The Co-occurrence of Self-Harm and Aggression: A Cognitive-Emotional Model of Dual-Harm

The association between aggressive behaviour and non-suicidal self-injury and shared risk factors in adults with mild intellectual disability

BACKGROUND

Aggressive behaviour (AB) and non-suicidal self-injury (NSSI) are common in people with mild intellectual disability or borderline intellectual functioning, leading to adverse consequences for themselves and those around them.

METHOD

We investigated the relationship between AB (both total and physical in particular) and NSSI and risk factors in 125 residents in a treatment clinic using incident reports and standard clinical measurements.

RESULTS

There was a weak correlation between AB and NSSI, as well as between impulsivity and total AB, and between coping and AB and NSSI. However, NSSI, impulsivity and coping skills did not predict AB.

CONCLUSION

Results do not corroborate those of other studies in this area. In future studies impulsivity, coping, aggression and NSSI may be measured using other instruments, and differences between people with and without intellectual disability regarding these variables may be explored.

An Examination of Hate-Motivated Behavior Among Adults in Scotland and Associations with Risk Factors for Self-Directed Violence

Hate-motivated behavior (HMB) ranges from microaggressions to criminal acts and is a public health concern with consequences for the physical and mental well-being of individuals, families, and communities. The Hate-Motivated Behavior Checklist (HMBC) was developed with the goal of advancing the measurement of HMB perpetration. To provide insights into perpetration and victimization across the HMB continuum in Scotland, the present study sought to examine the factor structure of both the original HMBC and our adapted victimization version in a sample of adults currently living in Scotland. It also aimed to test associations between HMB and cognitions, which are related to self-directed violence (defeat and entrapment). Participants (n = 447) completed an online cross-sectional survey assessing demographic factors, HMB (perpetration and victimization), and perceptions of defeat and entrapment. Confirmatory factor analysis was used to examine the factor structure of the HMBC and the adapted victimization version of this checklist and path analyses were implemented to provide insights into potential links between HMB, defeat, and entrapment. In line with previous work, results provided support for interpreting the HMB Checklist as a single-factor total score. This was also true for the victimization version of the checklist. Results indicated that HMB victimization (but not perpetration) was associated with increased perceptions of defeat and entrapment. These findings suggest that the HMBC (for assessing both perpetration and victimization) represents potentially useful tools for HMB research and supports their applicability outside of an American context. Furthermore, by examining HMB through the lens of a contemporary model of suicidal behavior, our findings also provide insights into potential psychological mechanisms linking interpersonal and self-directed violence. Future research should implement prospective research designs and integrate measures of self-directed violence outcomes alongside HMB, defeat, and entrapment, to further advance understanding of this association.

The dexamethasone suppression test as a biomarker for suicidal behavior: A systematic review and meta-analysis

BACKGROUND

The dexamethasone suppression test (DST), which measures HPA-axis functioning, is a potential biomarker for suicidal behavior. The current study aimed (a) to synthesize available knowledge on the association between DST non-suppression and suicidal behavior, and (b) to study potential moderators.

METHODS

A total of 4236 studies were screened, 43 were included. Suicide attempts and suicide completion were studied separately. The meta-analysis included 37 effect sizes for suicide attempts (n = 3733) and 11 effect sizes for suicide completion (n = 1626).

RESULTS

DST non-suppression was associated with completed suicide (odds ratio (OR) = 2.10, (95 % CI [1.37, 3.23]). For suicide attempts, we found no evidence that DST status was associated in the overall meta-analysis including all patient samples. However, moderator analysis indicated that the DST status was associated with suicide attempts in patient samples that included psychopathology other than just mood disorders, such as psychotic, substance use and personality disorders (OR = 2.34, 95 % CI [1.39-3.93], k = 11).

LIMITATIONS

The potential influence of publication bias and exclusion of some relevant published studies (since effect sizes could not be calculated, authors could not supply data or authors could not be reached) are limitations. Furthermore, missing moderator data decreased our ability to explain heterogeneity between studies.

CONCLUSIONS

The results of this meta-analysis support the hypothesis that DST non-suppression is predictive of suicidal behavior. More research is needed to investigate optimal cut-off values, confounding factors and the potential usefulness of the DST in clinical practice in terms of personalized medicine.

Sexual Offending: Adverse Childhood Experiences, Shame, and Self-Compassion Explain the Variance in Self-Harm and Harm Towards Others?

Research investigating potential pathways from Adverse Childhood Experiences (ACEs) to later self-harming and offending behaviours has inconsistent findings. Past research, however, has not fully explored the interplay between ACEs and modifiable psychological factors, such as shame and self-compassion. The present study explored the relationship between ACE, shame, and self-compassion to identify their role in explaining the variance in later harm in a sample of individuals who have committed sexual offences. Two hundred and fifty adults incarcerated for sexual offences participated. Multiple Regression and Mediation Analyses were applied to establish if ACE, shame and self-compassion explained the variance in harm and explore potential psychological pathways between ACE and harm, with shame and self-compassion as potential modifiable mediators. ACE, shame and self-compassion explained 55% of self-harm and 52% of psychological and physical harm variance. A more complex relationship was indicated for sexual harm, with only 19% of the variance explained by the model. The study increases our understanding of the relationship between variables and potential modifiable pathways between ACEs and later harming behaviours in a sample of individuals with sexual convictions. These modifiable psychological factors could be targeted to increase resilience, post-traumatic growth and reduce the risk of harm in later life.

Distinguishing pathways from bullying victimization to nonsuicidal self-injury and to cyberaggression: Do perceived ostracism and depression mediate their links?

Bullying victimization is related to increased aggressive behaviour, but little research considers both self- (e.g., nonsuicidal self-injury; NSSI) and other-directed (e.g., cyberaggression) outcomes. Moreover, little is known about the mediating mechanisms that underlie this relationship. Based on the General Aggression Model, the current study investigates the mediating roles of Perceived ostracism (PO) and depression in the relationship between bullying victimization and cyberaggression/NSSI among emerging adult. A total of 795 emerging adults (Mage = 19.66 years, SD = 1.46; 59.9% female) completed a multimeasure questionnaire measuring the targeted variables at three time points over one year. Structural equation modelling was used to test temporal mediation. After controlling for gender, age, and family monthly income, bullying victimization was found to positively predict later cyberaggression and NSSI. Mediation analysis revealed that the longitudinal association between bullying victimization and cyberaggression was mediated by PO; the longitudinal association between bullying victimization and NSSI was mediated by depression and was sequentially mediated by PO and depression. These findings extend the theory, prevention and interventions to include both self- and other-directed aggressive behaviour in the bullying context. Future research and practice may benefit from an emphasis on PO and depression-focused psychological interventions.

Dual harm among patients attending a mental health unit in Uganda: a hospital based retrospective study

BACKGROUND

Dual harm encompasses the complex interplay of the co-occurrence of self-harm and aggression. Individuals with dual harm may display a more hazardous pattern of harmful behaviors like homicide-suicide compared to people with sole harm. This study aimed to examine the presence of dual harm among general psychiatry inpatients in a mental health unit in Uganda.

METHODS

A retrospective chart review of 3098 inpatients from January 2018 to December 2021. Dual harm reported experience at admission was based on experiences of self-harm with harm to people or property or both. Logistic regression assessed the association between dual harm and sociodemographics and clinical characteristics.

RESULTS

A total of 29 (1%) patients experienced dual harm, with five having experienced self-harm with both harm to others and property, 23 with harm to people, and one with harm to property. Dual harm was statistically significantly associated with the male gender at bivariate analysis. However, there were no statistically significant factors associated with dual harm at multivariate analysis or sensitivity analysis with the specific types of dual harm.

CONCLUSION

General psychiatry inpatients in Uganda experience dual harm before admission at lower prevalence than in previous literature. However, no investigated sociodemographic and clinical factors could explain these experiences. Further studies looking at dual harm are warranted to understand these unfortunate experiences with serious consequences among patients in Uganda.

Workplace Objectification Leads to Self-Harm: The Mediating Effect of Depressive Moods

In the current research, we aimed to extend the literature on workplace objectification and contribute to employees' well-being by exploring whether and how workplace objectification increases self-harm as well as the coping strategy that may weaken the effect. Employing archive data analytic, correlational, longitudinal, and experimental designs, we found that workplace objectification was associated with, or led to, self-harm, irrespective of whether such actions provided an escape from work. This effect could not be simply ascribed to the negative nature of workplace objectification. We further found that depressive moods mediated this effect. The detrimental effect of workplace objectification on self-harm was lessened when employees perceived higher alternatives in life. Theoretical and managerial implications were discussed.

Childhood predictors of self-harm, externalised violence and transitioning to dual harm in a cohort of adolescents and young adults

BACKGROUND

The aetiology of dual harm (co-occurring self-harm and violence towards others) is poorly understood because most studies have investigated self-harm and violence separately. We aimed to examine childhood risk factors for self-harm, violence, and dual harm, including the transition from engaging in single harm to dual harm.

METHODS

Data from the Avon Longitudinal Study of Parents and Children, a UK-based birth cohort study, were used to estimate prevalence of self-reported engagement in self-harm, violence, and dual harm at ages 16 and 22 years. Risk ratios were calculated to indicate associations across various self-reported childhood risk factors and risks of single and dual harm, including the transition from single harm at age 16 years to dual harm at age 22.

RESULTS

At age 16 years, 18.1% of the 4176 cohort members had harmed themselves, 21.1% had engaged in violence towards others and 3.7% reported dual harm. At age 22 the equivalent prevalence estimates increased to 24.2, 25.8 and 6.8%, respectively. Depression and other mental health difficulties, drug and alcohol use, witnessing self-harm and being a victim of, or witnessing, violence were associated with higher risks of transitioning from self-harm or violence at age 16 to dual harm by age 22.

CONCLUSIONS

Prevalence of dual harm doubled from age 16 to 22 years, highlighting the importance of early identification and intervention during this high-risk period. Several childhood psychosocial risk factors associated specifically with dual harm at age 16 and with the transition to dual harm by age 22 have been identified.

Shame and Self-Compassion Connect Childhood Experience of Adversity With Harm Inflicted on the Self and Others

Self-harm, suicide, and harm inflicted on others (e.g., victimization) remain key areas of public concern. Past research has explored the link between adverse childhood experiences (ACEs) and later self-harming and offending behaviors. However, research has not fully explored the interplay between ACEs and modifiable psychological factors, such as shame and self-compassion, that could be targeted to reduce the risk of harm and increase resilience and capacity for post-traumatic growth. The present study explored the relationship between ACEs, harm, shame, and self-compassion. A total of 1,111 adults participated. Approximately 49% were female, 45% male, and 2% nonbinary. Just under a third of the sample were incarcerated. We adopted a cross-sectional survey design and included current and retrospective data. The relationship between the variables was analyzed using Pearson product-moment correlation, and structural equation modeling was applied to explore the potential psychological pathways of causation. The model predicted just under 50% of the harm to self (i.e., self-harm) variance and just over a third (35%) of the harm to others (i.e., psychological and physical aggression) variance. ACEs, shame, and self-compassion had varying roles in mediating the relationship between ACEs and harm. The study increases our understanding of modifiable causal pathways between ACEs and later harming behaviors. Additionally, it indicates the importance of understanding the different dimensions of shame when considering ways to reduce the potential long-term negative consequences of ACEs.

Associations between violence, self-harm and acute psychiatric service use: Implications for inpatient care

WHAT IS KNOWN ON THE SUBJECT?: Service users who behave violently may suffer. This is because violence can lead to unnecessary medication, seclusion on the ward and strained relationships with other people. It can also affect a service user's self-esteem and lead to feelings of shame. Service users who behave violently can also make life frightening and unpredictable for members of staff, and other service users on the ward. It is important to gain a sound understanding of violence in order to help reduce it. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Previous research has shown that having a past history of violence, being admitted to PICU and being admitted to hospital under section is associated with violent behaviour on the ward. We identified several new factors associated with violent behaviour, such as engaging in self-harm, being the target of another person's violence and being referred to a Psychiatric Liaison Team.

IMPLICATIONS FOR PRACTICE

For some service users, behaving violently may be a response to previous trauma and an expression of distress. It is therefore important that mental health nurses are supported by their employers to work with service users in a trauma-informed manner. Nurses employed across a range of psychiatric settings could benefit from direct interventions such as comprehensive trauma-informed care training and psychological debrief spaces, or systemic interventions to address staff shortages and improve ward conditions.

ABSTRACT

INTRODUCTION: Instances of violence in acute psychiatric settings are frequent, can be devastating for service users and staff, and are costly. Such settings would benefit from a greater understanding of violence.

AIM

We analysed the association between current and historical variables and rates of inpatient violence. To address gaps in current research, we included instances of self-harm and being the target of violence. We also included seldom used service metrics.

METHOD

Data were extracted on admissions to acute adult wards and PICUs 2017-2020 within South London and Maudsley NHS Foundation Trust. A zero-inflated negative binomial regression mixed model was used to analyse the impact of variables on rates of violence.

RESULTS

Variables associated with an increased rate of violence were as follows: an increased number of violent incidents in the year before admission, being admitted on MHA section, being admitted to PICU, instances of self-harm, being the target of violence and referral to a Psychiatric Liaison Team.

DISCUSSION

The novel associations found between enacting violence, self-harm and being the target of violence indicate trauma-informed care is crucial to reduce violent presentations of distress.

IMPLICATIONS FOR PRACTICE

System level interventions are crucial to ensure mental health nurses are supported to provide trauma-informed care.

What emotions do male prisoners experience in the lead-up to suicide and violence? A participatory visual method study

Rates of suicide and violence are higher amongst male prisoners than the general population. This study aimed to explore the emotional experiences of male prisoners in the distal and immediate lead-up to acts of suicide and violence. Nine male prisoners created drawings of their emotions in the lead-up to an act of suicide and/or violence. Accompanying verbal interview data was collected to explore the narrative of these drawings. Polytextual thematic analysis was conducted on both the visual and audio data. Three themes were found. 'The outside picture' depicted the emotions that male prisoners exhibited externally. 'The inside picture' illustrated the internal emotions felt by male prisoners which were often complex and abstract. 'The complexity of the picture' denotes the complicated relationship between emotions and suicide/violence. Male prisoners experience a range of emotions in the lead up to acts of suicide and violence, with a similar set of emotions being experienced immediately prior to both suicide and violence. This study has illustrated the benefits of using a novel and creative methodology, and has demonstrated that future research with male prisoners could benefit from adopting a participatory visual methodology.

Associations of bullying perpetration and peer victimization subtypes with preadolescent's suicidality, non-suicidal self-injury, neurocognition, and brain development

BACKGROUND

Although both peer victimization and bullying perpetration negatively impact preadolescents' development, the underlying neurobiological mechanism of this adverse relationship remains unclear. Besides, the specific psycho-cognitive patterns of different bullying subtypes also need further exploration, warranting large-scale studies on both general bullying and specific bullying subtypes.

METHODS

We adopted a retrospective methodology by utilizing the data from the Adolescent Brain and Cognitive DevelopmentSM Study (ABCD Study®) cohort collected between July 2018 and January 2021. Participants were preadolescents aged from 10 to 13 years. The main purpose of our study is to examine the associations of general and specific peer victimization/bullying perpetration with preadolescents' (1) suicidality and non-suicidal self-injury; (2) executive function and memory, including attention inhibition, processing speed, emotion working memory, and episodic memory; (3) brain structure abnormalities; and (4) brain network disturbances. Age, sex, race/ethnicity, body mass index (BMI), socioeconomic status (SES), and data acquisition site were included as covariates.

RESULTS

A total of 5819 participants aged from 10 to 13 years were included in this study. Higher risks of suicide ideation, suicide attempt, and non-suicidal self-injury were found to be associated with both bullying perpetration/peer victimization and their subtypes (i.e., overt, relational, and reputational). Meanwhile, poor episodic memory was shown to be associated with general victimization. As for perpetration, across all four tasks, significant positive associations of relational perpetration with executive function and episodic memory consistently manifested, yet opposite patterns were shown in overt perpetration. Notably, distinct psycho-cognitive patterns were shown among different subtypes. Additionally, victimization was associated with structural brain abnormalities in the bilateral paracentral and posterior cingulate cortex. Furthermore, victimization was associated with brain network disturbances between default mode network and dorsal attention network, between default mode network and fronto-parietal network, and ventral attention network related connectivities, including default mode network, dorsal attention network, cingulo-opercular network, cingulo-parietal network, and sensorimotor hand network. Perpetration was also associated with brain network disturbances between the attention network and the sensorimotor hand network.

CONCLUSIONS

Our findings offered new evidence for the literature landscape by emphasizing the associations of bullying experiences with preadolescents' clinical characteristics and cognitive functions, while distinctive psycho-cognitive patterns were shown among different subtypes. Additionally, there is evidence that these associations are related to neurocognitive brain networks involved in attention control and episodic retrieval. Given our findings, future interventions targeting ameliorating the deleterious effect of bullying experiences on preadolescents should consider their subtypes and utilize an ecosystemic approach involving all responsible parties.

A systematic review of the co-occurrence of self-harm and aggression: Is dual harm a unique behavioural construct?

Introduction

Dual harm is the co-occurrence of self-harm and aggression during an individual's lifetime. It is unclear whether sufficient evidence exists for dual harm as a unique clinical entity. This systematic review aimed to examine whether there are psychological factors that are uniquely associated with dual harm when compared to those who have engaged in sole harm (self-harm alone, aggression alone) and no harmful behaviours. Our secondary aim was to conduct a critical appraisal of the literature.

Methods

The review searched PsycINFO, PubMed, CINAHL, and EThOS on September 27, 2022, resulting in 31 eligible papers that represented 15,094 individuals. An adapted version of the Agency for Healthcare Research and Quality was used to assess risk of bias and a narrative synthesis was conducted.

Results

The included studies assessed differences in mental health problems, personality, and emotion related factors between the different behavioural groups. We found weak evidence that dual harm is an independent construct with unique psychological characteristics. Rather, our review suggests that dual harm results from the interaction of psychological risk factors that are associated with self-harm and aggression.

Discussion

The critical appraisal identified numerous limitations within the dual harm literature. Clinical implications and recommendations for future research are provided.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197323, identifier CRD42020197323.

The Association Between Media Exposure to Non Suicidal Self-Injury and Emergency Department Visits for Self-Harm

OBJECTIVE

This study aimed to evaluate the association between media exposure to non suicidal self-injury (NSSI) and emergency department (ED) visits due to self-harm in Korea, specifically before and after the initial broadcast of the song Barcode, which has an explicit focus on NSSI.

METHOD

We used the national emergency department information system to obtain data related to ED visits due to self-harm between January 1, 2014, and December 31, 2018. Using interrupted time series regression analysis, we assessed the monthly ED visits due to self-harm before and after the media exposure to NSSI on March 30, 2018. In addition, self-harm methods were assessed.

RESULTS

A total of 35,928,834 visits to ED were identified, of which 115,647 were due to self-harm. ED visits due to self-harm showed a significant step increase in the 10- to 14-year-old (β = 0.883, p = .001), 15- to 19-year-old (β = 2.941, p < .001), 20- to 24-year-old (β = 1.997, p = 0.002), and 25- to 29-year-old (β = 1.438, p = .029) age groups, before and after the media exposure to NSSI. The most pronounced increase was observed in male participants aged 20 to 24 years (β = 1.790, p = .012) and female participants aged 15 to 19 years (β = 5.158, p < .001). Self-harm by cutting has increased significantly in participants aged 10 to 29 years, and self-harm by poisoning has also increased significantly in participants aged 10 to 19 and 25 to 29 years.

CONCLUSION

ED visits due to self-harm increased significantly, especially in adolescents and young adults, following the exposure to NSSI. Responsible media reporting on NSSI and appropriate guidelines would help prevent a further increase in self-harm.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Multilevel interactions between family and neighbourhood socioeconomic indices in childhood and later risks of self-harm and violent criminality in Denmark: a national cohort study

BACKGROUND

A socioeconomically disadvantaged childhood has been associated with elevated self-harm and violent criminality risks during adolescence and young adulthood. However, whether these risks are modified by a neighbourhood's socioeconomic profile is unclear. The aim of our study was to compare risks among disadvantaged young people residing in deprived areas versus risks among similarly disadvantaged individuals residing in affluent areas.

METHODS

We did a national cohort study, using Danish interlinked national registers, from which we delineated a longitudinal cohort of people born in Denmark between Jan 1, 1981, and Dec 31, 2001, with two Danish-born parents, who were alive and residing in the country when they were aged 15 years, who were followed up for a hospital-treated self-harm episode or violent crime conviction. A neighbourhood affluence indicator was derived based on nationwide income quartiles, with parental income and educational attainment indicating the socioeconomic position of each cohort member's family. Bayesian multilevel survival analyses were done to examine the moderating influences of neighbourhood affluence on associations between family socioeconomic position and sex-specific risks for the two adverse outcomes.

FINDINGS

1 084 047 cohort members were followed up for 12·8 million person-years in aggregate. Individuals of a low socioeconomic position residing in deprived neighbourhoods had a higher incidence of both self-harm and violent criminality compared with equivalently disadvantaged peers residing in affluent areas. Women from a low-income background residing in affluent areas had, on average, 95 (highest density interval 76-118) fewer self-harm episodes and 25 (15-41) fewer violent crime convictions per 10 000 person-years compared with women of an equally low income residing in deprived areas, whereas men of a low income residing in affluent areas had 61 (39-81) fewer self-harm episodes and 88 (56-191) fewer violent crime convictions per 10 000 person-years than men of a low income residing in deprived areas.

INTERPRETATION

Even in a high-income European country with comprehensive social welfare and low levels of poverty and inequality, individuals residing in affluent neighbourhoods have lower risks of self-harm and violent criminality compared with individuals residing in deprived neighbourhoods. More research is needed to explore the potential of neighbourhood policies and interventions to reduce the harmful effects of growing up in socioeconomically deprived circumstances on later risk of self-harm and violent crime convictions.

FUNDING

European Research Council, Lundbeck Foundation Initiative for Integrative Psychiatric Research, and BERTHA, the Danish Big Data Centre for Environment and Health funded by the Novo Nordisk Foundation Challenge Programme.

Developmental Trajectories of Self-, Other-, and Dual-Harm across Adolescence: The Role of Relationships with Peers and Teachers

INTRODUCTION

We investigated the longitudinal course of self-, other-, and dual-harm in adolescents, focusing on the infliction of physical injury on oneself, another person, or both parties, respectively. We examined the within-person transitions between these types of harm and whether relationships with peers and teachers predict individual harm trajectories.

METHODS

We used community-representative longitudinal data (N = 1,482; 52% male; 50% both parents born abroad). The participants self-reported self- and other-harm at 13, 15, 17, and 20 years. We assigned them to groups with self-, other-, dual- or no harm at specific assessments. Bullying victimization and relationship quality with classmates and teachers were assessed at 13 and 17. We estimated transition probabilities between the harm groups using latent Markov chain models.

RESULTS

At age 13, 3% of the sample engaged in dual-harm, 10% in self-harm only, and 7% in other-harm only. These percentages decreased in late adolescence. Initial dual-harm was often followed by sex-specific single-harm: most of the female participants transitioned to self-harm, and male participants to other-harm. Those in the initial dual-harm group were less likely to stop harming than those in the initial single-harm groups (p < 0.05). Adverse relationship experiences generally predicted harm. A positive teacher-student bond was associated with the cessation of single-harm.

CONCLUSION

Single- and dual-harm in the form of physical injury typically emerge by mid-adolescence. After this point, adolescents commonly maintain harm, especially those who have presented with dual-harm. Helping adolescents cope with adverse relationship experiences and creating opportunities for positive relationship experiences could address these harmful behaviors.

A genetically informed prediction model for suicidal and aggressive behaviour in teens

Suicidal and aggressive behaviours cause significant personal and societal burden. As risk factors associated with these behaviours frequently overlap, combined approaches in predicting the behaviours may be useful in identifying those at risk for either. The current study aimed to create a model that predicted if individuals will exhibit suicidal behaviour, aggressive behaviour, both, or neither in late adolescence. A sample of 5,974 twins from the Child and Adolescent Twin Study in Sweden (CATSS) was broken down into a training (80%), tune (10%) and test (10%) set. The Netherlands Twin Register (NTR; N = 2702) was used for external validation. Our longitudinal data featured genetic, environmental, and psychosocial predictors derived from parental and self-report data. A stacked ensemble model was created which contained a gradient boosted machine, random forest, elastic net, and neural network. Model performance was transferable between CATSS and NTR (macro area under the receiver operating characteristic curve (AUC) [95% CI] AUCCATSS(test set) = 0.709 (0.671-0.747); AUCNTR = 0.685 (0.656-0.715), suggesting model generalisability across Northern Europe. The notable exception is suicidal behaviours in the NTR, which was no better than chance. The 25 highest scoring variable importance scores for the gradient boosted machines and random forest models included self-reported psychiatric symptoms in mid-adolescence, sex, and polygenic scores for psychiatric traits. The model's performance is comparable to current prediction models that use clinical interviews and is not yet suitable for clinical use. Moreover, genetic variables may have a role to play in predictive models of adolescent psychopathology.

Reseach progress in dual harm

Growing evidence supports an association between self-harm and aggression, and the two behaviors frequently co-occur. The co-occurrence of self-harm and aggression is termed as dual harm. Existing evidence reveals that rather than a simple co-occurrence of self-harm and aggression, dual-harm may be an independent behavior different from a sole harm behavior. Identification of characteristics and influencing factors for dual harm may help develop effective prevention strategies for the affected population. A review of the literature yields a high incidence of dual harm among the clinical and forensic populations. Individuals with dual harm engage in an earlier, more frequent, and a wider range of harmful behaviors, with the increased use of lethal methods. Common factors that affect dual harm include childhood adversities, emotional dysregulation, personality traits, mental disorders, and biological factors. A comprehensive theory to explain dual harm is still not available. Currently, two main theories for explaining mechanism of dual harm are the two-stage model of countervailing forces and the cognitive-emotional model. An in-depth exploration of characteristics, influencing factors, and theories for dual harm is of great importance for the prevention of dual harm.

The association of childhood adversities and mental health problems with dual-harm in individuals with serious aggressive behaviors

BACKGROUND

The coexistence of self-harm and aggression, which is referred to as dual-harm, is commonly seen in forensic population. Self-harm and aggression have often been studied separately, previous studies on risk factors of aggression or self-harm mainly focused on childhood adversities, emotional regulation, impulsivity and psychopathology, given their importance in the two behaviors. However, the factors associated with dual-harm remain unclear. This study aimed to explore potential risk factors associated with co-occurring self-harm among individuals with serious aggressive behaviors.

METHODS

This multi-center, cross-sectional case-control study was conducted from May 2013 to January 2016 and involved seven qualified forensic institutes located in seven provinces in China. Participants were individuals with serious aggressive behaviors and were suspected to have mental disorders. Lifetime history of self-harm was obtained by a self-report questionnaire, and serious aggressive behaviors were assessed with the use of participants' forensic archive. Sociodemographic and clinical information were collected using a self-designed standardized data collection form, and childhood adversities was assessed using a clinician-rated scale designed by our research team. The Psychopathy Checklist-Revised (PCL-R) was used to assess psychopathic traits and the Brief Psychiatric Rating Scale (BPRS) was used to assess psychiatric symptoms of the participants. Univariate and multivariate logistic regression analyses were performed to analyze the relevant factors for dual-harm.

RESULTS

A total of 423 individuals with serious aggressive behaviors were enrolled in the current study. Of them, 74 (17.5%) with self-harm history assigned into the dual-harm group (D-H) and 349 (82.5%) without self-harm history assigned into the aggression-only group (A-O). According to the binary logistic regression analysis, current diagnosis of mood disorder (OR = 3.2, 95%CI: 1.2-8.5), child abuse (OR = 2.8, 95%CI: 1.3-6.2), parental death (OR = 3.0, 95%CI: 1.2-7.5), and the score of the affective subscale in BPRS (OR = 1.7, 95%CI: 1.3-2.4) were significantly associated with dual-harm.

CONCLUSIONS

Our study suggested the necessity of integrated evaluation of self-harm among individuals with serious aggressive behaviors. Childhood adversities and psychiatric symptoms in this population require special attention.

Intimate partner violence victimization and perpetration as precursors to suicide

It remains unclear how often and under what circumstances intimate partner violence (IPV) precedes suicide. Available research on IPV and suicide focuses largely on homicide-suicide, which is a rare event (<2% of suicides). We focus instead on single suicides (i.e., suicides unconnected to other violent deaths), which are the most common type of fatal violence in the US.

Unfortunately, information about IPV circumstances is often unavailable for suicides. To address this gap, we sought to identify the proportion of single suicides that were preceded by IPV in North Carolina (NC), to describe the prevalence of IPV victimization and perpetration as precursors to suicide, and to explore how IPV-related suicides differ from other suicides. We used data from the NC Violent Death Reporting System (2010–2017, n = 9682 single suicides) and hand-reviewed textual data for a subset of cases (n = 2440) to document IPV circumstances.

We had robust inter-rater reliability (Kappa: 0.73) and identified n = 439 IPV-related suicides. Most were males who had perpetrated nonfatal IPV (n = 319, 72.7%) prior to dying by suicide. Our findings suggest that IPV was a precursor for at least 4.5% of single suicides.

Next, we conducted logistic regression analyses by sex comparing IPV-related suicides to other suicides. For both men and women, IPV was more common when the person who died by suicide had recently disclosed suicidal intent, was younger, used a firearm, and was involved with the criminal legal system, even after controlling for covariates. We also found sex-specific correlates for IPV circumstances in suicide.

Combined with homicide-suicide data (reported elsewhere), IPV is likely associated with 6.1% or more of suicides overall. Results suggest clear missed opportunities to intervene for this unique subpopulation, such as suicide screening and referral in IPV settings (e.g., batterer intervention programs, Family Justice Centers) that is tailored by sex.

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Intimate partner violence is a precipitating factor for 4.5% of single suicides.

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Most IPV-related single suicides were of men who perpetrated nonfatal IPV.

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Decedents in IPV-related suicides often used a firearm and disclosed intent.

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Integrated prevention strategies to target both IPV and suicide may be appropriate.

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When combined with homicide-suicide data, IPV influences 6.1% of suicides overall.

Self-harm and Aggression in Chinese Early Adolescents: Their Co-occurrence and the Role of Bullying Victimization

Self-harm and aggression increase markedly during early adolescence. However, few studies considered these harmful behaviors simultaneously. This study employed a person-centered approach to identify profiles of adolescents who differed in their patterns of self-harm, reactive aggression, and proactive aggression, examined the stability of these patterns, and explored the effect of bullying victimization on latent profile membership and transition. A total of 2463 early adolescents (48.8% girls, M_age = 13.93 ± 0.59) participated in two waves of the study over six months. The results indicated that low symptoms profile (80.4%), moderate aggression profile (14.2%), high aggression profile (3.0%), and high self-harm profile (2.4%) were identified at time 1, and low symptoms profile (82.1%), dual-harm profile (7.6%), high aggression profile (7.7%), and high self-harm profile (2.6%) were identified at time 2. Adolescents assigned to at-risk profiles showed moderate to high transition, suggesting the developmental heterogeneity of self-harm and aggression. Moreover, adolescents high in bullying victimization were more likely to belong or transition to at-risk profiles. The findings revealed the co-occurring and transitional nature of self-harm and aggression and the transdiagnostic role of bullying victimization, which can be used to guide prevention and intervention strategies.

The inter-connections between self-harm and aggressive behaviours: A general network analysis study of dual harm

Dual harm is the co-occurrence of self-harm and aggression during an individual's lifetime. This behaviour is especially prevalent within criminal justice and forensic settings. The forms of aggression that should be included in the definition of dual harm have not yet been established. This study aimed to use network analysis to inform an evidence-based definition of dual harm by assessing the relationship between self-harm and different forms of aggressive behaviour in young people (N = 3,579). We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Results revealed low correlations between the variables, leading to sparse network models with weak connections. We found that when separated into their distinct forms, aggressive acts and self-harm are only weakly correlated. Our work provides preliminary evidence to assist in understanding and managing dual harm within clinical and forensic settings and informs recommendations for future research.

Dual-harm in adolescence and associated clinical and parenting factors

PURPOSE

Both aggression toward others and self peak in adolescence and interpersonal violence and suicide are among the leading causes of death in young people worldwide. Individuals who show both aggression toward others and self, i.e. dual-harm, may experience the worst outcomes. The current study investigates clinical and parenting factors associated with dual-harming in adolescence, to provide new insights for prevention and treatment.

METHODS

In a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 1022; aged 12-17 years), we investigated co-occurrence in harm toward others and self and presented findings in an area-proportional Euler diagram. Four harm groups (no harm, other-harm, self-harm, and dual-harm) were compared on intelligence scores, general functioning, emotional and behavioral problems, substance use, parental hostility, and harsh parenting with ANCOVAs and logistic regressions.

RESULTS

In adolescents that other-harmed, the risk of self-harm was 1.9 times higher than for those who did not harm others. Dual-harm adolescents reported worse overall functioning, more emotional and behavioral problems, more parental hostility and harshness, and were more likely to use substances than those who did not engage in aggressive behaviors. No evidence of differences in intelligence scores between groups were found.

CONCLUSION

These findings highlight a vulnerable group of adolescents, at risk of future suicide, violent offending, and the development of severe psychopathology. Dual-harm is a promising marker for early intervention and referral to specialized mental health professionals. Further research is needed to examine underlying pathways and risk factors associated with persistent dual-harm trajectories into adulthood.