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People engage in nonsuicidal self-injury (NSSI) to reduce negative affect, but it is not clear why they engage in this harmful type of behavior instead of using healthier strategies. The primary goal of this study was to evaluate whether people choose NSSI to reduce negative affect because they perceive it to be less cognitively costly than other available strategies.In experiment one, 43 adults completed a novel, relief-based effort discounting task designed to index preferences about exerting cognitive effort to achieve relief. In experiment two, 149 adults, 52 % with a history of NSSI, completed our effort discounting task.Our main results suggest that people will accept less relief from an aversive experience if doing so requires expending less effort, i.e. they demonstrate effort discounting in the context of decisions about relief. We also found and that effort discounting is stronger among those with a history of NSSI, but this association became nonsignificant when simultaneously accounting for other conditions associated with aberrant effort tradeoffs.The use of a control group without NSSI or other potentially harmful relief-seeking behaviors limits our ability to draw specific conclusions about NSSI. The ecological validity of our task was limited by a modestly effective affect manipulation, and because participants made hypothetical choices.This study demonstrates that preferences about exerting cognitive effort may be a barrier to using healthier affect regulation strategies. Further, the preference not to exert cognitive effort, though present in NSSI, is likely not unique to NSSI. Instead, effort discounting may be a transdiagnostic mechanism promoting an array of harmful relief-seeking behaviors.

Few studies have been conducted focusing on the non-suicidal self-injury (NSSI) incidence rate and influencing factors among left-behind children in northeastern Sichuan, China. In this study, we investigated the incidence rate of the NSSI behaviors, levels of anxiety and depression in left-behind children in northeastern Sichuan, and relevant sociodemographic factors.The NSSI behaviors were identified using the Ottawa Self-injury Inventory (Chinese version). Its incidence rate and related influencing factors were evaluated by Cluster sampling; the Depression Anxiety Stress Scale-21 Items (DASS-21) was adopted to assess the levels of anxiety, depression, and stress.A total of 9450 adolescents met the inclusion criteria, including 543 with NSSI behaviors, and the prevalence of NSSI was 5.7 %. There were 3596 left-behind children, and 243 of them had NSSI behaviors, the NSSI incidence in left-behind children was 6.8 %. There were 5854 non-left-behind children, and the NSSI incidence in non-left-behind children was 5.1 %. Left-behind children's NSSI behaviors were remarkably correlated with five risk factors: being female (OR = 2.411, 95%CI = 1.773-3.279), parents' divorce (OR = 1.742, 95%CI = 1.262-2.404), elder age (OR = 1.120, 95%CI = 1.028-1.219), severe depression (OR = 1.212, 95%CI = 1.148-1.281), and high anxiety (OR = 1.170, 95%CI = 1.093-1.251).This is a cross-sectional study, we cannot probe into the causality between NSSI behaviors and corresponding risk factors. Reporting and recalling biases may be unavoidable as questionnaires are performed by self-rating scales and retrospective reports.The NSSI behaviors are common in left-behind children in northeastern Sichuan. This study proposes that prevention and intervention measures are necessary for the healthy growth of such children.

Numerous studies have questioned the reliability and validity of borderline personality disorder's (BPD) categorical conceptualization. DSM-5 Section III's alternative trait-based model of BPD may better capture borderline pathology, but aspects of its validity should be further established. Thus, the authors examined whether a latent BPD factor derived from Section III traits exhibits (1) familial aggregation among siblings and (2) association with constructs related to borderline pathology. The authors also tested whether gender moderated associations. A total of 498 community-recruited adults completed the Personality Inventory for DSM-5, a behavioral assessment of risk-taking, and reported their history of childhood maltreatment, substance use, nonsuicidal self-injury, and suicidal ideation. Familial aggregation was assessed among 232 sibling pairs. Siblings' BPD scores were significantly correlated and most external validators were significantly associated with BPD, with the exception of risk-taking. Results did not vary by gender. Findings further support the construct validity of Section III's BPD trait profile.

Background Psychiatric disorders are common among individuals treated for deliberate self-harm (DSH) in general hospitals. However, few large-scale studies have explicitly addressed psychiatric disorders among adult DSH patients. Aim To examine the presence of psychiatric disorders among adults presenting to general hospitals following DSH, and further to establish clinical and sociodemographic determinants of being diagnosed with a psychiatric disorder in this patient population. Method Data from several national registers were interlinked to identify all individuals aged 18 and older presenting to general hospital for DSH during the period 2008–2018. Logistic regression was used to examine the association between psychiatric disorders (ICD-10) and clinical and sociodemographic characteristics of the DSH patients. Results Altogether 39,534 subjects with 63,622 episodes of DSH were included in the study with a gender ratio (F:M) of 1.48. The majority were unmarried and had low income and education. Psychiatric disorders were present in 58.5 % of all episodes and in 54.3 % of the index episodes. Affective disorders displayed the highest prevalence (18.3 %), followed by alcohol use disorder (16.4 %). Personality disorders were highly prevalent among young females with multiple DSH episodes. Middle-aged individuals had the highest prevalence of psychiatric disorders. Presence of psychiatric disorders was significantly associated with DSH repetition. Limitations Data was restricted to variables available in the registers. Conclusions Psychiatric disorders were common among DSH patients in the present cohort, but distributed differently between the genders. DSH repetition and middle-age was associated with being diagnosed with a psychiatric disorder.

We examined the moderating role of posttraumatic stress disorder (PTSD) in the association between trauma and impulsive behaviors. Adult women ( N = 97) with a history of childhood sexual abuse (CSA; n = 26), rape in adulthood ( n = 21), both CSA and adult rape ( n = 25), or no history of sexual trauma ( n = 25) completed self-report questionnaires. PTSD symptoms were positively associated with self-harm and with stealing and accident proneness, but not with sexual impulsivity. Trauma group had no independent associations with impulsive behaviors. PTSD reexperiencing symptoms interacted with trauma group such that reexperiencing symptoms were positively associated with self-harm for the two trauma groups that included CSA but not for the control and adult rape-only groups. Overall, results indicate that PTSD symptoms-more so than the occurrence of trauma itself-associate with impulsive behavior. Results highlight the importance of assessing posttraumatic symptomatology, and not just trauma occurrence, when aiming to prevent or treat impulsive behaviors.

Problematic online behaviors, including sexting, cyberbullying, and Internet gaming disorder (IGD), were associated with a higher risk of self-harm among adolescents. However, the independent effect on self-harm brought by each problematic online behavior remains unknown.This cross-sectional nationwide survey investigated a representative sample of 8446 Taiwanese adolescents (49.7 % female, mean age = 15.4 ± 1.8, ranging from 10 to 18) in the summer of 2021. We used self-reported questionnaires to assess adolescents' problematic online behaviors. 18-item Risk-Taking and Self-Harm Inventory was applied to evaluate their self-harm risks. Adolescents with score ≥ 7 were considered self-harm identified. Multivariate regression analyses were performed to investigate the association between problematic online behaviors and self-harm risks.The prevalence of sexting, cyberbullying victimization, cyberbullying perpetration, and IGD was 1.3 %, 1.1 %, 0.9 %, and 0.7 %, respectively. Adolescents with sexting were associated with higher self-harm scores (β = 4.30, 95 % CI [3.35, 5.25]), so did adolescents with IGD (β = 3.33, 95 % CI [1.96, 4.71]), cyberbullying perpetration (β = 2.61, 95 % CI [1.03, 4.20]), and cyberbullying victimization (β = 1.40, 95 % CI [0.04, 2.76]). Also, sexting (OR = 5.16, 95 % CI [3.26, 8.07]) and IGD (OR = 3.11, 95 % CI [1.50, 6.15]) were associated with increased odds of identified self-harm behaviors.Sexting, cyberbullying victimization, cyberbullying perpetration, and IGD were all independently associated with an increased self-harm risk among adolescents. Among them, sexting was shown to be the most robust risk factor of identified self-harm behaviors. To prevent self-harm among adolescents, it is important to identify youth involved in problematic online behaviors, especially sexting.

Background: Quetiapine is frequently prescribed to people with personality disorder diagnoses, but this is not supported by evidence or treatment guidelines. Aims: To examine associations between periods of quetiapine prescribing and self-harm events in people with personality disorder. Method: Self-controlled case series using linked primary care and hospital records covering the period 2007–2017. We calculated incidence rates and incidence rate ratios (IRRs) for self-harm events during periods when people were prescribed (exposed to) quetiapine, as well as periods when they were unexposed or pre-exposed to quetiapine. Results: We analysed data from 1,082 individuals with established personality disorder diagnoses, all of whom had at least one period of quetiapine prescribing and at least one self-harm episode. Their baseline rate of self-harm (greater than 12 months before quetiapine treatment) was 0.52 episodes per year. Self-harm rates were elevated compared to the baseline rate in the month after quetiapine treatment was commenced (IRR 1.85; 95% confidence interval (CI) 1.46–2.34) and remained raised throughout the year after quetiapine treatment was started. However, self-harm rates were highest in the month prior to quetiapine initiation (IRR 3.59; 95% CI 2.83–4.55) and were elevated from 4 months before quetiapine initiation, compared to baseline. Conclusion: Self-harm rates were elevated throughout the first year of quetiapine prescribing, compared to the baseline rate. However, rates of self-harm reduced in the month after patients commenced quetiapine, compared to the month before quetiapine was initiated. Self-harm rates gradually dropped over a year of quetiapine treatment. Quetiapine may acutely reduce self-harm. Longer-term use and any potential benefits need to be balanced with the risk of adverse events.

Objectives This study aimed to describe existing knowledge of crisis supporters (volunteers responding to crisis calls/texts/messages) regarding self-harm and suicide in older adults and investigate knowledge translation through use of a novel online adaptive learning tool. Methods The online educational tool was tested in an Australian national sample of crisis supporters (trained volunteers) aged 18+. Knowledge Transfer was evaluated utilizing a pre/post intervention methodology for data collection. The collaboratively developed online educational tool comprised a pre-test (10 questions), middle learning module (individualised for participant's incorrect pre-test responses) and post-test (10 questions) on suicidal behaviours in older adults. Data analysed included the demographic characteristics of the participants, individual question scores, and summed pre- and post-tests scores. Group differences in change scores were assessed with either one-way between subjects ANOVA or independent samples t-test, depending on the number of groups within each variable. Pre-post education comparisons on individual change in scores were made using a paired samples t-test. Statistical significance was defined as p Results 104 crisis supporters completed the tool (pre-test, middle lesson and post-test). There was significant improvement in knowledge of crisis supporters after the intervention (pre-test scores Mean (M) = 4.56, SD = 1.62 and post-test scores M = 7.61, SD = 1.60; t (103) = 17.242, p Conclusion Dedicated training about suicidal behaviors in older adults is needed given their high rates of suicide and differing underlying reasons and needs compared to younger adults.

Purpose of Review Individuals with personality disorders are frequently seen in mental health settings. Their symptoms typically reflect a high level of suffering and burden of disease, with potentially harmful societal consequences, including costs related to absenteeism at work, high use of health services, ineffective or harmful parenting, substance use, suicidal and non-suicidal self-harming behavior, and aggressiveness with legal consequences. Psychotherapy is currently the first-line treatment for patients with personality disorders, but the study of psychotherapy in the domain of personality disorders faces specific challenges. Recent Findings Challenges include knowing what works for whom, identifying which putative mechanisms of change explain therapeutic effects, and including the social interaction context of patients with a personality disorder. By following a dimensional approach, psychotherapy research on personality disorders may serve as a model for the development and study of innovative psychotherapeutic interventions. Summary We recommend developing the following: (a) an evidence base to make treatment decisions based on individual features; (b) a data-driven approach to predictors, moderators, and mechanisms of change in psychotherapy; (c) methods for studying the interaction between social context and psychotherapy.

Bullying victimization has consistently been highlighted as a risk factor for self-injurious thoughts and behaviors (SITBs) in young people. This systematic review of prospective, community-based studies explored associations between bullying victimization (traditional/face-to-face and cyber) across the full spectrum of self-harm and suicidality, in children and young people aged up to (and including) 25 years. Importantly, associations by sex/gender were explored.MEDLINE, Embase, PsycINFO, CINAHL and Scopus were searched for articles meeting the inclusion criteria. Articles were screened by title, abstract and full text. Quality appraisal was performed using the Newcastle-Ottawa Scale for cohort studies. Data were synthesized narratively. The protocol is registered on PROSPERO (CRD42021261916) and followed PRISMA 2020 guidelines.A total of 35 papers were included, across 17 countries. Results were presented by bullying type: traditional/face-to-face (n = 25), cyber (n = 7) and/or an aggregate of both types (n = 7). Outcomes included suicidal ideation (n = 17), self-harm (n = 10), suicide attempt (n = 4), NSSI (n = 4), other (n = 7). Studies measured outcomes in under 18s (n = 24), 18-25-year-olds (n = 8) and both under 18s and 18-25-year-olds (n = 3). Studies exploring the role of sex/gender (20%) found some interesting nuances.Some weak to strong associations between bullying and SITBs were found yet conclusions are tentative due to study heterogeneity (e.g., methods used, conceptualizations and operationalisations of exposures/outcomes). Future research should address methodological issues raised in this review, and further explore gender differences in bullying, including by bullying sub-types (e.g., overt or relational) and victim status (e.g., victim or bully-victim).

Background: There is a complex and inconsistent relationship between bullying involvement and self-harmful thoughts and behaviour (SHTB) in young people. This novel systematic review aims to establish key interacting, moderating and mediating variables associated with SHTB in young people involved in bullying. Methods: The systematic review was registered with PROSPERO: CRD42020192023. A search was conducted (until February 2021) across databases: PubMed/MEDLINE, EMBASE, PsycINFO (Ovid), Cochrane Library, Scopus (Elsevier), Web of Science, ERIC and CINAHL (EBSCOhost). Observational studies containing quantitative primary or secondary data analyses were included in the review, on the basis that they examined interactions, moderators, or mediators between bullying involvement and SHTB in young people. Versions of the Newcastle-Ottawa Scale were used to assess risk of bias in the included studies. Results: A total of 57 studies were included. Overall, 3 studies identified interactions, 25 studies identified moderators and 21 studies identified mediators. 9 studies identified moderator-mediators. The findings were categorised as either self-harmful thoughts or self-harmful behaviours and synthesised under the following themes: socio-demographic; depression; parental; personality/psychological; and social/environmental. Limitations: This review uncovered significant heterogeneity and a paucity of replicated studies in the field, therefore, tentative conclusions have been drawn. Conclusions: This comprehensive review highlights the key role of depression as a mediator between traditional/cyber victimisation and SHTB in young people. The moderating effects of gender on mediation models investigating the role of depression suggest the possibility that females involved in bullying may be at increased suicide risk.

The main aim of this article is to compare the prevalence of four forms of physically self-destructive behavior in the offspring of parents with borderline personality disorder (BPD) and compare them to the offspring of parents with other personality disorders (OPD). At the 4- and 6-year waves in a prospective study of the long-term course of BPD, participants were asked to report on the self-destructive behaviors of their children using the Childhood Self-Destructiveness Scale. A total of 68 parents were interviewed regarding 131 children, 104 of whom were offspring of parents with BPD (n = 55) and 27 were offspring of parents with OPD (n = 13). BPD parents reported significantly more self-injury and substance abuse in their children than OPD parents. The results from this study suggest that both direct and indirect forms of self-destructive behavior are both more common and quite specific for the children of parents with BPD.

International audience; Background: After the Food and Drug Administration alert about antiepileptic medication and suicide, incident epilepsy has been associated with first or recurrent suicide attempts independently of psychiatric comorbidities and antiepileptic treatment. Following this thread, the aim of this study was to analyze if epilepsy was associated with a higher severity of lifetime suicide attempts (SAs).Methods: Analyses were carried out on 1677 adults hospitalized between 1999 and 2012 after a SA in a specialized ward for affective episodes. Five severity features were studied: frequent SAs (>2), early onset of first SA (≤26 years), history of violent SA, high suicide intent and high lethality of the SA. Adjusted logistic regression models were used to estimate the association between the lifetime diagnosis of epilepsy and the severity features.Results: Among suicide attempters, ninety-three patients reported a lifetime diagnosis of epilepsy (5.5%). Epileptic patients diagnosed after the first SA were more likely to be frequent suicide attempters than non-epileptic ones. They showed also higher SA planification scores.Limitations: Diagnosis accuracy is limited by the use of self-reports for epilepsy. The lack of precise information about the disease course and treatment have not allowed for further statistical analysis. With regard to psychiatric comorbidities, personality disorders could not be taken into account.Conclusions: Suicide attempters with epilepsy present an increased severity in some aspects of their suicidal behavior regardless of demographic and clinical variables. Our results give support to the existence of a bidirectional association between epilepsy and suicidal behavior.

Comorbidity of disordered eating (DE) behaviors and nonsuicidal self-injury (NSSI) is linked to increased functional impairment. The present study identified subtypes of DE and NSSI comorbidity in a non-Western, low- and middle-income country where there has been particularly little research in this area.Latent profile analyses (LPA) were conducted to identify patterns of subgroup comorbidity in self-reported DE behaviors and NSSI behaviors, in a sample of Vietnamese high-school students (N = 1451, 51% female). Parallel-process LPA was used to predict NSSI subgroup membership from DE subgroup membership.A seven-class LPA model was identified for DE: (1) Low frequencies of all DE behaviors; (2) Frequent levels of all DE behaviors; (3) Frequent fasting and purging behaviors; (4) Frequent binge eating only; (5) Moderate binge eating; (6) Moderate fasting and purging behaviors; (7) Exercise and fasting. A two-class (high versus low) model was identified for NSSI. Odds of membership in the high-NSSI class were significantly increased for all DE classes except the class characterized by moderate binge eating. Odds of belonging to the high-NSSI class were highest for those in DE classes involving purging behaviors. Males predominated in classes characterized by high behavior dysregulation.DE and NSSI represent important clinical concerns among Vietnamese youth in urban contexts, and males may show particular vulnerability for certain risk behaviors. The association of classes of DE behaviors to NSSI was particularly strong for classes that involved purging, highlighting the importance of this specific behavior for understanding comorbidity of DE and NSSI.Disordered eating and nonsuicidal self-injury (NSSI; hurting oneself without intending to die) commonly co-occur. There has been less research on disordered eating and NSSI among individuals from non-Western or low/middle-income countries. We examined patterns of these behaviors in a school-based sample of Vietnamese adolescents. We found that patterns of disordered eating distinguished by purging showed particular links to NSSI, which could have implications for screening and treatment.

QuestionEffective prevention of suicide requires a comprehensive understanding of risk factors.Study selection and analysisFive databases were systematically searched to identify psychological autopsy studies (published up to February 2022) that reported on risk factors for suicide mortality among adults in the general population. Effect sizes were pooled as odds ratios (ORs) using random-effects models for each risk factor examined in at least three independent samples.FindingsA total of 37 case–control studies from 23 countries were included, providing data on 40 risk factors in 5633 cases and 7101 controls. The magnitude of effect sizes varied substantially both between and within risk factor domains. Clinical factors had the strongest associations with suicide, including any mental disorder (OR=13.1, 95% CI 9.9 to 17.4) and a history of self-harm (OR=10.1, 95% CI 6.6 to 15.6). By comparison, effect sizes were smaller for other domains relating to sociodemographic status, family history, and adverse life events (OR range 2–5).ConclusionsA wide range of predisposing and precipitating factors are associated with suicide among adults in the general population, but with clear differences in their relative strength.PROSPERO registration numberCRD42021232878.

Opioid and other drug-related overdoses and suicides are leading causes of injury death and represent a significant public health threat in the United States (U.S.). This study examined clinical factors of three patient groups from two inpatient addiction treatment facilities in Appalachian West Virginia (n = 66). Patients were classified as having: 1) unintentional overdose(s) (OD), 2) suicidal ideation or suicide attempt(s) (SI/SA), and 3) suicidal ideation or suicide attempt, and unintentional overdose (SI/SA/OD). Multinomial logistic regression models were used to determine whether adverse childhood experiences, self-injurious behaviors, substance use history, overdose history, and past year stressful life events were differentially associated with history of SI/SA/OD. Participants in the OD group were more likely to have used heroin in the 24-h preceding their most recent overdose compared to either the SI/SA or SI/SA/OD groups. The multivariable model found participants with history of SI/SA had higher adverse childhood experience scores and more participants with history of SI/SA endorsed childhood physical abuse and teen dating violence. Overall, there are characteristics that distinguish unintentional overdose from suicidal ideation and attempt. Patients with SI/SA/OD appear to have greater clinical severity. More thorough evaluation of drugs involved in overdose and history of self-injury may help distinguish future risk and inform treatment planning.

To examine trajectories of treatment response in suicidal youth who participated in a randomized controlled trial comparing dialectical behavior therapy (DBT) and individual and group supportive therapy.Using latent class analysis across both treatment conditions, secondary analyses were conducted of data from a multisite randomized controlled trial comprising 173 youths ages 12-18 with repetitive self-harm (SH) (including ≥1 lifetime suicide attempts) and elevated suicidal ideation (SI). The sample was 95% female, 56.4% White, and 27.49% Latina. Participants received 6 months of DBT or individual and group supportive therapy and 6 months of follow-up. Primary outcomes were SH and SI.Of the sample, 63% and 74% were members of latent classes that showed improvement in SI and SH, respectively; 13% were total nonresponders, with no improvement in SI or SH. SH nonresponse emerged at the midpoint of treatment (3 months), with nonresponders showing a sharp increase in SH over the remainder of treatment and follow-up. Youth receiving DBT were significantly more likely to be an SH responder vs nonresponder than youths in individual and group supportive therapy (ꭓThis is the first study to identify trajectories of both SI and SH response to treatment in a sample of adolescents at risk of suicide. Results may inform personalized treatment approaches.Collaborative Adolescent Research on Emotions and Suicide (CARES); https://www.gov/; NCT01528020.

Language is a powerful form of communication that not only conveys ideas and knowledge but also can assign meaning and value to the world around us. As such, language has the power to shape our attitudes toward individuals, behaviors, and ideas, by labeling them (indirectly or not) as "good" or "bad." In this way, language can be used to propagate stigma and other unhelpful attitudes toward individuals who already experience stigma. One behavior that may be particularly prone to the impact of unhelpful language is nonsuicidal self-injury (NSSI). In this article, we draw on Staniland's NSSI stigma framework to demonstrate how an individual with lived experience of NSSI may be exposed to stigmatizing messaging through 30 different channels, and propose that the accumulation of these messages may be particularly damaging. We conclude by offering practical tips for clinicians and researchers wishing to empathically work with individuals who self-injure.

The objective was to examine the associations of socioecological connectedness with bullying victimization and depressive symptoms in early adolescence and with non-suicidal self-injury (NSSI) in mid-adolescence, and how these might differ between genders. Diverse adolescents (N = 4115; 49.1% girls) in the 7th grade reported on connections with parents/family, peers, school, and neighborhood, as well as bullying victimization and depressive symptoms, and NSSI in 10th grade (Me = 16.1 years). Structural equation modeling with WSLMV indicated that the lower likelihood of NSSI in 10th grade was associated with higher perceptions of connections between adolescents and their families, both directly as well as indirectly through reduced bully victimization and depressive symptoms three years earlier. Higher school connectedness was indirectly associated with the lower likelihood of NSSI through bullying victimization and depressive symptoms. Paths to NSSI varied for girls and boys. Results advance the understanding of developmental pathways leading to NSSI in adolescent girls and boys.

We examined whether the analgesic effect of alcohol mediates the association between alcohol and deliberate self-harm (DSH) using data from a larger study on alcohol effects (see Berman et al., 2017). Men (n = 106) and women (n = 104) low-risk alcohol drinkers (ages M = 26.00, SD = 6.98) recruited from the community who had no suicide attempt or episode of deliberate self-harm within the past year were randomly assigned to either a placebo drink condition or a drink calibrated to reach approximately .050%, .075%, or .100% blood alcohol concentration. Notable within-condition BAC variability, as well as overlap between conditions, suggested that BAC would be a more accurate indicator of intoxication compared to condition assignment. Pain tolerance was assessed by increasingly intense 1-second shocks delivered via fingertip electrodes. Self-reported pain associated with the pain tolerance index was also examined. A laboratory task of DSH, the Self-Aggression Paradigm (Berman & Walley, 2003), was then completed, with DSH operationalized as the number of self-administered shocks the participant was led to believe were twice the intensity of his or her pain tolerance and could cause “minor tissue damage that would quickly heal.” A negative binomial parallel mediational model for count data revealed that pain tolerance, but not self-report pain, mediated the effect of alcohol on DSH. As such, the current study provides preliminary experimental evidence that the analgesic effect of alcohol is partially responsible for link between alcohol intoxication and deliberate self-harm.

Nonsuicidal self-injury (NSSI) is a robust predictor of suicide ideation and attempts, but it is not clear how and why this connection is so strong. Using the Integrated Motivational-Volitional Model of suicide as a framework, select features of NSSI were examined as motivational moderators between hopelessness and suicide ideation.Data were collected from 420 emerging adults (mean age = 18.9; 84% female, 92% white), all of whom had past-year NSSI. Participants completed self-report measures that assessed NSSI and suicide history, effectiveness of NSSI in achieving functions, and hopelessness; they also completed the self-injury Implicit Association Test (IAT).Moderation analyses revealed that none of the interactions were significant. Additional analyses tested unconditional effects of all predictor variables and found hopelessness, self-rated future likelihood of engaging in NSSI, effectiveness of NSSI in achieving intrapersonal functions, and self-injury IAT scores were each significantly associated with suicide ideation.These results reinforce the important role of hopelessness, perceived effectiveness of NSSI in achieving intrapersonal functions, acknowledgement of future NSSI, and self-identification with NSSI as potential indicators of increased suicide risk, while also emphasizing further study of other possible moderating factors.HIGHLIGHTSFeatures of NSSI did not moderate the hopelessness-suicide ideation relationship.Features of NSSI did associate with increased suicide ideation frequency.Future likelihood of, implicit association with, and intrapersonal effectiveness of NSSI were important.

Objectives Patients with schizophrenia have a significant risk of self-harm. We aimed to explore the dynamic relationship between symptomatology, functioning and deliberate self-harm (DSH) and evaluate the feasibility of developing a self-harm risk prediction tool for patients with first-episode schizophrenia (FES). Methods Patients with FES (n = 1234) were followed up for 36 months. Symptomatology, functioning, treatment adherence and self-harm information were obtained monthly over the follow-up period. A time-varying vector autoregressive (VAR) model was used to study the contribution of clinical variables to self-harm over the 36th month. Random forest models for self-harm were established to classify the individuals with self-harm and predict future self-harm events. Results Over a 36-month period, 187 patients with FES had one or more self-harm events. The depressive symptoms contributed the most to self-harm prediction during the first year, while the importance of positive psychotic symptoms increased from the second year onwards. The random forest model with all static information and symptom instability achieved a good area under the receiver operating characteristic curve (AUROC = 0.77 ± 0.023) for identifying patients with DSH. With a sliding window analysis, the averaged AUROC of predicting a self-event was 0.65 ± 0.102 (ranging from 0.54 to 0.78) with the best model being 6-month predicted future 6-month self-harm for month 11–23 (AUROC = 0.7). Conclusions Results highlight the importance of the dynamic relationship of depressive and positive psychotic symptoms with self-harm and the possibility of self-harm prediction in FES with longitudinal clinical data.

Research regarding the accuracy of co-morbid psychiatric diagnoses in individuals with intellectual and developmental disabilities (IDD) is sparse. Yet correct diagnostic assignment is vital so that effective and appropriate treatment can be implemented, especially for the large numbers of individuals requiring expensive and restrictive behavioural health crisis services.A retrospective review of de-identified data from multidisciplinary specialty team assessments completed for 50 individuals with ID (IntellectualDisability) with and without ASD and unresolved behavioural health challenges was conducted. The accuracy and reliability of the psychiatric diagnoses upon referral were compared with the diagnoses after the comprehensive team evaluation, and within-individual diagnostic agreement was calculated. The agreement between the Mood and Anxiety Semi-Structured interview tool (MASS) and the full team evaluation was also calculated. The influence of demographic and clinical characteristics on diagnostic agreement was explored.The most common chief complaints upon referral were aggression to others and self-injurious behaviour. Individuals were taking a median of six medications (interquartile range: 5 to 7); 80% were taking an antipsychotic medication. The most common medical conditions were constipation (70%) and gastroesophageal reflux disease (52%). Measures of interrater reliability of the referral diagnoses with the team assessment were below 0.5 (kappa range: -0.04 to 0.39), with the exception of ruling out dementia (kappa = 0.85). The interrater reliability estimates for the MASS evaluations for depression and anxiety were higher (kappa = 0.69 and 0.64) and reflected higher sensitivity and PPV. The odds of any referral diagnosis being confirmed by team evaluation were low: 0.25 (range: 0 to 0.67). The level of diagnostic agreement for each patient was not significantly attributable to demographic or clinical characteristics, although effect sizes indicate a possible positive relationship to age and the number of prescribed psychotropic medications at referral.Individuals in the current study had serious psychiatric and behavioural problems despite psychiatric care in their communities. The majority of psychiatric diagnoses provided upon referral were not supported by the multidisciplinary specialty team's assessment. In addition to possible diagnostic inaccuracy, the group in the study suffered from multiple medical co-morbidities and were exposed to polypharmacy. Results emphasise the importance of multidisciplinary evaluation by clinicians with expertise in neurodevelopmental disabilities when people with ID with and without ASD have complex behavioural health needs that are unresponsive to usual care. In addition, based on agreement with the full team evaluation, the MASS shows promise as an assessment tool, especially with regards to identifying anxiety and depression.

ObjectiveSelf-harm among young autistic individuals is a clinical challenge, and the risk of premature death by suicide is strongly increased in this group. Using the advantage of total-population and family-based data, we investigated whether autism per se is a risk factor for self-harm independently of psychiatric comorbidities and how it differs from self-harm in non-autistic individuals.MethodsWe used The Stockholm Youth Cohort, a total-population register study, including all residents in Stockholm County aged 0–17 years between 2001 and 2011.Study participants were followed from age 10 to 27 for hospital admissions because of self-harm. We used modified Poisson regression to calculate relative risks (RR) using robust standard error to derive 95% confidence intervals (CI).ResultsIn all, 410,732 individuals were included in the cohort (9,070 with a diagnosis of autism). Autistic individuals had a fivefold increased adjusted relative risk of self-harm (RR 5.0 [95% CI 4.4–5.6]). The risk increase was more pronounced for autism without intellectual disability and particularly high for self-cutting 10.2 [7.1–14.7] and more violent methods 8.9 [5.2–15.4]. The association between autism and self-harm was independent of, but clearly exacerbated by comorbid psychiatric conditions. It was of similar magnitude as risks linked to these conditions per se, and not explained by shared familial factors.ConclusionSelf-harm severe enough to present to medical services is as common in autistic youth as in those with depression or ADHD. Potentially more lethal methods are more likely to be used of autistic self-harmers.

Suicide is a major, global, public health issue. Those who attempt suicide represent a high-risk subgroup for eventual death by suicide. We provide an update on emerging evidence for interventions for attempted suicide to reduce subsequent suicidal behavior.Major approaches that have been examined recently include pharmacological, psychosocial, brief active contact and outreach interventions, and digitally driven interventions. Notwithstanding the limited evidence base for most of these approaches, brief contact and follow-up interventions appear to have more robust effects on reduction of repeat suicidal behavior, including attempts; such approaches may have especial significance in emergency settings because of their brevity. Digital interventions for self-harm appear promising in the short-term whereas the evidence for pharmacological and psychosocial strategies remain inconclusive.Although current evidence supports the use of brief interventions, contact, and outreach for reducing risk of subsequent suicide attempts and suicidal behavior, there are large gaps and limitations in the evidence base related to trial design, lack of long-term efficacy data, and implementational challenges. More robustly designed long-term trials that examine integrated intervention approaches with well defined outcomes are needed to develop recommendations in this area.

This article explores the psychical expression of autoimmunity in the analytic situation; it is informed by biological theories of autoimmunity in contemporary immunology. Several of my patients developed autoimmune conditions in the course of their analyses, leading me to consider the role of psychical change in disrupting one's somatopsychic equilibrium. In the psychoanalytic literature, autoimmunity is used metaphorically for attack against what is foreign or unwanted in ourselves. Contemporary immunology, however, suggests a somewhat different metaphor. "Self-reactive" cells present in the body may attack self unless suppressed by inhibitory mechanisms. Biologically, limited self-destructiveness is necessary, but in autoimmune disease it becomes excessive and pathological. I suggest that the presence of biological "self-reactivity" implies an inherent self-destructiveness in line with Freud's thinking on the death instinct; the notion that this self-destructiveness also has adaptive aspects may contribute to our understanding of Freud's ideas. In three vignettes I illustrate clinical application of a modified metaphor of autoimmunity, finding that not only is the fusion of life and death instincts important for psychic development, but so is defusion when contained within the analytic relationship. The analytic task is to restore the balance between constructive and pathological self-destructiveness. Implications regarding controversies in psychosomatic theory are briefly considered.

Various opinions have been suggested regarding non suicidal self-injury (NSSI) and pain relationship. Opiorphin is a recently found peptide that inhibits enkephaline-catabolizing enzymes. Analgesia caused by opiorphine has been demonstrated in animal experiments. No studies have examined the relationship between opiorphin and pain sensation until today. We aimed to investigate opiorphine and pain threshold among self-injuring adolescents. Adolescents aged 14-18 years were included in the study. The NSSI group consisted of 37 adolescents diagnosed with NSSI according to DSM-V Section 3, and the non-NSSI group consisted of 36 adolescents without any psychiatric disorder. We measured pain threshold with a pressure sensitive algometer device and analyzed saliva opiorphin levels by ELISA method. Mediation analysis was performed using Process Macro developed by Hayes. NSSI group had statistically significantly higher pain threshold and opiorphin levels than the non-NSSI group. There was a positive correlation between pain threshold values and opiorphin levels in the NSSI group. Also, a positive correlation between opiorphin levels and total cutting episode number was found. We searched for a probable relationship of pain threshold with episode number of each type of NSSI act. Accordingly, a positive correlation with two major act and a negative correlation with two minor act was shown. The opiorphine was found to be a mediator variable in the relationship between the pain threshold and the cutting number. The relationship between opiorphin, pain threshold and cutting number and their mediating effects with each other may highlight the pain-based biological origins of NSSI.

Introduction: We investigated the longitudinal course of self-, other-, and dual-harm in adolescents, focusing on the infliction of physical injury on oneself, another person, or both parties, respectively. We examined the within-person transitions between these types of harm and whether relationships with peers and teachers predict individual harm trajectories. Methods: We used community-representative longitudinal data (N = 1,482; 52% male; 50% both parents born abroad). The participants self-reported self- and other-harm at 13, 15, 17, and 20 years. We assigned them to groups with self-, other-, dual- or no harm at specific assessments. Bullying victimization and relationship quality with classmates and teachers were assessed at 13 and 17. We estimated transition probabilities between the harm groups using latent Markov chain models. Results: At age 13, 3% of the sample engaged in dual-harm, 10% in self-harm only, and 7% in other-harm only. These percentages decreased in late adolescence. Initial dual-harm was often followed by sex-specific single-harm: most of the female participants transitioned to self-harm, and male participants to other-harm. Those in the initial dual-harm group were less likely to stop harming than those in the initial single-harm groups (p < 0.05). Adverse relationship experiences generally predicted harm. A positive teacher-student bond was associated with the cessation of single-harm. Conclusion: Single- and dual-harm in the form of physical injury typically emerge by mid-adolescence. After this point, adolescents commonly maintain harm, especially those who have presented with dual-harm. Helping adolescents cope with adverse relationship experiences and creating opportunities for positive relationship experiences could address these harmful behaviors.

INTRODUCTION: Among adolescents, an increasing rate of interpersonal interactions occur online. Previous research has shown that interpersonal context exerts a robust impact on suicidal thoughts or behaviors, yet little attention has focused on examining the content of online interactions surrounding self-injurious thoughts or behaviors. As such, the present study sought to compare online social networking behaviors among adolescents on days with and without experiencing self-injurious thoughts or behaviors, as influenced by childhood maltreatment history. METHOD: Adolescents aged 13 to 18 hospitalized for self-injurious thoughts or behaviors were recruited as part of an ongoing longitudinal study. A subsample (N = 22) of adolescents provided data from their online social networking platforms (i.e. Text Messages, Facebook, Instagram, and Twitter). Using a mixed-methods approach, online social networking data on days of experiencing self-injurious thoughts or behaviors and days of not experiencing self-injurious thoughts or behaviors were compared. RESULTS: Results indicate the frequency and content of online social networking messaging does not change by day of self-injurious thoughts or behaviors or history of childhood maltreatment. However, childhood maltreatment predicts received conflictual messages as well as sent symptomatic messages on days of experiencing self-injurious thoughts or behaviors. CONCLUSIONS: Childhood maltreatment may play a role in the content of adolescent online behaviors, particularly on days where they experience self-injurious thoughts or behaviors. Implications for intervention are discussed.

Dialectical behavior therapy (DBT) is an empirically supported behavioral treatment for individuals with borderline personality disorder who frequently exhibit life-threatening behavior, such as suicide attempts, nonsuicidal self-injury urges and actions, and suicidal ideation. We provide an overview of the theoretical framework by which DBT conceptualizes these life-threatening behaviors and the principles by which safety planning measures are implemented and maintained throughout treatment. The importance of orienting clients to treatment and obtaining their commitment to decrease life-threatening behavior is reviewed. Relevant strategies associated with risk management and assessment, such as the diary card, chain analysis, solution analysis, phone coaching, and consultation team, are described. The overview concludes with a case example to illustrate the application of these techniques with a DBT client with a long-standing history of engaging in life-threatening behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

We developed the Self-Injury Risk Assessment Protocol for Corrections (SIRAP-C) to meet legal mandates for self-directed violence (SDV) risk assessment standards in correctional settings. We focused on two empirical aims: (1) factor structure and internal consistency and (2) subscale associations with SDV and intervention recommendation outcomes.We expected a multifactorial SIRAP-C structure with acceptable internal consistency. We further expected SIRAP-C subscales would distinguish history of SDV events while incarcerated, current SDV event category, and treatment recommendation.We drew electronic health record data for adult incarcerated persons (Factor analyses supported a seven-factor SIRAP-C structure (27 items) comprising Depressive Symptoms, Reasons for Living, History of Self-Directed Violence, Current Suicidal Thinking, Family History of Self-Directed Violence, Coping Skills, and Social Connectedness. Subscales displayed acceptable internal consistency, with the exception of social connectedness in the confirmatory factor analysis subsample. Lower depressive symptoms and coping skills, as well as higher history of SDV, were associated with increased risk for a prior SDV assessment event while incarcerated. Lower depressive symptoms, current suicidal thinking, and coping skills and higher history of SDV marked worse risk for self-injurious behavior. Higher depressive symptoms and current suicidal thinking, as well as lower reasons for living, demarcated suicidal acts from self-injury. Higher history of SDV and lower coping skills indicated outpatient/residential treatment. Elevated depressive symptoms and history of SDV, as well as lower reasons for living and coping skills, were associated with inpatient hospitalization.The SIRAP-C represents a promising clinical approach advancing correctional SDV risk assessment. We offer future research, policy, and implementation recommendations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

To identify psychological interventions that improve outcomes for those who overdose, especially amongst Lesbian, Gay, Bisexual, Transgender, Intersex and Questioning populations.To recognize and assess the results from all studies including randomized control trials (RCTs) that have studied the efficiency of psychiatric and psychological assessment of people who have depression that undergo non-suicidal self-injury (NSSI) by self-poisoning, presenting to UK Accident and Emergency Departments.A scoping review of all studies including RCTs of psychiatric and psychological therapy treatments. Studies were selected according to types of engagement and intervention received. All studies including RCTs available in databases since 1998 in the Wiley version of the Cochrane controlled trials register in 1998 till 2021, Psych INFO, Medline, Google Scholar and from manually searching of journals were included. Studies that included information on repetition of the NSSI behaviour were also included. Altogether this amounts to 3900 randomized study participants with outcome data.Seven trials reported repetition of NSSI as an outcome measure which were classified into four categories. Problem-solving therapy is indicated as a promising therapy and has shown to significantly reduce repetition in participants who NSSI by overdosing than patients in the control treatment groups consisting of standard after care.The data show that manualized cognitive therapy psychological intervention was more effective than TAU after care. However, these differences are not statistically significant withip/i = .15; CI 0.61, 1.0 which crosses the line of no effect. And psychodynamic interpersonal therapy is more effective than the standard treatment. Despite being only one study in this subgroup the analysis shows a statistical significance withip/i = .009, CI 0.08; 0.7.

Objective The COVID-19 pandemic has had a complex impact on risks of suicide and non-fatal self-harm worldwide with some evidence of increased risk in specific populations including women, young people, and people from ethnic minority backgrounds. This review aims to systematically address whether SARS-CoV-2 infection and/or COVID-19 disease confer elevated risk directly. Method As part of a larger Living Systematic Review examining self-harm and suicide during the pandemic, automated daily searches using a broad list of keywords were performed on a comprehensive set of databases with data from relevant articles published between January 1, 2020 and July 18, 2021. Eligibility criteria for our present review included studies investigating suicide and/or self-harm in people infected with SARS-CoV-2 with or without manifestations of COVID-19 disease with a comparator group who did not have infection or disease. Suicidal and self-harm thoughts and behaviour (STBs) were outcomes of interest. Studies were excluded if they reported data for people who only had potential infection/disease without a confirmed exposure, clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 test result. Studies of news reports, treatment studies, and ecological studies examining rates of both SARS-CoV-2 infections and suicide/self-harm rates across a region were also excluded. Results We identified 12 studies examining STBs in nine distinct samples of people with SARS-CoV-2. These studies, which investigated STBs in the general population and in subpopulations, including healthcare workers, generally found positive associations between SARS-CoV-2 infection and/or COVID-19 disease and subsequent suicidal/self-harm thoughts and suicidal/self-harm behaviour. Conclusions This review identified some evidence that infection with SARS-CoV-2 and/or COVID-19 disease may be associated with increased risks for suicidal and self-harm thoughts and behaviours but a causal link cannot be inferred. Further research with longer follow-up periods is required to confirm these findings and to establish whether these associations are causal.

Objective A rapid clinical update on the potential interplay between social media use and rates of deliberate self-harm amongst young people in Australia. Conclusions Rising social media use has been associated with increasing cyberbullying and deliberate self-harm, especially in young women. On the other hand, social media use also provides beneficial support. Examination of problematic social media use in assessments of young people presenting with self-harm may be useful, along with discussion of responses to negative social media. In this point of view, we discuss these matters and the UK Royal College of Psychiatrists’ recommendations for reducing the negative impact of social media.

Non-suicidal self-injury (NSSI) is a clinically significant behavior with high relevance and prevalence, especially affecting approximately 17-18% of the adolescent population worldwide. The aim of this study is to perform a systematic review to evaluate the effectiveness of the available Specific Psychotherapeutic Interventions (SPI) focused on the reduction of NSSI behaviors. A systematic review was performed analyzing PsychINFO, MEDLINE, Web of Science, PubMed and Cochrane CentralRegister of Controlled Trials to identify studies of interest from January 2010 to December 2020. According to PRISMA guidelines, only 13 studies were included in the review. Six SPI were found to specifically and significantly reduce NSSI in adolescents: Developmental Group Psychotherapy (DGP), Therapeutic Assessment (TA), Cutting Down Program (CDP), Emotional Regulation Individual Therapy for Adolescents (ERITA), Treatment for Self-Injurious Behaviors (T-SIB) and Intensive Contextual Treatment (ICT). Furthermore, relevant improvements in anxiety and depression symptoms were observed. The results of this review demonstrate the effectiveness of these interventions, mainly the CPD and T-SIB, which are the only SPI that have been studied using Randomized Controlled Trial (RCT). Considering the clinical relevance and associated functional impairment of NSSI, more research is needed to replicate the results and to increase knowledge about SPIs.

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a multidimensional and hierarchical model of the latent structure of psychopathology. While HiTOP has received much support in child/adolescent community samples, fewer studies have assessed this model in clinical samples of children/adolescents. Here, we modelled the latent structure of 45 symptoms of psychopathology from a clinical sample of children/adolescents and assessed how dimensions of psychopathology were related to specific forms of trauma and suicidality/self-harm. Clinician-derived assessments were obtained from 507 people aged 7–18 years. Confirmatory factor analysis was used to determine the optimal fitting model, and structural equation modelling was used to estimate associations with trauma exposure and suicidality/self-harm. The best fitting model(s) included five first-order factors reflecting Fear, Distress, Externalizing, Thought Disorder, and Traumatic Stress, with a higher-order general factor (p) accounting for the covariation between these factors. Unique associations were identified between specific forms of trauma and each dimension of psychopathology. p was strongly associated with suicidality/self-harm, and of the first-order factors, Distress was most strongly associated with suicidality/self-harm. Findings support the predictions of HiTOP that the latent structure of child/adolescent psychopathology can be effectively described by a multidimensional and hierarchal model. Moreover, we found tentative evidence for a unique dimension of Traumatic Stress psychopathology. Our findings also highlight the unique associations between specific forms of early life trauma and specific dimensions of psychopathology, and the importance of Distress related psychopathology for suicidality/self-harm in children and adolescents.

Background Long-term use of testosterone can be associated with mood destabilizing effects. Most studies investigating psychiatric complications of anabolic steroids have used small samples, but a comprehensive assessment of the risk of developing mental health disorders after testosterone use has not been performed at the population level. Aim To determine whether testosterone therapy is associated with major depressive disorder or suicide attempts in men. Methods We conducted a retrospective cohort study of 70.3 million electronic health records collected from 46 healthcare organizations encompassing flagship hospitals, satellite hospitals, and outpatient clinics since 2008 to determine whether testosterone use is associated with major depressive disorder and suicide attempts in a large population. We included men 18 or older who either used testosterone or did not, defined by reported use, insurance claim, or prescription use of testosterone documented in the electronic health record. We propensity-score matched by age, race, ethnicity, obesity, and alcohol-related disorder. Additionally, a sub-group analysis was performed in testosterone deficient ( Outcomes We determined measures of association with a new diagnosis of major depressive disorder and suicide attempt or intentional self-harm following testosterone use within 5 years. Results A total of 263,579 men who used testosterone and 17,838,316 men who did not were included in the analysis. Testosterone use was independently associated with both Major Depressive Disorder (OR 1.99, 95% CI 1.94–2.04, P < .0001) and Suicide Attempt/Intentional Self-Harm (OR 1.52, 95% CI 1.40-1.65, P < .0001). Results remained significant in testosterone deficient sub-group analysis. Clinical Implications Men who use testosterone should be screened for and counseled about risks of depression and suicidality. Strengths and Limitations Strengths of this study include a large sample size, the ability to account for chronology of diagnoses, the use of propensity score matching to control for potentially confounding variables, and the consistency of results with sub-group analyses. Limitations include the potential for incorrect coding within the electronic health record, a lack of granular information regarding testosterone therapy adherence, the possibility that unrecorded testosterone or anabolic steroid use were prevalent but not captured within the control group, and a lack of data regarding testosterone withdrawal. Conclusion Testosterone use is independently associated with new-onset mental health disorders. Future studies are necessary to elucidate the role that androgen withdrawal plays and whether a causal relationship exists.

Behavioral models of nonsuicidal self-injury (NSSI) propose that experiencing desirable consequences following NSSI reinforces the behavior. However, these models do not specify whether experiencing more desirable consequences relative to other people (between-person), an individual's own average (within-person), or both, predicts NSSI severity. To address this gap, this study investigated the prospective, within- and between-person associations of desirable NSSI consequences with NSSI frequency (number of episodes) and versatility (number of methods).Two hundred and ten individuals (93.81% female, MWithin-person increases in desirable emotional consequences were unrelated to NSSI frequency three months later but predicted increases in NSSI versatility. Within-person increases in desirable social consequences predicted decreases in NSSI frequency three months later but were unrelated to NSSI versatility. Between-person variability in desirable consequences was unrelated to NSSI severity.Findings were partially consistent with behavioral models of NSSI. Going forward, we recommend that: (1) behavioral models articulate the salience of within-person fluctuations in consequences; (2) research clarifies the role of social consequences; and (3) clinicians use repeated assessments of emotional consequences to identify periods of elevated NSSI risk.

Some patients engage in self-harm behaviors while in the emergency department. Risk factors for self-harm have been described for inpatient and outpatient/community settings, but not among emergency department patients. Authors conducted case-control, retrospective reviews of medical records and incident reports for emergency department patients in two academic medical centers. Variables were analyzed using conditional logistic regression. There were 113 individuals who engaged in self-harm while in the emergency department and 226 individuals who did not. Four variables were significant in the final model: a history of nonsuicidal self-harm (odds ratio [OR], 4.28; 95% confidence interval [CI], 1.95-9.41), opioid use in the prior 2 weeks (OR, 2.89; CI, 1.19-7.02), current manic episode (OR, 3.59; CI, 1.33-9.70), and a history of seizures (OR, 4.19; CI, 1.16-15.14). Risk of self-harm while in the emergency department may be mitigated with interventions that support adaptive coping skills, promptly address pain and withdrawal symptoms, and treat mania.

PURPOSE: To help reduce suicide and other forms of self-harm, research with youth and their exposure to self-directed violence is critical. Yet we know little about how participants feel about taking part in a survey that asks about such exposure. The present study aims to understand the survey experience of youth and young adult participants in a study about exposure to self-directed violence. METHODS: A total of 990 participants, aged 13–23 years, were recruited through study advertisements on Facebook and Instagram between November 27, 2020, and December 4, 2020. Data for this cross-sectional study were collected in the United States. RESULTS: A total of 37.6% of participants felt somewhat upset from their survey experience, and 14.9% were upset or extremely upset with the highest levels of upset reported by cisgender sexual minority girls and gender minority youth. Lower odds of saying one’s contributions were valuable were noted for cisgender sexual minority boys and gender minority youth compared to cisgender heterosexual boys, as well as youth who reported exposure to self-directed violence. Eight in 10 youth felt it was important to ask questions about self-directed violence exposure in surveys. CONCLUSIONS: The research and practitioner communities should be particularly mindful of high-risk populations and identify innovative ways to better support and encourage their voice in research, as well as highlight the value of their participation. The results provide some guidance for those conducting research with youth on this topic.

Objective Older adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental healthcare is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental healthcare in suicidal older adults. Methods Retrospective cohort analysis using 2015 Medicare data for adults aged ≥65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n = 27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental healthcare. Results Overall, 30.3% of patients received follow-up mental healthcare within 7 days of discharge. However, follow-up rates were higher for patients with any mental healthcare within 30 days prehospitalization (43.7%) compared to patients with no recent mental healthcare (15.7%). Longer length of stay and care in psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental healthcare in the 30 days prehospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-white patients were less likely to receive follow-up care. Conclusion Timely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.

Veterans who decline to provide information on their history of self-injurious thoughts and behaviors (SITBs) may be at elevated suicide risk. We examined associations between non-response to a question assessing lifetime SITBs and proxy variables of suicide risk.In this population-based cross-sectional study of 4069 US veterans, responses to the Suicidal Behaviors Questionnaire-Revised were examined to group veterans into one of three categories: (1) denied lifetime SITBs, (2) reported lifetime SITBs, or (3) declined to respond.Overall, 69.5% of veterans denied a SITB history, 29.5% reported a SITB history, and 1.0% declined to provide information regarding SITBs. In adjusted analyses, veterans who declined to provide information on SITBs were significantly more likely than veterans who explicitly denied lifetime SITBs to screen positive for posttraumatic stress disorder; report lifetime non-suicidal self-injury; and report elevated levels of total trauma burden, externalizing behaviors, loneliness, received social support, and provided social support. Across these constructs, veterans who declined to provide SITB information were statistically indistinguishable from veterans who explicitly reported lifetime SITBs.Veterans who decline to provide information about suicidal thoughts and behaviors may represent a covert group at elevated risk for suicide.

Deliberate self-poisoning (DSP) in adolescents is increasing dramatically. Life at school is one of the most important life influences for this age group. This study aimed to investigate whether the frequency of DSP is higher during school term compared to holidays and whether this difference has become greater over time. This is an ecological study using Poisons Information Centre (PIC) data for all DSPs in 10-19 year olds from New South Wales, Tasmania and Australian Capital Territory that occurred between 2005 and 2018. For each call, the date of the poisoning was assigned as 'term' or 'holiday'. To control for population growth, calls were expressed as per 100,000 of the population per day. Multivariable Poisson regression was performed to investigate the combined impact of various predictors (state, sex, year, holiday/term, day of week, age) on call number. 26,432 calls were included in the analysis (73.6% female, 24.1% male and 2.3% unknown). Poisson regression showed significant effects for all predictors, with an increased likelihood of DSP during the school term compared with holidays and on Monday-Thursday compared with Saturday but only during the school term. DSP doubled between 2012 and 2017 and the disparity between DSP that occurs during term vs. holiday increased over that time frame. We conclude that some of the increase in DSP is likely due to school-specific stressors, hence the school environment is the ideal setting for self-harm prevention initiatives.

OBJECTIVE: Youth with bipolar disorder (BD) are at high risk for deliberate self-harm (DSH) and suicide. However, research regarding factors associated with DSH, a key suicide risk factor, among youth with BD is limited. In a population-based sample of youth with BD, we therefore investigated associations between demographic, clinical, and service utilization factors and DSH incidence and compared suicide, unintentional injury, and all-cause mortality to the general population. METHOD: We analyzed a retrospective cohort of youth aged 5 to 19 years with a new BD episode between 2010 and 2017 (n = 25,244) using Ohio Medicaid claims and death certificate data. Cox proportional hazards models examined associations between different factors and DSH. Mortality rates were compared to the general population using standardized mortality ratios. RESULTS: During follow-up, 1,517 (6.0%) youth had at least one DSH event. Older index age, female sex, comorbid psychiatric/medical conditions, prior DSH/suicidal ideation, and prior ER mental healthcare were associated with increased DSH risk. Prior DSH was most strongly associated with increased DSH risk for 3 months after a new BD episode. Being non-Hispanic Black (vs. White, non-Hispanic) and prior psychiatric hospitalization were associated with decreased DSH hazard. DSH risk was highest for 3 months after a new BD episode. Suicide, unintentional injury, and all-cause mortality rates were elevated in youth with BD. LIMITATIONS: May not generalize to other states or non-Medicaid populations; claims data cannot distinguish suicidal intent of self-harm CONCLUSION: Early intervention following a new BD episode, particularly among high-risk groups, is key to prevent DSH.

Purpose Both aggression toward others and self peak in adolescence and interpersonal violence and suicide are among the leading causes of death in young people worldwide. Individuals who show both aggression toward others and self, i.e. dual-harm, may experience the worst outcomes. The current study investigates clinical and parenting factors associated with dual-harming in adolescence, to provide new insights for prevention and treatment. Methods In a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 1022; aged 12–17 years), we investigated co-occurrence in harm toward others and self and presented findings in an area-proportional Euler diagram. Four harm groups (no harm, other-harm, self-harm, and dual-harm) were compared on intelligence scores, general functioning, emotional and behavioral problems, substance use, parental hostility, and harsh parenting with ANCOVAs and logistic regressions. Results In adolescents that other-harmed, the risk of self-harm was 1.9 times higher than for those who did not harm others. Dual-harm adolescents reported worse overall functioning, more emotional and behavioral problems, more parental hostility and harshness, and were more likely to use substances than those who did not engage in aggressive behaviors. No evidence of differences in intelligence scores between groups were found. Conclusion These findings highlight a vulnerable group of adolescents, at risk of future suicide, violent offending, and the development of severe psychopathology. Dual-harm is a promising marker for early intervention and referral to specialized mental health professionals. Further research is needed to examine underlying pathways and risk factors associated with persistent dual-harm trajectories into adulthood.

Background & AimsPrevious studies have shown that nonsuicidal self-injury (NSSI) has addictive features, and an addiction model of NSSI has been considered. Addictive features have been associated with severity of NSSI and adverse psychological experiences. Yet, there is debate over the extent to which NSSI and substance use disorders (SUDs) are similar experientially.MethodsTo evaluate the extent that people who self-injure experience NSSI like an addiction, we coded the posts of users of the subreddit r/selfharm (n= 500) for each of 11 DSM-5 SUD criteria adapted to NSSI.ResultsA majority (76.8%) of users endorsed at least two adapted SUD criteria in their posts, indicative of mild, moderate, or severe addiction. The most frequently endorsed criteria were urges or cravings (67.6%), escalating severity or tolerance (46.7%), and NSSI that is particularly hazardous. User-level addictive features positively predicted number of methods used for NSSI, number of psychiatric disorders, and particularly hazardous NSSI, but not suicidality. We also observed frequent use of language and concepts common in SUD recovery circles like Alcoholics Anonymous.Discussion & ConclusionOur findings support previous work describing the addiction potential of NSSI and associating addictive features with clinical severity. These results suggest that NSSI and SUD may share experiential similarities, which has implications for the treatment of NSSI. We also contribute to a growing body of work that uses social media as a window into the subjective experiences of stigmatized populations.

BackgroundThere is limited recent information regarding the risk of self-harm, somatic disorders and premature mortality following discharge from psychiatric hospital in young people.ObjectiveTo measure these risks in young people discharged from a psychiatric hospital as compared with both non-affected controls and non-hospitalised affected controls.MethodsData were extracted from the French national health records. Cases were compared with two control groups. Cases: all individuals aged 12–24 years, hospitalised in psychiatry in France in 2013–2014. Non-affected controls: matched for age and sex with cases, not hospitalised in psychiatry and no identification of a mental disorder in 2008–2014. Affected controls: unmatched youths identified with a mental disorder between 2008 and 2014, never hospitalised in psychiatry. Follow-up of 3 years. Logistic regression analyses were conducted with these confounding variables: age, sex, past hospitalisation for self-harm, past somatic disorder diagnosis.FindingsThe studied population comprised 73 300 hospitalised patients (53.6% males), 219 900 non-affected controls and 9 683 affected controls. All rates and adjusted risks were increased in hospitalised patients versus both non-affected and affected controls regarding a subsequent hospitalisation for self-harm (HR=105.5, 95% CIs (89.5 to 124.4) and HR=1.5, 95% CI (1.4 to 1.6)), a somatic disorder diagnosis (HR=4.1, 95% CI (3.9–4.1) and HR=1.4, 95% CI (1.3–1.5)), all-cause mortality (HR=13.3, 95% CI (10.6–16.7) and HR=2.2, 95% CI (1.5–3.0)) and suicide (HR=9.2, 95% CI (4.3–19.8) and HR=1.7, 95% CI (1.0–2.9)).ConclusionsThe first 3 years following psychiatric hospital admission of young people is a period of high risk for self-harm, somatic disorders and premature mortality.Clinical implicationsAttention to these negative outcomes urgently needs to be incorporated in aftercare policies.

Suicide is a common manner of death typically carried out via a specific mechanism. When a suicidal act is committed using more than one method, it is called a complex suicide. A complex suicide can be divided into planned and unplanned. We present three cases of complex suicide in which multiple methods were used and a previous history of self-harm was present. This case series highlights the significance of a detailed medicolegal death investigation, including interviews with relatives and other witnesses, and a thorough forensic autopsy/toxicological analysis to ascertain the cause and manner of death.

Child sexual abuse is a global issue affecting children. It burdens the entire society physically and mentally. It can cause eating disorders and non-suicidal self-injury in abused people (NSSI). Emotion regulation (ER) is an important etiological link between purging, NSSI, and abusive experiences. We interviewed 80 people, ranged in age from 13 to 20, of whom 62.5% had CSA, versus 30 healthy controls. The Toronto Alexithymia Scale, an eating disorders clinical interview, the Difficulties in Emotion Regulation Scale (DERS) to assess emotion dysregulation, the Self-punishment Scale to assess NSSI, the Mini-Kid for children under the age of 18, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) for those aged 18 and older were given to victims. CSA was found in 62.5% of the participants. Emotional dysregulation was strongly linked to CSA. Descriptive and identifying difficulties in feelings and externally oriented thinking (p0.001, p0.03, p0.001) were found to be associated with the development of alexithymia. CSA participants had higher NSSI than controls, with 28% having severe self-punishment symptoms (P0.001). Finally, CSA is common in kids and teens. It has negative effects on future generations' mental and physical health. All of these conditions can lead to alexithymia.

Nonsuicidal self-injury (NSSI) has been identified as one of the strongest predictors of suicide attempts. Wall/object punching is a particularly prevalent form of NSSI among male veterans that has been linked to both impulsivity and anger. The objective of the present study was to examine the indirect effect of impulsivity on wall/object punching via anger. Participants included 124 veterans (32 identified as women, 92 identified as men) with at least one psychiatric disorder. A third of the sample met criteria for NSSI disorder (33.1%) with nearly a half of the remaining sample endorsing NSSI. Almost half (41.94%) of the sample endorsed wall/object punching. Consistent with our hypothesis, impulsivity was significantly associated with anger, which was, in turn, significantly associated with wall/object punching. Impulsivity was found to be indirectly related to wall/object punching via anger. These findings underscore the significance of assessing and treating anger among veterans engaging in wall/object punching. Improving our knowledge of anger and impulsivity and their relationship with this particularly prevalent form of NSSI among veterans may lead to a better understanding of suicide risk among veterans and inform future treatments.