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Self-injurious behaviors (SIB) are common in autistic people. SIB is mainly studied as a broad category, rather than by specific SIB types. We aimed to determine associations of distinct SIB types with common psychiatric, emotional, medical, and socio-demographic factors.
Methods
Participants included 323 autistic youth (~50% non−/minimally-speaking) with high-confidence autism diagnoses ages 4–21 years. Data were collected by the Autism Inpatient Collection during admission to a specialized psychiatric inpatient unit (www.sfari.org/resource/autism-inpatient-collection/). Caregivers completed questionnaires about their child, including SIB type and severity. The youth completed assessments with clinicians. Elastic net regressions identified associations between SIB types and factors.
Results
No single factor relates to all SIB types. SIB types have unique sets of associations. Consistent with previous work, more repetitive motor movements and lower adaptive skills are associated with most types of SIB; female sex is associated with hair/skin pulling and self-rubbing/scratching. More attention-deficit/hyperactivity disorder symptoms are associated with self-rubbing/scratching, skin picking, hair/skin pulling, and inserts finger/object. Inserts finger/object has the most medical condition associations. Self-hitting against surface/object has the most emotion dysregulation associations.
Conclusions
Specific SIB types have unique sets of associations. Future work can develop clinical likelihood scores for specific SIB types in inpatient settings, which can be tested with large community samples. Current approaches for SIB focus on the behavior functions, but there is an opportunity to further develop interventions by considering the specific SIB type in assessment and treatment. Identifying factors associated with specific SIB types may aid with screening, prevention, and treatment of these often-impairing behaviors.
To examine and compare rates and methods of self-harm presenting to a tertiary referral hospital during an 18-month period since the onset of the COVID-19 pandemic with a similar period immediately prior to the pandemic onset.
Methods:
Data from an anonymized database compared rates of self-harm presentations and methods employed between 1st March 2020 and 31st August 2021 to a similar time-frame prior to the onset of the COVID-19 pandemic.
Results:
A 9.1% increase in presentations with self-harm was noted since the onset of the COVID-19 pandemic. Periods of more stringent restrictions were associated with higher levels of self-harm (daily rate of 2.10 v 0.77). A higher lethality of attempt was demonstrated post-COVID-19 onset (χ2 = 15.38, p < 0.001). Fewer individuals presenting with self-harm were diagnosed with an adjustment disorder since the onset of the COVID-19 pandemic (n = 84, 11.1%, v. n = 112, 16.2%, χ2 = 7.898, p = 0.005), with no other differences pertaining to psychiatric diagnosis noted. More patients actively engaged with mental health services (MHS) presented with self-harm (n = 239 (31.7%) v. n = 137, (19.8%), χ2 = 40.798, p ≤ 0.001) since the onset of the COVID-19 pandemic.
Conclusions:
Despite an initial reduction, an increase in rates of self-harm has occurred since the onset of the COVID-19 pandemic with higher rates evident during periods of higher government mandated restrictions. An increase in active patients of MHS presenting with self-harm potentially relates to reduced availability of supports and particularly group activities. The recommencement of group therapeutic interventions for individuals attending MHS in particular is warranted.
Research in recent years has raised an important question about the role of the Internet in the self-injurious and suicidal behavior of adolescents and youth.
Objectives
The aim of this work is to study the role of the experience of violence in real life and the dark triad in the creation and dissemination of self-destructive content among adolescents and youth.
Methods
827 Russian students aged 15-25 (59% female) сompleted the questionnaire and the “Dirty Dozen” (Kornilova, et al., 2015).
Results
Two-thirds of respondents have seen self-harm (72%) and suicidal (66%) content. Every seventh respondent (14%) is at risk, because he creates, approves with likes or disseminates self-destructive content among peers. Respondents at risk are more likely to have experienced physical (χ2=9.8, p<0.01), psychological (χ2=4.36, p<0.05) and sexualized (χ2=7.44, p<0.01) violence. Respondents who have a higher machiavellianism are more likely to approve (F=17.96, p=0.00) and disseminate (F=6.07, p<0.05) self-destructive content, less often using the «report» (F=4.06, p<0.05). Adolescents who have a higher psychopathic are more likely to create (F=7.34, p<0.01), disseminate (F=23.27, p=0.00) and approve (F=23.92, p=0.00) it.
Conclusions
Self-destructive online content is seen by most teens and youth, and every seventh creates, approves and distributes it among peers, being a victim of violence in real life and having potential tendencies towards self-harm or suicidal behavior. Teens and youth with higher machiavellianism and psychopathy can create and disseminate self-destructive content due to their own psychological problems, but also potentially involve others. Research was supported by the Russian Foundation for Fundamental Research, project 20-013-00857.
Disclosure
Research was supported by the Russian Foundation for Fundamental Research, project 20-013-00857.
Maternal suicide attempts are associated with adverse psychosocial outcomes in children, but the association with chronic morbidity is poorly understood. We examined the relationship between maternal suicide attempt and risk of hospitalization for potentially preventable conditions in offspring.
Methods
We analyzed a longitudinal cohort of 1 032 210 children born in Quebec, Canada between 2006 and 2019. The main exposure measure was maternal suicide attempt before or during pregnancy. Outcomes included child hospitalizations for potentially preventable conditions, including infectious diseases, dental caries, atopy, and injury up to 14 years after birth. We used adjusted Cox proportional hazards regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of maternal suicide attempt with risk of hospitalization for these outcomes.
Results
Compared with no suicide attempt, children whose mothers attempted suicide had an increased risk of hospitalization for infectious diseases (HR 1.11, 95% CI 1.06–1.16), dental caries (HR 1.31, 95% CI 1.15–1.48), and injury (HR 1.16, 95% CI 1.03–1.31). Risk of hospitalization for any of these outcomes was greater if mothers attempted suicide by hanging (HR 1.46, 95% CI 1.22–1.75), had their first attempt between the age of 25 and 34 years (HR 1.27, 95% CI 1.13–1.42), and had 3 or more attempts (HR 1.56, 95% CI 1.27–1.91). Maternal suicide attempts were more strongly associated with child hospitalization before 10 years of age.
Conclusions
Children whose mothers have a history of suicide attempt have an elevated risk of hospitalization for potentially preventable conditions.
A recent suicidal drive hypothesis posits that psychotic experiences (PEs) may serve to externalize internally generated and self-directed threat (i.e., self-injurious/suicidal behavior [SIB]) in order to optimize survival; however, it must first be demonstrated that such internal threat can both precede and inform PEs. The current study conducted the first known bidirectional analysis of SIB and PEs to test whether SIB could be considered as a plausible antecedent for PEs. Prospective data were utilized from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of 2232 twins, that captured SIB (any self-harm or suicidal attempt) and PEs at ages 12 and 18 years. Cross-lagged panel models demonstrated that the association between SIB at age 12 and PEs at age 18 was as strong as the association between PEs at age 12 and SIB at age 18. Indeed, the best representation of the data was a model where these paths were constrained to be equal (OR = 2.48, 95% CI = 1.63–3.79). Clinical interview case notes for those who reported both SIB and PEs at age 18, revealed that PEs were explicitly characterized by SIB/threat/death-related content for 39% of cases. These findings justify further investigation of the suicidal drive hypothesis.
When punishment is immediate, firm, and accompanied by a clear (and fair) explanation, and when it occurs in a variety of settings, it can be very effective in eliminating undesirable behavior. However, punishment can also produce undesireable side effects. One is conditioning fear. If children are punished for poor schoolwork, for example, this can create a dislike of the subject and of school; the resulting anxiety can also interfere with learning. Another possible side-effect is aggression. Aggression is an innate reaction to painful stimuli, and we can also learn to imitate aggressive models—if parents control behavior with physical force, children can learn that force is an appropriate way to get others to do what you want. Research has shown that spanking or other forms of painful punishment can substantially increase aggression, and seeing aggression on TV or films can have similar effects. Alternatives to corporal punishment include extinction, time-out, response cost, and reinforcing good behavior instead of punishing bad behavior.
The current study sought to examine the relationship between documented social media use and suicidality and self-injurious behaviors in adolescents at the time of psychiatric hospitalization.
Methods
We retrospectively identified adolescents (aged 12-17 years) hospitalized on an inpatient psychiatric unit during 1 year. Abstracted information included documented social media use, demographic variables, documented self-injurious behaviors, the Patient Health Questionnaire-9, and the Suicide Status Form-II. Logistic regression was implemented to examine the effect of social media use on the risk of self-injurious behaviors and suicidality.
Results
Fifty-six adolescents who used social media were identified and matched with 56 non-social media users. Those with reported social media use had significantly greater odds of self-injurious behaviors at admission (odds ratio, 2.55; 95% confidence intervals, 1.17-5.71; P = .02) vs youth without reported social media use. Adolescents with reported social media use also had greater odds of increased suicidal ideation and suicide risk than those with no reported use, but these relationships were not statistically significant.
Conclusions
Social media use in adolescents with a psychiatric admission may be associated with the risk of self-injurious behaviors and could be a marker of impulsivity. Further work should guide the assessment of social media use as part of a routine adolescent psychiatric history.
There have been many contradictory reports on the effectiveness of antidepressant drug treatments in autistic syndromes with sell-injurious behavior (SIB). We report a retrospective case study in which norepinephrinergic antidepressants (inhibitors of the re-uptake of norepinephrine) increased SIB each time they were administered.
– The family environment is known to be an important contributor to the course of psychiatric disorders. In this study, we examined the family context of eating disordered (ED) patients with and without self-injurious behaviors (SIB).
Method.
– A Dutch adaptation of the Family Environment Scale ‘Sci Eng 57(9-B):1997;5927’ was completed by 131 ED patients of whom 47% showed at least one form of SIB (e.g., cutting, burning, hair pulling, etc.).
Results
– Results showed a significant difference in family environment between patients with and without SIB. The family environment of self-injuring ED patients was less cohesive, expressive and socially oriented, and more conflictual and disorganized than the family environment of those without SIB. No significant differences in perceived family environment were found with respect to the number or form of SIB and the subtype of ED. Neither did we find a significant interaction effect between ED subtype and presence/absence of SIB.
Two autistic patients suffering from extreme cases of self-injurious behavior received an association of a sedative neuroleptic, a β-adrenoceptor blocking agent and an opiate antagonist. Within a few weeks after introduction, self-injurious behavior ended. Both patients have been followed-up for more than two years and have not relapsed.
Research on the phenomenon of self-injurious behaviour (SIB) has been very limited despite the relative high prevalence of this type of disorder. The relative lack of knowledge of psychopathology in this field and the methodological problems in performing research projects may have contributed to the limitations in the interest for this area. Recently, research into biological aspects of the etiopathogenesis of SIB has yielded results that might open new vistas for a rational and effective pharmacotherapeutical approach. In this concise review the psychiatric, neurological, biological, pharmacological and methodological aspects of SIB in mental retardation will be mentioned.
Non-suicidal self-injury (NSSI) is the deliberate and direct injuring of body tissue without suicidal intent for purposes not socially sanctioned. Few studies have examined the correlates of NSSI among young adults. This study aimed to identify predictors of lifetime and past-year NSSI, and describe motives for NSSI and disclosure of NSSI to others.
Method
Interviews were conducted annually with 1081 students enrolled in the College Life Study, a prospective longitudinal study conducted at a large public mid-Atlantic university. NSSI characteristics were assessed at Year 4. Demographic and predictor variables were assessed during Years 1 to 4. Multivariate logistic regression models were used to identify correlates of lifetime NSSI and predictors of past-year NSSI.
Results
The prevalence of past-year and lifetime NSSI was 2% and 7% respectively (>70% were female for both lifetime and past-year NSSI). Seven percent of NSSI cases self-injured once, whereas almost half self-injured six or more times. Independent predictors of past-year NSSI were maternal depression, non-heterosexual orientation, affective dysregulation and depression. Independent predictors of lifetime NSSI were depression, non-heterosexual orientation, paternal depression and female sex. One in six participants with NSSI had attempted suicide by young adulthood. The three most commonly reported motives for NSSI were mental distress, coping and situational stressors. Most (89%) told someone about their NSSI, most commonly a friend (68%).
Conclusions
This study identified unique predictors of NSSI, which should help to elucidate its etiology and has implications for early identification and interventions.
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