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Kuburi S, Ewing L, Hamza CA, Goldstein AL. A Daily Diary Study of the Relation between Stress and Nonsuicidal Self-Injury and the Moderating Role of Emotion Dysregulation in Emerging Adulthood. J Youth Adolesc 2024; 53:1605-1614. [PMID: 38282067 DOI: 10.1007/s10964-024-01946-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18-25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, Mage = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12-14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable.
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Affiliation(s)
- Sarah Kuburi
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada.
| | - Lexi Ewing
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Chloe A Hamza
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Abby L Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
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Gao Y, Liu J, Liu X, Wang Y, Qiu S. Dimensions of family stress and repetitive nonsuicidal self-injury in adolescence: Examining the interactive effects of impulsivity and emotion dysregulation. CHILD ABUSE & NEGLECT 2024; 152:106804. [PMID: 38636157 DOI: 10.1016/j.chiabu.2024.106804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/16/2023] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Repetitive non-suicidal self-injury (R-NSSI) in adolescence represents a significant risk factor for suicide. Although exposure to family stress is robustly associated with the risk of non-suicidal self-injury (NSSI), studies have not examined the potential mechanisms linking different forms of family stress and R-NSSI. OBJECTIVE This study examined how unique dimensions of family stress (threat and deprivation) relate to R-NSSI via interactions between impulsivity and emotion dysregulation. PARTICIPANTS AND SETTING The current sample included 3801 middle-school adolescents (42.2 % girls, Mage = 13.21 years). METHODS We conducted a two-wave study with 6-month intervals. Participants completed self-report measures assessing family stress, impulsivity, emotion dysregulation, and NSSI. RESULTS Moderate mediation analyses showed that threat was indirectly associated with NSSI frequency through the interaction of impulsivity and emotion dysregulation in the R-NSSI group and indirectly through impulsivity in the occasional NSSI (O-NSSI) group. Deprivation did not predict subsequent NSSI frequency in either group. CONCLUSIONS These findings lend empirical support to dimensional models of adversity and suggest that adolescents who experience threat-related family stress may have greater impulsivity and are more likely to report R-NSSI in the context of emotion dysregulation.
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Affiliation(s)
- Yemiao Gao
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jinmeng Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xia Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China.
| | - Yumeng Wang
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Shaojie Qiu
- Faculty of Psychology, Beijing Normal University, Beijing, China
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3
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Boyne H, Hamza CA. Pain tolerance as a 'barrier' to nonsuicidal self-injury: A longitudinal study. Psychiatry Res 2024; 336:115925. [PMID: 38678744 DOI: 10.1016/j.psychres.2024.115925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/26/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Theoretical perspectives underscore that low pain tolerance may be a relevant 'barrier' to non-suicidal self-injury (NSSI). However, there is limited longitudinal work on the link between pain tolerance and NSSI, which is needed to assess if pain tolerance precedes NSSI engagement, and/or if NSSI precedes altered pain tolerance. Further, assessing both NSSI frequency and versatility (or number of NSSI methods), in addition to engagement, can provide a more nuanced understanding of the influence of pain on NSSI severity. In the present study, 1125 undergraduate students at a large university (72 % female, Mage = 17.96) reported on their NSSI frequency, NSSI versatility, and perceived pain tolerance. Four individual regressions were run to examine the potential bidirectional nature of the association between NSSI frequency and pain tolerance, and NSSI versatility and pain tolerance. Pain tolerance predicted both NSSI frequency and versatility over time. Neither NSSI frequency nor versatility predicted pain tolerance. Results suggest that high pain tolerance may be a risk factor for severe NSSI engagement.
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Affiliation(s)
- Holly Boyne
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor St W, Toronto, ON, M5S 1V6, Canada.
| | - Chloe A Hamza
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor St W, Toronto, ON, M5S 1V6, Canada
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Petrovic J, Mills DJ, Heath NL. A self-determination theory perspective on the relationship between emotion regulation styles, mindfulness facets, and well-being in adults with self-injury. J Clin Psychol 2024. [PMID: 38781560 DOI: 10.1002/jclp.23708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/11/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The relevance of emotion regulation (ER) difficulties to nonsuicidal self-injury (NSSI; the deliberate destruction of one's bodily tissue without suicidal intent) has been repeatedly documented. Recently, specific mindfulness facets (i.e., awareness, nonjudging, describing) have been proposed as mechanisms that explain this relationship. The present study sought to extend this line of inquiry by exploring the mediating role of mindfulness facets in the relation between self-determination theory-based ER styles (i.e., integrative ER, suppressive ER, emotion dysregulation) and indices of positive and negative well-being (i.e., subjective vitality, NSSI difficulties), while controlling for gender, in adults with recent NSSI engagement. METHODS US adults with a history of more than one occurrence of NSSI within the last year (n = 222) completed online measures of ER styles, mindfulness facets, subjective vitality, and NSSI difficulties. RESULTS A mediation model indicated that the effects of ER styles on positive and negative well-being were explained by specific mindfulness facets (i.e., awareness, nonjudging, nonreactivity, describing). CONCLUSIONS The present study provides preliminary evidence that facets of dispositional mindfulness may be mechanisms through which ER styles impact positive and negative indices of well-being in adults with lived experience of NSSI.
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Affiliation(s)
- Julia Petrovic
- Department of Educational and Counselling Psychology (ECP), McGill University, Montréal, Québec, Canada
| | - Devin J Mills
- Department of Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Nancy L Heath
- Department of Educational and Counselling Psychology (ECP), McGill University, Montréal, Québec, Canada
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Kostic J, Žikić O, Djordjević V, Ristić A, Krivokapić Ž. Nonsuicidal Self-Injury and Suicidal Beliefs in Adolescent Inpatient. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:796. [PMID: 38792979 PMCID: PMC11122763 DOI: 10.3390/medicina60050796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Although nonsuicidal self-injury (NSSI), by definition, excludes suicidal intent, numerous studies show associations between NSSI and suicidal phenomena in clinical and outpatient adolescent samples. Given the growing interest in the relationship between NSSI and suicidal phenomena, the present study aimed to investigate the relationship between NSSI and suicidal beliefs in adolescent psychiatric inpatients. Materials and Methods: The study sample included 50 adolescent inpatients at a specialized facility, with a mean age of 15.44 ± 1.39, who fulfilled DSM-5 criteria for NSSI. For study purposes, we use the Ottawa Self-Injury Inventory (OSI) and Brief Suicide Cognitions Scale (B-SCS). Statistical data processing was performed in the R software 4.3.0 (R Core Team, Vienna, Austria). Results: Of all NSSI functions, the Internal ER function score was the highest (18.72 ± 7.08), followed by External ER (8.10 ± 3.11), Social Influence (5.88 ± 5.37), and Sensation Seeking (3.44 ± 2.98). The mean Craving (C) score was 14.06 ± 7.51. The mean value of the B-SCS score was 19.54 ± 5.24. It was found that the B-SCS score is significantly related to Internal ER (r = 0.441, p < 0.001) and Craving (r = 0.297, p = 0.036). The multivariable model shows that internal ER function and participants' age are significantly related to the B-SCS score. Conclusion: Despite the limitations of the study, it is emphasized that cognitions occurring across the fluid suicidal belief system alone do not fully capture the complexity of suicide, but assessing the suicidal belief system in NSSI inpatient adolescents could nevertheless provide helpful information for identifying individuals who may have an elevated vulnerability to experiencing suicidal ideas and behaviors over time.
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Affiliation(s)
- Jelena Kostic
- Medical College, University of Niš, 18000 Niš, Serbia
- Mental Health Protection University Clinical Centre Niš, 18000 Niš, Serbia
| | - Olivera Žikić
- Medical College, University of Niš, 18000 Niš, Serbia
- Mental Health Protection University Clinical Centre Niš, 18000 Niš, Serbia
| | - Vladimir Djordjević
- Medical College, University of Niš, 18000 Niš, Serbia
- Mental Health Protection University Clinical Centre Niš, 18000 Niš, Serbia
| | - Aleksandra Ristić
- Mental Health Protection University Clinical Centre Niš, 18000 Niš, Serbia
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Easdale-Cheele T, Parlatini V, Cortese S, Bellato A. A Narrative Review of the Efficacy of Interventions for Emotional Dysregulation, and Underlying Bio-Psycho-Social Factors. Brain Sci 2024; 14:453. [PMID: 38790432 PMCID: PMC11119869 DOI: 10.3390/brainsci14050453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
In this narrative, comprehensive, and updated review of the literature, we summarize evidence about the effectiveness of interventions aimed at reducing emotion dysregulation and improving emotion regulation in children, adolescents, and adults. After introducing emotion dysregulation and emotion regulation from a theoretical standpoint, we discuss the factors commonly associated with emotion regulation, including neurobiological and neuropsychological mechanisms, and the role of childhood adverse experiences and psycho-social factors in the onset of emotion dysregulation. We then present evidence about pharmacological and non-pharmacological interventions aiming at improving emotion dysregulation and promoting emotion regulation across the lifespan. Although our review was not intended as a traditional systematic review, and the search was only restricted to systematic reviews and meta-analyses, we highlighted important implications and provided recommendations for clinical practice and future research in this field.
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Affiliation(s)
- Thomas Easdale-Cheele
- School of Psychology, University of Southampton, Southampton SO17 1BJ, UK; (T.E.-C.); (V.P.); (S.C.)
| | - Valeria Parlatini
- School of Psychology, University of Southampton, Southampton SO17 1BJ, UK; (T.E.-C.); (V.P.); (S.C.)
- Centre for Innovation in Mental Health, University of Southampton, Southampton SO17 1BJ, UK
- Department of Child and Adolescent Psychiatry, Solent NHS Trust, Southampton SO19 8BR, UK
| | - Samuele Cortese
- School of Psychology, University of Southampton, Southampton SO17 1BJ, UK; (T.E.-C.); (V.P.); (S.C.)
- Centre for Innovation in Mental Health, University of Southampton, Southampton SO17 1BJ, UK
- Department of Child and Adolescent Psychiatry, Solent NHS Trust, Southampton SO19 8BR, UK
- Department of Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
- Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York, NY 11042, USA
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari “Aldo Moro”, 70100 Bari, Italy
| | - Alessio Bellato
- School of Psychology, University of Southampton, Southampton SO17 1BJ, UK; (T.E.-C.); (V.P.); (S.C.)
- Centre for Innovation in Mental Health, University of Southampton, Southampton SO17 1BJ, UK
- Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK
- School of Psychology, University of Nottingham Malaysia, Semenyih 43500, Malaysia
- Mind and Neurodevelopment (MiND) Interdisciplinary Cluster, University of Nottingham Malaysia, Semenyih 43500, Malaysia
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Guo Y, Lu R, Ou Y, Huang Y, Li J, Cui Y, Li D, Zheng Y, Liang X, Qiu S, Liu Y. A study on the association between prefrontal functional connectivity and non-suicidal self-injury in adolescents with depression. Front Neurol 2024; 15:1382136. [PMID: 38711563 PMCID: PMC11070463 DOI: 10.3389/fneur.2024.1382136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Objective Among adolescents with depression, the occurrence of non-suicidal self-injury (NSSI) behavior is prevalent, constituting a high-risk factor for suicide. However, there has been limited research on the neuroimaging mechanisms underlying adolescent depression and NSSI behavior, and the potential association between the two remains unclear. Therefore, this study aims to investigate the alterations in functional connectivity (FC) of the regions in the prefrontal cortex with the whole brain, and elucidates the relationship between these alterations and NSSI behavior in adolescents with depression. Methods A total of 68 participants were included in this study, including 35 adolescents with depression and 33 healthy controls. All participants underwent assessments using the 17-item Hamilton Depression Rating Scale (17-HAMD) and the Ottawa Self-Harm Inventory. In addition, functional magnetic resonance imaging (fMRI) data of the participants' brains were collected. Subsequently, the FCs of the regions in the prefrontal cortex with the whole brain was calculated. The FCs showing significant differences were then subjected to correlation analyses with 17-HAMD scores and NSSI behavior scores. Result Compared to the healthy control group, the adolescent depression group exhibited decreased FCs in several regions, including the right frontal eye field, left dorsolateral prefrontal cortex, right orbitofrontal cortex, left insula and right anterior cingulate coetex. The 17-HAMD score was positively correlated with the frequency of NSSI behavior within 1 year (rs = 0.461, p = 0.005). The FC between the right anterior cingulate cortex and the right precuneus showed a negative correlation with the 17-HAMD scores (rs = -0.401, p = 0.023). Additionally, the FC between the right orbitofrontal cortex and the right insula, demonstrated a negative correlation with the frequency of NSSI behavior within 1 year (rs = -0.438, p = 0.012, respectively). Conclusion Adolescents with depression showed decreased FCs of the prefrontal cortex with multiple brain regions, and some of these FCs were associated with the NSSI frequency within 1 year. This study provided neuroimaging evidence for the neurophysiological mechanisms underlying adolescent depression and its comorbidity with NSSI behavior.
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Affiliation(s)
- Yan Guo
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
- Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Ruoxi Lu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
| | - Yiwen Ou
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuxin Huang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jianyu Li
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Cui
- Cerebropathy Center, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Danian Li
- Cerebropathy Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanting Zheng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinyu Liang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
| | - Shijun Qiu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yujie Liu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Weatherford JV, Ruork AK, Yin Q, Lopez AC, Rizvi SL. Shame, suicidal ideation, and urges for non-suicidal self-injury among individuals with borderline personality disorder receiving dialectical behavior therapy: The mediating role of anger. Suicide Life Threat Behav 2024; 54:338-348. [PMID: 38265111 DOI: 10.1111/sltb.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/16/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a disorder of pervasive emotion dysregulation associated with high rates of self-injurious thoughts and behaviors (SITB). Understanding specific emotion states in relation to SITB is important for effective intervention. METHODS The current study examined whether, and how, the specific emotion of shame contributes to suicide ideation and urges to engage in non-suicidal self-injury (NSSI) both directly, and indirectly via anger, among individuals with BPD. Participants (N = 100) were enrolled in a 6-month comprehensive dialectical behavior therapy (DBT) program and provided daily ratings of shame, anger, suicide ideation, and urges for NSSI. RESULTS We found that higher daily ratings of shame and anger were directly associated with higher same-day ratings of both suicidal ideation and urges for NSSI. Furthermore, anger partially mediated the relationships between shame and both suicidal ideation and urges for NSSI. CONCLUSION These findings highlight shame and anger as potential antecedents of SITB among individuals with BPD. Clinical approaches, such as DBT, that include personalized, ongoing, clinical assessment of these specific affective states may be particularly important for treatment of SITB.
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Affiliation(s)
- Jessica V Weatherford
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Allison K Ruork
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Qingqing Yin
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Ana C Lopez
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Shireen L Rizvi
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
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Baetens I, Van Hove L, Azadfar Z, Van Heel M, Soyez V. The Effectivity of a School-Based Early Intervention Targeting Psychological Complaints and Non-Suicidal Self-Injury in Adolescents. J Clin Med 2024; 13:1852. [PMID: 38610615 PMCID: PMC11012402 DOI: 10.3390/jcm13071852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Recent research suggests a concerning trend of non-suicidal self-injury (NSSI) and suicidal behaviors emerging at younger ages (as early as age 12). Early onset of NSSI is linked to more severe outcomes. While universal school-based prevention programs have shown promise in addressing suicidal behaviors, there is limited research on their effectiveness in preventing NSSI onset among adolescents. This study aims to evaluate the efficacy of a universal prevention program in schools for NSSI and mental complaints while enhancing resilience and mental health in 11-14-year-old adolescents. Methods: In total, 329 Flemish secondary school students (55.6% female), aged 11 to 14 years, participated in a 4 h classroom universal prevention, with a focus on emotion regulation, mental health, and specific strategies to prevent NSSI and reduce stigma. For both the intervention and control group (N = 124), a pre-, post-, and one-month follow-up questionnaire was administered, containing reliable and valid measures for NSSI and suicidality, emotion regulation, help-seeking behaviors, well-being, and psychological distress. Results: The prevention program effectively reduced NSSI and psychological distress, particularly for adolescents with a history of NSSI. Conclusions: These findings support previous research on the effectiveness of school-based programs in reducing mental complaints and suggest promising outcomes for NSSI prevention.
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Affiliation(s)
- Imke Baetens
- Brussels University Consultation Centre (BRUCC), Department of Clinical Psychology, Vrije Universiteit Brussel, 1050 Ixelles, Belgium; (L.V.H.); (Z.A.); (M.V.H.); (V.S.)
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10
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Kim K, Woo S, Kim SH, Roh S, Kim S. The Prediction Model of Non-Suicidal Self-Injury in Psychiatric Patients Using Decision Tree Analysis. Yonsei Med J 2024; 65:137-147. [PMID: 38373833 PMCID: PMC10896672 DOI: 10.3349/ymj.2023.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 02/21/2024] Open
Abstract
PURPOSE The prevalence rate of non-suicidal self-injury (NSSI) in the clinical population is higher than that in the community sample, necessitating the need to investigate the predicting factors of NSSI in this group. The present study aimed to develop a prediction model of NSSI among psychiatric patients in Korea. MATERIALS AND METHODS Decision tree analysis was conducted on a sample of 224 psychiatric patients. Emotion regulation strategies (rumination, cognitive reappraisal, and expressive suppression), impulsivity, problematic alcohol use, working memory, depressive mood, and gender were included in the model as predictors of NSSI. RESULTS Results indicated that rumination, problematic alcohol use, and working memory predicted lifetime NSSI engagement among psychiatric patients. The best predictor of lifetime NSSI engagement was rumination. Specifically, when the level of rumination was high, the level of working memory was lower, and the risk of NSSI was higher. In the case of low levels of rumination, the higher the level of problematic alcohol use, the higher the risk of NSSI. The highest prevalence of lifetime NSSI engagement was found in a subgroup of patients with high levels of rumination and low levels of working memory. CONCLUSION The major contribution of this study is finding a combination of factors to predict the high-risk group of NSSI among psychiatric patients in Korea. This study provides evidence on the effect of rumination, working memory, and problematic alcohol use on NSSI. It is suggested that clinicians and researchers should pay more attention to emotion regulation and related vulnerabilities in preventing and treating NSSI.
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Affiliation(s)
- Kawon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, Korea
| | - Sungbum Woo
- Department of Counseling Psychology, Hanyang Cyber University, Seoul, Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, Korea
- Department of Psychiatry, College of Medicine and Institute of Mental Health, Hanyang University, Seoul, Korea
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Hospital, Seoul, Korea
- Department of Psychiatry, College of Medicine and Institute of Mental Health, Hanyang University, Seoul, Korea
| | - Sojung Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, Korea
- Department of Psychology, Yeungnam University, Gyeongsan, Korea.
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11
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Rådman G, Claréus B, Daukantaitė D. Adolescents' Emotion Regulation Strategies Questionnaire-Extended: Further Development and Associations With Mental Health Problems in Adolescence. Assessment 2024; 31:482-501. [PMID: 37056041 PMCID: PMC10822064 DOI: 10.1177/10731911231164619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Emotion regulation (ER) is implicated in a range of psychopathologies and behavioral problems that are prevalent or have their initial onset in adolescence. In this study, we aim to evaluate the psychometric properties (factor structure, internal consistency, and construct validity) of the Adolescents' Emotion Regulation Strategies Questionnaire-Extended (AERSQ-E), a modified and extended version of an ER instrument developed by Zhou et al. Across six sub-studies using data from different Swedish adolescent community samples (1,104 students in total), we generated and validated a 23-item version containing six subscales: rumination/negative thinking, positive reorientation, creative expression, aggressive outlet, social support, and distraction. Assessing test-retest reliability, internal consistency, measurement invariance as well as convergent and discriminant validity, we could establish, with some limitations, the general reliability and validity of the AERSQ-E as a valid measure of ER strategies for use in adolescence.
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12
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Chen XC, Xu JJ, Yin XT, Qiu YF, Yang R, Wang ZY, Han YW, Wang QK, Zhai JH, Zhang YS, Ran MS, Hu JM. Mediating role of anxiety and impulsivity in the association between child maltreatment and lifetime non-suicidal self-injury with and without suicidal self-injury. J Affect Disord 2024; 347:57-65. [PMID: 37995923 DOI: 10.1016/j.jad.2023.11.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Child maltreatment can increase the risk of lifetime non-suicidal self-injury (NSSI) and suicidal self-injury (SSI), but there is limited knowledge regarding the differences of potentially psychological mechanisms between NSSI with and without SSI. METHODS Participants, 3918 community-based Chinese young men aged 18-34 years in Chengdu, were included in this study. We investigated the association between depression, anxiety, psychosis, child maltreatment, adulthood traumatic events, impulsivity, alcohol dependence, drug abuse, and lifetime of NSSI among participants with and without SSI. Parallel mediation analysis was utilized to explore the mediators for the relation between child maltreatment and NSSI. RESULTS The prevalence of lifetime NSSI was 6.1 % (95 % CI: 5.4 %-6.9 %) among young men. Anxiety and impulsivity partially mediated the effect of child maltreatment on NSSI either with (indirect effect: 51.2 %) or without SSI (indirect effect: 34.3 %). Depression was independently and significantly associated with only NSSI but not with NSSI+SSI. Alcohol dependence and psychosis were independently and significantly associated with NSSI+SSI and mediated the effect of child maltreatment on NSSI+SSI. LIMITATIONS The cross-sectional survey data limits the robustness of the proof to the causal relationships. CONCLUSIONS Anxiety and impulsivity are associated with NSSI either with or without SSI and partially mediate the effect of child maltreatment on NSSI. Depression is associated with only NSSI, while alcohol dependence and psychosis are only associated with NSSI+SSI. It could be crucial to improve treatment and recovery of alcohol dependence and psychosis for preventing young men engaged in NSSI from attempting SSI.
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Affiliation(s)
- Xia-Can Chen
- Institute of Forensic Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Jia-Jun Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Tong Yin
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yu-Feng Qiu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Rui Yang
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Zi-Ye Wang
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yi-Wei Han
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Qi-Kai Wang
- Institute of Forensic Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Jin-Hui Zhai
- Institute of Forensic Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yu-Shu Zhang
- Institute of Forensic Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Mao-Sheng Ran
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Jun-Mei Hu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China.
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Aspeqvist E, Andersson H, Korhonen L, Dahlström Ö, Zetterqvist M. Measurement and stratification of nonsuicidal self-injury in adolescents. BMC Psychiatry 2024; 24:107. [PMID: 38326791 PMCID: PMC10848387 DOI: 10.1186/s12888-024-05535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI. METHODS The performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures. RESULTS A total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures. CONCLUSIONS When investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.
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Affiliation(s)
- Erik Aspeqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Hedvig Andersson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
- Barnafrid, Swedish National Center on Violence Against Children, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Athletics Research Center, Linköping University, Linköping, Sweden
| | - Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
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14
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Li J, Gao Y, Liu J, Liu X, Wang H. Impacts of difficulties with emotion regulation on the longitudinal relationship between peer victimization and changes in adolescent nonsuicidal self-injury. J Adolesc 2024; 96:350-359. [PMID: 38017669 DOI: 10.1002/jad.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/30/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Research has found that peer victimization is associated with adolescent nonsuicidal self-injury (NSSI) behavior; however, most of these studies ignored the association between these constructs at the within-person level. Additionally, the association between peer victimization and NSSI may vary among adolescents with different personal characteristics. With a longitudinal design, this study investigated whether and how emotion regulation (ER) difficulties moderate the relationship between peer victimization and changes in NSSI, with particular attention given to the unique moderating role of different dimensions of ER difficulties. METHODS The study sample comprised 3,561 adolescents aged between 10 and 17 years old (Mage = 13.22, SD = 0.85; 56.9% males). Self-report assessments were administered in December 2021 and June 2022 in Shanxi province, China. RESULTS The latent change score model showed that the adolescent NSSI increased during our assessments, with peer victimization as a significant predictor. ER difficulties moderated the association between peer victimization and NSSI changes, but interestingly, in an unexpected pattern. Specifically, peer victimization significantly predicted NSSI changes among adolescents with low ER difficulties but not for those with high ER difficulties. Moreover, among the multiple dimensions of ER difficulties, only nonacceptance of emotional responses and limited access to emotion regulation strategies interacted with peer victimization to predict NSSI changes and showed interaction patterns similar to those at the overall level of ER difficulties. CONCLUSIONS The current study revealed the moderating role of ER difficulties in the relationship between peer victimization and changes in NSSI. These findings provide intervention implications for adolescents who engage in NSSI.
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Affiliation(s)
- Jinwen Li
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yemiao Gao
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jinmeng Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xia Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Hui Wang
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
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Andersson H, Svensson E, Magnusson A, Holmqvist R, Zetterqvist M. Young adults looking back at their experiences of treatment and care for nonsuicidal self-injury during adolescence: a qualitative study. Child Adolesc Psychiatry Ment Health 2024; 18:16. [PMID: 38245758 PMCID: PMC10800066 DOI: 10.1186/s13034-024-00706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is associated with stigma, and negative attitudes among healthcare professionals toward NSSI have been reported. A person-centered approach that focuses on how individuals with lived experience of NSSI perceive the treatment and care they receive is invaluable in reducing barriers to help-seeking and improving treatment and mental healthcare services. The aim of the current qualitative study was to explore the perceptions of young adults when they look back upon their experiences of psychiatric treatment for NSSI during adolescence. METHODS Twenty-six individuals with lived experience of NSSI who were in contact with child and adolescent psychiatry during adolescence were interviewed. The interviews were analyzed using thematic analysis. RESULTS Three main themes were developed: Changed perceptions in retrospect, The importance of a collaborative conceptualization and Lasting impression of the relationship. Participants' perception of themselves as well as the treatment changed over time. The importance of a joint understanding of NSSI and an agreed-upon treatment focus was emphasized. The relationship to the mental health professionals, and experiences of how NSSI was communicated, were salient several years later. CONCLUSIONS Healthcare professionals need to communicate about NSSI in a respectful manner and include the perspective of the adolescent with lived experience of NSSI in a joint conceptualization of NSSI and treatment focus.
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Affiliation(s)
- H Andersson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden
| | - E Svensson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - A Magnusson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - R Holmqvist
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - M Zetterqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden.
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Zhong Y, He J, Luo J, Zhao J, Cen Y, Song Y, Wu Y, Lin C, Pan L, Luo J. A machine learning algorithm-based model for predicting the risk of non-suicidal self-injury among adolescents in western China: A multicentre cross-sectional study. J Affect Disord 2024; 345:369-377. [PMID: 37898476 DOI: 10.1016/j.jad.2023.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 10/30/2023]
Abstract
The prevalence of non-suicidal self-injurious (NSSI) in adolescents is high. However, few studies exist to predict NSSI in this population. This study employed a machine learning algorithm to develop a predictive model, aiming to more accurately assess the risk of NSSI in Chinese adolescents. Sociodemographic, psychological data were collected in 50 schools in western China. We constructed eXtreme Gradient Boosting (XGBoost) model and multivariate logistic regression model to predict the risk of NSSI and nomograms are plotted. Data from 13,304 adolescents were used for model development, with an average age of 13.00 ± 2.17 years; 617 individuals (4.6 %) reported non-suicidal self-injury (NSSI) behaviors. The results of the XGBoost model showed that depression and anxiety were the top two predictors of NSSI in adolescents. The results of the multivariate logistic regression model showed that the risk factors for adolescent NSSI behaviors include: gender (being female), Age, Living with whom (father), History of psychiatric consultation, Stress, Depression, Anxiety, Tolerance, Emotion abreaction. The XGBoost prediction and multivariate logistic regression model showed good predictive ability. Nomograms can serve as clinical tools to assist in intervention measures, helping adolescents reduce NSSI behaviors and improve their mental and physical well-being.
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Affiliation(s)
- Yunling Zhong
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Jinlong He
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Jing Luo
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Jiayu Zhao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Yu Cen
- School of Psychiatry, North Sichuan Medical College, 55 Dongshun Road, Gaoping District, Nanchong City, Sichuan Province, China
| | - Yuqin Song
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Yuhang Wu
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Cen Lin
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Lu Pan
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Jiaming Luo
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China; School of Psychiatry, North Sichuan Medical College, 55 Dongshun Road, Gaoping District, Nanchong City, Sichuan Province, China.
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17
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Williams AJ, Cleare S, Borschmann R, Tench CR, Gross J, Hollis C, Chapman-Nisar A, Naeche N, Townsend E, Slovak P. Enhancing emotion regulation with an in situ socially assistive robot among LGBTQ+ youth with self-harm ideation: protocol for a randomised controlled trial. BMJ Open 2024; 14:e079801. [PMID: 38195171 PMCID: PMC10806609 DOI: 10.1136/bmjopen-2023-079801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Purrble, a socially assistive robot, was codesigned with children to support in situ emotion regulation. Preliminary evidence has found that LGBTQ+ youth are receptive to Purrble and find it to be an acceptable intervention to assist with emotion dysregulation and their experiences of self-harm. The present study is designed to evaluate the impact of access to Purrble among LGBTQ+ youth who have self-harmful thoughts, when compared with waitlist controls. METHODS AND ANALYSIS The study is a single-blind, randomised control trial comparing access to the Purrble robot with waitlist control. A total of 168 LGBTQ+ youth aged 16-25 years with current self-harmful ideation will be recruited, all based within the UK. The primary outcome is emotion dysregulation (Difficulties with Emotion Regulation Scale-8) measured weekly across a 13-week period, including three pre-deployment timepoints. Secondary outcomes include self-harm (Self-Harm Questionnaire), anxiety (Generalised Anxiety Disorder-7) and depression (Patient Health Questionnaire-9). We will conduct analyses using linear mixed models to assess primary and secondary hypotheses. Intervention participants will have unlimited access to Purrble over the deployment period, which can be used as much or as little as they like. After all assessments, control participants will receive their Purrble, with all participants keeping the robot after the end of the study. After the study has ended, a subset of participants will be invited to participate in semistructured interviews to explore engagement and appropriation of Purrble, considering the young people's own views of Purrble as an intervention device. ETHICS AND DISSEMINATION Ethical approval was received from King's College London (RESCM-22/23-34570). Findings will be disseminated in peer review open access journals and at academic conferences. TRIAL REGISTRATION NUMBER NCT06025942.
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Affiliation(s)
- A Jess Williams
- Department of Informatics, King's College London, London, UK
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Seonaid Cleare
- Department of Informatics, King's College London, London, UK
- University of Glasgow, Glasgow, UK
| | - Rohan Borschmann
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Oxford, Oxford, UK
| | | | - James Gross
- Stanford University, Stanford, California, USA
| | - Chris Hollis
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | | | | | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Petr Slovak
- Department of Informatics, King's College London, London, UK
- University of Oxford, Oxford, UK
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18
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Chizhova OA, Iuzbashian PG. [Alexithymia and self-harm in people with borderline personality disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:102-108. [PMID: 38261291 DOI: 10.17116/jnevro2024124011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To estimate the prevalence of alexithymia and self-harm in patients with borderline personality disorder (BPD). To assess the role of alexithymia in the emergence of self-harm in patients with BPD. MATERIAL AND METHODS We studied 104 patients (85 women, 19 men aged 21 to 25 years (64.4%)), including 54 patients with and 50 patients without BPD. Most of them had incomplete higher education (55%). We used the Russian version of the 20-item Toronto Alexithymia Scale (TAS-20) to reveal alexithymia and SCID-II to diagnose BPD. The presence of self-harm behavior was confirmed by the subjects' anamnesis data. RESULTS The prevalence of alexithymia in patients with BPD was 83.3%, in the control group it was 52% (p=0.001). The prevalence of self-aggression was 70.3% (n=38) in patients with BPD, and 12% (n=6) in people without BPD. Self-harm among persons with alexithymia was noted in 62.5% (n=45). During the analysis, a connection between auto-aggression and alexithymia was found at the level of a statistical trend (p=0.051). CONCLUSION Alexithymia and self-harm are more common in patients with BPD than in healthy people. This type of emotional dysregulation mediates self-harm in patients with BPD.
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Affiliation(s)
- O A Chizhova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - P G Iuzbashian
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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19
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James KM, Balderrama-Durbin C, Israel E, Feurer C, Gibb BE. Self- and co-regulation of physiological activity during mother-daughter interactions: The role of adolescent non-suicidal self-injury. J Child Psychol Psychiatry 2024; 65:91-99. [PMID: 37469027 PMCID: PMC10796835 DOI: 10.1111/jcpp.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a significant public health concern that is thought to increase risk for future self-injurious behaviors, including suicide attempts. Notably, NSSI is especially prevalent among adolescents, which underscores a critical need to identify modifiable risk factors that could be targeted to reduce future risk. The current study examined self- and co-regulation of physiological responses during mother-daughter interactions in adolescent girls with and without a history of NSSI. METHODS Participants were 60 girls aged 13-17 with (n = 27) and without (n = 33) a history of NSSI and their mothers. Adolescents and their mothers completed positive and negative interaction tasks during which physiological reactivity was assessed via respiratory sinus arrhythmia (RSA). RESULTS Using Actor-Partner Interdependence Modeling (APIM), we found that adolescents with an NSSI history demonstrated a higher RSA setpoint than adolescents without this history during the negative, but not positive, interaction task. In addition, there were differences in co-regulation during the negatively valenced interaction, such that mothers of daughters with NSSI were more reactive to fluctuations in their daughters' RSA than mothers of daughters without an NSSI history. CONCLUSIONS These findings highlight intra- and interpersonal aspects of physiological dysregulation associated with NSSI that could provide promising targets of intervention to reduce future risk in adolescent girls.
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Affiliation(s)
| | | | - Elana Israel
- Binghamton University (SUNY), Department of Psychology
| | - Cope Feurer
- University of Illinois Chicago, Department of Psychiatry
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20
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Zhou X, Guo J, Wu H, Chen D, Wang C, You J. The Relationship between Ambivalence over Emotional Expression and Nonsuicidal Self-Injury Among Chinese Adolescents: A Longitudinal Moderated Mediation Model. Arch Suicide Res 2024; 28:90-106. [PMID: 36282550 DOI: 10.1080/13811118.2022.2134068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) has become a significant mental health concern for adolescents. Previous empirical studies have shown that ambivalence over emotional expression is positively associated with negative emotions and behaviors. However, little is known about the relationship between ambivalence over emotional expression and NSSI among adolescents. Therefore, this study used a longitudinal design to examine the relationship between ambivalence over emotional expression and NSSI among Chinese adolescents, and also to explore the mediating and moderating mechanisms underlying this relationship. METHOD A total of 1,672 students (45.8% males; Mage = 16.12 years, SD = 1.56) in a middle school in Guangzhou were tracked. The investigation was conducted twice, with an interval of 6 months. RESULTS Ambivalence over emotional expression was positively correlated with NSSI. After controlling for gender and baseline NSSI, anxiety symptoms fully mediated the association between ambivalence over emotional expression and NSSI. In addition, the relationship between ambivalence over emotional expression and NSSI was moderated by NSSI refusal self-efficacy. CONCLUSIONS These findings imply that to decrease ambivalence over emotional expression, to reduce anxiety symptoms, and to promote NSSI refusal self-efficacy may be useful for interventions and preventions of NSSI.HIGHLIGHTSTested the relationship between ambivalence over emotional expression and NSSI in adolescents.Examined a moderated-mediation model over six months.Found the mediated effect of anxiety symptoms and moderated effect of NSSI refusal self-efficacy in the relationship between ambivalence over emotional expression and NSSI.
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21
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Zhang R, Chen J, Zhang C, Xu W. Longitudinal association of mindfulness with aggression and non-suicidal self-injury in adolescence: The mediating role of shame-proneness. Aggress Behav 2024; 50:e22121. [PMID: 37909325 DOI: 10.1002/ab.22121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
The aim of the current study was to investigate the longitudinal association of facets of mindfulness with aggression and non-suicidal self-injury (NSSI) among adolescents and to explore whether shame-proneness can mediate the longitudinal association. The present longitudinal study investigated the associations between mindfulness, aggression, and NSSI in a sample of 706 Chinese adolescents (M = 15.33; SD = 1.34; 50.20% girls). Five facet mindfulness questionnaire was completed at baseline and middle school students' shame scale was completed at 6-month follow-up. The Chinese version of Buss-Perry aggression questionnaire and adolescents' self-harm scale were completed at both baseline and 6-month follow-up. Shame-proneness significantly mediated the longitudinal association between (a) describing and aggression (-0.107, 95% CI: [-0.151 to -0.067]), and NSSI (-0.041, 95% CI: [-0.069 to -0.019]). (b) Acting with awareness and aggression (-0.094, 95% CI: [-0.139 to -0.061]), and NSSI (-0.036, 95% CI: [-0.062 to -0.016]). (c) Nonjudging and aggression (-0.062, 95% CI: [-0.107 to -0.024]) and NSSI (-0.024, 95% CI: [-0.047 to -0.008]). Describing, acting with awareness, and nonjudging were predictive factors of aggression and self-injury in adolescents, and shame-proneness played a crucial role in the negative longitudinal association between them. Findings from the current study may offer some implications in the domains of clinical practice and education to improve mental health and further ameliorate the misbehavior among adolescents.
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Affiliation(s)
- Ruotong Zhang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jing Chen
- Institute of Psychology, Chinese Academic of Sciences, Beijing, China
| | - Chunyang Zhang
- China Academy of Civil Aviation Science and Technology, Beijing, China
| | - Wei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
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Liu J, Li JT, Zhou M, Liu HF, Fan YY, Mi S, Tang YL. Non-suicidal self-injury in adolescents with mood disorders and the roles of self-compassion and emotional regulation. Front Psychiatry 2023; 14:1214192. [PMID: 38179248 PMCID: PMC10764550 DOI: 10.3389/fpsyt.2023.1214192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Objective We aimed to investigate the characteristics and psychological mechanism of non-suicidal self-injury (NSSI) in adolescents with mood disorders. We examined how self-compassion and emotional regulation affected NSSI and tested the mediating role of self-compassion in the link between emotional regulation and NSSI. Method We recruited outpatient and inpatient adolescent patients with bipolar and related disorders or depressive disorders (DSM-5), with a focus on NSSI. We also recruited healthy controls from the community. We collected demographic and clinical data. The Adolescent Self-injury Questionnaire, Self-compassion Scale (SCS), and Emotion Regulation Questionnaire (ERQ) were used to assess the frequency and severity of NSSI, level of self-compassion, and emotional regulation. Results In total, we recruited 248 adolescent patients with mood disorders (N = 196 with NSSI, and 52 without NSSI) and 212 healthy controls. NSSI was significantly associated with the female sex, lower levels of education and less use of cognitive reappraisal strategies, lower levels of self-warmth, and higher levels of self-coldness. Multivariate analysis of variance showed that there were significant differences in the scores of ERQ, cognitive reassessment score, and the scores of SCS among the three groups, but no statistical differences in expressive suppression score among the three groups. Self-warmth had a mediating effect between cognitive reappraisal and NSSI behavior. Conclusion NSSI is prevalent among adolescent patients with mood disorders in clinical settings, especially among girls and those with lower levels of education and less cognitive reappraisal strategies. More clinical attention is needed. Self-compassion and its factors may mediate the association between emotional regulation and NSSI. Clinical implications and future research directions were discussed.
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Affiliation(s)
- Jing Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia-ting Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Man Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Hui-feng Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yang-yang Fan
- Faculty of Economics and Management, East China Normal University, Shanghai, China
| | - Si Mi
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, United States
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Bemmouna D, Lagzouli A, Weiner L. The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls. Mol Autism 2023; 14:47. [PMID: 38110995 PMCID: PMC10726572 DOI: 10.1186/s13229-023-00580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), whose aetiology has been attributed to biosocial factors. In autism spectrum condition (ASC), although ED is prevalent and is associated with decreased well-being (e.g. self-harm, suicidality), it has been understudied, especially in adults. It is therefore crucial to further understand ED in autistic adults to improve its treatment. Our study investigates ED, its behavioural correlates (e.g. self-harm, suicidality) and biosocial predictors in autistic adults relative to BPD and nonclinical controls (NC). METHODS A total of 724 participants (ASC = 154; BPD = 111; NC = 459) completed 11 self-reported questionnaires assessing ED, ASC and BPD traits, co-occurring disorders, alexithymia, emotional vulnerability and invalidating experiences (e.g. bullying, autistic camouflaging). The occurrence of ED behavioural correlates (i.e. self-harm, history of suicide attempts, and psychiatric hospitalizations) was collected. In addition, between-groups analyses, linear regressions and machine learning (ML) models were used to identify ED predictors in each group. RESULTS ED and its behavioural correlates were higher in ASC compared to NC, but milder than in BPD. While gender did not predict ED scores, autistic women had increased risk factors to ED, including sexual abuse and camouflaging. Interestingly, BPD traits, emotional vulnerability and alexithymia strongly predicted ED scores across the groups. Using ML models, sensory sensitivity and autistic camouflaging were associated with ED in ASC, and ADHD symptoms with ED in BPD. LIMITATIONS ASC and BPD diagnoses were self-reported, which did not allow us to check their accuracy. Additionally, we did not explore the transactional and the moderating/mediating relationships between the different variables. Moreover, our research is cross-sectional and cannot draw conclusions regarding the direction and causality of relationships between ED and other clinical dimensions. CONCLUSIONS ED and its behavioural correlates are heightened in BPD compared to ASC and nonclinical controls. In the ASC group, there were no gender differences in ED, despite the heightened exposure of autistic women to ED risk factors. BPD traits, emotional vulnerability, and alexithymia are core to ED regardless of diagnosis. Although less central, sensory sensitivity and autistic camouflaging seem to be specific predictors of ED in autistic adults.
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Affiliation(s)
- Doha Bemmouna
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France.
| | - Amine Lagzouli
- MSME, CNRS UMR 8208, Paris-Est Créteil University, Gustave Eiffel University, 94010, Créteil, France
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Luisa Weiner
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France.
- Psychiatry Department, University Hospitals of Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France.
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Ge Y, Xiao Y, Li M, Yang L, Song P, Li X, Yan H. Maladaptive cognitive regulation moderates the mediating role of emotion dysregulation on the association between psychosocial factors and non-suicidal self-injury in depression. Front Psychiatry 2023; 14:1279108. [PMID: 38098637 PMCID: PMC10719840 DOI: 10.3389/fpsyt.2023.1279108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
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.
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Affiliation(s)
- Yuqi Ge
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yang Xiao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Mingzhu Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lei Yang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Peihua Song
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xueni Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hao Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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25
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Lin W, Liang H, Jiang H, Mohd Nasir MA, Zhou H. Why is Smartphone Addiction More Common in Adolescents with Harsh Parenting? Depression and Experiential Avoidance's Multiple Mediating Roles. Psychol Res Behav Manag 2023; 16:4817-4828. [PMID: 38047152 PMCID: PMC10693199 DOI: 10.2147/prbm.s428167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/14/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Harsh parenting is positively correlated with adolescents' smartphone addiction, according to a growing corpus of studies. The various mediating processes that could underlie this link, however, are not well understood. Based upon the experiential avoidance model, the current research aimed to identify the relation between harsh parenting and adolescents' smartphone addiction and the mediating roles of adolescents' depression and experiential avoidance. Methods We recruited 456 adolescents (female = 52.6%; Mage = 13.19 years, SD = 0.85) at a public junior high school in China to complete the harsh discipline scale, 90-item Hopkins symptom checklist, acceptance and action questionnaire version II, and smartphone addiction scale short version. SPSS24.0 was used to conduct independent samples t-test, descriptive statistics, Pearson correlation analysis and common method bias test, PROCESS were used to conduct a significance test of the chain mediation effect on the data. Age, gender, and grade were used as con-founders that were controlled in order to make cautious predictions. Results The results showed that (1) harsh parenting was positively correlated with adolescents' depression, experiential avoidance, and smartphone addiction; (2) both depression and experiential avoidance fully mediated the link between harsh parenting and smartphone addiction; and (3) depression and experiential avoidance also sequentially mediated the link between harsh parenting and smartphone addiction. These findings have significant implications for the prevention and intervention of adolescents' smartphone addiction. Conclusion These findings suggested that harsh parenting may have an indirect impact on smartphone addiction in both a simple way (parallel mediation) and a complicated way (serial mediation). In addition, these studies shed light on smartphone addiction prevention and intervention.
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Affiliation(s)
- Wanqing Lin
- School of Applied Psychology, Social Work & Policy, UUM College of Arts & Sciences, University Utara Malaysia, Sintok, Malaysia
| | - Hanyu Liang
- School of Medical Humanities, Guizhou Medical University, Guiyang, People’s Republic of China
| | - Huaibin Jiang
- Department of Psychology, Fujian Polytechnic Normal University, Fuqing, People’s Republic of China
| | - Mohd Azrin Mohd Nasir
- School of Applied Psychology, Social Work & Policy, UUM College of Arts & Sciences, University Utara Malaysia, Sintok, Malaysia
| | - Huiling Zhou
- School of Medical Humanities, Guizhou Medical University, Guiyang, People’s Republic of China
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Laura B, Maisto D, Pezzulo G. Modeling and controlling the body in maladaptive ways: an active inference perspective on non-suicidal self-injury behaviors. Neurosci Conscious 2023; 2023:niad025. [PMID: 38028726 PMCID: PMC10681710 DOI: 10.1093/nc/niad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/12/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
A significant number of persons engage in paradoxical behaviors, such as extreme food restriction (up to starvation) and non-suicidal self-injuries, especially during periods of rapid changes, such as adolescence. Here, we contextualize these and related paradoxical behavior within an active inference view of brain functions, which assumes that the brain forms predictive models of bodily variables, emotional experiences, and the embodied self and continuously strives to reduce the uncertainty of such models. We propose that not only in conditions of excessive or prolonged uncertainty, such as in clinical conditions, but also during pivotal periods of developmental transition, paradoxical behaviors might emerge as maladaptive strategies to reduce uncertainty-by "acting on the body"- soliciting salient perceptual and interoceptive sensations, such as pain or excessive levels of hunger. Although such strategies are maladaptive and run against our basic homeostatic imperatives, they might be functional not only to provide some short-term reward (e.g. relief from emotional distress)-as previously proposed-but also to reduce uncertainty and possibly to restore a coherent model of one's bodily experience and the self, affording greater confidence in who we are and what course of actions we should pursue.
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Affiliation(s)
- Barca Laura
- Institute of Cognitive Sciences and Technologies, National Research Council, Via San Martino della Battaglia 44, Rome 00185, Italy
| | - Domenico Maisto
- Institute of Cognitive Sciences and Technologies, National Research Council, Via San Martino della Battaglia 44, Rome 00185, Italy
| | - Giovani Pezzulo
- Institute of Cognitive Sciences and Technologies, National Research Council, Via San Martino della Battaglia 44, Rome 00185, Italy
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Williams AJ, Townsend E, Naeche N, Chapman-Nisar A, Hollis C, Slovak P. Investigating the Feasibility, Acceptability, and Appropriation of a Socially Assistive Robot Among Minority Youth at Risk of Self-Harm: Results of 2 Mixed Methods Pilot Studies. JMIR Form Res 2023; 7:e52336. [PMID: 37991838 PMCID: PMC10701649 DOI: 10.2196/52336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Minority youth are at an increased risk of experiencing self-harmful thoughts and behaviors. However, there is limited evidence of successful interventions to support young people in the moment of their distress. Digital interventions are considered a potential solution for providing in-the-moment support for those at risk of adverse mental health and self-harm. OBJECTIVE These pilot studies aim to investigate the feasibility and acceptability of a new in situ intervention tool, Purrble, among two broad groups of minority youth: (1) lesbian, gay, bisexual, transgender, queer, and similar minority (LGBTQ+) youth and (2) racial and ethnic minority youth. Purrble was designed to support in-situ emotion regulation (ER) support when individuals are facing emotionally challenging situations. METHODS This study consisted of 2 mixed methods pilot studies that followed the same mixed methods design, including 3 weeks of daily and weekly surveys and optional follow-up interviews. Inclusion criteria were (1) aged between 16 and 25 years, (2) part of a minority group, (3) had experiences of self-harmful thoughts or behaviors or elevated symptoms of depression or anxiety, and (4) living in the United Kingdom at the time of the study. The primary outcomes were (1) the feasibility of Purrble as an intervention among pilot samples (analyzed by consent rate, retention rate, adherence to surveys, and engagement with the device) and (2) the acceptability and appropriation of Purrble across pilot studies as a tool to support ER in situ (thematically analyzed qualitative open-ended questions and interview data). The secondary outcomes were descriptive pilot data concerning the mental health outcomes in each sample. RESULTS In total, 21 LGBTQ+ young people participated in pilot study 1, with 86% (n=18) completing the baseline and 3 weeks of daily surveys. These young people maintained engagement with Purrble across deployment, across which period there was a decrease in self-harmful thoughts and anxiety symptoms. A total of 19 ethnic and racial minority youths participated in pilot study 2, and 84% (n=16) completed the study. Although pilot study 2 participants also maintained engagement with Purrble across deployment, this was to a lesser degree than participants of pilot study 1, and perceived mental health outcomes did not indicate potential change associated with the device. The thematic analysis indicated three superordinate themes: (1) stopping the self-harm cycle, (2) adopting ER strategies, and (3) stages of change. CONCLUSIONS These were the first pilot studies of a novel intervention that aimed to provide in situ ER support for young people at risk of self-harm. Both quantitative and qualitative findings indicate that young people found Purrble to be a feasible and acceptable intervention, as they effectively incorporated the device into their ER practices. These engagements with Purrble were described as interrupting the cycle of self-harmful ideation and behavior.
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Affiliation(s)
- A Jess Williams
- Department of Informatics, King's College London, London, United Kingdom
| | - Ellen Townsend
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Nkem Naeche
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Amelia Chapman-Nisar
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Chris Hollis
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Petr Slovak
- Department of Informatics, King's College London, London, United Kingdom
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Min J, Hein KE, Medlin AR, Mullins-Sweatt SN. Prevalence rate trends of borderline personality disorder symptoms and self-injurious behaviors in college students from 2017 to 2021. Psychiatry Res 2023; 329:115526. [PMID: 37839319 DOI: 10.1016/j.psychres.2023.115526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
The current study examines the prevalence rates of borderline personality disorder (BPD) symptoms and nonsuicidal self-injury (NSSI) behaviors amongst college students over a five-year period, including pre- and during the COVID pandemic. Online prescreener surveys were completed by undergraduate students (n = 12,756) attending a large Southern Plains University every semester from Spring of 2017 to Spring of 2021. The percentage of students with NSSI history and significant BPD symptoms were visualized by semester to examine trends over time. A series of logistic regressions and negative binomial regressions were conducted on NSSI history and BPD symptoms to examine whether the endorsement rates have been increasing over time and to compare before and during COVID pandemic. There was an increasing trend of NSSI rates and significant BPD symptoms over time for all sexes. Furthermore, there was a steeper increase in BPD symptoms specifically in female students over the last five years. Additionally, there was a significant increase in odds of elevated BPD symptoms and NSSI behaviors in the college students enrolled during the COVID pandemic compared with pre-COVID. Overall, there has been an increasing trend in BPD symptoms and NSSI rates over the last few years, including during the COVID pandemic.
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Affiliation(s)
- Jiwon Min
- Department of Psychology, Oklahoma State University, Stillwater, USA.
| | - Katherine E Hein
- Department of Psychology, Oklahoma State University, Stillwater, USA
| | - Austin R Medlin
- Department of Health & Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
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Buitron V, Maron M, Kudinova A, Thompson E, Barker DH, Wolff JC. Sleep disturbance and suicidality in psychiatrically hospitalized adolescents: The role of specific emotion regulation domains. J Clin Psychol 2023; 79:2515-2528. [PMID: 37329572 PMCID: PMC10880543 DOI: 10.1002/jclp.23558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/16/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Sleep disturbance is associated with broadband measurements of emotion regulation (ER). The linkage between ER, a multidimensional process, and suicidal ideation and suicide attempt is also documented in theoretical and empirical work. Recent research indicates that distinct profiles of ER are associated with psychiatric outcomes, including adolescent suicidal ideation and attempt. The present study examined whether specific domains of ER would explain the association between sleep disturbance, and ideation and attempt among psychiatrically hospitalized adolescents. METHOD The sample included 284 adolescents who completed self-report measures on sleep disturbance, ER, suicidal ideation, suicide attempt, and psychiatric symptoms upon inpatient hospitalization. RESULTS Findings indicated that sleep disturbance was associated with suicidal ideation. Further, a single ER domain (perceived limited access to ER strategies) fully accounted for the significant association between sleep disturbance and suicidal ideation. A reported suicide attempt in the past week was correlated with the nonacceptance of emotional responses, perceived limited access to ER strategies, and emotional clarity, but was not associated with sleep disturbance. DISCUSSION The current findings highlight the importance of examining narrowband ER and indicate the presence of differential associations between sleep disturbance, ER, and suicide-related outcomes. Findings further elucidate the possible role of impaired cognitive responses to emotional experiences in the co-occurrence of sleep disturbance and youth psychiatric outcomes.
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Affiliation(s)
- Victor Buitron
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Micaela Maron
- Bradley Hospital, East Providence, Rhode Island, USA
| | - Anastacia Kudinova
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - Elizabeth Thompson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - David H. Barker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jennifer C. Wolff
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Hospital, Providence, Rhode Island, USA
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Hedén L, Jonsson LS, Fredlund C. The Connection Between Sex as Self-Injury and Sexual Violence. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3531-3540. [PMID: 37640887 PMCID: PMC10703980 DOI: 10.1007/s10508-023-02669-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a suggested diagnosis recognized by DSM-5 as in need of further research. Recent studies conclude that sex as self-injury (SASI) and NSSI share similar functions, such as being used as emotional regulation. SASI has been associated with earlier sexual abuse, but the understanding of the association between sexual violence and SASI is still limited. The aim of this study was to further investigate the connection between sexual violence and the experience of SASI. How could SASI be related to sexual violence? The study used a qualitative design and was based on an anonymous questionnaire published on the websites of Swedish NGOs, providing help and support to women and youths, such as those in women's shelters. In total, 139 informants with a mean age of 27.9 years (range 15-64 years) were included in the study. Three main themes were found: (1) Normalization of sexual violence and a shift in boundaries could be seen as consequences of earlier experiences of sexual violence leading to SASI; (2) SASI could escalate into sexual violence through increased need of emotional regulation, increased risk-taking, and risk of victimization; (3) SASI could be used to regain control of re-experiences, the body, sexuality, and shame after sexual abuse. In conclusion, a complex connection was identified whereby SASI could escalate into sexual violence, and earlier experiences of sexual violence could lead to SASI in a vicious loop. Hence, SASI should be seen as a risk factor for further victimization and sexual abuse.
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Affiliation(s)
- Ludwig Hedén
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Linda S Jonsson
- Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Cecilia Fredlund
- Department of Psychiatry in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83, Linköping, Sweden.
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Gyori D, Farkas BF, Komaromy D, Horvath LO, Kollarovics N, Garas P, Balazs J. The Association between Nonsuicidal Self-Injury and Perfectionism in Adolescence: The Role of Mental Disorders. Eur J Investig Health Psychol Educ 2023; 13:2299-2327. [PMID: 37998053 PMCID: PMC10670610 DOI: 10.3390/ejihpe13110163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023] Open
Abstract
Previous evidence has drawn attention to the fact that maladaptive perfectionism is a risk factor for engagement in nonsuicidal self-injury (NSSI). Until now, few studies have examined this topic, especially among community adolescents. The aim of this study was to explore the relationship between perfectionism dimensions and NSSI functions to examine the potential mediating effect of mental disorders. Altogether, 146 Hungarian community adolescents (ages 13-18 years) were involved. All participants completed the Hungarian adaptation of the Inventory of Statements about Self-Injury (ISAS), the Frost Multidimensional Perfectionism Scale (FMPS), and the Mini International Neuropsychiatric Interview Kid. To analyse the interrelationships among NSSI, perfectionism, and mental disorders, we conducted regression and network analysis. Of the 146 adolescents, 90 (61.64%, girls: 71.11%) engaged in NSSI. The Concern over Mistakes and Doubts about Action scales of the FMPS significantly and positively predicted both NSSI intrapersonal and interpersonal motivation, with comparable effect sizes, and this association was fully mediated by anxiety disorders. There was a significant direct negative relationship between the FMPS Organisation dimension and both main NSSI functions. This study draws attention to an increasing trend and the extremely high NSSI prevalence rate among community adolescents. Adolescents with perfectionistic concerns are at heightened risk for anxiety disorders, which can increase their vulnerability to NSSI engagement.
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Affiliation(s)
- Dora Gyori
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
| | - Bernadett Frida Farkas
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Daniel Komaromy
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Department of Behavioural and Movement Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Lili Olga Horvath
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Pedagogical Services, 1141 Budapest, Hungary
| | - Nora Kollarovics
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Peter Garas
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Department of Psychology, Oslo New University College, 0456 Oslo, Norway
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van der Venne P, Mürner-Lavanchy I, Höper S, Koenig J, Kaess M. Physiological response to pain in female adolescents with nonsuicidal self-injury as a function of severity. J Affect Disord 2023; 339:64-73. [PMID: 37390927 DOI: 10.1016/j.jad.2023.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Preliminary evidence indicates altered hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) response to experimental pain in individuals with nonsuicidal self-injury (NSSI). This study investigated effects of NSSI severity and severity of psychopathology on the HPA axis and ANS response to pain. METHODS N = 164 adolescents with NSSI and n = 45 healthy controls received heat pain stimulation. Salivary cortisol, α-amylase and blood pressure were repeatedly assessed before and after painful stimulation. Heart rate (HR) and heart rate variability (HRV) were assessed continuously. NSSI severity and comorbid psychopathology were derived from diagnostic assessments. Main and interaction effects of time of measurement and NSSI severity, adjusted for severity of adverse childhood experiences, borderline personality disorder and depression, on HPA axis and ANS response to pain were examined using regression analyses. RESULTS Increasing NSSI severity predicted an increasing cortisol response (χ2(3) = 12.09, p = .007) to pain. After adjusting for comorbid psychopathology, greater NSSI severity predicted decreased α-amylase levels following pain (χ2(3) = 10.47, p = .015), and decreased HR (χ2(2) = 8.53, p = .014) and increased HRV(χ2(2) = 13.43, p = .001) response to pain. LIMITATIONS Future research should implement several NSSI severity indicators, potentially revealing complex associations with the physiological response to pain. Assessing physiological responses to pain in NSSI in a naturalistic setting presents a promising avenue for future research in NSI. CONCLUSIONS Findings indicate an increased pain-related HPA axis response and an ANS response characterized by reduced sympathetic and increased parasympathetic activity associated with NSSI severity. Results support claims for dimensional approaches to NSSI and its related psychopathology alongside shared, underlying neurobiological correlates.
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Affiliation(s)
- Patrice van der Venne
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Saskia Höper
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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Bruno S, Anconetani G, Rogier G, Del Casale A, Pompili M, Velotti P. Impulsivity traits and suicide related outcomes: A systematic review and meta-analysis using the UPPS model. J Affect Disord 2023; 339:571-583. [PMID: 37459976 DOI: 10.1016/j.jad.2023.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The affective, cognitive, and behavioral aspects of impulsivity involved in suicide-related outcomes can be investigated through the UPPS model, which conceptualizes these facets in multidimensional terms related to negative and positive urgency, lack of premeditation and perseverance, and sensation seeking. This systematic review and meta-analysis provided a comprehensive understanding of the role of all facets of impulsivity in the development of suicidal ideation and behaviors. METHODS We conducted a systematic search on six databases (PsycINFO, PsycARTICLES, PubMed, MEDLINE, Scopus, and Web of Science) until May 5,2023. Overall, 49 studies met the criteria for systematic review, of which 37 were included in a meta-analysis of data from 17.898 individuals. Additional moderation analyses included age, gender, sample status, country of study conduct, assessment instruments, type of suicide-related outcome, study quality, and research design. RESULTS We found significant relationships between aspects of impulsivity and suicide-related outcomes. Specially, affective facets related to impulsivity showed a stronger association with suicidal ideations and attempts than cognitive and behavioral dimensions, recommending the main involvement of emotional aspects-positive and negative-in suicide-related dimensions. LIMITATIONS The limited number of studies may have negatively impacted the power of moderation analyses. In addition, for most dimensions of impulsivity, the limited number of longitudinal studies did not allow to test the moderating role of research design. CONCLUSIONS This study supports the role of impulsivity in suicidal ideation and behavior, identifying the affective component of impulsivity as the most involved, providing a significant contribution from a clinical and diagnostic point of view.
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Affiliation(s)
- Serena Bruno
- Department of Dynamic and Clinical Psychology, Health Studies, University of Rome Sapienza, Italy
| | - Gerardo Anconetani
- Department of Dynamic and Clinical Psychology, Health Studies, University of Rome Sapienza, Italy
| | - Guyonne Rogier
- Department of Educational Sciences, University of Genoa, Italy
| | | | | | - Patrizia Velotti
- Department of Dynamic and Clinical Psychology, Health Studies, University of Rome Sapienza, Italy.
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Dawe-Lane E, Flouri E. Parenting in the early years and self-harm in adolescence: The role of control and reward systems in childhood. J Affect Disord 2023; 339:788-798. [PMID: 37474012 PMCID: PMC11139656 DOI: 10.1016/j.jad.2023.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Research suggests that early parenting may contribute to the development of self-harm but this has not been examined longitudinally. In this study, we explored the relationship between early parenting and self-harm in adolescence and considered whether (1) emotion regulation and (2) decision-making in childhood mediate the relationship between early parenting and self-harm. METHOD Using longitudinal data from the Millennium Cohort Study (MCS), we tested mediation models exploring the relationship between early parenting and self-harm in adolescence via emotion regulation and decision-making. Parenting was assessed at age 3 with measures of conflict, closeness and discipline. The trajectories of independence & self-regulation and emotional dysregulation were modelled from ages 3 to 7 years through latent growth curve analysis, with individual predicted slope and intercept values used in the mediation models. Decision-making (deliberation time, total time, delay aversion, quality of decision making, risk adjustment, risk-taking) was assessed using the Cambridge Gambling Task (CGT) at age 11. RESULTS In our sample (n = 11,145), we found no evidence of a direct association between early parenting and self-harm in adolescence. However, there were indirect effects of parenting (conflict and closeness) on self-harm via the slope of emotional dysregulation. Furthermore, delay aversion was positively associated with self-harm in adolescence. LIMITATIONS It must be acknowledged that we cannot determine causality and that self-report measures of parenting are vulnerable to several biases. CONCLUSION The findings support early identification and interventions for children exhibiting chronic emotional dysregulation and decision-making characterised by a bias for smaller, immediate over larger, delayed rewards.
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Affiliation(s)
- E Dawe-Lane
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom.
| | - E Flouri
- Institute of Education, Psychology and Human Development, University College London, London, United Kingdom
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Su R, John JR, Lin PI. Machine learning-based prediction for self-harm and suicide attempts in adolescents. Psychiatry Res 2023; 328:115446. [PMID: 37683319 DOI: 10.1016/j.psychres.2023.115446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
This study aimed to use machine learning (ML) models to predict the risk of self-harm and suicide attempts in adolescents. We conducted secondary analysis of cross-sectional data from the Longitudinal Study of Australian Children dataset. Several key variables at the age of 14-15 years were used to predict self-harm or suicide attempt at 16-17 years. Random forest classification models were used to select the optimal subset of predictors and subsequently make predictions. Among 2809 participants, 296 (10.54%) reported an act of self-harm and 145 (5.16%) reported attempting suicide at least once in the past 12 months. The area under the receiver operating curve was fair for self-harm (0.7397) and suicide attempt (0.7220), which outperformed the prediction strategy solely based on prior suicide or self-harm attempt (AUC: 0.6). The most important factors identified were similar, and included depressed feelings, strengths and difficulties questionnaire scores, perceptions of self, and school- and parent-related factors. The random forest classification algorithm, an ML technique, can effectively select the optimal subset of predictors from hundreds of variables to forecast the risks of suicide and self-harm among adolescents. Further research is needed to validate the utility and scalability of ML techniques in mental health research.
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Affiliation(s)
- Raymond Su
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James Rufus John
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Ping-I Lin
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Academic Unit of Child Psychiatry Services, South Western Sydney Local Health District, Liverpool, NSW, Australia; Department of Mental Health, School of Medicine, Western Sydney University, Penrith, NSW, Australia.
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Kayan Ocakoğlu B, Kafalı HY, Ocakoğlu FT, Kardaş B, Kardaş Ö, Işık A, Müjdecioğlu G, Akpınar S, Karakaya SEK, Balca Y, Yektaş Ç. Relations of Childhood Trauma and Emotional Dysregulation with Suicide Ideation and Suicidal Behaviour Severity in a Clinical Sample of Depressive Female Adolescents. IRANIAN JOURNAL OF PSYCHIATRY 2023; 18:443-454. [PMID: 37881414 PMCID: PMC10593995 DOI: 10.18502/ijps.v18i4.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/26/2022] [Accepted: 12/19/2022] [Indexed: 10/27/2023]
Abstract
Objective: This study aimed to explore the aspects of emotional dysregulation (ED) and childhood trauma (CT) which are associated with suicide ideation (SI) and suicidal behaviour (SB) severity in depressive female adolescents who previously attempted suicide. Method : In this cross-sectional study, we evaluated SI and SB severity. The Columbia-Suicide Severity Rating Scale (C-SSRS) was administered to 80 depressive female patients who had suicide attempts within the last month. Current suicide ideation (C-SI) and total score (C-TS), lifetime- suicide ideation (L-SI), and total score (L-TS) were obtained with the C-SSRS. Patients were recruited from five different provinces in Turkey. Additionally, the patients completed the Difficulties in Emotion Regulation Scale (DERS), Childhood Trauma Questionnaire (CTQ), and Beck Depression Inventory (BDI). The Pearson correlation test and a multiple linear regression analysis were used to determine variables predictive of suicide scores. Results: The results of multiple linear regression analysis indicated that the BDI and DERS - total scores explained 35% (adjusted R) of the variance in C-SI ((F (2;67) = 19.61, P < 0.001). C-TS was explained by 'BDI,' 'emotional neglect' and 'DERS impulse' (38% (adjusted R) (F (3;66) = 15.15, P < 0.001). L-SI was only associated with DERS strategies (explains 13% (adjusted R) of the variance in L-SI (F (1;68) = 10.411, P = 0.02). Concerning the C-SSRS L-TS, the DERS impulse and CTQ total accounted for 24% (adjusted R) of the variance (F (2;67) = 10.620, P < 0.001). Conclusion: The results of our study suggest that adolescents who have experienced emotional neglect and depressive symptoms are more at risk for suicidal ideation and behaviour. In addition, depressed adolescents who show impulsive behaviours and restricted emotional strategies are also at risk. Identifying neglected depressed adolescents and teaching impulse control and effective emotional strategies is important for the prevention of suicidal behaviours and thoughts.
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Affiliation(s)
- Binay Kayan Ocakoğlu
- Clinic of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Helin Yılmaz Kafalı
- Ministry of Health Ankara City Hospital Child and Adolescent Psychiatry Department, Ankara, Turkey
| | - Fevzi Tuna Ocakoğlu
- İstanbul Private French Lape Hospital Child and Adolescent Psychiatry Clinic, Istanbul, Turkey
| | - Burcu Kardaş
- Kocaeli University Faculty of Medicine Child and Adolescent Psychiatry Department, Kocaeli, Turkey
| | - Ömer Kardaş
- Kocaeli University Faculty of Medicine Child and Adolescent Psychiatry Department, Kocaeli, Turkey
| | - Adem Işık
- Van Regional Training and Research Hospital, Van, Turkey
| | | | - Serap Akpınar
- Ministry of Health Ankara City Hospital Child and Adolescent Psychiatry Department, Ankara, Turkey
| | | | - Yeliz Balca
- Diyarbakır Child Diseases Hospital Child and Adolescent Psychiatry Clinic, Diyarbakır, Turkey
| | - Çiğdem Yektaş
- Uskudar University Child and Adolescent Psychiatry Department, Istanbul, Turkey
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Dell’Osso L, Massoni L, Battaglini S, De Felice C, Nardi B, Amatori G, Cremone IM, Carpita B. Emotional dysregulation as a part of the autism spectrum continuum: a literature review from late childhood to adulthood. Front Psychiatry 2023; 14:1234518. [PMID: 37791135 PMCID: PMC10544895 DOI: 10.3389/fpsyt.2023.1234518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
The concept of emotional dysregulation (ED) has recently gained interest in the scientific literature and is commonly defined as the inability to use the modulatory mechanisms involved in emotion regulation, resulting in a functioning meaningfully below the baseline. Even though the data available are still limited, an increasing number of studies have hypothesized a promoting role for some of the core features of autism spectrum disorder (ASD) in the development of ED, in particular being repetitive behaviors, social difficulties and alexythimia. In this framework, the purpose of this study was to review the literature that is currently available about presence and correlates of ED in young adults with autism spectrum conditions as well as to offer some insights about possible implications for illness trajectories. The data reported seems to point to a shared etiology between ED and repetitive/restricted ASD symptoms, with perseveration features serving as the foundation for the inability to control one's emotions. In this context, a neurodevelopmental basis for ED could be consistent with the transnosographic conceptualization of ASD, which hypothesizes a potential neurodevelopmental basis for several psychiatric disorders, whose autistic traits would be the phenotypical presentation.
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Affiliation(s)
| | | | | | | | | | | | | | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Wu B, Zhang H, Chen J, Chen J, Liu Z, Cheng Y, Yuan T, Peng D. Potential mechanisms of non-suicidal self-injury (NSSI) in major depressive disorder: a systematic review. Gen Psychiatr 2023; 36:e100946. [PMID: 37655114 PMCID: PMC10465892 DOI: 10.1136/gpsych-2022-100946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) is a frequent and prominent phenomenon in major depressive disorder (MDD). Even though its prevalence and risk factors are relatively well understood, the potential mechanisms of NSSI in MDD remain elusive. Aims To review present evidence related to the potential mechanisms of NSSI in MDD. Methods According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, articles for this systematic review were searched on Medline (through PubMed), Embase (through Elsevier), PsycINFO (through OVID) and Web of Science databases for English articles, as well as China National Knowledge Infrastructure (CNKI), SinoMed, Wanfang Data, and the Chongqing VIP Chinese Science and Technology Periodical (VIP) Databases for Chinese articles published from the date of inception to 2 August 2022. Two researchers (BW, HZ) independently screened studies based on inclusion and exclusion criteria and assessed their quality. Results A total of 25 157 studies were searched. Only 25 of them were ultimately included, containing 3336 subjects (1535 patients with MDD and NSSI, 1403 patients with MDD without NSSI and 398 HCs). Included studies were divided into 6 categories: psychosocial factors (11 studies), neuroimaging (8 studies), stress and hypothalamic-pituitary-adrenal (HPA) axis (2 studies), pain perception (1 study), electroencephalogram (EEG) (2 studies) and epigenetics (1 study). Conclusions This systematic review indicates that patients with MDD and NSSI might have specific psychosocial factors, aberrant brain functions and neurochemical metabolisms, HPA axis dysfunctions, abnormal pain perceptions and epigenetic alterations.
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Affiliation(s)
- Baichuan Wu
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huifeng Zhang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghong Chen
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- General Psychiatry Editorial Office, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaye Chen
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhifen Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daihui Peng
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Korczak DJ, Westwell-Roper C, Sassi R. Diagnostic et traitement de la dépression à l’adolescence. CMAJ 2023; 195:E1050-E1058. [PMID: 37580075 PMCID: PMC10426345 DOI: 10.1503/cmaj.220966-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Daphne J Korczak
- Département de psychiatrie (Korczak), Hôpital pour enfants malades; Département de psychiatrie (Korczak), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont., Département de psychiatrie (Westwell-Roper, Sassi), Faculté de médecine, Université de la Colombie-Britannique, Vancouver, C.-B.
| | - Clara Westwell-Roper
- Département de psychiatrie (Korczak), Hôpital pour enfants malades; Département de psychiatrie (Korczak), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont., Département de psychiatrie (Westwell-Roper, Sassi), Faculté de médecine, Université de la Colombie-Britannique, Vancouver, C.-B
| | - Roberto Sassi
- Département de psychiatrie (Korczak), Hôpital pour enfants malades; Département de psychiatrie (Korczak), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont., Département de psychiatrie (Westwell-Roper, Sassi), Faculté de médecine, Université de la Colombie-Britannique, Vancouver, C.-B
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Vang M, Sherrard A, Tan CC. Parents' emotion dysregulation and children's emotional overeating: The role of emotion regulation feeding. Eat Behav 2023; 50:101795. [PMID: 37633220 DOI: 10.1016/j.eatbeh.2023.101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
Parents' use of food to regulate children's emotions (i.e., emotion regulation feeding) has been associated with children's emotional overeating. However, less is known about how parents' emotion regulation feeding acts as a moderator between parents' emotion dysregulation and children's emotional overeating. A total of 216 parents (Mage = 35.84 years, SD = 6.11) of 3- to 5-year-old children were recruited to complete an online survey. Analyses revealed that emotion regulation feeding moderated the association between parents' emotion dysregulation and children's emotional overeating, such that parents with high emotion dysregulation and high emotion regulation feeding had children who engaged in more emotional overeating compared to parents with low emotion regulation feeding. This finding suggests that less adaptive feeding aggravates the association between parents' emotion dysregulation and children's emotional overeating.
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Duncan‐Plummer T, Hasking P, Tonta K, Boyes M. The relationship between clinical perfectionism and nonsuicidal self-injury: The roles of experiential avoidance, self-esteem, and locus of control. J Clin Psychol 2023; 79:1799-1815. [PMID: 36870072 PMCID: PMC10952541 DOI: 10.1002/jclp.23506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/02/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES Perfectionism is linked to nonsuicidal self-injury (NSSI). Individuals with elevated perfectionism tend to avoid undesirable emotions and experience lower self-esteem, which are associated with NSSI. However, it is unclear if these mechanisms explain the link between clinical perfectionism and NSSI, and if locus of control is involved. We aimed to explore whether experiential avoidance and self-esteem would mediate the relationship between clinical perfectionism and NSSI, and if locus of control would moderate links between clinical perfectionism and both experiential avoidance and self-esteem. METHOD As part of a larger study, 514 Australian university students (Mage = 21.15 years, SD = 2.40; 73.5% female) completed an online survey of NSSI, clinical perfectionism, experiential avoidance, self-esteem, and locus of control. RESULTS Clinical perfectionism was associated with NSSI history, but not with recent NSSI or past year NSSI frequency. Lower self-esteem, but not experiential avoidance, mediated links between clinical perfectionism and NSSI history, recent NSSI, and NSSI frequency. More external locus of control was associated with NSSI, experiential avoidance, and lower self-esteem, but locus of control did not moderate pathways between clinical perfectionism and experiential avoidance or self-esteem. CONCLUSION University students reporting elevated clinical perfectionism may have a tendency to experience lower self-esteem which is associated with NSSI history, recency, and severity.
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Affiliation(s)
- Thomas Duncan‐Plummer
- School of Population Health, Faculty of Health SciencesCurtin UniversityPerthAustralia
| | - Penelope Hasking
- School of Population Health, Faculty of Health SciencesCurtin UniversityPerthAustralia
- Curtin enAble Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia
| | - Kate Tonta
- School of Population Health, Faculty of Health SciencesCurtin UniversityPerthAustralia
- Curtin enAble Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia
- Centre for Clinical InterventionsPerthAustralia
| | - Mark Boyes
- School of Population Health, Faculty of Health SciencesCurtin UniversityPerthAustralia
- Curtin enAble Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia
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Faura-Garcia J, Calvete E, Orue I. Longitudinal Associations Between Nonsuicidal Self-Injury, Depressive Symptoms, Hopelessness, and Emotional Dysregulation in Adolescents. Arch Suicide Res 2023:1-15. [PMID: 37498639 DOI: 10.1080/13811118.2023.2237075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Nonsuicidal self-injury (NSSI) in adolescents has been associated with increased depressive symptomatology, hopelessness, and emotional dysregulation; however, few studies have examined longitudinal associations between NSSI and these problems. This study examines the longitudinal relationships among these variables in community adolescents and whether the pattern of relationships varies between boys and girls. The participants were 785 adolescents (57.1% girls) aged 13 to 18 years (M = 15.64; SD = 1.08) who completed self-reported measures of NSSI, depression, hopelessness, and emotional dysregulation at least once at two moments separated by 1 year. The longitudinal model was tested through structural equation modeling and multiple group analysis. NSSI predicted increased depressive symptoms, hopelessness, and emotional dysregulation; depressive symptoms predicted NSSI; hopelessness predicted depressive symptoms; and emotional dysregulation predicted depressive symptoms and hopelessness. The pattern was similar for girls and boys, although girls scored higher on all variables. The results underscore the important bidirectional associations between NSSI and other risk factors throughout adolescence. These findings will support prevention and interventions for NSSI and internalizing symptoms in adolescents in school and clinical settings.
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Wang LJZ, Lan Y, Liu SJ, Yan WS. Impact of the COVID-19 and psychological risk factors on non-suicidal self-injury behavior among high school students: a one-year follow-up study. BMC Psychiatry 2023; 23:512. [PMID: 37452290 PMCID: PMC10349405 DOI: 10.1186/s12888-023-05021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Non-suicidal self-injury (NSSI) behavior is a severe public health issue in adolescents. This study investigated the possible impact of the coronavirus disease 2019 (COVID-19) and analyzed psychological risk factors on adolescent NSSI. METHODS A one-year follow-up study was conducted in September 2019 (Time 1) and September 2020 (Time 2) among 3588 high school students. The completed follow-up participants (N = 2527) were classified into no NSSI (negative at both time points), emerging NSSI (negative at Time 1 but positive at Time 2), and sustained NSSI (positive at both time points) subgroups according to their NSSI behaviors before and during the COVID-19 pandemic. Perceived family functioning, perceived school climate, negative life events, personality traits (neuroticism, impulsivity, and self-control) were assessed using self-report scales. RESULTS The data indicated an increase (10.3%) in the incidence of NSSI. Compared to no NSSI subjects, the emerging NSSI and sustained NSSI subgroups had lower perceived family functioning, higher neuroticism, higher impulse-system but lower self-control scores, and more negative life events. Logistic regressions revealed that after controlling for demographics, neuroticism and impulse-system levels at Time 1 positively predicted emerging NSSI behavior, and similarly, higher neuroticism and impulsivity and lower self-control at Time 1 predicted sustained NSSI behavior. CONCLUSIONS These findings highlighted the aggravated impact of the COVID-19 on NSSI, and suggested that individual neuroticism, impulsivity, and self-control traits might be crucial for the development of NSSI behavior among adolescent students.
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Affiliation(s)
- Lu-Jiao-Zi Wang
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Yan Lan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Su-Jiao Liu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Wan-Sen Yan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang, 550004, China.
- Guizhou Research Institute for Health Development, Guizhou Medical University, Guiyang, China.
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Apicella M, Serra G, Trasolini M, Andracchio E, Chieppa F, Averna R, Iannoni ME, Infranzi A, Moro M, Guidetti C, Maglio G, Raucci U, Reale A, Vicari S. Urgent psychiatric consultations for suicide attempt and suicidal ideation before and after the COVID-19 pandemic in an Italian pediatric emergency setting. Front Psychiatry 2023; 14:1135218. [PMID: 37457771 PMCID: PMC10348632 DOI: 10.3389/fpsyt.2023.1135218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/29/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Suicidal attempts (SAs) in youth have been increasing during the last decades. Methods We studied consultations, SA, and suicidal ideation (SI) in a pediatric emergency department (ED). Results From 1 January 2011 to 31 May 2022, 606,159 patients accessed the ED, 8,397 of who had a child psychiatry consultation (CPC). CPCs increased significantly by 11 times in the last decade (155 in 2011 vs. 1,824 in 2021, p < 0.001); CPCs for SA increased significantly by 33 times, from 6 in 2011 to 200 in 2021 (3.9% of total CPC vs. 11%, p < 0.001). While total CPCs increased constantly during the entire period (annual percent change (APC) of 21.7 from 2011 to 2021 in a 0 joinpoint model), CPCs for SA increased significantly from 2011 to 2016, were approximately stable from 2016 to 2020, and then had a peak in 2021 after the COVID-19 pandemic (APC from 2011 to 2016 of 64.1, APC of 1.2 from 2016 to 2020, and APC of 230 after 2020 in a 2-joinpoint model). Discussion Total CPCs in ED as well as evaluation for SA and SI increased significantly during the last decade. CPCs for SA had an additional increase after the COVID-19 pandemic. This picture warrants timely and efficient improvements in emergency settings and mental health resources.
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Affiliation(s)
- Massimo Apicella
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giulia Serra
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Monia Trasolini
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Elisa Andracchio
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Fabrizia Chieppa
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Roberto Averna
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maria Elena Iannoni
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Antonio Infranzi
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Marianna Moro
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Clotilde Guidetti
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gino Maglio
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Stefano Vicari
- Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Department of Life Sciences and Public Health, Catholic University, Rome, Italy
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Vogel AC, Geselowitz B, Tillman R, Barch DM, Luby JL, Whalen DJ. Developmental trajectories of anger and sadness dysregulation in childhood differentially predict later borderline symptoms. Dev Psychopathol 2023:1-16. [PMID: 37340976 PMCID: PMC10733555 DOI: 10.1017/s0954579423000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Difficulties with emotion regulation are integral to borderline personality disorder (BPD) and its hypothesized developmental pathway. Here, we prospectively assess trajectories of emotion processing across childhood, how BPD symptoms impact these trajectories, and whether developmental changes are transdiagnostic or specific to BPD, as major depressive (MDD) and conduct disorders (CD) are also characterized by emotion regulation difficulties. This study included 187 children enriched for those with early symptoms of depression and disruptive behaviors from a longitudinal study. We created multilevel models of multiple components of emotional processing from mean ages 9.05 to 18.55 years, and assessed the effect of late adolescent BPD, MDD, and CD symptoms on these trajectories. Linear trajectories of coping with sadness and anger, and quadratic trajectories of dysregulated expressions of sadness and anger were transdiagnostic, but also exhibited independent relationships with BPD symptoms. Only inhibition of sadness was related to BPD symptoms. The quadratic trajectories of poor emotional awareness and emotional reluctance were also independently related to BPD. Findings support examining separable components of emotion processing across development as potential precursors to BPD, underscoring the importance of understanding these trajectories as not only a marker of potential risk but also potential targets for prevention and intervention.
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Affiliation(s)
- Alecia C. Vogel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ben Geselowitz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis. St. Louis, MO, USA
- Department of Radiology, Washington University in St. Louis. St. Louis, MO, USA
| | - Joan L. Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Diana J. Whalen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Shen Y, Hu Y, Zhou Y, Fan X. Non-suicidal self-injury function: prevalence in adolescents with depression and its associations with non-suicidal self-injury severity, duration and suicide. Front Psychiatry 2023; 14:1188327. [PMID: 37333917 PMCID: PMC10272341 DOI: 10.3389/fpsyt.2023.1188327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Background Given that adolescents with depression are at the highest risk for non-suicidal self-injury (NSSI), a thorough understanding of their NSSI functions, as well as associations between functions and severe behavioral consequences, is essential for risk assessment and invention development. Methods Adolescents with depression from 16 hospitals across China, for whom data was available regarding their NSSI function, frequency, number of methods used, time characteristics, and suicide history were included. Descriptive statistical analyses were performed to determine the prevalence of NSSI functions. Regression analyses were conducted to explore the relationship between NSSI functions and behavioral characteristics of NSSI and suicide attempts. Results Affect regulation was the primary function of NSSI and followed by anti-dissociation in adolescents with depression. Females recognized automatic reinforcement functions more frequently than males, while males had a higher prevalence of social positive reinforcement functions. Automatic reinforce functions played the prominent role in associations between NSSI functions and all the severe behavioral consequences. Specifically, functions of anti-dissociation, affect regulation, and self-punishment were all associated with NSSI frequency, while higher levels of endorsements for anti-dissociation and self-punishment were linked to more NSSI methods, and greater level of endorsement for anti-dissociation was related to longer NSSI duration. Only the increase in endorsement of self-punishment was associated with a greater hazard of suicide attempts. Conclusion The dominant functions of NSSI in adolescents with depression was automatic reinforcement, specifically affect regulation. And prevalence of NSSI function differed between males and females. Anti-dissociation and self-punishment seemed to be the most risky factors as they were linked to severe NSSI or suicide behaviors. More attention should be given to these functions in risk evaluation, and the targeted interventions should be developed accordingly in a timely manner.
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Affiliation(s)
- Ying Shen
- Psychosomatic Medicine, The Third People’s Hospital of Ganzhou, Ganzhou, China
| | - Yingzi Hu
- Department of Psychology, Fudan University, Shanghai, China
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center of Tongji University, Shanghai, China
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xiwang Fan
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center of Tongji University, Shanghai, China
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Mettler J, Cho S, Stern M, Heath NL. Negative and Positive Emotional Reactivity in Women With and Without a History of Self-Injury. Psychol Rep 2023:332941231180118. [PMID: 37247614 DOI: 10.1177/00332941231180118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In trying to better understand why certain individuals self-injure, researchers have proposed high emotional reactivity for negative emotions may influence vulnerabilities and predispose individuals to react to stressful situations in a dysregulated manner, thus engaging in non-suicidal self-injury (NSSI). However, the role of emotional reactivity for positive emotions in those with a history of NSSI is still unclear. Thus, the present study sought to examine group differences in the reactivity of (a) negative and (b) positive emotions in young adults with and without a history of NSSI engagement, and (c) to evaluate whether the reactivity of positive emotions could predict NSSI engagement when controlling for reactivity of negative emotions. The sample consisted of 96 female students who reported engaging in NSSI within the past 2 years (Mage = 20.28 years, SD = 1.65) and an age-matched female comparison group with no NSSI history (Mage = 20.43 years, SD = 1.76). Results from separate MANOVAs indicated individuals with a history of NSSI reported higher negative reactivity across all aspects (emotional intensity, sensitivity, and persistence) than the comparison group, Wilk's λ = .86, F (3,188) = 10.65, p < .001, partial η2 = .145; however, no significant differences emerged for positive reactivity, Wilk's λ = .99, F (3,188) = 0.52, p = .669. Moreover, a logistic regression revealed that persistence of negative emotions was the only significant predictor of NSSI, Wald χ2 (1) = 4.54, p = .03. The present results highlight the importance of the persistence of negative emotions for individuals who engage in NSSI. Furthermore, the current study provides the first suggestion of no significant differences in positive emotional reactivity between individuals with and without NSSI; underlining the importance of focusing on negative emotional reactivity in clinical practice as well as using positive emotions to "undo" the effect of negative emotions.
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Affiliation(s)
- Jessica Mettler
- Faculty of Education, Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Sohyun Cho
- Faculty of Education, Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Melissa Stern
- Grey Zone Psychology & Wellness Centre, Montreal, Quebec, Canada
| | - Nancy L Heath
- Faculty of Education, Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
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Duncan-Plummer T, Hasking P, Tonta K, Boyes M. Cognitive-emotional networks in students with and without a history of non-suicidal self-injury. J Affect Disord 2023; 329:394-403. [PMID: 36828146 DOI: 10.1016/j.jad.2023.02.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Contemporary models of non-suicidal self-injury (NSSI) suggest that emotional vulnerabilities, negative self-schemas, and beliefs about NSSI work together to differentiate students who self-injure from those who do not. However, it is unclear how these mechanisms are differentially related among students with and without a history of NSSI. Considering this, we used a network analysis approach to explore how students with and without a history of NSSI vary in processing their emotional experiences in relation to their self-concepts and beliefs about NSSI. METHOD A sample of 480 university students (Mage = 21.18, SD = 2.43; 73.5 % female) completed self-report measures about their perceived emotional experiences (e.g., emotional reactivity, emotion regulation difficulties), self-concepts (e.g., self-esteem, self-efficacy), and NSSI. RESULTS A network comparison test revealed that students with a history of NSSI perceived themselves to have difficulties regulating particularly intense, unwanted negative emotions. In light of this, students with a history of NSSI expected some benefits of NSSI (e.g., emotion regulation) regardless of potential barriers (e.g., pain). Conversely, for students without a history of NSSI, expecting NSSI to have aversive outcomes was tied to expecting NSSI to have few benefits. LIMITATIONS The cross-sectional design limits inferences to be made about the network structures. CONCLUSIONS Students with and without a history of NSSI appear to differ in their cognitive processing of negative emotions and strategies used to deal with these emotions.
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Affiliation(s)
- Thomas Duncan-Plummer
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Penelope Hasking
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
| | - Kate Tonta
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - Mark Boyes
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
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Mereish EH, Peters JR, Brick LAD, Killam MA, Yen S. A daily diary study of minority stressors, suicidal ideation, nonsuicidal self-injury ideation, and affective mechanisms among sexual and gender minority youth. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:372-384. [PMID: 36996184 PMCID: PMC10164073 DOI: 10.1037/abn0000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Sexual and gender minority youth (SGMY) are at greater risk than their heterosexual and cisgender counterparts for suicidal thoughts and behaviors (STB) and nonsuicidal self-injury (NSSI). Unique stressors (i.e., minority stressors) specific to SGMY's stigmatized identities such as discrimination or concealment of one's identity are posited to explain these disparities. However, there is limited research examining the associations among minority stressors, affective mediating processes, and STB and NSSI in SGMY's daily lives. We conducted a 28-day daily diary study to test the mediating effects of daily negative and positive affect and emotion dysregulation between minority stressors and STB and NSSI among SGMY who were recruited from clinical and community settings. Participants were 92 SGMY, aged 12-19 years old (M = 16.45; SD = 1.81; 64% cisgender; 69% White). Results indicated that on days SGMY experienced external and internalized minority stressors, they reported greater intensity of suicidal and nonsuicidal self-injurious ideation and affective distress (i.e., greater negative affect, lower positive affect, and more emotion dysregulation). Greater affective reactivity processes were associated with greater suicidal and nonsuicidal self-injurious ideation intensity on the same day. Most of the within-person associations between external and internalized minority stressors and ideation intensity were mediated by heightened negative affect and emotion dysregulation but not lower positive affect. Our results provide the first evidence of these associations among SGMY, advance the minority stress model, and have implications for clinical interventions as we identified modifiable affective mechanisms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ethan H Mereish
- Lavender Lab, Department of Psychology, University of Maryland
| | - Jessica R Peters
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Brown University
| | - Leslie A D Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Brown University
| | - Matthew A Killam
- Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Brown University
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Warne N, Heron J, Mars B, Solmi F, Biddle L, Gunnell D, Hammerton G, Moran P, Munafò M, Penton‐Voak I, Skinner A, Stewart A, Bould H. Emotional dysregulation in childhood and disordered eating and self-harm in adolescence: prospective associations and mediating pathways. J Child Psychol Psychiatry 2023; 64:797-806. [PMID: 36541428 PMCID: PMC10152493 DOI: 10.1111/jcpp.13738] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emotional dysregulation may be a risk factor for disordered eating and self-harm in young people, but few prospective studies have assessed these associations long-term, or considered potential mediators. We examined prospective relationships between childhood emotional dysregulation and disordered eating and self-harm in adolescence; and social cognition, emotional recognition, and being bullied as mediators. METHODS We analysed Avon Longitudinal Study of Parents and Children data on 3,453 males and 3,481 females. We examined associations between emotional dysregulation at 7 years and any disordered eating and any self-harm at 16 years with probit regression models. We also assessed whether social cognition (7 years), emotional recognition (8 years) and bullying victimisation (11 years) mediated these relationships. RESULTS Emotional dysregulation at age 7 years was associated with disordered eating [fully adjusted probit B (95% CI) = 0.082 (0.029, 0.134)] and self-harm [fully adjusted probit B (95% CI) = 0.093 (0.036, 0.150)] at age 16 years. There was no evidence of sex interactions or difference in effects between self-harm and disordered eating. Mediation models found social cognition was a key pathway to disordered eating (females 51.2%; males 27.0% of total effect) and self-harm (females 15.7%; males 10.8% of total effect). Bullying victimisation was an important pathway to disordered eating (females 17.1%; males 10.0% of total effect), but only to self-harm in females (15.7% of total effect). Indirect effects were stronger for disordered eating than self-harm. CONCLUSIONS In males and females, emotional dysregulation in early childhood is associated with disordered eating and self-harm in adolescence and may be a useful target for prevention and treatment. Mediating pathways appeared to differ by sex and outcome, but social cognition was a key mediating pathway for both disordered eating and self-harm.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | | | - Lucy Biddle
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | - Gemma Hammerton
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Marcus Munafò
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Ian Penton‐Voak
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Andy Skinner
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Integrative Cancer Epidemiology ProgrammeBristol Medical School, University of BristolBristolUK
| | - Anne Stewart
- Department of PsychiatryUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Gloucestershire Health and Care NHS Foundation TrustGloucesterUK
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