Development and evaluation of a predictive algorithm and telehealth intervention to reduce suicidal behavior among university students.

BACKGROUND: Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk. METHODS: Data come from several waves of a prospective cohort study (2016-2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00-19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group. RESULTS: 5454 students ranging in age from 17-36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93-36.07]; Specificity = 97.46 [95% CI 96.21-98.38], PPV = 53.06 [95% CI 40.16-65.56]; AUC range: 0.895 [95% CIs 0.872-0.917] to 0.966 [95% CIs 0.939-0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort. CONCLUSIONS: Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students.

Communicating distress: suicide threats/gestures among clinical and community youth.

Although self-injurious thoughts and behaviors are a global health concern, little is known about suicidal threat/gesture(s) where a person leads others to believe they want to end their lives when they have no intention to do so. This study assessed the lifetime prevalence of self-injurious thoughts and behaviors among both community adolescents (n = 1117) and in clinical youth (n = 191). Suicide threats/gestures were common among youth; 12.2% of community adolescents and 18.0% of clinical youth reporting having made a suicide threat/gesture, most commonly in the context of other self-injurious thoughts and behaviors. Across both samples, suicide threats/gestures were not uniquely associated with suicide attempts, and youth who reported suicide threats/gestures in the context of a history of self-harm or suicide plan(s) were no more likely to report a history of suicide attempt(s). Suicide threats/gestures were distinguished from suicide attempts in that they primarily fulfilled positive social functions, rather than autonomic functions. Findings suggest that suicidal threats/gestures are common in both community and clinical youth, and are not uniquely associated with suicide attempts, but rather function to communicate distress to others.

Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis.

BACKGROUND: Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical. METHODS: We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12-19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7. RESULTS: Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = -0.44; 95% CI -0.81 to -0.07) and suicidal ideation (g = -0.31, 95% CI -0.52 to -0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = -0.98, 95% CI -1.15 to -0.81; suicidal ideation: g = -1.16, 95% CI -1.51 to -0.80; BPD symptoms: g = -0.97, 95% CI -1.31 to -0.63). CONCLUSIONS: DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

Emotion dysregulation in nonsuicidal self-injury: Dissociations between global self-reports and real-time responses to emotional challenge.

INTRODUCTION: Prominent theories of nonsuicidal self-injury (NSSI) propose that the behaviour is characterised by amplified emotional responses. However, little is known about how people who self-injure respond during emotional challenge. METHODS: We measured subjective and physiological responding (heart rate, heart rate variability, and electrodermal responding) among young adults with past-year NSSI (n = 51) and those with no lifetime NSSI (n = 50) during a resting baseline, a stress induction, and a post-stress resting phase. Participants reported the extent to which they spontaneously used cognitive reappraisal and expressive suppression during the post-stress phase. Two weeks later, a subset of the sample (n = 42) reported how they remembered feeling during the laboratory session. RESULTS: Although the NSSI group reported considerably greater emotion dysregulation than Controls, both groups showed similar subjective and psychological reactivity to, and recovery from, emotional challenge. Both groups used reappraisal and suppression regulation strategies following acute stress to a similar extent, and later came to remember the emotional challenge in a similar manner. LIMITATIONS: Within the NSSI group, past-year self-injury tended to be infrequent and sporadic. Only 43.6% of the sample participated in the follow-up survey assessing memory of emotional challenge. CONCLUSIONS: Findings demonstrate that the role of emotion in NSSI is more complex than prominent theories can account for, raising substantial questions regarding the nature of emotion in NSSI. A more comprehensive understanding of the role of emotion in NSSI is needed to inform intervention strategies to better support people who self-injure.

The presence of fear: How subjective fear, not physiological changes, shapes the experience of presence.

When we become engrossed in novels, films, games, or even our own wandering thoughts, we can feel present in a reality distinct from the real world. Although this subjective sense of presence is, presumably, a ubiquitous aspect of conscious experience, the mechanisms that produce it are unknown. Correlational studies conducted in virtual reality have shown that we feel more present when we are afraid, motivating claims that physiological changes contribute to presence; however, such causal claims remain to be evaluated. Here, we report two experiments that test the causal role of subjective and physiological components of fear (i.e., activation of the sympathetic nervous system) in generating presence. In Study 1, we validated a virtual reality simulation capable of inducing fear. Participants rated their emotions while they crossed a wooden plank that appeared to be suspended above a city street; at the same time, we recorded heart rate and skin conductance levels. Height exposure increased ratings of fear, presence, and both measures of sympathetic activation. Although presence and fear ratings were correlated during height exposure, presence and sympathetic activation were unrelated. In Study 2, we manipulated whether the plank appeared at height or at ground level. We also captured participants' movements, which revealed that alongside increases in subjective fear, presence, and sympathetic activation, participants also moved more slowly at height relative to controls. Using a mediational approach, we found that the relationship between height exposure and presence on the plank was fully mediated by self-reported fear, and not by sympathetic activation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotional responding to overt and subtle social exclusion among young women who engage in non-suicidal self-injury.

People who engage in non-suicidal self-injury (NSSI) consistently report greater emotion reactivity and dysregulation than their peers. However, evidence that these self-reports reflect an amplified emotional response under controlled conditions is limited. Here we test the effects of both subtle and overt social exclusion, to determine whether self-reported emotion dysregulation reflects responses to real-time emotional challenge for people who self-injure. We recruited 100 young women with past-year NSSI and 100 without NSSI to an online experiment. Participants took part in a baseline social inclusion ball-tossing game, followed by either an overt or subtle social exclusion ball-tossing game, while we measured negative mood and belongingness. Despite reporting greater emotion reactivity (d = 1.40) and dysregulation (d = 1.63) than controls, women with past-year NSSI showed no differences in negative mood or belongingness ratings in response to either overt or subtle social exclusion. Within the NSSI group, exploratory analyses found greater endorsement of intrapersonal functions predicted greater negative mood following social exclusion (ß = 0.19). Given that amplified emotional responding is central to prominent theoretical models of NSSI, findings highlight the need to better understand the divergence in findings between self-reported emotion dysregulation and real-time emotional responding among people who self-injure.

Who are we missing? Self-selection bias in nonsuicidal self-injury research.

BACKGROUND: Despite the threat of self-selection bias to the generalizability of research findings, remarkably little is known about who chooses to take part in non-suicidal self-injury (NSSI) research specifically. We aimed to establish the extent of willingness to take part in NSSI research within a commonly sampled population before assessing whether individual differences in demographic characteristics, NSSI lived experience, and participation experiences were associated with willingness to take part in future NSSI research. METHODS: New Zealand university students (n = 3098) completed self-report measures of their NSSI, psychological distress, emotional dysregulation, experience of their participation in the current study, and willingness to participate in future NSSI research. RESULTS: Most participants (78.2%) indicated that they were willing to take part in future NSSI research. Men, older participants, people with NSSI lived experience, and those with more frequent past-year NSSI were more likely to be willing to take part in future NSSI research. Participants who reported a more positive subjective experience of the current study also indicated greater willingness. CONCLUSIONS: Findings demonstrate systematic differences in who is willing to take part in NSSI research. Future research should implement methodological and statistical approaches to mitigate the impact of self-selection bias on NSSI research.

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.

Dataset describing Aotearoa New Zealand young adults' psychological well-being and behaviour during nationwide lockdown.

This dataset provides a comprehensive snapshot of 277 New Zealand young adult's (M age = 18.93, SD = 3.28) real-time behaviours and experiences during a seven-week nationwide lockdown. Participants were recruited through a university student participant pool and data were collected online during 20-27th April 2020 (Alert Level 4) and 6-13th May 2020 (Alert Level 3), constituting the 26th-33rd and 42nd-49th day (respectively) of a nationwide lockdown to manage the first wave of COVID-19 in Aotearoa New Zealand. Data have been used previously [1]. Data includes participants' self-reported compliance with legally mandated COVID-19 lockdown policies, as well as participants' self-reported knowledge of lockdown policies, lockdown characteristics, trust in government and information sources, COVID-19 specific worries, recent anxiety, depression, and stress symptoms, cognitive reappraisal and expressive suppression use, and Big Five personality traits. The dataset is freely accessible (CC-BY-4.0 license) at https://osf.io/pa4n3/. This database can provide insight into the psychological experience of strict COVID-19 lockdown, support policy makers to evaluate the efficiency COVID-19 public health messaging, and inform future policy to support public health and wellbeing during widespread lockdown and quarantine.

Locking down behavioural compliance: The role of emotion and emotion regulation in breaches of COVID-19 mitigation measures in Aotearoa New Zealand.

Although anxiety and worry can motivate engagement with COVID-19 preventative behaviours, people may cognitively reframe these unpleasant emotions, restoring wellbeing at the cost of public health behaviours. New Zealand young adults (n = 278) experiencing nationwide COVID-19 lockdown reported their worry, anxiety, reappraisal and lockdown compliance. Despite high knowledge of lockdown policies, 92.5% of participants reported one or more policy breaches (M = 2.74, SD = 1.86). Counter to predictions, no relationships were found between anxiety or worry with reappraisal or lockdown breaches. Findings highlight the importance of targeting young adults in promoting lockdown compliance and offer further insight into the role of emotion during a pandemic.

Nonsuicidal self-injury thoughts and behavioural characteristics: Associations with suicidal thoughts and behaviours among community adolescents.

BACKGROUND: We consider whether nonsuicidal self-injury (NSSI) thoughts - in the absence of any NSSI behaviour - are associated with suicidal thoughts and behaviours among adolescents, before examining whether characteristics of NSSI behaviour are associated with greater suicidal thoughts and behaviours. METHODS: Adolescents (n = 2,057, M age =15.56) recruited from secondary schools reported their lifetime history of NSSI, suicidal thoughts and behaviours, NSSI characteristics, and NSSI functions. Receiver Operating Characteristic analysis test whether NSSI status and characteristics of NSSI behaviour are diagnostic of clinically elevated suicidal thoughts and behaviours (a score of 7 or higher on the Suicide Behaviours Questionnaire-Revised). Regression models test whether NSSI functions predict greater suicidality. RESULTS: Adolescents with NSSI thoughts and those with NSSI behaviour were more likely to report lifetime suicidal ideation and past-year suicide plan(s) than adolescents with no history of NSSI. In addition, adolescents with a history of NSSI were more likely to report a lifetime history of suicide attempt(s) as well as past-year suicide attempt(s) than adolescents with no history of NSSI. A greater number of NSSI methods, requiring medical assistance for NSSI injuries, and engaging in NSSI for self-punishment, anti-suicide, and sensation-seeking functions were associated with greater severity of suicidal thoughts and behaviours. LIMITATIONS: Data are cross-sectional, limiting inferences about causality. CONCLUSIONS: Findings emphasize the importance of NSSI thoughts and characteristics of NSSI behaviour in understanding the complex relationship between NSSI and suicidal thoughts and behaviours among adolescents.

Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility.

Although nonsuicidal self-injury (NSSI)-deliberate damaging of body tissue without suicidal intent-is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.

Advancing a temporal framework for understanding the biology of nonsuicidal self- injury: An expert review.

Nonsuicidal self-injury (NSSI) is a serious clinical problem, particularly for adolescents and young adults. NSSI is a complex behavior that emerges through the intersecting effects of social, psychological, and biological mechanisms. Although the social and psychological contributions to risk for developing NSSI are relatively well understood and have guided the development of effective psychosocial treatments for self-injury, the biological mechanisms underlying NSSI have just begun to come to light. To evaluate and categorize the biological research conducted on the topic of NSSI, we propose a model that distinguishes between trait and state markers. According to this model, risk factors and mechanisms involved in NSSI can be distinguished into both trait and state factors. We review the existing evidence on distal biological traits (predictors) of NSSI, proximal biological traits (correlates) of NSSI, and biological states directly preceding or following NSSI. We conclude by providing recommendations for future research on the neurobiology of NSSI.

Open to interpretation? Inconsistent reporting of lifetime nonsuicidal self-injury across two common assessments.

Nonsuicidal self-injury (NSSI) is typically assessed using either single-item questionnaires or checklists of common behaviors, but preliminary research suggests that checklists produce higher lifetime prevalence rates. In 2 preregistered studies (combined n = 1,364), we tested whether memory cueing afforded by behavioral checklists accounts for this discrepancy. Participants reported their lifetime NSSI history using both a single-item and a checklist, with presentation order randomized across participants. Nearly a third of participants reported inconsistent NSSI histories on the 2 assessments, with participants 1.57 times more likely to report an NSSI history on a checklist than on a single-item. Counter to the memory account, this discrepancy was evident even when participants completed the checklist first, suggesting that the increased prevalence estimates captured by checklists are unlikely to simply reflect memory facilitation. Across the 2 samples, 12.5% of participants would have been incorrectly screened out in 2-step assessments; these participants were more likely to have engaged in NSSI historically, less likely to self-injure by cutting, and (in Study 2 only) were more likely to be men. These studies suggest that the inconsistencies across 2 of the most common NSSI assessments arise because people dissimilar to the lay conceptualization of self-injury are less likely to endorse a single-item, even when they have affirmed engaging in self-injury behaviors on a checklist. We argue that single-item and checklist assessments capture different aspects of NSSI, such that future research should distinguish between behaviorally identified NSSI assessed with behavioral checklists and self-identified NSSI assessed with single-item assessments. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents.

BACKGROUND: Self-harm is a clinically relevant and prevalent behaviour which peaks in adolescence. Given the high prevalence of self-harm, the high levels of psychiatric comorbidity, and its role as a risk factor for suicide, delivering evidence-based care is critical. METHODS: We conducted a systematic review and meta-analysis of the literature on treating self-harm in adolescents (12-19 years) published in the last 20 years, identifying 25 randomised controlled trials. We calculated the effect of treatment interventions relative to active control conditions in reducing self-harm, suicidal ideation and depressive symptoms. RESULTS: Overall, treatment interventions fared slightly better than active controls in decreasing self-harm (d = 0.13, 95% CI 0.04-0.22, p = .004), suicidal ideation (d = 0.31, 95% CI 0.12-0.50, p = .001) and depressive symptoms (d = 0.22, 95% CI 0.07-0.38, p = .006). Subgroup analysis of specific therapies revealed moderate effects of DBT-A in reducing self-harm (d = 0.51, 95% CI 0.18-0.85, p = .002) and suicidal ideation (d = 0.48, 95% CI 0.17-0.80, p = .003), as well as moderate effects of family-centred therapy in the treating suicidal ideation (d = 0.58, 95% CI 0.01-1.15, p = .049). CONCLUSIONS: The findings of our meta-analysis indicate that, overall, currently available treatments are effective in treating self-harm, suicidal ideation, and depressive symptoms in adolescence. Although the treatment intervention conditions showed only small to moderate effects in comparison to active controls, these differences were statistically significant and are clinically important. Further research is needed to understand the reduction in self-harm within active controls, which may arise due to the natural course of self-harm, or the potential efficacy of treatment as usual and enhanced usual care. Given the significant reduction of self-harm in active control conditions, delivering effective care to a large number of adolescents with self-harm may require developing stepped-care models in clinical practice. Expensive and poorly available treatments should be targeted at young people who most need them.

Rapid Review and Meta-Meta-Analysis of Self-Guided Interventions to Address Anxiety, Depression, and Stress During COVID-19 Social Distancing.

We conducted a rapid review and quantitative summary of meta-analyses that have examined interventions which can be used by individuals during quarantine and social distancing to manage anxiety, depression, stress, and subjective well-being. A literature search yielded 34 meta-analyses (total number of studies k = 1,390, n = 145,744) that were summarized. Overall, self-guided interventions showed small to medium effects in comparison to control groups. In particular, self-guided therapeutic approaches (including cognitive-behavioral, mindfulness, and acceptance-based interventions), selected positive psychology interventions, and multi-component and activity-based interventions (music, physical exercise) showed promising evidence for effectiveness. Overall, self-guided interventions on average did not show the same degree of effectiveness as traditional guided individual or group therapies. There was no consistent evidence of dose effects, baseline differences, and differential effectiveness of eHealth interventions. More research on the effectiveness of interventions in diverse cultural settings is needed.

Context retrieval and description benefits for recognition of unfamiliar faces.

Describing unfamiliar faces during or immediately after their presentation in a study phase can produce better recognition memory performance compared with a view-only control condition. We treated descriptions as elaborative information that is part of the study context and investigated how context retrieval influences recognition memory. Following general dual-process theories, we hypothesized that recollection would be used to recall descriptions and that description recall would influence recognition decisions, including the level of recognition confidence. In four experiments description conditions produced higher hit rates and higher levels of recognition confidence than control conditions. Participants recalled descriptive content on some trials, and this context retrieval was linked to an increase in the recognition confidence level. Repeating study faces in description conditions increased recognition scores, recognition confidence level, and context retrieval. Estimates of recollection from Yonelinas' (1994) dual-process signal detection ROCs were, on average, very close to the measures of context recall. Description conditions also produced higher estimates of familiarity. Finally, we found evidence that participants engaged in description activity in some ostensibly view-only trials. An emphasis on the information participants use in making their recognition decisions can advance understanding on description effects when descriptions are part of the study trial context. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Non-Suicidal Self-Injury, Sexuality Concerns, and Emotion Regulation among Sexually Diverse Adolescents: A Multiple Mediation Analysis.

Despite increasing interest in the prevalence and correlates of Non-Suicidal Self-Injury (NSSI) in adolescent populations, relatively few studies have examined NSSI among lesbian, gay and bisexual (LGB) adolescents. The current study explored sexuality concerns and elevated emotion dysregulation as potential mechanisms underlying the relationship between sexual orientation and elevated non-suicidal self-injury (NSSI). A community sample of 1,799 adolescents completed a questionnaire assessing NSSI, sexual orientation, sexuality concerns, and emotion regulation. Across the study, 20.6% of adolescents reported a history of NSSI. Adolescents who identify as "mostly heterosexual," "bisexual," and "mostly homosexual" were more likely to engage in NSSI than gay/lesbian, heterosexual, and asexual adolescents. Multiple mediation analysis showed that emotion regulation, but not sexuality concerns, mediated the relationship between sexual orientation and NSSI. The current study tested two theoretical pathways by which sexual orientation could predict NSSI engagement. Findings suggest that literature on general psychological processes, as well as group-specific minority stressors, can shed light on high rates of NSSI among LGB populations. Specifically, the challenges faced by LGB adolescents may undermine the development of emotion regulation. As such, this should be a key target of intervention with LGB adolescents engaging in NSSI.