Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury
Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury
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DOI：
10.1111/jcpp.12385
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发表时间：
2015-10-01
影响因子：
7.6
通讯作者：
Spirito, Anthony
中科院分区：
文献类型：
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作者：
Dickstein, Daniel P.;Puzia, Megan E.;Spirito, Anthony
背景：自杀是当今影响青少年的最重要的心理健康问题之一，尽管对其检测和预防的研究很多。除了自杀未遂(SAS)，临床医生还面临着另一个潜在的相关问题：非自杀性自残(NSSI)-定义为故意破坏身体组织而不打算死亡。NSSI可能会使患SA的风险增加七倍，但许多研究表明这一联系涉及同时从事NSSI和SAS的年轻人。因此，有必要对只接受NSSI或只接受SA的同质青少年群体进行比较，但不能两者兼而有之，以促进对每种形式的自我伤害的了解。自伤内隐联想任务(SI-IAT)是研究这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动机隐瞒的问题的客观行为数据，如SAS和NSSI。方法：我们使用计算机化的SI-IAT在三个相互排斥的组中评估切割和死亡/自杀的内隐相关性：(1)做过SA但从未参加过NSSI的青少年(n=47)；(2)参加过NSSI但从未做过SA的青少年(n=46)；(3)典型的发展对照(TDC)青少年(n=43)。结果：与SA或TDC参与者相比，非自杀性自伤参与者对切割的认同感更强。与我们的假设相反，NSSI参与者对自杀/死亡与生命的认同感比SA或TDC参与者更强。结论：在没有SA的青少年中，NSSI患者对自杀/死亡的强烈内隐态度表明，临床医生不应该认为NSSI并不严重。需要进一步的工作来阐明参与NSSI的年轻人获得这些更强的身份认同的机制，并首次进行SA以开发阻止这种转变的新的治疗和预防策略，最终减少青少年自杀。
Background: 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. Methods: 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). Results: 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. Conclusions: 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.