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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]

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]

Non-suicidal self-injury (NSSI) is the deliberate damage of one's own body tissue in the absence of suicidal intent. Research suggests that individuals engage in NSSI as a means of regulating their emotions and that NSSI is associated with emotion regulation difficulties. There is also evidence supporting the role of outcome expectancies and self-efficacy to resist NSSI. However, it is unclear how these factors work together to explain NSSI. To explore whether the relationships between five NSSI-specific outcome expectancies and NSSI history are moderated by emotion regulation difficulties and self-efficacy to resist NSSI. 1002 participants (Mage = 20.51, 72.5% female, 39.7% lifetime history of NSSI) completed an online survey including measures of NSSI history, outcome expectancies, self-efficacy to resist NSSI, and emotion regulation difficulties. Emotion regulation difficulties were associated with NSSI, as was expecting NSSI to regulate affect. Conversely, expectations of communication and/or pain, as well as self-efficacy to resist NSSI were negatively associated with NSSI. Expectancies also interacted with both difficulties in emotion regulation and self-efficacy to resist NSSI in predicting self-injury. For example, the association between expectations of affect regulation and self-injury was weaker when associated with greater self-efficacy to resist NSSI. These findings provide support for considering NSSI-specific cognitions in concert with emotion regulation when understanding NSSI. Outcome expectancies can differentiate people based on NSSI history. Emotion regulation difficulties and self-efficacy to resist NSSI moderate the relationships between outcome expectancies and NSSI history. Emotion regulation difficulties and low self-efficacy to resist NSSI work together to predict NSSI history. [ABSTRACT FROM AUTHOR]

Self-harm is a common phenomenon amongst young people, often used to regulate emotional distress. Over the last decade harm reduction approaches to self-harm have been introduced as a means to minimize risk and reinforce alternative coping strategies. However, there is a stark absence of research into the perceived usefulness of such techniques amongst adolescents, and previous studies have highlighted ethical concerns about advocating 'safer' forms of self-harm. This study aimed to investigate the perceived usefulness of harm reduction techniques for adolescents who self-harm. We purposively recruited current clients of a British early intervention program supporting young people in managing self-harm. We conducted semi-structured interviews and analyzed transcripts using thematic analysis. Eleven interviews with service users aged 14–15 years identified three main themes: (1) Controlling the uncontrollable; (2) Barriers to practising safer self-harm; and (3) Developing a broad repertoire of harm reduction techniques. Participants expressed mixed views regarding the usefulness of such approaches. Some described greater competence and empowerment in self-harm management, whilst others described the utility of harm reduction methods as either short-lived or situation-specific, with the potential for misuse of anatomical knowledge to cause further harm to high-risk adolescents. The findings from our sample suggest harm reduction techniques have a place in self-harm management for some individuals, but their usage should be monitored and offered alongside alternative strategies and therapeutic support. Our study highlights the need for further research on who would benefit from these techniques and how they can be implemented successfully. Harm reduction can help people who self–harm manage distress and maintain autonomy People who self-harm have a broad repertoire of harm reduction techniques Harm reduction can help reduce long-term damage and frequency of self-harm [ABSTRACT FROM AUTHOR]

There is a significant overlap in the motivations for nonsuicidal self-injury (NSSI) and alcohol use. Moreover, several theories would predict that more frequent alcohol use is likely associated with more NSSI engagement. Still, the size and direction of this association has not been well documented in the literature. To address this gap, the goal of this article was to conduct a meta-analysis of the relation between alcohol use and NSSI. Across 57 samples and 141,669 participants, we found that there was a significant positive association between NSSI and alcohol use, odds ratio = 1.78, 95% confidence interval [1.53, 2.07], k = 64, m = 52. Moderator analyses found that this effect was stronger for younger samples and samples with more severe alcohol use problems. These results help establish a link between NSSI and alcohol use. Implications and future directions for NSSI research and intervention are discussed. There are several reasons to think that NSSI and alcohol use are linked. No reviews or meta-analyses have been conducted. We found a significant and small effect linking greater NSSI with greater alcohol use. [ABSTRACT FROM AUTHOR]

The Netflix series 13 Reasons Why (13RW) has sparked controversy due to graphic depictions of youth suicide, bullying, and sexual assault. However, further research is needed examining experiences of the show among youth with psychiatric illness. This exploratory, mixed-methods study examines adolescents' perceptions of 13RW and associations among viewership, suicide-related media influence processes, and self-injurious thoughts and behaviors (SITBs). Participants were 242 adolescents hospitalized in a psychiatric inpatient facility; 60.7% female, 30.2% male, 9.1% other genders; ages 11 to 18; and 74.3% White, 7.5% Black, and 21.8% Hispanic. Participants completed measures of series viewership, media message processing, and SITBs. Participants who watched completed open-ended questions regarding beliefs and opinions about the series. In all, 50.4% of participants watched 13RW, with girls (63.3%) more likely to have watched than boys (26.0%). More than half (55.9%) of youth expressed negative reactions to the show, while approximately one-third (33.8%) expressed positive reactions. Having watched the series was associated with greater likelihood of past-year non-suicidal self-injury (NSSI), but not with suicidal ideation or past-year suicide attempts. Youth's interpretation of media messages in 13RW, including greater identification with and perceived likeability of the main character, were associated with suicidal ideation and past-year NSSI. Findings suggest high rates of 13RW viewership among psychiatrically hospitalized youth, particularly girls, and provide insight into factors that may affect youths' vulnerability to suicide-related media effects. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is a complex behavior that serves many functions and may be motivated by several factors. Although previously limited to the context of personality disorders, consideration of how general personality traits might be related to NSSI warrants examination. Our aims were to investigate whether clusters based upon the Big Five personality traits exist among people who have engaged in NSSI, and explore systematic differences with regard to gender, age, key indicators of NSSI severity, functions of NSSI, emotional avoidance, alexithymia, psychological distress, and emotion regulation strategies. A sample of 236 university students (83% female, M age = 21.59, SD = 5.43) who had engaged in NSSI completed an anonymous online questionnaire. Cluster analysis yielded three subgroups who were characterized by tendencies for resilience, dysregulation, and disagreeableness. Resilient and dyregulated profiles fell within opposite ends of a continuum with regard to severity of NSSI, psychological distress and alexithymia, and adaptive vs less adaptive emotion regulation strategies. Dysregulated characteristics were also associated with affect regulation and self-punishment functions of NSSI. Disagreeable characteristics were associated with high alexithymia and psychological distress. Implications of these findings for theory and tailored treatment approaches to NSSI are discussed. [ABSTRACT FROM AUTHOR]

Objective: The aim was to develop understanding around the experience of suicide in transgender youth. Method: Qualitative analysis with 85 interviews with transgender youth about their histories with suicidality was performed. Participants were recruited from community clinics in three counties (United States, Canada, and Ireland) between 2010 and 2014. Results: Factors that precipitated participants' suicide attempts included rejection based on gender identity and gender dysphoria. Participants demonstrated resilience by attempting to connect with loved ones for support and through self-awareness of mental states, including by regulating behaviors they perceived to adversely affect their mental health. Conclusions: Transgender youth may fear seeking health care due to health professionals' lack of understanding of transgender issues and fear of further victimization. Reframing suicidality as a rational decision-making process in response to stress may further understanding of why people attempt suicide and provide new avenues for intervention. [ABSTRACT FROM AUTHOR]

This study aimed to examine which specific emotion processes influence self-inflicted injury: basal respiratory sinus arrhythmia, baseline negative emotional intensity, emotional reactivity, or emotion regulation deficits. Self-injuring individuals with borderline personality disorder (N = 22) reported their lifetime self-injury frequency. Basal respiratory sinus arrhythmia and baseline skin conductance responses measurements were collected. Participants then either reacted as they usually would (i.e., emotional reactivity), or utilized mindfulness- or distraction-based strategies (i.e., emotion regulation), in response to negative images while self-reported negative emotion and skin conductance were monitored. Higher basal respiratory sinus arrhythmia and baseline emotional intensity predicted higher lifetime self-injury frequency. Chronic, resting emotion processes may be more important targets for reducing self-injury compared to labile, acute emotion processes. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury (NSSI) often occurs before age 15, yet the majority of research on risk factors for this dangerous behavior has focused on samples of older participants. Insecure attachment has been previously identified as a risk factor for both NSSI and behavioral problems, and behavioral problems appear to be particularly associated with NSSI among young populations. Redressing the lack of young adolescent NSSI research, the present study uses longitudinal data from a sample of young adolescents to test a model in which insecure attachment acts as a prospective risk factor for NSSI via emotional and behavioral problems. Data on NSSI, child-mother attachment, and emotional and behavioral problems were collected from 559 (41.1% male) Flemish adolescents when they were 13 years old (M = 12.71, SD =0.32), and again 1 year later. Insecure attachment was measured using maternal items on the Experiences in Close Relationships-Revised Child scale. Psychological adjustment was assessed with the Strengths and Difficulties Questionnaire. We found that anxious and avoidant attachment were indirectly associated with NSSI through behavioral problems but not through emotional problems. Findings highlight the role of behavioral problems as a risk factor for NSSI in early adolescence, a rarely studied developmental period during which NSSI often first starts. Findings suggest that one possible pathway for the attachment-NSSI association among young adolescents is through behavioral problems. Therapies that improve child-parent attachment may reduce NSSI among young adolescents both directly, and indirectly by improving behavioral problems. [ABSTRACT FROM AUTHOR]

This study replicates and extends prior work by examining how age of Non Suicidal Self-Injury (NSSI) onset relates to NSSI severity, suicidal behavior, perceived recovery from NSSI, and protective factors of life satisfaction, resilience, and subjective happiness. University students who reported engaging in NSSI within the past year (n = 644) completed on-line questionnaires assessing NSSI characteristics, suicidal behavior, and protective factors. Participants who began self-injuring at or before age 12 reported significantly more lifetime acts of NSSI, greater method versatility, and medically severe NSSI than those who began NSSI at older ages (17 years). Those with a typical age of onset (13-16 years) did not differ from the younger age group on method versatility, medical severity, past year frequency, or perceived recovery but did differ from those with an older age of onset. The proportion of individuals reporting suicide attempts significantly increased as the age of onset became younger. No age of onset group differences were observed on the protective factors. The age at which one begins NSSI appears to be a risk factor for increasingly severe NSSI and potential suicidal behavior. Early detection and intervention is important for reducing the negative consequences of engaging in NSSI. [ABSTRACT FROM AUTHOR]

This study sought to identify factors distinguishing transgender/gender non-conforming (GNC) adolescents across three groups: no self-harm, non-suicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA). Data were from the 2016 Minnesota Student Survey. The final analytic sample included 1,635 transgender/GNC students in grades 9 and 11. Logistic regression analyses determined factors that best distinguished transgender/GNC students who reported self-harm (NSSI only or NSSI + SA) from those who reported no self-harm, and transgender/GNC adolescents who reported NSSI + SA from those who reported NSSI only. Final models were developed over 3 stages of analysis that tested associations of variables within risk factor, protective factor, and health-risk behavior domains to self-harm. Over half (51.6%) of transgender/GNC adolescents reported past-year self-harm behavior. Factors that consistently distinguished transgender/GNC youth who reported self-harm from those who reported no self-harm included reports of a mental health problem, depression, running away from home, and substance use (alcohol or marijuana use). Factors that distinguished the NSSI + SA group from the NSSI only group were reports of a mental health problem, physical or sexual abuse, relationship violence, bullying victimization, less parent connectedness, lower grades, lower levels of perceived school safety, and running away from home. Clinicians and school personnel need to be prepared to address risk factors and enhance protective factors that may reduce the likelihood this population of vulnerable youth will engage in NSSI and/or attempt suicide. [ABSTRACT FROM AUTHOR]

The majority of non-suicidal self-injury (NSSI) research has used self- or clinician-rated measures of behavior which (a) are subject to reporting biases, or (b) have limited use in experimental designs that could illuminate causal relationships. Laboratory-based behavioral tasks have therefore been developed to assess NSSI-related behaviors more directly. We reviewed the behavioral methods that have been developed to assess NSSI tendencies or behaviors over the past 30 years. Several categories of laboratory analogues were identified: NSSI-related stimuli (e.g., NSSI pictures, implicit association tasks, guided imagery), experimenter administered pain stimuli (e.g., cold, heat, pressure, shock, and blade), and self-selected pain stimuli (e.g., cold and shock). These behavioral methods assess various aspects of NSSI and all have distinct advantages and shortcomings. Overall, these approaches have made significant contributions to the field complementing self- and clinician-ratings. [ABSTRACT FROM AUTHOR]

The current paper reviews extant quantitative and qualitative literature into how Non-Suicidal Self-Injury cessation occurs, and individuals' experiences of stopping. Specific search criteria utilizing a PRISMA format were used across 5 databases, which resulted in 454 papers being identified. After utilizing exclusion criteria and then review, nine of the 454 papers identified were retained for extensive synthesis and critique.Results: Results from 8 of the identified papers indicated that both intra and inter personal factors can influence self-injury cessation. These include: family support, self-esteem, emotional regulation, and professional help. Only 1 paper articulated a cessation process, describing it as a procedural event of developing interpersonal strength, then implementing alternative coping strategies. Limitations and implications of the studies are reported, concluding that further research is warranted to inform effective prevention and treatment strategies to ameliorate this growing public health concern. [ABSTRACT FROM AUTHOR]

This study sought to explore the relationships between depression, anxiety, stress, and non-suicidal self-injury (NSSI), and the mediating roles of rumination and emotion regulation in this relationship. The sample comprised 1,586 Australian university students who completed a self-report questionnaire assessing the relevant variables. Of the sample, 8.9% engaged in NSSI in the 4 weeks prior to the survey. Depression, anxiety, and stress each exerted a direct effect on NSSI, and each relationship was mediated by cognitive reappraisal. The relationship between stress and NSSI was also mediated by expressive suppression. The results imply intervention efforts aimed at teaching adaptive emotion regulation strategies for students experiencing high levels of psychological distress may reduce the frequency of NSSI. [ABSTRACT FROM PUBLISHER]

Mindfulness is often part of treatment for non-suicidal self-injury (NSSI); however, there has been limited research examining the role of mindfulness in NSSI. Thus, the current study sought to investigate the relationship among mindfulness, depressive symptoms, and NSSI (past year) in adolescents (N = 764; 56.8% female, M age = 14.42, SD = 0.64) with consideration of gender. Adolescents with recent NSSI (n = 74; 83.8% female, M age = 14.36, SD = 0.56) and a matched for age and gender no-NSSI group completed measures of mindfulness and depression. Findings revealed that mindfulness and depressive symptoms were negatively correlated, although significantly less so for the NSSI group. Second, the NSSI group reported greater depressive symptoms and less mindfulness. Finally, mindfulness was found to partially mediate the effect of depressive symptoms on NSSI. The present study is the first to provide empirical support for the protective role of mindfulness in NSSI. [ABSTRACT FROM PUBLISHER]

This study examined the relationship between frequency of exposure to non-suicidal self-injury (NSSI) and engagement in NSSI among adolescents. Ninety inpatient adolescents with a history of NSSI, ages 12 to 17, completed a structured interview. The majority of participants had learned about NSSI prior to initiating the behavior themselves. More frequent exposure to specific methods of NSSI was associated with greater frequency of using those same methods. Greater exposure to NSSI in the media and seeking out NSSI content were related to greater frequency of engagement in NSSI. Clinicians may help those who self-injure to become more knowledgeable and educated consumers of media to prevent NSSI behavior and contagion. [ABSTRACT FROM PUBLISHER]

The presented study aimed to advance understanding of the reasons for non-suicidal self-harm (NSSH) in adult male offenders, with and without borderline personality traits. 179 offenders completed self-report measures of NSSH and other clinical constructs, with 42 being identified as having self-harmed. Results were consistent with past research and supported the relative importance of intrapersonal over interpersonal functions, but also highlight that self-harm is performed rarely for one type of reason. The results also show that the presence of borderline personality traits increases the likelihood of endorsing a range of interpersonal reasons. These findings highlight the importance of understanding the range of reasons for engaging in NSSH to help manage the behaviour within the prison. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify differences between young people who seek help online for self-injury and those who self-injure but do not seek help online, in order to improve online services for young people at high risk of suicide. Young people reporting a history of self-injury (N = 679) were identified as part of larger study (N = 1,463) exploring help-seeking. One third of young people with a history of self-injury reported online help-seeking for self-injury. Online help-seekers were significantly more distressed, suicidal, and had a greater degree of self-injury compared to those who did not seek help online. The Internet provides an important form of support to the most at risk young people in this population, and may be a proximal step to face-to-face help-seeking. Further research is required to investigate the forms of support currently accessed by young people online, and their effectiveness. [ABSTRACT FROM PUBLISHER]

The objective of this study was to evaluate associations between self-injury training and attitudes across different health care professions. In the study, 342 psychologists, social workers, psychiatric, and medical nurses were recruited from 12 hospitals in Belgium. Participants completed a confidential questionnaire assessing attitudes, perceived knowledge/competence in self-injury, and prior self-injury training. Professionals with training reported more positive empathy, less negative attitudes, and greater perceived knowledge/competence, which was related to positive attitudes. Mental health providers had more positive attitudes than medical professionals. Conclusions: Attitudes towards self-injuring patients are multifaceted and vary across health professions. Training on self-injury should be incorporated into the educational curriculum of all health care professions. [ABSTRACT FROM PUBLISHER]

Self-injury represents a common yet perplexing set of behaviors, considered difficult to treat. The current study aimed to identify social and personal resources that may aid in cessation of self-injury. A community sample of 312 participants completed an online questionnaire. In line with Brown and Williams (2007), we compared all self-injurers (current and past) (106, 34%) with those who had never self-injured (206, 66%), and then current (38, 12.2%) with past self-injurers (68, 21.8%). Overall, self-injurers reported significantly lower levels of perceived social support, social connectedness, resilience, self-esteem, and life satisfaction compared to those with no such history. Further analysis indicated that family support, self-esteem, resilience, and satisfaction with life were significantly better for past compared to current self-injurers (at the p < 0.01 level). Logistic regression suggested that self-injurers could be distinguished from non self-injurers on Self-esteem and Social Connectedness. A further logistic regression suggested that past self-injurers could be distinguished from current self-injurers by their level of Resilience. The research has important preventive and clinical implications. [ABSTRACT FROM PUBLISHER]

The current study tested hypotheses derived from Joiner's (2005) interpersonal theory of suicide, which proposes that deliberate self-harm (DSH) becomes increasingly more reinforcing with repetition. One hundred six participants with a history of DSH completed questionnaires about their emotions and experience of physical pain during their most recent DSH episode. Consistent with prediction, people with more numerous past DSH episodes felt more soothed, more relieved, and calmer following their most recent episode of DSH. Contrary to prediction, greater numbers of past DSH episodes were associated with more intense physical pain during the most recent episode. The findings suggest that the emotion regulation functions of DSH may become more reinforcing with repetition. [ABSTRACT FROM AUTHOR]

Suicidal and non-suicidal self-injurious behaviors are pernicious and highly prevalent among youth worldwide. Studies confirm that engaging suicidal youth in outpatient treatment is a challenge for most therapists and that a substantial number of suicidal youth never follow through with treatment referrals received in emergency departments and eventually re-attempt suicide. The treatment engagement literature for suicidal youth has largely focused on identifying empirical correlates of attendance and testing interventions to increase compliance. In an effort to promote the use of theory in this field, this article employs Staudt's (2007) conceptual model of the treatment engagement process to both organize the empirical literature and to explain specific treatment engagement and retention strategies used in dialectical behavior therapy for suicidal adolescents. Recommendations for future research are offered. [ABSTRACT FROM AUTHOR]

A nationally representative sample of Norwegian high school students (ages 14 to 19, N = 2,924) completed self-reports in school about non-suicidal self-injury (NSSI), suicide attempt (SA), and risk and protective factors. They were re-examined 5 years later. In all 2.2% reported NSSI with no SA during the follow-up period and 3.2% reported SA. Several risk and protective factors were common to NSSI and SA: previous SA, young age, debut of sexual intercourse before the age of 15, and non-heterosexual sexual interest. However, other risk and protective factors were unique to NSSI or SA: Previous NSSI increased the risk for future NSSI whereas satisfaction with social support protected against later NSSI. Suicidal ideation increased the risk for SA whereas attachment to parents protected against it. NSSI did not increase the risk of future SA. NSSI and SA may be thus conceived of as only partly overlapping phenomena, and not necessarily just representing different degrees of suicidality. [ABSTRACT FROM AUTHOR]

The study of non-suicidal self-injury (NSSI) has focused largely on identifying diagnostic correlates and the functions of this behavior; however, little is known about the broader range of factors related to NSSI. We examined a wide array of factors hypothesized to correlate with non-suicidal self-injury (NSSI) and provided a qualitative analysis of adolescents' self-reported motivations for starting and stopping this behavior. Participants were 64 adolescents with a history of NSSI and 30 comparison adolescents without such a history matched on age, sex, and ethnicity recruited from the community and assessed during one laboratory visit. The presence of NSSI was associated with a family history of suicidal ideation, violence, and drug and alcohol abuse, but not with more general forms of psychopathology. NSSI also was associated with the presence of in utero complications, the occurrence of non-injurious repetitive behaviors during childhood, and endorsement of a homosexual or bisexual orientation. Self-injurers reported getting the idea to self-injure from peers (38%) more often than any other source, and most (78%) reported at least one reason for wanting to stop self-injury. Less than half were currently receiving treatment. This exploratory study provides new information about the correlates of NSSI that has implications for research and clinical work in this area. [ABSTRACT FROM AUTHOR]