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

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.

Dear Sir, I am writing to add to the pertinent points raised by the article ‘Deliberate self-harm in adolescents’.(1) Beyond the role of primary care physicians and specialist care, parents and school counsellors can access a community-based mental health programme called REACH (Response, Early intervention and Assessment in Community mental Health)(2,3) to help children and adolescents cope with self-harm behaviours. This programme is available to all students from mainstream and special schools in Singapore. The REACH team comprises different allied health professionals such as psychologists, occupational therapists, registered nurses and medical social workers in each of the four teams (in accordance with the Ministry of Education’s school zoning). After obtaining important information on the students from the school counsellor and a detailed triaging process, REACH’s multidisciplinary team responds in a timely manner based on the severity of the mental health condition. With its strategic location in the community and away from hospitals, REACH epitomises the term ‘right-siting’ of healthcare. In cases where the self-harm behaviour is due to a serious mental illness, REACH is able to quickly refer the student to a child psychiatrist clinic for further evaluation and management. With this approach, patients do not face the stigma of having to visit psychiatric clinics and there is less strain on the tertiary psychiatric clinics. REACH was first developed in 2007 under the National Mental Health Blueprint and is now operated by three hospitals – the North and South teams are under the Institute of Mental Health, while the West and East teams are under the National University Health System and KK Women’s and Children’s Hospital, respectively. With the parents’ consent, staff from the REACH team visit the students’ school or home to conduct an assessment or intervention. As the first assessment is free of charge (subsequent interventions are chargeable) and interventions are conducted in school or at home, REACH’s service is attractive to both parents and students. A case conference with the school and the student’s parents is also conducted at the end of the assessment and before any interventions are started. REACH’s service is meant to be time-limited with clear continuity-of-care guidelines and discharge policies. REACH aims to administer secondary intervention while bringing mental health care closer to students.(4) With general practitioners and voluntary welfare organisation staff trained in basic child mental health joining REACH as community partners, we hope that a growing mental health network will eventually be set up in Singapore to provide more seamless and effective mental health care for our child and adolescent populations. Yours sincerely,

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

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

Depression as a mediator between frequent nightmares and non-suicidal self-injury among adolescents: a 3-wave longitudinal model

Deliberate self-harm (DSH) is a major healthcare problem in adolescents. Identification of targets for prevention and treatment requires ongoing monitoring of trends and characteristics of those involved. Using data from the Oxford Monitoring System for Attempted Suicide, we have examined trends and characteristics in adolescents aged 12-18 years presenting to a general hospital because of DSH between 1990 and 2000. The numbers of presentations by females increased during the study period. An association of DSH with school stress was suggested by there being fewer presentations during the school holiday periods, the largest number in term times occurring on Mondays, and study problems being common. Self-poisoning was involved in more than 90% of episodes. Paracetamol overdoses decreased following legislation on pack sizes of analgesics. Antidepressant overdoses increased during the study period, in keeping with the rise in prescriptions. Drug misuse increased markedly in the boys, as did a history of violence to others. Being a victim of violence increased in girls. Suicide intent was higher in males. Problems faced by the adolescents showed marked gender differences, and differed between age groups and between those carrying out their first DSH episode and repeaters. Clinical management of DSH in adolescents requires a range of responses, often involving multiservice and multidisciplinary input. Preventive initiatives in schools are also required.

IntroductionIntentional self-harm in adolescents and young people included both suicidal behaviors and nonsuicidal self-injury (NSSI) is a serious issue in mental health systems. However, the majority of studies on self-harm in adolescents and young people focused on quantitative methodology which might has limitations to explain this complex phenomenon of intentional self-harm.ObjectivesThis study aimed to describe the subjective experiences of adolescents and young people who presented with intentional self-harm in order to provide better understanding of this behavioral phenomenon.MethodsThis is an exploratory qualitative study used phenomenological processes and thematic analysis.ResultsTwenty subjects aged 13-29 years were included in this study. The results revealed 6 themes regarding predisposing child - rearing environments and 9 themes regarding factors related to cessation of intentional self-harm.- 6 themes regarding predisposing child - rearing environmentsLack of emotional responsiveness/emotional neglectNegativity, criticism and harsh punishmentHigh academic expectationsComparison with siblingsSuperficial responsivenessEnmeshment and over involvement- 9 themes regarding factors related to cessation of intentional self-harmNegative perception to self-harm and desire to stopIncrease of adaptive copingFinding life purposesImprovement of psychiatric symptomsSupportive relationships and verbalizationTreatments / interventionsUnwanted consequences of self–harmSituations related to positive feelingsBehavioral controlMoreover, this study demonstrated the important functions of self-harm as an intrapersonal strategy for emotional regulation.ConclusionsThis study underscored the importance to view self-harm as a complex phenomenon and it is essential to understand the developmental pathways as well as the pathways to cessation of these complex behaviors. Moreover, various internal and external factors related to cessation of intentional self-harm were demonstrated and verbalization in safe and supportive atmosphere tended to be an important process to promote the cessation or decrease of intentional self-harm.Disclosure of InterestNone Declared

BackgroundSuicide is the second leading cause of death in all youth and among adults with bipolar disorder (BD). The risk of suicide in BD is among the highest of all psychiatric conditions. Self-harm, including suicide attempts and non-suicidal self-injury, is a leading risk factor for suicide. Neuroimaging studies suggest reward circuits are implicated in both BD and self-harm; however, studies have yet to examine self-harm related resting-state functional connectivity (rsFC) phenotypes within adolescent BD.MethodsResting-state fMRI data were analyzed for 141 adolescents, ages 13–20 years, including 38 with BD and lifetime self-harm (BDSH+), 33 with BD and no self-harm (BDSH−), and 70 healthy controls (HC). The dorsolateral prefrontal cortex (dlPFC), orbitofrontal cortex (OFC) and amygdala were examined as regions of interest in seed-to-voxel analyses. A general linear model was used to explore the bivariate correlations for each seed.ResultsBDSH− had increased positive rsFC between the left amygdala and left lateral occipital cortex, and between the right dlPFC and right frontal pole, and increased negative rsFC between the left amygdala and left superior frontal gyrus compared to BDSH+ and HC. BDSH+ had increased positive rsFC of the right OFC with the precuneus and left paracingulate gyrus compared to BDSH− and HC.ConclusionsThis study provides preliminary evidence of altered reward-related rsFC in relation to self-harm in adolescents with BD. Between-group differences conveyed a combination of putative risk and resilience connectivity patterns. Future studies are warranted to evaluate changes in rsFC in response to treatment and related changes in self-harm.

Adolescent group may be prone to a variety of behavioral disorders, one of which is nonsuicidal self-injury (NSSI), NSSI intervention is limited for its unknown mechanism, so this study aimed to explore the factors associated with and pathological mechanism underlying NSSI from the perspective of family dysfunction, alexithymia, circRNA_103636 in a sample of Chinese adolescents. A total of 200 MDD adolescents with NSSI and 200healthy controls were enrolled via a convenient sampling method in clinical settings. The Family APGAR Index (APGAR), Toronto Alexithymia Scale (TAS-20), and Adolescent Nonsuicidal Self-injury Assessment Questionnaire (ANSSIAQ) were used for mental assessment of the study group and control group participants. Real-time quantitative reverse transcription PCR (qRT-PCR) was utilized to detect circRNA_103636 expression in peripheral blood mononuclear cells (PBMCs). There were significant between-group differences of 134 patients (67%) in the study group and 42 patients in the control group (21%) with moderate or severe family dysfunction (P<0.01). The APGAR score was lower, and the difficulty identifying feeling (DIF), difficulty describing feeling (DDF) and externally oriented thinking (EOT) scores of the TAS-20 and ΔCt value of circRNA_103636 were greater in the study group than in the control group. NSSI behavior and NSSI function were negatively correlated with the APGAR score and positively correlated with DIF, DDF, and the EOT of TAS-20 and the ΔCt value of circRNA_103636. Multiple regression analysis confirmed that EOT, circRNA_103636 expression, and APGAR were predictors of ANSSIAQ, which could explain 40.5% of the variance. Similarly, the alexithymia and circRNA_103636 expression mediated the correlation between family dysfunction and NSSI in the study group, and these mediating effects accounted for 27.25% and 23.33%, respectively, of the total effect. Taken together, family dysfunction, alexithymia, and circRNA_103636 expression have predictive effects on NSSI and alexithymia, circRNA_103636 expressions are mediators between family dysfunction and NSSI in Chinese adolescent. Here, we established a new model for NSSI in which exposure to family dysfunction could induce pathological process by modulating personality traits and epigenetic regulators.

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.