The stigmatization of nonsuicidal self‐injury

Burke, Taylor A.; Piccirillo, Marilyn L.; Moore‐Berg, Samantha L.; Alloy, Lauren B.; Heimberg, Richard G.

doi:10.1002/jclp.22713

Cited by 79 publications

(62 citation statements)

References 75 publications

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“…It has also been suggested that males may present with a different clinical picture, including lower reported severity levels of self-harm correlates [23]. Self-harm has a history of being thought of as a problem mainly affecting females [24], but reporting levels may also be influenced by perceived stigma [25,26] as well as professional bias based on assumptions of sex difference. It is possible that SH in males to a larger extent run undetected or is misconceived, diminishing the strength of the association between SH in males and the different outcomes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of suicide risk and other outcomes among boys and girls who self-harm

Ohlis

Bjureberg

Lichtenstein

et al. 2020

Eur Child Adolesc Psychiatry

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Little is known about sex differences in outcomes of self-harm, and there are inconclusive results concerning the association between sex, self-harm, and suicide attempts. The aim of this study was to explore sex differences in outcomes of self-harm in adolescence. In this cohort study, all individuals (0-17 years) enrolled at the child-and adolescent mental health services (CAMHS) in Stockholm between 2001 and 2015 (N = 110,072) were followed in national registers from their last contact with the CAMHS, until end of 2015. Exposure was self-harm as reason for contact, outcome measures were: alcohol-/ substance use disorder, psychiatric hospitalization, non-violent or violent crime, and suicide. Differences in outcomes rates between exposed versus unexposed males, and exposed versus unexposed females, were examined using Cox regressions, expressed as hazard ratios (HR) with 95% confidence intervals (CI). Median follow-up time was 5.8 years (Q1: 2.3 years; Q3: 9.7 years). Self-harm was documented in 2.2% (N = 1241) males and 8.7% (4716) females. Exposed individuals had higher HR for all outcomes as compared with unexposed individuals of their own sex. Exposed females had more pronounced risk for drug use disorder (HR 11.2; 95% CI 9.9-12.7) compared with exposed males (HR 6.5, 95% 5.2-8.0). Both males and females who had engaged in self-harm had elevated risks for future suicide. Adjusting for socioeconomic status and age at start of follow-up only marginally affected the associations. Females and males with self-harm had similarly elevated risk for suicide, and self-harm was also an important risk marker for other adverse outcomes within both sexes.

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Section: Discussionmentioning

confidence: 99%

Comparison of suicide risk and other outcomes among boys and girls who self-harm

Ohlis

Bjureberg

Lichtenstein

et al. 2020

Eur Child Adolesc Psychiatry

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“…Although not always associated with suicide risk, NSSI (especially repetitive and severe self-injury) is one of the strongest independent predictors of future suicide attempts [16][17][18][19], and is associated with severe role impairment in daily life [9], stigma and feelings of shame [20,21], low levels of help-seeking [22,23], and poorer academic performance [24]. These findings underscore the necessity to address and respond to NSSI among college students [25].…”

Section: Introductionmentioning

confidence: 98%

Predicting the incidence of non-suicidal self-injury in college students

et al. 2019

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Background:Despite increased awareness that non-suicidal self-injury (NSSI) poses a significant public health concern on college campuses worldwide, few studies have prospectively investigated the incidence of NSSI in college and considered targeting college entrants at high risk for onset of NSSI.Methods:Using data from the Leuven College Surveys (n = 4,565; 56.8%female, Mage = 18.3, SD = 1.1), students provided data on NSSI, sociodemographics, traumatic experiences, stressful events, perceived social support, and mental disorders. A total of 2,163 baseline responders provided data at a two-year annual follow-up assessment (63.2% conditional response rate).Results:One-year incidence of first onset NSSI was 10.3% in year 1 and 6.0% in year 2, with a total of 8.6% reporting sporadic NSSI (1–4 times per year) and 7.0% reporting repetitive NSSI (≥ 5 times per year) during the first two years of college. Many hypothesized proximal and distal risk factors were associated with the subsequent onset of NSSI (ORs = 1.5–18.2). Dating violence prior to age 17 and severe role impairment in daily life were the strongest predictors. Multivariate prediction suggests that an intervention focused on the 10% at highest risk would reach 23.9% of students who report sporadic, and 36.1% of students who report repetitive NSSI during college (cross-validated AUCs =.70–.75).Discussion:The college period carries high risk for the onset of NSSI. Individualized web-based screening may be a promising approach for detecting young adults at high risk for self-injury and offering timely intervention.

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“…Pooled lifetime prevalence estimates of NSSI are close to 17%-18% among adolescents and 12%-20% among emerging adults (3,4). NSSI behaviors are an important predictor of future suicidal thoughts and behaviors (5)(6)(7)(8) and psychopathology (9,10), and are associated with stigma and feelings of shame (11)(12)(13), low levels of disclosure and help-seeking (14)(15)(16), and other adverse outcomes [e.g., poorer academic performance; (17)]. Together, these findings underscore the importance of a good understanding of the factors that underlie NSSI, with a view to informing preventive and intervention initiatives.…”

Section: Introductionmentioning

confidence: 99%

Fluctuations in Affective States and Self-Efficacy to Resist Non-Suicidal Self-Injury as Real-Time Predictors of Non-Suicidal Self-Injurious Thoughts and Behaviors

et al. 2020

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Introduction: Although research over the past decade has resulted in significantly increased knowledge about distal risk factors for non-suicidal self-injury (NSSI), little is known about short-term (proximal) factors that predict NSSI thoughts and behaviors. Drawing on contemporaneous theories of NSSI, as well as the concept of ideation-to-action, the present study clarifies (a) real-time factors that predict NSSI thoughts and (b) the extent to which theoretically important momentary factors (i.e., negative affect, positive affect, and selfefficacy to resist NSSI) predict NSSI behavior in daily life, beyond NSSI thoughts.Methods: Using experience sampling methodology, intensive longitudinal data was obtained from 30 young adults with frequent NSSI episodes in the last year. Participants completed assessments up to eight times per day for 12 consecutive days (signal-contingent sampling). This resulted in the collection of 2,222 assessments (median compliance = 79.2%) during which 591 NSSI thoughts and 270 NSSI behaviors were recorded. Using the dynamic structural equation modeling framework, multilevel vector autoregressive models were constructed.Results: Within the same assessment, negative affect was positively associated with NSSI thoughts, whereas positive affect and self-efficacy to resist NSSI were each negatively associated with NSSI thoughts. Across assessments, higher-than-usual negative affect and self-efficacy to resist NSSI were predictive of short-term change in NSSI thoughts. While fluctuations in both negative affect and positive affect prospectively predicted NSSI behavior, these factors became non-significant in models that controlled for the predictive effect of NSSI thoughts. In contrast, self-efficacy to resist NSSI incrementally predicted a lower probability of engaging in NSSI, above and beyond NSSI thoughts.Discussion: This study provides preliminary evidence that affective fluctuations may uniquely predict NSSI thoughts but not NSSI behaviors, and point to the role of personal belief in the ability to resist NSSI in preventing NSSI behavior. These findings illustrate the need to differentiate between the development of NSSI thoughts and the progression from NSSI thoughts to behavior, as these are likely distinct processes, with different predictors.

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The stigmatization of nonsuicidal self‐injury

Cited by 79 publications

References 75 publications

Comparison of suicide risk and other outcomes among boys and girls who self-harm

Comparison of suicide risk and other outcomes among boys and girls who self-harm

Predicting the incidence of non-suicidal self-injury in college students

Fluctuations in Affective States and Self-Efficacy to Resist Non-Suicidal Self-Injury as Real-Time Predictors of Non-Suicidal Self-Injurious Thoughts and Behaviors

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