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

'If one doesn't happen, the other will': forensic mental health service patients' experiences of co-occurring self-harm and aggression

BACKGROUND

Co-occurring self-harm and aggression (dual harm) is particularly prevalent among forensic mental health service (FMHS) patients. There is limited understanding of why this population engages in dual harm.

AIMS

This work aims to explore FMHS patients' experiences of dual harm and how they make sense of this behaviour, with a focus on the role of emotions.

METHOD

Participants were identified from their participation in a previous study. Sixteen FMHS patients with a lifetime history of dual harm were recruited from two hospitals. Individuals participated in one-to-one, semi-structured interviews where they reflected on past and/or current self-harm and aggression. Interview transcripts were analysed using reflexive thematic analysis.

RESULTS

Six themes were generated: self-harm and aggression as emotional regulation strategies, the consequences of witnessing harmful behaviours, relationships with others and the self, trapped within the criminal justice system, the convergence and divergence of self-harm and aggression, and moving forward as an FMHS patient. Themes highlighted shared risk factors of dual harm across participants, including emotional dysregulation, perceived lack of social support and witnessing harmful behaviours. Participants underlined the duality of their self-harm and aggression, primarily utilising both to regulate negative emotions. These behaviours also fulfilled distinct purposes at times (e.g. self-harm as punishment, aggression as defence). The impact of contextual factors within FMHSs, including restrictive practices and institutionalisation, were emphasised.

CONCLUSIONS

Findings provide recommendations that can help address dual harm within forensic settings, including (a) transdiagnostic, individualised approaches that consider the duality of self-harm and aggression; and (b) cultural and organisational focus on recovery-centred practice.

Longitudinal relations between bullying victimization and aggression: The multiple mediation effects of anger rumination and hostile automatic thoughts

Bullying victimization is widely accepted to be associated with aggression. However, the mechanisms underlying this relationship remain unknown. To examine the long-term impact of bullying victimization on aggression, the present study tested the potential mediating effects of both anger rumination and hostile automatic thoughts. A total of 809 undergraduates from four universities across China (74.80% female; Mage = 19.63 years, SD = 0.82 years) completed the survey on three occasions, with a 6-month delay between Time 1 and Time 2 and a 1-year interval between Time 2 and Time 3. A cross-lagged model of anger rumination and hostile automatic thoughts was developed to test whether they predicted one another, and two structural models were constructed to test their mediating roles in bullying victimization and aggression. Findings indicated that anger rumination and hostile automatic thoughts are mutually predictable; the correlation between bullying victimization and aggression is mediated independently by anger rumination and hostile automatic thoughts, and the chain mediation of bullying victimization predicting aggression first through anger rumination and then through hostile automatic thinking was established. In addition, an alternative mediation model is also significant, with hostile automatic thoughts as the primary mediator and anger rumination as the secondary mediator. These results highlight the significance of anger rumination and hostile automatic thoughts in the long-term effects of bullying victimization on aggression. Interventions designed to reduce undergraduate students' anger rumination and hostile automatic thoughts may help reduce their aggression.

Self-injury and suicidal ideation among Chinese adolescents involved in different subtypes of aggression: The role of gender

BACKGROUND

Although aggression associated self-injury and suicidal ideation, but the specific impact of different subtypes of aggression is unclear. Therefore, the current study aims to quantify the associations between five subtypes of aggression, self-injury, and suicidal ideation in Chinese adolescents.

METHOD

A total of 18,532 students were recruited in grades 7 to 12 using a stratified cluster sampling across five representative provinces in China. The Functional Assessment of Self-Mutilation (CH-FASM) and Buss and Warren's Aggression Questionnaire (BWAQ) assess self-injury and aggression, respectively.

RESULTS

During the last year, the proportion of self-injury, suicidal ideation, and self-injury plus suicidal ideation (SSI) were 13.4 %, 10.0 %, 12.4 %, respectively. Multivariate logistic regression indicated that hostility was associated with self-injury-only (OR = 1.033, 95 % CI = 1.021-1.044), suicidal ideation-only (OR = 1.075, 95 % CI = 1.061-1.088), and SSI (OR = 1.100, 95 % CI = 1.087-1.114) (all P < 0.001) across five subtypes of aggression. In gender stratification, physical aggression was risk factor for self-injury-only, suicidal ideation-only, and SSI (OR = 1.028, 95 % CI = 1.018-1.037, P < 0.001) in females. While anger was association with self-injury-only and suicidal ideation-only in males (P < 0.05).

LIMITATIONS

This study was a cross-sectional design and self-reported questionnaire.

CONCLUSION

Hostility is a strong predictor of self-injury and suicidal ideation across five subtypes of aggression. There are gender differences in relationships. Prevention programs for adolescents' self-injury and suicidal ideation should consider different subtypes of aggression and gender differences.