Impact of the COVID-19 pandemic on students at elevated risk of self-injury: The importance of virtual and online resources

Non-suicidal self-injury (NSSI), which involves deliberate damage to body tissue without suicidal intent, has long been a concern for schools and school staff. Secondary schools are an ideal setting in which to identify, and appropriately refer, students who self-injure as well as implement evidence-based prevention and early intervention programs. However, in the context of the global COVID-19 pandemic, schools have been closed and students sent home to learn online. This may result in the exacerbation of existing anxieties and pose several new stressors that cumulatively may increase risk of NSSI. In this article, we draw on recent research and our collective experience working with schools, as well as digital mental health, to outline some of these potential stressors and offer resources for school staff to help students who are engaging in or at risk of NSSI

Rapid review and meta-meta-analysis of self-guided interventions to address anxiety, depression, and stress during COVID-19 social distancing

We conducted a rapid review and quantitative summary of meta-analyses that have examined interventions which can be used by individuals during quarantine and social distancing to manage anxiety, depression, stress, and subjective well-being. A literature search yielded 34 meta-analyses (total number of studies k = 1,390, n = 145,744) that were summarized. Overall, self-guided interventions showed small to medium effects in comparison to control groups. In particular, self-guided therapeutic approaches (including cognitive-behavioral, mindfulness, and acceptance-based interventions), selected positive psychology interventions, and multi-component and activity-based interventions (music, physical exercise) showed promising evidence for effectiveness. Overall, self-guided interventions on average did not show the same degree of effectiveness as traditional guided individual or group therapies. There was no consistent evidence of dose effects, baseline differences, and differential effectiveness of eHealth interventions. More research on the effectiveness of interventions in diverse cultural settings is needed

Reciprocal risk: The longitudinal relationship between emotion regulation and non-suicidal self-injury

Poor emotion regulation has been highlighted as a potential risk factor for the development and maintenance of Non-Suicidal Self-Injury (NSSI; Fox et al., 2015). However, longitudinal research tracking the relationship between emotion regulation and NSSI during adolescence is limited. In addition, the conceptual argument that NSSI may in turn be a risk factor for poor emotion regulation (Gratz, 2003), remains largely untested. Three studies, all drawn from the Youth Wellbeing Study, were conducted to investigate the developmental relationship between emotion regulation and NSSI during adolescence. Study One established the psychometric properties of the Emotion Regulation Index for Children and Adolescents in a large sample of adolescents and validated the self-report measure for use in Studies Two and Three. Study Two assessed the longitudinal relationship between emotion regulation and NSSI within a cohort of young adolescents across a three year period. Consistent with previous research, poor emotion regulation predicted subsequent engagement in NSSI for both boys and girls, suggesting that poor emotion regulation may be causally implicated in the development of NSSI behaviours. Critically, this relationship was reciprocal; engaging in NSSI also predicted poorer subsequent emotion regulation. Study Three tests the hypothesis that NSSI ‘damages’ emotion regulation by impairing the interpersonal relationships which underlie the development of emotion regulation skills. Using a quasi-longitudinal multiple mediation analysis, the combination of Time Two Parental Attachment and Time Two Peer Attachment were found to fully mediate the relationship between Time One NSSI and Time Three Emotion Regulation, emphasising the primacy of these relationships during adolescence. This research is the first to empirically demonstrate the reciprocal complexity of the relationship between emotion regulation and NSSI, suggesting that the dynamic relationship between these two factors underlies the development of NSSI during adolescence

Emotion in non-suicidal self-injury: A contradiction between global self-reports and real-time responses

People who engage in non-suicidal self-injury (NSSI) report doing so largely to manage overwhelming emotions. Prominent theories of NSSI argue that an amplified emotional response system creates the context in which a person chooses to regulate their emotions by engaging in NSSI. In line with these theories, people who engage in NSSI consistently report greater global emotion reactivity and emotion dysregulation than do controls. These global self-reports of emotional functioning also predict the onset and cessation of NSSI, demonstrating their considerable utility in understanding the behaviour. However, global self-reports provide an overall evaluation of one’s average affective experience and so are ill-suited to isolating precise alterations in emotional responding. I first establish how best to assess NSSI (Study 1a and 1b). I then leverage experimental affective science and individual differences methodologies to test whether NSSI is characterised by a more reactive and intense emotional response to challenge, and/or whether factors that help to create, modify, and later recall the emotional response are altered in those who engage in NSSI compared with controls. Study 2 compared how young adults with a past-year history of NSSI and controls subjectively and physiologically reacted to, and recovered from, acute stress. Study 3 compared how young adults with a past-year history of NSSI and controls subjectively reacted to both explicit and more ambiguous social exclusion. Consistent with a wealth of research, across both Studies 2 and 3 people with a past-year history of NSSI reported considerably greater global emotion reactivity and emotion dysregulation than did controls. However, counter to predictions, both the NSSI and Control groups showed similar patterns of real-time emotional responding to both acute stress (Study 2) and social exclusion (Study 3), providing no evidence that NSSI is characterised by an amplified response to emotional challenge. In addition, we found no evidence that emotional recovery, emotion regulation strategy use, memory of emotional experience, or appraisal—all factors that shape the emotional response—operate differently in those who engage in NSSI. Focusing on how people make global self-reports, exploratory reanalysis of Study 2 and 3 suggests that people with no history of NSSI draw from their real-time experiences of acute (but not mild) emotional challenge when making judgements about their global emotion dysregulation. In contrast, people who engage in NSSI appear to rely on different channels of information when reporting their global emotion dysregulation. Overall, this thesis demonstrates that, despite reporting considerably poorer global emotional functioning, people who engage in NSSI show largely typical responses to real-time emotional challenges. Given that global self-reports of emotional functioning appear to be critical for understanding NSSI onset and cessation, the discrepancy between global self-reports and measures of real-time responding highlights the complexity of the relationship between emotion and NSSI. To advance our understanding of emotional responding in NSSI, research should: a) establish the conditions (if any) under which people who engage in NSSI show amplified emotional responding, and b) isolate the psychological processes that underlie the experience of poorer global emotional functioning reported by people who engage in NSSI.</p

Measurement of Non-Suicidal Self-Injury

Non-suicidal self-injury (NSSI) is typically assessed using single item questionnaires or checklists of common behaviours, but preliminary research suggests that checklists may produce higher prevalence rates. In two pre-registered studies (combined n = 1364), we tested whether greater memory cueing afforded by behavioural checklists, inattentive responding, or individual differences can account for this discrepancy between assessment methods

Open to interpretation? Inconsistent reporting of lifetime non-suicidal self-injury across two common assessments

Non-suicidal self-injury (NSSI) is typically assessed using either single-item questionnaires or checklists of common behaviours, but preliminary research suggests that checklists produce higher lifetime prevalence rates. In two pre-registered studies (combined n = 1364), we tested whether memory cueing afforded by behavioural checklists accounts for this discrepancy. Participants reported their lifetime NSSI history using both a single-item and a checklist, with presentation order randomised across participants. Nearly a third of participants reported inconsistent NSSI histories on the two assessments, with participants 1.57 times more likely to report an NSSI history on a checklist than on a single-item. Counter to the memory account, this discrepancy was evident even when participants completed the checklist first, suggesting that the increased prevalence estimates captured by checklists are unlikely to simply reflect memory facilitation. Across the two samples, 12.5% of participants would have been incorrectly screened out in two-step assessments; these participants were more likely to have engaged in NSSI historically, less likely to self-injure by cutting, and (in Study 2 only) were more likely to be men. These studies suggest that the inconsistencies across two of the most common NSSI assessments arise because people dissimilar to the lay conceptualisation of self-injury are less likely to endorse a single-item, even when they have affirmed engaging in self-injury behaviours on a checklist. We argue that single-item and checklist assessments capture different aspects of NSSI, such that future research should distinguish between behaviourally-identified NSSI assessed with behavioural checklists and self-identified NSSI assessed with single-item assessments

Open to interpretation? Inconsistent reporting of lifetime nonsuicidal self-injury across two common assessments

© 2020 american psychological association. Nonsuicidal self-injury (NSSI) is typically assessed using either single-item questionnaires or checklists of common behaviors, but preliminary research suggests that checklists produce higher lifetime prevalence rates. In 2 preregistered studies (combined n = 1,364), we tested whether memory cueing afforded by behavioral checklists accounts for this discrepancy. Participants reported their lifetime NSSI history using both a single-item and a checklist, with presentation order randomized across participants. Nearly a third of participants reported inconsistent NSSI histories on the 2 assessments, with participants 1.57 times more likely to report an NSSI history on a checklist than on a single-item. Counter to the memory account, this discrepancy was evident even when participants completed the checklist first, suggesting that the increased prevalence estimates captured by checklists are unlikely to simply reflect memory facilitation. Across the 2 samples, 12.5% of participants would have been incorrectly screened out in 2-step assessments; these participants were more likely to have engaged in NSSI historically, less likely to self-injure by cutting, and (in Study 2 only) were more likely to be men. These studies suggest that the inconsistencies across 2 of the most common NSSI assessments arise because people dissimilar to the lay conceptualization of self-injury are less likely to endorse a single-item, even when they have affirmed engaging in self-injury behaviors on a checklist. We argue that single-item and checklist assessments capture different aspects of NSSI, such that future research should distinguish between behaviorally identified NSSI assessed with behavioral checklists and self-identified NSSI assessed with single-item assessments

Nonsuicidal self-injury thoughts and behavioural characteristics: Associations with suicidal thoughts and behaviours among community adolescents

Background: We consider whether nonsuicidal self-injury (NSSI) thoughts – in the absence of any NSSI behaviour – are associated with suicidal thoughts and behaviours among adolescents, before examining whether characteristics of NSSI behaviour are associated with greater suicidal thoughts and behaviours. Methods: Adolescents (n = 2,057, M age =15.56) recruited from secondary schools reported their lifetime history of NSSI, suicidal thoughts and behaviours, NSSI characteristics, and NSSI functions. Receiver Operating Characteristic analysis test whether NSSI status and characteristics of NSSI behaviour are diagnostic of clinically elevated suicidal thoughts and behaviours (a score of 7 or higher on the Suicide Behaviours Questionnaire-Revised). Regression models test whether NSSI functions predict greater suicidality. Results: Adolescents with NSSI thoughts and those with NSSI behaviour were more likely to report lifetime suicidal ideation and past-year suicide plan(s) than adolescents with no history of NSSI. In addition, adolescents with a history of NSSI were more likely to report a lifetime history of suicide attempt(s) as well as past-year suicide attempt(s) than adolescents with no history of NSSI. A greater number of NSSI methods, requiring medical assistance for NSSI injuries, and engaging in NSSI for self-punishment, anti-suicide, and sensation-seeking functions were associated with greater severity of suicidal thoughts and behaviours. Limitations: Data are cross-sectional, limiting inferences about causality. Conclusions: Findings emphasize the importance of NSSI thoughts and characteristics of NSSI behaviour in understanding the complex relationship between NSSI and suicidal thoughts and behaviours among adolescents