Clinical diagnoses, characteristics of risk behaviour, differences between suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injury

Abstract

Objective: Self-injury (SI), self-injurious behaviour (SIB), including suicidal or non-suicidal self-injury (SSI, NSSI) represent an increasing problem among teenagers amounting to a 6–17% prevalence rate in adolescence, yet little data exists on detailed characteristics and associated factors of SI reaching clinical severity. There is also a scarcity of data distinguishing between suicidal and non-suicidal subsamples of self-injuring patients, i.e. showing which predictors contribute to develop self-injurious behaviour with a previous suicidal history (SSI). Method: Clinical diagnoses and characteristics of risk behaviour were examined in a crosssectional design in suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injurious behaviour. From the total pool of 708 new patients consecutively referred with various psychiatric problems in five regional child psychiatric centres in Western-Hungary over an 18-month period, 105 adolescent outpatients suffering from self-injurious behaviour participated in the study (28 males and 77 females aged from 14 to 18 years, mean age 15.97, SD 1.05). The Ottawa/Queen’s self-injury questionnaire (OSI) was used to measure the characteristics of risk behaviour, while the comorbid clinical diagnoses were confirmed by the M.I.N.I. Plus International Neuropsychiatric Interview. Descriptive statistics presented the frequencies of the characteristics of SI, bilateral comparisons were used to reveal relevant items to differentiate between sex, duration of practice and SSI versus NSSI and logistic regression was performed to identify significant predictors of suicidal subtype of self-injuring practice. Results: A total of 60% of the clinical SI population experienced a present or past episode of major depression. The motivation of patients to resist impulses and to discontinue malpractice was low. Cutting and scratching was the most common self-injuring methods. Two-thirds of the sample practised the impulsive type of SI, while 30% practised premeditated SI having an incubation time from 30 min to days and weeks before carrying out SI. Although duration of SI did not distinguish the sample in important aspects, girls and boys differed in several aspects of SI practice. SSI adolescents differed from their NSSI peers in a number of important characteristics including the frequency of actions, injured areas, methods, specific stresses and motivations. SSI adolescents were more likely to favour cutting of the lower leg and drug overdose as modes of SI. SSI adolescents were more likely to report addictive features than their peers with no suicidal motivation. From the aspect of self-injurious practice, logistic regression analysis found only two significant predictors for the combined pathology

Impulsivity and nonsuicidal self-injury: A review and meta-analysis

“…According to Janis and Nock (2009), individuals who engage in NSSI may make appraisals about their impulsivity using NSSI engagement as reference for their impulsive behavior ("I am impulsive because I self-injure"). Given that individuals who engage in NSSI typically do so soon after they experience the urge to self-injure (Csorba, Dinya, Plener, Nagy, & Pali, 2009;Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007;Nock & Prinstein, 2005), it is possible that individuals who engage in NSSI regard themselves as impulsive because of their NSSI engagement. McCloskey et al (2012) highlight, however, that individuals who engage in NSSI report greater engagement in a variety of impulsive or risky behavior behaviors than individuals who do not engage in NSSI (e.g., Gollust, Eisenberg, & Golberstein, 2008;Serras, Saules, Cranford, & Eisenberg, 2010), suggesting that there may be differences in impulsivity between individuals who engage in NSSI and individuals who do not engage in NSSI.…”

Out of the blue: Untangling the association between impulsivity and planning in self-harm

“…Focussing specifically on whether proximal planning was reported prior to the act (the most widely adopted criterion for "impulsive" suicidal acts) between 13% and 78% of suicide attempts appear impulsive across studies (Rimkeviciene et al, 2015). However, it is not clear whether similar findings occur for self-harm in general (though according to Csorba et al (2009) 27% report extended thinking about the act prior to non-suicidal forms of self-harm). Here we adopt the Royal College of Psychiatrist's definition of self-harm as an act of intentional self-injury irrespective of suicidal intent (which may cover a range of specific behaviours including self-cutting, burning and poisoning; Kapur et al, 2013;Royal College of Psychiatrists, 2010).…”

Erhebung von Suizidgedanken bei Jugendlichen: Vergleich zweier Instrumente

“…Als Antwortmöglichkeiten stehen: "nie", "1-5-mal", "monatlich", "wöchentlich" und "täglich" zur Verfügung. Der Fragebogen wurde bei kanadischen (Nixon et al, 2002) und ungarischen Jugendlichen (Csorba et al, 2009) eingesetzt. Im Rahmen der vorgelegten Studie erfolgte der Einsatz einer übersetzten und durch bilinguale native speaker rückü-bersetzten deutschen Version, für die bislang keine Validierung durchgeführt wurde.…”