Development Of Non-suicidal Self-injury Research Articles

The impact of depressive and anxious symptoms on non-suicidal self-injury behavior in adolescents: a network analysis

PurposeConceptualizing adolescent NSSI and emotional symptoms as a system of causal elements could provide valuable insights into the development of non-suicidal self-injury (NSSI) in adolescent. This study aimed to explore the intricate relationship between NSSI, depressive symptoms, and anxious symptoms in adolescents, identifying key symptoms to establish a theoretical foundation for targeted and effective interventions addressing NSSI behaviors in this population.MethodsA total of 412 adolescents with NSSI behaviors were selected from outpatients. Generalized anxious disorder scale (GAD-7) and patient health questionnaire (PHQ-9) were employed to measure anxious symptoms and depressive symptoms, respectively. The adolescent non-suicidal self-injury assessment questionnaire (ANSSIAQ) was used to evaluate NSSI of adolescent. Using network analysis, the NSSI、depressive symptoms and anxious symptoms network were constructed to identify the most central symptoms and the bridge symptoms within the networks.ResultsThe findings revealed that the NSSI functional nodes “coping with sadness and disappointment” and “relieving stress or anxious” exhibited the strongest correlation, with a regularized partial correlation coefficient was 0.401. The symptoms “having a desire to harm oneself and unable to stop” and the node “depressive symptoms” had the highest strength centrality in the network, and their strength centrality indices were 1.267 and 1.263, respectively. The bridge nodes were “having a desire to harm oneself and unable to stop” and “expressing one’s despair and hopelessness”, with expected impact indices of 0.389 and 0.396, respectively.ConclusionIn adolescents, the network revealed a closer connection between NSSI and depressive symptoms. “The desire to not stop hurting oneself” is not only broadly connected to other nodes but also could activate other nodes to maintain NSSI behavior. In light of these findings, precise targets for pharmacological treatment, psychotherapy, physical therapy, etc., are identified for adolescents with NSSI. Targeting this specific aspect in interventions may contribute to preventing and reducing NSSI behavior in adolescents.

Unveiling a novel clinical risk assessment model for identifying non-suicidal self-injury risks in depressed Chinese adolescents amidst the COVID-19 pandemic: insights from low self-esteem, internet use, and sleep disturbance.

Non-suicidal self-injury (NSSI) is a highly prevalent behavioral problem among depression adolescent patients that can result in numerous adverse outcomes. This study endeavors to bridge this knowledge gap by creating a comprehensive model that incorporates multiple aspects of NSSI to accurately evaluate its risk in adolescents with depression, thereby enhancing our ability to prevent and address this challenging issue. Using a cross-sectional design, we recruited 302 adolescents with depressive disorders who visited or were hospitalized at Shandong Mental Health Center from December 2021 to June 2022. The participants completed several self-report questionnaires, including the Chinese version of the Internet Addiction Test, the Pittsburgh Sleep Quality Index questionnaire, the Defeat Scale, the Social Avoidance and Distress Scale and the Children's Depression Inventory. Logistic regression analysis was performed to identify the diagnostic factors, which were further used to establish clinical risk assessment models. A receiver operating characteristic curve (ROC) to identify the best model. An external validating team was introduced to verify the assessing efficiency. Based on a logistic regression analysis, three variables have been identified as significant risk factors. Specifically, adolescents with depression who experience low self-esteem, internet use, or suffer from sleep disturbance face an increased risk of NSSI. An integrated risk index for NSSI exhibits excellent accuracy in identifying depressed adolescents at risk of NSSI (area under the curve = 0.86, sensitivity = 0.88, specificity = 0.69). In the validation cohort, the identification performance remains strong (area under the curve = 0.84, sensitivity = 0.72, specificity = 0.81). This study highlighted the role of self-esteem, internet use and sleep disturbance in the development of NSSI. The risk index diagnosing NSSI onset may help to guide the design and application of novel interventions to minimize this risky behavior in future depressed adolescents.

Microstructural abnormalities of white matter in the cingulum bundle of adolescents with major depression and non-suicidal self-injury.

Non-suicidal self-injury (NSSI) is prevalent in major depressive disorder (MDD) during adolescence, but the underlying neural mechanisms are unclear. This study aimed to investigate microstructural abnormalities in the cingulum bundle associated with NSSI and its clinical characteristics. 130 individuals completed the study, including 35 healthy controls, 47 MDD patients with NSSI, and 48 MDD patients without NSSI. We used tract-based spatial statistics (TBSS) with a region of interest (ROI) analysis to compare the fractional anisotropy (FA) of the cingulum bundle across the three groups. receiver-operating characteristics (ROC) analysis was employed to evaluate the ability of the difficulties with emotion regulation (DERS) score and mean FA of the cingulum to differentiate between the groups. MDD patients with NSSI showed reduced cingulum integrity in the left dorsal cingulum compared to MDD patients without NSSI and healthy controls. The severity of NSSI was negatively associated with cingulum integrity (r = -0.344, p = 0.005). Combining cingulum integrity and DERS scores allowed for successful differentiation between MDD patients with and without NSSI, achieving a sensitivity of 70% and specificity of 83%. Our study highlights the role of the cingulum bundle in the development of NSSI in adolescents with MDD. The findings support a frontolimbic theory of emotion regulation and suggest that cingulum integrity and DERS scores may serve as potential early diagnostic tools for identifying MDD patients with NSSI.

An Investigation of the Mediating Roles of Emotion Regulation Difficulties, Distress Tolerance, Self-Compassion, and Self-Disgust in the Association Between Childhood Trauma and Nonsuicidal Self-Injury

Objective Childhood maltreatment has been associated as a risk factor with the development of nonsuicidal self-injury (NSSI), with difficulty in emotion regulation explaining the association. However, little is known about the potential factors that make some individuals with maltreatment history more vulnerable to difficulties in emotion regulation and, in turn, engage in NSSI. The current study aimed to examine the roles of distress tolerance, self-compassion, and self-disgust in the association between childhood maltreatment types and emotion regulation difficulty, which was expected to predict NSSI. Method The sample included 397 university students between the ages of 18 and 30. Participants completed self-report scales assessing childhood maltreatment, emotion regulation difficulty, distress tolerance, self-compassion, self-disgust, and NSSI using the paper-pencil and online methods. The mediation model suggested for the association between childhood maltreatment types and NSSI was tested using path analysis. Results Low distress tolerance, low self-compassion, high self-disgust, and resulting high emotion regulation difficulty mediated the indirect effect of emotional neglect on NSSI. Conclusion The current study sheds light on various factors in the development and maintenance of NSSI and reveals three developmental pathways from emotional neglect in childhood to engaging in NSSI. HIGHLIGHTS Emotional neglect may be a distal risk factor for nonsuicidal self-injury (NSSI). Low distress tolerance and self-compassion and high self-disgust may increase the risk of NSSI. Emotion regulation difficulty may make people engage in NSSI to regulate emotions.

The downside of being openminded: The positive relation between openness to experience and nonsuicidal self-injury.

Sensation seeking and openness are two distinct, but related, individual differences that lead individuals to seek out intense sensations. As a result, these traits may also predispose individuals toward engaging in non-suicidal self-injury (NSSI); however, to date, no models have examined the relation between openness and NSSI after accounting for the influence of sensation. The goals of this study were to (1) examine the relation between openness and NSSI while accounting for sensation seeking in a sample of racially diverse undergraduates (N=340) and (2) conduct a meta-analysis of the existing research on the association between NSSI and openness. A negative binomial regression model demonstrated a significant positive association between NSSI and openness when accounting for sensation seeking; however, NSSI was not significantly related to sensation seeking. Moreover, multivariate meta-analysis with robust variance revealed a small, but significant, association between NSSI and openness across 15 studies. Together, these results suggest a positive association between openness and NSSI, highlighting an area for future research in what role openness to experience might play in the development of NSSI.

Non-Suicidal Self-Injury in Adolescence: The Role of Pre-Existing Vulnerabilities and COVID-19-Related Stress

For many adolescents, the COVID-19 pandemic represents a uniquely challenging period, and concerns have been raised about whether COVID-19-related stress may increase the risk for self-injurious behaviors among adolescents. This study examined the impact of pre-existing vulnerabilities on the occurrence and frequency of Non-Suicidal Self-Injury (NSSI) through COVID-19-related stress, and whether the impact of COVID-19-related stress on NSSI was buffered by the perceived social support during the pandemic. Participants were 1061 adolescents (52.40% females; Mage = 15.49 years, SD = 0.76) from a two-wave longitudinal study, which included assessments before the COVID-19 onset and one year later the declaration of the pandemic. Path analyses showed that adolescents with a prior history of NSSI, higher levels of internalizing symptoms, and poor regulatory emotional self-efficacy before the COVID-19 pandemic reported higher levels of COVID-19-related stress which in turn increased their risk to engage in NSSI. Besides, the findings did not support the role of social support as a moderator of the association between COVID-19 related stress and the occurrence/frequency of NSSI. These findings suggest that enhanced stress perception may serve as a key pathway for the continuation and development of NSSI among vulnerable adolescents facing adverse life events.

Mediating role of depression in the association between alexithymia and nonsuicidal self-injury in a representative sample of adolescents in Taiwan

BackgroundNock’s (2009) integrated theoretical model suggests that specific intrapersonal vulnerability factors caused by distal risk factors contribute to the development of nonsuicidal self-injury (NSSI). Alexithymia and depression have been found to predict NSSI. Based on Nock’s model, alexithymia plays a distal risk factor role to increase the risk of depression—an intrapersonal vulnerability factor—and further increase the risk of NSSI. However, small or unrepresentative samples in past studies limit the generalizability of the results. This study examined the roles of depression and alexithymia in predicting NSSI, as well as the mediating effect of depression in the relation between alexithymia and NSSI in a large representative sample of adolescents in Taiwan.MethodsUsing a cross-sectional study design, a large representative sample of 2,170 senior high school students in Taiwan was assessed by self-report measures of alexithymia, depression, and NSSI. Mediation analyses were performed to examine whether the relation between alexithymia and NSSI was mediated by depression. The questionnaires were administered in classrooms.ResultsResults showed that alexithymia positively predicted NSSI (β = 0.23, p < .001) and depression can also positively predict NSSI (β = 0.41, p < .001). Additionally, the association between alexithymia and NSSI was fully mediated by depression.ConclusionsThis study data provided evidence for the mediating role of depression between alexithymia and NSSI, which can be explained by Nock’s (2009) integrated theoretical model. The implications of the findings for future research and intervention were discussed.

Childhood Maltreatment, Stressful Life Events, Cognitive Emotion Regulation Strategies, and Non-suicidal Self-Injury in Adolescents and Young Adults With First-Episode Depressive Disorder: Direct and Indirect Pathways.

IntroductionChildhood maltreatment (CM), stressful life events (SLE), and cognitive emotion regulation strategies (CERS) have been considered crucial in the development of non-suicidal self-injury (NSSI) and major depressive disorder (MDD), but the pathways of this association are not clear. We aim to identify direct effects of CM and SLE on NSSI and depression severity and its indirect effects via CERS in adolescents and young adults with a diagnosis of MDD.MethodsA total of 114 patients (aged 14–24 years) with first episode MDD were included and further divided into the NSSI group (n = 56) and non-NSSI group (n = 58) according to the DSM-5 criteria. Diagnostic interviews and self-report measures were conducted to assess CM, SLE, CERS, and diagnose NSSI. Severity of depressive symptoms was measured using the Hamilton Rating Scale (HAMD). The structural equation model was used to assess the pathways.ResultsMDD patients with NSSI had more frequent family history of mental illness, more experience of CM and SLE, more serious depression, less use of adaptive CERS, and more use of maladaptive CERS. In the final structural equation model (χ2 = 4.82, df = 6, p = 0.57, CFI = 1.0, TLI = 1.10, and RMSEA = 0), the experience of CM and SLE showed a significant indirect effect on NSSI through adaptive CERS. CM and SLE only had direct effects on depression severity.ConclusionsNSSI are prevalent in adolescents and young adults with MDD and highly intertwined with CM, SLE, and CERS. Adaptive CERS, not maladaptive CERS may be a possible mechanism relating CM and SLE to NSSI in MDD patients.

Parents\u2019 lived experience of adolescents\u2019 repeated non-suicidal self-injury in China: a qualitative study

Background and objectivesThe prevalence of non-suicidal self-injury (NSSI) is high among adolescents. Parents have significant impact on the development of NSSI. Many quantitative studies have demonstrated the relationship between parental factors such as parenting behaviors and adolescents’ NSSI. However, few studies have explored parents’ responses and adolescent-parent reciprocal interaction during repeated NSSI. This study aimed to explore parents’ cognition, behaviors and adolescent-parent reciprocal interaction during repeated NSSI.MethodsThis is a phenomenological study. By purposive sampling, 24 parents of adolescents with repeated NSSI were recruited from a child and adolescent psychiatric ward in a mental health center in Chengdu, China. Semi-structured interviews were conducted and audio-recorded. Audio-recordings were transcribed verbatim and analyzed using thematic analysis.FindingsThree themes were identified: parents’ attribution, perceptions and coping behaviors of NSSI. Chronic stress of adolescents and triggers of NSSI were associated with parental expectations. Parents initially perceived NSSI as a manifestation of puberty, a way of making needs met or a coping strategy of negative emotions, and gradually realized that it was a condition requiring psychological assistance. Parents’ coping behaviors of NSSI were divided into 4 stages, namely denial, dissuasion, reflection and adaptation, and working as a team. To be more specific, parents’ coping strategies at dissuasion stage included criticizing and conciliating, while those at reflection and adaptation stage included neglecting, avoiding conflicts and increasing control.ConclusionsThese findings suggest that adjusting parents’ expectation and negative perceptions of NSSI is beneficial to reduce adolescent-parent conflict and adolescents’ inner conflict and prevent NSSI. Furthermore, it’s necessary to publicize NSSI related knowledge to promote the early detection and treatment of NSSI.

Internet addiction and nonsuicidal self-injury in adolescence: Associations with offline and online social support.

Both nonsuicidal self-injury (NSSI) and Internet addiction (IA) are important health issues for adolescents, and social support has been extensively examined as a protective factor for both. This study aims to compare the effect of offline and online social support on IA, and that on NSSI as well. A total of 1911 Chinese adolescents (53.27% females, Mage = 16.83 ± 0.37) completed self-report questionnaires assessing offline social support, online social support, IA, and NSSI. The structural equation modeling analysis showed that offline social support was negatively associated with IA and NSSI, while online social support was positively associated with IA and NSSI; IA was positively associated with NSSI. Furthermore, implications for preventions and interventions of IA and NSSI were discussed. The indirect model explained a relatively small variance of NSSI, indicating the possibility of additional factors in the development of NSSI that should be further investigated. This study indicated the differences between offline and online social support, and their different associations with IA and NSSI.

Adolescent nonsuicidal self-injury and cortisol response to the retrieval of adversity: A sibling study

BackgroundThere is evidence for alterations in hypothalamus-pituitary-adrenal (HPA) axis response to the retrieval of traumatic events among individuals with Posttraumatic Stress Disorder. However, no study has so far investigated HPA response to trauma retrieval among individuals engaging in non-suicidal self-injury (NSSI). In the present study, we compared reports of childhood adversity (CA) between adolescents engaging in NSSI and their siblings and tested for differences in the cortisol response to the retrieval of CA. MethodsThe sample consisted of 32 adolescents engaging in NSSI (Mage = 15.8 years) and their siblings (Mage = 15.6 years). Standardized interviews were used for the assessment of CA, NSSI, and axis I diagnoses. Salivary cortisol was measured before and after the trauma interview. Basal HPA axis activity was measured in hair. ResultsReports of CA were moderately interrelated between siblings. Adolescents engaging in NSSI reported more severe CA. A significant decrease of salivary cortisol during the trauma interview was found only in the NSSI group. The NSSI group had significantly higher hair cortisol levels. ConclusionsModerate relations in siblings’ reports of CA point to non-shared experiences that may play a role in the development of NSSI. In the NSSI group, the decrease of salivary cortisol during the interview may be explained by a downregulation of the HPA axis subsequent to the retrieval of former experience of CA.

Prospective Prediction of First Onset of Nonsuicidal Self-Injury in Adolescent Girls

Adolescent nonsuicidal self-injury (NSSI) is a significant risk factor for suicidal behavior and an important clinical marker of psychopathology. NSSI is especially common in adolescent girls. A number of psychosocial correlates of adolescent NSSI have been identified, including problems characterized by disinhibition and negative affectivity. However, it is unknown whether these characteristics prospectively predict first-onset NSSI, limiting our understanding of its etiology and prevention. The current study addresses this gap in the literature. Participants in the Adolescent Development of Emotion and Personality Traits (ADEPT) project at Stony Brook University who had not experienced NSSI at baseline (462 girls, mean age= 14.39 years, SD= 0.62 years) completed baseline measures of hypothesized risk factors related to problems with disinhibition and negative affectivity, including adolescent psychopathology, personality and clinical traits, and parental psychopathology. First onset of NSSI was monitored at 9-month intervals by in-person and telephone interviews over the next 36 months. There were 42 first onsets of NSSI (9.1%) in the 3 years since baseline. First-onset NSSI was independently predicted by adolescents' low conscientiousness, high avoidance, and parental substance abuse at baseline. The composite risk index predicting first-onset NSSI demonstrated good accuracy for identifying girls who will start self-injuring (area under the curve= 0.78, sensitivity= 0.85, specificity= 0.57). These results highlight the role of disinhibition and avoidance in the development of NSSI. The risk index predicting NSSI onset may help to guide the design and application of novel interventions to prevent this condition in adolescent girls.

A Longitudinal Person-Centered Examination of Nonsuicidal Self-injury Among University Students

Little is known about the development and maintenance of nonsuicidal self-injury (NSSI) over time; however, identifying individuals at risk for NSSI onset or its recurrent engagement is of critical importance for developing effective prevention and intervention strategies. To address this important gap in the literature, we used a person-centered approach to study patterns of change among self-injurers (i.e., new beginners, recovered injurers, relapsers, desisters, and persistent injurers). Undergraduate students (N = 666, 71.1 % female, M age = 19.15) from a mid-sized Canadian university participated in the two-wave study (assessments were 1 year apart). Participants completed the Inventory of Statements about Self-Injury (ISAS, Klonsky and Glenn in J Psychopathol Behav Assess 31:215-219, 2009) at Time 1, and a measure of past year NSSI frequency 1 year later. Participants also completed several measures of psychosocial risk (e.g., problem behaviors, problems with parents) at both time points. Consistent with Nock's (Ann Rev Clin Psychol 6:339-363, 2010) model on the development of NSSI over time, individuals who continued to engage in NSSI across the university years (i.e., persistent injurers) reported greater levels of psychosocial risk as compared to those in the other groups. Moreover, a discriminant function analysis revealed that new beginners, relapsed injurers, and persistent injurers were differentiated from recovered injurers and desisters by increases over time in problem behaviors, problems with parents, internalizing behaviors, and suicidal ideation. Our findings provide new insight into the course of NSSI engagement across the university years, and offer clinicians ways to discriminate among individuals with varying longitudinal patterns of NSSI (i.e., on measures of psychosocial risk, and motivations to stop self-injuring).

Perceived Dimensions of Parenting and Non-suicidal Self-injury in Young Adults

Family experiences are influential in the development of non-suicidal self-injury (NSSI). The current study aimed to identify specific dimensions underlying early parent-child relationships in association with NSSI. It was hypothesized that all relationship dimensions would be related with NSSI, with some dimensions being stronger predictors when accounting for shared variance. Gender differences were also assessed. Participants were grouped according to the endorsement of NSSI in the past 6 months, resulting in a Non-NSSI group (n = 1133) and a NSSI group (n = 105). Significant differences were found for the relationship dimensions between the two groups. When shared variance was accounted for, fear and alienation were the only dimensions predicting NSSI. Similar results were found for females (n = 887), while no analyses using males (n = 351) were significant. These results emphasize the need to acknowledge the role of parent-child relationships in prevention programs and intervention models for NSSI.