A Cross-Sectional Study Investigating the Relationship Between Alexithymia and Suicide, Violence, and Dual Harm in Male Prisoners

Exploring the relationship between distress rumination, resilience, depression, and self-injurious behaviors among Chinese college athletes infected with COVID-19: a cross-sectional study

Objectives

Distress rumination is a cause of suicidality and self-injurious behavior (SSIB) among individuals. Although previous studies have shown that distress rumination, SSIB, resilience, and depression are significantly related, the interaction mechanism remains unclear. This study aimed to evaluate resilience and depression as mediators of the relationship between distress rumination and SSIB among Chinese college athletes infected with COVID-19.

Methods

Convenience sampling was used to recruit participants from the National College Football Championship in Guangxi City, China from January to February 2023. Participants completed the Ruminative Responses Scale (RRS), a subscale of the Health-Risk Behavior Inventory (HBI), the Mental Toughness Index (MTI) and the Patient Health Questionnaire (PHQ-9). We used the PROCESS macro for SPSS to determine the mediating effect of resilience and depression between distress rumination and SSIB.

Results

A total of 350 Chinese college athletes participated in this study and completed the questionnaire survey. 289 (81.7% boys; Mage = 20.31 years, SD = 1.60) of them have been infected with COVID-19. 59.9% (n = 173) participants were from urban areas and 15.6% (n = 45) of participants have engaged in self-injurious behaviors or suicidal ideation. College athletes' distress rumination was significantly negatively correlated with resilience (r = - 0.28, p < 0.01), and was significantly positively correlated with depression (r = 0.49, p < 0.01) and SSIB (r = - 0.18, p < 0.01). Resilience was significantly negatively correlated with depression (r = - 0.35, p < 0.01) and SSIB (r = - 0.30, p < 0.01). Finally, depression was significantly positively correlated with SSIB (r = - 0.38, p < 0.01). Resilience and depression played a mediating role of the total effects of distress rumination and SSIB, respectively. Meanwhile, the chain mediating effect of resilience and depression was also significant.

Conclusion

This study found that distress rumination can directly predict SSIB, and indirectly predict SSIB through the mediating effect of resilience and depression, and the chain mediating effect of resilience-depression. Therefore, reducing the degree of distress rumination of college athletes infected by COVID-19 and improving their resilience, as well as reducing their depression may help prevent SSIB.

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.

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.

Influence of family function on social anxiety among Chinese nursing students: The mediating role of alexithymia

AIMS

This study aims to explore the relationship between family function, alexithymia and social anxiety among Chinese nursing students, especially to determine whether alexithymia acts as a mediator between family function and social anxiety among this social group.

DESIGN

A cross-sectional study.

METHODS

From January to March 2021, a cross-sectional study was conducted among 204 Chinese nursing students at a nursing school of a medical university in the Northeastern Region of China. The interaction anxiousness scale, APGAR family function scale and Tronto alexithymia scale were used for measurement of social anxiety, perceived family function and alexithymia respectively. The data were subjected to correlation analysis, multiple linear regression and structural equation modelling (SEM).

RESULTS

Results indicated that social anxiety score was negatively correlated with perceived family function (r = -.232), but positively with alexithymia (r = .307). After controlling for demographic variables, family function and alexithymia could explain 14.5% of the total variance in social anxiety. The SEM results suggested that the effect of family function on social anxiety was partially mediated by alexithymia with a 36.9% mediating effect.

CONCLUSIONS

This study reveals that alexithymia might partially mediate the impact of family function and social anxiety in Chinese nursing students. In this sense, improvement of alexithymia is expected to be an effective strategy to ameliorate the severity social anxiety in Chinese nursing students, especially for those with a dysfunctional family context.

Aggression, Alexithymia and Sense of Coherence in a Sample of Schizophrenic Outpatients

Schizophrenia elevates the risk for aggressive behavior, and there is a need to better understand the associated variables predicting aggression for treatment and prevention purposes. The aim of the present study is to determine the relationship between alexithymia, sense of coherence and aggressive behavior in a sample of schizophrenic outpatients. Using a correlational research design, standardized self-report questionnaires assessed aggression (brief aggression questionnaire—BAQ), alexithymia (Toronto Alexithymia Scale—TAS) and sense of coherence (sense of coherence questionnaire—SOC) in a sample of 100 schizophrenic outpatients in clinical remission. Participants reported high levels of aggression and alexithymia along with reduced sense of coherence. Significant negative correlations were evidenced among scores on the SOC scale (p < 0.001) with both the TAS as well as with the BAQ scales. However, a positive correlation (p < 0.001) was observed between the TAS and BAQ scales. Regression indicated that 27% of the variation in the BAQ rating was explained by the TAS, while an additional 17.8% was explained by the sense of coherence. The difficulty identifying feelings of alexithymia and the comprehensibility and manageability components of sense of coherence significantly predicted anger, hostility and physical aggression. Sense of coherence mediated the relationship between alexithymia and aggression. From the path analysis, comprehensibility emerged as the key factor counterbalancing alexithymic traits and aggressive behaviors, and manageability effectuated higher anger control. The findings hold practical implications for the treatment and rehabilitation of schizophrenic patients.

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.

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.

Alexithymia and Insecure Attachment among Male Intimate Partner Violence Aggressors in the Dominican Republic

The complexity of intimate partner violence and the impossibility of understanding it from single factors have been studied from different biological, psychological, and socio-cultural factors. A cross-sectional study was conducted on 187 men involved in legal proceedings for problems of violence in their intimate partner relationships in the Dominican Republic in order to explore whether insecure attachment represents a risk factor for alexithymia in men with violent behaviors. The attachment style was determinate by the Casullo and Fernández-Liporace Attachment Styles Scale, and alexithymia was assayed using the Latin American Consensual Toronto Alexithymia Scale (LAC TAS-20), a modification of the Toronto Alexithymia Scale (TAS-20). Chi-square test and multiple binary logistic regression analysis were performed to explore the phenomena of alexithymia and attachment styles in the context of a confinement center for male intimate partner offenders in the Dominican Republic. The results showed that insecure attachment represents a risk factor for alexithymia, being highest for avoidant attachment in the population studied. The results also highlight the influence of other factors such as education and maternal–familial relationships as a factor risk for alexithymia.

Male prisoners' experiences of taking part in research about suicide and violence: a mixed methods study

BACKGROUND

There is an apparent reluctance to engage 'vulnerable' participants in conversation about sensitive topics such as suicide and violence and this can often lead to a paucity of research in these areas. This study aimed to explore the experiences of male prisoners taking part in quantitative and qualitative research on suicide and violence.

METHODS

Participants at four male prisons completed a visual analogue scale of mood before and after data collection for both a cross-sectional study and also a qualitative interview. Participants were also asked to give three words to describe their experience of participation. A paired samples T-test was conducted to explore the difference in pre- and post-mood ratings, and content analysis was conducted to explore the positive and negative comments on participants' experiences.

RESULTS

Overall, participants' mood significantly improved after participating in a cross-sectional study about suicide and violence (from 4.8 out of 10 to 5.3, p = 0.016), and there was no significant change in mood following participation in a related qualitative study (5.1 to 5.0, p = 0.793). Participants primarily described their experiences as positive, stating that the process had been satisfying, calming, interesting, enlightening and beneficial. A smaller number of participants described their experiences as stressful, challenging, saddening, uncomfortable and bizarre.

CONCLUSIONS

This study has found that researching sensitive topics such as suicide and violence with male prisoners did not have a negative impact on mood, rather that participants largely enjoyed the experience. These findings dispel the myth that research about sensitive topics with prisoners is too risky and could inform how future researchers assess levels of risk to participants.