Non Suicidal Self-Injury and Eating Disorders.

Epidemiological data on non-suicidal self-injury (NSSI) in the context of eating disorders (ED) are limited, with estimates varying widely across studies and reviews being primarily narrative. Self-injurious behaviour is present in various psychiatric disorders of adolescents and young adults, including eating disorders. A study conducted on the general population of adolescents showed that 30% of females and 24% of 16-year-old males with an eating disorder had engaged in acts of self-harm compared with 8.3% of females and 4.0% of males without an eating disorder. In particular, self-harm behaviours, including Non-Suicidal Self-Injury (NSSI), suicide attempts (SA), and suicidal ideations (SI), are common among individuals with Anorexia Nervosa (AN) and Bulimia Nervosa (BN). Presence of eating disorders and self-injurious behaviours in the same individual is associated with more severe psychopathology increasing the risk of more severe depressive and anxiety symptoms and suicide attempts.

Self-Harm Behavior and Suicidality Among Adolescents in Samara Region.

INTRODUCTION: Self-harm behavior is a significant global concern, with Russia among the countries with high prevalence rates. Adolescents and young adults (15-29 years old) are particularly vulnerable, with suicide being the fourth leading cause of death in this age group. Our objective was to present statistics on suicidality and non-suicidal self-harm behavior (NSSH) among adolescents in the Samara region and to identify psychosocial differences between patients hospitalized for the first time and those hospitalized repeatedly. SUBJECTS AND METHODS: This study is a retrospective chart analysis of adolescents hospitalized due to suicidal ideation or attempts in 2023. Data were collected from hospital records, comprising a diverse sample of adolescents. RESULTS: The sample included 76 adolescents, with a significant gender imbalance, as 84.2% were female. Chronic family conflicts presumably were the most influential factor, rather than family composition. Data on hereditary predisposition were subjective and presumably did not correlate with the number of hospitalizations. Fetal hypoxia was the only notable perinatal pathology. Self-harm behavior was more common in readmissions, while suicidal thoughts were present in similar proportions in both initial and repeat hospitalizations. The main reasons for self-harm behavior were the desire to gain control over life or to relieve emotional pain. Only 2.6% of cases were directly aimed at suicide. CONCLUSIONS: Identified risk factors for suicidal behavior among adolescents included female gender, an unfavorable family environment, and NSSH, which, although not directly suicidal, increased the risk of future suicidal behavior. These factors should be considered in the diagnosis and prevention of suicidal behavior.

Suicidality in Youngers: an Observational Study in Outpatient Unit.

Suicidality (meaning ideation, self-harm and attempt to suicide) are major public health problems in adolescence and represent a worldwide public health concern. Non-suicidal self-injury (NSSI), often simply called self-injury, is the act of harming your own body on purpose, for example by cutting or burning yourself. NNSI is a common mental health threat among adolescents and it's usually not meant as a suicide attempt. Unfortunately, suicide is the second most common cause of death in young people worldwide and represents a public health problem. For this reason, we analyzed retrospective data from patients admitted in the Psychiatric Hospital from July 1st 2023 to June 30th 2024 to identify clinical features, risk factors of suicidality by analyzing the assessment we administered at time of hospitalization: Patient Health Questionnaire (PHQ-9), Ask Suicide Questionnaire (ASQ), G.T. MSRS scale. Within the 50 subjects of the sample, 30 patients attempt to suicide (60%); the large majority (90%) met the criteria for mixed state. This study shows that there is a high prevalence of mixed states in the inpatient unit admission, which is demonstrated both from the prescription of mood stabilizers, and confirmed by the diagnosis of mixed states rated with the scale. The use of structured interview with patient and families add on assessment suicide risk scale are fundamental, in order to guide a tailored psychopharmacological treatment, and improve prognosis.

Development and Use of Suicide Registry for Recording Patient Profile with Self-harm Visiting Tertiary Hospital of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Suicide is a major public health concern globally as well as in Nepal. It is important to have baseline data regarding suicide attempts to develop a prevention strategy. This study aims to describe the methodology used to develop a suicide registry and use it to collect data from patient visiting emergency or psychiatric outpatient department with suicide attempts in a tertiary care hospital. METHODS: This is a descriptive cross-sectional study conducted retrospectively after obtaining ethical approval (Reference number: drs2005211371) from institutional review committee. Total sampling was done from the database covering the period from October 1, 2017, to September 30, 2023. The database was in the form of suicide registry that was developed after reviewing the existing data of primary health care centres, private hospitals, and tertiary care centers and a series of discussions among mental health experts. Data was entered in Microsoft Excel and analysis was done. RESULTS: Among the 248 patients, there were 109 (43.95%) male and 139 (56.05%) female. There were 209 (84.27%) patients who attempted suicide inside home, poisoning was seen in 90 (36.29%) and 183 (73.79%) had impulsive intention. Out of total patients, 59 (23.79%) had prior communication and 84 (33.87%) had previous attempts, 109 (43.95%) patients had impulsive attempts as diagnosis and 75 (30.24%) had depression. CONCLUSIONS: As per the suicide registry, most of the patients attempted suicide inside home and the most common method used was ingestion of poison.

Longitudinal relations between non-suicidal self-injury and both depression and anxiety among senior high school adolescents: a cross-lagged panel network analysis.

Background: Comorbidity between non-suicidal self-injury (NSSI) and depression and anxiety was common. In the framework of network theory, the examination of directionality and gender differences in longitudinal relationships at the symptom level made a significant contribution to the understanding of comorbidity. Therefore, this study employed cross-lagged panel network analysis to investigate the longitudinal interrelations between NSSI and depression and anxiety in Chinese adolescents, with a focus on gender differences. Method: The study was conducted with a sample of 884 senior high school students (F/M: 481/403; mean age: 15.19 ± 0.48 years) from Jinchang City, Gansu Province, China. All respondents completed the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire and the two subscales (depression and anxiety) of the Brief Symptom Inventory at two intervals. The data were estimated in R 4.2.0 to construct the cross-lagged panel network (CLPN). Results: The CLPN results uncovered the gender differences. For boys, self-hitting and feeling scared emerged as central symptoms. Cutting predicted subsequent feelings of sadness (ß =  - 0.57), tension (ß =  - 0.52) and indifference (ß =  - 0.49), potentially serving as a bridge connecting NSSI to depression and anxiety. For girls, biting themselves and feeling scared were central symptoms. Carving and skin rubbing predicted subsequent feelings of indifference (ß =  - 0.31, -0.21), bridging NSSI to depression and anxiety. In addition, feeling scared emerged as the key bridge symptom connecting depression and anxiety. Conclusion: The findings showed the gender-specific developmental characteristics of the directional relations between NSSI and depression and anxiety at the symptom level. They provided new insights into the comorbidity of NSSI and depression and anxiety, carrying important implications for the screening and intervention of adolescent NSSI.

Australian Youth Self-Harm Atlas: spatial modelling and mapping of self-harm prevalence and related risk and protective factors to inform youth suicide prevention strategies.

AIMS: Suicide prevention strategies have shifted in many countries, from a national approach to one that is regionally tailored and responsive to local community needs. Previous Australian studies support this approach. However, most studies have focused on suicide deaths which may not fully capture a complete understanding of prevention needs, and few have focused on the priority population of youth. This was the first nationwide study to examine regional variability of self-harm prevalence and related factors in Australian young people. METHODS: A random sample of Australian adolescents (12-17-year-olds) were recruited as part of the Young Minds Matter (YMM) survey. Participants completed self-report questions on self-harm (i.e., non-suicidal self-harm and suicide attempts) in the previous 12 months. Using mixed effects regressions, an area-level model was built with YMM and Census data to produce out-of-sample small area predictions for self-harm prevalence. Spatial unit of analysis was Statistical Area Level 1 (average population 400 people), and all prevalence estimates were updated to 2019. RESULTS: Across Australia, there was large variability in youth self-harm prevalence estimates. Northern Territory, Western Australia, and South Australia had the highest estimated state prevalence. Psychological distress and depression were factors which best predicted self-harm at an individual level. At an area-level, the strongest predictor was a high percentage of single unemployed parents, while being in an area where ≥30% of parents were born overseas was associated with reduced odds of self-harm. CONCLUSIONS: This study identified characteristics of regions with lower and higher youth self-harm risk. These findings should assist governments and communities with developing and implementing regionally appropriate youth suicide prevention interventions and initiatives.

Trajectories of children evaluated for abuse.

INTRODUCTION: Child abuse increases the risk of substance abuse and non-suicidal self-injury, but the topic of school absenteeism and number of offspring has not been studied prospectively. This study presents the first assessment of these four outcomes among children evaluated for exposure to child abuse. METHODS: In the 2001-2007 period, the Department of Forensic Medicine, Aarhus University, Denmark, evaluated 375 children for exposure to abuse. These children were age- and gender-matched to children from population registries at a 1:6 ratio. Excluding siblings, 2,573 children were analysed. We used the Danish Education Register, the National Patient Register and the Central Civil Register to estimate outcomes and covariates. Negative binomial or Poisson models were used. Follow-up included data until 2016. RESULTS: For children aged 10-16 years, the incidence rate ratio (IRR) of substance abuse was increased for suspected abuse. The IRR of severe non-suicidal self-injury was 5.03 (95% confidence intervals (CI): 2.59-9.77) for children ≥ 7 years old. School absenteeism had an IRR of 1.30 (95% CI: 1.01-1.68) among children aged 0-3 years. The number of offspring was increased among children aged 12-16 years with suspicion of sexual abuse, IRR = 1.67 (95% CI: 1.27-2.20), and for children aged 8-11 years with suspicion of any abuse, IRR = 3.93 (95% CI: 2.14-7.22). CONCLUSIONS: Children evaluated for exposure to child abuse differed from their peers on all measured outcomes. The health and social services should devote attention to this group and the families they form. FUNDING: This study received financial support from the Danish Victims Fund. The execution, content and results of the materials are the sole responsibility of the authors. The analysis and viewpoints presented in relation to the materials are the responsibility of the authors and do not necessarily reflect the views of the Council of The Danish Victims Fund. TRIAL REGISTRATION: Not relevant.

[Non-suicidal self-injurious behaviors in adolescence Role of frontline practitioners]. / Comportements autodommageables sans intention suicidaire à l'adolescence. Rôle des intervenant-e-s en première ligne.

Non-suicidal self-injury (NSSI) is an increasing mental health issue among adolescents. General practitioners and pediatricians play a crucial role in detecting, evaluating, and managing these behaviors. This article aims to provide recommendations for the first line surrounding the young person, such as the appropriate stance to adopt and the use of a safety plan, for effectively managing NSSI patients. It takes into account the often-present interpersonal hypersensitivity in these patients and includes strategies for working with families and within a multidisciplinary network.

Les comportements autodommageables sans intention suicidaire (NSSI, non-suicidal self-injury) sont un problème de santé mentale en augmentation chez les adolescents. Les généralistes et pédiatres jouent un rôle crucial dans la détection, l'évaluation et la prise en charge de ces comportements. Cet article donne des recommandations, surtout pour les services non spécialisés, telles la posture à tenir et l'utilisation d'un plan de sécurité, pour une prise en charge appropriée des patients NSSI, en tenant compte de l'hypersensibilité interpersonnelle souvent présente chez ces patients, et en incluant des stratégies pour le travail avec les familles et en réseau.

Role of sleep problem on suicidal behaviour and non-suicidal self-injury among adolescents in Pokhara, Nepal.

INTRODUCTION: Sleep is a fundamental human requirement, considered one of the major contributing factors to physical and mental health, especially among adolescents. Poor quality sleep has many potential consequences including non-suicidal self-injury (NSSI), suicidal thoughts or behaviour and complete suicide. The NSSI and suicidal behaviour are increasing in Nepal. Thus, this study aimed to assess the role of sleep problem on suicidal behaviour and non-suicidal self-injury among adolescents in Pokhara metropolitan, Nepal. METHODS: A cross-sectional analytical study was conducted among 673 adolescents using a multistage cluster sampling technique from private and public schools in Pokhara Metropolitan. Self-administered questionnaire was used for data collection. Collected data was entered and managed in EpiData (version 3.1) and analysed in IBM SPSS (version 23). Binary logistic regression was used to identify the association of sleep problem with NSSI and suicidal behaviour. RESULTS: The study found that sleep problem (65.2%, 439), suicidal behaviour (18.6%, 125) and NSSI (57.9%, 390) were prevalent among adolescents in study setting. The presence of sleep problem significantly influenced the suicidal behavior (AOR = 3.88, 95% CI = 2.27-6.63) alongside the sex of student (AOR = 1.96, 95% CI = 1.28-3.00), adolescents from family having monthly income less than NPR 40,000 (AOR = 1.97 95% CI = 1.16-3.35) and private schools students (AOR = 2.99, 95% CI = 1.84-4.86). Likewise, sleep problem was also associated with non-suicidal self-injury (AOR = 3.24, 95% CI = 2.26-4.65), in addition to attending private school (AOR = 2.52, 95% CI = 1.71-3.72). CONCLUSION: This study concludes that sleep problem is prevalent among the adolescents and increase the risk of NSSI and suicidal behaviour. Therefore, parents and teachers need to assess their conditions and help them maintain sound sleep. Additionally, suicide prevention strategies need to be adopted to mitigate further risk.

A Multi-Mediation Analysis of the Association between Adverse Childhood Experiences and Non-Suicidal Self-Injury among South African Adolescents.

The available research findings suggest that non-suicidal self-injury (NSSI) constitutes an important public health issue, with identified risk factors for NSSI having been found to include exposure to adverse childhood experiences (ACEs) and comorbidity with various mental disorders. However, the available findings have, for the most part, been based on the experiences of individuals living in predominantly high-income countries located in the Global North, and it is not clear whether these findings can be confidently generalised to individuals living in low-resourced countries. As such, this cross-sectional study assessed risk factors for NSSI in a non-clinical sample of 636 South African adolescents (12-18 years old), with the data being analysed using a multi-mediation analysis. ACEs were assessed using a revised version of the ACEs Questionnaire, and NSSI was assessed using items adapted from the Self-Harm subscale of the Risk-Taking and Self-Harm Inventory for Adolescents, with emotion dysregulation, depression, and PTSD being considered as possible mediators. High prevalence rates for NSSI and exposure to five or more ACEs were reported by the participants, with the mediation analysis indicating that significant direct effects of adverse childhood experiences on NSSI were partially mediated by emotion dysregulation. These findings are discussed with respect to their implications for primary, secondary, and tertiary prevention.

Evaluation of health services and treatment alliance among extensively hospitalized patients due to severe self-harm - results from the Extreme Challenges project.

BACKGROUND: Extensive psychiatric hospitalization due to repeated severe self-harm (SH), is a poorly researched area, but a challenge within health services (HS). Recent studies have demonstrated high levels of involuntary treatment among patients with severe personality disorder (PD) and complex comorbidity. Keeping focus on extensively hospitalized SH patients, this study aimed to investigate patients' and clinicians' evaluation of HS and treatment alliance. METHOD: A cross-sectional study with an inpatient sample (age >18 years) with frequent (>5) or long (>4 weeks) psychiatric hospital admissions last year due to SH or SA recruited from 12 hospitals across health regions (N = 42). Evaluation included patient and clinician report. RESULTS: A minority of the patients (14%) were satisfied with HS before the current admission, 45% (patients) and 20% (clinicians) found the current admission helpful, and 46% (patients) and 14% (clinicians) worried about discharge. Treatment complaints were received in 38% of the cases. Outpatient mental HS were available after discharge for 68% and a majority of clinicians indicated satisfactory contact across HS. More intensive or specialized formats were unusual (structured outpatient treatment 35%, day treatment 21%, ambulatory services 32%, planned inpatient services 31%). Mutual problem understanding, aims, and confidence in therapists during the hospital stay were limited (patient-rated satisfactory mutual problem understanding: 39%, aims of stay: 50%, confidence: 50%). Patient and therapist alliance-ratings were in concordance for the majority. CONCLUSION: The study highlights poor HS satisfaction, poor patient-therapist coherence, limited treatment alliance and limited follow-up in structured treatments addressing SH or intermediary supportive ambulatory/day/inpatient services.

Association Between COVID-19 and Self-Harm: Nationwide Retrospective Ecological Spatiotemporal Study in Metropolitan France.

Background: The COVID-19 pandemic has not been associated with increases in suicidal behavior at the national, regional, or county level. However, previous studies were not conducted on a finer scale or adjusted for ecological factors. Objective: Our objective was to assess the fine-scale spatiotemporal association between self-harm and COVID-19 hospitalizations, while considering ecological factors. Methods: Using the French national hospital discharge database, we extracted data on hospitalizations for self-harm of patients older than 10 years (from 2019 to 2021) or for COVID-19 (from 2020 to 2021) in metropolitan France. We first calculated monthly standardized incidence ratios (SIRs) for COVID-19 between March 2020 and December 2021, using a Besag, York, and Mollié spatiotemporal model. Next, we entered the SIRs into an ecological regression in order to test the association between hospital admissions for self-harm and those for COVID-19. Lastly, we adjusted for ecological variables with time lags of 0 to 6 months. Results: Compared with a smoothed SIR of ≤1, smoothed SIRs from 1 to 3, from 3 to 4, and greater than 4 for COVID-19 hospital admissions were associated with a subsequent increase in hospital admissions for self-harm, with a time lag of 2 to 4 months, 4 months, and 6 months, respectively. Conclusions: A high SIR for hospital admissions for COVID-19 was a risk factor for hospital admission for self-harm some months after the epidemic peaks. This finding emphasizes the importance of monitoring and seeking to prevent suicide attempts outside the epidemic peak periods.

Developmental Assets and Their Relationship to Suicidal Behavior in Mexican Young Adults.

Suicide in young people is a public health problem. Typically, protective factors for suicide are not studied; research tends to focus on measuring risk factors. However, knowing the risk factors does not mean that we also know the opposing factors that influence a group's health problems. For this reason, we examined the relationship between developmental assets in Mexican youth aged 18 to 25 years who are not at risk for suicide, exhibit self-injurious behavior, and whose last suicide attempt had low or high lethality. A cross-sectional study of 478 young people (73% female and 27% male) from Mexico City was conducted using an online survey and correlations were tested with dummy variables (groups) and multinomial logistic regression. The no-risk group showed associations with all developmental assets, the self-injurious group had an association with the house rules variable, the low lethality group was correlated with twelve assets and the high lethality group with four assets. Four internal developmental strengths were significant in the regression model: avoidance of risk behaviors, school expectations, resistance to pressure, and expression of anger. These results suggest that PYD is a useful framework for examining suicide risk and promotes skill development in young college students.

Self-Harm Before and Six Months After Obesity Surgery.

PURPOSE: Previous research on obesity surgery (OS) showed that patients do not only experience weight loss but also improvements in certain mental health outcomes (e.g., depression) after OS. However, self-harm behaviors might increase after OS. Regarding self-harm, the literature is mostly limited to studies using data from hospital or emergency room charts. This longitudinal study examined self-reported self-harm behaviors and potential psychopathological correlates before and after OS. MATERIALS AND METHODS: Pre-surgery patients (N = 220) filled out a set of questionnaires before and approximately six months after OS. Self-harm behaviors were captured with the Self-Harm Inventory. The assessments further included standardized instruments to measure symptoms of depression, anxiety, eating disorders, alcohol use, and suicidal ideations. RESULTS: Any self-harm was reported by 24.6% before and by 25.0% after OS. No differences in the number of self-harm behaviors or prevalence of any self-harm before and after OS were found. Overall, 11.4% experienced self-harm behaviors at both times. A subset showed self-harm behaviors only before (13.2%) OS and another subset only after OS (13.6%). These two groups were about the same size. Self-harm behaviors showed strong associations with psychopathology after OS, especially with depression and suicidal ideation. CONCLUSION: No increase in self-harm behaviors after OS emerged. Still, a subgroup showed self-harm behaviors after OS closely linked to further psychopathology. This mirrors the need to implement screening for self-harm before and after OS into OS care. Further studies with longer follow up periods are needed to extend these findings.

Cyberbullying and Suicidal Behavior, Self-Harm, and Nonsuicidal Self-Injury: A Systematic Review of Longitudinal Studies.

Aim: Identify and systematically review cohort studies examining the association between cyberbullying (CB) and suicidal ideation, attempted suicide, self-harm, and nonsuicidal self-injury (NSSI). Methods: Systematic literature review following PRISMA guidelines. Searches for relevant literature were conducted in Scopus, Web of Science, PubMed, PsyINFO, CINAHL, Embase, and Cochrane up until July 2023. Cohort studies were included that provided information regarding the association between CB and different dimensions pertaining to self-injurious thoughts and behaviors (SITB) separately. Gathered information included data on study characteristics, sample characteristics, prevalence, and associations between CB and variables pertaining to SITB. Findings were synthesized, and grouping studies as a function of the outcome variable was analyzed. Results: A total of 19 studies were included. Suicidal ideation was analyzed in 11 studies, with the majority (n = 8) reporting statistically significant positive associations (aOR = 1.88 [1.08, 3.29], ß = 0.08 to 0.47). Only a single study conducted independent analysis of attempted suicide, finding a statistically significant association (aOR 1.88 [1.08, 3.29]). Outcomes regarding the self-harm variable were equivocal, with only two out of five studies finding a statistically significant association and one of these, which conducted a gender differentiated analysis, only finding a significant association in females. Studies that considered the NSSI dimension were also inconclusive, with only a limited number of studies (n = 5) producing contradictory outcomes. Conclusion: There is a need to continue exploring the relationship between CB and different dimensions within the spectrum of SITB through longitudinal studies. It is recommended that analyses adopt a new perspective in which short-term follow-up is prioritized or individualized follow-up periods are considered, given the rapidly changing nature of suicidal tendencies. It would be interesting to analyze the frequency, persistence, or severity of CB events and broaden research to include all age ranges. Special attention should also be given to potential gender differences and possible mediators or moderators.

A meta-analysis on the lifetime and period prevalence of self-injury among adolescents with depression.

Background: Adolescents are vulnerable to mental disorders due to physiological, psychosocial, and cognitive changes during this critical developmental stage. Depression, in particular, can lead to high-risk behaviors such as self-injury (SI) and suicide. This study aims to estimate the pooled prevalence of SI behaviors among adolescents with depression. Materials and methods: We systematically searched databases including EMBASE, Scopus, PubMed, and Web of Sciences for relevant articles published on adolescents with depression from January 1, 2000, to January 1, 2024. The quality assessment of the studies was conducted using the Joanna Briggs Institute (JBI) criteria. The global prevalence of SI was calculated based on a random effects model using Stata software version 17. Results: Our analysis included 29 studies involving 12,934 adolescents. The lifetime prevalence of SI was 52% (95% Confidence Interval [CI]: 41-64), while the period prevalence was 57% (95% CI: 49-64). Notably, a significant relationship was observed between the prevalence of SI and the year of publication of articles (p = 0.002). Furthermore, publication bias was not significant for both lifetime prevalence (p = 0.281) and period prevalence (0.358). Conclusion: The prevalence of self-injurious behaviors in adolescents with depression is alarmingly high, with more than half of adolescents having engaged in these high-risk behaviors during their lifetime or within the last year. Given the associated risk of suicide, it is crucial to identify individuals at risk and provide timely interventions.

Pediatric trauma during the COVID-19 lockdown: caregiver abuse and self-harm in a vulnerable population.

PURPOSE: This retrospective cohort study explores the impact of the COVID-19 pandemic on pediatric trauma cases in Singapore's National University Hospital from January 2015 to July 2021. The pandemic prompted unprecedented measures, altering societal dynamics. The study hypothesizes a reduction in major trauma incidents during the pandemic period. METHODS: This is a single-center retrospective study including all pediatric patients presenting with trauma-related ICD-9 codes, and an Injury Severity Score (ISS) greater than 8. Patients were stratified into two time periods: pre-pandemic (January 2015 to March 2020) and pandemic (April 2020 to July 2021) periods. RESULTS: Out of 254 pediatric trauma cases, 201 occurred pre-pandemic, and 53 during the pandemic. While overall trauma incidence remained similar, the pandemic period saw a shift in injury patterns. Home-based falls increased, vehicular accidents decreased, while deliberate self-harm and caregiver abuse rose significantly. The incidence of serious trauma attributed to non-accidental injury increased during the pandemic. CONCLUSION: The study reveals changing trauma patterns, emphasizing the importance of understanding societal impacts during pandemics. Notably cases of deliberate self-harm and caregiver abuse surged, echoing global concerns highlighted in other studies during the pandemic. The study underscores the need to preempt physical and psychological stressors in vulnerable populations during future pandemics.

The mediating effects of school bullying victimization in the relationship between childhood trauma and NSSI among adolescents with mood disorders.

BACKGROUND: Nonsuicidal self-injury (NSSI) is a serious problem in the adolescent population worldwide. Childhood trauma and bullying have been identified as risk factors for NSSI. We explored the relationships among Childhood trauma, Bullying victimization and the severity of NSSI behaviours, and test the effect of Bullying victimization in mediating the association between Childhood trauma and the NSSI behaviours. METHODS: A total of 123 adolescents were recruited. They were diagnosed with depression or depressive episodes of bipolar disorder and had experienced NSSI in the last year. They were assessed using the Chinese version of the Childhood Trauma Questionnaire (CTQ-C), the Revised Olweus Bullying Victimization Questionnaire (OBVQ-R), and the Adolescent Self-Harm Questionnaire (ASHQ). RESULTS: Females presented a significantly greater prevalence of sexual abuse and relationship bullying than boys. Individuals in the younger age group (10-14 years) presented a greater incidence of emotional neglect, verbal bullying, relationship bullying, and total bullying, and their NSSI score was also higher than that of those in the older age group (15-19 years). Only children show a greater prevalence of sexual abuse than nononly children. Single-parent families scored higher on emotional abuse, emotional neglect, physical neglect and physical bullying than two-parent families. There was a significant positive correlation between each dimension of childhood trauma and all the dimensions of bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. The mediating effects of bullying victimization on emotional abuse, physical abuse, emotional neglect and physical neglect were 14%, 21%, 20%, 13% and 20%, respectively. CONCLUSION: There was a significant positive correlation between childhood trauma and bullying, between childhood trauma and NSSI, and between bullying and NSSI. Childhood trauma can not only directly affect the severity of NSSI but also indirectly aggravate the severity of NSSI through bullying victimization. Bullying victimization played the partial mediating effects between Childhood trauma and NSSI.

Deliberate self-harm in adolescents screening positive for attention-deficit / hyperactivity disorder: a population-based study.

BACKGROUND: Adolescents with attention-deficit / hyperactivity disorder (ADHD) have an increased risk of self-harm. The risk of self-harm among adolescents who display an elevated level of ADHD symptoms, but without a formal diagnosis, is not well-studied and understood. OBJECTIVE: To investigate the relationship between self-reported symptoms of ADHD and self-harm in a population-based sample of adolescents. METHODS: Adolescents in the population-based youth@hordaland study were invited to complete the Adult ADHD Self-Report Scale (ASRS) and the Short Mood and Feelings Questionnaire (SMFQ). They were asked whether they ever deliberately have taken an overdose or tried to harm themselves on purpose, once or multiple times, defined according to the code used in the Child and Adolescent Self-harm in Europe (CASE) Study. Adolescents reporting severe problems on ≥ four of six selected items on the ASRS-v 1.1 screener were defined as ADHD-screen positive (ADHD-SC+), and the remaining sample as ADHD-screen negative (ADHD-SC-). SMFQ score ≥ 12 was used to define a high level of depressive symptoms. RESULTS: A total of 9692 adolescents (mean age 17.4 years, 53.1% females) participated in the study, of which 2390 (24.7%) screened positive on the ASRS. ADHD-SC+ adolescents engaged in self-harm more often than the ADHD-SC- group (14.6% vs. 5.4%, OR = 3.02, 95%CI [2.57-3.24]). This remained significant after adjustment for demographic variables, SMFQ score ≥ 12, symptoms of conduct disorder and familial history of self-harm and suicide attempts (OR = 1.58, 95%CI [1.31-1.89]). They were also more likely to report an overdose as their method of self-harm (OR = 1.52, 95%CI [1.05-2.23]). Within the ADHD-SC+ group female sex, high levels of inattention and hyperactivity/impulsivity symptoms, SMFQ score ≥ 12, symptoms indicating conduct disorder and familial history of self-harm and suicide attempts increased the likelihood of engaging in deliberate self-harm. CONCLUSION: Adolescents who screened positive for ADHD had increased risk of engaging in self-harm. Clinicians should consider the increased risk of such engagement in adolescents who present with high level of ADHD symptoms, even in the absence of a clinical ADHD diagnosis.