Abstract
Background: The lack of knowledge about Nonsuicidal Self-Injury (NSSI) in Spanish adolescents, especially NSSI thoughts may be due to the paucity of NSSI assessment instruments with validity evidence in this sample. The aim of this study was to assess NSSI thoughts and behavior. In addition, the study examined the association between various NSSI features and suicidal behavior and included a preliminary validation of the new Self-Injurious Thoughts and Behaviors Interview - Non-Suicidal Self-Injury (SITBI-NSSI). Method: 685 Spanish adolescents between 13 and 18 years old (M = 15.58, SD = 1.08; 60.9% girls) completed measures of NSSI features and suicidal behavior. Results: Among adolescents, 19% thought about self-injury, and 16.8% presented NSSI behaviors. The girls had higher levels of NSSI, as well as greater frequency, number of functions, methods, and suicidal thoughts and desire. Some of the functions, methods, and precipitants differed by sex. Those with ANS had a higher risk of suicidal behavior than the comparison group. The association of SITBI-NSSI with other measures supports the validity of the data. Conclusions: Most features of NSSI are similar to those found in Spanish and internationally. The SITBI-NSSI could facilitate the evaluation of NSSI in Spanish adolescents.
References
Al-Halabí, S., & Fonseca-Pedrero, E. (2021). Suicidal Behavior Prevention: The Time to Act is Now. Clínica y Salud, 32(2), 89–92. https://doi.org/10.5093/clysa2021a17
Al-Halabí, S., Sáiz, P. A., Burón, P., Garrido, M., Benabarre, A., Jiménez, E., Cervilla, J., Navarrete, M. I., Díaz-Mesa, E. M., García-Álvarez, L., Muñiz, J., Posner, K., Oquendo, M. A., García-Portilla, M. P., & Bobes, J. (2016). Validation of a Spanish version of the Columbia- Suicide Severity Rating Scale (C-SSRS). Revista de Psiquiatría y Salud Mental, 9(3), 134–142. https://doi.org/10.1016/j.rpsm.2016.02.004
Bousoño, M., Al-Halabí, S., Burón, P., Garrido, M., Díaz-Mesa, E. M., Galván, G., García-Álvarez, L., Velasco, Á., Rodríguez-Revuelta, J., Wasserman, C., Carli, V., Hoven, C., Sarchiapone, M., Wasserman, D., Bousoño, M., García-Portilla, M. P., Iglesias, C., Sáiz, P. A., & Bobes, J. (2021).
Alcohol use and risk factors for self-harm behavior in Spanish adolescents. Adicciones, 33(1), 53–62. https://doi.org/10.20882/adicciones.1239
Bresin, K., & Schoenleber, M. (2015). Gender differences in the prevalence of nonsuicidal self-injury: A meta-analysis. Clinical Psychology Review, 38, 55–64. https://doi.org/10.1016/j.cpr.2015.02.009
Brunner, R., Kaess, M., Parzer, P., Fischer, G., Carli, V., Hoven, C. W., Wasserman, C., Sarchiapone, M., Resch, F., Apter, A., Balazs, J., Barzilay, S., Bobes, J., Corcoran, P., Cosmanm, D., Haring, C., Iosuec, M., Kahn, J.-P., Keeley, H., … Wasserman, D. (2014). Life- time prevalence and psychosocial correlates of adolescent direct self- injurious behavior: A comparative study of findings in 11 European countries. Journal of Child Psychology and
Psychiatry, 55(4), 337– 348. https://doi.org/10.1111/jcpp.12166
Calvete, E., Orue, I., Aizpuru, L., & Brotherton, H. (2015). Prevalence and functions of non-suicidal self-injury in Spanish adolescents. Psicothema, 27(3), 223–228. https://doi.org/10.7334/psicothema2014.262
Calvete, E., Orue, I., & Sampedro, A. (2017). Does the acting with awareness trait of mindfulness buffer the predictive association between stressors and psychological symptoms in adolescents? Personality and Individual Differences, 105, 158–163. https://doi.org/10.1016/j.paid.2016.09.055
Calvo, N., García-González, S., Perez-Galbarro, C., Regales-Peco, C., Lugo- Marin, J., Ramos-Quiroga, J.-A., & Ferrer, M. (2022). Psychotherapeutic interventions specifically developed for NSSI in adolescence: A systematic review. European Neuropsychopharmacology, 58, 86–98. https://doi.org/10.1016/j.euroneuro.2022.02.009
Castellví, P., Lucas-Romero, E., Miranda-Mendizábal, A., Parés-Badell, O., Almenara, J., Alonso, I., Blasco, M. J., Cebrià, A., Gabilondo, A., Gili, M., Lagares, C., Piqueras, J. A., Roca, M., Rodríguez- Marín, J., Rodríguez-Jimenez, T., Soto-Sanz, V., & Alonso, J. (2017). Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis. Journal of
Affective Disorders, 215, 37–48. https://doi.org/10.1016/j.jad.2017.03.035
Cohen, Jacob. (2013). Statistical Power Analysis for the Behavioral Sciences. Routledge. https://doi.org/10.4324/9780203771587
D’Agostino, A., Pepi, R., Aportone, A., & Monti, M. R. (2018). Self- injurious thoughts and behaviors questionnaire-nonsuicidal (SITBQ-NS): Development and validation of a revised version of the self-injurious thoughts and behaviors interview (SITBI) for the self-assessment of nonsuicidal self-injury. Clinical Neuropsychiatry, 15(6), 344–352. https://search.proquest.com/docview/2174042331?accountid=14529
Díez-Gómez, A., Pérez-Albéniz, A., Ortuño-Sierra, J., & Fonseca- Pedrero, E. (2020). SENTIA: An Adolescent Suicidal Behavior Assessment Scale. Psicothema, 32(3), 382–389. https://doi.org/10.7334/psicothema2020.27
Faura-Garcia, J., Calvete, E., & Orue, I. (2021). Autolesion no suicida: conceptualización y evaluación clínica en población hispanoparlante [Non-suicidal self-injury: conceptualization and clinical evaluation in a Spanish-speaking population]. Papeles Del Psicólog, 42(3), 207– 2014. https://doi.org/10.23923/pap.psicol.2964
Faura-Garcia, J., Orue, I., & Calvete, E. (2021). Cyberbullying victimization and nonsuicidal self-injury in adolescents: The role of maladaptive schemas and dispositional mindfulness. Child Abuse & Neglect, 118, Article 105135. https://doi.org/10.1016/j.chiabu.2021.105135
Faura‐Garcia, J., Orue, I., & Calvete, E. (2021). Clinical assessment of non‐suicidal self‐injury: A systematic review of instruments. Clinical Psychology & Psychotherapy, 28(4), 739–765. https://doi.org/10.1002/cpp.2537
Fischer, G., Ameis, N., Parzer, P., Plener, P. L., Groschwitz, R., Vonderlin, E., Kölch, M., Brunner, R., & Kaess, M. (2014). The German version of the self-injurious thoughts and behaviors interview (SITBI-G): a tool to assess non-suicidal self-injury and suicidal behavior disorder. BMC Psychiatry, 14(1), 265–274. https://doi.org/10.1186/s12888-014-0265-0
Fonseca-Pedrero, E., Inchausti, F., Pérez-Gutiérrez, L., Aritio Solana, R., Ortuño-Sierra, J., Sánchez-García, M. . Á., Lucas-Molina, B., Domínguez, C., Foncea, D., Espinosa, V., Gorría, A., Urbiola-Merina, E., Fernández, M., Merina Díaz, C., Gutiérrez, C., Aures, M., Campos, M. S., Domínguez-Garrido, E., & Pérez de Albéniz Iturriaga, A. (2018). Suicidal ideation in a community-derived sample of Spanish adolescents. Revista de Psiquiatría y Salud Mental
(English Edition), 11(2), 76–85. https://doi.org/10.1016/j.rpsmen.2018.02.008
Fox, K. R., Harris, J. A., Wang, S. B., Millner, A. J., Deming, C. A., & Nock, M. K. (2020). Self-Injurious Thoughts and Behaviors Interview—Revised: Development, reliability, and validity. Psychological Assessment, 32(7), 677–689. https://doi.org/10.1037/pas0000819
Fox, K. R., Huang, X., Guzmán, E. M., Funsch, K. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2020). Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological Bulletin, 146(12), 1117–1145. https://doi.org/10.1037/bul000
Gandhi, A., Luyckx, K., Baetens, I., Kiekens, G., Sleuwaegen, E., Berens, A., Maitra, S., & Claes, L. (2018). Age of onset of non-suicidal self- injury in Dutch-speaking adolescents and emerging adults: An event history analysis of pooled data. Comprehensive Psychiatry, 80(1–38), 170–178. https://doi.org/10.1016/j.comppsych.2017.10.007
García-Nieto, R., Blasco-Fontecilla, H., Paz Yepes, M., & Baca-García,E. (2013). Traducción y validación de la Self-Injurious Thoughts and Behaviors Interview en población española con conducta suicida [Translation and validation of the Self-Injurious Thoughts and Behaviors Interview in a Spanish population with suicidal behavior]. Revista de Psiquiatría y Salud Mental, 6(3), 101–108. https://doi.org/10.1016/j.rpsm.2012.07.001
García-Nieto, R., Carballo, J. J., de Neira Hernando, M. D., de León- Martinez, V., & Baca-García, E. (2015). Clinical correlates of non- suicidal self-injury (NSSI) in an outpatient sample of adolescents. Archives of Suicide Research, 19(2), 218–230. https://dx.doi.org/10.1080/13811118.2014.957447
Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263.
Groschwitz, R. C., Kaess, M., Fischer, G., Ameis, N., Schulze, U. M. E., Brunner, R., Koelch, M., & Plener, P. L. (2015). The association of non-suicidal self-injury and suicidal behavior according to DSM- 5 in adolescent psychiatric inpatients. Psychiatry Research, 228(3), 454–461. https://dx.doi.org/10.1016/j.psychres.2015.06.019
Hawton, K., Harriss, L., Simkin, S., Bale, E., & Bond, A. (2004). Self- Cutting: Patient Characteristics Compared with Self-Poisoners. Suicide and Life-Threatening Behavior, 34(3), 199–208. https://doi.org/10.1521/suli.34.3.199.42776
Kiekens, G., Hasking, P., Boyes, M., Claes, L., Mortier, P., Auerbach, R. P., Cuijpers, P., Demyttenaere, K., Green, J. G., Kessler, R. C., Myin- Germeys, I., Nock, M. K., & Bruffaerts, R. (2018). The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors. Journal of Affective Disorders, 239, 171–179. https://doi.org/10.1016/j.jad.2018.06.033
Kirchner, T., Ferrer, L., Forns, M., & Zanini, D. (2011). Self-harm behavior and suicidal ideation among high school students. Gender differences and relationship with coping strategies. Actas Esp Psiquiatr, 39(4), 226–235. Lewis, S. P., Heath, N. L., Hasking, P. A., Whitlock, J. L., Wilson, M. S., & Plener, P. L. (2019). Addressing Self‐Injury on College Campuses: Institutional Recommendations. Journal of College Counseling, 22(1), 70–82. https://doi.org/10.1002/jocc.12115
Lloyd, E. E., Kelley, M. L., & Hope, T. (1997). Self-mutilation in a community sample of adolescents: Descriptive characteristics and provisional prevalence rates. [Poster session]. Annual Meeting of the Society for Behavioral Medicine, New Orleans, LA.
Marraccini, M. E., Brick, L. A., O’Neill, J. C., Weyandt, L. L., & Buchanan, A. L. (2020). Self-Injurious Thoughts and Behaviors Among College Students: A Latent Class Analysis. Archives of Suicide Research, 1–20. https://doi.org/10.1080/13811118.2020.1746942
Mollà, L., Batlle Vila, S., Treen, D., López, J., Sanz, N., Martín, L. M., Pérez, V., & Bulbena, A. (2015). Autolesiones no suicidas en adolescentes: revisión de los tratamientos psicológicos. Revista de Psicopatología y Psicología Clínica, 1(1), 51–61. https://doi.org/10.5944/rppc.vol.1.num.1.2015.14408
Morales, J. J., Buser, T. J., & Farag, M. S. (2018). Comparison of brief measures of the prevalence of nonsuicidal self-injury in a nonclinical sample of young adults. Journal of Mental Health Counseling, 40(2), 156–171. https://doi.org/10.17744/mehc.40.2.05
Muehlenkamp, J. J., Walsh, B. W., & McDade, M. (2010). Preventing Non-Suicidal Self-Injury in Adolescents: The Signs of Self-Injury Program. Journal of Youth and Adolescence, 39(3), 306–314. https://doi.org/10.1007/s10964-009-9450-8
Muehlenkamp, J. J., Xhunga, N., & Brausch, A. M. (2019). Self-injury Age of Onset: A Risk Factor for NSSI Severity and Suicidal Behavior. Archives of Suicide Research, 23(4), 551–563. https://doi.org/10.1080/13811118.2018.1486252
Nock, M. K., & Favazza, A. R. (2009). Nonsuicidal self-injury: definition and classification. In M. K. Nock (Ed.), Understanding Nonsuicidal Self-Injury: Origins, Assessment, and Treatment (pp. 9–18). American Psychological Association.
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self- Injurious Thoughts and Behaviors Interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317. https://doi.org/10.1037/1040-3590.19.3.309
Nock, M. K., & Prinstein, M. J. (2004). A Functional Approach to the Assessment of Self-Mutilative Behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890. https://doi.org/10.1037/0022-006X.72.5.885
Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of Abnormal Psychology, 118(4), 816–827. https://doi.org/10.1037/a0016948
Pérez, S., García-Alandete, J., Gallego, B., & Marco, J. H. (2021). Characteristics and Unidimensionality of Non-suicidal Self-injury in a Community Sample of Spanish Adolescents. Psicothema, 33(2), 251–258. https://doi.org/10.7334/psicothema2020.249
Pérez, S., García‐Alandete, J., Cañabate, M., & Marco, J. H. (2020). Confirmatory factor analysis of the Inventory of Statements About Self‐injury in a Spanish clinical sample. Journal of Clinical Psychology, 76(1), 102–117. https://doi.org/10.1002/jclp.22844
Rodríguez-Blanco, L., Carballo, J. J., Baca-García, E., Rodriguez- Blanco, L., Carballo, J. J., & Baca-Garcia, E. (2018). Use of Ecological Momentary Assessment (EMA) in Non-Suicidal Self-Injury (NSSI): A systematic review. Psychiatry Research, 263(1), 212–219. https://doi.org/10.1016/j.psychres.2018.02.051
Rowe, S. L., French, R. S., Henderson, C., Ougrin, D., Slade, M., & Moran, P. (2014). Help-seeking behaviour and adolescent self-harm: A systematic review. Australian & New Zealand Journal of Psychiatry, 48(12), 1083–1095. https://doi.org/10.1177/0004867414555718
Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of Nonsuicidal Self-Injury in Nonclinical Samples: Systematic Review, Meta-Analysis and Meta-Regression. Suicide and Life-Threatening Behavior, 44(3), 273–303. https://doi.org/10.1111/sltb.12070
Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227(1), 759–769. https://doi.org/10.1016/j.jad.2017.11.073
Victor, S. E., & Klonsky, E. D. (2014). Correlates of suicide attempts among self-injurers: A meta-analysis. Clinical Psychology Review, 34(4), 282–297. https://doi.org/10.1016/j.cpr.2014.03.005
Victor, S. E., Muehlenkamp, J. J., Hayes, N. A., Lengel, G. J., Styer, D. M., & Washburn, J. J. (2018). Characterizing gender differences in nonsuicidal self-injury: Evidence from a large clinical sample of adolescents and adults. Comprehensive Psychiatry, 82, 53–60. https://doi.org/10.1016/j.comppsych.2018.01.009