Preventing Non-Suicidal Self-Injury in Adolescents: The Signs of Self-Injury Program

Non-suicidal self-injury (NSSI) continues to be a problem among youth and there is a great need for programming aimed at reducing NSSI in adolescents. The signs of self-injury program is the first known NSSI school-based prevention program for adolescents that attempts to increase knowledge, improve help-seeking attitudes and behaviors, and decrease acts of NSSI. A total of five schools implemented the program in selected classrooms (n = 274 adolescents; 51.5% female, mean age = 16.07 years) that consisted of predominantly Caucasian (73%) adolescents. Researchers collected pre-post evaluation surveys of the program and feasibility interviews were conducted with the school guidance personnel who ran the program. Results indicated the prevention program did not produce iatrogenic effects, increased accurate knowledge and improved help-seeking attitudes and intentions among students. No significant changes were found in regards to self-reported formal help-seeking actions. Feasibility responses indicate the program is user-friendly and well received by school personnel. The data offer preliminary evidence that the program may be an effective prevention program for schools.     

Suicide Attempts and Self-Image Among Turkish Adolescents

The objective of this paper is to report on the role of self-image as an internal factor in suicide attempts of adolescents. Three groups of adolescents, suicide attempters (n = 33), nonsuicidal psychiatric outpatients (n = 50), and normal controls (n = 50), were administered Offer Self-Image Questionnaire, Beck Depression Inventory, Symptom Check List-90-R, and a socio-demographic questionnaire. The factors discriminating suicidal adolescents from the other 2 groups were increased number of siblings, being the older children, and negativity in the familial aspect of the self-image. The self-image factor was specific for suicidal girls but not for boys. Disturbance in the development of the self-image, especially in its relationship with other family members is an important risk factor in attempted suicides by female adolescents. This brings up the importance of including the family in the treatment of suicidal adolescents. None of the factors evaluated in this study are significant in attempted suicides by males. This point needs further research.     

Non-Suicidal Self-Injury and Depressive Symptoms During Middle Adolescence: A Longitudinal Analysis

Previous research has shown a consistent positive association between non-suicidal self-injury and depressive symptoms. However, the direction of the effects has not been examined. To understand whether non-suicidal self-injury predicts depressive symptoms or vice versa, we examined the relations between non-suicidal self-injury and depressive symptoms across three waves of self-report data collected 1 year apart from 506 Swedish adolescents (47 % girls; M age = 13.21; SD = .57) who were attending 7th grade at the onset of the study. The results suggest that depressive symptoms predict increases in non-suicidal self-injury 1 year later between the first and second waves of the study. Between the second and third waves of the study depressive symptoms and non-suicidal self-injury were significantly correlated indicating co-occurrence with no direction of effect rather than depressive symptoms predicting non-suicidal self-injury or vice versa. Group comparisons revealed no differences for boys and girls. The findings help clarify the relationships between non-suicidal self-injury and depressive symptoms during middle adolescence.     

Characteristics and Co-occurrence of Adolescent Non-Suicidal Self-Injury and Suicidal Behaviours in Pediatric Emergency Crisis Services

During the potentially tumultuous adolescent period, non-suicidal self-injury (NSSI) and suicide attempts are relatively common, particularly amongst youth who present to mental health services. These phenomena frequently co-occur but their relationship is unclear. This study evaluated clinical data from 468 youth between the ages of 12 and 17 years (63.5% female) to determine the incidence of NSSI 24 h prior to presentation at emergency crisis services, evaluated the overlap between NSSI and suicide attempt, and examined the characteristics of different types of self-harm. Half of the adolescents presenting to emergency crisis services had self-harmed within the previous 24 h, with most of these (91%) classified as NSSI only. The percentage of youth with a suicide attempt was 5% and the co-occurrence of these two behaviours was 4%. Group differences in depressive symptoms, suicidal ideation and impulsivity were identified, with the co-occurring NSSI and suicide attempt group presenting with the highest level of psychopathology. This study underscores the necessity of assessing suicidal ideation and NSSI in all youth presenting to mental health services.     

The Influence of Romantic Attachment and Intimate Partner Violence on Non-Suicidal Self-Injury in Young Adults

Several theoretical models for non-suicidal self-injury (NSSI) have been proposed. Despite an abundance of theoretical speculation, few empirical studies have examined the impact of intimate relationship functioning on NSSI. The present study examines the influence of romantic attachment and received intimate partner violence (physical, psychological and sexual) on recent reports of NSSI behaviors and thoughts. The sample was composed of 537 (79.9% female) primarily Caucasian university students between the ages of 18 and 25 years and currently involved in a romantic relationship. The results reveal that anxiety over abandonment was a significant predictor of NSSI thoughts and behaviors in women and a significant predictor of NSSI thoughts in men. Moreover, the experience of intimate partner violence emerged as a significant predictor of NSSI behaviors in both men and women. Continued empirical investigations into the influence of intimate relationship functioning on NSSI will facilitate the development of psychological interventions for young adults dealing with self-harm.     

The Role of Cognitive Distortion in the Relationship Between Abuse,Assault, and Non-Suicidal Self-Injury

The purpose of this study was to examine the relationship between childhood abuse, assault, cognitive distortion, and non-suicidal self-injury (NSSI) in a clinical adolescent sample. The sample included one hundred eighty-five psychiatrically hospitalized adolescents and their parents. Adolescent participants were predominantly female (71.4%), Caucasian (84%), and of non-Hispanic ethnicity (9.2%). Participants completed a diagnostic interview and self-report measures to assess youth history of abuse and assault, cognitive errors, negative self-views, and recent NSSI. No relationship was found between childhood abuse and NSSI. However, a history of assault was associated with NSSI among youth who reported higher cognitive errors and more negative self-views, even after controlling for gender and internalizing disorders. These results suggest that existing affect regulation models of NSSI may be enhanced by incorporating the role of cognitive distortion. Clinically, results also suggest that assessing adolescent victims of assault for cognitive errors and negative self-views, and helping them restructure these cognitive distortions when present, may reduce the likelihood of NSSI.     

Meaning in Life Moderates Relations between Personality and Temperament and Nonsuicidal Self-Injury in Hospitalized Adolescents

Journal of Youth and Adolescence - Previous research indicates that sensation seeking, emotion dysregulation, and impulsivity are predictive of non-suicidal self-injury (NSSI). A body of research...     

Eating Attitudes and Weight-Loss Attempts in Female Adolescents and Their Mothers

This study examined the relationship between mothers' eating attitudes and weight-loss attempts and their adolescent daughters' body dissatisfaction and weight-loss attempts. Two modes of transmission of mother's values to the daughter (modeling and encouragement) and two forms of weight-loss behavior (moderate and extreme) were examined. Female 10th and llth graders and their mothers completed eating attitudes and behaviors questionnaires. Daughter's moderate weight-loss attempts (e.g., dietary restraint and exercising) and its associated body dissatisfaction were significantly associated with mother's encouraging her daughter to lose weight. In contrast, daughter's more extreme weight-loss behaviors (e.g., fasting, crash dieting, and skipping meals) were predicted by mother's reports of her own body dissatisfaction and mother's use of extreme weight-loss behaviors herself. These effects were not simply an artefact of daughter's body weight. Implications for theory and prevention were noted.     

Epidemiology of Suicide Attempts among Youth Transitioning to Adulthood

Suicide is the second leading cause of death for older adolescents and young adults. Although empirical literature has identified important risk factors of suicidal behavior, it is less understood if changes in risk factors correspond with changes in suicide risk. To address this knowledge gap, we assessed if there were different trajectories of suicidal behavior as youth transition into young adulthood and determined what time-varying risk factors predicted these trajectories. This study used four waves of data spanning approximately 13 years from the National Longitudinal Study of Adolescent Health. The sample included 9027 respondents who were 12–18 years old (M?=?15.26; SD?=?1.76) at Wave 1, 50% male, 17% Hispanic, and 58% White. The results indicated that 93.6% of the sample had a low likelihood for suicide attempts across time, 5.1% had an elevated likelihood of attempting suicide in adolescence but not young adulthood, and 1.3% had an elevated likelihood of attempting suicide during adolescence and adulthood. The likelihood of a suicide attempt corresponded with changes on depression, impulsivity, delinquency, alcohol problems, family and friend suicide history, and experience with partner violence. Determining how suicide risk changes as youth transition into young adulthood and what factors predict these changes can help prevent suicide. Interventions targeting these risk factors could lead to reductions in suicide attempts.     

Contextual Socioeconomic Disadvantage and Adolescent Suicide Attempts: A Multilevel Investigation

Journal of Youth and Adolescence - Multilevel research on whether and how contextual socioeconomic disadvantage affects adolescent suicidal behaviors is scarce. Using data from the first two waves...     

Acculturative Stress,Perceived Discrimination,and Vulnerability to Suicide Attempts Among Emerging Adults

Cultural factors are often neglected in studies of suicidal behavior among emerging adults. The present study examined acculturative stress and perceived discrimination as statistical predictors of a suicide attempt history among an ethnically diverse sample of 969 emerging adults, ages 18–25 (M = 18.8). Females made up 68% of the sample, and the racial/ethnic composition included Asian, Latino, Black, and White (US-born and non-US-born) individuals. There were no statistically significant racial/ethnic differences in endorsement of a suicide attempt history, with an overall rate of 8% in the sample. Asian participants reported higher acculturative stress than all other racial/ethnic groups, while both Asian and Black participants reported having experienced more discrimination in the previous year, compared to other groups. Logistic regression analyses suggested that familial acculturative stress was associated with 2 times higher odds of endorsing a past suicide attempt, overall. More specifically, it was associated with over 2 times higher odds among Asian participants, over 4 times higher odds among Black participants, and over 3 times higher odds among non-US-born White participants, while social acculturative stress was associated with over 3 times higher odds of endorsing a past suicide attempt among Latino participants. Environmental acculturative stress was associated with decreased odds of endorsing a suicide attempt history, overall, but not when examined separately by racial/ethnic group. Perceived discrimination was associated with over 5 times higher odds of a suicide attempt, overall, and specifically was associated with over 3 times higher odds among Latino participants and over 10 times higher odds among White, US-born participants. These findings suggest the importance of addressing culturally-related variables in treatment with emerging adults of racially/ethnically diverse backgrounds to reduce risk for suicidal behavior.     

The Role of Exposure to Self-Injury Among Peers in Predicting Later Self-Injury

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.     

Distress Intolerance Mediates the Relationship between Child Maltreatment and Nonsuicidal Self-Injury among Chinese Adolescents: A Three-Wave Longitudinal Study

Nonsuicidal self-injury (NSSI) is a serious public health concern among adolescents. Identifying risk factors of NSSI is important to effectively prevent or reduce such behavior. Child maltreatment is one of the most widely recognized risk factors for NSSI. How child maltreatment and NSSI is related, however, is still unclear. The present study tested the temporal relationship between physical and emotional abuse and NSSI, with distress intolerance as the potential mediator. Potential gender differences on these associations were also tested. We assessed all study variables among 2259 Chinese adolescents (53.8% females; M_age?=?15.11 years, SD?=?1.57) for three times at 6-month intervals. The results showed that distress intolerance only mediated the relationship between emotional abuse and NSSI, but not between physical abuse and NSSI. In addition, this mediation effect of distress intolerance was significant only for females. The findings of this study can help researchers and practitioners understand pathways by which child maltreatment impacts adolescent NSSI. Implications for preventions and interventions of NSSI were discussed.     

Gender Differences in Strains Associated with Suicidal Behavior Among Adolescents

Scholars such as Durkheim and Chodorow have argued that the social strains contributing to suicide vary by sex. Specifically, it has been asserted that women relative to men either do not respond to social strain with suicide, or respond to relational but not status strains. Conversely, others assert that process differences never existed, or at the least have dissipated with increasing equality between the subgroups. Neither side has offered convincing empirical evidence for their position. This study examines social strains contributing to suicidal behavior among adolescents, by sex, to address this debate. Results clearly support the presence of process differences and delineate the specific nature of these differences. Generally, males and females are responsive to both status and relational strains. However, theoretical models suggesting males are more status oriented whereas females are more relationally dependent are supported. Results hold theoretical and interventionist implications for the contextual nature of suicide among adolescents.     

The Mediating Roles of Stress and Maladaptive Behaviors on Self-Harm and Suicide Attempts Among Runaway and Homeless Youth

Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and psychosocial background characteristics and self-injurious outcomes through the lens of the stress process paradigm. The model was tested in a sample of runaway and homeless youth from Los Angeles County (N = 474, age 12–24, 41 % female, 17 % White, 32.5 % African American, 21.5 % Hispanic/Latino). Background variables (gender, age, sexual minority status, parental drug use history, and emotional distress) predicted hypothesized mediators of maladaptive behaviors and recent stress. In turn, it was hypothesized that the mediators would predict self-harming behaviors and suicide attempts in the last 3 months. Females and LGBT (lesbian, gay, bisexual, transgender) youth were more likely to have self-harmed and attempted suicide; younger participants reported more self-harming. The mediating constructs were associated more highly with self-harming than suicide attempts bivariately, although differences were modest. Maladaptive behaviors and recent stress were significant predictors of self-harm, whereas only recent stress was a significant predictor of suicide attempts. All background factors were significant predictors of recent stress. Older age, a history of parental drug use, and greater emotional distress predicted problem drug use. Males, younger participants, and participants with emotional distress reported more delinquent behaviors. Significant indirect effects on self-harming behaviors were mediated through stress and maladaptive behaviors. The hypothesized paradigm was useful in explaining the associations among background factors and self-injurious outcomes and the influence of mediating factors on these associations.     

Positive Daily Family Interactions Eliminate Gender Differences in Internalizing Symptoms Among Adolescents

By the age of 18, girls are more than twice as likely as boys to experience internalizing symptoms. Focusing upon the family, a significant factor for adolescent mental health, we examined how positive and negative daily family interactions relate to gender differences in internalizing symptoms. 681 12th grade students (54 % female) completed diary checklists each night for 2 weeks in which they indicated whether they got along with their family (positive family interactions) and argued with their family (negative family interactions). Results indicate that negative daily family interactions explain, in part, why females experience heightened internalizing symptoms. Yet, even in the face of negative family interactions, positive daily family interactions have salutatory effects, reducing females’ emotional distress and eliminating gender differences in internalizing symptoms at high levels of positive interactions. These findings underscore the importance of positive family interactions for adolescent girls’ mental health.     

Ethnic Differences in Trajectories of Family Cohesion for Mexican American and Non-Hispanic White Adolescents

This study examined gender, family structure, SES and language usage as predictors of cultural orientation and family cohesion. Ethnic differences in trajectories of family cohesion were tested within a hierarchical linear modeling framework. The sample consisted of 4156 adolescent respondents, measured at three time points during three consecutive years. The three study groups consisted of Mexican Americans oriented to Mexican culture (N = 738), Mexican Americans oriented to majority American culture (N = 867), and Non-Hispanic Whites (N = 2551). Family cohesion was assessed using the cohesion subscale of the Family Adaptability and Cohesion Scale (FACES III). Analyses consisted of hierarchical linear modeling (HLM) in which a linear trajectory of family cohesion for the three groups was computed followed by a test for the effects of ethnicity with the inclusion of control variables. Thus, ethnic differences in the trajectories of family cohesion over time were examined. Neither group of Mexican Americans was significantly different from Non-Hispanic Whites in initial status. However, Mexican Americans oriented to Mexican culture showed a significant increase in family cohesion at mid adolescence. Judith C. Baer is an Associate Professor at Rutgers University. She received her Ph.D. in Social Work from the University of Houston. Her major research interests include the study of adolescent development within the contexts of culture, and family, adolescent sexual risk taking, and the nosology of mental disorders. Mark F. Schmitz is Clinical Assistant Professor at Temple University. He received his Ph.D. in sociology at Iowa State University. His major research interest involves the use of several large epidemiologic datasets for an extensive examination of the empirical basis for the diagnostic criteria of various DSM-IV mental disorders. He also is involved in research on cultural issues in child development and family processes.     

Different Trajectories of Depressive Symptoms in Children and Adolescents: Predictors and Differences in Girls and Boys

The development of depressive symptoms in childhood and adolescence can follow different pathways. This study examined heterogeneity in the development of self-reported depressive symptoms and the predictive influence of mothers’ depressive symptoms, the number of life events, and loss events via growth mixture modeling over a four-year period in a large community sample of German children and adolescents (N = 3,902; mean age 11.39 years; 49.6 % female). This procedure was conducted for the total sample as well as for separate samples of girls and boys. Four different classes of trajectories for the total and the girls’ model were identified, but only three classes for the boys. Girls showed higher intercepts and stronger increases in symptoms over time, whereas boys displayed stronger decreases. In the total model, mothers’ depressive symptoms and the number of life events significantly increased the level of depressive symptoms. In the gender models, only mothers’ depressive symptoms showed significant influence on the level of symptoms in girls and boys, whereas for life events this was only true for boys. In every model, the significant predictors discriminated at least between some classes. Loss events showed no significant influence in any model. In sum, there are meaningful differences in the development of depressive symptoms in girls and boys. These results have several implications for prevention and future research.