Colleen M. Jacobson

The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature

This article critically reviewed the research addressing the epidemiology and phenomenology of non-suicidal self-injury (NSSI) among adolescents. Articles were identified through a search of Medline and Psychinfo. Findings indicate a lifetime prevalence of NSSI ranging from 13.0% to 23.2%. Reasons for engaging in NSSI include to regulate emotion and to elicit attention. Correlates of NSSI include a history of sexual abuse, depression, anxiety, alexithymia, hostility, smoking, dissociation, suicidal ideation, and suicidal behaviors. Suggested areas of future research include identifying the psychiatric diagnoses associated with NSSI among adolescents, determining the temporal link between NSSI and suicide attempts, learning more about the course of NSSI, understanding the biological underpinnings of NSSI, and identifying effective treatments for NSSI in adolescents.

Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial

Objectives: An increasingly important concern for clinicians who care for patients at the end of life is their spiritual well‐being and sense of meaning and purpose in life. In response to the need for short‐term interventions to address spiritual well‐being, we developed Meaning Centered Group Psychotherapy (MCGP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace and purpose in their lives, even as they approach the end of life.

Psychiatric Impairment Among Adolescents Engaging in Different Types of Deliberate Self-Harm

This retrospective chart review study of 227 participants examined the psychiatric profiles of outpatient adolescents ages 12 to 19 years (M = 15.08 years, SD = 1.72 years) engaging in different types of deliberate self-harm (DSH) behaviors. Participants were divided into four groups: no deliberate self-harm (NoDSH; n = 119), nonsuicidal self-injury only (NSSI only; n = 30), suicide attempt only (n = 38), and suicide attempt plus NSSI (n = 40). Those who attempted suicide were more likely to have major depressive disorder and/or posttraumatic stress disorder than those who engaged in NSSI only. Those who engaged in any type of DSH were more likely to have features of borderline personality disorder than those who did not engage in DSH. The suicidal ideation levels of those in the NSSI group were similar to those in the NoDSH group. Findings offer empirical support for the importance of distinguishing between suicidal and nonsuicidal self-harm behaviors.

Fact or fiction: diagnosing borderline personality disorder in adolescents.

Borderline Personality Disorder (BPD) has long been considered a mental health problem that results in considerable costs in terms of human suffering and psychiatric expenses among adult patients. Although the diagnosis of BPD for adolescents is frequently used in clinical settings, the field of mental health has questioned whether one should diagnose BPD among adolescents. This paper reviews the recent empirical literature (identified through PsycINFO 1980 to present) to evaluate prevalence, reliability, and validity of a BPD diagnosis in adolescents. It is concluded that the features BPD diagnoses in adolescents are comparable to those in adults. Furthermore, there appears to be a legitimate subgroup of adolescents for whom the diagnosis remains stable over time as well as a less severe subgroup that moves in and out of the diagnosis. While caution is warranted, formal assessment of BPD in adolescents may yield more accurate and effective treatment for adolescents experiencing BPD symptomatology. More longitudinal research is necessary to further explicate the issues of diagnosing BPD in adolescents.

Depression and IL-6 Blood Plasma Concentrations in Advanced Cancer Patients

The authors explored the relationship between depression and interleukin-6 (IL-6) blood plasma concentrations among advanced-stage cancer patients. Seventy-three patients with advanced cancer were rated on depression with the Hamilton Rating Scale for Depression and gave blood to be assayed for blood plasma concentration of IL-6. Initial results found no correlation between depression and IL-6. Subsequent analyses found that among those whose blood was drawn within 48 hours of interview completion, depression and IL-6 were highly correlated. Future studies focusing on the relationship between immune functioning and depression must be particularly vigilant regarding methodological issues.

Clinical assessment of depression in terminally ill cancer patients: a practical guide.

Depression is commonly experienced by cancer patients at the end of life. The identification of patients suffering from depression is essential to provide clinicians with an opportunity to relieve considerable suffering. However, the assessment of depressive symptoms is complex and often challenging in a terminally ill cancer population. This article offers practical guidelines to assist clinicians with the diagnosis of depression, reviews the defining symptoms of depression and their unique presentation in patients at the end of life, suggests modifications of the standard diagnostic interview, and provides examples of specific assessment questions to target depressive symptoms at the end of life.

Reasons for attempting suicide among a community sample of adolescents

The motives of suicide attempts among a community sample of 99 U.S. high school students were explored. Participants completed an in-depth computer-assisted self interview about their most recent attempts as well as additional psychosocial measures. Results indicated that nearly 75% of the adolescents engaged in suicide attempts for reasons other than killing themselves and that depressive symptoms and premeditation prior to the attempt were significantly associated with increased risk for engaging in the attempts with death as a clear motive. Linking motive for an attempt (death, interpersonal communication, emotion regulation) and treatment approach may improve prevention of subsequent attempts and completed suicides.

Epidemiology and Sociocultural Aspects of Non-suicidal Self-Injury and Eating Disorders 2

Eating disorders (ED), including anorexia nervosa, bulimia nervosa, and bingeeating disorder, and non-suicidal self-injury (NSSI) are significant public health problems among adolescents and young adults. This chapter reviews the overlap between these behaviors, focusing on epidemiological and sociocultural characteristics that may be related to the high degree of comorbidity within patients. Eating disorders and NSSI fall along the continuum of self-harm, and up to 72 % of people with an ED also engaging in NSSI and up to 54 % of people who engage in NSSI report comorbid eating pathology. The likelihood of engaging in NSSI is greater among patients with purging-type EDs than those with non-purging-type EDs, suggesting an etiological link between purging and NSSI. Those engaging in ED and NSSI are at an increased risk for suicidal behaviors and are likely to have certain comorbidities including Borderline Personality Disorder, depressive symptoms, and substance use. Further, people with comorbid ED and NSSI are at an increased risk for experiencing traumatic events and having negative attitudes toward their bodies. Clinical implications for assessment and treatment of individuals with ED and NSSI are discussed throughout the chapter.

The Association of Interpersonal and Intrapersonal Emotional Experiences with Non-Suicidal Self-Injury in Young Adults

Non-suicidal self-injury (NSSI), the intentional damage to body tissue without the intent to die, is a prevalent public health problem in the U.S. and around the world. The current study sought to identify intrapersonal (emotional reactivity) and interpersonal (emotional expressiveness to others) correlates of NSSI in order to provide insight into how to best tailor prevention and treatment efforts. Four hundred and forty nine college students were surveyed about various psychological characteristics as well as engagement in NSSI. Results indicated that those who have difficulty expressing emotions are at an increased risk for NSSI even after controlling for depressive symptoms and that emotional expressiveness acts as a partial mediator between depression and NSSI. Emotional expressiveness should be a target of treatment among people who engage in NSSI.

Emotion Reactivity, Comfort Expressing Emotions, and Future Suicidal Ideation in Emerging Adults

OBJECTIVE Emotion reactivity and difficulties in expressing emotions have been implicated in risk for suicidal behavior. This study examined comfort in expressing emotions (positive vs. negative) and depressive symptoms as mediators of the prospective relation between emotion reactivity and suicidal ideation. DESIGN Emerging adults (N = 143; 72% female; 28% White) completed measures of emotion reactivity, comfort expressing emotions, and suicidal ideation at baseline and of depressive symptoms and suicidal ideation 12 months later. RESULTS Emotion reactivity predicted suicidal ideation at follow-up through depressive symptoms. Difficulty expressing love-but not happiness, sadness, and anger-partially mediated the relationship between emotion reactivity and suicidal ideation at follow-up before but not after adjusting for baseline ideation. CONCLUSION The relation between high emotion reactivity and suicidal ideation may be explained by discomfort in the expression of positive emotions and by depressive symptoms. Promotion of comfort in positive emotion expression may reduce vulnerability to suicidal ideation.