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Gender diverse youth face higher risk of engaging in self-injurious thoughts and behaviors (SITBs) compared to cisgender youth. Limitations in past research include a focus on older adolescents, an emphasis on specific gender identity labels that may not be inclusive of the range of youth gender experiences, and reliance on cross-sectional data. Thus, the current study prospectively evaluated dimensions of experienced gender in relation to first-onset SITBs among preadolescents. Data were drawn from the Adolescent Brain Cognitive Development Study, a longitudinal study of youth across the United States. Youth (n = 7909) were aged 10–11 during initial assessment, and follow-up was conducted one year later. Two dimensions of experienced gender, felt-gender incongruence (not feeling aligned with the gender associated with one's sex assigned at birth) and gender non-contentedness (feeling dissatisfaction with the gender associated with one's sex assigned at birth), were assessed. Primary outcomes included non-suicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA). Logistic regressions were conducted stratified by sex assigned at birth. For youth assigned female at birth, felt-gender incongruence was prospectively associated with first-onset NSSI and SI and gender non-contentedness was prospectively associated with first-onset of NSSI. For youth assigned male at birth, gender non-contentedness was prospectively associated with first-onset SI. Diverse experienced gender did not prospectively predict SA. Dimensions of experienced gender may be associated with subsequent first-onset SITBs among preadolescents. These findings support the need for future research on risk and protective factors that may mediate or moderate this relationship. • Gender diverse youth are at elevated risk of self-injurious thoughts and behaviors • This longitudinal study explores experienced gender among 7909 preadolescents • Felt-gender incongruence predicts new suicidal ideation and nonsuicidal self-injury • Gender non-contentedness predicts new suicidal ideation and nonsuicidal self-injury • Future research should explore minority stress, which may explain this association [ABSTRACT FROM AUTHOR]

Objective: Adolescents and young adults are at risk for non-suicidal self-injury (NSSI) and suicidal behavior. This study examined intrapersonal (depressive symptoms, self-criticism) and family (perceived family functioning, parenting style, parental attachment) factors associated with reported history of NSSI in a college sample. Method: Participants included 111 undergraduate students (Mage = 20.2) from a private, nonprofit university. Data were collected via online survey. Hierarchical logistic regression analysis was conducted. Results: The final model was statically significant, Nagelkerke R2 =.40, suggesting a robust association between the predictors and history of NSSI. Self-criticism and unhealthy family functioning were significant predictors of NSSI behaviors after controlling for study variables and demographic characteristics. Reported history of engaging in NSSI was positively correlated with parent alienation, unhealthy family functioning, self-criticizing behaviors, and depressive symptoms. Conclusion: College mental health providers should be familiar with risk factors of NSSI as well as strategies to address self-criticism. [ABSTRACT FROM AUTHOR]

This article presents a structured blueprint for school psychologists to assess and intervene in cases of automatically maintained self-injurious behavior (SIB) while adhering to the Least Restrictive Environment (LRE) mandate. We outline a six-step process for conducting Functional Behavior Assessments (FBAs) of automatically maintained SIB, integrating recent research on SIB subtypes with established FBA methodologies. The steps include: (1) indirect assessment, (2) descriptive observations, (3) preference assessment, (4) automatic self-injury screening and brief functional analysis (BFA), (5) competing stimulus assessment (CSA), and (6) development of function-based interventions aligned with LRE principles. We illustrate the application of this blueprint through a hypothetical case study. By following this systematic approach, school psychologists can more effectively identify the specific subtype of automatically maintained SIB and design targeted interventions that balance behavior reduction with LRE requirements. [ABSTRACT FROM AUTHOR]

Background: Adults with intellectual disability (ID) are at high risk of exhibiting challenging behaviors, especially those with autism spectrum disorder (ASD). There are clinical and transdiagnostic variables that are largely related to the existence of these behaviors, and it is necessary to know the particularities of their role in people with ASD and ID relative to those without ASD. Method: Eighty adults with ID and 83 with an additional ASD diagnosis participated in the study. We analyzed answers provided by their therapists to different measures of challenging behavior. Results: For the ASD population, emotional reactivity stood out as a predictor of self-injury, aggression and stereotypy. In the non-ASD group, the role of executive functioning and working memory were significant predictors of aggression and stereotypy was significant. Conclusions: Interventions aimed at the reduction of challenging behaviors in adults with ID should consider these variables to adjust to the needs of these individuals, mainly from a preventive perspective. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Many people who engage in non‐suicidal self‐injury (NSSI) do not access support from health services, and evidence regarding the effectiveness of interventions is mixed. Despite this, NSSI prevalence rates decrease from adolescence into adulthood. Little is known about what helps alleviate difficulties with NSSI beyond psychological or medical intervention. This study sought to understand factors influencing naturalistic improvements in NSSI.Semi‐structured interviews were conducted over video call with 16 participants who believed their difficulties with NSSI had improved due to factors not attributed to psychological or medical intervention. Interviews were audio recorded and transcribed verbatim for analysis.A reflexive thematic analysis revealed four main themes. Increased insight into NSSI experiences promoted self‐compassion and self‐acceptance and enabled participants to reflect on the conflicting role of NSSI. Safe and supportive relationships helped alleviate loneliness, and developing alternative coping strategies enhanced feelings of control over self‐injury. Creating a life guided by personal values promoted independence, choice, and self‐esteem.The findings of the study highlight several internal and external naturalistic processes deemed meaningful in improving difficulties with NSSI. Clinical implications include the importance of developing and embedding these approaches within services and interventions to improve outcomes for individuals who self‐injure while promoting a person‐centred approach. [ABSTRACT FROM AUTHOR]

Background: Historically, the research and treatment of self-injury has been disciplinarily siloed. As a result, the behaviour is understood and treated differently among individuals with and without intellectual and developmental disabilities. We explore the potential for an interdisciplinary research and practice agenda in self-injury. Method: We conducted 10 focus groups with experts in self-injury and analysed discussions that resulted from the question: "What is the role of interdisciplinarity in the study and treatment of self-injury?" Results: Through a reflexive thematic analysis we came up with actionable and positively-oriented themes: Interdisciplinarity at the Individual Level, Context of Needed Systems-Level Change, Highlighting Workforce Support, Strategic Use of Implementation and Dissemination Science, and The Pursuit of Integration. Each theme includes several subthemes that describe specific strategies. Conclusions: An interdisciplinary approach is not only possible but worthwhile and would be particularly beneficial to supporting individuals with intellectual and developmental disabilities engaging in self-injurious behaviour. [ABSTRACT FROM AUTHOR]

Objective: Experiential avoidance, an individual's unwillingness to experience uncomfortable internal feelings/emotions, has been found to be associated with history of self-injury. This association is mainly found in studies that use global measures of experiential avoidance. However, experiential avoidance is purported to be a multidimensional construct. This study aims to test both unidimensional and multidimensional measures of experiential avoidance and their associations with self-injury. Method: University students (n = 632, M = 25.01, SD = 7.13, 78.8% female, 70.9% with lived experience of self-injury) completed well-validated self-report measures of self-injury, experiential avoidance (The Brief and the Multidimensional Experiential Avoidance Questionnaire). Results: As expected, all sub-scales of multidimensional measure of experiential avoidance were highly correlated with the global score for experiential avoidance. The global measure of experiential avoidance differentiated individuals with no history, with past history, and recent history of self-injury. When assessed using the multidimensional measure, only the sub-factors behavioural avoidance and repression and denial differentiated those with no history of self-injury from those with recent history and those with recent history from those with past history of self-injury. Conclusion: Findings raise the possibility that associations between experiential avoidance and self-injury may be down to two specific aspects of experiential avoidance, namely 1) behavioural avoidance and 2) repression/denial. If true, this will have important theoretical, clinical, and measurement implications for research into self-injury. Key Points: What is already known about this topic: Self-injury is prevalent among university students. Experiential avoidance is associated with non-suicidal self-injury. Experiential avoidance is a multi-dimensional construct. What this topic adds: Despite the knowledge that experiential avoidance is a multidimensional construct, most studies utilise unidimensional measures to capture the construct. This study explores experiential avoidance from a unidimensional and multidimensional approach. Experiential avoidance is associated with non-suicidal self-injury, however, when we look at the specific aspects of experiential avoidance, only behavioural avoidance and repression/denial retain the association. Understanding the specific aspects of experiential avoidance that are associated with engagement in self-injury can assist in providing more targeted clinical interventions. [ABSTRACT FROM AUTHOR]

Military sexual harassment (MSH) and assault (MSA) are prevalent among service members and are linked to negative psychosocial outcomes, including self-directed violence. Veterans identifying as women or as sexual or gender minorities are at heightened risk for both MSH/MSA and self-directed violence, but their relationship remains understudied in these populations. We examined associations of MSH and MSA with nonsuicidal self-injury (NSSI) and tested whether relations varied by self-identified gender or sexual orientation in two national samples of U.S. veterans. Sample 1 included post-9/11 veterans who had recently discharged from service (n = 1,494); sample 2 included veterans from any service era (n = 1,187). Veterans self-reported MSH, MSA, gender identity and sexual orientation, and lifetime and past-month histories of NSSI. We estimated logistic regressions to examine the associations of MSH and MSA history with NSSI and evaluated gender (man or woman) and sexual orientation as moderators of these relations. Results suggested significant associations of both MSH and MSA with NSSI but largely failed to support moderation of these associations by either gender or sexual orientation identity. Screening for both MSH and MSA in veterans across gender and sexual orientation identities appears indicated in clinical assessment of NSSI. • Military sexual trauma (MST) is more strongly linked to suicidality in women vs. men. • MST has been associated with nonsuicidal self-injury (NSSI). • Whether the MST-NSSI link varies by gender or sexual orientation is unclear. • Findings did not support moderation of NSSI with MST by gender, sexual orientation. [ABSTRACT FROM AUTHOR]

Background: Non‐suicidal self‐injury (NSSI) is a significant public health concern. Research and treatment interventions largely focus on stopping self‐injury. People who self‐injure do not necessarily equate recovery to cessation. Qualitative accounts allow greater understanding of personal recovery narratives. This study aimed to synthesise personal conceptualisations of NSSI recovery. Methods: Participants had lived experience of NSSI and discussed their recovery. Papers not written in English or had a quantitative design were excluded. Four databases (PsycInfo, CINAHL, Medline and Web of Science) were systematically searched. The quality of each paper was assessed using the CASP quality assessment tool. Data were synthesised using a meta‐ethnographic approach. Results: Thirteen studies comprising 159 participants were included. Three overarching themes were developed. While ceasing NSSI was an important aspect of recovery for some, recovery was typically viewed more holistically, encompassing developments within the self and relationships. Recovery was regarded an ongoing non‐linear journey. The personal and multifaceted nature of the recovery process emerged through a line of argument synthesis. Conclusions: This was the first qualitative synthesis of personal conceptualisations of NSSI recovery. The findings highlighted the personal and multifaceted nature of NSSI recovery and supported person‐centred models of self‐injury recovery. Clinical implications include the importance of expanding self‐injury recovery beyond cessation within research and clinical practice, and for collaborative and person‐centred approaches to be embraced when supporting those who self‐injure. [ABSTRACT FROM AUTHOR]

Introduction: Interpretative phenomenological analysis (IPA) is used to explore how people make sense of their personal and social world, although a search of recent literature suggests that it has not been applied to better understand self‐injury (SI). The goal of this paper was to employ an IPA methodology to gain a deeper understanding of the impact witnessing the physical manifestations of SI has on therapists. Method: The study recruited a purposive sample of nine English‐speaking psychotherapists. Questions designed to relate to the participant's experience of witnessing the physical manifestations of SI were piloted with non‐participating psychotherapists whose experience matched those of the sample. Individual interviews were conducted by the primary researcher. Data Analysis: Analysis involved the hermeneutic circle, moving between the part and the whole to capture and record the unique experience of the individual participants. This entailed the following: reading and re‐reading the transcripts; initial noting; developing emergent themes; connecting emergent themes; and pattern identification across cases. Results: Two superordinate themes were identified that encapsulated how participants experienced, perceived and understood their own reactions to clients' SI presentation. The first, Shock, included the subordinate themes of Controlling reactions, Managing physical revulsion, Therapeutic holding and Revisiting and ruminating. The second, Responsibility, included the subordinate themes of Client responsibility, Professional responsibility, Personal responsibility and Responsibility for hope. Implications: Implications relate to core training for psychotherapists, the focus on continuing professional development, and the policies and procedures needed to support psychotherapists. [ABSTRACT FROM AUTHOR]

Body dysmorphic disorder (BDD) is thought to be associated with considerable suicide risk. This nationwide cohort study quantified the risks of intentional self-harm—including nonsuicidal self-injuries and suicide attempts—and death by suicide in BDD. Individuals with a validated ICD-10 diagnosis of BDD in the Swedish National Patient Register, registered between January 1, 1997, and December 31, 2020, were matched with 10 unexposed individuals (i.e., without BDD) from the general population on birth year, sex, and county of residence. Conditional Poisson regression models estimated incidence rate ratios and 95% CIs for intentional self-harm. Stratified Cox proportional hazards models estimated hazard ratios and 95% CIs for death by suicide. Models adjusted for sociodemographic variables and lifetime psychiatric comorbidities. Among 2833 individuals with BDD and 28,330 unexposed matched individuals, 466 (16.45%) and 1071 (3.78%), respectively, had at least 1 record of intentional self-harm during the study period (incidence rate ratio = 3.37; 95% CI, 3.02–3.76). In the BDD group, about two-thirds (n = 314; 67%) had their first recorded self-harm event before their first BDD diagnosis. A total of 17 (0.60%) individuals with BDD and 27 (0.10%) unexposed individuals died by suicide (hazard ratio = 3.47; 95% CI, 1.76–6.85). All results remained robust to additional adjustment for lifetime psychiatric comorbidities. A higher proportion of individuals with BDD who died by suicide had at least 1 previous record of intentional self-harm compared with unexposed individuals (52.94% vs. 22.22%; p =.036). BDD was associated with a 3-fold increased risk of intentional self-harm and death by suicide. [ABSTRACT FROM AUTHOR]

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

Introduction Method Data Analysis Results Implications for Practice This paper explores how working with clients who self‐injure generates significant emotional reactions in therapists, often difficult to manage. Drawing on my clinical experience as a researcher and counsellor, I provide an evocative autoethnographic account, highlighting hidden, forbidden or taboo feelings. The aim was to deepen understanding of therapists' emotional realities and contribute to the limited literature on this subject.Through journaling, sketching, metaphor and field notes, I detail personal experiences with clients who self‐injure. This autoethnography explores my emotions and reactions. A case vignette illustrates my experiences, promoting critical and empathic consideration of how therapist emotions are experienced.I use autoethnographic methods to analyse the emotional impact and existential reflections of working with clients who self‐injure, employing layers of qualitative interpretation from various personal data sources.Findings reveal that working with clients who self‐injure forces me to confront my mortality, evoking deep existential reflections and intense emotions like vulnerability and fear. This disrupts my sense of immortality, highlighting my role's limitations and evoking shame and self‐doubt about my ability to alleviate suffering.This paper advances research on self‐injury and emphasises autoethnography as a valuable avenue for counsellors engaging in research. Grounded in PhD study, this paper makes an original contribution to knowledge. Integrating discussions on mortality and emotional vulnerability into supervision and training is crucial, alongside comprehensive training that addresses emotional and unconscious issues. Accessible supervision fosters growth, reduces stigma and supports therapists working with clients who self‐injure. [ABSTRACT FROM AUTHOR]

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

SATB2-associated syndrome (SAS) is a genetic syndrome characterised by intellectual disability, severe speech delay, and palatal and dental problems. Behaviours that challenge (BtC) are reported frequently; however, there is limited research on specific forms of BtC and the correlates of these behaviours. The current study explores correlates of well-defined BtC, self-injury, aggression, and property destruction, in SAS. Eighty-one parents/caregivers of individuals with SAS (53.1% male, Mage 10.12 years) completed questionnaire measures of health, behavioural, emotional, and autism characteristics. Individuals with SAS were grouped based on caregiver responses to the presence or absence of self-injury, aggression, and property destruction on the Challenging Behaviour Questionnaire. Rates of self-injury, aggression and property destruction were 42%, 77% and 49%, respectively. Between-group comparisons were conducted to compare characteristics between behaviour groups. Significantly differing characteristics were entered into separate hierarchical logistic regressions for each form of BtC. Behavioural comparisons indicated variation in the characteristics associated with each behaviour. All hierarchical logistic regression models were significant (p <.001): self-injury (χ2(5) = 38.46, R2 = 0.571), aggression (χ2(4) = 25.12, R2 = 0.414), property destruction (χ2(4) = 23.70, R2 = 0.346), explaining between 34.6% and 57.1% of the variance in behaviour presence. This is the first study to identify correlates of self-injury, aggression, and property destruction in SAS. Variability in the characteristics associated with each behaviour highlights the importance of specificity when examining BtC. Understanding correlates of specific forms of BtC has important implications for informing SAS-associated pathways to behavioural outcomes and the implementation of tailored behavioural interventions. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is common in adolescence. Rumination is a key risk factor and often co-occurs with depressive symptoms. This is the first study to examine the joint longitudinal trajectories of rumination and depressive symptoms as predictors of NSSI, and the adverse experiences associated with these trajectories. A community sample of 1,835 adolescents (55.9% male participants, 12.3 ± 0.5 years of age) completed questionnaires to assess adverse childhood experiences, rumination, depressive symptoms, and NSSI. Assessments were made 4 times over 18 months. A parallel process growth mixture model showed that youth with high trajectories of rumination but low trajectories of depression had moderately increased odds of NSSI (2.43-fold, 95% CI 1.53-3.91) compared with adolescents with low trajectories of both rumination and depression. Odds ratios (ORs) in adolescents with low trajectories of rumination but increasing or high trajectories of depression were similarly elevated, suggesting that high trajectories of rumination or depression were risk factors in isolation. However, odds were 10.06-fold greater (95% CI 5.68-18.02) when high trajectories of rumination occurred in tandem with high trajectories of depression. Multinomial logistic regression showed that male sex (OR 10.54, 95% CI 5.66-19.63), peer victimization (OR 2.25, 95% CI 1.72-2.96), and parental alienation (OR 1.94, 95% CI 1.46-2.57) were key determinants of membership in the highest risk group. Risk for NSSI is markedly increased in adolescents with high longitudinal trajectories of depression and rumination. Reducing exposure to peer victimization, cyber victimization, emotional abuse, parental alienation, and interparental conflict may reduce risk. The authors of this study conducted a longitudinal analysis of 1,835 adolescents in the Peoples Republic of China to evaluate rumination and depressive symptoms as predictors of nonsuicidal self-injury. The authors found that high trajectories of either rumination or depression alone was associated with an elevated risk of nonsuicidal self-injury. The combination of high trajectories of both rumination and depression resulted in the highest risk. Male sex, peer victimization, cyber victimization, and parental alienation were more common in the highest trajectory risk groups. [ABSTRACT FROM AUTHOR]

Although theory and research implicate self-criticism as a risk factor for non-suicidal self-injury (NSSI), the nature of this association in daily life remains unclear. This study used ecological momentary assessment (EMA) to address whether (1) trait and state self-criticism elevate the risk of NSSI, (2) state self-criticism predicts NSSI behavior in real-time via increased NSSI urge intensity, and (3) the risk pattern extends to disordered eating (DE; binge eating, purging, restrictive eating). A total of 125 treatment-seeking individuals who self-injure (87.20% female; M age = 22.98, SD = 5.32) completed measures of trait self-criticism at intake, followed by six daily assessments for 28 days (15,098 assessments; median compliance = 78.6%) measuring self-critical thoughts, NSSI, and DE. Multilevel vector autoregressive models were constructed within a dynamic structural equation modeling framework. Patients who reported higher mean state self-critical thoughts experienced more intense NSSI urges and an increased risk for NSSI behavior during the 28-day EMA period. Higher-than-usual self-critical thoughts predicted NSSI urge intensity and NSSI behavior within the following 2 h. NSSI urge intensity partially mediated the effect of self-critical thoughts on NSSI behavior. Trait self-criticism did not predict comorbid DE, but mean state self-critical thoughts were associated with binge eating and restrictive eating. The within-person risk pattern of self-criticism generally extended to DE, with full mediation via DE urges for purging and restrictive eating, but not binge eating. Self-criticism is a real-time predictor of NSSI and comorbid DE. These findings underscore the relevance of monitoring self-criticism outside the therapy room, as it may be an important treatment target. • Aggregated state self-criticism predicted NSSI, binge eating, and restricting. • State self-criticism predicted NSSI urges and behaviors within the next 2 h. • NSSI urges partially mediated the effect of state self-criticism on NSSI behavior. • This within-person risk pattern extended to purging and restricting. • Self-criticism is a real-time risk factor of NSSI and comorbid disordered eating. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is a growing phenomenon, yet there is still a limited understanding of the behavior, intent behind the behavior and what individuals themselves say about their behavior. This study collected pro-NSSI public blog posts from Reddit and analyzed the content linguistically using Linguistic Inquiry and Word Count software, to examine the use of NSSI specific words, linguistic and psychological linguistic properties. The results inform current mental health practices by dispelling myths and providing insight into the inner world of people who engage in NSSI. The linguistic properties found in the analysis reflected the predicted results; authors of pro-NSSI posts used first-person singular pronouns extensively, indicating high levels of mental health distress and isolation. This study demonstrates how understanding the language of self-harm can help inform mental health treatment using family therapy. [ABSTRACT FROM AUTHOR]

Objective: Non-suicidal self-injury (NSSI) is a significant mental health issue among depressed adolescents. This study aimed to investigate roles of psychological mindedness (PM) and self-compassion among depressed Turkish adolescents with NSSI. The mediating roles of PM and self-compassion between depression severity and NSSI were evaluated. Method: 119 depressed adolescents evaluated at a child psychiatry outpatient clinic in Turkey were categorised based on NSSI experience. Self-compassion and psychological mindedness scales (covering psychological interest, insight, help-seeking, and capacity for change subscales) were measured. Results: PM and self-compassion scores were lower in depressed adolescents with NSSI than adolescents without NSSI. Psychological interest (Odds Ratio (OR): 0.886, Confidence Interval (CI): 0.788–0.996), capacity for change (OR: 0.902, CI: 0.815–0.998), and self-compassion (OR: 0.937, CI: 0.879–0.999) emerged as protective factors against NSSI. Also, significant indirect effects of PM and self-compassion were observed between depression severity and NSSI. Seeking psychological help related to both intrapersonal and interpersonal functions, whereas psychological interest specifically related to interpersonal functions. Conclusions: PM and self-compassion appear as protective factors, with certain PM components linked to intrapersonal and interpersonal functions of NSSI. Thus, integrating interventions to boost PM and self-compassion into depression treatment strategies could be crucial. KEY POINTS: What is already known about this topic: It is known that the level of self-compassion and psychological mindedness (PM) is low in depressed individuals. Although NSSI is frequently associated with depressed adolescents, self-injury is not observed in all depressed cases. NSSI has intrapersonal and interpersonal functions, and the role of these functions varies with different psychopathology, including depression. What this topic adds: Depressed adolescents with higher PM and self-compassion scores are protected from NSSI. PM and self-compassion in depressed adolescents mediate the NSSI with no significant association with depression severity. Some components of PM are related to the intrapersonal and interpersonal functions of the NSSI. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury (NSSI) among adolescents continues to be a significant public health concern worldwide. A recent systematic review and meta-analysis found that the global prevalence of NSSI in adolescents aged 12–18 years was 17.2%, with higher rates reported among females (19.7%) than males (14.8%). This behavior has been linked to several negative outcomes, such as depression, anxiety, substance abuse, and suicidal ideation. The present study aimed to classify adolescents based on intrapersonal and interpersonal factors associated with NSSI proposed in Nock's (2009) integrated model of NSSI, to identify distinct clusters targeting specific risk factors. This encompassed negative cognition, emotional vulnerability, poor coping skill, peer-victimization, family adaptability, and perceived stress. A total of 881 adolescents aged 11–16 years in South Korea completed self-reported questionnaires on automatic thoughts, depression, emotional regulation, peer victimization, family adaptability and perceived stress. Latent profile analysis (LPA) revealed three distinct classes: "the severe group", "the moderate group", "the mild group". Class 3 ("severe group": N = 127) exhibited greater severity related to NSSI, including negative cognition, emotional vulnerability, poor coping skills, peer victimization, and perceived stress, with weaker levels of factors that can prevent NSSI compared to class 1 ("mild group": N = 416) and class 2 ("moderated group": N = 338). The present study emphasizes the importance of considering both intrapersonal (e.g., negative automatic thoughts & emotional dysregulation) and interpersonal factors (i.e., peer victimization) when understanding NSSI - among adolescents. These findings can be utilized to develop interventions aimed at reducing the prevalence and severity of NSSI among adolescents. [ABSTRACT FROM AUTHOR]

Adolescents face several changes that cause conflict and emotional stress during adolescence. The conflicts and emotional pressure faced by teenagers cause teenagers to experience distress so that teenagers will have difficulty controlling themselves and carry out actions that are detrimental to themselves. In dealing with stressful conditions, teenagers need to develop behavior by implementing coping strategies. However, not all teenagers are able to develop and choose appropriate coping strategies in dealing with stressful conditions, one of which is engaging in self-injury behavior. Self-injury behavior is the behavior of individuals who deliberately hurt or injure themselves with the aim of reducing the emotional problems they are facing. Self-injury behavior has the impact of feeling satisfied because it feels capable of venting negative emotions, however, another impact of self-injury behavior is addiction, which can lead to attempts to commit suicide. It is important for research to be able to describe how teenagers experience self-injury behavior. This research is a qualitative phenomenological research with semi-structured interviews with three teenagers as resource persons. The data obtained was then analyzed using interpretive phenomenology based on Kahija (2017). The results in this study include 1) motives for self-injury behavior, 2) dynamics of self-injury behavior and, 3) experience of carrying out self-injury behavior. [ABSTRACT FROM AUTHOR]

Objective: Most studies of the DSM-5 proposed non-suicidal self-injury disorder (NSSID) have focused on documenting its prevalence, associated features, and evaluating the validity of the criteria. There is scant data assessing the temporal course, or onset and offset, of NSSID. This study examined the course of NSSID and each criterion over a one-year period. Method: Data were obtained from 171 young adults (mean age = 18.79; 84% women, 92% White, 37% in treatment) with past year NSSI engagement (mean frequency = 12.47, SD = 20.9) who completed a minimum of two, out of three, waves of data collection. Participants completed the Non-Suicidal Self-Injury Disorder Scale along with demographic measures at baseline, 6-month, and 12-month follow-up. Results: Over a third of participants met NSSID criteria at each time point, with moderate persistence (K = 0.42 to 0.46). Chi-square tests revealed significant onset and offset patterns of NSSID and among select criteria. Binary logistic regression analyses revealed that meeting the criterion A (frequency of NSSI) and criterion E (impairment) thresholds at baseline were the only meaningful predictors of diagnostic status at 6- and 12-month follow-up. Limitations: The use of self-report measures and having a homogenous sample restrict generalizability of the findings. Conclusions: Meeting NSSID criteria appears to persist over time, but only 2 of the 6 criteria may be relevant to diagnostic status across time. Further research on the temporal course, reliability, and clinical validity of the proposed disorder, especially within diverse clinically severe, populations is greatly needed. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) is a behaviour many counselling psychologists encounter in practice, and the way clinician's respond can have an important impact on the individual's experience of recovery. The person-centred NSSI recovery framework incorporates the voices of lived experience in understanding the multi-faceted nature of recovery. Objectives: This paper outlines important considerations for how the recovery framework can guide clinicians with respect to both therapeutic stance and intervention targets in order to support clients in navigating their experience of NSSI and recovery. Implications: Clinicians should adopt a strengths-based approach and foster self-efficacy and self-compassion with persons with lived experience. This paper provides specific recommendations for counselling psychologists and their clients, including encouraging clinicians to avoid making assumptions about the causes, meanings, and outcomes of self-injury, and to be cognizant of the non-linear nature of the recovery process. [ABSTRACT FROM AUTHOR]

Background: The prevalence of self-injury and suicide is higher than the general population of people living with HIV/AIDS (PLWHA). However, the results reported in existing studies are highly variable in China. The purpose of this systematic review and meta-analysis was to synthesize the currently available high-quality evidence to explore the prevalence and influence factors of self-injury and suicide among PLWHA in China. Method: We retrieve literature written in Chinese and English through databases such as PubMed, Embase, Web of Science, Cochrane Library, SinoMed, CNKI, WanFang Database, and CQVIP from inception to 1 September 2022. Sata 16.0 software was used for analysis. Results: A total of 28 studies were included with a sample size of 1,433,971 and had a satisfactory quality score of ≥ 5. The prevalence among PLWHA in China were 30% for suicidal ideation (SI), 5% for suicide attempt (SA), 8% for suicide plan (SP), 7% for attempted suicide (AS), and 3‰ for completed suicide. High stigma (OR = 2.94, 95%CI: 1.90 − 4.57), depression (OR, 3.17; 95%CI, 2.20 − 4.57), anxiety (OR, 3.06; 95%CI, 2.23 − 4.20), low self-esteem (OR, 3.82, 95%CI, 2.22 − 6.57), high HIV related stress (OR, 2.53; 95%CI, 1.36 − 4.72), and unemployment (OR, 2.50; 95%CI, 1.51 − 4.15) are risk factors for SI; high social support (OR, 0.61; 95%CI, 0.44 − 0.84) and spouse infected with HIV (OR, 0.39; 95%CI, 0.21 − 0.74) are protective factors for SI; depression (OR, 1.62; 95%CI, 1.24 − 2.13), high aggression (OR, 4.66; 95%CI, 2.59 − 8.39), and more negative life events (OR, 2.51; 95%CI, 1.47 − 4.29) are risk factors for AS; high level of education (OR, 1.31; 95%CI, 1.21 − 1.43) is risk factor for CS. Conclusion: Figures indicate that approximately one-third of PLWHA had suicidal ideation, and three out of 1,000 completed suicide in China. Positive events are protective factors for self-injury and suicide among PLWHA, while negative events are risk factors. This suggests that psychosocial support and risk assessment should be integrated into the care of PLWHA. [ABSTRACT FROM AUTHOR]

Background: Adolescents with attention-deficit / hyperactivity disorder (ADHD) have an increased risk of self-harm. The risk of self-harm among adolescents who display an elevated level of ADHD symptoms, but without a formal diagnosis, is not well-studied and understood. Objective: To investigate the relationship between self-reported symptoms of ADHD and self-harm in a population-based sample of adolescents. Methods: Adolescents in the population-based youth@hordaland study were invited to complete the Adult ADHD Self-Report Scale (ASRS) and the Short Mood and Feelings Questionnaire (SMFQ). They were asked whether they ever deliberately have taken an overdose or tried to harm themselves on purpose, once or multiple times, defined according to the code used in the Child and Adolescent Self-harm in Europe (CASE) Study. Adolescents reporting severe problems on ≥ four of six selected items on the ASRS-v 1.1 screener were defined as ADHD-screen positive (ADHD-SC+), and the remaining sample as ADHD-screen negative (ADHD-SC-). SMFQ score ≥ 12 was used to define a high level of depressive symptoms. Results: A total of 9692 adolescents (mean age 17.4 years, 53.1% females) participated in the study, of which 2390 (24.7%) screened positive on the ASRS. ADHD-SC+ adolescents engaged in self-harm more often than the ADHD-SC- group (14.6% vs. 5.4%, OR = 3.02, 95%CI [2.57–3.24]). This remained significant after adjustment for demographic variables, SMFQ score ≥ 12, symptoms of conduct disorder and familial history of self-harm and suicide attempts (OR = 1.58, 95%CI [1.31–1.89]). They were also more likely to report an overdose as their method of self-harm (OR = 1.52, 95%CI [1.05–2.23]). Within the ADHD-SC+ group female sex, high levels of inattention and hyperactivity/impulsivity symptoms, SMFQ score ≥ 12, symptoms indicating conduct disorder and familial history of self-harm and suicide attempts increased the likelihood of engaging in deliberate self-harm. Conclusion: Adolescents who screened positive for ADHD had increased risk of engaging in self-harm. Clinicians should consider the increased risk of such engagement in adolescents who present with high level of ADHD symptoms, even in the absence of a clinical ADHD diagnosis. [ABSTRACT FROM AUTHOR]

Background: Self-directed violence (SDV) comprises both suicide and self-injury and represents a pressing problem among incarcerated persons. Negative impacts of SDV in correctional settings also extend to behavioral health clinicians (BHCs) (e.g., job turnover). Correctional SDV risk assessment and management standards include staff training as part of the comprehensive approach. The Core Competency Model for Corrections (CCM-C) is a novel, evidence-informed training program for BHCs covering both clinician self-management and clinical care skills. Methods: This pilot trial is a type 3 hybrid implementation–effectiveness approach. It will employ a wait-list control sequential cross-over design. Participants (N = 50–100) will be BHCs employed by the North Carolina Department of Adult Corrections. Following stratification for years of clinical experience, BHCs will be randomly assigned to (1) a training group that receives CCM-C immediately and (2) a wait-list control receiving CCM-C approximately 6 weeks later. Electronically administrated survey evaluation will occur across baseline and two follow-up (i.e., 2 weeks after each training session) time points. Discussion: The primary outcome is feasibility assessed through collaboration with a Corrections Advisory Panel and feedback from BHCs. Secondary effectiveness outcomes that will be evaluated over time include SDV-related knowledge, attitudes, stigma, and intent to use training content. We will examine a tertiary outcome, namely compassion fatigue. Clinical trial limitations and impacts are discussed. Trial registration: Clinicaltrials.gov, NCT06359574. This study was registered on 04/05/2024. [ABSTRACT FROM AUTHOR]

Background: Sexuality and gender minoritised (SGM) adolescents are at increased risk of self-injury and suicide, and experience barriers to accessing mental health support. Dialectical behaviour therapy (DBT) is an effective treatment for self-injury and emotion dysregulation in adolescent populations, but few studies have published outcomes of DBT for SGM young people. Aims: This study aimed to investigate treatment outcomes and completion for SGM adolescents and their cisgender and heterosexual peers, in the National & Specialist CAMHS, DBT service (UK). Method: Treatment completion, and opting out before and during treatment were examined for sexual and gender identity groups, as well as changes by the end of treatment in emotion dysregulation, self-injury, in-patient bed-days, emergency department attendances, and borderline personality disorder, depression and anxiety symptoms. Results: SGM adolescents were over-represented in this service, even after considering their increased risk for self-injury. No statistically significant differences were found for treatment completion between the sexual orientation and gender identity groups, although there were patterns indicating possible lower treatment uptake and completion that warrant further investigation. Clinical outcomes for treatment-completers showed improvement by the end of DBT for each group, with few exceptions. Discussion: These results are from relatively small subsamples, and it was not possible to separate by sex assigned at birth. Findings should be treated tentatively and as early indications of effect sizes to inform future studies. This study suggests that DBT could be a useful treatment for SGM adolescents in a highly specialist treatment setting. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) involves the deliberate harm of one's body without the intent to commit suicide and is particularly concerning among adolescents. Teachers play a critical role as gatekeepers in identifying and addressing self-harm, underscoring the importance of their knowledge and response strategies in this area. This study explored how teachers' knowledge, attitudes towards NSSI, perceived roles, and workplace barriers affect their responses to students exhibiting NSSI behaviors. Methods: A cross-sectional survey was conducted among 203 middle and high school teachers in Israel. Data were collected during July and August 2023 using six validated questionnaires. Results: Higher levels of teacher knowledge, positive attitudes, and strong role perceptions correlated with more effective responses to NSSI, whereas increased workplace barriers tended to diminish response efficacy. Positive correlations emerged between role perception and both knowledge and attitudes, whereas negative correlations emerged between workplace barriers, attitudes, and role perceptions. Teaching experience moderated the impact of role perception and workplace barriers on responses. Significant differences were observed between regular and special education settings, although no differences were noted in referral rates or years of seniority. Conclusions: These findings suggest that enhancing teacher knowledge and attitudes towards NSSI, while addressing workplace barriers, can improve response efficacy in educational settings. [ABSTRACT FROM AUTHOR]

The purpose of this article was to examine whether psychological flourishing, a multi-dimensional construct of well-being, has the potential to play a preventative role in suicidal and nonsuicidal thoughts and actions. This two-part study utilized cross-sectional survey data from college students across the United States, assessing levels of psychological distress, loneliness, and psychological flourishing. Frequencies of suicidal ideation, intent, previous suicidal attempts, and nonsuicidal self-injury (NSSI) were also assessed. Data collected in 2019 were used for Study 1 (n = 38,679) and data collected in 2020 were used for Study 2 (n = 50,307). Psychological flourishing is significantly inversely related to suicide and NSSI risk when controlling for loneliness and psychological distress. There were two-way interactions between flourishing and distress, whereby under conditions of high distress, the inverse effect of flourishing on suicidal ideation, intent, and attempts and NSSI was more pronounced. These results were consistent across both studies. Subgroup analyses revealed similar results regardless of participants' race, sexual orientation, and gender identity. Inverse associations between flourishing and self-injurious thoughts and behaviors suggest that flourishing may buffer risk of suicide and NSSI, and these findings may have important implications for developing evidence-based therapeutic interventions. Additional research, including longitudinal and clinical work, is warranted. [ABSTRACT FROM AUTHOR]

Objective: This current study aimed to validate the Indonesian version of the Inventory of Statements About Self-Injury (ISAS) questionnaire, which provides a better understanding of Non-Suicidal Self-Injury (NSSI) disorders. Method: The study used a cross-sectional design and involved 314 adolescents and young adults in high school or university. A stratified sampling method was used. All participants filled out the ISAS questionnaire. Data were analyzed for content validity, construct validity, item discrimination value, and internal consistency (Croncbach's α). The translation process was carried out using forward and back-translation methods. Results: The ISAS questionnaire consists of section I, the behavioral scale, and section II, the functional scale. For content validity, Aiken's V coefficient obtained for both scale sections I and II is in the range of 0.917 -- 1. This result shows that all items on the scale have very good validity. Confirmatory Factor Analyses were carried out using Lisrel 8.80 software on section II, resulting in several goodness of fit values that were not good enough (χ2 = 457.68; P < 0.000; df = 64; χ2 / df = 7.151, RMSEA = 0.130) and several other values that are quite acceptable (CFI = 0.95; SRMS = 0.057; NFI = 0.95; GFI = 0.83). The factor loading from section II ranges from 0.43 - 0.91. The item discrimination value using the corrected item-total correlation of section I is in the range of 0.031 - 0.837 and section II ranges from 0.290 -- 0.854. The reliability analysis values in section I and II of the ISAS are α = 0.527 and α = 0.966, respectively. Conclusion: This is the first study to have validated the Indonesian version of the ISAS questionnaire. The Indonesian version of the ISAS questionnaire is considered a valid and reliable instrument to assess NSSI disorders. [ABSTRACT FROM AUTHOR]

Purpose: The few studies that have explored self-harm presentation times at hospital emergency departments (EDs) – an important factor that can determine if a patient receives a mental health assessment – primarily focus on adult samples. This study examined the times of self-harm presentations to EDs, self-harm methods used, mental health assessments, and admission data across different age-groups. Methods: Using data from the National Self-Harm Registry Ireland over a 13-year timeframe (2007–2019), this study compared times, days, seasons, methods of self-harm, and admission data for children (8–12 years), adolescents (13–17 years), young adults (18–25 years) and adults (> 25 years). Results: The majority of the 152,474 self-harm presentations (78.6%) for all ages occurred out-of-hours (outside the standard working hours or in-hours times of 09:00–17:00, Monday-Friday). The four hours before midnight had the highest proportions of self-harm presentations for adolescents (27.9%) and adults (23.1%), whereas the four hours after midnight had the highest proportion of self-harm presentations for young adults (22.9%). The 16:00-midnight timeframe had highest proportion of self-harm presentations in children (52.3%). Higher proportions of patients received a mental health assessment in-hours compared to out-of-hours among young adults (78.2% vs. 73.3%) and adults (76.1% vs. 72.0%). Self-harm presentations were lowest during summer months in children and adolescents. Discussion: Hospitals should ensure that adequate resources are available for individuals presenting with self-harm, especially in the case of overcrowded EDs, and protocols need to be designed for those presenting with self-harm due to intoxication. In line with national policy, protocols for patients presenting during out-of-hours should be designed that can incorporate services from allied health multidisciplinary teams, social work, addiction services and counselling organisations. Given the lower rates of self-harm during school holidays for children and adolescents, the school environment must be considered in the context of mental health and self-harm public health prevention interventions. [ABSTRACT FROM AUTHOR]

Although aggression associated self-injury and suicidal ideation, but the specific impact of different subtypes of aggression is unclear. Therefore, the current study aims to quantify the associations between five subtypes of aggression, self-injury, and suicidal ideation in Chinese adolescents. A total of 18,532 students were recruited in grades 7 to 12 using a stratified cluster sampling across five representative provinces in China. The Functional Assessment of Self-Mutilation (CH-FASM) and Buss and Warren's Aggression Questionnaire (BWAQ) assess self-injury and aggression, respectively. During the last year, the proportion of self-injury, suicidal ideation, and self-injury plus suicidal ideation (SSI) were 13.4 %, 10.0 %, 12.4 %, respectively. Multivariate logistic regression indicated that hostility was associated with self-injury-only (OR = 1.033, 95 % CI = 1.021–1.044), suicidal ideation-only (OR = 1.075, 95 % CI = 1.061–1.088), and SSI (OR = 1.100, 95 % CI = 1.087–1.114) (all P < 0.001) across five subtypes of aggression. In gender stratification, physical aggression was risk factor for self-injury-only, suicidal ideation-only, and SSI (OR = 1.028, 95 % CI = 1.018–1.037, P < 0.001) in females. While anger was association with self-injury-only and suicidal ideation-only in males (P < 0.05). This study was a cross-sectional design and self-reported questionnaire. Hostility is a strong predictor of self-injury and suicidal ideation across five subtypes of aggression. There are gender differences in relationships. Prevention programs for adolescents' self-injury and suicidal ideation should consider different subtypes of aggression and gender differences. • Not all subtypes of aggression are significantly associated with self-injury and suicidal ideation. • Hostility is the strongest predictor for self-injury and suicidal ideation. • There are gender differences in relationship between aggression, self-injury, and suicidal ideation. [ABSTRACT FROM AUTHOR]

In Lesch-Nyhan disease (LND), early dopamine deficiency is thought to contribute to dystonia and self-injury, gradually developing over the first years of life. Previous attempts to restore dopamine levels in older patients have been unsuccessful. Based on the hypothesis that very early dopamine replacement can prevent full phenotypic development, we treated three patients with LND from infancy with levodopa. Levodopa/carbidopa (4:1) was started at age 11 to 13 months, aiming at escalating to 5 to 6 mg/kg levodopa per day. Follow-up focused on dystonia severity and whether self-injury occurred. In addition, the literature was reviewed to delineate the age at onset of self-injury for all reported cases to date. During long-term follow-up, self-injury appears to have been prevented in two patients (now aged 14 and 15.5 years), as their HPRT1 gene mutations had been invariably associated with self-injury before. Future self-injury is unlikely, as only 1.1% of 264 published cases had self-injury onset later in life than these patients' current ages. The third patient started self-injury at age 1.5 years, while on a substantially lower levodopa dose. A clear effect of levodopa on dystonia could not be determined. Our observations suggest that levodopa, given early enough and sufficiently dosed, might be able to prevent self-injury in LND. Therefore, levodopa could be considered in patients with LND as early as possible, at least before the self-injury appears. Further research is needed to establish very early levodopa as an effective treatment strategy in LND, and to optimize timing and dosing. [ABSTRACT FROM AUTHOR]

Nonsuicidal self‐injury (NSSI) is theorized to be caused by negative associations with the self, including low self‐esteem, but the mechanisms explaining why low self‐esteem is related to more severe NSSI are unclear. The current study aimed to address this limitation by evaluating a mediation model, proposing that low self‐esteem would relate to more severe NSSI through increasing self‐punishment motivations. Data came from 468 undergraduate students with a history of NSSI who completed an online survey measuring NSSI characteristics and functions, self‐esteem, and self‐punishment motivations for NSSI. Mediation was tested using a structural equation model using bootstrapped 95% percentile‐corrected confidence intervals in which NSSI severity was modeled as a latent variable composed of NSSI frequency, recency, and versatility of methods. The total model was significant and the indirect effect of self‐esteem on NSSI severity through self‐punishment motives was significant. Self‐esteem also retained significant direct effects on NSSI severity, indicating partial mediation. These results provide support for the benefits and barriers model of NSSI, suggesting that negative self‐views increase risk for more severe NSSI through self‐punishment motivations. Clinical interventions that emphasize self‐compassion and focus on modifying self‐punishment motivations may help reduce NSSI behavior. [ABSTRACT FROM AUTHOR]

Objective: The Interpersonal Theory of Suicide (ITS) could help identify differences in groups of suicidal adolescents and inform treatment. Method: Latent Profile Analysis (LPA) using thwarted belongingness (TB), perceived burdensomeness (PB), hopelessness, and capability was conducted on data from an at‐risk clinical sample (N = 500). The ITS prediction that changes in TB and PB are associated with changes in suicidal ideation was tested using admission and discharge data. Results: Latent Profile Analysis identified three profiles with increasing complexity and severity on ITS factors. The profiles were labelled low‐severity (7.6% of participants), moderate‐severity (45.2%), and high‐severity (47.2%). ITS predictions were partially supported for the full sample and only for the high‐severity and moderate‐severity subgroups, whereby changes in TB were significantly associated with changes in suicidal ideation over the course of treatment. However, changes in PB were only significant in the moderate‐severity subgroup, and none of the ITS predictions were supported in the low‐severity subgroup. Additionally, effect sizes for changes in TB and PB were modest in all analyses. Conclusions: Our findings highlight the importance reducing low belongingness in youth, which is a component of all supported interventions of youth suicide prevention. However, given the modest association of changes in ITS variables had with changes in suicidal ideation, it may be fruitful to elaborate on the relative importance on types of low belongingness or include other non‐ITS variables. [ABSTRACT FROM AUTHOR]

Background: Challenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as "complex". Yet it remains vague what this supposed complexity entails at the individual level. This case-study used a three-step mixed-methods analytical strategy, inspired by complex systems theory. First, we construed a holistic summary of relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential change-inducing mechanisms between different phases. Case presentation: A woman, living at a residential facility, diagnosed with mild intellectual disability and borderline personality disorder, who shows a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to self-rate challenging behaviors daily for 560 days. Conclusions: A qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care or compliments. Coercive measures increased the chance of challenging behavior the day after and psychological therapy sessions decreased the chance of self-injury the day after. The majority of contemporaneous and lagged associations between these 11 factors and self-reported challenging behaviors were non-significant, indicating that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline 11 distinct stable phases were identified that alternated between four unique states: high levels of aggression and self-injury, average aggression and self-injury, low aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were triggered by extraordinary events in her environment, or preceded by increased fluctuations in her self-ratings, or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when she experiences bad times, keeping in mind that better times lie ahead is hopeful and realistic. [ABSTRACT FROM AUTHOR]

Objective: To explore the relation of self-injury behavior to thyroid hormones and lipids in adolescent patients with depression. Methods: A total of 182 adolescent inpatients who met the diagnostic criteria for depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) were enrolled, including 38 cases with self-injurious behavior and 144 cases without self-injurious. The differences in various indicators between the two groups were compared, and logistic regression analysis was used to analyze factors related to self-injury in adolescents with depression. Results: The patients with self-injurious behavior had higher levels of total cholesterol and high-density lipoprotein cholesterol (HDL-C) compared to those without self-injurious behavior (P<0.05). They also had lower levels of free thyroxine compared to the group without self-injurious behavior (P<0.05). Logistic regression analysis results showed that those with longer duration of disease (OR = 1.03) and higher HDL-C levels (OR = 12.75) were more likely to have self-injurious behaviors. Conclusion: Long duration of disease and high level of HDL-C may be risk factors for self-injurious behavior in adolescents with depression, while low level of free thyroxine may serve as a protective factor. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Non‐suicidal self‐injury (NSSI) is common among adolescents receiving inpatient psychiatric treatment and the months post‐discharge is a high‐risk period for self‐injurious behavior. Thus, identifying predictors that shape the course of post‐discharge NSSI may provide insights into ways to improve clinical outcomes. Accordingly, we used machine learning to identify the strongest predictors of NSSI trajectories drawn from a comprehensive clinical assessment.The study included adolescents (N = 612; females n = 435; 71.1%) aged 13–19‐years‐old (M = 15.6, SD = 1.4) undergoing inpatient treatment. Youth were administered clinical interviews and symptom questionnaires at intake (baseline) and before termination. NSSI frequency was assessed at 1‐, 3‐, and 6‐month follow‐ups. Latent class growth analyses were used to group adolescents based on their pattern of NSSI across follow‐ups.Three classes were identified: Low Stable (n = 83), Moderate Fluctuating (n = 260), and High Persistent (n = 269). Important predictors of the High Persistent class in our regularized regression models (LASSO) included baseline psychiatric symptoms and comorbidity, past‐week suicidal ideation (SI) severity, lifetime average and worst‐point SI intensity, and NSSI in the past 30 days (bs = 0.75–2.33). Only worst‐point lifetime suicide ideation intensity was identified as a predictor of the Low Stable class (b = −8.82); no predictors of the Moderate Fluctuating class emerged.This study found a set of intake clinical variables that indicate which adolescents may experience persistent NSSI post‐discharge. Accordingly, this may help identify youth that may benefit from additional monitoring and support post‐hospitalization. [ABSTRACT FROM AUTHOR]

Background: Prevalence of self-harm In England is rising, however contact with statutory services remains relatively low. There is growing recognition of the potential role voluntary, community and social enterprise sector (VCSE) organisations have in the provision of self-harm support. We aimed to explore individuals' experiences of using these services and the barriers and facilitators to accessing support. Methods: Qualitative, online interviews with 23 adults (18+) who have accessed support from VCSE organisations for self-harm in the Yorkshire and the Humber region were undertaken. Interviews were audio recorded and transcribed verbatim. Thematic analysis was undertaken using NVivo software. Results: Participants described how a lack of service flexibility and the perception that their individual needs were not being heard often made them less likely to engage with both statutory and VCSE organisations. The complexity of care pathways made it difficult for them to access appropriate support when required, as did a lack of awareness of the types of support available. Participants described how engagement was improved by services that fostered a sense of community. The delivery of peer support played a key role in creating this sense of belonging. Education and workplace settings were also viewed as key sources of support for individuals, with a lack of mental health literacy acting as a barrier to access in these environments. Conclusions: VCSE organisations can play a crucial role in the provision of support for self-harm, however, pathways into these services remain complex and links between statutory and non-statutory services need to be strengthened. The provision of peer support is viewed as a crucial component of effective support in VCSE organisations. Further supervision and training should be offered to those providing peer support to ensure that their own mental health is protected. [ABSTRACT FROM AUTHOR]

Self-harm is a major public health concern in young people and is governed by a complex interaction of different risk factors. While many studies have identified these risk factors, less is known about how they tend to co-occur together. A latent class analysis was conducted using risk factors for self-harm from two waves at ages 13 and 17 from the Growing Up in Ireland (GUI) study their associations with self-harm were examined longitudinally at ages 17 and 20, respectively. At age 13, there was a 'peer problems' group with higher probabilities of bullying, being unpopular and internalising problems and a 'school and substance use problems' group with higher probabilities of substance use, truancy or excessive absence from school and violence. Both of these two groups had over a two-fold risk of self-harm at age 17 in comparison to the low risk factor group. At age 17, there was a group with depression that was diagnosed by a medical professional with the highest relative risk (RR:13.9 (95 % CI 10.2–19.0)) of self-harm at age 20. Two other groups with undiagnosed depression had high probabilities of being bullied, and either high or low probabilities of substance use that had a 9.4 (95 % CI 6.8–13.1) and 7.4 (95 % CI 5.5–10.0) relative risk of self-harm at age 20, respectively. Identifying hidden sub-groups using risk factors for self-harm in young people can inform potential public health interventions by clinicians and other professionals who work with young people. • High risk subgroups for self-harm can be identified in adolescents. • Peer problems and substance use at age 13 are strong indicators of self-harm. • Adolescents with depression at age 17 are at a high risk of self-harm by age 20. • Adolescent undiagnosed depression can be identified by other risk indicators. [ABSTRACT FROM AUTHOR]

Suicide and self-injury have become increasingly serious public health crises. Yet current evidence about the association between sedentary behavior (SB) and suicide is inconclusive. We explore the relationship between SB and suicide behavior to provide intervention measures to change the risk factors of the latter. We searched PubMed, Embase, Cochrane Library, and Web of Science from database inception to September 10, 2023. Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) were used as effect measures. Subgroup analysis was conducted based on gender, regions and countries, age, and study type. A total of 13 studies were included. According to the meta-analysis of suicide type, compared with individuals without sedentary behavior, individuals with sedentary behavior have a higher risk of suicide attempt (OR = 1.23, 95%CI: 1.15–1.37, p < 0.001), suicide ideation (OR = 1.47, 95%CI:1.28–1.68, p < 0.001) and suicide plan (OR = 1.30, 95%CI:1.16–1.44, p < 0.001). We conducted multiple subgroup analyses for different suicidal behaviors. The analysis found that SB can increase the risk of suicide attempt in different subgroups of different genders, different research centers, Africa, and adolescents; SB can increase the risk of suicide ideation in the subgroups of different genders and ages, different research centers, Asia and Africa; SB can increase the risk of suicide plan in the subgroups of different genders, multi-center study, Africa, and adolescents. Future research should focus on objective SB measurement and explore its dose-response relation and time limit. A sedentary lifestyle is associated with suicide behavior risk, with varying effects across age groups and regions, as evidenced in both single-center and multi-center studies. • Sedentary behavior (SB) significantly increases the risk of suicidal behaviors. • Higher risks of suicide attempts, ideation, and planning in sedentary individuals. • Subgroup analyses reveal varying SB impact on suicide across genders, ages, and regions. • Consistent findings of SB's influence on suicide in both single and multi-center studies. [ABSTRACT FROM AUTHOR]

Introduction: Mentalization‐based therapy (MBT) and its adapted version for adolescents (MBT‐A) are repeatedly highlighted as promising treatments for reducing self‐harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self‐harm, recent meta‐analyses have yielded mixed results. To inform best‐practice clinical decision‐making, we conducted a systematic review and meta‐analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(‐A) in reducing self‐harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). Methods: Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre–post, three RCTs) and five MBT‐A studies (two pre–post, three RCTs). Aggregated effect sizes were estimated using random‐effects models. Meta‐regressions were conducted to assess the effect of moderator variables (treatment duration, drop‐out rates, and age) on effect sizes. Results: Overall, both MBT and MBT‐A demonstrated promising effects in reducing self‐harm (g = −0.82, 95% CI −1.15 to −0.50), borderline personality disorder (g = −1.08, 95% CI −1.38 to −0.77), and depression (g = −1.1, 95% CI −1.52 to −0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(‐A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = −0.56, 95% CI −0.88 to −0.24). Conclusion: Although the pre–post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(‐A) to control conditions, so that prioritizing the application of MBT (‐A) for the treatment of self‐harm is not supported. Possible explanations and further implications are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Patients receiving treatment for self‐injurious thoughts and behaviors (SITBs) have diverse backgrounds, yet it remains unclear exactly who is represented in the current SITB treatment literature. Methods: We conducted a systematic review of the past 50 years of randomized controlled trials (RCTs) testing SITB treatments to evaluate sampling practices and reporting of sample characteristics, as well as inclusion of global populations across the included 525 papers. We also assessed changes over the past five decades in these three domains. Results: SITB RCTs frequently reported age and sex (98.6%–95.1%), less frequently reported race (83.4%–38.6%), socioeconomic status (48.1%–46.1%) and ethnicity (41.9%–8.1%), and rarely reported LGBTQ+ status (3.7%–1.6%). U.S.‐based RCTs featured predominantly White, non‐Hispanic, and non‐LGBTQ+ samples. Most RCTs were conducted in high‐income North American or European countries. Sample reporting practices, sample representativeness, and inclusion of global populations modestly and inconsistently improved over time. Conclusions: There has not been substantial improvement in reporting practices, sample representativeness, or inclusion of global populations in SITB RCTs over the past 50 years. Acknowledging who is being studied and representing diverse populations in SITB treatment research is key to connecting research advances with those who may need it most. [ABSTRACT FROM AUTHOR]

Previous studies demonstrated that boredom leads to increased self-administration of painful electric stimulation, a proxy for non-suicidal self-injury (NSSI). However, in these experimental studies, participants had no behavioral alternatives besides electric stimulation to break the monotony. A first aim in the current experimental study was to examine whether boredom still leads to self-administering aversive stimuli when positive behavioral alternatives are present. This boredom effect was furthermore compared to an anger induction. The second aim was to examine whether history of NSSI and negative urgency (i.e., the tendency to engage in impulsive action in response to negative emotions) positively moderate the link between boredom and self-administered aversive stimuli. In a between-subjects design using college students (N = 129), participants were randomly assigned to one of three emotion induction writing tasks (i.e., boredom, anger, neutral), during which frequency of self-administered positive (chirping birds) and aversive (screaming pig) sounds was measured. The latter was used as a proxy for NSSI behavior. Results showed that boredom led to increased selection of aversive sounds compared to the neutral and anger conditions, despite the presence of a positive alternative (i.e., positive sounds). No difference in frequency of selecting the aversive sounds was observed between the anger and neutral condition. Neither history of NSSI nor negative urgency moderated the effect of condition on self-administered aversive stimuli. The current results tentatively support a causal and specific link between boredom and NSSI, and warrant further examination of the role of boredom in maladaptive behaviors such as NSSI. [ABSTRACT FROM AUTHOR]

Research indicates that there is a strong association between childhood adversity and youth suicide and self-harm. However, there is currently a lack of understanding about the patterns of adversity most frequently experienced by youth across social settings, and whether these typologies differently predict youth engagement in suicide and self-harm. This study examines the dominant patterns of adversity experienced by adolescents across home, peer, and school contexts, and explores the relationship between youth's adversity profiles and their suicide and self-harm outcomes, across a two year period (2020–2022). Secondary analyses were performed on data collected from 10,281 (50 % male) adolescents who participated in the Irish Planet Youth questionnaire in 2020 (n = 5004) or 2022 (n = 5277). Findings from clustered latent class analyses indicated that there are four dominant profiles of adversity experienced by adolescents. Class 1 (Multiple Adversity) was characterised by a high probability of experiencing adversity across multiple social settings. Class 2 (Parent Adversity) had a strong likelihood of experiencing adversity with parents. Class 3 (Peer Adversity) were likely to experience adversity within the peer/friend domain. Class 4 was characterised by a low probability of experiencing adversity. Findings from logistic regression models with BCH training weights indicated that there were significant differences in self-harm and suicidality across the adversity classes. In comparison to the low adversity group, adolescents in the multiple adversity group were more likely to self-harm and attempt suicide. These findings are based on cross-sectional data and rely on the use of single-item measurements, which may limit the generalisability of findings. Results indicate that youth who experience adversity across home, peer and school contexts are at the greatest risk of engaging in suicide and self-harm. These findings have important implications for policy and practice, and suggest that youth experiencing adversity across multiple settings should be priority targets for intervention. • Youth who experience adversity are at greater risk of suicide and self-harm. • Youth who experience adversity across multiple settings are most at risk. • Greater consideration of the context in which adversity is experienced is needed. [ABSTRACT FROM AUTHOR]

Suicidal risk has been a significant mental health problem. However, the predictive ability for repeated self-harm (SH) has not improved over the past decades. This study thus aimed to explore a potential tool with theoretical accommodation and clinical application by employing traditional logistic regression (LR) and newly developed machine learning, random forest algorithm (RF). Starting with 89 items from six commonly used scales (i.e., proximal suicide risk factors) as preliminary predictors, both LR and RF resulted in a better solution with much fewer items in two phases of item selections and analyses, with prediction accuracy 88.6% and 79.8%, respectively. A combination with 12 selected items, named LR-12, well predicted repeated self-harm in 6-month follow-up with satisfactory performance (AUC = 0.84, 95% CI: 0.76–0.92; cut-off point by 1/2 with sensitivity 81.1% and specificity 74.0%). The psychometrically appealing LR-12 could be used as a screening scale for suicide risk assessment. [ABSTRACT FROM AUTHOR]

Self‐injurious thoughts and behaviors (SITBs), including suicidal thoughts, suicide attempts, and nonsuicidal self‐injury, are highly prevalent among adolescents. Identifying adolescents at risk for SITBs relies on their disclosure, and these disclosures commonly occur in therapy context. Moreover, therapists often breach confidentiality to inform adolescents' parent or guardian when they disclose SITBs. Research has explored rates of and barriers to disclosure among adolescents, yet no studies have examined adolescents' experiences of disclosure in the therapy context. Further, no studies have examined adolescents' experiences when their parents are then informed. In this study, we examined qualitative responses from 1495 adolescents who had experienced a SITB disclosure in the therapy context. Qualitative questions included asking adolescents to describe how the SITB disclosure occurred, how their parents were informed, and their parents' reactions. Using open and axial coding, several themes emerged. Adolescents described therapist breaches of confidentiality as collaborative, noncollaborative, or unclear. Adolescents described their parents' affective responses, communication about SITBs, validating and invalidating responses, treatment‐oriented responses, and ways that parents restricted their access to people, places, and activities. Findings have implications for the development of clinical guidelines when adolescents disclose SITBs in therapy and highlight areas for future research in adolescent SITB disclosure. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury is a common issue seen by counselors. Fifteen females ranging in age from 18–26 participated in interviews focusing on understanding experiences young adults find helpful in curbing self-injurious behaviors. Participants shared their experiences with NSSI and interactions they considered helpful. Themes and subthemes emerged: responding to emotional pain (a lack of support and coping skills), helpful interactions (presence and understanding, listening, and no judgment), and non-helpful negative interactions (judgment and attempts to eliminate NSSI). Based on participants' experiences, it may be most helpful for counselors, across theoretical approaches, to focus on basic counseling skills when working with NSSI. [ABSTRACT FROM AUTHOR]

Renewal is a relapse phenomenon that refers to the recurrence of a previously reduced behavior following a change in stimulus conditions. Muething et al. (2022) examined the phenomenology of renewal among individuals with automatically maintained challenging behavior treated at an outpatient clinic. We replicated their findings by retrospectively examining renewal across various topographies of automatically maintained behavior treated at an inpatient hospital, and we extended their work by also examining differences across subtypes of automatically maintained self‐injurious behavior. The prevalence of renewal was comparable to that observed by Muething et al., supporting the notion that automatically maintained challenging behavior is susceptible to relapse phenomena. Furthermore, renewal was twice as likely to occur for individuals with Subtype 2 versus Subtype 1 self‐injurious behavior, providing additional evidence of behavioral differentiation between subtypes. Our findings suggest that even after apparent stability in treatment, practitioners should remain vigilant for the recurrence of automatically maintained behavior during generalization. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) is a growing healthcare problem. Individuals with NSSI have an increased risk of suicidality. Due to stigma, they may self-injure in secret, which means they might not seek help until events have escalated to include suicidal ideation or a mental disorder. Interventions delivered via mobile phone applications (apps) have been linked to reductions in self-injury. This protocol outlines a trial, which examines whether the Zero Self-Harm intervention, consisting of an app for people with NSSI, can reduce the number of NSSI episodes, suicide ideation, and depressive symptoms. Methods: The trial will be conducted as a 6-month 2-arm, parallel-group, multicentre, pragmatic, randomized clinical superiority trial. The intervention group will receive the app and instructions on how to use it, while the control group will be allocated to a waitlist and allowed to download the app after 6 months. After inclusion, participants will be asked to complete questionnaires at baseline, 3 months, and 6 months. The primary outcome is the number of NSSI episodes during the preceding month, as measured at the 6 months follow-up with the Deliberate Self-Harm Inventory. A total of 280 participants, 140 in each arm, will be included. Discussion: This trial will assess the effectiveness of the Zero Self-Harm intervention to reduce the number of NSSI episodes. If effective, the app will have the potential to support a large group of people with NSSI. Considering the stigma related to NSSI, the fact that the app may be used in private and anonymously might make it an appealing and acceptable option for support. The app was developed in collaboration with people with lived experiences related to current and/or previous NSSI. As a result of this, the app focuses on minimizing harm, rather than stopping NSSI. This might enhance its utilization. Trial registration: ClinicalTrials.gov NCT04463654. Registered on 7 June 2020. [ABSTRACT FROM AUTHOR]