University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
Psychol Med. 2023 Dec;53(16):7636-7645. doi: 10.1017/S0033291723001447. Epub 2023 Jun 7.
Nonsuicidal self-injury (NSSI) is prevalent in adolescent clinical samples. There is evidence that NSSI can be treated effectively but data on individual treatment outcomes is limited. The goal of this study was to examine response, remission, exacerbation, and relapse rates over one and two years, respectively, among a clinical sample of adolescents with NSSI. Furthermore, we aimed to identify clinically relevant predictors of NSSI trajectories.
The sample consists of = 203 adolescents (12-17 y., 94% female) from a specialized outpatient clinic for risk-taking and self-harming behavior with NSSI on at least five days in the six months before first assessment. Assessments were completed at baseline and one (FU1) and two (FU2) years later using structured clinical interviews and self-report questionnaires.
At FU1, 75% reported a reduction in NSSI frequency by at least 50% (treatment response); among those, one third (25% of the entire sample) achieved a remission (0 NSSI); an exacerbation (⩾50% more NSSI) was observed in 11% of patients. Of those in remission, 41% relapsed one year later. Predictors of non-response or non-remission were inpatient treatment and depressive symptoms. Adolescents with lower NSSI frequency at baseline had a higher risk of exacerbation. Due to limited sample size at FU2 no prediction model for relapse was established.
While most adolescents presenting with NSSI achieved significant improvement, more attention should be paid to the rather low rates of full remission. Prediction and early detection of individuals who deteriorate during or relapse after treatment is critical.
非自杀性自伤（NSSI）在青少年临床样本中较为常见。有证据表明 NSSI 可以得到有效治疗，但个体治疗效果的数据有限。本研究的目的是分别在一年内和两年内，检查 NSSI 青少年临床样本中分别的反应、缓解、恶化和复发率。此外，我们旨在确定 NSSI 轨迹的临床相关预测因素。
该样本包括 203 名青少年（12-17 岁，94%为女性），来自一个专门的冒险和自伤行为门诊，这些青少年在首次评估前的六个月内至少有五天存在 NSSI。评估在基线和一年（FU1）和两年（FU2）后进行，使用结构化临床访谈和自我报告问卷。
在 FU1，75%的人报告 NSSI 频率至少减少了 50%（治疗反应）；其中，三分之一（整个样本的 25%）达到缓解（无 NSSI）；11%的患者出现恶化（NSSI 增加 ⩾50%）。在缓解的患者中，41%的人在一年后复发。非反应或非缓解的预测因素是住院治疗和抑郁症状。基线时 NSSI 频率较低的青少年恶化的风险更高。由于 FU2 的样本量有限，因此未建立复发的预测模型。
虽然大多数患有 NSSI 的青少年都有显著改善，但更多地关注完全缓解率较低的问题更为重要。预测和早期发现在治疗期间或治疗后恶化的个体至关重要。
