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Devine DP. The neuropathology of Self-Injurious Behavior: Studies using animal models. Brain Res 2024; 1844:149172. [PMID: 39163896 DOI: 10.1016/j.brainres.2024.149172] [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: 04/14/2024] [Revised: 07/27/2024] [Accepted: 08/17/2024] [Indexed: 08/22/2024]
Abstract
Self-injurious behavior is a debilitating characteristic that is highly prevalent in autism and other neurodevelopmental disorders. In these populations, self-injury has typically been interpreted in relation to behavioral reinforcement and/or sensory stimulation. However, self-injury is also commonly exhibited by people with a variety of neuropsychiatric disorders, where it is typically described in relation to emotional regulation and the presence or absence of suicidal ideation. Interestingly, self-injury has also been documented in many non-human animal species, especially when exposed to early environmental deprivation, isolation, and distress. Despite the propensity of animals to self-injure under adverse conditions, animal models of self-injury have not been the focus of much research, and translation of the data from these models has largely been limited to autism and neurodevelopmental disorders. This review summarizes evidence that common biological and environmental mechanisms may contribute to vulnerability for self-injury in neurodevelopmental disorders, psychiatric disorders, and distressed animals, and that investigations using animal models may be highly beneficial when considering self-injury as a behavioral phenotype that exists across diagnostic categories. Investigations using animal models have revealed that individual differences in stress responses and anxiety-related behavior contribute to vulnerability for self-injury. Animal models have implicated dysregulation of monoaminergic, glutamatergic, and other neurotransmitter systems in expression of self-injury, and these models have suggested neural targets for pharmacotherapy that have potential relevance for diverse clinical populations.
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Affiliation(s)
- Darragh P Devine
- University of Florida, Department of Psychology, Behavioral and Cognitive Neuroscience Program, Gainesville, FL 32611-2250, USA.
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2
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Li Y, Wan Z, Gong X, Wen L, Sun T, Liu J, Xie X, Zhang C, Cai Z. The association between child maltreatment, cognitive reappraisal, negative coping styles, and non-suicidal self-injury in adolescents with major depressive disorder. BMC Psychiatry 2024; 24:592. [PMID: 39223473 PMCID: PMC11370082 DOI: 10.1186/s12888-024-06041-2] [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: 01/30/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a significant public health concern among adolescents with major depressive disorders (MDD). Although previous research has linked child maltreatment (CM) to NSSI, the precise mechanisms remain unclear. This study aims to investigate the association between CM, cognitive reappraisal (CR), negative coping styles (NC) and NSSI in adolescents with MDD, from the perspectives of both Latent Variable Theory and the Network Theory of Mental Disorder. METHODS A sample of 651 adolescents with MDD was recruited from January to December 2023. Data on CM, CR, NC, and NSSI were collected through paper-based self-reported questionnaires. Data analysis primarily involved structural equation modeling and network analysis. RESULTS The reporting rate of NSSI among adolescents with MDD was 48.2%. CM showed a significant positive correlation with NSSI. NSSI was affected by CM through three paths: the mediating role of CR, the mediating role of NC, and the chain mediating role of both CR and NC. Emotional abuse (EA) was the central node, while NSSI, EA, and "The urge to cry quietly when faced with troubles"(NC10) were the key bridge nodes. CONCLUSIONS This study is the first to use both structural equation modeling and network analysis to explore the explore the relationship between CM, CR, NC, and NSSI in adolescents with MDD, providing a theoretical basis for future early prevention and targeted interventions for adolescents with MDD.
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Affiliation(s)
- Yinglin Li
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zhiying Wan
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xuan Gong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Li Wen
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Ting Sun
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jingfang Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xiangying Xie
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Chunlong Zhang
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zhongxiang Cai
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Christensen SH, Heinrichsen M, Møhl B, Rubæk L, Byrialsen KK, Ojala O, Hellner C, Pagsberg AK, Bjureberg J, Morthorst B. Internet-delivered emotion regulation therapy for adolescents engaging in non-suicidal self-injury and their parents: A qualitative, online focus group study. Psychol Psychother 2024. [PMID: 39148399 DOI: 10.1111/papt.12541] [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: 02/22/2024] [Accepted: 07/08/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVES We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI). DESIGN A qualitative study nested within a controlled feasibility trial. METHODS Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis. RESULTS Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents. CONCLUSION Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.
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Affiliation(s)
- Sofie Heidenheim Christensen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Michella Heinrichsen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Bo Møhl
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Lotte Rubæk
- Self-Injury Team, Child and Adolescent Mental Health Services, Copenhagen, Denmark
| | - Katherine Krage Byrialsen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Olivia Ojala
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, & Stockholm Health Care Services, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, & Stockholm Health Care Services, Stockholm, Sweden
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, & Stockholm Health Care Services, Stockholm, Sweden
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Britt Morthorst
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
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Celedonia KL, Karukivi M, Valenti MW, Geldsetzer P, Wilson ML. Temporal Patterns of Suicidality Among Adolescents Receiving Behavioral and Mental Health Services in the Community: A Survival Analysis. Community Ment Health J 2024:10.1007/s10597-024-01334-y. [PMID: 39110294 DOI: 10.1007/s10597-024-01334-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: 02/05/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024]
Abstract
Adolescent suicide is a major public health concern, particularly among adolescents who have endured Adverse Childhood Experiences (ACEs). Adolescents who have been exposed to multiple ACEs are as much as three times more likely to present with suicidality compared to the general adolescent population. Adolescents who have been exposed to multiple ACEs are also more likely to receive behavioral and mental health services in the community. It is therefore important to understand patterns of suicidality among this sub-population of adolescents in order to provide the best clinical care. The present study examined the temporal patterns of suicidality among adolescents who have been exposed to multiple ACEs and are receiving behavioral and mental health services in the community. Using Electronic Health Record (EHR) data from a community-based behavioral and mental health care organization, an exploratory survival analysis was conducted on time to suicidal thoughts and behaviors (STBs) after suicidality risk screen at intake. Average time from suicidality risk screen at intake to STB was 185 days (6.2 months). Youth who screened negative for suicidality risk at intake had a longer survival time than youth who screened positive for suicidality risk, and the survival distributions between the two groups was significant. Predictors of STBs were also examined, with gender being a significant predictor of an STB occurring during the follow-up period. These findings may be used to guide suicidality screening and clinical practice at community-based behavioral and mental health care organizations serving adolescents who have been exposed to multiple ACEs.
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Affiliation(s)
- Karen L Celedonia
- Turku Brain Injury Centre, Injury Epidemiology and Prevention (IEP) Research Group, Turku University Hospital, University of Turku, Turku, Finland.
- Social Research and Innovation Center, Pressley Ridge, Pittsburgh, PA, USA.
| | - Max Karukivi
- Department of Adolescent Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Michael W Valenti
- Social Research and Innovation Center, Pressley Ridge, Pittsburgh, PA, USA
| | - Pascal Geldsetzer
- Department of Medicine (Primary Care and Population Health), Stanford University, California, USA
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Levkovich I, Stregolev B. Non-Suicidal Self-Injury among Adolescents: Effect of Knowledge, Attitudes, Role Perceptions, and Barriers in Mental Health Care on Teachers' Responses. Behav Sci (Basel) 2024; 14:617. [PMID: 39062440 PMCID: PMC11273488 DOI: 10.3390/bs14070617] [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: 05/10/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) involves the deliberate harm of one's body without the intent to commit suicide and is particularly concerning among adolescents. Teachers play a critical role as gatekeepers in identifying and addressing self-harm, underscoring the importance of their knowledge and response strategies in this area. This study explored how teachers' knowledge, attitudes towards NSSI, perceived roles, and workplace barriers affect their responses to students exhibiting NSSI behaviors. METHODS A cross-sectional survey was conducted among 203 middle and high school teachers in Israel. Data were collected during July and August 2023 using six validated questionnaires. RESULTS Higher levels of teacher knowledge, positive attitudes, and strong role perceptions correlated with more effective responses to NSSI, whereas increased workplace barriers tended to diminish response efficacy. Positive correlations emerged between role perception and both knowledge and attitudes, whereas negative correlations emerged between workplace barriers, attitudes, and role perceptions. Teaching experience moderated the impact of role perception and workplace barriers on responses. Significant differences were observed between regular and special education settings, although no differences were noted in referral rates or years of seniority. CONCLUSIONS These findings suggest that enhancing teacher knowledge and attitudes towards NSSI, while addressing workplace barriers, can improve response efficacy in educational settings.
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Affiliation(s)
- Inbar Levkovich
- Faculty of Education, Faculty of Education, Tel-Hai Academic College, Kiryat Shmona 12208, Israel
| | - Batel Stregolev
- Faculty of Graduate Studies, Oranim Academic College, Kiryat Tivon 36006, Israel;
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Vahabi A, Daştan AE, Mirzazada J, Yoğun Y, Tezgel O, Aktuğlu K. Self-inflicted tourniquet application resulted with two fasciotomies: Case report of an initially omitted Munchausen case. Int J Surg Case Rep 2024; 119:109746. [PMID: 38728968 PMCID: PMC11101880 DOI: 10.1016/j.ijscr.2024.109746] [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: 04/16/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Compartment syndrome is an emergency which requires prompt intervention. While main challenge typically revolves around determining necessity for fasciotomy in suspected cases, etiology is often pronounced, leaving little room for differential diagnosis. CASE REPORT We report a case with unconventional presentation and clinical course, ultimately diagnosed as Munchausen Syndrome. DISCUSSION It has been reported that individuals with Munchausen syndrome are successful at manipulating healthcare professionals. They often study the symptoms of their sickness, examination findings, and findings that may alert doctors, mastering their techniques over time. CONCLUSION It is of importance to consider Munchausen Syndrome as a potential cause, particularly in cases where clinical history and course of symptoms do not align with our experiences and cannot be reconciled with other possible diagnostic patterns.
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Affiliation(s)
- Arman Vahabi
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey.
| | - Ali Engin Daştan
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey
| | - Javad Mirzazada
- VM Medical Park Hospital, Department of Orthopedics and Traumatology, Kocaeli, Turkey
| | - Yener Yoğun
- Ankara University School of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Okan Tezgel
- Van Educational and Research Hospital, Department of Orthopedics and Traumatology, Van, Turkey
| | - Kemal Aktuğlu
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey
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Abstract
Joiner and colleagues' Interpersonal Theory of Suicide (IPTS), a prominent "desire-capability" model of suicide-based on the common-sense idea that people take their own lives because they want to, and can-is critiqued from a biological perspective. Tinbergen's ethological "four questions" guide the analysis: evolution, survival value, ontogeny, and proximate causation, each addressing a different aspect of biological understanding. Problems for IPTS emerge with all four. As a parsimonious solution, the desire-capability hypothesis is reconceived as an ultimate, instead of proximate, mode of explanation. By this light, desire and capability for suicide combined in our species' ancestral past, thus making suicide a recurrent survival threat, and driving the evolution of special-purpose defensive adaptations. This stance tallies with the pain-brain theory of the evolution of suicide, and with Joiner and colleagues' own investigation into organismic anti-suicide defenses, which appears to conflict conceptually with IPTS. These defenses' evolved algorithm may make suicide an intrinsically aleatory phenomenon, opaque to usefully accurate prediction. Positive implications for prevention and research are proposed.
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Villodas ML. Suicidality and Non-Suicidal Self-Injury: A Narrative Review of Measurement, Risk, and Disparities among Minoritized and System-Involved Youth in the USA. CHILDREN (BASEL, SWITZERLAND) 2024; 11:466. [PMID: 38671683 PMCID: PMC11048987 DOI: 10.3390/children11040466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Suicidality and non-suicidal self-injury (NSSI) among youth in the United States continue to be a growing and serious public health concern. With alarming rates of suicide trending in the wrong direction, researchers are committed to bending the curve of suicide and reducing rates by 2025. Understanding the antecedents and conditions, existing measures, and disparate prevalence rates across minoritized groups is imperative for developing effective strategies for meeting this goal. This study presents a narrative review of the operationalization, measurement, risk factors (e.g., firearms and social media), and disparities across race, ethnicity, age, gender identity, ability, sexual orientation, immigration statuses, and system involvement (e.g., foster care and juvenile justice) of suicidality and non-suicidal self-harm across youth in the United States. Implications for research, practice, and policy approaches that incorporate positive youth development, cultural, and youth participation in interventions are discussed.
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Affiliation(s)
- Melissa L Villodas
- Department of Social Work, George Mason University, Fairfax, VA 22030, USA
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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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Aspeqvist E, Andersson H, Korhonen L, Dahlström Ö, Zetterqvist M. Measurement and stratification of nonsuicidal self-injury in adolescents. BMC Psychiatry 2024; 24:107. [PMID: 38326791 PMCID: PMC10848387 DOI: 10.1186/s12888-024-05535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI. METHODS The performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures. RESULTS A total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures. CONCLUSIONS When investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.
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Affiliation(s)
- Erik Aspeqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Hedvig Andersson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
- Barnafrid, Swedish National Center on Violence Against Children, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Athletics Research Center, Linköping University, Linköping, Sweden
| | - Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
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Kudinova AY, Brick LA, Armey M, Nugent NR. Micro-sequences of anger and shame and non-suicidal self-injury in youth: an ecological momentary assessment study. J Child Psychol Psychiatry 2024; 65:137-147. [PMID: 37525367 PMCID: PMC10828100 DOI: 10.1111/jcpp.13869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is a significant mental health concern with the highest prevalence among adolescents. NSSI has been conceptualized as one of the maladaptive strategies to cope with challenging affect or a form of self-punishment. Although characterizing moment-to-moment associations between shame and NSSI in individuals' real-world environment and partitioning between- and within-person effects is critical for mobile and timely interventions, most studies examined habitual experiences of negative affective states and focused on adults. METHOD In this study, we focused on in vivo anger at self and others and shame and NSSI among 158 adolescents 3 weeks following their psychiatric hospitalizations using ecological momentary assessment (EMA) technology. RESULTS We found that greater between-person levels of anger at self and others were linked to a higher number of subsequent NSSI occurrences within a day. These findings remained primarily unchanged when we statistically adjusted for participants' age, sex assigned at birth, the number of current psychiatric diagnoses, EMA response rates, and youth lifetime history of SI. Within-person increases in NSSI were linked to increased anger at self over and beyond between-person average levels of NSSI. CONCLUSIONS These findings highlight the potential regulatory role of NSSI to decrease negative affective states and point to the clinical utility of assessing and early mobile interventions targeting challenging affect in youth.
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Affiliation(s)
- Anastacia Y Kudinova
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Child Psychiatry, Bradley Hospital, Providence, RI, USA
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael Armey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Elyoseph Z, Levkovich I. Beyond the Surface: Teachers' Perceptions and Experiences in Cases of Non-Suicidal Self-Injury Among High School Students. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228231223275. [PMID: 38174720 DOI: 10.1177/00302228231223275] [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: 01/05/2024]
Abstract
Non-suicidal self-injury (NNSI) among adolescents is a significant concern. This study aimed to explore teachers' perceptions and experiences in cases of NSSI among their students. This qualitative-phenomenological study used in-depth, semi-structured interviews conducted with 27 teachers from high-schools in Israel. Thematic analysis was used to identify patterns and themes. Theme 1 highlighted the emotional impact of discovering self-injury incidents, including panic, confusion, and helplessness. Theme 2 focused on teachers' limited professional support and their need for training and guidance. Theme 3 explored teachers' desire to help students and their strategies for building connections and providing empathy, sometimes despite emotional detachment. Theme 4 emphasized the importance of involving parents and the need for effective communication. This study emphasizes the importance of providing teachers comprehensive training to address NSSI effectively. These findings provide a better understanding of teachers' experiences and underscore the need for enhanced support systems.
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Affiliation(s)
- Zohar Elyoseph
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College, Kiryat Tiv'on, Israel
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13
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Liu J, Li JT, Zhou M, Liu HF, Fan YY, Mi S, Tang YL. Non-suicidal self-injury in adolescents with mood disorders and the roles of self-compassion and emotional regulation. Front Psychiatry 2023; 14:1214192. [PMID: 38179248 PMCID: PMC10764550 DOI: 10.3389/fpsyt.2023.1214192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Objective We aimed to investigate the characteristics and psychological mechanism of non-suicidal self-injury (NSSI) in adolescents with mood disorders. We examined how self-compassion and emotional regulation affected NSSI and tested the mediating role of self-compassion in the link between emotional regulation and NSSI. Method We recruited outpatient and inpatient adolescent patients with bipolar and related disorders or depressive disorders (DSM-5), with a focus on NSSI. We also recruited healthy controls from the community. We collected demographic and clinical data. The Adolescent Self-injury Questionnaire, Self-compassion Scale (SCS), and Emotion Regulation Questionnaire (ERQ) were used to assess the frequency and severity of NSSI, level of self-compassion, and emotional regulation. Results In total, we recruited 248 adolescent patients with mood disorders (N = 196 with NSSI, and 52 without NSSI) and 212 healthy controls. NSSI was significantly associated with the female sex, lower levels of education and less use of cognitive reappraisal strategies, lower levels of self-warmth, and higher levels of self-coldness. Multivariate analysis of variance showed that there were significant differences in the scores of ERQ, cognitive reassessment score, and the scores of SCS among the three groups, but no statistical differences in expressive suppression score among the three groups. Self-warmth had a mediating effect between cognitive reappraisal and NSSI behavior. Conclusion NSSI is prevalent among adolescent patients with mood disorders in clinical settings, especially among girls and those with lower levels of education and less cognitive reappraisal strategies. More clinical attention is needed. Self-compassion and its factors may mediate the association between emotional regulation and NSSI. Clinical implications and future research directions were discussed.
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Affiliation(s)
- Jing Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia-ting Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Man Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Hui-feng Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yang-yang Fan
- Faculty of Economics and Management, East China Normal University, Shanghai, China
| | - Si Mi
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, United States
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14
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Dierickx S, Claes L, Buelens T, Smits D, Kiekens G. DSM-5 non-suicidal self-injury disorder in a community sample: comparing NSSI engagement, recency and severity among emerging adults. Front Psychiatry 2023; 14:1251514. [PMID: 38144473 PMCID: PMC10748385 DOI: 10.3389/fpsyt.2023.1251514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Up to one in five emerging adults engage in non-suicidal self-injury (NSSI). Providing a better understanding of factors that differentiate between who engages in lifetime NSSI and who is more likely to engage in recent and clinically severe NSSI can provide meaningful information for prevention and intervention of NSSI. The present study (n = 669) considered NSSI lifetime engagement (no prior history of NSSI vs. lifetime NSSI), recency [past NSSI (>12 months ago) vs. recent (≤12-month) NSSI], and clinical severity among those with recent NSSI (subthreshold vs. DSM-5 NSSI disorder). The prevalence of NSSI disorder was 8.4% in emerging adults aged 18 to 26 years old. Higher anxiety levels were related to NSSI engagement, but only depressive symptoms and NSSI versatility were consistently associated with more recent NSSI and NSSI disorder. A stepped-care approach may be required in addressing NSSI among emerging adults.
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Affiliation(s)
- Serafine Dierickx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Expertise Unit Resilient People, University Colleges Leuven-Limburg, Leuven, Belgium
| | - Laurence Claes
- Expertise Unit Resilient People, University Colleges Leuven-Limburg, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Tinne Buelens
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Dirk Smits
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Department, Odisee University of Applied Sciences, Brussel, Belgium
| | - Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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15
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Hussein MA, Nallani R, Jenkins PM, Haake RS, Perinjelil V, Cranford J, Campbell A, Dryden A, Kenney S, Herdman K, Dombrowski A, Sachwani-Daswani G. The role of trauma services in intentional self-harm at a regional level 1 trauma center. Injury 2023; 54:110981. [PMID: 37596120 DOI: 10.1016/j.injury.2023.110981] [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: 01/23/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Suicide claims many lives globally, each year. For every person that dies by suicide, multitudes more attempt it. A national shortage of psychiatrists may prevent many individuals from receiving timely mental health care. For many individuals, the primary entry point into the healthcare system is through the emergency department. The trauma service frequently treats patients with severe self-inflicted injuries and for many this is not the first time. This represents an opportunity for intervention to disrupt the cycle and prevent future death. METHODS We conducted a retrospective chart review of all patients with self-inflicted injuries, admitted to the trauma surgery service between 2012 and 2021. All patients above 10 years old were included. RESULTS Four hundred forty-one patients were admitted due to self-injurious behavior in the period under study. The majority of patients (71.9%) had a pre-existing mental health disorder. Fifty six patients suffered fatal injuries; the majority were White (78.6%), males (80.3%), and were inflicted by gunshot (71.4%). Nearly one third of patients with self-inflicted injuries had a history of self-injurious behavior with the average number of attempts being 2.7 (SD: ±3.8). CONCLUSIONS We need interdisciplinary and innovative solutions for this public health crisis. Perhaps telemedicine can be used to buttress the access to adequate mental health care. More research needs to be done to better identify the barriers individuals encounter in accessing mental health care, both pre- and post-crisis. The goal is that, by identifying the gaps, we can collaboratively bridge them to prevent a preventable death.
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Affiliation(s)
- Mohamed A Hussein
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Rohit Nallani
- College of Human Medicine, Michigan State University, MI, USA
| | - Phillip M Jenkins
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Robert Stephen Haake
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Vinu Perinjelil
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - James Cranford
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA; Department of Emergency Medicine, University of Michigan Medicine, MI, USA
| | - Amber Campbell
- College of Human Medicine, Michigan State University, MI, USA
| | - Arriona Dryden
- College of Human Medicine, Michigan State University, MI, USA
| | - Sarak Kenney
- College of Human Medicine, Michigan State University, MI, USA
| | - Kaitlin Herdman
- College of Human Medicine, Michigan State University, MI, USA
| | - Amber Dombrowski
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Gul Sachwani-Daswani
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA.
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16
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Finch EF, Boccagno C, Hooley JM. Hurting the Grandiose Self: Examining Presence, Frequency, and Functions of Nonsuicidal Self-Injury in Pathological Narcissism. J Pers Disord 2023; 37:424-443. [PMID: 37721781 DOI: 10.1521/pedi.2023.37.4.424] [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] [Indexed: 09/19/2023]
Abstract
The present study examines whether dimensions of pathological narcissism are associated with the presence, frequency, and function of nonsuicidal self-injury (NSSI). Adults (N = 252) completed questionnaires assessing narcissistic grandiosity, narcissistic vulnerability, fluctuation between these narcissistic states, and borderline personality disorder (BPD) symptoms. Those with a history of NSSI (n = 105) also reported the method, frequency, and function of their NSSI engagement. When controlling for co-occurring BPD symptoms, there were very few associations between vulnerability, grandiosity, and narcissistic fluctuation and NSSI presence and frequency. However, a clear pattern emerged regarding NSSI functions. Although vulnerability and narcissistic fluctuation were not associated with any functions of NSSI when co-occurring BPD symptoms were controlled for, grandiosity was positively associated with all interpersonal functions of NSSI (e.g., peer bonding, revenge) and negatively associated with the intrapersonal function of affect regulation. These results suggest a unique relationship between narcissistic grandiosity and NSSI that may inform clinical intervention.
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Affiliation(s)
- Ellen F Finch
- From Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Chelsea Boccagno
- From Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Jill M Hooley
- From Department of Psychology, Harvard University, Cambridge, Massachusetts
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17
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Gómez-Peresmitré G, Platas-Acevedo RS, León-Hernández R, Guzmán-Saldaña R. Self-Injurious Behavior and Its Characteristics in a Sample of Mexican Adolescent Students. Healthcare (Basel) 2023; 11:1682. [PMID: 37372799 PMCID: PMC10298567 DOI: 10.3390/healthcare11121682] [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: 03/09/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Adolescence is a difficult stage, a period of risk for developing disorders, including depression and self-injurious behavior. A non-random sample was drawn (n = 563) from first-year high school students (32.8%) 185 males and 378 females (67.14%) from public schools in Mexico. The age range was 15 and 19 years, with a mean age of 15.63 (SD = 0.78). According to the results, the sample was divided into n1 = 414 (73.3%) adolescents without self-injury (S.I.) and n2 = 149 (26.4%) S.I. adolescents. In addition, results were obtained on methods, motives, time, and frequency of S.I., and a model was generated in which depression and first sexual experience obtained the highest Odd Ratio and d values in their relationship with S.I. Finally, we contrasted the results with earlier reports and concluded that depression is an important variable in S.I. behavior. Early S.I. detection will prevent the aggravation of S.I. and suicide attempts.
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Affiliation(s)
- Gilda Gómez-Peresmitré
- Faculty of Psychology, The National Autonomous University of Mexico, Av. Universidad 3004 Col Copilco-Universidad, Alcaldía, Coyoacán, Mexico City C.P. 04510, Mexico
| | - Romana Silvia Platas-Acevedo
- Faculty of Psychology, The National Autonomous University of Mexico, Av. Universidad 3004 Col Copilco-Universidad, Alcaldía, Coyoacán, Mexico City C.P. 04510, Mexico
| | - Rodrigo León-Hernández
- National Council of Science and Technology, Avenida Insurgentes Sur 1582, Crédito Constructor, Ciudad de México C.P. 03940, Mexico
| | - Rebeca Guzmán-Saldaña
- Institute of Health Sciences, Autonomous University of the State of Hidalgo, Camino a Tilcuautla s/n Pueblo San Juan Tilcuautla, Hidalgo C.P. 42160, Mexico
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18
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Cummings JAF. Nonsuicidal Self-Injury. Am J Nurs 2023; 123:44-47. [PMID: 37233139 DOI: 10.1097/01.naj.0000938732.60723.b9] [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: 05/27/2023]
Abstract
ABSTRACT Nonsuicidal self-injury (NSSI) is an area of growing concern for the health care community, as evidenced by its identification as a Healthy People 2030 objective and as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In the past, nurses may have identified patients who cut or harmed themselves as having suicidal intent, yet NSSI is increasingly recognized and investigated as a separate disorder. This article provides an overview of NSSI, including information about risk factors, clinical assessment, and preventive efforts.
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Affiliation(s)
- Jo Ann F Cummings
- Jo Ann F. Cummings is an associate professor at Georgian Court University in Lakewood, NJ, and volunteers as an advanced practice nurse in pediatrics in a medical clinic. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise
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19
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Bond KS, Lyons JN, Cottrill FA, Sabo AV, Baillie SE, Rossetto A, Kelly L, Kelly CM, Reavley NJ, Jorm AF, Morgan AJ. Evaluation of the Conversations about Non-Suicidal Self-Injury Mental Health First Aid Course: Effects on Knowledge, Stigmatising Attitudes, Confidence and Helping Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3749. [PMID: 36834439 PMCID: PMC9963380 DOI: 10.3390/ijerph20043749] [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: 11/29/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a common mental health problem, with a 19% lifetime prevalence in Australian adolescents and 12% in adults. Though rates of professional help-seeking for NSSI are low, disclosure to family and friends is more common, providing opportunities for them to encourage professional support. Mental Health First Aid® Australia's Conversations about Non-Suicidal Self-Injury course provides evidence-based training for the general public to support a person engaging in NSSI. METHODS This uncontrolled trial evaluated the effects of the Conversations about Non-Suicidal Self-Injury course on participants' knowledge, confidence, stigmatising attitudes, and intended and actual helping behaviours. Surveys were administered pre- and post-course, and at a six-month follow-up. A linear mixed-model analysis determined mean change over time, and effect sizes were estimated using Cohen's d. Course satisfaction was assessed using descriptive statistics and summative content analysis of qualitative data. RESULTS The pre-course survey was completed by 147 Australian participants (77.5% female, mean age 45.8 years), 137 (93.2%) at post-course and 72 (49%) at follow-up. Knowledge, confidence, quality of intended helping behaviours, and quality of actual helping behaviours increased significantly at both time points. Social distance decreased significantly at all time points and stigma decreased significantly at post-course. The course was perceived to be highly acceptable by participants. CONCLUSIONS There is initial evidence that the Conversations about Non-Suicidal Self-Injury course is effective and acceptable for members of the public who may support a person engaging in NSSI.
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Affiliation(s)
- Kathy S. Bond
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Julia N. Lyons
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Fairlie A. Cottrill
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Amanda V. Sabo
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
| | - Simone E. Baillie
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Alyssia Rossetto
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
| | - Louise Kelly
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Claire M. Kelly
- Mental Health First Aid Australia, Level 18, 150 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Nicola J. Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
| | - Anthony F. Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
| | - Amy J. Morgan
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3010, Australia
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20
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Vafaei T, Samavi SA, Whisenhunt JL, Najarpourian S. An investigation of self-injury in female adolescents: a qualitative study. QUALITY & QUANTITY 2023; 57:1-24. [PMID: 36816810 PMCID: PMC9923642 DOI: 10.1007/s11135-023-01632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
This study aimed to investigate the phenomenon of self-injury among female adolescents. The research was qualitative, and the sampling method was purposive non-random; the sample size was 20 Iranian girl adolescents aged 13-15 years who had experienced non-suicidal self-injury. Data were collected through semi-structured interviews. The data analysis process was performed during three coding steps (open, axial, selective), through which the basic codes and categories were identified. Study results indicate that the main factors in adolescents' self-injury were individual or psychological (thoughts, emotions, and behaviors) and social (peers, family, communication with different gender, communication with others, media/cyberspace, school, and economic). In the former, the role of emotions was remarkable, while in the latter, the family played a key role. Further, results revealed that communication within the family was an important motivating and sustentative factor in adolescents' self-injury. The results can help counselors in working with adolescents who self-injure; results can also be used in the development and implementation of treatment plans.
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Affiliation(s)
- Tayebeh Vafaei
- Department of Counseling, University of Hormozgan, Bandar Abbas, Iran
| | | | - Julia L. Whisenhunt
- Department of Counseling, Higher Education, and Speech-Language Pathology, University of West Georgia, Carrollton, GA USA
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21
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Kibitov AA, Merkulova TV, Mazo GE. [Polymorphisms of OPRM1, OPRK1, DCC genes and non-suicidal self-injuries in adults]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:116-123. [PMID: 38147391 DOI: 10.17116/jnevro2023123121116] [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] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To investigate the associations of OPRM1 gene rs179971, OPRK1 gene rs6473797 and DCC gene rs8084280 polymorphisms with non-suicidal self-injury (NSSI) characteristics and motivations in adults. MATERIAL AND METHODS A pilot sample included 28 adult patients with history of NSSI (89.3% (n=25) women, median age (Q1-Q3) - 23 (21.25-25) years). Most patients (78.6%, n=20) had a diagnosis of bipolar disorder. NSSI characteristics and motivations were assessed using the Inventory of Statements about Self-Injury (ISAS) scale. The Childhood Trauma Questionnaire (CTQ) was used to control for childhood trauma - one of the most important environmental factors associated with NSSI. The Baratt Impulsivity Scale (BIS) and the Buss-Perry Aggression Questionnaire (BPAQ) were also used to assess impulsivity and aggression, respectively. RT-PCR was used for genotyping, a genetic effect was assessed using the dominant model. Mann-Whitney U-test, Pearson χ2-test and multiple linear regression were used for statistical analysis. RESULTS Carriers of the minor G allele of OPRM1 gene rs1779971 had a higher level of aggression assessed by BPAQ (p=0.02). The minor C allele of OPRK1 gene rs6473797 was associated with an increase of the subjective importance of «Affect regulation» (B=2.23; CI 95% [0.39-4.06]; p=0.022) and «Anti-dissociation» (B=3.31; CI 95% [0.18-6.44]; p=0.039) motivations, whereas the minor T allele of DCC gene rs8084280, on the contrary, was associated with a decrease of the importance of «Affect regulation» (B=-1.74; CI 95% [-3.30 - -0.18]; p=0.032). Moreover, this effect was found after adjusting for diagnosis, sex, age, and the presence of childhood trauma. CONCLUSIONS To our knowledge, this is the first study on the association of genetic markers with NSSI motivations. The results of this pilot study demonstrate that OPRK1 and DCC gene polymorphisms can determine differences in motivations for self-harm, however, these results require confirmation in large samples.
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Affiliation(s)
- A A Kibitov
- Mental Health Research Center, Moscow, Russia
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St-Petersburg, Russia
| | - T V Merkulova
- Serbsky National Medical Research Centre on Psychiatry and Addictions, Moscow, Russia
| | - G E Mazo
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St-Petersburg, Russia
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22
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Dong X, Zou Y, Zou Q, Zhao N, Li S, Liu G, Hu M, Sun W. Non-suicidal self-injury: A bibliometrics study and visualization analysis from 2002 to 2022. Front Psychiatry 2023; 14:1019225. [PMID: 36846216 PMCID: PMC9948622 DOI: 10.3389/fpsyt.2023.1019225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/02/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To overview the research actuality and offer the hotspots and cutting-edge issues in the field of Non-suicidal Self-injury (NSSI) by using bibliometric analysis. MATERIALS AND METHODS Publications related to NSSI from 2002 to 2022 were extracted from the Web of Science Core Collection (WoSCC) database. CiteSpace V 6.1.R2 and VOSviewer 1.6.18 were used to visually analyzed institutions, countries, journals, authors, references, and keywords in research on NSSI. RESULTS A total of 799 studies about NSSI were analyzed via CiteSpace and VOSviewer. The number of annual publications related to NSSI is fluctuating growth. The USA and Harvard University are the most productive country and institutions. In the case of journals and co-cited journals, Psychiatry Research are the most productive journal and also ranked highest among co-cited journals. Furthermore, Michael Kaess has published the most publications, and Matthew K. Nock is the most cited author. An article published by Swannell SV et al. shows the highest citation counts. After analysis, the most common keywords are harm, adolescents and prevalence. The gender difference, diagnosis, and dysregulation are frontier areas of NSSI research. CONCLUSION This study analyzed the research of NSSI from multiple perspectives, and provides valuable information for researchers to capture the current status, hot spots, and frontier trends of NSSI.
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Affiliation(s)
- Xiangli Dong
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yuchen Zou
- Jiangxi Medical College, Nanchang University, Nanchang, China.,Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qing Zou
- Jiangxi Medical College, Nanchang University, Nanchang, China.,Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Na Zhao
- Department of Rehabilitation Medicine, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Shilin Li
- Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Guanxiu Liu
- Jiangxi Medical College, Nanchang University, Nanchang, China.,Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Maorong Hu
- Jiangxi Medical College, Nanchang University, Nanchang, China.,Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weiming Sun
- Jiangxi Medical College, Nanchang University, Nanchang, China.,Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Oh Y, Lee S, Rogers ML, You S. Assessment of acute and non-acute suicide crisis symptoms: Validation of the Korean version of the acute suicidal affective disturbance inventory. Front Psychol 2022; 13:1034130. [DOI: 10.3389/fpsyg.2022.1034130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide risk assessment is predominantly based on assessing current/recent suicidal ideation and past suicidal behavior. However, suicidal ideation and lifetime suicide attempt are poor predictors of imminent suicide risk or crisis. The acute suicidal affective disturbance inventory-lifetime (ASADI-L) was developed to assess symptoms of acute suicidal affective disturbance, which includes a drastic increase in suicidal intent, perceptions of social and/or self-alienation, hopelessness, and overarousal. However, the ASADI-L has not yet been validated in a Korean population. Also, the ASADI-L has only been validated for people who experience a drastic increase in suicidal intention over the course of hours or days (i.e., the acute suicidal intention group) and not validated for those who experience suicidal intention for a longer period (i.e., the non-acute suicidal intention group). Thus, the aims of this study were to (1) validate the ASADI-L in a sample of Korean community adults; and (2) compare clinical characteristics of the acute and non-acute suicidal intention groups. Among 1,675 community adults, data from 682 participants who reported a lifetime drastic increase in suicidal intent were analyzed. Results indicated that the ASADI-L has relevant reliability, validity, and a unidimensional factor structure. The acute suicidal intention group had higher ASAD symptoms as well as clinical symptoms than the non-acute group, but the two groups did not differ in history of suicide attempt. Overall, these findings suggest that the ASADI-L is a valid measure of acute and non-acute suicidal affective disturbance among Korean adults. Further investigation of the differences in acute and non-acute suicide risk is warranted.
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Meheli S, Banerjee D. Revisiting Social Stigma in Non-suicidal Self-injury: A Narrative Review. CONSORTIUM PSYCHIATRICUM 2022; 3:6-18. [PMID: 39044918 PMCID: PMC11262124 DOI: 10.17816/cp196] [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: 06/26/2022] [Accepted: 09/23/2022] [Indexed: 11/08/2022] Open
Abstract
Non-suicidal self-injury (NSSI) is highly prevalent in our community. Yet, there is a significant discrepancy between the number of individuals engaging in NSSI and those who seek treatment for NSSI. This discrepancy can be due to the high social stigma associated with the behavior. The impact of NSSI stigma is significant and can impair the quality of life in the individuals engaging in NSSI, delay help-seeking, reduce access to mental health care and further fuel misinformation. Even though the symptomatology, risks, and demographics of NSSI have received attention in terms of research, there is limited literature on NSSI stigma and its consequences. With that background set, this review provides a bird's-eye view of the different levels of stigma in NSSI (public, self, and health care), associated discrimination, the various aspects of such stigmatization (NSSI-related language, physical scarring, misinformation, the media), and, finally, the collaborative clinical-outreach interventions for mitigating NSSI-associated social stigma. If NSSI is indeed recognized as a clinical disorder, future research would need to focus on these constructs of stigma and treat them with the same importance as the one given to clinical studies of intervention and symptomatology in NSSI.
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25
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Neurocognitive functioning in adolescents with non-suicidal self-injury. J Affect Disord 2022; 311:55-62. [PMID: 35550828 DOI: 10.1016/j.jad.2022.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/30/2022] [Accepted: 05/05/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a highly prevalent transdiagnostic psychiatric symptom in adolescents. Research in adults has begun to investigate neurocognitive processes associated with NSSI as potential underlying phenotypes. However, research on neurocognitive function in adolescent patients with NSSI is scarce. METHODS In this study, we examined neurocognitive functioning in the domains of processing speed, attention, learning, working memory, and executive function in a relatively large sample of n = 240 adolescent patients engaging in NSSI and n = 49 healthy controls. Further, associations between neurocognitive performance and clinical characteristics in the patient group were examined. RESULTS While conventional regression analyses showed somewhat weaker neurocognition in the NSSI group in several domains, propensity score matching for IQ showed little evidence that patients engaging in NSSI showed worse neurocognition when general intelligence was considered. Further, a random forest machine learning algorithm was not able to classify NSSI vs. control groups based on neurocognitive features. Within the patient group, linear regression and latent class analyses yielded little evidence that neurocognitive performance was related with clinical characteristics or phenotypes. LIMITATIONS As the study did not include a clinical control group, findings might not be specific to NSSI. CONCLUSIONS Our findings challenge the importance of specific neurocognitive measures related to the presence or severity of NSSI in adolescents. Future studies should consider general intelligence as an important confounding factor and should focus on domains of affective cognition. Finally, longitudinal studies are needed to determine whether low neurocognitive performance serves to inform prognosis of NSSI or psychopathology in general.
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Xiao Q, Song X, Huang L, Hou D, Huang X. Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: A meta-analysis. Front Psychiatry 2022; 13:912441. [PMID: 36032224 PMCID: PMC9399519 DOI: 10.3389/fpsyt.2022.912441] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adolescents with immature mind and unstable emotional control are high-risk groups of non-suicidal self-injury (NSSI) behavior. We meta-analyzed the global prevalence of NSSI and prevalence of NSSI characteristics in a non-clinical sample of adolescents between 2010 and 2021. Methods A systematic search for relevant articles published from January 1, 2010 to June 30, 2021 was performed within the scholarly database search engines of CBM, CNKI, VIP, Wanfang, PubMed, Web of Science, PsycINFO, and Embase. Eligibility criteria were as follows: provided cross-sectional data on the prevalence of NSSI; the subjects were non-clinical sample adolescents; and a clear definition of NSSI was reported. We used the following definiton of NSSI as our standard: the deliberate, self-inflicted destruction of body tissue, such as cutting, burning, and biting, without attempted suicide. The quality evaluation tool for cross-sectional studies recommended by the JBI was used. The global prevalence of NSSI was calculated based on the random-effects model by Comprehensive Meta-analysis version 3.0. Subgroup analyses were performed to compare the prevalence according to sex, living place, smoking or drinking history, and family structure. Results Sixty-two studies involving 264,638 adolescents were included. The aggregate prevalence of NSSI among a non-clinical sample of adolescents was similar between over a lifetime (22.0%, 95% CI 17.9-26.6) and during a 12-month period (23.2%, 95% CI 20.2-26.5). Repetitive NSSI was more common than episodic NSSI (20.3% vs. 8.3%) but the frequency of mild injury (12.6%) was similar to that of moderate injury (11.6%). Multiple-method NSSI occurred slightly more often compared than one-method NSSI (16.0% vs. 11.1%). The top three types of NSSI in adolescents were banging/hitting (12.0%, 95% CI 8.9-15.9), pinching (10.0%, 95% CI 6.7-14.8), and pulling hair (9.8%, 95% CI 8.3-11.5), and the least common type was swallowing drugs/toxic substances/chemicals (1.0%, 95% CI 0.5-2.2). Subgroup analyses showed that being female, smoking, drinking, having siblings, and belonging to a single-parent family may be linked to higher prevalence of NSSI. Conclusion This meta-analysis found a high prevalence of NSSI in non-clinical sample of adolescents, but there are some changes in severity, methods, and reasons. Based on the current evidence, adolescents in modern society are more inclined to implement NSSI behavior by a variety of ways, which usually are repetitive, and moderate and severe injuries are gradually increasing. It is also worth noting that adolescents with siblings or in single-parent families are relatively more likely to implement NSSI behavior due to maladjustment to the new family model. Future research needs to continue to elucidate the features and risk factors of NSSI so as to intervene in a targeted way. Limitation The limitation of this study is that the heterogeneity among the included studies is not low, and it is mainly related to Chinese and English studies. The results of this study should be used with caution. Systematic review registration [www.crd.york.ac.uk/prospero/], identifier [CRD42022283217].
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Affiliation(s)
- Qingqing Xiao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaozhen Song
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Lijuan Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Dandan Hou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xuehua Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
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Gabella BA, Hume B, Li L, Mabida M, Costich J. Multi-site medical record review for validation of intentional self-harm coding in emergency departments. Inj Epidemiol 2022; 9:16. [PMID: 35672865 PMCID: PMC9175468 DOI: 10.1186/s40621-022-00380-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Codes in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), are used for injury surveillance, including surveillance of intentional self-harm, as they appear in administrative billing records. This study estimated the positive predictive value of ICD-10-CM codes for intentional self-harm in emergency department (ED) billing records for patients aged 10 years and older who did not die and were not admitted to an inpatient medical service. METHODS The study team in Maryland, Colorado, and Massachusetts selected all or a random sample of ED billing records with an ICD-10-CM code for intentional self-harm (specific codes that began with X71-X83, T36-T65, T71, T14.91). Positive predictive value (PPV) was determined by the number and percentage of records with a physician diagnosis of intentional self-harm, based on a retrospective review of the original medical record. RESULTS The estimated PPV for the codes' capture of intentional self-harm based on physician diagnosis in the original medical record was 89.8% (95% CI 85.0-93.4) for Maryland records, 91.9% (95% CI 87.7-95.0) for Colorado records, and 97.3% (95% CI 95.1-98.7) for Massachusetts records. CONCLUSION Given the high PPV of the codes, epidemiologists can use the codes for public health surveillance of intentional self-harm treated in the ED using ICD-10-CM coded administrative billing records. However, these codes and related variables in the billing database cannot definitively distinguish between suicidal and non-suicidal intentional self-harm.
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Affiliation(s)
- Barbara A. Gabella
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, A4, Denver, CO 80246-1530 USA
| | - Beth Hume
- Massachusetts Department of Public Health, Boston, MA USA
| | - Linda Li
- Maryland Department of Health, Baltimore, MD USA
| | | | - Julia Costich
- Department of Health Management and Policy and Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY USA
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Mendez I, Sintes A, Pascual JC, Puntí J, Lara A, Briones-Buixassa L, Nicolaou S, Schmidt C, Romero S, Fernández M, Carmona I Farrés C, Soler J, Santamarina-Perez P, Vega D. Borderline personality traits mediate the relationship between low perceived social support and non-suicidal self-injury in a clinical sample of adolescents. J Affect Disord 2022; 302:204-213. [PMID: 35038480 DOI: 10.1016/j.jad.2022.01.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a serious public health concern among adolescents, especially in clinical settings. Social support plays a critical role in the onset and maintenance of NSSI in adolescence. NSSI is closely associated with borderline personality disorder (BPD), yet no previous work has analyzed the mediating role of borderline traits in the relationship between perceived social support (PSS) and NSSI. This study aimed to address this gap. METHODS Participants were 228 adolescent patients (12 to 18 years old), who completed a clinical interview and self-report measures of BPD-traits, current psychological distress, emotion dysregulation and PSS. They were grouped based on the presence (vs. absence) of NSSI. Univariate and multivariate logistic regression analyses were used to identify risk factors of NSSI, and a mediation analysis was conducted to examine the intermediary role of borderline traits in the relationship between PSS and NSSI. RESULTS NSSI was highly prevalent in our sample (58%) and was associated with higher clinical severity. Low PSS predicted NSSI in univariate, but not multivariate regression. Mediation analyses showed that borderline traits fully accounted for the relationship between low PSS and NSSI, even when controlling for current psychological distress and gender. LIMITATIONS Cross-sectional design through self-report assessment. CONCLUSIONS Findings suggest that adolescents with low PSS are especially vulnerable for developing NSSI due to elevated BPD traits. In clinical settings, interventions aimed to reduce borderline symptoms may be a promising treatment option for adolescents with NSSI and low PSS.
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Affiliation(s)
- Iria Mendez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Sintes
- Servicio de salud mental infantojuvenil, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Juan Carlos Pascual
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Puntí
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Hospital de Dia de Adolescentes. Servicio de Salud Mental. Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain; Departamento de Psicología Clínica y de la Salud, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anaís Lara
- Servicio de Psiquiatría y Psicología, ALTHAIA, Xarxa Assistencial i Universitària de Manresa, Barcelona, Manresa, Spain
| | - Laia Briones-Buixassa
- Mental Health and Social Innovation Research Group and Centre for Health and Social Care Research, Universitat de Vic - Universitat Central de Catalunya, Catalonia, Spain
| | - Stella Nicolaou
- PhD Programme in Biomedicine, University of Barcelona, Spain; Psychiatry and Mental Health Department, Consorci Sanitari de l'Anoia & Fundació Sanitària d'Igualada, Hospital Universitari d'Igualada. Av. Catalunya 11, Barcelona, Igualada 08700, Spain
| | - Carlos Schmidt
- Psychiatry and Mental Health Department, Consorci Sanitari de l'Anoia & Fundació Sanitària d'Igualada, Hospital Universitari d'Igualada. Av. Catalunya 11, Barcelona, Igualada 08700, Spain
| | - Soledad Romero
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Fernández
- Servicio de salud mental infantojuvenil, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Cristina Carmona I Farrés
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Soler
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Santamarina-Perez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Daniel Vega
- Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Psychiatry and Mental Health Department, Consorci Sanitari de l'Anoia & Fundació Sanitària d'Igualada, Hospital Universitari d'Igualada. Av. Catalunya 11, Barcelona, Igualada 08700, Spain.
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Arnold S, Wiese A, Zaid S, Correll CU, Jaite C. Lifetime prevalence and clinical correlates of nonsuicidal self-injury in youth inpatients with eating disorders: a retrospective chart review. Child Adolesc Psychiatry Ment Health 2022; 16:17. [PMID: 35227292 PMCID: PMC8884089 DOI: 10.1186/s13034-022-00446-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Youths with eating disorders (EDs) engaging in nonsuicidal self-injury (NSSI) are at higher suicide risk because EDs and NSSI are associated with suicidality. However, epidemiologic data on NSSI lacks in the vulnerable group of youth ED inpatients. METHODS This retrospective chart review included patients up to 18 years of age with an ICD-10 diagnosis of anorexia nervosa, restricting type (AN-R), anorexia nervosa, binge-purge type (AN-BP), and bulimia nervosa (BN), treated at the child and adolescent inpatient department of the University Hospital in Berlin, Germany, between 1990 and 2015. Across and within ED subgroups, lifetime NSSI prevalence, methods of self-harm, and clinical correlates were evaluated. Independent correlations of demographic and clinical factors with NSSI were identified via multivariable regression models. RESULTS Of 382 inpatients (median = 15.6 (range = 9-18) years, females = 97.1%), 21.5% reported lifetime NSSI, consisting of cutting = 86.6%, scratching = 12.2%, and hitting = 8.5%. NSSI was more frequent in BN (47.6%) and AN-BP (39.3%) than AN-R (8.3%) (Φ = 0.43). Across ED subgroups, NSSI was associated with a higher prevalence of psychiatric comorbidities (AN-R: Φ = 0.55; AN-BP: Φ = 0.69; BN: Φ = 0.78), suicidal ideation (AN-R: Φ = 0.30; AN-BP: Φ = 0.38; BN: Φ = 0.29), and psychiatric medication use (AN-R: Φ = 0.23; AN-BP: Φ = 0.64; BN: Φ = 0.60). In multivariable regression analyses, NSSI was independently associated with a higher prevalence of psychiatric comorbidities (AN-R: OR = 2.93 [1.42, 6.04]; AN-BP: OR = 2.67 [1.13, 6.31]; BN: OR = 3.75 [1.71, 8.23]). Additionally, independent correlates with NSSI in AN-R included a higher prevalence of suicidal ideation (OR = 0.21 [0.72, 0.64]) and less weekly weight gain (OR = 0.03 [0.02, 0.43]), while in BN, NSSI was correlated with longer inpatient treatment duration (OR = 1.01 [1.00, 1.02]). CONCLUSIONS There is a high lifetime prevalence of NSSI among youth with AN and BN requiring inpatient treatment, especially those with binge-purge behaviors. Treatment programs must be tailored to address psychiatric comorbidities and suicidality to improve patient care and suicide prevention. TRIAL REGISTRATION This study was not considered a clinical trial but a retrospective chart review based on routinely assessed clinical parameters. The study includes data from human participants, however: (1) no intervention and no prospective assignment to interventions were performed, and (2) no evaluation of an intervention on participants was accomplished.
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Affiliation(s)
- Sabine Arnold
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Antonia Wiese
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Zaid
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph U. Correll
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany ,grid.440243.50000 0004 0453 5950Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY USA ,grid.512756.20000 0004 0370 4759Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Charlotte Jaite
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Non-suicidal self-injury and attachment trauma in adolescent inpatients with psychiatric disorders. Compr Psychiatry 2021; 111:152273. [PMID: 34555553 DOI: 10.1016/j.comppsych.2021.152273] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/31/2021] [Accepted: 09/08/2021] [Indexed: 01/04/2023] Open
Abstract
This study examined how non-suicidal self-injury disorder (NSSID) differs with respect to mental disorders, gender and attachment status in adolescent psychiatric patients. In particular, we analyzed attachment-related traumatic material underlying adolescent NSSID. Our sample consisted of 137 in-patient adolescents aged 12 to 18 years (73% female, Mage = 15.09, SD = 1.44; 27% male, Mage = 14.65, SD = 1.53). Forty-four patients (32.1%) fulfilled the diagnostic criteria for NSSID according to the DSM-5 and ninety-three patients (67.9%) did not meet diagnostic criteria for NSSID. Our results revealed a higher prevalence of NSSID in female patients and in patients with mood disorders. In the total sample, 52% of our in-patients were classified with an unresolved attachment status. The diagnostic subgroup analysis demonstrated a higher percentage of unresolved attachment status only in patients with eating disorders and NSSID. However, our in-depth analysis of the total sample revealed that patients with NSSID demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. In particular the theme of helplessness in interpersonal conflicts left them in a state of attachment dysregulation. Intervention strategies targeting traumatic attachment-related themes might be useful to reduce the number of adolescents engaging in NSSI.
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Novak MA, Meyer JS. A Rhesus Monkey Model of Non-suicidal Self-Injury. Front Behav Neurosci 2021; 15:674127. [PMID: 34421551 PMCID: PMC8374142 DOI: 10.3389/fnbeh.2021.674127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Non-suicidal self-injury (NSSI) is a type of behavioral pathology seen not only in a variety of clinical conditions but also among non-clinical populations, particularly adolescents and young adults. With the exception of rare genetic conditions that give rise to self-harming behaviors, the etiology of NSSI and the events that trigger specific episodes of this behavior remain poorly understood. This review presents the features of an important, extensively studied animal model of NSSI, namely spontaneously occurring self-injurious behavior (SIB) in rhesus macaque monkeys. We compare and contrast rhesus monkey SIB with NSSI with respect to form, prevalence rates, environmental and biological risk factors, behavioral correlates, proposed functions, and treatment modalities. Many parallels between rhesus monkey SIB and NSSI are demonstrated, which supports the validity of this animal model across several domains. Determining the etiology of spontaneously occurring SIB in monkeys, its underlying biological mechanisms, and which pharmacological agents are most effective for treating the disorder may aid in identifying potential risk factors for the occurrence of NSSI in humans and developing medications for severe cases that are resistant to conventional psychotherapeutic approaches.
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Affiliation(s)
- Melinda A Novak
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, United States
| | - Jerrold S Meyer
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, United States
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Rodríguez-Blanco L, Carballo-Belloso JJ, de León S, Baca-García E. A longitudinal study of adolescents engaged in Non-Suicidal Self Injury (NSSI): clinical follow-up from adolescence to young adulthood. Psychiatry Res 2021; 297:113711. [PMID: 33486275 DOI: 10.1016/j.psychres.2021.113711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
The main aim of the current study is to examine the demographic and clinical factors that predict a continuity of the use of Mental Health Services (MHS) in adulthood by subjects who have engaged in non-suicidal-self-injury behaviors (NSSI) and have been followed in MHS in their teen years. A cohort of 147 participants was selected from an original sample of 267 adolescent patients recruited from the Child and Adolescent Outpatient Psychiatric Services. Patients were divided into two groups: those who had engaged in NSSI (NSSI-group), and those who had not (non-NSSI-group). Rate of use of MHS in adulthood was calculated for both groups and univariate analyses and binary logistic regression analysis were applied. In the NSSI-group, two factors appeared to influence a continuity of the use of MHS in adulthood. Prosocial behavior was associated with a greater use of MHS in adulthood whereas behavioral problems were associated with less use. Only prosocial behavior was maintained in the regression model as a predictor. Our findings could have implications for clinical practice with NSSI patients and highlight the importance of working on specific areas that could prevent treatment abandonment in the transition from adolescence to adulthood.
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Affiliation(s)
- Lucía Rodríguez-Blanco
- Psychiatry Department, General Hospital of Villalba Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Collado Villalba. Madrid, Spain; Psychiatry Department, Autonomous University of Madrid. 4, Arzobispo Morcillo, 28029. Madrid, Spain.
| | - Juan Jose Carballo-Belloso
- Child and Adolescent Psychiatry Department, Universitary Hospital Gregorio Marañón. 46, Dr. Esquerdo, 28007. Madrid, Spain; CIBERSAM, Carlos III Institute of Health. Madrid, Spain 3-5, Monforte de Lemos, 28029. Madrid, Spain
| | - Santiago de León
- Signal Theory and Communications Department. Carlos III University. 30, Universiy Avenue, 28911. Leganés. Madrid
| | - Enrique Baca-García
- Psychiatry Department, General Hospital of Villalba Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Collado Villalba. Madrid, Spain; Psychiatry Department, Autonomous University of Madrid. 4, Arzobispo Morcillo, 28029. Madrid, Spain; CIBERSAM, Carlos III Institute of Health. Madrid, Spain 3-5, Monforte de Lemos, 28029. Madrid, Spain; Psychiatry Department, University Hospital Jiménez Díaz Foundationt. 2, Reyes Católicos Avenue, 28040. Madrid, Spain; Psychiatry Department, University Hospital Rey Juan Carlos. Gladiolo, s/n, 28933. Mostoles, Spain; Psychiatry Department, University Hospital Infanta Elena. 21, Reyes Católicos Avenue, 28342. Valdemoro, Spain; Psychiatry Department, Catholic University of the Maule. San Miguel Avenue, 3605. Talca, Chile; Psychiatry Department, University Hospital of Nimes, 4, Rue du Professeur Robert Debré, 30029. Nîmes, Francia
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Koposov R, Stickley A, Ruchkin V. Non-Suicidal Self-Injury Among Incarcerated Adolescents: Prevalence, Personality, and Psychiatric Comorbidity. Front Psychiatry 2021; 12:652004. [PMID: 34093271 PMCID: PMC8170036 DOI: 10.3389/fpsyt.2021.652004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Incarcerated adolescents represent a risk group for non-suicidal self-injury (NSSI), but research on this population has been limited and no studies have been conducted in Russia. To address this deficit, this study examined NSSI and the factors associated with it among youth in a juvenile correctional facility in Russia. Methods: NSSI and psychopathology were assessed using a psychiatric interview and self-report questionnaire in 368 incarcerated male adolescents aged 14-19 years (mean age 16.4 years, S.D. 0.9) from Northern Russia. Results: 18.2% (N = 67) of the study participants had a history of NSSI and also had higher rates of anxiety, post-traumatic stress disorder (PTSD), depression, community violence exposure and scored higher on most of the Youth Self-Report problem scales. In addition, 31.3% of the NSSI group reported previous suicidal ideation and had thought about a specific suicide method compared to 12.0% in the No-NSSI group. Adolescents with NSSI also differed significantly from the No-NSSI group on self-directedness (lower) and self-transcendence (higher) personality traits. Conclusion: NSSI is common in incarcerated adolescents in Russia and is associated with extensive psychiatric comorbidity, suicidal ideation and specific personality traits.
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Affiliation(s)
- Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Epidemiology and Modern Technologies of Vaccination, Institute of Professional Education, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Center of Neurology and Psychiatry, Kodaira, Japan.,Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Child Study Center, Yale School of Medicine, New Haven, CT, United States.,Säter Forensic Psychiatric Clinic, Säter, Sweden
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Non-suicidal self-injury disorder as a stand-alone diagnosis in a consecutive help-seeking sample of adolescents. J Affect Disord 2020; 274:1122-1125. [PMID: 32663940 DOI: 10.1016/j.jad.2020.06.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/27/2020] [Accepted: 06/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND With inclusion of non-suicidal self-injury disorder (NSSID) in the DSM-5, empirical data are crucial to gather information regarding its clinical validity and relevance. Until now, research focused mostly on single diagnostic criteria of NSSID. The present study aimed to characterize NSSID with and without comorbid diagnoses in a large help-seeking adolescent sample, investigating the clinical validity and selectivity of NSSID within the theoretical framework of Robins and Guze. METHODS Interview and self-report data of n = 464 adolescents (mean age = 14.95 years, SD = 1.43, 89.17% female) with NSSID according to DSM-5 from a German outpatient clinic were analysed with descriptive statistics. Group differences were calculated with χ2 tests or t-tests respectively. Stability of NSSID without comorbidity was investigated after 12 months. RESULTS Within a consecutive help-seeking sample, NSSID as a stand-alone diagnosis (without comorbidity) was rare (only 3.7%), associated with low illness severity and psychopathological distress, and prospectively rather unstable. LIMITATION Selection bias due to the help-seeking population and female preponderance. CONCLUSION Based on the theoretical framework applied, NSSI should be considered as an unspecific precursor for psychopathological development generally and suicide specifically but it may be of limited significance as a 'pure and sole' diagnostic entity. Results add to existing claims to re-propose classification criteria to better picture the clinical group of affected adolescents.
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