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Objective: This study aimed to develop a Korean version of the Nonsuicidal Self-injury Inventory (K-NSSI) through the Deliberate Self-harm Inventory (DSHI) developed by Gratz for the Korean context and confirm its reliability and validity for clinical application. Methods: A total of 188 participants were analyzed utilizing the DSHI, the Korean version of the Self-harm Inventory, the Personality Assessment Inventory-Borderline Features (PAI-BOR), and the DSM-5 Level-2-Depression scale (Level- 2-Dep). Cronbach's α assessed their reliability, while frequency analysis examined the items of the K-NSSI scales. Validity of the K-NSSI was confirmed through correlation analyses between K-NSSI (tendency for and frequency of nonsuicidal self-injury [NSSI] behavior) and SHI, PAI-BOR total scale, four subscales of PAI-BOR, and Level-2-Dep scale. Polyserial correlations analyzed the correlation between the presence of NSSI behavior and other scales. Confirmatory factor analysis and structural equation modeling explored the relationship between borderline personality features and self-harm. Results: Cronbach's α was 0.71, indicating an "acceptable" level of reliability. Statistically significant correlations were observed between the presence of NSSI behavior and the total scores of SHI and PAI-BOR, and the four subscales of PAI-BOR. The frequency of NSSI showed statistically significant correlations with the total score of SHI and PAI-BOR, and its four subscales. Notably, 13.8% of participants reported engaging in self-harm behaviors, 26.9% reported a single occurrence, and 73.1% reported two or more instances. Structural equation modeling demonstrated that self-harm adequately predicted borderline personality traits. Conclusion: This study successfully validated the adaptation of DSHI into K-NSSI. The K-NSSI can facilitate interventions for self-harm incidents. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is rare in childhood but becomes prevalent in adolescence, which suggests that early intervention might be indicated. As childhood predictors of NSSI in adolescence are largely unknown, identifying these predictors was the aim of this study. In a birth cohort sample (n = 759) of Norwegian children, NSSI at 12, 14, or 16 years of age was regressed on predictors of NSSI at age 6 (parental factors: depression, parenting stress, negativity/hostility, emotional availability to the child; child factors: temperamental negative affectivity, emotion regulation, symptoms of emotional and behavioral disorders; external events: victimization from bullying, serious negative life events). Semistructured clinical interviews with adolescents and their parents were used to assess DSM-5 –defined NSSI and NSSI disorder. NSSI during the preceding 12 months at 12, 14, or 16 years of age was reported by 81 adolescents (10.0%, 95% CI 8.2-11.9), and NSSI disorder was reported by 20 adolescents (2.7%, 95% CI 1.9-3.8). In multivariable logistic regression analysis, female gender (odds ratio 11.6, 95% CI 4.0-33.5), parenting stress (odds ratio 4.8, 95% CI 1.4-16.5), and parental negativity/hostility (odds ratio 1.8, 95% CI 1.2-2.7) predicted NSSI, whereas child factors and external events were not predictive. Parental factors when the child is 6 years of age—parenting stress and negativity/hostility toward the child—predict NSSI in adolescence. Universal and indicated programs targeting these aspects of parenting during childhood might reduce NSSI in adolescence. Almost 1 in 4 adolescents engage in deliberate self-harm without wanting to die from it. However, childhood predictors of nonsuicidal self-injury are largely unknown. This study from Norway followed 759 children from birth until adolescence. The authors found that children who perceived their parents as more negative and hostile at 6 years old were at increased risk of engaging in self-injury when they became adolescents. Children whose parents reported more stress in the parenting role were also at increased risk of engaging in self-harm during adolescence. The authors conclude alleviating parental stress and improving parent-child relations at an early age might decrease the risk of adolescent self-harm. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. [ABSTRACT FROM AUTHOR]

Background: Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents and young adults worldwide. It is linked to a broad variety of mental disorders and an increased suicide risk. Despite its high prevalence, research on the underlying mechanisms and on potential risk and resilience factors for maintaining or quitting NSSI remains scarce. This manuscript presents an overview of the "Self-injury: Treatment-Assessment-Recovery" (STAR) collaboration, which aimed to address these gaps. Methods: We investigated the natural course of NSSI as well as its social, psychological, and neurobiological predictors (observational study; OS). OS data collection occurred at four timepoints (baseline [T0], 4 [post, T1], 12 [follow-up (FU), T2], and 18 [FU, T3] months after baseline) for the NSSI group, which was compared to a healthy control (HC) group at T0 only. Online self-report was used at all timepoints, while semi-structured interviews (face-to-face (f2f)) were conducted at T0 and T3. At T0 only, we conducted ecological momentary assessment and neurobiological investigations. Here, we present the general methodology and sample characteristics of the completed OS including the f2f subprojects, while other subprojects are not within the scope of this paper. Sample description: The OS sample consists of 343 participants at T0 (180 NSSI, 163 HC). Mean age in the NSSI group (T0) was 18.1 years (SD = 2.09, range: 15–25), gender-related data is available for 166: 156 = female, 7 = male, 3 = transgender, 10 = not disclosed). In the HC group, mean age (T0) was 19.1 years (SD = 2.35, range: 15–25) (142 = female, 21 = male). At T1, 128 (71.11%) of the NSSI participants completed the questionnaires, at T2 125 (69.44%) and at T3 104 (57.78%). In the fMRI subproject, 126 adolescents participated (NSSI = 66, HC = 60, 100% female; mean age (T0): NSSI = 18.10 years, SD = 2.21; HC = 19.08, SD = 2.36). Conclusion: Understanding predictors is of utmost importance for adequate diagnosis and intervention for NSSI. Our OS applied a multimodal investigation of social, psychological, and neurobiological parameters and is the largest sample of adolescents with NSSI to date including follow-up assessments. As health care providers require specific knowledge to develop new treatments, we believe that our in-depth assessments can potentially enhance care for youths engaging in NSSI. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The study aims to investigate the efficacy of sertraline medication plus dialectical behavior therapy (DBT) in reducing nonsuicidal self‐injury (NSSI) behavior and depression among adolescents.Participants were 100 adolescents with depression and NSSI behaviors, 50 of whom received sertraline medication plus DBT and 50 of whom received sertraline medication plus cognitive behavioral therapy (CBT) for 12 weeks.During 6 months post intervention, 26 (57.8%) participants did not report having engaged in any form of NSSI in the sertraline + DBT group and 15 (32.6%) in the sertraline + CBT group, showing significant difference. The sertraline + DBT group and the sertraline + CBT group exhibited significant difference regarding the proportions of cutting skin and biting self. The scores of anxiety, depression, aggression against self in four modified overt aggression scale categories, and Personal and Social Performance were notably lower in the sertraline + DBT group than those in the sertraline + CBT group at 6 months post intervention.Sertraline medication plus DBT could decrease NSSI episodes and improve symptoms of anxiety and depression for adolescents, and these changes were comparable to those of CBT. More importantly, DBT was demonstrated better clinical improvements at 6‐month follow‐up. [ABSTRACT FROM AUTHOR]

College counseling centers are seeing increasing rates of suicidal thoughts and behaviors, and nonsuicidal self-injury (NSSI) among students. The high degree of need and limited resources underscores the need for novel approaches to identify at-risk students. We used latent profile analysis (LPA) to identify subgroups of students (n = 371) with different patterns of interpersonal factors and examine whether these subgroups differed by risk for self-injurious thoughts and behaviors. The best-fitting LPA had three profiles, which differed in urges to die by suicide and engage in NSSI. The profile with low average social support and higher instability (greater day-to-day fluctuations of self-reported social support and rejection) was associated with greatest risk, suggesting that this combination leaves individuals more vulnerable to suicide and NSSI. [ABSTRACT FROM AUTHOR]

Although nonsuicidal self-injury (NSSI) is prevalent among adolescents and is associated with an increased risk of adverse outcomes, many adolescents with NSSI do not seek help. However, there is a lack of research on the factors that may increase the likelihood of help-seeking, especially within Asia. To address this gap, the present study examined whether certain factors were associated with informal and formal help-seeking – specifically gender, severity of NSSI, functions of NSSI and authoritative parenting. 121 adolescents (M age = 16.2 years, 71.1% female) were recruited from specialist outpatient clinics and inpatient psychiatric wards from a public hospital in Singapore. One caregiver per adolescent was also recruited. Data from self-report questionnaires were analysed using logistics regression analyses. The results suggest that the severity of NSSI increases the likelihood of informal help-seeking, while adolescents who have parents with more authoritative parenting style are less likely to seek informal help. Gender and functions of NSSI were not found to be associated with help-seeking. The findings from this study can guide professionals in their efforts to encourage help-seeking within Asian populations, as well as inform prevention and treatment programs for Asian adolescents with NSSI. Plain language summary: Factors that encourage Asian youths who self-harm to get help from non-professionals and professionals: There are many youths who engage in self-harm for reasons other than suicide. Although self-harm could lead to various negative outcomes, many youths do not seek help. However, not much is known about what encourages these youths to seek help from non-professionals (e.g., family, friends) and professionals (e.g., psychologists), especially within Asia. This paper looked at certain factors that may be linked to whether youths seek help – including gender, severity of self-harm, reasons for self-harm, and parenting style. Youths and caregivers were recruited from a public hospital in Singapore. The study found that youths with more severe self-harm are more likely to seek help from non-professionals, whereas youths with parents who are highly responsive and provide consistent discipline are less likely to seek help from non-professionals. None of the factors studied were relevant in whether youths sought help from professionals. The findings from this study can guide professionals to prevent and treat self-harm in Asia, as well as improve efforts to encourage Asian youths to seek help. [ABSTRACT FROM AUTHOR]

This study aimed to explore the pathway from childhood trauma to nonsuicidal self-injury (NSSI) in adolescents with major depressive disorder (MDD) and to examine the chain-mediating role of psychological resilience and depressive symptoms in this pathway. A total of 391 adolescents with MDD were recruited in the present study. The Chinese version of the Childhood Trauma Questionnaire—Short Form (CTQ-SF), the Chinese version of the Symptoms Check List-90 (SCL-90), the Chinese version of the Conner-Davidson Resilience Scale (CD-RISC), and the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC) were used to evaluate childhood trauma, depressive symptoms, psychological resilience and NSSI, respectively. Our results showed that 60.87% of adolescents with MDD had NSSI in the past month. Childhood trauma frequency was negatively correlated with psychological resilience but positively correlated with depressive symptoms and NSSI severity in adolescents with MDD. The stepwise logistic regression analysis identified that age, childhood trauma and depressive symptoms could independently predict the occurrence of NSSI, and the three-step hierarchical regression showed that childhood trauma, psychological resilience and depressive symptoms were all significantly associated with NSSI frequency in adolescents with MDD. Furthermore, the chain-mediation analysis revealed that psychological resilience and depression serially mediated the relationship between childhood trauma and NSSI in adolescents with MDD. Interventions targeted at improving resilience and depression may mitigate the impact of childhood trauma severity on NSSI risk in adolescents with MDD. [ABSTRACT FROM AUTHOR]

The outbreak of the coronavirus disease 2019 (COVID-19) pandemic threatened adolescents' mental health and livelihoods, which can worsen their non-suicidal self-injury (NSSI) behaviors. With the significant increase of total online time use, adolescents become more prone to problematic internet use (PIU). This study examined whether depression mediated the relationship between PIU and NSSI among adolescence during the COVID-19 outbreak. Constructed with a cross-sectional design during the COVID-19 outbreak in Taiwan, 1060 participants were drawn from junior high schools through stratified and cluster sampling, and completed a set of comprehensive surveys. The mediation model demonstrated a good fit to the data, GFI =.96, CFI =.97, NFI =.97, NNFI =.95, IFI =.97, and SRMR =.02. The overall fit of the mediational model was adequate. The path from PIU to depression, β =.41, p <.001, and the path from depression to NSSI, β =.40, p <.001, were both significant. Moreover, the effect of PIU to NSSI decreased from.23 (p <.001) to.05 (p =.099) when depression was incorporated into the analysis. Moreover, results in bootstrapping analysis displayed that the indirect effect (PIU on NSSI via depression) was statistically significant (p <.001) and the direct effect (PIU on NSSI) was statistically non-significant (p =.134). The full mediation model was confirmed. The findings of the structure equation modeling and bootstrap analysis showed that PIU significantly and positively predicted NSSI, and that depression fully mediated this relationship. [ABSTRACT FROM AUTHOR]

Prominent theories of nonsuicidal self-injury (NSSI) propose that the behaviour is characterised by amplified emotional responses. However, little is known about how people who self-injure respond during emotional challenge. We measured subjective and physiological responding (heart rate, heart rate variability, and electrodermal responding) among young adults with past-year NSSI (n = 51) and those with no lifetime NSSI (n = 50) during a resting baseline, a stress induction, and a post-stress resting phase. Participants reported the extent to which they spontaneously used cognitive reappraisal and expressive suppression during the post-stress phase. Two weeks later, a subset of the sample (n = 42) reported how they remembered feeling during the laboratory session. Although the NSSI group reported considerably greater emotion dysregulation than Controls, both groups showed similar subjective and psychological reactivity to, and recovery from, emotional challenge. Both groups used reappraisal and suppression regulation strategies following acute stress to a similar extent, and later came to remember the emotional challenge in a similar manner. Within the NSSI group, past-year self-injury tended to be infrequent and sporadic. Only 43.6% of the sample participated in the follow-up survey assessing memory of emotional challenge. Findings demonstrate that the role of emotion in NSSI is more complex than prominent theories can account for, raising substantial questions regarding the nature of emotion in NSSI. A more comprehensive understanding of the role of emotion in NSSI is needed to inform intervention strategies to better support people who self-injure. • An amplified emotional response to challenge is thought to underlie self-injury. • People who self-injure report elevated emotion dysregulation compared to controls. • Both groups showed similar subjective and physiological responses to acute stress. • Both groups later remembered their emotional experience in a similar manner. • A greater understanding of emotion in self-injury is needed to inform treatment. [ABSTRACT FROM AUTHOR]

Psychological treatments targeting emotion dysregulation in adolescents reduce nonsuicidal self-injury (NSSI) but predicting treatment outcome remains difficult. Identifying sub-groups based on repeated measurements of emotion dysregulation pre-treatment may guide personalized treatment recommendations. We used data from a recent trial evaluating internet-delivered emotion regulation therapy for adolescents with NSSI (n = 138). Latent profile analysis was used to identify sub-groups based on pre-treatment responses on the 16-item version of the Difficulties in Emotion Regulation Scale. The primary outcome was self-rated NSSI frequency during treatment, and secondary outcome was the proportion of participants with no NSSI 1-month post-treatment. Three sub-groups of emotion dysregulation were identified: low variability and low mean (Group 1), low variability and high mean (Group 2), and high variability and low mean (Group 3). Sub-groups did not differ in NSSI frequency during treatment (Group 2 IRR = 1.06 [95% CI 0.49–2.29], p = .88; Group 3 IRR = 1.22 [95% CI 0.31–4.76], p = .77). However, more participants in Group 1 compared to Group 2 abstained from NSSI at 1-month post-treatment (OR = 3.63 [95% CI 1.16–11.33], p = 0.01). Latent profile analysis identified sub-groups predictive of NSSI absence post-treatment, demonstrating clinical utility. [ABSTRACT FROM AUTHOR]

We aimed to examine whether positive and negative coping styles mediated the influences of childhood trauma on NSSI or depressive severity in adolescents with major depressive disorder (MDD). The Children's Depression Inventory (CDI), the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC), the short-form Childhood Trauma Questionnaire (CTQ-SF), and the Simplified Coping Style Questionnaire (SCSQ) were evaluated in 313 adolescents with MDD. MDD adolescents with NSSI had higher CTQ-SF total score, emotional and sexual abuse subscale scores, but lower CDI total and subscale scores compared to the patients without NSSI. The multiple linear regression analysis revealed that emotional abuse (β = 0.075, 95 % CI: 0.042–0.107) and ineffectiveness (β = −0.084, 95 % CI: −0.160 ∼ −0.009) were significantly associated with the frequency of NSSI in adolescents with MDD, but emotional abuse (β = 0.884, 95 % CI: 0.570–1.197), sexual abuse (β = 0.825, 95 % CI: 0.527–1.124) and negative coping style (β = 0.370, 95 % CI: 0.036–0.704) were independently associated with the depressive severity in these adolescents. Furthermore, the mediation analysis demonstrated that positive coping style partially mediates the effect of childhood trauma on NSSI (Indirect effect = 0.002, 95 % bootCI: 0.001–0.004), while the negative coping style partially mediates the relationship between childhood trauma and depressive severity (Indirect effect = 0.024, 95 % bootCI: 0.005–0.051) in adolescents with MDD. A cross-sectional design, the retrospective self-reported data, the small sample size. Our findings suggest that coping styles may serve as mediators on the path from childhood trauma to NSSI or depressive severity in MDD adolescents. • Adolescent depressive patients with nonsuicidal self-injury (NSSI) had higher level of childhood maltreatment compared to patients without. • Childhood maltreatment is positively correlated to the NSSI and depressive severity in adolescents with major depressive disorder. • The coping style can mediate the effect of childhood trauma on NSSI and depressive severity in depressive adolescents. [ABSTRACT FROM AUTHOR]

Background: Despite the wide‐ranging negative consequences of nonsuicidal self‐injury (NSSI), there are few evidence‐based treatments for NSSI among adolescents and little is known about what treatments that work best for whom. The objective of this study was to investigate moderators (i.e., for whom a specific treatment works) and predictors (i.e., factors associated with treatment outcome independent of treatment type) of treatment outcome in a randomized clinical trial comparing internet‐delivered emotion regulation individual therapy for adolescents (IERITA) plus treatment as usual (TAU) to TAU alone. Methods: Adolescents (N = 166; mean [SD] age = 15.0 [1.2] years) with NSSI disorder were randomized to IERITA plus TAU (n = 84) or TAU‐only (n = 82). Adolescent emotion regulation difficulties, suicidality, NSSI frequency, depressive symptoms, sleep difficulties, global functioning, and age, and parental invalidation, were measured pre‐treatment and investigated as moderators and predictors of treatment outcome (i.e., NSSI frequency during treatment and for 4 weeks post‐treatment). A zero‐inflated negative binomial generalized linear mixed effects regression model was used to estimate the rate of NSSI change as a function of both treatment condition and moderator/predictor. Results: No significant moderators of treatment outcome were found. Parental invalidation was a significant predictor of treatment outcome regardless of treatment condition, such that high levels of parental invalidation pre‐treatment were associated with a less favorable NSSI frequency. Conclusions: We did not find evidence of a differential treatment effect as a function of any of the examined client factors. Future research should investigate moderation in larger samples and with sufficient statistical power to detect moderation effects of smaller magnitude. Results suggest that parental invalidation may have a negative impact on treatment response and highlight the importance of further investigating parental invalidation in the context of NSSI treatments. [ABSTRACT FROM AUTHOR]

Military sexual assault (MSA) is a prevalent issue among military personnel that has been linked to adverse mental and physical health outcomes, including posttraumatic stress disorder (PTSD) and suicidal thoughts and behaviors. The present study sought to investigate the relationship between MSA and nonsuicidal self-injury (NSSI) in a national sample of Gulf War-I Era U.S. veterans. The study analyzed data from 1,153 Gulf War-I veterans collected through a cross-sectional survey that assessed demographic information, clinical outcomes, military background, and history of MSA and NSSI. MSA was found to be significantly associated with NSSI at the bivariate level (OR = 2.19, p <.001). Further, MSA remained significantly associated with NSSI (AOR = 2.50, p =.002) after controlling for relevant demographics and clinical outcomes. Veterans with a history of MSA were approximately two and half times more likely to engage in NSSI than veterans who had not experienced MSA. The present findings provide preliminary evidence linking MSA and NSSI. Further, the findings highlight the importance of assessing MSA and NSSI in veteran populations, particularly among those seeking treatment for PTSD. [ABSTRACT FROM AUTHOR]

To evaluate rates of remission, recovery, relapse, and recurrence in suicidal youth who participated in a clinical trial comparing Dialectical Behavior Therapy (DBT) and Individual and Group Supportive Therapy (IGST). Participants were 173 youth, aged 12 to 18 years, with repetitive self-harm (including at least 1 prior suicide attempt [SA]) and elevated suicidal ideation (SI). Participants received 6 months of DBT or IGST and were followed for 6 months post-treatment. The sample was 95% female, 56.4% White, and 27.49% Latina. Remission was defined as absence of SA or nonsuicidal self-injury (NSSI) across one 3-month interval; recovery was defined across 2 or more consecutive intervals. Relapse and recurrence were defined as SA or NSSI following remission or recovery. Cross-tabulation with χ2 was used for between-group contrasts. Over 70% of the sample reported remission of SA at each treatment and follow-up interval. There were significantly higher rates of remission and recovery and lower rates of relapse and recurrence for SA in DBT than for IGST. Across treatments and time points, SA had higher remission and recovery rates and lower relapse and recurrence rates than NSSI. There were no significant differences in NSSI remission between conditions; however, participants receiving DBT had significantly higher NSSI recovery rates than those receiving IGST for the 3- to 9-month, 3- to 12-month, and 6- to 12-month intervals. Results showed higher percentages of SA remission and recovery for DBT as compared to IGST. NSSI was less likely to remit than SA. This study examined rates of remission, recovery, relapse, and recurrence of suicide attempts (SA) and nonsuicidal self-injury (NSSI) among the participants in the CARES Study, a randomized clinical trial of 6 months of Dialectical Behavior Therapy or Individual and Group Supportive Therapy. 173 youth aged 12 to 18 years participated in the study and were followed for 6 months post treatment. Over 70% of the sample reported remission of SA at each treatment and follow-up interval. There were significantly higher rates of remission and recovery and lower rates of relapse and recurrence for SA among participants who received Dialectical Behavioral Therapy. Across both treatments, remission and recovery rates were lower and relapse and recurrence rates were higher for NSSI than for SA. These results underscore the value of Dialectical Behavioral Therapy as a first line treatment for youth at high risk for suicide. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. Collaborative Adolescent Research on Emotions and Suicide (CARES); https://www.clinicaltrials.gov/ ; NCT01528020. [ABSTRACT FROM AUTHOR]

Background: The relevance of emotion regulation (ER) difficulties to nonsuicidal self‐injury (NSSI; the deliberate destruction of one's bodily tissue without suicidal intent) has been repeatedly documented. Recently, specific mindfulness facets (i.e., awareness, nonjudging, describing) have been proposed as mechanisms that explain this relationship. The present study sought to extend this line of inquiry by exploring the mediating role of mindfulness facets in the relation between self‐determination theory‐based ER styles (i.e., integrative ER, suppressive ER, emotion dysregulation) and indices of positive and negative well‐being (i.e., subjective vitality, NSSI difficulties), while controlling for gender, in adults with recent NSSI engagement. Methods: US adults with a history of more than one occurrence of NSSI within the last year (n = 222) completed online measures of ER styles, mindfulness facets, subjective vitality, and NSSI difficulties. Results: A mediation model indicated that the effects of ER styles on positive and negative well‐being were explained by specific mindfulness facets (i.e., awareness, nonjudging, nonreactivity, describing). Conclusions: The present study provides preliminary evidence that facets of dispositional mindfulness may be mechanisms through which ER styles impact positive and negative indices of well‐being in adults with lived experience of NSSI. [ABSTRACT FROM AUTHOR]

Shaoli Shi,1 Guangyao Li,2 Xiaoli Zhu,2 Lingming Kong2 1Psychiatry Department, The 5th People’s Hospital of Luoyang, Luoyang, Henan Province, 471027, People’s Republic of China; 2Treatment & Prevention Center, No. 904th Hospital, Changzhou, Jiangsu Province, 213003, People’s Republic of ChinaCorrespondence: Lingming Kong, Treatment & Prevention Center, No. 904th Hospital, North Peace Road 55, No. 904th Hospital, Changzhou, Jiangsu, 213003, People’s Republic of China, Email lingmk123@163.comBackground: Adolescent group may be prone to a variety of behavioral disorders, one of which is nonsuicidal self-injury (NSSI), NSSI intervention is limited for its unknown mechanism, so this study aimed to explore the factors associated with and pathological mechanism underlying NSSI from the perspective of family dysfunction, alexithymia, circRNA_103636 in a sample of Chinese adolescents.Methods: A total of 200 MDD adolescents with NSSI and 200 healthy controls were enrolled via a convenient sampling method in clinical settings. The Family APGAR Index (APGAR), Toronto Alexithymia Scale (TAS-20), and Adolescent Nonsuicidal Self-injury Assessment Questionnaire (ANSSIAQ) were used for mental assessment of the study group and control group participants. Real-time quantitative reverse transcription PCR (qRT–PCR) was utilized to detect circRNA_103636 expression in peripheral blood mononuclear cells (PBMCs).Results: There were significant between-group differences of 134 patients (67%) in the study group and 42 patients in the control group (21%) with moderate or severe family dysfunction (P< 0.01). The APGAR score was lower, and the difficulty identifying feeling (DIF), difficulty describing feeling (DDF) and externally oriented thinking (EOT) scores of the TAS-20 and ΔCt value of circRNA_103636 were greater in the study group than in the control group. NSSI behavior and NSSI function were negatively correlated with the APGAR score and positively correlated with DIF, DDF, and the EOT of TAS-20 and the ΔCt value of circRNA_103636. Multiple regression analysis confirmed that EOT, circRNA_103636 expression, and APGAR were predictors of ANSSIAQ, which could explain 40.5% of the variance. Similarly, the alexithymia and circRNA_103636 expression mediated the correlation between family dysfunction and NSSI in the study group, and these mediating effects accounted for 27.25% and 23.33%, respectively, of the total effect. Taken together, family dysfunction, alexithymia, and circRNA_103636 expression have predictive effects on NSSI and alexithymia, circRNA_103636 expressions are mediators between family dysfunction and NSSI in Chinese adolescent.Conclusion: Here, we established a new model for NSSI in which exposure to family dysfunction could induce pathological process by modulating personality traits and epigenetic regulators.Keywords: nonsuicidal self-injury, family dysfunction, alexithymia, circRNA_103636, epigenetics

Abstract Background Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents and young adults worldwide. It is linked to a broad variety of mental disorders and an increased suicide risk. Despite its high prevalence, research on the underlying mechanisms and on potential risk and resilience factors for maintaining or quitting NSSI remains scarce. This manuscript presents an overview of the “Self-injury: Treatment-Assessment-Recovery” (STAR) collaboration, which aimed to address these gaps. Methods We investigated the natural course of NSSI as well as its social, psychological, and neurobiological predictors (observational study; OS). OS data collection occurred at four timepoints (baseline [T0], 4 [post, T1], 12 [follow-up (FU), T2], and 18 [FU, T3] months after baseline) for the NSSI group, which was compared to a healthy control (HC) group at T0 only. Online self-report was used at all timepoints, while semi-structured interviews (face-to-face (f2f)) were conducted at T0 and T3. At T0 only, we conducted ecological momentary assessment and neurobiological investigations. Here, we present the general methodology and sample characteristics of the completed OS including the f2f subprojects, while other subprojects are not within the scope of this paper. Sample description The OS sample consists of 343 participants at T0 (180 NSSI, 163 HC). Mean age in the NSSI group (T0) was 18.1 years (SD = 2.09, range: 15–25), gender-related data is available for 166: 156 = female, 7 = male, 3 = transgender, 10 = not disclosed). In the HC group, mean age (T0) was 19.1 years (SD = 2.35, range: 15–25) (142 = female, 21 = male). At T1, 128 (71.11%) of the NSSI participants completed the questionnaires, at T2 125 (69.44%) and at T3 104 (57.78%). In the fMRI subproject, 126 adolescents participated (NSSI = 66, HC = 60, 100% female; mean age (T0): NSSI = 18.10 years, SD = 2.21; HC = 19.08, SD = 2.36). Conclusion Understanding predictors is of utmost importance for adequate diagnosis and intervention for NSSI. Our OS applied a multimodal investigation of social, psychological, and neurobiological parameters and is the largest sample of adolescents with NSSI to date including follow-up assessments. As health care providers require specific knowledge to develop new treatments, we believe that our in-depth assessments can potentially enhance care for youths engaging in NSSI.

Abstract Nonsuicidal self-injury (NSSI) is one of the major public health problems endangering adolescents. However, the neural mechanisms of NSSI is still unclear. The purpose of this study was to explore regional brain activity and corresponding brain circuits in drug-naïve adolescents with NSSI using amplitude of low-frequency fluctuations (ALFF) combined with functional connectivity (FC) analysis. Thirty-two drug-naïve adolescents with NSSI (NSSI group) and 29 healthy controls matched for sex, age, and level of education (HC group) were enrolled in this study. ALFF and seed-based FC analyses were used to examine the alterations in regional brain activity and corresponding brain circuits. The correlation between ALFF or FC values of aberrant brain regions and clinical characteristics were detected by Pearson correlation analysis. The NSSI group showed increased ALFF in the left inferior and middle occipital gyri, lingual gyrus, and fusiform gyrus; additionally, decreased ALFF in the right medial cingulate gyrus, left anterior cingulate gyrus, and left medial superior frontal gyrus compared to those in the HC group. With the left inferior occipital gyrus as seed, the NSSI group showed increased FC between the left inferior occipital gyrus and the bilateral superior parietal gyrus, right inferior parietal angular gyrus, right inferior frontal gyrus of the insular region, and left precuneus relative to that the HC group. With the left anterior cingulate gyrus as seed, the NSSI group showed increased FC between the left anterior cingulate gyrus and right dorsolateral superior frontal gyrus. With the left lingual gyrus as seed, the NSSI group showed increased FC between the left lingual gyrus and right middle frontal gyrus, and decreased FC between the left lingual gyrus and the left superior temporal gyrus, right supplementary motor area, and left rolandic operculum. With the left fusiform gyrus as seed, the NSSI group showed increased FC between the left fusiform gyrus and left middle and inferior temporal gyrus, and decreased FC between the left fusiform gyrus and the bilateral postcentral gyrus, right precentral gyrus, right lingual gyrus, and left inferior parietal angular gyrus. Moreover, the FC value between the left fusiform gyrus and left inferior temporal gyrus was positively correlated with suicidal ideations score. This study highlights alterations in regional brain activity and corresponding brain circuits in brain regions related to visual and emotional regulation functions in drug-naïve adolescents with NSSI. These findings may facilitate better understand the underlying neural mechanisms of NSSI in adolescents.

Nonsuicidal self-injury (NSSI) is prevalent among emerging adults in post-secondary school, but little is known about change and stability in NSSI during the transition to university. Moreover, there has been limited person-centered work focusing on heterogeneity in NSSI engagement among students over time. The present study aimed to investigate the development and maintenance of NSSI across the first year of university and explore predictors of potential variability in trajectories of NSSI. The present sample consisted of 1125 first-year university students at a large post-secondary institution (Mage = 17.96, 71 % female, 28 % male, 1 % gender diverse) who participated in a larger longitudinal study. Participants completed an online survey three times over their first year of university. Latent growth curve modeling (LGCM) in Mplus was utilized to explore different NSSI group trajectories across first year university. NSSI was prevalent among first year students (35 %). LGCM revealed one developmental trajectory; NSSI engagement decreased across the first year of university. Students who engaged in NSSI had increased difficulties with emotion regulation, lower self-compassion, and lower levels of social support compared to students who did not engage in NSSI. The present study may be subject to recall errors and future studies should include more gender diverse samples to increase generalization of findings. Findings highlight the transition to university as a peak period of vulnerability for NSSI engagement and emphasize the need for proactive university intervention efforts to mitigate risk and improve student well-being. • Trajectories of nonsuicidal self-injury (NSSI) were examined among young adults. • Although NSSI was prevalent, only one trajectory of NSSI over time was identified. • NSSI engagement decreased among young adults across the first year of university. • Emotion regulation, self-compassion, and social support were relevant risk factors. • Implications for student mental health research and practice are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background Nonsuicidal self-injury (NSSI) is a serious problem in the adolescent population worldwide. Childhood trauma and bullying have been identified as risk factors for NSSI. We explored the relationships among Childhood trauma, Bullying victimization and the severity of NSSI behaviours, and test the effect of Bullying victimization in mediating the association between Childhood trauma and the NSSI behaviours. Methods A total of 123 adolescents were recruited. They were diagnosed with depression or depressive episodes of bipolar disorder and had experienced NSSI in the last year. They were assessed using the Chinese version of the Childhood Trauma Questionnaire (CTQ-C), the Revised Olweus Bullying Victimization Questionnaire (OBVQ-R), and the Adolescent Self-Harm Questionnaire (ASHQ). Results Females presented a significantly greater prevalence of sexual abuse and relationship bullying than boys. Individuals in the younger age group (10–14 years) presented a greater incidence of emotional neglect, verbal bullying, relationship bullying, and total bullying, and their NSSI score was also higher than that of those in the older age group (15–19 years). Only children show a greater prevalence of sexual abuse than nononly children. Single-parent families scored higher on emotional abuse, emotional neglect, physical neglect and physical bullying than two-parent families. There was a significant positive correlation between each dimension of childhood trauma and all the dimensions of bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. The mediating effects of bullying victimization on emotional abuse, physical abuse, emotional neglect and physical neglect were 14%, 21%, 20%, 13% and 20%, respectively. Conclusion There was a significant positive correlation between childhood trauma and bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. Bullying victimization played the partial mediating effects between Childhood trauma and NSSI.

Background: Intentional self-harm presents a significant challenge within the mental health system, yet misconceptions persist regarding its nature, particularly the view that nonsuicidal self-injury (NSSI) serves as a mere call for attention and represents impulsive behavior. This study aimed to explore the process and experiences of self-harm among young adults in India to address this stigmatization. Methods: Semi-structured interviews were conducted with eight participants aged 21–24 years, encompassing diverse psychiatric diagnoses and a history of NSSI. These interviews aimed to delve into the nuanced experiences and perspectives surrounding self-harm in this demographic. Results: Thematic analysis of the interviews unveiled six overarching themes: distal risk factors, proximal risk factors, methods and conditions to self-harm, during the act, after the act, and considerations to be taken while planning intervention. These themes shed light on various factors influencing self-harm behaviors and the context in which they occur. Conclusion: The findings underscore the necessity of incorporating individuals’ unique processes of self-harm into intervention planning to effectively support those at risk of self-harm. By understanding the complex interplay of factors involved, mental health professionals can develop targeted and comprehensive interventions to address NSSI effectively.

Background: There is a consensus that both nonsuicidal self-injury (NSSI) and suicidal ideation as risk factors for suicidal behavior have a strong connection. However, a lack of longitudinal information has limited the clarification of the concrete relationship between them. Aims: This study aimed to examine the specific mechanism between NSSI and suicidal ideation over time, during adolescence. Method: A longitudinal study was conducted with 193 Chinese adolescents. NSSI and suicidal ideations were examined over the course of a 1year followed-up, and three waves of data were collected. Results: The NSSI at time T1 significantly positively predicted suicidal ideation at time T2; Suicidal ideation at time T2 also significantly positively predicted NSSI at time T3. Limitations: Given that the small number of participants with suicidal ideation and NSSI, the findings of the study should be interpreted with caution and a lager sample is needed in the future. Conclusion: It was suggested that NSSI may occur before suicidal ideation, which in turn would strengthen NSSI, so interventions should be carried out from two aspects (behaviors and thoughts) to improve adolescents' mental health. [ABSTRACT FROM AUTHOR]

While prior research has studied associations between child abuse and nonsuicidal self-injury (NSSI), there is limited research assessing unwanted pursuit behavior (UPB) victimization and NSSI. In addition, few studies have assessed the self-reported functions of NSSI among survivors of violence. Among a sample of 18–25-year-old young adults (N = 333), both UPB victimization and child abuse were significantly associated with NSSI frequency. In regression models, UPB victimization was associated with increased use of affect regulation, antidissociation/feeling-generation, self-punishment, and antisuicide functions, while child abuse was associated only with antidissociation/feeling-generation and self-punishment. Affect regulation mediated the association between UPB victimization and NSSI frequency, but not the association between child victimization and NSSI frequency. Implications for research and clinical practice will be discussed. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsConclusionsHistorically, 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.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?”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.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]

Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18–25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, Mage = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12–14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable. [ABSTRACT FROM AUTHOR]

Childhood maltreatment has been associated as a risk factor with the development of nonsuicidal self-injury (NSSI), with difficulty in emotion regulation explaining the association. However, little is known about the potential factors that make some individuals with maltreatment history more vulnerable to difficulties in emotion regulation and, in turn, engage in NSSI. The current study aimed to examine the roles of distress tolerance, self-compassion, and self-disgust in the association between childhood maltreatment types and emotion regulation difficulty, which was expected to predict NSSI. The sample included 397 university students between the ages of 18 and 30. Participants completed self-report scales assessing childhood maltreatment, emotion regulation difficulty, distress tolerance, self-compassion, self-disgust, and NSSI using the paper-pencil and online methods. The mediation model suggested for the association between childhood maltreatment types and NSSI was tested using path analysis. Low distress tolerance, low self-compassion, high self-disgust, and resulting high emotion regulation difficulty mediated the indirect effect of emotional neglect on NSSI. The current study sheds light on various factors in the development and maintenance of NSSI and reveals three developmental pathways from emotional neglect in childhood to engaging in NSSI. Emotional neglect may be a distal risk factor for nonsuicidal self-injury (NSSI). Low distress tolerance and self-compassion and high self-disgust may increase the risk of NSSI. Emotion regulation difficulty may make people engage in NSSI to regulate emotions. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) in adolescents has been associated with increased depressive symptomatology, hopelessness, and emotional dysregulation; however, few studies have examined longitudinal associations between NSSI and these problems. This study examines the longitudinal relationships among these variables in community adolescents and whether the pattern of relationships varies between boys and girls. The participants were 785 adolescents (57.1% girls) aged 13 to 18 years (M = 15.64; SD = 1.08) who completed self-reported measures of NSSI, depression, hopelessness, and emotional dysregulation at least once at two moments separated by 1 year. The longitudinal model was tested through structural equation modeling and multiple group analysis. NSSI predicted increased depressive symptoms, hopelessness, and emotional dysregulation; depressive symptoms predicted NSSI; hopelessness predicted depressive symptoms; and emotional dysregulation predicted depressive symptoms and hopelessness. The pattern was similar for girls and boys, although girls scored higher on all variables. The results underscore the important bidirectional associations between NSSI and other risk factors throughout adolescence. These findings will support prevention and interventions for NSSI and internalizing symptoms in adolescents in school and clinical settings. Sometime in the last year, 38.4% of the participating adolescents reported nonsuicidal self-injury (NSSI). The girls scored significantly higher than the boys in NSSI annual presence, depression, hopelessness, and emotional dysregulation. NSSI in the past year increased depressive symptoms, hopelessness, and emotional dysregulation 1 year later; depressive symptoms predicted NSSI; hopelessness predicted depressive symptoms, and emotional dysregulation predicted an increase in depressive symptoms and hopelessness. The predictive model did not differ according to gender. [ABSTRACT FROM AUTHOR]

Background: Intentional self-harm presents a significant challenge within the mental health system, yet misconceptions persist regarding its nature, particularly the view that nonsuicidal self-injury (NSSI) serves as a mere call for attention and represents impulsive behavior. This study aimed to explore the process and experiences of self-harm among young adults in India to address this stigmatization. Methods: Semi-structured interviews were conducted with eight participants aged 21-24 years, encompassing diverse psychiatric diagnoses and a history of NSSI. These interviews aimed to delve into the nuanced experiences and perspectives surrounding self-harm in this demographic. Results: Thematic analysis of the interviews unveiled six overarching themes: distal risk factors, proximal risk factors, methods and conditions to self-harm, during the act, after the act, and considerations to be taken while planning intervention. These themes shed light on various factors influencing self-harm behaviors and the context in which they occur. Conclusion: The findings underscore the necessity of incorporating individuals' unique processes of self-harm into intervention planning to effectively support those at risk of self-harm. By understanding the complex interplay of factors involved, mental health professionals can develop targeted and comprehensive interventions to address NSSI effectively. [ABSTRACT FROM AUTHOR]

Many feel uncomfortable discussing self-directed violence with individuals in their social circle, often leading to concerned posts on social media. Previous studies address self-harm, suicide, and nonsuicidal self-injury; however, minimal literature combines suicide and nonsuicidal self-injury to explore common themes representing self-directed violence. This study identified themes from suicide and self-harm subreddit communities, with themes common to each subreddit comprising themes of self-directed violence. Using 1,989 Reddit posts from suicide and self-harm communities, we employed an inductive thematic analysis to explore how users discussed self-directed violence within anonymous online communities. Ultimately, the impact of using Reddit for discussion of self-directed violence depends on the individual. We generated six themes, with two from self-harm data (i.e., graphic descriptions of self-harm behavior and continued self-harm to manage emotions), two from suicide data (i.e., support-seeking to replace social connections and triggering moments initiating suicide-related thoughts, plans, and behavior), and two themes embodying self-directed violence (i.e., prevention through creative expression and safety for discussion mainly exists online). Despite attempts to provide help-seeking resources, the use of Reddit for connection and inquiry about coping skills for self-directed violence cessation could increase users' risk for detrimental mental health impacts from the inclusion of detailed descriptions of self-harm, suicide plans, past attempts, suicide or nonsuicidal self-injury means, and suicide notes left for loved ones. Given the delicate balance of seeking support and increasing exposure to graphic content, it is crucial to discuss the nuances of Reddit exchanges with Reddit users, practitioners, moderators, and developers. [ABSTRACT FROM AUTHOR]

Bullying victimization is related to increased aggressive behaviour, but little research considers both self‐ (e.g., nonsuicidal self‐injury; NSSI) and other‐directed (e.g., cyberaggression) outcomes. Moreover, little is known about the mediating mechanisms that underlie this relationship. Based on the General Aggression Model, the current study investigates the mediating roles of Perceived ostracism (PO) and depression in the relationship between bullying victimization and cyberaggression/NSSI among emerging adult. A total of 795 emerging adults (Mage = 19.66 years, SD = 1.46; 59.9% female) completed a multimeasure questionnaire measuring the targeted variables at three time points over one year. Structural equation modelling was used to test temporal mediation. After controlling for gender, age, and family monthly income, bullying victimization was found to positively predict later cyberaggression and NSSI. Mediation analysis revealed that the longitudinal association between bullying victimization and cyberaggression was mediated by PO; the longitudinal association between bullying victimization and NSSI was mediated by depression and was sequentially mediated by PO and depression. These findings extend the theory, prevention and interventions to include both self‐ and other‐directed aggressive behaviour in the bullying context. Future research and practice may benefit from an emphasis on PO and depression‐focused psychological interventions. [ABSTRACT FROM AUTHOR]

Identifying transdiagnostic mechanisms that relate to nonsuicidal self-injury (NSSI), the intentional destruction of one's own body tissue without suicidal intent and for purposes not culturally or socially sanctioned, is critical for the development and further refinement of NSSI-focused interventions. Accordingly, the present study aimed to characterize potential roles for anhedonia, repetitive negative thinking, and trait mindfulness as they relate to history of NSSI, NSSI urge-to-action, and NSSI functions. We hypothesized that these variables would relate to NSSI, NSSI urge-to-action, and explored correlations with functions of NSSI: interpersonal (i.e., reinforcement is social) and intrapersonal (e.g., reinforcement is self-focused) functions. Results indicated that greater anhedonia was related to history of NSSI. Among participants who reported history of NSSI, lower levels of trait mindfulness were associated with less time spent between NSSI urge and NSSI action. Finally, amongst participants who reported history of NSSI, interpersonal functions of NSSI were positively correlated with greater anhedonia, while intrapersonal NSSI function was positively correlated with higher levels of repetitive negative thinking, suggesting potential differential mechanisms that may contribute to the maintenance of NSSI. This work highlights transdiagnostic mechanisms that relate to history of NSSI, NSSI urge-to-action latency, and potential differential correlates of NSSI functions. [ABSTRACT FROM AUTHOR]

Abstract Background Despite the wide‐ranging negative consequences of nonsuicidal self‐injury (NSSI), there are few evidence‐based treatments for NSSI among adolescents and little is known about what treatments that work best for whom. The objective of this study was to investigate moderators (i.e., for whom a specific treatment works) and predictors (i.e., factors associated with treatment outcome independent of treatment type) of treatment outcome in a randomized clinical trial comparing internet‐delivered emotion regulation individual therapy for adolescents (IERITA) plus treatment as usual (TAU) to TAU alone. Methods Adolescents (N = 166; mean [SD] age = 15.0 [1.2] years) with NSSI disorder were randomized to IERITA plus TAU (n = 84) or TAU‐only (n = 82). Adolescent emotion regulation difficulties, suicidality, NSSI frequency, depressive symptoms, sleep difficulties, global functioning, and age, and parental invalidation, were measured pre‐treatment and investigated as moderators and predictors of treatment outcome (i.e., NSSI frequency during treatment and for 4 weeks post‐treatment). A zero‐inflated negative binomial generalized linear mixed effects regression model was used to estimate the rate of NSSI change as a function of both treatment condition and moderator/predictor. Results No significant moderators of treatment outcome were found. Parental invalidation was a significant predictor of treatment outcome regardless of treatment condition, such that high levels of parental invalidation pre‐treatment were associated with a less favorable NSSI frequency. Conclusions We did not find evidence of a differential treatment effect as a function of any of the examined client factors. Future research should investigate moderation in larger samples and with sufficient statistical power to detect moderation effects of smaller magnitude. Results suggest that parental invalidation may have a negative impact on treatment response and highlight the importance of further investigating parental invalidation in the context of NSSI treatments.

Abstract Background Borderline personality traits play a significant role in nonsuicidal self-injury (NSSI), particularly in depressed youths. NSSI is also highly correlated with negative life events. This research aimed to explore the connections between negative life events, borderline personality traits, and NSSI. Methods The study included 338 depressed youth aged 13 to 25 years. Self-reported measures and clinical interviews were utilized to evaluate the depressive symptoms, borderline personality traits, negative life events, and NSSI behaviours of these participants. Identifying variables linked to NSSI was the aim of our analysis, and we also conducted a mediation analysis to look into the influence of borderline traits on the connection between negative life events and NSSI. Results Of the 338 depressed youth, approximately 59.47% (201/338) displayed NSSI, which was associated with greater clinical severity. Borderline traits had an independent influence on NSSI and it partially explained the connection between negative life events and NSSI, even when accounting for depression symptoms. Depressed youth who were more vulnerable to NSSI behaviours often experienced negative life events such as interpersonal relationships, academic pressure, being punished, and loss. Conclusions Our research suggests that depressed youth who experience more negative life events are more likely to experience NSSI, and negative life events indirectly influence nonsuicidal self-injury through borderline personality traits. Implementing interventions focused on mitigating borderline symptoms could be a promising therapeutic approach for addressing NSSI in young people.

Previous research suggests that nonsuicidal self‐injury (NSSI; the intentional destruction of bodily tissue without suicidal intent) occurs among elementary‐aged children. However, it remains unclear to what extent elementary school educators encounter NSSI among students and how they respond. Therefore, this study investigated cross‐national differences in Canadian and Belgian elementary school educators' knowledge of, and experience with NSSI among students. More specifically, elementary school educators' perceived reasons and supportive needs of students who engage in NSSI, as well as their own professional development needs, were explored. In total, 181 elementary school educators across Canada (n = 63) and Belgium (n = 118) were recruited through teacher association listservs and by school administrators who distributed the study information to school staff. Chi‐square tests revealed that Canadian elementary school educators had more often encountered NSSI among their students than Belgian educators, although Canadian and Belgian school educators' similarly reported feeling ill‐equipped to deal with NSSI among students. Thematic analyses revealed that educators believe elementary‐aged students engage in NSSI because of various intrapersonal (e.g., low self‐esteem) and interpersonal stressors (e.g., bullying). Moreover, the majority of educators would like professional development to more effectively respond to students. Implications for schools and future research are discussed. Practitioner points: The majority of Belgian and Canadian elementary school educators similarly report observing, and interacting with elementary school students who engage in nonsuicidal self‐injury (NSSI).Cross‐nationally, elementary school educators report lacking skills and training to effectively respond to, and support students engaging in NSSI.Both Belgian and Canadian elementary school educators report wanting professional development to receive training to be able to more effectively respond to, and support their students engaging in NSSI. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is frequently encountered in adolescents, but its predictive value for suicidality or other clinical characteristics is challenging due to its heterogeneous nature. This study used latent class analysis to identify subgroups of NSSI and compared these on sociodemographic characteristics, adverse outcomes and protective factors. The study included 966 high-risk adolescents, Mage 14.9 y, SD 0.9 y, 51.8% female. Four classes emerged: (1) "Low NSSI–Low suicidality", (2) "Moderate NSSI-Low suicidality", (3) "Moderate NSSI-High suicidality", and (4) "High NSSI-High suicidality". Girls predominated in the high suicidality classes. Generally, Class 4 had the poorest outcomes: more internalizing and externalizing problems, less social support from friends and families and worst self-esteem. These findings emphasize the need for interventions tailored to specific phenotypes of adolescents engaging in NSSI. [ABSTRACT FROM AUTHOR]

• People who self-injure experience more negative affective-cognitive states in daily life. • We found higher and more variable negative affect, rumination, and self-criticism. • We observed a negative affect–self-critical cascade in people who self-injure. • Enhancing positive affect may help buffer dysfunctional cognitions. • Baseline variables partially negated observed differences. Although the literature suggests trait-like differences in affective and cognitive vulnerabilities between individuals with and without a history of nonsuicidal self-injury (NSSI), little is known about how these dispositional differences are experienced in the natural environment. The present study compares the intensity, inertia, interaction, and variability of affective (negative and positive affect) and cognitive states (rumination, self-criticism) in the everyday lives of individuals who do and do not engage in NSSI. Using experience sampling methodology (ESM), 60 emerging adults (ages = 18–22 years) with and without past-year NSSI (equally distributed) completed eight questionnaires per day for 12 days (in total, 96 questionnaires per participant), resulting in 4,587 assessments (median compliance = 83.3%; IQR = 71.9–91.7). In a dynamic structural equation modeling framework, dynamic parameters (i.e., mean intensity, carryover effects, spillover effects, and within-person variability) were evaluated using multilevel vector autoregressive models. Emerging adults who engage in NSSI experience higher intensity and greater variability of negative affect, rumination, and self-criticism, whereas those who do not engage in NSSI experience higher intensity and lower variability of positive affect. In addition, past-year NSSI predicted stronger affective-cognitive interactions over time, with stronger spillover effects of negative and positive affect on subsequent rumination and self-criticism in individuals who engage in NSSI. Depressive symptoms and trait levels of emotion dysregulation and self-criticism partially negated these differences. Our findings provide evidence that emerging adults who self-injure experience more negative affective-cognitive states in daily life and point to the potential relevance of boosting positive emotions to buffer negative cognitions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although nonsuicidal self-injury (NSSI), by definition, excludes suicidal intent, numerous studies show associations between NSSI and suicidal phenomena in clinical and outpatient adolescent samples. Given the growing interest in the relationship between NSSI and suicidal phenomena, the present study aimed to investigate the relationship between NSSI and suicidal beliefs in adolescent psychiatric inpatients. Materials and Methods: The study sample included 50 adolescent inpatients at a specialized facility, with a mean age of 15.44 ± 1.39, who fulfilled DSM-5 criteria for NSSI. For study purposes, we use the Ottawa Self-Injury Inventory (OSI) and Brief Suicide Cognitions Scale (B-SCS). Statistical data processing was performed in the R software 4.3.0 (R Core Team, Vienna, Austria). Results: Of all NSSI functions, the Internal ER function score was the highest (18.72 ± 7.08), followed by External ER (8.10 ± 3.11), Social Influence (5.88 ± 5.37), and Sensation Seeking (3.44 ± 2.98). The mean Craving (C) score was 14.06 ± 7.51. The mean value of the B-SCS score was 19.54 ± 5.24. It was found that the B-SCS score is significantly related to Internal ER (r = 0.441, p < 0.001) and Craving (r = 0.297, p = 0.036). The multivariable model shows that internal ER function and participants' age are significantly related to the B-SCS score. Conclusion: Despite the limitations of the study, it is emphasized that cognitions occurring across the fluid suicidal belief system alone do not fully capture the complexity of suicide, but assessing the suicidal belief system in NSSI inpatient adolescents could nevertheless provide helpful information for identifying individuals who may have an elevated vulnerability to experiencing suicidal ideas and behaviors over time. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self‐injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots.Using the 2013–2019 Minnesota Student Surveys, we assessed associations of student‐reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety.Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures.Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated. [ABSTRACT FROM AUTHOR]

AbstractA growing body of literature indicates that individuals belonging to sexual minority groups are at an increased risk of severe nonsuicidal self-injury (NSSI) behaviors. This study aimed to examine the potential factors mediating sexual minority status and more severe NSSI behaviors. A total of 296 self-identified sexual minorities and 206 heterosexuals who reported engaging in at least five-lifetime NSSI episodes were recruited online. The participants completed an online survey that included demographics, measures of depressive symptoms, and the frequency and functions of NSSI behaviors. Serial mediation analyses indicated that the association between sexual minority status and more frequent NSSI behaviors was mediated by depressive symptoms and intrapersonal functions of NSSI. Further analyses revealed that NSSI functions may vary by minority status, with individuals reporting a sexual minority status showing more frequent endorsements of intrapersonal functions. This study’s findings contribute to the literature by elucidating the complex role of clinical factors that mediate the relationship between sexual minority status and increased risk of engaging in more frequent NSSI behaviors. Our findings underscore the importance of developing a comprehensive perspective on NSSI behaviors, including the characteristics of NSSI functions and current clinical symptoms, as well as disadvantaged backgrounds, such as minority status. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) outcome expectancies (i.e., the expectations that certain outcomes will follow NSSI) have been confirmed to predict NSSI engagement. However, it remains unclear whether adolescents hold different patterns of NSSI outcome expectancies and therefore vary in their risks of NSSI engagement. Moreover, little is known about whether patterns transition over time, influencing the development of NSSI. Additionally, possible gender differences in the patterns and their transitions need to be explored. This study aims to address these research gaps. A total of 679 adolescents (55.8% females; Mage = 15.19, SDage = 1.40) completed questionnaires and were surveyed semiannually for three times. Using latent profile analysis, regular latent transition analysis, and random intercept latent transition analysis, this study identified four patterns of NSSI outcome expectancies: High Affect Regulation and Moderate Negative Expectancies, Low Negative Expectancies, High Negative Expectancies, and High Communication and Negative Expectancies. The first two patterns showed high risks of NSSI, whereas the latter two patterns showed low risks of NSSI. Low Negative Expectancies was an unstable pattern. It had higher probabilities of transitioning to another high-risk pattern than transitioning to the low-risk patterns. The other three patterns had high stability. Gender had no significant effects on the four patterns or their transitions. The findings highlight the combined effects of NSSI outcome expectancies and underscore that NSSI outcome expectancies may change over time. Prevention and interventions targeting multiple factors corresponding to these expectancies should be developed. [ABSTRACT FROM AUTHOR]

There is evidence indicating that childhood maltreatment is linked to the occurrence of non-suicidal self-injury (NSSI). Nevertheless, the association between childhood maltreatment and the automatic-negative reinforcement aspect of NSSI remains understudied. Chapman's (2006) experiential avoidance model posits that the main factor in sustaining NSSI is negative reinforcement, specifically through the avoidance or escape from distressful emotional experiences. The current study examines a conceptual framework based on this theory and the available literature that explores the potential mediation role of alexithymia in the relation between childhood maltreatment and the automatic-negative reinforcement of NSSI. Additionally, this study investigates how this process may be influenced by individuals' attitudes toward seeking professional help. 3657 adolescents (1616 females) completed questionnaires regarding childhood maltreatment, alexithymia, help-seeking attitudes, the NSSI, and its functions. The findings of the study exposed a positive link between childhood maltreatment and the automatic-negative reinforcement of NSSI, with the mediating role of alexithymia. Interestingly, it was unexpected to discover that individuals with high help-seeking attitudes experienced an intensification of the relationship between childhood maltreatment and both alexithymia and the automatic-negative reinforcement of NSSI. The study's cross-sectional design hindered the inference of causality. The present study demonstrated that it is crucial to consider the impact of both alexithymia and help-seeking attitudes in adolescents who have experienced maltreatment. These findings hold implications for preventive interventions that target the reduction of NSSI behaviors driven by automatic-negative reinforcement. • Childhood maltreatment was positively associated with the automatic-negative reinforcement of NSSI. • Alexithymia served as a partial mediator in this relationship between childhood maltreatment and the automatic negative reinforcement of NSSI. • Help-seeking attitudes influenced the mediation effect of alexithymia in the association between childhood maltreatment and the automatic-negative reinforcement of NSSI. [ABSTRACT FROM AUTHOR]

Objective: Sleep problems are a significant risk factor for identifying and preventing suicidal involvement among adolescents. However, there is limited evidence to assess the underlying mechanisms between them. This study investigated the longitudinal relationship between sleep problems and suicidal behavior and examined whether this relationship was moderated by negative emotions, low self‐control, and nonsuicidal self‐injury (NSSI). Methods: From December 2020 onward, we assessed 1214 Chinese secondary school adolescents (60.7% were boys, aged 13–19 years) three times, 6 months apart. Results: In the direct effects model, sleep problems were found to have a positive impact on adolescent suicidal behavior. In the indirect effects model, we observed that sleep problems were associated with an elevated risk of suicidal behavior through several pathways: one‐mediator path of negative emotions, low self‐control, and NSSI, respectively; two‐mediator path of negative emotions via low self‐control, negative emotions via NSSI, and low self‐control via NSSI, and three‐mediator path from negative emotions to NSSI via low self‐control. Conclusions: This longitudinal study provides evidence that sleep problems in adolescents may increase suicidal behavior by exacerbating negative emotions, weakening self‐control, and promoting NSSI. The findings suggest sleep problems should be addressed in suicide prevention and intervention efforts for adolescents. [ABSTRACT FROM AUTHOR]

Background: This study aims to conduct the first‐ever evaluation of our previously proposed behaviors of "hemomania" in individuals engaged with nonsuicidal self‐injury (NSSI). Methods: The study encompassed 130 outpatients engaged with NSSI who applied at the psychiatry outpatient clinic. NSSI behaviors were assessed using the Inventory of Statements About Self‐Injury, while psychiatric diagnoses were evaluated using the Structured Clinical Interview for DSM‐5 Disorders‐Clinician Version. Subsequently, participants completed the Depression Anxiety Stress Scale‐21 and Short Form of Barratt Impulsiveness Scale. Results: The prevalence of at least one hemomania behavior including seeing blood, tasting blood, bloodletting, and blood‐drinking was observed to be 43.1% in individuals with NSSI. When participants were divided into two groups, individuals with hemomania exhibited: (1) a higher incidence of psychiatric comorbidities, increased suicide attempts, and more severe symptoms of depression, anxiety, stress, and impulsivity, (2) higher comorbidity rates of borderline personality disorder, body‐focused repetitive behaviors, and dissociative disorders, and (3) elevated frequencies of certain NSSI behaviors, including cutting, biting, needle‐ticking, and carving, compared to those without. Conclusion: Hemomania could be considered a specific impulse control disorder, characterized by heightened impulsivity and a persistent urge to obtain one's own blood. However, further studies are needed to validate this hypothesis. [ABSTRACT FROM AUTHOR]

Background: Nonsuicidal self-injury (NSSI) among adolescents is a growing global concern. However, effective interventions for treating NSSI are limited. Method: A 36-week quasi-experimental study design of parent--child group resilience training (intervention group) for adolescents aged 12-17 years was used and compared with treatment-as-usual (control group). The primary endpoint was the frequency of NSSI assessed with the Ottawa Self-Injury Inventory (OSI), and the secondary endpoints were the levels of depression, hope, resilience, and family adaptability and cohesion as assessed by the 24-item Hamilton depression rating scale (HAMD-24), Herth Hope Scale (HHS), Connor- Davidson Resilience Scale (CD-RISC), and Family Adaptability and Cohesion Evaluation Scale, second edition (FACES-II-CV), respectively. Result: A total of 118 participants completed the trial. Both groups showed a significant reduction in NSSI frequency after 12, 24, and 36 weeks of intervention (p< 0.05), although the intervention group did not differ significantly from the control group. After 12, 24, and 36 weeks of intervention, the CD-RISC, HHS, HAMD-24, and FACES-II-CV scores in the intervention and control groups improved over baseline (p< 0.05). Furthermore, the intervention group had higher scores on the CD-RISC, HHS, and FACES-II-CV and lower scores on the HAMD-24 than the control group after 12, 24, and 36 weeks of intervention (p < 0.05). Conclusion: Parent--child group emotional regulation and resilience training showed promise as treatment options for NSSI among adolescents, leading to increased hope, resilience, and improved family dynamics among NSSI teens. Moreover, NSSI frequency significantly decreased in the intervention group compared to baseline. [ABSTRACT FROM AUTHOR]

The stigmatized nature of nonsuicidal self-injury may render TikTok, a short-form, video-sharing social media platform, appealing to individuals who engage in this behavior. Since this community faces biased scrutiny based on stigmatization surrounding mental health, nonsuicidal self-injury users may turn to TikTok, which offers a space for users to engage in discussions of nonsuicidal self-injury, exchange social support, experience validation with little fear of stigmatization, and facilitate harm reduction strategies. While TikTok's Community Guidelines permit users to share personal experiences with mental health topics, TikTok explicitly bans content that shows, promotes, or shares plans for self-harm. As such, TikTok may moderate user-generated content, leading to exclusion and marginalization in this digital space. Through semi-structured interviews with 8 TikTok users and a content analysis of 150 TikTok videos, we explore how users with a history of nonsuicidal self-injury experience TikTok's algorithm to engage with content on nonsuicidal self-injury. Findings demonstrate that users understand how to circumnavigate TikTok's algorithm through hashtags, signaling, and algospeak to maintain visibility while also circumnavigating algorithmic detection on the platform. Furthermore, findings emphasize that users actively engage in self-surveillance, self-censorship, and self-policing to create a safe online community of care. Content moderation, however, can ultimately hinder progress toward the destigmatization of nonsuicidal self-injury. [ABSTRACT FROM AUTHOR]

Social media is increasingly popular among adolescents, and it has been integrated into their daily life. Previous research have indicated mix results in the relationship between social media exposure and nonsuicidal self-injury (NSSI) behaviors. Given that most of prior studies were cross-sectional, the present study investigated the reciprocal relation between exposure to NSSI on social media and NSSI behaviors using longitudinal data among Chinese adolescents. We conducted three waves assessment among 1962 secondary school adolescents (52.3% females; Mage = 14.59 years, SDage = 1.27), with a six-month interval between each wave (Wave 1: November 2020; Wave 2: May 2021; Wave 3: November 2021). Social media exposure to NSSI, actual NSSI engagement, and depression were assessed at each wave by self-report questionnaires. Consistent with our hypotheses, social media exposure, NSSI, and depression were significantly and positively related to each other across all waves. Results showed a bidirectional association between social media exposure and NSSI, even after controlling for depression. Greater exposure to NSSI on social media predicted more frequently engagement in NSSI over time, and vice versa. Findings of this study suggest a bidirectional association between social media exposure and NSSI among adolescents. Interventions that encourage media education may decrease the media's influence on the contagion of NSSI. [ABSTRACT FROM AUTHOR]

Rehabilitation counselors have a unique role in addressing suicidal and self-injury thoughts and behaviors in people with disabilities. Adults and adolescents with disabilities are at increased risk of suicide and nonsuicidal self-injury (NSSI), necessitating that rehabilitation counselors possess the knowledge and skills to respond systematically and effectively. To address this need, rehabilitation counselors should have access to sufficient education and ongoing training on self-injury terminology, prominent theories, ethical and legal issues related to research and practice, risk/protective factors, and risk assessment processes and instruments. The objective of this article is to provide rehabilitation counseling professionals with an overview of research on suicidality and NSSI, including a review of existing literature related to specific disability groups. Key issues and recommended considerations for rehabilitation counselors are highlighted, including training, risk assessment, evidence-based practice, ethical considerations, self-awareness, and supervision and support. [ABSTRACT FROM AUTHOR]