The pooled prevalence and influential factors of non-suicidal self-injury in non-clinical samples during the COVID-19 outbreak: A meta-analysis

Prevalence and correlates of nonsuicidal self-injury among youths in Singapore: findings from the National Youth Mental Health Study

BACKGROUND

Nonsuicidal self-injury (NSSI) is a common phenomenon; a recent meta-analysis of studies conducted among non-clinical adolescents reported a global lifetime prevalence rate of 22.0%. NSSI results in significant impairment and is associated with negative outcomes later in young adulthood. There is, however, a dearth of research on the occurrence of NSSI in Singapore's youth population. Past studies examining NSSI behaviours among youths in Singapore were conducted using clinical samples, which tend to report a higher prevalence compared to community samples. The present study aims to establish the prevalence of NSSI and examine its associated sociodemographic and psychosocial correlates in the general youth population.

METHODS

This study included 2600 youths aged 15-35 years who participated in the National Youth Mental Health Study, a nationwide cross-sectional survey of the mental health status of youths in Singapore. The Deliberate Self-Harm Inventory and Depression Anxiety Stress Scales Short Form were used to assess NSSI behaviours and mental health symptoms. Data on coping strategies, perceived social support and resilience were also collected.

RESULTS

The lifetime prevalence of NSSI among youths in Singapore was 25.0%, and the 12-month prevalence was found to be 6.8%. The median age of onset for lifetime NSSI was 14 years. Significantly higher odds of lifetime NSSI were observed among youths aged 15-29 years, females, and youths with lower educational attainment. Youths with severe and extremely severe symptoms of depression and anxiety and those with greater use of avoidance coping strategy were associated with higher odds of lifetime NSSI. Higher resilience scores were associated with lower odds of lifetime NSSI.

CONCLUSION

1 in 4 youths in Singapore had engaged in self-injurious behaviour at least once in their lifetime. Screening and early intervention programs could be targeted at the more vulnerable youth groups such as those in early- and mid- adolescence. Potential areas for future research and interventions could include resilience building and educating youths on adaptive coping strategies. The limitations of the cross-sectional study design and the use of self-reported data should be considered when interpreting the study findings.

Clinical characteristics and prevalence of adolescent self-harm before, during and after the COVID-19 pandemic: retrospective cross-sectional database study

BACKGROUND

Evidence indicates that the COVID-19 pandemic has led to an increase in self-harm among adolescents; however, little is known about the trends in prevalence after the end of the pandemic.

AIMS

This retrospective cross-sectional database study evaluates changes in the prevalence and clinical characteristics of self-harm among adolescents who sought attention from the emergency service of the largest children's psychiatric hospital in Mexico before, during and after the COVID-19 pandemic.

METHOD

After comparing the clinical characteristics of self-harm between the three periods, we calculated the monthly prevalence of self-harm among patients (n = 3520) visiting the hospital's emergency psychiatric services over a period of 58 months. Using joinpoint regression, we evaluated temporal trends in self-harm prevalence.

RESULTS

Affective disorders and hitting as a method of self-harm were more frequent during and after the pandemic in comparison with the pre-pandemic period. The prevalence of self-harm diminished from March 2019 to March 2023, a trend followed by an increase coinciding with the end of the pandemic and the return to normal activities.

CONCLUSIONS

The significant increase in prevalence observed after the end of the pandemic suggests a long-term impact on mental health of adolescents. This underscores the need for monitoring this population during post-pandemic years to provide timely interventions.

Experiences and Cognitive Characteristics of Non-Suicidal Self-Injury in Adolescents With Depression: A Qualitative Study

PURPOSE

To elucidate the underlying motivations, experiential dimensions, and cognitive perceptions in adolescents with depression and non-suicidal self-injury (NSSI).

METHOD

A descriptive qualitative design was used. Participants were 18 Chinese adolescents with depression and NSSI. Conventional content analysis was used for data analysis.

RESULTS

Three primary themes and 11 subthemes were identified: Triggers of NSSI (personal, family, school, and social factors); Experiencing Emotional Complexity in NSSI Implementation (mitigating psychological distress, awakening a sense of existential life, generating secondary negative emotions, stimulating reflections on life and death); and Perceptions and Understandings of NSSI Are Diverse (NSSI as a form of seeking validation or approval, an addictive behavior, a means to attain a sense of control, and unacceptable behavior).

CONCLUSION

Although nursing staff should provide comprehensive treatment and psychological support, efforts should also be made to strengthen caregiving skills of family members, thereby promoting overall physical and mental health of adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 62(11), 47-55.].

Psychosocial alterations during the COVID-19 pandemic and the global burden of anxiety and major depressive disorders in adolescents, 1990-2021: challenges in mental health amid socioeconomic disparities

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic, a global health crisis, profoundly impacted all aspects of daily life. Adolescence, a pivotal stage of psychological and social development, is heavily influenced by the psychosocial and socio-cultural context. Hence, it is imperative to thoroughly understand the psychosocial changes adolescents experienced during the pandemic and implement effective management initiatives.

DATA SOURCES

We examined the incidence rates of depressive and anxiety disorders among adolescents aged 10-19 years globally and regionally. We utilized data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to compare pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Our investigation covered 204 countries and territories across the six World Health Organization regions. We conducted a comprehensive literature search using databases including PubMed/MEDLINE, Scopus, and Google Scholar, employing search terms such as "psychosocial", "adolescent", "youth", "risk factors", "COVID-19 pandemic", "prevention", and "intervention".

RESULTS

During the pandemic, the mental health outcomes of adolescents deteriorated, particularly in terms of depressive and anxiety disorders. According to GBD 2021, the incidence rate of anxiety disorders increased from 720.26 [95% uncertainty intervals (UI) = 548.90-929.19] before the COVID-19 pandemic (2018-2019) to 880.87 per 100,000 people (95% UI = 670.43-1132.58) during the COVID-19 pandemic (2020-2021). Similarly, the incidence rate of major depressive disorder increased from 2333.91 (95% UI = 1626.92-3138.55) before the COVID-19 pandemic to 3030.49 per 100,000 people (95% UI = 2096.73-4077.73) during the COVID-19 pandemic. This worsening was notably pronounced in high-income countries (HICs). Rapid environmental changes, including heightened social anxiety, school closures, economic crises, and exacerbated racism, have been shown to adversely affect the mental well-being of adolescents.

CONCLUSIONS

The abrupt shift to remote learning and the absence of in-person social interactions heightened feelings of loneliness, anxiety, sadness, and stress among adolescents. This change magnified existing socioeconomic disparities, posing additional challenges. These complexities profoundly impact adolescents' well-being, especially vulnerable groups like those from HICs, females, and minorities. Acknowledging the underreporting bias in low- to middle-income countries highlights the importance of addressing these mental health alterations in assessments and interventions within these regions as well. Urgent interventions are crucial as the pandemic-induced mental stress may have lasting effects on adolescents' mental health.

Experiences and attitudes of psychiatric nurses in caring for patients with repeated non-suicidal self-injury in China: a qualitative study

BACKGROUND

The incidence of non-suicidal self-injury (NSSI) is high and often occurs repeatedly. Psychiatric nurses play a vital role in the care and treatment of NSSI patients, as they have the most frequent contact with patients. The experiences and attitudes of nurses has a direct affect on the quality of care they provide to patients. Negative care experiences and attitudes of patient aversion on behalf of nurses may delay the observation and treatment of changes in the patient's condition, leading to irreversible risks. Although cross-sectional studies have investigated the attitudes of medical staff toward NSSI patients, quantitative research results cannot comprehensively reflect the emotional experiences and complex psychological changes of the study subjects. A few studies have focused on the psychiatric nurses' care experiences and attitudes toward patients with repeated NSSI.

OBJECTIVE

This study aimed to explore psychiatric nurses' care experiences and attitudes toward patients during repeated NSSI.

METHODS

A thematic analysis qualitative study was used. Using purposive sampling, 18 psychiatric nurses were recruited from a mental health center in Chengdu, China. Semi-structured interviews were conducted and audio-recorded. Audio-recordings were transcribed verbatim and analyzed using six-phase thematic analysis.

RESULTS

Four themes emerged from the analysis: psychiatric nurses' care experiences, perceptions, care attitudes and coping style toward repeated NSSI patients. Psychiatric nurses have experienced negative care experiences and severe career burnout during the patient's repeated NSSI. Nurses' attitudes toward NSSI patients changed during repeated NSSI, from understanding to indifference to anger and resentment. At the same time, it was found that nurses' coping style with NSSI patients could be divided into three stages, namely, active coping, neglect and perfunctory, and criticism and punishment.

CONCLUSIONS

The findings have implications for health care systems regarding interventions to improve nurses' care experiences and attitudes toward repeated NSSI patients. These findings suggest that enhancing nurses' understanding of NSSI, establishing standardized emergency response and intervention programs, guiding positive professional values and responsibility, and improving nurses' caring attitudes can promote the early detection and timely intervention of NSSI.

Does the decision to disclose non-suicidal self-injury align with decision-making frameworks of personal information disclosure? A directed content analysis

Non-suicidal self-injury (NSSI) is the deliberate damage caused to one's own body tissue, without the intent to die. Voluntary disclosure of one's NSSI can catalyze help-seeking and provision of support, although what informs the decision to disclose NSSI is not yet well understood. There is currently no existing framework specific to the process of NSSI disclosure, and the aim of this study was to assess the fit between factors involved in the decision to disclose NSSI and two broader frameworks of disclosure: the Disclosure Decision-Making and Disclosure Processes models. A directed content analysis was used to code interview transcripts from 15 participants, all of whom were university students aged between 18 and 25 (M = 20.33, SD = 1.88), with 11 identifying as female. All participants had lived experience of NSSI which they had previously disclosed to at least one other person. All codes within the coding matrix, which were informed by the disclosure models, were identified as being present in the data. Of the 229 units of data, 95.63% were captured in the existing frameworks with only 10 instances being unique to NSSI disclosure. Though factors that inform the decision to disclose NSSI largely align with the aforementioned models of disclosure, there are aspects of disclosure decision-making that may be specific to NSSI.

Non-suicidal self-injury among youth students during COVID-19 pandemic: the role of psychological factors in Jingzhou, China

Objective

This study aimed to explore the impact of the COVID-19 pandemic on non-suicidal self-injury (NSSI) among youth students, and the mediating role of psychological factors in the relationship between the COVID-19 pandemic and NSSI.

Method

An online survey was conducted at junior and senior high schools, as well as universities located in Jingzhou, Hubei Province, China between June 2021 and January 2022. The COVID-19 Impact Index was constructed using multiple correspondence analysis (MCA) method. The bootstrapping method was used for mediation analysis.

Results

A total of 16025 youth participated in the study and 12507 youth (78.1%) finished the questionnaires. The COVID-19 Impact Index had a significantly positive effect on NSSI (r=0.16, p<0.001). The mediation analysis results showed that the COVID-19 Impact Index had a significant indirect effect on youth' NSSI (β=0.0918, 95% CI [0.0788, 0.1048]), and this indirect effect was mainly achieved through affecting youth' anxiety, depression and post-traumatic stress disorder (PTSD). The mediation effect of anxiety on NSSI was 0.0584, the direct effect was 0.0334, and the mediation proportion was 63.6%. The mediation effect of depression on NSSI was 0.0668, the direct effect was 0.0250, and the mediation proportion was 72.8%. The mediation effect of PTSD on NSSI was 0.0640, the direct effect was 0.0278, and the mediation proportion was 69.7%. All the mediation effects, direct effects and total effects were statistically significant (p<0.001).

Conclusion

The higher the impact of the COVID-19 Impact Index, the higher the prevalence of NSSI among youth students. Anxiety, depression and PTSD had mediated the relationship between the COVID-19 Impact Index and NSSI. It is suggested that specific health policies, mental health services and interventions should be developed to reduce the NSSI and improve mental health status among youth students during the COVID-19 pandemic.

"Swipe & slice": decoding digital struggles with non-suicidal self-injuries among youngsters

Introduction

Nonsuicidal-self-injury (NSSI)-related content recently emerged on social networking sites (SNS), despite its relationship with NSSI conducts is still unclear.

Methods

Hence, the current population-based cross-sectional study investigated the interplay between SNS use, NSSI content engagement, risky social media challenges (RSMCs), in a sample of 404 young adults (aged 18-24), focusing on the influence of problematic social media use (PSMU) and fear of missing out (FoMO).

Results

Around 51.5% of the samplewas engaged inNSSI-related contents on SNS, being mostly females (p<0.001), younger (p=0.005), transgender people and nonbinary people (p=0.030) and those who displayed higher PSMU (p<0.001) or FoMO (p=0.031). Around 66.2% of the sample currently practice NSSIs, predominantly among females (p<0.001), those using BeReal (p=0.012), actively looking for NSSIrelated contents on SNS (p<0.001) to be part of a group (p=0.0025) or learn how to practice NSSI (p=0.025). PSMU (p<0.001) and FoMO (p<0.001) emerged as significant predictors of NSSI content engagement, particularly among active seekers. NSSI conducts were significantly predicted by FoMO (p<0.001) and Snapchat (p=0.044), while negatively predicted by male sex (p<0.001), higher educational level (p=0.019) and age at which NSSI-related contents were firstly looked for (p=0.028).

Discussion

These findings underline the need to implement preventivepolicies and targeted interventions to monitor NSSI-related contents on SNS, the impact of PSMU and FoMO on NSSI, particularly among youngsters.