Adolescents; Nonsuicidal self-injury; Observational study; Risk factors; Self-harm; fMRI; Pediatrics, Perinatology and Child Health; Psychiatry and Mental Health
Abstract :
[en] BACKGROUND: Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents and young adults worldwide. It is linked to a broad variety of mental disorders and an increased suicide risk. Despite its high prevalence, research on the underlying mechanisms and on potential risk and resilience factors for maintaining or quitting NSSI remains scarce. This manuscript presents an overview of the "Self-injury: Treatment-Assessment-Recovery" (STAR) collaboration, which aimed to address these gaps.
METHODS: We investigated the natural course of NSSI as well as its social, psychological, and neurobiological predictors (observational study; OS). OS data collection occurred at four timepoints (baseline [T0], 4 [post, T1], 12 [follow-up (FU), T2], and 18 [FU, T3] months after baseline) for the NSSI group, which was compared to a healthy control (HC) group at T0 only. Online self-report was used at all timepoints, while semi-structured interviews (face-to-face (f2f)) were conducted at T0 and T3. At T0 only, we conducted ecological momentary assessment and neurobiological investigations. Here, we present the general methodology and sample characteristics of the completed OS including the f2f subprojects, while other subprojects are not within the scope of this paper.
SAMPLE DESCRIPTION: The OS sample consists of 343 participants at T0 (180 NSSI, 163 HC). Mean age in the NSSI group (T0) was 18.1 years (SD = 2.09, range: 15-25), gender-related data is available for 166: 156 = female, 7 = male, 3 = transgender, 10 = not disclosed). In the HC group, mean age (T0) was 19.1 years (SD = 2.35, range: 15-25) (142 = female, 21 = male). At T1, 128 (71.11%) of the NSSI participants completed the questionnaires, at T2 125 (69.44%) and at T3 104 (57.78%). In the fMRI subproject, 126 adolescents participated (NSSI = 66, HC = 60, 100% female; mean age (T0): NSSI = 18.10 years, SD = 2.21; HC = 19.08, SD = 2.36).
CONCLUSION: Understanding predictors is of utmost importance for adequate diagnosis and intervention for NSSI. Our OS applied a multimodal investigation of social, psychological, and neurobiological parameters and is the largest sample of adolescents with NSSI to date including follow-up assessments. As health care providers require specific knowledge to develop new treatments, we believe that our in-depth assessments can potentially enhance care for youths engaging in NSSI.
Disciplines :
Treatment & clinical psychology
Author, co-author :
Spohrs, Jennifer; Department for Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Centre, Ulm, Germany. jennifer.spohrs@uni-ulm.de ; Department of Psychiatry, Psychotherapy and Psychotraumatology Military Medical Centre, Ulm, Germany. jennifer.spohrs@uni-ulm.de
Michelsen, Anna; Department for Child and Adolescent Psychiatry and Psychotherapy, Rostock University Medical Centre, Rostock, Germany
Abler, Birgit; Department of Psychiatry and Psychotherapy III, Ulm University Medical Centre, Ulm, Germany
Chioccheti, Andreas G; Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, Goethe University Frankfurt, Frankfurt am Main, Germany
Ebner Priemer, Ulrich W; Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany ; Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany ; German Center for Mental Health (DZPG), Partner Site Mannheim, Mannheim, Germany
Fegert, Jörg M; Department for Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Centre, Ulm, Germany
Höper, Saskia; Department for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
In-Albon, Tina; Department of Social Sciences, University of Mannheim, Mannheim, Germany
Kaess, Michael; Department for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany ; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
Koelch, Michael; Department for Child and Adolescent Psychiatry and Psychotherapy, Rostock University Medical Centre, Rostock, Germany ; German Center for Child and Adolescent Health (DZKJ), Partner Site Greifswald-Rostock, Rostock, Germany
Koenig, Elisa; Department for Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Centre, Ulm, Germany
Koenig, Julian; Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
Kraus, Laura; Department of Social Sciences, University of Mannheim, Mannheim, Germany
Nickel, Sandra; Department for Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Centre, Ulm, Germany
SANTANGELO, Philip ; University of Luxembourg > Faculty of Humanities, Education and Social Sciences (FHSE) > Department of Behavioural and Cognitive Sciences (DBCS) > Health and Behaviour
Schmahl, Christian; German Center for Mental Health (DZPG), Partner Site Mannheim, Mannheim, Germany ; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Mannheim University, Mannheim, Germany
Sicorello, Maurizio; German Center for Mental Health (DZPG), Partner Site Mannheim, Mannheim, Germany ; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Mannheim University, Mannheim, Germany
van der Venne, Patrice; Department for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
Plener, Paul L; Department for Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Centre, Ulm, Germany ; Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
BMBF - Bundesministerium für Bildung und Forschung
Funding text :
Acknowledgements: We would like to thank the cooperative effort of the entire STAR consortium: Paul L. Plener, Jennifer Spohrs, Birgit Abler, Sandra Nickel, Elisa Sittenberger, Lisa Schischke, Alina Gepr\u00E4gs, Isabell Liebhart, Andreas Witt, Cedric Sachser, Rebecca Brown, Vera M\u00FCnch, Elisa K\u00F6nig, J\u00F6rg Fegert, Ulrike Hoffmann (Ulm University Hospital); Christian Schmahl, Inga Niedtfeld, Maurizio Sicorello, Jenny Z\u00E4hringer (Central Institute of Mental Health in Mannheim); Tina In-Albon, Laura Kraus, Hasan-H\u00FCseyin Isik, Sira Schug (University of Kaiserslautern-Landau, Landau); Michael Koelch, Olaf Reis, Anna Michelsen (Rostock University Hospital); Andreas G. Chiocchetti, Silvia Lindlar, Regina Waltes (Frankfurt University Hospital); Michael Kaess, Julian Koenig, Markus M\u00F6ssner, Patrice van der Venne, Saskia H\u00F6per, Elisa Flach, Alexandra Edinger, Stephanie Bauer, Margarete Mattern, Sabine Herpertz (Heidelberg University Hospital); Ulrich W. Ebner Priemer, Philip S. Santangelo (Karlsruhe Institute of Technology), as well as all the participants.Open Access funding enabled and organized by Projekt DEAL. The STAR project is fully funded by the German Federal Ministry of Education and Research (BMBF) 01GL1747A, 01GL1747B, 01GL1747C, 01GL1747D, 01GL1747E, 01GL1747F.
American Psychiatric Association Diagnostic and statistical manual of mental disorders, fifth edition 2013 Arlington American Psychiatric Association 10.1176/appi.books.9780890425596
D. Gillies M.A. Christou A.C. Dixon O.J. Featherston I. Rapti A. Garcia-Anguita et al. Prevalence and characteristics of self-harm in adolescents: meta-analyses of community-based studies 1990–2015 J Am Acad Child Adolesc Psychiatry 2018 57 10 733 41 30274648 10.1016/j.jaac.2018.06.018
R. Brunner M. Kaess P. Parzer G. Fischer V. Carli C.W. Hoven et al. Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: a comparative study of findings in 11 European countries J Child Psychol Psychiatry 2014 55 4 337 48 24215434 10.1111/jcpp.12166
P.L. Plener G. Libal F. Keller J.M. Fegert J.J. Muehlenkamp An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA Psychol Med 2009 39 9 1549 58 1:STN:280:DC%2BD1Mrjtlajuw%3D%3D 19171079 10.1017/S0033291708005114
M. Zetterqvist L.G. Lundh Ö. Dahlström C.G. Svedin Prevalence and function of non-suicidal self-injury (NSSI) in a community sample of adolescents, using suggested DSM-5 criteria for a potential NSSI disorder J Abnorm Child Psychol 2013 41 5 759 73 23344701 10.1007/s10802-013-9712-5
P.L. Plener J.M. Fegert Non-suicidal self-injury: state of the art perspective of a proposed new syndrome for DSM V Child Adolesc Psychiatry Ment Health 2012 6 1 9 22463601 3350395 10.1186/1753-2000-6-9
P.L. Plener T.S. Schumacher L.M. Munz R.C. Groschwitz The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature Borderline Pers Disord Emot Dysregul 2015 2 1 2 10.1186/s40479-014-0024-3
O. Nakar R. Brunner O. Schilling A. Chanen G. Fischer P. Parzer et al. Developmental trajectories of self-injurious behavior, suicidal behavior and substance misuse and their association with adolescent borderline personality pathology J Affect Disord 2016 197 231 8 26995466 10.1016/j.jad.2016.03.029
T. In-Albon C. Ruf M. Schmid Proposed diagnostic criteria for the DSM-5 of nonsuicidal self-injury in female adolescents: diagnostic and clinical correlates Psychiatry J 2013 2013 1 12 10.1155/2013/159208
D. Ghinea A. Edinger P. Parzer J. Koenig F. Resch M. Kaess Non-suicidal self-injury disorder as a stand-alone diagnosis in a consecutive help-seeking sample of adolescents J Affect Disord 2020 274 1122 5 32663940 10.1016/j.jad.2020.06.009
P. Castellví E. Lucas-Romero A. Miranda-Mendizábal O. Parés-Badell J. Almenara I. Alonso et al. Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: a systematic review with meta-analysis J Affect Disord 2017 215 37 48 28315579 10.1016/j.jad.2017.03.035
J. Koenig R. Brunner G. Fischer-Waldschmidt P. Parzer P.L. Plener J. Park et al. Prospective risk for suicidal thoughts and behaviour in adolescents with onset, maintenance or cessation of direct self-injurious behaviour Eur Child Adolesc Psychiatry 2017 26 3 345 54 27558490 10.1007/s00787-016-0896-4
M.K. Nock M.J. Prinstein Contextual features and behavioral functions of self-mutilation among adolescents J Abnorm Psychol 2005 114 1 140 6 15709820 10.1037/0021-843X.114.1.140
P.J. Taylor K. Jomar K. Dhingra R. Forrester U. Shahmalak J.M. Dickson A meta-analysis of the prevalence of different functions of non-suicidal self-injury J Affect Disord 2018 227 759 69 29689691 10.1016/j.jad.2017.11.073
M. Kaess J.M. Hooley B. Klimes-Dougan J. Koenig P.L. Plener C. Reichl et al. Advancing a temporal framework for understanding the biology of nonsuicidal self- injury: an expert review Neurosci Biobehav Rev 2021 130 228 39 34450182 10.1016/j.neubiorev.2021.08.022
J. Koenig J. Klier P. Parzer P. Santangelo F. Resch U. Ebner-Priemer et al. High-frequency ecological momentary assessment of emotional and interpersonal states preceding and following self-injury in female adolescents Eur Child Adolesc Psychiatry 2021 30 8 1299 308 32862250 10.1007/s00787-020-01626-0
J. Koenig L. Rinnewitz M. Warth T.K. Hillecke R. Brunner F. Resch et al. Psychobiological response to pain in female adolescents with nonsuicidal self-injury J Psychiatry Neurosci 2017 42 3 189 99 28234208 10.1503/jpn.160074
P.L. Plener N. Bubalo A.K. Fladung A.G. Ludolph D. Lulé Prone to excitement: adolescent females with non-suicidal self-injury (NSSI) show altered cortical pattern to emotional and NSS-related material Psychiatry Res Neuroimaging 2012 203 2–3 146 52 10.1016/j.pscychresns.2011.12.012
C. Schmahl W. Greffrath U. Baumgärtner T. Schlereth W. Magerl A. Philipsen et al. Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behavior: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings Pain 2004 110 1 470 9 15275800 10.1016/j.pain.2004.04.035
A.E. Russell G. Hemani H.J. Jones T. Ford D. Gunnell J. Heron et al. An exploration of the genetic epidemiology of non-suicidal self-harm and suicide attempt BMC Psychiatry 2021 21 1 207 1:CAS:528:DC%2BB3MXhtFehsrzP 33892675 10.1186/s12888-021-03216-z
M.K. Nock J.M. Park C.T. Finn T.L. Deliberto H.J. Dour M.R. Banaji Measuring the suicidal mind Psychol Sci 2010 21 4 511 7 20424092 10.1177/0956797610364762
R.C. Brown T. Fischer A.D. Goldwich F. Keller R. Young P.L. Plener #cutting: non-suicidal self-injury (NSSI) on Instagram Psychol Med 2018 48 2 337 46 1:STN:280:DC%2BC1cjntlanug%3D%3D 28705261 10.1017/S0033291717001751
J. Hepp R.W. Carpenter L.M. Störkel S.E. Schmitz C. Schmahl I. Niedtfeld A systematic review of daily life studies on non-suicidal self-injury based on the four-function model Clin Psychol Rev 2020 82 101888 32949907 10.1016/j.cpr.2020.101888
Whitlock J, Purington A, Gershkovich M. Media, the internet, and nonsuicidal self-injury. In: Understanding nonsuicidal self-injury: origins, assessment, and treatment. Washington: American Psychological Association; pp. 139–55.
R. Young N. Sproeber R.C. Groschwitz M. Preiss P.L. Plener Why alternative teenagers self-harm: exploring the link between non-suicidal self-injury, attempted suicide and adolescent identity BMC Psychiatry 2014 14 1 137 24885081 10.1186/1471-244X-14-137
T. Tschan S. Pfeiffer R. Gutzweiler T. In-Albon A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury Child Adolesc Psychiatry Ment Health 2022 16 1 64 35941688 10.1186/s13034-022-00500-y
N. Heath J. Toste T. Nedecheva A. Charlebois An examination of Nonsuicidal Self-Injury among College Students J Ment Health Couns 2008 30 2 137 56 10.17744/mehc.30.2.8p879p3443514678
Kraus L, Schmid M, In-Albon T. Anti-suicide function of Nonsuicidal Self-Injury in Female Inpatient adolescents. Front Psychiatry. 2020;11.
J. Whitlock K.L. Knox The Relationship between Self-injurious behavior and suicide in a Young Adult Population Arch Pediatr Adolesc Med 2007 161 7 634 17606825 10.1001/archpedi.161.7.634
J. Bell Harmful or helpful? The role of the internet in self-harming and suicidal behaviour in young people Mental Health Rev J 2014 19 1 61 71 10.1108/MHRJ-05-2013-0019
M.P. Dyson L. Hartling J. Shulhan A. Chisholm A. Milne P. Sundar et al. A systematic review of Social Media Use to discuss and View Deliberate Self-Harm acts PLoS ONE 2016 11 5 e0155813 27191728 4871432 10.1371/journal.pone.0155813
E. Berger P. Hasking G. Martin Adolescents’ perspectives of Youth Non-suicidal Self-Injury Prevention Youth Soc 2017 49 1 3 22 10.1177/0044118X13520561
Koenig E, Hoffmann U, Fegert JM, Keller F, Sicorello M, Spohrs J et al. Training approaches for the dissemination of clinical guidelines for NSSI: a quasi-experimental trial. Child Adolesc Psychiatry Ment Health. 2024;18(1):99. http://www.ncbi.nlm.nih.gov/pubmed/39127743
M. Kaess J. Koenig S. Bauer M. Moessner G. Fischer-Waldschmidt M. Mattern et al. Self-injury: treatment, Assessment, Recovery (STAR): online intervention for adolescent non-suicidal self-injury - study protocol for a randomized controlled trial Trials 2019 20 1 425 31300065 6626324 10.1186/s13063-019-3501-6
S. Schneider V. Pflug In T. Albon J. Margraf Kinder-DIPS Open Access: diagnostisches interview bei psychischen Stö- rungen Im Kindes- Und Jugendalter 2017 Bochum Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
M. Zanarini Zanarini rating scale for borderline personality disorder (ZAN-BPD)- a continuous measure of DSM-IV borderline psychopathology J Pers Disord 2003 17 3 233 42 12839102 10.1521/pedi.17.3.233.22147
A.B. Magaña M.J. Goldstein M. Karno D.J. Miklowitz J. Jenkins I.R.H. Falloon A brief method for assessing expressed emotion in relatives of psychiatric patients Psychiatry Res 1986 17 3 203 12 3704028 10.1016/0165-1781(86)90049-1
U. Ravens-Sieberer M. Erhart L. Rajmil M. Herdman P. Auquier J. Bruil et al. Reliability, construct and criterion validity of the KIDSCREEN-10 score: a short measure for children and adolescents’ well-being and health-related quality of life Qual Life Res 2010 19 10 1487 500 20668950 2977059 10.1007/s11136-010-9706-5
J.G. Johnson E.S. Harris R.L. Spitzer J.B.W. Williams The patient health questionnaire for adolescents J Adolesc Health 2002 30 3 196 204 11869927 10.1016/S1054-139X(01)00333-0
T. In-Albon I. Niedtfeld M. Kaess NSSI severity questionnaire (NSSV-SG) 2017 Landau University of Koblenz-Landau
E.S. Paykel J.K. Myers J.J. Lindenthal J. Tanner Suicidal feelings in the general population: a prevalence study Br J Psychiatry 1974 124 582 460 9 1:STN:280:DyaE2c3mtFagsQ%3D%3D 4836376 10.1192/bjp.124.5.460
P. Moran M. Leese T. Lee P. Walters G. Thornicroft A. Mann Standardised assessment of personality– abbreviated scale (SAPAS): preliminary validation of a brief screen for personality disorder Br J Psychiatry 2003 183 3 228 32 12948996 10.1192/bjp.183.3.228
S.E. Victor E.D. Klonsky Validation of a brief version of the difficulties in emotion regulation scale (DERS-18) in five samples J Psychopathol Behav Assess 2016 38 4 582 9 10.1007/s10862-016-9547-9
H. Klasen W. Woerner A. Rothenberger R. Goodman German version of the strength and difficulties questionnaire (SDQ-German): overview and evaluation of initial validation and normative results Prax Kinderpsychol Kinderpsychiatr 2003 52 7 491 502 14526759
Schwarzer R. Skala zur Allgemeinen Selbstwirksamkeitserwartung [Internet]. 1999. https://www.researchgate.net/publication/238580838
M. Bohus N. Kleindienst M.F. Limberger R.D. Stieglitz M. Domsalla A.L. Chapman et al. The short version of the borderline symptom list (BSL-23): development and initial data on psychometric properties Psychopathology 2009 42 1 32 9 19023232 10.1159/000173701
A.G. Greenwald B.A. Nosek M.R. Banaji Understanding and using the implicit association test: I. An improved scoring algorithm J Pers Soc Psychol 2003 85 2 197 216 12916565 10.1037/0022-3514.85.2.197
D.P. Bernstein J.A. Stein M.D. Newcomb E. Walker D. Pogge T. Ahluvalia et al. Development and validation of a brief screening version of the childhood trauma questionnaire Child Abuse Negl 2003 27 2 169 90 12615092 10.1016/S0145-2134(02)00541-0
L.R. Derogatis N. Melisaratos The brief symptom inventory: an introductory report Psychol Med 1983 13 3 595 605 1:STN:280:DyaL2c%2Fhs1CnsQ%3D%3D 6622612 10.1017/S0033291700048017
G.H. Franke S. Jaeger H. Glaesmer C. Barkmann K. Petrowski E. Braehler Psychometric analysis of the brief symptom inventory 18 (BSI-18) in a representative German sample BMC Med Res Methodol 2017 17 1 14 28125960 10.1186/s12874-016-0283-3
A. Yousaf R. Waltes D. Haslinger S.M. Klauck E. Duketis M. Sachse et al. Quantitative genome-wide association study of six phenotypic subdomains identifies novel genome-wide significant variants in autism spectrum disorder Transl Psychiatry 2020 10 1 215 1:CAS:528:DC%2BB3cXhtlCqsbbE 32624584 10.1038/s41398-020-00906-2
M.A. Emon A. Heinson P. Wu D. Domingo-Fernández M. Sood H. Vrooman et al. Clustering of Alzheimer’s and Parkinson’s disease based on genetic burden of shared molecular mechanisms Sci Rep 2020 10 1 19097 1:CAS:528:DC%2BB3cXit12hs7rP 33154531 10.1038/s41598-020-76200-4
F. Willis S. Kuniss N. Kleindienst J. Naoum S. Reitz S. Boll et al. The role of nociceptive input and tissue injury on stress regulation in borderline personality disorder Pain 2017 158 3 479 87 27941497 10.1097/j.pain.0000000000000787
LANG JP. International affective picture system (IAPS): digitized photographs, instruction manual and affective ratings. Technical Report [Internet]. 2005 [cited 2022 Mar 9]; http://ci.nii.ac.jp/naid/10016894148/en/
K.D. Williams C.K.T. Cheung W. Choi Cyberostracism: effects of being ignored over the internet J Pers Soc Psychol 2000 79 5 748 62 1:STN:280:DC%2BD3M7islKktg%3D%3D 11079239 10.1037/0022-3514.79.5.748
D.J. Buysse C.F. Reynolds T.H. Monk S.R. Berman D.J. Kupfer The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research Psychiatry Res 1989 28 2 193 213 1:STN:280:DyaL1Mzhs1Wmsg%3D%3D 2748771 10.1016/0165-1781(89)90047-4
P. Wilhelm D. Schoebi Assessing mood in daily life Eur J Psychol Assess 2007 23 4 258 67 10.1027/1015-5759.23.4.258
C. Stiglmayr C. Schmahl J.D. Bremner M. Bohus U. Ebner-Priemer Development and psychometric characteristics of the DSS-4 as a short instrument to assess dissociative experience during neuropsychological experiments Psychopathology 2009 42 6 370 4 19752590 10.1159/000236908
Rosenberg M. Society and the adolescent self-image. Princeton University Press; 1965.
D.J. Powell W. Schlotz Daily life stress and the cortisol awakening response: testing the anticipation hypothesis PLoS ONE 2012 7 12 e52067 1:CAS:528:DC%2BC3sXlsVCquw%3D%3D 23284871 10.1371/journal.pone.0052067
B.C. Schouten L. Meeuwesen Cultural differences in medical communication: a review of the literature Patient Educ Couns 2006 64 1–3 21 34 16427760 10.1016/j.pec.2005.11.014
J. Hughson Janne R. Woodward-Kron A. Parker J. Hajek A. Bresin U. Knoch et al. A review of approaches to improve participation of culturally and linguistically diverse populations in clinical trials Trials 2016 17 1 263 27229153 10.1186/s13063-016-1384-3
