Are neurocognitive factors associated with repetition of self-harm? A systematic review

Abstract

Background:Prediction of self-harm is limited clinically. Early identification of individuals likely to repeat self-harm could improve outcomes and reduce suicide risk. Various neurocognitive deficits have been found in people who self-harm, but the ability of these to predict repetition has yet to be established Aims:Identify neurocognitive factors that may predict repetition of self-harm. Methods:Systematic narrative review of English language publications assessing neurocognitive functioning and self-harm repetition, searching multiple databases from inception to March 2015. Quality of studies was appraised. A narrative synthesis was performed. Results:7026 unique records were identified, and 169 full-texts assessed. 15 unique studies provided data. No imaging studies could be included. Most studies assessed cognitive control or problem solving, but neither factor was consistently associated with repetition. However, specific tasks may show promise. Two studies in adolescents suggest that value-based decision-making impairments could be predictive of repetition. There were too few results for memory to draw specific conclusions. Conclusions:Selected studies suggest promise for particular neurocognitive factors and specific cognitive tasks in terms of repetition of self-harm.

New Evidences about Subjective Well-Being in Adolescence and Its Links with Neurocognitive Performance

“…Statistically significant differences between the risk and the nonrisk groups were found in all the domains. These results are consistent with the idea that adolescents with different psychological difficulties including internalizing and externalizing problems or suicide problems have impairments in selective attention, cognitive flexibility, emotional recognition or emotional processing [38,39,45,46]. Thus, the results confirm the relationship between neuropsychological functioning and wellbeing, with phenotypic differences between groups of risk and nonrisk adolescents.…”

“…In addition, it allows for the implementation of close-in strategies or a two-stage process model in order to further comprehensively evaluate mental state or early interventions to improve the outcome. Different studies have shown the relationship between cognitive functions and mental difficulties with related brain areas [40,46]. Nonetheless, there is a lack of studies analyzing the performance in different neurocognitive domains and its relationship with subjective wellbeing.…”

“…A relevant number of children and adolescents would potentially present mental health difficulties throughout their life, having a clear impact not only on their personal lives but also on health and economic levels [47][48][49]. Impairments in neurocognitive domains have been found to be linked with psychological issues indicating a potential common underlying neurodevelopmental disorder, as well as links to cognitive functioning [40,46,50,51]. In particular, previous research analyzing more severe mental health problems and neurocognitive functioning are in line with the results found in this study.…”

Patient Self-Harm in the Emergency Department: An Evidence- Based Approach

“…Self-harm is defined as the intentional act of an individual to cause self-directed injury or poisoning irrespective of motivation. The World Health Organization (WHO) further qualifies this definition as an "act with a nonfatal outcome, in which an individual deliberately initiates a non-habitual behavior that, without intervention from others, will cause self-harm… and which is aimed at realizing changes which the subject desired via the actual or expected physical consequences" [6]. The mode of injury can include cutting, stabbing, burning, skin carving, ingestion, and self-medicating, with more severe episodes of DSH resulting in serious secondary manifestations, such as traumatic brain injuries, infections, skeletal fractures, and even unintended death [30,31].…”

“…DSH is defined as the intentional act of self-directed injury, irrespective of motivation. Important distinction is drawn between intentional self-directed injury without suicidal intent and an act of attempted suicide [6]. It is important to recognize that hospitalized patient population differs from individuals who engage in DSH across other settings, both in terms of impulsivity and the degree of violence involved during self-harm attempts [7][8][9][10].…”