Microstructural abnormalities of white matter in the cingulum bundle of adolescents with major depression and non-suicidal self-injury

BACKGROUND

Non-suicidal self-injury (NSSI) is prevalent in major depressive disorder (MDD) during adolescence, but the underlying neural mechanisms are unclear. This study aimed to investigate microstructural abnormalities in the cingulum bundle associated with NSSI and its clinical characteristics.

METHODS

130 individuals completed the study, including 35 healthy controls, 47 MDD patients with NSSI, and 48 MDD patients without NSSI. We used tract-based spatial statistics (TBSS) with a region of interest (ROI) analysis to compare the fractional anisotropy (FA) of the cingulum bundle across the three groups. receiver-operating characteristics (ROC) analysis was employed to evaluate the ability of the difficulties with emotion regulation (DERS) score and mean FA of the cingulum to differentiate between the groups.

RESULTS

MDD patients with NSSI showed reduced cingulum integrity in the left dorsal cingulum compared to MDD patients without NSSI and healthy controls. The severity of NSSI was negatively associated with cingulum integrity (r = -0.344, p = 0.005). Combining cingulum integrity and DERS scores allowed for successful differentiation between MDD patients with and without NSSI, achieving a sensitivity of 70% and specificity of 83%.

CONCLUSIONS

Our study highlights the role of the cingulum bundle in the development of NSSI in adolescents with MDD. The findings support a frontolimbic theory of emotion regulation and suggest that cingulum integrity and DERS scores may serve as potential early diagnostic tools for identifying MDD patients with NSSI.

Stressful Life Events, Sleep Quality and Non-Suicidal Self-Injury in Chinese Adolescents: The Moderating Effect of Sensation Seeking

Despite the growing evidence that stressful life events are associated with adolescent non-suicidal self-injury (NSSI), few studies have investigated the mediating and moderating mechanisms underlying this link. The current study examined whether sleep quality mediated the link between stressful life events and NSSI and whether this mediating process was moderated by adolescent sensation seeking. The participants were 1006 Chinese adolescents (48.21% boys; mean age = 13.16 years, SD = 0.67). They completed the Life Events Checklist, Pittsburgh Sleep Quality Index, UPPS-P Impulsive Behavior Scale, and NSSI Questionnaire. The PROCESS macro for SPSS was used to examine the hypothesized moderated mediation model. The results showed that sleep quality significantly mediated the positive association between stressful life events and adolescent NSSI. Moreover, this mediating pathway was moderated by sensation seeking. Specifically, the risk impact of stressful life events on NSSI through sleep quality was significant only among adolescents with high-level sensation seeking but not among those with low-level sensation seeking. These findings provide intervention insights to reduce the risk of adolescent NSSI.

Alexithymia and peer victimisation: interconnected pathways to adolescent non-suicidal self-injury

BACKGROUND

The prevalence of non-suicidal self-injury (NSSI) among adolescents underscores the importance of understanding the complex factors that drive this behaviour. Framed within broader constructs of emotional regulation theories, alexithymia and peer victimisation are thought to interact to influence NSSI behaviours.

AIM

This research addresses whether alexithymia and peer victimisation serve as risk factors for NSSI and, if so, how these factors interact with each other.

METHOD

This quantitative study analysed data from 605 adolescents, using a range of validated self-report measures including the Toronto Alexithymia Scale. Statistical analyses including one-way analysis of variance, multiple regression and structural equation modelling were employed to scrutinise the relationships among the variables.

RESULTS

Alexithymia and peer victimisation significantly predicted NSSI behaviours. Specifically, the 'difficulty in identifying feelings' subscale of alexithymia emerged as a noteworthy predictor of NSSI (P < 0.001). Peer victimisation mediated the relationship between alexithymia and NSSI, explaining approximately 24.50% of alexithymia's total effect on NSSI. In addition, age was a significant predictor of NSSI, but gender and education years were not (P > 0.05). These relationships were found to be invariant across genders.

CONCLUSIONS

This study enriches our understanding of the interplay between alexithymia, peer victimisation and NSSI, particularly within the Chinese context. Its findings have significant implications for a rethinking of alexithymia's theoretical construct and interventions targeting emotional literacy and peer dynamics among adolescents. Future research could benefit from a longitudinal design to establish causality.

Gender and Age Influence on Emergency Department Visits for Non-Suicidal Self-Injuries in School Aged Children in Italy: An 11 Years Retrospective Cross-Sectional Study

Objectives: Non-suicidal self-injury (NSSI) poses a threat in developmental ages, yet there is a scarcity of studies on NSSI trends, especially those in emergency departments (ED). Methods: The aim of this cross-sectional study is to describe trends in ED visits for NSSI among young people aged between 5 and 19 years in Italy from 2011 to 2021 in Piedmont. From the ministerial ED discharge information system, all occurring NSSIs were identified by medical report and/or ICD9CM code and reported as a population rate and a visit rate on all ED requests. Results: The general rate of ED visits remained stable, with around 210,000 (55% males) visits each year, along the whole period from 2011 to 2019, then halved during 2020 and 2021. The NSSI population and visits rates increased from 2013, peaking in 2019 at a rate of around 25 and 23 NSSI visits (girls) and 76 and 69 NSSI (boys) per 100,000 ED visits. In 2020 and 2021, the rate of NSSI visits increased, particularly in girls and among older adolescents. Conclusion: The gradual increase of NSSI over the last decade is a rising public health issue, which deserves wider attention to ensure early detection and prevention.

Maladaptive cognitive regulation moderates the mediating role of emotion dysregulation on the association between psychosocial factors and non-suicidal self-injury in depression

Introduction

Non-suicidal self-injury (NSSI) is highly prevalent in depression, and is associated with psychosocial factors, emotion dysregulation, and strategies of cognitive emotion regulation. However, the internal combination and interactions of these risk factors in depression remain unclear.

Methods

Data from 122 patients with depression, including 56 with NSSI and 66 without NSSI, were analyzed. Self-rating scales were used to assess psychosocial factors, emotion dysregulation, and cognitive regulation strategies. Sparse partial least squares discriminant analysis (sPLS-DA) was employed to explore internal combinations in each profile. A moderated mediation model was applied to examine their interactional relationship.

Results

The results identified an NSSI-related psychosocial profile characterized by high neuroticism, childhood trauma, poor family functioning, and low psychological resilience. Emotion dysregulation, including high levels of alexithymia, anhedonia, and emotion regulation difficulties, mediated the association between this psychosocial profile and NSSI. The mediated effect was further moderated by maladaptive cognitive regulation strategies.

Limitations

Lack of sufficient information on NSSI frequency and severity. Relatively small sample size for discussing the impact of gender and age of depressive patients with NSSI.

Conclusion

These findings hold important implications for the prevention, treatment, and rehabilitation of NSSI.

Early Adverse Family Experiences and Elevated Adrenocorticotropic Hormone Predict Non-Suicidal Self-Injury in Females with Non-Psychotic Mental Disorders and Suicidal Ideation

Nonsuicidal self-injurious behavior (NSSI), prevalent in patients with non-psychotic mental disorders (NPMD), is associated with numerous adverse outcomes. Despite active research into the clinical and psychological aspects of NSSI, the underlying biological mechanisms remain obscure. Early adverse experiences are believed to induce long-lasting changes in neuroendocrine mechanisms of stress control playing a key role in NSSI development. The aim of the study was to evaluate parameters potentially predicting development of NSSI in female patients with NPMD and suicidal ideation. Eighty female patients over 18 years with NPMD and suicidal ideation (40 with and 40 without NSSI) and 48 age matching women without evidence of mental illness (healthy controls) were enrolled. Diagnostic interviews and self-report measures were used to assess childhood maltreatment, presence, frequency, and characteristics of suicidal and self-injurious thoughts and behaviors, the Beck Depression Inventory scale to assess severity of depression. Hypothalamic-pituitary-adrenal axis markers, hormones, and neurotrophic factors were measured in blood serum. The likelihood of developing NSSI in patients with NPMD and suicidal ideation was associated with early adverse family history and elevated adrenocorticotropic hormone levels. Dysregulation of hypothalamic-pituitary-adrenal axis as a result of early chronic stress experiences may represent critical biological mechanism promoting the development of NSSI behaviors in patients with NPMD.

The relationship between depressive mood and non-suicidal self-injury among secondary vocational school students: the moderating role of borderline personality disorder tendencies

Background

Non-suicidal self-injury (NSSI) has become an important public health issue of global concern, often occurring in adolescents, and depressive mood is closely related to NSSI. In addition, NSSI is considered a symptom of borderline personality disorder. It has been found that adolescents in secondary vocational schools are more vulnerable to behavior and emotional disorders than those in general high schools. This study investigated the risk factors associated with NSSI affecting secondary vocational school students and analyzed the role of borderline personality disorder tendencies in promoting the occurrence of NSSI among students with depressive moods.

Methods

A total of 1,848 Chinese secondary vocational students completed a self-report questionnaire. The homemade NSSI behavior questionnaire, Patient Health Questionnaire-9 and Personality Diagnostic Questionnaire-4 were used in this survey. Binary logistic regression and PROCESS software analysis were used to explore the influencing factors associated with NSSI and to test for moderating effects.

Results

Female (OR = 3.412, 95% CI 2.301-5.060), drinking history (OR = 2.007, 95% CI 1.383-2.911), history of suicidal death exposure (OR = 3.161, 95% CI 1.999-4.999), depressive mood (OR = 2.436, 95% CI 1.668-3.558) and borderline personality disorder tendencies (OR = 2.558, 95% CI = 1.764-3.711) were independent risk factors for NSSI. Borderline personality disorder tendencies (B = 0.047, p = 0.000) moderated the relationship between depressive mood and NSSI. The stronger the borderline personality tendencies, the more NSSI behavior occurred when they were depressive.

Conclusions

Borderline personality disorder tendencies in secondary vocational school adolescents significantly enhance the association of depressive mood with NSSI. There is a moderating role for borderline personality disorder tendencies in depressive mood and NSSI.

Neural Signatures of Error Processing in Depressed Adolescents with Comorbid Non-Suicidal Self-Injury (NSSI)

Non-suicidal self-injury (NSSI), as a highly prevalent psychiatric symptom in adolescents and young adults, is defined as the deliberate destruction of body tissue without suicidal intent. Impulsivity and dysfunctional response inhibition have been suggested to play a central role in adolescents' vulnerability to self-harm. To investigate the potentially distinct neurobiology of NSSI, we used a well-established Go/No Go task in which activation of the inferior frontal gyrus (IFG) and dorsal anterior cingulate cortex (dACC) is interpreted as a neural correlate of processing failed response inhibition. Task-based functional magnetic resonance imaging data were obtained from 14 adolescents with a diagnosis of major depression and a history of NSSI (MD-NSSI), 13 depressed adolescents without NSSI (MD-only), and 14 healthy controls (HC). In line with hypotheses of dysfunctional response inhibition, we observed increased rates of commission errors in MD-NSSI along with significantly reduced error-related activations of the dACC and IFG. Intact response inhibition, as reflected by low commission error rates not different from HC, was observed in MD-only, along with increased activation of the error-processing network. Our findings support the hypothesis of a distinct neurobiological signature of NSSI. Further research on biomarkers of NSSI could focus on behavioral and neural correlates of failed response inhibition.

Parent-Adolescent Conflict, Depressive Symptoms, and Non-Suicidal Self-Injury among Chinese Adolescents: The Moderating Effect of the COMT Gene rs4680 Polymorphism

Existing research suggests that parent-adolescent conflict is associated with increased risk for adolescent non-suicidal self-injury (NSSI). However, adolescent NSSI reactions to parent-adolescent conflicts exhibit large individual differences. This study sought to explore whether depressive symptoms mediates the relationship between parent-adolescent conflict and adolescent NSSI, and whether this mediating process is moderated by the COMT gene rs4680 polymorphism. A total of 673 adolescents (364 males, 309 females) in the age range of 12 to 15 years (Mean_age = 12.81 years, SD = 0.48) completed questionnaires regarding parent-adolescent conflict, depressive symptoms, and NSSI. Genomic DNA was extracted from saliva and buccal cells from each participant. Bootstrapping techniques displayed statistically significant moderated mediation. The results showed that the positive association between parent-adolescent conflict and adolescent NSSI was in fact mediated by depressive symptoms. Moreover, this indirect link was moderated by the COMT gene rs4680 polymorphism. Specifically, the risk effect of parent-adolescent conflict on adolescent NSSI via depressive symptoms was stronger for adolescents with Val/Val genotype than for those with Met/Met or Val/Met genotype. These findings underscore the importance of examining the interaction between genes and the environment to understand how and when parent-adolescent conflict impacts adolescent NSSI.

Predicting risk along the suicidality continuum: A longitudinal, nationally representative study of the Irish population during the COVID-19 pandemic

INTRODUCTION

Little is known about the lifetime prevalence of different indicators of suicidality in the Irish general population; whether suicidality has increased during the COVID-19 pandemic; and what factors associated with belonging to different points on a continuum of suicidality risk.

METHODS

A nationally representative sample of Irish adults (N = 1,032) completed self-report measures in May 2020 and a follow-up in August 2020 (n = 715).

RESULTS

Lifetime prevalence rates were 29.5% for suicidal ideation, 12.9% for non-suicidal self-injury (NSSI), and 11.2% for attempted suicide. There were no changes in past two-week rates of NSSI and attempted suicide during the pandemic. Correlations between the indicators of suicidality supported a progression from ideation to NSSI to attempted suicide. Suicidal ideation alone was associated with being male, unemployed, higher loneliness, and lower religiosity. NSSI (with no co-occurring attempted suicide) was associated with a history of mental health treatment. Attempted suicide was associated with ethnic minority status, lower education, lower income, PTSD, depression, and history of mental health treatment.

CONCLUSION

Suicidal ideation, NSSI, and attempted suicide are relatively common phenomena in the general adult Irish population, and each has unique psychosocial correlates. These findings highlight important targets for prevention and intervention efforts.

Childhood maltreatment and self-hatred as distinguishing characteristics of psychiatric patients with self-harm: A comparison with clinical and healthy controls

INTRODUCTION

Deliberate self-harm (DSH) is common in clinical populations. Childhood maltreatment (CM) and attitudes both towards oneself and towards DSH may be of importance for the development of DSH. This study aimed to test whether patients with DSH report more CM, more negative attitudes towards oneself and more positive attitudes towards DSH than a clinical and a healthy comparison group, and whether the effects of CM are mediated by negative attitudes towards oneself.

METHOD

Females with DSH and psychiatric disorders (n = 34), females without DSH but with psychiatric disorders (n = 31) and healthy female individuals (n = 29) were compared regarding DSH, CM, attitudes towards the self and attitudes towards self-harm.

RESULTS

Females with DSH reported more emotional abuse and more self-hatred as compared to both comparison groups. The effect of emotional abuse was mediated by self-hatred. The DSH-group had significantly more positive attitudes towards DSH than the healthy comparison group.

CONCLUSION

Self-hatred and CM in the form of emotional abuse may be distinguishing characteristics of female patients with DSH in psychiatric settings. The present results are compatible with the hypothesis that emotional abuse leads to DSH via self-hatred, but the cross-sectional nature of the study precludes any causal conclusions. The clinical utility of the results is discussed.

A retrospective research on non-suicidal self-injurious behaviors among young patients diagnosed with mood disorders

BACKGROUND

Non-suicidal self-injury (NSSI) is an emerging public concern in both clinical and non-clinical settings, especially in the background of the coronavirus disease 2019 (COVID-19) pandemic. Nevertheless, knowledge of NSSI on a certain disease entity in the later stage of the pandemic was scarce.

OBJECTIVE

This study was conducted for the purpose of exploring the current occurrence and characteristics of NSSI in patients diagnosed with mood disorders (MDs) as well as its correlated factors in the later stage of the pandemic.

METHODS

Three hundred and forty-nine eligible subjects (M ± SD, 21.54 ± 7.62) admitted to a mental health center in Wuhan from 11 November 2021 to 31 January 2022 were included in our study. An umbrella questionnaire comprised of demographics, COVID-19-related factors, Yale-Brown Obsessive and Compulsive Scale (Y-BOCS), Pittsburgh Sleep Quality Index-Revised (PSQI-R), Mobile Phone Addiction Index (MPAI), and Ottawa Self-injury Inventory (OSI) was extended to each subject via shared QR code.

RESULTS

Of 349 patients with MDs included, 151 (43.27%) reported NSSI in the recent 1 month, among whom hand, lower arm/wrist, and scalp were the most hurt body parts, and cutting, hitting, and headbanging were the most adopted methods. "Own idea" was the most common origin of NSSI. In the logistic regression model, age bracket, family monthly income, occupation, level of obsessive-compulsive disorder (OCD) symptoms, sleep duration, withdrawal reaction to the mobile phone, and habits of using a mobile phone were independently associated with NSSI.

CONCLUSION

It was revealed by our study that NSSI was quite prevalent among patients with MDs, especially among those students, adolescents, comorbid with OCD symptoms, inadequate sleeping hours, and suffering from withdrawal reaction to mobile phones. Further research on NSSI in various psychiatric disorders and even in non-clinical settings such as the community population was in urgent need since NSSI in China was not rare.

Comparison of Patterns of Non-suicidal Self-Injury and Emotion Dysregulation Across Mood Disorder Subtypes

INTRODUCTION

Non-suicidal self-injury (NSSI) is frequently encountered in patients with mood disorders. Emotion dysregulation (ED), frequently observed in mood disorders, could be a major mediating factor in NSSI. The aim of this study was to explore differences in NSSI behavior and ED across mood disorder subtypes. The relationships between childhood trauma and NSSI and ED were also explored.

METHODS

A total of 191 patients with mood disorders were included in this study. The patterns of NSSI behavior and ED across patients with bipolar I disorder (BD-I), bipolar II disorder (BD-II), and major depressive disorder (MDD) were compared.

RESULTS

More than half (54%) of the subjects experienced NSSI. Patients with BD-II and MDD engaged in NSSI behavior more frequently than those diagnosed with BD-I. NSSI behaviors in patients with BD-II most commonly included cutting, whereas hitting behaviors were most common among other groups. Patients with BD-II and MDD reported more severe ED than those with BD-I. In the case of childhood trauma, those with BD-II and MDD reported greater emotional neglect than those with BD-I. Structural equation modeling revealed that ED mediated the association between childhood trauma and NSSI.

CONCLUSION

BD-I was associated with less frequent NSSI behavior and less severe ED than BD-II and MDD. ED mediated the association between childhood trauma and NSSI. Promoting emotion regulation strategies could prevent NSSI behavior in patients with mood disorders.

A meta-analysis of co-occurrence of non-suicidal self-injury and suicide attempt: Implications for clinical intervention and future diagnosis

BACKGROUND

Non-suicidal self-injury (NSSI) and suicide attempt (SA) are risk behaviors that lead to physical injury and even death in individuals, and are a very powerful risk factor when both occur together, with individuals presenting with more severe psychological and behavioral problems. Due to the different demographic characteristics of different study subjects, an overall understanding of the incidence and occurrence of this co-occurrence is lacking to clarify the focus of clinical interventions and future research directions.

METHODS

A systematic search was conducted for relevant studies in English and Chinese that reported data on co-occurring non-suicidal self-injury and suicide attempts as of May 2022. The incidence of co-occurrence of non-suicidal self-injury and suicide attempt (NSSI + SA) was calculated using Stata version 16.0 software based on a random-effects model, and the differences in incidence in different populations were compared by subgroups of age group, comorbidity, and time of occurrence. The study was written in strict accordance with PRISMA norms and registration was completed on the PROSPERO platform (CRD42022329095).

RESULTS

A total of 37 studies (139,573 individuals) were included for meta-analysis, and the combined incidence of non-suicidal self-injury and suicide attempt co-occurrence was 9.6%. Among different groups, the prevalence of NSSI + SA was 10, 11, 6, and 26% in adolescents and young adults, adults, the general population, and people with mental illness, respectively, and the co-occurrence of NSSI + SA within 12 months was 17%.

CONCLUSION

There is a significant group with a history of both non-suicidal self-injury and suicide attempts and presenting with more severe symptoms clinically. Targeted prevention and intervention are urgently needed, but the direction of intervention needs further research on the occurrence trajectory of this co-occurrence.

SYSTEMATIC REVIEW REGISTRATION

http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42022329095, identifier: CRD42022329095.

Associations of depressive and anxiety symptoms with non-suicidal self-injury and suicidal attempt among Chinese adolescents: The mediation role of sleep quality

BACKGROUND

Associations of depressive and anxiety symptoms with non-suicidal self-injury (NSSI) and suicide attempt (SA) are not well understood. We aimed to examine these associations among Chinese adolescents, and whether any potential association is mediated through sleep quality.

METHODS

We conducted a cross-sectional study among 1,771 (994 boys [56.1%] and 777 girls [43.9%], mean [SD] age was 12.9 [0.6] years) adolescents who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort (CAHGC) study. Depressive symptoms, anxiety symptoms, NSSI, SA and sleep quality were measured by validated questionnaire. Logistic regression models were employed to estimate the associations of depression and anxiety with NSSI and SA. Mediation analyses were conducted to explore the mediate effect of sleep quality.

RESULTS

The 12-month prevalence of NSSI and SA was 17.1 and 8.3%, respectively. Depressive and anxiety symptoms were significantly associated with NSSI (the adjusted odds ratio [aOR] was 1.89 [95% CI 1.34-2.65] for depressive symptoms and 2.84 [95% CI 2.05-3.94] for anxiety symptoms) and SA (the aOR was 3.20 [95% CI 2.03-5.05] for depressive symptoms and 2.98 [95% CI 1.84-4.84] for anxiety symptoms). No significant gender differences were found in the associations. The mediation proportion of sleep quality on the association of depressive and anxiety symptoms with NSSI, as well as depressive and anxiety symptoms with SA were 21.1, 13.9, 13.6, and 14.7, respectively.

CONCLUSION

Independent associations of depressive and anxiety symptoms with NSSI and SA were observed in Chinese adolescents, and there were no significant gender differences in the associations. Moreover, these associations were partially mediated through sleep quality. Targeted interventions for adolescents' NSSI and SA should focus on those who have depressive and anxiety symptoms, and poor sleep quality.

A Resting State Functional Magnetic Resonance Imaging Study of Unmedicated Adolescents With Non-suicidal Self-Injury Behaviors: Evidence From the Amplitude of Low-Frequency Fluctuation and Regional Homogeneity Indicator

BACKGROUND

Non-suicidal self-injury (NSSI) behaviors are common in adolescents with major depressive disorder (MDD). Brain studies specifically targeting adolescents with MDD and NSSI may provide new insights into suicide warnings in adolescents with MDD.

METHODS

This study examined the whole-brain neural activity in adolescents aged between 12-17 years, 50 unmedicated MDD patients with (nsMDDs) or without NSSI (nnsMDDs), and 25 healthy controls (HCs) participated in this study, and analyzed the correlation between the values of amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) in significantly different brain regions and the scores of the relevant clinical psychological scale.

RESULTS

Compared with nnsMDDs, nsMDDs had enhanced ALFF values in left middle occipital gyrus and left median cingulate and paracingulate gyri; the fALFF values of the right caudate nucleus was weakened in the nsMDDs; the ReHo values of right middle occipital gyrus and right middle temporal gyrus weakened and the ReHo values of right medial cingulate gyrus enhanced in nsMDDs. And all of differences were statistically significant. In nsMDDs, the value of ALFF in the left calcarine fissure and surrounding cortex was negatively correlated with the score of Children's depression Inventory (CDI); the value of fALFF in the right caudate nucleus was positively correlated with the score of Beck Scale for Suicidal Ideations (BSSI); the value of ReHo in the right middle temporal gyrus was positively correlated with the score of Multidimensional Anxiety Scale for Children (MASC); and the value of ReHo in the right median cingulate and paracingulate gyri was negatively correlated with the score of BSSI.

CONCLUSIONS

We found that in ALFF, fALFF and ReHo, the significant differences between nsMDDs and nnsMDDs are mainly located in default mode network (DMN) and visual network (VN), and there may be brain regions related to NSSI in DMN and VN. The significant differences brain regions in ALFF, fALFF and ReHo between nsMDDs and nnsMDDs were related to the total score of the relevant clinical psychological scale, and may be related to NSSI.

Risk of Suicidal Behavior in Children and Adolescents Exposed to Maltreatment: The Mediating Role of Borderline Personality Traits and Recent Stressful Life Events

Childhood maltreatment (CM) is associated with increased non-suicidal self-injury (NSSI) and suicidal behavior (SB), independently of demographic and mental health conditions. Self-Trauma Theory and Linehan’s Biopsychosocial Model might explain the emergence of Borderline Personality Disorder (BPD) symptoms as mediators of the association between CM and the risk of SB. However, little is known regarding such relationships when the exposure is recent for young persons. Here, we study 187 youths aged 7–17, with or without mental disorders. We explore CM experiences (considering the severity and frequency of different forms of neglect and abuse), recent stressful life events (SLEs), some BPD traits (emotion dysregulation, intense anger and impulsivity), and the risk of SB (including NSSI, suicide threat, suicide ideation, suicide plan and suicide attempt). We study the direct and mediating relationships between these variables via a structural equation analysis using the statistical software package EQS. Our findings suggest that youths exposed to more severe/frequent CM have more prominent BPD traits, and are more likely to have experienced recent SLEs. In turn, BPD traits increase the risk of SLEs. However, only emotion dysregulation and recent SLEs were found to be correlated with SB. Therefore, targeted interventions on emotion dysregulation are necessary to prevent NSSI or SB in children and adolescents exposed to CM, as is the minimization of further SLEs.

Executive functioning in psychiatric patients with deliberate self-harm, as compared with a psychiatric and a healthy comparison group

Introduction: Deliberate self-harm (DSH) is a common symptom in psychiatric disorders. It is a cross-diagnostic symptom, although it has mainly been associated with borderline personality disorder (BPD). Research has suggested an association between DSH and deficits in executive functioning. The main aim of the current study was to assess three specific aspects of executive functioning (EF) (working memory, inhibition and cognitive flexibility) among psychiatric patients with DSH, compared to a clinical and a healthy comparison group.Methods: Thirty psychiatric patients with DSH, 29 psychiatric patients without DSH and 29 healthy individuals were assessed with regard to psychiatric illness, self-harming behavior, EF, general cognitive functioning level and measures of psychopathology. The results were analyzed by means of ANOVA, regression analysis, Chi-square, and correlation analysis.Results: The patients with DSH showed deficits in cognitive flexibility and inhibition as compared to healthy individuals. In addition, the patients with DSH had greater deficits in cognitive flexibility than the patients without DSH; this effect was independent of concurrent severity of depressive symptoms but not independent of borderline symptomatology.Conclusion: Psychiatric patients with DSH may have deficits in cognitive flexibility as compared to both the healthy and clinical comparison groups. The results partly differ from previous related studies in the field. It is unclear to which extent the deficits in cognitive flexibility are due to other factors. More research is needed to understand the implications of such deficits, and if the results could be used for adapting treatment services and strategies. Future studies should include more similar comparison groups.

Clinical Correlates of Deliberate Self-Harm Among Migrant Trauma-Affected Subgroups

Introduction: Studies have shown that exposure to potentially traumatic events (PTEs) during the migration process has serious consequences on mental health. Migrants with a history of PTEs are more likely to inflict deliberate self-harm (DSH), a spectrum of behavior that includes non-suicidal self-injury (NSSI). With reference to a nonclinical sample of trauma-exposed migrants, this study aims to explore the prevalence of DSH and to assess the association with sociodemographic characteristics and clinical conditions, with particular attention to post-traumatic stress disorder (PTSD) symptoms, resilience capabilities, and feelings of hopelessness. Methods: A sample of migrants underwent a baseline evaluation at an outpatient department of the National Institute for Health, Migration and Poverty (INMP). Migrants with a history of torture, rape, or other severe forms of psychological, physical, or sexual violence were invited to undergo screening at the Institute's Mental Health Unit. Trauma-exposed migrants completed a series of self-report questionnaires that assessed the presence of PTSD, depression, anxiety, suicidal ideation, resilience, and feelings of hopelessness, in addition to DSH. Univariate and multivariate log-binomial regression models were used to test the association of age and clinical characteristic of migrants with DSH. Prevalence ratio (PR) with 95% confidence intervals (95% CI) and p-values were estimated. Results: A total of 169 migrants (76.9% males), aged between 18 and 68 years, M = 28.93; SD = 8.77), were selected. Of the sample, 26.6% were frequently engaging in some form of DSH, and 30.2% were diagnosed with at least one trauma-related disorder. DSH behaviors were most common in single and unemployed migrants as well as in subjects with post-traumatic stress symptoms, feelings of anxiety, hopelessness, low capability of resilience, and suicidal ideation. Taking into account age and hopelessness, we found that PTSD and low resilience capabilities were associated with a higher risk of DSH [PR adj: 2.21; 95% CI: (1.30-3.75) and PR adj: 2.32; 95% CI: (1.16-4.62), respectively]. Conclusion: Given the association between trauma exposure and DSH among migrants, exploring the presence of DSH behavior within the immigrant community is crucial for the implementation of measures to develop intervention in a clinical setting.

Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach

In 2013, DSM-5 urged for further research on non-suicidal self-injury (NSSI) and defined NSSI disorder (NSSI-D) for the first time separate from borderline personality disorder (BPD). However, research on the comorbidity between NSSI-D and BPD symptoms is still scarce, especially in adolescent populations. The current study selected 347 adolescents who engaged at least once in NSSI (78.4% girls, M age = 15.05) and investigated prevalence, comorbidity, gender differences, and bridge symptoms of NSSI-D and BPD. Network analysis allowed us to visualize the comorbidity structure of NSSI-D and BPD on a symptom-level and revealed which bridge symptoms connected both disorders. Our results supported NSSI-D as significantly distinct from, yet closely related to, BPD in adolescents. Even though girls were more likely to meet the NSSI-D criteria, our findings suggested that the manner in which NSSI-D and BPD symptoms were interconnected, did not differ between girls and boys. Furthermore, loneliness, impulsivity, separation anxiety, frequent thinking about NSSI, and negative affect prior to NSSI were detected as prominent bridge symptoms between NSSI-D and BPD. These bridge symptoms could provide useful targets for early intervention in and prevention of the development of comorbidity between NSSI-D and BPD. Although the current study was limited by a small male sample, these findings do provide novel insights in the complex comorbidity between NSSI-D and BPD symptoms in adolescence.

Functions of Non-Suicidal Self-Injury in Late Adolescence: A Latent Class Analysis

This study employed latent class analysis utilizing an array of features of non-suicidal self-injury (NSSI) in order to identify distinct subgroups of self-injurers. Participants were 359 undergraduates with NSSI history. Indicator variables were lifetime and last year frequency rates, number of methods, scarring, pain during self-injury, and functions of NSSI. Analyses yielded mild/experimental NSSI, moderate NSSI, moderate multiple functions NSSI, and severe NSSI groups, endorsing low, moderate, moderate multiple functions, and high frequencies of self-injury and presence of functions, respectively. Following class assignment, groups differed on self-esteem, social support and belongingness, internalizing symptoms, suicidal ideation and behaviors, and additional NSSI constructs. These subtype analyses emphasize matching phenotypes of NSSI to specific interventions considering dimensions of clinical functioning.

Testing an Integrative Model of Affect Regulation and Avoidance in Non-Suicidal Self-Injury and Disordered Eating

This research tested a model that integrates risk factors among non-suicidal self-injury (NSSI) and eating disorder (ED) behaviors with the aim of elucidating possible shared and unique mechanisms underlying both behaviors. Emotional distress, limited access to emotion regulation (ER) strategies, experiential avoidance, and NSSI/ED frequency were examined in a sample of 230 female undergraduates. Structural equation modeling indicated that limited access to ER strategies and avoidance mediated relationship between emotional distress and avoidance, which in turn was associated with NSSI and ED behaviors. Results suggest NSSI and ED behaviors may serve similar emotion regulation functions, and specifically highlight the role of experiential avoidance in these behaviors.

Correlates of Non-suicidal Self-Injury and Suicide Attempts in Bulimic Spectrum Disorders

Objective: The aim of this study was to examine the implication of personality, impulsivity, and emotion regulation difficulties in patients with a bulimic-spectrum disorder (BSD) and suicide attempts (SA), BSD patients with non-suicidal self-injury (NSSI), and BSD patients without these behaviors.

Method: One hundred and twenty-two female adult BSD patients were assessed using self-report questionnaires. Patients were clustered post-hoc into three groups depending on whether they presented BSD without NSSI or SA (BSD), BSD with lifetime NSSI (BSD + NSSI) or BSD with lifetime SA (BSD + SA).

Results: The BSD + NSSI and BSD + SA groups presented more emotion regulation difficulties, more eating and general psychopathology, and increased reward dependence in comparison with the BSD group. In addition, BSD + SA patients specifically showed problems with impulse control, while also presenting higher impulsivity than both the BSD and BSD + NSSI groups. No differences in impulsivity between the BSD and BSD + NSSI groups were found.

Conclusions: The results show that BSD + NSSI and BSD + SA share a common profile characterized by difficulties in emotion regulation and low reward dependence, but differ in impulsivity and cooperativeness. This suggests that self-injury, in patients without a history of suicide attempts (i.e., BSD + NSSI), may have a regulatory role rather than being due to impulsivity.

Non-Suicidal Self-Injury among Adolescents in Amman, Jordan

While previous research has demonstrated cross-national differences in non-suicidal self-injury (NSSI), most studies to date have taken place in North America. The present study investigated the prevalence and characteristics of NSSI in a sample of 952 Jordanian adolescents (49.8% female) between the ages of 11-19 years. Participants completed a screening measure to assess occurrence of NSSI and its characteristics. Results indicate an overall lifetime prevalence of 22.6% (n = 215), with significantly more males (26.98%, n = 129) than females (18.14%, n = 86) reporting having engaged in NSSI at least once in their lifetime. This study provides empirical evidence that adolescent engagement in NSSI occurs at similar prevalence levels in Jordan, relative to North American samples, whereas gender comparisons of prevalence and characteristics revealed several differences.

Examining non-suicidal self-injury among adolescents with mental health needs, in Ontario, Canada

The objectives of this study were to examine the prevalence of non-suicidal self-injury (NSSI) among adolescents with mental health needs and specific factors associated with NSSI among adolescents aged 14 to 18 years who received mental health services in adult mental health facilities in Ontario, Canada. Data on 2,013 adolescents were obtained from the Ontario Mental Health Reporting System using the Resident Assessment Instrument-Mental Health (RAI-MH) and were analyzed using logistic regression. Approximately, 20.2% (407 adolescents) of the sample engaged in NSSI within the last 12 months. Results from multivariate logistic regression indicate that females were 2.19 times more likely to engage in NSSI than males. Intentional misuse of prescription medication emerged as the most important factor associated with NSSI. Other factors found to be associated with NSSI included multiple psychiatric admissions, sexual abuse, use of alcohol, mood disorders (e.g., depression), adjustment disorders, personality disorders and symptoms of depression. The article discusses the implications of the findings, with suggestions for future research.

Direct and Indirect Peer Socialization of Adolescent Nonsuicidal Self-Injury

This study examined direct and indirect forms of peer socialization of non-suicidal self-injury (NSSI) in adolescent friendship networks. Data were collected among 348 adolescents (55% females; Mage = 15.02 years; SD = 0.53) at 4 assessment waves. Stochastic actor-based models revealed no evidence for direct socialization of NSSI: adolescents whose friends reported higher NSSI did not increase their NSSI over time. However, indirect forms of socialization were found. After controlling for direct socialization and selection effects, friends' depressive symptoms predicted changes in male and female adolescents' NSSI and friends' impulsivity predicted changes in male adolescents' NSSI. Findings highlight the importance of extending peer influence research beyond the classical "modeling" paradigm by providing evidence that peers may indirectly socialize adolescents' NSSI.