Assessment of Somatosensory Function and Self-harm in Adolescents.
Assessment of Somatosensory Function and Self-harm in Adolescents.
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DOI：
10.1001/jamanetworkopen.2021.16853
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发表时间：
2021-07-01
影响因子：
13.8
通讯作者：
Ougrin D
中科院分区：
文献类型：
--
作者：
Cummins TM;English O;Minnis H;Stahl D;O'Connor RC;Bannister K;McMahon SB;Ougrin D
这项横断面研究评估了青少年的躯体感觉功能，并将他们的躯体感觉特征与社区对照参与者进行比较，以调查与自我伤害发生率和频率的相关性。疼痛敏感性与12至17岁儿童和青少年的自我伤害频率相关吗？这项横断面研究的64名青少年系统地检查了一系列的疼痛和非疼痛的感觉刺激的敏感性。疼痛低敏感性与自我伤害频率显著相关，这些发现也延伸到非疼痛的感觉刺激;压力疼痛阈值与自我伤害发生率的显著特异性和敏感性相关。这些发现表明，压力疼痛阈值是一种新的生物标志物，用于识别青少年自我伤害的高风险。自我伤害是青少年自杀的一个危险因素，在团体和寄宿护理计划中的年轻人中发病率最高。虽然没有确定的风险因素存在自我伤害，青少年谁自我伤害可能会降低疼痛敏感性，但这还没有得到系统的研究。使用定量感觉测试（QST）评估儿童和青少年的躯体感觉功能，这些儿童和青少年在过去一年中根据自我伤害事件的数量分组，并将他们的躯体感觉特征与社区对照参与者进行比较，以调查与自我伤害发生率或频率的关联。这项横断面研究的招募从2019年1月开始，到2020年3月结束。排除标准包括智力残疾（智商<70）、自闭症谱系障碍或近期严重受伤。从英国格拉斯哥的地方当局寄宿护理机构以及英国伦敦和格拉斯哥的学校和青年团体招募了12至17岁的儿童和青少年，他们没有基础健康状况。64名志愿者样本包括13至17岁的青少年（34名[53%]女性; 50名[78%]居住在寄宿护理机构;平均[SD]年龄，16.34 [1.01]岁），在过去一年中发生了不同程度的自我伤害事件（无发作，31例[48%]; 1 - 4次发作，12例[19%]; ≥ 5次发作，2例[33%]）。参与者使用标准化QST协议进行测试，以建立基线体感功能。计算了躯体感觉敏感性、自残发生率和频率、居住状况、年龄、性别和处方药之间的关系。次要结局评估自我伤害是否与特定类型的测试（即疼痛或非疼痛）相关。共有64名13至17岁的参与者完成了测试（平均[SD]年龄，16.3 [1.0]岁; 34 [53%。女性和30名[47%]男性; 50名[78%]生活在集体之家）。在调整年龄、性别和处方药使用后，与社区对照组相比，发生5次或5次以上自残事件的青少年表现出显著的疼痛敏感性降低（SH组与对照组相比：-1.03 [95%CI，-1.47至-0.60]; P <.001）。敏感性降低也扩展到非疼痛刺激，类似地调整（SH组与对照组相比，发作5次或5次以上：-1.73; 95%CI，-2.62至-0.84; P <0.001）。压力疼痛阈值解释了观察到的大部分差异（31.1%[95%CI，10.5%至44.7%]; P <0.001）。这项研究的结果表明，感觉敏感性减退是自我伤害的青少年的一种表型，并且压力疼痛阈值具有临床潜力，可以作为一种快速，廉价，易于解释的测试来识别重复自我伤害风险增加的青少年。
This cross-sectional study assesses somatosensory function in adolescents and compares their somatosensory profiles with community control participants to investigate associations with the incidence and frequency of self-harm. Is pain sensitivity associated with self-harm frequency in children and adolescents aged 12 to 17 years? This cross-sectional study of 64 adolescents systematically examined sensitivity to a range of painful and nonpainful sensory stimuli. Pain hyposensitivity was significantly associated with self-harm frequency, and these findings also extended to nonpainful sensory stimuli; pressure pain threshold was associated with significant specificity and sensitivity for incidence of self-harm. These findings suggest that pressure pain threshold is a novel biomarker for identifying adolescents at high risk of self-harm. Self-harm is a risk factor for suicide in adolescents, with the prevalence highest in young people in group and residential care programs. Although no established risk factors for self-harm exist, adolescents who self-harm may have decreased pain sensitivity, but this has not been systematically investigated. To assess somatosensory function using quantitative sensory testing (QST) in children and adolescents living in care grouped by the number of episodes of self-harm in the past year and compare their somatosensory profiles with community control participants to investigate associations with the incidence or frequency of self-harm. Recruitment for this cross-sectional study began January 2019 and ended March 2020. Exclusion criteria included intellectual disability (intelligence quotient <70), autism spectrum disorder, or recent serious injury. Children and adolescents aged 12 to 17 years with no underlying health conditions were recruited from local authority residential care settings in Glasgow, UK, and schools and youth groups in London and Glasgow, UK. The volunteer sample of 64 participants included adolescents ages 13 to 17 years (34 [53%] females; 50 [78%] living in residential care; mean [SD] age, 16.34 [1.01] years) with varying incidents of self-harm in the past year (no episodes, 31 [48%]; 1-4 episodes, 12 [19%]; and ≥5 episodes, 2 [33%]). Participants were tested using a standardized QST protocol to establish baseline somatosensory function. Associations between somatosensory sensitivity, incidence and frequency of self-harm, residential status, age, gender, and prescription medication were calculated. Secondary outcomes assessed whether self-harm was associated with specific types of tests (ie, painful or nonpainful). A total of 64 participants ages 13 to 17 years completed testing (mean [SD] age, 16.3 [1.0] years; 34 [53%.] females and 30 [47%] males; 50 [78%] living in group homes). Adolescents with 5 or more self-harm incidences showed significant pain hyposensitivity compared with community control participants after adjusting for age, gender, and prescription drug use (SH group with 5 or more episodes vs control: −1.03 [95% CI, −1.47 to −0.60]; P < .001). Hyposensitivity also extended to nonpainful stimuli, similarly adjusted (SH group with 5 or more episodes vs control: −1.73; 95% CI, −2.62 to −0.84; P < .001). Pressure pain threshold accounted for most of the observed variance (31.1% [95% CI, 10.5% to 44.7%]; P < .001). The findings of this study suggest that sensory hyposensitivity is a phenotype of Adolescents who self-harm and that pressure pain threshold has clinical potential as a quick, inexpensive, and easily interpreted test to identify adolescents at increased risk of repeated self-harm.
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