Pain tolerance as a 'barrier' to nonsuicidal self-injury: A longitudinal study.

Theoretical perspectives underscore that low pain tolerance may be a relevant 'barrier' to non-suicidal self-injury (NSSI). However, there is limited longitudinal work on the link between pain tolerance and NSSI, which is needed to assess if pain tolerance precedes NSSI engagement, and/or if NSSI precedes altered pain tolerance. Further, assessing both NSSI frequency and versatility (or number of NSSI methods), in addition to engagement, can provide a more nuanced understanding of the influence of pain on NSSI severity. In the present study, 1125 undergraduate students at a large university (72 % female, Mage = 17.96) reported on their NSSI frequency, NSSI versatility, and perceived pain tolerance. Four individual regressions were run to examine the potential bidirectional nature of the association between NSSI frequency and pain tolerance, and NSSI versatility and pain tolerance. Pain tolerance predicted both NSSI frequency and versatility over time. Neither NSSI frequency nor versatility predicted pain tolerance. Results suggest that high pain tolerance may be a risk factor for severe NSSI engagement.

A Daily Diary Study of the Relation between Stress and Nonsuicidal Self-Injury and the Moderating Role of Emotion Dysregulation in Emerging Adulthood.

Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18-25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, Mage = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12-14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable.

Longitudinal Associations among Identity Processes and Mental Health in Young Adulthood: The Mediating Role of Social Support.

Emerging adulthood (ages 18-25) is a period of identity exploration, particularly for young adults navigating the transition to post-secondary school. Little is known about how changes in identity exploration may be related to emerging adults' mental health, or the role of social support plays in identity-related processes. In the present study, associations among identity exploration, internalizing symptoms, and perceived social support were examined. Participants included a diverse group of emerging adults (N = 1,125, Mage = 17.96 years) studying at a Canadian university. Random-intercept cross-lagged modeling demonstrated that within-person increases in exploration in breadth predicted fewer depressive symptoms over time, whereas within-person increases in exploration in depth predicted more depressive and anxious symptoms over time. A mediation effect from perceived support from significant other to depressive symptoms via exploration in breadth was also evident. Findings suggest that identity exploratory processes may be developmentally relevant in emerging adulthood, but their implications for mental health may differ. Perceived social support is also meaningfully related to identity exploration and mental health.

Surprise and delight: Response to informal versus formal mindfulness among university students with self-injury.

Nonsuicidal self-injury (NSSI) is defined as the deliberate destruction of one's bodily tissue without suicidal intent. Mindfulness practice is commonly incorporated into universities' stress management programming and may benefit students with a history of NSSI. However, recent findings suggest that these students may respond differentially to specific types of mindfulness practice (i.e., formal vs. informal practice). The present study qualitatively explored the acceptability of different types of mindfulness practice among university students with a history of NSSI. University students with a recent history of NSSI (n = 36) completed a semistructured interview following a brief mindfulness practice (i.e., either a formal body scan, formal sitting meditation, or informal practice). Reflexive thematic analysis of interview transcripts revealed five key themes. First, there appeared to be general misconceptions regarding what constitutes mindfulness practice (Theme 1). Nevertheless, within the present study, all mindfulness practices were carried out with relative ease (Theme 2). Notably, favorable physical and psychological experiences were predominant in response to informal practice (Theme 3). Preferences regarding level of guidance were more mixed in response to formal versus informal practice (Theme 4). Finally, only informal practice inspired feelings of delight and surprise following practice (Theme 5). Informal mindfulness practice is deemed highly acceptable by university students with a history of NSSI and clinicians should strongly consider emphasizing it in mindfulness-based interventions offered to these students, to provide them with the best opportunity to build a regular mindfulness practice and develop their emotion regulation abilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An examination of nonsuicidal self-injury disclosures in a high-risk university sample.

Objective: There is a lack of research examining factors that promote the disclosure of nonsuicidal self-injury (NSSI) among post-secondary students. However, elucidating which factors facilitate disclosures among students - particularly students with high risk NSSI - is important given that disclosure may facilitate access to care. Methods: Participants included 149 post-secondary students with recent NSSI (81% women, Mage = 19.96) who reported on their disclosures, as well as several potential correlates of disclosure. Results: Eighty-seven percent of respondents had disclosed NSSI, often to several informal sources. Students with higher willingness to disclose personally distressing information, perceived levels of social support, stressful experiences, and frequency of NSSI engagement were more likely to disclose NSSI to more types of sources and more unique individuals. Conclusion: Results suggest that disclosure is an ongoing process rather than a single event, and underscore the importance of teaching effective NSSI disclosure responses to campus community members.

A Longitudinal Examination of Recent Posttraumatic Stress Symptoms and Nonsuicidal Self-Injury among University Students.

Nonsuicidal self-injury is a burgeoning mental health concern amongst post-secondary students. In the present study, the link between posttraumatic stress symptoms (PTSS) and nonsuicidal self-injury (NSSI) was examined among post-secondary students over time, while accounting for the role of co-occurring depressive symptoms. Participants were 841 first-year university students with self-reported lifetime histories of trauma who reported on traumatic experiences, PTSS, depressive symptoms, and NSSI at three time points over the course of their first year of university. This study also included exploratory correlational analyses of the relation among PTSS and motivations for NSSI engagement. As expected, PTSS predicted NSSI engagement among students within and across time, though effects were small. The strongest correlations were among PTSS and engaging in NSSI for the purposes of fulfilling self-punishment desires and anti-dissociation (e.g., to reduce feelings of numbness). This study provides further support for theories underscoring NSSI as a means of coping with intra- and interpersonal distress among post-secondary students experiencing stressful life events, such as trauma.

The mental health impact of the COVID-19 pandemic on post-secondary students: A longitudinal study.

This prospective longitudinal study measured sex-specific changes in depression, anxiety, and stress scores using, validated Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Perceived Stress Scale (PSS) in a cohort of 1445 post-secondary students (500 males, 945 females) assessed at three time points from December 2020 to January 2022. Participants were ascertained from a population of 15,585 students with in-person activities on campus at baseline and recruited from December 2020 to January 2021. We also assessed how sociodemographic characteristics influenced students' mental health outcomes. Inverse probability weighting was used to account for missing data and attrition. Linear mixed effects models were used to analyze the relationship between the mental health scores in each questionnaire, demographic and academic data, and public health stringency measured by the local stringency index. No change was observed in questionnaire scores over time for males and females, but the stringency index was significantly associated with increased stress. Being in a non-health-related-field or being white affected males and females differently for stress and anxiety, but not depression. Demographics tended to be more influential on females' mental health than males. In conclusion, mental health resource allocation in time of emerging pandemic could benefit from targeted interventions.

A Person-Centered Investigation Into the Co-Development of Perceived Stress and Internalizing Symptoms Among Post-Secondary Students.

The early post-secondary years are regarded as a period of heightened vulnerability for stress and internalizing symptoms among emerging adults. However, there is a lack of research examining variability in stress and internalizing symptoms among students, the co-occurrence of stress and internalizing symptoms, or predictors of distinct profiles of stress and internalizing symptoms. To address these gaps in the literature, 1125 ethnically diverse first-year students (71% female; Mage = 17.96 years, SD = 0.69; 55% East or South Asian, 21% Caucasian, 24% other ethnicity) were surveyed three times across the first year of university. Latent growth mixture models revealed four distinct profiles (i.e., high distress, moderate increasing distress, low distress, high decreasing distress), in which patterns of perceived stress and internalizing symptoms co-occurred. Higher levels of exposure to stressful life events, identifying as female and/or LGBQ+ were associated with increasing and high distress profiles. The findings underscore variability in distress among students, as well as the strong associations between stressful experiences, perceived stress, and internalizing symptoms.

The effectiveness and acceptability of formal versus informal mindfulness among university students with and without recent nonsuicidal self-injury: Protocol for an online, parallel-group, randomized controlled trial.

BACKGROUND: Mindfulness-based programming comprising both formal (FM) and informal (IM) mindfulness practice is increasingly offered to university students. However, difficulties with emotion regulation, self-criticism, and a potentially complex relationship with their body may undermine the benefits of FM for students with a history of nonsuicidal self-injury (NSSI), given its requirement of sustained attention on thoughts, emotions, and bodily sensations. IM may be better tolerated by these students. This protocol describes a randomized controlled trial comparing a brief FM practice, a brief IM practice, and an active control task in university students with and without recent NSSI. METHODS: Recruitment began in November 2022. An online, parallel-group, single-blind, randomized controlled trial will compare a 10-min, single-session FM practice, a 10-min, single session IM practice, and a 10-min, single session active control task in university students with and without recent NSSI. Outcomes will be assessed immediately pre-intervention and within five minutes post-intervention. The primary outcome will be state mindfulness. Secondary outcomes will be state stress, state well-being, and acceptability. Students with a history of NSSI are expected to report (i) greater improvements in state mindfulness, stress, and well-being, and (ii) greater acceptability in the IM condition, relative to the FM and control conditions. This distinction is not expected to occur in the no-NSSI comparison group. CONCLUSION: This trial is the first to parse out the impacts of FM versus IM practice among university students with and without a history of self-injury. Findings will be relevant to academic and clinical audiences within university settings.

Educational stakeholders' attitudes and knowledge about nonsuicidal self-injury among university students: A cross-national study.

Nonsuicidal self-injury (NSSI) is a commonly occurring, yet historically poorly understood, mental health concern among post-secondary students. The present study sought to identify the current knowledge needs of university stakeholders to inform training efforts around effective NSSI response and student support on university campuses.Participants were 1,762 university students, staff, and student-staff (77% female) from seven universities in Canada, the USA, New Zealand, and Australia.Participants completed an online survey about their attitudes and knowledge of both general mental health and NSSI.University stakeholders reported significantly greater stigma toward NSSI than mental illness in general. Student-staff reported greater perceived knowledge and comfort, and demonstrated greater knowledge of NSSI, than students and staff.Findings underscore the need for additional training and resources to reduce stigma and increase knowledge about NSSI on university campuses internationally.

Pain analgesia or desensitization? A longitudinal lab-based study on the link between pain and nonsuicidal self-injury.

Mounting evidence suggests that individuals who engage in nonsuicidal self-injury (NSSI) have lower pain sensitivity (e.g., pain thresholds and tolerances) than individuals without a history of NSSI. However, research has been largely cross-sectional, so it is unclear whether low pain sensitivity may increase risk for NSSI, or whether NSSI diminishes pain sensitivity over time. In the present study, the relations among NSSI frequency, versatility (number of NSSI methods), pain threshold, and pain tolerance were examined using a longitudinal research design. Participants included 156 undergraduate students at a large university (87% female; Mage = 19.79) with a recent history of NSSI. Participants reported on their NSSI engagement and completed a cold pressor task in a baseline session, as well as at one year follow-up. Eight regression models were run to examine the nature of the association between the two pain measures (i.e., pain threshold and tolerance) and the two NSSI measures (i.e., frequency and versatility). Pain tolerance and pain threshold predicted NSSI versatility over time, but NSSI frequency and versatility did not predict pain threshold or tolerance over time. Results suggest that low pain sensitivity may be a risk factor for severe NSSI engagement.

Depressive Symptoms, Perceived Stress, Self-Compassion and Nonsuicidal Self-Injury Among Emerging Adults: An Examination of the Between and Within-Person Associations Over Time.

Many emerging adults report experiencing mental health challenges (e.g., depressive symptoms and perceived stress) during the transition to university. These mental health challenges often coincide with increased engagement in nonsuicidal self-injury (NSSI; e.g., self-cutting or burning without lethal intent), but longitudinal research exploring the nature of the associations among depressive symptoms, perceived stress, and NSSI are lacking. In the present study, it was examined whether depressive symptoms and perceived stress predicted increased risk for NSSI over time (or the reverse), and whether these effects were mediated or moderated by self-compassion. The sample consisted of 1,125 university students (Mage = 17.96 years, 74% female), who completed an online survey three times in first year university. A random intercept cross-lagged panel model revealed that higher depressive symptoms, perceived stress, NSSI, and lower self-compassion often co-occurred, but only NSSI predicted increased perceived stress over time. Theoretical and practical implications are discussed.

A Qualitative Investigation of the Positive and Negative Impacts of the COVID-19 Pandemic on Post-Secondary Students' Mental Health and Well-Being.

Evidence suggests that post-secondary students without pre-existing mental health concerns may have experienced worsening mental health during the COVID-19 pandemic, relative to students with pre-existing mental health concerns. To clarify the psychological impacts of the pandemic, and elucidate why differences may exist among students, 20 interviews were conducted with emerging adults enrolled in university. Using directed content analysis, eight themes were identified: three more common among students with pre-existing mental health concerns, three more common among students without pre-existing mental health concerns, and two shared. Although all students experienced novel stressors during the pandemic, students without pre-existing mental health concerns reported greater increases in social and academic isolation, relative to students with pre-existing mental health concerns. Students with pre-existing mental health concerns also leveraged existing coping repertoires, which further supported their ability to manage pandemic-related challenges. Findings highlight how postsecondary institutions can bolster student well-being.

The good, the bad, and the mixed: Experiences during COVID-19 among an online sample of adults.

Studies have outlined the negative consequences of the COVID-19 pandemic to psychological health. However, the potential within-individual diversity of experiences during COVID-19, and how such experiences relate to indices of psychological distress and COVID-19-specific stressors, remains to be explored. A large online sample of American MTurk Workers (N = 3,731; Mage = 39.54 years, SD = 13.12; 51.70% female) completed short assessments of psychological distress, COVID-19-specific stressors (e.g., wage loss, death), and seven items assessing negative and positive COVID-19 experiences. Latent profile analyses were used to identify underlying profiles of COVID-19 experiences. A four-profile solution was retained representing profiles that were: (1) predominantly positive (n = 839; 22.49%), (2) predominantly negative (n = 849; 22.76%), (3) moderately mixed (n = 1,748; 46.85%), and (4) high mixed (n = 295; 7.91%). The predominantly positive profile was associated with lower psychological distress, whereas both the predominantly negative and high mixed profiles were associated with higher psychological distress. Interestingly, specific COVID-19 stressful events were associated with the high mixed profile. The present study challenges the narrative that the impacts of COVID-19 have been unilaterally negative. Future directions for research are proposed.

A longitudinal examination of predictors of nonsuicidal self-injury disclosures among university students.

OBJECTIVE: There is a paucity of longitudinal research on predictors of disclosures of nonsuicidal self-injury (NSSI) among emerging adults. However, understanding the factors that facilitate disclosure is critical, as disclosure may serve as a first step in accessing care. To address this gap, the present study examined predictors of prospective NSSI disclosures in a postsecondary student sample. METHODS: A total of 475 university students with a history of NSSI (Mage = 17.96; 74.9% women) reported on several potential predictors of NSSI disclosure, and their disclosure history at baseline and 4- and 8-month follow-ups. RESULTS: It was found that 22% of students reported disclosing NSSI during the first year of university; students who had previously disclosed, and who reported greater NSSI severity, were more likely to disclose over time. CONCLUSION: Results of the present study suggest that disclosures often occur in the postsecondary context, and students who disclose NSSI may engage in more severe NSSI behaviours.

Stressful Experiences in University Predict Non-suicidal Self-Injury Through Emotional Reactivity.

Theoretical perspectives on non-suicidal self-injury (NSSI; direct and deliberate self-injury without lethal intent such as self-cutting or hitting) have long underscored the affective regulating properties of NSSI. Less attention has been given to the processes through which individuals choose to engage in NSSI, specifically, to regulate their distress. In the present study, we tested one theoretical model in which recent stressful experiences facilitates NSSI through emotional reactivity. Further, we tested whether the indirect link between stressful experiences and NSSI was moderated by several NSSI specific risk factors (e.g., having friends who engage in NSSI). Given the widespread prevalence of NSSI among community-based samples of adolescents and emerging adults, we surveyed 1,125 emerging adults in first-year university at a large academic institution (72% female, Mage = 17.96, 25% with a recent history of NSSI at Time 1). Participants completed an online survey three times (assessments were 4 months apart), reporting on their recent stressful experiences in university, emotional reactivity, NSSI, as well as three NSSI specific risk factors (i.e., close friend engagement in NSSI, high self-disgust, and low fear of pain). As expected, path analysis revealed that there was a significant indirect effect of recent stressful experiences on NSSI engagement, through emotional reactivity. However, this effect was maintained across moderator analyses. These novel findings underscore the salient role of proximally occurring stressors in the prediction of NSSI among emerging adults in university, and can inform developing theoretical perspectives on NSSI.

Examining the disclosure of nonsuicidal self-injury to informal and formal sources: A review of the literature.

Nonsuicidal self-injury (NSSI) is a widespread mental health concern among adolescents and young adults. Despite the high rates of NSSI, emerging research suggests that many individuals may conceal the behavior from others, given the stigma around the behavior. Understanding the factors that promote or hinder disclosure, as well as the nature of NSSI disclosure experiences, is important, as positive disclosure experiences may foster social connectedness, promote formal help-seeking, and ultimately serve to reduce NSSI engagement. To consolidate the existing literature and inform best practices for responding to NSSI disclosures, an electronic review of the literature on NSSI disclosure was conducted using PsycINFO, PsycArticles, PubMed, and Google Scholar. Forty-one studies that met search inclusion criteria were identified. In the current review, rates of NSSI disclosures across different populations and to different confidantes are summarized, and potential facilitators and barriers for disclosure are considered. In addition, functions, impacts, and outcomes of NSSI disclosures to different confidantes are discussed. Following the review of the literature, limitations of the existing literature and recommendations for future research in the area of NSSI disclosure are presented. We conclude with a brief summary of best practices for responding to NSSI disclosures.

Advocacy for improved response to self-injury in schools: A call to action for school psychologists.

Over the past several years, nonsuicidal self-injury (NSSI) has emerged as a widespread concern in school settings worldwide. However, despite significant strides in NSSI research, there remains a substantial knowledge gap with respect to what school staff know. Unfortunately, this can contribute to stigma and ineffective responding when working with students who self-injure. In light of its high rates and the risks with which NSSI associates, including death by suicide, this is worrisome. Accordingly, there is a pressing need for advocacy in schools to ensure that NSSI is prioritized and for proper knowledge and training be offered to school staff. The current article serves as a call to action for school psychologists as leaders and advocates in meeting these needs. We begin by articulating the central issues pertinent to low NSSI literacy and high NSSI stigma in schools, followed by a series of research-informed recommendations for timely and effective advocacy. By virtue of undertaking these initiatives, school staff will be better able to respond to the needs of youth who self-injure and advocate for them. This, in turn, can foster an enhanced school climate and greater student well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Addressing Self-Injury in Schools, Part 1: Understanding Nonsuicidal Self-Injury and the Importance of Respectful Curiosity in Supporting Youth Who Engage in Self-Injury.

Nonsuicidal self-injury (NSSI) is defined as the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned. School nurses are often a first point of contact for young people experiencing mental health challenges, and yet they often report they lack knowledge and training to provide care for persons who engage in NSSI. In the first of two parts, this article provides school nurses with a better understanding of NSSI and the distinctions between NSSI and suicidal behaviors, discusses the role of nurses' knowledge and attitudes on their ability to care for their patients' mental health needs, and discusses approaches for developing a respectful, empathic manner for working with and supporting youth who engage in self-injury. Part 2 will offer a strategy for brief assessment of NSSI and reflect on two case studies and their implications for school nursing practice.