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Kuburi S, Ewing L, Hamza CA, Goldstein AL. A Daily Diary Study of the Relation between Stress and Nonsuicidal Self-Injury and the Moderating Role of Emotion Dysregulation in Emerging Adulthood. J Youth Adolesc 2024; 53:1605-1614. [PMID: 38282067 DOI: 10.1007/s10964-024-01946-3] [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: 07/28/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18-25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, Mage = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12-14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable.
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Affiliation(s)
- Sarah Kuburi
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada.
| | - Lexi Ewing
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Chloe A Hamza
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Abby L Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
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2
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Kiekens G, Hasking P, Nock MK, Kleiman E, Kirtley OJ, Houben M, Boyes M, Bruffaerts R, Myin-Germeys I, Claes L. A Comparison of Affective-Cognitive States in Daily Life Between Emerging Adults With and Without Past-Year Nonsuicidal Self-Injury. Behav Ther 2024; 55:469-484. [PMID: 38670662 DOI: 10.1016/j.beth.2023.08.004] [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: 11/11/2022] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 04/28/2024]
Abstract
Although the literature suggests trait-like differences in affective and cognitive vulnerabilities between individuals with and without a history of nonsuicidal self-injury (NSSI), little is known about how these dispositional differences are experienced in the natural environment. The present study compares the intensity, inertia, interaction, and variability of affective (negative and positive affect) and cognitive states (rumination, self-criticism) in the everyday lives of individuals who do and do not engage in NSSI. Using experience sampling methodology (ESM), 60 emerging adults (ages = 18-22 years) with and without past-year NSSI (equally distributed) completed eight questionnaires per day for 12 days (in total, 96 questionnaires per participant), resulting in 4,587 assessments (median compliance = 83.3%; IQR = 71.9-91.7). In a dynamic structural equation modeling framework, dynamic parameters (i.e., mean intensity, carryover effects, spillover effects, and within-person variability) were evaluated using multilevel vector autoregressive models. Emerging adults who engage in NSSI experience higher intensity and greater variability of negative affect, rumination, and self-criticism, whereas those who do not engage in NSSI experience higher intensity and lower variability of positive affect. In addition, past-year NSSI predicted stronger affective-cognitive interactions over time, with stronger spillover effects of negative and positive affect on subsequent rumination and self-criticism in individuals who engage in NSSI. Depressive symptoms and trait levels of emotion dysregulation and self-criticism partially negated these differences. Our findings provide evidence that emerging adults who self-injure experience more negative affective-cognitive states in daily life and point to the potential relevance of boosting positive emotions to buffer negative cognitions.
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Ji JL, Kyron M, Saulsman L, Becerra R, Lin A, Hasking P, Holmes EA. Picturing self-harm: Investigating flash-forward mental imagery as a proximal and modifiable driver of non-suicidal self-injury. Suicide Life Threat Behav 2024. [PMID: 38597460 DOI: 10.1111/sltb.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Non-suicidal self-injury (NSSI) is theorized to be reinforced by its emotional consequences. Mental images of NSSI are commonly reported as occurring prior to NSSI. Based on the known functional properties of anticipatory mental imagery as an emotional and motivational amplifier, this study investigated whether NSSI mental imagery constitutes a proximal and dynamic mechanism underpinning NSSI risk. METHOD An intensive ecological momentary assessment (EMA) study was conducted to track the occurrence and characteristics of NSSI mental imagery alongside NSSI urge and behavior in naturalistic settings. A sample of N = 43 individuals aged 17 to 24 with a history of repetitive NSSI completed EMA surveys seven times a day for 14 days. RESULTS Mental preoccupation in the form of NSSI mental imagery-based flash-forwards to the actions, bodily sensations, and emotional benefits of NSSI was found to occur when NSSI urge was high but not when urge was low. Critically, objective cross-panel analyses showed that higher frequencies of NSSI imagery occurrence predicted greater future NSSI urge and increased likelihood of acting on urge, over and above current urge. CONCLUSIONS Mental imagery of NSSI is not simply an epiphenomenal by-product of NSSI urge and may constitute a dynamic and proximal novel intervention target.
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Affiliation(s)
- Julie L Ji
- School of Psychology, University of Plymouth, Plymouth, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Kyron
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Lisa Saulsman
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Rodrigo Becerra
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Penelope Hasking
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Emily A Holmes
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Christensen K, Victor SE, Littlefield AK, Mitchell SM. A comparison of retrospectively reported and ecological momentary assessment-reported perceived social support in predicting ecological momentary assessment-reported non-suicidal self-injury. Suicide Life Threat Behav 2024; 54:184-194. [PMID: 38078550 PMCID: PMC11021162 DOI: 10.1111/sltb.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/07/2023] [Accepted: 12/01/2023] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Non-suicidal self-injury (NSSI) urges and behaviors are associated with lower perceived social support and related constructs (e.g., perceived rejection). However, no studies have examined the concordance of retrospective (baseline) and ecological momentary assessment (EMA) perceived social support assessments. Retrospective and EMA reports are often only weakly to moderately correlated; measurement approaches may, therefore, impact observed associations between variables. We tested whether average EMA-reported perceived emotional social support uniquely predicts EMA-reported NSSI urges and behaviors above baseline-reported retrospective self-report of perceived emotional social support alone. METHODS 93 young adults (ages 18-34) with past-month NSSI urges or behaviors and lifetime NSSI behaviors completed a semi-structured interview, self-report surveys, and a 2-week EMA protocol. RESULTS Baseline- and EMA-reported perceived emotional social support were positively correlated (Kendall's tau-b = 0.51). Average EMA-reported social support was uniquely associated with EMA-reported NSSI urges but not NSSI behaviors. CONCLUSIONS EMA-reported perceived emotional social support captured information not represented by baseline reports alone, but improvement in model fit was modest. EMA-reported social support may further improve the estimation of EMA-reported NSSI urges if modeled as a proximal predictor of NSSI. Further work is needed to clarify temporal directions between social support and NSSI urges. Limitations are discussed.
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Affiliation(s)
- Kirsten Christensen
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Sarah E Victor
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Andrew K Littlefield
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Sean M Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
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McNeish D, Somers JA, Savord A. Dynamic structural equation models with binary and ordinal outcomes in Mplus. Behav Res Methods 2024; 56:1506-1532. [PMID: 37118647 PMCID: PMC10611901 DOI: 10.3758/s13428-023-02107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/30/2023]
Abstract
Intensive longitudinal designs are increasingly popular, as are dynamic structural equation models (DSEM) to accommodate unique features of these designs. Many helpful resources on DSEM exist, though they focus on continuous outcomes while categorical outcomes are omitted, briefly mentioned, or considered as a straightforward extension. This viewpoint regarding categorical outcomes is not unwarranted for technical audiences, but there are non-trivial nuances in model building and interpretation with categorical outcomes that are not necessarily straightforward for empirical researchers. Furthermore, categorical outcomes are common given that binary behavioral indicators or Likert responses are frequently solicited as low-burden variables to discourage participant non-response. This tutorial paper is therefore dedicated to providing an accessible treatment of DSEM in Mplus exclusively for categorical outcomes. We cover the general probit model whereby the raw categorical responses are assumed to come from an underlying normal process. We cover probit DSEM and expound why existing treatments have considered categorical outcomes as a straightforward extension of the continuous case. Data from a motivating ecological momentary assessment study with a binary outcome are used to demonstrate an unconditional model, a model with disaggregated covariates, and a model for data with a time trend. We provide annotated Mplus code for these models and discuss interpretation of the results. We then discuss model specification and interpretation in the case of an ordinal outcome and provide an example to highlight differences between ordinal and binary outcomes. We conclude with a discussion of caveats and extensions.
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Affiliation(s)
- Daniel McNeish
- Arizona State University, PO Box 871104, Tempe, AZ, 85287, USA.
| | | | - Andrea Savord
- Arizona State University, PO Box 871104, Tempe, AZ, 85287, USA
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Ahn CY, Lee JS. Digital Phenotyping for Real-Time Monitoring of Nonsuicidal Self-Injury: Protocol for a Prospective Observational Study. JMIR Res Protoc 2024; 13:e53597. [PMID: 38329791 PMCID: PMC10884894 DOI: 10.2196/53597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/29/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is a major global health concern. The limitations of traditional clinical and laboratory-based methodologies are recognized, and there is a pressing need to use novel approaches for the early detection and prevention of NSSI. Unfortunately, there is still a lack of basic knowledge of a descriptive nature on NSSI, including when, how, and why self-injury occurs in everyday life. Digital phenotyping offers the potential to predict and prevent NSSI by assessing objective and ecological measurements at multiple points in time. OBJECTIVE This study aims to identify real-time predictors and explain an individual's dynamic course of NSSI. METHODS This study will use a hybrid approach, combining elements of prospective observational research with non-face-to-face study methods. This study aims to recruit a cohort of 150 adults aged 20 to 29 years who have self-reported engaging in NSSI on 5 or more days within the past year. Participants will be enrolled in a longitudinal study conducted at 3-month intervals, spanning 3 long-term follow-up phases. The ecological momentary assessment (EMA) technique will be used via a smartphone app. Participants will be prompted to complete a self-injury and suicidality questionnaire and a mood appraisal questionnaire 3 times a day for a duration of 14 days. A wrist-worn wearable device will be used to collect heart rate, step count, and sleep patterns from participants. Dynamic structural equation modeling and machine learning approaches will be used. RESULTS Participant recruitment and data collection started in October 2023. Data collection and analysis are expected to be completed by December 2024. The results will be published in a peer-reviewed journal and presented at scientific conferences. CONCLUSIONS The insights gained from this study will not only shed light on the underlying mechanisms of NSSI but also pave the way for the development of tailored and culturally sensitive treatment options that can effectively address this major mental health concern. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53597.
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Affiliation(s)
- Chan-Young Ahn
- Department of Psychology, Kangwon National University, Chuncheon-si, Republic of Korea
| | - Jong-Sun Lee
- Department of Psychology, Kangwon National University, Chuncheon-si, Republic of Korea
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Moscardini EH, Le TP, Cowan T, Gerner J, Robinson A, Cohen AS, Tucker RP. Frequency and predictors of virtual hope box use in individuals experiencing suicidal ideation: An ecological momentary assessment investigation. Suicide Life Threat Behav 2024; 54:61-69. [PMID: 37960986 PMCID: PMC10922839 DOI: 10.1111/sltb.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/23/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The Virtual Hope Box (VHB) is a smartphone application designed to support emotion regulation when one is distressed, in a crisis, or experiencing suicidal ideation (SI). Initial proof of concept studies indicate that individuals are more likely to use the VHB than traditional hope boxes, and find it both easy to setup and helpful. To our knowledge, no studies have harnessed ambulatory assessment methodology to assess VHB use as it relates to incidence of suicidal thinking. METHODS As such, we recruited N = 50 undergraduates who endorsed SI either the past year or past 2 weeks to complete a 10-day investigation. At baseline, participants were oriented to the VHB and instructed on how to use the application. Over the next 10 days, participants responded to prompts five times per day on their personal smartphones regarding their current experiences of SI and stress as well as VHB usage. RESULTS Results found that most participants used the VHB at least once, rated its usefulness as high, and rated their perceived likelihood of future use as high. In addition, increases in state SI severity were related to subsequent VHB use. CONCLUSION The VHB may be a useful tool for managing crises in undergraduates experiencing suicidal thoughts.
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Affiliation(s)
- Emma H. Moscardini
- Louisiana State University, Baton Rouge, Louisiana, USA
- McLean Hospital/Harvard Medical School, Belmont, Massachusetts, USA
| | - Thanh P. Le
- Louisiana State University, Baton Rouge, Louisiana, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angelas, California, USA
| | - Tovah Cowan
- Louisiana State University, Baton Rouge, Louisiana, USA
| | | | | | - Alex S. Cohen
- Louisiana State University, Baton Rouge, Louisiana, USA
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Greene T, Contractor AA, Dicker-Oren SD, Fentem A, Sznitman SR. The Effects of the Processing of Positive Memories Technique on Posttrauma Affect and Cognitions Among Survivors of Trauma: Protocol for a Daily Diary Study. JMIR Res Protoc 2024; 13:e51838. [PMID: 38214953 PMCID: PMC10818235 DOI: 10.2196/51838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The Processing of Positive Memories Technique (PPMT) is a promising new treatment approach for posttraumatic stress disorder (PTSD), which involves detailed narration and processing of specific positive autobiographical memories. Indeed, preliminary case-series studies have found reductions in PTSD symptoms, negative affect, and negative cognitions among survivors of trauma who have received PPMT. However, PPMT's effects have not been investigated at the daily level. In this study, we describe the protocol for a study that will examine the daily-level impacts of PPMT in a trauma-exposed, nonclinical community sample. OBJECTIVE This study uses an innovative research protocol that combines case-series design and daily diary approaches to examine changes in daily affect, daily cognitions, and daily PTSD symptoms pre- and post-PPMT. We hypothesize that at the daily level, in comparison to their own pre-PPMT levels, following the PPMT intervention, participants will report (1) a lower count of endorsed daily PTSD symptoms, (2) increases in daily positive affect and decreases in daily negative affect, (3) increases in positive affect reactivity to daily positive events, and (4) decreases in daily posttrauma cognitions. METHODS We are currently recruiting participants (target n=70) from a metroplex in the southwest United States. Following a screening survey, eligible participants complete a preintervention baseline survey, followed by 21 daily surveys in their natural environments. Then, they receive 4 PPMT sessions on a weekly basis. After the conclusion of the PPMT intervention, participants complete a postintervention outcome survey and 21 daily surveys. To compare daily affect, daily cognitions, and daily PTSD symptoms before and after PPMT, we will use the daily diary report data and conduct multilevel random intercepts and slopes linear regression models. RESULTS Data collection was initiated in March 2022 and is expected to end by June 2024. As of November 28, 2023, a total of 515 participants had consented to the study in the screening phase. No analyses will be conducted until data collection has been completed. CONCLUSIONS Study findings could clarify whether deficits in positive autobiographical memory processes may also characterize PTSD alongside deficits in traumatic memory processes. Furthermore, PPMT could be an additional therapeutic tool for clinicians to help clients reduce posttraumatic distress in their everyday lives. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51838.
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Affiliation(s)
- Talya Greene
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, Denton, TX, United States
| | | | - Andrea Fentem
- Department of Psychology, University of North Texas, Denton, TX, United States
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Liu J, Yao Y, Deng X, Xu X, He W. How does emotional abuse affect adolescents' non-suicidal self-injury urges? A moderated chain mediation model. CHILD ABUSE & NEGLECT 2024; 147:106535. [PMID: 37980785 DOI: 10.1016/j.chiabu.2023.106535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Studying non-suicidal self-injury (NSSI) among adolescents has high clinical significance. Its urges have been identified as a potential predictor of NSSI behavior and may serve as a crucial intervention target. OBJECTIVE This study uses a moderated chain mediation model to explore the relationship between emotional abuse and adolescent NSSI urges. Additionally, we examine the mediating roles of ego depletion and self-esteem and the moderating effect of resilience. PARTICIPANTS AND SETTING We recruited 1129 Chinese adolescents (age M = 16.68; SD = 0.78; 49.4 % men) from secondary vocational schools in China. METHODS We assessed emotional abuse, ego depletion, self-esteem, and NSSI urges in a longitudinal investigation across two time points (T1: March 2023, T2: June 2023). RESULTS After controlling for age, sex, NSSI urges and self-esteem at T1, our study validates a moderated chain mediation model and finds that the mediating effect via self-esteem is 0.026 (95%CI = [0.011,0.046]), and the chain mediating effect via ego depletion and self-esteem is 0.031 (95%CI = [0.022,0.045]), whereas the direct effect of emotional abuse T1 on NSSI urges T2 is not significant (DE = 0.082, 95%CI = [-0.002, 0.167]) and the mediating effect via ego depletion is also not significant (IE = -0.003, 95%CI = [-0.022, 0.015]). Resilience moderates the impact of emotional abuse on ego depletion (β = 0.09, p < 0.01). CONCLUSIONS These findings suggest that ego depletion and self-esteem are potential mechanisms related to emotional abuse and adolescents' NSSI urges, whereas resilience can play a moderating role in reducing ego depletion.
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Affiliation(s)
- Jie Liu
- School of Psychology, Shanghai Normal University, Shanghai 200234, China
| | - Yan Yao
- Pinghu Vocational Secondary School, China
| | - Xun Deng
- School of Psychology, Shanghai Normal University, Shanghai 200234, China
| | - Xiongwei Xu
- School of Education, Shanghai Normal University, Shanghai 200234, China.
| | - Wen He
- School of Psychology, Shanghai Normal University, Shanghai 200234, China.
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10
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Zhou X, Guo J, Wu H, Chen D, Wang C, You J. The Relationship between Ambivalence over Emotional Expression and Nonsuicidal Self-Injury Among Chinese Adolescents: A Longitudinal Moderated Mediation Model. Arch Suicide Res 2024; 28:90-106. [PMID: 36282550 DOI: 10.1080/13811118.2022.2134068] [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] [Indexed: 11/02/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) has become a significant mental health concern for adolescents. Previous empirical studies have shown that ambivalence over emotional expression is positively associated with negative emotions and behaviors. However, little is known about the relationship between ambivalence over emotional expression and NSSI among adolescents. Therefore, this study used a longitudinal design to examine the relationship between ambivalence over emotional expression and NSSI among Chinese adolescents, and also to explore the mediating and moderating mechanisms underlying this relationship. METHOD A total of 1,672 students (45.8% males; Mage = 16.12 years, SD = 1.56) in a middle school in Guangzhou were tracked. The investigation was conducted twice, with an interval of 6 months. RESULTS Ambivalence over emotional expression was positively correlated with NSSI. After controlling for gender and baseline NSSI, anxiety symptoms fully mediated the association between ambivalence over emotional expression and NSSI. In addition, the relationship between ambivalence over emotional expression and NSSI was moderated by NSSI refusal self-efficacy. CONCLUSIONS These findings imply that to decrease ambivalence over emotional expression, to reduce anxiety symptoms, and to promote NSSI refusal self-efficacy may be useful for interventions and preventions of NSSI.HIGHLIGHTSTested the relationship between ambivalence over emotional expression and NSSI in adolescents.Examined a moderated-mediation model over six months.Found the mediated effect of anxiety symptoms and moderated effect of NSSI refusal self-efficacy in the relationship between ambivalence over emotional expression and NSSI.
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Esposito C, Dragone M, Affuso G, Amodeo AL, Bacchini D. Prevalence of engagement and frequency of non-suicidal self-injury behaviors in adolescence: an investigation of the longitudinal course and the role of temperamental effortful control. Eur Child Adolesc Psychiatry 2023; 32:2399-2414. [PMID: 36123505 PMCID: PMC10682258 DOI: 10.1007/s00787-022-02083-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022]
Abstract
Non-suicidal self-injury (NSSI) is among the most frequent maladaptive behaviors reported in adolescence, with prevalence rates around 18-22% in community samples worldwide. The onset of NSSI typically occurs between early and middle adolescence, with a peak during middle adolescence (14-15 years) and a subsequent decline during late adolescence. This study investigated the growth curves of NSSI across four years during adolescence, analyzing simultaneously the probability of engagement in NSSI at least once (i.e., prevalence) and the frequency of engagement once initiated (i.e., severity). Furthermore, the study examined the predicting role of effortful control on NSSI over time (time-varying effects), net of other key risk factors for NSSI, such as anxiety-depression and bullying victimization. A sample of 430 Italian adolescents enrolled in Grade 9 at baseline was involved in the study. Based on the Latent Growth Curve Zero-inflated Poisson methodology, the results indicated a negative quadratic trend of both NSSI prevalence, with an increase between T1 and T3 followed by a decrease in the subsequent wave, and NSSI frequency once initiated, with a peak at T2 followed by a decline over time. The results also showed that adolescents who reported low effortful control abilities had a heightened probability of involvement in NSSI at each time point, whereas no significant association was found with NSSI frequency once initiated. Findings from this study offer important insights into the developmental course of NSSI and point out the need for future in-depth investigations of the mechanisms that might underlie NSSI prevalence and severity throughout adolescence.
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Affiliation(s)
- Concetta Esposito
- Department of Humanities, University of Naples "Federico II", Naples, Italy.
| | - Mirella Dragone
- Department of Humanities, University of Naples "Federico II", Naples, Italy
| | - Gaetana Affuso
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Anna Lisa Amodeo
- Department of Humanities, University of Naples "Federico II", Naples, Italy
| | - Dario Bacchini
- Department of Humanities, University of Naples "Federico II", Naples, Italy
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12
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Kyron MJ, Houghton S, Lawrence D, Page AC, Hunter SC, Gunasekera S. A Short-Form Measure of Loneliness to Predict Depression Symptoms Among Adolescents. Child Psychiatry Hum Dev 2023; 54:1760-1770. [PMID: 35622303 PMCID: PMC10581951 DOI: 10.1007/s10578-022-01370-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to produce a short-form measure of loneliness and assesses its prediction of depressive symptoms relative to a comprehensive measure. Western Australian adolescents completed the Friendship Related Loneliness and Isolation subscales of the Perth Aloneness Scale (PALs) three times over 18 months (T 1 n = 1538; T 2, n = 1683; T 3, n = 1406). Items were reduced while preserving predictability. Follow-up confirmatory factor analyses and predictive models with the reduced and full PALs were then tested. A reduced six-item scale (PALs-6) preserved the two-factor structure of the PALs and showed strong prediction of very elevated depressive symptoms (Sensitivity = 0.70, Specificity = 0.78, AUC = 0.81); it was less successful in predicting future symptoms (Sensitivity = 0.67, Specificity = 0.64, AUC = 0.74). The PALs-6 provides a brief measure of adolescent loneliness for clinicians and researchers that also predicts very elevated levels of depression.
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Affiliation(s)
- Michael J Kyron
- Graduate School of Education, University of Western Australia, Perth, WA, 6009, Australia
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Stephen Houghton
- Graduate School of Education, University of Western Australia, Perth, WA, 6009, Australia.
- Department of Psychology, Glasgow Caledonian University, Glasgow, Scotland.
| | - David Lawrence
- Graduate School of Education, University of Western Australia, Perth, WA, 6009, Australia
| | - Andrew C Page
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Simon C Hunter
- Graduate School of Education, University of Western Australia, Perth, WA, 6009, Australia
- Department of Psychology, Glasgow Caledonian University, Glasgow, Scotland
| | - Sashya Gunasekera
- Graduate School of Education, University of Western Australia, Perth, WA, 6009, Australia
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13
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Haliczer LA, Dixon-Gordon KL. Social stressors, emotional responses, and NSSI urges and behaviors in daily life. J Affect Disord 2023; 338:601-609. [PMID: 37364658 DOI: 10.1016/j.jad.2023.06.043] [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: 02/03/2023] [Revised: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The defective self model of nonsuicidal self-injury (NSSI) theorizes that individuals who are highly self-critical are more likely to choose NSSI to regulate emotions. This model indirectly suggests that individuals who engage in NSSI may experience more self-conscious emotions in response to negative social feedback, increasing risk for near-term NSSI. This study examined (1) whether individuals with a history of NSSI (vs. without) display greater self-conscious and negative emotional reactions to daily social stressors, and more problematic features of these daily social stressors, and (2) whether greater-than-usual negative emotional reactions and social stressor features predict NSSI urges and behaviors in daily life. METHODS Participants were 134 female college students with recent, recurrent NSSI (n = 77) or no NSSI history (n = 57). Participants completed baseline measures of socioemotional functioning and a two-week daily diary protocol. RESULTS The NSSI (vs. no NSSI) group reported significantly greater self-conscious and negative emotional reactions to daily social stressors, and social stressors characterized by greater dysfunction. In the NSSI group, experiencing social stressors characterized by greater distress than one's average during the daily diary period was associated with same-day NSSI urges and behavior, greater confusion than one's average predicted same-day NSSI urges, and greater conflict than one's average predicted same-day NSSI behavior. Greater self-conscious and negative emotional reactions to these stressors than one's average predicted same-day NSSI urges and behavior. LIMITATIONS Limitations include reliance on self-report, a once-daily assessment, and lack of generalizability to other samples. CONCLUSIONS Interpersonal conflict and increased self-conscious emotions pose vulnerability for NSSI. Prevention and intervention efforts would benefit from including a focus on interpersonal functioning.
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Affiliation(s)
- Lauren A Haliczer
- University of Massachusetts Amherst, USA; Massachusetts General Hospital/Harvard Medical School, USA.
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14
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Brown RH, Speyer LG, Eisner MP, Ribeaud D, Murray A. Exploring the effect of ADHD traits on the moment-to-moment interplay between provocation and aggression: Evidence from dynamic structural equation modeling. Aggress Behav 2023; 49:469-479. [PMID: 36891623 DOI: 10.1002/ab.22081] [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: 06/22/2022] [Revised: 01/10/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
The relation between attention deficit hyperactivity disorder (ADHD) symptoms and aggression is well documented; however, the processes that account for higher levels of aggression associated with ADHD in the course of daily life are little understood. The current study used ecological momentary assessment to explore how ADHD traits relate to individual differences in perceiving provocation from others and the resultant aggressive behaviors; and the strengths of the links between provocation and aggression in the flow of daily life. A dynamic structural equation model was fit using data from a subpopulation of young adults involved in the longitudinal z-proso study (n = 259, median-age 20). Data on provocation and aggression was collected at four quasi-random time periods per day over a 14-day period. Individuals with higher ADHD trait levels reported higher instances of provocation and aggression, with ADHD traits significantly moderating aggression inertia such that those with higher levels of ADHD traits showed greater persistence of aggressive behavior over time. However, ADHD trait levels did not significantly moderate any of the observed cross-lagged effects. Our findings suggest that individuals with higher levels of ADHD traits are at greater risk of exposure to interpersonal interactions involving interpersonal provocation, show higher levels of aggressive behavior in daily life, and find it more difficult to reduce their aggression once triggered. These findings support the importance of targeting factors such as social skills and emotion regulation that may underpin the increased difficulties in interpersonal interactions often experienced by individuals with high levels of ADHD symptoms.
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Affiliation(s)
- Ruth H Brown
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Lydia G Speyer
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Manuel P Eisner
- Violence Research Centre, Institute of Criminology, University of Cambridge, Cambridge, UK
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Aja Murray
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
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15
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Saarijärvi P, Salmivalli C, Helmi S, Karukivi M. Early maladaptive schemas are associated with self-injury thoughts and behavior in adolescents. BMC Psychiatry 2023; 23:632. [PMID: 37644535 PMCID: PMC10466884 DOI: 10.1186/s12888-023-05127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Early maladaptive schemas (EMSs) and self-harm have been firmly linked in adults, but research on these associations in adolescents remains scarce. Additionally, the links between EMSs and functions of self-injury has not been previously studied in this age group. Thus, the aim of the present study was to investigate the associations of EMSs with self-harm thoughts and behavior, as well as with self-harm functions, among adolescents in specialized health care. METHODS The participants were recruited from first-visit 12-22-year-old adolescent patients entering specialized mental health care or pediatric care. For 118 participants, complete data were available for the Young Schema Questionnaire Short Form 2-Extended (YSQ) when entering care and the Ottawa Self-Injury Inventory Functions scale (OSI-F) one year later. YSQ was used to measure the participants' EMSs and OSI-F their self-harm thoughts and behavior. The associations of EMSs and self-harm were investigated in three groups: no self-harm, self-harm thoughts only, and both self-harm thoughts and behavior. The associations of EMSs with self-injury behavior functions were assessed in four categories: Internal Emotional Regulation, External Emotional Regulation, Social Influence, and Sensation Seeking. Additionally, EMSs' associations with addictive features of self-injury behavior were assessed. The magnitudes of effect sizes of differences between the self-harm groups were evaluated with Cliff's Delta. The associations of EMSs with self-injury functions were analyzed with general linear modeling and with self-injury addictive features using logistic regression. RESULTS The differences between the self-harm groups were significant for the majority of the EMSs. The stronger the EMSs were, the more severe the manifestations of self-harm. The effect sizes ranged from small to large depending on the EMS. Considering self-injury functions, Internal Emotional Regulation was associated with Self-Sacrifice EMS (p = 0.021), and External Emotional Regulation both with Abandonment (p = 0.040) and Unrelenting Standards (p = 0.012) EMSs. Being addicted to self-injury was associated with Abandonment (p = 0.043) and Dependence (p = 0.025) EMSs. CONCLUSIONS The present study shows that significant associations between EMSs and both self-harm thoughts and behavior exist also in adolescents. Stronger EMSs are linked to more severe self-harm. Knowledge of these associations may help to improve the understanding and treatment of adolescents suffering from self-harm.
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Affiliation(s)
- Pauliina Saarijärvi
- Department of Psychology and Speech-Language Pathology, University of Turku, Publicum building, 4th floor, 20014, Turku, Finland
- Department of Psychiatry, HUS Helsinki University Hospital and University of Helsinki, Adolescent Psychiatry, Finland
- Psychiatric Care Division, Satasairaala Hospital, Pori, Finland
- University of Turku, INVEST Research Flagship, Publicum building, 4th floor, 20014, Turku, Finland
| | - Christina Salmivalli
- Department of Psychology and Speech-Language Pathology, University of Turku, Publicum building, 4th floor, 20014, Turku, Finland
- University of Turku, INVEST Research Flagship, Publicum building, 4th floor, 20014, Turku, Finland
| | - Saija Helmi
- Faculty of Social Sciences (SOC), Tampere University, Welfare Sciences, Psychology, 33014, Finland
| | - Max Karukivi
- Psychiatric Care Division, Satasairaala Hospital, Pori, Finland.
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Kunnallissairaalantie 20, Turku, 20700, Finland.
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Kiekens G, Claes L, Schoefs S, Kemme NDF, Luyckx K, Kleiman EM, Nock MK, Myin-Germeys I. The Detection of Acute Risk of Self-injury Project: Protocol for an Ecological Momentary Assessment Study Among Individuals Seeking Treatment. JMIR Res Protoc 2023; 12:e46244. [PMID: 37318839 DOI: 10.2196/46244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is a major mental health concern. Despite increased research efforts on establishing the prevalence and correlates of the presence and severity of NSSI, we still lack basic knowledge of the course, predictors, and relationship of NSSI with other self-damaging behaviors in daily life. Such information will be helpful for better informing mental health professionals and allocating treatment resources. The DAILY (Detection of Acute rIsk of seLf-injurY) project will address these gaps among individuals seeking treatment. OBJECTIVE This protocol paper presents the DAILY project's aims, design, and materials used. The primary objectives are to advance understanding of (1) the short-term course and contexts of elevated risk for NSSI thoughts, urges, and behavior; (2) the transition from NSSI thoughts and urges to NSSI behavior; and (3) the association of NSSI with disordered eating, substance use, and suicidal thoughts and behaviors. A secondary aim is to evaluate the perspectives of individuals seeking treatment and mental health professionals regarding the feasibility, scope, and utility of digital self-monitoring and interventions that target NSSI in daily life. METHODS The DAILY project is funded by the Research Foundation Flanders (Belgium). Data collection involves 3 phases: a baseline assessment (phase 1), 28 days of ecological momentary assessment (EMA) followed by a clinical session and feedback survey (phase 2), and 2 follow-up surveys and an optional interview (phase 3). The EMA protocol consists of regular EMA surveys (6 times per day), additional burst EMA surveys spaced at a higher frequency when experiencing intense NSSI urges (3 surveys within 30 minutes), and event registrations of NSSI behavior. The primary outcomes are NSSI thoughts, NSSI urges, self-efficacy to resist NSSI, and NSSI behavior, with disordered eating (restrictive eating, binge eating, and purging), substance use (binge drinking and smoking cannabis), and suicidal thoughts and behaviors surveyed as secondary outcomes. The assessed predictors include emotions, cognitions, contextual information, and social appraisals. RESULTS We will recruit approximately 120 individuals seeking treatment aged 15 to 39 years from mental health services across the Flanders region of Belgium. Recruitment began in June 2021 and data collection is anticipated to conclude in August 2023. CONCLUSIONS The findings of the DAILY project will provide a detailed characterization of the short-term course and patterns of risk for NSSI and advance understanding of how, why, and when NSSI and other self-damaging behaviors unfold among individuals seeking treatment. This will inform clinical practice and provide the scientific building blocks for novel intervention approaches outside of the therapy room that support people who self-injure in real time. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46244.
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Affiliation(s)
- Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Steffie Schoefs
- Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Nian D F Kemme
- Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- University of the Free State, Bloemfontein, South Africa
| | - Evan M Kleiman
- Rutgers, The State University of New Jersey, New Jersey, NJ, United States
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
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Raudales AM, Yang M, Schatten HT, Armey MF, Weiss NH. Daily reciprocal relations between emotion dysregulation and non-suicidal self-injury among individuals with a history of sexual assault: The influence of posttraumatic stress symptoms. Suicide Life Threat Behav 2023; 53:124-136. [PMID: 36326152 DOI: 10.1111/sltb.12927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/03/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Non-suicidal self-injury (NSSI) is a serious public health concern that can be understood within an emotion dysregulation framework. The current study adds to the literature by utilizing a micro-longitudinal design and novel statistical modeling to test reciprocal associations between emotion dysregulation and NSSI, as well as the potential moderating effect of posttraumatic stress symptoms (PTSS). METHODS Participants were 81 individuals with a history of sexual assault and NSSI (Mage = 33.80; 67.9% women; 80.2% white) recruited from the community who self-reported on symptoms of emotion dysregulation and NSSI thoughts/behaviors once daily for 7 days. Average compliance rate was 72.8% (SD = 31.3%) and 34 participants (42.0%) endorsed NSSI thoughts/behaviors over the course of the study. RESULTS Findings revealed a significant positive effect of NSSI thoughts/behaviors on subsequent abilities to regulate negative emotions. Furthermore, while results did not detect a moderating influence of baseline PTSS on the relation between emotion dysregulation and NSSI thoughts/behaviors over time, individuals with higher baseline PTSS were found to experience heightened levels of NSSI thoughts/behaviors and emotion dysregulation on average. CONCLUSION Information from this study may be useful for future research and intervention development focused on the intersection of NSSI, PTSS, and emotion dysregulation.
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Affiliation(s)
- Alexa M Raudales
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael F Armey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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18
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Kiekens G, Hasking P, Bruffaerts R, Alonso J, Auerbach RP, Bantjes J, Benjet C, Boyes M, Chiu WT, Claes L, Cuijpers P, Ebert DD, Mak A, Mortier P, O’Neill S, Sampson NA, Stein DJ, Vilagut G, Nock MK, Kessler RC. Non-suicidal self-injury among first-year college students and its association with mental disorders: results from the World Mental Health International College Student (WMH-ICS) initiative. Psychol Med 2023; 53:875-886. [PMID: 34140062 PMCID: PMC8683565 DOI: 10.1017/s0033291721002245] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although non-suicidal self-injury (NSSI) is an issue of major concern to colleges worldwide, we lack detailed information about the epidemiology of NSSI among college students. The objectives of this study were to present the first cross-national data on the prevalence of NSSI and NSSI disorder among first-year college students and its association with mental disorders. METHODS Data come from a survey of the entering class in 24 colleges across nine countries participating in the World Mental Health International College Student (WMH-ICS) initiative assessed in web-based self-report surveys (20 842 first-year students). Using retrospective age-of-onset reports, we investigated time-ordered associations between NSSI and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) mood (major depressive and bipolar disorder), anxiety (generalized anxiety and panic disorder), and substance use disorders (alcohol and drug use disorder). RESULTS NSSI lifetime and 12-month prevalence were 17.7% and 8.4%. A positive screen of 12-month DSM-5 NSSI disorder was 2.3%. Of those with lifetime NSSI, 59.6% met the criteria for at least one mental disorder. Temporally primary lifetime mental disorders predicted subsequent onset of NSSI [median odds ratio (OR) 2.4], but these primary lifetime disorders did not consistently predict 12-month NSSI among respondents with lifetime NSSI. Conversely, even after controlling for pre-existing mental disorders, NSSI consistently predicted later onset of mental disorders (median OR 1.8) as well as 12-month persistence of mental disorders among students with a generalized anxiety disorder (OR 1.6) and bipolar disorder (OR 4.6). CONCLUSIONS NSSI is common among first-year college students and is a behavioral marker of various common mental disorders.
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Affiliation(s)
- Glenn Kiekens
- Center for Public Health Psychiatry, KU Leuven, Belgium
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Penelope Hasking
- School of Population Health, Curtin University, Perth, Australia
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, KU Leuven, Belgium
- Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
- Pompeu Fabra University, Barcelona, Spain
| | | | - Jason Bantjes
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences Stellenbosch University, South Africa
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Mark Boyes
- School of Population Health, Curtin University, Perth, Australia
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David D. Ebert
- Department for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University Munich, Germany
| | - Arthur Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Philippe Mortier
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Siobhan O’Neill
- School of Biomedical Sciences, Ulster University, Derry-Londonderry, Northern Ireland
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Gemma Vilagut
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Selby EA, Harnedy LE, Hiner M, Kim J. Developmental and Momentary Dynamics in the Onset and Maintenance of Nonsuicidal Self-Injurious Behavior and Borderline Personality Disorder. Curr Psychiatry Rep 2022; 24:897-909. [PMID: 36422833 DOI: 10.1007/s11920-022-01396-3] [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] [Accepted: 11/01/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Traditional conceptualizations of both nonsuicidal self-injury (NSSI) and borderline personality disorder (BPD) typically rely on static and unidirectional, linear associations between key biopsychosocial vulnerabilities. Instead, we argue that utilizing a complex dynamic systems view of NSSI and BPD will advance the field, as such conceptual models allow for analysis of bottom-up effects for key vulnerabilities on disorder and behavior emergence, as well as top-down effects of the emergent disorder on underlying vulnerabilities. RECENT FINDINGS Following the presentation of a novel framework highlighting momentary and developmental dynamics, we explore several advances in the field that exhibit key dynamic qualities or inform dynamic conceptualizations of NSSI and BPD. At the momentary dynamic level, several advances are being made with multimethod and repeated assessment approaches, as well as advanced bidirectional and complex modeling procedures. Additional progress is being made at the developmental dynamic level, although several questions have arisen regarding the problem of onset and subsequent trajectory, particularly with issues such as pain perception and the interplay between interpersonal, emotional, and behavioral symptoms before and after treatment. Self-injury and BPD both exhibit substantial momentary and developmental dynamics in underlying vulnerabilities, including potential variance in momentary dynamics as a function of psychopathological developmental stage (e.g., onset versus maintenance versus recovery). Recent work has highlighted the necessity of utilizing multimodal research to encapsulate a holistic view of the interplay of several vulnerability factors, the developmental importance of assessment timing, and the need to examine the dynamic interplay between affect, behavior, and interpersonal experiences in BPD and/or NSSI. Research also indicated substantial variation in key vulnerability factors at both between- and within-person levels, highlighting the utility of harnessing statistical models that allow for the simultaneous incorporation of numerous variables at both levels and across several time points. As such, by using a complex dynamic systems conceptualization, we can begin to better understand integrated connections between key vulnerabilities, how they collectively interact in the short term, and how changes in the dynamic interplay between vulnerabilities may arise over the long term and with successful treatment.
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Affiliation(s)
- Edward A Selby
- Department of Psychology, The State University of New Jersey, Tillett 101, 53 Avenue E. Piscatway, Rutgers, NJ, 08854, USA.
| | - Lauren E Harnedy
- Department of Psychology, The State University of New Jersey, Tillett 101, 53 Avenue E. Piscatway, Rutgers, NJ, 08854, USA
| | | | - Joanne Kim
- Department of Psychology, The State University of New Jersey, Tillett 101, 53 Avenue E. Piscatway, Rutgers, NJ, 08854, USA
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Hird K, Hasking P, Boyes M. Relationships between Outcome Expectancies and Non-Suicidal Self-Injury: Moderating Roles of Emotion Regulation Difficulties and Self-Efficacy to Resist Self-Injury. Arch Suicide Res 2022; 26:1688-1701. [PMID: 34636716 DOI: 10.1080/13811118.2021.1983492] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is the deliberate damage of one's own body tissue in the absence of suicidal intent. Research suggests that individuals engage in NSSI as a means of regulating their emotions and that NSSI is associated with emotion regulation difficulties. There is also evidence supporting the role of outcome expectancies and self-efficacy to resist NSSI. However, it is unclear how these factors work together to explain NSSI. OBJECTIVE To explore whether the relationships between five NSSI-specific outcome expectancies and NSSI history are moderated by emotion regulation difficulties and self-efficacy to resist NSSI. METHOD 1002 participants (Mage = 20.51, 72.5% female, 39.7% lifetime history of NSSI) completed an online survey including measures of NSSI history, outcome expectancies, self-efficacy to resist NSSI, and emotion regulation difficulties. RESULTS Emotion regulation difficulties were associated with NSSI, as was expecting NSSI to regulate affect. Conversely, expectations of communication and/or pain, as well as self-efficacy to resist NSSI were negatively associated with NSSI. Expectancies also interacted with both difficulties in emotion regulation and self-efficacy to resist NSSI in predicting self-injury. For example, the association between expectations of affect regulation and self-injury was weaker when associated with greater self-efficacy to resist NSSI. CONCLUSION These findings provide support for considering NSSI-specific cognitions in concert with emotion regulation when understanding NSSI.HighlightsOutcome expectancies can differentiate people based on NSSI history.Emotion regulation difficulties and self-efficacy to resist NSSI moderate the relationships between outcome expectancies and NSSI history.Emotion regulation difficulties and low self-efficacy to resist NSSI work together to predict NSSI history.
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21
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Brown AC, Dhingra K, Brown TD, Danquah AN, Taylor PJ. A systematic review of the relationship between momentary emotional states and nonsuicidal self-injurious thoughts and behaviours. Psychol Psychother 2022; 95:754-780. [PMID: 35526112 PMCID: PMC9833836 DOI: 10.1111/papt.12397] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/19/2022] [Accepted: 04/06/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is associated with high levels of distress, co-morbid mental health issues, and elevated risk of suicide. Previous literature indicates that emotion regulation is the most endorsed function of NSSI. Experience Sampling Methodology (ESM) provides a powerful tool for investigating the moment-to-moment associations between emotional states and NSSI thoughts and behaviours. The aim of the current study was to systematically review and evaluate ESM research concerning the relationship between momentary emotional states and NSSI. METHODS A systematic search of electronic databases from date of inception to 16th April 2021 was conducted. This was supplemented through backwards citation tracking. A risk of bias assessment was completed prior to data synthesis. RESULTS Nineteen eligible studies were identified for inclusion in the review. Heightened negative affect was found to typically precede instances of NSSIT thoughts and behaviour. Results were less consistent for positive affect. LIMITATIONS Sample sizes across studies were often small, meaningful effect sizes were not always reported, and non-validated measures of NSSI thoughts and behaviour were used during ESM assessments. CONCLUSIONS The results support affect regulation models of NSSI, and demonstrate the value of ESM studies, specifically those sampling more than once per day, in plotting the temporal, "in-the-moment" characteristics of these processes.
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Affiliation(s)
- Alexandra C. Brown
- Division of Psychology & Mental HealthManchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Katie Dhingra
- School of Social SciencesLeeds Beckett UniversityLeedsUK
| | - Terence D. Brown
- The Postgraduate Medical Education Council of TasmaniaHobartTasmaniaAustralia
| | - Adam N. Danquah
- Division of Psychology & Mental HealthManchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Peter James Taylor
- Division of Psychology & Mental HealthManchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
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22
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Brown AC, Latham C, Danquah AN, Dunlop BJ, Taylor PJ. "Cover up your arms, you're triggering people": A Mixed-Methods Investigation of Shame in those who Self-Injure. Psychol Psychother 2022; 95:701-716. [PMID: 35411671 PMCID: PMC9543642 DOI: 10.1111/papt.12394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Shame can be a powerfully aversive emotion that is associated with a wide variety of mental health difficulties including non-suicidal self-injury (NSSI). This study used a novel mixed-methods design (Qualitative Experiential Sequence Tracking; QUEST) to investigate the experiences of shame in a sample of individuals who self-injure. METHODS Six participants received prompts to complete brief online diaries three times per day over a period of 2 weeks. These diaries captured information about the experience of negative emotions, especially shame. Participants then underwent an individualised qualitative interview about their experiences over the previous 2 weeks. RESULTS Thematic analysis suggested that participants experienced shame as a social and relational emotion. Further themes included shame being associated with feelings of failure, being trapped, dangerous or contaminated, and hidden or exposed. The phenomenology of shame, and coping with shame, were also themes. NSSI could occur as a response to shame, but often shame was triggered or exacerbated by the responses of others to NSSI. CONCLUSIONS Consistent with previous research, shame was described as an aversive emotion occurring within interpersonal and broader societal contexts and involving a negative self-focus. A lack of compassion or understanding in response to NSSI, or anticipation of negative responses from others often triggered more intense shame than the NSSI itself. Future studies could use QUEST methodology with more diverse samples or different populations to further investigate experiences of shame.
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Affiliation(s)
- Alexandra C. Brown
- Division of Psychology & Mental HealthSchool of Health SciencesUniversity of ManchesterManchester Academic Health Sciences CentreManchesterUK
| | | | - Adam N. Danquah
- Division of Psychology & Mental HealthSchool of Health SciencesUniversity of ManchesterManchester Academic Health Sciences CentreManchesterUK
| | - Brendan J. Dunlop
- Division of Psychology & Mental HealthSchool of Health SciencesUniversity of ManchesterManchester Academic Health Sciences CentreManchesterUK
| | - Peter J. Taylor
- Division of Psychology & Mental HealthSchool of Health SciencesUniversity of ManchesterManchester Academic Health Sciences CentreManchesterUK
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Kuehn KS, Dora J, Harned MS, Foster KT, Song F, Smith MR, King KM. A meta-analysis on the affect regulation function of real-time self-injurious thoughts and behaviours. Nat Hum Behav 2022; 6:964-974. [PMID: 35484208 PMCID: PMC9329197 DOI: 10.1038/s41562-022-01340-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 03/17/2022] [Indexed: 11/09/2022]
Abstract
Prominent theories suggest that self-injurious thoughts and behaviours are negatively reinforced by decreased negative affect. The present meta-analysis quantifies effects from intensive longitudinal studies measuring negative affect and self-injurious thoughts and behaviours. We obtained data from 38 of the 79 studies (48%, 22 unique datasets) involving N = 1,644 participants (80% female, 75% white). Individual-participant data meta-analyses revealed changes in affect pre/post self-injurious thoughts and behaviours. In antecedent models, results supported increased negative affect before nonsuicidal self-injurious behaviour (k = 14, 95% CI 0.09 to 0.31) and suicidal thoughts (k = 14, 95% CI 0.03 to 0.19). For consequence models, negative affect was reduced following nonsuicidal self-injurious thoughts (k = 6, 95% CI -0.79 to -0.44), nonsuicidal self-injurious behaviours (k = 14, 95% CI -0.73 to -0.19) and suicidal thoughts (k = 13, 95% CI -0.79 to -0.23). Findings, which were not moderated by sampling strategies or sample composition, support the affect regulation function of self-injurious thoughts and behaviours.
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Affiliation(s)
- Kevin S Kuehn
- Department of Psychology, University of Washington, Seattle, WA, USA.
| | - Jonas Dora
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Melanie S Harned
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | - Frank Song
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michele R Smith
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Kevin M King
- Department of Psychology, University of Washington, Seattle, WA, USA
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Mendez I, Sintes A, Pascual JC, Puntí J, Lara A, Briones-Buixassa L, Nicolaou S, Schmidt C, Romero S, Fernández M, Carmona I Farrés C, Soler J, Santamarina-Perez P, Vega D. Borderline personality traits mediate the relationship between low perceived social support and non-suicidal self-injury in a clinical sample of adolescents. J Affect Disord 2022; 302:204-213. [PMID: 35038480 DOI: 10.1016/j.jad.2022.01.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a serious public health concern among adolescents, especially in clinical settings. Social support plays a critical role in the onset and maintenance of NSSI in adolescence. NSSI is closely associated with borderline personality disorder (BPD), yet no previous work has analyzed the mediating role of borderline traits in the relationship between perceived social support (PSS) and NSSI. This study aimed to address this gap. METHODS Participants were 228 adolescent patients (12 to 18 years old), who completed a clinical interview and self-report measures of BPD-traits, current psychological distress, emotion dysregulation and PSS. They were grouped based on the presence (vs. absence) of NSSI. Univariate and multivariate logistic regression analyses were used to identify risk factors of NSSI, and a mediation analysis was conducted to examine the intermediary role of borderline traits in the relationship between PSS and NSSI. RESULTS NSSI was highly prevalent in our sample (58%) and was associated with higher clinical severity. Low PSS predicted NSSI in univariate, but not multivariate regression. Mediation analyses showed that borderline traits fully accounted for the relationship between low PSS and NSSI, even when controlling for current psychological distress and gender. LIMITATIONS Cross-sectional design through self-report assessment. CONCLUSIONS Findings suggest that adolescents with low PSS are especially vulnerable for developing NSSI due to elevated BPD traits. In clinical settings, interventions aimed to reduce borderline symptoms may be a promising treatment option for adolescents with NSSI and low PSS.
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Affiliation(s)
- Iria Mendez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Sintes
- Servicio de salud mental infantojuvenil, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Juan Carlos Pascual
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Puntí
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Hospital de Dia de Adolescentes. Servicio de Salud Mental. Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain; Departamento de Psicología Clínica y de la Salud, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anaís Lara
- Servicio de Psiquiatría y Psicología, ALTHAIA, Xarxa Assistencial i Universitària de Manresa, Barcelona, Manresa, Spain
| | - Laia Briones-Buixassa
- Mental Health and Social Innovation Research Group and Centre for Health and Social Care Research, Universitat de Vic - Universitat Central de Catalunya, Catalonia, Spain
| | - Stella Nicolaou
- PhD Programme in Biomedicine, University of Barcelona, Spain; Psychiatry and Mental Health Department, Consorci Sanitari de l'Anoia & Fundació Sanitària d'Igualada, Hospital Universitari d'Igualada. Av. Catalunya 11, Barcelona, Igualada 08700, Spain
| | - Carlos Schmidt
- Psychiatry and Mental Health Department, Consorci Sanitari de l'Anoia & Fundació Sanitària d'Igualada, Hospital Universitari d'Igualada. Av. Catalunya 11, Barcelona, Igualada 08700, Spain
| | - Soledad Romero
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Fernández
- Servicio de salud mental infantojuvenil, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Cristina Carmona I Farrés
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Soler
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Santamarina-Perez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Daniel Vega
- Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Psychiatry and Mental Health Department, Consorci Sanitari de l'Anoia & Fundació Sanitària d'Igualada, Hospital Universitari d'Igualada. Av. Catalunya 11, Barcelona, Igualada 08700, Spain.
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Nester MS, Brand BL, Schielke HJ, Kumar S. An examination of the relations between emotion dysregulation, dissociation, and self-injury among dissociative disorder patients. Eur J Psychotraumatol 2022; 13:2031592. [PMID: 35145611 PMCID: PMC8823688 DOI: 10.1080/20008198.2022.2031592] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To the best of our knowledge, however, the link between emotion dysregulation and self-injury has not yet been examined within a DD population. OBJECTIVE The present study investigated relations between emotion dysregulation, dissociation, and self-injury in DD patients, and explored patterns of emotion dysregulation difficulties among DD patients with and without recent histories of self-injury. METHOD We utilized linear and logistic regressions and t-test statistical methods to examine data from 235 patient-clinician dyads enrolled in the TOP DD Network Study. RESULTS Analyses revealed emotion dysregulation was associated with heightened dissociative symptoms and greater endorsement of self-injury in the past six months. Further, patients with a history of self-injury in the past six months reported more severe emotion dysregulation and dissociation than those without recent self-injury. As a group, DD patients reported the greatest difficulty engaging in goal-directed activities when distressed, followed by lack of emotional awareness and nonacceptance of emotional experiences. DD patients demonstrated similar patterns of emotion dysregulation difficulties irrespective of recent self-injury status. CONCLUSIONS Results support recommendations to strengthen emotion regulation skills as a means to decrease symptoms of dissociation and self-injury in DD patients.
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Affiliation(s)
- M Shae Nester
- Department of Psychology, Towson University, Towson, MD, USA
| | - Bethany L Brand
- Department of Psychology, Towson University, Towson, MD, USA
| | - Hugo J Schielke
- Traumatic Stress Injury & Concurrent Program, Homewood Health Centre, Guelph, Ontario, Canada
| | - Shaina Kumar
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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Kiekens G, Robinson K, Tatnell R, Kirtley OJ. Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility. JMIR Ment Health 2021; 8:e30915. [PMID: 34807835 PMCID: PMC8663644 DOI: 10.2196/30915] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 01/03/2023] Open
Abstract
Although nonsuicidal self-injury (NSSI)-deliberate damaging of body tissue without suicidal intent-is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.
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Affiliation(s)
- Glenn Kiekens
- Faculty of Psychology and Educational Sciences, Clinical Psychology, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Kealagh Robinson
- School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Ruth Tatnell
- Faculty of Health, School of Psychology, Deakin University, Melbourne, Australia
| | - Olivia J Kirtley
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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Dewa LH, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin P. SWAY: Associations between sleep disturbance and suicidality in psychiatric inpatients transitioning to the community: an ecological momentary assessment study protocol (Preprint). JMIR Res Protoc 2021; 11:e33817. [PMID: 35579920 PMCID: PMC9157316 DOI: 10.2196/33817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/16/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background Patients are at high risk of suicidal behavior and death by suicide immediately following discharge from inpatient psychiatric hospitals. Furthermore, there is a high prevalence of sleep problems in inpatient settings, which is associated with worse outcomes following hospitalization. However, it is unknown whether poor sleep is associated with suicidality following initial hospital discharge. Objective Our study objective is to describe a protocol for an ecological momentary assessment (EMA) study that aims to examine the relationship between sleep and suicidality in discharged patients. Methods Our study will use an EMA design based on a wearable device to examine the sleep-suicide relationship during the transition from acute inpatient care to the community. Prospectively discharged inpatients 18 to 35 years old with mental disorders (N=50) will be assessed for eligibility and recruited across 2 sites. Data on suicidal ideation, behavior, and imagery; nonsuicidal self-harm and imagery; defeat, entrapment, and hopelessness; affect; and sleep will be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objective sleep and daytime activity will be measured using the inbuilt MotionWare software. Questionnaires will be administered face-to-face at baseline and follow up, and data will also be collected on the acceptability and feasibility of using the Pro-Diary V watch to monitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient setting and suicidality. Results South Birmingham Research Ethics Committee (21/WM/0128) approved the study on June 28, 2021. We expect to see a relationship between poor sleep and postdischarge suicidality. Results will be available in 2022. Conclusions This protocol describes the first coproduced EMA study to examine the relationship between sleep and suicidality and to apply the integrated motivational volitional model in young patients transitioning from a psychiatric hospital to the community. We expect our findings will inform coproduction in suicidology research and clarify the role of digital monitoring of suicidality and sleep before and after initial hospital discharge. International Registered Report Identifier (IRRID) PRR1-10.2196/33817
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Affiliation(s)
- Lindsay H Dewa
- School of Public Health, Imperial College London, London, United Kingdom
- National Institute for Health and Care Research Imperial Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
| | - Sofia Pappa
- West London National Health Service Trust, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
- Division of Psychiatry, University College London, London, United Kingdom
| | - James Cooke
- National Institute for Health and Care Research Imperial Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
| | - Lizzie Mitchell
- National Institute for Health and Care Research Imperial Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
| | - Molly Hadley
- National Institute for Health and Care Research Imperial Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
| | - Martina Di Simplicio
- West London National Health Service Trust, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Thomas Woodcock
- School of Public Health, Imperial College London, London, United Kingdom
- Applied Research Collaboration Northwest London, Imperial College London, London, United Kingdom
| | - Paul Aylin
- School of Public Health, Imperial College London, London, United Kingdom
- National Institute for Health and Care Research Imperial Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
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Perini I, Zetterqvist M, Mayo LM. Beyond distress: a role for positive affect in nonsuicidal self-injury. Curr Opin Behav Sci 2021. [DOI: 10.1016/j.cobeha.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Robinson K, Garisch JA, Wilson MS. Nonsuicidal self-injury thoughts and behavioural characteristics: Associations with suicidal thoughts and behaviours among community adolescents. J Affect Disord 2021; 282:1247-1254. [PMID: 33601703 DOI: 10.1016/j.jad.2020.12.201] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/15/2020] [Accepted: 12/31/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND We consider whether nonsuicidal self-injury (NSSI) thoughts - in the absence of any NSSI behaviour - are associated with suicidal thoughts and behaviours among adolescents, before examining whether characteristics of NSSI behaviour are associated with greater suicidal thoughts and behaviours. METHODS Adolescents (n = 2,057, M age =15.56) recruited from secondary schools reported their lifetime history of NSSI, suicidal thoughts and behaviours, NSSI characteristics, and NSSI functions. Receiver Operating Characteristic analysis test whether NSSI status and characteristics of NSSI behaviour are diagnostic of clinically elevated suicidal thoughts and behaviours (a score of 7 or higher on the Suicide Behaviours Questionnaire-Revised). Regression models test whether NSSI functions predict greater suicidality. RESULTS Adolescents with NSSI thoughts and those with NSSI behaviour were more likely to report lifetime suicidal ideation and past-year suicide plan(s) than adolescents with no history of NSSI. In addition, adolescents with a history of NSSI were more likely to report a lifetime history of suicide attempt(s) as well as past-year suicide attempt(s) than adolescents with no history of NSSI. A greater number of NSSI methods, requiring medical assistance for NSSI injuries, and engaging in NSSI for self-punishment, anti-suicide, and sensation-seeking functions were associated with greater severity of suicidal thoughts and behaviours. LIMITATIONS Data are cross-sectional, limiting inferences about causality. CONCLUSIONS Findings emphasize the importance of NSSI thoughts and characteristics of NSSI behaviour in understanding the complex relationship between NSSI and suicidal thoughts and behaviours among adolescents.
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Affiliation(s)
- Kealagh Robinson
- School of Psychology, Victoria University of Wellington, New Zealand
| | - Jessica A Garisch
- School of Psychology, Victoria University of Wellington, New Zealand; Child and Adolescent Mental Health Service, Capital and Coast District Health Board, New Zealand
| | - Marc S Wilson
- School of Psychology, Victoria University of Wellington, New Zealand
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Wiguna T, Minayati K, Kaligis F, Ismail RI, Wijaya E, Murtani BJ, Pradana K. The Effect of Cyberbullying, Abuse, and Screen Time on Non-suicidal Self-Injury Among Adolescents During the Pandemic: A Perspective From the Mediating Role of Stress. Front Psychiatry 2021; 12:743329. [PMID: 34867535 PMCID: PMC8632872 DOI: 10.3389/fpsyt.2021.743329] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Adolescence is often a period of turmoil. The COVID-19 pandemic has increased adolescents' difficulty due to mental health consequences that may affect their developmental milestones. This study constructed and empirically tested a theoretical model of three predictive factors (cyberbullying, abuse, and screen time) and stress as the mediating factor in adolescent non-suicidal self-injury (NSSI). Structural equation model (SEM) analysis was applied to investigate stress as a mediating factor in the relationship between adolescent NSSI and cyberbullying, abuse, and screen time. This cross-sectional study used a "crowdsourcing" sample collection method to recruit 464 adolescents aged 11-17 years who were administered a questionnaire comprising scales on cyberbullying, abuse, screen time, stress, and NSSI. All scales had construct reliabilities ranging from 0.759 to 0.958. SEM statistical analysis was performed using Lisrel version 8.8 (Scientific Software International, USA) for Windows (Microsoft Corporation, Redmond, WA, USA). The mean (± SD) age of the cohort was 14.61 ± 1.65 years, and consisted of 66.7% females. Secondary high school was the highest educational background (58%). The study found that cyberbullying and abuse were direct positive predictors (critical t-value for the path > 1.96; p < 0.05) of adolescent NSSI; however, screen time did not have any direct relationship. Furthermore, stress was a significant full mediating factor of screen time and a partial mediating factor of cyberbullying and abuse in the relationship with adolescent NSSI (critical t-value of the path = 5.27; p < 0.05). Cyberbullying, screen time, and abuse with the mediating effect of stress could explain 48% of the variance in adolescent NSSI (R 2 = 0.48). Adolescent mental health prevention and promotion programs need to be redesigned during the current COVID-19 pandemic to manage their stress and minimize the mental health consequences of cyberbullying, abuse, and inappropriately increased screen time.
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Affiliation(s)
- Tjhin Wiguna
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Kusuma Minayati
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Fransiska Kaligis
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Raden Irawati Ismail
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Erik Wijaya
- Faculty of Psychology, Universitas Tarumanegara, Jakarta, Indonesia
| | - Belinda Julivia Murtani
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Kent Pradana
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Wang L, Cui Q, Liu J, Zou H. Emotion Reactivity and Suicide Risk in Patients With Depression: The Mediating Role of Non-Suicidal Self-Injury and Moderating Role of Childhood Neglect. Front Psychiatry 2021; 12:707181. [PMID: 34721098 PMCID: PMC8553945 DOI: 10.3389/fpsyt.2021.707181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The association between emotion reactivity (ER) and suicide risk has been confirmed in recent studies, especially in patients with depression. However, there is a lack of understanding of the underlying mechanism of the relation from ER to suicide risk among patients with depression. This study planned to examine a model of how ER, non-suicidal self-injury (NSSI), and childhood neglect (CN) interact to affect suicide risk in depressed patients. Methods: Four hundred and ninety-six patients (64.5% female, mean age = 30.40 years, SD = 12.56) who have accomplished self-rating instruments of ER, NSSI, CN, and suicide risk were included. Results: Findings showed that ER was positively connected with suicide risk, and NSSI partially mediated the above connection. Besides, CN moderated the mediation model, that is, the mediation effect was more pronounced in depressed patients with CN compared to depressed patients without CN. Conclusions: It was concluded that there is a relationship among ER, NSSI, CN, and suicide risk in patients with depression, and it strengthens our knowledge of the mechanism behind suicide risk. Our findings emphasize that the identification of NSSI and CN should be considered when assessing the suicide risk of patients with depression, as well as the intervention focus on emotion regulation and support for patients.
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Affiliation(s)
- Lu Wang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Qian Cui
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Jun Liu
- Department of Nursing, Anding Hospital, Capital Medical University, Beijing, China
| | - Haiou Zou
- School of Nursing, Peking Union Medical College, Beijing, China
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Lewis SP, Hasking PA. Self‐injury recovery: A person‐centered framework. J Clin Psychol 2020; 77:884-895. [DOI: 10.1002/jclp.23094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Stephen P. Lewis
- Department of Psychology University of Guelph Guelph Ontario Canada
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Hasking P, Lewis SP, Bloom E, Brausch A, Kaess M, Robinson K. Impact of the COVID-19 pandemic on students at elevated risk of self-injury: The importance of virtual and online resources. SCHOOL PSYCHOLOGY INTERNATIONAL 2020. [DOI: 10.1177/0143034320974414] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Non-suicidal self-injury (NSSI), which involves deliberate damage to body tissue without suicidal intent, has long been a concern for schools and school staff. Secondary schools are an ideal setting in which to identify, and appropriately refer, students who self-injure as well as implement evidence-based prevention and early intervention programs. However, in the context of the global COVID-19 pandemic, schools have been closed and students sent home to learn online. This may result in the exacerbation of existing anxieties and pose several new stressors that cumulatively may increase risk of NSSI. In this article, we draw on recent research and our collective experience working with schools, as well as digital mental health, to outline some of these potential stressors and offer resources for school staff to help students who are engaging in or at risk of NSSI.
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Affiliation(s)
| | | | - Elana Bloom
- Student Services Department, Lester B Pearson School Board, Quebec, Canada
| | - Amy Brausch
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY, USA
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kealagh Robinson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
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