PediMIND Program, Bradley Hospital, East Providence, RI, USA.
Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA.
J Child Psychol Psychiatry. 2015 Oct;56(10):1127-36. doi: 10.1111/jcpp.12385. Epub 2015 Feb 11.
Suicide is among the most important mental health issues affecting adolescents today despite much research on its detection and prevention. Beyond suicide attempts (SAs), clinicians are increasingly confronted with another, potentially related problem: non-suicidal self-injury (NSSI)-defined as the deliberate destruction of body tissue without intent to die. NSSI may increase risk for making an SA by sevenfold, but many studies examining this link have involved youths engaging in both NSSI and SAs. Thus, there is a need to compare homogeneous groups of adolescents engaged in NSSI-only or SA-only, but not both, to advance what is known about each form of self-harm. The self-injurious implicit association task (SI-IAT) is a particularly important computerized behavioral task to study such adolescents because the SI-IAT provides objective behavioral data about problems for which people may lack insight or be motivated to conceal, such as SAs and NSSI.
We evaluated implicit associations with cutting and death/suicide using the computerized SI-IAT in three mutually exclusive groups: (1) adolescents who made an SA but had never engaged in NSSI (n = 47); (2) adolescents who engaged in NSSI but had never made an SA (n = 46); and (3) typically developing control (TDC) adolescents without history of psychiatric problems (n = 43).
Nonsuicidal self-injury participants had stronger identification with cutting versus no cutting than either SA or TDC participants. Contrary to our hypothesis, NSSI participants had stronger identification with suicide/death versus life than either SA or TDC participants.
Strong implicit attitudes towards suicide/death among adolescents with NSSI without a prior SA suggest that clinicians should not dismiss NSSI as not serious. Further work is required to elucidate the mechanism by which youths engaged in NSSI acquire these stronger identifications and make a first-time SA to develop novel treatment and prevention strategies blocking this transformation, ultimately reducing youth suicide.
自杀是当今影响青少年的最重要的心理健康问题之一，尽管有很多关于自杀的检测和预防的研究。除了自杀未遂（SA）之外，临床医生越来越多地面临另一个潜在相关的问题：非自杀性自伤（NSSI）——定义为故意破坏身体组织而没有自杀的意图。NSSI 会使自杀的风险增加七倍，但许多研究这种关联的研究都涉及同时有 NSSI 和 SA 的青少年。因此，需要比较只从事 NSSI 或只从事 SA 的青少年的同质群体，而不是两者都从事，以了解每种形式的自我伤害。自我伤害内隐联想测验（SI-IAT）是研究此类青少年的一项特别重要的计算机化行为任务，因为 SI-IAT 提供了关于人们可能缺乏洞察力或有动机隐瞒的问题的客观行为数据，例如 SA 和 NSSI。
我们使用计算机化的 SI-IAT 在三个相互排斥的组中评估与切割和死亡/自杀相关的内隐联想：（1）曾经自杀未遂但从未从事过 NSSI 的青少年（n = 47）；（2）从事过 NSSI 但从未有过自杀未遂的青少年（n = 46）；和（3）没有精神病史的典型发展控制（TDC）青少年（n = 43）。
与 SA 或 TDC 参与者相比，非自杀性自伤参与者对切割的认同比对不切割的认同更强。与我们的假设相反，NSSI 参与者对自杀/死亡的认同比对生命的认同更强。
在没有先前 SA 的从事 NSSI 的青少年中，对自杀/死亡的强烈内隐态度表明，临床医生不应该将 NSSI 视为不严重。需要进一步的工作来阐明青少年从事 NSSI 并首次进行 SA 以制定新的治疗和预防策略来阻止这种转变的机制，最终降低青少年自杀率。
