Self-harm Group Research Articles

The Relationship Between Feelings of Emptiness and Self-Harm Among Thai Patients Exhibiting Borderline Personality Disorder Symptoms: The Mediating Role of the Inner Strengths

Background and Objectives: Fifty percent of individuals with borderline personality disorder (BPD) experience self-harm. One of the crucial factors related to self-harm is feelings of emptiness. While inner strengths, such as the Five Precepts, meditation, and equanimity, have been identified as potential buffers against negative mental health outcomes in BPD, their role in mediating the relationship between feelings of emptiness and self-harm is not well-documented. This study aimed to explore how these inner strengths mediate the relationship between feelings of emptiness and self-harm in individuals exhibiting BPD symptoms. Materials and Methods: A total of 302 Thai participants exhibiting BPD symptoms completed several assessments: the SCID-II Personality Disorder Questionnaire for BPD to assess feelings of emptiness and self-harm, the Inner-Strength-Based Inventory (i-SBI) to evaluate the Five Precepts, meditation, and equanimity, and the Outcome Inventory Depression (OI-Depression) to assess depression. Mean and standard deviation were used for continuous variables, such as age and OI-Depression. A t-test assessed mean differences in continuous variables between the self-harm group and the non-self-harm group. Chi-square tests examined differences in categorical variables with three or more levels, such as education. Pearson’s correlation and linear regression analyzed relationships between continuous variables, including i-SBI and OI-Depression scores. Mediation analysis was performed using IBM SPSS and AMOS, with self-harm as the outcome variable, feelings of emptiness as the predictor, and inner strengths as mediators. Results: The participants had a mean age of 36.56, with 65.4% being female. The analysis showed that the Five Precepts, meditation, and equanimity significantly mediated the relationship between feelings of emptiness and self-harm, with a standardized coefficient of β = 0.534 (95% CI = 0.417 to 0.647, p < 0.001). The indirect effect of feelings of emptiness through these inner strengths was significant (β = 0.034, 95% CI = 0.009 to 0.075, p = 0.005). The mediation model explained 38% of the variance in self-harm with a 3% increase, albeit small but significant. Conclusions: This study highlights that inner strengths negatively mediate the relationship between feelings of emptiness and self-harm, indicating that as these inner strengths increase, the direct impact of feelings of emptiness on self-harm decreases. These findings suggest that targeting inner strengths as protective factors could be a valuable strategy in developing interventions aimed at reducing self-harm by addressing the underlying emotional challenges associated with BPD.

Reward processing in young people with self-harm behaviour

Twenty percent of young people report a lifetime presence of self-harm (SH) behaviour, associated with negative health and functional outcomes. Understanding the underlying cognitive mechanisms is needed to develop targeted early interventions. Reward processing biases may underlie SH, aligning with accounts of the behaviour acquiring “addictive” characteristics. However, the specific nature of such biases remains unclear, particularly its relationship with negative affect (NA) that frequently triggers SH. In Study 1, we compared young people (aged 16–25) with SH to a group with NA but no SH history and a healthy control group on performance of a novel Incentive Delay Task (IDT), with SH-related (SH trials), positive social (social trials) or monetary images (money trials) as stimuli. In Study 2, a different sample of SH and HC participants completed the same IDT following NA induction via an online Trier Social Stress Test. For both studies, we hypothesised faster and more correct responses in the SH group than control groups on SH trials. Contradicting our hypothesis, there were no significant between-group differences in IDT performance on SH, social and money trials in either study. Certain SH characteristics (positive reinforcement, SH mental imagery, urge) were significantly correlated with better performance on SH trials in SH participants. Thus, broadly SH behaviour may not be underpinned by motivational biases towards SH-related cues or naturalistic rewards. Future studies should clarify whether incentivisation of SH-related cues instead explains individual differences in SH behaviour and its relation with treatment and prognosis.

Symptoms of the suicide crisis syndrome and therapist emotional responses: associations to self-harm and death by suicide within 18-months post-discharge among patients at an acute psychiatric department

Background and aims This study explored the associations between symptoms of the Suicide Crisis Syndrome (SCS) at admission and self-harm and death by suicide post-discharge. The association between clinicians’ emotional responses toward inpatients at admission and post-discharge self-harm and suicide death was also explored. Methods Within the first 24-h of admission, patients completed a self-report measure of symptoms of SCS, and clinicians reported their emotional responses toward the patients. Follow-up data were obtained from the Norwegian Patient Registry and the Norwegian Cause of Death Registry. Results Within 18 months post-discharge, 44 (12.7%) out of 347 patients had self-harmed, and five patients (1.4%) had died by suicide. At admission, patients who later self-harmed reported higher symptoms of SCS compared to the other patients. Clinicians reported more negative emotional responses toward the self-harm group. In a regression analysis, previous suicidal behavior and a diagnosis of “emotionally unstable personality disorder” (EUPD; F60.3) were associated with increased risk of self-harm post-discharge. Conclusion The results indicated that patients with post-discharge episodes of self-harm are significantly different from patients who do not self-harm in terms of more intense symptoms of SCS during admission. Clinicians’ negative emotional responses may be relevant in the assessment of the risk of post-discharge self-harm.

Prefrontal brain activity and self-injurious behavior in adolescents with major depressive disorder: A functional near-infrared spectroscopy (fNIRS) study

In clinical practice, accurately identifying self-injurious behavior among adolescents with major depressive disorder (MDD) is crucial for individualized treatment. This study aimed to examine the differences in prefrontal cortex activation using the functional near-infrared spectroscopy (fNIRS) during the verbal fluency task (VFT) assessment of adolescents with MDD and self-harm (SH) compared with those without SH. A total of 60 eligible patients were included for final analysis, with the SH group containing 36 participants, and the Non-SH group containing 24 participants. We found that right middle frontal gyrus (rMFG) was more activated in the SH group than that in the Non-SH group during the VFT assessments (z = −3.591, p = 0.004, FDR correction). The z-scores of beta values of rMFG exhibited a good discriminatory power with the area under the curve (AUC) in distinguishing the two groups (AUC = 0.775, p < 0.001). These findings reveal that the fNIRS-VFT paradigm may be a useful tool for discovering neurobiological differences among adolescents with MDD.

Comparing Ruminative and Distracting Responses and Emotion Regulation Difficulties in Early Community Adolescents With and Without Self-Harm.

This study aimed to compare the demographic characteristics, responses to negative emotions, and difficulties in emotion regulation between self-harming adolescents and control individuals aged 12-14 years from the community. Data were collected from adolescents in Chungcheong Province, South Korea, between September 2021 and November 2022. Demographic characteristics and responses to the Depressed Mood Questionnaire and Difficulties in Emotion Regulation Scale-16 (DERS-16) were compared between the self-harm and control groups. The self-harm group exhibited a higher prevalence of child abuse (odds ratio [OR]=4.787, 95% confidence interval [CI]=1.591-14.409, p=0.005) and school bullying victimization (OR=4.495, 95% CI=2.353-8.588, p<0.001) than those in the control group. The selfharm group displayed higher levels of rumination (t=7.88, p<0.001) and reduced distraction responses (reverse score t=2.25, p=0.025) than those of the control group. Additionally, the self-harm group scored higher on all subscales and the total DERS-16 score (t=7.61, p<0.001). Interventions for self-harming adolescents should address child abuse and bullying victimization. Prevention programs for self-harming adolescents should focus on reducing rumination responses, increasing distractive responses, and addressing difficulties in emotion regulation using dialectical behavior therapy-skill training.

Childhood Trauma and Self-harm in Youths with Bipolar Disorders.

Bipolar disorders (BD) in youth are associated with a high risk of self-harm behaviors. Childhood trauma (CT) is a relevant environmental stressor that is related to both BD diagnosis and self-harm in adulthood. It is not yet established whether CT may impact self-harm risk in youth. Therefore, the aim of this study was to investigate the distribution patterns of CT in youth BD with and without self-harm. We assessed 273 participants (aged 13-25 years), 96 youths with BD according to DSM-5 criteria and 177 healthy controls (HC). History of CT was obtained using the Childhood Trauma Questionnaire (CTQ). The association between CT and self-harm was tested using multivariate statistical models. Over 45% of participants with BD reported lifetime self-harm. The BD Self-harm group reported more emotional abuse, emotional neglect, sexual abuse, and physical abuse than HC. The BD No-Self-harm group reported more emotional abuse than HC. The BD Self-harm group reported more emotional abuse and neglect than the BD No-Self-harm group. The BD Self-harm group also reported separated parents, hospitalizations, smoking, use of antiepileptics, antipsychotics and lithium. Emotional abuse was an independent predictor of self-harm in youths with BD. Findings support the importance of assessing CT, in particular emotional abuse, in youth with BD at risk for self-harm.

Early maladaptive schemas are associated with self-injury thoughts and behavior in adolescents

BackgroundEarly maladaptive schemas (EMSs) and self-harm have been firmly linked in adults, but research on these associations in adolescents remains scarce. Additionally, the links between EMSs and functions of self-injury has not been previously studied in this age group. Thus, the aim of the present study was to investigate the associations of EMSs with self-harm thoughts and behavior, as well as with self-harm functions, among adolescents in specialized health care.MethodsThe participants were recruited from first-visit 12-22-year-old adolescent patients entering specialized mental health care or pediatric care. For 118 participants, complete data were available for the Young Schema Questionnaire Short Form 2-Extended (YSQ) when entering care and the Ottawa Self-Injury Inventory Functions scale (OSI-F) one year later. YSQ was used to measure the participants’ EMSs and OSI-F their self-harm thoughts and behavior. The associations of EMSs and self-harm were investigated in three groups: no self-harm, self-harm thoughts only, and both self-harm thoughts and behavior. The associations of EMSs with self-injury behavior functions were assessed in four categories: Internal Emotional Regulation, External Emotional Regulation, Social Influence, and Sensation Seeking. Additionally, EMSs’ associations with addictive features of self-injury behavior were assessed. The magnitudes of effect sizes of differences between the self-harm groups were evaluated with Cliff’s Delta. The associations of EMSs with self-injury functions were analyzed with general linear modeling and with self-injury addictive features using logistic regression.ResultsThe differences between the self-harm groups were significant for the majority of the EMSs. The stronger the EMSs were, the more severe the manifestations of self-harm. The effect sizes ranged from small to large depending on the EMS. Considering self-injury functions, Internal Emotional Regulation was associated with Self-Sacrifice EMS (p = 0.021), and External Emotional Regulation both with Abandonment (p = 0.040) and Unrelenting Standards (p = 0.012) EMSs. Being addicted to self-injury was associated with Abandonment (p = 0.043) and Dependence (p = 0.025) EMSs.ConclusionsThe present study shows that significant associations between EMSs and both self-harm thoughts and behavior exist also in adolescents. Stronger EMSs are linked to more severe self-harm. Knowledge of these associations may help to improve the understanding and treatment of adolescents suffering from self-harm.

Finding Voices: a survey of young people’s experiences of the ED

BackgroundMental health presentations in young people are increasing. Recurrence of self-harm (SH) presentations is common and of great concern since self-harm is known to be a risk factor for suicide....

Approach-avoidance biases to self-harm cues in young people with self-harm

BackgroundThe urge to self-harm can be likened to craving in addictive behaviours. However, it remains unclear whether cognitive mechanisms involved in craving, such as attentional biases to cues, also underpin the urge to self-harm. MethodsA Dot Probe Task was used to investigate attentional biases to self-harm cues in young people aged 16–25 with self-harm. Cues were shown for either 0.2 s or 2 s. Dot Probe Task performance in the Self-harm group (N = 50) was compared with age-matched Healthy Controls (N = 50) and age- and negative-affect (Depression Anxiety Stress Scale-21) matched controls with no self-harm (N = 50). ResultsThe Self-harm group showed significantly greater avoidance of self-harm cues than Healthy Controls at 2 s. The Negative Affect group showed significantly less difficulty disengaging from self-harm cues than the Self-harm group and Healthy Controls at 2 s. There were no between-group differences in attentional bias at 0.2 s. LimitationsStudy limitations that may affect attentional biases in the Self-harm group include not measuring indicators of recovery and recruiting only from the community potentially missing more severe self-harm presentations in clinical settings. ConclusionsAvoidance of self-harm cues in young people with self-harm may reflect conflict around self-harm behaviour, consistent with ambivalence models of craving. An ability to disengage from self-harm cues may be a protective factor in young people with higher levels of negative affect who do not self-harm. Whether these attentional biases represent a quantifiable marker of treatment response or susceptibility to relapse in individuals with self-harm remains an area for future investigation.

Incidence of Penetrating Trauma in an Urban Level 1–Trauma Center. A Retrospective Clinical Survey of the Years 2016-2021.

Introduction:Penetrating trauma is a highly visible issue in history, social media, and politics. Crime statistics showed increasing numbers of violations of the law banning assault weapons in Germany. Although these injuries have historically been rare in Germany, we have noticed increasing numbers in our hospital. Studies focusing on these injuries of penetrating trauma are lacking, hence a distinct therapy algorithm is missing.Method:All penetrating injuries proximal to the wrist and ankle in the years 2016-2021 were analyzed in a retrospective survey. Isolated injuries of hand and foot were excluded. Data were gathered from the clinical information system and the protocol of the emergency medical services. For further analysis we identified three distinct groups: Patients who acquired the injury by an accident (ACCIDENT), self-inflicted (SELF-HARM) or by crime (ASSAULT). The groups were compared using MicroSoft Excel® and Sigma plot® (Jandel, San Rafael, CA).Results:A total of 961 cases were identified. The analysis showed an increasing number of cases with penetrating injuries from 2016 until 2019. Furthermore, major differences between the groups were revealed. The assault victims (ASSAULT n=117) were mostly male (91%) and non-German (52%). They were more likely to be accompanied by the police (13%), to be intoxicated, to require hospital admission (also to critical care) and to require surgery as compared to the cases of the ACCIDENT (n=484) and SELF-HARM (n=360) group. The SELF-HARM group cases were predominantly female, younger and had psychiatric comorbidities.Conclusion:The cause of penetrating trauma injury is important and can provide information crucial to the management of the patient. The emergency treatment of assault victims is challenging due to the particular circumstances of these cases. Optimal preparation and anticipation of the accident and emergency staff are necessary to deal with these patients. In summary, assault victims had more serious injuries than the other groups.

Association between alcohol consumption and severity of self-harm behaviors based on suicidal intent in patients admitted to the emergency department for self-harm

This study aimed to investigate the association between alcohol consumption and the severity of self-harm behaviors based on the suicidal intents of patients admitted to the emergency department (ED) for self-harm. This was a retrospective study on patients admitted to the ED between March 2017 and December 2020 owing to self-harm behaviors and were grouped into a suicide attempt (SA) and non-suicidal self-harm (NSSH) group. A total of 642 (73.5%) and 232 (26.5%) patients were classified into SA and NSSH groups, respectively. In the SA group, 270 (42.1%) patients reported consuming alcohol, which was independently associated with ≥12 years of formal education and no history of psychiatric hospitalization. In the NSSH group, 87 (37.5%) patients reported consuming alcohol, which was associated with male sex, being married or unmarried but living together, ≥12 years of formal education, and no history of depression. Alcohol consumption could predict ED disposition in the SA group but not in the NSSH group. The impact of alcohol consumption varied according to suicidal intents among patients admitted to the ED for self-harm behavior. Regardless of suicidal intent, patients with a higher education level tended to drink alcohol when engaging in self-harm behaviors.

Differences in Influencing Factors Between Non-suicidal Self-Injury and Suicide Attempts in Chinese Adolescents: The Role of Gender

IntroductionNon-suicidal self-injury (NSSI) and suicide attempts (SA) are common in adolescents and are important risk factors for suicide deaths. They are related to various psychosocial, behavioral, and biological factors. We aimed to compare the differences on psychological behavior problem and family environment characteristics between NSSI and SA, and the role of gender.MethodsA multi-center population-based survey was conducted in 29 schools across 4 provinces in China. A total of 14,500 urban and rural adolescents in grades 7–12 completed a structured questionnaire to report their sociodemographic information, psychological and behavioral characteristics, childhood maltreatment, parent-child relationships, NSSI, and SA. Post-hoc tests, pairwise comparisons, and multinomial logistic regression analyses were conducted to explore the differences and similarities between subjects who had engaged in NSSI and SA.ResultsThe prevalence of NSSI and SA were 27.3 and 4.9%, respectively, and the co-occurrence of these two behaviors (NSSI + SA) was reported to 2.8%. The NSSI + SA group scored the highest on all study variables, followed by the SA-only group, the NSSI-only group, and the non-self-harm group (p < 0.001). Compared with the non-self-harm group, adolescents who reported either NSSI or SA scored significantly higher on all study variables (p< 0.0083). The comparison between other self-harm groups, this difference have varied in all research variables.ConclusionThe current study indicate that psychological, behavioral, and family relationships profiles of Chinese adolescents with SA and NSSI are similar, but the measured problematic characteristics were more severe in suicide attempters. In the future, it's necessary to pay more attention to adolescents with more serious psychological and behavioral problems to prevent and early intervene in their self-harm, and actively explore gender differences.

The serial mediational role of attachment and emotion regulation in the relationship between early life adverse experiences and self-harm in a group of individuals engaging in self-harm who interact in self-harm focused online platforms

PurposeStudies have demonstrated that adverse childhood experiences, attachment and emotion dysregulation are significant predictors of self-harm. Developmental theories of self-harm propose that adverse childhood experiences can influence attachment, which in turn has an impact on emotion dysregulation, leading to self-harm. However, to date no study has investigated this. The aim of this study was to investigate whether the relationship between early life experiences and self-harm is serially mediated by insecure attachment and emotion dysregulation. MethodsAn observational cross-sectional study design was adopted for this study. A sample of 284 adults (77% females), 64% of whom acknowledged a mental health disorder and 49% of whom have attempted suicide before, was recruited online via specific self-harm groups on social media platforms (e.g. the subreddit r/AdultSelf-Harm on Reddit) and was asked to complete an online survey, consisting of four self-report questionnaires. Conditional process analysis was used to investigate the proposed model (using the PROCESS macro). ResultsThe findings supported the serial mediation model [Indirect effect = 0.004, SE = 0.002, 95% CI (0.0007, 0.0090)], even after controlling for previous suicide attempts. ConclusionsThe findings of the study seem to provide a fruitful start to the development of conceptual models of self-harm. Applications regarding early identification and assessment of self-harm and the development of specific interventions are discussed.

Psychometric Assessment of Adverse Childhood Experiences International Questionnaire (ACE-IQ) with Adults Engaging in Non-Suicidal Self-Injury

Background: The current study aimed to investigate the psychometric properties of the Adverse Childhood Experiences – International Questionnaire (ACE-IQ) with individuals engaging in non-suicidal self-injury. Numerous studies have supported the association of adverse childhood experiences with non-suicidal self-injury. However, the majority of the measures used were limited to basic forms of abuse and neglect, indicating a need for the use of a more inclusive measure, such as the ACE-IQ. The psychometric properties of the measure though have only been briefly investigated with other populations, suggesting that a more thorough examination might be beneficial before its use. Method: Two hundred eighty-four adult participants (77.5% females) with a mean age of 23.4 (SD=5.7) were recruited online via specific self-harm groups on social media platforms. Participants were asked to complete an online survey consisting of three self-report measures regarding early childhood experiences and engagement in non-suicidal self-injury. Results: The findings of this study supported ACE-IQ’s reliability (Cronbach’s alpha = 0.854), convergent validity (r= 0.85, p<0.001 with the CTQ-SF), predictive validity (R 2 = 0.12, p=0.001 of the SHI total score) and discriminant validity (F-value = 13.90, p<0.001). An exploration of the factor structure demonstrated a 5-factor solution (physical abuse, sexual abuse, emotional abuse, exposure to violence, family environment). Conclusions: It was concluded that ACE-IQ is a reliable and valid measure to be used for research or clinical purposes with individuals engaging in non-suicidal self-injury, although further research is needed on its factor structure. Research and clinical implications are discussed.

Prevalence and clinical correlates of self-harm and suicidality during admission of children in a mental health inpatient unit.

Self-harm and suicidality are common presentations in children and adolescents requiring a mental health inpatient admission. Although there are several studies on adolescents, there is relatively limited research into childhood self-harm and suicidality during such admissions. A retrospective electronic file review was conducted on all children discharged from a national mental health inpatient children's unit over a 6-year period. Several independent variables were compared between self-harm/suicidal and non-self-harm/non-suicidal children. Separate analyses investigated changes in self-harm/suicidality, functional outcomes, and risk assessment ratings between admission and discharge. A total of 105 children were included in this study. During admission, 65.7% of them reported self-harm thoughts, 61% engaged in self-harm, 50.5% expressed suicidal thoughts, and 14.3% engaged in suicidal behavior. Thoughts and acts of self-harm were associated with previous self-harm, longer admissions, and Attention Deficit Hyperactivity Disorder. Suicidality overlapped with self-harm and was strongly predicted by previous self-harm. The prevalence of self-harm and suicidal thoughts and acts significantly decreased during admission. Children in the non-self-harm group had marginally better functional outcomes upon discharge compared to those in the self-harm group. Children and parents/caregivers were similarly satisfied with treatment, irrespective of children's self-harm/suicidality. Self-harm and suicidality were widespread among children admitted to hospital. Better understanding of the mechanisms and factors related to self-harm and suicidality in this age group could help mitigate associated risks and improve existing safety strategies.

A Theory-Based Longitudinal Investigation Examining Predictors of Self-Harm in Adolescents With and Without Bereavement Experiences.

BackgroundResearch has demonstrated that exposure to suicide can lead to increased vulnerability for self-harm or suicide. As a result, ideation-to-action models of suicide (e.g., the Integrated Motivational-Volitional Model of Suicide; IMV) recognise exposure as a significant risk factor which may be implicated in the translation of thoughts into actions. However, few studies have tested this theoretical link explicitly within an adolescent population, and examined how it compares to other types of bereavements.MethodsA 6-month prospective questionnaire study was conducted with 185 Scottish adolescents aged 11–17 (115 adolescents also completed the questionnaire at follow-up). The questionnaire included measures on experiences with bereavement and lifetime engagement in self-harm, as well as measures of defeat, entrapment, social support, coping, and other psychological variables.ResultsAt baseline, 11% of young people reported exposure to a suicide death, and 62% to a non-suicide death. In addition, 21% of pupils reported ever engaging in self-harm, while 24% had experienced self-harm ideation without engaging in it. Cross-sectional multivariate logistic regressions showed that maladaptive coping, family social support, glorifying/normalising beliefs about suicide, and family self-harm were significantly associated with self-harm group membership (control, ideation, or enactment groups). At follow-up, 9% of pupils reported exposure to a suicide death and 11% to a non-suicide death for the first time. A total of 29% of the sample reported self-harm at T2 (8% of participants for the first time), and 23% reported self-harm ideation without engaging in it. Multivariate analyses found that stigmatising beliefs about suicide, glorifying/normalising beliefs about suicide, and self-harm ideation at baseline were the only variables to predict self-harm group membership prospectively. Bereavement experiences, whether by suicide or non-suicide, did not predict self-harm group status at baseline nor at follow-up.ConclusionsThis study provides support for the validity of a theoretical model of suicide, even though predictive ability over the 6-months period was limited. Although difficulties with recruitment may have limited the statistical power, this study provides insight into the prevalence and experiences of suicide bereavement among adolescents and the factors related to the onset and maintenance of self-harm.

Characteristics and risk of repeat suicidal ideation and self-harm in patients who present to emergency departments with suicidal ideation or self-harm: A prospective cohort study

BackgroundCharacteristics and outcomes of patients presenting to Emergency Departments (EDs) have been under-examined. This paper describes the characteristics and risk of repeat suicidality amongst patients presenting to EDs with (1) suicidal ideation and (2) self-harm, compared to (3) controls in mental health crisis. MethodsThe Clinical Record Interactive Search tool identified 2211 patients who presented to three London EDs with suicidal ideation or self-harm, and 1108 control patients. All patients received a full psychosocial assessment. Chi-squared tests examined group characteristics. Cox regression models assessed the risk of re-presentation with suicidal ideation or self-harm within one year. ResultsThere were a higher proportion of females and individuals under the age of 25 in the self-harm group. Patients presenting with suicidal ideation or self-harm were more likely to be white, live in more deprived areas, and less likely to receive a psychiatric diagnosis within one year compared to controls. Risk of repeat suicidality within one year was 3–4 times higher in those with baseline suicidal ideation (adjusted HR = 3.66, 95% CI 2.44–5.48) or self-harm (HR = 3.53 95% CI 2.47–5.04) compared to controls. LimitationsTo be included patients needed to have a full psychosocial assessment. Incomplete records meant 21.4% of the sample was excluded. This will have introduced bias which might confound observed associations. ConclusionIndividuals presenting with either suicidal ideation or self-harm have similar risk for re-presentation within one year. Both groups would benefit from personalised risk management plans and active follow-up to reduce the risk of repeat suicidal behaviour.

Adverse Childhood Experiences and Hospital-Treated Self-Harm.

Adverse childhood experiences (ACEs) have been implicated in a range of negative health outcomes in adulthood, including increased suicide mortality. In this study, we explored the relationship between ACEs and hospital-treated self-harm. Specifically, we investigated whether those who had a history of repeat self-harm reported more ACEs than those who had self-harmed for the first time. Patients (n = 189) admitted to two hospitals in Glasgow (UK) following first-time (n = 41) or repeated (n = 148) self-harm completed psychosocial measures. Univariate analyses revealed that those presenting with repeat self-harm reported higher depressive symptoms, anxiety symptoms, intent to die, and ACEs, and lower dependent attachment style. However, only ACEs, along with female gender and depressive symptoms, significantly differentiated between the repeat self-harm group and the first-time self-harm group in the multivariate model. Controlling for all other psychosocial variables, participants who reported 4+ ACEs were significantly more likely to be in the repeat self-harm group as compared to those who experienced 0–3 ACEs. This finding highlights the pernicious effect of exposure to multiple ACEs. Further research is urgently required to better understand the mechanisms that explain this relationship. Clinicians should be aware of the extent of the association between ACEs and repeat self-harm.

Seeking help in times of economic hardship: access, experiences of services and unmet need

BackgroundEconomic recessions are often accompanied by increased levels of psychological distress and suicidal behaviour in affected populations. Little is known about the experiences of people seeking help for employment, financial and benefit-related difficulties during recessions. We investigated the experiences of people struggling financially in the aftermath of the Great Recession (2008-9) - including some who had self-harmed - and of the frontline support staff providing assistance.MethodsInterviews were conducted with three groups of people in two cities: i) people who had self-harmed due to employment, financial or benefit concerns (n = 19) (‘self-harm’); ii) people who were struggling financially drawn from the community (n = 22), including one focus group) (‘community’); iii) and frontline staff from voluntary and statutory sector organisations (e.g., Job Centres, Debt Advice and counselling agencies) providing support services to the groups (n = 25, including 2 focus groups) (‘service providers’). Data were analysed using the constant comparison method.ResultsService provision was described by people as confusing and difficult to access. The community sample reported considerably more knowledge and access to debt advice than the participants who had self-harmed – although both groups sought similar types of help. The self-harm group exhibited greater expectation that they should be self-reliant and also reported lower levels of informal networks and support from friends and relatives. They had also experienced more difficult circumstances such as benefit sanctions, and most had pre-existing mental health problems. Both self-harm and community groups indicated that practical help for debt and benefit issues would be the most useful – a view supported by service providers - and would have particularly helped those who self-harmed.ConclusionInterventions to identify those in need and aid them to access practical, reliable and free advice from support agencies could help mitigate the impact on mental health of benefit, debt and employment difficulties for vulnerable sections of society.

Psychological characteristics of self-harming behavior in Korean adolescents.

Recently, self-injury is drawing the attention of researchers and clinicians. The purpose of this study was to investigate the prevalence and psychological characteristics of adolescents who engage in self-harm and to examine the risk factors for engaging in this harmful behavior among Korean mid-adolescents. Participants were 784 adolescents aged 13-15 years. They completed self-report questionnaires that assessed (1) Non-Suicidal Self-Injury: the Self-Harm Questionnaire, Toronto Alexithymia Scale; (2) depression: Children's Depression Inventory; (3) adolescent-parent relationship: Parental Bonding Instrument; (4) peer attachment: Inventory of Parent and Peer Attachment; and (5) academic stress. Overall, 12.4% (n=97) of participants reported engaging in self-destructive behavior at least once in their lives. The primary reason for engaging in self-harm was to regulate negative emotions such as anger and sadness. As expected, the self-harm group showed statistically significant higher levels of academic stress, alexithymia, depression, and poor relationships with their parents and peers. Stepwise multiple regression analysis showed that alexithymia, depression, and peer relations were significant predictors of self-harming behavior. Given that the primary reason for engaging in self-harm is to cope with negative emotions, mental health professionals in school settings should regularly evaluate self-injurious behavior and provide prevention programs for adolescents at risk.