Engaging With Suicide and Self‐Harm Content Online: Evidence of Momentary Decreases in Self‐Injury and Suicidal Thoughts

Sexual minority young adults experience disproportionately high rates of self-injurious thoughts and behaviors (SITB), including suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI). While exposure to close others' SITB (eg, a friend or family member's suicide attempt) is a known risk factor for SITB, its role in sexual orientation disparities in SITB remains underexplored. To examine whether exposure to close others' SITB is associated with sexual orientation disparities in SITB. This cohort study assessed data from 2 nationally representative cohorts: the Swedish Pathways to Longitudinally Understanding Stress (PLUS) study (2023) and the Scottish Well-being Study ([SWS] conducted 2015-2018). The present study uses data only from the final wave of the PLUS study (2023) as this was the only wave that gathered information on exposure to close others' SITB (n = 1202). The present study also uses data from participants who completed the second through fourth follow-up waves of the SWS, as sexual orientation information was not collected at the first wave (n = 1828). Sexual orientation (heterosexual vs sexual minority) was the primary exposure. Exposure to close others' SITB, assessed via validated measures, was the primary mediator. In both cohorts, primary outcomes assessed participants' own SITB. In the PLUS cohort, the primary outcome was suicidal ideation measured using the Suicidal Ideation Attributes Scale (scores range from 0 to 50, with higher scores indicating more severe suicidal ideation). In SWS, there were 5 primary outcomes assessing past-year presence of suicidal ideation, NSSI, NSSI ideation, and suicide attempt as well as a composite indicator of any of these outcomes (none = 0 or any = 1). Mediation analyses estimated associations between sexual minority status and SITB outcomes, mediated by exposure to close others' SITB. Bootstrap bias-corrected 95% CIs were calculated with 5000 bootstrap samples. The PLUS cohort included 1202 participants (mean [SD] age, 30.2 [5.1] years; 906 [75.4%] female; 660 [54.9%] heterosexual). The SWS cohort included 1828 participants assessed across 3 waves (mean [SD] age, 26.9 [4.8] years; 1058 [57.9%] female; 1694 [93.1%] heterosexual). Sexual minority participants reported more frequent exposure to close others' SITB (eg, for suicide attempt: PLUS mean [SD], 0.41 [0.49] for sexual minority vs 0.23 [0.42] for heterosexual; P < .001; and SWS mean [SD], 0.28 [0.45] for sexual minority vs 0.14 [0.35] for heterosexual; P < .001) and higher SITB rates (eg, suicidal ideation: PLUS mean [SD], 4.67 [8.19] for sexual minority vs 1.97 [5.57] for heterosexual; P < .001; and SWS mean [SD], 0.35 [0.48] for sexual minority vs 0.13 [0.33]; P < .001) than heterosexual participants. In the PLUS cohort, exposure to close others' suicidal ideation accounted for 53.3% of the association between sexual orientation and past-month suicidal ideation (bootstrap 95% CI, 36.7%-76.0%). In the SWS cohort, exposure to close others' SITB (a composite indicator of exposure to close others' suicide attempt, suicide death, and NSSI) accounted for 46.9% of the association between sexual orientation and past-year NSSI (bootstrap 95% CI, 17.3%-86.3%). Findings from this study of 2 nationally representative cohorts of young adults suggest that exposure to close others' SITB may partially explain sexual orientation disparities in SITB. Findings underscore the need for further research into psychosocial mechanisms that may propagate SITB risk following exposure to close others' SITB in vulnerable populations.

Considerably less is known about self-injurious thoughts and behaviors (SITBs) in preadolescence than older age groups, owing partly to the common view that young children are incapable of suicidal thoughts. Yet, preadolescent suicide has increased in recent years and is now the fifth leading cause of death in this age group, leading the National Institute of Mental Health to identify it as a priority for research and intervention. To assess prevalence estimates of preadolescent SITBs, identify correlates of these outcomes, and conduct head-to-head comparisons of preadolescent and adolescent SITBs in terms of associated characteristics. MEDLINE, PsycINFO, and Embase were systematically searched from inception through December 23, 2021, for studies on the prevalence and correlates of preadolescent SITBs. The search was restricted to English language publications and peer-reviewed journals. Two reviewers independently identified studies providing data on prevalence and correlates of preadolescent SITBs. Two reviewers independently extracted data from each study, and the Joanna Briggs Institute Checklist for Prevalence Studies was used to assess study quality. Pooled prevalence and Cohen d were derived from random-effects meta-analyses. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Prevalence and correlates of suicidal ideation, suicide attempts, suicide deaths, and nonsuicidal self-injury among preadolescents. Fifty-eight studies with 626 486 590 individuals were included. Lifetime prevalence of suicide in the general population was 0.79 per 1 million children. Prevalence for lifetime suicidal thoughts, suicide attempts, and nonsuicidal self-injury among preadolescents were 15.1%, 2.6%, and 6.2%, respectively, in community samples. These data suggest that approximately 17.0% of preadolescents with suicidal ideation transition to attempting suicide. Across several analyses, male individuals appear more likely to have SITBs in preadolescence than adolescence. Correlate data were modest for SITBs other than suicidal ideation, but among specific disorders, attention-deficit/hyperactivity disorder (suicidal ideation: d = 0.54 [95% CI, 0.34-0.75]) and depression (suicidal ideation: d = 0.90 [95% CI, 0.71-1.09]; suicide attempts: d = 0.47 [95% CI, 0.26-0.68]) emerged as the strongest correlates. Among interpersonal factors, child maltreatment (suicidal ideation: d = 2.62 [95% CI, 1.56-3.67]) and parental support (suicidal ideation: d = -0.34 [95% CI, -0.46 to -0.22]) yielded the largest effect sizes. In this systematic review anda meta-analysis, although preadolescent suicide deaths were rare, other SITB types occur with concerning frequency. Male individuals were at greater risk for SITBs in preadolescence relative to adolescence. Attention-deficit/hyperactivity disorder, child maltreatment, and parental support were especially relevant to suicidal ideation, as well as depression for suicidal thoughts and behaviors, in this age group. Further study, especially of SITBs other than suicidal ideation, is needed.

Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) among youth are major public health concerns. Although a growing body of research has focused on the complex association between nonsuicidal and suicidal self-injury, the temporal relationship between these two classes of behaviors is unclear. The current study addresses this empirical gap by examining the course of SITBs in adolescents receiving outpatient (N=106; 82.1% female) and inpatient (N=174; 75.9% female) treatment. SITBs (co-occurrence, age-of-onset, and time lag between SITBs) and major psychiatric disorders were assessed at a single time point with well-validated structured interviews. Adolescents in both clinical samples reported high co-occurrence of SITBs: most adolescents reported both lifetime nonsuicidal self-injury (NSSI) and suicidal thoughts. A similar temporal pattern of SITBs was reported in the two samples: thoughts of NSSI and suicide ideation had the earliest age-of-onset, followed by NSSI behaviors, suicide plans, and suicide attempts. However, the age-of-onset for each SITB was younger in the inpatient sample than in the outpatient sample. In terms of time lag between SITBs, suicide ideation occurred on average before initial engagement in NSSI, suggesting that pathways to NSSI and suicidal behavior may occur simultaneously rather than in succession from nonsuicidal to suicidal self-injury. Results also indicated that the time to transition between SITBs was relatively fast, and that a key period for intervention and prevention is within the first 6-12months after the onset of suicidal thinking. Taken together, these findings have important implications for understanding the time-lagged relationship between nonsuicidal and suicidal self-injury.

Research in adolescents suggests associations between psychotic-like experiences (PLEs) and self-injurious thoughts and behaviors (SITBs), but insights into their temporal relationship, which may inform prediction, have been limited. Psychological distress (PD; symptoms of depression and anxiety) has been related to both PLEs and SITBs, and may modulate this relationship. Given that PLEs have been linked to the development of several mental disorders, and the relationships between SITBs and suicide, it is important to better understand their relationship. The present study sought to investigate these factors using a longitudinal school-based design. Adolescents (n = 1685, ages 12–18) completed annual self-report assessments (6 time points) on PLEs, SITBs (suicidal ideation (SI) and self-harm (SH)), as well as PD. The longitudinal associations between PLEs and SITBs were analyzed, employing two cross-lagged panel models (CLPMs), with and without adjustment for PD. Unadjusted CLPMs revealed significant bidirectional temporal associations between PLEs and SITBs (both SI and SH), suggesting that PLEs both predicted and were predicted by SITBs. When adjusting for PD, the effect of SI on PLEs remained significant, but not PLEs on SI; bidirectional associations between PLEs and SH also remained significant. A bidirectional longitudinal relationship where both PLEs and SITBs can precede (and perhaps predict) each other was suggested in adolescents. PD may play a particular role in situations where PLEs are followed by SI. Heightened awareness about relationships between these phenotypes may be an important step toward facilitating timely interventions for both mental disorders and suicide.

Self-injurious thoughts and behaviors (SITBs) are a growing concern among youth in sub-Saharan Africa, but their prevalence and correlates in this region are poorly understood. We therefore examined self-reported SITBs in a population-representative sample of youth in rural Burkina Faso. We used interviews from 1,538 adolescents aged 12 to 20 years living in 10 villages and 1 town in northwestern Burkina Faso. Adolescents were asked about their experiences with suicidal and nonsuicidal SITBs, adverse environmental factors, psychiatric symptoms, and interpersonal-social experiences. SITBs included lifetime prevalence of life is not worth living, passive suicide ideation, active suicide ideation, and nonsuicidal self-injury (NSSI). After describing SITB prevalence, we ran logistic and negative binomial regression models to predict SITBs. Weighted lifetime SITB prevalence estimates were: 15.6% (95% confidence interval [CI]: 13.7–18.0) for NSSI; 15.1% (95% CI: [13.2, 17.0]) for life is not worth living; 5.0% (95% CI [3.9, 6.0]) for passive suicide ideation; and 2.3% (95% CI [1.6, 3.0]) for active suicide ideation. Prevalence of life is not worth living increased with age. All four SITBs were significantly positively associated with mental health symptoms (depression symptoms, probable posttraumatic stress disorder) and interpersonal-social experiences (peer and social connectedness, physical assault, sexual assault and unwanted sexual experiences). Females were significantly more likely to report that their life was not worth living compared to males (aOR = 0.68; 95% CI [0.48, 0.96]). There is a high prevalence of SITBs among youth in rural Burkina Faso, most notably NSSI and life is not worth living, with interpersonal-social factors being the strongest predictors. Our results highlight the need for longitudinal SITB assessment to understand how risk for SITBs operates in resource-constrained settings, and to design interventions to mitigate risk. Given low school enrollment in rural Burkina Faso, it will be important to consider youth suicide prevention and mental health initiatives that are not school-based.

Emotional and Behavioral Problem Profiles of Preteens With Self-Injurious Thoughts and Behaviors: A Multicultural Study

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. 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. 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. 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).

BackgroundGiven that cognitive decline lacks effective treatment options and has severe implications for healthy aging, internet use may achieve nonpharmacological relief of cognitive decline through cognitive stimulation and social engagement.ObjectiveThis longitudinal study aimed to investigate the relationship between the diversity, frequency, and type of internet use and cognitive decline, and to provide theoretical support and suggestions for mitigating cognitive decline in middle-aged and older adults.MethodsData were obtained from a total of 10,532 survey respondents from the China Family Panel Studies database from wave 3 (2014) and wave 5 (2018) of the survey. Cognitive function was measured using vocabulary tests, and internet use was categorized into five aspects: study, work, socializing, entertainment, and commercial-related activities. Associations between the diversity, frequency, and type of internet use and cognitive decline were estimated by controlling for demographic variables and health status risk factors through fixed-effects models.ResultsAfter controlling for demographic and health status risk factors, the type and frequency of internet use were found to be associated with cognitive functioning during the subsequent 4-year period, and different types of internet use had different effects on cognitive decline. Frequency of internet use of at least once a week for study (β=0.620, 95% CI 0.061 to 1.180; P=.04), work (β=0.896, 95% CI 0.271 to 1.520; P=.01), and entertainment (β=0.385, 95% CI –0.008 to 0.778; P=.06), as well as less than once a week for social purposes (β=0.860, 95% CI 0.074 to 1.650; P=.06), were associated with better cognitive function. Frequency of internet use of less than once a week for commercial-related activities (β=–0.906, 95% CI –1.480 to –0.337; P=.005) was associated with poorer cognitive function. Using the internet for more than one type of activity (β=0.458, 95% CI 0.065 to 0.850; P=.03) and at least once a week (β=0.436, 95% CI 0.066 to 0.806; P=.02) was associated with better cognitive function.ConclusionsThis study shows that breadth and depth of internet use are positively associated with cognitive function and that different types of internet use have different roles in cognitive decline. The importance of the internet as a nonpharmacological intervention pathway for cognitive decline is emphasized. Future research could explore specific mechanisms of influence.

Self-injurious thoughts and behaviors (SITBs) are a major public health problem that traditional interventions have been unable to address on a large scale. The goal of this series of studies was to take initial steps toward developing an effective SITB treatment that can be easily delivered on a very large scale. We created a brief (1-2 min), game-like app called Therapeutic Evaluative Conditioning (TEC), designed to increase aversion to SITBs and decrease aversion to the self. In 3 separate studies, we recruited participants with recent and severe histories of SITBs from web forums focused on self-injury and psychopathology (Ns = 114, 131, and 163) and randomly assigned them to receive access to the mobile treatment TEC app or a control app for 1 month. We tested the effect of TEC on the frequency of self-cutting, nonsuicidal self-injury more generally, suicide ideation, suicide plans, and suicidal behaviors. Analyses showed that, compared with the control app, TEC produced moderate reductions for all SITBs except suicide ideation. Across studies, the largest and most consistent reductions were for self-cutting episodes (32%-40%), suicide plans (21%-59%), and suicidal behaviors (33%-77%). Two of the 3 studies showed that TEC impacted its intended treatment targets and that greater change in these targets was associated with greater SITB reductions. TEC effects were not maintained at the 1-month posttreatment follow-up. Future versions of brief, mobile interventions like that tested here may have the potential to reduce SITBs and related behaviors on a large scale. (PsycINFO Database Record

The association between self-concept, self-concept clarity, and self-injurious thoughts and behaviors (SI, SA, and NSSI): A three-level meta-analysis.

Parental Expressed Emotion and Adolescent Self-Injury

Self-injurious thoughts and behaviors and alterations in positive valence systems: A systematic review of the literature

Subtypes of suicidal ideation among university students - An ecological momentary assessment study.

Objectives Trauma exposure (TE) and cognitive flexibility (CF) are risk factors for self-injurious thoughts and behaviors (SITBs). However, it is unknown whether these risk factors contribute to mechanisms associated with distinct categories of SITBs. The current study examined the potential moderating role of TE in the relationships between CF and multiple SITBs, including active suicidal ideation (SI), passive SI, non-suicidal self-injury (NSSI), and history of suicide attempt (SA), among pre-adolescent children. Methods A total of 11,326 children from the Adolescent Brain Cognitive Development study were included in the present study. SITBs and TE were measured by the Kiddy Schedule for Affective Disorder and Schizophrenia (KSADS). CF was measured using the NIH Cognitive Toolbox. Results Cumulative TE moderated the relationship of CF to active SI. Higher CF was associated with lower odds of current SI in children with a single lifetime TE, but not in children without trauma or with two or more TE. As a main effect, two or more TE predicted higher odds of active SI, passive SI, and lifetime SA, but not NSSI. Higher CF was associated with lower odds of passive SI, with effects not moderated by trauma exposure. Conclusion The current results clarify previously inconsistent findings about the relationship of CF to SI by identifying cumulative TE as a moderator. CF served as a protective factor against SI, but only in children with a single lifetime trauma. Implications for screening and treatment targets of children at risk for distinct categories of SITBs are discussed.

Temporal sequences of suicidal and nonsuicidal self-injurious thoughts and behaviors among inpatient and community-residing military veterans