Predictors of Self-Harm Types in Members of Online Communities: Age As a Moderating Variable

BACKGROUND

Deliberate self-harm includes direct and indirect behaviors that cause harm to the body. Various manifestations of such behavior (e.g., non-suicidal self-injuries) are prevalent in adolescent and youth populations, and they often serve as precursors of subsequent suicidal behavior. The interpersonal dynamics that lead to self-harm behavior remain understudied. Interpersonal sensitivity, defined as an anticipation of criticism and fear of rejection in one's relationships with other people, may become one such factor.

AIM

The present study was conducted to investigate the relationship between interpersonal sensitivity, psychopathological symptoms, and types of self-harm.

METHODS

The sample (n=804, 17-35 years, M=23.3±4.6 years) was recruited in online communities. A survey developed by the authors was used to measure the types of self-harm. Other measures included the Interpersonal Sensitivity Measure and Symptom Checklist-90-R.

RESULTS

It was discovered that superficial self-injuries could be related to more severe types of self-harm, destructive for the body on the whole (e.g., risk-taking, deprivation, fasting, substance abuse). Fear of rejection and psychopathological symptoms emerged as predictors of both superficial self-injuries and self-destructive behavior. Although younger respondents (17-19 years old) were more likely to inflict on themselves superficial self-injuries, those who scored high on fear of rejection were more likely to report more severe self-destructive behavior. Acute psychological distress elevated this risk for both younger and older participants (27-35 years old).

CONCLUSIONS

The results of the study point at the important role the dynamics of interpersonal relationships plays in perpetuating self-harm.

Monitoring of Intentional Self-Harm as a Tool to Detect Mental Disorders and Improve Access to Psychiatric Care

BACKGROUND

This article discusses the early diagnosis of mental disorders in connection with non-fatal intentional self-harm and suicide prevention.

AIM

To substantiate the efficacy of an intentional self-harm monitoring system as a tool for detecting mental disorders and improving access to psychiatric care for people who have attempted suicide.

METHODS

A cohort study was performed using materials obtained after the introduction of an intentional self-harm monitoring system and its implementation in the Stavropol Territory. We studied 2738 cases of intentional self-harm reported between 2016 and 2021. Study data were grouped using dual criteria based on a history of psychiatric follow-up, a history of psychiatric counseling, first/recurrent intentional self-harm, psychiatric examination after intentional self-harm, and a diagnosis of a mental disorder on psychiatric examination.

RESULTS

The official suicide attempt registration system was found to identify less than 15% of attempts. The primary incidence of mental disorders in suicide attempters was 61.4 times higher than the primary incidence of mental disorders in the general population of the Stavropol Territory. A supposedly healthy suicide attempter was 169 times more likely to be diagnosed with a mental disorder than a member of the general population. Primary diagnoses of mental disorders were 14.8 times more common in multiple suicide attempters without a diagnosis of a mental disorder at the time of the last attempt than in first-time attempters. Access to psychiatric care increases the mental disorder diagnosis rate in general and in suicide attempters in particular.

CONCLUSION

Monitoring of intentional self-harm is instrumental in the early diagnosis of mental disorders, suicide prevention, and improving access to psychiatric care for suicide attempters, also having an enormous research potential.

Anxiety, Suicidal Risk and Personal Characteristics of Medical Students

Background. The prevalence of anxiety, depression, personality traits and poor quality of life among medical students contributes to the formation of suicidal behavior

Aims. To reveal the relationship between the severity of anxiety, hopelessness, personality traits and suicidal risk in students of Irkutsk State Medical University.

Material and methods. The study included third-year students of the medical faculty of Irkutsk State Medical University (n = 61), average age – 19.7 ± 2.2 years. We used Spielberger – Khanin and Sheehan scales of self-assessment of the anxiety level, the personality questionnaire of Smisek – Mueller “Accent 2-90”, and Beck’s hopelessness scale.

Results. According to the results of testing on the Spielberger – Khanin scale, the severity of reactive anxiety reached moderate values in 57.3 % of students, severe anxiety was found in 32.8 %, the absence of anxiety – in 9.8 %. Personal anxiety on the Spielberger – Khanin scale was characterized by moderate values in 52.5 % of cases, severe anxiety was found in 45.9 %, the absence of anxiety – in 1.6 %. Moderate and high values of reactive and personal anxiety were significantly more common compared to the students with no anxiety. According to the psychometric assessment of students using Sheehan scale, clinically expressed anxiety was observed in 47.5 % of cases, severe anxiety disorder – in 4.9 %, lack of anxiety – in 47.5 %. The personality traits of students with anxiety include hyperthymia, excitability, dysthymia, cyclothymia, introversion and exaltation.

Нopelessness in students was detected in 27.9 % of cases (mild – in 16.4 %, moderate – in 9.8 %, severe – in 1.6 %). Тhe criterion of hopelessness was detected with pronounced situational and personal anxiety in comparison with moderately pronounced anxiety using Spielberger – Khanin scale (50 % and 39.3 % respectively); expressed and severe anxiety was detected in 51.7 % and 66.7 % of cases on the Sheehan scale.

The personality traits of students with hopelessness included stuckness, pedantry (standard level and level above average); cyclothymia in the form of unstable mood; demonstrativeness; excitability (normative level); dysthymia in the form of attempts to deny difficulties; exaltation (average level); introverted personality direction.

Conclusion. Determination of factors of suicidal risk is important in the prevention of suicidal behavior among medical students.

[Age-related features of mental development and mental state of adolescents, who committed suicide]

OBJECTIVE

To identify age-related psychopathological disorders and psychological characteristics of mental development and mental state of minors who committed suicide.

MATERIAL AND METHODS

The study included a continuous sample of 285 reports of post-mortem psychological-psychiatric forensic assessment (CSPE) of juveniles, aged 11 to 17 years (average age 14.92±1.82), who committed suicide, in 7 federal districts of the Russian Federation. Within the total sample, two age groups were compared: adolescents from 11 to 14 years old (1) and 15-17 years old (2). Document analysis, clinical-psychopathological, clinical-psychological, qualitative and statistical methods were used.

RESULTS AND CONCLUSION

Within the period from 11 to 17 years, the exponential growth of suicide rate is observed. An increase of family- and school-related psychological problems as well as difficulties in the relationship with the opposite sex are typical for the older group. Simultaneously, the effect of maladaptive individual features increases and psychopathological states and disorders, including, stress and adjustment disorders and depressive disorders, develop.

[Children and adolescents in situations of social distress]

The review article addresses transnational problems of socially stressful events and their contribution to the mental state of children and adolescents. The authors suggest the concept of distorted socialization in minors, who had experienced adverse events, with the formation of the concept of socially maladaptive distress reactions (SMDR). This typology has not just the age-related dynamics but also the gender specificity. Research methodology and systemic approach to SMDR from the perspective of understanding by specialists of various professions are significant for psychologists, neurologists and children's and adolescents' psychiatrists, including the forensic-psychiatric experts. The combined approach is important for the diagnostic qualification of conditions, development of correctional psychotherapeutic programs and expert approaches with reliance on gender signs, qualitative and quantitative characteristics of personal response in identifying SMDR.

Risk Factors and Approaches to Preventing Self-Injurious Behavior in Adolescents

The problem of self-injurious behavior from the point of view of the risk factors and prevention in adolescents is considered. Strategies of self-injurious behavior and characteristics of emotional dysregulation in those who self-injure are described. Finding help from peers/online friends and high stigmatizing/self-stigmatizing among self-injuring adolescents should be taken into account in treatment and prevention programs. Methods of preventing of self-injurious behavior are summarized. The following groups of methods are distinguished by purpose: informing about the problem, developing of adaptive self-regulation strategies and psychological and social support. The following prerequisites for developing school-based prevention programs of self-injurious behavior are defined: choosing a target group of adolescents (population, risk group, adolescents in stress-inducing situations), identifying the level of intervention (individual or group work with adolescents, their parents, teachers etc.), assessing the cultural specificity of the group. Programs should be based on current psychological knowledge about the development of self-injurious behavior and implicate the measuring of their efficacy.

The Psychological State of Family Members Who Have Experienced Various Forms of Suicide of a Loved One (Single Attempt, Chronic Suicide, Completed Suicide)

The suicidal behavior of a member of a family influences the emotional well-being of his/her relatives. This paper presents the results of a pilot study of emotional well-being, coping strategies and characteristics of the family system among relatives of persons with suicidal behavior. The study involved 40 people, the total sample was divided into three subgroups: relatives of patients who survived the first suicide attempt (n = 16); relatives of patients after multiple suicide attempts (n = 10); relatives of persons who committed suicide (n = 14). In the first part of the study, the symptoms of emotional distress were analyzed for the entire sample. Relatives of people with different forms of suicidal behavior are at risk of depression: two-thirds of the combined sample showed increased symptoms of depression. The coping strategies of positive redefinition and personal growth are negatively correlated with symptoms of depression. In the second part of the study, we analyzed differences between subgroups. The severity of the symptoms of depression is significantly higher in the subgroup of relatives of people with completed suicide compared to relatives of those who survived a single suicide attempt, the indicators of hardiness and cohesion of the family system are lower in the families of people with multiple suicide attempts compared to other forms of suicidal behavior.