suicide attempt, ideation, possible depressive or posttraumatic stress disorders, poor psychosocial functioning) were worse for members of the NSSI classes versus those in the low-risk group. A subset of U.S. veterans may engage in NSSI primarily via punching/banging methods. All patterns of NSSI engagement were associated with negative psychosocial outcomes relative to those in the low-risk class of the behavior.

The Mediating Effect of Stress between Extracurricular Activities and Suicidal Ideation in Chinese College Students

OBJECTIVE

The objective of this study was to explore the relationship between extracurricular activities, stress, and suicidal ideation and to examine the mediating effect of stress between extracurricular activities and suicidal ideation in Chinese college students.

METHOD

A total of 6446 college students were surveyed with a web-based online data collection system using the self-made demographic questionnaire, Suicidal Behaviors Questionnaire-Revised (SBQ-R), and the 21-Item Depression Anxiety Stress Scales (DASS-21). SPSS 24.0 was used for descriptive statistics and correlation analysis, and the bootstrap method in the process procedure for SPSS Version 3.4.1 was used to construct the mediating effect model.

RESULTS

Gender, school grades, living area, and family income status were influencing factors for suicidal ideation, stress, and extracurricular activities. Extracurricular activities were negatively correlated with stress (r = -0.083, p < 0.001) and suicidal ideation (r = -0.039, p < 0.01). Extracurricular activities had no direct predictive effect on college students' suicidal ideation (c = -0.198, CI: -0.418, 0.023), while stress had a mediating effect between extracurricular activities and suicidal ideation; the indirect mediating effect was 0.159.

CONCLUSIONS

Extracurricular activities indirectly predict college students' suicidal ideation through stress. A variety of extracurricular activities can decrease the stress and suicidal ideation of college students and benefit their mental health.

Non-suicidal self-injury (NSSI) among emerging adults: Sub-group profiles and their clinical relevance

BACKGROUND

High prevalence rates and variations in patterns of non-suicidal self-injury (NSSI) necessitate the identification of profiles of distinct sub-groups of self-injurers.

AIM

To identify homogenous sub-groups of NSSI in a community-based sample of emerging adults.

METHOD

Data was collected using a cross-sectional survey design from a sample of 1,574 emerging adults aged 18-25 years, via multi-stage sampling. Cluster analysis using the k-medoid partitioning method was used to identify homogenous sub-groups in the sub-sample of 353 self-injurers. Follow-up analysis was conducted on measures of self-criticism, brooding-rumination, emotion regulation difficulties, experiential avoidance, psychological distress, attachment style and perceived social support to explore the validity of the clusters.

RESULTS

Five homogenous sub-groups were identified; Multimethod, Exclusively Severe, Female Minor, Male Minor and Experimental NSSI. The sub-groups showed distinct patterns of NSSI behaviour, differing on the basis of gender, severity, frequency, diversification, age of onset and functions of NSSI. The Multimethod and Exclusively severe NSSI group members showed significantly higher psychological distress and emotion regulation difficulties.

CONCLUSION

Identification of distinct sub-groups highlights the heterogeneity in NSSI behaviour. This has implications for comprehensive assessment frameworks, early identification of more vulnerable groups of self-injurers, and planning of targeted interventions.

The Punished Self, the Unknown Self, and the Harmed Self - Toward a More Nuanced Understanding of Self-Harm Among Adolescent Girls

Self-harm among adolescents, mostly girls, has increased in the last years. Self-harm is associated with mental illness and the risk of suicide. This qualitative study aims to explore the lived experience of self-harm as it is related to everyday life and challenges among adolescents. Nineteen girls (13-18 years of age) in a clinical population (strategic selection) participated in personal interviews analyzed by Interpretative Phenomenological Analysis to capture how they made meaning of self-harm and essential features of experiencing self-harm. Adult persons with the first-hand experience of self-harm were included in the research analysis. Data-analysis resulted in three superordinate themes which all speak about ways to handle inner pain and vulnerability: 1. "I deserve pain," 2. "I don't want to feel anything," and 3. "I'm harmed, and no one cares." Each superordinate theme included four main themes characterizing essential features of difficult experiences during self-harm, the purpose of the action, self-descriptions, and the role of others during self-harm. The three superordinate themes are discussed as emerging self-representations - "the punished self," "the unknown self," and "the harmed self" - during the transitional age of adolescence. This article argues that subjective personal data on self-harm related to adolescents' everyday lives may indicate diversity in the capacity to integrate difficult needs, feelings, and traumatic experiences as part of the self. This knowledge may bring a nuanced understanding of self-harm in adolescence, enhance self-understanding and treatment motivation, and inform clinical adjustment.

A typology of nonsuicidal self-injury in a clinical sample: A latent class analysis

Nonsuicidal self‐injury(NSSI) is a behavioural concern and can present in diverse ways, varying by method, frequency, severity, function and so forth. The possible combinations of these features of NSSI produce an array of profiles that makes evaluation and management of this behaviour challenging. The aim of this study was to build upon previous work that reduces the heterogeneity of NSSI patterns by using latent class analysis (LCA) to identify a typology of NSSI. Participants consisted of 235 outpatients aged 14–35 years attending a tertiary psychiatric hospital in Singapore who had reported at least one NSSI behaviour within the last year. Eight indicators captured using the Functional Assessment of Self‐Mutilation were used in the LCA: frequency of NSSI, length of contemplation before engaging in NSSI, usage of more than three NSSI methods, suicidal ideation and four psychological functions of NSSI, that is, social‐positive, social‐negative, automatic‐positive and automatic‐negative. The LCA revealed three distinct groups: Class 1—Experimental/Mild NSSI, Class 2—Multiple functions NSSI/Low Suicide Ideation and Class 3—Multiplefunctions NSSI/Possible Suicide Ideation. Multinomial logistic regression analyses were conducted to examine the associations between class membership and sociodemographic variables as well as measures of emotion dysregulation, childhood trauma, depression and quality of life. Females were overrepresented in Class 3. In general, Class 3 had the poorest scores followed by Class 2. Our analyses suggest that different NSSI subtypes require different treatment indications. Profiling patterns of NSSI may be a potentially useful step in guiding treatment plans and strategies.

Associations of moderate-to-vigorous physical activity with psychological problems and suicidality in Chinese high school students: a cross-sectional study

Background

The body of literature regarding the associations between physical activity and psychological problems lacks consensus. Moreover, the role of gender has been scarcely investigated. The present study sought to fill the gap in the data by examining the associations, if any, between moderate-to-vigorous physical activity (MVPA), psychological problems, and self-harm behaviors based on different biological genders (male–female).

Methods

A self-administered questionnaire was used to measure MVPA and multiple psychological problems, including depression and anxiety; general emotion, behavior, and social problems; Attention Deficit Hyperactivity Disorder (ADHD); Oppositional Defiant Disorder (ODD); conduct problems; and self-harm behaviors. Participants were a nationally representative sample of Chinese high school students (N = 13, 349). A multiple logistic regression analysis of MVPA, stratified by gender, was conducted on the risk of psychological problems and self-harm behaviors in the total sample.

Results

For boys, a high frequency of MVPA was associated with a lower risk of depression (OR = 0.68, 95% CI [0.57–0.81]) and anxiety (OR = 0.71, 95% CI [0.53–0.96]) compared to the reference group. The moderate frequency of MVPA was associated with a lower risk of ADHD (OR = 0.73, 95% CI [0.56–0.94]) compared to the reference group. For girls, both MVPA groups were associated with a lower risk of depression (moderate MVPA: OR = 0.81, 95% CI [0.70–0.94]; high MVPA: OR = 0.67, 95% CI [0.54–0.83]) compared to the reference group. High MVPA was associated with a lower risk of ADHD (OR = 0.58, 95% CI [0.37–0.89]) compared to the reference group. Only moderate frequency of MVPA was associated with a lower risk of ODD (OR = 0.79, 95% CI [0.64–0.97]).

Conclusion

MVPA was associated with a lower risk of depression, anxiety, ADHD, and ODD in a gender-specific and MVPA frequency-specific manner. This implies that for specific psychological issues, PA interventions that are modified based on gender and frequency of MVPA may be more effective than PA interventions without these considerations.

Self-harm behaviors, suicidal ideation, and associated factors among rural left-behind children in west China

PURPOSE

This population-based cross-sectional study describes self-harm (SH) behaviors and associated factors in 2898 Chinese left-behind children (LBC).

METHODS

Descriptive statistics were used to present and compare the distributional characteristics of SH behaviors. Binary and ordinal logistic-regression models for survey data were applied to explore associated factors of SH.

RESULTS

Among the LBC, 48% (95% CI: 42%-54%) reported SH behaviors. SH was prominently associated with suicidal ideation. Boys, junior high-school students, and LBC whose fathers were poorly educated were observed to have higher prevalence of SH. Boys, local ethnic minorities, junior high-school students, and LBC whose fathers were comparatively well educated were observed to be at increased risk of more medically serious SH behaviors.

CONCLUSIONS

SH is a substantial public health problem among rural Chinese LBC. Targeted intervention measures should be developed to reduce future suicide risk.

Functions of Non-Suicidal Self-Injury in Late Adolescence: A Latent Class Analysis

This study employed latent class analysis utilizing an array of features of non-suicidal self-injury (NSSI) in order to identify distinct subgroups of self-injurers. Participants were 359 undergraduates with NSSI history. Indicator variables were lifetime and last year frequency rates, number of methods, scarring, pain during self-injury, and functions of NSSI. Analyses yielded mild/experimental NSSI, moderate NSSI, moderate multiple functions NSSI, and severe NSSI groups, endorsing low, moderate, moderate multiple functions, and high frequencies of self-injury and presence of functions, respectively. Following class assignment, groups differed on self-esteem, social support and belongingness, internalizing symptoms, suicidal ideation and behaviors, and additional NSSI constructs. These subtype analyses emphasize matching phenotypes of NSSI to specific interventions considering dimensions of clinical functioning.

Combined Patterns Of Physical Activity And Screen-Related Sedentary Behavior Among Chinese Adolescents And Their Correlations With Depression, Anxiety And Self-Injurious Behaviors

Background and purpose

There are increasing concern about independent associations between physical activity, screen-based sedentary behavior (SSB), and psychological problems, but only a few studies have attempted to explore combined patterns of physical activity and SSB in adolescents and their correlations with psychological problems. This study was aimed at identifying combined patterns of moderate-to-vigorous physical activity (MVPA) and SSB and examining the prevalence of different combined patterns and their correlations with depression, anxiety, and self-injurious behavior among Chinese adolescents.

Methods

Junior and senior high school students (N = 13,659; mean age 15.18±1.89) were recruited. Latent class analysis was conducted to identify combined patterns of MVPA and SSB. Associations between subgroups of MVPA and SSB and socio-demographic characteristics were assessed by logistic regression. Their correlation with depression, anxiety, and self-injurious behaviors was assessed by analysis of variance with analysis stratified by gender.

Results

Four latent classes were identified: high MVPA/low SSB group (64.7%), low MVPA/low SSB (26.7%), low MVPA/high SSB (4.8%), and low MVPA/moderate SSB (3.9%). Generally, the high MVPA/low SSB class was a relatively healthy group. The low MVPA/high SSB class was at risk of enduring depression, anxiety, and self-injurious behavior, with boys being more at risk than girls.

Conclusion

Four latent subgroups of MVPA and SSB were identified in Chinese adolescents. The findings highlight the potential role of concurrent MVPA and SSB, with gender-specific characteristics in the primary prevention of adolescent depression, anxiety, and self-injurious behaviors.

Executive Function and Resilience as Mediators of Adolescents' Perceived Stressful Life Events and School Adjustment

This study investigated psychological mechanisms underlying the relationship between stressful life events and school adjustment in Chinese adolescents. The Adolescent Self-rating Life Events Checklist, the Adolescent Executive Function Scale, the Chinese version of the Resilience Scale, and the School-adjustment Scale were administered to 1101 Chinese adolescents (465 males, 636 females), aged 11–19 years, from three secondary schools. Results from serial mediation analysis revealed that perceived stressful life events could affect school adjustment through the mediation of executive function and resilience. The mediation effect contained three paths, the separate mediation effect of executive function, the separate mediation effect of resilience, and the serial mediation effect of executive function and resilience. These findings provide valuable insights into the effect of perceived stressful life events on school adjustment of Chinese adolescents, and suggest that, the researchers and educators could enhance school adjustment in vulnerable groups by improving their executive function and resilience.

Suicidal ideation and attempted suicide amongst Chinese transgender persons: National population study

BACKGROUND

This study aims to understand suicidal ideation and suicide attempts among transgender individuals through an in-depth analysis of a nation-wide population general survey in China.

METHODS

Transgender Men (TM) and Women (TW) were investigated through a cross-sectional survey. A structured questionnaire was used to investigate participants' demographic information, perceived sexuality conflicts, childhood adversity and mental health conditions. Logistic regression models were utilized to investigate risk factors associated with suicidal ideation and suicide attempts in these groups. We also conducted a quasi-meta-analysis in order to compare the prevalence of suicidal ideation and attempted suicide between general and transgender populations in China.

RESULTS

A total of 1309 participants across 32 provinces and municipalities in China took part in this survey, out of 2060 valid questionnaires. In this transgender population, the lifetime prevalence of suicidal ideation and an attempt at suicide were 56.4% and 16.1%, respectively. This estimated prevalence rate is far greater than in Chinese community samples. For all transgender people, disliking birth-assigned sex, seeking sex reassignment surgery, having intense conflicts with parents, lifetime history of suffering from major depressive disorder, a recent episode of depression, self-harm, and seeking mental health services were significantly associated with increased risk of suicidal ideation. An education level of high school or equivalent, being married and/or separated/divorced, having intense conflicts with parents, or self-harm and seeking mental health services were all significantly associated with increased risk of suicide attempt. Although most risk factors for TM and TW were equivalent across groups, differences were observed in both suicidal ideation and suicide attempt models.

LIMITATIONS

The cross-sectional study design and lack of follow-up data are limitations of this study.

CONCLUSIONS

This is the first study to examine suicide within a Chinese transgender population. The clinical implications of these findings for Chinese mental health professionals are discussed. Also, the evidence from this study can be used to inform the practices of suicide prevention workers, and policy makers working with the transgender population.

Derivation and Validation of the Periodontal and Tooth Profile Classification System for Patient Stratification

BACKGROUND

The goal of this study is to use bioinformatics tools to explore identification and definition of distinct periodontal and tooth profile classes (PPCs/TPCs) among a cohort of individuals by using detailed clinical measures at the tooth level, including both periodontal measurements and tooth loss.

METHODS

Full-mouth clinical periodontal measurements (seven clinical parameters) from 6,793 individuals from the Dental Atherosclerosis Risk in Communities Study (DARIC) were used to identify PPC. A custom latent class analysis (LCA) procedure was developed to identify clinically distinct PPCs and TPCs. Three validation cohorts were used: NHANES (2009 to 2010 and 2011 to 2012) and the Piedmont Study population (7,785 individuals).

RESULTS

The LCA method identified seven distinct periodontal profile classes (PPCs A to G) and seven distinct tooth profile classes (TPCs A to G) ranging from health to severe periodontal disease status. The method enabled identification of classes with common clinical manifestations that are hidden under the current periodontal classification schemas. Class assignment was robust with small misclassification error in the presence of missing data. The PPC algorithm was applied and confirmed in three distinct cohorts.

CONCLUSIONS

The findings suggest PPC and TPC using LCA can provide robust periodontal clinical definitions that reflect disease patterns in the population at an individual and tooth level. These classifications can potentially be used for patient stratification and thus provide tools for integrating multiple datasets to assess risk for periodontitis progression and tooth loss in dental patients.