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Mannekote Thippaiah S, Ayub I, Challita YP, Ramos G, Richey KJ, Foster KN. Psychiatric Risk Factors and Burn Severity in Self-immolation. J Burn Care Res 2024; 45:851-857. [PMID: 38408298 DOI: 10.1093/jbcr/irae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Indexed: 02/28/2024]
Abstract
Self-immolation, a form of self-harm involving setting oneself on fire, is associated with high mortality, morbidity, and healthcare burden. This study aimed to characterize potential clinical correlates and predisposing factors for self-immolation based on burn severity using TBSA percentage scoring. Additional objectives included identifying motivational elements, associated risk factors, and clinical characteristics to optimize patient care and reduce future self-immolation incidents. A retrospective review of admissions to the Arizona Burn Center from July 2015 to August 2022 identified 103 self-immolation patients for the study. Burn severity was categorized as mild to moderate (TBSA < 20%) or severe (TBSA ≥ 20%) based on TBSA. This study population had a mortality rate of 21%. Positive urine drug screens were found in 44% of subjects, and 63% having chronic substance use, with methamphetamine (37%) and alcohol (30%), being the most prevalent. Underlying psychiatric illnesses were present in 83% of patients. Suicidal intent strongly predicted severe burns (P < .001) among the 68 severe burn cases identified. In conclusion, this study emphasizes that the presence of suicidal intent among self-immolation patients significantly correlates with burn severity. These findings highlight the importance of involving psychiatric services early in patient care to improve outcomes and reduce the recurrence of self-immolation acts.
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Affiliation(s)
- Srinagesh Mannekote Thippaiah
- Creighton University School of Medicine, 3100 N Central Ave, Phoenix, AZ 85012, USA
- The University of Arizona College of Medicine - Phoenix 475 N 5th St, Phoenix, AZ 85004, USA
- Valleywise Health- Behavioral Health Annex, Med-Psych Unit 2619 E Pierce St, Phoenix, AZ 85008, USA
- Valleywise Health Medical Center 2601 E Roosevelt St, Phoenix, AZ 85008, USA
| | - Ibraheim Ayub
- Valleywise Health Medical Center 2601 E Roosevelt St, Phoenix, AZ 85008, USA
| | - Youssef P Challita
- Valleywise Health Medical Center 2601 E Roosevelt St, Phoenix, AZ 85008, USA
| | - Gilbert Ramos
- Department of Research, Valleywise Health, Phoenix, AZ 85008, USA
| | - Karen J Richey
- Arizona Burn Center, Department of Burn Surgery, Valleywise Health, Phoenix, AZ 85008, USA
| | - Kevin N Foster
- Arizona Burn Center, Department of Burn Surgery, Valleywise Health, Phoenix, AZ 85008, USA
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Güngördü E, Ayaydin H. Peer Bullying and Psychiatric Diagnoses in Adolescents with Nonsuicidal Self-Injury. Psychiatry 2024:1-16. [PMID: 39102646 DOI: 10.1080/00332747.2024.2379752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
OBJECTIVES The aim of this study was to determine the comorbid psychiatric diagnoses, peer bullying rates and NSSI characteristics in adolescents who engage in self-injuring behavior. MATERIALS AND METHODS This case-controlled cross-sectional study was conducted between 1 March 2020 and 1 May 2021 in the Child and Adolescent Psychiatry and Paediatrics outpatient clinic of a hospital in the Southeastern Anatolia region of Turkey. The data of 50 adolescents with NSSI and 60 adolescents without NSSI attending school were compared. The data in the study were obtained using sociodemographic form prepared by the researchers, the Affective Disorders and Schizophrenia Interview Schedule for School-Age Children-Present and Lifetime Version-Dsm-5, Peer Bullying Scale Adolescent Form and Self-Injurious Behaviour Assessment Inventory. RESULTS Fifty adolescents (70% female) with a mean age of 15.4 years (S.D. = 1.4) with NSSI were included as case group and 60 adolescents (66.7% female) with a mean age of 15.5 years (S.D. = 1.3) without NSSI were included as control group. Banging/hitting self was the most common NSSI method, while affect regulation was the most common function. In the case group, verbal, isolation and damage to belongings among the victim subtypes in the last year were found to be significantly higher than in the control group. It was found that there was a positive correlation between the variety of self-injury methods and bullying exposure scores in adolescents with NSSI. Depression disorders, anxiety disorders, oppositional defiant disorder, attention deficit hyperactivity disorder, conduct disorder, and post-traumatic stress disorder diagnoses were found to be more prevalent in the group with NSSI. CONCLUSIONS Based on the finding, it was found that psychiatric diagnoses are more common in adolescents with NSSI, peer bullying subtypes are seen at a higher rate, and as bullying scores increase, the variety of NSSI methods also increases. It is thought that providing psychiatric evaluation and treatment for adolescents with NSSI, establishing cooperation with school and family for peer bullying, developing preventive mental health policies and effective intervention programmes may be beneficial.
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Goreis A, Pfeffer B, Hajek Gross C, Klinger D, Oehlke SM, Zesch H, Claes L, Plener PL, Kothgassner OD. Attentional Biases and Nonsuicidal Self-Injury Urges in Adolescents. JAMA Netw Open 2024; 7:e2422892. [PMID: 39023890 PMCID: PMC11258595 DOI: 10.1001/jamanetworkopen.2024.22892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/19/2024] [Indexed: 07/20/2024] Open
Abstract
Importance Nonsuicidal self-injury (NSSI) is a significant clinical concern among adolescents. Exposure to NSSI-related content on social media platforms has been suspected to potentially act as a trigger for NSSI. Objective To use free-viewing eye-tracking and dot-probe paradigms to examine attentional bias and psychophysiological responses to NSSI-related pictorial and textual stimuli in adolescents with and without a history of NSSI. Design, Setting, and Participants From June 2022 to April 2023, adolescent participants in Vienna, Austria with and without a history of NSSI were exposed to NSSI-related stimuli in this nonrandomized controlled trial. Data were analyzed from December 2023 to January 2024. Exposure Exposure to NSSI-related stimuli. Main Outcomes and Measures During both tasks, subjective arousal, NSSI urges, and autonomic nervous system activity were assessed. Results A total of 50 adolescents in 2 groups, 25 who engaged in NSSI (mean [SD] age 15.86 [1.14] years; 19 female participants [76%]) and 25 who did not (mean [SD] age 16.40 [1.71] years; 19 female participants [76%]) were included. Adolescents with a history of NSSI-but not those without a history of NSSI-showed a clear attentional bias toward NSSI-related images during eye-tracking, as indicated by increased initial fixations (500 ms stimulus presentation mean difference, 28.64%; 95% CI, 18.31%-38.98%; P < .001; 1000 ms stimulus presentation mean difference, 18.50%; 95% CI, 9.05%-27.95%; P < .001) and longer fixation durations (500 ms mean difference, 29.51 ms; 95% CI, 4.3-54.72 ms; P < .001; 1000 ms mean difference, 39.83 ms; 95% CI, 6.90-72.76 ms; P < .001), regardless of stimulus duration. This bias was associated with a heightened urge to engage in NSSI (d = 1.22; 95% CI, 0.69-1.73; P < .001), a trend not seen in adolescents without a history of NSSI. Similarly, in the dot-probe task, only the NSSI group showed an attentional bias toward NSSI images but not toward trauma images, emphasizing the specificity of their attentional bias. Physiological measures revealed no significant differences, suggesting that viewing NSSI images is not associated with increased autonomic arousal. Textual NSSI content did not provoke an attentional bias or heighten NSSI urges in either group. Conclusions and Relevance In this nonrandomized controlled trial of 50 adolescents, results highlighted a specific attentional bias toward NSSI-related pictorial stimuli in adolescents with a history of NSSI, particularly a difficulty in disengaging from NSSI images. These findings contribute to understanding maladaptive information processing in NSSI and suggest implications for clinical management and cognitive models addressing NSSI triggers. Trial Registration German Clinical Trials Register identifier: DRKS00025905.
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Affiliation(s)
- Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Bettina Pfeffer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Carola Hajek Gross
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Diana Klinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Sofia M. Oehlke
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Heidi Zesch
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Laurence Claes
- Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
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Xin M, Petrovic J, Yang C, Zhang L, Yang X. Nonsuicidal self-injury among Chinese university students during the post-COVID-19 era: analysis of sex differences and the impact of gender role conflict. Front Psychol 2024; 15:1362762. [PMID: 38979065 PMCID: PMC11229209 DOI: 10.3389/fpsyg.2024.1362762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/13/2024] [Indexed: 07/10/2024] Open
Abstract
Background Global centers of epidemic prevention and control have entered a new stage of normalization, namely, the "post-COVID-19 era." During the post-COVID-19 era, which is characterized by the time period following that with the most serious medical consequences, the psychosocial consequences of the COVID-19 pandemic began to receive worldwide attention, especially the degree of psychological distress it caused. Aim This study explored the differential impact of gender role conflict on Chinese university students' engagement in nonsuicidal self-injury (NSSI) as a function of biological sex following the global COVID-19 pandemic. Methods Participants were 1,600 university students in northwestern China (M age = 21.3 years; 50.8% women) who completed online measures of demographic variables (including biological sex, gender role conflict, and NSSI engagement). Results Women reported significantly more gender role conflicts than men did, while engagement in NSSI was significantly more prevalent among men than women. A total of 262 men reported engaging in at least one NSSI behavior, resulting in a prevalence rate of 33.25%. In comparison, a total of 106 individuals reported engaging in at least one NSSI behavior, resulting in a prevalence rate of 13.05% among women. Gender role conflict was found to significantly predict university students' NSSI engagement, regardless of biological sex. Conclusion This is the first empirical study to identify sex differences in both gender role conflict and engagement in NSSI among university students in Northwestern China during the post-COVID-19 era. In addition, the present study is the first to demonstrate how gender role conflict predicts engagement in NSSI across sexes. These findings will inform the literature on gender role conflict and NSSI, particularly the close relationship between gender role conflict and engagement in NSSI among Chinese university students, and they emphasize the need for continued efforts to explore NSSI cross-culturally.
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Affiliation(s)
- Moye Xin
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Julia Petrovic
- Human Development, McGill University, Montreal, QC, Canada
| | - Chengxi Yang
- School of Liberal Arts, Yulin University, Yulin, Shaanxi, China
| | - Lijin Zhang
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Xueyan Yang
- Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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Cliffe B, Moore E, Whittle K, Stallard P. Is a smartphone application (BlueIce) acceptable and safe for university students who self-harm: an open study. BMJ Open 2024; 14:e069862. [PMID: 38663920 PMCID: PMC11043752 DOI: 10.1136/bmjopen-2022-069862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Many university students self-harm but few receive support. Smartphone apps have been identified as acceptable sources of support for students who self-harm, but the use of supportive self-harm apps is yet to be explored in this population. OBJECTIVE This study sought to explore the acceptability and safety of a specific app (BlueIce) for university students who self-harm. METHODS This was an exploratory, mixed methods study with 15 university students attending university well-being services with self-harming thoughts and/or behaviours. BlueIce was offered alongside the face-to-face support provided by the well-being service. Self-harming thoughts and behaviours, coping self-efficacy, and symptoms of anxiety and depression were measured before and after using BlueIce for 6 weeks. Follow-up interviews were also undertaken to explore how students perceived BlueIce in more depth. RESULTS Following app use, there were statistically significant reductions in symptoms of anxiety (baseline M 12.47, SD 4.42; follow-up M 10, SD 4.16) t(14)=2.26, p=0.040, d=0.58 and depression (baseline M 16.5, SD 5.17, follow-up M 12.27, SD 3.66) t(13)=5.50, p<0.001, d=1.47. Qualitative findings showed participants found BlueIce to be acceptable, safe and helpful, and reported that they were more able to cope with difficult feelings and better understand their self-harm triggers following use of the app. CONCLUSION BlueIce was an acceptable, safe and helpful source of support for university students struggling with self-harm thoughts and/or behaviours. This builds on previous findings with adolescents and suggests that BlueIce could be a particularly acceptable and helpful resource for university students.
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Affiliation(s)
| | - Emma Moore
- Child and Adolescent Mental Health Services, Oxford Health NHS Mental Health Trust, Bristol, UK
| | - Kathryn Whittle
- Child and Adolescent Mental Health Services, Oxford Health NHS Mental Health Trust, Bristol, UK
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Hiew Y, Powell NL, Wong QY, Fong ZH, Fong YJ, Chee TT. Factors associated with informal and formal help-seeking among Asian adolescents with nonsuicidal self-injury. Clin Child Psychol Psychiatry 2024:13591045241241109. [PMID: 38565258 DOI: 10.1177/13591045241241109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Although nonsuicidal self-injury (NSSI) is prevalent among adolescents and is associated with an increased risk of adverse outcomes, many adolescents with NSSI do not seek help. However, there is a lack of research on the factors that may increase the likelihood of help-seeking, especially within Asia. To address this gap, the present study examined whether certain factors were associated with informal and formal help-seeking - specifically gender, severity of NSSI, functions of NSSI and authoritative parenting. 121 adolescents (Mage = 16.2 years, 71.1% female) were recruited from specialist outpatient clinics and inpatient psychiatric wards from a public hospital in Singapore. One caregiver per adolescent was also recruited. Data from self-report questionnaires were analysed using logistics regression analyses. The results suggest that the severity of NSSI increases the likelihood of informal help-seeking, while adolescents who have parents with more authoritative parenting style are less likely to seek informal help. Gender and functions of NSSI were not found to be associated with help-seeking. The findings from this study can guide professionals in their efforts to encourage help-seeking within Asian populations, as well as inform prevention and treatment programs for Asian adolescents with NSSI.
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Affiliation(s)
- Yvette Hiew
- Department of Psychology, National University of Singapore, Singapore
| | | | - Qiu Yan Wong
- Department of Psychology, National University of Singapore, Singapore
| | - Zhi Hui Fong
- Department of Psychological Medicine, National University Health System, Singapore
| | - Ying Jie Fong
- Department of Psychological Medicine, National University Health System, Singapore
| | - Tji Tjian Chee
- Department of Psychological Medicine, National University Health System, Singapore
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Sigurvinsdottir R, Gisladottir B, Asgeirsdottir BB, Sigfusdottir ID. Sexual Attraction and Non-Suicidal Self-Harm: The Role of Stressors and Psychological Mediators. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1293-1306. [PMID: 38347324 DOI: 10.1007/s10508-023-02792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 03/22/2024]
Abstract
Non-suicidal self-harm (NSSH) is a serious concern for the well-being of youth. Stressors relate to greater NSSH risk, such as being non-heterosexual in a heteronormative society. Other stressors may include traumatic experiences. These relationships may be mediated by psychological factors (depressed mood, anxiety, anger, and self-esteem) as well as contextual factors (support from parents and peers). The purpose of this study was to examine NSHH ideation and behavior among Icelandic youth, as well as relationships with stressors and mediators. Students in Icelandic high schools (N = 8921, 50.8% female) completed an in-class survey in the year 2016. Results showed an elevated risk of NSSH ideation and behavior among bisexual and homosexual youth. Mediation analyses showed that, for girls, being bisexual related to greater NSSH ideation and behavior, and these relationships were mediated by depressed mood, anger, and self-esteem, as well as by support from parents and peers. For boys, however, both homosexual and bisexual attraction related to greater risk for NSSH ideation and behavior, which was mediated by depressed mood, anger, and self-esteem. These results suggest that NSSH risk factors vary by gender and, therefore, they may benefit from different interventions to stop and prevent this behavior. This is the first study of its kind in Iceland, where sexual minority stress may need further study within the Nordic context.
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Affiliation(s)
| | | | | | - Inga Dora Sigfusdottir
- Department of Psychology, Reykjavik University, Menntavegur 1, 102, Reykjavik, Iceland
- Icelandic Centre for Social Research and Analysis, Reykjavik, Iceland
- Teachers College, Columbia University, New York, NY, USA
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Cherry JC, Fitzpatrick EA, Sandila NK, Lovas D, Hurley KF. Non-suicidal self-injury at a Canadian paediatric emergency department. CAN J EMERG MED 2024; 26:259-265. [PMID: 38565769 DOI: 10.1007/s43678-024-00657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/24/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Our primary objective was to determine agreement between non-suicidal self-injury recorded at triage and during subsequent mental health assessment. The secondary objective was to describe patients who reported non-suicidal self-injury. METHODS This is a health records review of patients aged 12-18 years who had an Emergency Mental Health Triage form on their health record from an ED visit June 1, 2017-May 31, 2018. We excluded patients with diagnoses of autism spectrum disorder or schizophrenia. We abstracted data from the Mental Health Triage form, Emergency Mental Health and Addictions Service Assessment forms and Assessment of Suicide and Risk Inventory. We calculated Cohen's Kappa coefficient, sensitivity, and negative predictive value to describe the extent to which the forms agreed and the performance of triage for identifying non-suicidal self-injury. We compared the cohort who reported non-suicidal self-injury with those who did not, using t-tests, Wilcoxon rank-sum tests, and chi-square tests. RESULTS We screened 955 ED visits and included 914 ED visits where 558 (58.4%) reported a history of non-suicidal self-injury. There were significantly more females in the group reporting non-suicidal self-injury (82.1%, n = 458) compared to the group not reporting non-suicidal self-injury (45.8%, n = 163). Patients reporting non-suicidal self-injury did so in triage and detailed Mental Health Assessment 64.7% of the time (Cohen's Kappa Coefficient 0.6); triage had sensitivity of 71.5% (95% CI 67.3-75.4) and negative predictive value of 71.2% (95% CI 68.2-74.0). Cutting was the most common method of non-suicidal self-injury (80.3%). CONCLUSION Screening at triage was moderately effective in identifying non-suicidal self-injury compared to a detailed assessment by a specialised mental health team. More than half of children and adolescents with a mental health-related concern in our ED reported a history of non-suicidal self-injury, most of which were female. This symptom is important for delineating patients' coping strategies.
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Affiliation(s)
- Jonathan C Cherry
- Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada.
| | - Eleanor A Fitzpatrick
- Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada
| | | | - David Lovas
- Department of Psychiatry, IWK Health, Dalhousie University, Halifax, NS, Canada
| | - Katrina F Hurley
- Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada
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Ying W, Shen Y, Ou J, Chen H, Jiang F, Yang F, Li J, Qian X, Luo W, Wang G, Dong H. Identifying clinical risk factors correlated with addictive features of non-suicidal self-injury among a consecutive psychiatric outpatient sample of adolescents and young adults. Eur Arch Psychiatry Clin Neurosci 2024; 274:291-300. [PMID: 37314538 DOI: 10.1007/s00406-023-01636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/03/2023] [Indexed: 06/15/2023]
Abstract
Non-suicidal self-injury (NSSI) is an issue primarily of concern in adolescents and young adults. Recent literature suggests that persistent, repetitive, and uncontrollable NSSI can be conceptualized as a behavioral addiction. The study aimed to examine the prevalence of NSSI with addictive features and the association of this prevalence with demographic and clinical variables using a cross-sectional and case-control design. A total of 548 outpatients (12 to 22 years old) meeting the criteria for NSSI disorder of DSM-5 were enrolled and completed clinical interviews by 4 psychiatrists. NSSI with addictive features were determined by using a single-factor structure of addictive features items in the Ottawa self-injury inventory (OSI). Current suicidality, psychiatric diagnosis, the OSI, the revised Chinese Internet Addiction Scale, the Childhood Trauma Questionnaire, and the 20-item Toronto Alexithymia Scale were collected. Binary logistic regression analyses were used to explore associations between risk factors and NSSI with addictive features. This study was conducted from April 2021 to May 2022. The mean age of participants was 15.93 (SD = 2.56) years with 418 females (76.3%), and the prevalence of addictive NSSI was 57.5% (n = 315). Subjects with addictive NSSI had a higher lifetime prevalence of nicotine and alcohol use, a higher prevalence of current internet addiction, suicidality, and alexithymia, and were more likely to have physical abuse/neglect, emotional abuse, and sexual abuse than NSSI subjects without addictive features. Among participants with NSSI, the strongest predictors of addictive features of NSSI were female (OR = 2.405, 95% CI 1.512-3.824, p < 0.0001), alcohol use (OR = 2.179, 95% CI 1.378-3.446, p = 0.001), current suicidality (OR = 3.790, 95% CI 2.351-6.109, p < 0.0001), and psysical abuse in childhood (OR = 2.470, 95% CI 1.653-3.690, p < 0.0001). Nearly 3 out of 5 patients (12-22 years old) with NSSI met the criteria of NSSI with addictive features in this psychiatric outpatients sample. Our study demonstrated the importance of the necessity to regularly assess suicide risk, and alcohol use, as well as focus more on females and subjects who had physical abuse in childhood to prevent addictive NSSI.
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Affiliation(s)
- Wang Ying
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yidong Shen
- Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jianjun Ou
- Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hui Chen
- Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Furong Jiang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fangru Yang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianling Li
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao Qian
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenfeng Luo
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Gang Wang
- Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Huixi Dong
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Guerrero E, Andreasson K, Larsen L, Buus N, Skovgaard Larsen JL, Krogh J, Thastum R, Lindberg L, Lindblad K, Erlangsen A, Nordentoft M. Zero Self-Harm app: a mobile phone application to reduce non-suicidal self-injury-study protocol for a randomized controlled trial. Trials 2024; 25:116. [PMID: 38341590 PMCID: PMC10859016 DOI: 10.1186/s13063-024-07932-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a growing healthcare problem. Individuals with NSSI have an increased risk of suicidality. Due to stigma, they may self-injure in secret, which means they might not seek help until events have escalated to include suicidal ideation or a mental disorder. Interventions delivered via mobile phone applications (apps) have been linked to reductions in self-injury. This protocol outlines a trial, which examines whether the Zero Self-Harm intervention, consisting of an app for people with NSSI, can reduce the number of NSSI episodes, suicide ideation, and depressive symptoms. METHODS The trial will be conducted as a 6-month 2-arm, parallel-group, multicentre, pragmatic, randomized clinical superiority trial. The intervention group will receive the app and instructions on how to use it, while the control group will be allocated to a waitlist and allowed to download the app after 6 months. After inclusion, participants will be asked to complete questionnaires at baseline, 3 months, and 6 months. The primary outcome is the number of NSSI episodes during the preceding month, as measured at the 6 months follow-up with the Deliberate Self-Harm Inventory. A total of 280 participants, 140 in each arm, will be included. DISCUSSION This trial will assess the effectiveness of the Zero Self-Harm intervention to reduce the number of NSSI episodes. If effective, the app will have the potential to support a large group of people with NSSI. Considering the stigma related to NSSI, the fact that the app may be used in private and anonymously might make it an appealing and acceptable option for support. The app was developed in collaboration with people with lived experiences related to current and/or previous NSSI. As a result of this, the app focuses on minimizing harm, rather than stopping NSSI. This might enhance its utilization. TRIAL REGISTRATION ClinicalTrials.gov NCT04463654 . Registered on 7 June 2020.
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Affiliation(s)
- Evelyn Guerrero
- Psychiatric Centre North Zealand, University Hospital of Hillerød, Dyrehavevej 48, 3400, Hillerød, Denmark
- Danish Research Institute for Suicide Prevention (DRISP), Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
| | - Kate Andreasson
- Psychiatric Centre North Zealand, University Hospital of Hillerød, Dyrehavevej 48, 3400, Hillerød, Denmark.
- Danish Research Institute for Suicide Prevention (DRISP), Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark.
| | - Lene Larsen
- Psychiatric Centre North Zealand, University Hospital of Hillerød, Dyrehavevej 48, 3400, Hillerød, Denmark
| | - Niels Buus
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C., Denmark
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Wellington Road, Clayton, 3800, Australia
| | - Jette Louise Skovgaard Larsen
- Danish Research Institute for Suicide Prevention (DRISP), Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
| | - Jesper Krogh
- Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
| | - Rasmus Thastum
- Children's Rights National Association, Trekronergade 26, 2500, Valby, Denmark
| | - Lone Lindberg
- Psykiatrisk Praksis, Arresødalsvej 79, 3300, Frederiksværk, Denmark
| | - Katrine Lindblad
- Centre of Eating Disorders and Self-Harm (VIOSS), Krumtappen 2, 2500, Valby, Denmark
| | - Annette Erlangsen
- Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C., Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway 8th floor, Baltimore, MD, 21205, USA
- Center of Mental Health Research, Australian National University, Building 63, Canberra, ACT, 2601, Australia
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
- Danish Research Institute for Suicide Prevention (DRISP), Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
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11
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Park Y, Qu W, Ammerman BA. Characteristics and Functions of Non-Suicidal Self-Injury That Inform Suicide Risk. Arch Suicide Res 2024:1-14. [PMID: 38314767 DOI: 10.1080/13811118.2024.2310556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
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.
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12
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Tickell A, Fonagy P, Hajdú K, Obradović S, Pilling S. 'Am I really the priority here?': help-seeking experiences of university students who self-harmed. BJPsych Open 2024; 10:e40. [PMID: 38297500 PMCID: PMC10897682 DOI: 10.1192/bjo.2023.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Self-harm is a significant problem in university students because of its association with emotional distress, physical harm, broader mental health issues and potential suicidality. Research suggests that fewer than half of students who have self-harmed seek professional help when at university. AIMS This study aimed to explore the help-seeking journeys of university students who had engaged in self-harm, to identify perceived facilitators and barriers to securing both formal and informal support. METHOD Participants comprised 12 students who had self-harmed during their university tenure. Engaging in two semi-structured interviews over the academic year, they shared insights into their help-seeking behaviours and proposed enhancements to local services. Data underwent reflexive thematic analysis within a critical realist framework. RESULTS The analysis identified four themes: 'The initial university phase poses the greatest challenge', 'Perceived criteria for "valid" mental health problems', 'Evading external judgements, concerns and consequences' and 'The pivotal role of treatment options and flexibility in recovery'. CONCLUSIONS Students felt isolated and misunderstood, which amplified self-harming tendencies and diminished inclinations for help-seeking. A prevalent belief was that for self-harm to be deemed 'valid', it must manifest with a certain severity; however, concurrent fears existed around the ramifications of perceived excessive severity. Participants expressed a desire for streamlined pathways to mental health resources, encompassing both university and external mental health services. Insights from this study could guide future research and inform current service paradigms within academic and healthcare systems.
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Affiliation(s)
- Alice Tickell
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Katalin Hajdú
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Sandra Obradović
- School of Psychology and Counselling, Faculty of Arts and Social Sciences, The Open University, UK
| | - Stephen Pilling
- Department of Clinical, Educational and Health Psychology, University College London, UK
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13
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Qin Q, Yang G, Li Y, Wu W, Wang J, Chen Z, Kong X, Zhang W, Zou H. The relationship between major life events and non-suicidal self-injury among college students: the effect of rumination and body image. Front Public Health 2024; 11:1308186. [PMID: 38298255 PMCID: PMC10828039 DOI: 10.3389/fpubh.2023.1308186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
Background Non-suicidal self-injury (NSSI) poses a growing risk to public health worldwide. While numerous studies have identified major life events as key risk factors for NSSI, the mechanisms by which emotional and cognitive problems mediate or moderate this relationship remain unclear. To enhance the understanding of this field, we will draw upon the cascade theory of self-injury and the benefits and barriers model, to examine the relationship between major life events and NSSI, as well as the effect of rumination and body image. Methods A sample of 2,717 college students (Mage = 19.81 years; SD = 1.09) participated in this study and anonymously completed the questionnaires. The moderated mediation model were conducted using Model 4 and Model 15 of the Process macro program in SPSS. Results The results showed that rumination mediated the positive relationship between major life events and NSSI. Furthermore, body image was found to moderate both the relationship between major life events and NSSI, as well as the relationship between rumination and NSSI. Conclusion The current findings suggest that rumination is an important mediator in the relationship between major life events and NSSI among college students. Teachers, parents, and researchers should recognize the important role of body image self-perceptions of college students and actively promote a healthy and accurate body image.
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Affiliation(s)
- Qian Qin
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Guangni Yang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- Department of Psychology, Lingnan University, Hong Kong, China
| | - Yue Li
- College of Teacher Education, South China Normal University, Guangzhou, China
| | - Wanchun Wu
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Jianping Wang
- College of Teacher Education, South China Normal University, Guangzhou, China
- Journal of South China Normal University, South China Normal University, Guangzhou, China
| | - Ziyao Chen
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Xiaohua Kong
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Wei Zhang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Hongyu Zou
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
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14
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Paladini G, Sciurpa E, Onorati R, Elhadidy HSMA, Giacomini G, Mamo C, Borraccino A. Gender and Age Influence on Emergency Department Visits for Non-Suicidal Self-Injuries in School Aged Children in Italy: An 11 Years Retrospective Cross-Sectional Study. Int J Public Health 2023; 68:1606370. [PMID: 38164389 PMCID: PMC10757917 DOI: 10.3389/ijph.2023.1606370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives: Non-suicidal self-injury (NSSI) poses a threat in developmental ages, yet there is a scarcity of studies on NSSI trends, especially those in emergency departments (ED). Methods: The aim of this cross-sectional study is to describe trends in ED visits for NSSI among young people aged between 5 and 19 years in Italy from 2011 to 2021 in Piedmont. From the ministerial ED discharge information system, all occurring NSSIs were identified by medical report and/or ICD9CM code and reported as a population rate and a visit rate on all ED requests. Results: The general rate of ED visits remained stable, with around 210,000 (55% males) visits each year, along the whole period from 2011 to 2019, then halved during 2020 and 2021. The NSSI population and visits rates increased from 2013, peaking in 2019 at a rate of around 25 and 23 NSSI visits (girls) and 76 and 69 NSSI (boys) per 100,000 ED visits. In 2020 and 2021, the rate of NSSI visits increased, particularly in girls and among older adolescents. Conclusion: The gradual increase of NSSI over the last decade is a rising public health issue, which deserves wider attention to ensure early detection and prevention.
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Affiliation(s)
- Giovanni Paladini
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Elena Sciurpa
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Roberta Onorati
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Grugliasco, Italy
| | | | - Gianmarco Giacomini
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Carlo Mamo
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Grugliasco, Italy
| | - Alberto Borraccino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
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15
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Goreis A, Prillinger K, Bedus C, Lipp R, Mayer A, Nater UM, Koenig J, Plener PL, Kothgassner OD. Physiological stress reactivity and self-harm: A meta-analysis. Psychoneuroendocrinology 2023; 158:106406. [PMID: 37783020 DOI: 10.1016/j.psyneuen.2023.106406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Self-harm is associated with alterations in the psychobiological stress response. Specifically, the reactivity of the autonomic nervous system (ANS) and the endocrine hypothalamic-pituitary-adrenal (HPA) axis may differ in individuals who engage in self-harm. However, evidence in this regard is inconsistent. BACKGROUND We conducted a preregistered random-effects meta-analysis of sympathetic ANS, parasympathetic ANS, sympathetic-parasympathetic, i.e., mixed-influence ANS, and HPA axis reactivity following laboratory stress exposure in individuals who engage in self-harm and controls. Stress exposure consisted of paradigms using either social-evaluative (e.g., TSST), emotional (e.g., negatively valenced visual stimuli), or physical (e.g., cold pressor test) challenges. A total of 29 studies (self-harm: n = 954, controls: n = 1122, 74% females) were included in the analysis. RESULTS Regarding ANS reactivity to stress, no differences emerged between the two groups. However, parasympathetic ANS activity was lower before stress (g = -0.30, CI -0.51 to -0.09) and after stressor cessation (g = 0.54, CI -1.07 to -0.01) in the self-harm group compared to controls. Regarding HPA axis reactivity, individuals who engage in self-harm showed significantly lower cortisol responses to stress than did controls (g = -0.26, CI -0.45 to -0.08). After stressor cessation (i.e., during stress recovery), cortisol was also lower in individuals who engage in self-harm compared to controls (g = -0.26, CI -0.43 to -0.08). CONCLUSIONS Lower basal parasympathetic ANS activity and flattened cortisol responses indicate dysregulation of psychobiological stress systems in individuals who engage in self-harm. A better understanding of the psychobiological underpinnings of self-harm may allow for the establishment of biomarkers of risk stratification and treatment monitoring in affected individuals.
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Affiliation(s)
- Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Carolin Bedus
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Ronja Lipp
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Anna Mayer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Urs M Nater
- Faculty of Psychology, University of Vienna, Vienna, Austria; University Research Platform "The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria.
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16
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Chen Y, Hu R, Xu X, Hong B, Zhang J, Jia P, Zhao L. The Effect of Mental Health Status and Family Function on Nonsuicidal Self-Injury: A Longitudinal Analysis of Chinese Children and Adolescents. Psychol Res Behav Manag 2023; 16:4491-4500. [PMID: 37936973 PMCID: PMC10627038 DOI: 10.2147/prbm.s429748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023] Open
Abstract
Background Nonsuicidal self-injury (NSSI) is an overwhelming social problem in children and adolescents. Focusing on the change of NSSI behavior, including onset, cessation, and maintenance, is crucial to developing effective prevention and intervention strategies. This study explored the effect of mental health status (depressive and anxiety symptoms) and family function on NSSI. Methods The study sample comprised 7554 children and adolescents based on the first two rounds of the Chengdu Positive Child Development (CPCD) dataset in China. Depressive and anxiety symptoms measured mental health status. The self-reported questionnaires also assessed NSSI behaviors and family function. The interrelationship between NSSI behaviors, mental health status, and family function was evaluated. Logistic regression and linear regression were performed to examine the interrelationship between mental health status, family function and NSSI behaviors. Sensitivity analysis was performed. Results In this study, 2167 (28.69%) participants reported NSSI at baseline and 2101 (27.81%) at follow-up. Depression, anxiety, and family function were salient influential factors in the prevalence, onset, and cessation of NSSI. Parents' accompaniment showed a significant effect on the prevalence of NSSI. Conclusion Depression, anxiety, family function, and parents' accompaniment are all associated with NSSI behaviors. Strategies targeting mental health status and family function could effectively protect children and adolescents from NSSI behaviors.
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Affiliation(s)
- Yuxin Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
- China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, People’s Republic of China
| | - Rui Hu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xinmao Xu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Binxue Hong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jinquan Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, People’s Republic of China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, People’s Republic of China
| | - Li Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
- China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, People’s Republic of China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, People’s Republic of China
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17
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Pape VR, Braun S, Peters S, Stingl M, Tucha O, Sammer G. The riddle of deliberate self-harm: Physiological and subjective effects of self-cutting cues in patients with borderline personality disorder and healthy controls. Personal Ment Health 2023; 17:328-351. [PMID: 37042027 DOI: 10.1002/pmh.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 04/13/2023]
Abstract
Self-harming behavior is a core symptom of borderline personality disorder. Self-report studies show a correlation between a lack of self-reported negative feelings toward self-cutting cues and the likelihood of future self-destructive behavior. Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50 years of age were confronted with pictures of self-cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self-Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self-cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self-cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self-cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long-lasting consequences of self-cutting behavior in the patients. Implications for therapy are discussed.
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Affiliation(s)
- Valeska Reichel Pape
- Institute of Psychiatry and Psychotherapy, University Medicine Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Silke Braun
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Svenja Peters
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Markus Stingl
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Oliver Tucha
- Institute of Psychiatry and Psychotherapy, University Medicine Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Gebhard Sammer
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
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Kuhlemeier A, Shattuck D, Willging C, Ramos MM. Associations Between Nonsuicidal Self-Injury and School-Based Health-Promotive Factors for Sexual and Gender Minority Youth and Their Peers. LGBT Health 2023; 10:617-628. [PMID: 37358568 PMCID: PMC10734899 DOI: 10.1089/lgbt.2021.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Purpose: The purpose of this study was to identify associations between school-based, health-promotive factors and nonsuicidal self-injury (NSSI) for sexual and gender minority youth and their heterosexual and cisgender peers. Methods: Using data from the 2019 New Mexico Youth Risk and Resiliency Survey (N = 17,811) and multilevel logistic regression to account for school-based clustering, we compared the effect of four school-based health-promotive factors on NSSI for stratified samples of lesbian/gay, bisexual, and gender-diverse (hereafter, gender minority [GM]) youth. Interactions were examined to evaluate the impact of school-based factors on NSSI for lesbian/gay, bisexual, (compared with heterosexual) and GM (compared with cisgender) youth. Results: Stratified analyses showed that three school-based factors (adult at school who listens, adult at school who believes they will be successful, clear school rules) were associated with lower odds of reporting NSSI for lesbian/gay and bisexual youth, but not GM youth. Interaction effects showed that lesbian/gay youth demonstrated greater reductions in odds of NSSI when reporting school-based supports compared with heterosexual youth. Associations between school-based factors and NSSI were not significantly different for bisexual compared with heterosexual youth. GM youth appear to experience no health-promotive effect on NSSI of school-based factors. Conclusions: Our findings underscore the potential of schools to provide supportive resources that reduce the odds of NSSI for most youth (i.e., heterosexual and bisexual youth), but are particularly effective in reducing NSSI among lesbian/gay youth. However, more study is needed to understand the potential impact of school-based health-promotive factors on NSSI for GM youth.
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Affiliation(s)
- Alena Kuhlemeier
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Daniel Shattuck
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Cathleen Willging
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Mary M. Ramos
- Division of Adolescent Medicine, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, USA
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19
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Haliczer LA, Dixon-Gordon KL. Social stressors, emotional responses, and NSSI urges and behaviors in daily life. J Affect Disord 2023; 338:601-609. [PMID: 37364658 DOI: 10.1016/j.jad.2023.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The defective self model of nonsuicidal self-injury (NSSI) theorizes that individuals who are highly self-critical are more likely to choose NSSI to regulate emotions. This model indirectly suggests that individuals who engage in NSSI may experience more self-conscious emotions in response to negative social feedback, increasing risk for near-term NSSI. This study examined (1) whether individuals with a history of NSSI (vs. without) display greater self-conscious and negative emotional reactions to daily social stressors, and more problematic features of these daily social stressors, and (2) whether greater-than-usual negative emotional reactions and social stressor features predict NSSI urges and behaviors in daily life. METHODS Participants were 134 female college students with recent, recurrent NSSI (n = 77) or no NSSI history (n = 57). Participants completed baseline measures of socioemotional functioning and a two-week daily diary protocol. RESULTS The NSSI (vs. no NSSI) group reported significantly greater self-conscious and negative emotional reactions to daily social stressors, and social stressors characterized by greater dysfunction. In the NSSI group, experiencing social stressors characterized by greater distress than one's average during the daily diary period was associated with same-day NSSI urges and behavior, greater confusion than one's average predicted same-day NSSI urges, and greater conflict than one's average predicted same-day NSSI behavior. Greater self-conscious and negative emotional reactions to these stressors than one's average predicted same-day NSSI urges and behavior. LIMITATIONS Limitations include reliance on self-report, a once-daily assessment, and lack of generalizability to other samples. CONCLUSIONS Interpersonal conflict and increased self-conscious emotions pose vulnerability for NSSI. Prevention and intervention efforts would benefit from including a focus on interpersonal functioning.
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Affiliation(s)
- Lauren A Haliczer
- University of Massachusetts Amherst, USA; Massachusetts General Hospital/Harvard Medical School, USA.
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20
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Xia Q, Zhang Y, Huang X. Psychological well-being and associated factors among parents of adolescents with non-suicidal self-injury: a cross-sectional study. Front Psychiatry 2023; 14:1253321. [PMID: 37743977 PMCID: PMC10513026 DOI: 10.3389/fpsyt.2023.1253321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) impacts not only adolescents who engage in it but also their parents. However, there has been limited research into the psychological well-being of these parents. This cross-sectional study aims to investigate the symptoms of anxiety and depression among parents of adolescents who engaged in NSSI in China and the factors associated with them. Methods A total of 400 parents of adolescents with NSSI were included. Socio-demographic information of these parents was collected. The Generalized Anxiety Disorder 7-item (GAD-7), the Patient Health Questionnaire 9-item (PHQ-9), and the Connor-Davidson Resilience Scale (CD-RISC) were used to assess symptoms of anxiety, depression, and psychological resilience, respectively. Results The majority of the parents were female (83.5%), married (86.3%), and had a senior high school or equivalent and lower education level (67.1%). The study found that 35.3% of the parents experienced clinically significant symptoms of anxiety (GAD-7 ≥ 7) and 40.1% had clinically significant symptoms of depression (PHQ-9 ≥ 7). Parents with larger ages and lower levels of psychological resilience were more likely to experience symptoms of anxiety and depression (p < 0.05). Parents who reported bad parent-child relationships showed a higher level of anxiety. Conclusion This study provides important insights into the symptoms of anxiety and depression among parents of adolescents with NSSI. Parental age, parent-child relationship, and psychological resilience were associated with symptoms of anxiety and depression in these parents. Implications for the development of interventions aimed at addressing symptoms of anxiety and depression in parents of adolescents with NSSI were discussed.
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Affiliation(s)
| | | | - Xuehua Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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21
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He K, Ji S, Sun L, Yang T, Chen L, Liu H, Wang K. Gender Differences in Facial Emotion Recognition Among Adolescents Depression with Non-Suicidal Self-Injury. Psychol Res Behav Manag 2023; 16:3531-3539. [PMID: 37675189 PMCID: PMC10479540 DOI: 10.2147/prbm.s418966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/12/2023] [Indexed: 09/08/2023] Open
Abstract
Objective Despite the perception that healthy female are superior at emotional identification, it remains unclear whether gender-specific differences exist in adolescent depression and whether such specific differences in emotional recognition are associated with the most salient feature of adolescent depression---non-suicidal self-injury (NSSI). Methods In this study, 1428 adolescents (1136 females and 292 males) with depression and NSSI were examined using the Facial Emotion Recognition Task, Patient Health Questionnaire-9 (PHQ-9), and Functional Assessment of Self-mutilation questionnaire (FASM). This study was grouped by gender. Data were analyzed using the descriptive statistics, independent sample t-test, chi-square test, non-parametric test (Mann-Whitney U-test), Spearman correlation and Multiple linear regression analysis. Results Depressed females reported a significantly greater frequency of self-injurious behaviour and more severe depressive symptoms than males. Face emotion recognition was also significantly more accurate in females and was positively correlated with levels of self-injury and depression, whereas no such correlations were found in males. Among depressed adolescents, face emotion recognition is better in females and is associated with self-injurious behaviour. Conclusion This study found that the greater susceptibility to depression and NSSI among adolescent females may stem in part from superior recognition and sensitivity to the negative emotions of others.
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Affiliation(s)
- Kongliang He
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
- Psychological Counseling Department, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Sifan Ji
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Lingmin Sun
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Tingting Yang
- Psychological Counseling Department, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
| | - Lu Chen
- Psychological Counseling Department, Hefei Fourth People’s Hospital, Hefei, 230022, People’s Republic of China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, People’s Republic of China
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Wallace GT, Henry KL, Barrett KC, Conner BT. Personality and emotion dysregulation profiles predict differential engagement in a wide range of health-risk behaviors. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1740-1752. [PMID: 34243687 DOI: 10.1080/07448481.2021.1947302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/13/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Health-risk behaviors have an unclear etiology and college students have elevated risk for engagement. Emotion dysregulation and several personality dimensions have been implicated in health-risk behaviors, but these constructs have rarely been studied together. Further, it is unknown if different types of health-risk behaviors have distinct etiologies. PARTICIPANTS 2077 college students completed a cross-sectional survey. METHODS Latent profile analysis discerned classes of participants from emotion dysregulation and personality dimensions. Differential engagement in self-injury, suicidality, disordered eating, substance misuse, and unprotected sex was evaluated across classes. RESULTS Three classes were identified, which were primarily distinguished by emotion dysregulation, urgency, and neuroticism. Health-risk behaviors generally increased across classes with increasing emotion-related constructs. Self-injury and suicidality demonstrated different patterns than other health-risk behaviors. CONCLUSIONS Results elucidate heterogeneity in health-risk behavior engagement. Focusing on emotional difficulties may be more important for reducing self-injury and suicidality than disordered eating, substance misuse, and risky sex.
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Affiliation(s)
- Gemma T Wallace
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Kimberly L Henry
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Karen C Barrett
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Bradley T Conner
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
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Farkas BF, Takacs ZK, Kollárovics N, Balázs J. The prevalence of self-injury in adolescence: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02264-y. [PMID: 37486387 DOI: 10.1007/s00787-023-02264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
In the past 10 years, there has been a growing interest in self-injurious behavior (SIB) among adolescents. The lifetime prevalence of SIB is between 16 and 22% in community sample with females more likely to engage in SIB. There are conflicting results about the global distribution of the prevalence of SIB and whether the SIB has increased in the 21st century. Our aim in the current study was to conduct a systematic search of and meta-analysis on the prevalence of SIB in adolescents over the past 5 years' worth of published papers and to examine gender, continental, and year differences. We conducted a systematic search in June 2020 of six databases (PubMed, Scopus, Web of Science, OVID Medline, PsycINFO, EBSCO) with three main search terms: "self-injurious behavior," "prevalence," and "adolescence." Article inclusion criteria were (a) written in English; (b) published between January 1, 2015, and June 18, 2020; and (c) focused on a community sample. Titles and abstracts of the articles were screened first. Then, the relevant full texts were read, and those that met the inclusion criteria were collected. We used Comprehensive Meta-Analysis software was used to conduct the analyses. After the screening process 97, articles were included in the meta-analysis. The age of the samples ranged from 11.00 to 18.53 years. The overall average prevalence of nonsuicidal self-injury in the studies was 16%. There was a significant gender difference: females reported a higher prevalence than males (19.4% and 12.9%, respectively). A significantly higher prevalence was found among Asian articles than those from other continents (19.5% and 14.7%, respectively). The prevalence of SIB did not change significantly between 2013 and 2018. The current research draws attention to the high prevalence of SIB among adolescents, especially among females and those living in Asia. It is important to address this behavior, both in terms of prevention and intervention.
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Affiliation(s)
| | - Zsofia K Takacs
- Faculty of Education and Psychology, Institute of Education, Eötvös Loránd University, Budapest, Hungary
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Nóra Kollárovics
- Mental Health Sciences Doctoral School, Semmelweis University, Budapest, Hungary
| | - Judit Balázs
- Department of Developmental and Clinical Child Psychology, Faculty of Education and Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Oslo New University College, Oslo, Norway
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Masland SR, Finch EF, Schnell SE. Effects of Group Psychotherapy for Nonsuicidal Self-Injury: A Meta-Analysis. Int J Group Psychother 2023; 73:183-201. [PMID: 38446601 DOI: 10.1080/00207284.2023.2191683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Nonsuicidal self-injury (NSSI) is prevalent and concerning among adolescents and adults. Although prior meta-analytic work has considered the efficacy of individual psychotherapy for reducing NSSI, the efficacy of group psychotherapy remains unclear. We conducted a systematic meta-analysis of group psychotherapy studies with NSSI measures. We identified a total of eight studies, including published articles (n = 6) or dissertations (n = 2) with 10 total effect sizes for group interventions. Overall, random-effects meta-analysis suggests that group psychotherapies have a significant small effect on NSSI. However, when corrected for publication bias, the effect is no longer significant. This meta-analysis cautiously suggests that group psychotherapies, which are cost-effective and efficient, hold promise for attenuating NSSI. The field would benefit from further study and treatment refinement, including consideration of what works for whom.
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Sorgi-Wilson KM, Cheung JC, Ciesinski NK, McCloskey MS. Cognition and Non-Suicidal Self-Injury: Exploring Relationships with Psychological Functions. Arch Suicide Res 2023; 27:1002-1018. [PMID: 35924878 PMCID: PMC9898468 DOI: 10.1080/13811118.2022.2106919] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is strongly associated with difficulties in emotion regulation, but its relationships with maladaptive cognitive processes are less clear. METHOD The current study examined relationships between self-reported NSSI (presence, number of methods, frequency, recency, duration, functions) and negative cognitive processes (rumination, worry, self-criticism, perceived burdensomeness, thwarted belongingness) among 1,357 undergraduates. Cognition variables were submitted to exploratory factor analysis (EFA), and relationships were examined between the resulting factors and NSSI history (among the full sample) and NSSI severity and functions (among those with a history of NSSI). RESULTS The EFA derived two higher order cognitive factors: repetitive negative thinking (RNT) and negative self-perception (NSP). Both RNT and NSP were significantly higher among participants with than those without a history of NSSI. Among those with NSSI, NSP, but not RNT, was positively related to lifetime NSSI frequency and number of methods, as well as recency (presence in the past 12 months) and total duration (in years) of NSSI engagement. Moreover, RNT and NSP were positively associated with aggregate intrapersonal (but not interpersonal) functions of NSSI. The two cognitive factors demonstrated differential relationships with the individual intrapersonal NSSI functions. CONCLUSIONS Higher order categories of cognitive risk factors may have unique relationships with functions and severity of NSSI, with possible implications for more targeted approaches to risk assessment and intervention.HighlightsNegative thinking and self-perception were higher in people who engage in NSSI.Negative self-perception was associated with greater NSSI severity.Negative thinking and self-perception had different relations to NSSI functions.
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26
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Mettler J, Cho S, Stern M, Heath NL. Negative and Positive Emotional Reactivity in Women With and Without a History of Self-Injury. Psychol Rep 2023:332941231180118. [PMID: 37247614 DOI: 10.1177/00332941231180118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In trying to better understand why certain individuals self-injure, researchers have proposed high emotional reactivity for negative emotions may influence vulnerabilities and predispose individuals to react to stressful situations in a dysregulated manner, thus engaging in non-suicidal self-injury (NSSI). However, the role of emotional reactivity for positive emotions in those with a history of NSSI is still unclear. Thus, the present study sought to examine group differences in the reactivity of (a) negative and (b) positive emotions in young adults with and without a history of NSSI engagement, and (c) to evaluate whether the reactivity of positive emotions could predict NSSI engagement when controlling for reactivity of negative emotions. The sample consisted of 96 female students who reported engaging in NSSI within the past 2 years (Mage = 20.28 years, SD = 1.65) and an age-matched female comparison group with no NSSI history (Mage = 20.43 years, SD = 1.76). Results from separate MANOVAs indicated individuals with a history of NSSI reported higher negative reactivity across all aspects (emotional intensity, sensitivity, and persistence) than the comparison group, Wilk's λ = .86, F (3,188) = 10.65, p < .001, partial η2 = .145; however, no significant differences emerged for positive reactivity, Wilk's λ = .99, F (3,188) = 0.52, p = .669. Moreover, a logistic regression revealed that persistence of negative emotions was the only significant predictor of NSSI, Wald χ2 (1) = 4.54, p = .03. The present results highlight the importance of the persistence of negative emotions for individuals who engage in NSSI. Furthermore, the current study provides the first suggestion of no significant differences in positive emotional reactivity between individuals with and without NSSI; underlining the importance of focusing on negative emotional reactivity in clinical practice as well as using positive emotions to "undo" the effect of negative emotions.
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Affiliation(s)
- Jessica Mettler
- Faculty of Education, Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Sohyun Cho
- Faculty of Education, Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Melissa Stern
- Grey Zone Psychology & Wellness Centre, Montreal, Quebec, Canada
| | - Nancy L Heath
- Faculty of Education, Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
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27
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Tseng YC, Ditchman N. Non-suicidal self-injury in a college sample: Intrapersonal and family factors. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-10. [PMID: 37167593 DOI: 10.1080/07448481.2023.2209206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Objective: Adolescents and young adults are at risk for non-suicidal self-injury (NSSI) and suicidal behavior. This study examined intrapersonal (depressive symptoms, self-criticism) and family (perceived family functioning, parenting style, parental attachment) factors associated with reported history of NSSI in a college sample. Method: Participants included 111 undergraduate students (Mage = 20.2) from a private, nonprofit university. Data were collected via online survey. Hierarchical logistic regression analysis was conducted. Results: The final model was statically significant, Nagelkerke R2 = .40, suggesting a robust association between the predictors and history of NSSI. Self-criticism and unhealthy family functioning were significant predictors of NSSI behaviors after controlling for study variables and demographic characteristics. Reported history of engaging in NSSI was positively correlated with parent alienation, unhealthy family functioning, self-criticizing behaviors, and depressive symptoms. Conclusion: College mental health providers should be familiar with risk factors of NSSI as well as strategies to address self-criticism.
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Affiliation(s)
- Yen Chun Tseng
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Nicole Ditchman
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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28
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Peng S, Zhang W, Yang T, Cottrell RR, Rockett IRH. Contextual influences on deliberate self-harm among Chinese university undergraduates: A representative nationwide study. J Affect Disord 2023; 335:371-376. [PMID: 37169084 DOI: 10.1016/j.jad.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Numerous studies have identified factors associated with deliberate self-harm (DSH), but environmental influences have largely been neglected. This study explored regional and university contextual factors that impact DSH among undergraduate students in China. METHODS Subjects in this observational cross-sectional study totaled 5016 undergraduate students, who were identified through multistage survey sampling in 22 Chinese universities. Individual-level data were obtained through a self-administered questionnaire, and environmental variables were extracted from the National Bureau of Statistics database. Multilevel logistic regression models were used to examine regional correlates of DSH. RESULTS The overall prevalence of self-reported DSH in the study sample was 7.5 % (95 % CI: 4.1 %, 10.9 %). The full multilevel logistic model showed university rank and city size were inversely associated with DSH prevalence (Adjusted Odds Ratio (AOR): 0.24 and 0.55). Regional unemployment rates were positively associated with DSH prevalence (AOR: 1.98, 95 % CI: 1.48, 2.65). DISCUSSION Contextual disparities appear to contribute to DSH among Chinese undergraduates. Preventive initiatives must focus on redressing imbalances in the allocation of social and economic resources across universities and regions.
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Affiliation(s)
- Sihui Peng
- School of Medicine, Jinan University, Guangzhou 510632, China
| | - Weifang Zhang
- The Stomatology Hospital, Zhejiang University School of Medicine, 310006, China
| | - Tingzhong Yang
- Department of Social Medicine/Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou 310058, China; Injury Control Research Center, West Virginia University, Morgantown, WV 26506-9190, USA.
| | - Randall R Cottrell
- Public Health Studies Program, School of Health and Applied Human Sciences, University of North Carolina, Wilmington, NC 28403, USA.
| | - Ian R H Rockett
- Department of Epidemiology, School of Public Health/Injury Control Research Center, West Virginia University, Morgantown, WV 26506-9190, USA.
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29
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Kim S, Woo S, Lee JS. Investigation of the Subtypes of Nonsuicidal Self-Injury Based on the Forms of Self-Harm Behavior: Examining Validity and Utility via Latent Class Analysis and Ecological Momentary Assessment. J Korean Med Sci 2023; 38:e132. [PMID: 37128876 PMCID: PMC10151622 DOI: 10.3346/jkms.2023.38.e132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/19/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND This study aimed to empirically derive and validate subtypes of nonsuicidal self-injury (NSSI) based on the forms of self-harm behavior. METHODS Sixty young adults who exhibited repetitive NSSI completed a clinical interview and baseline measures, followed by a two-week ecological momentary assessment (EMA). A latent class analysis was administered to identify NSSI subtypes based on the forms of self-harm behavior. The subtypes were then compared to baseline clinical and EMA variables, including emotions and urges to self-harm. RESULTS The best-fitting model supported two subtypes: 1) substance abuse and suicide attempt subtype and 2) cutting and scratching subtype. The substance abuse and suicide attempt subtype reported a higher rate of engaging in lifetime suicide plans and suicide attempts and a higher number of lifetime suicide attempts. They also showed significantly higher severity of self-harm behavior, borderline personality traits, anger, posttraumatic symptoms, and difficulties in emotion regulation when compared to the cutting and scratching subtype. However, there was no inter-subtype difference in self-esteem. In the EMA data, anger toward others, feeling of rejection, loneliness, and helplessness were significantly high in the substance abuse and suicide attempt subtype. The variability of anger toward others was also higher in this subtype compared to the cutting and scratching subtype. Finally, in the two-week research period, the substance abuse and suicide attempt group showed a higher rate of reported urges to self-harm with or without suicidal intent. CONCLUSION Findings support the validity of the subtypes based on the forms of self-harm behavior, suggesting the clinical utility of addressing heterogeneity within individuals exhibiting self-harm for assessment and treatment.
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Affiliation(s)
- Sojung Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Korea
- Department of Psychology, Yeungnam University, Gyeongsan, Korea.
| | - Sungbum Woo
- Cultural Contents Technology Research Institute, Gachon University, Seongnam, Korea
- Department of Counseling Psychology, Hanyang Cyber University, Seoul, Korea
| | - Jong-Sun Lee
- Department of Psychology, Kangwon National University, Chuncheon, Korea
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30
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Yan Y, Leong F, Song A, Goldman-Mellor S. Incidence and Correlates of Emergency Department Visits for Deliberate Self-Harm Among Asian American Youth. J Adolesc Health 2023; 72:510-518. [PMID: 36535866 PMCID: PMC10494551 DOI: 10.1016/j.jadohealth.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This study examined the epidemiology of self-harm emergency department (ED) visits among Asian American and Pacific Islander (AAPI) youth, and associated factors. METHODS We used California ED visit records in 2010 and 2011 to calculate incidence rates of self-harm ED visits for AAPI versus non-Hispanic White (NHW) patients aged 10-29 years. Demographic and clinical characteristics were compared for AAPI versus NHW patients presenting with self-harm. We used modified Poisson regression models to estimate the relative risk of recurrent ED self-harm visits for AAPI versus NHW patients and examined the association of insurance type and gender with recurrent self-harm among AAPIs. RESULTS Rates of self-harm ED visits for young AAPI patients were 38 and 26 per 100,000 among females and males, respectively. Although AAPI patients presenting with self-harm were equally or less likely than NHW patients to have comorbid psychological and substance use diagnoses at their index visit, they were 25% more likely to be admitted to hospital. However, they were 40% less likely to have a recurrent ED self-harm visit. Among AAPI patients, those who used Medicaid were significantly more likely than those with other insurance to be admitted as inpatients. DISCUSSION Young AAPI patients presenting to EDs with deliberate self-harm have different sociodemographic and clinical profiles compared to NHW patients. Our study also demonstrates significant heterogeneity in risk of recurrent self-harm by gender and insurance type among AAPI patients. This information may be useful for future intervention programs among self-harming AAPI youth.
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Affiliation(s)
- Yueqi Yan
- Health Sciences Research Institute, University of California, Merced, California
| | - Frederick Leong
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Anna Song
- Department of Psychological Science, University of California, Merced, California
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An Integrative Model of In-Hospital and Out-of-Hospital Nursing Care for Non-Suicidal Self-Injury: A Narrative Review. Brain Sci 2023; 13:brainsci13030466. [PMID: 36979278 PMCID: PMC10046685 DOI: 10.3390/brainsci13030466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Background: Non-suicidal self-injury (NSSI) refers to the intentional and repeated physical trauma of an individual without explicit suicidal intent, which has negative effects on the physical and mental well-being of an individual, especially for adolescents. Timely and accessible nursing care may play an important role in the survival and rehabilitation process of NSSI. Methods: In this review, we systematically discuss the nursing care of NSSI behavior and provide recommendations based on an integrated nursing model for NSSI management. Results: As reported in previous studies, a variety of factors can contribute to NSSI behavior, such as personality traits, current psychological status, history of mental illnesses, as well as family and social factors. In-hospital care is the most necessary and effective care during acute episodes of NSSI behavior. To effectively manage inpatients with NSSI behaviors, nurses should first understand the motivation of NSSI, and provide comprehensive and multi-level care through nurse-patient communication, individualized psychological care, and multidisciplinary cooperation with other professionals. While the purpose of out-of-hospital nursing is to reduce the frequency of NSSI behaviors by screening high-risk individuals, providing psychological support, promoting health education, and improving self-awareness. Conclusions: An integrative model of in-hospital and out-of-hospital nursing care can help improve the clinical management and long-term prognosis of patients with NSSI and minimize the risk of suicidal ideation or suicidal behavior.
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Liu RT. The epidemiology of non-suicidal self-injury: lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England. Psychol Med 2023; 53:274-282. [PMID: 33960286 PMCID: PMC10324294 DOI: 10.1017/s003329172100146x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although the clinical importance of non-suicidal self-injury (NSSI) has received increasing recognition, relatively little is known about its epidemiology. The objective of this study was to estimate the lifetime prevalence of NSSI in adults and its association with sociodemographic characteristics, psychiatric disorders, and lifetime treatment for NSSI. METHODS A nationally representative face-to-face survey was conducted with 7192 adults aged ≥18 years in England. Respondents were interviewed about engagement in NSSI, psychiatric illness, suicidal thoughts and behavior, and treatment history for this behavior. RESULTS The estimated lifetime prevalence rate of NSSI was 4.86%. Younger age, growing up without biological parents in the household, being unmarried, and impoverished backgrounds were associated with NSSI. The majority of respondents with lifetime NSSI (63.82%) had at least one current psychiatric disorder. Most psychiatric conditions were associated with greater odds of lifetime NSSI in multivariate models. NSSI was strongly associated with suicidal ideation and suicide attempts, respectively, even after accounting for psychiatric disorders and sociodemographic covariates. A substantial proportion of respondents with NSSI history (30.92%) have engaged in medically severe self-harm, as indexed by requiring medical attention for this behavior. The majority of respondents with NSSI (56.20%) had not received psychiatric care for this behavior. CONCLUSIONS NSSI is prevalent in the general population and associated with considerable psychiatric comorbidity. A high rate of unmet treatment needs is evident among those with this behavior. Those at the greatest lifetime risk for NSSI may also be particularly limited in their resources to cope with this behavior.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Support for a Transdiagnostic Motivational Model of Self-Damaging Behaviors: Comparing the Salience of Motives for Binge Drinking, Disordered Eating, and Nonsuicidal Self-Injury. Behav Ther 2022; 53:1219-1232. [PMID: 36229118 DOI: 10.1016/j.beth.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/31/2022] [Accepted: 06/18/2022] [Indexed: 11/23/2022]
Abstract
Integrating across motivational models suggests that different self-damaging behaviors (SDBs) are enacted for similar reasons. However, it remains unclear whether some motives are more relevant to certain SDBs than others. To answer this question, the present study compared the salience of 8 potentially shared motives across 3 exemplar SDBs, selected to represent different points along the internalizing and externalizing spectra: binge drinking, disordered eating (binge eating, purging, fasting), and nonsuicidal self-injury (NSSI). Seven hundred and four first-year university students (73% female, Mage = 17.97) completed monthly surveys assessing their engagement in and motives for SDBs. Motives were conceptualized as either interpersonal (bonding with others, conforming with others, communicating strength, communicating distress, reducing demands) or intrapersonal (reducing negative emotions, enhancing positive emotions, punishing oneself). Multilevel models compared endorsement of each motive across SDBs. Results revealed that SDBs were motivated by similar goals, albeit to different degrees. Although some exceptions emerged, interpersonal motives were most salient to binge drinking, followed by disordered eating, and then NSSI. In contrast, intrapersonal motives were most salient to NSSI, followed by disordered eating, and then binge drinking. Motivational differences were also found within disordered eating. For example, punishing oneself was more relevant to purging and fasting than binge eating, whereas relieving negative emotions was more relevant to binge eating and purging than fasting. Similar to dimensional models that position SDBs on internalizing or externalizing spectra, the salience of motives for binge drinking and NSSI may fall on distinct spectra (i.e., interpersonal and intrapersonal, respectively), with motives for disordered eating exhibiting elements consistent with both spectra. This study supports a common motivational framework for investigating and potentially treating a variety of topographically distinct SDBs.
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Huang H, Ding Y, Wan X, Liang Y, Zhang Y, Lu G, Chen C. A meta-analysis of the relationship between bullying and non-suicidal self-injury among children and adolescents. Sci Rep 2022; 12:17285. [PMID: 36241694 PMCID: PMC9568539 DOI: 10.1038/s41598-022-22122-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/10/2022] [Indexed: 01/10/2023] Open
Abstract
Non-suicidal self-injury (NSSI) has attracted increasing attention due to its high detection rate, high risk and high repeatability. There is a need for the early identification of preventable occurrence factors, which is necessary to facilitate screening and intervention, especially to facilitate the early detection of high-risk individuals. This research aims to investigate the relationship between bullying behaviour and non-suicidal self-injury among children and adolescents by means of meta-analysis. The PubMed, Embase, Web of Science, SCOPUS, PsycINFO, CKNI and WAN FANG databases were searched from inception to 14 December 2021 for studies that explored the relationship between bullying behaviour and NSSI among children and adolescents. A total of 29 articles met the inclusion criteria of the meta-analysis, and 54 independent effect sizes were obtained, including 53,501 subjects. Victims [OR 2.46 (95% CI 2.14-2.83); p < 0.001], bullies [OR 2.12 (95% CI 1.37-3.27); p < 0.001], and bully-victims [OR: 2.98 (95% CI 1.85-4.82); p < 0.001] were more likely to have NSSI than uninvolved children or adolescents. In addition, analyses showed the absence of publication bias. In the victim group, the older the age was, the lower the risk of NSSI (z = - 3.74, p = 0.00). Gender does not play a moderating effect on the association between bullying behaviour and non-suicidal self-injury. The relationship between involvement in bullying and NSSI was demonstrated. By taking measures to prevent bullying, the incidence of NSSI in children and adolescents can be potentially reduced.
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Affiliation(s)
- Haitao Huang
- grid.256922.80000 0000 9139 560XInstitute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, 475004 People’s Republic of China
| | - Yueming Ding
- grid.256922.80000 0000 9139 560XInstitute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, 475004 People’s Republic of China
| | - Xiao Wan
- grid.256922.80000 0000 9139 560XInstitute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, 475004 People’s Republic of China
| | - Yipei Liang
- grid.256922.80000 0000 9139 560XInstitute of Business Administration, School of Business, Henan University, Kaifeng, 475004 People’s Republic of China
| | - Yiming Zhang
- grid.256922.80000 0000 9139 560XInstitute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, 475004 People’s Republic of China
| | - Guangli Lu
- grid.256922.80000 0000 9139 560XInstitute of Business Administration, School of Business, Henan University, Kaifeng, 475004 People’s Republic of China
| | - Chaoran Chen
- grid.256922.80000 0000 9139 560XInstitute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, 475004 People’s Republic of China
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Kellerman JK, Millner AJ, Joyce VW, Nash CC, Buonopane R, Nock MK, Kleiman EM. Social Support and Nonsuicidal Self-injury among adolescent Psychiatric Inpatients. Res Child Adolesc Psychopathol 2022; 50:1351-1361. [PMID: 35579780 PMCID: PMC10773970 DOI: 10.1007/s10802-022-00931-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
Cross-sectional studies and prospective studies with long follow-up periods (e.g., years) have shown that lower levels of social support are associated with nonsuicidal self-injury (NSSI) among adolescents. This study examined how short-term changes in social support may contribute to NSSI behavior and whether different sources of support (e.g., friends, family members) provide differential protective effects against NSSI. We examined fluctuations in NSSI and social support perceived from multiple sources among a sample of 118 high-risk adolescents hospitalized for serious self-harm risk. Participants provided daily reports of social support and any self-injurious behavior for the duration of their inpatient treatment (721 total observations, average observations per participant = 6.11). Multi-level models were used to assess variability in social support and how these fluctuations relate to whether or not an individual engages in NSSI. Over one-third of participants reported engaging in NSSI at least once during inpatient hospitalization and self-reported social support varied within person across sources of support (ICC range = 0.68-0.81). Support perceived from family members and inpatient unit staff was inversely associated with NSSI, but no relationship was found between NSSI and support from other patients on the unit or friends outside of the unit. These findings suggest that the protective effects of social support for NSSI vary over short periods of time and that support perceived from adults is particularly relevant among this high-risk clinical sample. This study represents an important step in identifying risk factors to improve the detection and prevention of NSSI among adolescent inpatients.
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Affiliation(s)
- John K Kellerman
- Department of Psychology, School of Arts and Sciences Rutgers, The State University of New Jersey, 53 Avenue E, Room 627, 08854, Piscataway, NJ, USA.
| | - Alexander J Millner
- Franciscan Children's Hospital, Brighton, MA, USA
- Harvard University, Cambridge, MA, USA
| | | | - Carol C Nash
- Franciscan Children's Hospital, Brighton, MA, USA
| | | | - Matthew K Nock
- Franciscan Children's Hospital, Brighton, MA, USA
- Harvard University, Cambridge, MA, USA
| | - Evan M Kleiman
- Department of Psychology, School of Arts and Sciences Rutgers, The State University of New Jersey, 53 Avenue E, Room 627, 08854, Piscataway, NJ, USA
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Zhang R, Zhang C, Xu W. Longitudinal association of peer victimization with aggression and self-injury in adolescence: The mediating role of belief in a just world. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Miller AE, Racine SE. Emotion regulation difficulties as common and unique predictors of impulsive behaviors in university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1387-1395. [PMID: 32790500 DOI: 10.1080/07448481.2020.1799804] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 05/19/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
Objectives: Researchers examined associations between specific forms of emotion dysregulation and numerous behavioral manifestations of impulsivity (i.e., problematic alcohol use, drug use, risky sexual activity, binge eating, non-suicidal self-injury). Participants: Participants were 238 undergraduate students (69% female). Method: Emotion dysregulation was assessed using the Difficulties in Emotion Regulation Scale (DERS). Path models examined each DERS subscale on its own, and all DERS subscales together, as predictors of all impulsive behaviors. Results: Lack of emotional clarity predicted the largest number of impulsive behaviors, both on its own and after controlling for other forms of emotion dysregulation. Non-acceptance of emotions and difficulties achieving goals when upset also related to several impulsive behaviors. Conclusions: Certain emotion regulation difficulties, particularly poor emotional clarity, may represent specific mechanisms that lead to maladaptive impulsive behaviors. Findings provide useful information for incorporating specific emotion regulation skills in harm prevention programs and treatments for university students.
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Affiliation(s)
- Alexia E Miller
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Kruzan KP, Mohr DC, Reddy M. How Technologies Can Support Self-Injury Self-Management: Perspectives of Young Adults With Lived Experience of Nonsuicidal Self-Injury. Front Digit Health 2022; 4:913599. [PMID: 35847416 PMCID: PMC9278014 DOI: 10.3389/fdgth.2022.913599] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background There is growing interest in the design of digital interventions to improve conditions for young people who engage in high-risk behaviors, like nonsuicidal self-injury (NSSI). However, few studies have focused on how young people self-manage NSSI, or their existing, and historic, use of technologies to support their goals related to NSSI behavior change. Such an understanding has the potential to inform the design of digital interventions that meet this population's unique needs. Objectives This study aims to (a) understand the self-management practices of young adults who engage in NSSI, (b) explore how they currently use technologies for self-injury self-management, and (c) identify the ways they can envision an app-based technology supporting their self-management. Methods and Materials Twenty young adults (aged 18-24) with lived experience of NSSI, and who were not currently enrolled in therapy, were recruited from online venues. Participants completed baseline measures to assess mental health and NSSI characteristics, followed by a virtual 1-h semi-structured interview where they were invited to share their experience of self-management, their goals, and their thoughts on supportive technology. Interview scripts were transcribed and analyzed via thematic analysis. Results Themes and sub-themes are organized under two broad domain areas: (1) How young adults self-manage NSSI thoughts and behaviors and (2) Opportunities and challenges for digital interventions to assist young adults in their recovery process. We found that young adults had varied experiences with, and goals related to, NSSI. Participants reported a lack of effective strategies to reduce NSSI urges and a desire for an app-based technology to track patterns and deliver personalized suggestions for self-management. Participants reported existing use of technologies as part of self-management, as well as early information and support seeking for NSSI online. Conclusions This study contributes a greater understanding of young people's experiences with self-injury, their self-management practices, and their desire to engage with technology. Our findings highlight the need for design flexibility in developing digital interventions that support individual goals, unique presentations of NSSI, and needs at different phases of recovery. Implications for the design of highly personalized and relevant digital interventions to address NSSI are discussed.
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Affiliation(s)
- Kaylee Payne Kruzan
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David C. Mohr
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Madhu Reddy
- Department of Informatics, University of California, Irvine, Irvine, CA, United States
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Cliffe B, Moore E, Whittle K, Stallard P. The acceptability, safety, and effects of a smartphone application for university students who self-harm: an open study (Preprint). JMIR Form Res 2022. [DOI: 10.2196/40492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stagaki M, Nolte T, Feigenbaum J, King-Casas B, Lohrenz T, Fonagy P, Montague PR. The mediating role of attachment and mentalising in the relationship between childhood maltreatment, self-harm and suicidality. CHILD ABUSE & NEGLECT 2022; 128:105576. [PMID: 35313127 PMCID: PMC10466023 DOI: 10.1016/j.chiabu.2022.105576] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/01/2022] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. Based on a developmental mentalisation-based theoretical framework, childhood adversity compromises mentalising ability and attachment security, which in turn increase vulnerability to later stressors in adulthood. OBJECTIVE This study aimed to investigate the role of attachment and mentalising as potential mechanisms in the relationship between childhood maltreatment, self-harm and suicidality. PARTICIPANTS AND SETTING We recruited 907 adults from clinical and community settings in Greater London. METHODS The study design was cross-sectional. Participants completed self-report questionnaires on retrospectively rated childhood trauma, and current attachment to the romantic partner, mentalising, self-harm, suicidal ideation and attempt. We used structural equation modelling to examine the data and conceptualized childhood maltreatment as a general factor in a confirmatory bifactor model. RESULTS The results showed that childhood maltreatment was both directly associated with self-harm and suicidality and indirectly via the pathways of attachment and mentalising. CONCLUSIONS These findings indicate that insecure attachment and impaired mentalising partially explain the association between childhood maltreatment, self-harm and suicidality. Clinically, they provide support for the potential of mentalisation-based therapy or other psychosocial interventions that aim to mitigate the risk of self-harm and suicidality among individuals who have experienced childhood maltreatment via increasing understanding of self and other mental states.
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Affiliation(s)
- Maria Stagaki
- Division of Psychiatry, University College London, London, United Kingdom.
| | - Tobias Nolte
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom; Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Janet Feigenbaum
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Brooks King-Casas
- Fralin Biomedical Research Institute, Department of Psychology, Virginia Tech, Roanoke, VA, United States of America
| | - Terry Lohrenz
- Fralin Biomedical Research Institute, Department of Psychology, Virginia Tech, Roanoke, VA, United States of America
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, United Kingdom; Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - P Read Montague
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom; Fralin Biomedical Research Institute, Department of Psychology, Virginia Tech, Roanoke, VA, United States of America; Department of Physics, Virginia Tech, Blacksburg, VA, United States of America; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Virginia Tech, Roanoke, VA, United States of America
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Abstract
We aimed to determine differences between adolescents with non-suicidal self-harm with and without a history of suicide attempt (SA). Sixty-eight adolescents with a mean age of 15.6 years (SD = 1.5) attending child and adolescent psychiatric outpatient clinics for repeated self-harm in Oslo, Norway, were included. A battery of instruments was used to assess sociodemographic information and psychopathology such as Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, emotional and behavioral problems, borderline symptoms, depression, hopelessness, suicidal ideation, and history of SA. Twenty-six participants (38.2%) reported a lifetime history of SA. Compared to the participants without a history of SA, those with an SA history had used a higher number of methods of self-harm and methods with higher lethality and had higher degrees of emotional and behavioral problems. They also scored higher in depressive symptoms, borderline pathology, emotional dysregulation, hopelessness, and suicidal ideation. History of SA was independently associated with perceived moderate to high risk of death on the most severe episode of self-harm (adjusted odds ratio [aOR], 15.93; 95% confidence interval [CI], 1.96-129.66), a longer duration (months) since self-harm debut (aOR, 1.07; 95% CI, 1.01-1.13), and suicidal ideation severity (aOR, 1.05; 95% CI, 1.01-1.11). Parental report of behavioral problems associated with SA suggested a strong association with externalizing problems. A combination of having a high level of psychopathology, externalizing problems, an extended history of self-harm behavior and use of more lethal self-harm methods seems to entail a significantly increased risk for making SAs among adolescents with non-suicidal self-harm. HIGHLIGHTSNon-suicidal self-harm (NSSH) with suicide attempt may be distinctive from NSSH without suicide attempt.Adolescents with NSSH with suicide attempt had relatively greater psychopathology.Protracted/lethal self-harm methods and externalizing problems indicate comorbidity.
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Meaning in Life Moderates Relations between Personality and Temperament and Nonsuicidal Self-Injury in Hospitalized Adolescents. J Youth Adolesc 2022; 51:1622-1635. [PMID: 35478302 DOI: 10.1007/s10964-022-01615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/09/2022] [Indexed: 10/18/2022]
Abstract
Previous research indicates that sensation seeking, emotion dysregulation, and impulsivity are predictive of non-suicidal self-injury (NSSI). A body of research supports that meaning in life predicts improved mental health and well-being, including fewer suicidal thoughts and attempts, yet no research has examined the moderating effects of meaning in life on the relations between personality and temperament and NSSI. Given the growing incidence rates of NSSI among adolescents and the potential lifelong consequences of NSSI, it is imperative to better understand the factors that reduce the rates at which adolescents in a clinical sample engage in NSSI. The present study investigates if the protective factors of meaning in life moderate the relation between personality and temperament variables and NSSI among 126 adolescents (71% female, Mage = 16.1, SD = 1.1, range 13-18, 80% White) residing in an inpatient psychiatric hospital who endorsed NSSI in the last 12 months. Results from hurdle modeling indicate that two subtypes of meaning in life, presence of meaning in life and search for meaning of life, may serve as robust protective factors against engagement in NSSI among a clinical sample of adolescents. Additionally, results suggest that search for meaning, but not presence of meaning in life, variables moderate the relations between personality and temperament and NSSI. Results provide evidence that meaning in life is an understudied variable of importance in understanding how to prevent or treat NSSI. It also underscores the need to develop, refine, and test meaning-making interventions.
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Yang F, Jiang L, Miao J, Xu X, Ran H, Che Y, Fang D, Wang T, Xiao Y, Lu J. The association between non-suicidal self-injury and negative life events in children and adolescents in underdeveloped regions of south-western China. PeerJ 2022; 10:e12665. [PMID: 35287346 PMCID: PMC8917796 DOI: 10.7717/peerj.12665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/30/2021] [Indexed: 01/07/2023] Open
Abstract
Background The association between negative life events and Non-suicidal self-injury (NSSI) in children and adolescents has been extensively discussed. Nevertheless, little is known about the relationship between negative life events and repetition and severity of NSSI. This survey aims to understand the association between NSSI prevalence, severity, repetition and the negative life events in children and adolescents in underdeveloped regions in south-western China. Methods In this population-based cross-sectional study, 3,146 children and adolescents were included from underdeveloped regions of south-western China, and each of them requested to complete a self-assessment questionnaire. The Modified Version of Adolescents Self-Harm Scale (MASHS) and the Adolescent Self-rating negative Life Events Check-list were used to evaluate NSSI behaviors and negative life events, respectively. The statistical implementation of this study was carried out in the R statistical software, and the logistic regression analysis method was used to analyze the relationship between negative life events and adolescents' non-suicidal self-injury behaviors. Results The average age of all included participants was 13.31 years old. The lifetime prevalence of NSSI was 47.0% (95% CI [36.3-58.0%]). Gender, grade level and ASLEC was positively associated with NSSI. Further analysis revealed that, for all five dimensions of ASLEC, only interpersonal relationship factor (IRF) (OR 1.77 (95% CI [1.06-2.97])), health adaptation factor (HAF) (OR 2.08 (95% CI [1.31-3.31])) showed prominent association with NSSI. Multivariate Logistic regression models revealed that, repetitive NSSI (OR 4.54 (95% CI [3.66-5.63])) and NSSI severity (OR 9.01 (95% CI [6.11-13.29])) were positively associated with ASLEC. Conclusion NSSI is very common among children and adolescents in underdeveloped regions of south-western China. Negative life event are positively associated with NSSI, repeated NSSI, and severe NSSI. Negative life events centered intervention measures might be effective in reducing NSSI among school children and adolescents in underdeveloped regions of south-western China.
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Affiliation(s)
- Fan Yang
- First Affiliated Hospital of Kunming Medical University, Psychiatric Department, Kunming, Yunnan, China
| | - Linling Jiang
- First Affiliated Hospital of Kunming Medical University, Psychiatric Department, Kunming, Yunnan, China
| | - Jing Miao
- First Affiliated Hospital of Kunming Medical University, Psychiatric Department, Kunming, Yunnan, China
| | - Xiufeng Xu
- First Affiliated Hospital of Kunming Medical University, Psychiatric Department, Kunming, Yunnan, China
| | - Hailiang Ran
- Kunming Medical University, School of Public Health, Kunming, Yunnan, China
| | - Yusan Che
- Kunming Medical University, School of Public Health, Kunming, Yunnan, China
| | - Die Fang
- Kunming Medical University, School of Public Health, Kunming, Yunnan, China
| | - TianLan Wang
- Lincang Psychiatric Hospital, Lincang, Yunnan, China
| | - Yuanyuan Xiao
- Kunming Medical University, School of Public Health, Kunming, Yunnan, China
| | - Jin Lu
- First Affiliated Hospital of Kunming Medical University, Psychiatric Department, Kunming, Yunnan, China
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Holden RR, Patterson AA, Fekken GC. Childhood trauma and non-suicidal self-injury: Mental pain and depression as mediators in university and community samples? PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kim S, Seo DG, Park JC, Son Y, Lee JH, Yoon D, Kim JW, Yoo JH, Lee JS. Development and validation of the Self-Harm Screening Inventory (SHSI) for adolescents. PLoS One 2022; 17:e0262723. [PMID: 35143512 PMCID: PMC8830763 DOI: 10.1371/journal.pone.0262723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Sojung Kim
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, South
Korea
| | - Dong Gi Seo
- Department of Psychology, Hallym University, Chuncheon, Kangwon-do, South
Korea
| | - Jae-Chul Park
- Department of Psychology, Kangwon National University, Chuncheon,
Kangwon-do, South Korea
| | - Yeonkyeong Son
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, South
Korea
| | - Ji-Hyun Lee
- Department of Psychology, Hallym University, Chuncheon, Kangwon-do, South
Korea
| | - Dasol Yoon
- Department of Psychology, Kangwon National University, Chuncheon,
Kangwon-do, South Korea
| | - Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry
& Behavioral Sciences, Seoul National University College of Medicine, Seoul
National University Hospital, Seoul National University Children’s Hospital,
Seoul, South Korea
| | - Jae Hyun Yoo
- Department of Psychiatry, The Catholic University of Korea Seoul St.
Mary’s Hospital, Seoul, South Korea
| | - Jong-Sun Lee
- Department of Psychology, Kangwon National University, Chuncheon,
Kangwon-do, South Korea
- * E-mail:
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Abstract
Safety planning is recommended as a part of the response to everybody who presents after self-harm, although there is surprisingly little evidence for its effectiveness. There is potential for such plans to be experienced as unhelpful if patients are not genuinely involved in their production and if the plan does not include information about meaningful sources of support. Staff training is needed to ensure that plans are delivered in a collaborative way and self-harm services need to be improved nationally if such plans are to be effective.
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Cayubit RFO, Dimaculangan DMH, Lim SMG, Sanchez GMJB, Pazcoguin JMA, Reyes MES. Social networking and depressive symptom: Predictors of non-suicidal self-injury among adolescents. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02541-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kruzan KP, Whitlock J, Bazarova NN, Bhandari A, Chapman J. Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial. JMIR Form Res 2022; 6:e26526. [PMID: 35006076 PMCID: PMC8787664 DOI: 10.2196/26526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/10/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. OBJECTIVE The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help-seeking. METHODS Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help-seeking. RESULTS A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help-seeking. CONCLUSIONS Use of the peer support app was related to reduced NSSI frequency and greater confidence in one's ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help-seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. TRIAL REGISTRATION Open Science Foundation; https://osf.io/3uay9.
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Affiliation(s)
- Kaylee Payne Kruzan
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Janis Whitlock
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, United States
| | - Natalya N Bazarova
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Aparajita Bhandari
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Julia Chapman
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, United States
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Cliffe B, Stokes Z, Stallard P. The Acceptability of a Smartphone App (BlueIce) for University Students Who Self-harm. Arch Suicide Res 2022; 27:565-581. [PMID: 34983335 DOI: 10.1080/13811118.2021.2022552] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
University students are twice as likely to self-harm than community controls but, unfortunately, help-seeking among this population is particularly low. Given the stigma around self-harm, the face-to-face nature of traditional support for self-harm can be a barrier to help-seeking. Smartphone applications (apps) are a possible alternative source of support, and research has shown that students are receptive to this option. This study sought to assess the acceptability of a smartphone app called BlueIce for university students who self-harm. Semi-structured interviews were conducted with 25 students with a history of self-harm. A qualitative content analysis was undertaken and five categories were identified: the content of BlueIce, the use of BlueIce with university students, the function of BlueIce, comparison with other support, and the implementation and uptake of BlueIce. Responses to BlueIce were very positive with students believing BlueIce to be a helpful resource that was perceived as more accessible than alternative support. Participants believed it could provide help in moments of distress as well as helping individuals learn longer-term coping skills. Others felt that BlueIce would not be adequate for some people and would be better used alongside other face-to-face support. Overall, it was clear that BlueIce was acceptable to the students in this study. Future research should seek to evaluate the feasibility and effectiveness of BlueIce within a university setting with students. HIGHLIGHTSStudents who self-harm found the BlueIce app to be an acceptable and appealing source of support for self-harm as well as other mental health difficulties.Participants felt that the app was more accessible than other forms of support, particularly for individuals who prefer not to discuss self-harm with a professional.Some felt that BlueIce could provide immediate support in moments of distress, while others believed it to be a longer-term solution that could help students learn more adaptive coping strategies.
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Wong SL, Chung MC. The subjective experience of non-suicidal self-injury among female Chinese university students. Nord J Psychiatry 2022; 76:18-28. [PMID: 34061715 DOI: 10.1080/08039488.2021.1929461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the subjective experience of non-suicidal self-injury (NSSI) among female Chinese university students in Hong Kong. DESIGN Interpretative phenomenological analysis was used. METHODS Seven female students participated in the study, two engaged in biting and scratching, and three in cutting. RESULTS The majority of them indicated negative attitudes towards NSSI and saw no particular meaning attached to it. However, they all persisted with their behaviours, which suggested that they were unable to stop. Students found themselves in a paradoxical situation whereby although they saw no real benefit of NSSI, they still engaged in it to cope with distress. Feelings characterised by this distress were about entrapment and issues with academia, intimacy, loneliness, insecurity, negative self-worth, regulating distressing emotions, increasing positive physical sensations, healing oneself, and feeling alive. CONCLUSIONS The experience of hurting themselves persistently for these female students symbolised their struggle with academic or relationship difficulties, self-acceptance, emotional regulation and survival without self-injury.
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Affiliation(s)
- Siu Ling Wong
- Student Affairs Office, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Man Cheung Chung
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
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