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Guo X, Wang L, Li Z, Feng Z, Lu L, Jiang L, Zhao L. Factors and pathways of non-suicidal self-injury in children: insights from computational causal analysis. Front Public Health 2024; 12:1305746. [PMID: 38532971 PMCID: PMC10963487 DOI: 10.3389/fpubh.2024.1305746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Background Non-suicidal self-injury (NSSI) has become a significant public health issue, especially prevalent among adolescents. The complexity and multifactorial nature of NSSI necessitate a comprehensive understanding of its underlying causal factors. This research leverages the causal discovery methodology to explore these causal associations in children. Methods An observational dataset was scrutinized using the causal discovery method, particularly employing the constraint-based approach. By integrating machine learning and causal inference techniques, the study aimed to determine direct causal relationships associated with NSSI. The robustness of the causal relationships was evaluated using three methods to construct and validate it: the PC (Peter and Clark) method, Fast Causal Inference (FCI) method, and the GAE (Graphical Autoencoder) method. Results Analysis identified nine nodes with direct causal relationships to NSSI, including life satisfaction, depression, family dysfunction, sugary beverage consumption, PYD (positive youth development), internet addiction, COVID-19 related PTSD, academic anxiety, and sleep duration. Four principal causal pathways were identified, highlighting the roles of lockdown-induced lifestyle changes, screen time, positive adolescent development, and family dynamics in influencing NSSI risk. Conclusions An in-depth analysis of the factors leading to Non-Suicidal Self-Injury (NSSI), highlighting the intricate connections among individual, family, and pandemic-related influences. The results, derived from computational causal analysis, underscore the critical need for targeted interventions that tackle these diverse causative factors.
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Affiliation(s)
- Xinyu Guo
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Linna Wang
- College of Computer Science, Sichuan University, Chengdu, Sichuan, China
| | - Zhenchao Li
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ziliang Feng
- College of Computer Science, Sichuan University, Chengdu, Sichuan, China
| | - Li Lu
- College of Computer Science, Sichuan University, Chengdu, Sichuan, China
| | - Lihua Jiang
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Teaching and Research Section of General Practice, The General Practice Medical Center, West China Hospital of Sichuan University, Chengdu, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Chen XC, Xu JJ, Yin XT, Qiu YF, Yang R, Wang ZY, Han YW, Wang QK, Zhai JH, Zhang YS, Ran MS, Hu JM. Mediating role of anxiety and impulsivity in the association between child maltreatment and lifetime non-suicidal self-injury with and without suicidal self-injury. J Affect Disord 2024; 347:57-65. [PMID: 37995923 DOI: 10.1016/j.jad.2023.11.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Child maltreatment can increase the risk of lifetime non-suicidal self-injury (NSSI) and suicidal self-injury (SSI), but there is limited knowledge regarding the differences of potentially psychological mechanisms between NSSI with and without SSI. METHODS Participants, 3918 community-based Chinese young men aged 18-34 years in Chengdu, were included in this study. We investigated the association between depression, anxiety, psychosis, child maltreatment, adulthood traumatic events, impulsivity, alcohol dependence, drug abuse, and lifetime of NSSI among participants with and without SSI. Parallel mediation analysis was utilized to explore the mediators for the relation between child maltreatment and NSSI. RESULTS The prevalence of lifetime NSSI was 6.1 % (95 % CI: 5.4 %-6.9 %) among young men. Anxiety and impulsivity partially mediated the effect of child maltreatment on NSSI either with (indirect effect: 51.2 %) or without SSI (indirect effect: 34.3 %). Depression was independently and significantly associated with only NSSI but not with NSSI+SSI. Alcohol dependence and psychosis were independently and significantly associated with NSSI+SSI and mediated the effect of child maltreatment on NSSI+SSI. LIMITATIONS The cross-sectional survey data limits the robustness of the proof to the causal relationships. CONCLUSIONS Anxiety and impulsivity are associated with NSSI either with or without SSI and partially mediate the effect of child maltreatment on NSSI. Depression is associated with only NSSI, while alcohol dependence and psychosis are only associated with NSSI+SSI. It could be crucial to improve treatment and recovery of alcohol dependence and psychosis for preventing young men engaged in NSSI from attempting SSI.
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Affiliation(s)
- Xia-Can Chen
- Institute of Forensic Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Jia-Jun Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Tong Yin
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yu-Feng Qiu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Rui Yang
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Zi-Ye Wang
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yi-Wei Han
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Qi-Kai Wang
- Institute of Forensic Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Jin-Hui Zhai
- Institute of Forensic Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yu-Shu Zhang
- Institute of Forensic Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Mao-Sheng Ran
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Jun-Mei Hu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China.
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3
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Zhong Y, He J, Luo J, Zhao J, Cen Y, Song Y, Wu Y, Lin C, Pan L, Luo J. A machine learning algorithm-based model for predicting the risk of non-suicidal self-injury among adolescents in western China: A multicentre cross-sectional study. J Affect Disord 2024; 345:369-377. [PMID: 37898476 DOI: 10.1016/j.jad.2023.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 10/30/2023]
Abstract
The prevalence of non-suicidal self-injurious (NSSI) in adolescents is high. However, few studies exist to predict NSSI in this population. This study employed a machine learning algorithm to develop a predictive model, aiming to more accurately assess the risk of NSSI in Chinese adolescents. Sociodemographic, psychological data were collected in 50 schools in western China. We constructed eXtreme Gradient Boosting (XGBoost) model and multivariate logistic regression model to predict the risk of NSSI and nomograms are plotted. Data from 13,304 adolescents were used for model development, with an average age of 13.00 ± 2.17 years; 617 individuals (4.6 %) reported non-suicidal self-injury (NSSI) behaviors. The results of the XGBoost model showed that depression and anxiety were the top two predictors of NSSI in adolescents. The results of the multivariate logistic regression model showed that the risk factors for adolescent NSSI behaviors include: gender (being female), Age, Living with whom (father), History of psychiatric consultation, Stress, Depression, Anxiety, Tolerance, Emotion abreaction. The XGBoost prediction and multivariate logistic regression model showed good predictive ability. Nomograms can serve as clinical tools to assist in intervention measures, helping adolescents reduce NSSI behaviors and improve their mental and physical well-being.
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Affiliation(s)
- Yunling Zhong
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Jinlong He
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Jing Luo
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Jiayu Zhao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Yu Cen
- School of Psychiatry, North Sichuan Medical College, 55 Dongshun Road, Gaoping District, Nanchong City, Sichuan Province, China
| | - Yuqin Song
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Yuhang Wu
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Cen Lin
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Lu Pan
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Jiaming Luo
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Shunqing District, Nanchong City, Sichuan Province, China; School of Psychiatry, North Sichuan Medical College, 55 Dongshun Road, Gaoping District, Nanchong City, Sichuan Province, China.
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4
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Akbari M, Seydavi M, Firoozabadi MA, Babaeifard M. Distress tolerance and lifetime frequency of non-suicidal self-injury (NSSI): A systematic review and meta-analysis. Clin Psychol Psychother 2024; 31:e2957. [PMID: 38343352 DOI: 10.1002/cpp.2957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
NSSI has recently been recognized as a significant health issue given its documented association with psychopathology and across a broad spectrum of psychiatric disorders. It has been found that individuals experiencing heightened emotions, which is referred to as an emotional cascade, are more likely to engage in self-injury behaviour due to low levels of distress tolerance (DT). The current meta-analysis using PRISMA guidelines sought to quantify the strength of the association between DT and lifetime frequency of NSSI using 22 eligible studies (N = 14,588; F = 60.7%; age = 23.35 ± 7.30), mainly from the United States. The correlation between emotional DT and NSSI was a small negative correlation (r = -.14), and it was non-significant for behavioural DT and NSSI (r = .02). Also, the effect-size was significant for studies that used interview-based measure of NSSI (r = -.24), and it was non-significant when self-report measures of NSSI (r = -.11) utilized. The association between DT and NSSI was significant and negative across the general population (r = -.47), university students (r = -.17), and inpatients (r = -.27); surprisingly, it was significant and positive among adolescents or high school students (r = .17). The observed effect-sizes were independent of publication year, mean age and its standard deviation, study quality, female proportion, DT, NSSI measures reliability, and clinical status. Future studies on NSSI should consider DT as a spectrum from distress intolerance to distress over-tolerance, given that it seems it has different functions when different samples (e.g., adolescents) are studied.
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Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mahsa Akbarian Firoozabadi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Maryam Babaeifard
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
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5
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Yang J, Zhao Y. Examining bidirectional relations between sleep problems and non-suicidal self-injury/suicidal behavior in adolescents: emotion regulation difficulties and externalizing problems as mediators. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02334-1. [PMID: 38150149 DOI: 10.1007/s00787-023-02334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023]
Abstract
Based on previous empirical evidences and theoretical framework, sleep problems and non-suicidal self-injury (NSSI)/suicidal behavior may bidirectionally related to one another. However, this still needs to be examined through longitudinal research. Moreover, the mediating mechanisms accounting for their potential bidirectional relations have yet to be fully investigated. This study thus aimed to evaluate whether sleep problems and NSSI/suicidal behavior promoted each other directly or indirectly through the mediating roles of emotion regulation difficulties (ERD) and externalizing problems. A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82; Age range = 11-16 years old at T1) completed self-report measures on 3-time points across 1 year. Cross-lagged panel models were used to examine the focal longitudinal associations. Results revealed a predictive effect of sleep problems on NSSI and a positive bidirectional relation between sleep problems and suicidal behavior. Moreover, sleep problems exerted an indirect effect on NSSI through ERD, and vice versa. Additionally, both ERD and externalizing problems served as mediators in the pathway from suicidal behavior to sleep problems. This study disentangled the differential mediating roles of ERD and externalizing problems in the longitudinal associations between sleep problems and NSSI/suicidal behavior, which may help provide a more holistic theoretical framework through which to precisely identify key targets for early prevention and intervention of sleep problems and NSSI/suicidal behavior in adolescents.
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Affiliation(s)
- Jiaping Yang
- Department of Psychology, Guangzhou University, 230 Wai Huan Xi Rd, 510006, Guangzhou, China.
| | - Yinqiu Zhao
- School of Psychology, South China Normal University, 510631, Guangzhou, People's Republic of China
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6
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Meisler S, Sleman S, Orgler M, Tossman I, Hamdan S. Examining the relationship between non-suicidal self-injury and mental health among female Arab minority students: the role of identity conflict and acculturation stress. Front Psychiatry 2023; 14:1247175. [PMID: 38025473 PMCID: PMC10669148 DOI: 10.3389/fpsyt.2023.1247175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective Research suggests that individuals from minority backgrounds, including immigrants and ethnic minorities, may be at a higher risk for non-suicidal self-injury (NSSI). The aim of the present research is to examine the relationship between non-suicidal self-injury (NSSI) and identity conflict and acculturation stress, depression, and risk behaviors among female Arab minority students. Methods The sample analyzed consisted of 1,529 female Arab students (85.8% B.A. students, 14% M.A. students) aged 21-54 (M = 23, SD = 4.17). The participants completed self-reported questionnaires assessing NSSI engagement, identity conflict and acculturation stress, depression, and risky substance use behavior. Results As expected, we found a significant positive association between NSSI and identity crisis. In addition, an identity conflict and acculturation stress impact the effect of depression and risky substance use behaviors in engaging in self-injury. Namely, participants were more likely to engage in NSSI when they also experienced identity conflict and acculturation stress and exhibited depressive symptoms and tended to display risky substance use behavior. Conclusion These findings provide evidence that the relationship between depression, risky substance use behavior, and NSSI may be stronger among individuals who experience higher levels of identity conflict and acculturation stress. Implications for intervention and future research are briefly presented.
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Affiliation(s)
| | | | | | | | - Sami Hamdan
- The School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Tel Aviv-Yafo, Israel
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7
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Bürger A, von Schoenfeld C, Scheiner C, Seidel A, Wasserscheid A, Gad D, Kittel-Schneider S, Romanos M, Reiter AMF. Universal prevention for non-suicidal self-injury in adolescents is scarce - A systematic review. Front Psychiatry 2023; 14:1130610. [PMID: 37937233 PMCID: PMC10627158 DOI: 10.3389/fpsyt.2023.1130610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 10/02/2023] [Indexed: 11/09/2023] Open
Abstract
Non-suicidal self-injury (NSSI) during adolescence is a high-risk marker for the development and persistence of mental health problems and has been recognized as a significant public health problem. Whereas targeted prevention has indeed shown to be effective in reducing NSSI and improve mental health problems, access to such programs is limited. By face validity, universal prevention of NSSI seems an ideal starting point for a stepped-care model to circumvent a lack of resources in the medical care system. However, it is yet unclear how effective such approaches are. Here, we provide a summary of existing work on universal prevention of NSSI in adolescents younger than 21 years based on a systematic literature search. We found that only seven studies are available. None of the programs evaluated was found to be effective in reducing the incidence or frequency of NSSI. After providing a comprehensive summary of the existing work, we evaluate the fact that existing work primarily focusses on selected/targeted prevention and on psychoeducational methods. We derive implications for future directions in the field of universal prevention of NSSI.
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Affiliation(s)
- Arne Bürger
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Würzburg, Würzburg, Germany
| | - Cornelia von Schoenfeld
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Christin Scheiner
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Alexandra Seidel
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Antonia Wasserscheid
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Doreya Gad
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Acute Adult Mental Health Unit, Department of Psychiatry and Neurobehavioural Science, Cork University Hospital, Cork, Ireland
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Würzburg, Würzburg, Germany
| | - Andrea M. F. Reiter
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Würzburg, Würzburg, Germany
- Department of Psychology, University of Würzburg, Würzburg, Germany
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8
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Hu JH, Zhou DD, Ma LL, Zhao L, He XQ, Peng XY, Chen R, Chen WJ, Jiang ZH, Ran LY, Liu XY, Tao WQ, Yuan K, Wang W. A resting-state electroencephalographic microstates study in depressed adolescents with non-suicidal self-injury. J Psychiatr Res 2023; 165:264-272. [PMID: 37541092 DOI: 10.1016/j.jpsychires.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 07/15/2023] [Accepted: 07/15/2023] [Indexed: 08/06/2023]
Abstract
Neuroimaging studies have revealed abnormal brain activities in depressed teenagers who engage in non-suicidal self-injury (NSSI). We used resting-state electroencephalography (EEG) microstate analysis, which indicates the brief overlap of brain network activation for exploring the characteristics of large-scale cortical activities in depressed adolescents engaged with NSSI to clarify the underlying temporal mechanism. A modified k-means cluster algorithm was used to segment 64-channel resting-state EEG data into microstates. Data from 27 healthy adolescents, 37 adolescents with major depressive disorder (MDD), and 53 adolescents with both MDD and NSSI were examined in this study. The resting-state microstate parameters were compared among groups using the one-way ANOVA and Spearman correlation. Then the associations between significantly different microstate parameters and the depressive severity and self-harming data in the patient groups were further analyzed. The MDD group had higher contribution (p < 0.01), occurrence (p < 0.01) of microstate A, and higher microstate E→A transition (p < 0.05) than the HC and the NSSI group. The MDD group showed a distinctly longer duration (p < 0.05) of microstate A and microstate A→C transition than the HC. The transition probability from B to C was increased in the NSSI group compared to the HC. In the MDD group, the HAMD correlated with the duration of microstate A (Spearman's rho = 0.34, p = 0.044), as the PHQ-9 correlated with its occurrence (Spearman's rho = 0.37, p = 0.028). This research revealed that whereas depressive adolescents with NSSI and MDD displayed similar patterns with healthy controls in EEG microstate, the MDD group did not. Additionally, the non-random transition from microstate E→A may protect against recent self-harm in adolescents with MDD.
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Affiliation(s)
- Jin-Hui Hu
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Dong-Dong Zhou
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Lin-Li Ma
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Zhao
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Qing He
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Yu Peng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ran Chen
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Wan-Jun Chen
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-Hao Jiang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Liu-Yi Ran
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Yi Liu
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Wan-Qing Tao
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Yuan
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Wo Wang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China.
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9
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Sun K, Li A, Li Y, Xie J, Tong Y, Ma J, Wu Y. A cross-sectional study of non-suicidal self-injury in a Chinese adolescent inpatient cohort. Front Psychiatry 2023; 14:1109334. [PMID: 37293407 PMCID: PMC10244503 DOI: 10.3389/fpsyt.2023.1109334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/05/2023] [Indexed: 06/10/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) is a significant predictor of completed suicide and is increasingly recognized as a serious public health concern. Multiple factors, including social, familial, mental, and genetic factors could influence the occurrence of this behavior. Identifying the early risk factors is important for screening and preventing this behavior. Methods Here, we recruited a total of 742 adolescent inpatient participants from a mental health center and conducted a series of diagnostic interviews and questionnaires to assess NSSI behavior and other events. Bivariate analysis was used to detect differences between groups in NSSI and non-NSSI. Then, binary logistic regression was fitted to identify predictors of NSSI as a function of these questionnaire scores. Results Of the 742 adolescents examined, a total of 382 (51.5%) participants engaged in NSSI. Bivariate analysis showed that age, gender, depression, anxiety, insomnia, and childhood trauma was significantly associated with NSSI. Logistic regression results suggested that females had 2.43 higher odds of engaging in NSSI when compared to their male counterparts (OR = 3.43, 95%CI = 2.09-5.74, p = 1.70 × 10-6). Depression was a primary risk predictor for NSSI with each additional increase in symptoms of depression increasing the odds of engaging in NSSI by 18% (OR = 1.18, 95%CI = 1.12-1.25, p = 2.25 × 10-8). Conclusion More than half of the adolescent inpatients with psychiatric disorders have NSSI experience. Depression and gender were the risk factors for NSSI. Age at a specific range had a high prevalence of NSSI.
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Affiliation(s)
- Ke Sun
- Department of Child and Adolescent Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Anni Li
- Department of Child and Adolescent Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Yichen Li
- Department of Child and Adolescent Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Jun Xie
- Department of Child and Adolescent Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Yonghao Tong
- Department of Child and Adolescent Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Jun Ma
- Department of Child and Adolescent Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Wu
- Research Center for Mental Health and Neuroscience, Wuhan Mental Health Center, Wuhan, Hubei, China
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10
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Duncan-Plummer T, Hasking P, Tonta K, Boyes M. Cognitive-emotional networks in students with and without a history of non-suicidal self-injury. J Affect Disord 2023; 329:394-403. [PMID: 36828146 DOI: 10.1016/j.jad.2023.02.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Contemporary models of non-suicidal self-injury (NSSI) suggest that emotional vulnerabilities, negative self-schemas, and beliefs about NSSI work together to differentiate students who self-injure from those who do not. However, it is unclear how these mechanisms are differentially related among students with and without a history of NSSI. Considering this, we used a network analysis approach to explore how students with and without a history of NSSI vary in processing their emotional experiences in relation to their self-concepts and beliefs about NSSI. METHOD A sample of 480 university students (Mage = 21.18, SD = 2.43; 73.5 % female) completed self-report measures about their perceived emotional experiences (e.g., emotional reactivity, emotion regulation difficulties), self-concepts (e.g., self-esteem, self-efficacy), and NSSI. RESULTS A network comparison test revealed that students with a history of NSSI perceived themselves to have difficulties regulating particularly intense, unwanted negative emotions. In light of this, students with a history of NSSI expected some benefits of NSSI (e.g., emotion regulation) regardless of potential barriers (e.g., pain). Conversely, for students without a history of NSSI, expecting NSSI to have aversive outcomes was tied to expecting NSSI to have few benefits. LIMITATIONS The cross-sectional design limits inferences to be made about the network structures. CONCLUSIONS Students with and without a history of NSSI appear to differ in their cognitive processing of negative emotions and strategies used to deal with these emotions.
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Affiliation(s)
- Thomas Duncan-Plummer
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Penelope Hasking
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
| | - Kate Tonta
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - Mark Boyes
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
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Yang L, Jia FF, Lu XY, Jia CX. Internalizing and externalizing problems mediate the relationship between maltreatment and self-harm among UK adolescents. J Affect Disord 2023; 333:240-248. [PMID: 37084976 DOI: 10.1016/j.jad.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Maltreatment is a significant predictive factor for self-harm in adolescents. Internalizing and externalizing problems are both common psychopathological issues in adolescents. This study aimed to look into the link between maltreatment and self-harm in a large sample of adolescents in the UK, as well as the mediating effects that internalizing and externalizing problems play in this link. METHODS Data were pulled from the UK Millennium Cohort Study, and a total of 8894 adolescents were included in this analysis. All variables were assessed by Questionnaires. Path analysis was performed to assess the mediating effects of internalizing and externalizing problems in the link between maltreatment and self-harm. RESULTS 23.4 % of samples reported self-harm incidents during the preceding 12 months. Emotional abuse and physical abuse were significantly related to self-harm, and adolescents who had experienced multiple forms of maltreatment were more prone to self-harm. Mediation analysis revealed that internalizing problems were the primary mediator in the link between emotional abuse and self-harm, with the mediation effect size being 0.29. Internalizing and externalizing problems performed similarly in the link between physical abuse and self-harm, with mediation effect sizes of 0.23 and 0.19, respectively. LIMITATIONS The majority of the data was gathered through self-reporting. CONCLUSIONS Emotional abuse and physical abuse were significant predictors of self-harm, and their links with self-harm were partially mediated via internalizing and externalizing problems. Better supervision of maltreatment, and timely intervention for both internalizing and externalizing problems, are critical in preventing self-harm among adolescents.
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Affiliation(s)
- Li Yang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Fei-Fei Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Xin-Yi Lu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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12
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Zheng Q, Liu J, Ji Y, Zhang Y, Chen X, Liu B. Elevated levels of monocyte-lymphocyte ratio and platelet-lymphocyte ratio in adolescents with non-suicidal self-injury. BMC Psychiatry 2022; 22:618. [PMID: 36123674 PMCID: PMC9483869 DOI: 10.1186/s12888-022-04260-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) are blood indicators of systemic inflammation. This study aims to compare the levels of inflammatory indicators derived from blood routine tests between adolescents with non-suicidal self-injury (NSSI) and those with non-NSSI. METHODS A total of 201 adolescents with mood or emotional disorders were enrolled in this study, among which 106 had engaged in NSSI and 95 had never engaged in NSSI. NLR, MLR, and PLR were calculated based on the complete blood cell count. RESULTS There was no significant difference in demographic data between the two groups. The NSSI group exhibited significantly higher MLR (P = 0.001) and PLR (P = 0.007) than the non-NSSI group. Multivariate logistic regression analysis revealed that MLR (OR 1.545, 95%CI [1.087-2.281], P = 0.021) and PLR (OR 1.327, 95%CI [1.215-1.450], P < 0.001) were independently associated with NSSI. Receiver operating characteristic (ROC) curve analyses demonstrated that for differentiating NSSI from non-NSSI, the optimal cut-off value of MLR was 0.135 and the area under curve was 0.638 ([0.561- 0.715], P < 0.001), with a sensitivity of 90.60% and a specificity of 33.70%; the optimal cut-off value of PLR was 127.505 and the area under curve was of 0.611 ([0.533-0.689], P < 0.001), with a sensitivity of 39.60% and a specificity of 81.10%. CONCLUSIONS Systemic inflammation, as indicated by elevated MLR and PLR, was found to be strongly associated with NSSI among adolescents.
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Affiliation(s)
- Qi Zheng
- Department of Psychology, Xiamen Xianyue Hospital, Xiamen, 361000 Fujian China
| | - Jin Liu
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - YaJuan Ji
- Department of Psychology, Xiamen Xianyue Hospital, Xiamen, 361000 Fujian China
| | - Yan Zhang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - XinChao Chen
- Department of Psychology, Xiamen Xianyue Hospital, Xiamen, 361000, Fujian, China.
| | - BangShan Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Prevalence of suicidal ideation and self-harm behaviours in children aged 12 years and younger: a systematic review and meta-analysis. Lancet Psychiatry 2022; 9:703-714. [PMID: 35907406 DOI: 10.1016/s2215-0366(22)00193-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Suicide in children is a pressing public health concern. The increasing number of deaths by suicide and emergency visits for suicidal ideation and self-harm in children might not be fully representative; it is likely that many more children are in distress but do not seek out help. We conducted a systematic review and meta-analysis of existing studies to quantify the prevalence of suicidal ideation and self-harm behaviours among children in the community aged 12 years and younger. METHODS In this systematic review and meta-analysis, we searched PsycINFO, MEDLINE, and Web of Science via OVID from database inception to Feb 28, 2022, for articles published in French or English that reported estimates of prevalence of suicidal ideation (including suicide planning) and self-harm behaviours (namely, self-harm, suicide attempts, and non-suicidal self-injury) in children aged 12 years and younger. Reference lists were also searched; case studies, qualitative studies, and health-care visit studies were excluded. The outcomes were suicidal ideation, suicide plan or attempts, and self-harm. We used a random-effects model to calculate the overall pooled prevalence of suicidal ideation and self-harm behaviours for all timeframes combined and for ever versus the past 12 months for suicidal ideation. We used the Joanna Briggs Institute Critical Appraisal tool to evaluate the risk of bias in each study. This study is registered with PROSPERO, CRD42020179041. FINDINGS 28 articles, encompassing 30 studies overall, met the inclusion criteria, aggregating findings from 98 044 children (of whom 46 980 [50·5%] were girls and 46 136 [49·5%] were boys; six articles did not report sex or gender) aged 6-12 years. The pooled prevalence estimate was 7·5% (95% CI 5·9-9·6) for suicidal ideation from 28 studies and 2·2% (2·0-2·5) for suicide planning from three studies. The pooled prevalence was 1·4% (0·4-4·7) for self-harm from four studies, 1·3% (1·0-1·9) for suicide attempt from six studies, and 21·9% (6·2-54·5) for non-suicidal self-injury from two studies. The prevalence of suicidal ideation was higher in studies that included child-reported outcomes (10·9% [95% CI 8·1-14·5] for child only and 10·4% [6·8-15·5] for child and parent combined) than for parent-only reported outcomes (4·7% [3·4-6·6]; p=0·0004). The prevalence of suicidal ideation and self-harm behaviours was similar in boys and girls (suicidal ideation, 7·9% [95% CI 5·2-12·0] for boys vs 6·4% [3·7-10·7] for girls; self-harm behaviours, 3·5% [1·6-7·2] for boys vs 3·0% [1·4-6·4%] for girls). Detailed ethnicity data were not available. High heterogeneity was identified across estimates (I2>90%), which was not well explained by the characteristics of the studies. INTERPRETATION A high number of children in the general population can experience suicidal ideation and self-harm behaviours, thus underlining the need for more research on childhood suicide, including developmentally appropriate preventive strategies, such as youth-nominated support teams or dialectical behavioural therapy. FUNDING Canada Research Chair in Youth Mental Health and Suicide Prevention.
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Hartig A, Voss C, Herrmann L, Fahrenkrug S, Bindt C, Becker-Hebly I. Suicidal and nonsuicidal self-harming thoughts and behaviors in clinically referred children and adolescents with gender dysphoria. Clin Child Psychol Psychiatry 2022; 27:716-729. [PMID: 35213240 PMCID: PMC9234769 DOI: 10.1177/13591045211073941] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Young transgender or gender nonconforming (TGNC) children and adolescents or those with a gender dysphoria (GD) diagnosis show an increased risk of suicidal and nonsuicidal self-harming thoughts and behaviors (STBs). Data from German-speaking regions on this topic and studies comparing self- and parent-reported STBs have been scarce. The study aims were therefore to examine: (a) frequencies of self- and parent-reported STBs in a German clinical sample of children and adolescents with GD and (b) differences between age and gender groups, as well as between self- and parent-reports. METHODS Two items from the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR) were used to assess self- and parent-reported STBs in a sample of 343 adolescents and 49 children who presented to the Hamburg Gender Identity Service (Hamburg GIS) between 2013 and 2019. Seventy-eight percent of the analysis sample was assigned female at birth (AFAB), and 22% were assigned male at birth (AMAB). RESULTS Parents reported STBs on the CBCL for 16% and 6% of the cases in childhood and for 20% and 29% of the adolescent cases, respectively. STBs were self-reported by 38% and 45% of the adolescents who could report on the YSR. STBs were higher among adolescents than among children and in self-reports (YSR) compared to parent reports (CBCL). AFAB adolescents reported higher degrees of STBs than AMAB adolescents. CONCLUSIONS Children and adolescents with GD are a high-risk population for STBs, especially pubescent and AFAB individuals. Mental health professionals should screen early for STBs to prevent possible suicidal ideation-to-action transitions.
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Affiliation(s)
- Amelie Hartig
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, 37734University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Catharina Voss
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, 37734University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, 9169Technical University Dresden, Dresden, Germany
| | - Lena Herrmann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, 37734University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Saskia Fahrenkrug
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, 37734University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, 37734University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, 37734University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Liu CR, Wan LP, Liu BP, Jia CX, Liu X. Depressive symptoms mediate the association between maternal authoritarian parenting and non-suicidal self-injury among Chinese adolescents. J Affect Disord 2022; 305:213-219. [PMID: 35278486 DOI: 10.1016/j.jad.2022.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a significant public health concern. Authoritarian parenting is a common parenting style in China. Authoritarian parenting is associated with NSSI in adolescents. Little is known about the mechanism underlying this association. This study was to investigate the mediating effect of depressive symptoms on the association between maternal authoritarian parenting and NSSI among Chinese adolescents. METHODS A total of 7072 adolescents who participated in the 1-year follow-up of Shandong Adolescent Behavior & Health Cohort (SABHC) were included for the analysis. A self-administered questionnaire was used to assess authoritarian parenting, depressive symptoms, non-suicidal self-injury, and family demographics in November-December in 2015. One year later, a follow-up survey was carried out to assess participants' depressive symptoms and NSSI. RESULTS Of the sample, mean age was 14.58 (SD = 1.46) and 3536 (50%) were female at baseline. 19.4% adolescents reported having ever NSSI over the past 12 months at baseline, and 8.8% reported having ever NSSI at 1-year follow-up. The association of maternal authoritarian parenting with subsequent NSSI was at least partially mediated by depressive symptoms. Mediation analyses showed that effect size was 0.194 in the entire sample, 0.192 in females and 0.193 in males, respectively. LIMITATION All variables were measured based on self-report. CONCLUSIONS Maternal authoritarian parenting style is a significant predictor of NSSI and its association with NSSI is partially mediated by depressive symptoms among Chinese adolescents. It may be important to intervene poor parenting styles and depression to reduce the risk of NSSI in Chinese adolescents.
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Affiliation(s)
- Cai-Rui Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University and Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Li-Peng Wan
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University and Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University and Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University and Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China.
| | - Xianchen Liu
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
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16
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Sparrow-Downes VM, Trincao-Batra S, Cloutier P, Helleman AR, Salamatmanesh M, Gardner W, Baksh A, Kapur R, Sheridan N, Suntharalingam S, Currie L, Carrie LD, Hamilton A, Pajer K. Peripheral and neural correlates of self-harm in children and adolescents: a scoping review. BMC Psychiatry 2022; 22:318. [PMID: 35509053 PMCID: PMC9066835 DOI: 10.1186/s12888-022-03724-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-harm in children and adolescents is difficult to treat. Peripheral and neural correlates of self-harm could lead to biomarkers to guide precision care. We therefore conducted a scoping review of research on peripheral and neural correlates of self-harm in this age group. METHODS PubMed and Embase databases were searched from January 1980-May 2020, seeking English language peer-reviewed studies about peripheral and neural correlates of self-harm, defined as completed suicide, suicide attempts, suicidal ideation, or non-suicidal self-injury (NSSI) in subjects, birth to 19 years of age. Studies were excluded if only investigating self-harm in persons with intellectual or developmental disability syndromes. A blinded multi-stage assessment process by pairs of co-authors selected final studies for review. Risk of bias estimates were done on final studies. RESULTS We screened 5537 unduplicated abstracts, leading to the identification of 79 eligible studies in 76 papers. Of these, 48 investigated peripheral correlates and 31 examined neural correlates. Suicidality was the focus in 2/3 of the studies, with NSSI and any type of self-harm (subjects recruited with suicidality, NSSI, or both) investigated in the remaining studies. All studies used observational designs (primarily case-control), most used convenience samples of adolescent patients which were predominately female and half of which were recruited based on a disorder. Over a quarter of the specific correlates were investigated with only one study. Inter-study agreement on findings from specific correlates with more than one study was often low. Estimates of Good for risk of bias were assigned to 37% of the studies and the majority were rated as Fair. CONCLUSIONS Research on peripheral and neural correlates of self-harm is not sufficiently mature to identify potential biomarkers. Conflicting findings were reported for many of the correlates studied. Methodological problems may have produced biased findings and results are mainly generalizable to patients and girls. We provide recommendations to improve future peripheral and neural correlate research in children and adolescents, ages 3-19 years, with self-harm.
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Affiliation(s)
- Victoria M. Sparrow-Downes
- grid.25055.370000 0000 9130 6822Department of Family Medicine Residency Program, Memorial University of Newfoundland, NL St. John’s, Canada
| | - Sara Trincao-Batra
- grid.25055.370000 0000 9130 6822Department of Pediatrics Residency Program, Memorial University of Newfoundland, NL St. John’s, Canada
| | - Paula Cloutier
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - Amanda R. Helleman
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - Mina Salamatmanesh
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - William Gardner
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, ON Ottawa, Canada
| | - Anton Baksh
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada
| | - Rishi Kapur
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada
| | - Nicole Sheridan
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - Sinthuja Suntharalingam
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada
| | - Lisa Currie
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, ON Ottawa, Canada
| | - Liam D. Carrie
- Research Fellow, Harbourfront Health Group, Grand Falls, NB Canada
| | - Arthur Hamilton
- grid.34428.390000 0004 1936 893XPhD Program, Department of Cognitive Science, Carleton University, Ottawa, ON Canada
| | - Kathleen Pajer
- CHEO Research Institute, Ottawa, ON, Canada. .,Department of Psychiatry, University of Ottawa, ON, Ottawa, Canada.
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The Relation between Neuroticism and Non-Suicidal Self-Injury Behavior among College Students: Multiple Mediating Effects of Emotion Regulation and Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052885. [PMID: 35270578 PMCID: PMC8910599 DOI: 10.3390/ijerph19052885] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 01/07/2023]
Abstract
Background: Non-suicidal self-injury (NSSI) behavior among college students is a focus of attention in current society. In the information era, the Internet serves as a public health concern and as an effective pathway for prevention. In order to reduce NSSI behavior, we explore its influence factors, especially the relations between neuroticism, emotion regulation (ER), depression, and NSSI behavior. Methods: A total of 450 college students were surveyed with the Big Five Inventory-2, Emotion Regulation Questionnaire, Self-Rating Depression Scale, and Adolescent Non-Suicidal Self-Injury Assessment Questionnaire. Results: Regression analysis showed that neuroticism significantly negatively predicted emotion regulation, while it positively predicted depression and NSSI. Multiple mediation modeling demonstrated that neuroticism and emotion regulation had no significant direct effects on NSSI. However, neuroticism could indirectly affect NSSI through four pathways of multiple mediating effects, including depression, cognitive reappraisal-depression, expressive suppression-depression, and cognitive reappraisal-expressive suppression-depression. Conclusions: Neuroticism positively predicts depression and NSSI behavior, and affects NSSI through the mediating effect of ER and depression. Therefore, amelioration of neuroticism from the perspectives of emotion regulation and depression is recommended, so as to reduce NSSI behavior among college students with highly neurotic personalities.
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Miscioscia M, Angelico C, Raffagnato A, Gatta M. Psychopathological and Interactive-Relational Characteristics in Non-Suicidal Self-Injury Adolescent Outpatients. J Clin Med 2022; 11:jcm11051218. [PMID: 35268309 PMCID: PMC8911069 DOI: 10.3390/jcm11051218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Non-suicidal self-injury (NSSI) is described as behaviors that directly and intentionally inflict damage to body tissue without suicidal intent and for reasons not linked to cultural expectations or norms. Literature has confirmed several “specific risk factors” related to NSSI behaviors; emotional reactivity, internalizing problems, alexithymia traits, and maladaptive family functioning can predispose an individual to intrapersonal and interpersonal vulnerabilities related to difficulties in regulating one’s own cognitive-emotional experience. The present study aims to analyze and define the psychopathological and family interactive-relational characteristics of adolescents with NSSI through a case-control study. Thirty-one patients with NSSI and thirty-one patients without NSSI paired for sex, age, and psychiatric diagnosis (ICD-10) were recruited in Padua among two Child Neuropsychiatry Units before the COVID-19 pandemic. Results show a higher prevalence of internalizing problems, alexithymia trait related to “difficulty identifying feelings”, and lower quality of family functioning related to inclusion of partners, child involvement, and child self-regulation. These results carry significant implications for the clinical management and therapeutic care of non-suicidal self-injury patients and further confirm the need for an in-depth investigation of internalizing problems, alexithymia, and quality of family interactions.
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Affiliation(s)
- Marina Miscioscia
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padova, Italy; (C.A.); (A.R.); (M.G.)
- Department of Developmental and Social Psychology, University of Padua, 35131 Padova, Italy
- Correspondence: ; Tel.: +39-(049)-821-1160
| | - Caterina Angelico
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padova, Italy; (C.A.); (A.R.); (M.G.)
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padova, Italy; (C.A.); (A.R.); (M.G.)
| | - Michela Gatta
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padova, Italy; (C.A.); (A.R.); (M.G.)
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Poudel A, Lamichhane A, Magar KR, Khanal GP. Non suicidal self injury and suicidal behavior among adolescents: co-occurrence and associated risk factors. BMC Psychiatry 2022; 22:96. [PMID: 35139825 PMCID: PMC8827284 DOI: 10.1186/s12888-022-03763-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and suicidal behavior (SB) are the major public health problems in adolescents. Despite the increased focus on these phenomena, there exist no reliable data in Nepal. This study aimed to determine the prevalence of NSSI and SB among adolescents. Furthermore the study identified the relationship between these two behaviors and assessed demographic, behavioral, and psychological risk factors of NSSI and SB in Nepalese adolescents in a representative sample of the general population. METHODS The study was conducted among 730 adolescents studying in grade 9 to 12 of public and private schools of Pokhara Metropolitan city, Nepal. Data were collected through self administered standard tools- Functional Assessment of Self Mutilation (FASM) tool, Suicidal Behaviors Questionnaire-Revised (SBQ-R), Rosenberg self-esteem scale (RSES) and Beck Depression Inventory (BDI). Descriptive statistical measures such as frequency, percentage, mean, standard deviation, range were used to assess demographic characteristics and adolescent's behavior regarding NSSI and suicide. For inferential analysis chi-square and one way ANOVA test was used. Furthermore, to determine the predictors of NSSI and SB, multiple logistic regression analysis was used. RESULTS Regarding behavioral characteristics, nearly half of the sample 327 (44.8%) reported a history of NSSI in past 1 year. Furthermore, 25.8% (n = 188) of the overall sample engaged in minor NSSI only and 3.42% (n = 25) engaged in at least one act of moderate/severe NSSI. The mean number of type of NSSI performed was 2.63 ± 1.71. The most common type of NSSI method used were picking at wound (27.3%), biting self (20.3%), pulling hair out (11.8%), cutting self (11.1%). Boys (52.6%) were more likely to be engaged in NSSI than girls (47.4%) (χ2 = 10.298, p = 0.002). Furthermore, among 730 adolescents who completed the SBQ-R questionnaire, 131 (17.9%) had suicidal behaviors (SB) (as defined by SBQ-R a total score ≥ 7). Regarding sex differences female were significantly higher in life time prevalence of suicidal behavior than male (χ2 = 30.26, p = 0.001). Simple Chi-square tests indicated that NSSI was significantly associated with SB (χ2 = 58.16, P < .001). Logistic regressions identified the four significant predictors of NSSI behavior: male, low-level of self-esteem (SE), moderate to severe form of depression and SB. Similarly, significant predictors of SB were: female, low-level of SE, moderate to severe form of depression and NSSI behavior. CONCLUSION The prevalence of both NSSI and SB is high in adolescents. Despite the differences between NSSI and SB a significant number of adolescents reported a history of both behaviors. Lower level of SE and moderate to severe depression were the significant predictors of both NSSI and SB. Furthermore, male and adolescents with the history of SB were at risk of NSSI behavior whereas female sex and adolescents with the history of NSSI were at risk of SB.
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Affiliation(s)
- Anju Poudel
- Tribhuvan University, Institute of Medicine, Pokhara Nursing Campus, Pokhara, Nepal.
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Ye Z, Xiong F, Li W. A meta-analysis of co-occurrence of non-suicidal self-injury and suicide attempt: Implications for clinical intervention and future diagnosis. Front Psychiatry 2022; 13:976217. [PMID: 36032240 PMCID: PMC9411747 DOI: 10.3389/fpsyt.2022.976217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and suicide attempt (SA) are risk behaviors that lead to physical injury and even death in individuals, and are a very powerful risk factor when both occur together, with individuals presenting with more severe psychological and behavioral problems. Due to the different demographic characteristics of different study subjects, an overall understanding of the incidence and occurrence of this co-occurrence is lacking to clarify the focus of clinical interventions and future research directions. METHODS A systematic search was conducted for relevant studies in English and Chinese that reported data on co-occurring non-suicidal self-injury and suicide attempts as of May 2022. The incidence of co-occurrence of non-suicidal self-injury and suicide attempt (NSSI + SA) was calculated using Stata version 16.0 software based on a random-effects model, and the differences in incidence in different populations were compared by subgroups of age group, comorbidity, and time of occurrence. The study was written in strict accordance with PRISMA norms and registration was completed on the PROSPERO platform (CRD42022329095). RESULTS A total of 37 studies (139,573 individuals) were included for meta-analysis, and the combined incidence of non-suicidal self-injury and suicide attempt co-occurrence was 9.6%. Among different groups, the prevalence of NSSI + SA was 10, 11, 6, and 26% in adolescents and young adults, adults, the general population, and people with mental illness, respectively, and the co-occurrence of NSSI + SA within 12 months was 17%. CONCLUSION There is a significant group with a history of both non-suicidal self-injury and suicide attempts and presenting with more severe symptoms clinically. Targeted prevention and intervention are urgently needed, but the direction of intervention needs further research on the occurrence trajectory of this co-occurrence. SYSTEMATIC REVIEW REGISTRATION http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42022329095, identifier: CRD42022329095.
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Affiliation(s)
- Zhiyu Ye
- School of Education Research, China University of Geosciences, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Fang Xiong
- School of Education Research, China University of Geosciences, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Wentian Li
- Wuhan Mental Health Centre, Wuhan, China
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