Self-harm Behaviors Research Articles

Associations between insomnia symptom trajectories with depression and self-harm behaviors in Chinese college students before and during the COVID-19 pandemic: A five-wave longitudinal investigation

BackgroundSleep problems are highly prevalent during COVID-19 pandemic. However, only very limited studies have examined the changing patterns of insomnia symptom before and during the COVID-19 pandemic, and most of these studies were limited to two-wave designs and the variable-centered approach. MethodsThe data was taken from a large-scale health-related cohort among Chinese college students. This cohort was a five-wave design and 3834 participants who completed at least two waves were included in the present study. Growth mixture modeling (GMM) was used to estimate trajectory classes for insomnia symptoms, followed by binary logistic regression to explore the association between trajectory classes and subsequent mental health problems. ResultsGMM analyses extracted four distinct trajectories of insomnia symptoms: stable-low pattern (n = 2897, 75.6 %), increasing pattern (n = 405, 10.6 %), decreasing pattern (n = 182, 4.7 %), and stable-high pattern (n = 350, 9.1 %). Additionally, we found that individuals in stable-high and increasing patterns were more likely to experience mental health problems after the COVID-19 pandemic even after adjusting significant covariates and outcomes at baseline. ConclusionsAppreciable heterogeneity in insomnia symptoms among college students was revealed before and during the COVID-19 pandemic. About 20 % of college students were classified as high-risk patterns of insomnia symptoms. Psychological interventions should target such vulnerable groups to reduce the rates of mental health problems.

Associations between DSM-5 posttraumatic stress disorder Criterion E2 endorsement and selected self-destructive behaviors in recent-era veterans: A focus on disordered eating.

Revisions to the posttraumatic stress disorder (PTSD) criteria in the DSM-5 included a new criterion in the alterations in arousal and reactivity cluster (i.e., engagement in reckless and self-destructive behaviors; Criterion E2). Despite its clinical significance, little is known about how this symptom corresponds to engagement in specific direct and indirect self-harm behaviors. We examined associations between E2 and self-reported recent engagement in direct and indirect self-harm behaviors, including disordered eating, which is not included in the prototypical E2 symptom scope, in a trauma-exposed sample of 1,010 recent-era veterans (61.5% self-identified women, 38.5% self-identified men). We also tested whether gender moderated these associations. We repeated analyses in a subsample of participants with clinically elevated PTSD symptoms. Participants self-reported past-month PTSD symptoms (PCL-5) as well as past-month nonsuicidal self-injury, suicidal ideation, suicide planning, fasting, purging, binge eating, compulsive exercise, and problematic alcohol and drug use. We found no evidence for moderation by gender for any of the behaviors examined in the main sample. However, after controlling for gender and demographic covariates, weighted logistic regressions showed small, significant associations between E2 score and direct self-harm behaviors, substance use, purging, and binge eating, aORs = 1.30-1.91. Criterion E2 was linked to behaviors included in the typical symptom scope (self-directed violence, substance use) and those that are not (disordered eating behaviors). Comprehensive screening for self-destructive behaviors, including disordered eating, among veteran men and women who endorse Criterion E2 is indicated.

Evaluating co-occurring space-time clusters of depression and suicide-related outcomes before and during the COVID-19 pandemic

Rapidly emerging research on the mental health consequences of the COVID-19 pandemic shows increasing patterns of psychological distress, including anxiety and depression, and self-harming behaviors, particularly during the early months of the pandemic. Yet, few studies have investigated the spatial and temporal changes in depressive disorders and suicidal behavior during the pandemic. The objective of this retrospective analysis was to evaluate geographic patterns of emergency department admissions for depression and suicidal behavior in North Carolina before (March 2017-February 2020) and during the COVID-19 pandemic (March 2020 - December 2021). Univariate cluster detection examined each outcome separately and multivariate cluster detection was used to examine the co-occurrence of depression and suicide-related outcomes in SatScan; the Rand index evaluated cluster overlap. Cluster analyses were adjusted for age, race, and sex. Findings suggest that the mental health burden of depression and suicide-related outcomes remained high in many communities throughout the pandemic. Rural communities exhibited a larger increase in the co-occurrence of depression and suicide-related ED visits during the pandemic period. Results showed the exacerbation of depression and suicide-related outcomes in select communities and emphasize the need for targeted and sustained mental health interventions throughout the many phases of the COVID-19 pandemic.

Образ тела у подростков с суицидальным и несуицидальным самоповреждающим поведением: удовлетворенность собственным телом

<p style="text-align: justify;">The aim of the study was to examine the features of body image perception in adolescents with self-harming, suicidal and normative behavior in terms of satisfaction with their own bodies. A theoretical review of the phenomena of suicidal and self-harming behavior and current studies of body image in non-clinical and clinical samples was conducted. The description and results of the first part of the empirical study of body image, devoted to the study of satisfaction with one's own body, are presented. The study was conducted on three groups of adolescents: those with suicidal behavior (n=30, M<sub>age</sub>=15.10, SD<sub>age</sub>=0.97, 26.7% of males), self-injurious behavior (n=27, M<sub>age</sub>=15.48, SD<sub>age</sub>=1.10, 11.1% of males) and normative behavior (control group: n=30, M<sub>age</sub>=15.40, SD<sub>age</sub>=0.96, 50% of males). The first group was distinguished on the basis of anamnestic data (suicide attempts in the last year or current hospitalization due to high suicide risk), the second group was distinguished on the basis of the Self-Harming Behavior Reason Scale (N.A. Polskaya, 2017): repeated cuts, punctures, and/or self-burns in the last year. The following methods were used: Self-Harming Behavior Reason Scale (N.A. Polskaya, 2017), Body Focus Questionnaire (Fisher, 1970), adapted by E.T. Sokolova (1985) and a questionnaire to collect socio-demographic data (gender, age, presence of psychiatric diagnoses, suicide attempts). The results suggest that self-harm is determined by an adolescent's need to reduce psychoemotional tension and gain control over emotions, and these determinants are stronger in the main groups than in the control groups, but no differences were found between the main groups. Satisfaction with one's own body is lower in the main groups compared to controls, but no differences were found between the main groups.</p>

Maltreatment experiences and mental health indicators among elite athletes

This study explored the relationships between athletes’ experiences of maltreatment and mental health indicators. Canadian National Team athletes completed an online, anonymous survey that assessed reported experiences of maltreatment (psychological, physical, sexual harm and neglect), and mental health indicators of well-being, eating disorders and self-harming behaviours. All forms of maltreatment had a significant, positive correlation with eating disorder and self-harming behaviours, and a negative correlation with well-being. The relationships between maltreatment and mental health indicators differed based on identity characteristics of the athletes. Further work is needed on the prevention and intervention of maltreatment in sport to reduce the behaviours associated with negative health outcomes.

Parent and Carer Skills Groups in Dialectical Behaviour Therapy for High-Risk Adolescents with Severe Emotion Dysregulation: A Mixed-Methods Evaluation of Participants' Outcomes and Experiences.

There is an established evidence-base for dialectical behaviour therapy for adolescents (DBT-A) in the treatment of young people with severe emotion dysregulation and related problems, including repeated self-harm and suicidal behaviours. However, few studies have reported on parental involvement in such treatments. This study aims to explore the outcomes and experiences of participants of a dedicated skills group for parents and carers embedded within an adapted DBT-A programme in the United Kingdom. This study was conducted within a specialist outpatient Child and Adolescent Mental Health Services (CAMHS) DBT programme in the National Health Service (NHS) in London. Participants were parents and carers of adolescents engaged in the DBT-A programme. Participants attended a 6-month parent and carer skills group intervention and completed self-report measures relating to carer distress, communication and family functioning, at pre-intervention and post-intervention. Following the intervention, semi-structured interviews were also completed with a subgroup of participants to explore their experiences of the skills group and how they perceived its effectiveness. Quantitative and qualitative methods were used to analyse the data collected from participants. Forty-one parents and carers completed the intervention. Participants reported a number of statistically significant changes from pre- to post-intervention: general levels of distress and problems in family communication decreased, while perceived openness of family communication and strengths and adaptability in family functioning increased. A thematic analysis of post-intervention interviews examining participant experiences identified six themes: (1) experiences prior to DBT; (2) safety in DBT; (3) experiences with other parents and carers; (4) new understandings; (5) changes in behaviours; and (6) future suggestions. Parents and carers who attended a dedicated DBT skills groups, adapted for local needs, reported improvements in their wellbeing, as well as interactions with their adolescents and more general family functioning, by the end of the intervention. Further studies are needed which report on caregiver involvement in DBT.

Mental health nurses' perception of self-harm among people receiving psychiatric care in the Kingdom of Saudi Arabia.

Mental health nurses (MHNs) play an important role in dealing with those receiving psychiatric care for self-harming behaviour. How nurses perceive this group of people is pivotal to timely prevention of such harmful behaviour. This project aimed to assess MHNs perception of self-harming behaviour among those receiving psychiatric care in the Kingdom of Saudi Arabia (KSA). Descriptive research was conducted with 400 nurses at governmental hospitals affiliated to the Ministry of Health and Population (MOHP) in the KSA. Data were collected using an online survey and questionnaire: the survey was divided into two sections: one concerned with demographic characteristics of the participants, the second section focusing on their workplace characteristics. The Self-Harm Antipathy Scale-Swedish Revision (SHAS-SR) was used to assess perceptions of self-harm among MHNs. This scale included 19 items categorized into five subscales. Finding showed that more than half of nurses had a low perception of those who self-harmed. Additionally, there was a highly significant association between the nurses' total self-harm perception scores and their workplace characteristics. Promoting person-centred care to those who self-harm through the creation of a collaborative nurse-patient relationship, may improve insight and understanding of the behaviour. Continuous professional development for staff who provide care for those who self-harm would promote better understanding of the behaviour. In addition, workshops, presentations and modelling good practice, are all key for transferring information into real-world applications for MHNs to provide better care for those who self-harm.

Population attributable fractions of adverse childhood experiences for emotional problems and self-harming behaviors among middle school students in China.

The population attributable fractions of health outcomes attributed to adverse childhood experiences (ACEs) among Chinese middle school students is unknown. Of all the 22,868 middle school students, 29.8 % had exposure to four or more ACEs. Findings showed a graded relationship between ACE scores and those adverse outcomes. The PAFs of six outcomes attributed to experiencing ≥4 ACEs ranged from 23.1 % to 44.2 %. The results emphasized the significance of preventive interventions to alleviate the negative legacies of ACEs.

Effect of Electronic Rounding Board on Falls and Self-harm Among Psychiatric Inpatients: Quality Improvement Project.

More than 1 million falls are reported in US hospitals each year. Psychiatric inpatients are at high risk for self-harm behaviors with reported suicide rate of 6.5 per 1000 patients. Patient observation is the primary risk management intervention in preventing adverse patient safety incidents. This project aimed to examine the effectiveness of handheld electronic rounding board (ObservSMART) implementation on falls and self-harm incidents among psychiatric inpatients. A retrospective review of adverse patient safety incidents was conducted to compare the 6-month preimplementation period versus the 6-month postimplementation period with staff training and implementation in July 2019. The monthly fall rates per 1000 patient-days were 3.53 versus 3.80 during the pre- and postimplementation periods, respectively. About one-third of the falls resulted in mild or moderate injuries for both periods. The incidence of self-harm was 3 versus 7 during the pre- and postimplementation periods, with incidence of 1 versus 6, respectively, among adult patients, who are more likely to hide self-harm. Although there were no changes in falls, the implementation of ObservSMART markedly increased the detection of patient self-harm, including self-injury and suicide attempts. It also ensures staff accountability and provides an easy-to-use tool to perform timely, proximity-based patient observations.

Role of the Psychiatric Nurse in Improving the Psychosocial Health of Families After Suicide

Suicide is defined as death that occurs as a result of deliberate self-harming behavior with the intention of ending one's life. Each suicide has many physical, economic and psychological short and long-term effects on the individual, family, friends and society. The death of an individual as a result of suicide creates a traumatic effect for family members and causes family members to experience various psychosocial problems. For this reason, it is very important to focus on the consequences of suicide in family members who have lost due to suicide, to evaluate the family's reactions to suicide, and to provide the needed psychosocial support. In this context, in this review, it is aimed to review the literature on the psychosocial problems experienced by families who have lost due to suicide and to present up-to-date information on the role of psychiatric nurse in improving the psychosocial health status of families.

Case Report on Emotionally Unstable Personality Disorder- Borderline Type [F60.31

Borderline personality disorder (BPD), is a mental illness that impacts a person’s ability to control their emotions. This breakdown in emotional regulation can make a person more impulsive, have a negative impact on how they feel about themselves, and damage their relationships with other people. Patients who are impacted frequently engage in self-harm and other risky behaviors because they find it difficult to bring their mental state back to a healthy or normal baseline. They might also suffer with disconnection from reality, a sense of emptiness, and a dread of abandonment. BPD often starts during early adulthood and manifests itself in a range of circumstances. BPD affects 1.6% of individuals annually, with some estimates going as high as 6%. About three times as many women than men are diagnosed. With age, the illness seems to become less prevalent. Over the course of ten years, up to 50% of people with BPD get better. The case report's detailed content is listed below. Keywords: Borderline personality disorder, abandonment, delusion, hallucination, cognitive behavior therapy.

Risk and protective factors associated with mental health status in an Italian sample of students during the fourth wave of COVID-19 pandemic

BackgroundIt is well known that the COVID-19 pandemic has caused a global health crisis, especially for young people. However, most studies were conducted during the first waves of the pandemic. Few Italian studies specifically attempted to broadly assess young people’s mental health status during the fourth wave of the pandemic.MethodsThis study aimed at evaluating the mental health status among a group of Italian adolescents and young adults during the fourth wave of the COVID-19 pandemic. 11,839 high school students and 15,000 university students (age range 14–25) were asked to complete a multidimensional online survey, of which 7,146 (26,6%) agreed to participate. The survey also included standardized measures for depression, anxiety, anger, somatic symptoms, resilience, loneliness and post-traumatic growth. Two separate clusters were identified through cluster analysis. Random forest, classification tree and logistic regressions analyses were applied to identify factors associated to a good or a poor level of mental health and, thus, to define students’ mental health profiles.ResultsOverall, the students in our sample showed high levels of psychopathology. The clustering methods performed identified two separate clusters reflecting groups of students with different psychological features, that we further defined as "poor mental health" and "good mental health". The random forest and the logistic regressions found that the most discriminating variables among those two groups were: UCLA Loneliness Scale score, self-harm behaviors, Connor-Davidson Resilience Scale-10 score, satisfaction with family relationships, Fear of COVID-19 Scale score, gender and binge eating behaviors. The classification tree analysis identified students’ profiles, showing that, globally, poor mental health was defined by higher scores of loneliness and self-harm, followed by being of female gender, presenting binge eating behaviors and, finally, having unsatisfying family relationships.ConclusionsThe results of this study confirmed the major psychological distress caused by the COVID-19 pandemic in a large sample of Italian students, and provided further insights regarding those factors associated with a good or poor mental health status. Our findings suggest the importance of implementing programs targeting aspects that have been found to be associated to a good mental health.

Parents of Adolescents Who Experience Suicidal Phenomena-A Scoping Review of Their Experience.

High prevalence rates of self-harm and suicide in adolescence provide unique challenges for parents. The aim of this scoping review was to explore key gaps in our understanding of the current scientific literature on the experience of parents who have adolescent children experiencing suicide crisis or self-harm. Four academic databases were searched using three broad concepts: self-harming behaviour or suicidal crisis; adolescents or young people; and the experiences or behaviour of parents, between journal inception and March 2022. Information reporting on the parents' experience was extracted and a qualitative synthesis was conducted. Twenty-two articles met inclusion criteria and were assessed in detail. The experience of parents with an adolescent engaged in self-harm or suicidal crisis were classified into three temporal themes: discovery of the suicidal phenomena, management of suicidal phenomena, and after the suicidal phenomena had ceased. Parents caring for an adolescent experiencing self-harm or suicidal crisis experience poorer psychological wellbeing, difficulty accessing support services, and changes in the parent-child relationship. Parents desire greater support for both themselves and their child and further investigation is required to understand specifically which supports would be most appropriate at each stage.

Brief admission—a promising novel crisis management method

Self-harm among children and adolescents is currently increasing and is strongly associated with suicide. 1 Griffin E McMahon E McNicholas F Corcoran P Perry IJ Arensman E Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007–2016. Soc Psychiatry Psychiatr Epidemiol. 2018; 53: 663-671 Crossref PubMed Scopus (81) Google Scholar Inpatient care in child and adolescent psychiatry has not yet evolved sufficiently to provide care that promotes the patient's autonomy and sense of self-determination, 2 Griffiths R Dawber A McDougall T Midgley S Baker J Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: systematic review and narrative synthesis. Int J Ment Health Nurs. 2022; 31: 35-50 Crossref PubMed Scopus (2) Google Scholar but there are various restrictive ways to handle impulsive self-harm and suicidal behaviours. 2 Griffiths R Dawber A McDougall T Midgley S Baker J Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: systematic review and narrative synthesis. Int J Ment Health Nurs. 2022; 31: 35-50 Crossref PubMed Scopus (2) Google Scholar Lengthy inpatient stays, coercive actions, and even forensic hospital admission have been used for life-saving purposes. 2 Griffiths R Dawber A McDougall T Midgley S Baker J Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: systematic review and narrative synthesis. Int J Ment Health Nurs. 2022; 31: 35-50 Crossref PubMed Scopus (2) Google Scholar Given the need for better approaches, it is crucial to study alternative ways to handle crises to prevent iatrogenic damage. 3 Cha CB Franz PJ Guzmán EM Glenn CR Kleiman EM Nock MK Annual research review: suicide among youth—epidemiology, (potential) etiology, and treatment. J Child Psychol Psychiatry. 2018; 59: 460-482 Crossref PubMed Scopus (258) Google Scholar Furthermore, coordinated treatment plans to prevent new crises by bridging the gap between inpatient and outpatient care are often obstructed by the different cultures of these care settings. To date, there are no standardised methods in child and adolescent inpatient care that ease or prevent self-harm without using coercive methods. New non-restrictive methods that reduce the need for lengthy constraining inpatient stays and promote continuity across inpatient and outpatient care are urgently required. 2 Griffiths R Dawber A McDougall T Midgley S Baker J Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: systematic review and narrative synthesis. Int J Ment Health Nurs. 2022; 31: 35-50 Crossref PubMed Scopus (2) Google Scholar Introducing brief admissions by self-referral in child and adolescent psychiatry: an observational cohort study in SwedenOur findings suggest that brief admissions can be successfully implemented in paediatric psychiatry and appear to be an effective crisis management method for adolescents, associated with reduced demand for emergency care. Future randomised controlled trials are warranted. Full-Text PDF

Frequency and predictors of individual treatment outcomes (response, remission, exacerbation, and relapse) in clinical adolescents with nonsuicidal self-injury.

Nonsuicidal self-injury (NSSI) is prevalent in adolescent clinical samples. There is evidence that NSSI can be treated effectively but data on individual treatment outcomes is limited. The goal of this study was to examine response, remission, exacerbation, and relapse rates over one and two years, respectively, among a clinical sample of adolescents with NSSI. Furthermore, we aimed to identify clinically relevant predictors of NSSI trajectories. The sample consists of n = 203 adolescents (12-17 y., 94% female) from a specialized outpatient clinic for risk-taking and self-harming behavior with NSSI on at least five days in the six months before first assessment. Assessments were completed at baseline and one (FU1) and two (FU2) years later using structured clinical interviews and self-report questionnaires. At FU1, 75% reported a reduction in NSSI frequency by at least 50% (treatment response); among those, one third (25% of the entire sample) achieved a remission (0 NSSI); an exacerbation (⩾50% more NSSI) was observed in 11% of patients. Of those in remission, 41% relapsed one year later. Predictors of non-response or non-remission were inpatient treatment and depressive symptoms. Adolescents with lower NSSI frequency at baseline had a higher risk of exacerbation. Due to limited sample size at FU2 no prediction model for relapse was established. While most adolescents presenting with NSSI achieved significant improvement, more attention should be paid to the rather low rates of full remission. Prediction and early detection of individuals who deteriorate during or relapse after treatment is critical.

Family functioning and self-harm behaviors in adolescents and young people in the municipality of Valledupar-Colombia

Introduction: There are risk factors associated with the life cycle of adolescence and early adulthood, such as depression and hopelessness, disappointment and guilt at the impossibility of meeting parental expectations, family problems, a history of suicide in relatives, friends, and/or colleagues, difficulties in communication, a tendency to isolation, few interpersonal relationships, abuse of psychoactive substances, cuts or blows to the body, ideas, fantasies or previous attempts, considering suicide as a heroic act. Suicidal ideation and behavior in adolescence and youth is a public health problem with emotional, family, economic, and social consequences.

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.

The prevalence of mental illness in young people in custody over time: a comparison of three surveys in New South Wales

Few studies have examined the prevalence of mental illness in young people over time within the same jurisdiction. In the current study, we compared data from three large surveys of youth in custody in New South Wales, conducted in 2003, 2009 and 2015. We examined rates of mental illness, self-harm and suicidal behaviours, substance use and childhood trauma and found little consistent change over time, though some fluctuations were observed regarding certain mental illnesses and substance use. We also descriptively compared findings with observed rates for the general population and found that young people in custody showed higher levels of all examined variables. In sum, these data suggest little improvement in the well-being of young people in custody in New South Wales over time. Better identification and treatment of these issues are vital if young people are to be prevented from becoming enmeshed in the criminal justice system.

Harmonisation of welfare indicators for macaques and marmosets used or bred for research.

Background: Accurate assessment of the welfare of non-human primates (NHPs) used and bred for scientific purposes is essential for effective implementation of obligations to optimise their well-being, for validation of refinement techniques and novel welfare indicators, and for ensuring the highest quality data is obtained from these animals. Despite the importance of welfare assessment in NHP research, there is little consensus on what should be measured. Greater harmonisation of welfare indicators between facilities would enable greater collaboration and data sharing to address welfare-related questions in the management and use of NHPs. Methods: A Delphi consultation was used to survey attendees of the 2019 NC3Rs Primate Welfare Meeting (73 respondents) to build consensus on which welfare indicators for macaques and marmosets are reliable, valid, and practicable, and how these can be measured. Results: Self-harm behaviour, social enrichment, cage dimensions, body weight, a health monitoring programme, appetite, staff training, and positive reinforcement training were considered valid, reliable, and practicable indicators for macaques (≥70% consensus) within a hypothetical scenario context involving 500 animals. Indicators ranked important for assessing marmoset welfare were body weight, NHP induced and environmentally induced injuries, cage furniture, huddled posture, mortality, blood in excreta, and physical enrichment. Participants working with macaques in infectious disease and breeding identified a greater range of indicators as valid and reliable than did those working in neuroscience and toxicology, where animal-based indicators were considered the most important. The findings for macaques were compared with a previous Delphi consultation, and the expert-defined consensus from the two surveys used to develop a prototype protocol for assessing macaque welfare in research settings. Conclusions: Together the Delphi results and proto-protocol enable those working with research NHPs to more effectively assess the welfare of the animals in their care and to collaborate to advance refinement of NHP management and use.

A Rapid Systematic Review of the Prevalence of Suicide and Self-Harm Behaviors in Adolescents During the COVID-19 Pandemic.

Background: COVID-19 has caused psychological, social, and physical isolation in adolescents resulting in varying rates of suicidal behavior and self-harm. Aims: We investigated the pandemic's impact on adolescent suicidal behavior and self-harm by reviewing the existing literature. Methods: We searched PubMed using keywords: adolescent, suicide, suicidal behavior, self-harm, prevalence, and COVID-19 and included studies reporting primary data only. Results: Of the 551 studies identified, we included 39 studies in the final analysis. Two of the six high-quality population-based suicide registry studies reported increased suicide rates during the pandemic. Seven of fifteen emergency department-based studies out of which four were of high quality and three high-quality population-based health registry studies reported increased self-harm. A few school and community-based surveys and national helpline data also reported an increase in suicidal behavior or self-harm. Limitations: Methodological heterogeneity of the included studies. Conclusions: There is wide variation in study methodology, population, settings, and age groups in the included studies. Suicidal behavior and self-harm were increased in specific study settings and adolescent populations during the pandemic. More methodologically rigorous research is needed to evaluate the impact of COVID-19 on adolescent suicidal behavior and self-harm.