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Natividad A, Huxley E, Townsend ML, Grenyer BFS, Pickard JA. What aspects of mindfulness and emotion regulation underpin self-harm in individuals with borderline personality disorder? J Ment Health 2024; 33:141-149. [PMID: 36916308 DOI: 10.1080/09638237.2023.2182425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/16/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Self-harm presents significant risk for individuals with borderline personality disorder (BPD). Both self-harm and BPD are associated with deficits in mindfulness and emotion dysregulation. Previous research suggests that thought suppression and emotional inexpressivity may underpin self-harm in people with BPD, suggesting potential links to self-harm functions common for those with BPD. More research is needed to strengthen our understanding of this relationship. AIMS This study examines how BPD symptoms, mindfulness, emotion dysregulation and self-harm functions are related. METHODS Australian community outpatients diagnosed with BPD (N = 110) completed measures of mindfulness, emotion dysregulation and self-harm functions. Serial mediation analyses were conducted to examine relationships between variables. RESULTS BPD symptoms, chronic emptiness, mindfulness skills, describing and non-reacting, emotion dysregulation areas of emotion regulation strategies and poor emotional clarity were associated with recent self-harm. Various combinations of describing, strategies and clarity mediated the path between emptiness and self-harm functions more likely to be endorsed by individuals with a diagnosis of BPD. Describing was associated with all but anti-suicide function, while strategies was associated with all but anti-dissociation. CONCLUSION The study highlights how individuals with BPD experiencing chronic emptiness may benefit from treatment targeting describing skills and adaptive emotion regulation strategies.
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Affiliation(s)
- Ana Natividad
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Elizabeth Huxley
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Judy A Pickard
- School of Psychology, University of Wollongong, Wollongong, Australia
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2
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Chen Y, Wang J, Lin H, Richards M, Yang X, Wang T, Chen X, Fu C. Network structure of emotional and behavioral problems, loneliness, and suicidal thoughts in adolescents at the school closure and reopening stage in China. Transl Pediatr 2023; 12:1373-1385. [PMID: 37575901 PMCID: PMC10416125 DOI: 10.21037/tp-23-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Public restriction and school closure policies during the pandemic may have long-term effects on adolescents' mental health, and adolescents' feelings and needs may change as the pandemic progresses. This study was conducted to explore the network structure and differences in emotional and behavioral problems (EBPs), loneliness, and suicidal thoughts in adolescents during different pandemic periods in China. Methods Based on two cross-sectional studies conducted in Taizhou, China, during school closure (April 16 to May 14, 2020) and reopening (May 25 to July 10, 2021) using online questionnaire, a total of 14,726 adolescents (school closure: 6,587, school reopening: 8,139) were recruited. EBPs were evaluated based on the student version of the Strengths and Difficulties Questionnaire (SDQ). Loneliness and suicidal thoughts were measured by item 20 and item 9 of the Chinese version of the Children's Depression Inventory (CDI), respectively. Network analysis was used to estimate the network connections and properties between EBPs, loneliness, and suicidal thoughts. Results The prevalence of psychosocial problems significantly increased at the school reopening compared with the school closure: EBPs: 36.8% vs. 31.6%; loneliness: 40.3% vs. 33.9%; suicidal thoughts: 40.8% vs. 15.4%. Suicidal thoughts showed the closest connections with being unhappy and lonely. Being bullied was strongly connected with conduct problems of lying and stealing. The links between hyperactivity symptoms and the other domains of EBPs were stronger after the school reopened. Being unhappy and showing the hyperactivity symptoms of "nonpersistent, distractible, and fidgety" presented high network and bridge (increasing transference from one symptom domain to another) centrality. Loneliness showed high expected influence and bridge centrality. Conclusions This study highlighted the high prevalence of EBPs, loneliness, and suicidal thoughts in Chinese adolescents. It also presented the network structure of these psychological problems over different pandemic stages. It is recommended that psychological support should be provided for adolescents, especially focusing on the central and bridge symptoms highlighted in this study.
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Affiliation(s)
- Yun Chen
- School of Public Health, Key Laboratory of Public Health Safety, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Jingyi Wang
- School of Public Health, Key Laboratory of Public Health Safety, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Haijiang Lin
- Taizhou City Center of Disease Control and Prevention, Taizhou, China
| | - Marcus Richards
- Medical Research Council Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Xiulu Yang
- School of Public Health, Key Laboratory of Public Health Safety, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Tingting Wang
- Taizhou City Center of Disease Control and Prevention, Taizhou, China
| | - Xiaoxiao Chen
- Taizhou City Center of Disease Control and Prevention, Taizhou, China
| | - Chaowei Fu
- School of Public Health, Key Laboratory of Public Health Safety, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
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Taylor P. Challenging the Myth of "Attention Seeking" Women with Suicidality: A Grounded Theory Study about Applying Counter-Pressure to Manage System Entrapment. Issues Ment Health Nurs 2022; 43:613-624. [PMID: 35026123 DOI: 10.1080/01612840.2021.2014608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Some women who express suicidal intent and engage in non-lethal self-harm perceive that nurses and other health care workers label them as attention-seeking and manipulative. An understanding of women's help-seeking behaviors that challenges suicide myths is presented. The purpose of this study was to examine help-seeking for suicidality in women with histories of intimate partner violence using a multiple qualitative research design of grounded theory and photovoice. Women from New Brunswick, Canada, over the age of 19 who left an abusive partner (n = 32) were interviewed and seven local women from this sample participated in five photovoice group sessions where they collectively examined self-generated photos of their experiences. Transcripts of the interviews and group sessions were analyzed using the constant comparative approach, yielding a theoretical rendering of women's help seeking. Results include a process of Applying Counter-Pressure as a way of pushing back against System Entrapment, or the sense of being invalidated and dehumanized by health care providers with the goal to Feel Human. Findings provide an understanding of women's behavior when seeking help for suicidality and may reduce nurses' assumptions and judgments when providing care. Trauma and violence informed care provides a framework from which to guide interventions that acknowledge the role of past and ongoing trauma in women's lives, supporting nurses' capacity to be validating and helping women to continue living.
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Affiliation(s)
- Petrea Taylor
- Faculty of Nursing, University of New Brunswick, Moncton, New Brunswick, Canada
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Munson KA, Janney CA, Goodwin K, Nagalla M. Cultural Representations of Borderline Personality Disorder. FRONTIERS IN SOCIOLOGY 2022; 7:832497. [PMID: 35399194 PMCID: PMC8990760 DOI: 10.3389/fsoc.2022.832497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/OBJECTIVE Borderline Personality Disorder (BPD) is characterized by unstable interpersonal relationships, impulsivity, and self-harm. There are many distinct stressors that predispose individuals to develop BPD or engage in self-harm behaviors. The objective of this systematic review was to compare methods of self-harm and psychological stressors in BPD across different cultures. METHODS A PubMed database search was conducted with the goal of capturing all articles (n = 22) that discussed methods of self-harm in BPD in any culture. Data extracted from the articles included methods of self-harm, psychological stressors, sample size, rurality, geographical location, and proportion of males to females. RESULTS Key differences were noted in the methods of self-harm. Eastern nations (n = 5) reported higher rates of self-poisoning (60%) than Western nations (11%). Western nations (n = 9) reported higher rates of skin-mutilating behavior (100%) than Eastern nations (80%). Two of the articles included participants from rural settings, one in the Sundarban region of India and the other in Mississippi. Notably, the Sundarban region reported the highest rate of poisoning (93%) whereas the Mississippi region reported high rates of skin mutilation. Differences were also noted in psychological stressors as the rates of interpersonal problems were higher in Western than in Eastern nations. CONCLUSIONS Additional research should be conducted into the presentation of BPD in different cultures. An improved understanding of the cultural presentations of BPD could improve diagnosis and treatment in various populations.
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Affiliation(s)
- Katherine A. Munson
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Carol A. Janney
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, United States
| | - Kelsie Goodwin
- School of Osteopathic Medicine, A. T. Still University, Kirksville, MO, United States
| | - Madhavi Nagalla
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, United States
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Balcombe L, De Leo D. The Potential Impact of Adjunct Digital Tools and Technology to Help Distressed and Suicidal Men: An Integrative Review. Front Psychol 2022; 12:796371. [PMID: 35058855 PMCID: PMC8765720 DOI: 10.3389/fpsyg.2021.796371] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022] Open
Abstract
Suicidal men feel the need to be self-reliant and that they cannot find another way out of relationship or socioeconomic issues. Suicide prevention is of crucial importance worldwide. The much higher rate of suicide in men engenders action. The prelude is a subjective experience that can be very isolating and severely distressing. Men may not realize a change in their thinking and behaviors, which makes it more difficult to seek and get help, thereby interrupting a "downward spiral". Stoicism often prevents men from admitting to their personal struggle. The lack of "quality" connections and "non-tailored" therapies has led to a high number of men "walking out" on traditional clinical approaches. But there are complicated relationships in motivations and formative behaviors of suicide with regards to emotional state, psychiatric disorders, interpersonal life events and suicidal behavior method selection. Middle-aged and older men have alternated as the most at-risk of suicide. There is no one solution that applies to all men, but digital tools may be of assistance (e.g., video conferences, social networks, telephone calls, and emails). Digital interventions require higher levels of effectiveness for distress and suicidality but self-guided approaches may be the most suitable for men especially where linked with an integrated online suicide prevention platform (e.g., quick response with online chats, phone calls, and emails). Furthermore, technology-enabled models of care offer promise to advance appropriate linking to mental health services through better and faster understanding of the specific needs of individuals (e.g., socio-cultural) and the type and level of suicidality experienced. Long-term evidence for suicidality and its evaluation may benefit from progressing human computer-interaction and providing impetus for an eminent integrated digital platform.
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Affiliation(s)
- Luke Balcombe
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
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Ortuño-Sierra J, Aritio-Solana R, Del Casal ADG, Fonseca-Pedrero E. Neurocognitive Functioning in Adolescents at Risk for Suicidal Behaviors. Arch Suicide Res 2021; 25:657-671. [PMID: 32264769 DOI: 10.1080/13811118.2020.1746938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Today, little is still known about the neurocognitive functioning of the individual at risk for suicide in a relevant developmental stage like adolescence. Thus, the main goal of the present work was to analyze the neurocognitive performance of adolescents at high risk for suicide. A total of 1509 adolescents from a stratified random cluster sampling were selected. Adolescents at risk for suicidal behaviors included 83 participants. A comparison group of 83 participants matched by age and gender was also randomly selected from the sample. The Paykel Suicide Scale (PSS) and the University of Pennsylvania Computerized Neurocognitive Battery for children (included 14 tasks assessing five neurobehavioral domains: executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed) were used. Adolescents at risk for suicide revealed statistically significant impairments across different neurocognitive domains including complex cognition, episodic memory and social cognition. No significant differences were found for Sensorimotor and Executive Function domains. Results found in the present study contribute relevant information about the nature of the neurocognitive impairments associated with suicide and add information in order to deeper comprehend the tentative etiology of suicide thoughts and attempts in adolescents with the aim to establish preventive treatments.
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Moselli M, Frattini C, Williams R, Ronningstam E. The Study of Motivation in the Suicidal Process: The Motivational Interview for Suicidality. Front Psychiatry 2020; 11:598866. [PMID: 33519549 PMCID: PMC7838538 DOI: 10.3389/fpsyt.2020.598866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/30/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: Suicide is the outcome of a process starting with the experiences of an unbearable pain or hopelessness, passing from suicidal ideation and planning, to possible para-suicidal behaviors or actual attempts. Recent studies have evidenced the necessity to integrate approaches based on the identification of psychopathological diagnoses and other variables as possible predictors of suicidal conduct with a more clinically based approach. A clinical assessment is needed that focuses on the patients' mental state with respect to thoughts concerning death and suicide. In particular, a qualitative assessment of motivations underlying the suicidal process could represent an effective guide for clinicians engaged in the difficult field of preventing adolescents' suicidal gestures. Most instruments investigating the suicidal motivation are self-report measures, possibly resulting in a lack of sufficiently valid assessment of this area. In the present work, we present the Motivational Interview for Suicidality in Adolescence (MIS-A) aiming at identifying the motivational areas sustaining suicidal ideation and gestures in this phase of development. Materials and Methods: The identification of the different areas derives from a thorough review of the empirical literature subsequently vetted by expert clinicians who selected specific reasons behind suicidal ideation and gesture. Result: The MIS is a semi-structured clinician-report interview. The interview is composed of seven areas and 14 sub-areas, evaluated on a four-point Likert scale: illness motivated attempts area, chronic presence of internal pessimistic criticism area, sense of defeat and entrapment area, relational area, external motivated crisis area, extreme and unusual cases area, and lack of control area. Conclusions: The path followed in the creation of the MIS reflects both an empirically orientated and a clinically informed approach. Creating this MIS is the first step within a wider research project that will allow one to test the reliability of the instrument.
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Affiliation(s)
- Marta Moselli
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, Rome, Italy
| | - Camilla Frattini
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, Rome, Italy
| | - Riccardo Williams
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, Rome, Italy
| | - Elsa Ronningstam
- Harvard Medical School, McLean Hospital, Belmont, MA, United States
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Guo L, Wang W, Wang T, Li W, Gong M, Zhang S, Zhang WH, Lu C. Association of emotional and behavioral problems with single and multiple suicide attempts among Chinese adolescents: Modulated by academic performance. J Affect Disord 2019; 258:25-32. [PMID: 31382101 DOI: 10.1016/j.jad.2019.07.085] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND There were differences in the characteristics and prevalence rates between individuals with a history of one suicide attempt and those with multiple suicide attempts. This large-scale study was conducted to test, among Chinese adolescents, the associations of emotional and behavioral problems with single and multiple suicide attempts and whether these associations vary with adolescents' academic performance. METHODS Data were drawn from the 2019 School-based Chinese Adolescents Health Survey (n = 20,702). Information about emotional and behavioral problems, suicide attempts, suicidal ideation, academic performance, and sleep duration was gathered. Multinomial logistic regression models using Firth penalized likelihood approach and appropriate sampling weights were performed. RESULTS Compared with no suicide attempt, peer problems, emotional problems, conduct problems, and hyperactivity were associated with an elevated risk of both a single suicide attempt and multiple suicide attempts, respectively (P < 0.05); the magnitudes of these associations in multiple suicide attempters were higher than those in single suicide attempters. Further stratification analyses by academic performance showed a greater association of the four difficulties with multiple suicide attempts in adolescents reporting poor academic performance than in those with good or average academic performance. LIMITATIONS The school-based study sample only included students, and causal inference could not be delineated due to the cross-sectional design. CONCLUSIONS Emotional and behavioral problems are associated with an elevated risk of single and multiple suicide attempts with differences between multiple suicide attempters and single suicide attempters. Adolescent academic performance plays a modulating role in these associations for multiple suicide attempts.
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Affiliation(s)
- Lan Guo
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Wanxin Wang
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Tian Wang
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Wenyan Li
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Meiqian Gong
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Sheng Zhang
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Wei-Hong Zhang
- Department of Public Health and Primary Care, International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium; Research Center for Public Health, Tsinghua University, Beijing, People's Republic of China
| | - Ciyong Lu
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
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Suicide by plastic bag suffocation combined with the mixture of citric acid and baking soda in an adolescent. Int J Legal Med 2019; 133:177-180. [DOI: 10.1007/s00414-018-1856-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 05/11/2018] [Indexed: 11/25/2022]
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