Clinical Characteristics Associated with Suicidal Attempt and Non-Suicidal Self-Injury in Korean Adolescents

Prefrontal brain activity and self-injurious behavior in adolescents with major depressive disorder: A functional near-infrared spectroscopy (fNIRS) study

In clinical practice, accurately identifying self-injurious behavior among adolescents with major depressive disorder (MDD) is crucial for individualized treatment. This study aimed to examine the differences in prefrontal cortex activation using the functional near-infrared spectroscopy (fNIRS) during the verbal fluency task (VFT) assessment of adolescents with MDD and self-harm (SH) compared with those without SH. A total of 60 eligible patients were included for final analysis, with the SH group containing 36 participants, and the Non-SH group containing 24 participants. We found that right middle frontal gyrus (rMFG) was more activated in the SH group than that in the Non-SH group during the VFT assessments (z = -3.591, p = 0.004, FDR correction). The z-scores of beta values of rMFG exhibited a good discriminatory power with the area under the curve (AUC) in distinguishing the two groups (AUC = 0.775, p < 0.001). These findings reveal that the fNIRS-VFT paradigm may be a useful tool for discovering neurobiological differences among adolescents with MDD.

Analyzing Co-Occurrence of Non-Suicidal Self-Injury With Suicidal Ideation and Related Factors Among Adolescents in Jeju Island

Objectives

Non-suicidal self-injury (NSSI) and suicidal behavior, including suicidal ideation (SI) and suicide attempts, are important predictors of suicide in adolescents. This study aimed to investigate the associations between NSSI, SI, NSSI+SI, mental health problems, and family factors in Korean adolescents in Jeju Island, with an emphasis on key findings.

Methods

A total of 561 adolescents completed self-report questionnaires regarding demographics, NSSI, SI, suicidal behavior, perceived family functioning, and mental health problems, which were assessed using Center for Epidemiological Studies Depression Scale for Children, Screen for Children Anxiety-Related Disorders (SCARED), and Youth Self-Report (YSR). Data were analyzed using descriptive statistics, one-way analysis of variance, chi-square test, post-hoc analyses, and multivariate logistic regression.

Results

In this study, 22.3% of adolescents reported either NSSI or SI, with 5.5% reporting NSSI and 20.7% reporting SI. Combined (NSSI+SI) group showed a significantly higher SCARED score, anxiety/depression, thought problems, attention problem, and rule breaking on YSR than did the SI only group. Higher level of depression and anxiety were significantly associated with NSSI and SI. Female sex and perceived family dissatisfaction were significantly associated factors for SI, but not for NSSI in multivariate logistic regression.

Conclusion

This study provides insights into the clinical characteristics and associated factors among adolescents with NSSI, SI, and NSSI+SI in Jeju Island. Identifying these results can inform the development of targeted prevention and intervention strategies to mitigate the negative consequences of these behaviors and contribute to a better understanding of the role of family in this context.

Predicting suicidal behavior in individuals with depression over 50 years of age: Evidence from the UK biobank

Objective

To construct applicable models suitable for predicting the risk of suicidal behavior among individuals with depression, particularly on the progression from no history of suicidal behavior to suicide attempts, as well as from suicidal ideation to suicide attempts.

Methods

Based on a prospective cohort from the UK Biobank, a total of 55,139 individuals aged 50 and above with depression were enrolled in the study, among whom 29,528 exhibited suicidal behavior. Specifically, they were divided into control (25,611), suicidal ideation (24,361), and suicide attempt (5167) groups. Least absolute shrinkage and selection operator (LASSO) regression was used to identify a subset of important features for distinguishing suicidal ideation and suicide attempts. We used the Gradient Boosting Decision Tree (GBDT) algorithm with stratified 10-fold cross-validation and grid-search to construct the prediction models for suicidal ideation or suicide attempts. To address the dataset imbalance in classifying suicide attempts, we used random under-sampling. The SHapley Additive exPlanations (SHAP) were used to estimate the important variables in the GBDT model.

Results

Significant differences in sociodemographic, economic, lifestyle, and psychological factors were observed across the three groups. Each classifier optimally utilized 8-11 features. Overall, the algorithms predicting suicide attempts demonstrated slightly higher performance than those predicting suicidal ideation. The GBDT classifier achieved the highest accuracy, with AUROC scores of 0.914 for suicide attempts and 0.803 for suicidal ideation. Distinctive predictive factors were identified for each group: while depression's inherent characteristics crucially distinguished the suicidal ideation group from controls, some key predictors, including the age of depression onset and childhood trauma events, were identified for suicide attempts.

Conclusions

We established applicable machine learning-based models for predicting suicidal behavior, particularly suicide attempts, in individuals with depression, and clarified the differences in predictors between suicidal ideation and suicide attempts.

The Association Between Media Exposure to Non Suicidal Self-Injury and Emergency Department Visits for Self-Harm

OBJECTIVE

This study aimed to evaluate the association between media exposure to non suicidal self-injury (NSSI) and emergency department (ED) visits due to self-harm in Korea, specifically before and after the initial broadcast of the song Barcode, which has an explicit focus on NSSI.

METHOD

We used the national emergency department information system to obtain data related to ED visits due to self-harm between January 1, 2014, and December 31, 2018. Using interrupted time series regression analysis, we assessed the monthly ED visits due to self-harm before and after the media exposure to NSSI on March 30, 2018. In addition, self-harm methods were assessed.

RESULTS

A total of 35,928,834 visits to ED were identified, of which 115,647 were due to self-harm. ED visits due to self-harm showed a significant step increase in the 10- to 14-year-old (β = 0.883, p = .001), 15- to 19-year-old (β = 2.941, p < .001), 20- to 24-year-old (β = 1.997, p = 0.002), and 25- to 29-year-old (β = 1.438, p = .029) age groups, before and after the media exposure to NSSI. The most pronounced increase was observed in male participants aged 20 to 24 years (β = 1.790, p = .012) and female participants aged 15 to 19 years (β = 5.158, p < .001). Self-harm by cutting has increased significantly in participants aged 10 to 29 years, and self-harm by poisoning has also increased significantly in participants aged 10 to 19 and 25 to 29 years.

CONCLUSION

ED visits due to self-harm increased significantly, especially in adolescents and young adults, following the exposure to NSSI. Responsible media reporting on NSSI and appropriate guidelines would help prevent a further increase in self-harm.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Increased Right Dorsolateral Prefrontal Cortex Connectivity During Emotion Recognition Task in Adolescents With Self-Injurious Behavior: A Functional Near-Infrared Spectroscopy Study

OBJECTIVE

Research on neural correlates in the prefrontal cortex (PFC) associated with self-injurious behavior has mainly been performed in adults. However, studies on adolescents are scarce. We aimed to investigate the activation and connectivity of the PFC between adolescents with self-injurious behavior (ASI) and psychiatric controls (PC) using functional near-infrared spectroscopy (fNIRS).

METHODS

We used an emotion recognition task during fNIRS to assess 37 adolescents (23 with self-injurious behavior and 14 PC) between June 2020 and October 2021 and compared connectivity and activation between the two groups. We also measured adverse childhood events (ACE, Adverse Childhood Experiences) and performed a correlation analysis of channel activation according to ACE total scores.

RESULTS

The difference in activation between the groups was not statistically significant. The connectivity of channel 6 was statistically significant. The interaction between channel 6 and the ACE total score showed statistical significance between the two groups(t[33] -2.61; p=0.014). The ASI group showed a negative correlation with the total ACE score.

CONCLUSION

This is the first study to investigate PFC connectivity using fNIRS in ASI. It has the implication of a novel attempt with a practically useful tool to uncover neurobiological differences among Korean adolescents.

Influence of academic stress and school bullying on self-harm behaviors among Chinese middle school students: The mediation effect of depression and anxiety

Objective

The purpose of this study was to explore the relationship between academic stress, school bullying and self-harm behaviors among Chinese middle school students and to further explore the impact of anxiety and depression on this relationship.

Methods

The students (aged 12-16 years) in a middle school in Changsha city were invited to respond to a questionnaire through an online platform. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess the severity of anxiety and depressive symptoms, respectively. The experience of being bullied, academic stress, and self-harm behaviors were assessed using several questions on the basis of previous studies.

Results

A total of 1,313 middle school students completed the study, and 3.40% and 4.10% of them reported suicide attempts (SAs) and non-suicidal self-injury (NSSI), respectively. Univariate logistic regression analysis revealed that anxiety symptoms (OR = 1.23, 95% CI: 1.18-1.28; OR = 1.25, 95% CI: 1.19-1.31), depressive symptoms (OR = 1.20, 95% CI: 1.16-1.25; OR = 1.26, 95% CI: 1.20-1.31), school bullying (OR = 3.8, 95% CI: 2.11-6.89; OR = 2.76, 95% CI: 1.39-5.47), and academic stress (OR = 2.20, 95% CI: 1.27-3.80; OR = 3.80, 95% CI: 1.20-7.25) were common factors of NSSI and SAs. In addition, depressive symptoms showed a mediating effect on the association of school bullying and academic stress with SAs or NSSI, and anxiety symptoms showed a mediating effect on the association of school bullying and academic stress with NSSI only.

Conclusion

Appropriate strategies are needed to reduce academic pressure and prevent school bullying. Meanwhile, negative emotions such as depression and anxiety should be evaluated and intervened in to prevent self-harm behaviors among middle school students.

Influencing factors of non-suicidal self-injury according to DSM-5 in adolescents admitted to the psychiatric department: a cross-sectional study

BACKGROUND

Non-suicidal self-injury (NSSI) is being increasingly recognized as a prominent mental health concern, especially among adolescents. In psychiatric clinical samples, its incidence is high and difficult to identify. However, few studies have explored the NSSI behavior of psychiatric hospitalized adolescents. This study aimed to explore the influencing factors of NSSI according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in adolescents admitted to the psychiatric department.

METHODS

In this cross-sectional study, by convenient sampling, a total of 505 psychiatric adolescent inpatients aged 10-19 years completed questionnaires to record details of sociodemographic characteristics, the NSSI questionnaire, the Child Psychological Abuse and Neglect Scale (CPANS), the self-report version of the Strengths and Difficulties Questionnaire (self-report SDQ), the Coping Style Scale for Middle School Students (CSSMSS), which were compared between NSSI inpatients and non-NSSI inpatients. This study used the diagnostic criteria for NSSI disorder in DSM-5: adolescent patients who have NSSI behaviors for more than 5 times in the past 1 year are called NSSI. A multiple logistic regression model was built to explore the relationships among general information, CPANS, SDQ, CSSMSS, and NSSI. Risk for NSSI is quantified by odds ratio (OR) with 95% confidence interval (CI).

RESULTS

The results showed that 77.82% (n=393) of adolescent inpatients had NSSI, and 80.0% were female (n=404). NSSI adolescent inpatients experienced more family scolding, psychological abuse, and neglect and showed more positive attitudes toward NSSI than non-NSSI adolescent inpatients. However, after controlling for covariables, the difference disappeared. NSSI behavior was significantly associated with female (OR =2.391, 95% CI: 1.396-4.097, P=0.002), younger age (10-14 years old) (OR =1.876, 95% CI: 1.154-3.049, P=0.011), have close friends (OR =0.355, 95% CI: 0.164-0.768, P=0.008), peer discussion about self-injury (OR =1.977, 95% CI: 1.047-3.734, P=0.036), emotional and behavioral difficulties (OR =1.853, 95% CI: 1.054-3.258, P=0.032), problem-oriented coping styles (OR =0.968, 95% CI: 0.945-0.991, P=0.007), emotion-oriented coping styles (OR =1.035, 95% CI: 1.006-41.064, P=0.016).

CONCLUSIONS

Measures should be taken to prevent and reduce the occurrence of NSSI behaviors among hospitalized adolescents in psychiatric department, which include improving adolescents' attitude towards NSSI, reducing adolescents' gathering behavior in the ward, preventing adolescents from discussing NSSI through social media, improving their coping style when facing difficulties, and reasonably regulating their abnormal emotions and behaviors.