Does Nonsuicidal Self-Injury Predict Later Suicidal Attempts? A Review of Studies

Psychopathological and interpersonal factors associated with suicide attempts in Mexican clinical patients with and without a history of child sexual abuse

Suicidal behavior in the Mexican population is understudied, and there is a paucity of research exploring the role of psychological factors and of the interpersonal theory of suicide in this population. The objectives of this work were: to explore the associations between interpersonal and psychopathological variables and suicide attempts. We also explored psychopathological differences in suicidal behavior between patients with a history of child sexual abuse and those without and examined the most accurate predictors of suicide attempts in the study sample. Finally, we tested the mediation between related variables. Results showed that the most accurate predictors of suicide attempts were perceived burdensomeness, suicidal ideation, and suicide plans. Patients with a history of child sexual abuse differed in levels of depressive symptoms, hopelessness, perceived burdensomeness, and NSSI frequency. Suicide plans mediated the associated between perceived burdensomeness and suicide attempts. Clinical and intervention implications are discussed.

Exploring the effect of family function on non-suicidal self-injury among Chinese adolescents in different family socioeconomic status

BACKGROUND

Non-suicidal self-injury (NSSI) among adolescents represents an alarming public health concern worldwide. Both family function and family socioeconomic status (SES) were found to play important roles in adolescent NSSI engagement. However, the effects of family function on NSSI among adolescents in different family SES are not well evidenced.

AIMS

This study aimed to explore how family functions (adaptation, partnership, growth, affection, and resolve) affect NSSI among adolescents in different family SES levels.

METHODS

Data used in this study was derived from the Students' Mental Health Network Project (SMHN), a survey conducted among 8,872 pairs of adolescent-caregivers in a city in central China. Socio-demographic characteristics, family function, NSSI, adverse life events, and depressive symptoms were measured among adolescents. Family SES were generated from caregivers self-reported information using principal component analysis. Chi-square test and multivariate binary logistic regression analyses were adopted to analyze the effects of family function on NSSI.

RESULTS

It revealed that 10.2% of adolescents reported engaging in NSSI in the past 12 months. Poor family function and high family SES were positively associated with NSSI. Partnership, both adaptation and affection, resolve were NSSI-protective factors for adolescents in low, middle, high family SES, respectively.

CONCLUSIONS

Efforts to address NSSI should acknowledge the association between family function and NSSI among adolescents in different family SES levels.

A latent profile analysis of at-risk first-year undergraduate students

Objective: We examined whether meaningful subgroups of self-injurious behaviors (SIBs) would emerge within a pool of first-year college students already deemed at elevated risk. Participants: First-year undergraduates (N = 1,068) recruited in 2015-2018 Fall terms. Methods: Past-year nonsuicidal self-injury (NSSI) frequency, past-year number of NSSI methods used, lifetime suicide attempt (SA) history, and recency of SA were included in a latent profile analysis. Results: Four subgroups emerged: low SIB (n = 558, 52%), high NSSI only (n = 182, 17%), high SIB (n = 141, 13%), and high SA only (n = 187, 18%). Students in the high SIB group reported higher levels of suicidal ideation at baseline and follow-up in comparison to all groups. Those in the high NSSI only or high SIB groups had relatively higher levels of NSSI at baseline and follow-up. Conclusions: Findings highlight the amount of heterogeneity within a high-risk group, along with the importance of considering distal and proximal SIBs in university screening efforts.

Associations of military sexual harassment and assault with nonsuicidal self-injury: Examining gender and sexual orientation as moderators

Military sexual harassment (MSH) and assault (MSA) are prevalent among service members and are linked to negative psychosocial outcomes, including self-directed violence. Veterans identifying as women or as sexual or gender minorities are at heightened risk for both MSH/MSA and self-directed violence, but their relationship remains understudied in these populations. We examined associations of MSH and MSA with nonsuicidal self-injury (NSSI) and tested whether relations varied by self-identified gender or sexual orientation in two national samples of U.S. veterans. Sample 1 included post-9/11 veterans who had recently discharged from service (n = 1,494); sample 2 included veterans from any service era (n = 1,187). Veterans self-reported MSH, MSA, gender identity and sexual orientation, and lifetime and past-month histories of NSSI. We estimated logistic regressions to examine the associations of MSH and MSA history with NSSI and evaluated gender (man or woman) and sexual orientation as moderators of these relations. Results suggested significant associations of both MSH and MSA with NSSI but largely failed to support moderation of these associations by either gender or sexual orientation identity. Screening for both MSH and MSA in veterans across gender and sexual orientation identities appears indicated in clinical assessment of NSSI.

Assessing the contributions of gender, clinical symptoms, and psychometric traits to non-suicidal self-injury behaviors in Chinese adolescents: a nomogram approach

BACKGROUND

Non-suicidal self-injury (NSSI) behaviors among adolescents with mood disorders represent a significant global public health concern. This study aimed to assess the prevalence and identify key predictors of NSSI behaviors in Chinese adolescents diagnosed with depressive or bipolar disorders, addressing a critical gap in the literature.

METHOD

Data from 2343 participants in the Chinese Adolescent Depression Cohort (CADC) were analyzed. The study employed a comprehensive approach, utilizing medical records, clinical assessments, and validated psychometric instruments. Statistical analyses included chi-square tests, logistic regression, and ROC curve analyses, culminating in the development of a predictive nomogram.

RESULTS

The prevalence of NSSI behaviors was strikingly high at 73.32%. Significant predictors included female gender (AOR = 2.14, 95% CI [1.70, 2.68]), presence of hallucinations (AOR = 1.52, 95% CI [1.18, 1.97]), borderline personality features (AOR = 1.03, 95% CI [1.01, 1.08]), and childhood trauma (AOR = 1.02, 95% CI [1.01, 1.03]). The study's key contribution is a predictive nomogram with an AUC of 0.74, demonstrating good efficacy in predicting NSSI behaviors.

CONCLUSION

This research reveals an alarmingly high prevalence of NSSI behaviors in Chinese adolescents with mood disorders and identifies critical predictors spanning demographic, clinical, and psychometric domains. The developed nomogram offers a novel approach for risk assessment, highlighting the importance of comprehensive evaluations in adolescent mental healthcare. These findings have significant implications for developing targeted interventions and improving risk assessment strategies in clinical practice.

Self-injury and suicidal behaviors in high-risk adolescents: Distal predictors, proximal correlates, and interactive effects of impulsivity and emotion dysregulation

Suicide rates are rising among U.S. youth, yet our understanding of developmental mechanisms associated with increased suicide risk is limited. One high-risk pathway involves an interaction between heritable trait impulsivity and emotion dysregulation (ED). Together, these confer increased vulnerability to nonsuicidal self-injury (NSSI), suicide ideation (SI), and suicide attempts (SAs). Previous work, however, has been limited to homogeneous samples. We extend the Impulsivity × ED hypothesis to a more diverse sample of adolescents (N = 344, ages 12-15 at Baseline, 107 males and 237 females) who were treated for major depression and assessed four times over two years. In multilevel models, the impulsivity × ED interaction was associated with higher levels and worse trajectories of NSSI, SI, and SAs. As expected, stressful life events were also associated with poorer trajectories for all outcomes, and NSSI was associated with future and concurrent SI and SAs. These findings extend one developmental pathway of risk for self-harming and suicidal behaviors to more diverse adolescents, with potential implications for prevention.

Changes in Emotion Regulation During the Course of Dialectical Behaviour Therapy: Effects on Non-Suicidal Self-Injury and Binge Eating Across Two Samples

Dialectical Behaviour Therapy (DBT) has demonstrated effectiveness in reducing harmful behaviours associated with emotion dysregulation, including non-suicidal self-injury (NSSI) and binge eating. It has been hypothesized that the effects of DBT on NSSI and binge eating are the result of improvements in emotion regulation (ER); however, the extent to which changes in ER account for reductions in these behaviours is unclear. The present study leverages two unique clinical samples to examine the degree to which changes in ER influence changes in the frequency of NSSI and binge eating over the course of DBT. Participants included 189 Veterans receiving outpatient DBT and 117 civilians enrolled in a DBT Intensive Outpatient Program. Analyses examined changes in ER, binge eating and NSSI over the course of treatment, as well as the extent to which NSSI and binge eating frequency were influenced by changes in ER. In the Veteran sample, DBT led to improvements in ER abilities and significant reductions in NSSI and binge eating; however, changes in ER did not account for observed reductions in NSSI or binge eating. In the civilian sample, the effects of DBT on ER, NSSI and binge eating were nonsignificant. Our findings suggest that ER may not be the only mechanism through which DBT exerts its effects on NSSI and binge eating. The effects of DBT on ER and self-damaging behaviours may vary based on factors such as treatment setting, time in treatment and clinical severity of the sample.

A Multi-Mediation Analysis of the Association between Adverse Childhood Experiences and Non-Suicidal Self-Injury among South African Adolescents

The available research findings suggest that non-suicidal self-injury (NSSI) constitutes an important public health issue, with identified risk factors for NSSI having been found to include exposure to adverse childhood experiences (ACEs) and comorbidity with various mental disorders. However, the available findings have, for the most part, been based on the experiences of individuals living in predominantly high-income countries located in the Global North, and it is not clear whether these findings can be confidently generalised to individuals living in low-resourced countries. As such, this cross-sectional study assessed risk factors for NSSI in a non-clinical sample of 636 South African adolescents (12-18 years old), with the data being analysed using a multi-mediation analysis. ACEs were assessed using a revised version of the ACEs Questionnaire, and NSSI was assessed using items adapted from the Self-Harm subscale of the Risk-Taking and Self-Harm Inventory for Adolescents, with emotion dysregulation, depression, and PTSD being considered as possible mediators. High prevalence rates for NSSI and exposure to five or more ACEs were reported by the participants, with the mediation analysis indicating that significant direct effects of adverse childhood experiences on NSSI were partially mediated by emotion dysregulation. These findings are discussed with respect to their implications for primary, secondary, and tertiary prevention.

Suicide attempts and non-suicidal self-injury in Chinese adolescents: Predictive models using a neural network model

INTRODUCTION

Suicide attempts (SA) are a significant contributor to suicide deaths, and non-suicidal self-injury (NSSI) can increase the risk of SA. Many adolescents experience both NSSI and SA, which are affected by various factors. This study aimed to identify the risk factors and essential warning signs of SA, establish a predictive model for SA using multiple dimensions and large samples, and provide a multidimensional perspective for clinical diagnosis and intervention.

METHODS

A total of 9140 participants aged 12-18 years participated in an online survey; 6959 participants were included in the statistical analysis. A multilayer perceptron algorithm was used to establish a prediction model for adolescent SA (with or without); adolescents with NSSI behavior were extracted as a subgroup to establish a prediction model.

RESULTS

Both the prediction model performance of the SA group and the NSSI-SA subgroup were strong, with high accuracy, and AUC values of 0.93 and 0.88, indicating good discrimination. Decision curve analysis (DCA) demonstrated that the clinical intervention value of the prediction results was high and that the clinical intervention benefits of the NSSI-SA subgroup were greater than those of the SA group.

CONCLUSIONS

Our study demonstrated that the predictive model has a high degree of accuracy and discrimination, thereby identifying significant factors associated with adolescent SA. As long as adolescents exhibit NSSI behavior, relative suicide interventions should be implemented to prevent future hazards. This study can provide guidance and more nuanced insights for clinical diagnosis as well as a foundation for clinical treatment.

Childhood Trauma and Non-Suicidal Self-Injury Among Chinese Adolescents: The Chain-Mediated Role of Alexithymia and Rumination

OBJECTIVE

To explore the associations between childhood trauma, alexithymia, rumination, and non-suicidal self-injury (NSSI) among adolescents and to provide theoretical and empirical evidence for effective prevention, identification, and intervention of NSSI in the future.

METHODS

Questionnaires, including the Childhood Trauma Questionnaire, the twenty-item Toronto Alexithymia scale, the Ruminative Responses Scale, and the Adolescents Self-Harm Scale, were given to 1,270 Chinese teenagers. The mediating role was simulated utilizing Amos 24.0.

RESULTS

The Pearson's product-difference correlation analyses indicated the two-by-two significant correlations between childhood trauma, alexithymia, rumination, and NSSI. The structural equation modeling suggests that alexithymia and rumination partially mediate between childhood trauma and NSSI in teenagers, respectively. Additionally, it reveals that alexithymia and rumination chain mediate between childhood trauma and NSSI.

CONCLUSION

The study confirms the impact of childhood trauma on adolescents' NSSI and also highlights the mediating role of alexithymia and rumination between the two. This study enriches the findings of NSSI and provides a theoretical basis for preventing and intervening in dysfunctional behaviors among adolescents.

Interrupting the Self-Harm Continuum

Background: Nonsuicidal self-injury (NSSI) has increased rapidly and is frequently linked to suicidal behavior; it has been argued that these behaviors are key points on a self-harm continuum. Aims: The current research explored self-harm and help-seeking behaviors, with the aim of identifying possibilities for prevention of further harm, including suicide. Methods: An online survey of 304 New Zealanders was undertaken, with the majority being aged under 25 and female. Results: Nearly half of the sample had engaged in self-harm and most of those had experienced suicidal thoughts; close to a quarter had made a suicide attempt. NSSI was used as a way of dealing with emotional distress. Very few sought help of any kind, especially professional support; of those who did seek professional support, most found it helpful but did not necessarily stop self-harming as a result. Limitations: Men are under-represented in the sample - though this is in accordance with the population of people who engage in NSSI. Conclusion: Many participants engaged in NSSI and also had suicidal thoughts using NSSI as an emotion regulation strategy; some participants appeared to use NSSI rather than attempting suicide. Given a link between NSSI and suicidal thoughts and behaviors, reluctance to seek help and on-going injurious behavior among some who do seek help, there is a need for increased identification and proactive support specifically focusing on improving emotion regulation and targeted at injurious behavior.

DSM-5 Non-Suicidal Self-Injury Disorder in a Clinical Sample of Adolescents with Recurrent Self-Harm Behavior

INTRODUCTION

Non-suicidal self-injury disorder (NSSID) is a new diagnosis proposed in DSM-5 with a need of further study, especially in adolescent clinical populations where non-suicidal self-injury (NSSI) is particularly prevalent. We aimed to study characteristics of NSSID and estimate an optimal cutoff frequency level of NSSI behavior.

METHODS

Data were collected from 103 outpatient adolescents (ages 12-18) with recurrent self-harm behavior.

RESULTS

Adolescents with NSSID reported significantly more frequent NSSI behavior and suicide attempts than adolescents without NSSID. Frequency of NSSI, global functioning, depressive symptoms, number of self-harm methods and anxiety symptoms best discriminated between adolescents with and without NSSID. An optimal cutoff level for a diagnosis of NSSID was found to be ≥15 days with NSSI during the last year, which led to a reduction in the rate of adolescents diagnosed with NSSID from 54% to 46%.

CONCLUSION

This study shows that NSSID is a highly impairing disorder characterized by high risk of multiple NSSI and suicide attempts, decreased functioning and other associated psychiatric disorders. Clinical awareness of these risks are important to ensure early detection and treatment. Future prospective longitudinal studies are needed to further validate the characteristics of the NSSID diagnosis and its clinical utility.

Suicidal Ideation and Non-Suicidal Self-Injury Following Early Childhood Psychotic Experiences in Preadolescent Children at Familial High Risk of Schizophrenia or Bipolar Disorder-The Danish High Risk and Resilience Study, VIA 11

BACKGROUND AND HYPOTHESIS

Suicide is a leading cause of death in youth and is often preceded by suicidal ideation (SI) and non-suicidal self-injury (NSSI). Identifying early markers of risk for SI and NSSI could improve timely identification of at-risk individuals.

STUDY DESIGN

Children (mean age 11.9, SD 0.2) at familial high risk of schizophrenia (N = 171), or bipolar disorder (N = 104), and controls (N = 174) were assessed for psychotic experiences (PE), SI, NSSI, and Axis I mental disorders in face-to-face interviews in early and middle childhood (age 7 and 11).

STUDY RESULTS

Having 2 types of early childhood PE predicted middle childhood SI after accounting for previous SI, NSSI, and mental disorders (OR 2.8, 95% CI 1.1-6.9; P = .03). Two PE predicted NSSI (OR 3.0, 95% CI 1.2-7.7; P = .02) in excess of previous SI, NSSI, mental disorders, and familial risk. Persistent and incident PE predicted SI (OR 3.2, 95% CI, 1.1-8.8; P = .03; OR 3.8, 95% CI, 1.3-11.5; P = .02) in the fully adjusted model. Nineteen percent of children with persistent PE reported middle childhood SI vs 3.8% of those who never reported PE. In children with early childhood mental disorders, those who reported 2 PE had 4.4-fold increased odds of later SI (95% CI, 1.2-16.7; P = .03) after adjustments. PE were nondifferentially associated with outcomes across familial risk groups.

CONCLUSIONS

Early childhood PE index elevated risk for subsequent SI and NSSI beyond what can be attributed to presence of mental disorders. Mental health screenings and clinical assessments should include early childhood PE.

Improving capacity to identify, assess, and manage adolescents engaging in non-suicidal self-injury using patient avatars

PURPOSE

We developed and evaluated a training comprising a didactic and virtual practice session with human-guided patient avatars to increase pediatric residents' competence to identify and assess non-suicidal self-injury (NSSI) and suicide risk.

METHODS

Thirty pediatric residents at three children's hospitals in Florida participated in the training and completed pre-, one-month post-, and three-months post-training surveys. One-way repeated measures ANOVA with post-hoc comparisons determined changes in confidence, comfort, behavioral intentions, attitudes, knowledge, and behavior over time. Qualitative responses provided feedback on the training, especially the novel practice session with adolescent patient avatars.

RESULTS

Three-months post-training residents expressed significantly greater confidence in talking to adolescents who self-injure, applying the SOARS method to assess self-injury, and assessing functions/reasons for self-injury; reported feeling significantly more comfortable asking about self-injury, well-equipped to handle the emotional aspects of self-injury, and comfortable treating adolescents who self-injure; reported greater behavioral intentions to talk to adolescents about self-injury, assess an adolescent's stage of change for stopping self-injury, and provide brief interventions for adolescents who self-injure; and used SOARS to evaluate current NSSI with a greater proportion of adolescent patients. Qualitative feedback expressed positive perceptions, especially related to the virtual-reality role-play session.

CONCLUSIONS

Incorporating an interactive, human-guided virtual experience using role-playing and feedback with patient avatars represents a viable option comparable to using typical standardized patients to expand the scalability of NSSI trainings for pediatric residents, especially when they occur virtually.

Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review

BACKGROUND

A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures.

METHODS

We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report.

RESULTS

This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration.

CONCLUSION

This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.

Cybervictimization and non-suicidal self-injury among Chinese adolescents: The effect of depression and school connectedness

Cybervictimization has been shown in many studies to be a risk factor for adolescent non-suicidal self-injurious behavior (NSSI). In this study we tested the roles of depression and school connectedness in this association. The Integrative Model of NSSI, Emotion Regulation and Interpersonal Relationship Model of NSSI, and Integrative Model of Social Media and Suicide provided the conceptual framework for the study. A sample of 1106 adolescents (Mage = 13.17; SD = 0.69; 51.78% girls) completed anonymous questionnaires in their classrooms. The results of structural equation modeling showed that the positive association between cybervictimization and adolescent NSSI was mediated by depression. Moreover, this indirect link was stronger for adolescents with low vs. high school connectedness. The results have implications for intervention programs aimed at reducing NSSI among adolescents.

Association of sociodemographic, proximal, and distal clinical factors with current suicidal ideation: Findings from a nonclinical sample of young adults

BACKGROUND

Accumulating evidence indicates that a variety of distal and proximal factors might impact a risk of suicide. However, the association between both groups of factors remains unknown. Therefore, in the present study, we aimed to investigate the interplay between distal and proximal correlates of the current suicidal ideation.

METHODS

A total of 3,000 individuals (aged 18-35 years, 41.7% males), who had reported a negative history of psychiatric treatment, were enrolled through an online computer-assisted web interview. Self-reports were administered to measure: (a) distal factors: a history of childhood trauma (CT), reading disabilities (RDs), symptoms of attention-deficit/hyperactivity disorder (ADHD), lifetime history of non-suicidal self-injury (NSSI), lifetime problematic substance use as well as family history of schizophrenia and mood disorders; (b) proximal factors: depressive symptoms, psychotic-like experiences (PLEs), and insomnia; and (c) sociodemographic characteristics.

RESULTS

Suicidal ideation was directly associated with unemployment, being single, higher level of RD, lifetime history of NSSI as well as higher severity of PLEs, depression, and insomnia. The association of distal factors with suicidal ideation was fully (a history of CT and symptoms of ADHD) or partially (a history of NSSI and RD) mediated by proximal factors (PLEs, depression, and insomnia).

CONCLUSIONS

Main findings from this study posit the role of distal factors related to neurodevelopmental disorders, CT and NSSI in shaping suicide risk. Their effects might be partially or fully mediated by depression, PLEs, and insomnia.

Self-mutilation in people with psychiatric diagnosis - literature review

Introduction: Self-mutilation is of an auto-aggressive nature. They take many forms. Usually they do not occur as an isolated phenomenon. Self-injuring persons often have a diagnosed mental disorder, and a psychiatric diagnosis is one of the risk factors for the occurrence of self-harm. Material and method: In this study, articles were analyzed that contained information on the occurrence of various mental disorders. These articles searched for information on the occurrence of self-mutilation, its type, origin and causes.  Discussion: Self-mutilation is common in patients with a psychiatric diagnosis. The frequency of such behaviors can range from 33% to 50% in people with autism, up to 22%, and even 49% in people diagnosed with psychotic disorders. Acts of selfharm may affect 50-78% of people diagnosed with border-line personality disorder. In adolescents with eating disorders, 41% of patients report self-harm. In the group of people diagnosed with bipolar disorder, it may be as high as 77.3%. People with depression are also a large self-injuring group. It is reported that it may be up to 71.2% of patients with unipolar disorder. Conclusions: Self-mutilation is a phenomenon that is more and more topical and common not only in the adolescent population. This is a multi-factorial issue. One of the risk factors are mental disorders. Self-mutineers choose various methods, and this choice depends, among others, on from recognition. The size of the phenomenon and its evolution make it necessary to study it in order to increase the level of knowledge, update information and, consequently, the ability to help people at risk of NSSI.  Keywords: self-mutilation, autism spectrum disorder, schizophrenia, bipolar disorder, personality disorders

Trajectories of nonsuicidal self‐injury during adolescence

OBJECTIVE

Although nonsuicidal self-injury is a public health concern, there is little information on how it changes across adolescence or what contributes to stability or change. We aimed to identify trajectories of stability and change in self-injury from ages 13 to 17 years, and to identify interpersonal and intrapersonal correlates that differentiate between trajectories of stability and change.

METHOD

We used five annual waves of cohort-sequential data, targeting 7th and 8th graders attending all public schools in three municipalities in central Sweden. The data were gathered via questionnaires, using a multi-item measure of non-suicidal self-injury and assessing negative experiences at home, in school, with peers, and in romantic settings, as well as intrapersonal issues (internalizing symptoms and difficulties with emotional, and behavioral regulation). The analytic sample was 3195 adolescents (51.7% boys, 48.3% girls; ages 12-16 years at T1, M = 13.61; SD = 0.66), most of whom were born in Sweden (88.6%) to at least one parent of Swedish origin (77.4%).

RESULTS

Latent growth curve modeling revealed three self-injury trajectories: a stable-low, a low-increasing, and an increasing-decreasing trajectory. Adolescents in the stable-low class reported the best overall adjustment at ages 13 and 16. Comparatively, adolescents in the other two classes reported similar levels of difficulty interpersonally and intrapersonally. Where they differed, the increase-decrease class fared worse than the low-increasing class.

CONCLUSIONS

This study suggests the need to frame self-injury as having multiple directions of development during adolescence and develop theory that aligns with differential patterns of self-injury development.

Non-suicidal self-injury and its relation to suicide through acquired capability: investigating this causal mechanism in a mainly late-diagnosed autistic sample

BACKGROUND

Non-suicidal self-injury (NSSI) has been linked with a higher risk of suicide attempts in autistic and non-autistic people. In the general population, NSSI may confer acquired capability for suicide by eroding one's fear and avoidance of pain and death. The present study aimed to explore acquired capability as the mediator of increased suicide risk conferred by NSSI in autistic and non-autistic adults.

METHODS

Autistic and non-autistic adults (n = 314, n = 312) completed an online survey exploring lifetime suicide attempts, experience with NSSI, and acquired capability for suicide. We explored relationships between lifetime incidence of NSSI and lifetime suicide attempts via three facets of acquired capability (pain tolerance, reduced fear of death, and mental rehearsal of suicide). In self-harming participants (224 autistic and 156 non-autistic), we explored whether particular types and features of NSSI might be especially associated with capability and through that with suicide: namely engagement in scratching, cutting, and self-hitting, and engaging in more numerous forms of NSSI.

RESULTS

While a higher frequency of NSSI was associated with all three facets of acquired capability, only reduced fear of death and mental rehearsal of suicide mediated an indirect relationship with lifetime suicide attempts. NSSI also directly predicted more numerous suicide attempts. Autistic people tended towards reduced fear of death and mental rehearsal regardless of NSSI status. Among self-harming autistic and non-autistic participants, cutting and an increased number of NSSI behaviours were associated with lifetime suicide attempts directly and indirectly via acquired capability. In both groups, self-hitting was associated with lifetime suicide attempts only via acquired capability.

LIMITATIONS

Our cross-sectional methodology negates inferences of directionality. While we controlled for age, our samples were poorly matched, with the autistic group two times older on average. The autistic sample, predominantly late-diagnosed, female and highly qualified, were unrepresentative of the whole autistic community.

CONCLUSIONS

Our data suggest that acquired capability, as measured herein, is an incomplete explanation for the association between NSSI and suicide risk. A broader construct with stable and transient facets may offer greater explanatory power, but it is probable that other variables explain or provide additional means through which this association arises.

A Qualitative Study of Self and Caregiver Perspectives on How Autistic Individuals Cope With Trauma

Background

Coping can moderate the relationship between trauma exposure and trauma symptoms. There are many conceptualisations of coping in the general population, but limited research has considered how autistic individuals cope, despite their above-average rates of traumatic exposure.

Objectives

To describe the range of coping strategies autistic individuals use following traumatic events.

Methods

Fourteen autistic adults and 15 caregivers of autistic individuals, recruited via stratified purposive sampling, completed semi-structured interviews. Participants were asked to describe how they/their child attempted to cope with events they perceived as traumatic. Using an existing theoretical framework and reflexive thematic analysis, coping strategies were identified, described, and organized into themes.

Results

Coping strategies used by autistic individuals could be organized into 3 main themes: (1) Engaging with Trauma, (2) Disengaging from Trauma, and (3) Self-Regulatory Coping. After the three main themes were developed, a fourth integrative theme, Diagnostic Overshadowing, was created to capture participants' reports of the overlap or confusion between coping and autism-related behaviors.

Conclusions

Autistic individuals use many strategies to cope with trauma, many of which are traditionally recognized as coping, but some of which may be less easily recognized given their overlap with autism-related behaviors. Findings highlight considerations for conceptualizing coping in autism, including factors influencing how individuals cope with trauma, and how aspects of autism may shape or overlap with coping behavior. Research building on these findings may inform a more nuanced understanding of how autistic people respond to adversity, and how to support coping strategies that promote recovery from trauma.

A Rhesus Monkey Model of Non-suicidal Self-Injury

Non-suicidal self-injury (NSSI) is a type of behavioral pathology seen not only in a variety of clinical conditions but also among non-clinical populations, particularly adolescents and young adults. With the exception of rare genetic conditions that give rise to self-harming behaviors, the etiology of NSSI and the events that trigger specific episodes of this behavior remain poorly understood. This review presents the features of an important, extensively studied animal model of NSSI, namely spontaneously occurring self-injurious behavior (SIB) in rhesus macaque monkeys. We compare and contrast rhesus monkey SIB with NSSI with respect to form, prevalence rates, environmental and biological risk factors, behavioral correlates, proposed functions, and treatment modalities. Many parallels between rhesus monkey SIB and NSSI are demonstrated, which supports the validity of this animal model across several domains. Determining the etiology of spontaneously occurring SIB in monkeys, its underlying biological mechanisms, and which pharmacological agents are most effective for treating the disorder may aid in identifying potential risk factors for the occurrence of NSSI in humans and developing medications for severe cases that are resistant to conventional psychotherapeutic approaches.

Dissecting pain processing in adolescents with Non-Suicidal Self Injury: Could suicide risk lurk among the electrodes?

Background

Although non‐suicidal self‐injury (NSSI) disorder is highly prevalent in adolescents, its relationship with pain system function and suicidality is still controversial. The present study was designed to assess the function of the nociceptive afferent pathways and the endogenous pain modulation in adolescent patients with NSSI and to longitudinally register any suicide attempt, describe its frequency and find a possible association between suicide, neurophysiological measures and psychological measures.

Methods

We enrolled 30 adolescents suffering from NSSI and 20 age‐ and gender‐matched healthy controls. Patients underwent a comprehensive psychological evaluation. Each participant underwent thermal pain thresholds of the quantitative sensory testing, laser‐evoked potential recording to study the ascending nociceptive pathway and the conditioned pain modulation testing to test the endogenous pain modulation.

Results

We found that patients with NSSI had a reduced amplitude of the N2 component of laser‐evoked potentials and an abnormal conditioned pain modulation. The amplitude of the N2 was associated with suicidal risk.

Conclusions

The deficit of the endogenous pain modulation likely depends on a saturation due to continuous pain solicitation. The strong association of a reduced amplitude of the N2 component with suicide suggests that it may serve as a possible biomarker in self‐harming adolescents.

Significance

The present study identifies the N2 component of laser‐evoked potentials as a possible neurophysiological biomarker of suicidal risk in patients with non‐suicidal self‐injury, therefore, raising the possibility for a non‐invasive test to identify subjects at higher risk of suicide among self‐harming patients.

Self-harm in the context of borderline personality disorder

The present article gives a selective overview of recent studies on the role of nonsuicidal self-injury (NSSI) and suicidal behavior in the context of borderline personality disorder (BPD). Previous research found self-harming behavior, particularly NSSI, to constitute an easily accessible marker in the early detection of individuals at risk of development of BPD. The review further summarizes studies that investigated inter-relations between BPD features and self-harming behavior over time. Mainly, affective instability has been shown to play a role in the maintenance of NSSI and the increased risk of suicidal behavior among individuals with BPD. Finally, results about the effectiveness of treatment programs on the reduction of self-harming behavior among individuals with BPD are presented.