Self-harm Behaviors Research Articles

BDNF and stress/mood-related interactions on emotional disorder symptoms, executive functioning, and deliberate self-harm

Some prior research has suggested that the brain-derived neurotrophic factor (BDNF) gene may amplify responses related to life stress (e.g., depression and anxiety) or associated with negative moods (e.g., self-harm and diminished cognitive functioning). The purpose of this study was to investigate whether stress/mood-related associations with depressive and anxiety symptoms, deliberate self-harm, and executive functioning (EF) are moderated by genotypic variations in BDNF rs10835210 (a relatively understudied BDNF polymorphism) in a nonclinical sample. As part of a larger study, European American social drinkers (N = 132; 43.9% female; M age = 26.0, SD = 7.6) were genotyped for BDNF rs10835210 and were administered self-report measures of subjective life stress, depressive and anxiety symptoms, and history of non-suicidal self-injury (NSSI) and behavioral measures of EF and deliberate self-harm. Results indicated that BDNF significantly moderated the life stress associations with depressive symptoms and NSSI, the anxious mood association with EF, and the depressed mood association with deliberate self-harm behavior. Each of these BDNF × stress/mood interactions were characterized by stress/mood associations that were stronger in individuals with the AA genotype (homozygous for the minor allele) than in individuals possessing a genotype that included the major allele (AC or CC). The main limitations of the present study were use of a cross-sectional design, modest sample size, and investigating only one BDNF polymorphism. Despite these limitations and though preliminary, current findings suggest that variations in BDNF may confer vulnerability to stress or mood, which may result in more adverse emotional, cognitive, or behavioral outcomes.

Understanding Filipino Jail Detainees’ Self-Harming Behavior: A Grounded Theory Explortion

This grounded theory exploration aims to advance a theory that explains the development of self harming behavior (SHB) among a select group of Filipino jail detainees. Using the Classical Glaserian Grounded Theory procedure, a novel process that describes Filipino Detainees’ Phases of Self Harming Behavior (gravitational, transformational, interventional and dispositional) emerged. Findings from this inquiry may serve as bases for policy-making and intervention programs that inform the triggers and preventative factors associated with SHB in the penal setting. These may further raise awareness of forensic mental health and human rights violations among detainees in flawed justice systems in low-to-middle income countries (LMICs).

Joint Contributions of Depression and Insufficient Sleep to Self-Harm Behaviors in Chinese College Students: A Population-Based Study in Jiangsu, China.

Self-harm in young people is common, and previous studies have shown that insufficient sleep or depression was associated with self-harm. However, the joint association of insufficient sleep and depression with self-harm is unknown. We employed representative population-based data from the "Surveillance for Common Disease and Health Risk Factors Among Students in Jiangsu Province 2019" project. College students reported their self-harm behavior over the past year. Rate ratios (RRs) and corresponding 95% confidence intervals (CIs) for self-harm in relation to sleep and depression were modeled using negative binomial regression with a sample population as an offset, adjusting for age, gender, and region. The instrumental variable approach was used for the sensitivity analyses. Of the study population, approximately 3.8% reported self-harm behaviors. Students with sufficient sleep experienced a lower risk of self-harm than those with insufficient sleep. Compared with students with sufficient sleep and the absence of depression, the adjusted risk of self-harm was elevated 3-fold (1.46-4.51) in those reporting insufficient sleep in the absence of depression, 11-fold (6.26-17.77) in those with sufficient sleep and definite depression, and 15-fold (8.54-25.17) in those with both insufficient sleep and definite depression. The sensitivity analyses indicate that insufficient sleep remained a contributing risk factor for self-harm. Lack of sleep in young people is significantly associated with self-harm, particularly in the presence of depression. The provision of mental health care and attention to sleep deprivation are particularly important for college students.

The five self-harm behavior groupings measure: empirical and thematic data from a novel comprehensive self-harm assessment.

The Five Self-Harm Behavior Groupings Measure (5S-HM) is a novel assessment that evaluates behaviours which may go undetected by existing measures. Self-harm is formulated across directness and lethality spectra, including under-studied behaviors such as indirect self-harm, harmful self-neglect and sexual self-harm. Aims of the study were to: (1) empirically evaluate the 5S-HM; (2) to determine whether the 5S-HM generates relevant new information with respect to the forms and functions given by participants for self-harm within a clinical sample; (3) to test the utility and novel contributions of the Unified Model of Self-Harm and the 5S-HM by extension. Data were collected from N = 199 individuals (Mage = 29.98, SD = 8.41, 86.4% female), receiving specialized evidence-based treatments for self-harm, borderline personality disorder or eating disorders. Construct validity was determined via Spearman correlations, and internal consistency was established from Cronbach's alpha. Inductive thematic analysis was used to analyze and interpret qualitative data on reasons, forms and functions participants reported in relation to self-harm following Braun and Clarke's analytic guidelines. Thematic mapping was used to summarize qualitative data. Test-retest reliability on a subsample of n = 24, tested 14 days after Time 1 was supported by a good intraclass correlation (0.68). Internal consistency (Cronbach's alpha = 0.75) was acceptable to good, as was construct validity comparing the 5S-HM total score to two validated self-harm measures (rho = 0.40, p < 0.01; rho = 0.26, p < 0.01). A thematic map depicting antecedents and consequences of self-harm over time suggests that self-harm is initiated by negative emotional states and self-intolerance. Novel findings in relation to sexual self-harm indicated that reasons for these behaviors were either to improve or worsen one's situation through being hurt by someone else. The empirical analyses of the 5S-HM demonstrate that it is a robust measure for use in clinical and research settings. Thematic analyses proposed explanations for why self-harm behaviors are initiated and how they are reinforced over time. Sexual self-harm in particular requires further careful study.

Significant Increase in Deliberate Self-Poisonings Among Adolescents During the Second Year of the COVID-19 Pandemic

PurposeThe COVID-19 pandemic has been associated with a decline in mental health of adolescents. The aim of this study was to analyze the rate of deliberate self-poisonings (DSPs) among adolescents reported to the Dutch Poisons Information Center before and during the COVID-19 pandemic. MethodsA retrospective study from 2016 until 2021 was performed to characterize DSPs among adolescents, and to analyze trends in the number of DSPs. All DSPs among adolescents with the age of 13 up to and including 17 years were included. DSP characteristics included: age, gender, bodyweight, used substance, dose, and treatment advice. Trends in the number of DSPs were analyzed using time series decomposition and Seasonal Autoregressive Integrated Moving Average models. ResultsSix thousand nine hundred fifteen DSPs in adolescents were recorded from January first 2016 until December 31st 2021. Females were involved in 84% of adolescent DSPs. A strong increase in the number of DSPs was observed in 2021 (45% increase compared to 2020), which deviated from the predicted trend based on previous years. This increase was most prominent in 13-, 14-, and 15-year-old female adolescents. Commonly involved drugs were paracetamol, ibuprofen, methylphenidate, fluoxetine, and quetiapine. The contribution of paracetamol rose from 33% in 2019 to 40% in 2021. DiscussionThe strong increase in the number of DSPs during the second year of the COVID-19 pandemic suggests that long-term containment measures such as quarantines, lockdowns, and school closures may enhance self-harm behavior among adolescents, especially among younger females (13–15 years of age), with a preference for paracetamol as DSP substance.

The incidence and profile of self-harm among prisoners: findings from the Self-Harm Assessment and Data Analysis Project 2017–2019

PurposeInternationally, rates of suicide and lifetime self-harm are higher in prisoners compared to the general population. This study aims to identify specific characteristics of self-harming behaviour and to establish a profile of prisoners who engage in self-harm.Design/methodology/approachData from the Self-Harm Assessment and Data Analysis Project (SADA) on self-harm episodes in prisons in the Republic of Ireland during 2017–2019 was used. Annual rates per 1,000 were calculated by age and gender.FindingsThe rate of self-harm between 2017 and 2019 was 31 per 1,000 prisoners for men and six times higher at 184 per 1,000 prisoners for women. The rate of self-harm was twice as high among prisoners on remand than sentenced prisoners (60.5 versus 31.3 per 1,000). The highest rates of self-harm among sentenced prisoners were observed among 18–29-year-old men (45 per 1,000) and women (125 per 1,000). The rate of self-harm was higher among women prisoners in all age groups. Contributory factors associated with self-harm were mainly related to mental health but also linked to a prisoner’s environment and relationships.Practical implicationsThere is a need to ensure access to timely and suitable mental health services, including both appropriate referral and provision of evidence-based mental health interventions to address the needs of these cohorts.Originality/valueTo the best of the authors’ knowledge, this is the first national study to systematically examine incidence and patterns of self-harm among the prison population in Ireland. The recording of severity/intent of each episode is novel when assessing self-harm among the prison population.

Understanding self-harm and suicidal behaviours in South Asian communities in the UK: systematic review and meta-synthesis.

Previous findings have indicated that self-harm and suicide are associated with different rates, and different risk and protective factors in South Asian people compared with White people in the UK. Substantial qualitative research has explored experiences of self-harm and suicide in South Asian people. The study aims to review the existing qualitative evidence on self-harm and suicidal behaviours in South Asian communities in the UK. Systematic searches were conducted on Medline, EMBASE, PsycINFO, CINAHL, Open Dissertations and the British Library Ethos databases. We selected qualitative studies from both journals and grey literature that included South Asian participants who were resident in the UK and presented perceptions or experiences of self-harm and/or suicidal behaviour. Analysis was undertaken based on the meta-ethnographic approach. Fifteen studies were included in the analysis. Experience of self-harm was discussed based on three aspects: behind self-harm, functions of self-harm and recovery from self-harm. 'Behind self-harm' refers to factors associated with self-harm and suicide. 'Functions of self-harm' captures the meaning attributed to self-harm and suicide. 'Recovery from self-harm' encapsulates personal and professional help, and practical suggestions for the improvement of mental health services. Although some similarities with the majority White population were present, there were also crucial differences that need consideration when shaping health policies, improving access to health services and developing culturally sensitive psychosocial interventions for self-harm and suicide specific to South Asian communities in the UK.

Planned improvement actions based on patient safety incident reports in Estonian hospitals: a document analysis

AimAim of this study was to describe and analyse associations of incidents and their improvement actions in hospital setting.MethodsIt was a retrospective document analysis of incident reporting systems’ reports registered...

A Suicide-Specific Diagnosis – The Case Against

A Suicide-Specific Diagnosis – The Case Against

Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities-Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment.

Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically.

Self-Harm Behaviors, Suicide Attempts, and Suicidal Ideation in a Clinical Sample of Children and Adolescents with Psychiatric Disorders

Suicidal ideation and self-harm behaviors have been found to be important risk factors for suicide. The aim of this study was to explore the rates of psychiatric disorders among different groups of patients with suicidal ideation, suicide attempts, and non-suicidal self-harm behaviors and to identify the associated socio-demographic and clinical variables. We conducted a cross-sectional study with emergency-admitted patients presenting with non-suicidal self-harm behaviors, suicide attempts, or suicidal ideation to the emergency room of the Child and Adolescent Psychiatry Clinic in Cluj-Napoca, Romania. Data were collected from the patients' charts using a questionnaire that contained socio-demographic and clinical variables. A total of 95 patients aged between 6 and 18 years were included in the study. Ingesting medication and cutting were the most frequently used methods to attempt suicide. Depression and mixed affective and conduct disorders were the diagnoses most commonly associated with suicidal behavior. Girls with depressive symptoms were more probable to have suicide attempts than boys, and girls with depressive symptoms and behavioral problems registered more self-harm behaviors. Further research should systematically examine the relationship between self-harm behaviors and suicide attempts and the profile of patients at risk of future suicide attempts.

COVID-19 and Pediatric Mental Health Hospitalizations

To analyze Australian national data to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health-related hospital presentations among children and adolescents during the pandemic period with restrictions, and the period after the restrictions eased. We analyzed the monthly mental health-related inpatient admissions and emergency department (ED) attendances data from 6 large pediatric hospitals across Australia, using the Bayesian structural time series models. The COVID-19 restriction period was from March 2020 to December 2021 and the COVID-19 restriction-eased period from January to June 2022. A total of 130 801 mental health-related hospital admissions (54 907) and ED attendances (75 894) were analyzed. During the COVID-19 restriction period, there was a significant increase in inpatient admissions related to deliberate self-harm behaviors (82%, 95% credible interval [CrI], 7%-160%) and ED attendances related to overall mental health disorders (15%, 95% CrI, 1.1%-30%) and eating disorders (76%, 95% CrI, 36%-115%). The increase was higher among females and those living in the least socioeconomically disadvantaged areas, suggesting a widening gap between mental health-related presentations by sex and socioeconomic status. After the restrictions eased, there were slight declines in mental health-related hospital presentations; however, the numbers remained higher than the pre-COVID-19 levels. The increase in mental health-related hospital presentations during the COVID-19 period calls for additional support for pediatric mental health care, particularly for eating disorders and deliberate self-harm among female adolescents. It is important to monitor pediatric mental health service use as we enter "COVID-19 normal" period.

Suicidality risk in children and adolescents with externalizing disorders: symptoms profiles at high risk and the moderating role of dysregulated family relationships.

Children and adolescents with externalizing disorders are at risk for suicidal ideation or behavior. Factors that put them at risk could be symptoms related or facilitated by their environment. We evaluated the links of symptoms profiles with suicidality, and the effects of family relationship characteristics on these links. Latent profile analysis was used to subgroup participants referred for ADHD assessment (n = 1249, aged 6-17) based on their externalizing and internalizing symptoms. Self- and parent-reported child suicidal ideation (S-SI, P-SI), and parent-reported self-harm behavior (P-SHB) were compared across profiles. The moderating effects of parent-reported marital conflict and parenting practices were examined. A four-profile model showed optimal fit. Participants of the Low Symptoms profile followed by the Inattentive-Hyperactive/Impulsive profile showed lower P-SI compared to those of the Irritable-Defiant and the Conduct Problems profiles. Low Symptoms participants also reported lower S-SI compared to those of the Inattentive-Hyperactive/Impulsive and the Irritable-Defiant profiles. Participants of the Irritable-Defiant and the Conduct Problems profiles had higher P-SHB compared to the Low Symptoms and the Inattentive-Hyperactive/Impulsive participants. Dysregulated marital conflict practices were associated with greater increase in P-SI in all profiles compared to the Low Symptoms profile. Aggressive marital conflict practices were associated with increased P-SHB in the Conduct Problems profile compared to the Inattentive-Hyperactive/Impulsive profile. Children and adolescents with irritability and defiance symptoms with or without conduct problems show higher risk for suicidal ideation and behavior compared to those with ADHD symptoms alone. Dysregulated and aggressive marital conflict practices might pose additional suicidality risk in children and adolescents with disruptive behavior.

The riddle of deliberate self-harm: Physiological and subjective effects of self-cutting cues in patients with borderline personality disorder and healthy controls.

Self-harming behavior is a core symptom of borderline personality disorder. Self-report studies show a correlation between a lack of self-reported negative feelings toward self-cutting cues and the likelihood of future self-destructive behavior. Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50 years of age were confronted with pictures of self-cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self-Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self-cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self-cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self-cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long-lasting consequences of self-cutting behavior in the patients. Implications for therapy are discussed.

Adverse childhood experiences as a risk factor for non-suicidal self-injury and suicide attempts in forensic psychiatric patients

BackgroundExposure to adverse childhood experiences (ACE) have been found to have profound negative consequences on an individuals’ health. Non-suicidal self-injury (NSSI) is a clinically complex and serious global health issue and is closely related to suicide attempts. Previous research has found associations between ACE and NSSI and suicide attempts in clinical samples. However, this association has to our knowledge not been studied to this extent in a sample of forensic psychiatric patients. The aim of this study was therefore to describe the prevalence of adverse childhood experiences (ACE) and their associations with non-suicidal self-injury (NSSI) and/or suicide attempts in forensic psychiatric patients.MethodsThe current study is a cross-sectional study of a consecutive cohort of 98 forensic psychiatric patients (86.7% male) in Sweden. We invited 184 patients with a predicted stay of > 8 weeks who had been cleared for participation by their treating psychiatrist. Of these, 83 declined and 98 eligible patients provided informed consent. Information on ACE, NSSI, and suicide attempts derived from files, self-reports (Childhood Trauma Questionnaire-Short Form; CTQ-SF), and interviews were compared separately among participants with and without NSSI or suicide attempts using t-tests. The dose–response association between ACE and NSSI/suicide attempts was analysed using binary logistic regression.ResultsIn file reviews, 57.2% of participants reported physical abuse, 20% sexual abuse, and 43% repeated bullying by peers during childhood. NSSI and suicide attempts were associated significantly with CTQ-SF total scores, with medium effect sizes (d = .60 to .63, p < .01), and strongly with several CTQ-SF subscales. Parental substance abuse was also associated with NSSI (p = .006, OR = 3.23; 95% confidence interval [CI] = 1.36 to 7.66) and suicide attempts (p = .018, OR = 2.75; 95% CI = 1.18 to 6.42). Each additional ACE factor predicted an increased probability of NSSI (p = .016, OR = 1.29; CI = 1.04 to 1.59) but not of suicide attempts. When anxiety and depressive disorders were included in the model, ACE remained a significant predictor of NSSI.ConclusionsWe report extensive ACE, from both files and self-reports. When comparing groups, correlations were found between ACE and NSSI, and ACE and suicide attempts among forensic psychiatric patients. ACE seem to predict NSSI but not suicide attempts in this group, even when controlling for affective and anxiety disorders. Early ACE among forensic psychiatric patients, especially physical and emotional abuse and parental substance abuse, have important impacts on self-harming behaviours that must be acknowledged both by the institutions that meet them as children and in their later assessment and treatment.

The Risk-Taking and Self-Harm Inventory for Adolescents: Validation of the Italian Version (RTSHIA-I)

The aim of the present paper is to establish the factorial validity and reliability of the Risk-Taking and Self-Harm Inventory for Adolescents (RTSHIA), proposed by Vrouva and colleagues in 2010, in an Italian sample. The RTSHIA measures both Risk-Taking and Self-Harm behavior in adolescents. We administered the scale to a total of 1292 Italian adolescents from 9th to 12th grade; to verify the validity of the scale, we also assessed emotion regulation and psychopathological traits. The exploratory factor analysis (EFA) (N = 638) and the confirmatory factor analysis (CFA) (N = 660) confirmed the original two-factor structure of the RTSHIA (Risk-Taking and Self-Harm). The only differences in the Italian version of the RTSHIA (RTSHIA-I) were that one item was moved from the original Risk-Taking factor to the Italian Self-Harm factor, and another item that was not included in the original RTSHIA is now part of the Risk-Taking factor in the Italian version. The reliability of the RTSHIA-I is also confirmed, and both factors correlate with emotion regulation and externalizing/internalizing traits. Our results suggest that the RTSHIA-I is a useful tool for assessing Risk-Taking and Self-Harm behaviors in Italian adolescents, and the correlational patterns indicate that these behaviors may be related to difficulties in mentalization skills.

The Role of Childhood Trauma, Cognitive Flexibility, and Cognitive Distortions in Predicting Self-harming Behaviors among Female Adolescents

Background: Increasing public health concerns are being raised about adolescent self-harming behaviors. The previous study indicates that childhood trauma can be related to self-harm. Objectives: The study aimed to investigate the relationship between childhood trauma, cognitive flexibility, and cognitive distortions in predicting self-harming behaviors among female adolescents in Shahrood, Iran. Materials &amp; Methods: The research method was cross-sectional. The statistical population of the study included all female students in the junior high schools of Shahrood, Iran in the academic year 2022-23. A sample of 220 female adolescents (aged 13–15) was recruited through multi-stage sampling. Participants had at least one self-harming behavior in their clinical records. The child Trauma Questionnaire (CTQ), Cognitive Flexibility Inventory-Iranian Version, The Cognitive Distortion Scale, and Self-Harm Behavior Questionnaire were completed. Data were analyzed using the Pearson correlation coefficient and multivariate linear regression model. Results: The mean age of study participants was 13.70 (standard deviation=1.02), almost 73% of the samples were from 13 to 14 years old, and most students came from three- and four-member families (81%). Findings of multivariate linear regression revealed that childhood trauma (β=0.137, t=2.828) and cognitive distortions (β = 0.188, t=3.940) were positive and significant predictors of self-harming behaviors in adolescents. Moreover, Cognitive flexibility (β = -0.237, t=-4.957) was a negative and significant predictor of self-harming behaviors in adolescents. Conclusion: The results of this study may have implications for increasing mental health awareness among students and school programs to prevent self-harm.

457 Assessment of Mental Health Needs of Transgender Adults Seen at a Midwest Transgender Center

OBJECTIVES/GOALS: Prior studies suggest that transgender individuals are at greater risk of mental health problems. This study aims to determine the mental health care needs of the adult transgender population seen at a tertiary referral hospital in the Midwest region of the United States and assess necessary resources to provide optimal care. METHODS/STUDY POPULATION: This descriptive, retrospective, cross-sectional study included all new transgender patients &gt; 18 years old, seen at the Washington University Transgender Center since December 2019 through May 2022. Electronic medical record data obtained from their initial and subsequent follow-up visits include 1) Demographics: date of birth, age, race, ethnicity, sex assigned at birth, gender identity, zip code of residency 2) Mental health diagnosis: Previous mental health diagnosis, mental health history 3) Mental health care access: mental health providers, mental health treatment, previous mental health admission, resources provided in clinic. RESULTS/ANTICIPATED RESULTS: 487 patient records were reviewed. Median age at initial visit was 24 years (18 - 75 yr), with 46% identify as woman, 37% as man. Predominantly white (84%), 11% were black. 93% had primary health insurance At the first visit, 81% reported having some mental health diagnosis: depression (88%), anxiety (71%), attention deficit disorder (21%). Prior suicide attempt reported on 12% and 5% with self-harm behavior. Only 48% had a therapist and 22% had an established psychiatrist First follow up occurred with a median of 4 months (1-22 months). 4 patients reported new suicide attempt, 3 reported new self-harm behavior. 9 patients required a hospital admission due to a psychiatric condition. 4% reported a new mental health diagnosis (most common: depression and anxiety). No changes noted on access to therapist or psychiatrist DISCUSSION/SIGNIFICANCE: Our study shows that adult transgender individuals have high rates of depression, anxiety, and overall psychological distress which is exacerbated by poor access to mental healthcare. This indicates a critical need to include mental healthcare professionals during the evaluation of adult transgender individuals

Investigating the Effective Factors in the Formation of Deliberate Self-harm in Adolescence: Mental Health Professionals’ Viewpoints

Objective: This study aims to investigate the issues related to the formation and persistence of deliberate self-harm behavior in adolescents from Iranian mental health professionals’ viewpoints. Methods: The present qualitative study used semi-structured interviews to record the experiences of 9 mental health professionals with work experience in deliberate self-harm behavior in adolescence. The participants were selected via the purposive sampling method. The Sterling content analysis method was used to analyze the transcription of the interviews. Results: The semantic units of the interview were classified into 32 initial codes. The extracted sub-themes were as follows: A rejection of new identities, repression, the disintegration of social identity, materialism, economic poverty, unresolved parental conflicts, the lack of authority, the ambivalency between boundaries and freedom, shame, and guilt, blame, fear of harm, liberation, self-care, escape mechanism, and replacement, affect regulation, coping with self-disintegration and self-esteem, relationship conflicts with adults and peers, identity creation, identity disorder, boundless mental structure, lack of self-confidence, and distorted self-perception. The following four themes were categorized as subcategories of transformational injuries: Traumatic society, vulnerable family, interpersonal impact, and interpersonal effectiveness. Conclusion: Mental health specialists considered deliberate self-harm traumatic; however, they deem it for eliminating negative emotions and controlling the internal and external world of adolescents. Furthermore, they consider this behavior a reaction to cultural conflicts, cultural materialism, and the disintegration of identity and role during adolescence in families not being capable to facilitate low-risk transformation for adolescents because of economic and psychological factors.

Mental Health Conditions Among University Students

College students are one of the populations that are vulnerable to mental health disorders; various reasons can cause this. Sometimes there are triggers that cause students to feel that their mental health is not good, such as academic fatigue, academic stress, social support, and others. This study aims to find out how the mental health conditions at a university in Jakarta are described. The study involved 207 participants from 7 faculties using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Deliberate Self Harm Inventory questionnaires. The analysis technique used was accidental sampling, and the data analysis technique used the Independent Sample T-test. The results showed that men have lower levels of anxiety and depression than women, while women tend to hurt themselves more than men. In conclusion, every faculty has students who experience anxiety disorders, depression, and self-harm behavior. As for this research, it can be used as additional data from previous research, especially at the University where this study was taken. The limitations of this research are in the aspects of the sampling method and the limitations of measuring instruments.