Clinical Characteristics Associated with Suicidal Attempt and Non-Suicidal Self-Injury in Korean Adolescents

ObjectiveThis study evaluated the association between mood and anxiety symptoms and suicidal attempt (SA) and/or non-suicidal self-injury (NSSI) in adolescents seeking mental health services. We also tested predictors of SA and NSSI. MethodsWe retrospectively reviewed the medical records of 220 adolescents who completed psychological assessment in clinical sample. Participants did the Adolescent General Behavior Inventory (A-GBI) and Children’s Depression Inventory (CDI). SA and NSSI were assessed retrospectively by interview. The caregiver of participants completed the Beck Depression Inventory (BDI) for themselves. Results17% of total participants had a history of SA, and 24% experienced NSSI. Both SA and NSSI were more common in girls. The score of depressive subscale on A-GBI was higher in adolescents with SA than those without. The participants with NSSI showed higher scores on CDI and depressive subscale on A-GBI than those without. SA was associated with maternal BDI and history of NSSI; female sex, depressive subscale on A-GBI, and history of SA with NSSI. ConclusionOur study found that NSSI and SA are strongly associated in adolescents. Female sex and depressive symptoms of the adolescents were also significantly associated with NSSI in Korean adolescent. Findings are consistent with patterns in other countries.     

Non-suicidal self-injury in adolescence: A longitudinal study of the relationship between NSSI,psychological distress and perceived parenting

ObjectiveThe present study investigates whether either adolescents' psychological distress and/or perceived parenting predicted the occurrence of NSSI. Furthermore, the consequences of NSSI are examined in a three-wave longitudinal study.DesignThe sample at time 1 (age 12) consisted of 1396 adolescent reports and 1438 parent reports. At time 2 (age 13), 827 adolescent reports and 936 parent reports were obtained. Time 3 (age 14) included 754 adolescent reports and 790 parent reports. Psychological distress of adolescents was measured using the Strengths and Difficulties Questionnaire. Perceived parenting behaviors were examined by the Parental Behavior Scale and the Psychological Control Scale.ResultsA total of 10% of the adolescents engaged in NSSI at least once before age 15. Higher psychological distress of adolescents at time 1 was associated with the presence of NSSI at time 2 or 3. The association between psychological distress at time 1 and perception of decreased parental rule setting at time 3 was mediated by the presence of NSSI at time 2.ConclusionsThe present study showed that psychological distress at age 12 predicts NSSI over time and that parental awareness of NSSI changes the perception of parenting behaviors.     

Romantic and sexual activities, parent–adolescent stress, and depressive symptoms among early adolescent girls

Building on evidence that romantic experiences are associated with depressive symptoms in adolescence, we examined their bidirectional association, as well as the role of sexual activity and parent–adolescent stress in their association. Data were collected from 71 early adolescent girls (M age 13.45 years; SD = 0.68) and their primary caregiver initially and one year later. Results indicated that adolescents who engaged in more romantic activities experienced increases in depressive symptoms over time. Second, greater depressive symptoms predicted romantic involvement and sexual activities, including intercourse, one year later. Third, dysphoric adolescents who were experiencing higher parent–adolescent stress were the most likely to engage in subsequent sexual intercourse. Implications for understanding how the association between depressive symptoms and romantic and sexual experiences develops and the course of this association are discussed.     

Clinical characteristics and functions of non-suicide self-injury in youth

PurposeLittle is known about the clinical characteristics and motivations for engaging in non-suicide self-injury (NSSI) behaviors in adolescence. The aim of this study was to examine the prevalence, characteristics and functions of NSSI among adolescents in community settings, and to explore risk factors related to this behavior.Subjects and methodsTwo hundred and seventy-five adolescents aged 12 to 17 were recruited randomly from different High Schools in Israel. They completed self-report questionnaires assessing NSSI (Ottawa Self-Injury Inventory), depression (Children's Depression Inventory – CDI) and impulsivity (Barratt Impulsiveness Scale – BIS-II).ResultsIn the past year, 20.7% of the participants reported engaging NSSI at least once. Among them, 42.1% declared they are still engaging in NSSI at the present. Motives for NSSI were internal emotion regulation reasons, external emotion regulation reasons for social influences. In addition, the NSSI group reported significantly higher levels of depressive, impulsivity and suicidal ideations. Depressive symptoms were found as significant predictors of NSSI in the future.Discussion and conclusionsHigh rates of NSSI among community adolescents were found. Depression, impulsivity and suicidal ideation were found significantly related to NSSI. Mental health professionals in schools and in primary care should routinely assess NSSI among adolescents.     

The role of parental psychopathology and personality in adolescent non-suicidal self-injury

Adolescent non-suicidal self-injury (NSSI), a significant risk factor for suicidal behavior, is strongly associated with adolescent psychopathology and personality traits, particularly those characterized by poor self-regulation. Some parental psychopathology and personality traits have also been identified as risk factors for adolescent NSSI, but specific parental characteristics and mechanisms involved in this association have not been systematically examined. The current study comprehensively investigated the contribution of parental psychopathology and personality to adolescent NSSI using data from the baseline wave of the Adolescent Development of Emotion and Personality Traits (ADEPT) study of 550 adolescent girls (mean age = 14.39 years, SD = 0.63) and their biological parents. We first investigated whether parental lifetime psychiatric diagnoses, and personality and clinical (rumination, self-criticism, emotional reliance) traits were associated with adolescent NSSI. We also tested whether adolescent history of psychiatric illness, personality, and clinical traits mediated the associations between parental characteristics and adolescent NSSI. Parental substance use disorder, adult-ADHD symptoms, self-criticism, and lower agreeableness and conscientiousness were associated with offspring's NSSI. These associations were mediated through adolescent characteristics. In contrast, parental mood and anxiety disorders and neuroticism were unrelated to adolescent NSSI. The results suggest that parental traits and disorders characterized by self-regulatory difficulties and lack of support constitute risk factors for self-injury in adolescent girls, acting via adolescent traits. This demonstrates that parental influences play a significant role in the etiology of adolescent NSSI.     

Rejection sensitivity and depressive symptoms: Longitudinal actor-partner effects in adolescent romantic relationships

The present study utilizes the actor-partner interdependence model to examine the longitudinal relationship between rejection sensitivity and one's own and one's partner's depressive symptoms. The sample included adolescent romantic couples from the U.S. (N = 198 adolescents; 50% girls; 90.2% Caucasian) whose rejection sensitivity at Time 1 and depressive symptoms approximately one year later (Time 2) were assessed. Additionally, aggressive behaviors and maintenance behaviors that commonly associated with rejection sensitivity (e.g., self-silencing) are explored as mediators. Results indicate that boyfriends' rejection sensitivity at Time 1 predicted girlfriends' depressive symptoms at Time 2. Additionally, girls' rejection sensitivity predicted their own and their boyfriends' self-silencing. Developmental and clinical implications are discussed.     

Perceived parental sacrifice,filial piety and hopelessness among Chinese adolescents: A cross-lagged panel study

IntroductionThere is a dearth of research on examining the longitudinal effects of cultural family processes on adolescent hopelessness, and the mechanisms through which the effects happen. Hence, the present study examined the relationship among parental (paternal and maternal) sacrifices, filial piety and adolescent hopelessness in the Chinese context.MethodsThe study was based on a three-wave longitudinal data from a sample of 1569 Chinese adolescents (Time 1: mean age = 13.15 ± .92 years; 50.8% girls). The adolescents were invited to fill out a questionnaire containing measurements of studied variables thrice, at an interval of one year.ResultsThe results of cross-lagged panel analysis indicated that maternal sacrifice was associated with filial piety, which in turn was linked with hopelessness among Chinese adolescents. Moreover, there was bidirectional effects of adolescent hopelessness at earlier time point on paternal and maternal sacrifice at later time point via filial piety.ConclusionsThe study showed that maternal sacrifice serves as a protective factor that reduces adolescents’ sense of hopelessness via the development of filial piety. At the same time, the bidirectional indirect effects of filial piety on the relationship between parental sacrifice and adolescent hopelessness also alert family researchers and youth practitioners on the child effects on parental behavior in Chinese families. Theoretical and practical implications of the findings are discussed.     

Depression as a mediator between frequent nightmares and non-suicidal self-injury among adolescents: a 3-wave longitudinal model

BackgroundFrequent nightmares and depression are associated with non-suicidal self-injury (NSSI) in adolescents. Little is known about the mediating role of depression in the nightmare-NSSI link. This study explores the longitudinal mediating effect of depression on the relationship between frequent nightmares and NSSI as well as the moderating effect of gender using a three-wave longitudinal design.MethodsParticipants were adolescents from the Shandong Adolescent Behavior and Health Cohort who were surveyed at baseline, 1 year later, and 2 years later. A self-administered questionnaire was used to measure nightmare frequency, depression, and NSSI. Structural equation modeling and multiple-group analysis were used to test the mediating effect of depression and the moderating effect of gender. Covariates included demographics and earlier measures of depression and NSSI.ResultsAmong 6995 participants, 3399 (48.6%) were females, mean age was 14.86 (SD = 1.50) years at baseline. Frequent nightmares had a significant mediation effect on NSSI through depression (B_ab = 0.06, 95% CI = 0.02–0.10) after controlling for demographics and earlier measures of depression and NSSI. Gender had no significant moderating effect on the nightmare-NSSI association.LimitationsAll data were collected by self-report.ConclusionsThe association between frequent nightmares and NSSI in adolescents was partially mediated by depression. Frequent nightmares and depression should be assessed and treated to prevent self-harm in adolescents.     

Parental Influences on Adolescent Major Depressive Symptoms and Marijuana Use

Adolescent depression is associated with many negative outcomes, including elevated marijuana use. Although parental influences on adolescent depressive symptoms and marijuana use have been examined independently, their interrelation remains understudied. The current research investigates the hypothesis that lower levels of parental monitoring and warmth are inversely associated with adolescent depressive symptoms and marijuana use. A path analytic approach (N = 12,115) on data from a representative US sample indicated depressive symptoms had an indirect effect on the relationship between parental warmth (p < .001), monitoring (p = .013), and adolescent marijuana use. Exploring relationships grouped by respondents’ age (12–14 and 15–17 years, respectively) revealed minor differences. Depressive symptoms had significant indirect effects on parental warmth and marijuana use (both p < .001) and on parental monitoring and marijuana use (both p < .05). Parental influences appear to play an important role in marijuana use among adolescents with depressive symptoms.

     

Can Social Support be Protective against Depressive Symptoms in Adolescents from 24 Low- and Middle-Income Countries?

Background: Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports. However, it still remains largely unknown regarding the associations between social support(s) and depressive symptoms among adolescents living in low- and middle-income countries (LMICs). The aim of this study aimed to explore the associations between different types of social support and depressive symptoms in adolescents from LMICs. Methods: Data were retrieved from the Global School-based Health Survey (GSHS) in which 92,551 adolescents (50.6% females) were included with mean of 15.6 years. Depressive symptoms in the past one month as the dependent variable were measured in combination with social support (was measured by “During the past 30 days, how often were most of the students in your school kind and helpful?”). Multivariable logistic regression and meta-analysis of country-wise estimates were performed to investigate the associations between social support and depressive symptoms, and the heterogeneity of the associations across the countries, respectively. Results: The prevalence of depressive symptoms was 30.9% of adolescents from LMICs. Peer support and parental connectedness were two major factors that were significantly associated with depression symptoms in adolescents. However, the associations of peer support and parental connectedness with depressive symptoms were significant in males and females, respectively. The country-wise analysis indicated that varied inconsistency (small to large) across the associations of peer support and parental connectedness with depressive symptoms in adolescents. Conclusion: Results in this study provides multi-national evidence of the protective roles of social support against depressive symptoms among adolescents. However, the association between social support and depression symptoms may be moderated by sex and types of social support. Although we found that social support may be an important protective factor against depressive symptoms in adolescents from LMICs, specifically designed interventions should be implemented based on sex difference and country difference.     

The relation of substance use with different levels of depressive symptoms and the moderating effect of sex and age in Taiwanese adolescents

BackgroundThe aim of this cross-sectional study was to examine (a) the relation of substance use with different levels of depressive symptoms and (b) the moderating effect of sex and age on the association between different levels of depressive symptoms and substance use in Taiwanese adolescents.MethodsThe study group consisted of 9070 adolescent students in southern Taiwan aged 12 to 19 years who were sorted into 3 different levels of depressive symptoms on the Center for Epidemiologic Studies Depression Scale. The Questionnaire for Experience in Substance Use was used to assess each participant's experience with smoking, alcohol consumption, betel nut chewing, sedative/hypnotic use, and illicit drug use in the preceding year. The rates of substance use were compared among adolescents with different levels of depressive symptoms using generalized linear mixed-model analysis. The moderating effects of sex and age on the association between different levels of depressive symptoms and substance use were also examined.ResultsAdolescents with severe depressive symptoms had higher rates of using all 5 kinds of substances than did nondepressed ones. Adolescents with minor depressive symptoms had higher rates of using all substances except for illicit drugs than did nondepressed ones. There was no significant difference in the rates of substance use between adolescents with severe and minor depressive symptoms. Sex and age had no moderating effect on the association between the level of depressive symptoms and substance use.ConclusionsIt is necessary to carefully screen substance use among adolescents with depressive symptoms, even if they are below the threshold for significant depression.     

Longitudinal covariance of resting-state cardiac function and borderline personality disorder symptoms in adolescent non-suicidal self-injury

Objectives: Cardiac function is altered in borderline personality disorder (BPD). In adolescents with non-suicidal self-injury (NSSI) resting heart rate (HR) and vagally mediated heart rate variability (vmHRV) are associated with BPD symptoms. The study aimed to investigate longitudinal covariance of BPD symptoms and cardiac function in adolescent NSSI.

Methods: HR and vmHRV were recorded in female adolescents with NSSI (n?=?17) completing a baseline and 1-year follow-up assessment. Physiological data, structured clinical interviews and self-reports were obtained at both time points. Predictors of change in clinical outcomes and cardiac function were assessed.

Results: Patients showed a reduction of NSSI (z_(34;17)?=?–3.79, P?z_(34;17)?=?–3.74, P?z_(34;17)?=?2.87, P?=?0.004). Symptoms of BPD and frequency of BPD diagnosis did not significantly change. No significant differences on HR or vmHRV were observed. Changes in BPD symptoms were associated with changes in HR (r₍₁₇₎= 0.532, P?=?0.028) and vmHRV (r₍₁₇₎?=?–0.516, P?=?0.033).

Conclusions: Longitudinal changes in BPD symptomatology in adolescents engaging in NSSI are associated with changes in resting cardiac function. Clinical studies are needed to investigate the utility of cardiac markers to track treatment outcome in adolescents with BPD.     

The Protective Role of Self-Compassion on Risk Factors for Non-suicidal Self-Injury in Adolescence

Non-suicidal self-injury (NSSI) in adolescence is a serious public health problem. Although self-compassion is a protective factor of mental health difficulties in adult populations, its potential impact on adolescence remains scarcely explored. Therefore, we aimed to test whether self-compassion can mitigate the impact of daily peer hassles and depressive symptoms on NSSI. The participants were 643 adolescents (51.6 % female) with ages between 12 and 18 years, from middle and secondary schools. Self-report questionnaires were used to measure daily peer hassles, depressive symptoms, self-compassion and NSSI. Daily peer hassles were positively correlated with depressive symptoms and NSSI. Self-compassion was inversely associated with daily peer hassles and depressive symptoms and NSSI. Path analysis showed that self-compassion had a moderator effect on the association between depressive symptoms and NSSI. Results suggest that self-compassion can be a protective process, as it may buffer against the impact of depressive symptoms on NSSI. This study presents preventive and clinical implications for educators and therapists working with adolescents.     

A short-term longitudinal examination of the relations between depression,anhedonia, and self-injurious thoughts and behaviors in adults with a history of self-injury

BackgroundLimited research has addressed the role of anhedonia in predicting suicidality and/or nonsuicidal self-injury (NSSI) in adults, despite evidence suggesting that loss of interest or pleasure may increase vulnerability for self-inflicted harm, even beyond other depressive symptoms.MethodsIn the current study, we explored the role of symptoms of depression and recent changes in anhedonia in predicting suicidality, NSSI ideation, and perceptions of NSSI helpfulness among individuals with a history of NSSI or suicide attempts (N = 187).ResultsWe found that changes in anhedonia partially mediated the effect of depression on suicidality, and fully mediated the effect of depression on perceptions of NSSI helpfulness. Anhedonia did not predict NSSI ideation above and beyond depression symptoms, and did not significantly predict NSSI frequency when accounting for suicidality. Compared to individuals with a history of NSSI only or suicide attempt only, people with a history of both NSSI and suicide attempt evidenced greater risk and symptomatology.ConclusionsResults confirm the relation between anhedonia and suicidality evidenced in past research, but suggest a complex relationship between anhedonia, depression, and facets of non-suicidal self-injury.     

Depressive symptoms amongst adolescent primary care attenders

Abstract. Background: Background High rates of depressive disorder have been documented amongst adolescents attending general practitioners (GPs) in urban areas. However, little is known about the associations of adolescent depression in primary care. Method: We completed a cross-sectional questionnaire survey of adolescents, their parents and general practitioners, following adolescent attendance at the surgery. Results: We found high levels of depressive symptoms to be present in adolescent attenders of a broad range of social backgrounds. Depressive symptoms were associated with the following demographic and contextual factors: older age, female gender and parental psychiatric symptoms. They were also associated with the presence of physical symptoms causing psychosocial impairment, with health risks (use of cannabis and exposure to drugs) and with use of services (both primary care and mental health services). Levels of depressive symptoms were similar in urban and suburban groups. However, associations of depressive symptoms with smoking, exposure to drugs, cannabis use and primary care attendance were demonstrated in the suburban group and not the urban group. Conclusion: Adolescent GP attenders have high levels of depressive symptomatology. GP recognition and intervention should have the potential to impact on adolescent depression and on associated risks.     

The predictive capacity of perceived expressed emotion as a dynamic entity of adolescents from the general community

Background  

In previous studies, it has been demonstrated that high parental expressed emotion (EE) is predictive of depressive, aggressive and delinquency symptoms of adolescents. Two issues have received much less prominence in EE research, these being studies of adolescent perceived EE and the measurement of the EE as a dynamic, developmental construct. This 4-year, three-wave, longitudinal study of perceived EE of adolescents from the general community examines if adolescent perceived EE measured with the traditional, one-measurement EE approach as well as adolescent perceived EE measured with a repeated measured, dynamic EE approach can predict adolescent depressive, aggressive and delinquency symptoms.     

伴非自杀性自伤行为青少年抑郁症患者述情和家庭教育方式研究

目的了解青少年抑郁症患者非自杀性自伤行为的现状,并对比分析伴或不伴非自杀性自伤行为患者的述情方式和家庭教育方式差异。方法回顾性连续纳入2018年1月至2019年2月四川大学华西医院心理卫生中心收治的241例青少年抑郁症患者为调查对象,采用多伦多述情障碍量表、家庭教育方式量表、患者健康问卷抑郁量表对其进行调查,并对比伴非自杀性自伤行为(研究组)和不伴非自杀性自伤行为(对照组)患者的差异。结果241例患者中,44.8%(108/241)的青少年抑郁症患者有非自杀性自伤行为。与对照组(133例)比较,研究组家庭教育方式量表中父亲的惩罚/严厉[(24.80±7.36)分比(21.41±6.89)分]、过分干涉[(23.56±5.02)分比(21.74±4.66)分]、拒绝/否认[(13.44±4.39)分比(11.35±3.81)分]、过度保护因子[(12.56±3.28)分比(11.20±2.94)分]得分较高,差异均有统计学意义(均P<0.05),母亲的过分干涉/保护[(42.23±8.06)分比(37.73±7.80)分]、拒绝/否认[(18.65±5.85)分比(15.70±5.72)分]、惩罚/严厉因子[(19.13±6.52)分比(15.97±6.20)分]得分较高,差异均有统计学意义(均P<0.05)。在述情障碍量表中,研究组难以识别自己的情感及难以描述自己的情感因子得分高于对照组[分别为(25.19±6.23)分比(22.12±7.09)分,(18.06±4.19)分比(15.90±4.52)分],差异均有统计学意义(均P<0.05)。结论青少年抑郁症患者中,伴非自杀性自伤行为的发生率较高,其述情方式和家庭教育方式与不伴非自杀性自伤行为患者存在差异。     

The influence of personality traits and emotional and behavioral problems on repetitive nonsuicidal self-injury in a school sample

BackgroundNonsuicidal self-injury (NSSI) is highly prevalent among adolescents and associated with various mental health problems and suicidality. Previous studies have found that certain personality traits are related to NSSI behavior, however only few studies examined personality traits in adolescents with NSSI. Our study aimed to assess the relationship between personality traits and emotional and behavioral problems in predicting repetitive NSSI among adolescents from a school sample.MethodsFour hundred and forty-seven students (M = 14.95 years, SD = 0.74, 52% male) completed self-report measures on NSSI, personality traits, and emotional and behavioral problems.ResultsThe past year prevalence of occasional and repetitive NSSI was 4.9% and 6.3% respectively. Repetitive NSSI was significantly associated with female gender, higher levels of age, novelty seeking, harm avoidance, self-transcendence, antisocial behavior, and positive self and lower levels of persistence and self-directedness in univariate analyses. However, multivariate logistic regression analyses indicated that only high levels of antisocial behavior and low levels of self-directedness significantly predicted repetitive NSSI.ConclusionsThe association between a lack of self-directedness and NSSI emphasizes the significance of targeting self-directedness in psychotherapy by strengthening self-awareness, affect tolerance and emotion regulation, as well as establishing and pursuing long-term goals.     

Developmental trajectory of purpose identification during adolescence: Links to life satisfaction and depressive symptoms

IntroductionWhereas evidence has shown that a sense of purpose is linked to optimal adjustment, longitudinal work investigating the development of purpose identification as well as its effect on psychological functioning among non-Western samples during adolescence is needed.MethodsThree hundred and eighty-seven senior high school students (253 female, 65.37%; mean age = 15.76 years at the first investigation) from Taiwan completed surveys four times beginning in the fall of tenth grade and ending in the spring of eleventh grade with a six-month interval. Using self-ratings, purpose identification was evaluated in all four assessments and psychological functioning was examined through life satisfaction and depressive symptoms in the first and the last survey.ResultsGrowth curve analyses revealed an increased slope in purpose identification over the first two years of high school, and such a trajectory was similar across boys and girls. Additionally, increases in purpose identification predicted enhanced life satisfaction and reduced depressive symptoms among both boys and girls. There was only one gender difference: The negative association between purpose identification trajectory and depressive symptoms was stronger for girls than for boys.ConclusionsThere is an increase in the development of identified purpose during middle adolescence among high school students in Taiwan. Such change not only promotes life satisfaction in adolescents but is also preventive of adolescent depression. As such, the current findings highlight the significance for adolescents to discover and commit to a purpose.     

Adolescent non-suicidal self-injury: a cross-national study of community samples from Italy, the Netherlands and the United States

This study examined rates and correlates of non-suicidal self-injury (NSSI) across three non-clinical adolescent samples from different countries. Surveys were administered to 1862 adolescents (M(age)=15.69, S.D.=0.87) from Italy (n=827), the Netherlands (n=675), and United States (n=360), including measures of NSSI, substance use, internal (i.e., depressive symptoms, loneliness), and interpersonal factors (i.e., peer victimization, peer preference). After controlling for socio-demographic differences, similar prevalence of NSSI was found across the three samples, with approximately 24% of the adolescents reporting at least one NSSI episode within the last year. Multivariate logistic regressions showed that adolescents' victimization and higher levels of depressive symptoms and family-related loneliness were associated concurrently with NSSI comparably in all three samples. However, multi-group analyses indicated that the association between NSSI and substance use varied significantly across samples, indicating that NSSI related more strongly to substance use (i.e., cigarette smoking and frequent marijuana use) in the sample from the United States rather than the samples from the Netherlands and Italy. Findings provide evidence of NSSI and suggest high similarities in rates and correlates across samples from different countries. Future research should further explore NSSI cross-nationally.