Sexual Attraction and Non-Suicidal Self-Harm: The Role of Stressors and Psychological Mediators

Non-suicidal self-harm (NSSH) is a serious concern for the well-being of youth. Stressors relate to greater NSSH risk, such as being non-heterosexual in a heteronormative society. Other stressors may include traumatic experiences. These relationships may be mediated by psychological factors (depressed mood, anxiety, anger, and self-esteem) as well as contextual factors (support from parents and peers). The purpose of this study was to examine NSHH ideation and behavior among Icelandic youth, as well as relationships with stressors and mediators. Students in Icelandic high schools (N = 8921, 50.8% female) completed an in-class survey in the year 2016. Results showed an elevated risk of NSSH ideation and behavior among bisexual and homosexual youth. Mediation analyses showed that, for girls, being bisexual related to greater NSSH ideation and behavior, and these relationships were mediated by depressed mood, anger, and self-esteem, as well as by support from parents and peers. For boys, however, both homosexual and bisexual attraction related to greater risk for NSSH ideation and behavior, which was mediated by depressed mood, anger, and self-esteem. These results suggest that NSSH risk factors vary by gender and, therefore, they may benefit from different interventions to stop and prevent this behavior. This is the first study of its kind in Iceland, where sexual minority stress may need further study within the Nordic context.

Examining the relationship between non-suicidal self-harm and suicidality within the past 12-months and gaming problems in Norwegian full-time students

BACKGROUND

Although gaming problems are associated with poor mental health, few population-based studies have examined its association with self-harm and suicidality. This study investigates the association between gaming problems, non-suicidal self-harm and suicidality within the past year, stratified by sex among Norwegian full-time students.

METHODS

Data derived from the Norwegian Students' Health and Wellbeing Study 2022 (N = 59,544). The respondents were categorized into non-gamers, recreational gamers, engaged gamers, problematic gamers, and addicted gamers based on the Game Addiction Scale for Adolescents. Log-link binomial regression models, stratified by sex, adjusted for age, were used to estimate the risk ratio of non-suicidal self-harm (ideation and behavior) and suicidal behaviors (ideation and attempt) across different levels of gaming problems.

RESULTS

Among females, the risk of non-suicidal self-harm and suicidal ideation increased from non-gamer to problem gamer, with no differences between problem and addicted gamers. Among males, the risk of non-suicidal self-harm increased from non-gamers to engaged gamers, but no differences were observed between engaged, problematic, and addicted gamers. No sex × gaming category interaction was observed for suicide attempts. Engaged and addicted gamers had higher risks of suicide attempt than non-gamers and recreational gamers.

CONCLUSIONS

Gaming problems are associated with increased risk of non-suicidal self-harm and suicidal ideation among females. Among males, no differences were observed between engaged, problem and addicted gamers. The results highlight sex when studying health related outcomes and their association to level of gaming problems. Longitudinal studies are warranted to uncover the temporal mechanisms between IGD, non-suicidal self-harm and suicidality.

A systematic review on gender dysphoria in adolescents and young adults: focus on suicidal and self-harming ideation and behaviours

INTRODUCTION

Gender dysphoria (GD) is characterized by the incongruence between one's experienced and expressed gender and assigned-sex-at-birth; it is associated with clinically significant distress. In recent years, the number of young patients diagnosed with GD has increased considerably. Recent studies reported that GD adolescents present behavioural and emotional problems and internalizing problems. Furthermore, this population shows a prevalence of psychiatric symptoms, like depression and anxiety. Several studies showed high rates of suicidal and non-suicidal self-injurious thoughts and behaviour in GD adolescents. To increase understanding of overall mental health status and potential risks of young people with GD, this systematic review focused on risk of suicide and self-harm gestures.

METHODS

We followed the PRISMA 2020 statement, collecting empirical studies from four electronic databases, i.e., PubMed, Scopus, PsycINFO, and Web of Science.

RESULTS

Twenty-one studies on GD and gender nonconforming identity, suicidality, and self-harm in adolescents and young adults met inclusion criteria. Results showed that GD adolescents have more suicidal ideation, life-threatening behaviour, self-injurious thoughts or self-harm than their cisgender peers. Assessment methods were heterogeneous.

CONCLUSION

A standardised assessment is needed. Understanding the mental health status of transgender young people could help develop and provide effective clinical pathways and interventions.

Sleep duration trajectory during the transition to adolescence and subsequent risk of non-suicidal self-harm

Non-suicidal self-harm (NSSH) and chronic insufficient sleep are both major health problems during the transition from childhood to adolescence. We examined to identify sleep duration trajectories from childhood to adolescence and their associations with subsequent risk of NSSH. A cohort of children around the period of pubertal onset (7-9 years old) were followed from 2013 over 6 years. Group-based trajectory modeling was recruited to identify sleep duration trajectories derived from 5 repeated measures. Association between sleep duration trajectories with the risk of NSSH was examined using multivariate logistic regression model. Nonlinear dose-response associations between sleep duration and NSSH risk were also assessed using restricted cubic spline models. Of the 1973 participants included in the study (mean ± SD, 8.1 ± 0.9 years age at baseline, 41.1% female). Three sleep duration trajectories were identified: persistent sleeping ≥ 8 h/day (27.7%), moderately decreasing (60.8%) and rapidly decreasing (11.5%) sleep duration groups. After multivariable adjustment for covariates, compared with the persistent sleeping ≥ 8 h/day group, the odds ratio of NSSH was 2.58 (95% CI 1.92, 3.45) for the moderately decreasing group, and 4.16 (2.86, 6.04) for rapidly decreasing group. In dose-response analysis, sleep duration was associated with NSSH risk in a non-linear fashion (χ² = 25.16, P_nonlinearity < 0.001). When compared with the reference (sleep duration = 8 h), the ORs (95% CI) for NSSH risks were 3.20 (1.93, 5.29), 2.37 (1.64, 3.41), 1.75 (1.39, 2.20) and 1.30 (1.18, 1.44) for sleep duration at 4 to 7 h, respectively. Also, we found sleep duration at 9 h [0.82 (0.75, 0.89)] and at 10 h [0.72 (0.57, 0.91)] significantly associated with decreased risk of NSSH. Longitudinal sleep duration patterns may assist in identification of adolescents at greatest risk of NSSH in the future, which could lead to improved targeting of prevention and intervention strategies. The findings also highlight a non-linear relationship between sleep duration and NSSH during the transition to adolescence.

Using the integrated motivational-volitional (IMV) model of suicidal behaviour to differentiate those with and without suicidal intent in hospital treated self-harm

Self-harm is a major public health concern. In order to respond to self-harm effectively, it is important to understand the factors associated with self-harm with and without suicidal intent. To this end, we investigated psychological factors selected from the Integrated Motivational-Volitional (IMV) model of suicidal behaviour in individuals who had recently been admitted to hospital for self-harm, with the aim of examining the characteristics of those who expressed intent to die versus those without suicidal intent. Individuals (n = 500, 60.6% female) admitted to two hospitals in central Scotland following self-harm with (suicide attempt [SA] group, n = 336) or without (non-suicidal self-harm [NSSH] group, n = 164) suicidal intent completed a range of psychological measures. Over half of the participants reported previous episodes of self-harm (SA, n = 239, 71.1%; NSSH, n = 91, 55.5%). Univariate analyses revealed that the SA and NSSH groups differed on some of the psychological measures with higher depressive symptoms, defeat, entrapment, acquired capability and impulsivity in the SA compared to the NSSH group. In the multivariate model, suicidal ideation, defeat, internal entrapment and perceived burdensomeness independently differentiated between the groups. These findings highlight the complex profiles of individuals presenting at hospital with self-harm and emphasise the need to investigate differences between subtypes of self-harm in order to support individuals optimally. Applying frameworks such as the IMV model to further understanding of self-harm might assist in the development of targeted psychological interventions to reduce risk of repeat self-harm or suicide.

Psychotic experiences from preadolescence to adolescence: when should we be worried about adolescent risk behaviors?

Psychotic experiences (PE), below the threshold of psychotic disorder, are common in the general population. PE are associated with risk behaviors such as suicidality, non-suicidal self-injury (NSSI) and substance use. However, PE as specific or causal phenomena of these risk behaviors are still debated. We aimed to examine the longitudinal trajectories of PE from preadolescence to adolescence and their associated risk behaviors in adolescence. A total of 1138 adolescents from the Copenhagen Child Cohort 2000 were assessed for PE and risk behaviors (NSSI, suicide ideation and -attempts and substance use) at age 11 and 16 years, along with measures of general psychopathology and depressive symptoms specifically. Self-reported impact of general psychopathology tended to be associated with more PE persistence. PE were associated with all risk behaviors in cross section at both follow-ups. Persistent PE from ages 11 to 16 and incident PE at age 16 were associated with risk behaviors at age 16, whereas remitting PE from age 11 to 16 were not. After adjustment for co-occurring depressive symptoms and general psychopathology, all associations were markedly reduced. After exclusion of preadolescents who already had expressed risk behavior at age 11, PE in preadolescence did not stand out as an independent predictor of incident adolescent risk behaviors. The current study suggests that PE in preadolescence and adolescence may not play a direct causal role regarding NSSI, suicidality, and substance use. However, PE are still useful clinical markers of severity of psychopathology and associated risk behaviors.

Hopelessness is associated with repeated suicidal behaviors after discharge in patients admitted to emergency departments for attempted suicide

BACKGROUND

Hopelessness may be associated with an increased risk of suicide. However, findings regarding the long-term predictive ability of the Beck Hopelessness Scale (BHS) for suicide are inconsistent. This study investigated the long-term predictive ability of BHS scores for subsequent self-harm episodes in individuals admitted to an emergency department after attempting suicide.

METHODS

The BHS was administered to 805 adult patients with a DSM-IV-TR axis I disorder admitted to an emergency department following a suicide attempt. The patients were followed for at least 18 months and up to 5 years. The incidence of the first subsequent suicidal behavior (attempt or dying by suicide) was examined and the numbers per person-year of overall repeat self-harm episodes, suicide attempt episodes, and non-suicidal self-harm episodes were evaluated.

RESULTS

The total BHS scores showed significant associations with the overall number of self-harm episodes per person-year (incidence rate ratio [IRR], 1.05; 95% confidence interval [CI], 1.03-1.07; p < 0.0001), the number of suicide attempt episodes per person-year (IRR, 1.05; 95%CI, 1.03-1.08; p < 0.0001), and the number of non-suicidal self-harm episodes per person-year (IRR, 1.05; 95%CI, 1.03-1.07; p < 0.0001).

LIMITATIONS

The study excluded children and adolescents. The sample size, while large, was insufficient to ensure generalizability, or to allow subanalyses based on specific disorders.

CONCLUSIONS

Hopelessness scores assessed in the emergency department after a self-harming episode were associated with a rate of repetition of suicidal behaviors after discharge. Additional strategies to address hopelessness of these patients are warranted.