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Introduction: Patients living with dementia as well as patients with neurological deficits are at significant risk for injury from multiple sources. Injuries may include falls, neglect, and, in some cases, self-injury. These patients require significant observation and closely monitored care. Case Report: A 90-year-old man presented to a suburban emergency department (ED) by his family, who cared for him at home. The following case report describes a patient with dementia, hemineglect, and bruxism from a previous stroke who suffered a self-induced, partial amputation of his own thumb on the neglected side of his body.   Conclusion: Patients with dementia and neurologic deficits present frequently in the ED. These patients are at considerable risk of self-injury. The emergency physician should maintain vigilance in both screening for injuries and being aware of these risks when planning living arrangements after disposition from the ED.

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

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

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

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

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

This paper discusses the scientific rationale and methodological considerations for incorporating the menstrual cycle as a time-varying intra-individual factor in personalized medicine models, such as Just-In-Time Adaptive Interventions (JITAIs). Among patients, accumulating evidence suggests that the normal hormone fluctuations of the menstrual cycle represent a time-varying factor that can trigger or exacerbate psychiatric symptoms, including but not limited to affective dysregulation, suicidality, and irritability. While only a minority of the general female population experiences significant cyclical changes, this hormone-sensitive response appears to be greater among patients with psychiatric disorders, with studies demonstrating that a majority of patients recruited for past-month suicidal ideation demonstrate worsening of their suicidality around menses. However, no interventions target suicidality during this monthly period of elevated risk despite evidence of a clear recurring biological trigger. This unique and recurrent "biotype" of suicidality is well-suited for JITAIs. In addition to providing a rationale for the inclusion of the cycle in JITAI, we provide illustrative options and examples regarding the measurement and implementation of cycle variables in JITAIs. We discuss how JITAIs might be leveraged to use menstrual cycle data to identify states of vulnerability within people and strategically select and deploy interventions based upon their receptivity at various phases in the cycle. Furthermore, we discuss how to integrate passive measures for tracking the menstrual cycle. Although much research is needed before implementation, we maintain that the menstrual cycle represents a critically understudied time-varying feature that may markedly improve the accuracy of JITAI models for predicting suicidality. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

The rising prevalence of self-injury among adolescents urges us to explore the risk factor underlying its etiology. While previous research has highlighted the important influence of family factors on self-injury, the mechanisms behind it warrant further exploration. This study constructs three moderated mediation models to explored the longitudinal relationship between family functioning and self-injury, and examined the mediating role of depression and the moderating role of negative cognitive emotion regulation (NCER). Data were collected from 705 middle school students (345 boys and 360 girls; Mage = 13.23 years, SD = 0.87) in Hunan Province, China, through a two-wave quantitative survey conducted six months apart. The participants completed self-report questionnaires on family APGAR index scale, children's depression inventory, cognitive emotion regulation questionnaire, and adolescent self-injury scale. The results indicate that family functioning significantly predicts adolescent self-injury later on (β = -0.095, p < 0.01). Depression at both Time 1 (T1) and Time2(T2) fully mediates the relationship between family functioning (T1) and self-injury (T2). Regarding moderation effects, NCER (T1) did not moderate the impact of depression (T1) on self-injury(T2) (β = 0.025, p = 0.43). However, NCER (T2) significantly moderated the effect of depression (T1) on self-injury (T2) (β = 0.082, p < 0.01). and also moderated the relationship between depression (T2) and self-injury (T2) (β = 0.127, p < 0.001). These findings support the experiential avoidance model and extend the existing literature by demonstrating that depression played a completely mediating role between family functioning and self-injury, which is not only immediate, but also delayed. Additionally, higher NCER as a risk factor amplified the negative effect of depression on self-injury. It implied that interventions focused on reducing depression and enhancing cognitive emotion regulation may effectively reduce self-injury. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Aims/hypothesis: Regulators worldwide are reviewing safety data on glucagon-like peptide-1 receptor agonists (GLP-1RA), following reports by the Icelandic Medicines Agency in July 2023 of suicidal ideation and self-injury (SIS) in individuals taking liraglutide and semaglutide. We aimed to assess the risk of SIS in new users of GLP-1RA when compared with sodium-glucose cotransporter 2 inhibitors (SGLT-2i) users, prescribed to treat type 2 diabetes in individuals with obesity. Methods: This is a cohort study combining several population-wide databases and covering a Spanish population of five million inhabitants, including all adults with obesity who initiated treatment with either GLP-1RA or SGLT-2i for type 2 diabetes from 2015 to 2021. To estimate the comparative effect of GLP-1RA on the risk of SIS, we employed a new user, active comparator design and we carried out multivariable Cox regression modelling with inverse probability of treatment weighting (IPTW) based on propensity scores. We performed several stratified and sensitivity analyses. Results: We included 3040 patients initiating treatment with GLP-1RA and 11,627 with SGLT-2i. When compared with patients treated with SGLT-2i, those in the GLP-1RA group were younger (55 vs 60 years old, p<0.001), had more anxiety (49.4% vs 41.5%, p<0.001), sleep disorders (43.2% vs 34.1%, p<0.001) and depression (24.4% vs 19.0%, p<0.001), and were more obese (35.1% of individuals with BMI ≥40 vs 15.1%, p<0.001). After propensity score weighting, standardised mean differences between groups were <0.1 for all covariates, showing adequate balance between groups at baseline after adjustment. In the main per-protocol analyses we found no evidence that GLP-1RA increased the incidence of SIS (HR 1.04; 95% CI 0.35, 3.14). Intention-to-treat analyses resulted in an HR of 1.36 (95% CI 0.51, 3.61). In analyses excluding individuals with no BMI information and using imputation for BMI missing values, respective HRs were 0.89 (95% CI 0.26, 3.14) and 1.29 (95% CI 0.42, 3.92). Stratified analyses showed no differences between subgroups. Conclusions/interpretation: Our findings do not support an increased risk of SIS when taking GLP-1RA in individuals with type 2 diabetes and obesity; however, the rarity of SIS events and the wide uncertainty of effect size (although null, effect may be compatible with a risk as high as threefold) calls for a cautious interpretation of our results. Further studies, including final evaluations from regulatory bodies, are called for to discard a causal link between GLP-1RA and suicidality. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

Objective: The aim of the present study was to investigate the effectiveness of Cognitive-Behavioral Therapy (CBT) on improving the quality of life in adolescents engaging in non-suicidal self-injury (NSSI). Methods and Materials: The research method was quasi-experimental with a pre-test and post-test control group design. The statistical population of the present study included 16 to 18-year-old high school students (both boys and girls) in Sari. From this population, 100 individuals were selected through convenience sampling, and among them, 28 individuals who obtained the highest scores on the Non-Suicidal Self-Injury Questionnaire (NSSI) were selected based on inclusion criteria and were randomly assigned to an experimental group and a control group (each group consisting of 14 individuals). The experimental group received group CBT over 12 sessions of 90 minutes each, while the control group received no intervention until the post-test phase. The tools used in this study included the Non-Suicidal Self-Injury Questionnaire (Klonsky & Glenn, 2011) and the Quality of Life Questionnaire (Ware & Sherbourne, 1992). The data obtained in the pre-test and post-test phases were analyzed using covariance analysis with SPSS-22 software. Findings: The results showed that CBT led to an increase in the quality of life of adolescents. Conclusion: The findings provide evidence that CBT is a suitable method for increasing the quality of life in adolescents engaging in non-suicidal self-injury and can lead to the enhancement of their mental health. [ABSTRACT FROM AUTHOR]

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

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

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

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

Epidemics of self-injury are increasingly framed as public health crises and risk facing youth in Canada. This article examines the discursive construction of youth self-injury as risk in mainstream Canadian news articles through a neoliberal governmentality framework. It argues that self-injury risk discourses are consistent with neoliberal mental health paradigms, which individualize and depoliticize distress while responsibilizing individuals for recovery and wellbeing. The construction of youth self-injury in terms of risk simultaneously undergirds the surveillance, regulation, and coercive control of self-injuring subjects. Based on a critical discourse analysis of Canadian news articles addressing the problem of youth self-injury, this article identifies and discusses three interrelated themes from study findings: social (media) contagion, failed resilience, and system overwhelm. Ultimately, it suggests that the construction of self-injury in terms of risk frames self-injuring youth as failed neoliberal subjects. Risk discourses are therefore incompatible with social justice paradigms in mental health. [ABSTRACT FROM AUTHOR]

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

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

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

Background: Trichotillomania and skin picking disorder have been characterized as body-focused repetitive behavior (BFRB) disorders (i.e., repetitive self-grooming behaviors that involve biting, pulling, picking, or scraping one's own hair, skin, lips, cheeks, or nails). Trichotillomania and skin picking disorder have also historically been classified, by some, as types of compulsive self-injury as they involve repetitive hair pulling and skin picking, respectively. The question of the relationship of these disorders to more conventional forms of self-injury such as cutting or self-burning remains incompletely investigated. The objective of this study was to examine the relationship of these two disorders with non-suicidal self-injury (NSSI). Methods: Adults with trichotillomania (n = 93) and skin picking (n = 105) or both (n = 82) were recruited from the general population using advertisements and online support groups and completed an online survey. Participants completed self-report instruments to characterize clinical profiles and associated characteristics. In addition, each participant completed a mental health history questionnaire. Results: Of the 280 adults with BFRB disorders, 141 (50.1%) reported a history of self-injury independent of hair pulling and skin picking. Participants with a history of self-injury reported significantly worse pulling and picking symptoms (p  < .001) and were significantly more likely to have co-occurring alcohol problems (p  < .001), borderline personality disorder (p  < .001), buying disorder (p  < .001), gambling disorder (p  < .001), compulsive sex behavior (p  < 001), and binge eating disorder (p  = .041). Conclusions: NSSI appears common in trichotillomania and skin picking disorder and may be part of a larger constellation of behaviors associated with impulse control or reward-related dysfunction. [ABSTRACT FROM AUTHOR]

Emerging adulthood is associated with change and distress. The System for Adult Growth and Emergence – Foundations (SAGE-F) treatment program, a six-week outpatient DBT intensive, was developed to improve emotional functioning for such individuals. Utilizing a single-group design, the current study aims to re-examine (n = 48) and expand (n = 83) initial therapeutic findings of SAGE-F. Participants were administered an assessment battery at pre-treatment, upon immediate completion of SAGE-F, six-weeks after baseline, and at three months following program completion. Results were comparable to the pilot study: the completion of SAGE-F, when compared to baseline, is associated with reductions in mood dysregulation and self-harm, and improvements in functioning capacities, with gains sustained for at least three months. Further, program completion was associated with improved DBT skill use, with individuals demonstrating more insight of skill dysfunction rather than skill growth. Results continue to support that SAGE-F provides both immediate and long-term benefits. [ABSTRACT FROM AUTHOR]

Objective Experiential avoidance, an individual’s unwillingness to experience uncomfortable internal feelings/emotions, has been found to be associated with history of self-injury. This association is mainly found in studies that use global measures of experiential avoidance. However, experiential avoidance is purported to be a multidimensional construct. This study aims to test both unidimensional and multidimensional measures of experiential avoidance and their associations with self-injury.Method University students (n = 632, M = 25.01, SD = 7.13, 78.8% female, 70.9% with lived experience of self-injury) completed well-validated self-report measures of self-injury, experiential avoidance (The Brief and the Multidimensional Experiential Avoidance Questionnaire).Results As expected, all sub-scales of multidimensional measure of experiential avoidance were highly correlated with the global score for experiential avoidance. The global measure of experiential avoidance differentiated individuals with no history, with past history, and recent history of self-injury. When assessed using the multidimensional measure, only the sub-factors behavioural avoidance and repression and denial differentiated those with no history of self-injury from those with recent history and those with recent history from those with past history of self-injury.Conclusion Findings raise the possibility that associations between experiential avoidance and self-injury may be down to two specific aspects of experiential avoidance, namely 1) behavioural avoidance and 2) repression/denial. If true, this will have important theoretical, clinical, and measurement implications for research into self-injury.

Solitary confinement is a harrowing human rights and public health problem that is currently inflicted as a routine punishment for a litany of prison rule violations, a reactionary tactic to quell resistance to prison conditions, and as a destination of last resort for people serious mental illnesses (SMI) who are especially vulnerable to its harms. An extensive body of research has documented clusters of psychiatric symptoms-emotional distress, cognitive deficits, social withdrawal, anxiety, paranoia, sleeplessness, and hallucinations-linked to solitary confinement that often manifest in decompensating behaviors, which include self-injury and suicide. This study summarizes the historical evolution of solitary confinement, recaps its linkages to self-injury and suicidality, and offers a theoretical framework grounded in ecosocial theory, and supplemented with concepts from theories of dehumanization and carceral geography. Findings bolster extant evidence on the harms of solitary confinement by focusing on whether and how exertions of power by prison staff to deploy mechanisms of dehumanization-as a pathway between SMI and self-injury among a cross section of adult men (n = 517) exposed to solitary confinement in Louisiana prisons in 2017. Findings reinforce the need for structural interventions that diffuse forms of carceral power and practices that continue to subject people to isolation, dehumanization, and violence.

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

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

Introduction: At present, the incidence of adolescent depression is increasing each year, having a wide and profound impact on adolescents. This study investigated the mood state of mid-to-late adolescents and young adults and analyzed related factors; clarified the incidence of depression, suicide, and self-injurious thoughts/behaviors in this population; and conducted relevant analysis of related factors of depression and anxiety. Methods: Study subjects were students aged 14-25 years, from three high schools and one university in Liaoning Province. Study subjects were evaluated using several questionnaires that combined online and offline methods. Specifically, the Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Simplified Coping Style Questionnaire (SCSQ), Child Depression Inventory (CDI), the Chinese version of the Spence Child Anxiety Scale (SCAS), and a general questionnaire were utilized. Single-factor ANOVA, t-test, Chi-square, and multiple regression analysis were used to analyze the data. Results: The results showed that, among the 14-17-year-old subjects, the incidence of depression was 336 (14.7%), the incidence of anxiety was 763 (33.5%). Among the 18-25-year-old subjects, the incidence of depression was 34 (8.6%), the incidence of anxiety was 7 (1.8%). In the general questionnaire, 2081 (77.8%) individuals were depressed, 689 (25.8%) had thoughts of self-injury, and 323 (12.1%) had self-injurious behaviors. Among the 14-17-year-old subjects, 1789 (78.46%) were depressed, 689 (30.22%) had self-injury thoughts, and 319 (1.71%) had self-injurious behaviors. Among the 18-25-year-old subjects, 292 (73.92%) were depressed, but 4 (1.01%) had self-injurious behaviors. The incidence of depression and anxiety in adolescents is high, presenting with a certain risk of self-injury. However, age is an important factor in the occurrence of depression and anxiety; among the 18-25-year-old subjects, the incidence of depression (8.6% vs. 4.7%) and anxiety (1.8% vs. 33.5%) was lower than that among the 14-17-year-old population. Through comparative analysis, adolescents aged 14-17 remained at high risk of depression and anxiety. Discussion: In the analysis of risk factors for depression and anxiety, relationships with classmates, teachers, and parents were reported as important influencing factors of emotional state. Further, a good coping style was found to be protective against depression and anxiety. [ABSTRACT FROM AUTHOR]

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

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