Beauchaine Theodore P, Hinshaw Stephen P, Bridge Jeffrey A
Department of Psychology, The Ohio State University.
Departments of Psychology and Psychiatry, The University of California, Berkeley; University of California, San Francisco.
Clin Psychol Sci. 2019 Jul;7(4):643-667. doi: 10.1177/2167702618818474. Epub 2019 Jan 28.
Non-suicidal self-injury (NSSI) affects 15-20% of adolescents-disproportionately girls-and is a strong predictor of eventual suicide attempts and suicide. Many girls now initiate NSSI before age 10. These early-starters exhibit greater frequency of NSSI, use more diverse methods, and are hospitalized more often, yet there are no empirically supported prevention programs for preadolescents. Obstacles to prevention include ascertaining who is sufficiently vulnerable and specifying mechanistic intervention targets. Recent research indicates that (1) preadolescent girls with ADHD who are also maltreated are at alarming risk for NSSI and suicide attempts by adolescence, and (2) the conjoint effects of these vulnerabilities are sufficiently potent for targeted prevention. Research also indicates that existing interventions are effective in altering child- and family-level mechanisms of NSSI. These interventions alter neurobiological markers of vulnerability, which can be used as proximal efficacy signals of prevention response, without waiting for NSSI and suicide attempts to emerge.
非自杀性自伤行为（NSSI）影响着15%至20%的青少年——女孩受影响的比例尤其高——并且是最终自杀未遂和自杀的有力预测指标。现在许多女孩在10岁之前就开始出现非自杀性自伤行为。这些早期开始自伤的女孩非自杀性自伤行为的频率更高，使用的方法更多样，住院的次数也更多，但目前还没有针对青春期前儿童的经实证支持的预防项目。预防工作的障碍包括确定哪些人易受伤害程度足够高，以及明确机械性干预目标。最近的研究表明：（1）患有注意力缺陷多动障碍（ADHD）且遭受过虐待的青春期前女孩在青春期出现非自杀性自伤行为和自杀未遂的风险惊人；（2）这些脆弱性因素的共同作用足以强大到开展有针对性的预防。研究还表明，现有的干预措施在改变非自杀性自伤行为的儿童和家庭层面机制方面是有效的。这些干预措施改变了脆弱性的神经生物学标志物，这些标志物可用作预防反应的近端疗效信号，而无需等待非自杀性自伤行为和自杀未遂行为出现。
