Urgent Need to Focus on Gender‐Diverse Adolescents in Mental Health Prevention Research: A Cross‐Sectional Comparative Study

Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) among youth are major public health concerns. Although a growing body of research has focused on the complex association between nonsuicidal and suicidal self-injury, the temporal relationship between these two classes of behaviors is unclear. The current study addresses this empirical gap by examining the course of SITBs in adolescents receiving outpatient (N=106; 82.1% female) and inpatient (N=174; 75.9% female) treatment. SITBs (co-occurrence, age-of-onset, and time lag between SITBs) and major psychiatric disorders were assessed at a single time point with well-validated structured interviews. Adolescents in both clinical samples reported high co-occurrence of SITBs: most adolescents reported both lifetime nonsuicidal self-injury (NSSI) and suicidal thoughts. A similar temporal pattern of SITBs was reported in the two samples: thoughts of NSSI and suicide ideation had the earliest age-of-onset, followed by NSSI behaviors, suicide plans, and suicide attempts. However, the age-of-onset for each SITB was younger in the inpatient sample than in the outpatient sample. In terms of time lag between SITBs, suicide ideation occurred on average before initial engagement in NSSI, suggesting that pathways to NSSI and suicidal behavior may occur simultaneously rather than in succession from nonsuicidal to suicidal self-injury. Results also indicated that the time to transition between SITBs was relatively fast, and that a key period for intervention and prevention is within the first 6-12months after the onset of suicidal thinking. Taken together, these findings have important implications for understanding the time-lagged relationship between nonsuicidal and suicidal self-injury.

Background: It is necessary to understand that self-harm is the most common behavior in both suicide and non-suicidal self-injury (NSSI) though those are not interrelated. Both result in physical damage to better or cope, whereas behaviors related to suicide are undertaken to end the capacity to feel at all by ending one’s life. Aim: The aim of the study was to explore NSSI behavior and emotional dysregulation among college students and find relationship between NSSI behavior and emotional dysregulation. Methods: A descriptive cross-sectional survey was carried out and total 896 college students were selected by multistage cluster sampling method from one district of Karnataka, India. The data was collected using FASM and DERS tool. Results: The study revealed that 21.9% of the participants were found to have NSSI behavior. Participants were having both minor behavior (66.84%) and severe behavior (71.94%) of NSSI. Mean age of onset of NSSI behavior was 16.88 years. The present study found significant relationship between NSSI behavior and emotional dysregulation (t value: 4.19, p value: <0.01). Participants were having emotional dysregulation with mean value of 100.32. International Journal of Scientific Research in Engineering and Management (IJSREM) Volume: 07 Issue: 10 | October - 2023 SJIF Rating: 8.176 ISSN: 2582-3930 © 2023, IJSREM | www.ijsrem.com DOI: 10.55041/IJSREM26329 | Page 2 Conclusion: The findings of the study show the need to increase the awareness and understanding of NSSIs and to plan targeted interventions among college youth. An information booklet on emotion regulation strategies was developed by the researcher to improve students’ knowledge and awareness. Keywords NSSI (Non-suicidal self-injury), Emotional dysregulation, FASM (Functional Assessment of Self-Mutilation) questionnaire, DERS (Difficulties in Emotional Regulation Scale)

Using the objectification theory, scholars have theorized the sense of detachment and disregard for the body that results from continued body objectification are believed to put a person at greater risk for non-suicidal self-injury (NSSI), due to a lack of emotional investment in the body. The goal of the current study was to longitudinally investigate the association between body objectification and NSSI among an early adolescent sample. The overall sample consisted of 120 participants (56 % female) who ranged in age from 11 to 13 years of age (M = 12.34, SD = .48). Participants were followed over the course of a 12-month period, and classified into three groups of interest; adolescents who reported maintaining NSSI behaviour over the course of a year (NSSI Maintain group, n = 20), adolescents who reported stopping the behaviour over the course of a year (NSSI Stop group, n = 40), and a comparison group of adolescents who did not report engaging in NSSI (n = 60). Using a 3 (NSSI Maintain, NSSI Stop, and Comparison) X 2 (Gender) X 2 (Time 1 and Time 2) repeated measures multiple analysis of variance (MANOVA), results indicated a significant group by time interaction, showing group differences with respect to body shame and body surveillance over time. Specifically, both NSSI groups reported significantly greater body shame and body surveillance over time than the non-NSSI group. Additionally, the NSSI Maintain group reported significantly greater body surveillance at T2 when compared to the NSSI Stop and non-NSSI group. The NSSI Maintain group also reported significantly more emotion dysregulation difficulties and depressive symptoms at T2 when compared to the NSSI Stop and non-NSSI group. The influence of body objectification as a core intrapersonal risk factor related to the maintenance and cessation of NSSI behaviour is discussed, as are clinical implications considering body objectification as an important variable in prevention and treatment efforts.

The lifetime prevalence of major depressive disorder (MDD) in adolescents is reported to be as high as 20%; thus, MDD constitutes a significant social and public health burden. MDD is often associated with nonsuicidal self-injury (NSSI) behavior, but the contributing factors including cognitive function have not been investigated in detail. To this end, the present study evaluated cognitive impairment and psychosocial factors in associated with MDD with NSSI behavior. Eighteen and 21 drug-naïve patients with first-episode MDD with or without NSSI (NSSI+/– group) and 24 healthy control subjects (HC) were enrolled in the study. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Adolescent Self-injury Questionnaire, Beck Scale for Suicide Ideation–Chinese Version (BSI-CV), Shame Scale for Middle School Students, Sensation Seeking Scale (SSS) and Childhood Trauma Questionnaire (CTQ) were used to assess depression-related behaviors, and event-related potentials (ERPs) were recorded as a measure of cognitive function. The latency of the N1, N2, P3a, P3b, and P50 components of ERPs at the Cz electrode point; P50 amplitude and P50 inhibition (S1/S2) showed significant differences between the 3 groups. CTQ scores also differed across three groups, and the NSSI– and NSSI+ groups showed significant differences in scores on the Shame Scale for Middle School Students. Thus, cognitive function was impaired in adolescents with MDD with NSSI behavior, which was mainly manifested as memory decline, attention and executive function deficits, and low anti-interference ability. We also found that childhood abuse, lack of social support, and a sense of shame contributed to NSSI behavior. These findings provide insight into the risk factors for MDD with NSSI behavior, which can help mental health workers more effectively diagnose and treat these patients.

The depression of college students requires psychological intervention based on clinical drug treatment. Group psychological counseling is an effective psychological intervention. This study aims to explore the effect of group psychological counseling on negative emotions and Nonsuicidal Self-injury (NSSI) behaviors of college students with depression. A total of 84 students with depression by screening diagnosis at Qingdao University in March 2018 were divided into the control group (n=42) and the intervention group (n=42). Students in the control group only received drug therapy, whereas the intervention group underwent group psychological counseling intervention based on drug therapy. A comparison between depression, self-injury behaviors, and sense of life purpose of the two groups before and after the intervention was performed. The post-test Self-Rating Depression Scale (SDS) standard score of students in both groups was significantly lower than the pre-test SDS standard score (P<0.05). The SDS standard scores of the post-test and the trace test in the intervention group were significantly lower than those in the control group (P<0.05). Compared with the pre-test value, the total scores in the Meaning in Life Questionnaire (MLQ) of the post-test in both groups significantly increased. The intervention group received significantly higher scores in the MLQ of the post-test and trace test compared with the control group (P<0.05). Both groups also received significantly higher scores in the post-test in the Quality System Audit (QSA) compared with the pre-test (P<0.05). The intervention group also received higher scores on the post-test and trace test in some dimensions in the QSA compared with those of the control group (P<0.05). Group psychological counseling intervention for college students with depression can alleviate their depressive symptoms, improve their sense of life meaning, reduce the risk of suicide, and control their NSSI behaviors.

Symptoms of depression increase during adolescence as do nonsuicidal self-injurious behaviors (NSSI). The present study aimed to investigate how self-criticism interacted with the effects of stressful life events on depressive symptoms and NSSI and whether self-compassion would buffer these negative effects. A total of 908 Chinese adolescents (Mage = 13.46, SD = 0.57) completed a cross-sectional survey. The main and interacted effects of stressful life events, self-criticism, self-compassion on depressive symptoms and NSSI were examined respectively. The results showed that self-criticism significantly moderated the relationships between stressful events and depression and NSSI. Self-compassion could buffer the negative impacts of stressful events and self-criticism on NSSI but not on depression. High self-compassion significantly reduced the magnitude of the association between stressful life events and NSSI in adolescents with low self-criticism but not in those with high self-criticism. Self-criticism exacerbated the negative impacts of stressful life events on both depressive symptoms and NSSI, but self-compassion only buffered the impact of stressful life events on NSSI. Interventions designed to reduce NSSI risk of Chinese adolescents may benefit from training them to improve self-compassion abilities and to be less self-critical.

In Australia, adolescent suicidal and non-suicidal self-injury (NSSI) behaviours have been steadily increasing over that past two decades. However, existing research on the geographic distribution of these behaviours in Australia largely focuses on adults, suicides, or uses pre-COVID-19 data. This study aimed to map and describe the geographic regions where ambulance attendances for adolescent suicidal and NSSI behaviours are occurring. Data from the National Ambulance Surveillance System were used to analyse three-year averages and per capita rates of ambulance attendances for adolescents (12-17 years) across local government areas in New South Wales (NSW), Victoria, and Tasmania from 2021 to 2023. The three-year annual average of ambulance attendances for adolescent suicidal behaviour and NSSI were 6,504 in NSW (35.94 per 10,000), 4,017 in Victoria (25.61 per 10,000), and 444 in Tasmania (44.86 per 10,000). Nearly 90% of attendances required transport to hospital, and over 50% occurred outside traditional service hours. Results identified that Major Cities and high socioeconomic status (SES) local government areas (LGAs), were significantly less likely to have higher rates of ambulance attendances for adolescent suicidal and NSSI behaviours. This study highlights substantial variability across three eastern states of Australia where adolescent suicidal and NSSI behaviours are occurring, demonstrating the need for accessible after-hours mental health support, and that regional and lower SES LGA's are disproportionately impacted. Given the concerning state of adolescent mental health in Australia, this study highlights the need for targeted, data-informed responses to reduce the current reliance on emergency care.

Despite the theoretical and empirical relevance of anxiety sensitivity (AS) to nonsuicidal self-injury (NSSI), few studies have investigated this association. This study examined the incremental validity of AS dimensions in NSSI frequency and versatility, above and beyond emotion dysregulation and relevant covariates (racial/ethnic background, negative affectivity). AS dimensions were expected to account for additional unique variance in NSSI outcomes. Participants included 204 patients (50.5% female) with substance use disorders in residential treatment. In this sample, 37.2% reported a history of NSSI. The hierarchical regression models revealed a unique positive association between AS social concerns and NSSI outcomes when adjusting for model variables. In contrast, AS physical concerns were uniquely negatively associated with NSSI outcomes. Findings provide support for AS social concerns as a vulnerability for engagement in NSSI behaviors and highlight this particular AS dimension as a potential treatment target for NSSI prevention and intervention programs.

Numerous studies revealed increased rates of mental health problems in veterinarians all over the world and a related higher risk in death by suicide. Several research has focused on the mental health status in veterinary medicine students and a recent publication from Germany reported a 4.2 times higher suicide risk for veterinary medicine students compared to the general population of the same age range. The aim of this study was to evaluate the prevalence of suicidality (suicidal ideation and suicidal attempts) in Austrian veterinary medicine students and to identify underlying risk factors. The hypothesis is that there is a high prevalence of suicidal behavior among Austrian veterinary medicine students as well as an association between high depression rates and suicidal behavior and a relation between non-suicidal self-injury (NSSI) and suicidal behavior. A total of 430 Austrian veterinary medicine students (29.11% of the total population of Austrian veterinary medicine students, 85.8% female, mean age 23.14years) filled out an online questionnaire regarding their mental health status, including symptoms of depression (PHQ-9), NSSI, and suicidal behavior (SBQ-R) between November 2022 and January 2023. In 55% of the evaluated questionnaires, students got above the cut-off for clinically relevant symptoms of depression, in 20.6% for suicidal behavior, and 31.2% reported non-suicidal self-injury. There was a 6.5 times higher risk to experience suicidal behavior for those who exceeded the cut-off for clinically relevant depressive symptoms and a 4.9 times higher risk for those who engaged in NSSI. Further findings of this study showed significant associations between loneliness, high stress, the (preferred) specialization in zoo- and wildlife medicine, and the male gender with suicidality. In conclusion, Austrian veterinary medicine students are at high risk for suicidal behavior especially when it comes to underlying mental health problems such as depression, NSSI, high stress, or experiencing loneliness.

This study explores the relationship model among the dark triad traits, non-suicidal self-injury (NSSI) behavior in adolescents, negative life events, and depression. A moderated mediation model was tested among 224 middle school students with left-behind experience in Inner Monolgia. These students were surveyed using the Dirty Dozen Dark Triad Measure, the Adolescent Self-Harm scale, the Adolescent Self—Rating Life Events Checklist, and the Center for Epidemiologic Studies Depression Scale. The dark triad traits had a significant positive predictive effect on NSSI behavior among adolescents with left-behind experience and indirectly influenced NSSI behavior through negative life events. The second half of the mediation path of “the dark triad traits → negative life events → NSSI behavior” was moderated by depression. The influence of the dark triad traits on NSSI behavior is exerted through negative life events, and the relationship between negative life events and NSSI behavior is moderated by depression.

ABSTRACTThis study used structural equation modeling to examine the relationships between emotion dysregulation, internalizing symptoms, nonsuicidal self-injury (NSSI), and suicide. One hundred forty-eight undergraduates completed a brief structured interview and self-report measures of emotion dysregulation, internalizing symptoms, and NSSI and suicidal behaviors. Results indicated a significant indirect effect of emotion dysregulation on NSSI via internalizing symptoms and on suicide attempts via NSSI. Findings provide a more nuanced understanding of the indirect association between emotion dysregulation and NSSI and suicidal behaviors. Implications for the potential utility of targeting internalizing symptoms as well as emotion dysregulation in interventions addressing NSSI and suicidal behaviors are discussed.

PurposeThis study aimed to present the methods for screening, monitoring, and intervening with patients at high risk for mental health issues with COVID-19 at residential treatment centers, which are isolation treatment facilities for COVID-19 patients.MethodsWe evaluated the mental health status of COVID-19 patients in three residential treatment centers. At admission and one day before discharge, patients received via their mobile a questionnaire containing one question each on anxiety, subjective psychological distress, post-traumatic stress symptoms, depression and suicidal ideation to identify those at high risk for mental health issues. High-risk patients and normal-risk participants who requested consultation were referred for psychological counseling. We evaluated the participants’ clinical and mental health characteristics and performed a logistic regression analysis to identify factors associated with worsened depression and suicide risk at discharge.ResultsOf 5,163 qualifying patients, 1,941 patients (37.6%) had their mental health assessed both at admission and discharge. In total, 661 persons (34.1%) required mental health support at admission and 648 persons (33.4%) at discharge. The patients at high risk for mental health issues at admission had an odds ratio of 5.31 (95% CI: 4.23–6.66) for depression at discharge, compared to those with normal mental health status at admission. The group that requested professional psychological counseling at admission showed an odds ratio of 2.33 (95% CI: 1.31–4.13) for depression at discharge.ConclusionsRepeated mental health monitoring is crucial for COVID-19 patients. Additionally, a flexible intervention strategy should be developed to implement different screening methods for patients at high risk for mental health issues, depending on the status of the COVID-19 epidemic and available resources.

Limited understanding exists regarding the neurobiological mechanisms underlying non-suicidal self-injury (NSSI) and suicide attempts (SA) in depressed adolescents. The maturation of brain network is crucial during adolescence, yet the abnormal alternations in depressed adolescents with NSSI or NSSI+SA remain poorly understood. Resting-state functional magnetic resonance imaging data were collected from 114 depressed adolescents, classified into three groups: clinical control (non-self-harm), NSSI only, and NSSI+SA based on self-harm history. The alternations of resting-state functional connectivity (RSFC) were identified through support vector machine-based classification. Convergent alterations in NSSI and NSSI+SA predominantly centered on the inter-network RSFC between the Limbic network and the three core neurocognitive networks (SalVAttn, Control, and Default networks). Divergent alterations in the NSSI+SA group primarily focused on the Visual, Limbic, and Subcortical networks. Additionally, the severity of depressive symptoms only showed a significant correlation with altered RSFCs between Limbic and DorsAttn or Visual networks, strengthening the fact that increased depression severity alone does not fully explain observed FC alternations in the NSSI+SA group. Convergent alterations suggest a shared neurobiological mechanism along the self-destructiveness continuum. Divergent alterations may indicate biomarkers differentiating risk for SA, informing neurobiologically guided interventions.

ObjectiveTo explore the mediating mechanism of intrusive rumination between social support and non-suicidal self-injury (NSSI) behavior in patients with depression.MethodsPatients with depression admitted to our hospital from September 2023 to February 2024 were selected as the study subjects. A questionnaire survey was conducted using the General Information Questionnaire, Intrusive Rumination Scale, Perceived Social Support Scale, and Ottawa Self-Injury Inventory (OSI). Pearson correlation analysis and structural equation modeling (SEM) were used to test the mediating effect.ResultsThe scores for intrusive rumination, total social support, and NSSI behavior in 120 depressed patients were (15.71 ± 2.13), (47.85 ± 4.69), and (16.35 ± 2.65), respectively. NSSI behavior was negatively correlated with the total social support score and its three dimensions (P< 0.05), and positively correlated with the total intrusive rumination score (P< 0.05). Intrusive rumination showed a mediating effect of 27.40% between social support and NSSI behavior.ConclusionSocial support can influence NSSI behavior in depressed patients by regulating intrusive rumination. It is crucial to emphasize the assessment of intrusive rumination in clinical practice to reduce the occurrence of NSSI behavior.

ABSTRACTS Objective The current study aimed to investigate the sociodemographic and psychological variables as well as the function of NSSI related to the cessation of NSSI by analyzing the difference between those currently engaged in nonsuicidal self-injury (NSSI) and those who have stopped NSSI behaviors. Methods A total of 490 adults with a history of NSSI (359 females) were assigned to one of two groups: NSSI engagement within the last 12 months or “current NSSI” (n = 402) vs. no episode of NSSI in the previous 12 months or “lifetime NSSI” (n = 88). Results There were no significant group differences in sex or socioeconomic status, while individuals with current NSSI were slightly younger than those who had ceased NSSI behavior. Regarding the functions of NSSI, the current NSSI group endorsed more intrapersonal functions. Moreover, the participants who had ceased NSSI behavior reported significantly less perceived stress, dysfunctional attitudes, alexithymia, emotion reactivity, and suicidal ideation. On the other hand, the lifetime NSSI group showed greater psychological resources such as self-esteem, distress tolerance, and resilience. Conclusions We revealed apparent differences in NSSI functions, clinical symptoms, and psychological resources depending on the maintenance and cessation of NSSI. This study highlights the need for a better understanding of the factors that stop as well as those that continue NSSI behaviors. HIGHLIGHTS The lifetime NSSI group reported more intrapersonal NSSI functions. The current NSSI group suffered from more clinical symptoms. Individuals who ceased NSSI had more psychological resources.