Social factors associated with non-suicidal self-injury (NSSI),Child and Adolescent Psychiatry and Mental Health

当前位置： X-MOL 学术 › Child Adolesc. Psychiatry Ment. Health › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Social factors associated with non-suicidal self-injury (NSSI)
Child and Adolescent Psychiatry and Mental Health ( IF 5.6 ) Pub Date : 2019-06-12 , DOI: 10.1186/s13034-019-0284-1
Rebecca C. Brown , Andreas Witt

Non-suicidal self-injury (NSSI) is highly prevalent among adolescents and young adults. Besides (neuro-) biological elements, social factors seem to play a crucial role in the onset and maintenance of NSSI. These factors can include parent–child or sibling relationships, peer-relationships, as well as experiences with social media or at school. Although cultural differences may have a large influence on the prevalence and nature of NSSI, little is known about NSSI in non-Western countries. Furthermore, potentially traumatizing life events can be associated with the onset and maintenance of NSSI. Especially for young people who were forced to leave their homes and live as refugees in foreign countries, one might expect higher rates of NSSI. However, research on NSSI in this particularly vulnerable group is scarce.

In the current thematic series we brought together six unique manuscripts from different cultural backgrounds, focusing on a variety of potential social risk factors for the onset and maintenance of NSSI.

The first manuscript by Lauw et al. [1] describes the prevalence, nature and risk factors for deliberate self-harm among adolescents in Singapore. Interestingly, the prevalence rate of 23.1% was similar to results of studies from Western countries, and the most common type of NSSI (cutting) corresponds to Western reports. Furthermore, NSSI was associated with depressive symptoms, female gender, and alcohol use, as has been shown in previous studies. However, unlike previous studies from Western cultures, NSSI was not associated with family factors. The authors suggest that this might be due to stigma and common misperceptions towards mental illness in Singapore, which may have led to participants withholding information about a positive history of psychiatric illness within the family. Future research from Asian countries is needed in order to find out more about social and other risk factors in Asian cultures.

Another manuscript focusing on adolescents from non-Western countries by Verroken et al. [2], reports on NSSI among refugee minors in Belgium. Unexpectedly, prevalence rates, methods and functions of NSSI are comparable to results from Western study samples. However, those adolescents who engaged in NSSI showed a rather high number of acts of NSSI as compared to Western studies, as well as an increased risk of clinically significant emotional, conduct, and peer problems, and suicidality. Interestingly, like in the Singaporean study [1], family factors (i.e. being accompanied or not, having both parents around), were not significantly associated with NSSI.

Results from those two studies are especially remarkable in the light of the other four manuscripts of this series. These studies were conducted in Western samples and focused on family factors associated with NSSI.

Two longitudinal studies investigated the association with peer and parent relationships and NSSI. The first study by Victor et al. [3] was conducted in an urban sample of US-American adolescent girls. In this study, negative parental variables (like parental harsh punishment, low parental monitoring and poor quality of attachment to parents) predicted NSSI onset, while positive parenting behaviors decreased the odds of NSSI. Similarly, negative peer variables (like poorer social self-worth and self-competence, more negative perception of peers and peer victimization) increased the odds for NSSI. Furthermore, in combined multivariate models, only peer factors were associated significantly with NSSI onset. This study therefore shows the importance of both peer and parental relationships in the light of NSSI onset.

The second study on this matter by Gandhi et al. [4] investigated longitudinal data from a high school data set from Belgium. In addition to showing a significant association of peer and maternal attachment with subsequent NSSI, this study showed a significant mediation of this association by identity synthesis and confusion. As also discussed by Victor and colleagues, it therefore seems to be important to look at factors that are influenced by dysfunctional paternal or peer relationships or attachment, like identity formation, which then in turn might lead to onset or ongoing NSSI.

While parents and peers are often targeted when investigating mental illness, siblings are mainly overlooked. In the first study of its kind, Tschan et al. [5] investigated sibling relationships of Swiss female adolescents in the light of NSSI. Adolescents with NSSI reported significantly higher rivalry scores and less warmth and empathy in sibling relationships than non-clinical controls. Furthermore, when siblings of adolescents with NSSI were asked, they also reported a wide range of negative emotional and familial consequences of their sisters’ NSSI. For example, they reported to be feeling left alone or a distressing family situation. This study highlights the importance of considering the whole family system, not only with regard of risk or protective factors for the onset or maintenance of NSSI, but also with regard of possible negative impacts on other family members.

The last (but certainly not least) study of this series by Waals et al. [6] describes the NSSI Family Distress Cascade Theory, which addresses the most important points of the previous manuscripts included in this series. It explains how adolescents go through a challenging period between personal autonomy and connectedness with their family, and identity formation. When NSSI occurs, caregivers often feel confused about how to react to their child’s NSSI, as they may feel ashamed, afraid or shameful. In reaction to those feelings, caregivers might increase efforts to control the child’s behavior. In turn, the adolescent might experience this behavior as an intrusion, which might then lead to decreased family functioning, which might then lead to increased risk for NSSI (as shown by other articles in this series).

In summary, manuscripts of this series show how complex the association of social factors and NSSI is. First, there seem to be cultural differences with regard of the perceived impact of family factors on NSSI. While all studies conducted in Western samples showed associations of family factors with NSSI, those conducted in non-Western studies did not. Whether this is due to actual differences, or differences in how cultural norms influenced participants’ answers, is yet to be determined. Next to the impact of negative peer and paternal relationship on NSSI onset in two longitudinal studies, two other manuscripts made a strong point of considering the whole family system and keeping the needs of psycho-education and sometimes also psychotherapy of parents and siblings of adolescents with NSSI in mind.

None.

1.
Lauw MSM, Abraham AM, Loh CBL. Deliberate self-harm among adolescent psychiatric outpatients in Singapore: prevalence, nature and risk factors. Child Adolesc Psychiatry Ment Health. 2018;12:35.
- Article
- Google Scholar
2.
Verroken S, et al. Starting from scratch: prevalence, methods, and functions of non-suicidal self-injury among refugee minors in Belgium. Child Adolesc Psychiatry Ment Health. 2018;12:51.
- Article
- Google Scholar
3.
Victor SE, et al. Parent and peer relationships as longitudinal predictors of adolescent non-suicidal self-injury onset. Child Adolesc Psychiatry Ment Health. 2019;13:1.
- Article
- Google Scholar
4.
Gandhi A, et al. Maternal and peer attachment, identity formation, and non-suicidal self-injury: a longitudinal mediation study. Child Adolesc Psychiatry Ment Health. 2019;13:7.
- Article
- Google Scholar
5.
Tschan T, et al. Sibling relationships of female adolescents with nonsuicidal self-injury disorder in comparison to a clinical and a nonclinical control group. Child Adolesc Psychiatry Ment Health. 2019;13:15.
- Article
- Google Scholar
6.
Waals L, et al. The NSSI family distress cascade theory. Child Adolesc Psychiatry Ment Health. 2018;12:52.
- Article
- Google Scholar

Download references

None.

No funding was received for this manuscript.

Affiliations

Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Steinhoevelstr. 5, 89075, Ulm, Germany
- Rebecca C. Brown
- & Andreas Witt

Authors

Rebecca C. BrownView author publicationsYou can also search for this author in
- PubMed
- Google Scholar
Andreas WittView author publicationsYou can also search for this author in
- PubMed
- Google Scholar

Contributions

Both authors drafted the manuscript, critically reviewed it. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to Rebecca C. Brown.

Ethics approval and consent to participate

None.

Consent for publication

None.

Competing interests

The authors declare that they do not have any competing interests. RCB has received funding from the Baden-Wuerttembergstiftung, unrelated to this publication.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

Cite this article

Brown, R.C., Witt, A. Social factors associated with non-suicidal self-injury (NSSI). Child Adolesc Psychiatry Ment Health 13, 23 (2019). https://doi.org/10.1186/s13034-019-0284-1

Download citation

Received: 15 April 2019
Accepted: 04 June 2019
Published: 12 June 2019
DOI: https://doi.org/10.1186/s13034-019-0284-1

中文翻译：

与非自杀性自残（NSSI）相关的社会因素

非自杀性自残（NSSI）在青少年和年轻人中非常普遍。除了（神经）生物学因素外，社会因素似乎在NSSI的发作和维持中也起着至关重要的作用。这些因素可能包括父母与子女或兄弟姐妹的关系，同伴关系以及社交媒体或学校的经历。尽管文化差异可能对NSSI的流行和性质产生很大影响，但在非西方国家对NSSI知之甚少。此外，潜在的创伤性生活事件可能与NSSI的发作和维持有关。特别是对于那些被迫离开家园并在国外作为难民生活的年轻人，人们可能会期望NSSI的比率更高。但是，在这个特别脆弱的人群中对NSSI的研究很少。

在当前的主题系列中，我们汇集了六种来自不同文化背景的独特手稿，重点研究了NSSI发作和维持的各种潜在社会风险因素。

Lauw等人的第一篇手稿。[1]描述了新加坡青少年故意自我伤害的患病率，性质和危险因素。有趣的是，患病率为23.1％，与西方国家的研究结果相似，最常见的NSSI（切割）类型与西方报道相对应。此外，如先前的研究所示，NSSI与抑郁症状，女性性别和饮酒有关。但是，与以前的西方文化研究不同，NSSI与家庭因素无关。作者认为，这可能是由于在新加坡对精神疾病的耻辱和普遍误解所致，这可能导致参与者隐瞒有关家庭中精神疾病阳性史的信息。

Verroken等人撰写的另一本针对非西方国家青少年的手稿。[2]，关于比利时难民未成年人中NSSI的报道。出乎意料的是，NSSI的患病率，方法和功能与西方研究样本的结果相当。但是，与西方研究相比，从事NSSI的青少年表现出相当高的NSSI行为，并且临床上明显的情绪，行为，同伴问题和自杀倾向的风险增加。有趣的是，就像新加坡人的研究[1]一样，家庭因素（即是否陪伴，父母双方都在身边）与NSSI没有显着相关。

根据本系列的其他四篇手稿，这两项研究的结果尤为突出。这些研究是在西方样本中进行的，并且侧重于与NSSI相关的家庭因素。

两项纵向研究调查了同伴，父母关系和NSSI的关联。Victor等人的第一项研究。[3]是在城市样本的美国-美国少女中进行的。在这项研究中，负面的父母变量（如父母的严厉惩罚，较低的父母监督和较差的父母依恋质量）预测了NSSI的发作，而积极的父母行为降低了NSSI的几率。同样，负面的同龄人变量（例如较差的社会自我价值和自我竞争能力，对同龄人的负面看法更多以及同伴受害）增加了NSSI的几率。此外，在组合多元模型中，只有对等因素与NSSI发作显着相关。因此，根据NSSI的发作，这项研究表明了同伴和父母关系的重要性。

Gandhi等人对此事的第二项研究。[4]研究了来自比利时的高中数据集的纵向数据。除了显示同伴和母亲依恋与随后的NSSI显着相关外，这项研究还通过身份合成和混淆显示了这种相关的显着中介。正如Victor及其同事所讨论的那样，因此，重要的是要查看受功能障碍的父母或同伴关系或依恋影响的因素，例如身份形成，这继而可能导致NSSI的发作或持续。

尽管父母和同伴在研究精神疾病时经常成为攻击目标，但兄弟姐妹却被忽略了。在同类研究中，Tschan等人。[5]根据NSSI调查了瑞士女性青少年的同胞关系。与非临床对照相比，NSSI青少年的兄弟姐妹关系中的竞争得分高得多，而同伴关系中的热情和同理心则少。此外，当被问及患有NSSI的青少年的兄弟姐妹时，他们还报告了其姐妹的NSSI带来的广泛的负面情绪和家庭后果。例如，他们报告说感到孤单或家庭状况令人苦恼。这项研究突显了考虑整个家庭系统的重要性，不仅考虑到NSSI发作或维持的风险或保护因素，

Waals等人对该系列的最后（但并非最不重要）研究。[6]描述了NSSI家庭遇难级联理论，它解决了本系列中以前手稿的最重要的要点。它解释了青少年如何在个人自主，与家人的联系与身份形成之间度过充满挑战的时期。当发生NSSI时，看护者通常会对如何应对孩子的NSSI感到困惑，因为他们可能会感到as愧，恐惧或可耻。为了对这些感觉做出反应，看护人可能会加大努力来控制孩子的行为。反过来，青少年可能会以入侵的方式经历这种行为，这可能会导致家庭功能下降，进而导致NSSI风险增加（如本系列其他文章所示）。

总而言之，本系列的手稿显示了社会因素与NSSI的关联有多么复杂。首先，在家庭因素对NSSI的影响方面，似乎存在文化差异。尽管所有在西方样本中进行的研究均显示家庭因素与NSSI的关联，但在非西方研究中却没有。这是否是由于实际差异，还是文化规范如何影响参与者答案的差异，尚待确定。在两项纵向研究中，除了负面的同伴和父母关系对NSSI发作的影响外，另外两份手稿着重考虑了整个家庭系统，并保持了对父母和兄弟姐妹青少年进行心理教育以及有时对他们的兄弟姐妹进行心理治疗的需求。牢记NSSI。

没有。

1。
Lauw MSM，Abraham AM和Loh CBL。新加坡青少年精神科门诊患者故意的自我伤害：患病率，性质和危险因素。儿童Adolesc精神病学保健。2018; 12：35。
- 文章
- 谷歌学术
2。
Verroken S等。从头开始：比利时未成年人中非自杀性自残的流行，方法和功能。儿童Adolesc精神病学保健。2018; 12：51。
- 文章
- 谷歌学术
3。
Victor SE等。父母和同伴关系是青少年非自杀性自残发作的纵向预测指标。儿童Adolesc精神病学保健。2019; 13：1。
- 文章
- 谷歌学术
4，
甘地A等。产妇和同伴的依恋，身份形成和非自杀性自残：纵向调解研究。儿童Adolesc精神病学保健。2019; 13：7。
- 文章
- 谷歌学术
5，
Tschan T等。与临床和非临床对照组相比，患有非自杀性自残障碍的女性青少年的同胞关系。儿童Adolesc精神病学保健。2019; 13：15。
- 文章
- 谷歌学术
6，
Waals L等。NSSI家庭遇险级联理论。儿童Adolesc精神病学保健。2018; 12：52。
- 文章
- 谷歌学术

下载参考

没有。

没有为该手稿获得任何资金。

隶属关系

Steinhoevelstr，乌尔姆大学医院儿童和青少年精神病学与心理治疗系。5，89075，乌尔姆，德国
- 丽贝卡·布朗
- ＆安德烈亚斯·维特（Andreas Witt）

作者

丽贝卡C.布朗查看作者出版物您也可以搜索该作者在
- 考研
- 谷歌学术
Andreas Witt查看作者出版物您还可以在以下位置搜索该作者
- 考研
- 谷歌学术

会费

两位作者都起草了手稿，并对其进行了严格的审查。两位作者都阅读并批准了最后的手稿。

通讯作者

对应于丽贝卡·布朗（Rebecca C. Brown）。

道德规范的批准和参与同意

没有。

同意发表

没有。

利益争夺

作者宣称他们没有任何利益冲突。RCB已从Baden-Wuerttembergstiftung获得了与该出版物无关的资金。

发行人的便条

对于已发布地图和机构隶属关系中的管辖权主张，Springer Nature保持中立。

开放获取本文根据知识共享署名4.0国际许可（http://creativecommons.org/licenses/by/4.0/）的条款进行分发，该许可允许您以任何方式无限制地使用，分发和复制任何媒体适当的版权归原始作者和来源，提供指向知识共享许可的链接，并指出是否进行了更改。除非另有说明，否则，知识共享公共领域专用豁免（http://creativecommons.org/publicdomain/zero/1.0/）适用于本文提供的数据。

转载和许可