Research progress on the addictive characteristics of non-suicidal self-injury.

In recent years, especially after the outbreak of COVID-19, a large number of non-suicidal self-injury (NSSI) behaviors in adolescents have emerged, which has attracted wide attention from the society and become a serious public mental health problem. Repeated NSSI is also considered as an addictive behavior, which shares many similar neurobiological mechanisms with substance addiction, such as the dopamine reward system and the endogenous opioid system. This paper aims to review the domestic and international research progress on the characteristics of addiction in NSSI, including the general background, mechanism, assessment, and intervention.Copyright © 2022 Chinese Journal of Psychiatry. All rights reserved

The First Wave of COVID-19 in Forensic Psychiatry: A Rapid Review Series

At the beginning of the pandemic, experts expected an increasing number of hospitalizations in forensic settings, uncontrollable outbreaks of COVID-19, and deterioration of mental health of residents within institutions. Certain publications corroborated these concerns;however, no synthesis of the results of empirical publications at the initial stage of the pandemic has yet been conducted. Three rapid reviews were conducted on these topics. Besides almost a two-fold decrease in the total number of urgent consultations/hospitalizations, there were no changes in the number of involuntary hospitalizations, suicide attempts, and psychoses. The COVID-19 morbidity and mortality rates in secure institutions were compatible with the general population. However, the lockdown period was associated with a significant increase in self-harm in secure settings.

Comparisons of mental health symptoms, treatment access, and self-harm behaviors in rural adolescents before and during the COVID-19 pandemic.

The COVID-19 pandemic disrupted the lives of adolescents worldwide, and research on the mental health effects are ongoing. Adolescents living in rural areas of the United States were already known to be at a disadvantage in terms of access to mental health services, as well as elevated rates of mental health concerns and self-harm risk. Research on how these factors may have changed since the pandemic began is needed to better understand which areas saw the biggest impact and where we can best direct resources to assist youth. Data from the current study were taken from a project examining adolescent mental health and self-harm risk. The pandemic disrupted the timeline for the study resulting in data being collected in two separate waves: before (n = 695) and after (n = 206) the pandemic began. Comparisons were made between these two samples on multiple factors including depression, anxiety, emotion dysregulation, alcohol and substance use, experiencing of bullying, overall impairment, mental health services access, and self-harm. Results indicated that adolescents in the pandemic sample were more likely to have seen a counselor and been hospitalized for a mental health reason, and were more likely to have experienced past-year suicide thoughts and plans than adolescents in the pre-pandemic sample. The pandemic sample also showed more depression and anxiety symptoms, greater emotion dysregulation, and greater intensity of recent suicide ideation. Implications for assisting youth through post-pandemic times are discussed.

Traumatic pediatric firearm injuries during the COVID-19 pandemic

Statement of Purpose: The purpose of this study is to epidemiologically describe firearms injuries treated at a Level 1 pediatric trauma center occurring during the COVID-19 pandemic and compare them to injuries seen in the year prior.Methods: This is a retrospective chart review of patients seen by pediatric trauma surgery for a firearm injury between February 1, 2019 and March 30, 2021;the pre-pandemic time period included February 1, 2019 – March 9, 2020 and the pandemic period included March 10, 2020 – March 31, 2021. We excluded patients with firearms injuries that were not assessed by trauma surgery and patients with injuries from non-powder guns.Results: Twenty-eight patients were seen for firearm injuries in the pre-pandemic period;22 (78.5%) were male, and the mean age was 13.3 years, with 17.8% of patients < 10 years old. Sixteen (57.1%) were black, 8 (28.6%) white, and 4 (14.3%) multiracial. The pandemic period included 80 patients with firearm injuries, with 59 (74%) male, and a mean age of 12.5 years. Seventeen (21.5%) were < 10 years old. Fifty-six (70%) of patients during the pandemic period were black, 15 (20%) white, 6 (7.5%) multiracial, and 2 (2.5%) Hispanic. There was no statistically significant difference between the two groups demographically. No patients were identified as having an intentional self-inflicted firearm injury.Conclusion: While there was a nearly threefold increase in pediatric firearm injuries seen during the pandemic, the demographics of the victims have not changed compared to pre-pandemic patterns. This reflects a need for ongoing and targeted preventive measures to reduce these extremely high-risk injuries.Key Take Away Points [list] [list] [list_item] Since the World Health Organization (WHO) declared a pandemic from the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 or COVID-19), there has been a dramatic increase in the number of pediatric firearm injuries identified when compared to the preceding year. [/list_item] [list_item] A continued pattern of racial distribution before and during the pandemic with black children being overrepresented in the population with firearm injury as compared to all injuries seen was identified, with an overwhelming majority of firearm injuries occurring in urban areas. [/list_item] [list_item] The profound escalation of firearm injury in the pediatric population during the pandemic demonstrates the critical need for intensive community intervention and prevention efforts. [/list_item] [/list]

Impact of the COVID-19 pandemic on students at elevated risk of self-injury: The importance of virtual and online resources

Non-suicidal self-injury (NSSI), which involves deliberate damage to body tissue without suicidal intent, has long been a concern for schools and school staff. Secondary schools are an ideal setting in which to identify, and appropriately refer, students who self-injure as well as implement evidence-based prevention and early intervention programs. However, in the context of the global COVID-19 pandemic, schools have been closed and students sent home to learn online. This may result in the exacerbation of existing anxieties and pose several new stressors that cumulatively may increase risk of NSSI. In this article, we draw on recent research and our collective experience working with schools, as well as digital mental health, to outline some of these potential stressors and offer resources for school staff to help students who are engaging in or at risk of NSSI. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Pain tolerance feedback and deliberate self-harm in men and women

There is a growing literature supporting the idea that those who engage in non-suicidal deliberate self-harm (DSH) have altered pain perception compared to individuals who do not. For example, individuals who report a history of non-suicidal DSH behavior have a decreased sensitivity to transient pain during laboratory-based pain induction (e.g., Glenn et al., 2014). Research suggests that brief manipulations targeting individual beliefs can affect performance on subsequent tasks, including measures of pain sensitivity. To date, however, no study has examined the effects of experimentally manipulated pain perception on DSH behavior. The Self-Aggression Paradigm (SAP: Berman & Walley, 2003;McCloskey & Berman, 2003) allows for the prospective observation of the effects of experimental manipulations on a laboratory analogue of DSH. Therefore, the aim of the current study was to determine if experimentally manipulated false feedback about pain tolerance affects DSH behavior during the SAP, thus potentially providing evidence for a causal linkage between pain perception and DSH. Eighty participants were randomly assigned to one of three feedback groups: High pain tolerance, low pain tolerance, and a control condition with neutral feedback provided after completing the SAP. Participants were provided false feedback regarding their pain tolerance after a pressure algometer task. It was predicted that participants in the high pain tolerance feedback group would have the highest DSH on the SAP, with DSH defined as the level of shock self-administered during a series of reaction-time trials. No significant group differences, however, emerged based on group assignment. Men engaged in more DSH than women during the study independent of feedback group assignment. A secondary aim of the current study was to provide further validation for the SAP using multiple pain induction modalities. Implications of the current findings and future research directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The psychosocial consequences of covid-19 in adolescents with nonsuicidal self-injury.

BACKGROUND: Young people have been especially affected by the psychosocial consequences of the covid-19 pandemic. Covid-19 has potentially also been more stressful for vulnerable groups with mental health problems. METHODS: In this cross-sectional study, the psychosocial effects of covid-19 in a vulnerable group of adolescents with nonsuicidal self-injury (NSSI) from a sample of 1602 Swedish high-school students were examined. Data were collected in 2020 and 2021. First, adolescents with and without NSSI were compared on how they perceived the psychosocial impact of covid-19, and second, a hierarchical multiple regression analysis was used to examine whether lifetime NSSI experience was associated with perceived psychosocial consequences of covid-19, when demographic variables and symptoms of mental health problems were controlled for. Interaction effects were also examined. RESULTS: Significantly more individuals with NSSI reported being burdened by covid-19 compared to those without NSSI. When demographic variables and mental health symptoms were controlled for, adding NSSI experience did not, however, increase the amount of variance explained in the model. The total model explained 23.2% of the variance in perceived psychosocial impact of covid-19. Perceiving the family's financial situation as poor and neither good nor bad, studying a theoretical high school program, symptoms of depression and difficulties with emotion regulation were significantly associated with perceived negative psychosocial impact of the covid-19 pandemic. There was a significant interaction effect between NSSI experience and depressive symptoms. The effect of NSSI experience was larger when depressive symptoms were lower. CONCLUSIONS: Lifetime NSSI experience in itself was not associated with psychosocial covid-19 consequences when other variables were controlled for, whereas symptoms of depression and difficulties with emotion regulation were. Results imply that vulnerable adolescents with mental health symptoms need special attention and access to mental health support in order to prevent further stress and worsening of mental health symptoms in the wake of the covid-19 pandemic.

[Effect of Family Environment on Non-Suicidal Self-Injury Among Middle School Students During the COVID-19 Epidemic: The Mediating Role of Depression].

Objective: To study the current status of non-suicidal self-injury (NSSI) incidents among middle school students in Chengdu during the COVID-19 epidemic and to explore the mechanism of action of depression on the relationship between family environment and NSSI. Methods: Data were obtained from the Chengdu Positive Child Development (CDPD) cohort. In June and July 2020, after primary and secondary schools were reopened after the closure due to the COVID-19 epidemic, on-site questionnaire surveys were conducted with the Deliberate Self-Harm Inventory (DSHI), the Chinese Family Assessment Instrument (C-FAI), and Center for Epidemiologic Studies Depression Scale for Children (CES-DC), thereby obtaining the data of 3595 middle school students. Two-sample t-test and χ 2 test were used to compare the incidence of NSSI among middle school students of different grades and genders, and the Model 58 test of the SPSS PROCESS component was used to analyze the mediating effect of gender-mediated depression. Results: 1) The incidence of NSSI among middle school students in Chengdu during the COVID-19 epidemic was 49.67%. The incidence of NSSI among ninth-graders (80.70%) was significantly higher than those of the eighth graders (33.82%) and seventh graders (32.32%), and the incidence of NSSI among female middle school students (54.75%) was significantly higher than that of male students (44.52%). 2) Family environment ( r=0.34, P<0.001) and depression ( r=0.50, P<0.001) were positively correlated with NSSI. 3) Depression partially mediated the effect of family environment on NSSI, with the mediating effect accounting for 64.64% of the total effect. Compared with that of male students, the positive predictive effect between family environment and depression and that between depression and NSSI in female middle school students were more significant. Conclusion: During the COVID-19 pandemic, middle school students in Chengdu had a high incidence of NSSI, which indicates that the family environment should be improved, more attention should be given to gender differences, and early screening and intervention for depression should be strengthened to reduce the incidence of NSSI.

Borderline personality disorder traits and rates of NSSI during the COVID-19 pandemic: An initial investigation.

Objective: The current study evaluated frequency of nonsuicidal self-injury (NSSI) and associated maladaptive traits between three time periods: pre-pandemic, early pandemic, and later pandemic. Participants: Two college student samples (n = 362; n = 337) were collected via two online studies. Method: Participants completed measures assessing maladaptive borderline personality traits, engagement in NSSI over the past month, and reasons for and types of NSSI engaged in across the lifetime. Results: Results demonstrated a stable and potentially a slight increase in general rates of NSSI over the course of the pandemic. Further, specific maladaptive traits that underly borderline personality disorder (i.e., despondence, fragility, self-disturbance, and anxious-uncertainty) were related to engagement in NSSI 1-month post COVID. Conclusion: The study highlights the need for added interventions that might reach at risk populations during these heightened periods of stress.

Adolescent non-suicidal self-injury during the COVID-19 pandemic: A prospective longitudinal study of biological predictors of maladaptive emotion regulation.

BACKGROUND: Non-suicidal self-injury (NSSI) in adolescence is thought to stem from interactions between vulnerability in developing biological systems and experience of stressors. The current study assesses whether multiple levels of the stress system's response to threat could prospectively predict NSSI engagement during the COVID-19 pandemic, a shared, time-locked stressor. METHODS: Participants were 64 female adolescents (ages 12-16) from community and clinical settings who were oversampled for NSSI histories. Prior to the onset of the COVID-19 pandemic, adolescents completed a protocol that measured hypothalamic-pituitary-adrenal axis response to a social stressor (via salivary cortisol), amygdala volume, amygdala emotion-evoked activation, and frontolimbic resting-state functional connectivity. During early months of the pandemic (Summer 2020), measures of NSSI behavior (Inventory of Statements About Self-Injury), emotion regulation difficulties (Difficulties in Emotion Regulation Scale), perceived stress (Perceived Stress Scale), and pandemic-related stressors (Epidemic Pandemic Impacts Inventory) were collected. Multinomial logistic regression was used to assess if pre-pandemic biomarkers predicted mid-pandemic NSSI engagement: persistence of NSSI (Persist; N = 21), cessation of NSSI (Desist; N = 26), and no history of NSSI (Never; N = 17). Linear regressions explored if pre-pandemic biomarkers predicted mid-pandemic difficulties in emotion regulation and perceived stress. RESULTS: Higher pre-pandemic overall cortisol response to stress and amygdala emotion-evoked activation characterized adolescents who persisted in NSSI, compared to those who desisted. These findings remained significant when controlling for pandemic related stressors. Lower prepandemic cortisol reactivity predicted more difficulties in emotion regulation during the pandemic. This finding did not remain significant after controlling for pandemic related stressors. CONCLUSIONS: Findings suggest that patterns in key biological threat response systems may confer vulnerability for risk outcomes including NSSI engagement in adolescent females in the context of a shared, novel, naturally-occurring stressor. The results point to the importance of multi-level, longitudinal approaches for understanding the interface between developing neurobiological systems and experiential stress in at-risk adolescents. Identified patterns give insight into potential risk assessment strategies based on an understanding of the multi-level threat response.

Non-suicidal self-injury and emotional burden among university students during the COVID-19 pandemic: cross-sectional online survey.

Owing to restrictions of the COVID-19 pandemic, increased stress is evident in university students with a lifetime history of non-suicidal self-injury (NSSI). Therefore, we examined two groups of university students (n = 174) in an online survey, one that exhibited early NSSI in adolescence (n = 51) and another that exhibited continuous NSSI beyond the age of 18 (n = 123) (German Clinical Trials Register DRKS00023731). We compared the two groups in terms of depressive symptoms in the previous 2 weeks as well as self-perceived changes in emotional burden, urge to self-injure and NSSI frequency in the first year of the pandemic compared with the year before (pre-pandemic). Among other findings, both groups showed an increase in emotional burden and urge to self-injure.

Self-harm in Young People: Investigating the Role of Resilience and Posttraumatic Stress Related to the COVID-19 Pandemic.

Evidence shows that young people may have experienced increased levels of posttraumatic stress and depression during the COVID-19 pandemic. However, the landscape on self-harm is still unclear. This study aimed to examine the role of COVID-19 related posttraumatic stress, depression and resilience as predictors of self-harm with and without suicidal intent. Participants were 625 young people aged 17-25 years old (M = 20.2 years, SD = 2.47). Resilience was measured using the self-reported Child & Youth Resilience Scale Measure - Revised (CYRM-R). Posttraumatic stress related to COVID-19 were measured using the Impact of Event Scale- Revised. Depression was measured using the depression subscale of the Depression, Anxiety and Stress Scale-21. Self-harm was evaluated with two dichotomous items. Participants reported high levels of depression and COVID-19 posttraumatic stress, and a significant percentage reported engaging in self-harm. Hierarchical logistic regressions showed that caregiver resilience decreased approximately 20% the odds of engaging in self harm with and without suicidal intent remaining a consistent predictor even after accounting posttraumatic stress and depression in the models. Posttraumatic stress and depression predicted a one-fold increase in the odds of engaging in self-harm with and without suicidal intent. However, posttraumatic stress was no longer a significant predictor when depression was entered in the model in self-harm without suicidal intent. The COVID-19 pandemic may have increased the likelihood of engaging in self-harm in young people. However, caregiver resilience seems to operate as a protective factor. This important finding carries implications beyond the context of the COVID-19 pandemic.

A retrospective research on non-suicidal self-injurious behaviors among young patients diagnosed with mood disorders.

Background: Non-suicidal self-injury (NSSI) is an emerging public concern in both clinical and non-clinical settings, especially in the background of the coronavirus disease 2019 (COVID-19) pandemic. Nevertheless, knowledge of NSSI on a certain disease entity in the later stage of the pandemic was scarce. Objective: This study was conducted for the purpose of exploring the current occurrence and characteristics of NSSI in patients diagnosed with mood disorders (MDs) as well as its correlated factors in the later stage of the pandemic. Methods: Three hundred and forty-nine eligible subjects (M ± SD, 21.54 ± 7.62) admitted to a mental health center in Wuhan from 11 November 2021 to 31 January 2022 were included in our study. An umbrella questionnaire comprised of demographics, COVID-19-related factors, Yale-Brown Obsessive and Compulsive Scale (Y-BOCS), Pittsburgh Sleep Quality Index-Revised (PSQI-R), Mobile Phone Addiction Index (MPAI), and Ottawa Self-injury Inventory (OSI) was extended to each subject via shared QR code. Results: Of 349 patients with MDs included, 151 (43.27%) reported NSSI in the recent 1 month, among whom hand, lower arm/wrist, and scalp were the most hurt body parts, and cutting, hitting, and headbanging were the most adopted methods. "Own idea" was the most common origin of NSSI. In the logistic regression model, age bracket, family monthly income, occupation, level of obsessive-compulsive disorder (OCD) symptoms, sleep duration, withdrawal reaction to the mobile phone, and habits of using a mobile phone were independently associated with NSSI. Conclusion: It was revealed by our study that NSSI was quite prevalent among patients with MDs, especially among those students, adolescents, comorbid with OCD symptoms, inadequate sleeping hours, and suffering from withdrawal reaction to mobile phones. Further research on NSSI in various psychiatric disorders and even in non-clinical settings such as the community population was in urgent need since NSSI in China was not rare.

Associations between coping styles, gender, their interaction and non-suicidal self-injury among middle school students in rural west China: A multicentre cross-sectional study.

Background: To investigate the association between coping styles, gender, their interactions and non-suicidal self-injurious (NSSI) behaviors among middle school students in rural western China under COVID-19. Methods: A multicentre cross-sectional study method was used to conduct an online survey of 8,361 students from 23 middle schools in the northern Sichuan region by clustering sampling, using the General Information Questionnaire, the Ottawa Self-Injury Inventory, and the Coping Style Scale for Middle School Students. Results: The past year prevalence of NSSI among middle school students in rural west China was 5.7%. The differences in scores between those with and without NSSI on all dimensions of coping styles were statistically significant (p < 0.001). Multivariate logistic regression analysis revealed that vocational high school (OR = 1.67), girls (OR = 2.5), single parent with divorced parents (OR = 1.89), remarriage with divorced parents (OR = 1.81), and tolerance (OR = 1.17), venting emotions (OR = 1.15) and fantasy/denial (OR = 1.07) in coping styles may increase the risk of NSSI among middle school students, while problem solving (OR = 0.9) and seeking social support (OR = 0.9) among coping styles may reduce the risk of NSSI among middle school students. The interaction results show that gender has a moderating role in the process of endurance, avoidance, venting of emotions, and fantasy/denial influencing non-suicidal self-injury in middle school students. Conclusion: There is an association between coping styles and self-injury among middle school students in rural areas in western China, with gender playing a moderating role. Active attention should be paid to students' coping styles and encouraging them to adopt positive coping styles as well as avoid negative coping styles, especially in the case of girls, which can help prevent self-injury.

Covid-19 Lockdown and Non-Suicidal Self-Injury: A Mixed Methods Analysis of NSSI During Australia's National Lockdown.

OBJECTIVE: The Covid-19 global pandemic has meant large parts of the world's population have been isolated from others for often months at a time due to lockdown measures to stop the spread. The effects of isolation can be damaging and increase risk of self-injury (NSSI) and suicide. We examined the effects of the first Australian national lockdown on NSSI urges and behavior. METHOD: We asked 345 people with current or past lived experience of NSSI both quantitative and qualitative questions about how their urges and behavior changed during lockdown and assessed how changes were related to demographic variables including work and living conditions. RESULTS: Women, socially disadvantaged and unemployed people were at greater risk of increased NSSI urges and behavior. Social connection was important, with both quantitative and qualitative responses indicating that for some, decreased social anxiety and social pressures was related to a reduction in NSSI, whereas for others the lack of social connection and engagement was associated with worsening urges and behaviors. CONCLUSION: Lockdown had mixed impacts on people with lived experience of NSSI, with most reporting no change or a decrease to urges and behavior, however, for socially disadvantaged people in particular, lockdown lead to worsening urges and behavior and even relapse. Future research might examine these effects longitudinally and with greater focus on intersectionality.HighlightsIdentified NSSI risk/protective factors, and an understanding of lived experienceLockdowns have mixed impacts, some people decreased, some increased NSSISocial connection plays an important role in NSSI engagement and reduction.

Unravelling psychiatric heterogeneity and predicting suicide attempts in women with trauma-related dissociation using artificial intelligence

Background: Suicide is a leading cause of death, and rates of attempted suicide have increased during the COVID-19 pandemic. The under-diagnosed psychiatric phenotype of dissociation is associated with elevated suicidal self-injury;however, it has largely been left out of attempts to predict and prevent suicide. Objective: We designed an artificial intelligence approach to identify dissociative patients and predict prior suicide attempts in an unbiased, data-driven manner. Method: Participants were 30 controls and 93 treatment-seeking female patients with posttraumatic stress disorder (PTSD) and various levels of dissociation, including some with the PTSD dissociative subtype and some with dissociative identity disorder (DID). Results: Unsupervised learning models identified patients along a spectrum of dissociation. Moreover, supervised learning models accurately predicted prior suicide attempts with an score up to 0.83. DID had the highest risk of prior suicide attempts, and distinct subtypes of dissociation predicted suicide attempts in PTSD and DID. Conclusions: These findings expand our understanding of the dissociative phenotype and underscore the urgent need to assess for dissociation to identify individuals at high-risk of suicidal self-injury.

Generation COVID-19 and bodily disorders: Hyperbolic narratives and a developmental psychopathology perspective.

Starting from spring 2020, newspapers headlines and studies have suggested that the COVID-19 pandemics had a negative impact especially on the mental health of children and adolescents, so that terms like "lost generation" or "generation COVID-19" have been used to define youth in time of pandemic crisis. Similarly, international health agencies reported an increase in depression and anxiety among adolescents in COVID-19 time, but also a rise in bodily disorders, such as non-suicidal self-injury and eating disorders. However, scientific data on this matter are not as clear as they seem and theoretical-clinical proposals regarding the processes involved are lacking. Focusing specifically on bodily disorders in adolescents during COVID-19, the aim of this perspective paper is to review this issue and propose a novel viewpoint on it. Firstly, data regarding frequency and phenomenology of bodily disorders in adolescence before and during the pandemic will be presented to underline possible discrepancies, gaps, or hyperbolic descriptions in the literature published after the COVID-19 outbreak. Secondly, a specific theoretical-clinical perspective will be proposed, that is, a developmental psychopathology perspective which attempts to frame these phenomena in a more nuanced and complex way, taking into account the role of developmental processes in adolescence age and its difficulties in the specific, subjective life-context of the individual, when intertwining with vulnerability factors and stressful life events. As such, the function of the body for the adolescent as a primary mean for regulating the self-other relationship and developing a greater sense of self-agency will be highlighted. The final objective is to help the clinician in developing both a critical thinking about the data that are shared in public outlets and an intervention that takes into account the complexity of contemporary psychopathological phenomena.

Improving Care for Young People who Self Harm

AimsOur aim was to improve the quality and consistency of care given to young people who presented to our urban Emergency Department (ED) with self-harm.MethodsWe evaluated Hospital Episode Statistics to assess the number of young people presenting to our ED with self-harm over a 6 month period from 2020-2021. We distributed a questionnaire to all staff members working with young people in ED, in order to understand our current practice of support measures offered. This received 26 responses. Following this, we introduced an information pack collating relevant resources and created a website to signpost young people and their families to appropriate local and national support. We liaised closely with CAMHS and Paediatric staff to raise awareness of the information pack and ensure consistent implementation.ResultsHospital statistics showed that the number of young people presenting with self-harm increased by 30% in late 2020 and early 2021, following the initial COVID-19 lockdown. Our initial staff questionnaire highlighted that there was significant variation in practice, and that ED doctors wanted information and resources to give to young people and their carers. People were signposting to 20 different resources although 4 respondents denied signposting. We produced a paper information pack and collated resources on an easy-to-access website. CAMHS practitioners working with young people who self-harm valued the information packs and fed back that families appreciated having a guide of helpful resources to take away. This work led to the development of a guideline to provide a clear pathway of care of young people who self-harm for all health professionals to follow.ConclusionSelf harm commonly presents to the Emergency Department and cases have increased locally and nationally during the pandemic. A readily available information pack and website providing easy access to local and national resources can improve the quality and consistency of care given to young people presenting with self-harm. This project highlighted the importance of integrated care, bringing paediatric and CAMHS colleagues together to improve the care and support for young people and their families at a very vulnerable and stressful time.

Non-Suicidal Self-Injury in Adolescence: The Role of Pre-Existing Vulnerabilities and COVID-19-Related Stress.

For many adolescents, the COVID-19 pandemic represents a uniquely challenging period, and concerns have been raised about whether COVID-19-related stress may increase the risk for self-injurious behaviors among adolescents. This study examined the impact of pre-existing vulnerabilities on the occurrence and frequency of Non-Suicidal Self-Injury (NSSI) through COVID-19-related stress, and whether the impact of COVID-19-related stress on NSSI was buffered by the perceived social support during the pandemic. Participants were 1061 adolescents (52.40% females; Mage = 15.49 years, SD = 0.76) from a two-wave longitudinal study, which included assessments before the COVID-19 onset and one year later the declaration of the pandemic. Path analyses showed that adolescents with a prior history of NSSI, higher levels of internalizing symptoms, and poor regulatory emotional self-efficacy before the COVID-19 pandemic reported higher levels of COVID-19-related stress which in turn increased their risk to engage in NSSI. Besides, the findings did not support the role of social support as a moderator of the association between COVID-19 related stress and the occurrence/frequency of NSSI. These findings suggest that enhanced stress perception may serve as a key pathway for the continuation and development of NSSI among vulnerable adolescents facing adverse life events.