Abstract
Background
The knowledge of how the separate Attention-Deficit/Hyperactivity Disorder (ADHD) subdimensions (impulsivity, hyperactivity, and inattention) are associated with nonsuicidal ...self-injury (NSSI) and suicidal behavior (SB) is limited. The objective of this study was to investigate the associations of childhood ADHD subdimensions with NSSI and SB in children at risk of neurodevelopmental disorders (NDDs; including ADHD).
Methods
The sample (N = 391) included twin pairs where at least one twin screened positive for at least one NDD or common comorbidity at age 9 or 12. Data on ADHD subdimensions was collected through a telephone interview with a caregiver/legal guardian at age 9 or 12, and data on NSSI and SB was collected through an in-person clinical assessment at age 15. The associations between the ADHD subdimensions and NSSI or SB were tested in three different models: (1) univariable, (2) together with the other ADHD subdimensions, and (3) in a confounder-adjusted model including other NDD symptoms in addition to ADHD subdimensions, for NSSI and SB separately.
Results
A total of 32 (8.2%) adolescents reported life-time engagement of NSSI, and 18 (4.6%) SB. Childhood impulsivity was associated with SB and childhood inattention with NSSI, in all models. Hyperactivity was not meaningfully associated with any of the outcomes.
Conclusion
Impulsivity and inattention, but not hyperactivity, may be of particular importance in understanding SB and NSSI. Brief screening for impulsivity and inattention in childhood could facilitate detection of children vulnerable to NSSI and SB and indicate valuable information for preventive and intervention strategies.
To examine associations between race, ethnicity, and parent-child nativity, and common mental health conditions among U.S. children and adolescents.
Data were from 2016 to 2019 National Survey of ...Children's Health, a US population-based, serial cross-sectional survey, and restricted to children who had access to health care. We used weighted multivariable logistic regression to examine the associations between race and ethnicity (Asian, Black, Hispanic, White, Other-race); mental health outcomes (depression, anxiety, and behavior/conduct problems) stratified by household generation; and between household generation and outcomes stratified by race and ethnicity, adjusting for demographics (age, sex, family income to poverty ratio, parental education), and an adverse childhood experience (ACE) score.
When stratifying by household generation, racial and ethnic minority children generally had similar to lower odds of outcomes compared with White children, with the exception of higher odds of behavior/conduct problems among third + -generation Black children. When stratifying by race and ethnicity, third + generation children had increased odds of depression compared to their first-generation counterparts. Third + generation, racial and ethnic minority children had increased odds of anxiety and behavior/conduct problems compared with their first-generation counterparts. The associations generally remained significant after adjusting for the ACE score.
Lower odds of common mental health conditions in racial and ethnic minority children could be due to factors such as differential reporting, and higher estimates, including those in third + generation children, could be due to factors including discrimination; systemic racism; and other factors that vary by generation and need further investigation to advance health equity.
Background
More knowledge about risks of clinical outcomes associated with nonsuicidal self‐injury (NSSI) and suicide attempts (SAs) is needed to inform risk assessment and intervention.
Methods
...Longitudinal cohort study based on 1,855 youths was clinically assessed for NSSI and SA, and followed up (from December, 2011 to December 2013) for the outcomes; diagnosed self‐injury, alcohol/substance use disorder, and psychiatric inpatient care data derived from Swedish registers. Hazard ratios (HRs) and 95% confidence intervals (CIs) of the outcomes were estimated with Cox regressions, and additionally adjusted for the potential effect of sex and the number of clinical assessments. NSSI and SA were treated as time‐varying covariates.
Results
Youths with NSSI had elevated risks of all outcomes, compared with youths without NSSI or SA; the HR was 2.3, 95% confidence interval 1.6, 3.4 for self‐injury, 1.4 0.9, 2.1 for alcohol/substance use disorder, and 1.3 1.0, 1.7 for psychiatric inpatient care. Youths with SA displayed higher risks for the outcomes than the NSSI group; the HR was 5.5 2.4, 12.6 for self‐injury, 2.0 0.9, 4.4 for alcohol/substance use disorder, and 2.6 1.5, 4.5 for psychiatric inpatient care. Youths with both NSSI and SA showed similar risks as youths with SA; HR 4.1 2.0, 8.3 for self‐injury, 2.0 1.1, 4.1 for alcohol/substance use disorder, but a higher risk of psychiatric inpatient care; HR 5.0 3.1, 7.9. All results remained virtually unchanged in the adjusted analyses.
Conclusions
Youths with NSSI and/or SA had higher risks for subsequent adverse clinical outcomes. These excess risks were more pronounced among youths with SA and youths with both NSSI and SA, and the risk for psychiatric inpatient care was particularly high in youths with both NSSI and SA. Our findings suggest that early interventions for youths with NSSI or SA should not exclusively focus on suicide prevention, but also consider the risk of subsequent alcohol/substance use disorder.
Objective
Self‐harm among young autistic individuals is a clinical challenge, and the risk of premature death by suicide is strongly increased in this group. Using the advantage of total‐population ...and family‐based data, we investigated whether autism per se is a risk factor for self‐harm independently of psychiatric comorbidities and how it differs from self‐harm in non‐autistic individuals.
Methods
We used The Stockholm Youth Cohort, a total‐population register study, including all residents in Stockholm County aged 0–17 years between 2001 and 2011.Study participants were followed from age 10 to 27 for hospital admissions because of self‐harm. We used modified Poisson regression to calculate relative risks (RR) using robust standard error to derive 95% confidence intervals (CI).
Results
In all, 410,732 individuals were included in the cohort (9,070 with a diagnosis of autism). Autistic individuals had a fivefold increased adjusted relative risk of self‐harm (RR 5.0 95% CI 4.4–5.6). The risk increase was more pronounced for autism without intellectual disability and particularly high for self‐cutting 10.2 7.1–14.7 and more violent methods 8.9 5.2–15.4. The association between autism and self‐harm was independent of, but clearly exacerbated by comorbid psychiatric conditions. It was of similar magnitude as risks linked to these conditions per se, and not explained by shared familial factors.
Conclusion
Self‐harm severe enough to present to medical services is as common in autistic youth as in those with depression or ADHD. Potentially more lethal methods are more likely to be used of autistic self‐harmers.
Abstract Higher education is an increasingly necessary achievement to attain employment. However, even in cases where a student has the academic skills to succeed, educational environments may not ...support students across all other domains necessary for education success, including social and communication needs. This is especially true for students with disabilities and autistic students, where the rate of completion of non-compulsory education is unknown. We used the Stockholm Youth Cohort (children aged 0–17 years from 2001 to 2011), a total population cohort ( N = 736,180) including 3,918 autistic individuals, to investigate the association between autism without intellectual disability and completion of upper secondary education. We assessed the impact of sex and co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) on this association. By age 20 years (the expected age of completion), 68% of autistic students and 91% of non-autistic students admitted to upper secondary education had completed. In logistic regression models adjusted for student demographics, autistic students had almost five-fold higher odds of not completing secondary school (OR 4.90, 95% CI 4.56 5.26) compared to their non-autistic peers. Autistic students with ADHD had particularly high odds of non-completion of upper secondary school. Autistic students without intellectual disability attending mainstream education are substantially less likely to complete upper secondary education as compared to their peers. These findings have implications for the appraisal of how inclusive school policies serve autistic students’ academic and social needs, ultimately addressing population health and independent living.
Abstract Introduction Both suicide and self‐harm are disproportionately common in autistic people. Sex differences in risk of self‐harm and suicide are observed in the general population, but ...findings are mixed for autistic people. Self‐cutting may be a particularly risky self‐harm behaviour for suicide in autistic people. We aimed to explore sex differences and differences in method of self‐harm in the association between self‐harm and suicide in autistic and non‐autistic adolescents and young adults. Methods We used a total population register of 2.8 million Swedish residents. Participants were followed from age 12 until December 2021 for medical treatment because of self‐harm, and death from suicide. We used Cox proportional hazard regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of death from suicide following self‐harm, and Relative Excessive Risk due to Interaction (RERI) to explore the interaction between self‐harm and autism in females and males. Results We identified 85,143 autistic individuals (31,288 female; 53,855 male) and 2,628,382 non‐autistic individuals (1,286,481 female; 1,341,901 male) aged 12–37 years. Incidence of suicide following self‐harm was higher in autistic males (incidence per 100,000 risk‐years = 169.0 95% CI 135.1, 211.3) than females (125.4 99.4, 158.3). The relative risk was higher for autistic females (HR 26.1 95% CI 20.2, 33.7) than autistic males (12.5 9.9, 15.8). An additive effect of both autism and self‐harm was observed in both females (RERI = 9.8) and males (2.0). Autistic individuals who self‐harmed through cutting were at greatest risk of death from suicide (HR 25.1 17.9, 35.2), compared to other methods. Conclusion Autistic males and females are at increased risk of death from suicide following severe self‐harm, particularly self‐cutting.
Objective
Childhood attention‐deficit /hyperactivity disorder (ADHD) is known to be associated with adult Borderline Personality Disorder (BPD). We investigated if any of the subdimensions of ...childhood ADHD, that is, impulsivity, inattention, or hyperactivity was more prominent in this association.
Methods
In a nation‐wide cohort (N = 13,330), we utilized parent reported symptoms of childhood ADHD and clinically ascertained adult BPD diagnoses. The summed total scores of ADHD symptoms and its three subdimensions were used and standardized for effect size comparison. Associations were analyzed using Cox regression with sex and birth‐year adjustments. Secondary outcomes were BPD‐associated traits (i.e., self‐harm and substance use) analyzed using logistic‐ and linear regression respectively.
Results
ADHD symptom severity was positively associated with BPD with a hazard ratio (HR) of 1.47 (95% confidence interval CI: 1.22–1.79) per standard deviation increase in total ADHD symptoms. Impulsivity was the most prominent subdimension with the only statistically significant association when analyzed in a model mutually adjusted for all ADHD subdimensions—HR for inattention: 1.15 (95% CI: 0.85–1.55), hyperactivity: 0.94 (95% CI: 0.69–1.26), impulsivity: 1.46 (95% CI: 1.12–1.91). In secondary analyses, weak positive associations were seen between total ADHD symptom score and self‐harm and substance use. In analyses by subdimensions of ADHD, associations were weak and most prominent for inattention in the model with self‐harm.
Conclusion
Childhood ADHD symptoms were associated with subsequent development of BPD diagnosis and appeared to be driven primarily by impulsivity. Our findings are important for understanding the association between childhood symptoms of ADHD and subsequent BPD.
Background
Self‐harm is common and there is a need for studies that investigate the relevance of this behavior in clinical samples to inform risk assessment and treatment. The objectives in the ...current studies were to compare clinical and psychosocial correlates and subsequent adverse outcomes in youth who present to child and adolescent mental health services (CAMHS) with self‐harm only (SH), self‐harm with suicidality (SH+SU), with those without any indication of SH or SH+SU.
Methods
We conducted a case–control study and a longitudinal cohort study using data from a regional clinical care register, and Swedish national registers. The case–control study included all patients (5–17 years) between 2011 and 2015 (N = 25,161). SH and SH+SU cases were compared with controls (patients without SH) regarding a range of correlates. The longitudinal study included former CAMHS patients (N = 6,120) who were followed for a median time of 2.8 years after termination of CAMHS contact regarding outcomes such as clinical care consumption, social welfare recipiency, and crime conviction.
Results
In the case–control study, both the SH and SH+SU groups received more clinical care, had lower global functioning, and higher odds of having mental disorders compared to controls. In most comparisons, the SH+SU group had more problems than the SH group. In the longitudinal study, the same pattern emerged for most outcomes; for example, the adjusted hazard ratio for recurrent care due to self‐harm was 23.1 (95% confidence interval CI, 17.0–31.4) in the SH+SU group compared to 3.9 (95% CI, 2.3–6.7) in the SH group.
Conclusions
Adolescent patients presenting with self‐harm have higher risks for adverse outcomes than patients without self‐harm. Suicidality in addition to self‐harm is associated with more severe outcomes, importantly recurrent episodes of care for self‐harm.
Background: Self-harm among adolescents is prevalent, and is a risk factor for suicide, which is one of the leading causes of death among youth worldwide. There is a need to better understand the ...role and impact of self-harm within clinical samples, and the subsequent risks associated with self-harm with and without suicidal intent. Dialectical behavior therapy (DBT) has the strongest empirical support for treatment of self-harm among adolescents, and extended knowledge on important treatment components is critical for the development of brief, efficacious interventions that are easily accessible for adolescents.Aim: The aims were to• Study clinical and psychosocial correlates as well as long-term outcome among clinical samples with self-harm• Explore experiences of care among young adults who have participated in specialist- level interventions targeting self-harm (i.e. DBT)Methods: The clinical and psychosocial correlations was studied in a case-control study (N = 25,161) comparing three subgroups of patients; 1) self-harm only, 2) self-harm and suicidality, and 3) neither self-harm nor suicidality (controls). Linear regression and logistic regression were used to calculate associations. Outcomes were studied in three different longitudinal cohort studies: 1) outcomes after self-harm with and without suicidal ideation/behavior (N = 6,120) , 2) outcomes for boys or girls with self-harm (N = 110,072) , and 3) outcomes after nonsuicidal self-injury (NSSI) or suicide attempt (SA) using NSSI and SA as time-varying covariates (N = 2,219). By using Cox regression, Hazard Ratios with 95% Confidence Intervals were estimated for each outcome. Salient treatment components were studied with a qualitative analysis of 19 semi-structured interviews with former DBT patients.Results: Self-harm within clinical populations was associated with higher clinical and psychosocial burden and higher risk of adverse outcomes, e.g. alcohol/substance misuse, violent and nonviolent criminality, as compared with patients with no self-harm. Patients with both self-harm and suicidality are the most vulnerable group. The young self-harming patient valued a therapist who showed explicit concern and trust in the patient’s competence to change destructive behaviors, but also meeting and learning from peers.Conclusion: Help-seeking boys and girls with self-harm need appropriate care and assessment, including prevention and treatment of alcohol and substance use. Self-harm might serve as a risk marker for emotion dysregulation and impulsivity within both sexes.Suicidality in addition to self-harm need to be regularly assessed and signals highly increased risks for future adverse outcomes. Interventions that lower the risks are necessary. Young patients with self-harm, can be strongly motivated, and work hard, to improve their well- being and pursue a life worth living. Teaching and learning from peers might be of particular value and importance among adolescents.
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