History Of Self-harming Behaviour Research Articles

Association of family function and suicide risk in teenagers with a history of self-harm behaviors: mediating role of subjective wellbeing and depression.

A history of self-harm behaviors is closely associated with subsequent suicide death. Although many factors associated with suicide have been identified, it remains unclear how these factors interact to influence suicide risk, especially among teenagers with a history of self-harm behaviors. Data were collected from 913 teenagers with a history of self-harm behaviors through a cross-sectional study. The Family Adaptation, Partnership, Growth, Affection, and Resolve index was used to assess teenagers' family function. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 were used to evaluate depression and anxiety in teenagers and their parents, respectively. The Delighted Terrible Faces Scale was used to assess teenagers' perception of subjective wellbeing. The Suicidal Behaviors Questionnaire-Revised was used to evaluate teenagers' suicide risk. Student's t-test, one-way ANOVA, multivariate linear regression, Pearson's correlation, and a structural equation model (SEM) were applied to data analysis. Overall, 78.6% of teenagers with a history of self-harm behaviors were at risk for possible suicide. Female gender, severity of teenagers' depression, family function, and subjective wellbeing were significantly associated with suicide risk. The results of SEM suggested that there was a significant chain mediation effect of subjective wellbeing and depression between family function and suicide risk. Family function was closely associated with suicide risk in teenagers with a history of self-harm behaviors, and depression and subjective wellbeing were sequential mediators in the association between family function and suicide risk.

Self-harm behaviour and externally-directed aggression in psychiatric outpatients: a multicentre, prospective study (viormed-2 study)

The aim of the project was to investigate differences between outpatients with Severe Mental Disorders (SMDs) with and without a history of Self-Harm behaviour (SHb) and/or Violent behaviour against other people (Vb) in relation to: (a) socio-demographic and clinical characteristics, (b) violent behaviour during a 1-year FU, (c) predictors of SHb and Vb during the FU. Outpatients with SMDs, with and without a history of Vb were enrolled. They were divided in four groups: patients with lifetime Vb (V), patients with both Vb and SHb (V-SH), patients with only SHb (SH) and patients with no history of SHb and Vb (control group, CONT). The frequency and severity of SHb and Vb during the FU were assessed every two weeks by the MOAS. Overall 246 patients were enrolled. BPRS-E Depression item, the SLOF Social acceptability, the BDHI Indirect Aggression, the BIS Motor Impulsiveness and the STAXI-2 Control-Out showed significant correlations with all the four groups (p < 0.030). V and V-SH patient groups reached higher scores in all MOAS sub-scales. Age among the SH group and BPRS-E affect-anxiety subscale among the V group significantly predicted aggression against people. In people with SMDs a history of SHb or Vb is associated with different medium-term outcomes.

The Effects of rTMS on Impulsivity in Normal Adults: a Systematic Review and Meta-Analysis.

Impulsivity is a multi-dimensional construct that is regarded as a symptom of many psychiatric disorders. Harm resulting from impulsive behaviour can be substantial for the individuals concerned, for their social network, and for wider society. Therefore, the importance of developing therapeutic interventions to target impulsivity is paramount. We conducted a systematic review and meta-analysis of the literature from AMED, Embase, Medline, and PsycINFO databases on the use of repetitive transcranial magnetic stimulation (rTMS) in healthy adults to modulate different subdomains (motor, temporal and reflection) of impulsivity. The results indicated that rTMS has distinct effects on different impulsivity subdomains. It has a significant, albeit small, effect on modulating motor impulsivity (g = 0.30, 95% CI, 0.17 to 0.43, p < .001) and a moderate effect on temporal impulsivity (g = 0.59, 95% CI, 0.32 to 0.86, p < .001). Subgroup analyses (e.g., excitatory vs. inhibitory rTMS, conventional rTMS vs. theta burst stimulation, analyses by stimulation sites, and type of outcome measure used) identified key parameters associated with the effects of rTMS on motor and temporal impulsivity. Age, sex, stimulation intensity and the number of pulses were not significant moderators for effects of rTMS on motor impulsivity. Due to lack of sufficient data to inform a meta-analysis, it has not been possible to assess the effects of rTMS on reflection impulsivity. The present findings provide preliminary evidence that rTMS can be used to modulate motor and temporal impulsivity in healthy individuals. Further studies are required to extend the use of rTMS to modulate impulsivity in those at most risk of engaging in harmful behaviour as a result of impulsivity, such as patients with offending histories and those with a history of self-harming behaviour.

The Relationship Between Childhood Traumas, Identity Development, Difficulties in Emotion Regulation and Psychopathology

The present study aimed to explore the relationship between traumatic experiences, difficulties in emotion regulation, identity confusion and psychopathology. Six hundred and thirty five university students volunteered to participate to the first step of the study (460 (72.4%) females and 175 (27.6%) males). The mean age was 20.57 (17-29) years. The participants who scored above the group mean (X=44) on the Childhood Trauma Questionnaire- Short Form (CTQ-SF) were invited for a diagnostic interview. A total of 69 participants, consisting of 46 females (66.7%) and 23 males (33.3%), with a mean group age of 20.93 (17-29) years, were included in the second step of the study. All participants completed the General Information Form, the CTQSF, the Difficulties in Emotion Regulation Scale (DERS), the Sense of Identity Assessment Form (SIAF), SCID-I and SCID II. Prevalence of childhood traumas in the study group was 31.3%. Participants who came from low income groups, who were using psychotropic medications, who had family or personal history of self harm behaviour and who attempted suicide had significantly higher CTQ-SF scores. The SIAF scores of the subgroup diagnosed with psychiatric disorders were significantly higher than those of the undiagnosed. However, they did not differ with respect to their CTQ-SF and DERS scores. Results showed that difficulties in emotion regulation played a partial mediating role in the association of childhood traumatic events, in particular emotional abuse, with identity confusion. The present study demonstrated that childhood traumatic events not only have effects on emotion regulation and the development of sense of identity, but also may be associated with self harm behaviours in the later stages of life. For prevention studies, enhancing parenting skills and raising community awareness to this issue would be beneficial.

Comparison of defence mechanisms in adolescent patients with deliberate self-harm behaviour and without it

IntroductionTwenty percent of children and adolescent population are suffering from psychiatric disorders, according to World Health Organization. Above that, clinical work and previous published reports point to increase of self-harm behaviour incidence and prevalence in many countries, including Croatia.AimsTo compare defence mechanisms in adolescent patients with deliberate self-harm behaviour and without it.ObjectivesTo explore differences in adaptive and maladaptive defence mechanisms in adolescent patients with self-harm behaviour and without this behaviour; to gain better insight in possible perception and functioning patterns in these two patient subgroups. To assess the effect of possible differences on early diagnostic procedure and therapeutic plan.MethodsDefence Style Questionnaire (DSQ) was administered to 150 patients aged between 14 and 18 years on their first visit to child and adolescent psychiatrist. Sevety-nine patients had history of self-harm behaviour and 81 patients had negative anamnestic data on such behaviour.ResultsComparison of defence mechanisms in these two patient subgroups showed a statistically relevant difference in using defence mechanisms.ConclusionResults of this study showed significant difference between patients with self-harm behaviour and without such behaviour regarding used defence mechanisms. Awareness of specific mental patterns in patients with self-harm behaviour provides better assessment of suicidal risk and optimal individual approach planning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Influence of Sex on Suicidal Phenotypes in Affective Disorder Patients with Traumatic Childhood Experiences.

ObjectivesIn the current study, we aimed to investigate the impact of childhood trauma on suicidal behaviour phenotypes in a group of patients with diagnosed affective disorder (unipolar or bipolar affective disorder).Patients and MethodsPatients with and without a history of childhood abuse, measured by Childhood Trauma Questionnaire (CTQ), were assessed to explore risks for suicidal behaviour (including suicide attempt, self-harm and non-suicidal self-injury). The tested sample consisted of 258 patients (111 males and 147 females, in-patients and out-patients at the Department of Psychiatry and Psychotherapy, Medical University of Vienna and University Hospital Tulln, Lower Austria). Psychiatric diagnoses were derived from the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) interview. In addition, patients were administered the Lifetime Parasuicidal Count (LPC), Suicidal Behaviour Questionnaire (SBQ-R), and Viennese Suicide Risk Assessment Scale (VISURIAS) questionnaires.ResultsIn contrast to male suicide attempters, female suicide attempters showed both significantly higher total CTQ scores (p<0.001), and higher CTQ subscores (emotional, physical and sexual abuse, as well as emotional and physical neglect) in comparison to the non-suicidal control group. Besides, females with a history of self-harming behaviour (including suicidal intention) and Non-Suicidal-Self Injury (NSSI) had significantly higher CTQ total scores (p<0.001) than the control group.ConclusionThese findings suggest gender differences in suicidal behaviour after being exposed to childhood trauma.

Suicidal imagery, history of suicidality, and acquired capability in young adults

Purpose – The purpose of this paper is to examine the role of suicide-related mental imagery in suicidal behavior. It was hypothesized that greater frequency and vividness of suicide-related imagery would be associated with more suicidal behaviors, and acquired capability for suicide was expected to mediate this relationship. Hypotheses were tested by surveying 237 undergraduate students (59 percent female; mean age=20) who completed self-report measures that assessed suicidal cognitions, acquired capability for suicide, and history of self-harm behaviors. Design/methodology/approach – Hypotheses were tested by surveying 237 undergraduate students (59 percent female; mean age=20) who completed self-report measures that assessed suicidal cognitions, acquired capability for suicide, and history of self-harm behaviors. Findings – Results suggested that frequency and vividness of suicide-related imagery were positively correlated with suicidality. Acquired capability was not related to study variables; thus additional mediational analysis was unwarranted. Originality/value – Few studies have examined suicidal imagery and how it relates to actual self-harm behavior. The current study provides an exploratory view of features of imagery related to suicidal thoughts; findings imply that understanding mental imagery may play an important role in clinical risk assessment and treatment for suicidality.

Can supervising self-harm be part of ethical nursing practice?

It was reported in 2006 that a regime of 'supervised self harm' had been implemented at St George's Hospital, Stafford. This involves patients with a history of self-harming behaviour being offered both emotional and practical support to enable them to do so. This support can extend to the provision of knives or razors to enable them to self-harm while they are being supervised by a nurse. This article discusses, and evaluates from an ethical perspective, three competing responses to self-harming behaviours: to prevent it; to allow it; and to make provision for supervised self-harm. It is argued that of these three options the prevention strategy is the least plausible. A tentative conclusion is offered in support of supervised self-harm.

The Abuse of Prescription Medications in Borderline Personality Disorder

To the Editor: In the literature on Axis I comorbidity in borderline personality disorder (BPD), males with BPD invariably evidence significantly higher rates of substance use disorders than females.1–5 In a previous study, we found that the self-reported abuse of prescription medications was associated with BPD, according to 2 self-report measures for this Axis II disorder.6 However, we did not undertake an analysis of gender. We wondered whether males would evidence higher rates of prescription substance abuse, echoing the current literature. Method. Participants were men and women, ages 18 to 65 years, who were being seen at an outpatient internal medicine clinic for nonemergent medical care. Exclusion criteria were medical (eg, dementia, pain), intellectual (eg, mental retardation), or psychiatric disorders (eg, psychotic) that would preclude the completion of a research booklet. A total of 492 people were invited to participate; 419 agreed, for a response rate of 85.2%. Of these, 130 were male and 287 were female (2 failed to indicate sex). Respondents ranged in age from 18 to 65 years (mean = 49.48 years, SD = 15.26 years). Most were white/Caucasian (358; 85.4%); 35 were African American, 11 were classified as “other,” 8 were Native American, 4 were Asian, 2 were Hispanic, and 1 failed to indicate race/ethnicity. With regard to education, most (92.1%) had at least graduated high school, with 159 (37.9%) having attended some college and 110 (26.3%) having earned at least a 4-year college degree. One of the authors (C. L.) approached incoming patients in the lobby of the outpatient facility, informally assessed exclusion criteria, and invited candidates to participate. Participants completed a 4-page research booklet and placed completed research booklets into sealed envelopes and then into a collection box in the lobby. The initial section of the research booklet explored demographic information. The next section contained the Self-Harm Inventory (SHI),7 a 22-item assessment that explores lifetime history of self-harm behaviors. One item on the SHI asks, “Have you ever intentionally, or on purpose, abused prescription medication?” The final section of the research booklet contained the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4).8 Data were collected during April 2009. This project was approved by the institutional review boards of the affiliated community hospital as well as the university. Survey completion was assumed to be implied consent. Results. In this sample, 118 men and 272 women completed both the SHI item relating to the abuse of prescription medications and the PDQ-4. Eleven men and 22 women endorsed the abuse of prescription medications. As for associations with BPD, using a cut-off score of 5 on the PDQ-4, 5 of the preceding men scored in the range suggestive of BPD, resulting in 27.8% of male participants with BPD endorsing the abuse of prescription medications. Likewise, 11 of the women who endorsed the abuse of prescription medications scored in the PDQ-4 range suggestive of BPD, resulting in 26.1% of female participants with BPD endorsing the abuse of prescription medications—nearly identical proportions. According to these data, in internal medicine outpatients with BPD, there are no discernible gender differences with regard to the abuse of prescription medications. Note that these data are in contrast with the existing literature on gender differences in BPD and comorbid substance abuse. This finding may be explained by the possibility that women may excuse substance-abuse behavior if the substance is a legitimate prescription, rather than an illicit street substance. Regardless of explanation, this finding indicates that clinicians need to be equally alert to the abuse of prescription medications in both males and females with BPD—a finding that is unique to the current literature. This study has a number of potential limitations, including the self-report nature of the data and the associated inherent difficulties with this type of methodology; the small total number of individuals who reported the abuse of prescription medications, which potentially compromises statistical interpretation; and the lack of clarification regarding either the nature of the abuse or type of abused prescription substance. However, this is the first study, to our knowledge, to examine gender patterns in self-reported prescription abuse, and the findings are novel in that they are contrary to the established findings of a gender difference in patients with BPD with regard to other types of substance abuse.

Teenaged, Depressed, and Treatment Resistant: What Predicts Self-Harm?

Self-harm affects thousands of depressed teenagers each year. A careful meta-analysis of pediatric antidepressant trials by the Food and Drug Administration (FDA) showed a higher rate of spontaneously reported suicidal behaviors in adolescents randomly assigned to antidepressants versus placebo. The publicity about this relationship and the subsequent FDA black box warning was followed by a decrease in antidepressant use (1) and a possible increase in adolescent suicides. Whether the increase is real and sustained is still unclear (2-4). Data that can identify who is at risk for an increase in reported self-harm with medication are difficult to find. Standardized systematic assessment of suicidal events in adolescent trials have only recently been developed (5), and adolescents with a history of self-harm behaviors, the ones with greatest risk, have usually been excluded from clinical trials.

Cutting across boundaries: A case study using feminist praxis to understand the meanings of self-harm

Deliberate self-harm predominantly occurs in women under the age of 30 years. This qualitative case study using feminist methods explored the experiences of three women who each had a long history of self-harming behaviour. Psychoanalytical concepts are used to explore the meaning of the conflicts that these women experience. Emergent themes include: great expectations, I speak but no one hears, sexual naivety meets sexual violence, and redrawing the sexual map. This thematic analysis helps facilitate an insight into what these women are trying to communicate, and provides guidance for mental health professionals to more effectively respond to the challenges of working with women who self-harm.

Supporting young people who repeatedly self-harm

This paper explores the views and experiences of a group of 74 young people aged 16-22 who were interviewed following presentation in accident and emergency (A&E) departments after intentionally harming themselves. It focuses on a sub-group of 38 young people with a history of self-harm behaviour that extended from when they were under the age of 16, one-third of whom had been or were currently in care. Whilst some had kept their self-harming hidden and had not received any professional intervention until they reached adulthood, others had been in touch with services, although their treatment had not prevented them from continuing to self-harm. Medication was perceived as 'fobbing off', particularly when unaccompanied by other treatments. The young people described their encounters with counsellors and clinicians, some of whom they perceived not to understand or to listen to their perspective. Whilst not representative of all young people who self-harm, these views are important and deserve attention if interventions for children and adolescents are to prevent repetition of self-harm.

A study of factors affecting suicide in Aboriginal and 'other' populationsin the Top End of the Northern Territory through an audit of coronial records.

A recent increase in suicide among the Tiwi people of Bathurst and Melville Islands in the Northern Territory led to a review of recent suicides in the Top End of the Northern Territory using the coroner's records. The aim of the review was to establish through the coronial files whether there were any significant differences in the factors that related to suicide in Aboriginal people and other people in the Top End. Coronial determinations of suicide in the Top End for the years 1991-1998 were examined using a structured coding instrument. Hanging was a prominent method of suicide among Aboriginal people. Aboriginals who committed suicide were more likely to have a history of self-harm behaviour. Suicide among Aboriginal people was irregular in distribution with a higher general risk for Aboriginal people resident in the east Arnhem region. A recent rise in suicide in the Tiwi community occurred against a background of social disruption similar to that which occurred against suicides in the Aboriginal population of the Kimberley region in Western Australia. There are some important differences in the factors attributed to suicide in the Aboriginal and other populations in the Top End. Furthermore, our study highlights regional differences in suicide risk among different Aboriginal populations in the Top End.