Self-harm Research Articles

Prospectively predicting 6-month risk for non-suicidal self-injury among adolescents after psychiatric hospitalization based on a predictive model

BackgroundIt is challenging to predict the occurrence of non-suicidal self-injury (NSSI) among adolescents over short periods. Moreover, the predictive value of indices for NSSI remains elusive. Thus, this study aimed to identify predictors of NSSI within 6 months among adolescents after psychiatric hospitalization by establishing a risk assessment model.MethodsA total of 632 high-risk participants were included in this study. The distribution characteristics of adolescent NSSI were initially assessed through a cross-sectional survey, following which risk factors were identified using logistic regression analysis. The risk score method was then used to construct a 6-month risk assessment model for NSSI. Lastly, the predictive effect of the model was evaluated by indicators such as the area under the receiver operating characteristic (ROC) curve and the positive predictive value.ResultsAfter 6 months, 412 cases of NSSI were identified. According to the logistic regression model, the frequency of relapses, medication status, and NSSI history were identified as influencing factors. Higher scores on the Impulsive Behavior Scale and Pittsburgh Sleep Quality Index were associated with a higher risk of NSSI. Conversely, higher scores on the Pain and Belief Perception Scale were correlated with a lower risk of NSSI. Moreover, the area under the ROC curve for the predictive model was 0.9989, with a 95% confidence interval of (0.9979, 0.9999), highlighting its high predictive ability and accuracy. The predictive model was validated using 78 patients, yielding an area under the ROC curve of 0.9703 and a 95% confidence interval of (0.9167, 0.9999), demonstrating outstanding predictability.ConclusionThese results collectively showed that the predictive model could accurately predict adolescent NSSI. Thus, the model’s primary variables may be applied to predict the risk of NSSI in the clinical setting.

Symptom Shifting From Nonsuicidal Self-Injury to Substance Use and Borderline Personality Pathology

ImportanceA decline in nonsuicidal self-injury (NSSI) behavior is often viewed as an indication of mental health improvement when treating adolescents and young adults with borderline personality pathology. However, evidence shows that an initial decrease in NSSI behavior does not always signal recovery, and potential symptom shifting needs to be considered.ObjectiveTo examine the codevelopment of NSSI and substance use in adolescents and young adults receiving treatment for NSSI behavior and to explore whether shifting from NSSI behavior to substance use is associated with emerging or persistent borderline personality pathology.Design, Setting, and ParticipantsThis cohort study used data from the AtR!Sk study. The study included a consecutive sample of adolescents and young adults with NSSI behavior who presented to a specialized outpatient clinic for early intervention of borderline personality pathology. A baseline assessment (between May 3, 2016, and December 19, 2019) and 2 annual follow-up assessments were conducted. Data were analyzed from April 15, 2023, to September 5, 2024.Main Outcomes and MeasuresThe frequencies of NSSI behavior and substance use were self-reported. Diagnostic interviews were carried out to assess borderline personality pathology. Growth mixture models were specified to identify latent classes with different joint trajectories of NSSI behavior and substance use, and the classes were compared for the number of fulfilled borderline personality disorder (BPD) diagnostic criteria.ResultsOverall, 277 adolescents and young adults (249 [89.9%] female; mean [SD] age at baseline, 14.9 [1.5] years) were included in the study (number at first follow-up, 135; number at second follow-up, 82). Three latent classes were extracted from the data. A decline in NSSI behavior following treatment was common. Class 1 (estimated class count: 32.5; 11.7% of participants) was further characterized by a decline in substance use; class 2 (210.1; 75.9% of participants), by a moderate increase in substance use; and class 3 (34.4; 12.4% of participants), by a strong increase in substance use. The number of fulfilled BPD diagnostic criteria in class 1 (mean [SE], 4.64 [0.40]; comparison: χ2, 11.64; P < .001) and class 3 (mean [SE], 4.29 [0.41]; comparison: χ2, 5.98; P = .01) was greater than that in class 2 (mean [SE], 3.18 [0.15]) at baseline. The number of fulfilled BPD criteria remained high at the second follow-up assessment in class 3 (mean [SE], 5.15 [0.84]) but not in class 1 (mean [SE], 2.05 [0.54]).Conclusions and RelevanceIn this cohort study of adolescent patients with NSSI behavior, a decline in this behavior was commonly paired with an increase in substance use. This finding suggests that a decrease in NSSI behavior alone may be insufficient to indicate treatment success. Monitoring the joint trajectories of NSSI behavior and substance use may be a promising avenue toward early detection and targeted treatment of adolescent borderline personality pathology.

Barriers to Youth Disclosing Self-Injurious Thoughts and Behaviors: A Focus on the Therapeutic Context

Objective Disclosure of self-injurious thoughts and behaviors (SITBs) can serve as a catalyst to receiving mental health and lifesaving care; yet, many young people do not disclose these experiences to their therapists. In this study we aimed to identify barriers to adolescents disclosing their SITBs to their therapists and to compare these barriers across non-disclosure of suicidal ideation, suicidal behavior, and non-suicidal self-injury. Method Participants (n = 292) all had lived experience of at least one SITB and were an average age of 15.55 years, with the majority identifying as cisgender girls (68.15%). Using inductive content analysis of open-ended responses, six main categories of disclosure barriers were identified. Results These overarching barriers were: Agency Theft, Irrelevance, Therapeutic (Mis)Alliance, Internalized Stigma, Anticipated Stigma, and Lacking Disclosure Self-Efficacy. The majority (85.29%) of subordinate barriers were common across the three SITBs. Conclusions Adolescents may hesitate to disclose their SITBs to their therapists for many reasons; prioritizing the therapeutic relationship and working collaboratively with adolescents could be instrumental in not only fostering disclosure but also an overall more positive therapeutic experience.

Transoral penetrating craniocerebral injury: a case report and literature review

A penetrating brain injury is a rare type of neurosurgical trauma associated with extremely high mortality and disability rates. Penetrating skull base injuries caused by arrows seldom occur because injuries caused by such weapons are more likely to be accidental. However, the number of self-inflicted injuries is increasing, and these injuries have varying patterns and high mortality rates. We report a case of a transoral penetrating craniocerebral injury caused by an arrow in a suicidal patient. Preoperative imaging is crucial for detecting and planning the surgical approach. Surgery is an effective treatment for this type of injury. Additionally, we reviewed previous case reports on this type of injury to provide recommendations for its clinical detection and treatment.

Self-Injury and the Treatment Gap: An Interdisciplinary Exploration of Beliefs About Causal Variables and Treatment Goals Among Caregivers, Researchers, and Clinicians

ABSTRACT Introduction There is a gap between individuals with intellectual and developmental disabilities (IDD) who need treatment for self-injurious behavior (SIB) and those who receive it. One contributing factor may be a multiplicity of beliefs about the nature of SIB and its treatment. Methods Using reflexive thematic analysis, we interviewed and integrated two knowledge sources: the perspectives of family caregivers for individuals with SIB and IDD and the perspectives of clinicians and researchers who treat and study self-injury. Results We present results from two primary belief categories: perceptions of causal variables and treatment goals. Conclusion By contextualizing the current paradigms of research and practice in self-injury as siloed depending on whether an individual does or does not have IDD, we discuss ways to deepen our understanding of the process of treatment provision for self-injurious behavior to inform efforts to close the treatment gap.

Exploring the Relationship Between Adverse Childhood Experiences and Non-suicidal Self-injury in Young Adults: The Role of Mental Health and Social Support

Exploring the Relationship Between Adverse Childhood Experiences and Non-suicidal Self-injury in Young Adults: The Role of Mental Health and Social Support

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.

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

ABSTRACTBackgroundAs 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.MethodsOur 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.ResultsUsing 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.LimitationsA homogenous sample and cross‐sectional design limit generalisability of our findings across populations and across time.ConclusionsOur 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.

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

Non-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' non-suicidal self-injurious behavior through the use of network analysis. The 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 factors. In 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. The cross-sectional design of this study couldn't clarify the causal inference between independent variables and results. Anhedonia is the key factor affecting adolescents' emotion regulation. Furthermore, we hypothesize that adolescent non-suicidal self-injury is an emotional disorder, and anhedonia plays an important role in preventing and intervening in adolescent non-suicidal self-injury behavior.

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.

Integrated psychiatric and surgical care in managing self-inflicted abdominal trauma: a case report in a resource-limited setting

Introduction and importance: Self-inflicted abdominal stab wounds present rare yet critical challenges requiring urgent surgical intervention and comprehensive psychiatric evaluation. Such injuries often correlate with psychiatric disorders like schizophrenia and alcohol dependence, posing significant clinical and psychological management hurdles. Case presentation: A 36-year-old male with a history of chronic alcohol use and schizophrenia presented with a self-inflicted stab wound to the abdomen following auditory hallucinations. Upon admission, he was hemodynamically unstable, with eviscerated bowel loops and a lacerated greater omentum. Prompt surgical exploration revealed extensive abdominal trauma necessitating meticulous repair and intensive postoperative care. Clinical discussion: The case highlights the intricate interplay between severe psychiatric illness and self-harm, exacerbated by alcohol intoxication. Integrated psychiatric and surgical care proved pivotal in achieving stabilization and facilitating recovery. The challenges encountered in a resource-limited setting included a lack of advanced imaging modalities, limited access to specialized psychiatric care, and constraints in postoperative monitoring equipment, underscoring the importance of adaptive management strategies. Conclusion: This report emphasizes the critical need for a multidisciplinary approach in managing self-inflicted abdominal injuries. The successful outcome underscores the efficacy of timely surgical intervention and comprehensive psychiatric support. Integrated care models are essential for addressing the complex needs of patients with psychiatric comorbidities, ensuring holistic management, and reducing the risk of recurrence in similar cases.