Nonsuicidal self-injury in a clinical sample of adolescents in Serbi

Ksenija Kolundžija; Jelena Srdanović Maraš; Jasminka Marković; Tamara Dimić

doi:10.2298/VSP211126026K

Ksenija Kolundžija University of Novi Sad, Faculty of Medicine, Department of Psychology, Novi Sad, Serbia
Jelena Srdanović Maraš Private Office for Child Psychiatry Krug, Novi Sad, Serbia
Jasminka Marković Private Office for Child Psychiatry Krug, Novi Sad, Serbia
Tamara Dimić Nua Healthcare John’s Lane, Naas East, Naas, Co. Kildare, Republic of Ireland

DOI: https://doi.org/10.2298/VSP211126026K

Keywords: adolescent, adolescent psychiatry, psychopathology, self-injurious behavior

Abstract

Background/Aim. Nonsuicidal self-injury (NSSI) among adolescents is recognized as a significant public health concern. Adolescents with mental health problems are at an especially high risk of NSSI. The aim of the study was to assess the sociodemographic and clinical characteristics of patients with NSSI and the features of NSSI, as well as the impact of emotional reactivity and internalizing/externalizing problems on them. Methods. The observational study included a clinical sample of 111 adolescents treated at the Department of Child and Ado-lescent Psychiatry, Psychiatric Clinic at the University Clinical Center of Vojvodina, from March 2018 to Octo-ber 2019. The adolescents were divided into two groups: group A comprised of adolescents who had at least one episode of NSSI in the last year, and group B comprised of adolescents who had no NSSI episode in their experi-ence. The following clinical scales were used to examine the differences between adolescents from group A and group B: self-report questionnaires about emotional and behavioral problems (Youth Self-Report – YSR, Child Behavior Checklist – CBCL), emotional reactivity (Emo-tion Reactivity Scale – ERS), and suicidality (Self-Injurious Thoughts and Behaviors Interview – SITBI). Results. Group A contained a total of 58 adolescents older than the subjects of group B and was predominated by female participants. They had the first episode of NSSI at 13.05 and the last at 14.80 years. The most common methods of NSSI were cutting, scratching, and biting. Adolescents from group A had higher scores on ERS, higher scores on internalizing and externalizing problems, as well as higher total scores on YSR, but there was no difference between groups regarding scores on the CBCL scale. Conclusion. Due to the results ob-tained for emotional and behavioral problems, adoles-cents with NSSI should have a detailed psychiatric as-sessment, including social support, pharmacotherapy, and psychotherapy, to better understand NSSI and help them develop better coping skills.

References

1. Brown RC, Plener PL. Non-suicidal Self-Injury in Adolescence. Curr Psychiatry Rep 2017; 19(3): 20.

2. Nock M. Self-injury. Annu Rev Clin Psychol 2010; 6: 339‒63.

3. Nock MK, Joiner TE Jr, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res 2006; 144(1): 65‒72.

4. Klonsky ED, Muehlenkamp JJ. Self-injury: a research review for the practitioner. J Clin Psychol 2007; 63(11): 1045‒56.

5. Rodav O, Levy S, Hamdan S. Clinical characteristics and func-tions of non-suicide self-injury in youth. Eur Psychiatry 2014; 29(8): 503‒8.

6. Selby EA, Kranzler A, Fehling KB, Panza E. Nonsuicidal self-injury disorder: The path to diagnostic validity and final obsta-cles. Clin Psychol Rev 2015; 38: 79‒91.

7. Bentley KH, Cassiello-Robbins CF, Vittorio L, Sauer-Zavala S, Bar-low DH. The association between nonsuicidal self-injury and the emotional disorders: A meta-analytic review. Clin Psychol Rev 2015; 37: 72‒88.

8. Sornberger MJ, Heath NL, Toste JR, McLouth R. Nonsuicidal self-injury and gender: patterns of prevalence, methods, and loca-tions among adolescents. Suicide Life Threat Behav 2012; 42(3): 266‒78.

9. Klonsky ED, Victor SE, Saffer BY. Nonsuicidal self-injury: what we know, and what we need to know. Can J Psychiatry 2014; 59(11): 565‒8.

10. Muehlenkamp JJ, Claes L, Havertape L, Plener PL. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health 2012; 6: 10.

11. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Sui-cide and suicidal behavior. Epidemiol Rev 2008; 30(1): 133‒54.

12. Zetterqvist M. The DSM-5 diagnosis of nonsuicidal self-injury disorder: a review of the empirical literature. Child Adolesc Psychiatry Ment Health. 2015; 9: 31.

13. Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev 2007; 27(2): 226‒39.

14. Bresin K, Gordon KH. Changes in negative affect following pain (vs. nonpainful) stimulation in individuals with and without a history of nonsuicidal self-injury. Personal Disord 2013; 4(1): 62‒6.

15. Wolff JC, Thompson E, Thomas SA, Nesi J, Bettis AH, Ransford B, et al. Emotion dysregulation and non-suicidal self-injury: a sys-tematic review and meta-analysis. Eur Psychiatry 2019; 59: 25‒36.

16. Nock MK, Wedig MM, Holmberg EB, Hooley JM. The emotion reactivity scale: development, evaluation, and relation to self-injurious thoughts and behaviors. Behav Ther 2008; 39(2): 107‒16.

17. Kleiman EM, Ammerman BA, Kulper DA, Uyeji LL, Jenkins AL, McCloskey MS. Forms of non-suicidal self-injury as a function of trait aggression. Compr Psychiatry 2015; 59: 21‒7.

18. Mennin DS, Holaway RM, Fresco DM, Moore MT, Heimberg RG. Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behav Ther 2007; 38(3): 284‒302.

19. Achenbach TM, Rescorla LA. Manual for the ASEBA school-age forms & profiles. Burlington: Research Centre for Children, Youth and Families, University of Vermont; 2001.

20. Nock MK, Holmberg EB, Photos VI, Michel BD. Self-injurious thoughts, and behaviours interview: development, reliability, and validity in an adolescent sample. Psychol Assess 2007; 19(3): 309‒17.

21. Cha CB, Augenstein TM, Frost KH, Gallagher K, D'Angelo EJ, Nock MK. Using implicit and explicit measures to predict non-suicidal self-injury among adolescent inpatients. J Am Acad Child Adolesc Psychiatry 2016; 55(1): 62‒8.

22. Lero M, Živanović D, Mitković-Vončina M. Nonsuicidal self-injury among adolescents with disorders of emotion and behavior:

Clinical characteristics and association with suicidality. Med Podml 2019; 70(3): 32‒8.

23. Sevecke K, Bock A, Fenzel L, Gander M, Fuchs M. Nonsuicidal self-injury in a naturalistic sample of adolescents undergoing inpatient psychiatric treatment: prevalence, gender distribution and comorbidities. Psychiatr Danub 2017; 29(4): 522‒8.

24. Kaess M, Parzer P, Mattern M, Plener PL, Bifulco A, Resch F, et al. Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth. Psychiatry Res 2013; 206(2‒3): 265‒72.

25. Victor SE, Muehlenkamp JJ, Hayes NA, Lengel GJ, Styer DM, Washburn JJ. Characterizing gender differences in nonsuicidal self-injury: evidence from a large clinical sample of adolescents and adults. Compr Psychiatry 2018; 82: 53‒60.

26. Whitlock J, Eckenrode J, Silverman D. Self-injurious behaviors in a college population. Pediatrics 2006; 117(6): 1939‒48.

27. Favazza AR. Repetitive Self-Mutilation. Psychiatr Ann 1992; 22(2): 60‒3.

28. Stewart JG, Esposito EC, Glenn CR, Gilman SE, Pridgen B, Gold J, et al. Adolescent self-injurers: comparing non-ideators, suicide idea-tors, and suicide attempters. J Psychiatr Res 2017; 84: 105‒12.

29. Ribeiro JD, Franklin JC, Fox KR, Bentley KH, Kleiman EM, Chang BP, et al. Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a me-ta-analysis of longitudinal studies. Psychol Med 2016; 46(2): 225‒36.

30. Smith GT, Cyders MA. Integrating affect and impulsivity: The role of positive and negative urgency in substance use risk. Drug Alcohol Depend 2016; 163(Suppl 1): S3‒S12.

31. Meszaros G, Horvath LO, Balazs J. Self-injury and externalizing pathology: a systematic literature review. BMC Psychiatry 2017; 17(1): 160.

32. Glenn CR, Blumenthal TD, Klonsky ED, Hajcak G. Emotional re-activity in nonsuicidal self-injury: divergence between self-report and startle measures. Int J Psychophysiol 2011; 80(2): 166‒70.