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    Reciprocal Associations Between Adolescent Girls' Chronic Interpersonal Stress and Nonsuicidal Self-Injury: A Multi-wave Prospective Investigation. Miller Adam Bryant,Linthicum Katherine P,Helms Sarah W,Giletta Matteo,Rudolph Karen D,Hastings Paul D,Nock Matthew K,Prinstein Mitchell J The Journal of adolescent health : official publication of the Society for Adolescent Medicine PURPOSE:Nonsuicidal self-injury (NSSI) is associated with increased risk of suicide attempts. Theories of NSSI assert interpersonal stress as a common risk factor for, and perhaps consequence of, NSSI. Prior research has not examined reciprocal associations between chronic interpersonal stress and NSSI. This study used a multiwave, prospective design to address this gap in a sample of adolescent girls, a group with elevated risk for both chronic interpersonal stress and NSSI. Pubertal development was examined as a moderator of the reciprocal associations. METHODS:Adolescent girls (N = 220; ages 12-16, M age = 14.69 years) at heightened risk for NSSI completed a baseline assessment and follow-up assessments over 18 months, divided into two 9-month epochs (Time 1 and 2). Pubertal development was assessed via self- and parent-report. Chronic interpersonal stress was assessed using a semistructured interview at the end of each time period. NSSI was measured using a semistructured clinical interview every 3 months within both time periods to enhance accurate reporting. RESULTS:Path models revealed that chronic romantic stress during Time 1, but not peer or parent-child stress, predicted NSSI during Time 2 among girls with more advanced pubertal development. Moreover, NSSI during Time 1 predicted higher levels of chronic romantic and parent-child stress during Time 2. CONCLUSIONS:Results revealed a reciprocal relationship between chronic romantic stress and engagement in NSSI. Further, this association may be best understood in the context of pubertal development. 10.1016/j.jadohealth.2018.06.033
    Peer Acceptance and Nonsuicidal Self-injury among Chinese Adolescents: A Longitudinal Moderated Mediation Model. Wu Nini,Hou Yang,Chen Peiyi,You Jianing Journal of youth and adolescence Peer relationship plays an important role in non-suicidal self-injury (NSSI). However, little is known about how and in what conditions peer relationship may influence NSSI. By integrating multiple theories (i.e., attachment theory, the emotional regulation model of self-compassion and NSSI, and the differential-susceptibility theory), the current study investigated two potential mediators (i.e., self-compassion and depressive symptoms) and one potential moderator (i.e., behavioral impulsivity) of the relation between peer acceptance and NSSI. Participants were 813 Chinese adolescents (43% female; Mage at Wave 1 = 13.15 years) from a two-wave longitudinal study with data spanning one year. The results revealed that the indirect pathways linking peer acceptance and NSSI were conditioned on the level of behavioral impulsivity. Specifically, for adolescents with lower levels of impulsivity, a higher level of peer acceptance was related to fewer depressive symptoms directly or indirectly through self-compassion; fewer depressive symptoms, in turn, were linked to fewer NSSI behaviors longitudinally. For adolescents with higher levels of behavioral impulsivity, peer acceptance was related to fewer NSSI behaviors only through self-compassion. Results indicate that increasing peer acceptance is important in reducing adolescent NSSI. Interventions designed to reduce adolescent NSSI may also be effective if they focus on promoting adolescent self-compassion, particularly for adolescents with higher levels of behavioral impulsivity. 10.1007/s10964-019-01093-0
    The best friend and friendship group influence on adolescent nonsuicidal self-injury. You Jianing,Lin Min Pei,Fu Kei,Leung Freedom Journal of abnormal child psychology This study examined associations of peer socialization and selection, over time, with nonsuicidal self-injury (NSSI) among 5,787 (54.2 % females) Chinese community adolescents. Both effects were tested using two aspects of adolescents' friendship networks: the best friend and the friendship group. Participants completed questionnaires assessing NSSI, depressive symptoms and maladaptive impulsive behaviors at two waves of time over a 6-month period. Results showed that even after controlling for the effects of depressive symptoms and maladaptive impulsive behaviors, the best friends' engagement in NSSI still significantly predicted adolescents' own engagement in NSSI. Adolescents' friendship groups' NSSI status also significantly predicted their own NSSI status and frequency. Additionally, adolescents with NSSI tended to join peer groups with other members also engaging in NSSI. 10.1007/s10802-013-9734-z
    Characterizing Interpersonal Difficulties Among Young Adults Who Engage in Nonsuicidal Self-Injury Using a Daily Diary. Turner Brianna J,Wakefield Matthew A,Gratz Kim L,Chapman Alexander L Behavior therapy Compared to people who have never engaged in nonsuicidal self-injury (NSSI), people with a history of NSSI report multiple interpersonal problems. Theories propose that these interpersonal difficulties play a role in prompting and maintaining NSSI. The cross-sectional nature of most studies in this area limits our understanding of how day-to-day interpersonal experiences relate to the global interpersonal impairments observed among individuals with NSSI, and vice versa. This study compared young adults with (n=60) and without (n=56) recent, repeated NSSI on baseline and daily measures of interpersonal functioning during a 14-day daily diary study. Groups differed in baseline social anxiety, excessive reassurance seeking, and use of support seeking relative to other coping strategies, but did not differ in self-perceived interpersonal competence. In terms of day-to-day functioning, participants with (vs. without) NSSI had significantly less contact with their families and friends, perceived less support following interactions with friends, and were less likely to seek support to cope, regardless of level of negative affect. With the exception of contact with family members, these group differences in daily interpersonal functioning were accounted for by baseline levels of social anxiety and use of support seeking. Contrary to expectations, participants with NSSI had more frequent contact with their romantic partners, did not differ in perceptions of support in romantic relationships, and did not report more intense negative affect following negative interpersonal interactions. This study provides a novel test of recent interpersonal theories of NSSI using daily reports. 10.1016/j.beth.2016.07.001
    Brief report: the association between non-suicidal self-injury, self-concept and acquaintance with self-injurious peers in a sample of adolescents. Claes Laurence,Houben Adinda,Vandereycken Walter,Bijttebier Patricia,Muehlenkamp Jennifer Journal of adolescence The current study investigated the association between non-suicidal self-injury (NSSI), self-concept and acquaintance with NSSI peers in a sample of 150 high school students (60% female) with a mean age of 15.56 (SD=2.00) years. Analyses showed that students with NSSI rated themselves lower on academic intelligence, physical attractiveness, social skills and emotional stability than their non-NSSI peers. The self-injurers also had more friends who engaged in NSSI, and having more NSSI acquaintances was negatively related to self-esteem. It could be that adolescents with lower self-esteem are more attracted to self-injuring peers, or that adolescents with low self-esteem are more vulnerable to copy NSSI to deal with their problems or to gain a certain identity in their peer group. Future studies must test these possible NSSI pathways. 10.1016/j.adolescence.2009.10.012
    Peer group impulsivity moderated the individual-level relationship between depressive symptoms and adolescent nonsuicidal self-injury. You Jianing,Zheng Chuhua,Lin Min-Pei,Leung Freedom Journal of adolescence This study examined the influence of impulsive friendship group contexts on nonsuicidal self-injury (NSSI) and how peer group impulsivity (i.e. negative urgency and premeditation) moderated the individual level relationship between depression and NSSI among 1701 Chinese secondary school students (1147 females). Participants were assessed twice over a 6-month interval. After controlling for direct socialization effects for NSSI, multilevel analysis indicated that friendship group negative urgency exerted a significant influence on NSSI. Additionally, friendship group premeditation weakened the relation between individual depression and NSSI, while friendship group negative urgency strengthened the relation between depression and NSSI. The results suggest the contribution of indirect peer influence effects to NSSI. 10.1016/j.adolescence.2015.12.008
    Peer influence and nonsuicidal self injury: longitudinal results in community and clinically-referred adolescent samples. Prinstein Mitchell J,Heilbron Nicole,Guerry John D,Franklin Joseph C,Rancourt Diana,Simon Valerie,Spirito Anthony Journal of abnormal child psychology Research suggests that adolescents' engagement in nonsuicidal self-injurious (NSSI) behaviors may be increasing over time, yet little is known regarding distal longitudinal factors that may promote engagement in these behaviors. Data from two longitudinal studies are presented to examine whether NSSI may be associated with peer influence processes. Study 1 included 377 adolescents from a community-based sample; Study 2 included 140 clinically-referred adolescents recruited from a psychiatric inpatient facility. In Study 1, adolescents' NSSI was examined at baseline and one year later. Adolescents' nominated best friend reported their own levels of NSSI. In Study 2, adolescents' NSSI was examined at baseline as well as 9 and 18-months post-baseline. Adolescents' perceptions of their friends' engagement in self-injurious behavior (including suicidality) and depressed mood also were examined at all three time points. Baseline depressive symptoms were measured in both studies; gender and age were examined as moderators of peer influence effects. Results from both studies supported longitudinal peer socialization effects of friends' self-injurious behavior on adolescents' own NSSI for girls, but not for boys, even after controlling for depressive symptoms as a predictor. Study 1 suggested socialization effects mostly for younger youth. Results from Study 2 also suggested longitudinal socialization effects, as well as peer selection effects; adolescents' NSSI was associated with increasing perceptions of their friends' engagement in depressive/self-injurious thoughts and behavior. Findings contribute to the nascent literature on longitudinal predictors of NSSI and to work on peer influence. 10.1007/s10802-010-9423-0
    Peer Socialization of Non-Suicidal Self-Injury in Adolescents' Close Friendships. Schwartz-Mette Rebecca A,Lawrence Hannah R Journal of abnormal child psychology Non-suicidal self-injury (NSSI), or self-harming behavior without intent to die (Nock Current Directions in Psychological Science, 18, 78-83, 2009), is associated with distress and impairment across domains, including increased risk for suicidality (Kiekens et al. Journal of Affective Disorders, 239, 171-179, 2018). In adolescence, prevalence of NSSI is high (Swannell et al. Suicide and Life-threatening Behavior, 44, 273-303, 2014), and peer influence regarding NSSI is thought to be strong (Brechwald and Prinstein Journal of Research on Adolescence, 21, 166-79, 2011). Although concern regarding "clusters" of NSSI has long been documented, peer socialization of NSSI in adolescence is understudied. This paper tests peer influence on NSSI frequency within adolescent friendship dyads. Emotion regulation difficulties and friendship quality were evaluated as factors that may influence susceptibility to peer influence effects. Adolescents (N = 196, M age = 15.68, 69.9% female, 87.6% White) nested within 93 friendship dyads reported on their own NSSI frequency, difficulties in emotion regulation, and friendship quality at three time points spaced 3 months apart. Cross-lagged Actor-Partner Interdependence Models examined peer influence effects over time. Friends' Time 1 frequency of NSSI uniquely predicted adolescents' own NSSI frequency over 3 and 6 months, controlling for initial similarity among friends as well as individual risk factors for NSSI. Peer influence effects were strongest in adolescents with higher levels of emotion regulation difficulty but did not vary as a function of friendship quality. Friends' NSSI frequency is a significant and unique predictor of increases in adolescents' own NSSI frequency over time. Implications for interventions that leverage the important developmental context of peer relationships are discussed. 10.1007/s10802-019-00569-8
    Understanding the social context of adolescent nonsuicidal self-injury. Victor Sarah E,Klonsky Elisha David Journal of clinical psychology OBJECTIVE:Research investigating the social context of adolescent nonsuicidal self-injury (NSSI) has been limited. We therefore examined social characteristics of NSSI, such as knowledge of friends' NSSI and the role friends play in continuing NSSI, and their relationships to other known NSSI correlates, such as suicidality. METHOD:We assessed NSSI characteristics, including social features, in a community sample of 89 self-injuring adolescents. We also assessed psychosocial correlates of NSSI, including impulsivity, self-concept, and psychiatric symptoms. RESULTS:Knowledge of friends' NSSI was relatively common among self-injurers. In addition, knowledge of friends' NSSI was associated with use of more NSSI methods, cutting behaviors, and suicidal ideation, but not with other NSSI correlates. However, teaching or encouragement of NSSI by friends was rare. CONCLUSIONS:Knowledge of friends' NSSI may serve as marker of increased severity among adolescent self-injurers. These findings have implications for identifying and intervening with high-risk self-injuring youth. 10.1002/jclp.22657
    The role of exposure to self-injury among peers in predicting later self-injury. Hasking Penelope,Andrews Tori,Martin Graham Journal of youth and adolescence While researchers are beginning to reach consensus around key psychological correlates of non-suicidal self-injury (NSSI), comparatively less work has been done investigating the role and influence of peers. Given evidence that engagement in this behavior may be susceptible to peer influence, especially during the early stages of its course, the current study prospectively explored whether knowing a friend who self-injures is associated with the onset, severity, and subsequent engagement in NSSI. The moderating roles of adverse life events, substance use and previous suicidal behavior in this relationship also were explored. Self-report data were collected from 1,973 school-based adolescents (aged 12-18 years; 72 % female) at two time points, 1 year apart. Knowing a friend who self-injured, negative life events, psychological distress and thoughts of NSSI differentiated those who self-injured from those who did not, and also predicted the onset of NSSI within the study period. Further, adverse life events and previous thoughts of NSSI moderated the relationship between exposure to NSSI in peers and engaging in NSSI at Time 2. However, the effect of having a friend who self-injures was not related to the severity of NSSI. Having a friend who self-injures appears to be a risk factor for self-injury among youth who are experiencing high levels of distress. Implications of these findings are discussed. 10.1007/s10964-013-9931-7
    The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Blasco-Fontecilla Hilario,Fernández-Fernández Roberto,Colino Laura,Fajardo Lourdes,Perteguer-Barrio Rosa,de Leon Jose Frontiers in psychiatry INTRODUCTION:Behavioral addictions such as gambling, sun-tanning, shopping, Internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse). Recent literature suggests that both non-suicidal self-injury (NSSI) and suicidal behavior (SB) can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors. METHOD:This is a narrative review. The authors performed literature searches in PubMed and Google for suicidal behavior, self-harming, addiction, and "major repeaters." Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts) represent a distinctive suicidal phenotype and are the individuals at risk of developing an addiction to SB. RESULTS:The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as "addictions," and the putative mechanisms underlying them. CONCLUSION:Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual's self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction. 10.3389/fpsyt.2016.00008
    Effect of alcohol dose on deliberate self-harm in men and women. Berman Mitchell E,Fanning Jennifer R,Guillot Casey R,Marsic Angelika,Bullock Joshua,Nadorff Michael R,McCloskey Michael S Journal of consulting and clinical psychology OBJECTIVE:Nonexperimental survey and field research support the notion that alcohol use may be associated with deliberate self-harm (DSH) across the spectrum of lethality, from nonsuicidal self-injury (NSSI) through suicide. Nonexperimental studies, however, provide limited information about potential causal relationships between alcohol consumption and DSH. Two previous experiments showed that a relatively high-dose of alcohol increases the likelihood of engaging in DSH in men, with DSH defined by the self-administration of a "painful" shock (the self-aggression paradigm [SAP]; Berman & Walley, 2003; McCloskey & Berman, 2003). In this study, we examined whether (a) lower doses of alcohol also elicit DSH, (b) this effect occurs for women as well as men, and (c) individual differences in past nonsuicidal self-injury (NSSI) moderate alcohol's effects on DSH. METHOD:Nonalcohol dependent men and women (N = 210) were assigned either to .00%, .05%, .075%, or .100% blood alcohol concentration (BAC) drink conditions and completed a self-rating scale of NSSI (the Deliberate Self-Harm Inventory [DSHI]; Gratz, 2001). As in previous SAP studies, DSH was operationalized by shock setting behavior during a competitive reaction time (RT) game. RESULTS:Overall, a greater proportion of participants in the .075% and .100% (but not .050%) alcohol conditions self-selected a "painful" shock to administer compared to participants in the placebo condition. NSSI predicted self-administration of painful shocks, but did not moderate the alcohol effect. CONCLUSIONS:Results provide experimental evidence to support the notion that interventions for self-harm should include processes to monitor and limit alcohol intake. (PsycINFO Database Record 10.1037/ccp0000222
    Alcohol misuse and self-harm: an opportunity for early intervention in the emergency department. Ness Jennifer The lancet. Psychiatry 10.1016/S2215-0366(17)30095-0
    Internet Addiction among Adolescents May Predict Self-Harm/Suicidal Behavior: A Prospective Study. Pan Pei-Yin,Yeh Chin-Bin The Journal of pediatrics OBJECTIVE:To explore the role of Internet addiction in the development of self-harm/suicidal behavior among adolescents after 1-year of follow-up. STUDY DESIGN:We conducted this 1-year, prospective cohort study of 1861 adolescents (mean age 15.93 years) attending a senior high school in Taiwan; 1735 respondents (93.2%) were classified as having no history of self-harm/suicidal attempts in the initial assessment and were referred to as the "noncase" cohort. The Chen Internet Addiction Scale was used to identify individuals with Internet addiction. The participants were evaluated for self-harm/suicidal behavior again 1 year later and the "noncase" cohort was selected for statistical analysis. To examine the relationship between Internet addiction and self-harm/suicidal behavior, multivariate logistic regression analysis was performed using Internet addiction at baseline as the predictor for newly developed self-harm/suicidal behavior in the next year, after adjustment for potential confounding variables. RESULTS:The prevalence rate of Internet addiction at baseline was 23.0%. There were 59 students (3.9%) who were identified as having developed new self-harm/suicidal behaviors on follow-up assessments. After controlling for the effects of potential confounders, the relative risk of newly emerging self-harm/suicidal behavior for participants who were classified as Internet addicted was 2.41 (95% CI 1.16-4.99, P = .018) when compared with those without Internet addiction. CONCLUSIONS:Our findings indicate that Internet addiction is prospectively associated with the incidence of self-harm/suicidal behavior in adolescents. 10.1016/j.jpeds.2018.01.046
    Association of Internet Addiction With Nonsuicidal Self-injury Among Adolescents in China. Tang Jie,Ma Ying,Lewis Stephen P,Chen Ruoling,Clifford Angela,Ammerman Brooke A,Gazimbi Marufu Martin,Byrne Adrian,Wu Yu,Lu Xinchuan,Chang Hongjuan,Kang Chun,Tiemeier Henning,Yu Yizhen JAMA network open Importance:Both nonsuicidal self-injury (NSSI), defined as the direct, deliberate damage of one's body tissue without suicidal intent, and internet addiction among adolescents are public health concerns. However, the possible association of NSSI with internet addiction is not well understood. Objective:To examine the occurrence of internet addiction with NSSI and any sex differences among Chinese adolescents. Design, Setting, and Participants:A multicenter, cross-sectional, survey study was conducted from February 18 to October 15, 2015, among adolescents aged 11 to 20 years from 343 classes in 45 public high schools across 5 provinces of China. Data analysis was performed from August 1, 2018, to March 1, 2019. Exposures:Possible internet addiction and internet addiction. Main Outcomes and Measures:Less-frequent (1-4 times) NSSI and more-frequent (≥5 times) NSSI were surveyed using the Chinese version of the Functional Assessment of Self-Mutilation. Results:A total of 15 623 students (8043 male [51.5%] and 7580 female [48.5%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) participated. Of these, 4670 participants (29.9%) met the criteria for possible internet addiction and 509 participants (3.3%) met the criteria for internet addiction. A total of 2667 students (17.1%) engaged in less-frequent NSSI, while 1798 students (11.5%) engaged in more-frequent NSSI in the 12 months preceding the survey. Both possible internet addiction and internet addiction were associated with less-frequent or more-frequent NSSI. The adjusted odds ratios were 1.29 (95% CI, 1.17-1.42) for possible internet addiction and 1.41 (95% CI, 1.11-1.80) for internet addiction for less-frequent NSSI; for more-frequent NSSI, the adjusted odds ratios were 1.75 (95% CI, 1.56-1.96) for possible internet addiction and 2.66 (95% CI, 2.10-3.38) for internet addiction. These associations were similarly observed among age groups of 11 to 14, 15 to 17, and 18 to 20 years. No sex disparities were found in the associations of internet addiction with NSSI, except among adolescents aged 11 to 14 years, where the odds ratios for possible internet addiction with less-frequent NSSI were higher in male adolescents (1.53; 95% CI, 1.25-1.88) than female adolescents (1.13; 95% CI, 0.90-1.47). Conclusion and Relevance:Internet addiction appears to be associated with NSSI, and the findings of this study suggest that the association was similar between male adolescents and female adolescents. These data suggest that evaluation of the risk of NSSI for adolescents in association with internet addiction may help health care professionals in developing preventive interventions for NSSI. 10.1001/jamanetworkopen.2020.6863
    Nonsuicidal Self-Injury Among a Representative Sample of US Adolescents, 2015. Monto Martin A,McRee Nick,Deryck Frank S American journal of public health OBJECTIVES:To provide prevalence estimates of adolescent nonsuicidal self-injury (NSSI) based on large, representative, nonclinical samples of high-school students, and to explore gender differences in health risks associated with NSSI. METHODS:We used 2015 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System data to estimate the prevalence of self-injury and variables potentially associated with self-injury for high-school-age boys (n = 32 150) and girls (n = 32 521) in 11 US states. We used logistic regression analysis to consider associations between NSSI and other health risks. RESULTS:Rates of boys reporting purposefully hurting themselves without wanting to die over the past 12 months ranged from 6.4% (Delaware) to 14.8% (Nevada). Rates for girls varied from 17.7% (Delaware) to 30.8% (Idaho). Rates declined with age and varied by race and ethnicity. Depression; suicidal thoughts, plans, and attempts; sexual minority status; being electronically bullied; smoking; and substance use were associated with NSSI. There were minor differences in associations between NSSI and health risk variables by gender. CONCLUSIONS:Nonclinical populations of adolescents are at high risk for self-injury. Nonsuicidal self-injury was higher among girls than among boys, but patterns of association with other health risks were similar. 10.2105/AJPH.2018.304470
    Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis. Liu Richard T,Sheehan Ana E,Walsh Rachel F L,Sanzari Christina M,Cheek Shayna M,Hernandez Evelyn M Clinical psychology review The current review presents a meta-analysis of the existing empirical literature on the prevalence of non-suicidal self-injury (NSSI) among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as on correlates of NSSI within sexual and gender minority populations. Eligible publications (n = 51) were identified through a systematic search of PsycINFO, MEDLINE, and Embase, supplemented by a search of references of prior reviews on this topic. NSSI prevalence rates were quite elevated among sexual (29.68% lifetime) and gender (46.65% lifetime) minority individuals compared to heterosexual and/or cisgender peers (14.57% lifetime), with transgender (46.65% lifetime) and bisexual (41.47% lifetime) individuals being at greatest risk. Even among these group findings, sexual minority youth emerged as an especially vulnerable population. Moreover, current evidence suggests these rates and differences between LGBT and heterosexual and/or cisgender peers have not declined over time. These findings may in some measure be due to the existence of LGBT-specific risk correlates combined with general risk correlates being more severe among sexual and gender minority populations. Additional research, particularly employing a longitudinal design, is needed in this area to advance efforts to reduce risk for NSSI among sexual and gender minority individuals. 10.1016/j.cpr.2019.101783
    Longitudinal predictors of self-injurious thoughts and behaviors in sexual and gender minority adolescents. Smith Diana M,Wang Shirley B,Carter Mikaela L,Fox Kathryn R,Hooley Jill M Journal of abnormal psychology Sexual and gender minority (SGM) populations are at increased risk for several negative psychological outcomes, including self-injury. Although correlates of self-injurious thoughts and behaviors (SITBs) have been identified, it is unclear which factors are prospective predictors of SITB engagement in SGM youth. The current study investigated an online sample of 252 SGM adolescents over a 6-month period. Participants reported attitudes based on SGM identity, depression, self-criticism, body image, family support and family strain, friend NSSI engagement, and experiences of everyday discrimination. Lasso and elastic net regularized logistic regressions were used to examine which baseline variables were associated with SITB engagement at follow-up. Models resulted in excellent predictive accuracy of nonsuicidal self-injury and suicidal ideation (mean Area Under the Receiving Operating Characteristics Curve [AUC] of 0.90 and 0.91), good predictive accuracy for suicide plans (mean AUC = 0.85), and fair predictive accuracy for suicidal behaviors (mean AUC = 0.78). Several variables emerged as prospectively related to SITB risk, with varied associations across different SITBs. Results suggest that minority-specific factors may predict SITBs in SGM adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved). 10.1037/abn0000483
    Suicide Risk Behaviors Among Sexual Minority Adolescents in the United States, 2015. Caputi Theodore L,Smith Davey,Ayers John W JAMA 10.1001/jama.2017.16908
    Population-Based Analysis of Temporal Trends in the Prevalence of Depressed Mood Among Sexual Minority and Heterosexual Youths From 1999 Through 2017. Bettis Alexandra H,Liu Richard T JAMA pediatrics 10.1001/jamapediatrics.2019.3804
    Resistance as a form of resilience in sexual and gender minorities: Differential moderating roles of collective action on the discrimination-depression relationship among sexual minority men and women. Chan Randolph C H,Mak Winnie W S Social science & medicine (1982) BACKGROUND:As a fundamental means for transforming and advancing the conditions of lesbian, gay, bisexual, and transgender (LGBT) individuals, collective action has gained increasing attention in research, policy, and practice over the past decade. While collective action is influential in driving public awareness and policy changes, less is known about its psychological effects on individuals undertaking collective action. METHODS:The present study developed a scale to measure collective action for LGBT rights and examined the underlying dimensions of collective action in a sample of 1050 LGBT individuals in Hong Kong. The moderating roles of collective action on the relationship between perceived discrimination and depressive symptoms were also examined. RESULTS:The LGBT Collective Action Scale measured two dimensions of collective action, i.e., private and public collective action. Private collective action moderated the association between perceived discrimination and depressive symptoms among sexual minority men and women; however, the moderating effect of public collective action was only found in sexual minority women. CONCLUSIONS:These differential moderating effects could be attributed to gender role socialization and gender-specific coping mechanisms in response to minority stress. Although public collective action is more powerful in triggering structural changes than private collective action, individuals in less democratic societies may not necessarily have access to public collective action due to the absence of opportunity structures. Private collective action, which is able to be initiated and undertaken individually, can be directed to transform heterosexist biases in interpersonal context. For LGBT individuals in less democratic societies, private collective action may be a more manageable way to maintain mental health in the face of stigmatization. 10.1016/j.socscimed.2021.114056
    Adolescents with anorexia nervosa with or without non-suicidal self-injury: clinical and psychopathological features. Riva Anna,Pigni Maria,Bomba Monica,Nacinovich Renata Eating and weight disorders : EWD PURPOSE:Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. METHODS:The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. RESULTS:AN + NSSI group showed higher prevalence of binging-purging-type AN (p < .001), and mean higher age (p = .008) and Body Mass Index (BMI) (p = .002) than AN without NSSI group. Concerning psychological scales, AN + NSSI group showed higher scores in mostly of the sub-scale of the test Eating Disorders Inventory-3, higher scores at the scale for depression (p < 0.001) and higher scores at the three indexes of Symptom Checklist 90-Revised test, Global Severity Index (p < 0.001), Positive Symptoms total (p = .003) and Positive Symptom Distress Index (p < 0.001). No differences emerged at Children's Global Assessment Scale and at scale for evaluation of alexithymia. Regression analyses showed that a diagnosis of binging-purging-type AN (p = .001) predicts NSSI. CONCLUSION:Results suggest that adolescents with AN and NSSI show peculiar clinical features with higher prevalence of binging-purging-type AN and more severe psychopathological traits than adolescents with AN without NSSI. LEVEL OF EVIDENCE:Level III: Evidence obtained from cohort or case-control analytic studies. 10.1007/s40519-021-01311-4
    Posttraumatic stress symptomology and non-suicidal self-injury: The role of intrusion and arousal symptoms. Alharbi Reem,Varese Filippo,Husain Nusrat,Taylor Peter James Journal of affective disorders BACKGROUND:Previous evidence has shown a strong relation between Posttraumatic Stress Disorder (PTSD) symptomology and Non-Suicidal Self-Injury (NSSI). The current study aimed to extend prior research by investigating the relationship between PTSD symptom clusters (arousal and intrusion) and NSSI, and putative moderators of this association within a large-scale adult sample in England. METHOD:A subsample of participants with experiences of trauma in adulthood (n = 2,480) from the Adult Psychiatric Morbidity Survey 2007 (APMS 2007) was utilised to examine the relations among PTSD intrusion and arousal symptom clusters, childhood interpersonal trauma, perceived social support and lifetime NSSI. RESULTS:Arousal symptoms were consistently associated with NSSI, even when adjusting for multiple covariates, and had a stronger relationship than intrusion symptoms. Childhood interpersonal trauma was independently and significantly associated with lifetime NSSI after adjusting for covariates. The moderating effects of childhood interpersonal trauma and perceived social support were not statistically significant. LIMITATIONS:The study was cross-sectional and utilised self-report assessments to measure PTSD, NSSI, and childhood interpersonal trauma. CONCLUSION:Findings support the role of PTSD arousal and childhood interpersonal trauma in relation to NSSI. The moderating role of childhood interpersonal trauma and perceived social support lacks supporting evidence. Findings highlight the need for NSSI screening as well as for specific interventions that target the complex needs of those who exhibit elevated PTSD arousal symptoms, especially those with a history of childhood interpersonal trauma. 10.1016/j.jad.2020.07.084
    Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach. Buelens Tinne,Costantini Giulio,Luyckx Koen,Claes Laurence Frontiers in psychiatry In 2013, DSM-5 urged for further research on non-suicidal self-injury (NSSI) and defined NSSI disorder (NSSI-D) for the first time separate from borderline personality disorder (BPD). However, research on the comorbidity between NSSI-D and BPD symptoms is still scarce, especially in adolescent populations. The current study selected 347 adolescents who engaged at least once in NSSI (78.4% girls, = 15.05) and investigated prevalence, comorbidity, gender differences, and bridge symptoms of NSSI-D and BPD. Network analysis allowed us to visualize the comorbidity structure of NSSI-D and BPD on a symptom-level and revealed which bridge symptoms connected both disorders. Our results supported NSSI-D as significantly distinct from, yet closely related to, BPD in adolescents. Even though girls were more likely to meet the NSSI-D criteria, our findings suggested that the manner in which NSSI-D and BPD symptoms were interconnected, did not differ between girls and boys. Furthermore, loneliness, impulsivity, separation anxiety, frequent thinking about NSSI, and negative affect prior to NSSI were detected as prominent bridge symptoms between NSSI-D and BPD. These bridge symptoms could provide useful targets for early intervention in and prevention of the development of comorbidity between NSSI-D and BPD. Although the current study was limited by a small male sample, these findings do provide novel insights in the complex comorbidity between NSSI-D and BPD symptoms in adolescence. 10.3389/fpsyt.2020.580922
    Insomnia symptoms and non-suicidal self-injury in adolescence: understanding temporal relations and mechanisms. Latina Delia,Bauducco Serena,Tilton-Weaver Lauree Journal of sleep research We propose a theoretical model of insomnia symptoms and non-suicidal self-injury (NSSI) that posits bidirectional linkages. We hypothesised that heightened depressive symptoms and impulsivity that result from insomnia increase NSSI. We also posit that the shame associated with NSSI triggers repetitive negative thinking, in turn increasing insomnia. Using three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1,457; M  = 13.2, SD = 0.43; 52.7% boys), we assessed the mediating role of depressive symptoms, impulsivity, rumination, and worry on the link between insomnia and NSSI. After controlling for depressive symptoms, we found that insomnia was related to increases in NSSI from the second to the third time point (ß  = 0.09, p = .01). NSSI was consistently related to increased insomnia (ß  = 0.09, p = .01; ß  = 0.11, p < .001). In addition, depressive symptoms (ß  = 0.01, p = .02), but not impulsivity (ß  = 0.01, p = .09), mediated the path from insomnia to increased NSSI. Neither worry (ß  = 0.00, p = .59) nor rumination (ß  = 0.00, p = .96) mediated the link between NSSI and increased insomnia. We conclude that NSSI and insomnia maintain each other over time. Thus, screening adolescents for insomnia symptoms may help identify those at risk of NSSI. Although depression seems to explain why insomnia is a risk factor for NSSI, further studies should investigate why NSSI plays a role in the maintenance of insomnia. This understanding will lay the foundation for intervention. 10.1111/jsr.13190
    Nonsuicidal Self-Injury Is Associated With Attenuated Interoceptive Responses to Self-Critical Rumination. Young Hayley A,Davies Jason,Freegard Gary,Benton David Behavior therapy Nonsuicidal self-injury (NSSI) is a prevalent and dangerous behavior. Those with a history of NSSI often report high levels of self-critical rumination (SCR), a form of negatively valenced introspective self-referential processing. It is plausible that this overly analytical style of relating to the self might hinder the ability to process interoceptive signals, thereby increasing the capacity to engage in behaviors that cause bodily harm. Two studies investigated whether trait or state SCR influenced aspects of interoception in those with and without a history of NSSI. In Study 1 (N = 180), irrespective of NSSI history, trait SCR was associated with finding attending to the heartbeat unpleasant. However, no associations were observed for interoceptive confidence, or metacognitive insight into their interoceptive abilities (confidence-accuracy correspondence). Trait SCR was associated with having higher interoceptive accuracy, but only in those without a history of NSSI. In Study 2 (N = 98), irrespective of NSSI history, state self-criticism led to a more negative interoceptive valence, and reduced participants' metacognitive insight. In those without a history of NSSI, state self-criticism also increased interoceptive accuracy-an effect attenuated in those with NSSI. These findings suggest that those with NSSI are characterized by a blunted interoceptive response to negatively valenced self-focused attention. 10.1016/j.beth.2021.02.010
    Assessment of nonsuicidal self-injury: development and initial validation of the Non-Suicidal Self-Injury-Assessment Tool (NSSI-AT). Whitlock Janis,Exner-Cortens Deinera,Purington Amanda Psychological assessment Research tools for assessing nonsuicidal self-injury (NSSI) epidemiology in community populations are few and are either limited in the scope of NSSI characteristics assessed or included as part of suicide assessment. Though these surveys have been immensely useful in establishing the presence of NSSI and in documenting basic epidemiological characteristics, they have been less useful in describing secondary NSSI features such as NSSI context, habituation, or perceived life impact. The aim of the current study was to examine the reliability of the test scores and validity of test score interpretations in a university population for the Non-Suicidal Self-Injury-Assessment Tool (NSSI-AT), a web-based measure of NSSI designed to assess primary (such as form, frequency, and function) and secondary (including but not limited to NSSI habituation; contexts in which NSSI is practiced; and NSSI perceived life interference, treatment, and impacts) NSSI characteristics for research purposes. Data for these analyses were drawn from 3 samples, all of which were originally part of a 2007 study of randomly selected students from 8 northeast and midwest public and private universities that participated in a web-based study entitled the Survey of Student Wellbeing. Overall, results provide support for the reliability of NSSI-AT test scores (as assessed by test-retest) and validity of NSSI-AT test score interpretations for the behavior and frequency modules (as assessed using concurrent, convergent, and discriminant evidence) in this population. Implications for research as well as next steps are discussed. 10.1037/a0036611
    Does fearlessness about death mediate the association between NSSI and suicide attempts? A longitudinal study of over 1,000 high-risk individuals. Harris Lauren M,Ribeiro Jessica D Journal of consulting and clinical psychology OBJECTIVE:Nonsuicidal self-injury (NSSI) is often cited as a key risk factor for future suicidal behavior. Capability for suicide has been repeatedly cited as an important mechanism that can account for this association. Despite this, direct tests of this hypothesis have been rare and methodologically constrained. In the present study, we conducted a direct test of this hypothesis while addressing several constraints of prior literature. METHOD:In a large sample of suicidal and self-injuring adults (n = 1,020), we tested whether changes in fearlessness about death (FAD), a core facet of the capability for suicide, accounted for the relationship between NSSI and future suicide attempts at 28-day and 2-year follow-up. FAD was assessed using the gold-standard self-report form (ACSS-FAD), an implicit test of suicide-related affect (affect misattribution paradigm-Suicide), and explicit affective ratings of suicide-relevant images. Mediation with bootstrapping was implemented to test our main hypotheses. RESULTS:As anticipated, lifetime NSSI frequency was significantly associated with suicide attempt frequency at follow-up; however, FAD failed to consistently mediate this association. Results were largely consistent across all three measures of FAD. Post hoc power analyses indicated sufficient power to detect small effects. CONCLUSIONS:Taken together, these results fail to support the hypothesis that capability for suicide explains the link between NSSI and future suicidal behavior. We discuss the implications of our results for research and theory, situating our findings in the context of recent advances in the understanding of suicide risk more broadly. (PsycInfo Database Record (c) 2021 APA, all rights reserved). 10.1037/ccp0000626
    Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk. Dunlop Brendan J,Hartley Samantha,Oladokun Olayinka,Taylor Peter J Journal of affective disorders BACKGROUND:Bisexual people have been found to be at increased risk of non-suicidal self-injury (NSSI) when compared to heterosexual and gay or lesbian people. The purpose of this review was to update the estimated risk of NSSI for bisexual people and to examine variables that have been associated with NSSI in this population. METHODS:The protocol for this paper was pre-registered (CRD42019145299). An electronic search of PsycINFO, CINAHL Plus, PubMed, Ovid Online and Web of Science was undertaken from earliest available date to October 2019. Twenty-four eligible papers were identified. Meta-analyses, including moderator analysis, were conducted to ascertain NSSI risk and a narrative synthesis was undertaken of predictors and correlates. All studies were assessed for risk of bias. RESULTS:Bisexual people had up to six times the odds of engaging in NSSI compared to other sexualities. Mental health variables of anxiety and depression symptoms were found to be most commonly associated with NSSI for this population. The majority of studies had moderate risk of bias. This review demonstrates that bisexual people have an elevated risk of engaging in NSSI. Increased incidence of anxiety and depression and exposure to negative life events may explain this increased risk. LIMITATIONS:Studies were found to be consistently cross-sectional in design and limited to western cultures. A limitation of this review was that only English language papers were included. CONCLUSIONS:Results are clinically relevant as they suggest early identification and prevention of NSSI can be achieved. Future research should examine bisexual people independently of others. 10.1016/j.jad.2020.07.103