Off track or on? Associations of positive and negative life events with the continuation versus cessation of repetitive adolescent nonsuicidal self-injury.

OBJECTIVE: This study examined how patterns of repetitive (≥5 instances) nonsuicidal self-injury (NSSI) associate with measures of resilience and life events retrospectively reported to have occurred within the last year, 1 to <5 years ago, and 5 to <10 years ago. METHOD: Life events reported by 557 young adults (mean [SD] age 25.3 [0.68]; 59.2% women) were classified as positive, negative, or profoundly negative based on their relationship to participants' mental health and well-being. We subsequently examined how these categories, together with resilience, were cross-sectionally associated with reporting no NSSI, and the (full/partial) cessation/continuation of repetitive NSSI from adolescence to young adulthood. RESULTS: Repetitive NSSI in adolescence was associated with (profoundly) negative life events. Relative to cessation, NSSI continuation was significantly associated with more kinds of negative life events (odds ratio [OR] = 1.79) and fewer kinds of positive life events 1 to <5 years ago (OR = 0.65) and tended to be associated with lower resilience (b = -0.63, p = 0.056). Neither life events nor resilience significantly differentiated individuals reporting full or partial cessation. CONCLUSION: Resilience appears important for the cessation of repetitive NSSI, but contextual factors must still be considered. Assessing positive life events in future studies holds promise.

Is ceasing self-injury enough? Differences in psychological health between people reporting behavioral cessation of non-suicidal self-injury and those who consider themselves to have stopped self-injuring.

OBJECTIVE: This study examined the overlap between considering oneself to have stopped nonsuicidal self-injury (NSSI) and the actual cessation of the behavior in terms of days self-injured in the last month and last year, and how these operationalizations are associated with constructs related to NSSI recovery. METHODS: A cross-sectional survey including measures of coping, emotion dysregulation, psychological distress, general self-efficacy, and self-efficacy in resisting NSSI was answered by 144 adults aged 17-81 years (Mage [SD] = 21.43 [7.32]). RESULTS: Having self-injured for ≥5 days in the last year was overly inclusive of individuals who currently considered themselves as having stopped NSSI (39.02%). Considering oneself to have stopped NSSI was associated with better emotion regulation (Cohen's d = 0.45), and higher general self-efficacy and higher self-efficacy to resist NSSI (d = 0.59-0.64) than behavioral cessation. Not actually engaging in NSSI was only associated with self-efficacy to resist NSSI in risk contexts, such that fewer days self-injured in the last year increased confidence (partial η2 = 0.085). CONCLUSION: Accounting for whether an individual considers themselves as having stopped NSSI or not may complement estimates of behavioral cessation, and strengthen outcomes associated with NSSI recovery.

What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up.

This study examined the longitudinal associations between non-suicidal self-injury (NSSI) in early adolescence and various positive and negative aspects of mental health in young adulthood. The participants were a cohort of regular school students (n = 1064) in grades 7-8 from a Swedish municipality. Nine hundred and ninety-one of these completed an 11-page questionnaire (T1: Mage = 13.7; 50.3% girls); 1 year later, 984 students completed the questionnaire again (T2: Mage = 14.8; 51.1% girls); and 10 years later, 557 took part (T3: Mage = 25.3; 59.2% women). The prevalence of any NSSI (≥ 1 instance) decreased from about 40% in adolescence to 18.7% in young adulthood, while the prevalence of repetitive NSSI (≥ 5 instances) decreased from about 18 to 10%. Compared to individuals who reported no NSSI as adolescents, and controlling for gender and psychological difficulties in adolescence, adolescents with stable repetitive NSSI (i.e., repetitive NSSI at both T1 and T2) showed significantly higher levels of stress, anxiety, NSSI, and difficulties in emotion regulation 10 years later. Even infrequent and unstable repetitive NSSI in adolescence was associated with negative outcomes in young adulthood. These results suggest that stable repetitive NSSI in adolescence is a strong risk factor for mental health problems in young adulthood and that occasional engagement in NSSI in adolescence is an indicator of vulnerability for poorer mental health in young adulthood.

Physicians' gender bias in the diagnostic assessment of medically unexplained symptoms and its effect on patient-physician relations.

Nonspecific, functional, and somatoform (NFS) syndromes is an umbrella term for various diagnoses with medically unexplained symptoms. These syndromes are more prevalent among women than among men, and associated with negative preconceptions that can impede rehabilitation. In two studies, we quantitatively assess how patients' gender affects the diagnostic assessment of NFS syndromes, as well as the healthcare experiences of individuals diagnosed with NFS syndromes. In the first study, our vignette-based experiment showed that Swedish general practitioners (N = 90) were gender biased in their diagnostic assessment of NFS syndromes, such that a female patient with back pain was more likely to be assigned a NFS syndrome compared to an otherwise identical male patient. In the second study, a large community sample of Swedish individuals with medically explained (n = 432) and unexplained pain (n = 521) evaluated their treating physician's relational conduct. Even after accounting for a variety of sociodemographic variables and other pain characteristics, women with at least one NFS syndrome percieved their physician's relational conduct as significantly poorer than other women as well as men with and without NFS syndromes. When women's pain is more likely than men's to be assessed as NFS, their rehabilitation could be prolonged as pertient alternative diagnoses and treatments are omittied and their negative healthcare experiences lower their volition to partake and persevere in treatment.

Adolescents' Emotion Regulation Strategies Questionnaire-Extended: Further Development and Associations With Mental Health Problems in Adolescence.

Emotion regulation (ER) is implicated in a range of psychopathologies and behavioral problems that are prevalent or have their initial onset in adolescence. In this study, we aim to evaluate the psychometric properties (factor structure, internal consistency, and construct validity) of the Adolescents' Emotion Regulation Strategies Questionnaire-Extended (AERSQ-E), a modified and extended version of an ER instrument developed by Zhou et al. Across six sub-studies using data from different Swedish adolescent community samples (1,104 students in total), we generated and validated a 23-item version containing six subscales: rumination/negative thinking, positive reorientation, creative expression, aggressive outlet, social support, and distraction. Assessing test-retest reliability, internal consistency, measurement invariance as well as convergent and discriminant validity, we could establish, with some limitations, the general reliability and validity of the AERSQ-E as a valid measure of ER strategies for use in adolescence.

Developmental pathways of repetitive non-suicidal self-injury: predictors in adolescence and psychological outcomes in young adulthood.

BACKGROUND: Much longitudinal research has been carried out on non-suicidal self-injury (NSSI) during the last decades, but there still is a lack of studies of the individual developmental pathways of NSSI from adolescence into young adulthood. The aim of the present study was to investigate individual developmental pathways of repetitive non-suicidal self-injury (repNSSI) from adolescence into young adulthood, including adolescent predictors and psychological outcomes in young adulthood. Three developmental pathways were targeted: stable adolescence-limited repNSSI; repNSSI prolonged into young adulthood; and late-onset repNSSI; with no repNSSI as comparison. METHODS: Data were taken from a cohort of compulsory school students (N = 1064) in grades 7-8 in a Swedish municipality. The cohort was followed longitudinally, and this study included all individuals (n = 475) with NSSI data from three waves: T1 (when they were 13-15 years old); T2 (one year later); and T3 (ten years later). RepNSSI was operationalized as self-reports of at least 5 instances of NSSI during the past six/twelve months. RESULTS: The two pathways that involved stable repNSSI were observed significantly more often than expected by chance, with the strongest overrepresentation for the Prolonged RepNSSI pathway. Still, most adolescents who engaged in stable repNSSI stopped this before reaching young adulthood. Those who stopped did not, however, show a significantly better psychological adjustment in young adulthood than those who continued. Compared to participants with no repNSSI, participants who had stopped still reported significantly more stress, anxiety, and emotional dysregulation. As to the prediction of late onset NSSI, the findings were less robust, but sporadic NSSI at T1 and poor sleep at T2 were significant predictors, whereas depressive symptoms fell just short of significance at both timepoints. CONCLUSIONS: The present results indicate that among adolescents who engage in stable adolescent repNSSI (1) significantly more individuals than expected by chance still engage in repNSSI ten years later, and (2) those who stop engaging in repNSSI do not show significantly better psychological adjustment than those who still engage in it. The present findings also indicate that late onset of repNSSI as reported in young adulthood to some extent is predictable from symptom measures ten years earlier.

Psychometric Exploration of the Swedish Translation of the Sexual Orientation Microaggressions Scale (SOMS), and a Commentary on the Validity of the Construct of Microaggressions.

The aim of the present study was to assess the psychometric properties of a Swedish translation of the Sexual Orientation Microaggressions Scale (SOMS) in a convenience sample of 267 Swedish LGB+ people (Mean age = 36.41). Testing suggested some strengths in terms of factor structure and 2-week test-retest reliability (ICC > .79). Also, internal consistency (α = .80-.91) and convergent validity were supported for most subscales. However, the Assumption of Deviance subscale was associated with low response variability and internal consistency (α = .35), and the correlational pattern between the Environmental Microaggressions subscale and mental health variables diverged from the overall trend. Furthermore, measurement invariance between homo- and bisexual participants was not supported for most subscales, and although microaggressions would be theoretically irrelevant to a small comparison sample of heterosexual people (N = 76, Mean age = 40.43), metric invariance of the Environmental Microaggressions subscale was supported in comparison to LGB+ people. We argue that these limitations suggest a restricted applicability of the SOMS in a Swedish context, and this has consequences for the definition and operationalization of the construct of microaggressions as a whole. Therefore, more research on the latent properties of microaggressions in Swedish as well as in other contexts is required.

"What I couldn't do before, I can do now": Narrations of agentic shifts and psychological growth by young adults reporting discontinuation of self-injury since adolescence.

PURPOSE: We explore young adults' narrations of life events in association with nonsuicidal self-injury (NSSI) discontinuation, psychological growth, and agency. METHODS: Transcripts from eleven face-to-face interviews with individuals who quantitatively reported injuring themselves in adolescence (2007-2008) but not in young adulthood (2017) were narratively analysed. RESULTS: We found that at starting points, a period preceding an agentic shift in the narrative, participants endured stressful living conditions and mental illness. During this period, participants perceived no point in trying to initiate change because they did not perceive themselves as having the capacity to do so and nor could they adequately utilize any formal or informal support. After a turning point that enabled agency due to gaining a sense of belongingness, liberation, or perspective, participants underwent a process of attaining psychological well-being. However, narrating psychological growth also required momentum points, encompassing the management of and moving on from stressful contexts, along with the recognition of milestones marking improvement relative to the starting points. CONCLUSIONS: NSSI discontinuation was narrated in conjunction with psychological growth when participants also experienced themselves as situated within an agentic context, because agency is understood as necessary to react to and manage current and future life circumstances.

Patients' return-to-work expectancy relates to their beliefs about their physician's opinion regarding return to work volition and ability.

PURPOSE: This study investigates the relationship between sick-listed patients' return to work (RTW) expectancy and how they perceive that their physicians evaluate their ability and volition for RTW. METHODS: Hierarchical logistic regression controlling for sociodemographic factors and pain characteristics was carried out on cross-sectional data from 205 participants (mean age= 47.24±9.66 years, 83.9% women). They were currently on full-time sick leave with a total duration of 10 years or less and represented various diagnosed and undiagnosed pain conditions. RESULTS: A positive expectation for RTW within a year was significantly associated with the belief that the physician favorably evaluated one's ability (OR= 1.44, 95% CI= 1.13-1.83) and volition (OR= 1.42, 95% CI= 1.11-1.83) to RTW. This held even when other variables significantly associated with RTW expectancy were accounted for. Beyond beliefs, only age made a significant contribution in our final model (OR= 0.94, 95% CI= 0.90-0.98). CONCLUSION: The results indicate that patients' beliefs regarding their physician's opinion about their ability and volition for RTW influence their own RTW expectancy. Rehabilitation might be facilitated if health care professionals address and affirm patients' ability and volition for RTW, regardless of patients' pain characteristics or if the total duration of their sick leave is <10 years. As other studies have found that RTW expectancy is one of the strongest predictors for actual RTW, future research should test the effect of beliefs about physicians' opinions on actual RTW rates.

Validation of a Swedish version of the short UPPS-P impulsive behavior scale among young adults.

The UPPS-P model of impulsivity proposes that impulsivity comprises five distinct facets-negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking. The UPPS-P Impulsive Behavior Scale has been used to measure these facets. The purpose of the current study was to develop and evaluate the psychometric properties of a Swedish version of the 20-item UPPS-P Impulsive Behavior Scale (SUPPS-P). The sample comprised 343 Swedish young adults (Mage = 24.21, SD = 2.01; 27% men, 2% other or undisclosed gender identity) who answered a questionnaire including the SUPPS-P; Depression, Anxiety, and Stress Scale (DASS-21); and questions regarding their alcohol consumption and substance use. Confirmatory factor analysis supported a 5-factor, inter-correlated model, where each subscale of the SUPPS-P constitutes one latent variable. The convergent validity was established by replicating previously found correlations between the different impulsivity facets and depression, anxiety, frequency of alcohol consumption, and substance use. The internal consistency was acceptable for all the SUPPS-P subscales (Cronbach's α = 0.65-0.78, McDonald's ω = 0.65-0.79), except lack of perseverance (Cronbach's α = 0.60, McDonald's ω = 0.61). Thus, while the Swedish version of the SUPPS-P is suitable for assessing impulsivity in Swedish young adult samples, further research is needed to improve the psychometric properties of the lack of perseverance subscale.