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Nonsuicidal self-injury (NSSI) is a robust predictor of suicide attempts. However, understanding of NSSI and associated treatment utilization among Veterans is limited. Although impairment may be assumed, few studies examine the association between NSSI and psychosocial functioning, a core component of the rehabilitation framework of mental health. In a national survey of Veterans, current NSSI (n = 88) was associated with higher rates of suicidal thoughts and behaviors and more severe psychosocial impairment after adjusting for demographics and probable diagnoses of posttraumatic stress disorder, major depressive disorder, and alcohol use disorder, compared to Veterans without NSSI (n = 979). Only half of Veterans with NSSI were engaged with mental health services, with few appointments attended, suggesting that these Veterans are not receiving treatment interventions. Results underscore the adverse outcomes associated with NSSI. Underutilization of mental health services highlights the importance of screening for NSSI among Veterans to improve psychosocial outcomes.
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Transtorno Depressivo Maior , Serviços de Saúde Mental , Comportamento Autodestrutivo , Veteranos , Humanos , Veteranos/psicologia , Ideação Suicida , Transtorno Depressivo Maior/epidemiologia , Comportamento Autodestrutivo/terapia , Comportamento Autodestrutivo/psicologia , Fatores de RiscoRESUMO
Media coverage of non-suicidal self-injury (NSSI) ranges from providing helpful education to displaying graphic images. We offer the first research-informed, consensus-based guidelines for the responsible reporting and depicting of NSSI in the media, while also advising on ideas for dissemination and collaboration between media professionals and healthcare experts.
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Comportamento Autodestrutivo , Consenso , HumanosRESUMO
Nonsuicidal self-injury (NSSI) is a prevalent and dangerous behavior among young adults, but no treatments specific to NSSI have been developed for patients without borderline personality disorder. The purpose of this study was to develop and investigate a novel intervention for NSSI among young adults. The intervention is a 9-session behavioral treatment designed to decrease the frequency of NSSI behaviors and urges. Using an open pilot design, feasibility and acceptability were investigated in a small sample (n = 12) over a 3-month follow-up period. A preliminary investigation of change in NSSI was also conducted. Feasibility and acceptability of the intervention were supported. Medium to large effect sizes were found for decreases in NSSI behaviors and urges over the follow-up period. Results of this open pilot trial support the further evaluation of this intervention.
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Purpose: Quantitative data on the psychological effects of microaggressions toward sexual and gender minority individuals have grown substantially. Sexual orientation-based and transgender and gender-diverse (trans+) identity-based microaggressions have been thematically identified in prior research. In addition, combined lesbian, gay, bisexual, transgender and gender-diverse, queer/questioning, and other non-heterosexual (LGBTQ) microaggressions can be examined intersectionally with other marginalized identities. This systematic review synthesizes research on the relationships among these microaggressions and psychological correlates and outcomes. Methods: Forty-five quantitative studies examining sexual orientation-, trans+ identity-, or intersectional identity-based microaggressions and various psychological outcomes were identified from systematic searches of PsycINFO, PsycARTICLES, MEDLINE, and PubMed databases. Data regarding microaggressions were extracted, synthesized, and grouped by mental health outcome or correlate. Results: Sexual orientation-based microaggressions were risk factors for depression, anxiety, and internalized stigma and were positively associated with psychological distress, traumatic stress symptoms, alcohol use and abuse, cannabis use and problems, suicidal ideation, and suicide attempt. Trans+ identity-based microaggressions were positively associated with depression, suicide attempt, and cannabis use. LGBTQ intersectional identity-based microaggressions concerning race/ethnicity were associated with depression, anxiety, and suicidal ideation. Research on other intersectional identity-based microaggressions is scarce. Conclusion: These findings emphasize the psychological harm inflicted by various microaggressions on LGBTQ late adolescents and early adults. Future work should focus on microaggressions toward individuals with trans+ and intersectional identities and protective factors for these experiences. This review also highlights the distinct need for community-based research on implementing microintervention strategies in family, school, and work environments to mitigate the harmful effects of these microaggressions.
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Nonsuicidal self-injury (NSSI) is a highly prevalent behavior among clinical and nonclinical samples. Despite the prevalence, maladaptive, and potentially dangerous nature of the behavior, no empirically supported interventions have been identified specifically for NSSI, and clinicians report a lack of knowledge regarding the treatment of NSSI. This article discusses the application of a common component of therapy, the case formulation, to conceptualizing and treating NSSI. This strategy for case formulation incorporates cognitive-behavioral and functional analytic approaches while focusing on factors pertinent to the development, maintenance, and treatment of NSSI. A case example is presented.
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Neuropsychological functioning has not yet been investigated among prisoners who engage in self-injurious behaviors, specifically attempted suicide and nonsuicidal self-injury (NSSI). The purpose of this study was to investigate neuropsychological functioning in prisoners with and without histories of NSSI and attempted suicide. The sample consisted of 173 male prisoners referred for neuropsychological evaluation. Of participants, 56% reported a history of self-injury. Performance on the neuropsychological domains of intelligence, memory, attention, motor functioning, and executive functioning was assessed. No group differences were found among those with NSSI, with NSSI and suicide attempts, and with no history of deliberate self-harm, although functioning was poor in all domains. Implications of the high prevalence of self-injury in this prison sample, as well as implications of impaired functioning on the treatment of self-injurious behaviors, are discussed.
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Although attempted suicide and non-suicidal self-injury (NSSI) differ in several important ways, a significant number of individuals report histories of both behaviors. The current study further examined the relations between NSSI and attempted suicide among psychiatric inpatients. Self-report questionnaires were administered to 117 psychiatric inpatients at a general hospital (M=39.45 years old, S.D.=12.84 years, range=17-73 years). We found that presence and number of NSSI episodes were significantly related to presence and number of suicide attempts. Supporting the importance of NSSI assessment, patients' history of NSSI (presence and frequency) was more strongly associated with history of suicide attempts than were patients' depressive symptoms, hopelessness, and symptoms of borderline personality disorder, and as strongly associated with suicide attempt history as current levels of suicidal ideation. Finally, among patients with a history of suicide attempts, those with an NSSI history reported significantly greater lethal intent for their most severe attempt, and patients' number of prior NSSI episodes was positively correlated with the level of lethal intent associated with their most severe suicide attempt.
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Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Comportamento Autodestrutivo/etiologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Adulto JovemRESUMO
Pain tolerance and dissociation have individually been shown to be risk factors for suicidal behaviors. The aim of the current study was to investigate how dissociation and physiological pain tolerance influence the relation between suicidal thoughts and behaviors. The sample consisted of 70 undergraduate college students who completed self-report measures of suicidality and dissociation and an electrical stimulation task to measure physiological pain tolerance. Results showed that dissociation and suicidal ideation, but not pain tolerance, were independently associated with increased suicide attempts. A three-way interaction of suicidal ideation, physiological pain tolerance, and dissociation statistically predicted number of suicide attempts, with an increased number of suicide attempts associated with high suicidal ideation and dissociation, regardless of pain tolerance. These results suggest that dissociation plays a significant role in predicting suicide attempts, perhaps by engendering a state of disconnect from one's body.
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Transtornos Dissociativos/psicologia , Medição da Dor/psicologia , Limiar da Dor/fisiologia , Limiar da Dor/psicologia , Ideação Suicida , Adolescente , Adulto , Transtornos Dissociativos/diagnóstico , Feminino , Humanos , Masculino , Medição da Dor/métodos , Medição da Dor/tendências , Valor Preditivo dos Testes , Fatores de Risco , Autorrelato , Estudantes/psicologia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Universidades/tendências , Adulto JovemRESUMO
OBJECTIVE: Non-suicidal self-injury (NSSI) is of concern given the increased risk for suicide attempt. Prevalence rates of NSSI are highest among adolescents and young adults. These groups also exhibit the highest rates of Internet use. Previous research suggests that online communication of NSSI can serve as both a risk and protective factor related to NSSI engagement. This study explored online disinhibition in the context of NSSI e-communities as a potential factor that could contribute to opposing NSSI outcomes. METHOD: The study sample consisted of 200 individuals 18 years or older (M = 21.76, SD = 5.24) recruited from social networking sites (i.e., Reddit, LiveJournal). These participants provided self-report of their NSSI histories and degree of online disinhibition. RESULTS: Those who engaged in Internet communication of NSSI at the highest level endorsed more online disinhibition than those less involved with NSSI content. Furthermore, within this group of high communicators, increased toxic disinhibition predicted lower lifetime frequency of NSSI. CONCLUSIONS: This study suggests that online behavior, including toxic disinhibition, may contribute to NSSI outcomes. Online disinhibition and its relationship to NSSI should be an area of continued research. Cyberbullying may be an additional construct of interest in future studies of NSSI e-communication.
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Comportamento Problema , Comportamento Autodestrutivo , Adolescente , Humanos , Internet , Fatores de Proteção , Comportamento Autodestrutivo/epidemiologia , Ideação Suicida , Tentativa de Suicídio , Adulto JovemRESUMO
Objective: Despite the prevalence and impact of nonsuicidal self-injury (NSSI), there are few treatments developed to treat the behavior specifically, and little is known about moderators of treatment response. The Treatment for Self-Injurious Behaviors (T-SIB), a brief, behavioral intervention, was developed to treat NSSI in young adults; a previous pilot randomized controlled trial (RCT) comparing T-SIB with treatment as usual (TAU) provided support for the intervention. This study examined demographic, clinical, and NSSI-related predictors of treatment outcome in the pilot RCT for T-SIB. Method: Young adults (N = 33) were randomized to receive T-SIB or treatment as usual; all participants were included in intent-to-treat analyses. The primary outcome of NSSI behaviors was assessed at baseline, posttreatment (9 weeks), and 3-month follow up, and potential moderators were assessed at baseline. Results: Greater lifetime and last year NSSI frequency was associated with fewer NSSI behaviors at posttreatment and follow up among participants in T-SIB. Anxious symptoms also moderated treatment outcomes, but other demographic and clinical variables did not. Conclusion: Previous research has shown that T-SIB is more effective than TAU overall; the current study suggests that T-SIB may be effective for individuals with more frequent NSSI and those with elevated anxiety. A larger evaluation of T-SIB is supported. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Terapia Comportamental/métodos , Psicoterapia Breve/métodos , Comportamento Autodestrutivo/terapia , Adolescente , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Comportamento Autodestrutivo/psicologia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: A growing body of research suggests that individuals with a history of multiple suicide attempts exhibit more severe psychopathology than individuals with only one or no previous suicide attempts. Given the strong link between diagnoses of major depression and suicide risk, our primary goal was to determine which specific depressive characteristics differentiate multiple attempters from patients with one or no previous attempts. METHODS: Participants were 121 depressed adult psychiatric inpatients. Participants were administered diagnostic interviews to assess the course and characteristics of their depression history as well as measures of suicidal ideation, suicide attempts, depressive symptoms, hopelessness, and dysfunctional attitudes. RESULTS: Patients with a history of multiple suicide attempts exhibited higher levels of suicidal ideation and depressive symptoms, but not hopelessness or dysfunctional attitudes, than the other two groups. In addition, multiple attempters reported an earlier age of major depression onset. CONCLUSIONS: The current results add to a growing body of research suggesting that multiple attempters may represent a distinct patient population.
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Transtorno Depressivo Maior/diagnóstico , Tentativa de Suicídio/psicologia , Adulto , Idade de Início , Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental , Terapia Combinada , Cultura , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Terapia Familiar , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Motivação , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Recidiva , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/estatística & dados numéricosRESUMO
There is a paucity of research on the emergence of suicidal ideation in recently hospitalized patients undergoing treatment for depression. As part of a larger clinical trial, patients (N = 103) with major depression without suicidal ideation at hospital discharge were followed for up to 6 months while receiving study-related outpatient treatments. Fifty-five percent reported the emergence of suicidal ideation during the outpatient period, with the vast majority (79%) exhibiting this problem within the first 2 months post-discharge. Seventy percent of those reporting severe suicidality prior to hospitalization exhibited a reemergence of suicidal ideation post-discharge. However, 29% without significant suicidality at the index hospitalization later developed suicidal ideation during the outpatient treatment period. A faster time to the emergence of suicidal ideation was predicted by both higher prehospitalization levels of suicidal ideation as well as greater depression severity at hospital discharge. Overall, rates of emergent suicidal ideation found in the current sample of recently hospitalized patients were higher than those reported in previous outpatient samples.
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Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/reabilitação , Hospitalização/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Masculino , Índice de Gravidade de Doença , Ajustamento Social , Inquéritos e Questionários , Fatores de TempoRESUMO
Research has shown both childhood physical and sexual abuse to be associated with later suicide attempts, although some studies have not supported these findings. However, few studies have investigated differences in physical and sexual abuse histories among single and multiple suicide attempters. The goals of the current study were two-fold: (a) to replicate previous findings of associations between childhood sexual and physical abuse and suicide attempts, and (b) to explore differences in reports of childhood physical and sexual abuse among single and multiple suicide attempters. While our results supported the findings that individuals with a history of suicide attempts are more likely to report histories of childhood physical and sexual abuse, we did not find a difference in reported abuse between single and multiple suicide attempters. Implications of these findings, as well as implications for future research, are discussed.
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Maus-Tratos Infantis/psicologia , Transtorno Depressivo Maior/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Criança , Maus-Tratos Infantis/diagnóstico , Abuso Sexual na Infância/diagnóstico , Abuso Sexual na Infância/psicologia , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Masculino , Inventário de Personalidade , Recidiva , Reprodutibilidade dos Testes , Projetos de Pesquisa , Tentativa de Suicídio/psicologiaRESUMO
The goal of this study was to examine the use of specific coping strategies among self-mutilating college students. The self-mutilating group (n = 44) reported utilizing avoidance strategies more often than did a control group (n = 44) matched for general psychological distress but with no history of self-mutilation. In addition, female, but not male, self-mutilators endorsed using problem-solving and social support seeking strategies less often than nonmutilators. These findings suggest that coping strategies in general and avoidance-based strategies in particular may be important targets for the treatment of self-mutilative behaviors.
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Adaptação Psicológica , Automutilação/prevenção & controle , Automutilação/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Inventário de Personalidade , Estados UnidosRESUMO
OBJECTIVE: Nonsuicidal self-injury (NSSI) is prevalent among young adults and associated with negative medical and psychological consequences, necessitating its treatment. However, few treatments have been developed to treat NSSI specifically, or to treat the behavior among individuals without borderline personality disorder. The purpose of this study was to investigate the Treatment for Self-Injurious Behaviors (T-SIB), a brief, behavioral intervention specifically developed to treat NSSI among young adults, in a pilot randomized controlled trial (RCT). METHOD: Young adults (N = 33; age: M = 22.36 years, SD = 3.40) meeting inclusion and exclusion criteria were randomly assigned to the treatment (T-SIB; n = 15) or treatment as usual (n = 18) condition. The sample was 93.9% female, 42.4% Caucasian, and 30.3% Hispanic/Latino. RESULTS: Feasibility and acceptability of the study and intervention were supported, and medium effects were found for decreased NSSI frequency in the T-SIB group using intent-to-treat analyses. CONCLUSION: Results of this study support the further evaluation of T-SIB in a larger RCT. (PsycINFO Database Record
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Terapia Comportamental/métodos , Comportamento Autodestrutivo/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , Comportamento Autodestrutivo/psicologia , Resultado do Tratamento , Adulto JovemRESUMO
Although hopelessness and depression are known risk factors for suicide, most individuals who are hopeless or depressed never make a suicide attempt. In this study, we tested the hypothesis that college students' (n = 230) attitudes toward suicide (the degree to which they see it as an acceptable option under some circumstances) would moderate the link between both hopelessness and depressive symptoms and their levels of suicidal ideation. This moderation hypothesis was supported, but only among men. Specifically, among men, levels of hopelessness and depressive symptoms were significantly related to suicidal ideation among only those with relatively positive attitudes toward suicide.
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Atitude , Suicídio/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Inquéritos e Questionários , Estados Unidos , UniversidadesRESUMO
The interpersonal psychological theory of suicide provides a useful framework for considering the relationship between non-suicidal self-injury and suicide. Researchers propose that NSSI increases acquired capability for suicide. We predicted that both NSSI frequency and the IPTS acquired capability construct (decreased fear of death and increased pain tolerance) would separately interact with suicidal ideation to predict suicide attempts. Undergraduate students (N = 113) completed self-report questionnaires, and a subsample (n = 66) also completed a pain sensitivity task. NSSI frequency significantly moderated the association between suicidal ideation and suicide attempts. However, in a separate model, acquired capability did not moderate this relationship. Our understanding of the relationship between suicidal ideation and suicidal behavior can be enhanced by factors associated with NSSI that are distinct from the acquired capability construct.
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Atitude Frente a Morte , Relações Interpessoais , Limiar da Dor/psicologia , Comportamento Autodestrutivo , Estudantes/psicologia , Ideação Suicida , Prevenção do Suicídio , Suicídio , Adolescente , Feminino , Humanos , Masculino , Teoria Psicológica , Medição de Risco/métodos , Fatores de Risco , Autorrelato , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/psicologia , Suicídio/psicologia , Inquéritos e Questionários , Universidades , Adulto JovemRESUMO
Prospective predictors of persistent nonsuicidal self-injury (NSSI) were examined in adolescents admitted to an inpatient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months. Seventy-one (77%) participants reported NSSI at baseline, and 40 (56%) persisted at the 6 month follow-up. Those who endorsed automatic positive reinforcement (APR) as the predominant reason for NSSI were more likely to persist in NSSI. Depression over follow-up, but not at baseline, also predicted persistence. These results suggest that helping high-risk adolescents to identify alternative ways of generating emotion(s) to counter the effects of APR that may accompany NSSI should be a high priority treatment target.
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Comportamento Autodestrutivo/epidemiologia , Ideação Suicida , Adolescente , Depressão/psicologia , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Medição de Risco , Comportamento Autodestrutivo/psicologiaRESUMO
The goal of this study was to examine the relationship between self-mutilation and symptoms of depression and anxiety in a nonclinical population. Self-mutilators reported significantly more symptoms of depression and anxiety than did the control group. When the group of self-mutilators was divided into individuals who cut themselves and individuals who harm themselves in other ways, we found that the between-group differences were primarily due to individuals with a history of cutting. Yet when symptoms of borderline personality disorder (BPD) were statistically controlled, all significant between-group differences in depressive and anxious symptoms were reduced to nonsignificant. These findings highlight the importance of assessing symptoms of BPD in self-mutilators, regardless of diagnosis.
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Ansiedade/epidemiologia , Transtorno da Personalidade Borderline/epidemiologia , Depressão/epidemiologia , Automutilação/epidemiologia , Adolescente , Ansiedade/diagnóstico , Ansiedade/psicologia , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Inquéritos e QuestionáriosRESUMO
Research suggests that individuals with a history of non-suicidal self-injury (NSSI) do not have difficulty generating alternatives to social problems but choose more negative solutions, suggesting a deficit in decision-making. However, studies report no significant differences in risky decision-making on a performance-based task among individuals with and without NSSI histories. A limitation of these studies is that decision-making was only assessed at baseline. As individuals with a history of NSSI typically self-injure when experiencing negative emotions, decision-making ability may become impaired specifically in the presence of these emotions. The aim of the current study was to investigate decision-making ability among individuals with and without NSSI histories both at baseline and following a distressing social exclusion task. We compared individuals with (n=48) and without (n=72) NSSI histories on the Iowa Gambling Task, a behavioral measure of risky decision-making, before and after exclusion or inclusion on the Cyberball task. Results indicated no significant group differences in performance regardless of condition. When participants were grouped by racial/ethnic minority status, results indicated that non-Hispanic White individuals with a history of NSSI exhibited deterioration in risky decision-making ability following social exclusion. Potential explanations for these findings and clinical implications are discussed.