Comment on: Deliberate self-harm in adolescents

Adolescents belong to the high-risk group for deliberate self-harm. Data shows that about 20 percent of teenagers in the world engage in self-injurious behavior in forms of scratching, razor blading, hitting, biting, hair-grabbing, and head-banging against walls just to relieve pain. This study aims to determine the correlation between emotion dysregulation and deliberate self-harm in adolescents. This study applied two instruments to measure each variable: (1) Difficulties in Emotion Regulation Scale (DERS), developed by Victor and Klonsky (2016), to measure emotion dysregulation; and (2) Deliberate Self-Harm Inventory, developed by Gratz (2001), to measure deliberate self-harm. Researchers implemented a quantitative approach with a correlational design to answer the research questions. Participants were 174 adolescents recruited from the distribution of online questionnaires with purposive sampling technique. Findings from the study indicate that emotion dysregulation is positively correlated with deliberate self-harm in adolescents with a sig p value < 0.005. This research concludes that the higher the emotion dysregulation, the higher the deliberate self-harm in adolescents.

To determine the prevalence and the associated psychological and social factors of occasional and repetitive deliberate self-harming behavior in adolescents. Cross-sectional self-report survey. One hundred twenty-one schools in Germany. A representative sample of 5759 ninth-grade students was studied between 2004 and 2005. Deliberate self-harm (DSH) and suicidal behaviors, emotional and behavioral problems (Youth Self-Report), living standard, family composition, parental conflict and illness, school type and performance, relationship to peers, bullying, body satisfaction and dieting, media consumption, smoking, and alcohol and drug use. Occasional forms of DSH within the previous year were reported by 10.9% of the ninth-grade students. Four percent of the students reported repetitive forms of DSH. Suicidal behavior was strongly associated with repetitive DSH, an association that held for both subtypes of DSH. The findings also indicated that social background factors were important concomitants of occasional DSH but were not related to an increased likelihood of repetitive DSH. Symptoms of depression/anxiety and delinquent/aggressive behavior were associated with self-harming behavior in both adolescent girls and boys. The data suggest that there is a link between social factors and occasional DSH and, especially in repetitive DSH, that there is a strong association between DSH and suicidal behavior as well as DSH and emotional and behavioral problems. These findings indicate a different pathway in the development of DSH in adolescents. The results support a need to investigate the possible neurobiological underpinnings of DSH within a longitudinal model to enhance the knowledge of this poorly understood behavior.

Context and perspectives in adolescent health psychology.- A biopsychosocial perspective on adolescent health and disease.- Issues of diversity in adolescent health psychology: exploring sociocultural influences on adolescent health.- Socioeconomic influences on health and health behavior in adolescents.- Public health approaches to adolescent health beyond disease and illness.- Epidemiology of adolescent health.- Disease prevention in adolescence.- Determinants of health-related behaviors in adolescence.- Psychosocial stress, emotion regulation, and resilience in adolescents.- Mental literacy, mental health, and adolescents.- Advances in measurements and utilization of health-related quality of life instruments.- The Effects of physical activity on the physical and psychological health of adolescents.- Adolescent sexual assault: prevalence, risk associates, outcomes, and intervention.- Intimate partner violence in adolescent romantic relationships.- Continuity of behavior and parenting from childhood through adolescence.- School performance.- Brain development and health implications in adolescents.- Puberty: its role in adolescent maturation.- Adolescent sexuality and sexual behavior.- Intervention effectiveness research in adolescent health psychology: Methodological issues and strategies.- Training issues in adolescent health.- Reforming the behavioral health delivery system for adolescents: why is it needed and what is psychology's role?.- Confidentiality and care of the adolescent patient.- Treatment adherence in adolescents.- Smoking in adolescents.- Adolescent substance abuse.- Attention deficit/hyperactivity disorder in adolescence.- Social and biological changes during adolescence that precipitate the onset of antisocial behavior.- Personality disorders in adolescence.- Deliberate self-harm in adolescents.- Eating disorders in adolescents.- Anxiety in adolescents.- Depression and suicide-related behavior in adolescence.- Adolescents with intellectual disabilities.- Pregnancy in adolescents.- Sexually transmitted infections (STIs) and the developing adolescent: influences of and strategies to reduce STI acquisition.- HIV among adolescents in the United States.- Obesity in adolescents.- Cardiovascular complaints in adolescence: clinical considerations.- Asthma in adolescents.- Endocrine disorders in adolescents.- Musculoskeletal injuries in adolescents: a sports medicine model.- Headaches in adolescents.- Chronic pain in adolescents: physiological and psychological bases for pain.

This paper is a systematic review of the research literature that identifies psychological and psychosocial factors associated with adolescent deliberate self-harm (DSH). The aims of this review were to identify the key psychological and psychosocial factors that aid the identification of individuals at risk of DSH, and suggest specific strategies for intervention. Research has highlighted a parallel rise in rates of DSH referrals to general hospitals and rates of successful suicides in the younger age groups and gender groups. It is also highlighted that pressure on services in responding to these increases may be resulting in an inadequate response to both first-episode DSH and repetition of self-harm. One cause for concern is the lack of adequate psychosocial assessment for adolescents presenting at hospital following a DSH incident. Research of the literature suggests that there may be a paucity of research into after-care strategies in self-harm to prevent repetition and escalation of self-destructive behaviour. A systematic review of the literature was conducted to identify the psychological and psychosocial factors relating to DSH. Results. The results found typical psychological and psychosocial factors associated with DSH in adolescents, although psychosocial factors were less consistently measured because of the breadth of tools and methods used. It is discussed whether associated factors are causative of DSH or the accompanying symptoms in DSH. It is suggested that positive psychosocial factors may have a part to play in providing protection against DSH behaviour. Therapeutic responses to DSH are suggested as preventative measures against repeat episodes.

Few studies have examined the relation between suicide-related behaviors and Borderline Personality Disorder (BPD) in adolescent samples. The current study investigated the incremental validity of BPD relative to Major Depressive Disorder (MDD) for suicide-related behaviors in a psychiatric sample of adolescents at the cross-sectional level of analysis. The sample included N = 156 consecutive admissions (55.1% female; M age = 15.47; SD = 1.41), to the adolescent treatment program of an inpatient treatment facility. Of the sample 19.2% (n = 30) met criteria for BPD on the Child Interview for DSM-IV Borderline Personality Disorder and 39.1% (n = 61) met criteria for MDD on the Computerized Diagnostic Interview Schedule for Children-IV. Results showed that BPD conferred additional risk for suicidal ideation and deliberate self-harm. Our findings support the clinical impression that BPD should be evaluated in inpatient samples of adolescents either through intake interviews or more structured assessments.

Incidence and Course of Adolescent Deliberate Self-Harm in Victoria, Australia, and Washington State

Deliberate self-harm in adolescents: hopelessness, depression, problems and problem-solving

A large body of evidence suggests that adolescent mental health has worsened in recent years, particularly amongst young women. We investigated three putative risk factors which are very prevalent in the modern-day life of adolescents: social media use, sexting, and body dissatisfaction We wanted to investigate how these potential risk factors influence adolescents' mental health, and whether the effects differ between genders.We used a population-based survey of predominantly students (mean age 15 years) conducted in secondary schools in Ireland (September-December 2021) in one urban area (North County Dublin) and two rural areas (Cavan, Monaghan) - The "Planet Youth North Dublin, Cavan and Monaghan study". We examined three mental health outcomes (using the Strengths and Difficulties Questionnaire (SDQ)) and self-harm behaviours. We fitted linear mixed models to examine associations between risk factors and mental health outcomes in both genders separately, adjusting for confounders.All three risk factors were associated with poorer mental health in both genders, with larger effects in females. High social media usage (>4 hrs/day) was associated with increased poor mental health risk. Body dissatisfaction was linked to self-harm and worse mental health, being more prevalent in females (60% vs 36%). Sending sexually explicit messages was associated with poor mental health and self-harm risk in both genders.Our findings show that high digital use, body image disturbance and sexting behaviours in teenage life have a strong association with poor mental health and self-harm, with these factors being more prevalent in females.

Randomized Trial of Group Therapy for Repeated Deliberate Self-Harm in Adolescents

Psychologists, psychiatrists, doctors, and other associated professions, as well as the public from all over Europe have noticed the negative impact of the COVID-19 pandemic on mental health. In this regard, adolescents appear to be a highly vulnerable group, which is more affected than adults and children in many aspects. This study focuses on a specific and extremely maladaptive way of coping with mental stress and problems – deliberate self-harm. It offers an epidemiological study of the prevalence of self-harm among Slovak youths, its forms and related variables, carried out on a sample of 2,280 adolescents aged 11 – 19 using the SHI questionnaire. The results reveal that within the overall prevalence of 45.2%, the most vulnerable group are girls from non-traditional families who began to self-harm at an early age. The most frequent forms of self-harm among adolescents were torturing with self-defeating thoughts, followed by both direct and indirect forms of physical self-harm. An analysis of the willingness to disclose self-harming behaviour shows that the need to raise awareness of this behaviour should be mostly oriented towards adolescents.

Adolescence is a developmental period of significantly risk for self-harm (SH). This paper aims to analyse the associations between experiences of threat and submissiveness in childhood, positive and negative affect, fears of compassion and SH behaviours. Furthermore, it aims to explore the relative contribution of early experiences of threat and submissiveness, negative affect and fears of compassion to the prediction of the severity of SH. Participants were 831 adolescents, aged between 13-18 years old, from schools in centre region of Portugal. Results show that personal feelings of threat and submissiveness, negative affect, fear of compassion for self and gender significantly predict SH. These results suggest that adolescents with deliberate SH have not only difficulties in dealing with negative emotions, but also fear of compassion towards the self. These findings emphasize the potential value of incorporating self-compassion approaches and addressing the fears of compassion in the treatment of SH in adolescents.

Objective: This meta-analysis aimed to estimate the global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents. Methods: A systematic search for relevant articles published between 1989 to 2018 was performed in multiple electronic databases. The aggregate 12-month and lifetime prevalence of suicidal behavior, deliberate self-harm, and non-suicidal self-injury were calculated based on the random-effects model. Subgroup analyses were performed to compare the prevalence according to school attendance and geographical regions. Results: A total of 686,672 children and adolescents were included. The aggregate lifetime and 12-month prevalence of suicide attempts was 6% (95% CI: 4.7–7.7%) and 4.5% (95% CI: 3.4–5.9%) respectively. The aggregate lifetime and 12-month prevalence of suicidal plan was 9.9% (95% CI: 5.5–17%) and 7.5% (95% CI: 4.5–12.1%) respectively. The aggregate lifetime and 12-month prevalence of suicidal ideation was 18% (95% CI: 14.2–22.7%) and 14.2% (95% CI: 11.6–17.3%) respectively. The aggregate lifetime and 12-month prevalence of non-suicidal self-injury was 22.1% (95% CI: 16.9–28.4%) and 19.5% (95% CI: 13.3–27.6%) respectively. The aggregate lifetime and 12-month prevalence of deliberate self-harm was 13.7% (95% CI: 11.0–17.0%) and 14.2% (95% CI: 10.1–19.5%) respectively. Subgroup analyses showed that full-time school attendance, non-Western countries, low and middle-income countries, and geographical locations might contribute to the higher aggregate prevalence of suicidal behaviors, deliberate self-harm, and non-suicidal self-injury. Conclusions: This meta-analysis found that non-suicidal self-injury, suicidal ideation, and deliberate self-harm were the three most common suicidal and self-harm behaviors in children and adolescents.

In this study, it is aimed to examine this research from a wide perspective and to emphasize the importance of more specific studies on the subject. In this research, national and international studies on self-harm behavior were compiled. Self-injurious behavior is frequently encountered as an advanced behavioral problem. (Şipal, 2010) Self-injurious behavior is that a person can harm one's own tissues in such a way as to cause severe acts without the will to die consciously. Self-injurious behavior is associated with many psychiatric disorders. In addition, deliberate self-harm behavior should be separated from suicide attempts. Self-injurious behavior usually begins in adolescence. “In the community sample studies, it was found that self-injurious behavior was seen in 1/3 and 1/2 of adolescents (Lloyd-Richardson et al. 2007, Yates et al. 2008). self-injurious behavior typically begins in adolescence and often occurs impulsively; adolescents and young adulthood (Claassen et al. 2006) (Bildik, Somer, Basay, Basay, &amp;Ozbaran, 2012). According to the results of the study, identity confusion and low self-esteem symptoms were found to be significantly more frequent in adolescents with self-injurious behavior (Akdemir, Zeki, Unal, Kara, &amp; Cetin, 2013). It is observed that traumas experienced in the past are related to deliberate self-harm behavior. There are many reasons for self-harm behavior. One of them is abuse. If the trauma experienced is remembered, self-harm behavior arises in order to replace the high level of anxiety with physical pain. Miller and Favazza investigated the reasons for self-mutilation and listed the factors that caused self-mutilation as follows: To have a sense of relaxation; Suppressing emotional pain; Moving away from the feeling of emptiness to show their experiences.(Aksoy, Ögel, 2003). However, in individuals who frequently repeat the act of self-harm, feelings of embarrassment, guilt, regret, and desire for social isolation may also be exacerbated by the stimulation of other negative emotions. (Gratz, 2003) It has been suggested that there may be many biological factors under self-harm behavior. Some of them are opiate system disorder, hypersensitivity of dopamine receptors, decrease in the amount of serotonin. There are psychodynamic opinions about self-harm behavior. Emerson (1913) and Fenichel (1945) stated that self-harm behavior is a substitute for masturbation and is equivalent. Then, behaviorists related to self-harm behavior started to study. According to the behavioral approach, self-harm behavior was later learned and considered as a sense of self-protection against the difficulties of life. Intentional self-harm behavior is difficult to explain, but in recent years it has attracted attention by researchers (Chapman, Gratz, &amp; Brown, 2006). In line with the literature review on the subject, it is seen that the studies on this subject need to be more detailed and more specialized case groups should be examined.

BACKGROUNDPrevious studies have shown that personality traits are associated with self-harm (SH) in adolescents. However, the role of resilience in this association remains unclear. Our research aims to explore the hypothesized mediation effect of resilience in the relationship between personality traits and SH in Chinese children and adolescents.AIMTo evaluate resilience as a mediator of the association between personality traits and SH.METHODSA population-based cross-sectional survey involving 4471 children and adolescents in Yunnan province in southwestern China was carried out. Relevant data were collected by self-reporting questionnaires. Univariate and multivariate logistic regression models were employed to identify associated factors of SH. A path model was used to assess the mediation effect of resilience with respect to personality traits and SH association.RESULTSAmong the 4471 subjects, 1795 reported SH, with a prevalence of 40.1% (95%CI: 34.4%-46.0%). All dimensions of personality traits were significantly associated with SH prevalence. Resilience significantly mediated the associations between three dimensions of personality (extroversion, neuroticism, psychoticism) and SH, accounting for 21.5%, 4.53%, and 9.65%, respectively, of the total associations. Among all dimensions of resilience, only emotional regulation played a significant mediation role.CONCLUSIONThe results of the study suggest that improving emotion regulation ability might be effective in preventing personality-associated SH among Chinese children and adolescents.

Objective To examine the status of self-harm, depression and anxiety and to analyze the relation of self-harm with depression and anxiety in college students. Methods Totally 9 638 college students were randomly selected from five universities in Anhui province using stratified cluster sampling and were surveyed with basic demographic characteristics, Depression Self Rating Scale (SDS), Self-evaluation of Anxiety Scale (SAS) and self-harm behavior questionnaire. Results The detection rate of selfharm among college students was 22.94%(2 211), boys (24.51%) were higher than girls(21.72%), the difference was statistically significant (χ 2 = 10.46, P <0.05). The detection rate of depression was 28.57%(2 754). The detection rate of anxiety was 11.11% (1 071). The detection rate of self-harm in the depression group was 33.48%, which was significantly higher than those without depression group (18.72%) (χ 2 = 242.22, P <0.01). The similar results were found in the anxiety analysis, students with anxiety showed higher detection rate in self-harm (48.74%) than those without anxiety (19.72%) (χ 2 =453.66, P <0.01). Both depression and anxiety were positively associated with self-harm behaviors ( r = 0.24, 0.27, P <0.01). Multivariate Logistic regression model found that after covariates controlled, depression ( OR = 1.48) and anxiety ( OR = 2.84) were positively associated with self-harm of college students ( P <0.05). Conclusion Self-harm, depression and anxiety among college students in Anhui Province are at a high level, and a positive correlation between self-harm behaviors and depression and anxiety is observed. Attention should be paid to the mental health education of college students. 【摘要】 目的 了解安黴省大学生自伤行为与抑郁、焦虑症状现况及其相关性, 为减少大学生自伤行为发生提供理论依 据。 方法 采用分层整群抽样的方法, 对安黴省5所高校的9 638名在校大学生进行问卷调查, 问卷内容包括基本人口学 特征、抑郁自评量表（SDS)、焦虑自评量表（SAS)和自伤行为问卷等。 结果 9 638名大学生自伤行为检出率为22.94% (2 211名）, 男生（24.51%)高于女生（21.72%), 差异有统计学意义(χ 2 = 10.46, P <0.05);抑郁检出率为28.57%(2 754名）, 焦虑检出率为11.11%(1 071名）。抑郁组自伤行为的检出率为33.48%, 高于非抑郁组（18.72%), 差异有统计学意义(χ 2 = 242.22, P <0.01);焦虑组自伤行为的检出率为48.74%, 高于非焦虑组（19.72%), 差异有统计学意义(χ 2 =453.66,<0.01)。 抑郁、焦虑均与自伤行为存在正相关( r 值分别为0.24,0.27'值均<0.01)。多因素Logistic回归分析表明, 在控制其他相 关的影响因素后, 抑郁（ OR =1.48)及焦虑（ OR = 2.84)与大学生自伤行为发生呈正相关( P 值均<0.05)。 结论 安黴省大学 生自伤行为、抑郁和焦虑检出率不容乐观, 且自伤行为与抑郁、焦虑之间呈正相关。应重视对大学生的心理健康教育。