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Nonsuicidal Self-injury in Asian Versus Caucasian University Students: Who, How, and Why?
Abstract
The correlates of nonsuicidal self-injury (NSSI) among Asian and Caucasian university students; differences in the rates, frequency, forms, severity, and emotional contexts of NSSI among self-injuring students; and whether Asian students who are highly oriented toward Asian culture differed from those less oriented toward Asian culture in NSSI characteristics were investigated. University students (N = 931), including 360 Caucasian students (n = 95, 26.4%, with a history of ≥ 1 episode of NSSI) and 571 Asian students (n = 107, 18.7%, with a history of NSSI), completed questionnaires assessing NSSI, acculturation, and putative risk factors for NSSI. Caucasian students were more likely to report NSSI, particularly cutting behavior, self-injured with greater frequency and versatility, and reported greater increases in positively valenced, high arousal emotions following NSSI, compared to Asian students. Among Asian students, obsessive–compulsive symptoms, experiential avoidance, and anger suppression increased the likelihood of reporting a history of NSSI. Among Caucasian students, lack of emotional clarity and anger suppression increased likelihood of NSSI. Finally, some tentative findings suggested potentially important differences in rates and frequency of NSSI among Asian students who were highly oriented toward Asian culture compared with those less oriented toward Asian culture.
... Seven research groups published 12 studies that examined the association between NSSI and experiential avoidance among university students (Anderson, 2009;Anderson et al., 2018;Anderson and Crowther, 2012;Bentley et al., 2015;Gratz et al., 2010;Greene et al., 2019;Haywood et al., 2022;Horgan and Martin, 2016;Liu et al., 2021;Singhal et al., 2021;Steele, 2017;Turner et al., 2015). Experiential avoidance was positively associated with NSSI (Anderson et al., 2018;Anderson and Crowther, 2012;Gratz et al., 2010;Haywood et al., 2022;Horgan and Martin, 2016;Liu et al., 2021;Turner et al., 2015). ...
... Seven research groups published 12 studies that examined the association between NSSI and experiential avoidance among university students (Anderson, 2009;Anderson et al., 2018;Anderson and Crowther, 2012;Bentley et al., 2015;Gratz et al., 2010;Greene et al., 2019;Haywood et al., 2022;Horgan and Martin, 2016;Liu et al., 2021;Singhal et al., 2021;Steele, 2017;Turner et al., 2015). Experiential avoidance was positively associated with NSSI (Anderson et al., 2018;Anderson and Crowther, 2012;Gratz et al., 2010;Haywood et al., 2022;Horgan and Martin, 2016;Liu et al., 2021;Turner et al., 2015). Anderson and Crowther (2012) and Greene et al. (2019) reported that participants with a history of NSSI reported higher scores on measures of experiential avoidance than those with no history of NSSI. ...
... Anderson and Crowther (2012) and Greene et al. (2019) reported that participants with a history of NSSI reported higher scores on measures of experiential avoidance than those with no history of NSSI. Turner et al. (2015) reported positive associations between experiential avoidance and NSSI among Asian and Caucasian participants, but these were only significant among Asian participants. Likewise, Horgan and Martin (2016) reported significant differences in experiential avoidance among individuals who had recently engaged in NSSI and those who had no history of NSSI, as well as individuals with a current history of NSSI and individuals had previously engaged in NSSI. ...
Objectives
Non-suicidal self-injury (NSSI) is the intentional and deliberate damage to an individual's own body tissue without the intent to suicide. Individuals who have higher self-reported levels of experiential avoidance are more likely to report a history of NSSI. The current study systematically reviewed the literature and meta-analysed studies assessing associations between experiential avoidance and self-injury.
Method
An extensive review was conducted of several databases (including ProQuest, Joanna Briggs, Web of Science, PsychArticles, PubMed, Scopus, and Ovid). Eighteen articles (two dissertations) met the inclusion criteria for the systematic review and 14 were analysed in a Robust Bayesian Meta-analysis. This review was registered through PROSPERO (CRD42020198041).
Results
There was a small to medium, pooled effect size (d = 0.48, 95 % Credibility Interval 0.00–0.85). There was strong evidence for this effect size (Bayes Factor = 12.16), although there was considerable heterogeneity between studies (τ =0.68, 95 % CI [0.44, 0.1.05]). The analysis testing whether these findings may be due to publication bias was inconclusive (Bayes Factor = 2.45).
Limitations
The majority of studies included were cross-sectional, in English, and most studies were of university students. While some studies reported on recency/frequency of NSSI there was not enough data to conduct meta-analysis.
Conclusion
These results suggest there is a robust association between history of NSSI and experiential avoidance. However, as most studies operationalise avoidance as a unidimensional construct, it is not clear which aspects of avoidance differentiate individuals with and without a history of NSSI.
... Os estudos disponíveis mostram que as dificuldades de confiança, comunicação e alienação com os pais estão associadas à ideação suicida, comportamentos autolesivos sem finalidade suicida e tentativas de suicídio em adolescentes da Bélgica 10 e jovens do Canadá 11 . No entanto, esses resultados diferem em adolescentes da Noruega 12 e adultos jovens do Canadá de origem asiática e caucasiana, nos quais não se observa relação entre essas variáveis 13 . As associações nesses estudos são divergentes para a figura parental. ...
... No entanto, em adolescentes noruegueses não foi encontrada associação com tentativas de suicídio (OR = 0,98; IC 95% 0,94-1,03) 12 . Da mesma forma, em estudantes universitários com sintomas depressivos entre 17 e 54 anos de origem caucasiana e asiática, não foi observada associação entre a comunicação com os pais em geral e comportamentos autolesivos em asiáticos (OR = 1,00; IC95% 0,94-1,07) ou caucasiano (OR = 1,04; IC 95% 0,96 -1,12) 13 . ...
... Em várias investigações, as dimensões do apego estão associadas a problemas comporta-mentais e emocionais em adolescentes 27 , bem como a comportamentos suicidas. No entanto, existem restrições para comparar nossos resultados de forma precisa e ampla, pois os estudos sobre a dimensionalidade do apego e dos comportamentos suicidas não consideram o risco de suicídio, mas sim os comportamentos autolesivos ou tentativas de suicídio [10][11][12][13] . Em geral, a confiança, a comunicação com a mãe e o pai mostram-se relevantes em diferentes investigações sobre comportamentos suicidas, mesmo quando ajustadas por variáveis como não morar com pais biológicos, intoxicação pelo consumo de álcool e sintomas depressivos 12 , além de variáveis como confusão de identidade 10 , gênero e vitimização 14 . ...
RESUMO Objetivo: Estabelecer a associação entre as dimensões de apego e o risco de suicídio em universitários colombianos. Método: Um estudo transversal foi desenvolvido com estudantes universitários de Santa Marta na Colômbia, que completaram o inventário de anexos da Armsden & Greenberg e a escala de risco de suicídio da Plutchik. Resultados: Participaram da pesquisa 142 estudantes entre 16 e 20 anos (M = 17,7, DP = 1,0), dos quais 54,2% eram mulheres, 42,3% dos estudantes apresentaram baixa confiança com a mãe, 38% possuíam pouca comunicação com a mãe, 30,3% alta alienação com a mãe, 41,5% baixa confiança com o pai, 50,7% baixa comunicação com o pai, 33,8% alta alienação com o pai e 14,8% alto risco de suicídio. Após ajuste para vitimização, as variáveis má comunicação com a mãe (OR = 4,54, IC95% 1,58-12,5), alienação com a mãe (OR = 3,28, IC95% 1,22-8,83) e baixa confiança no pai (OR = 4,54, 95 IC% 1,55-12,6) foram associados ao suicídio de alto risco. Conclusões: Baixa comunicação da mãe, alta alienação da mãe e baixa confiança do pai estão associadas a alto risco de suicídio em estudantes universitários colombianos. Novos estudos são necessários. ABSTRACT Objective: Establish the association between attachment dimensions and suicidal risk in college students of Colombia. Method: A cross-sectional study was designed with college students from Santa Marta, Colombia, who completed the Armsden & Greenberg attachment inventory and the Plutchik suicide risk scale. Results: a total of 142 students between 16 and 20 years old participated in the research (M=17.7, SD=1.0), where 54.2% were women, 42.3% of students showed low confidence in the mother, 38% low communication with the mother, 30.3% high alienation with the mother, 41.5% low confidence in the father, 50.7% low communication with the father, 33.8% high alienation in the father and 14.8% high suicide risk. After adjusting for victimization, the variables poor communication with mother (OR=4.54, 95%CI 1.58-12.5), alienation with the mother (OR=3.28, 95%CI 1.22-8.83) and low confidence with the father (OR=4.54, 95%CI 1.55-12.6) were associated with high risk suicide. Conclusions: Low communication in the mother, high alienation with the mother and low confidence in the father are associated with high suicidal risk in Colombian college students. New studies are needed.
... Studies show divergent associations between trust, communication and alienation, and suicidal behaviors in adolescents. Some authors reported a significant association between trust and communication with parents and suicidal ideation or self-injurious suicidal or non-suicidal behaviors [18][19][20] , however, others found independence between these variables 20,21 . Nature is different in forms of suicidal behavior 22 , therefore, the study of the attachment dimensions and the suicide risk is relevant in the face of scarce empirical evidence. ...
... The complex configuration of factors predicting suicidal behavior requires consideration of mediating variables in the absence of association 4 . In the same way, it is important to recognize the cultural characteristics in the attachment formation, due to the different parenting patterns that modify trust, communication, and alienation between parents and children 21 . ...
Attachment is considered an important element in mental health, however, the relationship between attachment dimensions and suicidal risk has been little studied. Objective: To establish the association between trust, communication, and alienation and suicide risk in Colombian school adolescents. Subjects and Method: A cross-sectional observational study with an analytical component was designed in a randomized sample of 399 school adolescents (n = 1,901), according to a 30% prevalence of high suicide risk, members of the official educational institutions of Santa Marta (Colombia), the commune with the highest index of unsatisfied basic needs. Participants completed the Armsden & Greenberg attachment inventory and the Plutchik suicide risk scale, both validated locally. Reliability and association tests were calculated. Results: Adolescents were 339 adolescents between 13 and 19 years of age (M = 15.7, SD = 1.1), 57.8% were women. 59.9% of adolescents showed low trust in the mother, 57.2% low communication with the mother, 54.9% low alienation with the mother, 46.3%, low trust in the father, 49% low communication with the father, 48.7% low alienation with the father, and 28.6% high suicide risk. There was an association (adjusted) between high suicide risk and trust in the mother (OR = 2.00, 95%CI 1.12-3.57), communication with the mother (OR = 3.80, 95%CI 2.13-6.75), trust in the father (OR = 2.39, 95%CI 1.41-4.03), and communication with the father (OR = 2.01, 95%CI 1.19-3.37). Conclusions: Low trust and low communication with mother and father are risk factors for high suicide risk in Colombian school adolescents. Further research on this association in other populations is needed, as well as to consider other mediating factors.
... These studies also suggest that non-Hispanic white and Hispanic students may not appreciably differ in NSSI prevalence (Eisenberg et al., 2013;Kuentzel et al., 2012;Wester & Trepal, 2015). Some research suggests that Asian students have a lower prevalence of NSSI than non-Hispanic white students (Turner, Arya, & Chapman, 2015;Wester & Trepal, 2015), although other studies have failed to find this effect (Eisenberg et al., 2013;Kuentzel et al., 2012). Beyond simple prevalence of NSSI across groups, cultural experience may also moderate the impact of various risk factors for NSSI. ...
... Among individuals engaging in NSSI, research on how racial and ethnic identity relate to NSSI characteristics and course is less common, but suggestive of intriguing possibilities for further development of theoretical models underlying NSSI. For example, university students of Asian descent who reported high orientation towards Asian cultural norms reported, on average, less severe NSSI (i.e., lower frequency, fewer methods), compared to those who reported lower orientation towards Asian cultural norms (Turner et al., 2015). Although these findings are specific to Canada and the population sampled, they highlight the important role of cultural values, norms, and preferences in the development and maintenance of NSSI. ...
... Los estudios muestran asociaciones divergentes entre la confianza, comunicación y alienación y los comportamientos suicidas en adolescentes. Algunos auto-res informaron asociación significativa entre confianza y comunicación con padres e ideación suicida o comportamientos autolesivos con o sin fines suicidas [18][19][20] ; no obstante, otros hallaron independencia entre esas variables 20,21 . ...
... La compleja configuración de factores predictores de los comportamientos suicidas requiere considerar variables mediadoras ante la ausencia de asociación 4 . De la misma forma, es importante reconocer las características culturales en la formación del apego, debido a los diferentes patrones de crianza que modifican la confianza, comunicación y alienación entre padres e hijos 21 . ...
Introducción:
Los vínculos de apego se consideran un elemento importante en la salud mental; sin embargo, se ha estudiado poco la relación entre las dimensiones apego y el riesgo suicida.
Objetivo:
Establecer la asociación entre la confianza, comunicación y alienación y el riesgo suicida en adolescentes escolari zados de Colombia.
Sujetos y Método:
Estudio observacional de corte transversal con componente analítico, en una muestra aleatorizada de 399 adolescentes escolarizados (n = 1.901), según prevalencia de alto riesgo de suicidio del 30%, pertenecientes a las instituciones educativas oficiales de Santa Marta (Colombia), comuna con mayor índice de necesidades básicas insatisfechas. Los participantes completaron el inventario de apego de Armsden & Greenberg y la escala de riesgo suicida de Plutchik, ambas validadas localmente. Se calcularon pruebas de confiabilidad y asociación.
Resultados:
Los adolescentes tenían entre 13 y 19 años (M = 15,7; DE = 1,1), el 57,8% mujeres. El 59,9% presentó baja confianza con la madre, 57,2% baja comunicación con la madre, 54,9% baja alienación con la madre, 46,3%, baja confianza con padre, 49% baja comunicación con el padre, 48,7% baja alienación con el padre y el 28,6% alto riesgo suicida. Se encontró asociación (ajustada) entre el alto riesgo de suicidio y la confianza con la madre (OR = 2,00; IC95% 1,12-3,57), comunicación con madre (OR = 3,80; IC95% 2,13-6,75), confianza con padre (OR = 2,39 IC95%; 1,41-4,03) y comunicación con el padre (OR = 2,01; IC95% 1,19-3,37).
Conclusión:
La baja confianza y baja comunicación con madre y padre son factores de riesgo para el alto riesgo suicida en adolescentes escolarizados de una ciudad colombiana. Es necesario ampliar la investigación de esta asociación en otras poblaciones, así como considerar otros factores mediadores.
... Parenting styles found within Eastern and Western cultures may differ such that Eastern parents may consider it more acceptable to criticize their children (Chao and Tseng, 2002). Moreover, previous studies have indicated that the quality of parent-child relationships is more strongly associated with NSSI among Asians than Caucasians (Turner et al., 2015). It is therefore possible that the relationship between parental criticism and NSSI will be less robust in Western samples. ...
... Furthermore, the majority of these previous studies were based on data collected from Chinese adolescents. Researchers have found stronger associations between parent-child relationship quality and NSSI among Asians compared to Caucasians (Turner et al., 2015). Moreover, it may be the case that Eastern parents consider it more acceptable to criticize their children than Western parents (Chao and Tseng, 2002). ...
... NSSI related studies from non-Western cultures have begun to emerge after 2010 [9][10][11]. Given the common emotional susceptibility and vulnerability of adolescence, the prevalence and after-effects of NSSI have become equally serious in China [12,13]. ...
Background
This study was designed to investigate potential gender differences in the interrelations between different types of stressful life events and non-suicidal self injury (NSSI) among Chinese youth, as well as to test the direct and moderating impacts of online social support on Chinese students’ NSSI engagement under the pressure of different types of stressful life events.
Methods
Based on the data of 2200 students from middle - highschools and universities in Northwestern China, gender difference (male/female binary) in stressful life events, online social support, NSSI and their correlations were analyzed in the study.
Results
Among different types of stressful life events, male students were reported to experience a significantly higher impact of punishment and interpersonal relationship than females. Female students only experienced significantly higher learning pressure than males; Gender difference was not indentified in NSSI among youth; Stressful life events related to punishment could significantly predict NSSI engagement among males. Stressful life events related to learning pressures, interpersonal relationships, and adaption were significantly correlated to NSSI engagement among females; Online social support didn’t had a significant direct effect on youth’s NSSI, although it did significantly moderate the relationship between specific types of stressful life events (i.e., loss, interpersonal relationships, adaption among males and all types among females) and their NSSI.
Conclusion
The present study has provided evidence of specified types of stressful life events being risk factors in affecting youth’s NSSI: For male students, the higher impacts of stressful life events related to punishment they experienced, the more likely they were about to engage in NSSI. For female students, stressful life events related to learning pressure, interpersonal relationships and adaption were all proved as significant predictors and risky factors of female youth’s NSSI; Online social support did not impact on individual’s NSSI engagement directly, but moderated it significantly as a protective factor.
... For instance, NSSI patients showed a significantly higher level of innerdirected anger compared to no-NSSI groups . The suppression of angry feelings (i.e., redirect anger inwardly) was also found to increase the likelihood to engage in NSSI among both Caucasian and Asian students (Turner, Arya, & Chapman, 2015). ...
Objective:
Parental rejection, poor self-concept, anger expression, and negative body investment have often been associated with non-suicidal self-injury (NSSI). However, research has investigated each factor separately. To address this shortcoming, the main aim of the study was to integrate these factors and test a hierarchical regression to examine the impact of each factor above and beyond the others.
Method:
A cross-sectional sample of 481 Italian high school students aged 13-19 (Mage=15.48; SD=1.46) were screened by self-report measures that assess parental rejection, self-concept, anger expression, body emotional investment, and NSSI. A semi-structured interview was administered in order to assess the characteristics of self-injurious behaviors.
Results:
After the interview, twenty-three (4.8%) students reported having engaged in NSSI (Mage =12.63; SD=1.58). Neither gender nor age differences were found. The hierarchical regression revealed the NSSI was associated with the inward expression of anger (ORs=1.1-1.7) and the negative body investment (ORs=.037-.281).
Conclusions:
These findings point out that the expression of anger inwardly and the emotional investment in the body may be salient factors to consider in understanding the occurrence of NSSI among adolescents. The clinical relevance of these findings was discussed.
... For example, China, a developing Eastern country, has significantly different cultural and social value characteristics to those of developed Western societies; this will likely introduce a unique set of risk factors for NSSI. Previous research showed cultural factors might significantly impact the meanings, risk factors, and gender differences in NSSI (20), and research is required to investigate such culturally specific risks and protective factors of NSSI (21). Moreover, the mental health field in China began relatively late, in both clinical and educational settings. ...
Background: Adolescent non-suicidal self-injury (NSSI) is becoming a serious public health concern worldwide. In recent years, there has seen a significant increase in both the growth rate and cases of NSSI in Eastern countries, such as Japan, India, and China. In China, most schools have a mental health office that comprises mental health professionals (MHPs), who are the first to respond to student mental health problems, which include NSSI. MHPs possess comprehensive knowledge as well as unique insight into adolescent NSSI. However, very few studies on NSSI have incorporated their perspectives. In this work, we seek to add novel insight by conducting a study focusing on adolescent NSSI from the perspective of MHPs.
Methods: We recruited a total of 24 MHPs from different schools using purposive sampling and conducted a semi-structured interview on NSSI-related issues. Each interview was voice recorded and lasted ~30 min. A thematic analysis was performed for the responses to study the most common and concerning issues underlying NSSI.
Results: We extracted three major themes and eight sub-themes from the interview records, which included (1) the impact of Chinese culture on NSSI (sex-bias discrimination, overly high expectations, and inappropriate parenting style); (2) life events in school (internet use, academic pressure, and romantic relationships); and (3) opinions on the status quo of NSSI in China (ignorance and stigma).
Conclusion: Results showed that culturally sensitive influential factors, such as sex-bias discrimination, the imposing of unrealistic expectations for personal achievement, and inappropriate parenting style, should be given more attention to prevent, assess, and intervene in NSSI. Emerging factors of modern society and adolescent lifestyles, such as academic pressure, internet use, and romantic relationships, should also be considered for treatments.
... Secondly, the discrepancy might be due to the study sample. Turner et al. (2014) found that lack of emotional clarity increased the likelihood of non-suicidal self-injury in White students rather than Asian students. It might be that lack of emotional clarity among Chinese is not as important as the White when predicting suicidality. ...
Emotion reactivity and emotion dysregulation have been implicated in risk for suicidality. However, it remains unclear whether emotion reactivity and emotion dysregulation are predictive factors of suicide ideation, the progression from suicide ideation to suicide attempt, or both. The present study explored the relationship among emotion reactivity, emotion dysregulation, suicide ideation, and suicide attempt within a sample of Chinese undergraduates (n = 1596). According to lifetime suicidality, the current sample was divided into three groups: (a) non-ideators (no lifetime suicide ideation and no lifetime suicide attempts), (b) suicide ideators (with lifetime suicide ideation and no lifetime suicide attempts), and (c) suicide attempters (with lifetime suicide ideation and lifetime suicide attempts). Results of multinomial logistic regression suggested that compared to non-ideators, suicide ideators reported greater problems with emotion reactivity, and greater difficulties in emotion dysregulation, especially for emotion regulation strategies and emotional clarity. Compared to suicide ideators, suicide attempters reported greater difficulties in emotion dysregulation, especially for controlling impulses of negative emotions and emotional awareness. Emotion reactivity and emotion dysregulation are differentially associated with lifetime suicidality, and these findings provide preliminary guidance for suicide prevention and intervention.
... Наряду с фактором возраста и пола культуральные особенности относятся к числу значимых переменных, определяющих частоту НССП в популяции. Так, в нескольких исследователях выявлен более низкий риск самоповреждений в среде афро-и арабоамериканцев, а также среди ортодоксальных мусульман и баптистов [96], что, по мнению части авторов, предопределяет необходимость проведения масштабных сравнительных транскультуральных исследований [97][98][99]. ...
This text reviews the evolution of the concept of non-suicidal self-injury (NSSI) and discusses its place in the current classification systems. Data on the prevalence of NSSI are presented in detail and the effects of such variables as, gender, age, sexual orientation on the rate and type of NSSI are analyzed. Finally, the comorbidity of NSSI with affective and personality disorders, as well as eating disorders, is examined.
... Thus, there is a need to examine other motives for NSSI beyond just emotional relief. In particular, given preliminary evidence that a number of NSSI motives operate to varying degrees across individuals (Turner et al. 2015), research is needed to examine whether different motives are more or less relevant to different psychiatric disorders. Understanding the full range of motives for NSSI and the differential relevance of particular motives to specific psychiatric populations may assist clinicians in determining which motives are most important to assess in the context of a particular psychiatric disorder. ...
Although researchers have identified a number of factors that may motivate individuals to engage in nonsuicidal self-injury (NSSI), few studies have examined whether motives for NSSI differ as a function of psychiatric diagnosis. Therefore, the goal of the present study was to examine motives for lifetime NSSI among individuals with a history of psychiatric disorders associated with elevated rates of NSSI: depressive disorders and posttraumatic stress disorder (PTSD). Young adults (N = 139) with a history of NSSI completed several diagnostic interviews and questionnaires, including a measure of lifetime NSSI motives. Results demonstrated that participants with (vs. without) a lifetime depressive disorder reported significantly lower levels of interpersonal influence motives for NSSI, and participants with (vs. without) lifetime PTSD reported significantly higher levels of emotional relief and feeling generation motives. Further, results revealed a significant interaction between lifetime depressive disorders and PTSD for interpersonal communication motives; specifically, whereas participants with lifetime diagnoses of both a depressive disorder and PTSD did not differ significantly in reported interpersonal communication motives from participants with neither diagnosis, those with lifetime PTSD but without a lifetime depressive disorder reported significantly higher levels of interpersonal communication motives than those without either diagnosis. Results suggest that a history of depression and PTSD (alone and in combination) may be associated with different motives for NSSI.
... Thus, there is a need to examine other motives for NSSI beyond just emotional relief. In particular, given preliminary evidence that a number of NSSI motives operate to varying degrees across individuals (Turner et al. 2015), research is needed to examine whether different motives are more or less relevant to different psychiatric disorders. Understanding the full range of motives for NSSI and the differential relevance of particular motives to specific psychiatric populations may assist clinicians in determining which motives are most important to assess in the context of a particular psychiatric disorder. ...
... In order to drawn a generally accepted conclusion, the types of NSSI behaviors should be unified in different studies, and/or each type of NSSI behaviors should be studied separately in future study. Some other epidemiological features of NSSI in the present study including ethnicity (Kuentzel et al., 2012), religion and being the only one child (Turner et al., 2015), were also inconsistent with previous studies, which may also, at least partly due to heterogeneity of samples and measurement tools of NSSI used (Tang et al., 2013). ...
... In contrast to our results, however, You et al. [12] found that impulsivity remained predictive of, and was more strongly associated with NSSI than affective instability when both traits were included in the same regression model. This discrepancy could have resulted from impulsivity being more prominent in adolescents [25], or from differences between Asian and Caucasian participants [30]. You et al. [12] also measured impulsivity with a questionnaire that lists pathological impulsive behaviours known to result from dysregulated emotions (e.g., binge eating, substance abuse, anger outbursts [13,17,18]), whereas we used an item that assesses the tendency to behave impulsively in general. ...
Background
Impulsivity and affective instability are related traits known to be associated with nonsuicidal self-injury, although few longitudinal studies have examined this relationship. The purpose of this study was to determine if impulsivity and affective instability predict future nonsuicidal self-injury in the general population while accounting for the overlap between these traits.
Methods
Logistic regression analyses were conducted on data from 2344 participants who completed an 18-month follow-up of the 2000 British National Psychiatric Morbidity Survey. Affective instability and impulsivity were assessed at baseline with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Nonsuicidal self-injury was assessed at baseline and follow-up during semi-structured interviews.
Results
Affective instability and impulsivity predicted the onset of nonsuicidal self-injury during the follow-up period. Affective instability, but not impulsivity, predicted the continuation of nonsuicidal self-injury during the follow-up period. Affective instability accounted for part of the relationship between impulsivity and nonsuicidal self-injury.
Conclusions
Affective instability and impulsivity are important predictors of nonsuicidal self-injury in the general population. It may be more useful to target affective instability over impulsivity for the treatment of nonsuicidal self-injury.
... For example, evidence indicates that self-injurers with BPD may engage in more severe NSSI compared to those in various clinical comparison groups. Two studies showed that psychiatric inpatients with BPD exhibited more versatile (i.e., using a larger number of different NSSI methods; Turner et al., 2013;Anestis et al., 2015;Turner et al., 2015;Gratz et al., 2015) NSSI and suicide attempts (Sansone et al., 2002;Sansone et al., 2005) the other hand, these groups reported similar ages of self-injury onset (Sansone et al., 2002). In a community sample, a subgroup of adult self-injurers who scored high on measures of BPD symptoms also endorsed more frequent suicidal ideation and attempts, and were more likely to have received medical intervention as a result of their suicidal behavior, compared to other subgroups of selfinjurers (Klonsky and Olino, 2008). ...
Although non-suicidal self-injury (NSSI) occurs in people with and without borderline personality disorder (BPD), few studies have compared the clinical characteristics of these two groups. The present study sampled adults with a history of NSSI and compared those with and without BPD on (a) NSSI features, (b) co-occurring psychiatric disorders, and (c) severity of depression, suicidal ideation and emotion dysregulation. Participants (NSSI+BPD, n=46; NSSI Only, n=54) completed semi-structured interviews and self-report measures. Whereas the groups did not differ in age of NSSI onset, the NSSI+BPD group engaged in more frequent, recent and severe NSSI, and reported higher rates of skin carving, head banging, self-punching and self-scratching than the NSSI Only group. Participants with BPD also showed greater diagnostic comorbidity, particularly for anxiety disorders, but did not differ from participants without BPD in rates of mood, substance or psychotic disorders. The NSSI+BPD group reported more severe depressive symptomatology, suicidal ideation and emotion dysregulation than the NSSI Only group. Supplementary analyses on the subset of participants with recent (past year) NSSI revealed similarly medium to large differences between those with and without BPD. Implications for assessment and treatment are discussed.
Copyright © 2015. Published by Elsevier Ireland Ltd.
Introduction
This systematic review and meta-analysis aimed to (i) examine the associations between experiential avoidance (EA), non-suicidal self-injury (NSSI), and suicide experiences, and (ii) identify sample- and methodological-related variables affecting the strength of these associations.
Method
Medline, Embase, PsychINFO, Web of Science, and CINAHL were searched until April 2020. Random-effect meta-analyses were applied. The I2 statistic and the Egger's test assessed heterogeneity and publication bias. Meta-regression analyses were used to evaluate the impact of moderator variables on the strength of these associations.
Results
Data from 19 independent studies based on n = 9900 participants were pooled. The analyses demonstrated a weak but significant association between EA and NSSI. None of the examined moderator variables influenced the strength of this relationship. There was an indication of publication bias, suggesting that this association may have been inflated. The associations between EA, and suicide ideation and behaviors were moderate to strong.
Discussion
The current study concluded that (i) the EA model for NSSI should be revised by incorporating new evidence implicating feelings of relief in NSSI, and (ii) future studies should examine interactive factors between EA and key psychological components in the pathways to suicide experiences because these findings have direct clinical implications.
Objectives
To examine change in non‐suicidal self‐injury (NSSI) frequency, quality of life, and functional impairment from admission to discharge in patients enrolled in partial hospitalization and intensive outpatient programmes (PHP/IOP) designed to treat NSSI. Demographic, clinical, and treatment‐related predictors of changes were also examined.
Design
Data were collected as part of routine clinical assessment procedures at admission and discharge from patients enrolled in a PHP/IOP programme designed to treat NSSI. The clinical assessment included measures examining quality of life, functional impairment, and NSSI behaviour.
Methods
Paired t‐tests were used to examine change in NSSI frequency, quality of life, and functional impairment. Reliable clinical change analyses were used to identify clinically significant change in quality of life and functional impairment. Multilevel mixed‐effects regression was used to examine predictors of change for quality of life and functional impairment. Negative binomial regression was used to examine predictors of change for NSSI frequency.
Results
From admission to discharge, NSSI frequency significantly decreased and quality of life and functional impairment evidenced clinically significant change. Age, race/ethnicity, and insurance type predicted change in functional impairment, while gender predicted change in quality of life. Urge to self‐injure predicted change in NSSI frequency. Borderline symptoms predicted change across all outcome variables.
Conclusions
Patients who completed a day treatment programme for NSSI evidenced significant change in NSSI frequency, functional impairment, and quality of life at discharge; however, several demographic and clinical variables were associated with change.
Practitioner points
• Patients who engage in NSSI show significant change from admission to discharge in a day treatment programme dedicated to the treatment of NSSI.
• Quality of life and functional impairment are important outcome variables to consider and evaluate in higher levels of care.
• It is important to consider demographic and clinical variables when creating a treatment plan for NSSI.
• Although BPD symptoms may be important to consider in day treatment for NSSI, interpersonal dysfunction, depressive symptoms, and mood lability may also affect change in symptoms.
Objective: This study aimed to systemically review the literature regarding self-harm, emotion regulation, and experiential avoidance. Method: Articles were identified through systematic searches of several databases using combinations of the phrases “emotion regulation” AND “experiential avoidance” AND “self-harm,” or “self-injury,” and “BPD” or “Borderline Personality Disorder.” Additional searches were conducted inclusive of terms related to experiential avoidance and emotion regulation, as well as other disorders related to self-harm. Seventeen articles were identified and reviewed. Results: Results tentatively support the role of experiential avoidance in self-harm; some studies described phenomena similar to experiential avoidance without using the term. Discussion: Poor emotion regulation was often cited as a reason for engagement in self-harm. Several gaps in the literature were identified and discussed.
Objective:
The purpose of this study was to examine distress tolerance as a moderator of the relationship between emotional clarity and deliberate self-harm (DSH) in a diverse sample of trauma-exposed adolescents in acute psychiatric care at high risk of suicidal behavior. It was hypothesized that distress tolerance would emerge as a significant moderator, such that the association between emotional clarity and DSH would be significant among youth with high, but not low, distress tolerance.
Method:
Participants (N=50; 52.0% female; M=15.1years, SD=0.51; 44% White) completed measures of emotion dysregulation, DSH, history of suicide attempts, as well as a behavioral measure of distress tolerance.
Results:
Controlling for history of suicide attempts, results revealed a significant interaction between distress tolerance and emotional clarity in relation to DSH. Specifically, emotional clarity difficulties were related to DSH at high, but not low, levels of distress tolerance.
Conclusions:
Findings suggest that DSH among trauma-exposed youth with high rates of past suicide attempts is most likely when low emotion clarity is coupled with a high tolerance for emotional distress. Given that DSH significantly increases risk for suicide among youth with psychiatric needs, assessment of emotional clarity and distress tolerance deficits is apt to be warranted to facilitate identification of these youth for targeted intervention.
Resumen
El contexto universitario constituye un escenario complejo que puede potenciar el desarrollo personal de los estudiantes, pero también puede estimular la experimentación de emociones negativas. El estudio presentado en este artículo se orientó a explorar la afectividad negativa en estudiantes universitarios. Se realizó un muestreo probabilístico. La muestra estuvo compuesta por 1.377 estudiantes a los que se les administró el Autorreporte Vivencial. Se utilizó el análisis descriptivo univariante y también el análisis de conglomerados en 2 etapas, el análisis categórico de componentes principales y los árboles de decisión. Los resultados revelaron bajos niveles de afecto negativo. Los estudiantes se dividieron en 2 grupos que se diferencian en la intensidad con la que experimentan las diferentes emociones negativas, con mayor presencia de las mujeres en el conglomerado de peores resultados. Se identificó que la tristeza y la angustia demostraron ser los mejores predictores de la afectividad negativa en los estudiantes universitarios. Los resultados alcanzados constituyen los primeros pasos para el diseño de estrategias preventivas y de promoción de la salud mental en el contexto universitario.
This study examines characteristics (i.e., prevalence, method, age of onset, frequency) of nonsuicidal self-injury (NSSI) and associated risk factors in a college student sample. Results revealed 11.68% admitted to engaging in NSSI at least once and no significant gender difference in occurrence of NSSI. Even in this college sample, those who self-injure differed substantially from non-self-injurers with regard to emotion regulation, but were not found to differ significantly on either early attachment or childhood trauma and abuse. Importance of understanding NSSI as an emerging behavior among college students is discussed.
This study investigated clinically-significant non-suicidal self-injury (NSSI), defined as five or more lifetime episodes of NSSI, among racially and ethnically diverse emerging adults with a focus on factors unique to the minority experience. Seven hundred and nine emerging adults at an urban university, 85 % of whom were non-White, completed questionnaires assessing NSSI, racism, ethnic identity, Borderline Personality Disorder (BPD) characteristics such as impulsive behavior, emotion and interpersonal dysregulation and identity disturbance, suicidal behavior, and current depression and anxiety symptoms. Overall, 13 % of the sample reported a history of clinically-significant NSSI. Asian and White emerging adults reported significantly higher rates of NSSI than Hispanics and Blacks. Logistic regression analyses revealed positive relationships between BPD characteristics and NSSI and current anxiety and NSSI, which were not attenuated by increased ethnic identification. Experience with racism did not predict NSSI in the multivariate model. These findings are discussed as they pertain to current understanding and prevention of NSSI among racial and ethnic minority emerging adults.
The results of two studies are reported. Study I involved the development of the Inventory of Parent and Peer Attachment (IPPA), a self-report instrument for use with adolescents. Subject were 179 college students aged 16-20 years. Item content of the instrument was suggested by attachment theory's formulations concerning the nature of feelings toward attachment figures. In Study II, the convergent validity of the IPPA was examined. Also, a hierarchial regression model was employed to investigate the association between quality of attachment and self-esteem, life-satisfaction, and affective status. Respondents were 86 adolescents from the Study I sample. As hypothesized, perceived quality of both parent and peer attachments was significantly related to psychological well-being. Results of the development of a theoretically focused, exploratory classification scheme indicated that adolescents classified as highly securely attached reported greater satisfaction with themselves, a higher likelihood of seeking social support, and less symptomatic response to stressful life events.
This study clarified the association of maladaptive, potentially self-damaging behaviors with suicidality. Specifically, we examined whether greater frequency (i.e., how often) or greater versatility (i.e., how many ways) of several self-damaging behaviors, including non-suicidal self-injury (NSSI), substance use, and disordered eating, increased risk for suicide. Participants who engaged in NSSI (N = 142) completed questionnaires assessing suicidal and self-damaging behavior at baseline and engagement in suicidal behaviors (e.g., ideation, attempts, talking about suicide) 3 months later. Results suggest that the versatility rather than frequency of self-damaging behaviors is most robustly associated with suicide risk. Engaging in multiple methods of NSSI and using a greater number of illicit substances were positively associated with suicide risk. Further, versatility of NSSI interacted with depression to predict suicide risk at 3-month follow-up such that highly depressed participants who engaged in more methods of NSSI exhibited highest risk, whereas those who engaged in more methods with low depression exhibited the lowest risk.
The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items, A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAO) were then examined in 8 additional samples. All totaled, over 2,400
The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items. A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAQ) were then examined in 8 additional samples. All totaled, over 2,400 participants were studied. As expected, higher levels of experiential avoidance were associated with higher levels of general psychopathology, depression, anxiety, a variety of specific fears, trauma, and a lower quality of life. The AAQ related to more specific measures of avoidant coping and to self-deceptive positivity, but the relation to psychopathology could not be fully accounted for by these alternative measures. The data provide some initial support for the model of experiential avoidance based on Relational Frame Theory that is incorporated into Acceptance and Commitment Therapy, and provides researchers with a preliminary measure for use in population-based studies on experiential avoidance.
Prior studies of nonsuicidal self-injury (NSSI) suggest the existence of multiple NSSI typologies. Using data from 2,101 university students, this study employed latent class analysis to investigate NSSI typologies. Results show a good fitting 3-class solution with distinct quantitative and qualitative differences. Class 1 was composed largely of women using 1 form to engage in superficial tissue damage with moderate (<11) lifetime incidents. Class 2 was composed predominately of men using 1 to 3 forms to engage in self-battery and light tissue damage, with low (2–10) lifetime incidents. Class 3 was composed largely of women using more than 3 self-injury forms and engaging in behaviors with the potential for a high degree of tissue damage with moderate to high numbers of lifetime incidents. All 3 classes were at elevated risk for adverse conditions when compared to no-NSSI respondents. We conclude that NSSI typologies exist and may warrant
differential clinical assessment and treatment.
Few studies have examined the role of culturally relevant factors in suicidal behavior among Asian Americans. Using the National Latino and Asian American Study (NLAAS) (Alegria et al., 2004; Heeringa et al., 2004), the current study examined the role of culturally related variables (family conflict, perceived discrimination, and ethnic identity) on suicidal ideation and suicide attempts in a nationally representative sample of 2,095 Asian Americans. Important covariates were sociodemographic characteristics (gender, age, marital status, years of education, household poverty, and nativity status), depressive and anxiety disorders, and number of chronic conditions. Gender related correlates were also explored. The lifetime prevalence of suicidal ideation and attempts was 8.8% and 2.5%, respectively. Female gender, family conflict, perceived discrimination, and the presence of lifetime depressive or anxiety disorders were positively correlated with suicidal ideation and attempts. A high level of identification with one’s ethnic group was associated with lower rates of suicide attempts. Among Asian men, but not women, the presence of chronic medical conditions was associated with suicidal ideation. Findings highlight the contributions to suicide risk of cultural factors and gender differences in Asian Americans. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Multicultural researchers and theorists have noted that client adherence to culture-of-origin values plays an important role in the provision of culturally relevant and sensitive psychological services. However, lack of instruments that measure ethnic cultural values has been a shortcoming in past research that attempted to examine this relationship. In this article, the development of the Asian Values Scale (AVS) is described, and the results of 4 studies investigating the psychometric properties of the AVS are reported. The results indicate that the AVS has adequate internal and 2-week test–retest reliability. Also, factor analysis and comparisons of AVS scores to scores on the Individualism–Collectivism scale (H. Triandis, 1995) and the Suinn-Lew Asian Self-Identity Acculturation Scale (R. M. Sunn, K. Rickard-Figueroa, S. Lew & P. Vigil, 1987) provided evidence of convergent and divergent validity for the AVS. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Given recent attention to emotion regulation as a potentially unifying function of diverse symptom
presentations, there is a need for comprehensive measures that adequately assess difficulties in emotion
regulation among adults. This paper (a) proposes an integrative conceptualization of emotion
regulation as involving not just the modulation of emotional arousal, but also the awareness, understanding,
and acceptance of emotions, and the ability to act in desired ways regardless of emotional
state; and (b) begins to explore the factor structure and psychometric properties of a new measure, the
Difficulties in Emotion Regulation Scale (DERS). Two samples of undergraduate students completed
questionnaire packets. Preliminary findings suggest that the DERS has high internal consistency, good
test–retest reliability, and adequate construct and predictive validity.
Although attempted suicide and non-suicidal self-injury (NSSI) are distinct behaviors differing in intent, form, and function, the behaviors co-occur at a high rate in both adults and adolescents. Researchers have begun to investigate the association between attempted suicide and NSSI among adolescents. The purpose of this paper is to present current research on this association. First, we discuss definitional issues associated with self-injurious behaviors. Next, we present research on the co-occurrence of attempted suicide and NSSI, including prevalence and associations with self-injury characteristics. We then discuss psychosocial variables associated with engaging in both NSSI and attempted suicide or one type of self-injury alone. Finally, we present the research to date on risk factors uniquely associated with either attempted suicide or NSSI. Implications for mental health professionals and future avenues of research are discussed.
This study examined the relative importance of four major BPD features, that is, affective instability, disturbed interpersonal relationship, unstable sense of self, and behavioral impulsivity, in explaining the presence, initiation, repetition, and discontinuation of non-suicidal self-injury (NSSI) among a 2-year follow-up sample of 4,782 (68.5% girls) Hong Kong Chinese secondary school students. Affective instability, disturbed interpersonal relationship and behavioral impulsivity were significantly associated with the presence of NSSI both concurrently and longitudinally. These three BPD features were also related to the future initiation of NSSI. On the other hand, only behavioral impulsivity made a significant contribution to the repetition of NSSI. Additionally, a lower level of affective instability was also associated with quitting NSSI. We discussed some possible mechanisms underlying the effects of different BPD features on different developmental stages of NSSI.
Although suicide-related outcomes among Asian American adolescents are a serious public health problem in the United States, research in this area has been relatively sparse. To address this gap in the empirical literature, this study examined subgroups of Asian American adolescents for whom family, school, and peer relationships exerted differential effects on suicide attempts. Data were drawn from Waves 1 and 2 of the National Longitudinal Study of Adolescent Health dataset and included responses from a national sample of 959 Asian American adolescents (48.0% girls; average age at Wave 2 = 16.43). A latent class regression was used to assess the optimal number of latent classes (i.e., subgroups of participants) that explained the associations between family, school, and peer relationships and subsequent suicide attempts. Three latent classes were identified. Most participants belonged to a latent class in which family, school, and peer relationships were protective factors. However, stronger school relationships and peer relationships were found to be risk factors in two other latent classes. The three latent classes also differed significantly in terms of suicide attempts, gender, and acculturation. The practical implications of this study, particularly for educators and mental health professionals, are discussed.
To evaluate the clinical and prognostic significance of suicide attempts (SAs) and nonsuicidal self-injury (NSSI) in adolescents with treatment-resistant depression.
Depressed adolescents who did not improve with an adequate SSRI trial (N = 334) were randomized to a medication switch (SSRI or venlafaxine), with or without cognitive-behavioral therapy. NSSI and SAs were assessed at baseline and throughout the 24-week treatment period.
Of the youths, 47.4% reported a history of self-injurious behavior at baseline: 23.9% NSSI alone, 14% NSSI+SAs, and 9.5% SAs alone. The 24-week incidence rates of SAs and NSSI were 7% and 11%, respectively; these rates were highest among youths with NSSI+SAs at baseline. NSSI history predicted both incident SAs (hazard ratio [HR]= 5.28, 95% confidence interval [CI] = 1.80-15.47, z = 3.04, p = .002) and incident NSSI (HR = 7.31, z = 4.19, 95% CI = 2.88-18.54, p < .001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95% CI = 0.81-4.52, z = 2.29, p = .13). In the most parsimonious model predicting time to incident SAs, baseline NSSI history and hopelessness were significant predictors, adjusting for treatment effects. Parallel analyses predicting time to incident NSSI through week 24 identified baseline NSSI history and physical and/or sexual abuse history as significant predictors.
NSSI is a common problem among youths with treatment-resistant depression and is a significant predictor of future SAs and NSSI, underscoring the critical need for strategies that target the prevention of both NSSI and suicidal behavior.
Treatment of SSRI-Resistant Depression in Adolescents (TORDIA). URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00018902.
This study examined the association between non-suicidal self-injury (NSSI) and suicide attempts among Chinese adolescents and college students.
A total sample of 2013 Chinese students were randomly selected from five schools in Wuhan, China, including 1101 boys and 912 girls with the age ranging between 10 and 24 years. NSSI, suicidal ideation, suicide attempts and depressive symptoms were measured by self-rated questionnaires. Self-reported suicide attempts were regressed on suicidal ideation and NSSI, controlling for participants' depressive symptoms, and demographic characteristics.
The self-reported prevalence rates of NSSI, suicidal ideation, suicide attempts were 15.5%, 8.8%, and 3.5%, respectively. Logistic regression analyses indicated that NSSI was significantly associated with self-reported suicide attempts. Analyses examining the conditional association of NSSI and suicidal ideation with self-reported suicide attempts revealed that NSSI was significantly associated with greater risk of suicide attempts in those not reporting suicidal ideation than those reporting suicidal ideation in the past year.
These findings highlight the importance of NSSI as a potentially independent risk factor for suicide attempts among Chinese/Han adolescents and college students.
Previous studies revealed a high prevalence of nonsuicidal self-injury (NSSI) in western adolescents and suggested the existence of multiple self-injurer subgroups. This study examined the prevalence of NSSI among Hong Kong Chinese adolescents and compared different subgroups of self-injurers on several psychological correlates of NSSI related to borderline personality disorder. A total of 6,374 secondary school students (67.6% girls) completed self-report questionnaires. Multivariate analyses of variance and follow-up logistic regression analyses were used to compare differences between subgroups of self-injurers. Overall, 15% of adolescents reported engaging in NSSI. Gender differences varied regarding different self-injury methods. Repetitive self-injurers had more emotional and impulse-control problems than episodic ones. Severe NSSI adolescents were also more impulsive than mild NSSI adolescents. The frequency and severity of NSSI acted as two important dimensions in distinguishing between self-injurers. Clinical implications of these results are discussed.
Self-mutilation, examined in samples of the general population, clinical groups, and self-identified self-mutilators, was reported by 4% of the general and 21% of the clinical sample, and was equally prevalent among males and females. Results suggest that such behavior is used to decrease dissociation, emotional distress, and posttraumatic symptoms. Childhood sexual abuse was associated with self-mutilation in both clinical and nonclinical samples.
Research on deliberate self-harm (intentionally injuring oneself without suicidal intent) has focused on clinical and forensic populations. Studying only these populations, which typically have serious psychopathology, may lead to inflated estimates of the association between self-harm and psychiatric disorder, as well as of the prevalence of deliberate self-harm. The present study investigated the prevalence and correlates of deliberate self-harm in a large group of nonclinical subjects.
Participants were 1,986 military recruits, 62% of whom were men, who were participating in a study of peer assessment of personality traits and pathology. Individuals who did and did not report a history of self-harm were compared on measures of personality and psychopathology.
Approximately 4% of the participants reported a history of deliberate self-harm. Compared with participants without a history of deliberate self-harm, self-harmers scored higher on self- and peer-report measures of borderline, schizotypal, dependent, and avoidant personality disorder symptoms and reported more symptoms of anxiety and depression. Item-level analyses indicated that peers viewed self-harmers as having strange and intense emotions and a heightened sensitivity to interpersonal rejection.
About one of every 25 members of a large group of relatively high-functioning nonclinical subjects reported a history of self-harm. Self-harmers had more symptoms of several personality disorders than non-self-harmers, and their performance across measures suggested that anxiety plays a prominent role in their psychopathology. Future research should investigate whether psychotherapies or psychiatric medications known to reduce symptoms of anxiety can be effective in treating deliberate self-harm.
Adolescent self-mutilative behavior (SMB) is a pervasive and dangerous problem, yet factors influencing the performance of SMB are not well understood. The authors examined the contextual features and behavioral functions of SMB in a sample of 89 adolescent psychiatric inpatients. SMB typically was performed impulsively, in the absence of physical pain, and without the use of alcohol or drugs. Moreover, analyses supported the construct validity of a functional model in which adolescents reported engaging in SMB for both automatic and social reinforcement. Considering the functions of SMB clarified the relations between SMB and other clinical constructs reported in previous studies such as suicide attempts, posttraumatic stress, and social concerns and has direct implications for the assessment and treatment of SMB.
The goal was to assess the prevalence, forms, demographic and mental health correlates of self-injurious behaviors in a representative college sample.
A random sample of undergraduate and graduate students at 2 northeastern US universities were invited to participate in an Internet-based survey in the spring of 2005. Thirty-seven percent of the 8300 invited participants responded.
The lifetime prevalence rate of having > or =1 self-injurious behavior incident was 17.0%. Seventy-five percent of those students engaged in self-injurious behaviors more than once. Thirty-six percent reported that no one knew about their self-injurious behaviors and only 3.29% indicated that a physician knew. Compared with non-self-injurers, those with repeat self-injurious behavior incidents were more likely to be female, bisexual or questioning their sexual orientation. They were less likely to be Asian/Asian American and >24 years of age. When controlling for demographic characteristics, those with repeat self-injurious behavior incidents were more likely to report a history of emotional abuse or sexual abuse, ever having considered or attempted suicide, elevated levels of psychological distress, and > or =1 characteristic of an eating disorder. A dose-response gradient was evident in each of these areas when single-incident self-injurious behaviors were compared with repeat-incident self-injurious behaviors.
A substantial number of college students reported self-injurious behaviors in their lifetimes. Many of the behaviors occurred among individuals who had never been in therapy for any reason and who only rarely disclosed their self-injurious behaviors to anyone. Single self-injurious behavior incidents were correlated with a history of abuse and comorbid adverse health conditions but less strongly than were repeat self-injurious behavior incidents. The reticence of these clients to seek help or advice renders it critical that medical and mental health providers find effective strategies for detecting and addressing self-injurious behaviors.
Given recent attention to emotion regulation as a potentially unifying function of diverse symptom presentations, there is a need for comprehensive measures that adequately assess difficulties in emotion regulation among adults. This paper (a) proposes an integrative conceptualization of emotion regulation as involving not just the modulation of emotional arousal, but also the awareness, understanding, and acceptance of emotions, and the ability to act in desired ways regardless of emotional state; and (b) begins to explore the factor structure and psychometric properties of a new measure, the Difficulties in Emotion Regulation Scale (DERS). Two samples of undergraduate students completed questionnaire packets. Preliminary findings suggest that the DERS has high internal consistency, good test–retest reliability, and adequate construct and predictive validity.
Self-mutilation is a disturbing and puzzling behavior encountered in patients with borderline personality disorder. Detailed descriptions from five patients with recent self-mutilation experiences are offered to illustrate the sequential development of symptoms leading to and immediately following self-mutilation. The authors speculate about the implications of the phenomenology of these states concerning psychodynamic and biological underpinnings, possible therapeutic approaches, and future research questions.
G*Power (Erdfelder, Faul, & Buchner, 1996) was designed as a general stand-alone power analysis program for statistical tests commonly used in social and behavioral research. G*Power 3 is a major extension of, and improvement over, the previous versions. It runs on widely used computer platforms (i.e., Windows XP, Windows Vista, and Mac OS X 10.4) and covers many different statistical tests of the t, F, and chi2 test families. In addition, it includes power analyses for z tests and some exact tests. G*Power 3 provides improved effect size calculators and graphic options, supports both distribution-based and design-based input modes, and offers all types of power analyses in which users might be interested. Like its predecessors, G*Power 3 is free.
We examined the relationship between Asian American college students' levels of acculturation, enculturation, and psychological distress. We also explored the methods Asian American college students prefer when seeking help for psychological concerns. The sample included 601 Asian American students from a large public university in Southern California. Respondents completed an online questionnaire, which included instruments assessing acculturation and enculturation levels as well as psychological distress and help-seeking preferences. Regression analyses indicated that when Asian American students hold a greater degree of European values they are less likely to experience psychological distress. A repeated-measures ANOVA found that Asian American students prefer more covert approaches to mental health treatment. These findings both compliment and contradict previous studies of acculturation, enculturation, psychological distress and help-seeking among the Asian American college student population.
As part of a larger research programme concerned with the role of anger/hostility in heart disease in Singapore, three commonly used measures of anger/hostility (Cook & Medley Ho Scale, STAXI, Buss-Durkee Hostility Inventory) were examined for reliability and validity in an Asian population. A total of 968 Singaporean Chinese, Malay and Indian respondents completed one or more of these measures together with measures of symptom and illness experience. In addition, blood pressure and heart rate measures were taken for 201 respondents. Overall, the Ho and STAXI measures had reasonably high internal consistency and test-retest reliability. Internal consistency and test-retest reliability for the Buss Durkee measure were high for the total score but variable for the component scales. Correlation and regression showed that the Ho and STAXI appeared to be tapping a common core of variance, which can be characterized as trait anger. Correlations of the Ho and STAXI with health measures produced modest but statistically significant correlations for measures of symptom and illness experience and generally low and non-significant correlations for heart rate and blood pressure.
Previous studies have shown that multiple factors predict suicidal behavior in Asian Americans but have provided little guidance on how to rate the relative impact of these risks. To increase our understanding of suicide in Asian Americans, recursive partitioning analysis was used to identify risk factors most relevant to predicting suicidal behaviors and enhance the decision-making process of clinicians faced with clients presenting with multiple risk factors. Using a classification and regression tree (CART) and random forest analyses, we examined the role of previously identified correlates of suicidal ideation and suicide attempts in 2,095 Asian Americans from the National Latino and Asian American Study (Alegria et al., 2008). Random forest analysis showed that depressive and anxiety disorder were the best predictors of lifetime suicidal ideation, followed by family conflict and family cohesion. The model correctly classified lifetime suicidal ideation with moderate sensitivity (72%) and specificity (76%). CART analysis found that family conflict predicted suicide attempts in more than half of the individuals with suicidal ideation. Of those who reported low family conflict, 73% attempted suicide if they had low family support. Perceived discrimination was the next best predictor of suicide attempts (63%) when family issues were not a problem. Cross-validation of this model had moderate sensitivity (75%) but low specificity (39%). These findings highlight the importance of considering family relationship when assessing suicide risk in Asian Americans. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Conducted 2 studies to examine individual differences in affective response intensity to identical levels of emotion-provoking stimulation. In Study 1, with 62 undergraduates, the stimuli were daily life events. Ss recorded 2 events/day for 56 consecutive days and rated their affective reactions to those events. A total of 5,971 event descriptions were obtained. These event descriptions were given to a team of coders who rated each event in terms of how objectively good or bad it was. Study 2 presented 176 undergraduates with standardized life event descriptions, ranging from very good to very bad, and asked how they would react emotionally to each event. Ss were divided into high and low affect-intensity groups on the basis of their responses to a measure of affect intensity. Findings were consistent across both studies. High-intense Ss responded to the actual and hypothetical life events with stronger or more intense affective reactions. This finding held regardless of whether the events elicited positive or negative affect and regardless of whether the emotional stimulation was judged to be slightly, moderately, or very strong. Results are discussed in terms of stimulus intensity modulation theory and prior research on affect. (58 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated the relationships among Asian-American acculturation, gender, and willingness to seek personal and academic counseling. 98 male and 89 female Asian-American undergraduates (aged 17–36 yrs) completed a questionnaire regarding demographic characteristics, willingness to see a counselor, and level of acculturation. Neither acculturation nor gender significantly related to Ss' willingness to see a counselor for either a personal or an academic problem. However, Ss were more willing to see a counselor for an academic problem than for a personal problem. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Among rising concerns surrounding heightened suicide in certain subgroups of Asian Americans, it is important to understand the help-seeking rates and pathways among Asian Americans experiencing suicidality. This study examined perceived need for care, help-seeking behavior, and chosen sources of care among Asian Americans compared with Latinos in the National Latino and Asian American Study who reported a history of lifetime suicidal ideation, suicide attempts, or mental disorders without history of suicide. Consistent with existing literature in Caucasians, suicide attempts in Asian Americans and Latinos were related to greater help seeking and perceived need beyond that of mental disorders only. However, Asian Americans with suicide attempts still reported lower perceived need and help-seeking behaviors compared with Latinos. In contrast to both the existing literature and Latinos in this study, Asian Americans with suicidal ideation were no more likely to perceive a need for help or seek help than Asian Americans with a mental disorder without history of suicide and were less likely to seek and perceive a need for help than Latinos with suicidal ideation. These findings point to the idea that Asian Americans who have serious suicidal ideation or attempts may underestimate the importance of their condition and do not receive the level of attention and support needed. Findings also show that Asian Americans with suicidal ideation and attempts prefer seeking help from nonprofessional rather than professional sources of help, other than medical professionals. Clinical implications for outreach, assessment, and management of suicide are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The structure and measurement of acculturation/enculturation was investigated on 2 Asian American samples. Factor analyses revealed similar 2-factor structures for both acculturation and enculturation. The factor-analytic-derived measure yielded scores with adequate reliability and marginal construct validity. Acculturation/enculturation differences by generation status, gender, and country region were also detected. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Compared 48 nonsuicidal self-mutilating female psychiatric patients (aged 13–17 yrs) with 48 age- and sex-matched nonmutilating patients, using chart reviews of clinical and descriptive characteristics. Self-mutilating Ss were characterized by higher frequencies of sleep disorders and sexual abuse and greater treatment with psychotropic medications. They had higher levels of depression, anxiety, hostility, and somatic complaints and greater difficulties with body comfort and confidence. They exhibited more severe symptoms, as indicated by the SCL-90 (Revised), and had more Axis 1 diagnoses of affective and eating disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this study was to examine the relationship between family cohesion and suicide ideation in a national, adult community sample of Asian Americans (N=2072). The data for this study were drawn from the National Latino and Asian American Study, the first national epidemiological study of Asian Americans' mental health. The results indicate that family cohesion was negatively related to suicide ideation. In addition, English language proficiency moderated the relationship between family cohesion and suicide ideation. Family cohesion was related to lower odds of suicide ideation among low English proficiency Asian Americans. In contrast, family cohesion was not significantly related to suicide ideation among high English proficiency Asian Americans. Further, the findings are consistent with a model in which the relationship between family cohesion and suicide ideation was partially mediated by psychological distress. Practical implications for addressing suicide ideation among Asian Americans are discussed.
This study examines help seeking and utilization patterns of 161 Asian or Pacific Islander Americans and 1332 White Americans randomly selected in the Los Angeles area, based on the first wave of the Epidemiological Catchment Area (ECA) study. Logistic regression analyses are performed to detect ethnic differences in disclosing mental health problems and utilizing mental health services. Results show that Asian Americans are more reticent than White Americans about mental distress regardless of whether they speak with professionals or family and friends, and that they are unwilling to use mental health services of any type. However, contrary to common assumptions, Asian Americans claim somatic discomfort as frequently as White Americans do, and the somatic discomfort is independent of Asian Americans' unwillingness to talk about mental health problems. © 1998 John Wiley & Sons, Inc.
Deliberate self-harm has recently begun to receive more systematic attention from clinical researchers.
However, there remains a general lack of consensus as to how to define and measure this important
clinical construct. There is still no standardized, empirically validated measure of deliberate selfharm,
making it more difficult for research in this area to advance. The present paper provides an
integrative, conceptual definition of deliberate self-harm as well as preliminary psychometric data on a
newly developed measure of self-harm, the Deliberate Self-Harm Inventory (DSHI). One hundred and
fifty participants from undergraduate psychology courses completed research packets consisting of the
DSHI and other measures, and 93 of these participants completed the DSHI again after an interval of
2–4 weeks (M D3:3 weeks). Preliminary findings indicate that the DSHI has high internal consistency;
adequate construct, convergent, and discriminant validity; and adequate test-retest reliability.
Understanding the functions of nonsuicidal self-injury (NSSI) has important implications for the development and refinement of theoretical models and treatments of NSSI. Emotional and social vulnerabilities associated with five common functions of NSSI-emotion relief (ER), feeling generation (FG), self-punishment (SP), interpersonal influence (II), and interpersonal communication (IC)-were investigated to clarify why individuals use this behavior in the service of different purposes. Female participants (n = 162) with a history of NSSI completed online measures of self-injury, emotion regulation strategies and abilities, trait affectivity, social problem-solving styles, and interpersonal problems. ER functions were associated with more intense affectivity, expressive suppression, and limited access to emotion regulation strategies. FG functions were associated with a lack of emotional clarity. Similar to ER functions, SP functions were associated with greater affective intensity and expressive suppression. II functions were negatively associated with expressive suppression and positively associated with domineering/controlling and intrusive/needy interpersonal styles. IC functions were negatively associated with expressive suppression and positively associated with a vindictive or self-centered interpersonal style. These findings highlight the specific affective traits, emotional and social skill deficits, and interpersonal styles that may render a person more likely to engage in NSSI to achieve specific goals.
Typescript. Thesis (Ph. D.)--University of Illinois at Urbana-Champaign, 1984. Vita. Includes bibliographical references (leaves 146-169). Available on microfilm from University Mirofilms.
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.
This study examined clinical characteristics and laboratory-measured impulsive behavior of adolescents engaging in either non-suicidal self-injury with (NSSI+SA; n=25) or without (NSSI-Only; n=31) suicide attempts. We hypothesized that adolescent with NSSI+SI would exhibit more severe clinical symptoms and higher levels of behavioral impulsivity compared to adolescents with NSSI-Only. Adolescents were recruited from an inpatient psychiatric hospital unit and the two groups were compared on demographic characteristics, psychopathology, self-reported clinical ratings, methods of non-suicidal self-injury, and two laboratory impulsivity measures. Primary evaluations were conducted during psychiatric hospitalization, and a subset of those tested during hospitalization was retested 4-6 weeks after discharge. During hospitalization, NSSI+SA patients reported worse depression, hopelessness, and impulsivity on standard clinical measures, and demonstrated elevated impulsivity on a reward-directed laboratory measure compared to NSSI-Only patients. In the follow-up analyses, depression, hopelessness, suicidal ideation, and laboratory impulsivity were improved for both groups, but the NSSI+SA group still exhibited significantly more depressive symptoms, hopelessness, and impulsivity than the NSSI-Only group. Risk assessments for adolescents with NSSI+SA should include consideration not only of the severity of clinical symptoms but of the current level impulsivity as well.
The functions of non-suicidal self-injury were examined in 39 young adults with a history of skin-cutting and other self-injurious behaviors including banging, burning, and severe scratching. Consequences, affect-states, and reasons associated with self-injury were assessed by a structured interview. Results indicate that self-injury is associated with improvements in affective valence and decreases in affective arousal. Specifically, participants tended to feel overwhelmed, sad, and frustrated before self-injury, and relieved and calm after self-injury. Further, these affective changes predict lifetime frequency of self-injury, suggesting that they reinforce the behavior. Finally, although reasons for self-injury related to both affect-regulation (e.g., to release emotional pressure that builds up inside of me) and self-punishment (e.g., to express anger at myself) were endorsed by a majority of participants, affect-regulation reasons were overwhelmingly rated as primary and self-punishment reasons as secondary.
This study explored the symptoms of self-injurious behaviour (SIB) in a consecutive sample of 54 mostly female psychiatric inpatients. The phenomenological analysis presented SIB as quite a uniform syndrome that starts latest in early adulthood, is often committed impulsively, is used in the function of releasing tension and occurs in patients with eating and psychoactive substance use but also schizophrenic disorders. The quality of mood preceding SIB was best characterized as dysphoria and was qualitatively not different from patients' longstanding affective traits. Two subgroups were differentiated, those with borderline personality disorder and those without; there was some evidence that patients with borderline personality disorder present a quite homogeneous core group of SIB, whereas others show a higher variety of psychopathological features. The hypothesis is proposed that poor affect regulation is the underlying psychopathological dimension.
The charts of 660 consecutive admissions to a university psychiatric hospital were examined. After excluding those with mental retardation, 32 patients who had mutilated themselves and 88 patients admitted for unsuccessful suicide attempts were identified. Women were significantly overrepresented among the mutilators, but the groups did not differ with respect to age. Most analyses were restricted to women, of whom 27 were self-mutilators and 51 were nonmutilating suicide attempters. Mutilators were less likely to receive diagnoses of major depression or adjustment disorder but were more likely to have a history of substance abuse and receive Axis II diagnoses. The mutilative behavior was generally repetitive. The most common form was superficial cutting of the arms and wrists. Reports of lifetime sexual or physical abuse were more common among mutilators. Mutilators also had frequent histories of suicide attempts distinct from their mutilation behavior, multiple hospitalizations, and transfer to state hospitals for longer-term care. These findings suggest a chronic course with significant morbidity and associated features which may be of clinical significance.
This self-report study examined the risk factors for deliberate self-harm among college students. Results indicated that insecure attachment, childhood separation, emotional neglect, sexual abuse, and dissociation were significant predictors of self-harm. Substantial gender differences in the risk factors for self-harm behavior were also revealed. Suggestions for future research are provided.
Data from 390 high school students were collected to examine potential differences between adolescents who had attempted suicide and those who engaged in self-injurious behavior on measures of depression, suicidal ideation, and attitudes toward life and death. Significant differences were found between controls and the self-harm groups on all dependent variables. A significant difference on attitudes toward life was found between the self-injury and suicide attempt groups. Post-hoc regression analyses showed that measures of depression, suicide ideation, and attitudes towards life predicted participants' self-harm categorization. These findings provide preliminary evidence that self-injurious behavior is different from attempted suicide among a community sample of adolescents.
Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.
Despite the clinical importance of deliberate self-harm, research on the risk factors for self-harm among nonclinical populations has been limited. This study examined the role of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity in the self-harm behavior of 249 female college students. Childhood maltreatment and low positive affect intensity/reactivity reliably distinguished women with frequent self-harm from women with no history of self-harm, as did the combination of greater maltreatment, greater inexpressivity, and higher levels of affect intensity/reactivity (global and negative). Among women with a history of self-harm, emotional inexpressivity was associated with more frequent self-harm, as was the combination of greater maltreatment, greater inexpressivity, and lower levels of positive affect intensity/reactivity.
Non-suicidal self-injury (NSSI) is a prevalent behavioral problem, yet many fundamental aspects of NSSI remain unknown. This case series study reports on the diagnostic correlates of adolescents with a recent history of NSSI and examines the relation between NSSI and suicide attempts. Data are from clinical interviews with 89 adolescents admitted to an adolescent psychiatric inpatient unit who engaged in NSSI in the previous 12 months. Results revealed that 87.6% of adolescents engaging in NSSI met criteria for a DSM-IV Axis I diagnosis (M=3.0, S.D.=2.2, range=0 to 8 diagnoses), including externalizing (62.9%), internalizing (51.7%), and substance use (59.6%) disorders. Most adolescents assessed also met criteria for an Axis II personality disorder (67.3%). Overall, 70% of adolescents engaging in NSSI reported a lifetime suicide attempt and 55% reported multiple attempts. Characteristics of NSSI associated with making suicide attempts included a longer history of NSSI, use of a greater number of methods, and absence of physical pain during NSSI. These findings demonstrate the diagnostic heterogeneity of adolescents engaging in NSSI, highlight the significant overlap between NSSI and suicide attempts, and provide a point of departure for future research aimed at elucidating the relations between non-suicidal and suicidal self-injury.