Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies

Childhood maltreatment and non-suicidal self-injury: the mediating role of mentalization and depression

Background: Childhood maltreatment (CM) is recognized as one of the primary factors increasing the risk of non-suicidal self-injury (NSSI).Objectives: This study aims to further understand the impact of different types of CM on the mechanisms underlying NSSI risk by examining the potential mediating roles of mentalization and depression.Method: A self-report survey was conducted with 1645 Chinese youths (933 males, 712 females; mean age = 18.25, SD = 0.64) to evaluate their experiences of CM, depression, mentalization, and NSSI frequency over the past year. Structural equation modelling was utilized to examine the direct and indirect pathways linking CM to NSSI risk via mentalization and depression.Results: The study found that emotional abuse, physical abuse, mentalization, and depression had significant direct effects on NSSI risk. Moreover, mentalization and depression mediated the relationship between emotional abuse and NSSI risk, while emotional neglect and physical neglect indirectly influenced NSSI risk only through depression. Physical abuse had a significant direct effect on NSSI risk, whereas sexual abuse did not show any direct or indirect effects.Conclusions: The findings suggest that childhood emotional abuse has a markedly different impact compared to other forms of CM. Interventions focused on improving mentalization may be particularly effective in addressing the effects of emotional abuse, mitigating depression, and reducing the risk of NSSI.

Evaluating the ability of artificial intelligence to predict suicide: A systematic review of reviews

INTRODUCTION

Suicide remains a critical global public health issue, with approximately 800,000 deaths annually. Despite various prevention efforts, suicide rates are rising, highlighting the need for more effective strategies. Traditional suicide risk assessment methods often fall short in accuracy and predictive capability. This has driven interest in artificial intelligence (AI), particularly machine learning (ML), as a potential solution. This paper reviews systematic evaluations of AI's effectiveness in predicting suicide risk, aiming to explore AI's potential while addressing its challenges and limitations.

METHODOLOGY

A meta-research approach was used to review existing systematic reviews on AI's role in suicide risk prediction. Following PRISMA guidelines, a comprehensive search was conducted in PubMed and Web of Science for publications from 2004 to 2024. Relevant studies were selected based on specific inclusion criteria, and data were extracted on review characteristics, AI techniques, outcomes, and methodological quality. The review focuses on AI/ML models predicting suicidal ideation (SI), suicide attempts (SA), and suicide deaths (SD) separately, excluding non-suicidal self-injury.

RESULTS

Out of 96 initial articles, 23 met the inclusion criteria for full-text review. Most studies focused on developing ML models to identify suicide risk, showing promising results in enhancing accuracy and effectiveness. These models utilize various data sources and analytical techniques. However, challenges remain, including high bias risk and issues with interpretability, which necessitate further validation and refinement of AI-driven methods.

CONCLUSION

The review underscores the significant potential of AI, especially ML, in predicting suicide risk and attempts. Although ML models show promise, challenges like data limitations, bias, and interpretability issues need addressing. Continued research and ethical scrutiny are crucial to fully realize AI's potential in suicide prevention.

Longitudinal association between stigma and suicidal ideation among patients with major depressive disorder

BACKGROUND

To explore the longitudinal associations between stigma and suicidal ideation among patients with major depressive disorder (MDD).

METHODS

Data were from patients with MDD in the Depression Cohort in China. At baseline and weeks 4, 8, 12, 24, 48, and 72, the presence (yes and no) and severity (scores) of suicidal ideation were evaluated using the Beck Scale for Suicide Ideation, and stigma was assessed using the Depression Stigma Scale. Generalized linear mixed models were used to explore the association between stigma and suicidal ideation.

RESULTS

Among 1123 patients with a mean age of 27.9 (SD, 7.3) years, 71.1 % were female. Restricted cubic splines showed positive linear dose-response associations of personal stigma and perceived stigma with the likelihood and severity of suicidal ideation. The adjusted ORs (95 % CIs) for each 10 score increment in personal stigma and perceived stigma were 1.49 (1.18, 1.89) and 1.46 (1.20, 1.77) for the likelihood of suicidal ideation, respectively. The adjusted β coefficients (95 % CIs) for each 10 score increment in personal stigma and perceived stigma were 0.222 (0.121, 0.322) and 0.202 (0.123, 0.281) for suicidal ideation scores, respectively.

LIMITATIONS

Information on sigma, suicidal ideation, and potential covariates was self-reported, so reporting bias was inevitable.

CONCLUSIONS

In this longitudinal study in patients with MDD, more severe personal stigma and perceived stigma were associated with a higher likelihood of suicidal ideation and more severe suicidal ideation. These findings suggest that reducing personal stigma and perceived stigma may help prevent suicidal behavior among patients with MDD.

Validity and feasibility of the oxford mental illness suicide tool (OxMIS): A mini-review and meta-analysis

BACKGROUND

Individuals with severe mental illness are at a greater risk of suicide than the general population. Therefore, a concerted effort has been made to create increasingly precise and reliable tools over the last decade. Among these tools, in 2019 the Oxford Mental Illness and Suicide Tool (OxMIS) was developed to estimate the probability of suicide risk within 12 months for individuals diagnosed with bipolar disorder or schizophrenia spectrum disorder. Therefore, in this review, we aimed to synthesise the peer-reviewed literature collected on the OxMIS tool.

METHODS

A systematic literature search was conducted using the databases PubMed, PsycINFO, Scopus, and Web of Science, resulting in the identification of 129 records. After removing duplicates and conducting an in-depth review of the full texts, 5 articles were included in the mini-review. Additionally, a fixed-effects model was employed to calculate the pooled effect size from 2 studies using Comprehensive Meta-Analysis (CMA) 3.7 software.

RESULTS

The OxMIS tool was found to be clinically feasible and to lead to an average cost-saving of approximately £300 per assessed patient as well as a marginal improvement in quality-adjusted life years. Furthermore, the OxMIS tool achieved good discrimination accuracy in terms of sensitivity and specificity in a Swedish and Finnish validation sample. The overall pooled odd ratio (OR) was 3.416 [95 % CI: 3.092-3.774].

LIMITATIONS

The first limitation pertains to the scarcity of studies on OxMIS, which necessitates a degree of caution in interpreting the results. Moreover, although the reviewed studies analyzed different aspects of the use of OxMIS, the differences in objectives and research designs limited a comprehensive comparison of the results between the included studies. Finally, the discrepancy in the prevalence of high suicide risk among patients of different study populations requires further investigation in future studies.

CONCLUSION

From the reviewed studies emerged that OxMIS is a novel and promising web-based tool that is capable of estimating the suicide risk of patients with serious mental illnesses. Nevertheless, further external validation studies are required to confirm its clinical utility across different study populations.

Self-harm thoughts among postpartum women - associated factors

BACKGROUND

Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented.

AIM

We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs.

METHOD

1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables.

RESULTS

Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs.

CONCLUSION

The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.

Construction and verification of risk prediction model for suicidal attempts of mood disorder based on machine learning

BACKGROUND

Mood disorders (MD) are closely related to suicide attempt (SA). Developing an effective prediction model for SA in MD patients could play a crucial role in the early identification of high-risk groups.

METHODS

1099 patients with MD were collected to Model construction. 387 MD patients were enrolled for external validate. The least absolute shrinkage and selection operator (LASSO) regression was used to screen features that may be related to SA as predictors. Ten machine learning algorithms were applied to the training set to construct the SA prediction model. The machine learning model with the best sensitivity and stability was selected according to AUC, F1 score, accuracy and other indicators. The locally explanatory technique of Shapley Additive Explanations (SHAP) was used to rank and interpret the importance of features collected in best model to analyze the potential impact of each feature on SA. Meanwhile, to further validate the stability of the model, the sensitivity analysis utilizing k-fold cross-validation and external validate in another center were performed.

RESULTS

This study incorporates 8 features. Prediction models was constructed based on 10 different machine learning methods. The results showed that the prediction model constructed by Random Forest (RF) method had good discriminant ability and stability (AUC of Testing = 0.741, AUC of Training = 0.786, AUC of validation = 0.788) and acceptable discriminant. Further, the prediction model showed that the most valuable features for predicting SA were Polarity and previous SA.

CONCLUSION

The RF method can better construct the risk prediction model of SA in MD patients.

Internet gaming disorder predicts the incidence, persistence, and worsening of suicidal ideation: A population-based cohort study of 96,158 Chinese adolescents

INTRODUCTION

While cross-sectional studies suggest a strong association between internet gaming disorder (IGD) and suicidal ideation, longitudinal evidence is limited. This two-wave longitudinal study investigated whether IGD predicts the one-year incidence, persistence, and worsening of suicidal ideation.

METHODS

A total of 96,158 Chinese adolescents were assessed in November 2022 and one year later. IGD was measured using the 9-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF), categorizing participants as non-gamers, gamers without IGD, and gamers with IGD. Suicidal ideation and their severity were evaluated using the ninth item of the 9-item Patient Health Questionnaire. Baseline demographics, lifestyle factors, and internalizing and externalizing problems were collected and controlled. Multiple logistic regression models examined associations between IGD and incident, persistent, and worsening suicidal ideation, with subgroup and sensitivity analyses performed.

RESULTS

The prevalence of baseline suicidal ideation was 21.4 %, including 17.5 % mild, 2.5 % moderate, and 1.3 % severe. The one-year incidence and persistence rates of suicidal ideation were 13.8 % and 50.1 %, respectively. Among 19,254 adolescents with mild or moderate suicidal ideation, 1656 reported worsening over the year. Compared to non-gamers, gamers with IGD had a higher risk of incident (adjusted odds ratio [AOR], 1.95; 95 % CI, 1.57-2.42), persistent (AOR, 1.56; 95 % CI, 1.34-1.82), and worsening suicidal ideation (AOR, 1.75; 95 % CI, 1.37-2.23) (all p < 0.001).

CONCLUSIONS

IGD contributes to the development, persistence, and worsening of suicidal ideation among Chinese adolescents. Targeted interventions addressing IGD may reduce suicidal ideation in this population.

LIMITATIONS

Self-reported data potentially introduced bias.

A cohort study of predictors of short-term nonfatal suicidal and self-harm events among individuals with mental health disorders treated in the emergency department

BACKGROUND

Patients presenting to emergency departments (EDs) for mental health problems have an elevated short-term risk of repeat ED visits, subsequent hospitalization, and suicide.

OBJECTIVE

Use health records to identify predictors of nonfatal suicidal or self-harm events following emergency department visits of individuals with mental health disorders.

METHODS

Electronic health record data from 2015 to 2022 were used to identify ED visits with mental health diagnoses for individuals 10 and older; extract 408 potential predictors including demographic, historical and baseline clinical characteristics from structured and unstructured data; and subsequent suicidal and self-harm events. We constructed a series of progressively additive logistic regression and gradient tree boosting (GTB) models to evaluate how groups of clinical features influenced likelihood of a nonfatal event 180-days after an ED visit.

RESULTS

Records identified 2,445,597 ED episodes and 176,000 subsequent suicidal or self-harm events within 180-days. Individuals experiencing an event relative to those without an event were less likely to be > 65 (3.6 % vs 16.7 %; h = 0.46), more likely to be male (55.7 % vs 40.8 %; h = 0.30) and covered by Medicaid (61.5 % vs 42.2 %, h = 0.39). The final model with 408 clinical features resulted in an AUC of 0.851 (logistic regression) and 0.863 (GTB). Diagnoses of bulimia nervosa (OR = 1.84, p < .0001) and cutting (OR = 2.62, p < .0001) were most highly associated with any subsequent event and suicidal self-harm, respectively.

CONCLUSION

Machine learning algorithms effectively predicted nonfatal suicide-related events within six months following ED visits among individuals with mental health disorders highlighting the importance of suicide symptom focused assessment and prevention efforts during routine emergency mental healthcare, particularly for patients with bulimia nervosa.

Internet-delivered emotion regulation therapy for adolescents engaging in non-suicidal self-injury and their parents: A qualitative, online focus group study

OBJECTIVES

We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI).

DESIGN

A qualitative study nested within a controlled feasibility trial.

METHODS

Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis.

RESULTS

Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents.

CONCLUSION

Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.

Evaluation of Psychological Resilience, Alexithymia, and Impulsivity Characteristics in Persons Who Attempted Suicide with Drugs

ObjectiveIn this study, it was aimed to research the connection between psychological resilience, alexithymia, depression, anxiety and impulsivity in patients who attempted suicide with drugs.MethodsThe patient group (n = 66) who attempted suicide with drugs and the control group (n = 66) without any psychiatric diagnosis were examined in the study. Sociodemographic data form, Psychological Resilience Scale, Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory, Beck Anxiety Inventory, Barratt Impulsivity Scale (BIS-11) were used in the study.ResultsIt was found that PRS dedication and challenge are significantly higher in the control group (p = .039 and p = .003, respectively). When the undiagnosed group who attempted suicide were compared with the control group, it was observed that there is a significant difference between BIS-11 total and TAS total after bonferonni correction (respectively; p = .002; p = .001), while, there is no statistically significant difference in terms of PRS total score (p = .483)ConclusionIt was observed that patients who attempted suicide with drugs had low levels of psychological resilience, high alexithymia levels. In the absence of an additional diagnosis of depression, psychological resilience did not differ in terms of suicide attempts. In the suicide group, those who did not receive any additional diagnosis were not more impulsive than those who were depressed.

Large-scale Text Mining of Suicide Attempt improves Identification of Distinct Suicidal Events in Electronic Health Records

In this study, we explore a natural language processing (NLP) algorithm's capacity to identify proximal but distinct suicide attempt (SA) events compared to diagnostic code-based approaches. This study used an NLP algorithm with high precision in identifying SA events, which processes clinical notes for suicide-related text expressions and generates SA outcome relevance scores on mentioned dates. We chart reviewed all SA visit pairs less than 15 days apart. Despite sample size limitations, our NLP method surpassed the code-based model's performance (0.85 [95% CI: 0.74 - 0.92] vs. 0.78 [95% CI: 0.56 - 0.92], p = 0.71). More importantly, NLP detected three times more SA visit pairs <15 days compared to the code-based approach (71 vs. 23), with only 3 overlaps. This study demonstrates NLP's efficacy in identifying distinct SA visit pairs. Given minimal overlap, we suggest leveraging both clinical notes and diagnostic codes for a comprehensive SA event detection.

Documentation of suicidality in connection with specialised healthcare for physical conditions: a retrospective review of somatic medical records prior to suicide in Sweden

OBJECTIVES

To evaluate whether suicidality was documented prior to suicide in patients in contact with specialised somatic healthcare providers for physical conditions and to identify factors related to such documentation.

DESIGN AND SETTINGS

Retrospective cohort study in which medical records from specialised somatic (non-psychiatric) healthcare services (internal medicine, infectious disease, surgery, urology, etc) in 20 of Sweden's 21 regions were reviewed up to 2 years before suicide.

PARTICIPANTS

Those who died by suicide in Sweden 2015 and had received specialised somatic healthcare for a diagnosed physical condition were included, n=468 (331 men and 137 women). THE OUTCOME VARIABLE: Documentation of suicidality (ie, death wishes, suicidal thoughts, plans, attempts and notations of known suicidality or elevated suicide risk). Potential associations of patients' characteristics and clinical factors with the outcome were tested in logistic regression models.

RESULTS

Of the 468 patients, 111 (24%) were positive for the outcome variable Documentation of suicidality, regardless of whether they were assessed as suicidal or not. Elevated suicide risk was noted in 27 patients (6% of the total cohort). Multivariate logistic regression analysis showed that experience of distress (OR: 4.81; 95% CI: 1.96 to 11.81), contact with psychiatric services (OR: 4.68; 95% CI: 2.60 to 8.43), psychiatric comorbidity (OR: 4.33; 95% CI: 2.41 to 7.76) and female sex (OR: 2.91; 95% CI: 1.68 to 5.06) were independently associated with documentation of suicidality. A third (36%) had a doctor consultation in specialised somatic healthcare during their last month of life. Of these, 17% were assessed for suicidality, and elevated suicide risk was noted in 7%.

CONCLUSIONS

Documentation of suicidality was observed in one quarter of patients who received specialised somatic healthcare for physical conditions and subsequently died by suicide. These results indicate a need to increase clinician awareness of suicidal issues and assessments and to integrate questions about mental health into specialised somatic practice.

The Temporal Dynamics of Sleep Disturbances, Depression, and Self-Injurious Thoughts and Behaviors in Preadolescents: A Year-Long Intensive Longitudinal Study

Despite research exploring preadolescent mood disorders, the ability to predict increases in depression severity and risk for self-injurious thoughts and behaviors (SITBs) remains poor, leaving clinicians few markers to predict increases in individual risk. One promising area of research has focused on sleep disturbances as an acute and proximal risk factor for depression and SITBs. However, little of this research has focused on children prior to adolescence or incorporated designs that enable us to disentangle the directionality of the associations between these constructs. The current study explored the temporal dynamics and directionality of the association between sleep disturbances and psychological symptoms, including depression, suicidal thoughts, and self-harm behaviors in a sample of preadolescents enriched for a history of early childhood mood disorders. Participants completed weekly electronic assessments for one year to examine week-by-week associations between sleep disturbances (i.e., trouble sleeping and fatigue) and depression, suicidal thoughts, and self-harm behaviors. Both trouble sleeping and fatigue were found to predict and precede increased depression severity, and trouble sleeping predicted endorsement of self-harm behaviors the following week, even when controlling for prior depression severity and self-harm behaviors, respectively. There was no evidence for the reverse association (i.e., depression severity or self-harm behaviors predicting subsequent sleep disturbances). Our findings provide the first evidence for a temporal and directional association between sleep disturbances and subsequent depression severity and self-harm behaviors in preadolescents. These findings highlight the potential utility targeting sleep within existing treatments for depression and self-harm behaviors in preadolescents.

Construction and validation of a predictive model for suicidal ideation in non-psychiatric elderly inpatients

BACKGROUND

Suicide poses a substantial public health challenge globally, with the elderly population being particularly vulnerable. Research into suicide risk factors among elderly inpatients with non-psychiatric disorders remains limited. This investigation focused on crafting a machine learning-based prediction model for suicidal ideation (SI) in this population to aid suicide prevention efforts in general hospitals.

METHODS

A total of 807 non-psychiatric elderly inpatients aged over 60 were assessed using demographic and clinical data, and SI was measured using the Patient Health Questionnaire-9 (PHQ-9). Data were processed utilizing machine learning algorithms, and predictive models were developed using multiple logistic regression, Nomogram, and Random Forest models.

RESULTS

Key predictors included PHQ-8, Athens Insomnia Scale, hospitalization frequency, Perceived Social Support from Family scale, comorbidities, income, and employment status. Both models demonstrated excellent predictive performance, with AUC values exceeding 0.9 for both training and test sets. Notably, the Random Forest model outperformed others, achieving an AUC of 0.958, with high accuracy (0.952), precision (0.962), sensitivity (0.987), and an F1 score of 0.974.

CONCLUSION

These models offer valuable tools for suicide risk prediction in elderly non-psychiatric inpatients, supporting clinical prevention strategies.

The Relationship Between Identity Confusion and Adolescent Non-Suicidal Self-Injury: The Mediating Role of Psychological Distress and the Moderating Role of Life History Strategy

Previous research has shown that an increase in identity confusion is associated with a higher risk of non-suicidal self-injury (NSSI) in adolescents. Based on the identity-NSSI interplay model, we tested psychological distress as a mediator of this association. Based on the life history theory, we tested whether a slow life history strategy could weaken this mediation process. Five hundred and eighty-two Chinese middle school students (Mage = 13.75, SD = 0.67) completed questionnaires regarding identity confusion, psychological distress, life history strategy, and NSSI in May 2024. The results of structural equation modeling showed that identity confusion significantly predicted adolescent NSSI, and psychological distress mediated the association. Life history strategy moderated the second stage of the indirect effect (i.e., the relationship between psychological distress and NSSI). Specifically, the slower the life history strategy, the weaker the indirect effect of identity confusion on NSSI through psychological distress. These findings highlight the value of integrating life history strategy into research on adolescent NSSI.

Identifying most important predictors for suicidal thoughts and behaviours among healthcare workers active during the Spain COVID-19 pandemic: a machine-learning approach

AIMS

Studies conducted during the COVID-19 pandemic found high occurrence of suicidal thoughts and behaviours (STBs) among healthcare workers (HCWs). The current study aimed to (1) develop a machine learning-based prediction model for future STBs using data from a large prospective cohort of Spanish HCWs and (2) identify the most important variables in terms of contribution to the model's predictive accuracy.

METHODS

This is a prospective, multicentre cohort study of Spanish HCWs active during the COVID-19 pandemic. A total of 8,996 HCWs participated in the web-based baseline survey (May-July 2020) and 4,809 in the 4-month follow-up survey. A total of 219 predictor variables were derived from the baseline survey. The outcome variable was any STB at the 4-month follow-up. Variable selection was done using an L1 regularized linear Support Vector Classifier (SVC). A random forest model with 5-fold cross-validation was developed, in which the Synthetic Minority Oversampling Technique (SMOTE) and undersampling of the majority class balancing techniques were tested. The model was evaluated by the area under the Receiver Operating Characteristic (AUROC) curve and the area under the precision-recall curve. Shapley's additive explanatory values (SHAP values) were used to evaluate the overall contribution of each variable to the prediction of future STBs. Results were obtained separately by gender.

RESULTS

The prevalence of STBs in HCWs at the 4-month follow-up was 7.9% (women = 7.8%, men = 8.2%). Thirty-four variables were selected by the L1 regularized linear SVC. The best results were obtained without data balancing techniques: AUROC = 0.87 (0.86 for women and 0.87 for men) and area under the precision-recall curve = 0.50 (0.55 for women and 0.45 for men). Based on SHAP values, the most important baseline predictors for any STB at the 4-month follow-up were the presence of passive suicidal ideation, the number of days in the past 30 days with passive or active suicidal ideation, the number of days in the past 30 days with binge eating episodes, the number of panic attacks (women only) and the frequency of intrusive thoughts (men only).

CONCLUSIONS

Machine learning-based prediction models for STBs in HCWs during the COVID-19 pandemic trained on web-based survey data present high discrimination and classification capacity. Future clinical implementations of this model could enable the early detection of HCWs at the highest risk for developing adverse mental health outcomes.

STUDY REGISTRATION

NCT04556565.

Empowerment moderates risk for suicide among LGBTQ+ young adults

INTRODUCTION

There is a great need to examine resilience-based, modifiable protective factors of the established risk-relationship between experiences of discrimination, suicidal thoughts and behaviors, and nonsuicidal self-injury (NSSI) among sexual and gender diverse (SGD) youth. Preliminary studies suggest that psychological empowerment shows promise as a potential protective factor. The current study evaluated whether empowerment moderated the relationship between experiences of sexual and gender discrimination, NSSI, suicide ideation, and past-year suicide attempts.

METHODS

Three hundred five LGBTQ + -identifying young adults completed an anonymous online survey assessing discriminatory experiences, psychological empowerment, NSSI history, past-year worst-point suicide ideation and suicide attempts. Five moderated regression models were conducted using the PROCESS macro for SPSS.

RESULTS

Empowerment significantly moderated the relationship between sexual/gender-discrimination and suicide attempt as well as the relationships between suicide ideation and NSSI on past-year attempts. When empowerment was high, sexual/gender discrimination, suicide ideation, and NSSI were no longer significantly associated with past-year suicide attempts, suggesting a protective effect. Empowerment had a significant, negative relationship with both suicide ideation and NSSI frequency but did not moderate the effect of discrimination experiences on these variables.

CONCLUSION

Empowerment appears to be a viable protective factor for suicide risk among sexual and gender diverse young adults. Interventions that promote the development of a sense of empowerment may help to reduce risk and prevent suicide within this high-risk population.

Prevalence of suicide attempts and related factors among adolescents in Taiwan using a nationally representative survey

PURPOSE

This study aimed to apply stress-diathesis model to investigate the prevalence of suicide attempts and associated factors in a nationally representative sample of adolescents.

METHODS

A cross-sectional design and secondary data analysis were conducted using the parent study "Taiwan Youth Health Survey" data. A total of 5511 junior high school students were included. The outcome variable was self-reported suicide attempts, and the independent variables included self-reported stress and diathesis factors.

RESULTS

The prevalence of suicide attempts among adolescents was 7.7 %, with rates of 6.1 % for boys and 9.4 % for girls. The multiple logistic regression revealed that girls, loneliness, suicide ideation and plans, smoking, drinking alcohol, consumption of carbonated soft drinks (CSDs), eating fast food, experiencing a severe injury, being bullied, and lacking close friends were associated with an increased risk for attempting suicide. For boys, anxiety, smoking, experiencing severe injuries were identified as significant risk factors. For girls, loneliness, drinking alcohol, consuming CSDs, eating fast food, being bullied, and less parental supervision were identified as significant risk factors. The derived prediction score for the total group, boys, and girls yielded areas under the cure of 0.85, 0.82, and 0.87, respectively. The regression model, which incorporated interaction terms, demonstrated that loneliness, consumption of CSDs, and less parental supervision are gender-specific risk factors.

CONCLUSION

It is essential to consider gender differences in preventive measures. Appropriate interventions should be tailored to address both predispositions and stress unique to each gender, ensuring that gender-specific risk factors are managed more comprehensively.

The Prevalence and Incidence of Suicidal Thoughts and Behavior in a Smartphone-Delivered Treatment Trial for Body Dysmorphic Disorder: Cohort Study

Background

People with past suicidal thoughts and behavior (STB) are often excluded from digital mental health intervention (DMHI) treatment trials. This may perpetuate barriers to care and reduce treatment generalizability, especially in populations with elevated rates of STB, such as body dysmorphic disorder (BDD). We conducted a cohort study of randomized controlled trial (RCT) participants (N=80) who received a smartphone-based cognitive behavioral therapy (CBT) treatment for BDD that allowed for most forms of past STB, except for past-month active suicidal ideation.

Objective

This study had two objectives: (1) to characterize the sample's lifetime prevalence of STB and (2) to estimate and predict STB incidence during the trial.

Methods

We completed secondary analyses on data from an RCT of smartphone-delivered CBT for BDD. The primary outcomes consisted of STB severity and suicide attempt assessed at baseline with the Columbia-Suicide Severity Rating Scale (C-SSRS) and weekly during the trial via one item from the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR item #12; 1043 observations). We computed descriptive statistics (n, %) and ran a series of bi- and multivariate linear regressions predicting STB incidence during the 3-month trial.

Results

At baseline, 40% of participants reported a lifetime history of active suicidal thoughts and 10% reported lifetime suicide attempts. During the 3-month trial, 42.5% reporting thinking about death or suicide via weekly assessment. No participants reported frequent or acute suicidal thoughts, plans, or attempts. Lifetime suicide attempt (odds ratio 11, 95% CI 2.14-59.14; P<.01) and lifetime severity of suicidal thoughts (odds ratio 1.76, 95% CI 1.21-2.77; P<.01) were significant bivariate predictors of death- or suicide-related thought incidence reported during the trial. Multivariate models including STB risk factor covariates (eg, age, and sexual orientation) modestly improved prediction of death- or suicide-related thoughts (eg, positive predictive value=0.91, negative predictive value=0.75, and area under the receiver operating characteristic curve=0.83).

Conclusions

Although some participants may think about death and suicide during a DMHI trial, it may be safe and feasible to include participants with most forms of past STB. Among other procedures, researchers should carefully select eligibility criteria, use frequent, ongoing, low-burden, and valid monitoring procedures, and implement risk mitigation protocols tailored to the presenting problem.

Evaluating the Effectiveness of a Post-Training Enhancement to the LifeKeepers Suicide Prevention Gatekeeper Training

Background: Gatekeeper training (GKT) programs improve knowledge and self-efficacy in suicide prevention, but the sustainability of these improvements is uncertain. While booster sessions are suggested to enhance retention, existing research is inconclusive. Aim: This study aimed to evaluate the effectiveness of booster sessions in the LifeKeepers GKT program for maintaining long-term knowledge and self-efficacy at 6 months post-training. Method: A total of 1,732 participants who had completed LifeKeepers GKT were randomly assigned to one of three trial groups, an intervention (booster), control (training as usual), or attention control group. Participants completed measures of knowledge and self-efficacy at 3, 6, and 12 months and reported their frequency of interventions and referrals at 3 and 6 months. Results: No significant differences were found between the groups in terms of knowledge retention, self-efficacy, or behavior change at any follow-up point. However, sustained improvements were observed across all groups. Limitations: Ceiling effects and attrition may have influenced the findings. Conclusion: Booster sessions did not significantly enhance knowledge, self-efficacy, or behavior outcomes. All groups demonstrated sustained improvements, but ceiling effects and attrition caution against overinterpreting the findings. Further research is needed to explore effective strategies for long-term retention.

The Lifetime Prevalence of Non-Suicidal Self-Injury in Children and Adolescents With Eating Disorders-A Systematic Review and Meta-Analysis

OBJECTIVE

Eating disorders (EDs) and non-suicidal self-injury (NSSI) are both phenomena with onset in adolescence. Their co-occurrence is associated with higher symptom severity and an elevated risk of suicide. In this meta-analysis, we examine the lifetime prevalence of NSSI in youth with EDs.

METHODS

We searched PsycInfo, PubMed and previously published systematic reviews for studies reporting on lifetime NSSI prevalence among children and adolescents (19 years or younger) with an ED (anorexia nervosa, bulimia nervosa, binge eating or other specified feeding and EDs) published until June 2024. A generalized linear mixed model meta-analysis was performed to estimate the pooled prevalence. Meta-regressions and multivariate meta-analyses were conducted to estimate separate prevalence rates based on ED diagnosis and care frame (e.g., inpatient vs. outpatient), respectively.

RESULTS

Fifteen studies comprising 3311 children and adolescents were included. Pooled lifetime NSSI prevalence across all ED diagnoses was 34.2% [CI: 27.5%-41.7%]. Heterogeneity was large (I2 = 93.8%). Lifetime NSSI prevalence rates were significantly higher for participants with bulimia nervosa (53.6%) and those with anorexia nervosa binge-eating/purging type (51.9%) than for participants with anorexia nervosa restrictive type (15.8%).

DISCUSSION

The small number of studies and the large heterogeneity limit the conclusiveness of this meta-analysis. Results suggest an even higher prevalence of lifetime NSSI in adolescents with an ED than in adults with an ED. The results support previous findings indicating higher prevalence rates of NSSI for EDs associated with binge eating and purging behaviours than for restrictive EDs.

The complex relationship between NSSI exposure and suicidal risk: Insights from a short-term longitudinal study

OBJECTIVE

Adolescent suicide has become a critical global public health issue. While non-suicidal self-injury (NSSI) is closely associated with suicide, the role of NSSI exposure remains unclear. This study aims to explore possible mechanisms among NSSI exposure, NSSI engagement, and future suicidal risk.

METHOD

A total of 2,155 Chinese middle school students (47.9 % girls; M = 13.38 years, SD = 0.66) participated in the study. During the first survey, they reported demographic information, NSSI exposure, and NSSI engagement. Three months later, they completed follow-up assessments on suicidal risk and depressive symptoms.

RESULTS

Our results revealed three distinct relational patterns between NSSI exposure, NSSI engagement, and future suicidal risk: (1) NSSI exposure is associated with future suicidal risk through the mediating role of NSSI engagement (indirect effect = 0.145, SE = 0.02, 95 % CI [0.107, 0.183]); (2) NSSI exposure independently impact suicidal risk without NSSI engagement (β = 0.046, SE = 0.018, t = 2.299, p < 0.05); (3) NSSI exposure amplifies the predictive effect of NSSI engagement (β = 0.053, SE = 0.014, t = 3.844, p < 0.001, 95 % CI [0.023, 0.010]).

CONCLUSIONS

Our findings highlight the importance of interpersonal exposure, rather than media exposure, in these pathways. This study uncovers multiple pathways through which NSSI exposure influences suicidal risk, offering preliminary evidence for targeted prevention strategies.

Preventing suicide with Safe Alternatives for Teens and Youths (SAFETY): a randomised feasibility trial

BACKGROUND

Suicide attempts are common in youth and have potentially lethal outcomes. Effective treatments targeting suicide attempts are scarce.

OBJECTIVE

To assess the feasibility and preliminary efficacy of a family-based cognitive behavioural treatment relative to an active control for youth with suicidal behaviour.

METHODS

30 youths (93% female; mean (SD) age=14.6 (1.5) years) residing in Sweden with recent suicidal behaviour (last 3 months) and at least one available parent were randomised to 12 weeks of the family-based cognitive behavioural treatment Safe Alternatives for Teens and Youths (SAFETY) or supportive therapy, an active control treatment. Primary endpoint was 3-month post-treatment. Feasibility outcomes included treatment and assessment compliance, adverse events, treatment credibility and treatment satisfaction. Secondary outcomes included suicide attempt, non-suicidal self-injury, anxiety, depression, quality of life and emotion dysregulation.

FINDINGS

Both treatments showed high compliance, satisfaction, credibility and session completion, with few adverse events and dropouts as well as low attrition (7% at primary endpoint). At the primary endpoint, two (14%) participants in SAFETY and four (27%) in supportive therapy had attempted suicide. Non-suicidal self-injury was reduced by 95% (incidence rate ratio=0.05 (95% CI 0.01 to 0.20)) in SAFETY and 69% (incidence rate ratio=0.31 (0.11 to 0.83)) in supportive therapy. Participation in SAFETY, but not in supportive therapy, was associated with moderate-to-large within-group improvements in anxiety and depression (Cohen's d=0.85 [0.33 to 1.40]), quality of life (d=1.01 [0.48 to 1.56]) and emotion dysregulation (d=1.22 [0.45 to 2.03]).

CONCLUSIONS

The results suggest that SAFETY is feasible and promising for youth with suicidal behaviour.

CLINICAL IMPLICATIONS

A large randomised controlled trial is warranted to further examine the efficacy of SAFETY.

TRIAL REGISTRATION NUMBER

NCT05537623.

Suicidal ideation, attempted suicide and determinants among prisoners in Ethiopia 2024: a systematic review and meta-analysis

INTRODUCTION

Prisoners face severe restrictions on freedom and social connections, negatively impacting their mental health and increasing suicidal thoughts and attempts. Suicide is a significant public health concern, with rates among inmates much higher than in the general population. Research indicates that suicidal ideation is common among convicts. Despite the alarming prevalence of suicidal ideation and attempts among inmates, many countries lack comprehensive data on prison suicides, highlighting the need for targeted preventive strategies. This systematic review and meta-analysis aims to synthesize findings of different studies and pool them to provide a comprehensive figure of suicidal ideation and attempts among prisoners and to inform policymakers on improving health services for vulnerable inmates.

OBJECTIVE

This study comprehensively assessed and pooled the prevalence of suicidal ideation and attempts and the effect size of determinants among prisoners in Ethiopia.

METHODS

Systematic searches for observational studies were conducted in various databases, including PubMed (MEDLINE), CINAHL (EBSCO), Embase, Web of Science, HINARI, Science Direct, Google Scholar, Mednar, and the Cochrane Library. Observational studies involving inmates from 2015 to 2024 were included, except those who fulfill exclusion criteria. Four research groups independently selected studies, extracted data, and assessed quality. Nine studies involving 4435 prisoners were included. A meta-analysis using random-effects models was performed.

RESULTS

A total of nine studies involving 4435 study participants were included in the review. This study of studies revealed that the pooled prevalence of suicidal ideation and attempted suicide among prisoners in Ethiopia was 23.28% (95% confidence intervals (CI): 12.26%, 34.29%) and 10.20% (95% CI: 8.63%, 11.78%), respectively. Depression, poor social support, suicidal history, and previous mental illness were significantly associated. Statistically significant heterogeneity across included studies was found both for suicidal ideation (I2 = 98.74%, p ≤ 0.001) and suicidal attempts (I2 = 73.05%, p ≤ 0.001). Egger's test revealed publication bias in studies on suicidal ideation (p = 0.001) but not in studies on suicidal attempts (p = 0.271).

CONCLUSION

This study revealed a high prevalence of suicidal ideation and attempts among prisoners. These public health problems are significantly determined by depression, poor social support, mental illness, and family history of suicide. The review advocates for integrating mental health services in prisons, including routine screenings, while emphasizing the need to combat the marginalization of prisoners for meaningful change.

TRIAL REGISTRATION

The protocol for this study was submitted and registered in PROSPERO on 03 May 2024, and the first version of this protocol was published on 14 May 2024 with the PROSPERO ID of CRD42024542958.

Characteristics of Self-Harm in an Emergency Situation Among Youth: A Longitudinal Five- Year Cohort Study

Self-harm is a growing phenomenon among young people. This study examined self-harm rates in youths over five years, before and after the onset of the COVID-19 pandemic. Additionally, we explored risk factors influencing self-harm repetition. We conducted a retrospective analysis of people under 25 years who presented with self-harm at an emergency department in Seville, Spain, from January 1st 2018 to December 31st 2022. Participants were identified through hospital records. We used Joinpoint regression analysis to assess changes in trends and compared demographic and clinical variables between pre- and post-pandemic periods. Cox regression analysis was employed to identify predictors of repeated self-harm. The study included of 726 individuals, with 282 (38.84%) and 444 (61.16%) first-time self-harm cases before and after the COVID-19 pandemic onset, respectively. A significant increase in self-harm rates was observed from December 2020 to March 2021. Post-pandemic, there was an over-representation of 10-14-year-olds, increased substance use rates, and a higher proportion of suicide attempts compared to non-suicidal self-injuries. Affective disorders, personality disorders, lifetime psychiatric history, and previous non-suicidal self-injuries were associated with higher rates of recurring self-harm episodes. Self-harm among young people increased one year after the initial COVID-19 outbreak. Post-pandemic first-time self-harm cases exhibited higher rates of substance use and tended to engage in suicide attempts, particularly among 10-14-year-olds. Recurrence was associated with psychiatric diagnosis, psychiatric history and non-suicidal self-harm history.

Psychometric Properties of the Beck Scale for Suicidal Ideation in a Diverse Sample

Suicidal ideation disproportionately impacts minoritized populations; yet, these populations have been historically underrepresented in the development and validation of risk assessments, including the Beck Scale for Suicidal Ideation (BSS). The current study investigated the psychometric properties of the BSS in a combined sample (N = 1,026) of minoritized adults to examine its generalizability across diverse identities. Item response theory (IRT) models were estimated, and parameters including differential item functioning (DIF) were evaluated. Results showed that the original BSS and a 5-item BSS devised in a majority-aligning sample had significant model misspecification in the current study's diverse sample, but a reduced 14-item and 8-item scale has good properties and may be better-performing alternatives. DIF results supported measurement invariance of the BSS across race/ethnicity, sexual orientation, social class, and history of suicide attempts. Inclusion of certain suicidal behaviors (e.g., writing a note) into an assessment of suicidal ideation may not be effective.

"I Can't Overcome It": Exploring the Relationship Between Bullying Victimization and NSSI Among College Students Through the Lens of Emotion-Driven Mechanism

With its susceptibility in victimized populations and the potential for suicidality, non-suicidal self-injury (NSSI) is among the most severe health concerns in college students, indicating an urgency to explore its antecedents and interventions. The present study aims to examine the relationship between bullying victimization and NSSI and the mediating roles of internal shame, external shame, depressive symptoms, and PTSD symptoms based on the general strain theory, the vulnerability-stress theory, and the transactional stress theory. By adopting a three-time-point design with 6-month intervals, hypotheses were tested using data from 634 Chinese college students (374 female; Mage = 18.97). Through a structural equation modeling approach, the study found that bullying victimization was positively correlated with NSSI via internal shame and depressive symptoms. However, this study found no evidence for the mediating association of either external shame or PTSD symptoms in the examined relationship. Through a lens of emotion-driven mechanism, this study contributes to understanding the roles of internal shame and depressive symptoms in NSSI intervention strategies among victims of bullying. The results also illuminate the differentiation of the mechanisms of internal and external shame and the discrepancy between depressive symptoms and PTSD symptoms as two types of post-traumatic symptomatology.

Characterizing suicidal thoughts and behaviours in individuals presenting to a psychiatric emergency department: a protocol for a multimethod approach for suicide prevention research

INTRODUCTION

Identifying individuals at risk of suicide remains an ongoing challenge. Previous research investigating risk factors for suicidal thoughts and behaviours (STB) has been informative for assessing suicide risk. However, the complex biological, psychological and sociocultural factors underlying STB have not been comprehensively captured to date, which has limited our understanding of how these factors interact to influence STB. Moreover, acute care settings, such as emergency departments (EDs), are often first points of contact for individuals with STB, highlighting a need for more research in these settings.

METHODS AND ANALYSIS

We aim to (1) characterize a cohort seeking care for STB and their clinical trajectories; (2) situate the cohort by comparing its characteristics and outcomes to other groups seeking emergency care; (3) explore their experiences of seeking care; and (4) examine blood-based biomarkers modulating risk for STB. Using a multimethod, prospective cohort design, we will follow up to 500 people aged 16 or older presenting to the ED with STB at a psychiatric hospital over 1 year. Analyses will involve descriptive statistics and latent profile analysis to characterize the cohort, hypothesis tests and regression models to situate the cohort, qualitative analysis based on a realist research framework to understand experiences, and within-participant comparisons of proteins, mRNA and epigenetic DNA modifications to examine biomarkers of contrasting states of STB.

ETHICS AND DISSEMINATION

This study was approved by the hospital's Research Ethics Board with safeguards in place to ensure the well-being of participants and research team. An integrated knowledge translation approach will be used for dissemination, wherein patient and family advisors are engaged throughout each study phase. Findings will enhance our understanding of the multifactorial nature of suicide risk, inform strategies for prevention and provide important insights into characteristics, experiences and outcomes of individuals with STB, who are under-represented in mental health research.

Clinician Suicide Risk Assessment for Prediction of Suicide Attempt in a Large Health Care System

Importance

Clinical practice guidelines recommend suicide risk screening and assessment across behavioral health settings. The predictive accuracy of real-world clinician assessments for stratifying patients by risk of future suicidal behavior, however, remains understudied.

Objective

To evaluate routine clinical suicide risk assessment for prospectively predicting suicide attempt.

Design, Setting, and Participants

This electronic health record-based, prognostic study included 89 957 patients (≥5 years of age) with a structured suicide risk assessment (based on the Suicide Assessment Five-step Evaluation and Triage framework) that was documented by 2577 clinicians during outpatient, inpatient, and emergency department encounters at 12 hospitals in the Mass General Brigham health system between July 2019 and February 2023.

Main Outcomes and Measures

The primary outcome was an emergency department visit with a suicide attempt code recorded in the electronic health record within 90 days or 180 days of the index suicide risk assessment. The predictive performance of suicide risk assessments was evaluated on a temporal test set first using stratified prevalence (clinicians' overall risk estimates from a single suicide risk assessment item indicating minimal, low, moderate, or high risk) and then using machine learning models (incorporating all suicide risk assessment items).

Results

Of the 812 114 analyzed suicide risk assessments from the electronic health record, 58.81% were with female patients and 3.27% were with patients who were Asian, 5.26% were Black, 3.02% were Hispanic, 77.44% were White, and 11.00% were of Other or Unknown race. After suicide risk assessments were conducted during outpatient encounters, the suicide attempt rate was 0.12% within 90 days and 0.22% within 180 days; for inpatient encounters, the rate was 0.79% within 90 days and 1.29% within 180 days; and for emergency department encounters, the rate was 2.40% within 90 days and 3.70% within 180 days. Among patients evaluated during outpatient encounters, clinicians' overall single-item risk estimates had an area under the curve (AUC) value of 0.77 (95% CI, 0.72-0.81) for 90-day suicide attempt prediction; among patients evaluated during inpatient encounters, the AUC was 0.64 (95% CI, 0.59-0.69); and among patients evaluated during emergency department encounters, the AUC was 0.60 (95% CI, 0.55-0.64). Incorporating all clinician-documented suicide risk assessment items (87 predictors) via machine learning significantly increased the AUC for 90-day risk prediction to 0.87 (95% CI, 0.83-0.90) among patients evaluated during outpatient encounters, 0.79 (95% CI, 0.74-0.84) among patients evaluated during inpatient encounters, and 0.76 (95% CI, 0.72-0.80) among patients evaluated during emergency department encounters. Performance was similar for 180-day suicide risk prediction. The positive predictive values for the best-performing machine learning models (with 95% specificity) ranged from 3.6 to 10.1 times the prevalence for suicide attempt.

Conclusions and Relevance

Clinicians stratify patients for suicide risk at levels significantly above chance. However, the predictive accuracy improves significantly by statistically incorporating information about recent suicidal thoughts and behaviors and other factors routinely assessed during clinical suicide risk assessment.

Psychosocial Correlates of Suicidal Ideation and Behavior in Adolescents and Preadolescent Children Discharged from an Emergency Department in Israel

OBJECTIVES

Adolescent suicidal behavior is highly prevalent in pediatric psychiatric emergency departments, and there is a growing occurrence of such behavior among preadolescent children. This study aims to examine the psychosocial factors associated with nonfatal suicidal behaviors in children (<12 years old) and adolescents (aged 12-18), to gain insight into unique and shared characteristics of suicidal behavior across these two age groups.

METHOD

This study investigates the psychosocial characteristics associated with suicidal ideation and behaviors in an emergency department sample of 183 children and adolescents aged 7-18 years in Israel. Participants completed a diagnostic interview, and self-report and parent-report questionnaires of psychosocial measures. Cross-sectional correlational and regression analyses were used to determine significant correlates of suicidal outcomes within the two age groups.

RESULTS

Among adolescents, females exhibited a higher prevalence of suicidal thoughts and behaviors, while in children, both boys and girls showed similar rates. Depression correlated with suicidal ideation for both adolescents and children. In children, anxiety and conduct symptoms were associated with suicidal behavior, whereas in adolescents, suicidal behavior was associated with depression and anxiety.

CONCLUSIONS

The present findings contribute to the growing understanding of factors associated with suicidal thoughts and behaviors among children in comparison to adolescents. These findings underscore the importance of targeting specific risk factors when developing assessment and intervention strategies tailored to the two age groups.

Cumulative Interpersonal Risk, Non-Suicidal Self-Injury, and Suicide Attempts in Early Adolescence: Between-Person Differences and within-Person Effects

Poor interpersonal relationships are one of the risk factors for non-suicidal self-injury (NSSI) and suicidal behaviors among adolescents. Previous studies have mostly focused on a single interpersonal perspective, and it remains uncertain how the cumulative interpersonal risk across time and domains interacts with NSSI and suicide. The current study employed cross-lagged panel models (CLPM) and random intercept cross-lagged panel models (RI-CLPM) to investigate the interaction among cumulative interpersonal risk, NSSI, and suicide attempts at both the between-person and within-person levels, while examining sex differences in these relationships. A total of 1038 Chinese adolescents (47.0% girls; baseline Mage = 12.35 years, SD = 0.52) participated in a four-wave longitudinal survey with 6-months intervals. The results showed that at the between-person level, there were reciprocal predictive relationships between cumulative interpersonal risk, NSSI and suicide attempts. At the within-person level, changes in NSSI affected changes in cumulative interpersonal risk, and suicide attempts exhibited a reciprocal relationship with cumulative interpersonal risk and NSSI, with significant sex differences observed. These findings underscore the stable and trait-like associations between cumulative interpersonal risk, NSSI and suicide attempts. Given these findings, to reduce the occurrence of suicide among adolescents, it is essential to target interventions aimed tat enhancing their interpersonal adaptability.

Trauma Exposure Moderates the Link Between Cognitive Flexibility and Suicide Risk in Pre-Adolescent Children

OBJECTIVES

Trauma exposure (TE) and cognitive flexibility (CF) are risk factors for self-injurious thoughts and behaviors (SITBs). However, it is unknown whether these risk factors contribute to mechanisms associated with distinct categories of SITBs. The current study examined the potential moderating role of TE in the relationships between CF and multiple SITBs, including active suicidal ideation (SI), passive SI, non-suicidal self-injury (NSSI), and history of suicide attempt (SA), among pre-adolescent children.

METHODS

A total of 11,326 children from the Adolescent Brain Cognitive Development study were included in the present study. SITBs and TE were measured by the Kiddy Schedule for Affective Disorder and Schizophrenia (KSADS). CF was measured using the NIH Cognitive Toolbox.

RESULTS

Cumulative TE moderated the relationship of CF to active SI. Higher CF was associated with lower odds of current SI in children with a single lifetime TE, but not in children without trauma or with two or more TE. As a main effect, two or more TE predicted higher odds of active SI, passive SI, and lifetime SA, but not NSSI. Higher CF was associated with lower odds of passive SI, with effects not moderated by trauma exposure.

CONCLUSION

The current results clarify previously inconsistent findings about the relationship of CF to SI by identifying cumulative TE as a moderator. CF served as a protective factor against SI, but only in children with a single lifetime trauma. Implications for screening and treatment targets of children at risk for distinct categories of SITBs are discussed.

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.

Internet gaming disorder and suicidal behaviors mediated by sleep disturbance: a large-scale school-based study in 135,174 Chinese middle school students

Emerging research suggests a positive association between Internet gaming disorder (IGD) and suicidal behaviors. However, existing studies predominantly focus on suicidal ideation rather than suicide attempts and often do not adequately control for potential psychological confounders. The mechanism linking IGD to suicidality remains unclear. This study aims to assess the independent association between IGD and suicidal behaviors and to examine the mediating role of sleep disturbance among Chinese adolescents. We recruited 135,174 middle school students from Zigong City using cluster sampling. Data on demographics, suicidal ideation, and suicidal attempts were collected. IGD was assessed using the Internet Gaming Disorder Scale-Short Form. Mental distress, including depression, anxiety, hyperactivity/inattention, conduct problems, sleep problems, and psychotic experiences, was evaluated using standardized questionnaires. Multiple logistic regression models and mediation analysis were conducted. The prevalence rates of IGD, suicidal behaviors, suicidal ideation, and suicide attempts were 1.6%, 16.7%, 11.9%, and 9.8%, respectively. Adolescents with IGD showed a significantly higher risk for suicidality: nearly 60% reported suicidal behaviors, 50% reported suicidal ideation, and 40% reported suicide attempts. Both IGD and gaming usage were independently linked to suicidal behaviors. Sleep disturbance partially mediated the relationship between IGD and suicidal behaviors, accounting for 47.0% of the total effect. Our studies call for timely and regular assessments for suicidality and sleep disturbance in IGD. Targeted interventions addressing sleep disturbance might reduce suicidal risk among adolescents with IGD.

Psychometric Properties of the Modified Scale for Suicidal Ideation-Self-Report-Revised With High-Risk Adolescents

In treatment-seeking samples, approximately 40% of adolescents with suicidal ideation transition to engaging in suicidal behavior. Thus, assessment of the severity of suicidal ideation during care is critically important. However, few free, self-report, evidence-based measures that assess for severity of suicidal ideation exist. To address this need, the present study examined several psychometric properties of a revised version of the Modified Scale for Suicidal Ideation-Self Report (MSSI-SR-R) with adolescents. A sample of 284 adolescents (Mage = 15.30; SD = 1.42; range = 12-18; 62.7% White; 75.7% Non-Hispanic/Latinx) enrolled in a partial hospital program (PHP) completed the MSSI-SR-R at the beginning of treatment. The factor structure of the MSSI-SR-R was assessed using bifactor exploratory structural equation modeling. Measurement invariance across sexual identity was also examined. Internal consistency was calculated using omega. Validity was assessed by comparing scores on the MSSI-SR-R to well-validated self-report measures of suicidal thought and behaviors as well as depressive symptoms. Results supported a bifactor model with a general factor and two specific factors (i.e., Desire/Ideation and Plans/Preparation), which was invariant across sexual identity. The MSSI-SR-R total score demonstrated good reliability and was positively associated with measures of suicidal ideation and behaviors as well as depressive symptom severity. Though additional psychometric work is needed, the MSSI-SR-R demonstrated good psychometric properties. It may offer utility in clinical settings as a brief, free, and validated assessment of severity of suicidal ideation.

Psychometric properties of the Persian version of Self-Injurious Thoughts and Behaviors Questionnaire-Nonsuicidal (SITBQ-NS) in an Iranian outpatient sample

Nonsuicidal self-injury (NSSI) is a clinically significant behavior often associated with several psychiatric disorders, underscoring the importance of accurately assessing both NSSI thoughts and behaviors. The Self-Injurious Thoughts and Behaviors Questionnaire-Nonsuicidal (SITBQ-NS) is a self-report instrument designed to assess the full range of NSSI thoughts and behaviors. However, the psychometric properties of the SITBQ-NS have not been adequately investigated, particularly in Eastern cultures. To address this gap, the present study examined the psychometric properties of the Persian version of the SITBQ-NS using data from 350 outpatients (age range: 18-60 years, M = 27.65, SD = 6.61; 20 % male) recruited from two psychiatric hospitals and two university counseling and psychological services centers in Tehran, Iran. Confirmatory factor analysis (CFA) supported the originally proposed two-factor model, showing excellent internal consistency and the expected associations with relevant external correlates. Furthermore, receiver operating characteristic (ROC) analysis revealed excellent sensitivity and specificity for the SITBQ-NS subscale scores, demonstrating its effectiveness in identifying NSSI. Overall, the results suggest that the Persian version of the SITBQ-NS has a robust factor structure and is a reliable, valid tool for assessing NSSI thoughts and behaviors in clinical and research settings in Iran.

Self-injurious thoughts and behaviors among Hispanic/Latine college students in the US: Disaggregating by key sub-group characteristics

Objective: Hispanic/Latine college students are increasingly at high risk to experience self-injurious thoughts and behaviors (SITBs). This brief report examined SITB prevalence rates among a national sample of Hispanic/Latine college students, with specificity to sub-group characteristics. Participants: Hispanic college students across 139 institutions from a national survey of college student mental health (Healthy Minds Study) in the US (N = 12,499). Methods: The present cross-sectional, secondary data analysis examines prevalence rates of SITBs by sub-group characteristics (nativity, heritage, documentation status, other socio-demographics) using chi-square analyses and standardized residuals. Results: Younger (18-24 years old; p < 0.001), US-Born (p < 0.001), gender expansive/transgender (p < 0.001), and financially stressed (p < 0.001) Hispanic/Latine college students report higher rates of SITBs overall. Conclusion: Findings underscore the importance of examining overlapping and intersecting identities that can inform prevention efforts for the Hispanic/Latine student population in the US. Policy and institution-level recommendations for resource allocation and tailored prevention strategies are discussed.

"It's like I used to share a room with self-injury, but now it lives next door": Exploring experiences of naturalistic improvement in non-suicidal self-injury

BACKGROUND

Many people who engage in non-suicidal self-injury (NSSI) do not access support from health services, and evidence regarding the effectiveness of interventions is mixed. Despite this, NSSI prevalence rates decrease from adolescence into adulthood. Little is known about what helps alleviate difficulties with NSSI beyond psychological or medical intervention. This study sought to understand factors influencing naturalistic improvements in NSSI.

METHODS

Semi-structured interviews were conducted over video call with 16 participants who believed their difficulties with NSSI had improved due to factors not attributed to psychological or medical intervention. Interviews were audio recorded and transcribed verbatim for analysis.

RESULTS

A reflexive thematic analysis revealed four main themes. Increased insight into NSSI experiences promoted self-compassion and self-acceptance and enabled participants to reflect on the conflicting role of NSSI. Safe and supportive relationships helped alleviate loneliness, and developing alternative coping strategies enhanced feelings of control over self-injury. Creating a life guided by personal values promoted independence, choice, and self-esteem.

CONCLUSIONS

The findings of the study highlight several internal and external naturalistic processes deemed meaningful in improving difficulties with NSSI. Clinical implications include the importance of developing and embedding these approaches within services and interventions to improve outcomes for individuals who self-injure while promoting a person-centred approach.

Anhedonia Links Sleep Problems and Suicidal Thoughts: An Intensive Longitudinal Study in High-Risk Adolescents

Growing research indicates that sleep problems are a robust independent risk factor for suicidal thoughts and behaviors among youth. However, relatively little is known about how this risk is conferred. This study used an intensive longitudinal design to investigate anhedonia as a mechanism linking sleep problems and next-day suicidal thoughts in a clinically high-risk sample of adolescents. Adolescents (N = 48; Mage=14.96; 77.1% white, 64.6% female) completed an ecological momentary assessment (EMA) study design for 28 days following discharge from acute psychiatric care for suicide risk. Daily sleep diaries were used to assess prior night total sleep time and sleep onset latency. Ecological momentary assessment was used to assess anhedonia and suicidal thoughts up to six times per day. A series of multi-level structural equation models were used to examine facets of anhedonia as parallel mediators of the association between sleep problems and next-day suicidal thoughts. Significant direct effects were found between sleep problems and consummatory anhedonia, consummatory anhedonia and suicidal thoughts, and anticipatory anhedonia and suicidal thoughts. There were significant indirect (mediated) effects between sleep problems and next-day suicidal thoughts through consummatory anhedonia, but not anticipatory anhedonia. Findings provide initial evidence as to how sleep problems may confer risk for next-day suicidal thoughts- by increasing consummatory anhedonia. Future research is needed to replicate these findings in larger samples and investigate how modifying anhedonia may mitigate suicide risk in youth.

Sub-groups of emotion dysregulation in youth with nonsuicidal self-injury: latent profile analysis of a randomized controlled trial

Psychological treatments targeting emotion dysregulation in adolescents reduce nonsuicidal self-injury (NSSI) but predicting treatment outcome remains difficult. Identifying sub-groups based on repeated measurements of emotion dysregulation pre-treatment may guide personalized treatment recommendations. We used data from a recent trial evaluating internet-delivered emotion regulation therapy for adolescents with NSSI (n = 138). Latent profile analysis was used to identify sub-groups based on pre-treatment responses on the 16-item version of the Difficulties in Emotion Regulation Scale. The primary outcome was self-rated NSSI frequency during treatment, and secondary outcome was the proportion of participants with no NSSI 1-month post-treatment. Three sub-groups of emotion dysregulation were identified: low variability and low mean (Group 1), low variability and high mean (Group 2), and high variability and low mean (Group 3). Sub-groups did not differ in NSSI frequency during treatment (Group 2 IRR = 1.06 [95% CI 0.49-2.29], p = .88; Group 3 IRR = 1.22 [95% CI 0.31-4.76], p = .77). However, more participants in Group 1 compared to Group 2 abstained from NSSI at 1-month post-treatment (OR = 3.63 [95% CI 1.16-11.33], p = 0.01). Latent profile analysis identified sub-groups predictive of NSSI absence post-treatment, demonstrating clinical utility.

Predictors of Suicide Attempts and Reattempts in a Sample of Chilean Adolescents

BACKGROUND

Suicide is a public health problem worldwide, especially among adolescents. Chile is one of the Latin American countries with the highest suicide rates; however, few studies have investigated the risk factors for suicide attempts in this specific population. We aimed to describe the suicidal behaviour of Chilean adolescents and to explore the factors associated with suicide attempts and reattempts in this population.

METHODS

Adolescents (10-19 years) with a diagnosis of psychiatric disorders were recruited in the Maule region, Chile, between 2018 and 2021. Sociodemographic and clinical variables were collected. Logistic regression was performed to explore the association between these variables and suicide attempts.

RESULTS

Factors associated with increased odds of suicide attempts included age, sexual orientation, Adverse Childhood Events (ACEs) and past and current symptomatology. Factors that decreased the odds of suicide attempts were previous psychotherapy or pharmacological treatment, responsiveness and warmth from mother and father. Active symptoms at the time of assessment increased the odds of reattempting suicide.

CONCLUSIONS

In our sample, clinical and trauma-related factors emerged as the most important factors in predicting suicide attempts. Although age, sexual orientation and family dysfunction also played a notable role, positive relationships with parents seemed to be protective. In addition, current symptoms of stress, anxiety and depression significantly increased the likelihood of reattempts. These findings provide valuable knowledge about suicidality in Chile, although further research is needed to expand the evidence in our media.

Nonsuicidal self-injury in a cross-sectional community survey of New Zealand adults: Associations with demographic and psychological characteristics

OBJECTIVE

Understanding of nonsuicidal self-injury relies almost exclusively on adolescent and emerging adult samples. We investigated the prevalence of lifetime and past-year nonsuicidal self-injury among New Zealanders aged 16-75 years and above, before evaluating if established associations between nonsuicidal self-injury, and demographic and psychological characteristics generalise to adults.

METHOD

New Zealand adults (n = 4906; median age 55-59 years; 55.5% female) completed a cross-sectional survey assessing lifetime and past-year nonsuicidal self-injury, psychological distress, self-esteem, emotion dysregulation, and social desirability susceptibility.

RESULTS

Nonsuicidal self-injury was common among adults; 25.6% participants reported ever self-injuring and 10.7% had done so at least once in the past year. Women and younger participants were more likely to report lifetime self-injury. Although younger participants were also more likely to report past-year self-injury than older participants, this age effect was attenuated for men (b = -0.09) compared to women (b = -0.18). Self-esteem (odds ratios 0.74, 0.74), psychological distress (odds ratios 1.09, 1.16), emotion dysregulation (odds ratios 2.05, 1.88), and desire to manage others' impressions of oneself (odds ratios 0.88, 0.85) were uniquely associated with both lifetime and past-year nonsuicidal self-injury, respectively, and these effects were not moderated by age.

CONCLUSION

Although self-injury was most common among emerging adults, adults of all ages reported self-injuring. Individuals with a greater desire to manage how others perceive them appeared to underreport their nonsuicidal self-injury. While men were less likely than women to self-injure, they may also be more likely to continue self-injuring over adulthood, suggesting that the developmental factors which drive self-injury cessation among adults differ for men and women.

The association between nonsuicidal and suicidal self-injurious behaviors: A systematic review and expanded conceptual model

OBJECTIVES

Nonsuicidal self-injury (NSSI) is one of the strongest predictors of suicidal behavior. Despite this, the field still has a limited understanding of the mechanisms by which this relationship is conferred.

METHOD

We conducted a systematic review of the empirical research examining potential factors driving (i.e., moderators, mediators) the relationship between NSSI and suicidal behavior to address this gap in the literature.

RESULTS

We identified only 15 studies examining moderators or mediators of this relationship, examining 40 unique mediators and 22 unique moderators. Three prominent weaknesses were identified in the reviewed literature: (1) limited intersection with existing theoretical models of the NSSI - suicidal behavior relationship, (2) little replication of findings across studies (i.e., only four mediators and four moderators assessed in multiple studies), and (3) only one of the included studies utilized a prospective design. Research to date does little to improve our understanding of the theoretical or prospective relationship between NSSI and suicidal behavior, highlighting a foundational gap in the literature.

DISCUSSION

We propose the Nonsuicidal to Suicidal Self-Injury Pathway Model, a new conceptual model of the relationship between NSSI and suicidal behavior, drawing on extant theory and empirical research; we discuss future directions for work in this area.

Validation of a machine learning model for indirect screening of suicidal ideation in the general population

Suicide is among the leading causes of death worldwide and a concerning public health problem, accounting for over 700,000 registered deaths worldwide. However, suicide deaths are preventable with timely and evidence-based interventions, which are often low-cost. Suicidal tendencies range from passive thoughts to ideation and actions, with ideation strongly predicting suicide. However, current screening methods yield limited accuracy, impeding effective prevention. The primary goal of this study was to validate a machine-learning-based model for screening suicidality using indirect questions, developed on data collected during the early COVID-19 pandemic and to differentiate suicide risk among subgroups like age and gender. The detection of suicidal ideation (SI) was based on habits, demographic features, strategies for coping with stress, and satisfaction with three important aspects of life. The model performed on par with the earlier study, surprisingly generalizing well even with different characteristics of the underlying population, not showing any significant effect of the machine learning drift. The sample of 1199 respondents reported an 18.6% prevalence of SI in the past month. The presented model for indirect suicidality screening has proven its validity in different circumstances and timeframes, emphasizing its potential as a tool for suicide prevention and intervention in the general population.

Association Among BMI, Self-Esteem, and Nonsuicidal Self-Injury in Young Adults to Understand the Influence of Socioenvironmental Factors: Longitudinal Study

Background

Nonsuicidal self-injury (NSSI) is a major public health problem leading to psychological problems in adolescents and young adults, similar to disorders such as depression and anxiety.

Objective

The aims of this study were to investigate (1) the interaction between BMI and socioenvironmental factors (including chronotype and mental health) that contribute to NSSI, and (2) whether self-esteem plays a mediating role in this association.

Methods

From May to June 2022, the multistage cluster sampling method was used to sample college students in four grades, including freshmen and seniors. The baseline participants were followed up 6 months later, excluding those who did not qualify, and the participants included 1772 college students. Socioenvironmental factors (chronotype/mental health), self-esteem, and NSSI were measured using a questionnaire. Multivariate linear regression models and chi-square analysis were used to evaluate the linear relationship between BMI, socioenvironmental factors, and self-esteem and the NSSI status. We use a process approach (mediation-moderation analysis) to explore the complex relationships between these variables.

Results

The mean age of the participants was 20.53 (SD 1.65) years at baseline. A significant association was revealed, suggesting that a high BMI (β=.056, 95% CI 0.008-0.086, P=.018) was associated with a higher NSSI. There was also an interaction among BMI, socioenvironmental factors, and NSSI. Socioenvironmental factors played both moderating and mediating roles in the relationship between BMI and NSSI, whereas self-esteem only played a mediating role.

Conclusions

Paying attention to factors such as overweight and obesity is important for early BMI control to identify other potential risk factors for NSSI and to evaluate how self-esteem can be improved considering multiple perspectives to improve the effect of BMI on NSSI in adolescents.

Prevalence rate of perceived gender discrimination and its associations with suicide behaviors in Chinese adolescents: the mediating roles of depressive symptoms and anxiety symptoms

This cross-sectional study aimed to investigate the prevalence rate of perceived gender discrimination and its associations with suicidal ideation and suicide attempts, as well as the mediating roles of depressive symptoms and anxiety symptoms in Chinese adolescents. From October 2021 to March 2022, we adopted a multi-stage stratified cluster random sampling method to recruit students from grades 7-12 in China. A total of 79,211 adolescents aged 10-19 years from eight provinces completed the survey with valid data for the current study. Data were weighted to adjust for unequal probabilities of selection and differential response as well as to post-stratify the sample to match the population distribution. The weighted prevalence rate of perceived gender discrimination was 3.5% in Chinese adolescents, with girls having a higher prevalence rate than boys (5.5% vs.1.7%; P-value < 0.001). In the full-adjusted model, perceived gender discrimination was associated with a higher likelihood of suicidal ideation (OR, 2.16; 95% CI, 1.93-2.42) and suicide attempts (OR, 1.62; 95% CI, 1.39-1.88). Mediation analyses showed that depressive symptoms and anxiety symptoms significantly mediated 39.5% and 5.7% of the association between perceived gender discrimination and suicidal ideation, respectively, and depressive symptoms and anxiety symptoms significantly mediated 54.3% and 7.0% of the association between perceived gender discrimination and suicide attempts, respectively. These findings suggest the need for targeted interventions to reduce gender discrimination against adolescents, especially girls, which might help prevent their suicidal behaviors and mental health problems.

Suicide in Italy: Epidemiological Trends, Contributing Factors, and the Forensic Pathologist's Role in Prevention and Investigation

Suicide in Italy represents a serious public health problem, with significant data highlighting the urgency for prevention interventions. According to the epidemiological data, in the two-year period 2020-2021, 7422 suicides were recorded, representing an increase compared to previous years. Suicide is the most extreme self-harm. The contributing factors that surround this event are multiple, typically in conditions of serious distress or psychological distress, in particular in people suffering from serious psychiatric and/or mental disorders, such as depression. The role of the forensic pathologist in the context of suicide is crucial for ascertaining the contributing factors of death and for understanding the circumstances that lead to the suicidal act. Forensic medicine plays a crucial role in the analysis and understanding of suicides, addressing both the legal and medical implications. The aim of this study was to accurately describe the phenomenon of suicide in Italy. The accuracy of the review was very important in paying attention to the large difference in how the phenomenon manifests itself in the male population compared to the female population. The different ages at which suicide is committed were highlighted. The geographical difference between the North and the South and between the more urbanized areas compared to the rural areas where suicide is committed was analyzed. This scientific work also aimed to explore how forensic pathologists contribute to the resolution of complex forensic investigations. Psychological autopsy is an investigative method used primarily in cases of violent or questionable death, with the aim of understanding the psychological and social circumstances that led to an individual's death. This practice is distinct from forensic autopsy, which focuses on the physical analysis of the body to determine the cause of death. The role of forensic pathologists in investigating suicide cases is crucial, as they not only determine the cause of death but also analyze the psychological implications that may have led to the extreme act. The main objective of a forensic pathologist in these cases is to gather and interpret evidence that can help understand the psychological and social context that influenced the decision to commit suicide, identifying any warning signs and underlying motivations and factors that may have contributed to the suicide. This approach provides valuable information for prevention, enhancing the understanding of the psychological mechanisms behind suicide and supporting targeted interventions in the future. The manuscripts also have an explanatory purpose and may have a therapeutic role in helping surviving relatives understand suicide. Knowledge of the messages contained in suicide notes could be useful for suicide prevention programs.

Body Regard as a Volitional Factor for Suicide Attempts: Implications for Ideation to Action Frameworks

INTRODUCTION

One's relationship with, attitudes toward, and subjective experiences of the body have been theorized to contribute to self-preservation and self-destruction. These components of body regard have demonstrated associations with suicidal thoughts and behaviors but remain understudied. This study examined whether body regard acts as a moderator of the relationship between suicide ideation and attempts as well as its effect on the relationships of other established suicide risk factors.

METHODS

A random sample survey of 2021 young adults was conducted assessing body regard, fearlessness about death, depression, anxiety, stress, lifetime NSSI, and past year suicide ideation and attempts.

RESULTS

A logistic regression analyses revealed that body regard was a significant predictor of past year suicide attempt, alongside NSSI, and suicide ideation. Follow-up moderation analyses found that body regard significantly moderated the effect of suicide ideation such that ideation was only significantly associated with suicide attempts when body regard was low. High body regard also weakened the effect of ideation on attempts across levels of NSSI.

CONCLUSIONS

Body regard may operate as a volitional factor for suicide attempts while also buffering the moderating relationships of other risk factors. Etiological models, assessment, and treatments aimed at addressing suicide risk should include attention to one's body regard.

Daily nonsuicidal self-injury thoughts in emerging adulthood: The relevance of pre-adolescent borderline traits

Longitudinal studies exploring the role of early personality vulnerabilities as risk factors for later NSSI dynamics are scarce. In this study, we assess how pre-adolescent borderline personality pathology (BPP) traits (assessed at mean age 12.78; SDage = 1.38, age range = 7.17-14.78) shape dynamic links between daily socio-emotional dysregulation and NSSI thoughts during emerging adulthood (Mage = 20.96, SDage = 1.63). Mothers of 131 children completed questionnaires about their child's BPP traits in pre-adolescence. These children were re-assessed eight years later and were asked to complete a daily diary for 14 consecutive days. During these 14 days, behavioral and emotional dysregulation as well as NSSI thoughts were self-reported. Multilevel structural equation modeling was used (1) to examine dynamic links between socio-emotional dysregulation manifestations and NSSI thoughts in early adulthood, and (2) to explore the role of pre-adolescent BPP traits in moderating these early-adult dynamic associations. Our findings suggest that young adults who were described by their mothers as high on BPP traits (especially anxious and paranoid traits) during pre-adolescence, tended to respond more with NSSI thoughts when experiencing dysregulation or when perceiving others as rejecting in young adulthood. Results are discussed in terms of potential targets for indicated prevention of NSSI development.

Mapping punishment avoidance learning deficits in non-suicidal self-injury in young adults with and without borderline personality disorder: An fMRI study

INTRODUCTION

Non-suicidal self-injury (NSSI) is a growing public health concern among young adults in both clinical and non-clinical settings. Despite evidence linking NSSI to alterations in learning from reward and punishment, this area remains understudied, especially in non-clinical populations without borderline personality disorder (BPD).

METHODS

We employed a modified version of the Probabilistic Stimulus Selection (PSS) task in two groups of young adults with recurrent NSSI, with (NSSI+BPD) and without BPD (NSSI), and an additional group of healthy controls (HC). While undergoing functional magnetic resonance imaging (fMRI), participants were asked to choose between pairs of stimuli with different reward probabilities. In the training phase, they received probabilistic feedback and learned to identify the most rewarding option within fixed pairs. In the test phase, these learned stimuli were recombined into novel pairs, where participants' accuracy in selecting the most rewarding and avoiding the most punishing options reflected their ability to learn from reward and punishment, respectively.

RESULTS

Compared to HC, participants in the NSSI and NSSI+BPD groups were less accurate at avoiding the most punishing options than at choosing the most rewarding options, and showed reduced activity in the nucleus accumbens (NAcc) during punishment avoidance relative to reward selection.

LIMITATIONS

The modest sample size, descriptive rather than modeling approach, and absence of ecological momentary assessments may limit the results.

CONCLUSION

Findings suggest that reduced activation of the NAcc when avoiding loss may underlie difficulties in learning to avoid punishment in young adults with NSSI, regardless of the presence of BPD.