Non-suicidal self-injury and suicidal behavior: prevalence, co-occurrence, and correlates of suicide among adolescents in Hong Kong

Background

Despite increasing concern over the prevalence of non-suicidal self-injury (NSSI) among adolescents, there is debate about its classification as a stand-alone psychiatric diagnosis. This study investigated the patterns, co-occurrence, and correlates of NSSI and other suicidal behaviors among a representative community sample of in-school adolescents.

Methods

A cross-sectional survey of 2,317 adolescents was conducted. Participants were asked to self-report NSSI, suicidal ideation, suicide attempt, and psychosocial conditions over the past 12 months. Logistic regression and cumulative logit modeling analyses were conducted to investigate the different and similar correlates among these self-harm behaviors.

Results

The age-standardized prevalence rates of NSSI among male and female adolescents were estimated to be 13.4 and 19.7 %, respectively, compared with 11.1 and 10.1 % for male and female suicide attempt. Only a small proportion engaged in NSSI exclusively in the past year. NSSI by burning or reckless and risky behaviors, frequent drinking, and sexual experience were associated with increasing severity level of suicidal behaviors among individuals with NSSI.

Conclusions

NSSI is prevalent among in-school adolescents in Hong Kong. However, it co-occurs with suicidal ideation and suicide attempt. High lethality of NSSI, frequent drinking habit, and lifetime sexual experience are suggested to be indicators for screening potential suicide attempters among those having NSSI.     

Autism spectrum symptoms in children with neurological disorders

Background

The behaviours of non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research.

Methods

We conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe.

Results

Fifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3) and DSH (16.1% SD = 11.6) studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization.

Conclusion

NSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.     

Non-suicidal self-injurious behavior in forensic child and adolescent populations: Clinical features and relationship with depression

Objective:

To investigate risk factors for non-suicidal self-injury (NSSI), and present the relationship between NSSI and depression in children and adolescents who appeared for forensic examination.

Methods:

This study consisted of 295 children and adolescents who were brought for judicial examination in the TR Ministry of Justice Forensic Science Department, Council of Forensic Medicine, Ankara, Turkey between May and October 2013. Sociodemographic factors, alcohol and substance abuse, and history of sexual abuse and suicide attempts were assessed using a semi-structured questionnaire. During forensic medical examinations, NSSI was evaluated. Depression was assessed using the Beck Depression Inventory.

Results:

The frequency of NSSI was 20.2% among boys, and 30.6% among girls. Statistical differences were found between subjects with and without NSSI in terms of number of children in their families, whether or not their parents were divorced, whether they held part-time jobs, or had a history of sexual abuse, substance abuse, or suicide attempts, and the number of criminal involvements. Those with NSSI had higher depressive scores than others (p<0.001).

Conclusion:

Children and adolescents with NSSI have wide-ranging problems in their lives. In a forensic adolescent population, depressive symptoms are more common in individuals with NSSI behaviors, and the specific characteristics of these behaviors need further investigation.Non-suicidal self-injury (NSSI) is deliberate, direct destruction or alteration of body tissue without intention of suicide that is unacceptable to society.1 Numerous terms, including self-mutilation, self-injury, and self-harm have been used in the literature to describe NSSI. Self-mutilation and self-injury are usually synonymous and defined as directly harmful attempts against the body. Today, self-injury and NSSI are preferred over self-mutilation. Self-harm is used to define indirect harmful attempts including alcohol and drug use, reckless driving, and so forth.2 Non-suicidal self-injury is applied primarily to convert intensive painful moods including sorrow, guilt, flashbacks, and depersonalization, to physical pain. Other reasons include self-punishment, attention-getting, imposing guilt, and adapting to friends with NSSI.3 Favazza4 divided self-injury behavior into 4 main categories: major, stereotypical, compulsive, and impulsive. Although the first 3 are often encountered in populations, the prevalence of compulsive and impulsive behaviors is rising. Cutting, carving, scraping, and burning the skin and subdermal tissue, wringing, pulling, or bruising the skin and hair or both is included in NSSI.5 Studies suggest that self-injury behavior generally occurs during mid- or late adolescence and progressively decreases after early adulthood. Some studies report NSSI is found primarily in females,3,4,6 but others suggest no gender difference.7,8 This discrepancy may be a result of study methods. For example, burning and self-hitting behaviors were found to be more common in males, cutting and scratching behaviors were found more common in females.9 Various studies based on community and clinical inpatient samples suggest that prevalence of NSSI varies between 13-45% among adolescents.10,11 In a study using high school students in Turkey, self-injury behavior prevalence was estimated at 21.4%.12 Non-suicidal self-injury is a common finding in psychiatric and forensic examinations. Studies demonstrate that numerous psychiatric disorders including depressive, anxiety, and behavioral disorders, drug abuse, dissociative, borderline, and antisocial personality disorders, stress and violence, and abuse are frequently encountered with NSSI.13-15 Additionally, NSSI is reportedly more frequent among criminal adolescents.16 Studies examining factors associated with NSSI are limited. We found few studies that investigated the relationship between depression level and NSSI in forensic child and adolescent groups in Turkey, and results were contradictory. Therefore, this study was aimed at determining psychosocial factors and risk factors for NSSI and its association with depression levels among children and adolescents referred for forensic examinations. We hypothesize that NSSI incidents will be frequent among forensic child and adolescent populations, and NSSI will correlate with risk factors including sociodemographic properties and depression.     

Adolescent non-suicidal self-injury (NSSI) in German-speaking countries: comparing prevalence rates from three community samples

Purpose

Non-suicidal self-injury (NSSI) has been recognized as a significant mental health problem in adolescence with high prevalence rates. To date, there are few studies that compare rates of adolescent NSSI between different countries. Thus far no prevalence rates of adolescent NSSI have been reported for Austrian or Swiss community samples.

Methods

This study aimed to assess and compare rates of adolescent NSSI in school samples from Austria, Germany and Switzerland using the same assessment instrument (Ottawa Self-Injury Inventory; OSI).

Results

Within these countries, 6-month prevalence rates between 7.6 and 14.6 % were found, with rates showing significant differences between countries (χ² = 16.54, p = 0.02).

Conclusions

These results demonstrate with some variability the significant rates of NSSI in youth in a cross-country study.     

Longitudinal effects of psychological symptoms on non-suicidal self-injury: a difference between adolescents and young adults in China

Purpose

Few longitudinal studies have examined the psychological symptoms that may lead to non-suicidal self-injury (NSSI) among Chinese adolescents and young adults. This study determined the predictive effects of psychological symptoms for NSSI during a 9-month follow-up period.

Methods

Data from 17,622 students, 12–24 years of age, were analyzed in a cross-sectional fashion with respect to associations between psychological symptoms and NSSI. Follow-up surveys were performed 3, 6, and 9 months later. Incident cases of NSSI during follow-up were correlated with the psychological symptoms at baseline.

Results

A total of 3,001 (17.0 %) students reported that they had NSSI in the 12 months before the initial assessment. The total rate of NSSI revealed no statistically significant differences by gender, but marked differences between grades. The response rate 3, 6, and 9 months later was 91.8, 81.8, and 79.1 %, respectively. Our cross-sectional study demonstrated statistically significant associations between emotional problems, conduct problems, social adaptation problems, psychological problems, and NSSI (P < 0.01). In the longitudinal study, emotional problems, conduct problems, social adaptation problems, and psychological problems at baseline had statistically significant associations with incident NSSI in follow-up involving the adolescents, while the association in young adults was attenuated after adjustment for confounding variables. Moreover, psychological symptoms at baseline showed a monotonic dose–response relationship with NSSI in follow-up involving adolescents.

Conclusions

The findings suggest that adolescents with psychological symptoms are a group with elevated risks for later NSSI. The prevention programs of NSSI should target attenuating the severity of psychological symptoms.

     

Non-suicidal Self-Injury in Adolescence

Purpose of Review

Non-suicidal self-injury (NSSI) is a common mental health threat among adolescents. This review aims to present the current literature on epidemiology, etiology, and therapeutic approaches with a focus on the period of adolescence.

Recent Findings

NSSI is widespread among adolescents both in community as well as in clinical settings with lifetime prevalence rates between 17 and 60% in recent studies. It is influenced by multiple factors including social contagion, interpersonal stressors, neurobiological background, as well as emotional dysregulation and adverse experiences in childhood.

Summary

There is still a lack of studies regarding the psychotherapeutic as well as the psychopharmacological treatment of NSSI in adolescence. Furthermore, sufficient evidence for prevention programs is missing.

     

Emotion regulation individual therapy for adolescents with nonsuicidal self-injury disorder: a feasibility study

Background

Nonsuicidal self-injury (NSSI) is a serious health risk behavior that forms the basis of a tentative diagnosis in DSM-5, NSSI Disorder (NSSID). To date, established treatments specific to NSSI or NSSID are scarce. As a first step in evaluating the feasibility, acceptability, and utility of a novel treatment for adolescents with NSSID, we conducted an open trial of emotion regulation individual therapy for adolescents (ERITA): a 12-week, behavioral treatment aimed at directly targeting both NSSI and its proposed underlying mechanism of emotion regulation difficulties.

Methods

Seventeen girls (aged 13–17; mean = 15.31) with NSSID were enrolled in a study adopting an uncontrolled open trial design with self-report and clinician-rated assessments of NSSI and other self-destructive behaviors, emotion regulation difficulties, borderline personality features, and global functioning administered at pre-treatment, post-treatment, and 6-month follow-up. Measures of NSSI and emotion regulation difficulties were also administered weekly during treatment.

Results

Ratings of treatment credibility and expectancy and the treatment completion rate (88%) were satisfactory, and both therapeutic alliance and treatment attendance were strong. Intent-to-treat analyses revealed significant improvements associated with large effect sizes in past-month NSSI frequency, emotion regulation difficulties, self-destructive behaviors, and global functioning, as well as a medium effect size in past-month NSSI versatility, from pre- to post-treatment. Further, all of these improvements were either maintained or further improved upon at 6-month follow-up. Finally, change in emotion regulation difficulties mediated improvements in NSSI over the course of treatment.

Conclusions

Results suggest the acceptability, feasibility, and utility of this treatment for adolescents with NSSID.

Trial registration

ClinicalTrials.gov (NCT02326012, December 22, 2014, retrospectively registered).

     

Starting from scratch: prevalence,methods, and functions of non-suicidal self-injury among refugee minors in Belgium

Background

As many refugee minors have gone/go through stressful life experiences and uncertainty, one might expect mental health issues, including self-injury. However, literature on non-suicidal self-injury (NSSI) in refugee minors is scarce. This study explores the prevalence, methods, and functions of NSSI in refugee minors in Belgium, and compares research results to the existing literature on NSSI in Western adolescents.

Methods

Data were obtained from 121 refugee minors (mean age?=?16.12, SD?=?1.23; range 14–18 years) through schools located in the Flemish and Brussels-Capital regions of Belgium. The sample consists of 39.7% girls and 60.3% boys. Self-report questionnaires were used to explore socio-economic data, NSSI behaviour (e.g. The Brief Non-Suicidal Self-injury Assessment Tool; BNNSI-AT) and emotional and behavioural difficulties (The Strengths and Difficulties Questionnaire; SDQ). Non-parametric Chi square tests were used for statistical comparisons of the obtained data as well as independent-sample t-tests and Fisher’s exact tests.

Results

Results show a lifetime NSSI prevalence rate of 17.4%. Being accompanied or not, having both parents around, or living in an asylum centre did not influence NSSI prevalence. An average of 2.65 methods of NSSI was applied (SD?=?2.50; range 1–9). The mean number of functions per person was six (SD?=?4.97, range 0–16), with automatic functions reported the most. The data do point towards a greater psychological strain, with 68.4% reporting more than five acts of NSSI. Results of the SDQ’s Total Difficulties Scale and, more specifically, of the Emotional Problems, Conduct Problems, Peer Problems and Impact Scales indicate a substantial risk of clinically significant problems within the NSSI group. The Peer Problems and Impact Scales also point towards a high risk for suicidality amongst self-injuring refugees.

Conclusions

Prevalence rates, methods and functions are comparable to Western samples. However, the higher incidence of the NSSI and the results on the SDQ also emphasise the vulnerability of refugee minors.

     

The iceberg of suicide and self-harm in Irish adolescents: a population-based study

Purpose

Suicide is a leading cause of death among adolescents. Self-harm is the most important risk factor for suicide, yet the majority of self-harm does not come to the attention of health services. The purpose of this study was to establish the relative incidence of adolescent suicide, hospital-treated self-harm and self-harm in the community.

Methods

Annual suicide rates were calculated for 15–17 year-old in the Cork and Kerry region in Ireland based on data from the Central Statistics Office. Rates of hospital-treated self-harm were collected by the Irish National Registry of Deliberate Self-Harm. Rates of self-harm in the community were assessed using a survey of 3,881 adolescents, the Child and Adolescent Self-harm in Europe study.

Results

The annual suicide rate was 10/100,000. Suicide was six times more common among boys than girls. The annual incidence rate of hospital-treated self-harm was approximately 344/100,000, with the female rate almost twice the male rate. The rate of self-harm in the community was 5,551/100,000, and girls were almost four times more likely to report self-harm. For every boy who died by suicide, 16 presented to hospital with self-harm and 146 reported self-harm in the community. For every female suicide, 162 girls presented to hospital with self-harm and 3,296 reported self-harm.

Conclusions

Gender differences in relative rates of self-harm and suicide are very large, with boys who have harmed themselves at particularly high risk of suicide. Knowledge of the relative incidence of self-harm and suicide in adolescents can inform prevention programmes and services.     

Emotional face recognition in adolescent suicide attempters and adolescents engaging in non-suicidal self-injury

Little is known about the bio-behavioral mechanisms underlying and differentiating suicide attempts from non-suicidal self-injury (NSSI) in adolescents. Adolescents who attempt suicide or engage in NSSI often report significant interpersonal and social difficulties. Emotional face recognition ability is a fundamental skill required for successful social interactions, and deficits in this ability may provide insight into the unique brain–behavior interactions underlying suicide attempts versus NSSI in adolescents. Therefore, we examined emotional face recognition ability among three mutually exclusive groups: (1) inpatient adolescents who attempted suicide (SA, n = 30); (2) inpatient adolescents engaged in NSSI (NSSI, n = 30); and (3) typically developing controls (TDC, n = 30) without psychiatric illness. Participants included adolescents aged 13–17 years, matched on age, gender and full-scale IQ. Emotional face recognition was evaluated using the diagnostic assessment of nonverbal accuracy (DANVA-2). Compared to TDC youth, adolescents with NSSI made more errors on child fearful and adult sad face recognition while controlling for psychopathology and medication status (ps < 0.05). No differences were found on emotional face recognition between NSSI and SA groups. Secondary analyses showed that compared to inpatients without major depression, those with major depression made fewer errors on adult sad face recognition even when controlling for group status (p < 0.05). Further, compared to inpatients without generalized anxiety, those with generalized anxiety made fewer recognition errors on adult happy faces even when controlling for group status (p < 0.05). Adolescent inpatients engaged in NSSI showed greater deficits in emotional face recognition than TDC, but not inpatient adolescents who attempted suicide. Further results suggest the importance of psychopathology in emotional face recognition. Replication of these preliminary results and examination of the role of context-dependent emotional processing are needed moving forward.     

Service use in adolescents at risk of depression and self-harm: prospective longitudinal study

Purpose

Although depression and self-harm are common mental health problems in adolescents, there are barriers to accessing help. Using a community-based sample, this study investigates predictors of service contacts for adolescents at high risk of depression and self-harm.

Methods

Three thousand seven hundred and forty-nine (3,749) 12- to 16-year-olds in UK secondary (high) schools provided baseline and 6 months’ follow-up data on mood, self-harm and service contacts with a range of primary and secondary healthcare services.

Results

Although most adolescents at high risk of depression or self-harm had seen their general practitioner (GP) in the previous 6 months, less than one-third had used primary or secondary healthcare services for emotional problems. 5 % of adolescents who reported self-harm had seen specialist child and adolescent mental health services in the previous 6 months. In longitudinal analyses, after adjustment for confounders, both depression and self-harm predicted the use of any healthcare services [adjusted odds ratio (AOR) = 1.34 (95 % CI 1.09, 1.64); AOR = 1.38 (95 % CI 1.02, 1.86), respectively] and of specialist mental health services [AOR = 5.48 (95 % CI 2.27, 13.25); AOR = 2.58 (95 % CI 1.11, 6.00), respectively]. Amongst those with probable depression, 79 % had seen their GP and 5 % specialist mental health services in the preceding year.

Conclusions

Most adolescents at high risk of depression or self-harm see their GP over a 6-month period although only a minority of them access specialist mental health services. Their consultations within primary care settings provide a potential opportunity for their identification and for signposting to appropriate specialist services.     

Treating Nonsuicidal Self-Injury: A Systematic Review of Psychological and Pharmacological Interventions

Objective:

Nonsuicidal self-injury (NSSI), the deliberate, self-inflicted damage of bodily tissue without the intent to die, is associated with various negative outcomes. Although basic and epidemiologic research on NSSI has increased during the last 2 decades, literature on effective interventions targeting NSSI is still emerging. Here, we present a comprehensive, systematic review of existing psychological and pharmacological treatments designed specifically for NSSI, or including outcome assessments examining change in NSSI.

Method:

We conducted a systematic search of PsycINFO, MEDLINE, and ERIC databases to retrieve relevant articles that met inclusion criteria; specifically, uncontrolled and controlled trials that 1) presented quantitative outcome data on NSSI, and 2) clearly differentiated NSSI from suicidal self-injury (SSI). Consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, definition of NSSI, we excluded studies examining populations with developmental or intellectual disabilities, or with psychotic disorders.

Results:

Several interventions appear to hold promise for reducing NSSI, including dialectical behaviour therapy, emotion regulation group therapy, manual-assisted cognitive therapy, dynamic deconstructive psychotherapy, atypical antipsychotics (aripiprazole), naltrexone, and selective serotonin reuptake inhibitors (with or without cognitive-behavioural therapy). Nevertheless, there remains a paucity of well-controlled studies investigating treatment efficacy for NSSI.

Conclusions:

Structured psychotherapeutic approaches focusing on collaborative therapeutic relationships, motivation for change, and directly addressing NSSI behaviours seem to be most effective in reducing NSSI. Medications targeting the serotonergic, dopaminergic and opioid systems also have demonstrated some benefits. Future studies employing controlled designs as well as a clear delineation of NSSI and SSI will improve knowledge regarding treatment effects.     

Correlates of Nonsuicidal Self-Injury and Suicide Attempts Among Tertiary Care,Emergency Department Patients

Objective:

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA.

Methods:

Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 (n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates.

Results:

NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI.

Conclusions:

NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles.     

Gender Differences in at Risk Versus Offender Adolescents: A Dimensional Approach of Antisocial Behavior

The current study investigated gender differences in the main components of antisocial behavior in an at-risk versus an offender group of adolescents. One-hundred and forty-three adolescents divided into two different risk groups [at risk (n = 54) and offenders (n = 89)] were compared according to gender (111 boys and 32 girls). Externalizing symptoms were assessed with the Delinquent and Aggressive subscales of the Youth Self-report Questionnaire, internalizing problems with the Beck Anxiety Inventory and the Beck Depressive Inventory and personality traits with the Barratt-Impulsiveness Scale as well as the Youth Psychopathic Traits Inventory. Results revealed a consistent interaction pattern, with girls presenting higher levels of externalizing symptoms, more motor impulsivity and a more arrogant and deceitful interpersonal style than boys in the at-risk group. In contrast, in the offenders’ group, psychopathic traits were more present in boys than in girls. Regarding internalizing problems, girls showed more depression than boys, independently of the risk group. Among offending youths, girls present equally severe externalizing problems, and problematic personality traits as boys. At-risk girls have the highest rates of difficulties across the tested domains and should therefore be specifically targeted for prevention and intervention.     

Nonsuicidal self-harm and suicide attempts in adolescents: differences in kind or in degree?

Purpose

The purpose of the present study was to measure the prevalence of self-harm (SH) behaviours and examine potential differences in characteristics among adolescents reporting on self-harm (SH), depending on whether they had attempted suicide (SA), performed nonsuicidal self-harm (NSSH), or both.

Methods

Cross-sectional survey of 11,440 adolescents aged 14–17 years in the city of Oslo, Norway. Responses regarding measures of lifetime SH and risk factors were collected. The response rate was 92.7 %. Data were analysed by segregating SH responses into the categories of NSSH, SA, and NSSH + SA.

Results

Among all respondents, 4.3 % reported NSSH, 4.5 % reported SA, 5.0 % reported both NSSH and SA, and 86.2 % reported no SH. The group reporting to have engaged in both behaviours comprised more girls and reported more suicidal ideation, problematic lifestyles, poorer subjective health, and more psychological problems compared with the other groups. The four groups could be distinguished by one discriminant function that accounted for most of the explained variance.

Conclusions

Our findings suggest that NSSH and SA are parts of the same dimensional construct in which suicidal ideation carries much of the weight in adolescents from a school-based sample. They also indicate the group of adolescents who seems to alternate between NSSH and SA is more burdened with mental ill-health and behavioural problems compared with others. These adolescents should therefore be targeted by clinicians and school health personnel for identification and provision of adequate help and services.     

Psychotherapeutic approaches to non-suicidal self-injury in adolescents

ABSTRACT: Non-suicidal self-injury (NSSI) among adolescents is gaining increasing attention in both clinical and scientific arenas. The lifetime prevalence of NSSI is estimated to vary between 7.5% to 8% for preadolescents, increasing to between 12% and 23% for adolescents. Despite the prevalence and the increasing interest in NSSI, few psychotherapeutic treatments have been designed specifically for NSSI, and no treatments have been evaluated specifically for the treatment of NSSI among adolescents. Consequently, child and adolescent clinicians are left with little evidence-based guidance for treating this challenging population. To provide some guidance, evaluations of treatments for adults with NSSI and for adolescents with related conditions, such as deliberate self-harm and borderline personality disorder, are reviewed. Clinical guidelines and resources are also discussed to assist with the gaps in the knowledge base for treatment of NSSI among adolescents.     

Parental socio-economic position during childhood as a determinant of self-harm in adolescence

Purpose

Socio-economic position (SEP) during childhood and parental social mobility have been associated with subsequent health outcomes in adolescence and adulthood. This study investigates whether parental SEP during childhood is associated with subsequent self-harm in adolescence.

Methods

This study uses data from a prospective birth-cohort study (the Avon Longitudinal Study of Parents and Children) which followed 14,610 births in 1991–1992 to age 16–18 years (n = 4,810). The association of parental SEP recorded pre-birth and throughout childhood with self-harm was investigated using logistic regression models, with analyses conducted separately for those reporting self-harm (a) with and (b) without suicidal intent. The impact of missing data was investigated using multiple imputation methods.

Results

Lower parental SEP was associated with increased risk of offspring self-harm with suicidal intent, with less consistent associations evident for self-harm without suicidal intent. Associations were somewhat stronger in relation to measures of SEP in later childhood. Depressive symptoms appeared to partially mediate the associations. Adolescents of parents reporting consistently low income levels during childhood were approximately 1.5 times more likely to engage in SH than those never to report low income.

Conclusions

Lower SEP during childhood is associated with the subsequent risk of self-harm with suicidal intent in adolescence. This association is stronger in those experiencing consistently lower SEP.     

Association Between Smoking and Heart Rate Variability Among Individuals with Depression

Background

Both depression and smoking have been independently associated with lower heart rate variability (HRV), suggesting dysregulation of cardiac autonomic function. However, no studies have systematically explored the effects of smoking on HRV among depressed patients.

Purpose

This study examined differences in HRV based on smoking status among depressed individuals.

Methods

Electrophysiological data were examined among 77 adult outpatients without a history of myocardial infarction, who met criteria for major depressive disorder or dysthymia. Frequency domain [low frequency (LF), high frequency (HF), LF/HF ratio, respiratory sinus arrhythmia (RSA)] parameters of HRV, and heart rate and inter-beat interval (IBI) data were compared between depressed smokers (n?=?34) and depressed nonsmokers (n?=?44).

Results

After controlling for covariates, depressed smokers, compared to depressed nonsmokers, displayed significantly lower LF, HF, and RSA.

Conclusions

Among depressed patients, smoking is associated with significantly lower HRV, indicating dysregulated autonomic modulation of the heart.     

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.