Non-suicidal Self-injury Thoughts Research Articles

The Short-Term Course of Nonsuicidal Self-Injury Among Individuals Seeking Psychiatric Treatment.

A major portion of adolescents and adults seeking psychiatric treatment report nonsuicidal self-injury (NSSI) within the past month, yet the short-term course of NSSI among these patients remains poorly understood. To advance the understanding of the short-term course of NSSI cognitions (ie, thoughts, urges, and self-efficacy to resist self-injury) and behavior. A cohort study was conducted using an intensive longitudinal design with ecological momentary assessment, including 6 daily surveys and event registrations of self-injury for 28 days. Data were collected from June 2021 to August 2023. Individuals using mental health services in the Flanders region in Belgium reporting past-month NSSI urges and/or behavior at intake were recruited by referral. Nonsuicidal self-injury thoughts, urges, self-efficacy, and behavior. Sociodemographic and clinical baseline characteristics served as between-person variables. Descriptive and variability statistics and dynamic structural equation modeling were used. Participants completed a mean (SD) of 121 (34.5) surveys, totaling 15 098 longitudinal assessments (median adherence, 78.6%; IQR, 59.5%-88.7%). Among 125 patients (87.2% female; median age, 22.0 [range, 15-39] years; 52.8% heterosexual), NSSI thoughts and urges were present during most assessments but were low in intensity (individual means [SD] on a 0- to 6-point scale, 1.52 [1.13] for urges; 1.57 [1.18] for thoughts). The prevalence of NSSI behavior was 84.0% monthly, 49.90% weekly, and 18.19% daily. Between-patient variability was substantial (intraclass correlation coefficient, 0.43-0.47; range of individual means for cognitions, 0-6; individual frequency behavior, 0-103), with recency and frequency of NSSI thoughts and behavior at intake consistently associated with individual differences in the course of NSSI. The greatest variability was observed within patients (root mean square of successive differences from 1.31 for self-efficacy to 1.40 for instability of thoughts), characterized by changes in the intensity of cognitions by more than 1 within-person SD between assessments less than 2 hours apart in 1 of 5 instances. Nonsuicidal self-injury behavior is rare in the morning, increased in the afternoon, and most frequent in the evening. Nonsuicidal self-injury cognitions were contemporaneous and temporally associated with each other's course, with higher-than-usual thoughts and lower self-efficacy uniquely signaling heightened risk for NSSI behavior in the next 2 hours. In this cohort study of treatment-seeking individuals, NSSI cognitions and behavior appeared to be dynamic over the short term. These findings suggest the potential utility of self-monitoring outside the therapy setting and the need to focus assessment and interventions on the evening hours.

A Prospective Examination of Sexual Orientation and Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors Among a Diverse Sample of At-risk Young Adult Women.

Minoritized sexual orientation is an established correlate for suicide ideation (SI) and nonsuicidal self-injury (NSSI); however, prospective associations between sexual orientation and SI and NSSI is limited. The current study builds on existing literature by examining sexual orientation as a prospective distal risk factor for SI and NSSI risk among a diverse sample of young women after adjusting for histories of SI and/or NSSI and empirically supported correlates and risk factors. Participants were 135 young adult women (aged 18-24), who were predominately Black with approximately half of the sample experiencing poverty. Participants completed an interview that assessed SI and NSSI at baseline and 6- and 12-month follow-ups. A single item was used to collect participants' self-identified sexual orientation at baseline. Minoritized sexual orientation was strongly associated with NSSI history and future SI and NSSI, adjusting for baseline correlates and predictors of interest. Psychological and physical victimization, race, and poverty were non-significant prospective predictors of SI and NSSI. Race and poverty did not moderate the associations between sexual orientation and follow-up SI and NSSI. These findings suggest young adult women who self-identify as lesbian, gay, bisexual, queer, or questioning (LGBQ) are more likely than those who identify as heterosexual to experience both SI and NSSI in the following year. Sexual orientation should be part of a culturally-informed comprehensive risk assessment. A culturally-informed intersectionality approach may be necessary to identify culturally-specific risk and resiliency factors for SI and NSSI that can guide effective prevention and intervention strategies for LGBQ individuals.

The Relationship Between Perceived Stress, Impulsivity, Executive Dysfunction and Non-Suicidal Self-Injury Thoughts Among Chinese College Students: A Gender Difference Study.

The present study aimed to investigate the potential role of perceived stress, impulsivity trait, executive dysfunction in non-suicidal self-injury (NSSI) thoughts among college students, as well as the gender differences. A sample of 890 university students completed self-report measures of NSSI thoughts in the past month, the level of perceived stress, impulsivity traits, and executive dysfunction. Compared to those with low level of perceived stress, participants with high level of perceived stress reported significant higher levels of impulsivity trait and executive dysfunction, and higher frequency of NSSI thoughts, and there were no gender differences. Male participants with NSSI thoughts, compared to males without NSSI thoughts, reported significant higher levels of perceived stress and executive dysfunction. Female participants with NSSI thoughts, compared to females without NSSI thoughts, reported significant higher levels of perceived stress, impulsivity trait, and executive dysfunction. Hierarchical regression analysis revealed only executive dysfunction was associated with NSSI thoughts in males, while only perceived stress was associated with NSSI thoughts in females. This study revealed different influence factors for NSSI thoughts in male and female college students. NSSI thoughts in males were more likely associated with executive dysfunction while in females were due to recently perceived stress.

Dehumanization and the Association With Nonsuicidal Self-Injury and Suicidal Ideation in an Incarcerated Population.

Background: Self-injurious and suicidal thoughts create critical concerns for incarcerated populations, yet relatively little is known about how they are formed and perpetuated within US jails. Dehumanization has been presented as a potentially novel risk factor toward aspects of self-harm; thus, this study assessed the perception of dehumanization from officers by those currently incarcerated. Methods: Across two jail settings (n = 410), self-report surveys were administered asking questions relating to perception of officer dehumanization alongside aspects of nonsuicidal self-injury (NSSI) and suicidal ideation. Results: The findings indicate that perceived officer dehumanization is associated with NSSI thoughts, actively seeking NSSI, and suicidal ideation in jail, but not with NSSI in jail. Limitations: These data are cross-sectional, thus future work should examine the temporal order of these relationships. Conclusions: Perceptions of officer dehumanization appear to be clinically relevant in jail settings; therefore, future research should longitudinally determine how dehumanization imparts suicide risk.

A Daily Diary Study of the Relation between Stress and Nonsuicidal Self-Injury and the Moderating Role of Emotion Dysregulation in Emerging Adulthood.

Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18-25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, Mage = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12-14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable.

Association between sports-related concussions and the risk of self-injury thoughts and behaviors: Who, and under what circumstances?

BackgroundUnderstanding the association between sport-related concussions and the risk of suicidal and non-suicidal self-injury thoughts and behaviors (SITBs), including non-suicidal self-injury (NSSI), suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA), is crucial for suicide prevention. We aimed to identify the circumstances in which individuals with or without a concussion are vulnerable to SITBs. MethodsThe cross-sectional study included 85,469 students from 63 Chinese university with a mean age of 19.6 years. Firstly, propensity score matching, and inverse probability of treatment weighting (IPTW) were used to match the concussion and non-concussion group based on a range of biological, social, and psychological factors. Subsequently, multivariable logistic regression and a decision tree algorithm were employed to evaluate the interaction and cumulative impact of these risk factors and concussion on the probability of SITBs. ResultsIn the unmatched sample, concussion exposures were associated with all SITBs, with NSSI (OR, 1.41), SI (OR, 1.10), SP (OR, 1.23), and SA (OR, 1.28). However, the matched and weighted sample only had a significant association with NSSI and SI. The decision tree model revealed that, in the unmatched sample, among individuals without depressive symptoms or childhood emotional abuse, the risk of concussion on SITBs increased from 45.5 % to 65.2 % (χ2, 9.370; adjusted P = .002) after experiencing sexual abuse and verbal bullying. In the matched sample, the risk increased from 46.2 % to 64.6 % (χ2, 6.848; adjusted P = .009). ConclusionOur study revealed that individuals who suffered concussions exhibited a significantly higher risk of SITBs.

Interrupting the Self-Harm Continuum.

Background: Nonsuicidal self-injury (NSSI) has increased rapidly and is frequently linked to suicidal behavior; it has been argued that these behaviors are key points on a self-harm continuum. Aims: The current research explored self-harm and help-seeking behaviors, with the aim of identifying possibilities for prevention of further harm, including suicide. Methods: An online survey of 304 New Zealanders was undertaken, with the majority being aged under 25 and female. Results: Nearly half of the sample had engaged in self-harm and most of those had experienced suicidal thoughts; close to a quarter had made a suicide attempt. NSSI was used as a way of dealing with emotional distress. Very few sought help of any kind, especially professional support; of those who did seek professional support, most found it helpful but did not necessarily stop self-harming as a result. Limitations: Men are under-represented in the sample - though this is in accordance with the population of people who engage in NSSI. Conclusion: Many participants engaged in NSSI and also had suicidal thoughts using NSSI as an emotion regulation strategy; some participants appeared to use NSSI rather than attempting suicide. Given a link between NSSI and suicidal thoughts and behaviors, reluctance to seek help and on-going injurious behavior among some who do seek help, there is a need for increased identification and proactive support specifically focusing on improving emotion regulation and targeted at injurious behavior.

Daily nonsuicidal self-injury thoughts in emerging adulthood: The relevance of pre-adolescent borderline traits

Abstract Longitudinal studies exploring the role of early personality vulnerabilities as risk factors for later NSSI dynamics are scarce. In this study, we assess how pre-adolescent borderline personality pathology (BPP) traits (assessed at mean age 12.78; SDage = 1.38, age range = 7.17–14.78) shape dynamic links between daily socio-emotional dysregulation and NSSI thoughts during emerging adulthood (Mage = 20.96, SDage = 1.63). Mothers of 131 children completed questionnaires about their child’s BPP traits in pre-adolescence. These children were re-assessed eight years later and were asked to complete a daily diary for 14 consecutive days. During these 14 days, behavioral and emotional dysregulation as well as NSSI thoughts were self-reported. Multilevel structural equation modeling was used (1) to examine dynamic links between socio-emotional dysregulation manifestations and NSSI thoughts in early adulthood, and (2) to explore the role of pre-adolescent BPP traits in moderating these early-adult dynamic associations. Our findings suggest that young adults who were described by their mothers as high on BPP traits (especially anxious and paranoid traits) during pre-adolescence, tended to respond more with NSSI thoughts when experiencing dysregulation or when perceiving others as rejecting in young adulthood. Results are discussed in terms of potential targets for indicated prevention of NSSI development.

Nonsuicidal Self-Injury Thoughts and Behavior in Adolescents: Validation of SITBI-NSSI.

The lack of knowledge about Nonsuicidal Self-Injury (NSSI) in Spanish adolescents, especially NSSI thoughts may be due to the paucity of NSSI assessment instruments with validity evidence in this sample. The aim of this study was to assess NSSI thoughts and behavior. In addition, the study examined the association between various NSSI features and suicidal behavior and included a preliminary validation of the new Self-Injurious Thoughts and Behaviors Interview - Non-Suicidal Self-Injury (SITBI-NSSI). 685 Spanish adolescents between 13 and 18 years old (M = 15.58, SD = 1.08; 60.9% girls) completed measures of NSSI features and suicidal behavior. Among adolescents, 19% thought about self-injury, and 16.8% presented NSSI behaviors. The girls had higher levels of NSSI, as well as greater frequency, number of functions, methods, and suicidal thoughts and desire. Some of the functions, methods, and precipitants differed by sex. Those with ANS had a higher risk of suicidal behavior than the comparison group. The association of SITBI-NSSI with other measures supports the validity of the data. Most features of NSSI are similar to those found in Spanish and internationally. The SITBI-NSSI could facilitate the evaluation of NSSI in Spanish adolescents.

Concurrent changes in nonsuicidal self-injury and suicide thoughts and behaviors.

Nonsuicidal self-injury (NSSI) is a risk factor for suicide, yet how changes in NSSI engagement relate to suicide ideation, planning, and attempts remains largely unknown. The current study aims to fill this gap by examining how changes in NSSI frequency over time related to concurrent changes in suicide thoughts and behaviors. Data came from a sample of 403 self-injuring young adults who completed assessments of NSSI and suicide thoughts and behaviors at baseline, 6, and 12 months. Bivariate latent growth modeling, adjusting for covariates of lifetime NSSI frequency and treatment status, was used to examine the extent to which changes in NSSI frequency related to suicide ideation and suicide planning. The frequency of NSSI declined across the study period. The slopes of NSSI and suicide ideation were significantly correlated, suggesting individuals with sharper declines in NSSI across time also showed sharper declines in suicide ideation. The intercepts between NSSI and suicide planning were significantly correlated, suggesting those with high NSSI frequency at baseline tended to report higher suicide planning across time. After covariate adjustment, the intercept of suicide planning marginally (p = 0.08) correlated with the slope of NSSI, tentatively suggesting that those who had less reductions in NSSI tended to have higher frequencies of suicide planning. These results provide new evidence that changes in NSSI are related to subsequent changes in suicide thoughts and behaviors. Monitoring suicide risk among those with NSSI is important and treatment aiming to reduce NSSI may also reduce suicide risk.

How Technologies Can Support Self-Injury Self-Management: Perspectives of Young Adults With Lived Experience of Nonsuicidal Self-Injury.

BackgroundThere is growing interest in the design of digital interventions to improve conditions for young people who engage in high-risk behaviors, like nonsuicidal self-injury (NSSI). However, few studies have focused on how young people self-manage NSSI, or their existing, and historic, use of technologies to support their goals related to NSSI behavior change. Such an understanding has the potential to inform the design of digital interventions that meet this population's unique needs.ObjectivesThis study aims to (a) understand the self-management practices of young adults who engage in NSSI, (b) explore how they currently use technologies for self-injury self-management, and (c) identify the ways they can envision an app-based technology supporting their self-management.Methods and MaterialsTwenty young adults (aged 18–24) with lived experience of NSSI, and who were not currently enrolled in therapy, were recruited from online venues. Participants completed baseline measures to assess mental health and NSSI characteristics, followed by a virtual 1-h semi-structured interview where they were invited to share their experience of self-management, their goals, and their thoughts on supportive technology. Interview scripts were transcribed and analyzed via thematic analysis.ResultsThemes and sub-themes are organized under two broad domain areas: (1) How young adults self-manage NSSI thoughts and behaviors and (2) Opportunities and challenges for digital interventions to assist young adults in their recovery process. We found that young adults had varied experiences with, and goals related to, NSSI. Participants reported a lack of effective strategies to reduce NSSI urges and a desire for an app-based technology to track patterns and deliver personalized suggestions for self-management. Participants reported existing use of technologies as part of self-management, as well as early information and support seeking for NSSI online.ConclusionsThis study contributes a greater understanding of young people's experiences with self-injury, their self-management practices, and their desire to engage with technology. Our findings highlight the need for design flexibility in developing digital interventions that support individual goals, unique presentations of NSSI, and needs at different phases of recovery. Implications for the design of highly personalized and relevant digital interventions to address NSSI are discussed.

Non-suicidal Self-injurious Thoughts and Behaviors Among Adolescent Inpatients.

Non-suicidal self-injury (NSSI) is a serious public health concern that typically onsets during early adolescence. Adolescents (N = 980, ages 12-19 years) admitted for acute, residential psychiatric treatment completed baseline clinical interviews assessing mental disorders and questionnaires measuring demographics, early life adversity, and symptom severity. Prevalence rates of NSSI for lifetime (thoughts: 78%; behaviors: 72%), past year (thoughts: 74%; behaviors: 65%), and past month (thoughts: 68%; behaviors: 51%) were high. Although effect sizes were modest, the presence of a lifetime depressive disorder, sexual abuse, and comorbidity (i.e., three or more current disorders) were significant correlates of experiencing NSSI thoughts and behaviors. Furthermore, lifetime depressive disorder, current anxiety disorder, and comorbidity were associated with a greater odds of persistent NSSI thoughts and/or behaviors. Longitudinal studies are needed to determine whether targeting these factors reduces the persistence of NSSI thoughts and behaviors.

“You leave the chat with a different feeling than when you came in”. A Content Analysis about Negative Experiences Following Instant Messaging among Adolescents with and without a History of Non-Suicidal Self-Injury

BACKGROUND: Instant messaging platforms seem to positively contribute to adolescent emotional well-being. However, some scholars show a link between the use of these platforms and negative emotional experiences. These emotions could be perceived as even more overwhelming for certain subgroups of adolescents, such as those who engage in non-suicidal self-injury (NSSI), and lead to self-injury to deal with otherwise difficult to handle feelings.
 OBJECTIVE: The current study aimed at providing a deeper understanding of what kind of experiences during instant messaging communications are perceived as emotionally upsetting by adolescents with and without NSSI, and which situations could trigger NSSI thoughts or attempts in adolescents with lived experiences.
 METHOD: We used content analysis to analyze short interviews conducted with a total of 17 adolescents with and without lived experiences of NSSI.
 RESULTS: Our results showed that experience of Involvement in conflicts, and especially Name-calling and insults, triggered negative emotional experiences for most adolescents (76.5%). Interpersonal stressors like Name-calling and insults, Disagreements or arguments, Unwanted contact, Friendship break-up and “Ghosting” were identified as major triggers for NSSI.
 CONCLUSION: These findings could be used for the purpose of facilitating future research into mapping negative experiences adolescents have on instant messaging platforms, as well as used as a clinical guide to identify situations related to NSSI thoughts or episodes.

A systematic review of the relationship between momentary emotional states and nonsuicidal self-injurious thoughts and behaviours.

Nonsuicidal self-injury (NSSI) is associated with high levels of distress, co-morbid mental health issues, and elevated risk of suicide. Previous literature indicates that emotion regulation is the most endorsed function of NSSI. Experience Sampling Methodology (ESM) provides a powerful tool for investigating the moment-to-moment associations between emotional states and NSSI thoughts and behaviours. The aim of the current study was to systematically review and evaluate ESM research concerning the relationship between momentary emotional states and NSSI. A systematic search of electronic databases from date of inception to 16th April 2021 was conducted. This was supplemented through backwards citation tracking. A risk of bias assessment was completed prior to data synthesis. Nineteen eligible studies were identified for inclusion in the review. Heightened negative affect was found to typically precede instances of NSSIT thoughts and behaviour. Results were less consistent for positive affect. Sample sizes across studies were often small, meaningful effect sizes were not always reported, and non-validated measures of NSSI thoughts and behaviour were used during ESM assessments. The results support affect regulation models of NSSI, and demonstrate the value of ESM studies, specifically those sampling more than once per day, in plotting the temporal, "in-the-moment" characteristics of these processes.

A meta-analysis on the affect regulation function of real-time self-injurious thoughts and behaviours.

Prominent theories suggest self-injurious thoughts and behaviors (SITBs) are negatively reinforced by decreased negative affect. The present meta-analysis quantifies effects from intensive longitudinal studies measuring negative affect and SITBs. We obtained data from 38 of the 79 studies (48%; 22 unique datasets) involving N = 1,644 participants (80% female; 75% white). Individual participant data meta-analyses revealed changes in affect pre/post SITBs. In antecedent models, results supported increased negative affect before non-suicidal self-injurious (NSSI) behavior (k = 14; 95% CI = 0.09 – 0.31) and suicidal thoughts (k = 14; 95% CI = 0.03 – 0.19). For consequence models, negative affect was reduced following NSSI thoughts (k = 6; 95% CI = −0.79 – −0.44), NSSI behaviors (k = 14; 95% CI = −0.73 – −0.19) and suicidal thoughts (k = 13; 95% CI = −0.79 – −0.23). Findings, which were not moderated by sampling strategies or sample composition, support the affect regulation function of SITBs.

Affective variability and childhood abuse increase the risk for nonsuicidal self-injury following psychiatric hospitalization.

Childhood abuse is associated with myriad negative behavioral health outcomes, including nonsuicidal self-injury (NSSI). Models aimed at understanding the mechanism whereby childhood abuse may exert negative effects frequently highlight alterations or dysregulations in experienced affect, particularly during times of stress. The period immediately following discharge from psychiatric hospitalization represents a time of risk for individuals experiencing NSSI. We aimed to investigate the extent to which childhood abuse predicts affective variability and examine whether affective variability predicts who will experience NSSI thoughts or behaviors in the 6 months following hospital discharge. Participants were adults (N = 133) engaged in a 3-week ecological momentary assessment study immediately following psychiatric hospitalization who returned for a 6-month follow-up. Location scale modeling (LSM) was used to model the impact of childhood abuse on affect variability; estimates of affect variability were then resampled and examined as risk factors for NSSI at follow-up. Overall, individuals who experienced childhood abuse reported lower positive affect intensity. Participants exposed to emotional and sexual abuse reported less between-person variability in positive affect, and those who experienced sexual abuse evidenced higher between-person variability in negative affect. Models indicated that higher overall negative affect was associated with a higher NSSI risk, ORs ∼ 1.82-2.10 even after accounting for childhood abuse and lifetime NSSI. These findings indicate the importance of in vivo affect as a critical influence on behavior during high-risk periods, reinforcing the need to move beyond traditional cross-sectional approaches of assessment, analysis, and treatment.

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

BackgroundSuicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) are major health concerns among military veterans yet little is known about the temporal relations among these outcomes. This study examined the temporal relations between suicidal and nonsuicidal SITBs among higher-risk veterans. Specifically, we identified when SITBs emerged and evaluated the role of nonsuicidal self-injury (NSSI) in the medical lethality of suicide attempts (SA), relative risk, and survival time of suicidal SITBs (i.e., suicide ideation [SI], suicide plan, SA). MethodCross-sectional data were collected from two samples examining suicide risk among veterans receiving inpatient psychiatric care (n = 157) and community-residing veterans with current depression and/or past month SI (n = 200). Participants completed an interview to assess SITBs. ResultsSITBs emerged between ages 14-28 years with behaviors emerging, on average, earlier among inpatient veterans. The time lag between SITBs was not significantly different between groups. Inpatient veterans had a significantly shorter time lag from SI to SA. NSSI history predicted an increase in relative risk for all suicidal SITBs and shorter survival time. There was no association between NSSI history and medical lethality of the most serious SA for both groups. LimitationsLimitations included use of cross-sectional, retrospective self-report with age-of-onset endorsed in years and not all SITBs were assessed (e.g., passive SI). ConclusionsVeterans with a NSSI history are at high risk for suicidal SITBs and have a shorter survival time. Results showed thoughts (i.e., NSSI thoughts, SI) emerged before behavior (i.e., NSSI, SA) and NSSI emerged before SA.

Short-term associations between nonsuicidal and suicidal thoughts and behaviors: A daily diary study with high-risk adolescents

BackgroundIn this daily dairy study of adolescents at elevated suicide risk, we examined proximal associations between nonsuicidal self-injury (NSSI) and suicidal thoughts as well as behaviors. We also investigated the prominence of the anti-suicide function underlying NSSI engagement, relative to intrapersonal and interpersonal motives. MethodsSeventy-eight adolescents (67.9% female; ages 13-17) hospitalized due to suicide risk completed daily surveys assessing NSSI and suicidal thoughts for four weeks after discharge (n=1621 observations). Suicidal behavior (actual, aborted, interrupted suicide attempts) was assessed at 1-month follow-up. ResultsOver and above lifetime NSSI, adolescents who generally experienced more enduring (OR=2.54, p=<.001) and intense (OR=1.87, p=.002) suicidal ideation were more likely to engage in NSSI on a given day. Moreover, NSSI likelihood increased when adolescents experienced more enduring (OR=1.99, p<.001) and intense (OR=1.66, p<.001) ideation relative to their typical levels. This pattern was consistent for those with recent NSSI. The anti-suicide function of NSSI was frequently endorsed at hospitalization and when NSSI occurred daily (65.6% of the time), alongside the intrapersonal-negative motive (to avoid aversive states). Exploratory analyses suggest adolescents with suicidal behavior within the month after discharge experienced higher NSSI levels reported daily over the same period (Hedge's g=1.26, p=<.001). LimitationsDaily-level associations were examined concurrently and generalizability of results is limited by sample characteristics. ConclusionsThe notable proximal associations between NSSI and suicidal thoughts and behaviors, as well as the prominence of the anti-suicide function, point to the importance of intervention efforts targeting these intersecting phenomena among adolescents at elevated suicide risk.

Sex differences in the associations of nonmedical use of prescription drugs with self-injurious thoughts and behaviors among adolescents: A large-scale study in China

Background To investigate the sex differences in the associations of nonmedical use of opioids and sedatives with non-suicidal self-injury (NSSI), suicidal thoughts, and suicide attempts.Methods This study presents secondary analyses of the 2015 National School-based Chinese Adolescents Health Survey. A total of 152, 527 students (aged 10-20 years) completing standard questionnaires were included in analyses. Appropriate sampling weights were utilized.Results After adjusting for the demographic profile, academic pressure, and depressive symptoms, nonmedical use of opioids (adjusted odds ratio [aOR]=1.82, 95% confidence interval [CI]=1.69~1.96) and sedatives (aOR=2.03, 95% CI=1.90~2.18) remain positively associated with NSSI, and adolescents who reported opioids or sedatives misuse were at a higher risk for suicidal thoughts and suicide attempts. A significant sex difference was found in the effects of nonmedical use of sedatives on NSSI, with the effects in girls stronger than that in boys (Ratio of two odds ratio [ROR]=1.18, P=0.011). Girls reporting nonmedical use of opioids and sedatives also had an increased risk of suicidal thoughts than boys (opioids misuse: ROR=1.25, P=0.002; sedatives misuse: ROR=1.21, P=0.006).Limitations Causal inference could not be tested due to the cross-sectional design.Conclusion Although nonmedical use of opioids or sedatives was associated with the increased risks of NSSI, suicidal thoughts, and suicide attempts among both boys and girls, there exist significant sex differences in these associations, and girls exhibited a higher risk of NSSI and suicidal thoughts than boys. Intervention strategies are needed to help vulnerable adolescents (e.g., those involved in NMUPD), with a focus on girls.

Prospective and Concurrent Affective Dynamics in Self-Injurious Thoughts and Behaviors: An Examination in Young Adult Women

Affective dynamics, assessed using ecological momentary assessment (EMA), provide a nuanced understanding of within-person fluctuations of negative affect (NA) and positive affect (PA) in daily life. NA and PA dynamics have been associated with psychopathology and response to psychological treatments. NA and PA dynamics have been rarely studied concurrently in association with self-injurious thoughts and behaviors (SITB), transdiagnostic difficulties encountered regularly in clinical and community settings. Here we present EMA data from a large, diverse sample of young adult women with high rates of SITB to examine NA and PA dynamics (mean intensity, variability, and inertia). Specifically, we considered the prospective associations between past-year suicidal thoughts and past-year nonsuicidal self-injury and affective dynamics, as well as the concurrent associations between affective dynamics, EMA-reported suicidal thoughts, and EMA-reported urges for nonsuicidal self-injury. Results demonstrate that elevated mean NA and NA variability are robustly associated with all types of SITB assessed prospectively or concurrently. Interestingly, these associations were weakest for past-year nonsuicidal self-injurious behaviors, relative to past-year and concurrent suicidal or nonsuicidal self-injurious thoughts. Past-year suicidal thoughts further predicted increased NA inertia. Decreased PA inertia was associated with past-year nonsuicidal self-injury behavior, as well as concurrent EMA suicidal thoughts. We found no associations (prospective or concurrent) between SITB and mean PA intensity or PA variability. These results highlight the importance of understanding affective processes to develop real-world interventions to prevent nonsuicidal self-injury and suicidal behavior in daily life.