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Liu D, Qu D, Xu S, Wang Y, Chen R. Profile of childhood trauma subtypes associated with self-injurious thoughts and behaviors. Psychol Trauma 2024; 16:S63-S71. [PMID: 37650803 DOI: 10.1037/tra0001544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Childhood trauma has been identified as a risk factor for self-injurious thoughts and behaviors (STBs), but the roles of different types of childhood trauma have not been clarified. The current study aimed to explore the association between different childhood trauma experiences and STB profiles. METHOD The current study utilized data from a cross-sectional survey of 89,281 Chinese university and college students (Mage = 19.6). Participants were classified into one of six STBs groups, including individuals who are not suicidal or having nonsuicidal self-injury (NS) behavior, individuals with suicidal ideation (SI), individuals with nonsuicidal self-injury (NSSI) behavior, individuals with suicide attempt (SA), individuals with both NSSI and SI (NSSI + SI) and individuals with both NSSI and SA (NSSI + SA). Several multinomial logistic regressions were performed. RESULTS The individuals reporting more emotional abuse experiences are significantly more likely to report higher-risk STB profiles (OR =1.06-1.64). Emotional neglect is also a significant factor predicting higher STB risk compared to NS and SI groups (OR = 1.02-1.08). Mixed findings were found for physical neglect and sexual abuse, as they show different directions of risk-predicting effects in different STB groups. Physical abuse did not significantly predict STBs. CONCLUSIONS Our results indicate that exposure to childhood emotional abuse increase the risk for all types of STBs, which calls for special attention in future suicide prevention and intervention programs. Our findings further imply possible roles for different subtypes of traumatic experiences to trigger different SBTs, which warrant future exploration. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Dongyu Liu
- Vanke School of Public Health, Tsinghua University
| | - Diyang Qu
- Vanke School of Public Health, Tsinghua University
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University
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Qin Q, Yang G, Li Y, Wu W, Wang J, Chen Z, Kong X, Zhang W, Zou H. The relationship between major life events and non-suicidal self-injury among college students: the effect of rumination and body image. Front Public Health 2024; 11:1308186. [PMID: 38298255 PMCID: PMC10828039 DOI: 10.3389/fpubh.2023.1308186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
Background Non-suicidal self-injury (NSSI) poses a growing risk to public health worldwide. While numerous studies have identified major life events as key risk factors for NSSI, the mechanisms by which emotional and cognitive problems mediate or moderate this relationship remain unclear. To enhance the understanding of this field, we will draw upon the cascade theory of self-injury and the benefits and barriers model, to examine the relationship between major life events and NSSI, as well as the effect of rumination and body image. Methods A sample of 2,717 college students (Mage = 19.81 years; SD = 1.09) participated in this study and anonymously completed the questionnaires. The moderated mediation model were conducted using Model 4 and Model 15 of the Process macro program in SPSS. Results The results showed that rumination mediated the positive relationship between major life events and NSSI. Furthermore, body image was found to moderate both the relationship between major life events and NSSI, as well as the relationship between rumination and NSSI. Conclusion The current findings suggest that rumination is an important mediator in the relationship between major life events and NSSI among college students. Teachers, parents, and researchers should recognize the important role of body image self-perceptions of college students and actively promote a healthy and accurate body image.
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Affiliation(s)
- Qian Qin
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Guangni Yang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- Department of Psychology, Lingnan University, Hong Kong, China
| | - Yue Li
- College of Teacher Education, South China Normal University, Guangzhou, China
| | - Wanchun Wu
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Jianping Wang
- College of Teacher Education, South China Normal University, Guangzhou, China
- Journal of South China Normal University, South China Normal University, Guangzhou, China
| | - Ziyao Chen
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Xiaohua Kong
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Wei Zhang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Hongyu Zou
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
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Walker AR, Srasuebkul P, Trollor JN, Wand APF, Draper B, Cvejic RC, Moxey A, Reppermund S. Risk factors for dementia and self-harm: A linkage study. Alzheimers Dement 2023; 19:5138-5150. [PMID: 37126409 DOI: 10.1002/alz.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 03/11/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION People living with dementia experience poor mental health and high rates of self-harm. We investigated risk factors for self-harm in people aged > 40 years living with dementia and risk factors for dementia after self-harm. METHODS Using linked hospital data from New South Wales, Australia, we defined a dementia cohort (n = 154,811) and a self-harm cohort (n = 28,972). Using survival analyses, we investigated predictors of self-harm for the dementia cohort, and predictors of dementia for the self-harm cohort. RESULTS We found self-harm or dementia diagnoses occurred most often within 24 months of a dementia diagnosis or initial self-harm presentation, respectively. Men living with dementia, and people with complex psychiatric profiles, had the greatest risk of self-harm. Men who had self-harmed had the greatest risk of dementia diagnoses. DISCUSSION Men and people with complex psychiatric profiles and dementia may particularly benefit from post-diagnosis mental and behavioral support to reduce risk of self-harm.
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Affiliation(s)
- Adrian R Walker
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Preeyaporn Srasuebkul
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Julian N Trollor
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Anne P F Wand
- Speciality of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Eastern Suburbs Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Rachael C Cvejic
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annette Moxey
- Dementia Australia, Griffith, Australian Capital Territory, Australia
| | - Simone Reppermund
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Warne N, Heron J, Mars B, Solmi F, Biddle L, Gunnell D, Hammerton G, Moran P, Munafò M, Penton‐Voak I, Skinner A, Stewart A, Bould H. Emotional dysregulation in childhood and disordered eating and self-harm in adolescence: prospective associations and mediating pathways. J Child Psychol Psychiatry 2023; 64:797-806. [PMID: 36541428 PMCID: PMC10152493 DOI: 10.1111/jcpp.13738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emotional dysregulation may be a risk factor for disordered eating and self-harm in young people, but few prospective studies have assessed these associations long-term, or considered potential mediators. We examined prospective relationships between childhood emotional dysregulation and disordered eating and self-harm in adolescence; and social cognition, emotional recognition, and being bullied as mediators. METHODS We analysed Avon Longitudinal Study of Parents and Children data on 3,453 males and 3,481 females. We examined associations between emotional dysregulation at 7 years and any disordered eating and any self-harm at 16 years with probit regression models. We also assessed whether social cognition (7 years), emotional recognition (8 years) and bullying victimisation (11 years) mediated these relationships. RESULTS Emotional dysregulation at age 7 years was associated with disordered eating [fully adjusted probit B (95% CI) = 0.082 (0.029, 0.134)] and self-harm [fully adjusted probit B (95% CI) = 0.093 (0.036, 0.150)] at age 16 years. There was no evidence of sex interactions or difference in effects between self-harm and disordered eating. Mediation models found social cognition was a key pathway to disordered eating (females 51.2%; males 27.0% of total effect) and self-harm (females 15.7%; males 10.8% of total effect). Bullying victimisation was an important pathway to disordered eating (females 17.1%; males 10.0% of total effect), but only to self-harm in females (15.7% of total effect). Indirect effects were stronger for disordered eating than self-harm. CONCLUSIONS In males and females, emotional dysregulation in early childhood is associated with disordered eating and self-harm in adolescence and may be a useful target for prevention and treatment. Mediating pathways appeared to differ by sex and outcome, but social cognition was a key mediating pathway for both disordered eating and self-harm.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | | | - Lucy Biddle
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | - Gemma Hammerton
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Marcus Munafò
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Ian Penton‐Voak
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Andy Skinner
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Integrative Cancer Epidemiology ProgrammeBristol Medical School, University of BristolBristolUK
| | - Anne Stewart
- Department of PsychiatryUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Gloucestershire Health and Care NHS Foundation TrustGloucesterUK
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Ping A, Yang M, Xu S, Li Q, Feng Y, Gao K, Wang S, Duan K. Correlations between GRIN2B and GRIN3A gene polymorphisms and postpartum depressive symptoms in Chinese parturients undergoing cesarean section: A prospective cohort study. J Psychosom Res 2023; 168:111210. [PMID: 36898314 DOI: 10.1016/j.jpsychores.2023.111210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 02/16/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To investigate the association of postpartum depressive symptoms (PDS) and self-harm ideation with n-methyl-d-aspartate (NMDA) receptor GRIN2B and GRIN3A gene polymorphisms and other risk factors in women undergoing cesarean section. METHODS A total of 362 parturients undergoing cesarean section under lumbar anesthesia were selected and their postpartum depression level was assessed by the Edinburgh Postpartum Depression Scale (EPDS) at 42 days postpartum, with an EPDS score of 9/10 as the cut-off value. Three GRIN2B SNP loci (rs1805476, rs3026174, rs4522263) and five GRIN3A SNP loci (rs1983812, rs2050639, rs2050641, rs3739722, rs10989563) were selected for genotype detection. The role of each SNP, linkage disequilibrium and haplotypes in the development of postpartum depression was analyzed. Logistic regression analysis was performed for related risk factors. RESULTS PDS incidence was 16.85%, and self-harm ideation incidence was 13.54%. Univariate analysis showed that GRIN2B rs1805476, rs3026174 and rs4522263 gene polymorphisms were associated with PDS (p < 0.05), with GRIN2B rs4522263 gene also associated with maternal self-harm ideation. GRIN3A rs1983812, rs2050639, rest rs2050641, rs3739722 and rs10989563 alleles were not associated with PDS. Logistic regression analysis indicated that high pregnancy stress, as well as rs1805476 and rs4522263 alleles were PDS risk factors following cesarean delivery. GRIN2B (TTG p = 0.002) and GRIN3A (TGTTC p = 0.002) haplotypes were associated with the lower PDS incidence and higher PDS incidence respectively. CONCLUSION GRIN2B rs1805476 GG genotype, rs4522263 CC genotype and high stress during pregnancy were risk factors for PDS, whilst a significantly higher incidence of self-harm ideation was evident in parturients carrying GRIN2B rs4522263 CC genotype.
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Affiliation(s)
- Anqi Ping
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, PR China
| | - Mi Yang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, PR China
| | - Shouyu Xu
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, PR China
| | - Qiuwen Li
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, PR China
| | - Yunfei Feng
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, PR China
| | - Kai Gao
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, PR China
| | - Saiying Wang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, PR China.
| | - Kaiming Duan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, PR China.
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Rizeq J, McCann D. The cognitive, emotional, and behavioral sequelae of trauma exposure: An integrative approach to examining trauma's effect. Psychol Trauma 2023; 15:313-321. [PMID: 34618483 DOI: 10.1037/tra0001152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In this study, we tested direct pathways from trauma exposure to trauma symptomatology and risky and self-destructive behavior and indirect pathways through two cognitive and affective mechanisms: (a) world assumptions and (b) emotion dysregulation. METHOD A sample of 270 undergraduate students with an average age of 20.02 years participated in the study (204 women, 65 men, and one participant choosing not to disclose). Participants completed self-report measures assessing trauma exposure, trauma symptoms, emotion dysregulation, world assumptions, and lifetime and past-month engagement in any of 38 risky and self-destructive behaviors. RESULTS The direct path from trauma exposure to trauma symptoms was significant, and so was the indirect effect of self-worth assumptions on this association. The indirect pathway between trauma symptoms and risky and self-destructive behavior in the past month was significant through difficulties with impulse control when distressed. Trauma symptoms had an indirect effect on the association between trauma exposure and lifetime and past-month engagement in risky and self-destructive behavior, while the direct pathway from trauma exposure to lifetime engagement remained significant. CONCLUSION We offer theoretically and empirically supported integrative pathways that explicate some aspects of trauma exposure's negative sequelae with potential areas for intervention. Clinical Impact Statement: Trauma exposure is widespread and is associated with negative views about oneself and the world and with difficulties in managing one's emotions, which in part is associated with individuals' risk for developing psychopathology and engaging in risky and self-destructive behaviors. The findings inform optimal time for intervention and prevention efforts targeting trauma exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Wilson E, Crudgington H, Morgan C, Hirsch C, Prina M, Gayer-Anderson C. The longitudinal course of childhood bullying victimization and associations with self-injurious thoughts and behaviors in children and young people: A systematic review of the literature. J Adolesc 2023; 95:5-33. [PMID: 36210652 PMCID: PMC10092090 DOI: 10.1002/jad.12097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Bullying victimization has consistently been highlighted as a risk factor for self-injurious thoughts and behaviors (SITBs) in young people. This systematic review of prospective, community-based studies explored associations between bullying victimization (traditional/face-to-face and cyber) across the full spectrum of self-harm and suicidality, in children and young people aged up to (and including) 25 years. Importantly, associations by sex/gender were explored. METHODS MEDLINE, Embase, PsycINFO, CINAHL and Scopus were searched for articles meeting the inclusion criteria. Articles were screened by title, abstract and full text. Quality appraisal was performed using the Newcastle-Ottawa Scale for cohort studies. Data were synthesized narratively. The protocol is registered on PROSPERO (CRD42021261916) and followed PRISMA 2020 guidelines. RESULTS A total of 35 papers were included, across 17 countries. Results were presented by bullying type: traditional/face-to-face (n = 25), cyber (n = 7) and/or an aggregate of both types (n = 7). Outcomes included suicidal ideation (n = 17), self-harm (n = 10), suicide attempt (n = 4), NSSI (n = 4), other (n = 7). Studies measured outcomes in under 18s (n = 24), 18-25-year-olds (n = 8) and both under 18s and 18-25-year-olds (n = 3). Studies exploring the role of sex/gender (20%) found some interesting nuances. CONCLUSIONS Some weak to strong associations between bullying and SITBs were found yet conclusions are tentative due to study heterogeneity (e.g., methods used, conceptualizations and operationalisations of exposures/outcomes). Future research should address methodological issues raised in this review, and further explore gender differences in bullying, including by bullying sub-types (e.g., overt or relational) and victim status (e.g., victim or bully-victim).
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Affiliation(s)
- Emma Wilson
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Holly Crudgington
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Craig Morgan
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Colette Hirsch
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Matthew Prina
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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Ahmad K, Beatson A, Campbell M, Hashmi R, Keating BW, Mulcahy R, Riedel A, Wang S. The impact of gender and age on bullying role, self-harm and suicide: Evidence from a cohort study of Australian children. PLoS One 2023; 18:e0278446. [PMID: 36602997 PMCID: PMC9815580 DOI: 10.1371/journal.pone.0278446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023] Open
Abstract
There has been limited longitudinal investigation to date into the association between bullying, self-harm, and suicidality in Australia and the impact of specific demographic differences on this relationship. This is despite the continued rise in the incidence of bullying, self-harm, and suicide. As such, the current study draws on data from the Longitudinal Survey of Australian children (LSAC) to examine the association between bullying, self-harm, and suicidality and explore the impact of demographic differences across three bullying related behaviors (being bullied, bullying others and being both bullied and bullying others). The evidence indicates that bully-victims exhibit the highest risk of self-harm and suicidality in Australia. When considering demographic differences, it was identified that females and adolescents aged 16-17-years-of-age had the highest risk of self-harm and suicidality. Further, a direct curvilinear relationship between age and the categories of self-harm was identified with an inflection point around 16-17 years. The study supports the need for further investigation into the association between bullying, self-harm, and suicidality longitudinally with a particular focus on other moderators.
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Affiliation(s)
- Kabir Ahmad
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Amanda Beatson
- QUT Business School, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Marilyn Campbell
- School of Early Childhood & Inclusive Education, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Rubayyat Hashmi
- QUT Business School, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Byron W. Keating
- QUT Business School, Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail:
| | - Rory Mulcahy
- School of Business and Creative Industries, University of the Sunshine Coast, Moreton Bay, Queensland, Australia
| | - Aimee Riedel
- School of Business and Creative Industries, University of the Sunshine Coast, Moreton Bay, Queensland, Australia
| | - Shasha Wang
- QUT Business School, Queensland University of Technology, Brisbane, Queensland, Australia
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Bashynskyi OO, Pyliagina GY, Fradelos EC. SELF-DESTRUCTIVE BEHAVIOR IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS. FEATURES OF PATHOGENESIS AND PATHODYNAMICS. Wiad Lek 2022; 75:1832-1838. [PMID: 36089865 DOI: 10.36740/wlek202208103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To prove the heterogeneity of pathogenetic mechanisms and pathodynamics of self-destructive behaviour (SdB) in patients with schizophrenia spectrum disorders (SSD). PATIENTS AND METHODS Materials and methods: We examined 112 patients with different kinds of SSD: 55 men (49.1%) and 57 women (50.9%), 34.9±8 years old. In 44.6% of patients the features of SdB were present during more than half of disease time (Gr1) - before and after self-injury or suicidal attempt (SI\SA) as well as in acute psychosis exacerbation or in remission. They committed SI\SA mainly in a psychotraumatic situations and due to permanent feelings with a self-destructive content. In 55.4% of patients (Gr2) acute manifestations of SdB with realization of impulsive SI\SA were caused only as secondary symptoms of the severe exacerbation of psychosis. Self-destructive or suicidal ideas disappeared in Gr2 patients after the reduction of acute psychotic symptoms. RESULTS Results: Psychometric testing by the PANSS confirmed the comparability of these groups. линеpatients' reaction on a psychological problems, especially family conflicts, the desire to reduce the high level of subjective anxiety or to draw attention to themselves. In 92% of these patients at the moment of examination manifestations of SDB and the same self-destructive motives persisted. While patients of Gr2 committed impulsive SI\SA only by the influence of command pseudohallucinations or delusional ideas at the acute psychosis. At the time of the study (in state without acute psychotic symptoms or in remission) all patients of Gr2 showed no SDB signs. The data according to the Big Five Personality Test fixed substantial distinctions in personal characteristics of patients in Gr1 and Gr2 as well. CONCLUSION Conclusions: Our study proved the scientific hypothesis that the pathogenesis and dynamics of SdB in patients with SSD (who committed SI\SA) have essential differences. The research results allowed to describe two types of personal portrait of patients with SSD and SdB who had realized SI\SA. This crucial pathogenetic variances are important to design of the therapy strategies of those patients.
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Florido Ngu F, Kelman I, Chambers J, Ayeb-Karlsson S. Correlating heatwaves and relative humidity with suicide (fatal intentional self-harm). Sci Rep 2021; 11:22175. [PMID: 34782650 PMCID: PMC8593067 DOI: 10.1038/s41598-021-01448-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Empirical evidence suggests that the effects of anthropogenic climate change, and heat in particular, could have a significant impact on mental health. This article investigates the correlation between heatwaves and/or relative humidity and suicide (fatal intentional self-harm) on a global scale. The covariance between heat/humidity and suicide was modelled using a negative binomial Poisson regression with data from 60 countries between 1979-2016. Statistically significant increases and decreases in suicide were found, as well as many cases with no significant correlation. We found that relative humidity showed a more significant correlation with suicide compared to heatwaves and that both younger age groups and women seemed to be more significantly affected by changes in humidity and heatwave counts in comparison with the rest of the population. Further research is needed to provide a larger and more consistent basis for epidemiological studies; to understand better the connections among heat, humidity and mental health; and to explore in more detail which population groups are particularly impacted and why.
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Affiliation(s)
- Fernando Florido Ngu
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Ilan Kelman
- Institute for Risk and Disaster Reduction, University College London, London, UK.
- Institute for Global Health, University College London, London, UK.
- University of Agder, Kristiansand, Norway.
| | - Jonathan Chambers
- Institute for Environmental Science, University of Geneva, Geneva, Switzerland
| | - Sonja Ayeb-Karlsson
- University of Sussex, Brighton, UK
- United Nations University's Institute for Environment and Human Security, Bonn, Germany
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Fernando SM, Qureshi D, Sood MM, Pugliese M, Talarico R, Myran DT, Herridge MS, Needham DM, Rochwerg B, Cook DJ, Wunsch H, Fowler RA, Scales DC, Bienvenu OJ, Rowan KM, Kisilewicz M, Thompson LH, Tanuseputro P, Kyeremanteng K. Suicide and self-harm in adult survivors of critical illness: population based cohort study. BMJ 2021; 373:n973. [PMID: 33952509 PMCID: PMC8097311 DOI: 10.1136/bmj.n973] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. DESIGN Population based cohort study using linked and validated provincial databases. SETTING Ontario, Canada between January 2009 and December 2017 (inclusive). PARTICIPANTS Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. MAIN OUTCOME MEASURES The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. RESULTS 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors (v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). CONCLUSIONS Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Danial Qureshi
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Manish M Sood
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Pugliese
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Talarico
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel T Myran
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dale M Needham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Deborah J Cook
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Hannah Wunsch
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert A Fowler
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Damon C Scales
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, Napier House, London, UK
| | | | - Laura H Thompson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
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Lee J, Jung SM, Jeon S. Delayed emergence from propofol anesthesia in a patient with Lesch-Nyhan syndrome: A case report. Medicine (Baltimore) 2020; 99:e21847. [PMID: 32846834 PMCID: PMC7447411 DOI: 10.1097/md.0000000000021847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Lesch-Nyhan syndrome (LNS) is an X-linked recessive disorder presenting with uric acid overproduction, neurocognitive disability, and behavioral disturbances. Inhalational anesthesia has been frequently used in LNS patients undergoing surgery. Characteristic compulsive self-injurious behavior and high risk of emesis may hinder inhalational induction. Propofol may be beneficial for these patients because of its easy and rapid titration for anesthetic depth during induction, early recovery from anesthesia, and antiemetic effect as well as uricosuric effect. PATIENT CONCERNS A 16-year-old male adolescent was scheduled for percutaneous nephrolithotomy. He exhibited poorly controlled muscle, self-injurious behaviors and intellectual disability. DIAGNOSIS The patient presented with neurodevelopmental delay in the first year of life, and was diagnosed with LNS, with a substitution of phenylalanine to leucine in hypoxanthine-guanine phosphoribosyltransferase (HPRT) 1 gene on the X-chromosome at 3 years of age. INTERVENTIONS Total intravenous anesthesia was used for induction and maintenance of anesthesia with propofol and remifentanil using target-controlled infusion. OUTCOMES Time to recovery of consciousness was prolonged after uneventful surgery. Serum uric acid levels gradually increased during postoperative period. LESSONS Propofol anesthesia using target-controlled infusion does not provide significant clinical advantages in rapid emergence from anesthesia and management of hyperuricemia in LNS patients undergoing urological surgery.
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Lung FW, Shu BC, Chiang TL, Lin SJ. Relationships between internet use, deliberate self-harm, and happiness in adolescents: A Taiwan birth cohort pilot study. PLoS One 2020; 15:e0235834. [PMID: 32649690 PMCID: PMC7351192 DOI: 10.1371/journal.pone.0235834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/23/2020] [Indexed: 11/25/2022] Open
Abstract
The potential risk of internet use on adolescents' self-harm is a major concern. Vulnerable adolescents who are susceptible to bullying are also susceptible to the negative influence of the internet. In this study, the pathway associations were investigated between the risk factors of deliberate self-harm, experience of being bullied, internet use, and protective factors of maternal monitoring on perceived happiness of 12- and 13-year-old adolescents in the Taiwan Birth Cohort Pilot Study dataset (n = 1,457). The Chinese Oxford Happiness Questionnaire was used to measure the adolescents' self-perceived levels of happiness, in two dimensions of social adaptation status and psychological well-being. Our results show that 354 (24.3%) of the 12-year-olds reported having been bullied, and 289 (19.8%) of the 13-year-olds reported this. Seventy-nine (5.4%) of 13-year-olds reported deliberate self-harm in the past year. Results of a structural equation model showed that those who had been bullied at age 12 years were at greater risk of deliberate self-harm at age 13 years. A negative association was found between duration of internet use and perceived level of happiness. Adolescents who spent >5 h online during days off school were at higher risk of deliberate self-harm, and perceived a lower level of happiness. Therefore, spending >5 h online during days off school could be used as an indicator in future preventive action programs to screen out those at a high risk of excessive internet use, deliberate self-harm, and psychological well-being and social adjustment issues.
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Affiliation(s)
- For-Wey Lung
- Calo Psychiatric Center, Pingtung County, Taiwan
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Bih-Ching Shu
- Department of Nursing, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tung-Liang Chiang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shio-Jean Lin
- Genetic Counseling Center, Chi Mei Medical Center, Tainan, Taiwan
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Campos AI, Verweij KJH, Statham DJ, Madden PAF, Maciejewski DF, Davis KAS, John A, Hotopf M, Heath AC, Martin NG, Rentería ME. Genetic aetiology of self-harm ideation and behaviour. Sci Rep 2020; 10:9713. [PMID: 32546850 PMCID: PMC7297971 DOI: 10.1038/s41598-020-66737-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
Family studies have identified a heritable component to self-harm that is partially independent from comorbid psychiatric disorders. However, the genetic aetiology of broad sense (non-suicidal and suicidal) self-harm has not been characterised on the molecular level. In addition, controversy exists about the degree to which suicidal and non-suicidal self-harm share a common genetic aetiology. In the present study, we conduct genome-wide association studies (GWAS) on lifetime self-harm ideation and self-harm behaviour (i.e. any lifetime self-harm act regardless of suicidal intent) using data from the UK Biobank (n > 156,000). We also perform genome wide gene-based tests and characterize the SNP heritability and genetic correlations between these traits. Finally, we test whether polygenic risk scores (PRS) for self-harm ideation and self-harm behaviour predict suicide attempt, suicide thoughts and non-suicidal self-harm (NSSH) in an independent target sample of 8,703 Australian adults. Our GWAS results identified one genome-wide significant locus associated with each of the two phenotypes. SNP heritability (hsnp2) estimates were ~10%, and both traits were highly genetically correlated (LDSC rg > 0.8). Gene-based tests identified seven genes associated with self-harm ideation and four with self-harm behaviour. Furthermore, in the target sample, PRS for self-harm ideation were significantly associated with suicide thoughts and NSSH, and PRS for self-harm behaviour predicted suicide thoughts and suicide attempt. Follow up regressions identified a shared genetic aetiology between NSSH and suicide thoughts, and between suicide thoughts and suicide attempt. Evidence for shared genetic aetiology between NSSH and suicide attempt was not statistically significant.
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Affiliation(s)
- Adrian I Campos
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia.
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
| | - Karin J H Verweij
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Dixie J Statham
- Discipline of Psychology, School of Health and Life Sciences, Federation University, Ballarat, VIC, 3550, Australia
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Dominique F Maciejewski
- Department of Developmental Psychopathology, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Katrina A S Davis
- KCL Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ann John
- HDRUK, Swansea University Medical School, Swansea, UK
| | - Matthew Hotopf
- KCL Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Nicholas G Martin
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Miguel E Rentería
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia.
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
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Abstract
Individual or singly-housing laboratory rats is common in many animal facilities, but has an adverse impact on the welfare of this social species. It has previously been shown that a small proportion of individually housed mice (∼5%) engage in pathological overgrooming behaviour, but this has not been assessed in rats. We performed an observational study to determine the prevalence of overgrooming-related self-injury and whether providing nesting material enrichment throughout an animal's life would affect the prevalence or severity of overgrooming-related self-injury. Due to protocol differences between projects in our behavioural neuroscience lab, unenriched rats received a nylabone and a shelter (n = 167), while baseline-enriched rats received a nylabone, shelter and shredded paper nesting material throughout experiments (n = 238). Unenriched rats received nesting material enrichment after the onset of overgrooming-related self-injury. Over 18 months, rats were monitored by their experimenters on a daily basis (5-7 days/week over 2-3 months/project) and any cases of overgrooming-related self-injury were recorded. Replicating the findings of previous studies in mice, we observed 20 cases of overgrooming-related self-injury (∼5%) with no difference in prevalence between rats on the basis of supplier, cage position, experimental procedure (behavioural only or involving surgical procedures), reinforcer (ethanol or sugar) or level of baseline-enrichment. While there was no difference in onset severity between rats that were unenriched at baseline and baseline-enriched rats, baseline-enriched rats had lower self-injury severity scores at one-, two- and four-week follow-ups. These results suggest that nesting material enrichment provided throughout an animal's life may reduce overgrooming-related self-injury.
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Affiliation(s)
- Shaun Y-S Khoo
- Center for Studies in Behavioral Neurobiology, Department of Psychology, 5618Concordia University, Montreal, Canada
| | - Vanessa Correia
- Center for Studies in Behavioral Neurobiology, Department of Psychology, 5618Concordia University, Montreal, Canada
| | - Alexandra Uhrig
- Center for Studies in Behavioral Neurobiology, Department of Psychology, 5618Concordia University, Montreal, Canada
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Abstract
Importance Obesity is associated with an increased prevalence of psychiatric disorders. The association of bariatric surgery with mental health outcomes is poorly understood. Objective To investigate the association of bariatric surgery with the incidence of outpatient, emergency department (ED), and inpatient mental health service use. Design, Setting, and Participants This statewide, mirror-image, longitudinal cohort study used data from Western Australian Department of Health Data Linkage Branch records from all patients undergoing index (ie, first) bariatric surgery in Western Australia over a 10-year period (January 2007-December 2016), with mean (SD) follow-up periods of 10.2 (2.9) years before and 5.2 (2.9) years after index bariatric surgery. The data analysis was performed between November 2018 and March 2019. Exposures Index bariatric surgery. Main Outcomes and Measures The incidence and predictors for mental health presentations, deliberate self-harm, and suicide in association with the timing of bariatric surgery. Results A total of 24 766 patients underwent index bariatric surgery; of these, the mean (SD) age was 42.5 (11.7) years and 19 144 (77.3%) were women. Use of at least 1 mental health service occurred in 3976 patients (16.1%), with 1401 patients (35.2%) presenting only before surgery, 1025 (25.8%) presenting before and after surgery, and 1550 patients (39.0%) presenting only after surgery. There was an increase in psychiatric illness presentations after bariatric surgery (outpatient clinic attendance: incidence rate ratio [IRR], 2.3; 95% CI, 2.3-2.4; ED attendance: IRR, 3.0; 95% CI, 2.8-3.2; psychiatric hospitalization: IRR, 3.0; 95% CI, 2.8-3.1). There was also a 5-fold increase in deliberate self-harm presentations to an ED after surgery (IRR, 4.7; 95% CI, 3.8-5.7), with 25 of 261 postoperatives deaths (9.6%) due to suicide. Complications after bariatric surgery requiring further surgical intervention and a history of mental health service provision before surgery were the most important associations with subsequent mental health presentations after surgery. Deliberate self-harm and mental and behavioral disorders due to psychoactive substance use before bariatric surgery were the main associations with subsequent deliberate self-harm or suicide after surgery. Conclusions and Relevance We observed an increase in mental health service presentations after bariatric surgery, particularly among those who had prior psychiatric illnesses or developed surgical complications requiring further surgery. These findings caution the hypothesis that weight reduction by bariatric surgery will improve mental health in patients with obesity.
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Affiliation(s)
- David J. R. Morgan
- Department of Intensive Care Medicine, St John of God Subiaco Hospital, Perth, Western Australia
- University of Western Australia, Perth, Western Australia
| | - Kwok M. Ho
- Department of Intensive Care Medicine, St John of God Subiaco Hospital, Perth, Western Australia
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia
| | - Cameron Platell
- Department of Surgery, St John of God Subiaco Hospital, Perth, Western Australia
- School of Medicine, University of Western Australia, Perth, Western Australia
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Abstract
BACKGROUND Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships. METHOD In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30-57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling. RESULTS Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43-3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex. CONCLUSIONS Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression.
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Affiliation(s)
- O A Oginni
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E J Robinson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Jones
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Q Rahman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Peng Z, Klomek AB, Li L, Su X, Sillanmäki L, Chudal R, Sourander A. Associations between Chinese adolescents subjected to traditional and cyber bullying and suicidal ideation, self-harm and suicide attempts. BMC Psychiatry 2019; 19:324. [PMID: 31660917 PMCID: PMC6819572 DOI: 10.1186/s12888-019-2319-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 10/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence of bullying is high among adolescents. Adolescents who were victims of bullying have a higher risk of self-harm and suicidal behavior than adolescents who were non-victims. However, research on suicide and both traditional and cyber bullying was limited in China. Therefore, this study examined the associations between Chinese adolescents who were the victims of traditional and cyber bullying and the prevalence of suicidal ideation, self-harm and suicide attempts. METHODS This was a population-based study of 2647 students (51.2% girls) with a mean age of 13.6 ± 1.1 years from 10 junior high schools in Shantou, China. Information on bullying victimization, suicidal ideation, self-harm and suicide attempts were collected using a self-administered questionnaire and the psychopathology of the students was assessed using the Strengths and Difficulties Questionnaire (SDQ). The associations were examined with multinomial logistic regression, adjusted for covariates. RESULTS Traditional bullying victimization was reported by 16.7% of the adolescents, cyber bullying victimization by 9.0% and both by 3.5%. The prevalence of suicidal ideation was 23.5%, self-harm was 6.2% and suicide attempts was 4.2%. Psychopathology symptoms were risk factors for suicide ideation only, ideation plus self-harm, self-harm only and suicide attempts. Victims of both traditional and cyber bullying had the highest risk of suicidal ideation only, ideation plus self-harm and suicide attempts, compared to those reporting one form of bullying. Victims of cyber bullying only had the second highest risk of suicidal ideation only and suicidal ideation plus self-harm compared to non-victims. CONCLUSIONS Adolescents who were victims of both traditional and cyber bullying had greater risks of adverse outcomes of suicidal ideation only, suicidal ideation plus self-harm and suicide attempts. The results of the current study suggest that those exposed to both forms of bullying should be routinely screened for suicidal risk. In addition, school-based anti-bully interventions should also target cyber bullying.
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Affiliation(s)
- Zhekuan Peng
- Injury Prevention Research Center, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China
| | | | - Liping Li
- Injury Prevention Research Center, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China.
| | - Xuefen Su
- Injury Prevention Research Center, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China
| | - Lauri Sillanmäki
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
| | - Roshan Chudal
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
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Bornioli A, Lewis-Smith H, Smith A, Slater A, Bray I. Adolescent body dissatisfaction and disordered eating: Predictors of later risky health behaviours. Soc Sci Med 2019; 238:112458. [PMID: 31450163 DOI: 10.1016/j.socscimed.2019.112458] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/16/2019] [Accepted: 07/28/2019] [Indexed: 01/10/2023]
Abstract
RATIONALE Body dissatisfaction is prevalent among teenagers, and may influence the uptake of risky health behaviours. OBJECTIVE The study assessed the influence of body dissatisfaction on smoking, cannabis use, drug use, self-harm, gambling, and drinking and the mediating role of disordered eating in a population-based sample of British adolescents. METHOD Participants were 2634 females and 1684 males from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Logistic regression was used to test if body dissatisfaction at 14 years old predicted the onset of risky health behaviours at 21 years old. Mediation analysis tested the mediating role of disordered eating at 16 years old on each risky health behaviour. RESULTS Among females, body dissatisfaction predicted smoking (OR = 1.40, 95% CI = 1.15, 1.72), cannabis use (OR = 1.20, 95% CI = 1.00, 1.43), drug use (OR = 1.51, 95% CI = 1.20, 1.90), self-harm (OR = 1.44, 95% CI = 1.13, 1.84) and high-risk drinking (OR = 1.41, 95% CI = 1.10, 1.80). Disordered eating symptoms had mediating effects on some behaviours. Among males, body dissatisfaction predicted smoking (OR = 1.44, 95% CI = 1.14, 1.81) and no effect of disordered eating was found on any risky health behaviour. CONCLUSIONS This is the first prospective study to demonstrate that body dissatisfaction in adolescence predicts the occurrence of several risky health behaviours, and elucidates the mediating role of disordered eating. The findings highlight that body dissatisfaction is a public health concern. Early interventions to promote body satisfaction may reduce the prevalence of later risky health behaviours.
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Affiliation(s)
- Anna Bornioli
- Centre for Public Health and Wellbeing, Department of Health and Social Science, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Centre for Appearance Research, Department of Health and Social Science, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
| | - Helena Lewis-Smith
- Centre for Appearance Research, Department of Health and Social Science, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Andrew Smith
- Applied Statistics Group, Department of Engineering Design and Mathematics, Faculty of Environment and Technology, University of the West of England, Bristol, UK
| | - Amy Slater
- Centre for Appearance Research, Department of Health and Social Science, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Isabelle Bray
- Centre for Public Health and Wellbeing, Department of Health and Social Science, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Abstract
Individuals diagnosed with intellectual and developmental disabilities (IDD) frequently exhibit self-injurious behavior (SIB). Previous research has examined the published literature on behavioral treatments of SIB from 1964-2000. Results suggested that these treatments were highly efficacious at decreasing SIB, particularly when based on the results of a functional assessment. The purpose of this review is to update, replicate, and extend the previous research. The current findings indicate an increase in studies reporting automatically maintained SIB as well as less efficacious treatments overall. Discussion of our conclusions and methods of SIB assessment and treatment are discussed, both as they relate to the previous review and for future directions.
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Affiliation(s)
- Lesley A Shawler
- Lesley A. Shawler, Samantha R. Russo, and Jennifer L. Hilton, Endicott College; SungWoo Kahng, Rutgers University; Cheryl J. Davis, The Sage Colleges; and Michael F. Dorsey, Amego, Inc
| | - Samantha R Russo
- Lesley A. Shawler, Samantha R. Russo, and Jennifer L. Hilton, Endicott College; SungWoo Kahng, Rutgers University; Cheryl J. Davis, The Sage Colleges; and Michael F. Dorsey, Amego, Inc
| | - Jennifer L Hilton
- Lesley A. Shawler, Samantha R. Russo, and Jennifer L. Hilton, Endicott College; SungWoo Kahng, Rutgers University; Cheryl J. Davis, The Sage Colleges; and Michael F. Dorsey, Amego, Inc
| | - SungWoo Kahng
- Lesley A. Shawler, Samantha R. Russo, and Jennifer L. Hilton, Endicott College; SungWoo Kahng, Rutgers University; Cheryl J. Davis, The Sage Colleges; and Michael F. Dorsey, Amego, Inc
| | - Cheryl J Davis
- Lesley A. Shawler, Samantha R. Russo, and Jennifer L. Hilton, Endicott College; SungWoo Kahng, Rutgers University; Cheryl J. Davis, The Sage Colleges; and Michael F. Dorsey, Amego, Inc
| | - Michael F Dorsey
- Lesley A. Shawler, Samantha R. Russo, and Jennifer L. Hilton, Endicott College; SungWoo Kahng, Rutgers University; Cheryl J. Davis, The Sage Colleges; and Michael F. Dorsey, Amego, Inc
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23
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Abstract
It is not uncommon for patients with obsessive-compulsive disorder (OCD) to present with symptoms that suggest possible risk. This can include apparent risk, which reflects the content of obsessional fears, and genuine risk arising as the unintended consequence of compulsive behaviors. In both situations, risk can cause confusion in relation to diagnosis and treatment. The current article adds to the small existing literature on risk in OCD by presenting case examples illustrating different types of risk in the context of pediatric OCD, along with a discussion of their implications for management. The cases highlight that it is crucial that risk in OCD is considered carefully within the context of the phenomenology of the disorder. Guidance is offered to support clinical decision making and treatment planning.
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Affiliation(s)
- Angela Lewis
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Caroline Stokes
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Isobel Heyman
- Great Ormond Street Hospital and the Institute of Child Health, University College London, London, UK
| | | | - Georgina Krebs
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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24
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Abstract
IMPORTANCE Restless legs syndrome (RLS) is a common neurologic disorder that has been previously found to be associated with higher odds of suicidal ideation. In the context of the increasing suicide rate in the United States, the evidence regarding the association between RLS and the risk of suicide and self-harm is limited. OBJECTIVE To investigate the association between RLS and risk of suicide and self-harm. DESIGN, SETTING, AND PARTICIPANTS This cohort study was performed using Truven Health MarketScan national claims data from 2006 to 2014; the baseline data were from 2006 to 2008, and the follow-up data covered 6 years (January 1, 2009, to December 31, 2014). Included were 24 179 nonpregnant participants with RLS and 145 194 age- and sex-matched participants without RLS at baseline (2006-2008), who were free of suicide, self-harm, cardiovascular disease, or cancer at study baseline. Data analysis was performed from February 1, 2018, to January 1, 2019. EXPOSURE Diagnosis of RLS, as identified by the International Classification of Diseases, Ninth Revision code. MAIN OUTCOMES AND MEASURES Incident suicide and self-harm event, identified by the International Classification of Diseases, Ninth Revision diagnosis code. RESULTS Among 169 373 participants in the current analysis, the mean (SD) age was 49.4 (9.1) years; 53 426 (31.5%) participants were men. During a mean (SD) follow-up duration of 5.2 (2.2) years, 119 incident suicide and self-harm cases were identified. Individuals with RLS had a higher risk of suicide or self-harm compared with those without RLS (adjusted hazard ratio, 2.66; 95% CI, 1.70-4.15), after adjusting for lifestyle factors (eg, alcohol and obesity), presence of chronic diseases (eg, depression, insomnia, diabetes, chronic kidney disease, peripheral neuropathy, iron-deficiency anemia, and Parkinson disease), and use of medications. Excluding those with depression, insomnia, obstructive sleep apnea, and other common chronic conditions, the significant association between RLS and suicide or self-harm persisted (adjusted hazard ratio, 4.14; 95% CI, 2.17-7.92). CONCLUSIONS AND RELEVANCE Restless legs syndrome was associated with a high risk of suicide and self-harm, and the risk was independent of most identified diseases and conditions.
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Affiliation(s)
- Sheng Zhuang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Muzi Na
- Department of Nutritional Sciences, Pennsylvania State University, State College, University Park
| | - John W. Winkelman
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Neurology, Massachusetts General Hospital, Boston
| | - Djibril Ba
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, State College, University Park
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25
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Srinivasan R, Wolstencroft J, Erwood M, Raymond FL, van den Bree M, Hall J, Skuse D. Mental health and behavioural problems in children with XXYY: a comparison with intellectual disabilities. J Intellect Disabil Res 2019; 63:477-488. [PMID: 30993819 DOI: 10.1111/jir.12607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 12/17/2018] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The phenotype of children with XXYY has predominantly been defined by comparison to other sex chromosome aneuploidies trisomies affecting male children; however, the intellectual ability of children with XXYY is lower than children with other sex chromosome aneuploidies trisomies. It is not known to what extent the phenotype identified to date is specific to XXYY, rather than a reflection of lower IQ. This study evaluates the mental health and behaviour of children with XXYY, in comparison to children with intellectual disabilities of heterogeneous genetic origin. METHODS Fifteen children with XXYY and 30 controls matched for age (4-14 years), sex and intellectual ability were ascertained from the IMAGINE ID study. IMAGINE ID participants have intellectual disabilities due to genetic anomalies confirmed by National Health Service Regional Genetic Centre laboratories. The mental health and behaviour of participants was examined with the Development and Well-being Assessment and the Strengths and Difficulties Questionnaire. RESULTS Children with XXYY experienced significantly more frequent and intense temper outbursts than the control group. CONCLUSION Our results suggest that temper outbursts may be specifically associated with the XXYY phenotype. These problems have a significant impact on the daily lives of boys with XXYY and their families. It is crucial to ensure that families are well supported to manage these difficulties.
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Affiliation(s)
- R Srinivasan
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J Wolstencroft
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - M Erwood
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - F L Raymond
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Biomedical Campus, Cambridge, UK
| | - M van den Bree
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - J Hall
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - D Skuse
- Great Ormond Street Institute of Child Health, University College London, London, UK
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26
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Abstract
Although self-injurious behavior is a common comorbid behavior problem among individuals with neurodevelopmental disorders, little is known about its etiology and underlying neurobiology. Interestingly, it shows up in various forms across patient groups with distinct genetic errors and diagnostic categories. This suggests that there may be shared neuropathology that confers vulnerability in these disparate groups. Convergent evidence from clinical pharmacotherapy, brain imaging studies, postmortem neurochemical analyses, and animal models indicates that dopaminergic insufficiency is a key contributing factor. This chapter provides an overview of studies in which animal models have been used to investigate the biochemical basis of self-injury and highlights the convergence in findings between these models and expression of self-injury in humans.
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Affiliation(s)
- Darragh P Devine
- Behavioral and Cognitive Neuroscience Program, Department of Psychology, University of Florida, Gainesville, FL, USA.
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27
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Tudela Torras M, Abad Más L. [Reduction of dysfunctional self-injurious and self-stimulatory behaviors in autism disorders spectrum through occupational therapy]. Medicina (B Aires) 2019; 79:38-43. [PMID: 30776278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Self-stimulatory and self-injurious behaviors are very frequent in neurodevelopmental disorders, being a source of anxiety and suffering for persons who have that behavior and their families. Sometimes these behaviors are so intense and frequent that it becomes a selfintegrity risk. A bibliographic review was conducted on the different approaches that have been developed until today; in addition, this article explains the methodology applied in our clinic, with a data collection on the effect of therapy on self-injurious and self-stimulatory behaviors in 20 cases, as a starting point for future research. The sensory integration model that complements pharmacological and behavioral cognitive treatment is highlighted, since it considers sensory needs relevant and trains the capacity for functional self-regulation.
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Affiliation(s)
- María Tudela Torras
- RED CENIT, Centros de Desarrollo Cognitivo (CEDECO), Centros de Integración Sensorial (CIS), Valencia, España. E-mail:
| | - Luis Abad Más
- RED CENIT, Centros de Desarrollo Cognitivo (CEDECO), Centros de Integración Sensorial (CIS), Valencia, España
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Liu W, Sun H, Zhang X, Chen Q, Xu Y, Chen X, Ding Z. Air pollution associated with non-suicidal self-injury in Chinese adolescent students: A cross-sectional study. Chemosphere 2018; 209:944-949. [PMID: 30114744 PMCID: PMC6100799 DOI: 10.1016/j.chemosphere.2018.06.168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a frequent phenomenon in adolescents and is closely related to eventual suicide. Although the effect of air pollution on various diseases has been extensively investigated, no studies examined its effect on NSSI in young students. OBJECTIVES We investigated the effect of air pollution on NSSI in Chinese students. METHODS We investigated the incidence of NSSI in the past 12 months in 54 923 Chinese students with an anonymous questionnaire. We assessed the air pollution exposure of each student by the air quality matched with their schools, which were calculated by the inverse distance weighting method from the environmental monitoring data. We discussed the association between ambient air pollutants and the incidence of NSSI using generalized additive mixed models. RESULTS A 10 μg/m3 increase in the annual moving average concentration of particulate matter with diameters less than 2.5 μm (PM2.5) and ozone (O3) was associated with a 13.9 percent and a 10.5 percent increase in the odds ratio (OR) of NSSI, respectively. In addition, a 0.1 mg/m3 increase in the annual moving average concentration of carbon monoxide (CO) was associated with a 4.8 percent increase in the OR of NSSI. NO2 and SO2 were not related to NSSI. CO and O3 show non-linear effects on NSSI. Male students in high school are the most s to the effects of PM2.5 on NSSI. CONCLUSIONS Our study suggests that increases in PM2.5, O3 and CO may increase the incidence of NSSI among adolescent students.
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Affiliation(s)
- Weina Liu
- Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Road 172, 210009 Nanjing, China
| | - Hong Sun
- Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Road 172, 210009 Nanjing, China.
| | - Xin Zhang
- School of Statistics, Beijing Normal University, 19 XinJieKouWai Street, 100875 Beijing, China
| | - Qi Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Road 172, 210009 Nanjing, China
| | - Yan Xu
- Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Road 172, 210009 Nanjing, China
| | - Xi Chen
- Department of Health Policy and Management, Department of Economics, Yale University, 60 College St., New Haven, CT 06520, USA
| | - Zhen Ding
- Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Road 172, 210009 Nanjing, China.
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29
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Shahwan S, Abdin E, Zhang Y, Sambasivam R, Fauziana R, Mahesh M, Ong SH, Chong SA, Subramaniam M. Deliberate Self-Harm in Psychiatric Outpatients Aged 14-35 Years in Singapore. Ann Acad Med Singap 2018; 47:360-372. [PMID: 30324964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The main aim of the study was to identify the prevalence of deliberate self-harm (DSH) in a sample of youth outpatients attending the state psychiatric hospital in Singapore and to identify the sociodemographic and psychological/clinical risk factors associated with DSH. The secondary aim of the study was to examine if different forms of DSH had distinguishing risk factors. MATERIALS AND METHODS A total of 400 outpatients at the Institute of Mental Health completed a self-report survey comprising sociodemographic questions, the Functional Assessment of Self-Mutilation, Childhood Trauma Questionnaire, Parental Bonding Instrument and the Patient Health Questionnaire Depression Scale. Logistic regression models were used to test the associations. RESULTS The overall prevalence of DSH in our clinical population was 58.8%. Cutting/carving (25.4%) and hitting (20.4%) were the most common forms of DSH in the past 12 months. DSH acts were performed primarily for emotion regulation purposes. The risk factors for DSH in general were younger age group, female gender, abuse history and higher depression scores. Gender and age group were the factors that were differentially associated with cutting and hitting one's self. CONCLUSION There was a high prevalence of DSH in the psychiatric outpatient population. The risk factors identified in this study are consistent with those of international studies which point to their stability across cultures.
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30
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Halayem S, Charfi N, Touati M, Mrabet A, Bouden A. Sensitivity to pain in autistic spectrum disorders: Its links with self-gressivity. Tunis Med 2018; 96:501-504. [PMID: 30430528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the link between pain sensitivity in autism spectrum disorders (ASD) and self-aggressive behavior. METHODS we performed a cross-sectional study which involved 50 children fulfilling DSM-V criteria for ASD; confirmed by the Autism Diagnostic Interview Revised. The severity of autism was determined using the Childhood Autism Rating Scale (CARS).The psycho-educational profile (PEP-R) was used to assess the age of development and perception. Sensitivity to pain was assessed with item IX of the CARS. Self-aggressive behavior was assessed by the Behavior Problems Inventory. RESULTS Pain sensitivity was lowered in 40% and elevated in 4% of children. In the univariate analysis, no statistically significant association was found between normal sensitivity or hyper sensitivity to pain and the presence of auto-aggressiveness. A significant association was found between the presence of hypo-sensitivity to pain and the following variables: auto-aggression (p = 0.007, OR = 5.8, 95% CI = 1.5-21) , frequency of self-aggression (p = 0.001), intensity of self-aggression (p = 0.05), location of auto-aggressiveness at head and (P = 0.007, OR = 7.6, 95% CI = 1.8-14), higher score at CARS, and lower perception score at PEP-R (p = 0.012). Multiple-varied analysis identified risk factors for hypo-sensitivity to pain: lower perceptual score (p = 0.003, adjusted OR = 4.3, 95% CI = 1.9-54) and location of self-aggression at head and hands (p = 0.001, adjusted OR = 1.09, 95% CI = 1.02-1.09). CONCLUSION It would be interesting to develop tools allowing a fine and precise evaluation of the painful sensation.
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Vega D, Sintes A, Fernández M, Puntí J, Soler J, Santamarina P, Soto À, Lara A, Méndez I, Martínez-Giménez R, Romero S, Pascual JC. Review and update on non-suicidal self-injury: who, how and why? Actas Esp Psiquiatr 2018; 46:146-155. [PMID: 30079928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 06/08/2023]
Abstract
Non-suicidal self-injury (NSSI) is defined as the direct and deliberate destruction of one’s own body tissue in the absence of lethal intent. Following decades of progressive increase in the incidence of NSSI among adolescents and young adults, as well as growing scientific interest, the disorder was listed as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). In this review we provide updated information on this phenomenon, focusing on: prevalence, course and prognosis; associated factors; its relationship with psychopathology; and the role of the mass media, social networks, and the internet. Finally, we discuss some conclusions and future proposals, emphasizing the need for collaborative work to better understand NSSI in Spain, and to improve prevention and treatment strategies.
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Affiliation(s)
- Daniel Vega
- Servicio de Salud Mental, Hospital de Igualada, Consorci Sanitari de l’Anoia, Igualada, Barcelona, Spain Unidad de Psicología Médica, Departamento de Psiquiatría y Medicina Legal, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Anna Sintes
- Servicio de Psiquiatría y Psicología, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Marta Fernández
- Servicio de Psiquiatría, ALTHAIA, Xarxa Assistencial de Manresa, Manresa, Barcelona, Spain
| | - Joaquim Puntí
- Salud Mental, Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain. Departamento de Psicología Clínica y de la Salud, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Joaquim Soler
- Servicio de Psiquiatría, Hospital de la Santa Creu y Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Pilar Santamarina
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Àngel Soto
- Servicio de Salud Mental, Hospital de Igualada, Consorci Sanitari de l’Anoia, Igualada, Barcelona, Spain
| | - Anais Lara
- Servicio de Psiquiatría, ALTHAIA, Xarxa Assistencial de Manresa, Manresa, Barcelona, Spain
| | - Iria Méndez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Raquel Martínez-Giménez
- Servicio de Salud Mental, Hospital de Igualada, Consorci Sanitari de l’Anoia, Igualada, Barcelona, Spain
| | - Soledad Romero
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Juan Carlos Pascual
- Servicio de Psiquiatría, Hospital de la Santa Creu y Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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32
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Abstract
Mild traumatic brain injury (mTBI) is highly prevalent, with an estimated occurrence in the United States of more than 1.3 million per year. While one consequence of mTBI is impulsive aggressive behavior, very few studies have examined the relationship between history of mTBI and aggressive behavior in impulsively aggressive individuals. The authors examined the relationship between history of mTBI in a healthy control group (HC; N=453), a control group with psychiatric disorders (PC; N=486), and individuals with intermittent explosive disorder (IED; N=695), a disorder of primary impulsive aggression. Results demonstrated that IED study participants were significantly more likely to have a history of mTBI (with or without history of a brief loss of consciousness [LOC]) compared with both HC and PC participants. A similar observation was made with regard to self-directed aggression (i.e., suicidal or self-injurious behavior), although group differences were only among those with mTBI with LOC. For both other- and self-directed aggression variables, the authors observed a stepwise increase in dimensional aggression and impulsivity scores across participants as a function of mTBI history. Given that impulsive aggressive behavior begins very early in life, these data are consistent with the hypothesis that lifelong presence of an impulsive aggressive temperament places impulsive aggressive individuals in circumstances that put them at greater risk for mTBI compared with other individuals with and without nonimpulsive aggressive psychopathology.
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Affiliation(s)
- Caterina Mosti
- From the Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago (CM, EFC)
| | - Emil F Coccaro
- From the Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago (CM, EFC)
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Neovius M, Bruze G, Jacobson P, Sjöholm K, Johansson K, Granath F, Sundström J, Näslund I, Marcus C, Ottosson J, Peltonen M, Carlsson LMS. Risk of suicide and non-fatal self-harm after bariatric surgery: results from two matched cohort studies. Lancet Diabetes Endocrinol 2018; 6:197-207. [PMID: 29329975 PMCID: PMC5932484 DOI: 10.1016/s2213-8587(17)30437-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/09/2017] [Accepted: 10/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery reduces mortality, but might have adverse effects on mental health. We assessed the risk of suicide and self-harm after bariatric surgery compared with non-surgical obesity treatment. METHODS Suicide and non-fatal self-harm events retrieved from nationwide Swedish registers were examined in two cohorts. The non-randomised, prospective Swedish Obese Subjects (SOS) study compared bariatric surgery (n=2010; 1369 vertical-banded gastroplasty, 376 gastric banding, and 265 gastric bypass) with usual care (n=2037; recruitment 1987-2001). The second cohort consisted of individuals from the Scandinavian Obesity Surgery Registry (SOReg; n=20 256 patients who had gastric bypass) matched to individuals treated with intensive lifestyle modification (n=16 162; intervention 2006-13) on baseline BMI, age, sex, education level, diabetes, cardiovascular disease, history of self-harm, substance misuse, antidepressant use, anxiolytics use, and psychiatric health-care contacts. FINDINGS During 68 528 person-years (median 18; IQR 14-21) in the SOS study, suicides or non-fatal self-harm events were higher in the surgery group (n=87) than in the control group (n=49; adjusted hazard ratio [aHR] 1·78, 95% CI 1·23-2·57; p=0·0021); of these events, nine and three were suicides, respectively (3·06, 0·79-11·88; p=0·11). In analyses by primary procedure type, increased risk of suicide or non-fatal self-harm was identified for gastric bypass (3·48, 1·65-7·31; p=0·0010), gastric banding (2·43, 1·23-4·82; p=0·011), and vertical-banded gastroplasty (2·25, 1·37-3·71; p=0·0015) compared with controls. Out of nine deaths by suicide in the SOS surgery group, five occurred after gastric bypass (two primary and three converted procedures). During 149 582 person-years (median 3·9; IQR 2·8-5·2), more suicides or non-fatal self-harm events were reported in the SOReg gastric bypass group (n=341) than in the intensive lifestyle group (n=84; aHR 3·16, 2·46-4·06; p<0·0001); of these events, 33 and five were suicides, respectively (5·17, 1·86-14·37; p=0·0017). In SOS, substance misuse during follow-up was recorded in 48% (39/81) of patients treated with surgery and 28% (13/47) of controls with non-fatal self-harm events (p=0·023). Correspondingly, substance misuse during follow-up was recorded in 51% (162/316) of participants in the SOReg gastric bypass group and 29% (23/80) of participants in the intensive lifestyle group with non-fatal self-harm events (p=0·0003). The risk of suicide and self-harm was not associated with poor weight loss outcome. INTERPRETATION Bariatric surgery was associated with suicide and non-fatal self-harm. However, the absolute risks were low and do not justify a general discouragement of bariatric surgery. The findings indicate a need for thorough preoperative psychiatric history assessment along with provision of information about increased risk of self-harm following surgery. Moreover, the findings call for postoperative surveillance with particular attention to mental health. FUNDING US National Institutes of Health and Swedish Research Council.
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Affiliation(s)
- Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
| | - Gustaf Bruze
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Peter Jacobson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kajsa Sjöholm
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kari Johansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Granath
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Markku Peltonen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Lena M S Carlsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hettiarachchi LV, Kinner SA, Tibble H, Borschmann R. Self-Harm among Young People Detained in the Youth Justice System in Sri Lanka. Int J Environ Res Public Health 2018; 15:E209. [PMID: 29373512 PMCID: PMC5858278 DOI: 10.3390/ijerph15020209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/03/2022]
Abstract
Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries) have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age 15.0 years, SD = 2.3) detained in the youth justice system in Sri Lanka. Structured face-to-face questionnaires assessed demographic characteristics, family and social background, substance use, self-harm history (including frequency, method, and intention), bullying victimization, physical and sexual abuse (victimization and perpetration), and exposure to self-harm/suicide by others. Seventy-seven participants (43%) reported a lifetime history of self-harm, 19 of whom (25%) who reported doing so with suicidal intent. Fifty participants (65% of those with a history of self-harm) reported engaging in self-harm impulsively, with no prior planning. A history of self-harm was associated with being female, prior sexual abuse victimization, prior exposure to self-harm by friends, and a lifetime history of self-harm ideation. High rates of substance use, bullying victimization, parental incarceration, and exposure to suicide were reported across the sample. Young people detained in the youth justice system in Sri Lanka are a vulnerable group with high rates of self-harm, substance use, and psychosocial risk factors. Strategies for identifying and preventing self-harm, and targeted psychological interventions designed specifically to address impulsivity, may contribute to more positive outcomes in this marginalised population.
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Affiliation(s)
- Lushan V Hettiarachchi
- Forensic Psychiatric Unit, National Institute of Mental Health, Colombo 10620, Sri Lanka.
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne 3052, Australia.
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
- Mater Research Institute-UQ, University of Queensland, Brisbane 4072, Australia.
- Griffith Criminology Institute, Griffith University, Brisbane 4111, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia.
| | - Holly Tibble
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne 3052, Australia.
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE58AF, UK.
- Department of Psychiatry, University of Melbourne, Melbourne 3010, Australia.
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Nair N, Archer J, Statz A, Diallo O. Differences in Methods of Self-Inflicted Injuries by Sex in Wisconsin, 2002-2014. WMJ 2017; 116:196-199. [PMID: 29357207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Despite suicide prevention efforts, there remains a high burden of self-inflicted injuries in Wisconsin. OBJECTIVE Compare methods of suicide and nonfatal self-inflicted injury by sex in Wisconsin over a 12-year period. METHODS Suicide and nonfatal self-inflicted injury rates in Wisconsin between 2002 and 2014 were compared by sex and method using data from the Wisconsin Interactive Statistics on Health. Percentages of total suicides by method of injury for each sex were calculated. RESULTS Firearms and poisoning were the most common methods of suicide and nonfatal selfinflicted injuries, respectively. Rates of both suicide and nonfatal self-inflicted injuries differed significantly by sex and method. CONCLUSIONS Suicide prevention strategies in Wisconsin must account for the variability of method of self-inflicted injury between sexes.
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Affiliation(s)
- Nivedita Nair
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
| | - Joseph Archer
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Alexa Statz
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ousmane Diallo
- Wisconsin Division of Public Health, Department of Health Services, Madison, Wisconsin
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Maraz A, Hende B, Urbán R, Demetrovics Z. Pathological grooming: Evidence for a single factor behind trichotillomania, skin picking and nail biting. PLoS One 2017; 12:e0183806. [PMID: 28902896 PMCID: PMC5597179 DOI: 10.1371/journal.pone.0183806] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/13/2017] [Indexed: 01/18/2023] Open
Abstract
Although trichotillomania (TTM), skin picking (SP), and nail biting (NB) have been receiving growing scientific attention, the question as to whether these disorders can be regarded as separate entities or they are different manifestations of the same underlying tendency is unclear. Data were collected online in a community survey, yielding a sample of 2705 participants (66% women, mean age: 29.1, SD: 8.6). Hierarchical factor analysis was used to identify a common latent factor and the multiple indicators and multiple causes (MIMIC) modelling was applied to test the predictive effect of borderline personality disorder symptoms, impulsivity, distress and self-esteem on pathological grooming. Pearson correlation coefficients between TTM, SP and NB were between 0.13 and 0.29 (p < 0.01). The model yielded an excellent fit to the data (CFI = 0.992, TLI = 0.991, χ2 = 696.65, p < 0.001, df = 222, RMSEA = 0.030, Cfit of RMSEA = 1.000), supporting the existence of a latent factor. The MIMIC model indicated an adequate fit (CFI = 0.993, TLI = 0.992, χ2 = 655.8, p < 0.001, df = 307, RMSEA = 0.25, CI: 0.022-0.028, pclose = 1.000). TTM, SP and NB each were loaded significantly on the latent factor, indicating the presence of a general grooming factor. Impulsivity, psychiatric distress and contingent self-esteem had significant predictive effects, whereas borderline personality disorder had a nonsignificant predictive effect on the latent factor. We found evidence that the category of pathological grooming is meaningful and encompasses three symptom manifestations: trichotillomania, skin picking and nail biting. This latent underlying factor is not better explained by indicators of psychopathology, which supports the notion that the urge to self-groom, rather than general psychiatric distress, impulsivity, self-esteem or borderline symptomatology, is what drives individual grooming behaviours.
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MESH Headings
- Adult
- Animals
- Disruptive, Impulse Control, and Conduct Disorders/classification
- Disruptive, Impulse Control, and Conduct Disorders/diagnosis
- Disruptive, Impulse Control, and Conduct Disorders/epidemiology
- Disruptive, Impulse Control, and Conduct Disorders/etiology
- Female
- Grooming
- Humans
- Male
- Nail Biting/psychology
- Obsessive-Compulsive Disorder/classification
- Obsessive-Compulsive Disorder/diagnosis
- Obsessive-Compulsive Disorder/epidemiology
- Obsessive-Compulsive Disorder/etiology
- Self-Injurious Behavior/epidemiology
- Self-Injurious Behavior/etiology
- Skin/injuries
- Skin/pathology
- Stress, Psychological/complications
- Stress, Psychological/epidemiology
- Trichotillomania/epidemiology
- Trichotillomania/etiology
- Young Adult
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Affiliation(s)
- Aniko Maraz
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Borbála Hende
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Róbert Urbán
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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Wong WHS, Lee JCY, Ho FKW, Li TMH, Ip P, Chow CB. Stock Market Fluctuations and Self-Harm among Children and Adolescents in Hong Kong. Int J Environ Res Public Health 2017; 14:ijerph14060623. [PMID: 28598378 PMCID: PMC5486309 DOI: 10.3390/ijerph14060623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/22/2017] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
Although a few studies investigated the impact of stock market fluctuations on population health, the question of whether stock market fluctuations have an impact on self-harm in children and adolescents remain unanswered. This study therefore investigated the association between stock market fluctuations and self-harm among children and adolescents in Hong Kong. Daily self-harm attendance records were retrieved from all 18 local Accident and Emergency Departments (AED) from 2001 to 2012. 4931 children and adolescents who committed self-harm were included. The results indicated positive correlation between daily change in stock market index, Hang Seng Index (∇HSI, per 300 points), and daily self-harm incident risk of children and adolescents, without time lag between the two. The incident risk ratio for ∇HSI was 1.09 (p = 0.0339) in children and 1.06 (p = 0.0246) in adolescents. Importantly, non-trading days were found to impose significant protective effect in both groups against self-harm risk. Our results showed that stock market fluctuations were related to self-harm behaviors in children and adolescents. Parents and professionals should be educated about the potential harm of stock market fluctuations and the importance of effective parenting in reducing self-harm among children and adolescents.
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Affiliation(s)
- Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - James Chun-Yin Lee
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Frederick Ka-Wing Ho
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Tim Man-Ho Li
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Chun-Bong Chow
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Wang B, You J, Lin MP, Xu S, Leung F. Developmental Trajectories of Nonsuicidal Self-Injury in Adolescence and Intrapersonal/Interpersonal Risk Factors. J Res Adolesc 2017; 27:392-406. [PMID: 28876527 DOI: 10.1111/jora.12273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This 3-wave study investigated the developmental trajectories of nonsuicidal self-injury (NSSI) and intrapersonal/interpersonal risk factors among 3,381 Chinese adolescents (56.2% females) aged from 13 to 17 years during a 1-year period. Using an accelerated longitudinal design and latent class growth analysis, we identified four subgroups of NSSI trajectories: negligible (74.6%), experimental (12.8%), moderate decreasing (10.8%), and high fluctuating (1.9%). Adolescents reporting both intrapersonal (i.e., impulsive behaviors and depression) and interpersonal (i.e., unstable relationships and parental criticism) risk factors were significantly more likely to follow the latter three trajectories. The findings of this study suggest there is heterogeneity in NSSI development among adolescents and highlight the contributions of both intrapersonal and interpersonal risk factors in the engagement in NSSI.
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Affiliation(s)
- Biyao Wang
- South China Normal University
- University of Goettingen
| | | | | | - Sian Xu
- South China Normal University
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Quinn P, Surgenor P, McGilloway S. An exploratory service-based study of Deliberate Self-Harm (DSH) in Ireland: 'A hidden population'? Ir Med J 2017; 110:561. [PMID: 28737302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to investigate the nature and extent of deliberate self-harm (DSH) amongst those attending national crisis centres in Ireland, and to assess clients' views of the service. A secondary analysis was undertaken of a large data set of clients presenting with DSH (n=823). Clients were predominantly female, under 25 and with self-cutting widely reported (73%). DSH co-occurred with suicidal ideation (SI) (42%) and/or a suicide attempt (SA) (35%). Males were significantly more likely to present with more severe problems, and to use more dramatic methods of DSH; more severe presenting issues were also significantly associated with a history of having friends who engage in DSH. The treatment completion rate was 36%. Clients reported overwhelmingly positive views about the service. This is the first study in Ireland to provide insights into a 'hidden population' of people who engage in DSH. A need for greater awareness of DSH and its links to suicidal ideation/behaviour is indicated.
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Affiliation(s)
- P Quinn
- Maynooth University Department of Psychology, Maynooth, Co. Kildare, Ireland
| | - P Surgenor
- Research,Training and Education Department, Pieta House, Ireland
| | - S McGilloway
- Research,Training and Education Department, Pieta House, Ireland
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40
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Togawa M, Saito Y, Maegaki Y, Ohno K. [Treatment of self-injurious behaviors in Lesch-Nyhan syndrome with S-adenosylmethionine]. No To Hattatsu 2017; 49:25-27. [PMID: 30011150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An 11-year-old boy with Lesch-Nyhan syndrome (LNS) had persistently injured himself by biting his lips and buccal mucosa since infancy. Risperidone was only partially effective in suppressing this behavior. Oral administration of S-adenosylmethionine (SAMe), involving increasing the dose from 400 mg to 1 g, resulted in the amelioration of self-injurious behavior and anxiety as well as marked improvement in his self-esteem, performance at school, and friendships. No adverse effects were noted. SAMe may have a favorable effect on symptoms of LNS by activating monoaminergic pathways and/or increasing the adenosine pool in the salvage pathway of guanosine monophosphate synthesis. Defects in these pathways have been essentially implicated in the neurological pathophysiology of LNS.
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41
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Wu CS, Liao SC, Tsai YT, Chang SS, Tsai HJ. Comparative risk of self-harm hospitalization amongst depressive disorder patients using different antidepressants: a population-based cohort study in Taiwan. Psychol Med 2017; 47:81-92. [PMID: 27659718 DOI: 10.1017/s0033291716002257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the comparative risk of self-harm associated with the use of different antidepressants. METHOD A cohort study was conducted using data from Taiwan's National Health Insurance Research Database from 2001 to 2012. A total of 751 606 new antidepressant users with depressive disorders were included. The study outcome was hospitalization due to self-harm (International Classification of Diseases, Ninth Revision, Clinical Modification codes: E950-E958 and E980-E988). Cox proportional hazards models with stratification of the propensity score deciles were used to estimate the hazard ratios of self-harm hospitalization during the first year following the initiation of antidepressant treatment. RESULTS There were 1038 hospitalization episodes due to self-harm that occurred during the follow-up of 149 796 person-years, with an overall incidence rate of 6.9 [95% confidence interval (CI) 6.5-7.4] per 1000. Compared with fluoxetine, the risk of self-harm hospitalization was higher for maprotiline [adjusted hazard ratio (aHR) = 3.00, 95% CI 1.40-6.45], milnacipran (aHR = 2.34, 95% CI 1.24-4.43) and mirtazapine (aHR = 1.40, 95% CI 1.06-1.86), lower for bupropion (aHR = 0.51, 95% CI 0.30-0.86), and similar level of risk was found for other selective serotonin reuptake inhibitors (citalopram, escitalopram, fluvoxamine, paroxetine and sertraline). CONCLUSIONS The risk of self-harm may vary across different antidepressant drugs. It would be of importance to conduct further research to investigate the influence of antidepressant use on self-harm behaviors.
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Affiliation(s)
- C-S Wu
- Department of Psychiatry,National Taiwan University Hospital and College of Medicine, National Taiwan University,Taipei,Taiwan
| | - S-C Liao
- Department of Psychiatry,National Taiwan University Hospital and College of Medicine, National Taiwan University,Taipei,Taiwan
| | - Y-T Tsai
- Division of Biostatistics and Bioinformatics,Institute of Population Health Sciences, National Health Research Institutes,Zhunan,Taiwan
| | - S-S Chang
- Institute of Health Behaviors and Community Sciences and Department of Public Health,College of Public Health,National Taiwan University,Taipei,Taiwan
| | - H-J Tsai
- Division of Biostatistics and Bioinformatics,Institute of Population Health Sciences, National Health Research Institutes,Zhunan,Taiwan
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Hall SS, Barnett RP, Hustyi KM. Problem behaviour in adolescent boys with fragile X syndrome: relative prevalence, frequency and severity. J Intellect Disabil Res 2016; 60:1189-1199. [PMID: 27730710 PMCID: PMC5777854 DOI: 10.1111/jir.12341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/31/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND A large proportion of boys with fragile X syndrome (FXS), the most common known inherited form of intellectual disability (ID), exhibit problem behaviours (e.g. aggression, self-injury, property destruction and stereotypy) that can negatively impact the health and safety of others as well as the individual concerned. However, data are limited concerning the relative prevalence, frequency and severity of problem behaviours exhibited by boys with FXS compared with those by boys with mixed-aetiology ID who also exhibit problem behaviours. METHOD As part of a larger study on problem behaviour, we obtained survey data on 85 adolescent boys with FXS and 155 age-matched boys with mixed-aetiology ID who exhibited at least one form of problem behaviour. RESULTS For boys with FXS, stereotypy was reported to be more prevalent (χ2 = 4.52, P = 0.012), self-injury was reported to more frequent (U = 2525, P = 0.010) and aggression was reported to be less severe (U = 4176, P = 0.029) than for boys with mixed-aetiology ID. Ratings of aggression and property destruction were highly correlated in each group in terms of both frequency and severity (r = 0.60 to 0.71). Examination of the data by age indicated that the relative frequency of self-injury decreased with age in boys with FXS (χ2 = 8.29, P = 0.040). CONCLUSIONS Taken together, these results refine and extend previous studies concerning the specificity of the behavioural phenotype in FXS and indicate that specific forms of problem behaviour shown by boys with FXS appear to differ from those exhibited by boys with mixed-aetiology ID in terms of prevalence, frequency and severity. Studies employing more objective measures of frequency and severity, including direct observations, are needed to confirm these findings.
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Affiliation(s)
- S S Hall
- Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, USA
| | - R P Barnett
- Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, USA
| | - K M Hustyi
- Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, USA
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44
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Barnicot K, Gonzalez R, McCabe R, Priebe S. Skills use and common treatment processes in dialectical behaviour therapy for borderline personality disorder. J Behav Ther Exp Psychiatry 2016; 52:147-156. [PMID: 27132175 DOI: 10.1016/j.jbtep.2016.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 03/30/2016] [Accepted: 04/19/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Dialectical behaviour therapy (DBT) trains participants to use behavioural skills for managing their emotions. The study aimed to evaluate whether skills use is associated with positive treatment outcomes independently of treatment processes that are common across different therapeutic models. METHOD Use of the DBT skills and three common treatment processes (therapeutic alliance, treatment credibility and self-efficacy) were assessed every 2 months for a year in 70 individuals with borderline personality disorder receiving DBT. Mixed-multilevel modelling was used to determine the association of these factors with frequency of self-harm and with treatment dropout. RESULTS Participants who used the skills less often at any timepoint were more likely to drop out of DBT in the subsequent two months, independently of their self-efficacy, therapeutic alliance or perceived treatment credibility. More frequent use of the DBT skills and higher self-efficacy were each independently associated with less frequent concurrent self-harm. Treatment credibility and the alliance were not independently associated with self-harm or treatment dropout. LIMITATIONS The skills use measure could not be applied to a control group who did not receive DBT. The sample size was insufficient for structural equation modelling. CONCLUSION Practising the DBT skills and building an increased sense of self-efficacy may be important and partially independent treatment processes in dialectical behaviour therapy. However, the direction of the association between these variables and self-harm requires further evaluation.
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Affiliation(s)
- Kirsten Barnicot
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, Glen Road, London, E13 8SP, United Kingdom.
| | - Rafael Gonzalez
- Centre for Mental Health, Imperial College London, Commonwealth Building, Du Cane Road, London, W12 0NN, United Kingdom.
| | - Rosemarie McCabe
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, Glen Road, London, E13 8SP, United Kingdom.
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, Glen Road, London, E13 8SP, United Kingdom.
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Lüdtke J, In-Albon T, Michel C, Schmid M. Predictors for DSM-5 nonsuicidal self-injury in female adolescent inpatients: The role of childhood maltreatment, alexithymia, and dissociation. Psychiatry Res 2016; 239:346-52. [PMID: 27088878 DOI: 10.1016/j.psychres.2016.02.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/05/2016] [Accepted: 02/15/2016] [Indexed: 01/30/2023]
Abstract
The purpose of this study was to examine the relationship between various adverse childhood experiences, alexithymia, and dissociation in predicting nonsuicidal self-injury (NSSI) in an inpatient sample of female adolescents. Seventy-two adolescents (aged 14-18 years) with NSSI disorder (n=46) or mental disorders without NSSI (n=26) completed diagnostic interviews and self-report measures to assess NSSI disorder according to the DSM-5 criteria, childhood maltreatment, alexithymia, and dissociation. Alexithymia and dissociation were highly prevalent in both study groups. Multivariate logistic regression analyses indicated that only alexithymia was a significant predictor for NSSI, whereas childhood maltreatment and dissociation had no predictive influence. The association between alexithymia and NSSI emphasizes the significance of emotion regulation training for female adolescents with NSSI. Efforts to reduce NSSI behavior should therefore foster skills to heighten the perception and recognition of one's own emotions.
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Affiliation(s)
- Janine Lüdtke
- Department of Child and Adolescent Psychiatry, Psychiatric Clinics of the University Basel, Basel, Switzerland
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology, Department of Psychology, University of Koblenz-Landau, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marc Schmid
- Department of Child and Adolescent Psychiatry, Psychiatric Clinics of the University Basel, Basel, Switzerland.
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Courtemanche AB, Black WR, Reese RM. The Relationship Between Pain, Self-Injury, and Other Problem Behaviors in Young Children With Autism and Other Developmental Disabilities. Am J Intellect Dev Disabil 2016; 121:194-203. [PMID: 27119211 DOI: 10.1352/1944-7558-121.3.194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Research has suggested that individuals who engage in self-injurious behavior may have enhanced expressions of pain, which contradicts previous assertions of blunted pain sensitivity in this population. The purpose of this study was to measure expressions of pain among young children being evaluated for autism and other neurodevelopmental disabilities. The frequency of pain-related behaviors was assessed during everyday routines using the Non-Communicating Children's Pain Checklist (NCCPC-R) for 51 children. Significant group differences between children with and without self-injury were found for the NCCPC-R total scores. The frequency and severity of self-injury, aggression, and stereotypy were also highly correlated with the total scores on the NCCPC-R. These results continue to support that individuals with self-injury may have enhanced expressions of pain.
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Tang J, Yang W, Ahmed NI, Ma Y, Liu HY, Wang JJ, Wang PX, Du YK, Yu YZ. Stressful Life Events as a Predictor for Nonsuicidal Self-Injury in Southern Chinese Adolescence: A Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e2637. [PMID: 26945351 PMCID: PMC4782835 DOI: 10.1097/md.0000000000002637] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Stressful life events have been implicated in the etiology of kinds of psychopathology related to nonsuicidal self-injury (NSSI); however, few studies have examined the association between NSSI and stressful life events directly in Chinese school adolescents. In this study, we aim to estimate the prevalence rate of NSSI and examine its association with stressful life events in Southern Chinese adolescents. A total sample of 4405 students with age ranged from 10 to 22 years was randomly selected from 12 schools in 3 cities of Guangdong Province, China. NSSI, stressful life events, self-esteem, emotional management, and coping methods were measured by structured questionnaires. Multinomial logistic regression was used to examine the association of NSSI with stressful life events. Results showed the 1 year self-reported NSSI was 29.2%, with 22.6% engaged in "minor" NSSI (including hitting self, pulling hair, biting self, inserting objects under nails or skin, picking at a wound) and 6.6% in "moderate/sever" NSSI (including cutting/carving, burning, self-tattooing, scraping, and erasing skin). Self-hitting (15.9%), pulling hair out (10.9%), and self-inserting objects under nails or skin picking areas to dram blood (18.3%) were the most frequent types of NSSI among adolescents. Results also showed that "Minor NSSI" was associated with stressful life events on interpersonal, loss and health adaption, and "moderate/severe NSSI" was associated with life events on interpersonal, health adaption in Southern Chinese adolescents, even after adjusted for sex, age, residence, self-esteem, coping style, and emotional management. Results further suggested stressful life events were significantly associated with less risk of NSSI in those who had good emotional management ability.
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Affiliation(s)
- Jie Tang
- From the School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong (JT, PXW, JJW); Department of Nutrition and Food Hygiene, and MOE Key Lab of Environment and Health (WY); Department of Child, Adolescence & Women Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei (NIA, YKD & YZY); and Guangzhou Women and Children Medical Center (YM & HYL), Guangzhou, Guangdong, China
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Naicker N, de Jager P, Naidoo S, Mathee A. Household Factors Associated with Self-Harm in Johannesburg, South African Urban-Poor Households. PLoS One 2016; 11:e0146239. [PMID: 26731114 PMCID: PMC4701361 DOI: 10.1371/journal.pone.0146239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Low and middle income countries bear the majority burden of self-harm, yet there is a paucity of evidence detailing risk-factors for self-harm in these populations. This study aims to identify environmental, socio-economic and demographic household-level risk factors for self-harm in five impoverished urban communities in Johannesburg, South Africa. Methods Annual serial cross-sectional surveys were undertaken in five impoverished urban communities in Johannesburg for the Health, Environment and Development (HEAD) study. Logistic regression analysis using the HEAD study data (2006–2011) was conducted to identify household-level risk factors associated with self-harm (defined as a self-reported case of a fatal or non-fatal suicide attempt) within the household during the preceding year. Stepwise multivariate logistic regression analysis was employed to identify factors associated with self-harm. Results A total of 2 795 household interviews were conducted from 2006 to 2011. There was no significant trend in self-harm over time. Results from the final model showed that self-harm was significantly associated with households exposed to a violent crime during the past year (Adjusted Odds Ratio (AOR) 5.72; 95% CI 1.64–19.97); that have a member suffering from a chronic medical condition (AOR 8.95; 95% 2.39–33.56) and households exposed to indoor smoking (AOR 4.39; CI 95% 1.14–16.47). Conclusion This study provides evidence on household risk factors of self-harm in settings of urban poverty and has highlighted the potential for a more cost-effective approach to identifying those at risk of self-harm based on household level factors.
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Affiliation(s)
- Nisha Naicker
- Environment & Health Research Unit, South African Medical Research Council, Johannesburg, South Africa
- Department of Community Medicine, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Pieter de Jager
- Department of Community Medicine, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Epidemiology and Surveillance Unit, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - Shan Naidoo
- Department of Community Medicine, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela Mathee
- Environment & Health Research Unit, South African Medical Research Council, Johannesburg, South Africa
- Department of Community Medicine, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Paula-Perez I, Artigas-Pallares J. [Vulnerability to self-harm in autism]. Rev Neurol 2016; 62 Suppl 1:S27-S32. [PMID: 26922955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The reasons underlying self-harm in persons with autism do not appear to have a single, straightforward and simple explanation. Biological predisposition, certain psychological states involving stress, atypical sensory processing, communication disorders, medical problems, and limited emotional regulation, among others, can lead persons with autism to harm themselves. AIMS In this article a distinction is drawn, first of all, between self-harm related to neurodevelopmental disorders, such as autism, and self-harm linked to other psychiatric conditions. Second, a preliminary approach to an integrated model for the understanding of self-harm in autism is proposed. DEVELOPMENT Some of the hypotheses put forward to account for self-harm in autism are focused on atypical sensory processing, on communication disorders and medical problems, and on emotional dysregulation. CONCLUSIONS The limited number of studies conducted in this area and the inconsistency of the data resulting from them have led to great efforts being made to separate the facts from the suppositions in this subject. This modest initial proposal makes it possible to draw up a roadmap to guide and help persons with autism, their families and professionals in the process of reducing or eliminating this behaviour. It is suggested that self-harm should no longer be considered a disruptive behaviour and that it should be interpreted instead as an (inadequate) self-regulatory response to stress.
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Affiliation(s)
- I Paula-Perez
- Universidad de Barcelona, Edifici Llevant, 08035 Barcelona, Espana
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Abstract
Despite the growing consensus that negative reinforcement in the form of emotional relief plays a key role in the maintenance of deliberate self-harm (DSH), most of the research in this area has relied exclusively on self-report measures of the perceived motives for and emotional consequences of DSH. Thus, the primary aim of this study was to extend extant research on the role of emotional relief in DSH by examining the strength of the association of DSH with emotional relief using a novel version of the Implicit Association Test (IAT). The strength of the DSH-relief association among both participants with (vs. without) DSH and self-harming participants with (vs. without) BPD, as well as its associations with relevant clinical constructs (including DSH characteristics, self-reported motives for DSH, BPD pathology, and emotion dysregulation and avoidance) were examined in a community sample of young adults (113 with recent recurrent DSH; 135 without DSH). As hypothesized, results revealed stronger associations between DSH and relief among participants with versus without DSH, as well as among DSH participants with versus without BPD. Moreover, the strength of the DSH-relief association was positively associated with DSH frequency and versatility (both lifetime and at 6-month follow-up), BPD pathology, emotion dysregulation, experiential avoidance, and self-reported emotion relief motives for DSH. Findings provide support for theories emphasizing the role of emotional relief in DSH (particularly among individuals with BPD), as well as the construct validity, predictive utility, and incremental validity (relative to self-reported emotion relief motives) of this IAT.
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Affiliation(s)
- Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | | | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
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