Citation

Chan SKW, Zhou LF, Cai J, Liao Y, Huang Y, Deng ZY, Liu YJ, Chen XC, Gao R, Zhang XF, Tao YQ, Zhou L, Deng XP, Liu B, Ran MS. J. Affect. Disord. 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Elsevier Publishing)

DOI

10.1016/j.jad.2024.03.099

PMID

38518855

Abstract

Suicide was the fourth leading cause of mortality among 15-29 years old in 2019 (World Health Organization, 2021) and constitute a major public health burden particularly in the youth population. Suicide behaviors, including deliberate self-harm (DSH) and non-suicidal self-injury (NSSI), predict future suicide attempts and suicide in child and adolescents (Zahl and Hawton, 2004; Wilkinson et al., 2011; Aggarwal et al., 2017; Song et al., 2022). While DSH was used to denote self-injury behaviors with or without suicidal intent that have non-fatal outcomes, NSSI was employed to describe the deliberate damage to body tissue of oneself without suicidal intent (Muehlenkamp et al., 2012; Samari et al., 2020). DSH and NSSI are also closely related with poor mental health conditions such as depression and substance misuse (Zahl and Hawton, 2004; Moran et al., 2015). Despite the worldwide prevalence of suicide behaviors, differential prevalence of DSH and NSSI of regions with different culture, ethnicity and socioeconomic status have been reported. A recent meta-analysis found non-western countries and low- and middle-income countries have higher aggregate prevalence of DSH and NSSI (Lim et al., 2019). Therefore, exploring risk factors of suicide behaviors of youth in the low- and middle-income regions would provide crucial insight to inform the development of preventive strategies of suicide behaviors such as NSSI and thus reduce suicide death among the most vulnerable group.

Adolescence is a period with prominent brain maturation which extends into the third decade of our life (Kolk and Rakic, 2022). One characteristic of this process is the developmental mismatch between the early maturation of the subcortical structure including the affective system such as amygdala, which typically developed during adolescence (12-17 years old) (Somerville et al., 2010), and the more protracted development of the cognitive-regulatory system including the prefrontal cortex which reached full maturation in early adulthood (Nelson et al., 2005). This developmental mismatch likely leads to a deficit of prefrontal regulation of affect processing that contributes to increased risk-taking and impulsive behaviors (Nelson et al., 2005; Peake et al., 2013), including increased self-harm behaviors. Longitudinal study on the trajectories of suicide behaviors of the adolescent has indeed reported that a group of individuals have highest level of suicide behaviors starting early adolescence and gradually reduce in early adulthood while the suicide ideation peaks at late adolescence (age 17) (Erausquin et al., 2019). Studies of NSSI have also suggested that this behavior frequently onset between age 12 and 14 (Jacobson and Gould, 2007) with rise in prevalence during middle adolescence (Barrocas et al., 2015) and gradually reduced in young adulthood (Swannell et al., 2014). Though ample studies have examined the risk factors and predictors of self-harm behaviors of adolescent (Valencia-Agudo et al., 2018; Abdelraheem et al., 2019), studies on the differential risk factors of NSSI at different developmental stages during the adolescence period are lacking. ...

Language: en

Keywords

Adolescent and youth; COVID-19; Developmental stages; Mental health; Non-suicidal self-injury