A longitudinal study testing the role of psychache in the association between emotional abuse and suicidal ideation.

OBJECTIVE: Research suggests that emotional abuse is associated with adolescent suicidal ideation. But how they are related is still unclear. The present study tested the temporal relationship between emotional abuse and suicidal ideation, with psychache as the potential mediator. We also examined the reciprocal relationship between psychache and suicidal ideation. METHOD: A number of 2,259 Chinese high school students (53.8% females, mean age = 15.11, SD = 1.57) in Hong Kong completed questionnaires assessing emotional abuse, psychache, and suicidal ideation three times at 6-month intervals. RESULTS: The results supported the mediating effect of psychache in the path from emotional abuse to suicidal ideation. In addition, psychache and suicidal ideation were related reciprocally over time. CONCLUSION: The findings of this study may help researchers and practitioners understand the pathways by which emotional abuse impacts adolescent suicidal ideation. Implications for preventions and interventions of suicidal ideation were discussed.

The reciprocal associations between identity disturbance, relationship disturbance, and suicidal ideation among Chinese adolescents: A three-wave cross-lag study.

OBJECTIVE: Adolescence is a developmental period associated with a heightened risk for suicidal ideation. During this phase of life, individuals tend to focus on both intrapersonal self and interpersonal relationships. Thus, it is of much significance to understand the roles of intrapersonal and interpersonal factors in the development of suicidal ideation among adolescents. The present study examined the reciprocal associations between identity disturbance, relationship disturbance, and suicidal ideation by using a three-wave cross-lag model in a sample of adolescents. METHOD: A number of 3,600 Chinese adolescents (56.6% females, mean age = 14.58 years) completed questionnaires assessing the three main study variables as well as depressive symptoms, anxiety, and suicidal attempts three times at 6-month intervals. RESULTS: After controlling for gender, age, depressive symptoms, anxiety, and suicidal attempts, relationship disturbance significantly predicted suicidal ideation over time, and vice versa. Suicidal ideation significantly predicted identity disturbance over time, but not vice versa. We also found the mediating effect of relationship disturbance in the path from identity disturbance to suicidal ideation. CONCLUSION: The results suggested the important role of previous relationship disturbance in predicting later suicidal ideation. Theoretical and clinical implications of these findings were discussed.

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

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

Developmental Trajectories of Nonsuicidal Self-Injury in Adolescence and Intrapersonal/Interpersonal Risk Factors.

This 3-wave study investigated the developmental trajectories of nonsuicidal self-injury (NSSI) and intrapersonal/interpersonal risk factors among 3,381 Chinese adolescents (56.2% females) aged from 13 to 17 years during a 1-year period. Using an accelerated longitudinal design and latent class growth analysis, we identified four subgroups of NSSI trajectories: negligible (74.6%), experimental (12.8%), moderate decreasing (10.8%), and high fluctuating (1.9%). Adolescents reporting both intrapersonal (i.e., impulsive behaviors and depression) and interpersonal (i.e., unstable relationships and parental criticism) risk factors were significantly more likely to follow the latter three trajectories. The findings of this study suggest there is heterogeneity in NSSI development among adolescents and highlight the contributions of both intrapersonal and interpersonal risk factors in the engagement in NSSI.

Peer group impulsivity moderated the individual-level relationship between depressive symptoms and adolescent nonsuicidal self-injury.

This study examined the influence of impulsive friendship group contexts on nonsuicidal self-injury (NSSI) and how peer group impulsivity (i.e. negative urgency and premeditation) moderated the individual level relationship between depression and NSSI among 1701 Chinese secondary school students (1147 females). Participants were assessed twice over a 6-month interval. After controlling for direct socialization effects for NSSI, multilevel analysis indicated that friendship group negative urgency exerted a significant influence on NSSI. Additionally, friendship group premeditation weakened the relation between individual depression and NSSI, while friendship group negative urgency strengthened the relation between depression and NSSI. The results suggest the contribution of indirect peer influence effects to NSSI.

Functions of nonsuicidal self-injury among Chinese community adolescents.

This study examined functions of nonsuicidal self-injury (NSSI) among a large sample of Chinese high school students over a six-month period. Among Chinese adolescents, we identified three factors of NSSI functions, namely, Affect Regulation, Social Influence, and Social Avoidance. Affect Regulation was the most frequently endorsed function of NSSI, followed by Social Influence and Social Avoidance. Adolescent male self-injurers were more likely to endorse the Social Influence function than their female counterparts. Moderate/Severe Self-injurers did not differ from Minor Self-injurers on the endorsement of various NSSI functions. All functions of NSSI exhibited small to moderate stability over the six-month assessment period. Findings suggest that Chinese adolescents engaged in NSSI for multiple reasons. These reasons also varied considerably over time within individuals. Assessment of NSSI should thus regularly assess functions of the behavior.

Factor structure and psychometric properties of the Pathological Narcissism Inventory among Chinese university students.

The Pathological Narcissism Inventory (PNI) is a multidimensional measure of narcissistic pathology. This study examined the factor structure and psychometric properties of the PNI in a sample of Chinese university students in Hong Kong. Eight hundred and thirty-one students completed an online battery of questionnaires assessing narcissistic pathology, self-esteem, unstable sense of self, and maladaptive self-defense strategies. Results replicated the 7 first-order factors and the 2 second-order factors of the PNI. Each of the 7 first-order factors and the 2 second-order factors had good internal consistency. Preliminary findings also supported the concurrent validity of the PNI. The PNI appeared to be a valid measure of narcissistic pathology among Chinese. Findings of this study suggest that the core pathology of pathological narcissism might involve an inflated sense of self-importance that is not substantiated by actual achievement, and bearing this unsubstantiated sense of self-importance renders narcissists highly susceptible to self-deflation when their narcissistic needs are not met.

The role of depressive symptoms, family invalidation and behavioral impulsivity in the occurrence and repetition of non-suicidal self-injury in Chinese adolescents: a 2-year follow-up study.

This study used zero-inflated poisson regression analysis to examine the role of depressive symptoms, family invalidation, and behavioral impulsivity in the occurrence and repetition of non-suicidal self-injury among Chinese community adolescents over a 2-year period. Participants, 4782 high school students, were assessed twice during the follow-up period. Results indicate that while Year 1 depressive symptoms and family invalidation were significantly associated with the occurrence of Year 2 NSSI, Year 1 behavioral impulsivity contributed to both the occurrence and repetition of Year 2 NSSI. Findings of this study suggest that adolescents who display multiple impulsive behaviors may be at particular risk for engaging in repetitive NSSI. Clinical implications of these findings and future research directions were discussed.

Diagnosis of borderline personality disorder in China: current status and future directions.

This paper reviews the current status and future directions of borderline personality disorder (BPD) research in China. Although the committee of the third version of the Chinese Classification of Mental Disorders (CCMD-3) rejected BPD as a valid diagnostic category and instead adopted the term impulsive personality disorder (IPD), our literature review on personality disorders from 1979 to 2008 in China indicated that BPD was the most popular research topic among researchers and clinicians. Available empiric evidence on BPD in China provided preliminary support for the construct validity and clinical utility of BPD in clinical and nonclinical Chinese samples. Future studies in the following areas are suggested: 1) developing reliable assessment instruments for measuring BPD pathology in China, 2) comparing the construct validity and phenomenology of CCMD IPD and DSM BPD among Chinese patients, 3) examining potential cultural differences in symptom expression of BPD pathology among the Chinese, and 4) exploring indigenous and imported methods for treating BPD patients in China.

Impulsivity in Hong Kong-Chinese club-drug users.

To investigate the relationship between personality, club-drug use and high-risk drug-related behaviour, 360 club-drug users and 303 non-drug users in Hong Kong were assessed on measures of two impulsivity dimensions, reward drive and rash impulsivity, and a related trait of punishment sensitivity. The most frequently used drugs were ketamine, ecstasy, and cannabis, with the majority of participants using two or more drugs on any one occasion. Club-drug users were more rash-impulsive and reward-driven, and less punishment-sensitive than non-drug users (p<0.001). Rash impulsivity, but not reward drive or punishment sensitivity, was significantly (p<0.001) associated with risky drug-related behaviour. There was no association between any personality traits and preferred drug. These findings suggest that, while those who use club drugs are generally more impulsive and less punishment-sensitive, some discrete facets of impulsivity are associated with differing patterns of drug-use behaviour.

Clinical utility of the Cross-Cultural (Chinese) Personality Assessment Inventory (CPAI-2) in the assessment of substance use disorders among Chinese men.

This study examined the clinical utility of the Cross-Cultural (Chinese) Personality Inventory (CPAI-2) in differentiating the personality characteristics of Chinese men with substance use disorders from other psychiatric patients and normal control participants. The CPAI-2 profile of 121 Chinese men with substance use disorders was contrasted with that of a matched psychiatric comparison group (n = 172) and a normal comparison group (n = 187). Multivariate analyses of variance and logistic regression results supported the utility of the CPAI-2 clinical scales, especially Pathological Dependence, Antisocial Behavior, and Depression, for assessing substance use disorders. The Pathological Dependence scale (cutoff T score of 64) achieved good sensitivity and specificity. Apart from the universal personality traits related to neuroticism, conscientiousness, and agreeableness found in Western studies, the indigenously derived CPAI-2 personality scales, including Family Orientation and Harmony, highlighted deficits in social adjustment and interpersonal relationship as important cultural features in the personality characteristics of these participants. The study provided a cross-cultural extension to research on the relationship between personality and substance use disorders and could assist clinicians in considering culturally relevant treatment approaches.

Evolution of self-concept deficits in patients with eating disorders: the role of family concern about weight and appearance.

OBJECTIVE: The aims of this study were to analyse the influence of family concern about appearance on self-concept deficits in patients under treatment for eating disorders, and to identify predictors of eating attitudes and behaviours in control and clinical groups. METHOD: The participants were 123 women with diagnoses of DSM-IV-TR eating disorders and 124 female university students. All completed the eating attitudes test (EAT-40), the body dissatisfaction of the eating disorders inventory (EDI-BD), the Rosenberg self-esteem (RSE), the fear of negative evaluation (FNE) and the family concern about appearance scale (FCAS). Patients were administered with these instruments at admission and after 6 and 12 months of treatment. RESULTS: ANOVAs indicated that family concern about appearance had no influence on the evolution of self-concept deficits during treatment. Multiple regression analyses showed that the best predictor of eating attitudes in controls was FCAS score, while among patients the best predictor of how the disorder will evolve after 12 months of treatment was EAT-40 at admission. CONCLUSION: Families may transmit eating concerns, but this is not enough for the emergence of an eating disorder.

Perceived Parental Control, Self-Criticism, and Nonsuicidal Self-Injury Among Adolescents: Testing the Reciprocal Relationships by a Three-Wave Cross-Lag Model.

This study examined the prospective and reciprocal relationships among perceived parental control, self-criticism, and nonsuicidal self-injury (NSSI). We also examined the mediating effect of self-criticism in the relationship between perceived parental control and NSSI. We aimed to find out whether perceived parental control and self-criticism acted as risk factors for NSSI, or consequences of NSSI, or both. A group of 3,600 Chinese adolescents (mean age = 14.63 years, 56.6% female) completed questionnaires, with measures assessing NSSI, self-criticism, and parental control. A cross-lag model was used to test the reciprocal relationships among variables at 3 time points with 6-month intervals. Perceived parental control and self-criticism did not reliably predict later NSSI, but NSSI predicted later perceived parental control and self-criticism. Findings of this study emphasize the adverse effects of NSSI, and shed light on the intervention efforts of this behavior.

Distinguishing Pathways from Negative Emotions to Suicide Ideation and to Suicide Attempt: the Differential Mediating Effects of Nonsuicidal Self-Injury.

Negative emotion (NE) is one of the most widely examined risk factors for suicide ideation (SI) and suicide attempt (SA). However, little is known about the possibly different mechanisms underlying the pathways from NE to these two different suicide phenomena. Nonsuicidal self-injury (NSSI) is related to both negative emotions and suicidality. Thus, the present study aimed to test the differential roles of NSSI in the pathways from NE (specified by depression, anxiety, and stress) to SI and from NE to SA. This study hypothesized that NSSI served as a mediator in the relationship from NE to SA, but not in the relationship from NE to SI. We assessed the study variables among 3600 Chinese students (56.6% females, mean age = 14.63 years) for 3times at 6-month intervals. Structural equation modeling was used to test the hypotheses. Results partly supported the hypothesized longitudinal mediation model, such that NSSI fully mediated the relation from NE to SA in females, while partially mediated the relation from NE to SI in both females and males. Findings of this study may help to better understand the distinct mechanisms underlying the relationships from NE to SI and SA. Moreover, our finding regarding gender differences suggests the different emphases in suicide prevention and intervention programs across genders.

A Systematic Review of Associations between Amount of Meditation Practice and Outcomes in Interventions Using the Four Immeasurables Meditations.

Interventions using the "Four Immeasurables Meditations" (FIM) are effective for various outcomes; however, whether increased meditation practice in these interventions leads to better results has not been well investigated. This systematic review included 22 FIM interventions that reported associations between the amount of meditation practice and its outcomes. Despite the heterogeneity in intervention components and outcome variables, there were generally few significant associations between amount of meditation practice and its outcomes. Specifically, only five studies reported that more than half of the calculated results were significant. In comparison with correlations between total amount of practice and overall outcomes, the short-term influence of meditation practice was evaluated in fewer studies; however, it had a better association with outcomes. More studies are required that address the underlying mechanisms that elucidate how meditation practice leads to outcome changes in daily life. In this study, two promising mechanisms with initial evidence were discussed. This review also summarized common methodological issues including a lack of experimental manipulation and inaccurate measuring of meditation practice.

The Interactive Effects of Impulsivity and Negative Emotions on Adolescent Nonsuicidal Self-injury: A Latent Growth Curve Analysis.

This study employed latent growth curve analysis to evaluate the interactive effects of two specific facets of impulsivity (i.e., negative urgency [NU] and premeditation [PRE]) and negative emotions (NE) on the developmental trajectory of nonsuicidal self-injury (NSSI) among 3,453 (57% females) Chinese community adolescents. Participants completed questionnaires assessing NSSI, NU, PRE, and NE (i.e., depression, anxiety, and stress) at three waves of time. The initial levels of NE and NU significantly predicted the initial level of NSSI. Changes in NE and NU significantly predicted change in NSSI. Moreover, the initial levels of NU and PRE significantly moderated the relationship between the initial levels of NE and NSSI, such that among individuals with higher NU or less PRE, the three NE were associated with a higher level of NSSI. Additionally, among individuals with a faster increase in NU, depression and anxiety were associated with a faster increase in NSSI. These findings suggest that adolescents with trait impulsivity, especially in the form of NU, are more vulnerable to the engagement in NSSI.

A longitudinal moderated mediation model of nonsuicidal self-injury among adolescents.

This study tested a longitudinal moderated mediation model of the engagement in non suicidal self-injury (NSSI) based on Nock's (2009) integrated theoretical model of the development of NSSI. We assessed general predisposing factors (i.e. borderline personality disorder features), precipitating factors (i.e. negative emotions), and NSSI-specific vulnerability factors (i.e. behavioral impulsivity and self-criticism) among 3,600 Chinese secondary school adolescents (56.6 % females, aged between 12 and 18 years). Assessments were conducted for three times, 6 months apart. Results supported the longitudinal mediation model, such that negative emotions mediated the relation of borderline personality disorder features to NSSI. The moderating effects of behavioral impulsivity and self-criticism were both significant, indicating that adolescents with higher levels of both variables were more likely to engage in NSSI. Moreover, behavioral impulsivity made additional contribution to the prediction of future NSSI above and beyond the effects of other risk factors. Findings of this study may help to elucidate the diverse roles of different types of risk factors in the engagement in NSSI, and may also shed new light on our understanding about the nature of this behavior.

The effect of loving-kindness meditation on positive emotions: a meta-analytic review.

While it has been suggested that loving-kindness meditation (LKM) is an effective practice for promoting positive emotions, the empirical evidence in the literature remains unclear. Here, we provide a systematic review of 24 empirical studies (N = 1759) on LKM with self-reported positive emotions. The effect of LKM on positive emotions was estimated with meta-analysis, and the influence of variations across LKM interventions was further explored with subgroup analysis and meta-regression. The meta-analysis showed that (1) medium effect sizes for LKM interventions on daily positive emotions in both wait-list controlled RCTs and non-RCT studies; and (2) small to large effect sizes for the on-going practice of LKM on immediate positive emotions across different comparisons. Further analysis showed that (1) interventions focused on loving-kindness had medium effect size, but interventions focused on compassion showed small effect sizes; (2) the length of interventions and the time spent on meditation did not influence the effect sizes, but the studies without didactic components in interventions had small effect sizes. A few individual studies reported that the nature of positive emotions and individual differences also influenced the results. In sum, LKM practice and interventions are effective in enhancing positive emotions, but more studies are needed to identify the active components of the interventions, to compare different psychological operations, and to explore the applicability in clinical populations.

Psychometric properties and normative data of the Eating Disorder Inventory among 12 to 18 year old Chinese girls in Hong Kong.

The present study examined the psychometric properties of the Eating Disorder Inventory (EDI) among Chinese adolescent girls in Hong Kong. We also attempted to provide normative data for the EDI among 12- to 18-year-old Chinese girls in Hong Kong. Two thousand two hundred and fifty-six high school girls between the age of 12 and 18 years participated in this study. Subjects completed the questionnaire package anonymously at their schools. Findings indicate that the internal consistency estimates for the eight EDI scales were in the acceptable range, with alpha ranging from 0.68 for Perfectionism to 0.87 for Body Dissatisfaction. With the exception of a few items, the item-total correlations were also acceptable for the eight scales. Findings of the principal components analysis support the original eight clinically derived EDI constructs. Group comparison analyses reveal significant age differences and race differences in several EDI scales. EDI percentile scores are presented for girls 12-13 and 14-18 years of age in the present study. This study provides further empirical support to the transcultural validity of the EDI. It also highlights the importance of establishing age- and race-specific norms for the inventory.

Reliability and validity of a Chinese version of the Diagnostic Interview for Borderlines-Revised.

INTRODUCTION: Borderline personality disorder (BPD) is the most studied of the axis II disorders. One of the most widely used diagnostic instruments is the Diagnostic Interview for Borderline Patients-Revised (DIB-R). The aim of this study was to test the reliability and validity of DIB-R for use in the Chinese culture. METHODS: The reliability and validity of the DIB-R Chinese version were assessed in a sample of 236 outpatients with a probable BPD diagnosis. The Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) was used as a standard. Test-retest reliability was tested six months later with 20 patients, and inter-rater reliability was tested on 32 patients. RESULTS: The Chinese version of the DIB-R showed good internal global consistency (Cronbach's α of 0.916), good test-retest reliability (Pearson correlation of 0.704), good inter-rater reliability (intra-class correlation coefficient of 0.892 and kappa of 0.861). When compared with the DSM-IV diagnosis as measured by the SCID-II, the DIB-R showed relatively good sensitivity (0.768) and specificity (0.891) at the cutoff of 7, moderate diagnostic convergence (kappa of 0.631), as well as good discriminating validity. DISCUSSION: The Chinese version of the DIB-R has good psychometric properties, which renders it a valuable method for examining the presence, the severity, and component phenotypes of BPD in Chinese samples.