Janis Whitlock

Self-injurious behaviors in a college population.

OBJECTIVE. The goal was to assess the prevalence, forms, demographic and mental health correlates of self-injurious behaviors in a representative college sample. METHODS. A random sample of undergraduate and graduate students at 2 northeastern US universities were invited to participate in an Internet-based survey in the spring of 2005. Thirty-seven percent of the 8300 invited participants responded. RESULTS. The lifetime prevalence rate of having ≥1 self-injurious behavior incident was 17.0%. Seventy-five percent of those students engaged in self-injurious behaviors more than once. Thirty-six percent reported that no one knew about their self-injurious behaviors and only 3.29% indicated that a physician knew. Compared with non-self-injurers, those with repeat self-injurious behavior incidents were more likely to be female, bisexual or questioning their sexual orientation. They were less likely to be Asian/Asian American and >24 years of age. When controlling for demographic characteristics, those with repeat self-injurious behavior incidents were more likely to report a history of emotional abuse or sexual abuse, ever having considered or attempted suicide, elevated levels of psychological distress, and ≥1 characteristic of an eating disorder. A dose-response gradient was evident in each of these areas when single-incident self-injurious behaviors were compared with repeat-incident self-injurious behaviors. CONCLUSIONS. A substantial number of college students reported self-injurious behaviors in their lifetimes. Many of the behaviors occurred among individuals who had never been in therapy for any reason and who only rarely disclosed their self-injurious behaviors to anyone. Single self-injurious behavior incidents were correlated with a history of abuse and comorbid adverse health conditions but less strongly than were repeat self-injurious behavior incidents. The reticence of these clients to seek help or advice renders it critical that medical and mental health providers find effective strategies for detecting and addressing self-injurious behaviors.

The virtual cutting edge: the internet and adolescent self-injury

The 2 studies reported here use observational data from message boards to investigate how adolescents solicit and share information related to self-injurious behavior. Study 1 examines the prevalence and nature of these message boards, their users, and most commonly discussed topics. Study 2 was intended to explore the correlations between content areas raised for discussion. Both studies were intended to shed light on the role of message boards in spreading information about self-injurious practices and influencing help-seeking behavior. More than 400 self-injury message boards were identified. Most are populated by females who describe themselves as between 12 and 20 years of age. Findings show that online interactions clearly provide essential social support for otherwise isolated adolescents, but they may also normalize and encourage self-injurious behavior and add potentially lethal behaviors to the repertoire of established adolescent self-injurers and those exploring identity options.

Youth Perceptions of Life at School: Contextual Correlates of School Connectedness in Adolescence

A growing body of research shows school connectedness to be a powerful predictor of adolescent health and academic outcomes. This study advances a theoretically grounded definition of school connectedness and triangulates qualitative and quantitative methods to assess contextual correlates to school connectedness in 8th, 10th, and 12th grade youth. A survey examined the relationship between school connectedness and 4 developmental supports: meaningful roles at school, safety, creative engagement, and academic engagement as well as demographic and contextual control variables. Followup focus groups were used to identify other potentially salient contextual correlates. Findings from both methods suggest that school connectedness is strongly affected by opportunities for meaningful input into school policies and the extent to which class material engages student interests. Focus groups highlight the importance of youth-adult exchange in and outside of the classroom. Findings also revealed distinct differences by grade. Implications for school policy and practice as well as for future research in school connectedness are discussed.

Nonsuicidal Self-injury in a College Population: General Trends and Sex Differences

Abstract Objective: To describe basic nonsuicidal self-injury (NSSI) characteristics and to explore sex differences. Methods: A random sample from 8 universities were invited to participate in a Web-based survey in 2006–2007; 38.9% (n = 14,372) participated. Analysis assessed sex differences in NSSI prevalence, practices, severity, perceived dependency, and help-seeking; adjusted odds ratios for NSSI characteristics were calculated by sex status. Results: Lifetime NSSI prevalence rates averaged 15.3%. Females were more likely than males to self-injure because they were upset (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.3–2.1) or in hopes that someone would notice them (AOR = 1.6, 95% CI = 1.1–2.7). Males were 1.6 times (95% CI = 1.2–2.2) more likely to report anger and 4.0 times (95% CI = 2.3–6.8) more likely to report intoxication as an initiating factor. Sexual orientation predicted NSSI, particularly for women (Wald F = 8.81, p ≤ .000). Only 8.9% of the NSSI sample reported disclosing NSSI to a mental health professional. Conclusions: NSSI is common in college populations but varies significantly by sex and sexual orientation. NSSI disclosure is low among both sexes.

Variation in Nonsuicidal Self-Injury: Identification and Features of Latent Classes in a College Population of Emerging Adults

Prior studies of nonsuicidal self-injury (NSSI) suggest the existence of multiple NSSI typologies. Using data from 2,101 university students, this study employed latent class analysis to investigate NSSI typologies. Results show a good fitting 3-class solution with distinct quantitative and qualitative differences. Class 1 was composed largely of women using 1 form to engage in superficial tissue damage with moderate (< 11) lifetime incidents. Class 2 was composed predominately of men using 1 to 3 forms to engage in self-battery and light tissue damage, with low (2–10) lifetime incidents. Class 3 was composed largely of women using more than 3 self-injury forms and engaging in behaviors with the potential for a high degree of tissue damage with moderate to high numbers of lifetime incidents. All 3 classes were at elevated risk for adverse conditions when compared to no-NSSI respondents. We conclude that NSSI typologies exist and may warrant differential clinical assessment and treatment.

Interpersonal Features and Functions of Nonsuicidal Self‐injury

Etiological models of nonsuicidal self-injury (NSSI) suggest interpersonal features may be important to understand this behavior, but social functions and correlates have not been extensively studied. This study addresses existing limitations by examining interpersonal correlates and functions of NSSI within a stratified random sample of 1,243 predominantly Caucasian college students (mean age = 21.52, SD = 4.15 years). Participants completed an anonymous online survey assessing NSSI features, perceived social support, and disclosure experiences. Approximately 15% of the students endorsed NSSI. Interpersonal reasons were endorsed proportionally more often for initiating rather than repeating the behavior. Individuals with repetitive NSSI reported significantly lower perceived social support from family members and fewer individuals to seek advice from than single-act and control participants. Fifty-nine percent had disclosed their NSSI, but rarely to mental health professionals. Conversations with others about NSSI were rated as being mostly unhelpful. These results emphasize the importance of interpersonal features and functions of NSSI, suggesting treatments should focus on strengthening interpersonal bonds alongside emotion regulation. Improving responses to disclosures of NSSI is needed to promote communication about this behavior and perceived helpfulness of such conversations.

Self-injurious behavior in adolescents.

Janis Whitlock discusses the epidemiology and and care of adolescents undertaking nonsuicidal self-injury, also called “deliberate self-harm.”

Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors

Previous research has found associations between non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs), yet the nature of this relationship remains equivocal. The goal of the present study was to examine how lifetime NSSI frequency and individual NSSI functions relate to a history of suicidal ideation, plan, and attempt. Data were collected via a large (N=13,396) web-based survey of university students between the ages of 18 and 29. After demographics and psychiatric conditions were controlled for, we found a positive curvilinear relationship between NSSI frequency and each of the suicide outcomes. When examined among those with STBs, bipolar disorder and problematic substance use remained positively associated with risk for suicide attempt, but not NSSI. Analyses of individual NSSI functions showed differential associations with STBs of varying severity. Specifically, nearly every NSSI function was significantly related to suicide attempt, with functions related to avoiding committing suicide, coping with self-hatred, and feeling generation (anti-dissociation) showing the strongest risks for suicide attempt. From both clinical and research perspectives, these findings suggest the importance of assessing multiple reasons for engaging in self-injury.

Peer effects on risky behaviors: New evidence from college roommate assignments

Social scientists continue to devote considerable attention to spillover effects for risky behaviors because of the important policy implications and the persistent challenges in identifying unbiased causal effects. We use the natural experiment of assigned college roommates to estimate peer effects for several measures of health risks: binge drinking, smoking, illicit drug use, gambling, having multiple sex partners, suicidal ideation, and non-suicidal self-injury. We find significant peer effects for binge drinking but little evidence of effects for other outcomes, although there is tentative evidence that peer effects for smoking may be positive among men and negative among women. In contrast to prior research, the peer effects for binge drinking are significant for all subgroups defined by sex and prior drinking status. We also find that pre-existing risky behaviors predict the closeness of friendships, which underscores the significance of addressing selection biases in studies of peer effects.

Nonsuicidal Self-Injury in College Populations: Mental Health Provider Assessment of Prevalence and Need.

Concern about the prevalence of nonsuicidal self-injury is widespread. Members of an electronic listserv for college counseling center directors nationwide were invited to participate in a Web survey to investigate provider experience with nonsuicidal self-injury; 290 surveys were analyzed. Most respondents perceived recent increases in nonsuicidal self-injury and lack of effective treatment knowledge. Most favored dialectical behavior therapy or cognitive behavior therapy for treatment, but few found treatment effective. Implications for treatment and prevention in college settings are discussed.