Prevalence of Nonsuicidal Self‐Injury in Nonclinical Samples: Systematic Review,Meta‐Analysis and Meta‐Regression

Published prevalence estimates of nonsuicidal self‐injury (NSSI) among nonclinical samples are highly heterogeneous, raising concerns about their reliability and hindering attempts to explore the alleged increase in NSSI over time. Accordingly, the objectives of this study were to investigate the influence of methodological factors on heterogeneity in NSSI prevalence estimates, explore changes over time, and estimate overall international NSSI prevalence. Results showed that methodological factors contributed over half (51.6%) of the heterogeneity in prevalence estimates, and, after adjusting for these factors, NSSI prevalence did not increase over time. Overall, pooled NSSI prevalence was 17.2% among adolescents, 13.4% among young adults, and 5.5% among adults. Clearly, development of standardized methodology in NSSI research is crucial if accurate estimates are desired.     

Trauma‐Related Guilt Mediates the Relationship between Posttraumatic Stress Disorder and Suicidal Ideation in OEF/OIF/OND Veterans

Posttraumatic stress disorder (PTSD) and trauma‐related guilt are risk factors for suicidal ideation (SI) in veterans. Components of trauma‐related guilt were examined as serial mediators of the relationship between PTSD and SI. In a sample of 53 OEF/OIF/OND combat veterans, PTSD had an indirect effect on SI through a serial mediation chain of guilt cognitions, distress, and global guilt, suggesting that trauma‐related guilt via cognitions, distress, and global guilt is a pathway from PTSD to SI. Attention should be given to assessing and addressing trauma‐related guilt in veterans experiencing PTSD to prevent SI.     

Trajectories of Suicide Ideation,Nonsuicidal Self‐Injury,and Suicide Attempts in a Nonclinical Sample of Military Personnel and Veterans

Nonsuicidal self‐injury (NSSI) is a risk factor for suicide attempts, but little is known about NSSI among military personnel and veterans, or about the temporal sequencing of NSSI relative to suicide ideation and attempts. This study evaluates trajectories of suicide ideation, NSSI, and suicide attempts in a sample of 422 military personnel and veterans. Of those with a history of NSSI, 77% also experienced suicide ideation. Suicide ideation emerged before NSSI (67%) more often than the reverse (17%). Of those with a history of suicide attempt, 41% also engaged in NSSI. NSSI emerged prior to the first suicide attempt (91%) more often than the reverse (9%). The length of time from suicide ideation to suicide attempt was longer for those who first engaged in NSSI (median = 3.5 years) compared with those who did not engage in NSSI (median = 0.0 years), Wald χ²(1) = 11.985, p = .002. Age of onset was earlier for participants reporting NSSI only compared with those reporting both NSSI and suicide attempts (16.71 vs. 22.08 years), F(1, 45) = 4.149, p = .048. NSSI may serve as a “stepping stone” from suicide ideation to attempts for 41% of those who attempt suicide.     

Psychosocial and Moral Development of PTSD‐Diagnosed Combat Veterans

Two related studies were conducted in order to investigate whether psychosocial and moral development appeared to have been disrupted and arrested in veterans diagnosed as having posttraumatic stress disorder (PTSD). Study 1 was devoted to developing a measure of late adolescence, early adulthood, and adulthood stages of psychosocial development. In Study 2, a sample of 32 PTSD‐diagnosed and 32 PTSD‐free veterans participated. The PTSD‐diagnosed participants presented evidence of arrested psychosocial and moral development.     

How others respond to non‐suicidal self‐injury disclosure: A systematic review

Non‐suicidal self‐injury (NSSI) is an increasing health concern. Despite the potential benefits of disclosing the behaviour, many decide not to do so because of the fear of negative social reactions. In this review, we examined the existing research on reported and perceived reactions to NSSI disclosure with the aim of identifying how an individual who discloses their NSSI perceives others' responses to this disclosure, with the ultimate goal of understanding how these reactions may impact those who disclose their NSSI. Among the initial 275 studies, 10 fit the inclusion criteria. Three studies reported perceived responses by individuals who had disclosed their NSSI; six studies examined self‐reported responses by others; one study focused on disclosures online. Individuals who disclosed their NSSI often received negative responses, which caused them to withdraw from seeking further help. On the other hand, recipients' reactions to NSSI disclosure varied based on NSSI characteristics such as its perceived cause and/or underlying motivation. Results highlight the importance of providing support rather than searching for the underlying drives of NSSI.     

Cognitive and Emotion‐Regulatory Mediators of the Relationship Between Behavioral Approach System Sensitivity and Nonsuicidal Self‐Injury Frequency

Nonsuicidal self‐injury (NSSI) is highly prevalent among late adolescents and predicts the onset of suicidal ideation and behavior. Although research has established an association between the behavioral approach system (BAS) and NSSI, less research has explored mechanisms underlying this relationship. The authors examined negative and positive emotion regulation patterns, as well as the BAS‐relevant cognitive style of self‐criticism, as potential mechanisms through which a hypersensitive BAS might be related to NSSI frequency. Late adolescents (N = 177) with high and moderate BAS levels completed measures of self‐criticism, positive emotion regulation, brooding, and both lifetime and last‐year frequency of NSSI. Results indicated that self‐criticism and positive emotion dampening independently mediated the relationship between BAS and last‐year frequency of NSSI. Self‐criticism also mediated the relationship between BAS and lifetime frequency of NSSI. Results suggest that cognitive and emotion‐regulatory styles may help to explain why high BAS individuals are likely to engage in NSSI.     

Lifetime and 12‐Month Nonsuicidal Self‐Injury and Academic Performance in College Freshmen

We examined whether nonsuicidal self‐injury (NSSI) is associated with academic performance in college freshmen, using census‐based web surveys (N = 7,527; response = 65.4%). NSSI was assessed with items from the Self‐Injurious Thoughts and Behaviors Interview and subsequently linked with the administratively recorded academic year percentage (AYP). Freshmen with lifetime and 12‐month NSSI showed a reduction in AYP of 3.4% and 5.9%, respectively. The college environment was found to moderate the effect of 12‐month NSSI, with more strongly reduced AYPs in departments with higher‐than‐average mean departmental AYPs. The findings suggest that overall stress and test anxiety are underlying processes between NSSI membership and academic performance.     

Risk‐Related and Protective Correlates of Nonsuicidal Self‐Injury and Co‐Occurring Suicide Attempts among Incarcerated Women

Individual and environmental correlates of nonsuicidal self‐injury (NSSI) and co‐occurring suicide attempts (SA) among incarcerated women (N = 104) were examined. Participants completed measures of putative risk and protective factors, including coping styles, childhood maltreatment, and hopelessness. Results indicated that active coping was uniquely, negatively associated with the presence and frequency of NSSI, whereas avoidant coping and childhood physical/emotional abuse were positively associated with NSSI frequency. Conversely, among women with a history of NSSI, hopelessness was uniquely, positively associated with the presence and frequency of SA. Further, childhood sexual abuse was associated with the presence of SA, while physical/emotional abuse was associated with SA frequency. Hopelessness was more strongly related to SA frequency than NSSI frequency. These findings help disentangle the unique risk and protective factors for NSSI and co‐occurring SA in incarcerated samples.     

Nonsuicidal Self‐Injury,Stress, and Self‐Differentiation

The authors surveyed 458 young adults and examined the relationships among stress, self‐differentiation, and nonsuicidal self‐injury (NSSI). They conducted multiple regression analyses to explore whether characteristics of self‐differentiation (i.e., emotional reactivity and “I position”) were related to NSSI after controlling for the effects of stress, as well as whether emotional reactivity and I position served as mediators in the stress–NSSI relationship. I position and emotional reactivity both contributed statistically significant variance to NSSI after accounting for stress. Moreover, both I position and emotional reactivity served as partial mediators in the stress–NSSI relationship. The authors discuss counseling and research implications.     

In Eating‐Disordered Inpatient Adolescents,Self‐Criticism Predicts Nonsuicidal Self‐Injury

We examined the role of depressive traits—self‐criticism and dependency—in nonsuicidal self‐injury (NSSI) and suicidal ideation among inpatient adolescents with eating disorders. In two studies (N = 103 and 55), inpatients were assessed for depressive traits, suicidal ideations, and NSSI. In Study 2, motivation for carrying out NSSI was also assessed. In both studies, depression predicted suicidal ideation and self‐criticism predicted NSSI. In Study 2, depression and suicidal ideation also predicted NSSI. The automatic positive motivation for NSSI was predicted by dependency and depressive symptoms, and by a two‐way interaction between self‐criticism and dependency. Consistent with the “self‐punishment model,” self‐criticism appears to constitute a dimension of vulnerability for NSSI.     

Motivations for Self‐Injury,Affect, and Impulsivity: A Comparison of Individuals with Current Self‐Injury to Individuals with a History of Self‐Injury

Individuals who report nonsuicidal self‐injury (NSSI) are characterized by the tendency to act rashly while experiencing distress (negative urgency), the tendency to act without thinking, and endorsement of both social and affect regulation motives for the behavior. However, very little research has identified characteristics that distinguish current self‐injurers from those with a history of the behavior. The purpose of this study was to compare individuals with current self‐injury to a history of self‐injury on impulsivity‐related personality traits, motives for self‐injury, and distress. Among a sample of 429 undergraduates, 120 reported self‐injury. Among these 120 individuals, 33 endorsed self‐injury within the past month, with a mean frequency of 4.77 acts of NSSI. Within the self‐injury group, current self‐injurers reported higher endorsement of affect regulation motives for NSSI, and higher levels of current negative affect than individuals with a history of self‐injury. There were no differences between current and former self‐injurers on measures of impulsivity, endorsement of social motives for NSSI, or positive affect. We propose that individuals who use NSSI to regulate negative affect may be more likely to repeatedly engage in this behavior over time.     

Nonsuicidal self‐injury across cultures and ethnic and racial minorities: A review

The field of nonsuicidal self‐injury (NSSI) is dominated by research conducted with Caucasian‐majority samples in Western countries such as United States, Canada, Australia and European countries. This article critically reviewed the empirical research on NSSI in non‐Western countries and among ethnic/racial minority individuals who live in the West to give voice to and understand the patterns of NSSI among individuals who do not fall within the dominant Caucasian majority. The study found both similarities and differences between Western and non‐Western data in terms of characteristics and functions of NSSI. Differences in gender patterns in regards to prevalence of NSSI and methods used as well as presence of a more relational functionality of NSSI rather than emotion regulation functionality were two points of divergence in the findings of these studies. In addition, the findings seem to indicate that the role of ethnicity/race is mediated by important factors such as socioeconomic status (SES) and gender. Existing gaps in the literature and suggestions for further research are discussed.     

A Systematic Review: Non‐Suicidal Self‐injury in Australia and New Zealand's Indigenous Populations

Objective

To undertake a systematic review of non‐suicidal self‐injury (NSSI) prevalence, patterns, functions, and behavioural correlates for the Indigenous populations of Australia (Aboriginal and Torres Strait Islanders) and New Zealand (NZ; Maori).

Method

We searched the following electronic databases: PubMed, MedLine, Scopus, Web of Science, ScienceDirect, PsycInfo, and PsycArticles, CINAHL, and the Informit Health and Indigenous Peoples collections. Studies were included for review if they were published within the last 25 years and reported on NSSI in Australia and NZ's Indigenous populations.

Results

Seven studies were included, six of which came from Australia. The prevalence of NSSI in Australia ranged from 0.9% up to 22.50%; statistics varied by the different samples, types of prevalence, and relationship to alcohol. Several studies found that Aboriginal and Torres Strait Islander peoples had higher rates of NSSI than other Australians, but that this was not significantly higher. Two studies indicated that NSSI was linked to alcohol use, incarceration, and a younger age. The one NZ study was of injury and not specifically NSSI.

Conclusions

Findings are limited due to a small pool of literature. Cultural variations in NSSI presentation should be considered when working with Indigenous populations. Further research is required to help determine what cultural variations may exist.     

Social Identity,Groups, and Post‐Traumatic Stress Disorder

As with the identification and labelling of many mental health problems, the adoption of PTSD within DSM can be said to arise from contemporaneous social and political contexts: specifically the return to the United States of many war‐affected veterans from Vietnam ( Scott, 1993 ). The specific circumstances of the recognition of PTSD within DSM‐III have led several commentators to discuss it in terms of social construction (e.g., Summerfield, 2001 ). The current review argues that the orientation of theory and research aimed at understanding PTSD has been particularly informed by Western individualistic constructions of social phenomena. Our review calls for a blending of approaches to understanding post‐traumatic stress by considering the social structures and contexts in which it is expressed and in particular by considering how a group‐level analysis can inform incidence, diagnosis, and expression of post‐traumatic symptoms.     

An Examination of Disclosure of Nonsuicidal Self‐injury among University Students

Despite the widespread prevalence of nonsuicidal self‐injury (NSSI) among community‐based samples, little is known about which self‐injurers disclose their NSSI or the factors that promote disclosure among self‐injurers. To address this gap in the literature, we examined whether disclosers could be differentiated from nondisclosers on the basis of NSSI characteristics (e.g. frequency of NSSI and severity of NSSI), NSSI motivations (e.g. interpersonal and intrapersonal motivations) and psychosocial factors (e.g. suicidal ideation and self‐esteem). Participants consisted of a large sample of 268 self‐injuring undergraduate students (M_age = 19.07 years, 70.3% women) at a Canadian university. Results indicated that 57% of self‐injurers had never disclosed their NSSI to anyone. Self‐injurers were most likely to disclose to peers and romantic partners. Logistic regression analyses revealed that pain during NSSI, severity of NSSI, interpersonal motivations for engaging in NSSI, higher suicidal ideation and higher friendship quality were all associated with a greater likelihood of NSSI disclosure. Our findings suggest that individuals with severe NSSI and suicidal ideation may be more likely to disclose. Moreover, our findings underscore the importance of equipping friends and romantic partners with effective responses to NSSI disclosures to promote more formal help‐seeking behaviours among self‐injurers. Copyright © 2014 John Wiley & Sons, Ltd.     

Functions of Nonsuicidal Self‐Injury Are Differentially Associated with Suicide Ideation and Past Attempts among Childhood Trauma Survivors

Research into factors for suicide has revealed relations between trauma exposure and suicidality (e.g., Bridge, Goldstein, & Brent, 2006 ; Joiner, Sachs‐Ericson, Wingate, Brown, Anestis, & Selby, 2007 ) wherein painful and provocative experiences (e.g., nonsuicidal self‐injury [NSSI]) are an important link (e.g., Van Orden, Witte, Cukrowicz, Braithwaite, Selby, & Joiner, 2010 ; Smith, 2013 ). No prior research has assessed the relationship between functions of NSSI and suicidality among childhood trauma survivors. Participants who endorsed childhood trauma exposure (N = 121; M_age = 18.69, range 18–22) completed measures of posttraumatic stress disorder (PTSD) symptoms, NSSI, and suicidality. Multiple regressions assessing whether the four functions of NSSI predicted suicide ideation and past attempts after controlling for PTSD symptom severity found that only social negative reinforcement was associated with SI ( = .304, SE = .243, t = 2.23, p = .028), while only automatic negative reinforcement was associated with past attempts ( = .470, SE = .066, t = 2.25, p = .028). Findings highlight the importance of assessing NSSI functions when assessing suicidality among trauma survivors.     

Nonsuicidal Self‐Injury in College Students: The Role of Perfectionism and Rumination

A paucity of research exists examining personality and cognitive characteristics that may contribute to nonsuicidal self‐injury (NSSI). The purpose of the current study was to clarify the contribution of perfectionism and rumination, along with depression and anxiety, to NSSI within a sample of 170 college students. Group comparisons revealed that participants with a history of NSSI endorsed significantly more rumination and depressive and anxious symptoms then non‐NSSI controls. Results regarding perfectionism were mixed, with NSSI participants differing from controls on select aspects of perfectionism. Results suggest higher levels of depression and anxiety and a ruminative cognitive style may increase vulnerability for NSSI; however, further research is needed to clarify the contribution of perfectionism.     

Depression Mediates the Relationship Between Distress Tolerance and Nonsuicidal Self‐Injury Among Adolescents: One‐Year Follow‐Up

Through a one‐year follow‐up design, this study examined whether distress tolerance would increase the risk for nonsuicidal self‐injury (NSSI), mediated through depression in a representative sample of adolescents. Participants (N  = 2,170) were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling in time 1 (T1), and 1,832 students were followed‐up one year later (T2). Structure equation modeling results revealed that after controlling NSSI measured at T1, NSSI (T2) was significantly predicted by distress tolerance (T1) and fully mediated through depression (T2). The mediating role of depression in the relationship between distress tolerance and NSSI are discussed.     

Forgetting Trauma: Socially Shared Retrieval‐induced Forgetting and Post‐traumatic Stress Disorder

Memory for related but unpracticed aspects of an event can be impaired by selectively retrieving parts of the same event. This occurs when selective retrieval [within‐individual retrieval‐induced forgetting (WI‐RIF)] is undertaken by individuals and has been extended to social contexts—RIF can be produced in listeners [socially shared retrieval‐induced forgetting (SS‐RIF)] by a speaker's selective recounting. The effects of post‐traumatic stress disorder (PTSD) on WI‐RIF and SS‐RIF were examined by two experiments. In Experiment 1, combat veterans (with or without PTSD) and non‐veteran dyads participated in a RIF paired‐associates paradigm adapted for combat‐related stimuli. WI‐RIF and SS‐RIF occurred for combat‐related and neutral pairs regardless of group. However, greater WI‐RIF and SS‐RIF for combat‐related words were shown by individuals with PTSD. These findings were replicated by Experiment 2, in which either a combat‐related or neutral story was learned by participants, and selective retrieval was embedded in a conversation. That the selective retrieval of trauma‐related stimuli leads to enhancement of induced forgetting for individuals with PTSD under certain conditions is suggested by these data. Copyright © 2011 John Wiley & Sons, Ltd.     

Predicting Persistence of Nonsuicidal Self‐Injury in Suicidal Adolescents

Prospective predictors of persistent nonsuicidal self‐injury (NSSI) were examined in adolescents admitted to an inpatient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months. Seventy‐one (77%) participants reported NSSI at baseline, and 40 (56%) persisted at the 6 month follow‐up. Those who endorsed automatic positive reinforcement (APR) as the predominant reason for NSSI were more likely to persist in NSSI. Depression over follow‐up, but not at baseline, also predicted persistence. These results suggest that helping high‐risk adolescents to identify alternative ways of generating emotion(s) to counter the effects of APR that may accompany NSSI should be a high priority treatment target.