Self-harm Research Articles

Oxidative Stress in Depression: A Case-control Study of Serum MDA Levels and Lipid Levels in Patients With Depression in a Tertiary Care Hospital in South India

Introduction: Numerous theories have been proposed to substantiate the etiopathogenesis of depression. Recently, the hypothesis involving the oxidative stress (OS) pathway has been explored. Hence, potential markers are also being investigated for their role in depression. We aimed to assess the serum malondialdehyde (MDA) and serum lipid levels in individuals with depression and controls and explore associated factors. Methodology: A semi-structured questionnaire, complete with a mandatory consent form and a reliable, validated scale, namely the Hamilton Depression scale (HAM-D), was used. The method of sampling was purposive, with 100 depression cases in the psychiatry outpatient being included and 50 age-matched, gender-matched controls. Blood was collected from both groups to evaluate serum MDA and serum Lipid levels. Appropriate statistics using SPSS 20 were administered. Results: Our study had a female preponderance in cases, with 38% having major depressive disorder (MDD), 50% of whom showed suicidal ideas, and 10% had a prior history of deliberate self-harm. Mean HAM-D scores were higher in cases than controls, 18.57 ± 6.02, and mean MDA levels were higher in cases, 2.5 ± 1.02 mmol/L. HDL levels were lower in depression cases compared to controls, 38.34 ± 7.442. An inverse correlation was seen between mean serum MDA levels and HDL levels in depression cases. A significant relationship was observed between the parameters of depression and serum MDA levels. Conclusion: Significantly elevated mean serum MDA levels were observed in depression cases, along with significantly lowered mean HDL values compared to controls. We found a positive correlation between serum MDA levels and the severity, recurrence, and suicidality of depression. An inverse relation was observed between serum MDA values and mean HDL levels in depression. This emphasizes the need for clinical vigilance in employing these biomarkers not merely for assessment but also for HDL as a preventive measure in depression.

Self-injurious thoughts and behaviours as the reason for contact to Norwegian emergency primary care centres: an observational study

Objective To describe and compare contacts regarding self-injurious thoughts and behaviours to other contacts to emergency primary care. Design Observational study. Setting A sentinel network of seven emergency primary care centres throughout Norway. Subjects Initial contacts regarding patients 10 years and older during 12 consecutive months (11/2021–10/2022). Main outcome measures Contacts due to self-injurious thoughts and behaviours. Results Self-injurious thoughts and behaviours were the reason for contact for 0.6% (n = 478) of initial contacts for patients aged 10 years or older (n = 77 344). When compared to other contacts, self-injurious thoughts and behaviours were associated with female gender, younger age, occurrence during evening and nighttime, higher urgency, and more physician consultations and call-outs. Of contacts about self-injurious thoughts and behaviours, 58.2% were regarding thoughts and 41.8% about behaviours, and in 75.0% a history of similar contacts was recorded. Contacts regarding thoughts often concerned threats (30.6%) and were more often handled by telephone advice than contacts regarding behaviours. Contacts regarding behaviours with suicidal intent were associated with higher urgency and more physician call-outs than contacts regarding non-suicidal behaviours. Conclusion Self-injurious thoughts and behaviours are rare reasons for contact to emergency primary care but are assessed as more urgent than other contact reasons and trigger more extensive medical help. Many of the patients are known to the service through a history of similar contacts. Implications The infrequency and severity of these encounters might necessitate training, decision support and procedures to compensate for the health care personnel’s limited exposure.

Exploring nursing students’ experiences of contemplating self-injury during their clinical practicums: A phenomenological study

AimTo explore nursing students’ thoughts and feelings about self-injuring during their clinical practicums. BackgroundUnfamiliar clinical environments pose challenges for nursing students, potentially leading to high levels of stress. When students find it difficult to cope with emotional triggers, some contemplate self-injury. Yet, it is rare to explore nursing students’ thoughts and feelings related to self-injury during their clinical practicums. DesignA phenomenological approach was used. MethodsPurposive sampling was used and the participants were drawn from nursing students who graduated from universities in Taiwan. In-depth, semi-structured interviews were conducted from August to November 2023. Data saturation was reached after interviewing 15 participants. Colaizzi's seven steps and NVivo software were used for data analysis. ResultsFour themes and 14 subthemes emerged. They were: (1) Sensing an emotional crescendo: participants experienced anxieties about clinical educators, assignments, homework and the clinical practicums and these intensified across time. (2) Physical and mental dysregulation: participants experienced physical discomfort, psychological distress and negative thoughts when subjected to overwhelming pressures during their clinical practicums. (3) Unwholesome self-protective behaviors: participants expressed thoughts of self-injury, engaged in self-injurious behaviors, experienced suicidal ideations and attempted suicide as measures of relieving stress. (4) Compassionate self-protective behaviors: participants coped with stress through emotional voicing, modifying situations to adjust stress, reaching out for help, self-compassion and self-care. ConclusionsFindings raise awareness of the need for clinical educators to demonstrate empathy with nursing students who have thoughts of self-injury during their clinical practicums. Further, it is crucial for them to offer timely guidance on the healing process while simultaneously creating nurturing clinical environments wherein students could flourish and grow.

Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India

Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India

Momentary Associations Between Positive Coping and Nonsuicidal Self-Injury Risk Among Individuals With Problematic Alcohol Use.

Background: The use of positive coping skills has demonstrated protective effects with regard to Nonsuicidal Self-Injury (NSSI) engagement; however, cross-sectional evidence suggests that the presence of comorbid conditions, such as alcohol use disorders, may negate these benefits. Aims: The current study leverages ecological momentary assessment (EMA) to examine the between-person and within-person relationships between positive coping strategies and NSSI risk among individuals with problematic alcohol use. Method: Undergraduate students (n = 56) completed a 21-day EMA protocol, in which they completed four surveys per day asking about their use of several positive coping strategies and NSSI risk. Results: Socializing was the only coping strategy to demonstrate a protective effect on NSSI risk. Alternatively, the coping strategies of finding perspective, positive thinking, and sitting with feelings until they pass all increased risk for NSSI. Limitations: The current study was underpowered to disentangle relationships with urges to engage in NSSI and NSSI behaviors. Conclusion: The results suggest that using coping skills that may present physical barriers to engaging in NSSI may be effective for reducing momentary NSSI risk.

"Mastectomy for individuals with gender dysphoria below 26 years of age: A systematic review and meta-analysis".

Gender dysphoria (GD) refers to psychological distress associated with the incongruence between one's sex and one's gender. In response to GD, birth-registered females may choose to undergo mastectomy. In this systematic review, we summarize and assess the certainty of the evidence on the effects of mastectomy. We searched MEDLINE, Embase, PsycINFO, Social Sciences Abstracts, LGBTQ+ Source, and Sociological Abstracts through June 20, 2023. We included studies comparing mastectomy to no mastectomy in birth-registered females under 26 years of age with GD. Outcomes of interest included psychological and psychiatric outcomes, and physical complications. Pairs of reviewers independently screened articles, abstracted data, and assessed risk of bias of the included studies. We performed meta-analysis and assessed the certainty of the evidence using the GRADE approach. We included 39 studies. Observational studies (n=2) comparing mastectomy to chest binding provided very low certainty evidence for the outcome of GD. One observational study comparing mastectomy to no mastectomy provided very low certainty evidence for the outcomes global functioning and suicide attempts, and low certainty evidence for the outcome non-suicidal self-injury (aOR 0.47 [95% CI 0.22 to 0.97]). Before-after (n=2) studies provided very low certainty evidence for all outcomes. Evidence from case series (n=34) studies ranged from high to very low certainty. Case series studies demonstrated high certainty evidence for the outcomes of death, necrosis, and excessive scarring; however, these are limited in methodological quality. In comparative and before-after studies the evidence ranged from low to very low certainty.

Does the decision to disclose non-suicidal self-injury align with decision-making frameworks of personal information disclosure? A directed content analysis.

Non-suicidal self-injury (NSSI) is the deliberate damage caused to one's own body tissue, without the intent to die. Voluntary disclosure of one's NSSI can catalyze help-seeking and provision of support, although what informs the decision to disclose NSSI is not yet well understood. There is currently no existing framework specific to the process of NSSI disclosure, and the aim of this study was to assess the fit between factors involved in the decision to disclose NSSI and two broader frameworks of disclosure: the Disclosure Decision-Making and Disclosure Processes models. A directed content analysis was used to code interview transcripts from 15 participants, all of whom were university students aged between 18 and 25 (M = 20.33, SD = 1.88), with 11 identifying as female. All participants had lived experience of NSSI which they had previously disclosed to at least one other person. All codes within the coding matrix, which were informed by the disclosure models, were identified as being present in the data. Of the 229 units of data, 95.63% were captured in the existing frameworks with only 10 instances being unique to NSSI disclosure. Though factors that inform the decision to disclose NSSI largely align with the aforementioned models of disclosure, there are aspects of disclosure decision-making that may be specific to NSSI.

Patient Reported Outcomes in Patients with Cleft Lip and/or Palate Help Identify Youth at Risk for Suicidality.

To identify associations between scores on the CLEFT-Q and Columbia-Suicide Severity Rating Scale (C-SSRS) Lifetime Version in patients with cleft lip and/or palate (CLP). Prospective. Tertiary care center. Patients ages six and older administered both the CLEFT-Q questionnaire and C-SSRS survey between 2019 and 2024. Multidisciplinary care coordination facilitated by the team psychologist. Associations among demographics, CLEFT-Q responses, and suicidality. A total of 305 patients were included, 141 females (46.2%) and 164 males (53.8%). Fifty-one (16.7%) endorsed lifetime incidence of suicidal ideation, four (1.3%) endorsed suicidal behavior, 12 (3.9%) endorsed non-suicidal self-injury (NSSI), and one (0.3%) endorsed self-injurious behavior, intent unknown. Patients endorsing suicidal ideation had lower PROs in 12/13 categories on the CLEFT-Q questionnaire (p < 0.001). Those with suicidal behavior had lower PROs in three health-related quality of life categories (psychological function, p = 0.018; social function, p = 0.005; school function, p = 0.007), but no difference in other domains. A cutoff of ≤70 in the CLEFT-Q psychological function domain identified suicidal ideation with 72.9% sensitivity and 65.9% specificity and suicidal behavior with 100.0% sensitivity and 62.2% specificity. Patients with cleft lip and/or palate have increased risks for psychosocial challenges that are often missed by healthcare providers. This study reveals that patient-reported outcomes are worse in those with CLP who endorsed suicidal ideation and behavior. Low PRO responses identify suicidality with moderate sensitivity and specificity. Patients with low scores should be offered safety screenings and psychosocial support, ideally by mental healthcare professionals.

ThP7.12 - Penetrating Neck Injuries as a form of deliberate self-harm: A Pre and Post COVID-19 Comparison

Abstract Introduction In March 2020, the UK government implemented the first national lockdown to contain the spread of COVID-19. Despite success at curbing infection rates, early studies suggested a rise mental health issues, including an increased incidence of violent self-harm. This included penetrating neck injuries. Limited research is available on the pandemic’s effect on self-harm in the UK. Methods Data was collected from self-harm major trauma activations to a regional trauma centre, between 01/01/17 to 31/12/22. All patients identified with neck-related self-harm injuries were included. Demographic information and injury data was grouped for analysis into pre-COVID-19 (2017-19), and post-COVID-19 outbreak (2020-22) groups. Results Penetrating neck injuries due to self-harm, post-2019, increased fourfold (12 vs 47). Men were the majority in both periods, but women had a larger proportional increase (men 10 vs 34, women 2 vs 13). Mean ages of Men presenting increased (Men 44 vs 53, Women 36 vs 35) Conclusions The frequency of self-harm related neck injuries increased following lock down. Older men were most likely to present, however there was an associated rise in the number of women. We must further investigate the impact the pandemic had on the population’s mental health and tendency towards violent self-harm, particularly in older men.

Forecasting High-Risk Behavioral and Medical Events in Children with Autism Using Digital Behavioral Records.

Individuals with Autism Spectrum Disorder may display interfering behaviors that limit their inclusion in educational and community settings, negatively impacting their quality of life. These behaviors may also signal potential medical conditions or indicate upcoming high-risk behaviors. This study explores behavior patterns that precede high-risk, challenging behaviors or seizures the following day. We analyzed an existing dataset of behavior and seizure data from 331 children with profound ASD over nine years. We developed a deep learning-based algorithm designed to predict the likelihood of aggression, elopement, and self-injurious behavior (SIB) as three high-risk behavioral events, as well as seizure episodes as a high-risk medical event occurring the next day. The proposed model attained accuracies of 78.4%, 80.68%, 85.43%, and 69.95% for predicting the next-day occurrence of aggression, SIB, elopement, and seizure episodes, respectively. The results were proven significant for more than 95% of the population for all high-risk event predictions using permutation-based statistical tests. Our findings emphasize the potential of leveraging historical behavior data for the early detection of high-risk behavioral and medical events, paving the way for behavioral interventions and improved support in both social and educational environments.

Comparing hospitalized adult patients with chronic anorexia nervosa with versus without prior hospitalizations

BackgroundAnorexia nervosa (AN) is a severe psychiatric disorder, from which recovery is often protracted. The role of prior specialized inpatient treatment on subsequent treatment attempts for adults with chronic AN and predictors of treatment response for severe and enduring AN (SE-AN) are needed to improve outcomes.MethodParticipants (N = 135) with chronic AN (ill ≥7 years) admitted to an integrated inpatient-partial hospitalization eating disorders (ED) unit with prior ED hospitalization(s) (+ PH; n = 100) were compared to those without prior ED hospitalizations (-PH; n = 35) on admission characteristics (BMI, length of illness, outpatient ED treatment history, symptomatology (ED, anxiety, and depressive), history of suicide attempts or non-suicidal self-injury (NSSI)), treatment motivation and recovery self-efficacy, and discharge outcomes (discharge BMI, rate of weight gain, length of stay, clinical improvement).ResultsGroups were similar with regard to age, years ill, and admission BMI. The + PH group had lower desired weight, lifetime nadir BMI and self-efficacy for normative eating, and higher state and trait anxiety than the -PH group. +PH were also more likely to endorse history of NSSI and suicide attempt. Regarding discharge outcomes, most patients achieved weight restoration at program discharge (mean discharge BMI = 19.8 kg/m2). Groups did not differ on rate of weight gain, likelihood of attending partial hospital, partial hospital length of stay, program discharge BMI, or likelihood of clinical improvement (p’s > 0.05) although inpatient length of stay was longer for the + PH group.ConclusionsParticipants with chronic AN + PH exhibited more severe psychiatric comorbidity and lower self-efficacy for normative eating than AN -PH, however short-term discharge outcomes were similar. Future research should determine whether weight restoration and targeting comorbidities impacts relapse risk or need for rehospitalization among chronic and severe + PH. Despite similar illness durations, those with chronic AN -PH may be able to transition to partial hospital earlier. Conversely there is risk of undertreatment of chronic AN + PH given the recent shift promoting briefer self-directed admissions for adults with SE-AN. Research comparing + PH and -PH adults with chronic AN may facilitate efforts to individualize care and characterize relapse risk following intensive treatment.

Effect of Parenting Style, attachment to parents and self-compassion on the occurrence and recovery motivation for non-suicidal self-injury in adolescents.

Non-suicidal self-injury (NSSI) is a worldwide mental health problem that deserves thorough investigation. This study aims to explore the effect of parenting styles, attachment to parents, and self-compassion on the occurrence of non-suicidal self-injury (NSSI) behavior in adolescents and whether these factors influence their recovery motivation. A total of 132 adolescents who had engaged in NSSI within the last year and 72 adolescents who had never engaged in NSSI were recruited from the Shenzhen Kangning Hospital and from primary and secondary schools and communities. Differences in the Hamilton Depression Scale (HAMD), Inventory of Parent and Peer Attachment (IPPA), Egma Minn av. Bardndosnauppforstran (EMBU), and Self-Compassion Scale (SCS) of participants were compared. A binary logistic model was established to measure the odds ratios of these variables on the occurrence of NSSI. In the NSSI adolescent sample, separate binary logistic models were created with NSSI impulse inhibition, NSSI resistance activity, and NSSI recovery motivation as dependent variables and with parenting styles, attachment to parents, and self-compassion as independent variables. Compared with adolescents with no NSSI behavior, those who had engaged in NSSI within the past year had higher scores on the HAMD, as well as higher EMBU-negative father parental behavior (punishment, excessive interference, rejection, and overprotection), EMBU-negative mother parental behavior (excessive interference, rejection, and punishment), and SCS negative self-compassion scores. Moreover, adolescents with NSSI had lower EMBU-father emotional warmth, EMBU-mother emotional warmth, IPPA-attachment to father, IPPA-attachment to mother, and SCS positive self-compassion scores. Current depressive symptoms and maternal punishment are risk factors for NSSI in adolescents, while positive self-compassion was a protective factor. Positive self-compassion can positively predict NSSI impulse inhibition, NSSI resistance activity, and NSSI recovery motivation. However, we unexpectedly found that the father's emotional warmth negatively predicts NSSI resistance activity. This study found that positive self-compassion has a significant impact on the prevention of and recovery from NSSI behavior in adolescents.

Suicide Prevention Effects of Extreme Risk Protection Order Laws in Four States.

More than half of suicide deaths in the United States result from self-inflicted firearm injuries. Extreme risk protection order (ERPO) laws in 21 states and the District of Columbia temporarily limit access to firearms for individuals found in a civil court process to pose an imminent risk of harm to themselves or others. Research with large multistate study populations has been lacking to determine effectiveness of these laws. This study assembled records pertaining to 4,583 ERPO respondents in California, Connecticut, Maryland, and Washington. Matched records identified suicide decedents and self-injury method. Researchers applied case fatality rates for each suicide method to estimate nonfatal suicide attempts corresponding to observed deaths. Comparison of counterfactual to observed data patterns yielded estimates of the number of lives saved and number of ERPOs needed to avert one suicide. Estimates varied depending on the assumed probability that a gun owner who attempts suicide will use a gun. Two evidence-based approaches yielded estimates of 17 and 23 ERPOs needed to prevent one suicide. For the subset of 2,850 ERPO respondents with documented suicide concern, comparable estimates were 13 and 18, respectively. This study's findings add to growing evidence that ERPOs can be an effective and important suicide prevention tool.

Similarities and differences in the functions of non-suicidal self-injury (NSSI) across gender non-conforming and cisgender young adults

BackgroundNon-suicidal self-injury (NSSI) can be motivated by a broad range of functions and many individuals report multiple reasons for self-injuring. Most NSSI research has involved predominantly female samples and few studies have examined gender similarities and differences in function endorsement. MethodsWe characterise the prevalence and versatility of NSSI functions within a gender-diverse online sample of cisgender women (cis-women; n = 280), cisgender men (cis-men; n = 176), and transgender, non-binary, and other gender non-conforming young adults (TGNC; n = 80) age 18–30 (M = 23.73, SD = 3.55). The Ottawa Self-Injury Inventory (OSI-F) assessed 24 intrapersonal and social functions across nine domains: affect regulation, self-punishment, anti-dissociation, anti-suicide, sensation seeking, sexuality, interpersonal influence, and body image. ResultsTGNC participants and cis-women were significantly more likely to report intrapersonally motivated NSSI and greater function versatility than cis-men. Low mood, emotional distress, suicidality, and trauma symptomology appeared to contribute to gender differences in function endorsement. Gender similarities also emerged; across groups, intrapersonal functions were substantially more common than social functions, and the most endorsed domains were affect regulation and self-punishment. No domains were gender specific. LimitationsThe OSI-F was developed from majority female samples and may not adequately capture the experiences of other gender groups. ConclusionsInterventions which reduce distress and strengthen emotion regulation are likely to benefit individuals who self-injure regardless of gender. However, most individuals report multiple NSSI functions and person-centred interventions which address this complexity are needed. Future research should develop gender-informed treatment models which consider the unique experiences of TGNC individuals and cis-men who self-injure.

The association between child maltreatment, cognitive reappraisal, negative coping styles, and non-suicidal self-injury in adolescents with major depressive disorder

BackgroundNon-suicidal self-injury (NSSI) is a significant public health concern among adolescents with major depressive disorders (MDD). Although previous research has linked child maltreatment (CM) to NSSI, the precise mechanisms remain unclear. This study aims to investigate the association between CM, cognitive reappraisal (CR), negative coping styles (NC) and NSSI in adolescents with MDD, from the perspectives of both Latent Variable Theory and the Network Theory of Mental Disorder.MethodsA sample of 651 adolescents with MDD was recruited from January to December 2023. Data on CM, CR, NC, and NSSI were collected through paper-based self-reported questionnaires. Data analysis primarily involved structural equation modeling and network analysis.ResultsThe reporting rate of NSSI among adolescents with MDD was 48.2%. CM showed a significant positive correlation with NSSI. NSSI was affected by CM through three paths: the mediating role of CR, the mediating role of NC, and the chain mediating role of both CR and NC. Emotional abuse (EA) was the central node, while NSSI, EA, and “The urge to cry quietly when faced with troubles“(NC10) were the key bridge nodes.ConclusionsThis study is the first to use both structural equation modeling and network analysis to explore the explore the relationship between CM, CR, NC, and NSSI in adolescents with MDD, providing a theoretical basis for future early prevention and targeted interventions for adolescents with MDD.

Prevalence and correlates of non-suicidal self-injury among patients with bipolar disorder: A multicenter study across China

BackgroundNon-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies. MethodsNSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-)Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis. ResultsThe enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were “cutting” (41.2 %) and “hitting” (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05). LimitationsAs a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports. ConclusionOur study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.

Cybervictimization and Non-Suicidal Self-Injury Among Chinese College Students: an Exploration Through the Lens of Experiential Avoidance Model.

Non-suicidal self-injury (NSSI) is a growing public health concern among college students, with cybervictimization (CV) emerging as a significant contributing factor. Grounded in the experiential avoidance theory, this study investigates the mediating roles of cognitive fusion and negative emotions in the relationship between CV and NSSI, providing new insights into these key variables. A convenience sample of 457 undergraduate students (29% male; mean age 18.36±0.66 years) from two universities in Fujian Province participated in this study. Data were collected using the Cyberbullying Victimization Scale, Cognitive Fusion Questionnaire, Positive and Negative Affect Schedule, and Non-Suicidal Self-Injury Scale. Descriptive statistics and Pearson correlation analysis were conducted using SPSS 25.0, while the mediating effects were analyzed using Process 3.5. (1) Significant positive correlations were found among CV, cognitive fusion, negative emotions, and NSSI (p < 0.01). (2) CV was directly associated with NSSI (β = 0.22, p < 0.001) and positively predicted both cognitive fusion (β = 0.17, p < 0.001) and negative emotions (β = 0.15, p < 0.01). Additionally, cognitive fusion (β = 0.16, p < 0.01) and negative emotions (β = 0.11, p < 0.05) significantly predicted NSSI. (3) Mediation analyses revealed that cognitive fusion and negative emotions mediated the CV-NSSI relationship through three pathways: CV→cognitive fusion→NSSI (mediation effect = 0.026), CV→negative emotions→NSSI (mediation effect = 0.02), and CV→cognitive fusion→negative emotions→NSSI (mediation effect = 0.01). The study confirms that CV influences NSSI indirectly through cognitive fusion and negative emotions, supporting the experiential avoidance model. These findings underscore the importance of addressing cognitive and emotional processes in interventions aimed at reducing NSSI among college students.

A multi-modal assessment of self-knowledge in adolescents with non-suicidal self-injury: a research domains criteria (RDoC) study.

Adolescence is a critical period for brain development, consolidation of self-understanding, and onset of non-suicidal self-injury (NSSI). This study evaluated the RDoC (Research Domain Criteria) sub-construct of Self-Knowledge in relation to adolescent NSSI using multiple units of analysis. One hundred and sixty-four adolescents assigned female at birth (AFAB), ages 12-16 years with and without a history of NSSI entered a study involving clinical assessment and magnetic resonance imaging (MRI), including structural, resting-state functional MRI (fMRI), and fMRI during a self-evaluation task. For imaging analyses, we used an a priori defined Self Network (anterior cingulate, orbitofrontal, and posterior cingulate cortices; precuneus). We first examined interrelationships among multi-level Self variables. We then evaluated the individual relationships between NSSI severity and multi-level Self variables (self-report, behavior, multi-modal brain Self Network measures), then conducted model testing and multiple regression to test how Self variables (together) predicted NSSI severity. Cross-correlations revealed key links between self-reported global self-worth and self-evaluation task behavior. Individually, greater NSSI severity correlated with lower global self-worth, more frequent and faster negative self-evaluations, lower anterior Self Network activation during self-evaluation, and lower anterior and posterior Self Network resting-state connectivity. Multiple regression analysis revealed the model including multi-level Self variables explained NSSI better than a covariate-only model; the strongest predictive variables included self-worth, self-evaluation task behavior, and resting-state connectivity. Disruptions in Self-Knowledge across multiple levels of analysis relate to NSSI in adolescents. Findings suggest potential neurobiological treatment targets, potentially enhancing neuroplasticity in Self systems to facilitate greater flexibility (more frequently positive) of self-views in AFAB adolescents.

Predicting non-suicidal self-injury among Chinese adolescents: The application of ten algorithms of machine learning

Background and aimsHigh non-suicidal self-injury (NSSI) prevalence among adolescents is a global health issue. However, current prediction models for adolescent NSSI rely on a limited set of algorithms, resulting in biased predictions. Therefore, the aim of this study is to develop multiple machine learning models to enhance prediction accuracy and mitigate biases among Chinese adolescents. MethodsA total of 4487 junior and senior high school students in China were recruited. Multiple algorithms were included, such as logistic regression, decision tree, support vector machine, Naive Bayes, multi-layer perceptron, K-nearest neighbors, and ensemble learning algorithm like random forest, bagging, AdaBoost, and stacking to build predictive models. Data processing techniques, including standardization and the synthetic minority oversampling technique, were employed to optimize the predictive model. The model was trained on 70 % of the data, reserving 30 % for testing. ResultsThe ten prediction models achieved a good performance, with area under the receiver operating characteristic curve (AUC) scores above 0.700 in the test set. The stacking and random forest models achieved AUC scores of 0.904 and 0.898, respectively. The prediction performance of the Naive Bayes model was relatively poor. The top five important variables were resilience, bully, suicidal ideation, internet addiction, and depression. ConclusionsThe ensemble machine learning algorithm showed promising results predicting NSSI among adolescents. Such algorithms should be recommended for future NSSI research to enhance predictive accuracy. Identification of important features in NSSI prediction can help develop screening protocols and lay a foundation for clinical diagnosis and intervention in adolescent populations.

The Epidemiology of Genitourinary Self-inflicted Injuries: Analysis of the National Trauma Databank

ObjectivesTo provide insight into the epidemiologic characteristics and trends of genitourinary (GU) self-inflicted injury (SII). MethodsWe used data from the National Trauma Databank between 2017-2020. We described the characteristics of GU SII cases based on injured organ and then compared male and female injuries. ResultsWe identified 56,463 patients with SII, of which 1,508 (2.7%) had GU involvement. Most cases were male patients (77.3%) and white (70.6%). Median age was 35 years (IQR 26 – 50). The most commonly injured GU organs was kidney (43.4%), followed by scrotum / testes (22.5%), and penis (18.2%). Most cases (89.9%) represented a single-organ injury whereas 10.1% had two or more GU organs injured. Seventy-three of those with kidney injuries (11.2%) underwent nephrectomy. Only one patient performing GU SII had a diagnosis code for transsexualism but the majority (82.2%) suffered from pre-existing conditions of which 20.5% had three or more comorbidities. More than half the population (54.9%) had preexisting diagnosed mental or personality disorder. A non-GU co-injury was present in most cases (70.8%), most commonly affecting another abdominal organ (44.3%) or fractures (41.3%). A positive drug screen was found in 30.7% of cases. Most patients survived though 15.4% died. 94% of fatal cases had a concomitant non-GU injury. ConclusionsGU injuries account for 2.6% of all SII. These patients are often young white males with known mental or personality disorders. Kidneys were most common injuried and mortality was highest in cases of kidney and bladder injuries with multi-organ trauma involving non-GU organs.