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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

The best friend and friendship group influence on adolescent nonsuicidal self-injury.

This study examined associations of peer socialization and selection, over time, with nonsuicidal self-injury (NSSI) among 5,787 (54.2 % females) Chinese community adolescents. Both effects were tested using two aspects of adolescents' friendship networks: the best friend and the friendship group. Participants completed questionnaires assessing NSSI, depressive symptoms and maladaptive impulsive behaviors at two waves of time over a 6-month period. Results showed that even after controlling for the effects of depressive symptoms and maladaptive impulsive behaviors, the best friends' engagement in NSSI still significantly predicted adolescents' own engagement in NSSI. Adolescents' friendship groups' NSSI status also significantly predicted their own NSSI status and frequency. Additionally, adolescents with NSSI tended to join peer groups with other members also engaging in NSSI.

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.

Are DSM-IV-TR borderline personality disorder, ICD-10 emotionally unstable personality disorder, and CCMD-III impulsive personality disorder analogous diagnostic categories across psychiatric nomenclatures?

This study examined the validity of the borderline construct which encompasses diagnostic criteria from the DSM-IV-TR Borderline Personality Disorder (BPD), ICD-10 Emotionally Unstable Personality Disorder (EUPD), and CCMD-III Impulsive Personality Disorder (IPD) in a sample of 1,419 Chinese psychiatric patients. Participants completed the Chinese Personality Disorder Inventory and the Chinese Personality Assessment Inventory-2 assessing various disordered personality features. Adequate internal consistency was found for the borderline construct (α = .83). Exploratory factor analysis revealed two components: (1) affective and cognitive disturbances, and (2) impulse dysregulation, which were replicated by confirmatory factor analysis. Item analysis indicated that the various borderline criteria displayed similar levels of diagnostic efficiency, which does not support the elimination of fear of abandonment and transient psychotic features from the EUPD and IPD criteria set. Findings of this study suggest that BPD, EUPD, and IPD may represent analogous diagnostic categories across classification systems.

The associations between non-suicidal self-injury and borderline personality disorder features among Chinese adolescents.

This study examined the relative importance of four major BPD features, that is, affective instability, disturbed interpersonal relationship, unstable sense of self, and behavioral impulsivity, in explaining the presence, initiation, repetition, and discontinuation of non-suicidal self-injury (NSSI) among a 2-year follow-up sample of 4,782 (68.5% girls) Hong Kong Chinese secondary school students. Affective instability, disturbed interpersonal relationship and behavioral impulsivity were significantly associated with the presence of NSSI both concurrently and longitudinally. These three BPD features were also related to the future initiation of NSSI. On the other hand, only behavioral impulsivity made a significant contribution to the repetition of NSSI. Additionally, a lower level of affective instability was also associated with quitting NSSI. We discussed some possible mechanisms underlying the effects of different BPD features on different developmental stages of NSSI.

Exploring the reciprocal relations between nonsuicidal self-injury, negative emotions and relationship problems in Chinese adolescents: a longitudinal cross-lag study.

The present study explored the reciprocal relations between nonsuicidal self-injury (NSSI), negative emotions and relationship problems in a community sample of 2,435 (57.6% females) Chinese adolescents. Participants completed measures assessing 12 NSSI behaviors, three negative emotions (depression, anxiety and tension), and relationship problems at two time points over a 6-month period. A longitudinal cross-lag analysis was used to test the reciprocal relations among the studied variables. Results showed that after controlling for their initial associations, NSSI significantly predicted negative emotions over time but not vice versa, and relationship problems significantly predicted NSSI over time but not vice versa. Theoretical and clinical implications of these findings were discussed.

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.

The prevalence of nonsuicidal self-injury and different subgroups of self-injurers in Chinese adolescents.

Previous studies revealed a high prevalence of nonsuicidal self-injury (NSSI) in western adolescents and suggested the existence of multiple self-injurer subgroups. This study examined the prevalence of NSSI among Hong Kong Chinese adolescents and compared different subgroups of self-injurers on several psychological correlates of NSSI related to borderline personality disorder. A total of 6,374 secondary school students (67.6% girls) completed self-report questionnaires. Multivariate analyses of variance and follow-up logistic regression analyses were used to compare differences between subgroups of self-injurers. Overall, 15% of adolescents reported engaging in NSSI. Gender differences varied regarding different self-injury methods. Repetitive self-injurers had more emotional and impulse-control problems than episodic ones. Severe NSSI adolescents were also more impulsive than mild NSSI adolescents. The frequency and severity of NSSI acted as two important dimensions in distinguishing between self-injurers. Clinical implications of these results are discussed.