Self-harm Research Articles

ABORDAGEM FISIOTERAPÊUTICA NA REABILITAÇÃO DE PACIENTES COM EVALI

Electronic devices, commonly known as electronic cigarettes, aim to offer an alternative to traditional cigarette consumption, presenting similarities with these, but with the advantage of reducing the smoking habit and, according to their advertisements, causing less damage to users' health. This bibliographic review includes studies published from 2013 to 2024, selected through the Medline/PubMed, SciELO and LILACS databases. The pathophysiology of EVALI involves pulmonary surfactants, phagocytosis of inhaled particles and mucociliary clearance, essential factors for airway health. Respiratory physiotherapy emerges as an essential intervention for the rehabilitation and management of respiratory complications. The physiotherapeutic approach allows not only to minimize the risk of self-inflicted lung injuries, but also to help prevent muscle atrophy and optimize alveolar ventilation, promoting a safer and more efficient recovery.

Assessing the contributions of gender, clinical symptoms, and psychometric traits to non-suicidal self-injury behaviors in Chinese adolescents: a nomogram approach.

Non-suicidal self-injury (NSSI) behaviors among adolescents with mood disorders represent a significant global public health concern. This study aimed to assess the prevalence and identify key predictors of NSSI behaviors in Chinese adolescents diagnosed with depressive or bipolar disorders, addressing a critical gap in the literature. Data from 2343 participants in the Chinese Adolescent Depression Cohort (CADC) were analyzed. The study employed a comprehensive approach, utilizing medical records, clinical assessments, and validated psychometric instruments. Statistical analyses included chi-square tests, logistic regression, and ROC curve analyses, culminating in the development of a predictive nomogram. The prevalence of NSSI behaviors was strikingly high at 73.32%. Significant predictors included female gender (AOR = 2.14, 95% CI [1.70, 2.68]), presence of hallucinations (AOR = 1.52, 95% CI [1.18, 1.97]), borderline personality features (AOR = 1.03, 95% CI [1.01, 1.08]), and childhood trauma (AOR = 1.02, 95% CI [1.01, 1.03]). The study's key contribution is a predictive nomogram with an AUC of 0.74, demonstrating good efficacy in predicting NSSI behaviors. This research reveals an alarmingly high prevalence of NSSI behaviors in Chinese adolescents with mood disorders and identifies critical predictors spanning demographic, clinical, and psychometric domains. The developed nomogram offers a novel approach for risk assessment, highlighting the importance of comprehensive evaluations in adolescent mental healthcare. These findings have significant implications for developing targeted interventions and improving risk assessment strategies in clinical practice.

Public attitudes and knowledge about self-injury: A cross-sectional web-based survey of Japanese adults.

Nonsuicidal self-injury is common among adolescents. Dispelling related public misconceptions is essential for creating effective prevention and intervention strategies, as these myths contribute to stigmatization. This study examined the prevalence of self-injury myths among the Japanese public and explored how demographics and personal experiences influence these beliefs. A nationwide web-based self-report survey of 2000 Japanese adults (mean age = 44.6 ± 14.3 years) examined their agreement with 14 scientifically unsupported self-injury beliefs. Endorsement rates for each myth were calculated, and the associations between myth beliefs and other variables were explored. Fourteen myths were analyzed, with endorsement rates of 21.0%-68.7%. Logistic regression analysis indicated that men were more likely to endorse the myth that self-injury is uncommon (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI] = 1.17-1.79), whereas women were more prone to myths about the rarity of self-injury, using a single method, stimulation as the exclusive purpose, wrist-cutting prevalence, and average onset age. Younger participants were more likely to believe that self-injury is solely for stimulation than other age groups. Those with human-service professional experience were more likely to view self-injury as attention-seeking compared to those without such experience (AOR = 1.62, 95% CI = 1.07-2.46). With some exceptions, individuals who expressed confidence in their ability to respond to self-injurers were more likely to endorse the myths. These findings highlight the need for targeted educational interventions to dispel misconceptions about self-injury and improve public understanding of this complex behavior.

Virtual Mental Health Care and Suicide-Related Events

The rising suicide rates in the US emphasize the need for effective prevention. While telehealth has transformed access to mental health care, the impact of telehealth on suicide outcomes is unknown. To evaluate the association of virtual mental health services with individual-level suicide-related events (SREs). This retrospective cohort study using broadband access as an instrumental variable assessed a national sample of Veterans Health Administration patients who received mental health care between March 1, 2020, and December 31, 2021. Participants were recently separated (ie, discharged or released from active duty) veterans who completed their active duty service between March 1, 2019, and December 31, 2020, and who received at least 2 outpatient or inpatient diagnoses related to major depressive disorder, substance use disorder, or posttraumatic stress disorder within the year before their most recent separation date. Data were analyzed May 1 to October 31, 2023. Percentage of a patient's total mental health visits that were conducted virtually by psychiatrists, psychologists, or social workers within a calendar month. Binary measure indicating whether the patient had experienced an SRE (defined as a nonfatal suicide attempt, intentional self-harm, or suicide death) in a specific month and year as evaluated an instrumental variable probit model. The sample included 66 387 data points from 16 236 unique recently separated veterans. Among these entries, 44 766 were for male veterans (67.4%), the mean (SD) age across the sample was 32.9 (8.9) years, and the sample was representative of the US veteran population. There were 929 SREs (1.4%). Virtual mental health visits comprised a mean (SD) of 44.6% (46.1%) of all mental health visits. In instrumental variable probit analyses accounting for factors simultaneously associated with use of virtual mental health care and SRE risk, a 1% increase in the probability of virtual mental health visits was associated with a 2.5% decrease in SREs. Findings from this cohort study using a retrospective quasi-experimental design found that an increase in virtual mental health visits relative to total visits was associated with a statistically significant decrease in SREs, suggesting that providing virtual mental health services may reduce suicide-related outcomes.

Self-injury and suicidal behaviors in high-risk adolescents: Distal predictors, proximal correlates, and interactive effects of impulsivity and emotion dysregulation.

Suicide rates are rising among U.S. youth, yet our understanding of developmental mechanisms associated with increased suicide risk is limited. One high-risk pathway involves an interaction between heritable trait impulsivity and emotion dysregulation (ED). Together, these confer increased vulnerability to nonsuicidal self-injury (NSSI), suicide ideation (SI), and suicide attempts (SAs). Previous work, however, has been limited to homogeneous samples. We extend the Impulsivity × ED hypothesis to a more diverse sample of adolescents (N = 344, ages 12-15 at Baseline, 107 males and 237 females) who were treated for major depression and assessed four times over two years. In multilevel models, the impulsivity × ED interaction was associated with higher levels and worse trajectories of NSSI, SI, and SAs. As expected, stressful life events were also associated with poorer trajectories for all outcomes, and NSSI was associated with future and concurrent SI and SAs. These findings extend one developmental pathway of risk for self-harming and suicidal behaviors to more diverse adolescents, with potential implications for prevention.

Unleashing the Power of Induced Pluripotent stem Cells in in vitro Modelling of Lesch-Nyhan Disease.

Lesch-Nyhan disease (LND) is a monogenic rare neurodevelopmental disorder caused by a deficiency in hypoxanthine-guanine phosphoribosyltransferase (HPRT), the key enzyme of the purines salvage pathway. Beyond its well-documented metabolic consequences, HPRT deficiency leads to a distinctive neurobehavioral syndrome characterized by motor disabilities, cognitive deficits, and self-injurious behavior. Although various cell and animal models have been developed to investigate LND pathology, none have adequately elucidated the underlying mechanisms of its neurological alterations. Recent advances in human pluripotent stem cell research and in vitro differentiation techniques have ushered in a new era in rare neurodevelopmental disorders research. Pluripotent stem cells, with their ability to propagate indefinitely and to differentiate into virtually any cell type, offer a valuable alternative for modeling rare diseases, allowing for the detection of pathological events from the earliest stages of neuronal network development. Furthermore, the generation of patient-derived induced pluripotent stem cells using reprogramming technology provides an opportunity to develop a disease-relevant model within the context of a patient-specific genome. In this review, we examine current stem cell-based models of LND and assess their potential as optimal models for exploring key pathological molecular events during neurogenesis and for the discovering novel treatment options. We also address the limitations, challenges, and future prospects for improving the use of iPSCs in LND research.

Association between unintentional firearm injury characteristics and deaths in adolescents

BackgroundApproximately 15% of pediatric firearm injuries are unintentional. While demographic characteristics of unintentional firearm injuries have been described, the relationship between injury characteristics and mortality is not well understood. In this study, we identified injury characteristics associated with fatality among unintentional firearm injuries in adolescents.MethodsWe conducted a retrospective (May 2022-May 2023) cross-sectional study of unintentional firearm injuries among adolescents 12–17 years old using the Gun Violence Archive. Variables included victim age and sex, shooter age and sex, injury location, injury circumstance, number of firearms, type of firearm, firearm owner, census region, and shooter relationship to the victim. Logistic regression was used to identify variables associated with fatality.ResultsOf 319 unintentional incidents, 212 (66.5%) were non-fatal and 107 (34.5%) were fatal. Of all shootings, 176 (55.2%) occurred in a residence. A shooter was identified in 256 (80.3%) cases; 43.0% of these were a peer of the victim. The adjusted odds of fatality were higher when a peer was the shooter (aOR 5.38, 95% CI 2.57, 11.80) compared to self-inflicted injury and when the shooting took place in the victim’s residence (aOR 2.87, 95% CI 1.07, 7.88) or another residence (aOR 3.03, 95% CI 1.45, 6.67) versus a public location (Fig. 1).ConclusionsUnintentional firearm injuries were more likely fatal when a peer was the shooter and when the shooting occurred at a residence. This amplifies the importance of safe home firearm storage and exploring other evidence-based approaches to decreasing youth access to firearms.

The effectiveness and acceptability of formal versus informal mindfulness among university students with and without recent self-injury: A randomized controlled trial.

Mindfulness instruction comprising both formal (FM) and informal (IM) mindfulness practice is increasingly offered to university students. FM involves sustaining attention on thoughts, emotions and bodily sensations through structured practices, while IM involves incorporating mindfulness into daily activities. However, recent evidence suggests that FM may pose challenges for students with recent non-suicidal self-injury (NSSI), whereas the flexibility and brevity inherent in IM may be better tolerated. This randomized controlled trial compared a FM induction, IM induction and control task among university students with (n = 103) and without (n = 123) past-year NSSI in terms of acceptability and pre-post state mindfulness, stress and well-being. Notably, results did not differ as a function of NSSI history. Two-way ANOVAs revealed that only IM was consistently preferred over the control task. Furthermore, three-way mixed ANOVAs revealed that-when assessed using brief Visual Analogue Scales-state well-being increased in all conditions, state mindfulness increased after both IM and FM, and state stress only decreased after IM. Notably, these differences by condition appeared to be of short duration as they were not found with lengthier measures. Results highlight the potential promise of IM and the importance of measurement selection when assessing the transient effects of mindfulness inductions in research.

Interaction among negative mood, sleep, and diet habits in adolescents with non-suicidal self-injury: A cross-sectional network analysis

BackgroundNon-suicidal self-injury (NSSI) is a serious public health problem that can lead to adverse effects such as cognitive impairment, poor interpersonal relationships and violent crime. The progress of preventing and treating NSSI in adolescents depends on other changeable risk factors, such as negative mood, sleep, and diet habits. However, the risk factors for adolescent NSSI remain unclear. Therefore, this study explores the key factors influencing adolescents' NSSI behavior through the use of network analysis. MethodsThe study recruited 4040 middle school students aged 12–18 years old. From November 1st, 2023 to January 1st, 2024, paper questionnaires were utilized to investigate the participants' basic conditions, negative mood, NSSI, sleep conditions, and diet habits. Network analysis was used to explore the interrelationship among risk factors and discover the core factor. ResultsIn the network structure of adolescents with NSSI behavior, the most correlated nodes were negative emotions (CDI2) and low self-esteem (CDI3). Compared with adolescents without NSSI behavior, adolescents with NSSI behavior showed prominent anxiety symptoms related to injury avoidance (MASC1) and social anxiety (MASC2). Anhedonia (CDI1) was both the central node and the bridge node of the network. LimitationThe cross-sectional design of this study couldn't clarify the causal inference between independent variables and results. ConclusionAnhedonia is the key factor affecting adolescents' emotion regulation. Furthermore, we hypothesize that adolescent NSSI is an emotional disorder, and anhedonia plays an important role in preventing and intervening in adolescents' NSSI behavior.

The Role of the Bilateral Inferior Frontal Gyrus in Non-suicidal Self-injury (NSSI) among Depressed Adolescents: A Functional Near-infrared Spectroscopy (fNIRS) Study during Verbal Fluency Tasks

BackgroundThe diagnosis and treatment of adolescents engaging in non-suicidal self-injury (NSSI) have been a clinical focus. We examined the hemodynamic changes in verbal fluency tasks (VFT) of adolescents with depression and NSSI, and its association with NSSI indexes. MethodsSeventy-three adolescents with depression and NSSI and sixty-nine healthy controls (HCs) were employed. The VFT was performed by functional near-infrared spectroscopy (fNIRS). Independent-sample t-test, correlation analysis, and liner regression were measured. ResultsIn the VFT, reduced hemodynamic changes were found in the NSSI group, including thirteen channels. Totally seven ROIs were defined according to which brain region these channels had the largest coverage and other channels that also belonged to it. They are the right inferior frontal gyrus (RIFG, t = -2.53, FDR corrected p = 0.02), right middle frontal gyrus (RMFG, t = -3.47, FDR corrected p = 0.002), right superior frontal gyrus (RSFG, t = -2.98, FDR corrected p = 0.005), left middle frontal gyrus (LMFG, t = -3.26, FDR corrected p = 0.002), left inferior frontal gyrus (LIFG, t = -2.80, FDR corrected p = 0.001), left precentral gyrus (LPrCG, t = -2.22, FDR corrected p = 0.03), and left supramarginal gyrus (LSMG, t = -2.20, FDR corrected p = 0.03). Negative correlations were found between the frequency of NSSI and the bilateral IFG (RIFG, r = -0.28, p = 0.01; LIFG, r = -0.26, p = 0.03). BDI and BAI have positive correlations with the frequency of NSSI (BDI: r = 0.42, FDR corrected p < 0.001; BAI: r = 0.41, FDR corrected p < 0.001), but results of liner regression showed that both of them do not affect the association between the frequency of NSSI and hemodynamic changes in bilateral IFG (RIFG, p = 0.01; LIFG, p = 0.04). ConclusionAdolescents with depression and NSSI have worse performance in the VFT, and lower activation in the bilateral IFG may represent a higher frequency of NSSI. These results help physicians enhance the understanding of adolescents with depression and NSSI.

The association between aggressive behaviour and non-suicidal self-injury and shared risk factors in adults with mild intellectual disability.

Aggressive behaviour (AB) and non-suicidal self-injury (NSSI) are common in people with mild intellectual disability or borderline intellectual functioning, leading to adverse consequences for themselves and those around them. We investigated the relationship between AB (both total and physical in particular) and NSSI and risk factors in 125 residents in a treatment clinic using incident reports and standard clinical measurements. There was a weak correlation between AB and NSSI, as well as between impulsivity and total AB, and between coping and AB and NSSI. However, NSSI, impulsivity and coping skills did not predict AB. Results do not corroborate those of other studies in this area. In future studies impulsivity, coping, aggression and NSSI may be measured using other instruments, and differences between people with and without intellectual disability regarding these variables may be explored.

Exploring Unique Patterns of Self-Injury Recovery: A Latent Profile Analysis.

As nonsuicidal self-injury (NSSI) has become an increasing public health concern, the last few years have seen the emergence of efforts to address NSSI recovery. Although many recovery efforts adopt a medical view of self-injury and focus on cessation of the behaviour, recovery can mean many different things to different people. In this study, we provide initial empirical validation of the self-injury recovery framework, by assessing whether different recovery profiles exist. Our sample comprised 733 participants with lived experience of NSSI (M age = 24.54, sd = 6.39). Participants completed self-report measures of constructs related to NSSI recovery and NSSI characteristics. Using latent profile analysis, we identified six unique profiles reflecting differences in thoughts/urges to self-injure, self-efficacy, social support, optimism, coping, underlying adversities, perceptions of scarring, disclosure, resilience and self-compassion. Multivariate analyses of variance confirmed these profiles differed according to NSSI characteristics such as frequency of NSSI, a self-assessment of recovery, the desire to self-injure or avoid self-injury and the number of people disclosed to. A homogenous sample and cross-sectional design limit generalisability of our findings across populations and across time. Our findings reinforce that recovery can take many different forms, with different factors being relevant to different individuals. Adopting a person-centred approach that centres an individual's lived experience and emphasises what is important to them in the recovery process offers opportunities for more empathic responses to self-injury and better outcomes for individuals who self-injure.

Association between frailty and common psychiatric disorders: A bidirectional Mendelian randomization study

BackgroundThere is growing interest in exploring the relationship between frailty and common psychiatric disorders. However, there have been limited reports on the genetic variation level of frailty with psychiatric disorders. MethodWe conducted large-scale Two-sample Mendelian randomization (MR) analyses to examine whether there is an association between frailty and common psychiatric disorders (bipolar disorder [BD], major depressive disorder [MDD], schizophrenia, and suicide or other Intentional self-harm). We employed multiple MR approaches to conduct the MR analysis, including MR-Egger, weighted median, and random-effect inverse variance weighted (IVW). The IVW method served as the primary analysis. Heterogeneity testing and sensitivity analysis were also conducted in the MR study. ResultsThe MR results denoted that frailty was associated with an increased risk of BD (odds ratio (OR) =1.60, PIVW = 0.017), MDD (OR = 2.04, PIVW < 0.001), schizophrenia (OR = 1.91, PIVW = 0.005), and suicide or other Intentional self-harm (OR = 1.77, PIVW < 0.001). For reverse analysis, we observed no significant association between psychiatric disorders and the risk of frailty. These results remained consistent across sensitivity assessments. ConclusionsOur research indicates a potential unidirectional causal relationship, suggesting that frailty may serve as a risk factor for certain common psychiatric disorders. These findings carry important for implications for psychiatric disorders and frailty patient care.

Rumination, Loneliness, and Non-suicidal Self-injury among Adolescents with Major Depressive Disorder: The Moderating Role of Resilience

Rumination, Loneliness, and Non-suicidal Self-injury among Adolescents with Major Depressive Disorder: The Moderating Role of Resilience

The Role of Cognitive and Emotional Factors in the Relationship Between Childhood Trauma and Non-Suicidal Self-Injury Among College Students: A Network Analysis

The Role of Cognitive and Emotional Factors in the Relationship Between Childhood Trauma and Non-Suicidal Self-Injury Among College Students: A Network Analysis

Mapping punishment avoidance learning deficits in non-suicidal self-injury in young adults with and without borderline personality disorder: An fMRI study

IntroductionNon-suicidal self-injury (NSSI) is a growing public health concern among young adults in both clinical and non-clinical settings. Despite evidence linking NSSI to alterations in learning from reward and punishment, this area remains understudied, especially in non-clinical populations without borderline personality disorder (BPD). MethodsWe employed a modified version of the Probabilistic Stimulus Selection (PSS) task in two groups of young adults with recurrent NSSI, with (NSSI+BPD) and without BPD (NSSI), and an additional group of healthy controls (HC). While undergoing functional magnetic resonance imaging (fMRI), participants were asked to choose between pairs of stimuli with different reward probabilities. In the training phase, they received probabilistic feedback and learned to identify the most rewarding option within fixed pairs. In the test phase, these learned stimuli were recombined into novel pairs, where participants' accuracy in selecting the most rewarding and avoiding the most punishing options reflected their ability to learn from reward and punishment, respectively. ResultsCompared to HC, participants in the NSSI and NSSI+BPD groups were less accurate at avoiding the most punishing options than at choosing the most rewarding options, and showed reduced activity in the nucleus accumbens (NAcc) during punishment avoidance relative to reward selection. LimitationsThe modest sample size, descriptive rather than modeling approach, and absence of ecological momentary assessments may limit the results. ConclusionFindings suggest that reduced activation of the NAcc when avoiding loss may underlie difficulties in learning to avoid punishment in young adults with NSSI, regardless of the presence of BPD.

Gender-specific factors of suicidal ideation among high school students in Yunnan province, China: A machine learning approach.

Suicidal ideation (SI) assumes a pivotal role in predicting suicidal behaviors. The incidence of SI among high (junior and senior) school students is significantly higher than that of other age groups. The aim of this study is to explore the gender differences in SI among high school students in Yunnan Province. A total of 6180 students in grades 7-12 in Yunnan province, China from May 2021 to May 2022 participated in this survey. Univariate analysis was employed to describe the influencing factors of male and female students' SI. Subsequently, data were stratified by gender. Adopting machine learning technique, including Least Absolute Shrinkage and Selection Operator (Lasso) and Boruta algorithm, and logistic regression model to estimate the direction and effect magnitude of the influencing factors. The prevalence of SI was significantly higher for females (31.34%) than males (16.73%). The logistic regression model was established using the variables screened by Boruta algorithm, indicated that anxiety, depression, suffering emotion abuse or emotion neglect in childhood, non-suicidal self-injury, evening chronotype are common risk factors for SI in male and female students. Notably, female students who exhibited aggressive behavior, have experienced bullying, and were in the junior high school learning stage were more likely to report SI than their male counterparts. Females showed more vulnerability to SI than males especially among females in junior high school, reporting aggressive behavior and bullying experiences. Tailored prevention strategies, informed by these gender-related distinctions, should be developed and implemented.

Correlation Between Family Dysfunction and Nonsuicidal Self-Injury in a Sample of Chinese Adolescents: The Mediating Effect of Alexithymia and circRNA_103636

Correlation Between Family Dysfunction and Nonsuicidal Self-Injury in a Sample of Chinese Adolescents: The Mediating Effect of Alexithymia and circRNA_103636

Emotional Health Assessment in Students With Intellectual and Developmental Disabilities.

Students with intellectual and developmental disabilities (IDD) are likely to experience psychiatric symptoms, like depression, anxiety, and distress, throughout their lifetime. Due to communication differences and minimal use of specialized diagnostic assessments for anxiety and depression, emotional pain can often be overlooked or underestimated in students with IDD. This is often complicated by atypical presentations of anxiety and depression, such as externalized aggression, self-injurious behaviors, or other behavioral dysregulation, that can indicate emotional distress, physical pain, or other medical complications. School nurses play an important role in assessing for emotional and physical pain in students with IDD using assessment tools currently available and clinical judgment. Tools that have been created for use in this population may account for the diversity of communication, sensory, and developmental differences in students with IDD. Through leading education and advocacy for the interprofessional school team, school nurses can increase the access that students with IDD have to equitable emotional health evaluations and services. School nurses can also promote emotional wellness for students with IDD through the incorporation of mindful and community activities in the care plan.

Assessing suicidality in adult ADHD patients: prevalence and related factors

BackgroundThe association between Attention-deficit hyperactivity disorder (ADHD) and suicidality has been subject of growing interest for research in the latest years. Suicidality was generally assessed categorically and without the use of validated instruments, leading to heterogeneous or even conflicting evidence. The prevalence of both suicidal ideation and attempts varies considerably, and the associated risk factors remain unclear. Our study investigated suicidality in ADHD using a dimensional approach and a validated and internationally recognized instrument. Our primary aim was to evaluate the prevalence of suicidal ideation (SI), severe suicidal ideation (SSI), suicidal behavior (SB) and non suicidal self-injury behavior (NSSIB) in a sample of adult patients with ADHD. The second objective was to identify sociodemographic and clinical features associated with increased risk of suicidality in these patients.MethodsThe sample included 74 adult patients with clinical diagnosis of ADHD. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic regressions were used to examine predictors of SI, SSI, SB and NSSIB.ResultsThe lifetime prevalence of SI and SSI were 59.5% and 16.2%, respectively. The 9.5% of patients showed lifetime SB, while NSSIB was found in 10.8% of the subjects. Lifetime SI was associated with severity of inattentive symptoms during adulthood, low self-esteem and impairment in social functioning. Lifetime SSI appeared related to severity of inattentive symptoms during childhood, attentional impulsiveness and number of hospitalizations, while physical activity appeared to be protective. The prevalence of lifetime SB and NSSIB did not appear significantly related to any socio-demographic or clinical feature.ConclusionsAdults with ADHD should be considered at risk of suicide and it is important to determine which patients are at higher risk, in order to guide preventive interventions. The association between ADHD and suicidal ideation did not appear to be influenced by psychiatric comorbidities, but rather by inattention itself, which represents the core symptom of ADHD.