Nonsuicidal self-injury among veterans is associated with psychosocial impairment, suicidal thoughts and behaviors, and underutilization of mental health services.

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.

Microaggressions Toward Sexual and Gender Minority Emerging Adults: An Updated Systematic Review of Psychological Correlates and Outcomes and the Role of Intersectionality.

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.

Media guidelines for the responsible reporting and depicting of non-suicidal self-injury.

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.

Moderators of treatment response to an intervention for nonsuicidal self-injury in young adults.

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).

Online disinhibition and internet communication of non-suicidal self-injury.

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.

The interaction of dissociation, pain tolerance, and suicidal ideation in predicting suicide attempts.

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.

An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial.

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

Predicting Risk for Suicide: A Preliminary Examination of Non-Suicidal Self-Injury and the Acquired Capability Construct in a College Sample.

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.

Predicting Persistence of Nonsuicidal Self-Injury in Suicidal Adolescents.

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.

The roles of social stress and decision-making in non-suicidal self-injury.

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.

Development of an Intervention for Nonsuicidal Self-Injury in Young Adults: An Open Pilot Trial.

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.

Non-suicidal self-injury disorder in a community sample of adults.

Non-suicidal self-injury (NSSI) Disorder has been included in DSM-5 for the first time as a disorder requiring further research. The present study investigated DSM-5 criteria for NSSI Disorder in a community sample of adults and provided an initial investigation of differences between those with and without a diagnosis of NSSI Disorder and NSSI history. Participants over the age of 18 (N=548) completed an online survey using Amazon׳s MTurk. A lifetime history of NSSI was reported by 23% of the sample. Nearly 3% of the total sample and 11.2% of those with an NSSI history met criteria for NSSI Disorder. Those with NSSI Disorder were similar to participants with an NSSI history who did not meet criteria for the disorder on NSSI frequency and methods, and age of NSSI onset, use of coping strategies, and borderline symptoms, but they differed on automatic reinforcement of the behavior and reported interference with functioning. Endorsement of specific NSSI Disorder criteria, potential implications for the diagnosis, and avenues for future research are discussed.

Expanding and clarifying the role of emotion regulation in nonsuicidal self-injury.

OBJECTIVE: Deficits in emotion regulation have been implicated in nonsuicidal self-injury (NSSI) by both theory and research. Research indicates that NSSI is commonly performed as an emotion regulation strategy, as it often decreases the experience of negative affect. People who engage in NSSI often report greater emotion dysregulation than those without an NSSI history. Further, interventions that have demonstrated effectiveness in reducing NSSI involve a focus on emotion regulation skills. Given the important role of emotion regulation in NSSI, research should continue to develop our understanding of this construct. METHODS: We conducted a review of relevant research in emotion regulation and dysregulation and specific emotion regulation strategies in NSSI. RESULTS: First, we provide an overview of current research on emotion regulation and dysregulation in NSSI. Second, we discuss the application of a specific emotion regulation model to NSSI research, and review research on NSSI supporting the use of this model. CONCLUSION: NSSI has been associated with an emotion regulation function and trait emotion dysregulation among people who self-injure. Relevant research provides initial support for the applicability of a specific model of emotion regulation to NSSI. We suggest directions for future research to continue to cultivate our understanding of emotion regulation in NSSI.

The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates.

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.

A Cognitive-Behavioral Approach to Case Formulations for Nonsuicidal Self-Injury.

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.

NEUROPSYCHOLOGICAL FUNCTIONING IN PRISONERS WITH AND WITHOUT SELF-INJURIOUS BEHAVIORS: Implications for the Criminal Justice System.

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.

Non-suicidal self-injury, attempted suicide, and suicidal intent among psychiatric inpatients.

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.

An examination of non-suicidal self-injury in men: Do men differ from women in basic NSSI characteristics?

Researchers have reported similar prevalence rates for non-suicidal self-injury (NSSI) among men and women, yet few studies have investigated gender differences in NSSI. This study describes and compares basic NSSI characteristics among a nonclinical sample by gender. Forty-eight individuals reporting a history of NSSI were interviewed (M = 18.52 years old, SD = 1.18 years). NSSI characteristics, including frequency, age of onset, method of NSSI, pain and control during NSSI, and degree of medical injury were compared between men (n = 19) and women (n = 29). Men and women differed significantly on age of onset, degree of medical injury, and NSSI methods. This study supports previous findings of gender differences in NSSI and suggests that further investigation of gender differences in NSSI is warranted.

Depressive characteristics of adult psychiatric inpatients with a history of multiple versus one or no suicide attempts.

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.

The emergence of suicidal ideation during the post-hospital treatment of depressed patients.

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.