Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohort.

OBJECTIVE: We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies - including health, police and child protection - with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm. METHODS: Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts. RESULTS: Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services. CONCLUSION: Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.

Bullying and self-harming behavior in universities - A cross-sectional study of a sample of 327 university students.

INTRODUCTION: Bullying is a widespread public health issue, found in different contexts (e.g. schools, universities, workplaces, families), and it has negative consequences on both the perpetrator and the victim. There is a lack of studies addressing bullying among university students in Arab countries and more specifically in Lebanon. The objective of our study was to determine the prevalence of bullying among a sample of university students in Lebanon, its forms, and associated factors. METHODS: The study consists of a cross-sectional online survey addressed to university students in Lebanon that evaluates sociodemographic data, presence and type of bullying, history of bullying during childhood, adverse childhood experiences, daily life functioning, and mental health status (reported psychiatric disorders, substance use, self-harming behaviors, and suicidal attempts). Chi-Square and Fisher's exact tests were used to compare the results between victims of bullying and the rest of the sample. RESULTS: Three hundred and twenty-seven university students participated in this study. The prevalence of bullying was 14.1%. The main forms of reported bullying were verbal (58.7%) and social bullying (65.2%). The main associated factors were being a witness of bullying at university (84.8% vs. 56.2% - P<.001) and history of cyberbullying (13% vs. 4.6% - P=.024). Among students who reported current bullying, 28.3% had a psychiatric diagnosis, 19.6% reported substance use, 15.2% had self-harming behaviors, and 8.7% had suicide attempts. Victims of bullying in the university reported a significant negative impact on their daily lives (lack of interest in daily activities, academic decline) (83.7%) and mental health concerns (psychiatric disorders, substance use, suicide attempts) (88.4%). CONCLUSION: Even though bullying is an event less experienced in university than in school, it is nevertheless still present with potential negative impact on the victims. Bullying in a university setting is a public health issue that could benefit from more studies as well as prevention and intervention programs.

Trauma and self-harming behaviors in high school students: The mediating role of identity formation.

INTRODUCTION: This study investigated the link between trauma and self-harming behaviors in South African high school students, and examined the mediating role of identity formation. Traumatic experiences have been commonly associated with self-harming behaviors in adolescents. However, research addressing this association in non-Western countries is limited. METHODS: A total of 552 South African high school students aged 13-21 (60.4% female; Mage = 16 years) were included in the study. Students completed self-report questionnaires on traumatic experiences, identity formation, and self-harming behaviors (disturbed eating behaviors and suicidal thoughts and behaviors). RESULTS: Structural equation modelling indicated that the association between traumatic experiences and self-harming behaviors was partially mediated by identity formation. Traumatic experiences were associated with more identity diffusion, bulimia, and suicidal thoughts and behaviors. Identity diffusion, in turn, was associated with more drive for thinness, bulimia, body dissatisfaction, and suicidal thoughts and behaviors. Identity consolidation was positively associated with drive for thinness and negatively with body dissatisfaction and suicidal thoughts and behaviors. No moderation effects by gender or age were found. CONCLUSIONS: Traumatic experiences were associated with higher levels of identity diffusion, which, in turn, were associated with more self-harming behaviors in South African high school students. These findings suggest the importance of focusing on identity diffusion in prevention and intervention programs targeting self-harming behaviors.

Self-harming behaviours of asylum seekers and refugees in Europe: A systematic review.

The increasing number of asylum seekers and refugees in Europe calls for even more professionals to take care of refugees' mental health. Although different studies claim that migration could be a potential risk factor for self-harming behaviours, an in-depth exploration of the presence and characteristics of self-harm in the context of asylum is needed. In accordance with PRISMA guidelines, a systematic review was conducted across the databases Scopus, PubMed, Web of Knowledge and PsycArticles, regarding the main features of self-harming behaviour among refugees in Europe. Twelve articles and 3 main trajectories were identified: (1) A context at-risk: self-harm and detention centres; (2) A target at-risk: self-harm and unaccompanied minors; (3) A comparison between the mental health of asylum seekers and natives. Research on this topic in Europe is still underdeveloped and disorganised. Studies have mainly carried out wider quantitative investigations on mental health, usually overlapping self-harm with suicide. Detention centres emerged as the most widely investigated context and the one with the highest risk for self-harming behaviours. Instead, unaccompanied minors emerged as a particularly vulnerable category. Research in this field should be improved, combining quantitative and qualitative methods for a deeper understanding of the meanings of self-harm across cultures.

Probable Post-traumatic Stress Disorder and Self-harming Behaviour: Potential Barriers to Employment?

The current study screened for post-traumatic stress disorder (PTSD) and self-harming behaviours, often related to borderline personality disorder (BPD), among individuals in a job centre considered unemployable primarily for psychological reasons. Participants (N = 112) filled in questionnaires on PTSD symptoms (n = 62) and self-harming behaviours (n = 59) as part of participating in team-meetings providing the individuals with a return-to-work plan. Differences in demographic variables between individuals with and without valid protocols were small to moderate. Of the individuals filling in the PTSD questionnaire 40% fulfilled criteria for probable PTSD and 31% of the individuals filling in the questionnaire on self-harming behaviours reported five or more types of self-harming behaviours. Only a minority of these individuals had PTSD or BPD respectively mentioned in their case records. Further investigation of the prevalence of PTSD and self-harming behaviour among individuals considered unemployable is warranted as well as an enhanced focus in jobcentres and other institutions supporting employability on detection and treatment of PTSD and early signs of BPD.

Body image and nonsuicidal self-injury: Validation of the Body Investment Scale in participants with eating disorders.

The Body Investment Scale (BIS) assesses body image feelings, body care, protection of the body, and comfort in touch, in order to identify and distinguish participants with self-harming and self-destructive tendencies. However, the psychometric properties of the BIS were not analysed in participants diagnosed with eating disorders. The main objective of the present study is to confirm the factor structure of the Spanish version of the BIS and analyse its psychometric properties in a sample composed of women diagnosed with eating disorders. Participants were 250 Spanish women between 12 and 60 years old (M = 26.05, SD = 11.97) diagnosed with eating disorders. A confirmatory factor analysis showed a poor fit of the original BIS. The final model showed an acceptable 4-factor structure (Body Feelings, α = .88; Body Touch, α = .82; Body Protection, α = .77; Body Care, α = .68), with a good fit to the data (SBχ2(246)  = 393.21, CFI = .906, IFI = .908, RMSEA = .049). The relationships between the BIS and both the Purpose-In-Life Test-10 Items and Beck Hopelessness Scale were analysed, as well as differences in the BIS score according to nonsuicidal self-injuries and suicidal ideation in the past year. The BIS is an appropriate instrument to assess the body investment dimension of body image in women with eating disorders.

Nonsuicidal self-injury across cultures and ethnic and racial minorities: A review.

The field of nonsuicidal self-injury (NSSI) is dominated by research conducted with Caucasian-majority samples in Western countries such as United States, Canada, Australia and European countries. This article critically reviewed the empirical research on NSSI in non-Western countries and among ethnic/racial minority individuals who live in the West to give voice to and understand the patterns of NSSI among individuals who do not fall within the dominant Caucasian majority. The study found both similarities and differences between Western and non-Western data in terms of characteristics and functions of NSSI. Differences in gender patterns in regards to prevalence of NSSI and methods used as well as presence of a more relational functionality of NSSI rather than emotion regulation functionality were two points of divergence in the findings of these studies. In addition, the findings seem to indicate that the role of ethnicity/race is mediated by important factors such as socioeconomic status (SES) and gender. Existing gaps in the literature and suggestions for further research are discussed.

Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada.

BACKGROUND: Clustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. We identified geographic areas with higher numbers of adolescents who (1) presented to an emergency department (ED) for self-harm, and (2) were without a physician follow-up visit for mental health within 14 days post-ED visit. METHODS: We extracted a population-based cohort of adolescents aged 15-17 years (n = 3,927) with ED visits during 2002-2011 in Alberta, Canada. We defined the case as an individual with one or more ED presentations for self-harm in the fiscal year of the analysis. Crude case rates were calculated and clusters were identified using a spatial scan. RESULTS: The rates decreased over time for ED visits for self-harm (differences: girls -199.6/100,000; p < 0.01; boys -58.8/100,000; p < 0.01), and for adolescents without a follow-up visit within 14 days following an ED visit for self-harm (differences: girls -108.3/100,000; p < 0.01; boys -61.9/100,000; p < 0.01). Two space-time clusters were identified: (1) a North zone cluster during 2002-2006 (p < 0.01) and (2) a South zone cluster during 2003-2007 (p < 0.01). These clusters had higher numbers of adolescents who presented to the ED for self-harm (relative risks [RRs]: 1.58 for cluster 1, 3.54 for cluster 2) and were without a 14-day physician follow-up (RRs: 1.78 for cluster 1, 4.17 for cluster 2). In 2010/2011, clusters in the North, Edmonton, and Central zones were identified for adolescents with and without a follow-up visit within 14 days following an ED visit for self-harm (p < 0.01). CONCLUSIONS: The rates for ED visits for adolescents who self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period. The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care. The 2010/2011 geographic cluster suggests that the northern part of the province still has elevated numbers of adolescents visiting the ED for self-harm. Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.

Toward a re-interpretation of self-harm: A cross-contextual approach.

A common view is that self-harmers are individuals who are exposed to or have been exposed to stressors and hostility in everyday settings. A strand of research has also found that self-harmers expose other people to their hostility. Extending these findings, this study examined whether adolescent self-harmers are simultaneously exposed and expose others to hostility in their everyday interpersonal contexts-at home, at school, and during leisure-time. The participants were 1,482 adolescents, ranging from 13 to 16 years of age, who attended different schools in a medium-sized city in central Sweden. The results show that the adolescents involved in mutually hostile relationships in their different interpersonal contexts exhibited higher self-harm than the adolescents who were exposed to others' hostility or exposed other people to their hostility. Also, the more mutually hostile settings the adolescents were involved in, the more self-harm they reported. Overall, our findings suggest not only that self-harmers are exposed to hostility in their different interpersonal contexts, as has been typically assumed, but also that they simultaneously expose others to hostility in these contexts. This has implications for our understanding of young people who harm themselves and also for intervention. Aggr. Behav. 42:522-532, 2016. © 2016 Wiley Periodicals, Inc.

Prevalence and characteristics of cluster B personality disorder in a consultation-liaison psychiatry practice.

OBJECTIVE: Quantitative studies on cluster B-personality disorder (PD) in the general hospital are scarce. The aim of this study is to examine the prevalence and characteristics of cluster B-PD patients in a consultation-liaison practice. METHODS: Files of 258 consecutive patients referred for psychiatric consultation were examined. Cluster B patients were compared with the remaining patients. RESULTS: Eleven point six percent of these patients were diagnosed with a cluster B-PD. On univariate analysis, cluster B patients were more likely to be younger (P < 0.001), unmarried (P = 0.005), and without organic medical illness (P < 0.001).These patients had a shorter admission (P < 0.0001), and were more frequently treated in the emergency room (66.6% versus 37.5%, P = 0.02).There was a trend toward comorbid substance use disorder (P = 0.09). On multivariate analysis, cluster B patients presented significantly with self-harming behavior/ideation (80% versus 18%, OR = 12.07; 95% CI = 4.37-33.31; P < 0.0001). CONCLUSIONS: In view of the high prevalence of cluster B-PD in our preliminary study, general hospital staff requires practical skills for managing these high-maintenance patients. We believe that this study and further research will promote evidence-based recommendations for consultation-liaison psychiatrists.

Chronicity of self-harming behaviors among adolescent teenage girls living in refugee settlements in Northern Uganda.

BACKGROUND: Self-harming ideations demand targeted research due to their persistent nature, especially among female adolescents within refugee populations who face unique challenges that can exacerbate self-harming tendencies. This study aimed to assess the factors associated with self-harming ideations chronicity among female teenagers living in refugee settlement in Northern Uganda. METHOD: This cross-sectional study used a pretested questionnaire to assess self-harming ideations and other demographic characteristics. Ordinal logistic regression was used to determine factors associated with chronicity of self-harm ideations. RESULTS: Of 385 participants, the prevalence of self-harming ideations was 4.2% (n = 16) for acute, 8% (n = 31) for subacute, and 3.1% (n = 12) for chronic. The likelihood of having more chronic self-harming ideations increased with having ever been pregnant (adjusted odds ratio [aOR] = 3.78, 95% Confidence Interval [CI] = 1.57-9.08). However, having a spouse as the family head reduced the likelihood of having more chronic self-harming ideations (aOR = 0.19, 95% CI = 0.04-0.95). CONCLUSIONS: The persistence of self-harming thoughts among female teenagers in Northern Ugandan refugee settlements varies. Pregnancy history is associated with a higher chance of prolonged self-harming thoughts while having a spouse as the family's head is linked with a lower likelihood. Examining different demographic and familial elements when addressing the mental well-being of female teenage refugees is vital. It stresses the necessity for customized interventions and support networks targeting the reduction of self-harm behaviors among this vulnerable group.

Increasing prevalence of self-harm, suicidal behavior and suicidal ideation throughout a three-year period in the context of COVID-19 pandemic in Spain.

The COVID-19 pandemic had a great impact on mental health both in the general population and in individuals with preexisting mental disorders. Lockdown, social restrictions, changes in daily habits and limited access to health services led to changes in consultations in mental health services. This study aimed to determine changing trends in psychiatric admissions by the inclusion of adult patients admitted to the Emergency Department (ED) of Hospital Clínic of Barcelona between 2019 and 2021. Acute admissions, social issues and psychiatric diagnoses were compared between years, seasons and considering the interaction between both years and seasons. A total of 13,677 individuals were included in the analysis. An overall reduction in consultations to the ED and a higher proportion of acute admissions was observed in 2020 in context of the COVID-19 outbreak. Increased prevalence of sleeping disorders and substance use disorders was found in 2020. Self-harming behavior, suicidal thoughts and suicidal behavior showed an increasing tendency over time, with their highest rates in 2021. Prevention and management strategies should be considered in order to address increasing needs in mental health care.

Population attributable fractions of adverse childhood experiences for emotional problems and self-harming behaviors among middle school students in China.

The population attributable fractions of health outcomes attributed to adverse childhood experiences (ACEs) among Chinese middle school students is unknown. Of all the 22,868 middle school students, 29.8 % had exposure to four or more ACEs. Findings showed a graded relationship between ACE scores and those adverse outcomes. The PAFs of six outcomes attributed to experiencing ≥ 4 ACEs ranged from 23.1 % to 44.2 %. The results emphasized the significance of preventive interventions to alleviate the negative legacies of ACEs.

Navigating the "Mental Health Crisis" in Adolescents in the Aftermath of Covid-19 Pandemic: Experience and Insights from Frontline Psychiatric Service.

The COVID-19 pandemic had a great impact on adolescent mental health, with a dramatic rise in psychiatric emergencies that has challenged healthcare systems worldwide. This paper aims at focusing on reporting the authors' experience and their data collected on adolescent emergencies in 2022 in Tuscan, within the context of the "Azienda USL Toscana Nord Ovest", a large department covering about a third of Tuscany's Regional Health Service, in central Italy. The collected findings will be shortly presented and commented on, while providing insights concerning the importance of adapting healthcare systems to adequately respond to this growing crisis and the need for broader strategies to support adolescent mental health in these challenging times.

Teen Advisory Council Survey's Factors Associated With Self-Harming Thoughts.

Background: The evaluation of teens with self-harming thoughts (SHT) is a high-stakes task for physicians in community and emergency department (ED) settings. The lived experience of adolescents with stress and SHT provides an important source of insight for mental health professionals who evaluate and treat teens A snapshot of the lived experience of teens in northwest Louisiana was captured by the Step Forward Teen Advisory Council (TAC) in 2019. The TAC surveyed peers with the goal of identifying common stressors experienced by local teens in order to inform policy and practices in the local school system. The identification of stressors is a critical step in addressing SHT as adolescents who experience life stressors are at increased risk for self-harming thoughts (SHT), a known precursor to self-harm and suicide. Assessing youth for life stressors is a critical element of suicide prevention. Methods: Local teens queried 5,070 peers attending Caddo Parish schools to better understand the stressors faced by high school students in Northwest Louisiana using a student developed survey. Results were presented to peers at a virtual summit where teens developed action items to reduce stress and presented findings to local leaders. Their efforts ultimately lead to increased supports for students in local schools. Results: Over half of the teens surveyed reported stressors that negatively impacted their physical or emotional well-being. Students endorsing self-harming thoughts reported an average of 7.82 stressors as compared to 3.47 in peers without SHT. Teens with stressors at both home and school were more likely to experience SHT than teens with stressors in a single location. Conclusion: The Gen Z students who developed the TAC Survey identified stress as a major concern for teens in Northwest Louisiana. The TAC Survey data aligns local experience with established data regarding the association between stress, depression and SHT. Second, the results highlight the importance of diving deep to identify all stressors when assessing the risk of self-harm. Finally, the lived experience of local teens with SHT provides critical information for professionals to better understand risk for SHT and suicide in our region and beyond.

Understanding the Self-Harming Behavior of Filipino Male Detainees (32-58 Years Old): A Descriptive Phenomenology.

Self-harming behavior (SHB) has become a significant health issue among several populations, including adolescents, traumatized individuals, and persons deprived of liberty. Undoubtedly, incarceration takes a toll on inmates' mental health due to several stressful experiences while in custody. These taxing events make them vulnerable to maladaptive coping strategies, such as SHB. To date, many studies on this behavior have focused on high-income countries. Research has not explored much on this behavior among inmates in developing countries such as the Philippines. This phenomenological inquiry aims to characterize the experiences of select older male Filipino detainees engaged in SHB. Through vertical and horizontal analyses of the narratives shared, this study conceptualized the Self-Harming Behavior of Older Filipino Detainees as Tension and Compression. This model shows the forces that either pull or push the detainees to engage in self-injurious acts. Specifically, the seven themes surfaced: life dispositions, jail ecology, emotional baggage, physically and chemically-induced self-harming behavior, consequences, coping strategies, and cognizance. Findings from this inquiry may necessitate the provision of adequate and comprehensive prevention and intervention services for the self-harmers in jail, which are geared toward implementing a thorough psychological evaluation and promoting sound psychological well-being.

Mask wearing and self-harming thoughts among international students in the United States during COVID-19: The moderating role of discrimination.

Objective: This study examined associations among discrimination, mask-wearing behavior, and self-harming thoughts among international students in the United States during COVID-19. Participants: Undergraduate and graduate international students enrolled in universities during the 2020 summer semester participated in the online survey (N = 103). Methods: Perceived discrimination, mask-wearing behavior, and self-harming thoughts during COVID-19 were assessed by self-reports. Multivariable logistic regressions examined the association among discrimination, mask-wearing behavior, and self-harming thoughts and explored the potential moderation effect of discrimination on the association between mask-wearing and self-harming thoughts. Results: 18.6% of participants reported self-harming thoughts. Increased discrimination was significantly associated with increased odds of self-harming thoughts. Discrimination significantly moderated the association between mask wearing and self-harming thoughts. Conclusions: The findings highlight the importance of increased availability of culturally appropriate mental health services for international students and the need for increased advocacy to decrease discrimination against international students in the current societal context.

Results from Two Countries on How Thwarted Interpersonal Needs Contribute to Understanding Self-Harm.

Self-harming behavior (SHB) represents an important public health issue and is one of the most critical predictors of completed death by suicide. The current study evaluated the incremental contribution of the Interpersonal Theory of Suicide constructs of thwarted belongingness and perceived burdensomeness for the prediction of SHB beyond that associated with having a psychiatric diagnosis. Community adults from two different countries included a Portuguese sample of 414 adults, aged between 18 and 65 years (M = 45.09, SD = 13.11), and predominantly female (79%), and an American sample of 290 adults (198 men, 91 women, 1 unreported) with a mean age of 37.76 years (SD = 10.84) ranging from 20 to 71, who participated online. Results demonstrated mediation effects for perceived burdensomeness in the association of thwarted belongingness with SHB, partial mediation in the Portuguese sample and full mediation in the American sample. Findings also indicated that the interaction between thwarted belongingness and perceived burdensomeness failed to make a statistically significant contribution to the prediction of SHB. The results are discussed within the Interpersonal Theory of Suicide and its relevance for clinical practice.

Alexithymia and Psychopathological Manifestations Centered on the Body: Somatization and Self-Harm.

The present study aimed to investigate alexithymia and psychopathological manifestations centered on the body in a sample of adolescents with somatizing and/or self-harming issues to analyze the phenomenon of NSSI linked to Somatic Symptom Disorders (SSD). A sample of 184 adolescents between 12 and 19 years of age, was divided into three groups, one with NSSI (n = 49) and the second group with SSD (n = 57), comparing them with a third group of adolescents with SSD and NSSI (n = 78) to investigate their differences and similarities in psychopathological correlates and to analyze the mediation role of alexithymia and emotional dysregulation in NSSI and SSD related to internalizing problems. The battery of tests included the Toronto Alexithymia Scale (TAS-20) and the Youth Self-Report 11-18 (YSR). The NSSI + SSD group scored higher than the other two groups on all the YSR scales. The affective syndromes were the only clinical condition that discriminated between the three groups. On all the other syndrome scales, the NSSI + SSD group differed from the other two groups, while there were no differences between the NSSI group and the SSD group. The NSSI + SSD group revealed a more severely deficient emotional self-regulation. Difficulty identifying feelings was a trait shared by adolescents with SSD and those engaging in NSSI, a more complex overall alexithymia profile was associated with the combination of self-harming behavior and somatization. Alexithymia and emotional dysregulation played a mediating role in the relationship between internalizing problems and somatization. We did not find a mediating role in alexithymia and emotional dysregulation in the relationship between internalizing problems and self-injurious behavior. The combination of NSSI and SSD gave rise to more severe psychopathological correlates, clinical levels of alexithymia, and more severe deficient emotional self-regulation. Results of mediation role indicated a link between alexithymia, emotional dysregulation, and somatization.

Understanding Challenging Behaviors in Autism Spectrum Disorder: A Multi-Component, Interdisciplinary Model.

A multi-component, interdisciplinary model is described which explains the presence of, and in other cases the lack of, many challenging behaviors associated with autism spectrum disorder (ASD). More specifically, the model expands the operant behavioral conditioning paradigm by taking into account medical comorbidities and interoceptive processing.