Fluctuations in Affective States and Self-Efficacy to Resist Non-Suicidal Self-Injury as Real-Time Predictors of Non-Suicidal Self-Injurious Thoughts and Behaviors.

Ronny Bruffaerts,Laurence Claes,Matthew K. Nock,Olivia Kirtley,Inez Myin-Germeys,Mark Boyes,Glenn Kiekens,Penelope Hasking

doi:10.3389/fpsyt.2020.00214

Abstract

IntroductionAlthough research over the past decade has resulted in significantly increased knowledge about distal risk factors for non-suicidal self-injury (NSSI), little is known about short-term (proximal) factors that predict NSSI thoughts and behaviors. Drawing on contemporaneous theories of NSSI, as well as the concept of ideation-to-action, the present study clarifies (a) real-time factors that predict NSSI thoughts and (b) the extent to which theoretically important momentary factors (i.e., negative affect, positive affect, and self-efficacy to resist NSSI) predict NSSI behavior in daily life, beyond NSSI thoughts.MethodsUsing experience sampling methodology, intensive longitudinal data was obtained from 30 young adults with frequent NSSI episodes in the last year. Participants completed assessments up to eight times per day for 12 consecutive days (signal-contingent sampling). This resulted in the collection of 2,222 assessments (median compliance = 79.2%) during which 591 NSSI thoughts and 270 NSSI behaviors were recorded. Using the dynamic structural equation modeling framework, multilevel vector autoregressive models were constructed.ResultsWithin the same assessment, negative affect was positively associated with NSSI thoughts, whereas positive affect and self-efficacy to resist NSSI were each negatively associated with NSSI thoughts. Across assessments, higher-than-usual negative affect and self-efficacy to resist NSSI were predictive of short-term change in NSSI thoughts. While fluctuations in both negative affect and positive affect prospectively predicted NSSI behavior, these factors became non-significant in models that controlled for the predictive effect of NSSI thoughts. In contrast, self-efficacy to resist NSSI incrementally predicted a lower probability of engaging in NSSI, above and beyond NSSI thoughts.DiscussionThis study provides preliminary evidence that affective fluctuations may uniquely predict NSSI thoughts but not NSSI behaviors, and point to the role of personal belief in the ability to resist NSSI in preventing NSSI behavior. These findings illustrate the need to differentiate between the development of NSSI thoughts and the progression from NSSI thoughts to behavior, as these are likely distinct processes, with different predictors.

Highlights

Research over the past decade has resulted in significantly increased knowledge about distal risk factors for non-suicidal self-injury (NSSI), little is known about short-term factors that predict Non-suicidal self-injury (NSSI) thoughts and behaviors
These findings show that approximately half of the variability in negative affect and NSSI thoughts is due to within-person variance
Negative affect was significantly positively associated with NSSI thoughts, whereas positive affect and self-efficacy to resist NSSI were each negatively associated with NSSI thoughts

Summary

Introduction

Research over the past decade has resulted in significantly increased knowledge about distal risk factors for non-suicidal self-injury (NSSI), little is known about short-term (proximal) factors that predict NSSI thoughts and behaviors. NSSI behaviors are an important predictor of future suicidal thoughts and behaviors [5,6,7,8] and psychopathology [9, 10], and are associated with stigma and feelings of shame [11,12,13], low levels of disclosure and help-seeking [14,15,16], and other adverse outcomes [e.g., poorer academic performance; [17]]. While NSSI and its correlates have traditionally been studied using cross-sectional designs, over the past decade, concerted efforts have been made to clarify long-term (distal) predictors [18,19,20,21] These longitudinal studies typically take a populationlevel nomothetic approach (i.e., risk stratification at the betweenperson level), involving few measurement occasions (usually 2– 5) that are spaced over long observation windows (e.g., yearly). The recent proliferation of new technologies and smartphone-based apps have made it feasible to use experience sampling methods to study NSSI and its real-time predictors in daily life [22]

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