The Ottawa Self-Injury Inventory: Evaluation of an assessment measure of nonsuicidal self-injury in an inpatient sample of adolescents.

BACKGROUND: The Ottawa Self-Injury Inventory (OSI) is a self-report measure that offers a comprehensive assessment of nonsuicidal self-injury (NSSI), including measurement of its functions and addictive features. In a preliminary investigation of self injuring college students who completed the OSI, exploratory analysis revealed four function factors (Internal Emotion Regulation, Social Influence, External Emotion Regulation and Sensation Seeking) and a single Addictive Features factor. Rates of NSSI are particularly high in inpatient psychiatry youth. The OSI can assistin both standardizing assessment regarding functions and potential addictive features and aid case formulation leading to informed treatment planning. This report will describe a confirmatory factor analysis (CFA) of the OSI on youth hospitalized in a psychiatric unit in southwestern Ontario. METHODS: Demographic and self-report data were collected from all youth consecutively admitted to an adolescent in-patient unit who provided consent or assent. RESULTS: The mean age of the sample was 15.71 years (SD = 1.5) and 76 (81 %) were female. The CFA proved the same four function factors relevant, as in the previous study on college students (χ (2)(183) = 231.98, p = .008; χ (2)/df = 1.27; CFI = .91; RMSEA = .05). The model yielded significant correlations between factors (rs = .44-.90, p < .001). Higher NSSI frequency was related to higher scores on each function factor (rs = .24-.29, p < .05), except the External Emotion Regulation factor (r = .11, p > .05). The factor structure of the Addictive Features function was also confirmed (χ (2)(14) = 21.96, p > .05; χ (2)/df = 1.57; CFI = .96; RMSEA = .08). All the items had significant path estimates (.52 to .80). Cronbach's alpha for the Addictive Features scale was .84 with a mean score of 16.22 (SD = 6.90). Higher Addictive Features scores were related to more frequent NSSI (r = .48, p < .001). CONCLUSIONS: Results show further support for the OSI as a valid and reliable assessment tool in adolescents, in this case in a clinical setting, where results can inform case conceptualization and treatment planning.

Psychometric properties of the functions and addictive features scales of the Ottawa Self-Injury Inventory: a preliminary investigation using a university sample.

Nonsuicidal self-injury (NSSI) is an issue primarily of concern in adolescents and young adults. Thus far, no single NSSI self-report measure offers a fully comprehensive assessment of NSSI, particularly including measurement of both its functions and potential addictive features. The Ottawa Self-Injury Inventory (OSI) permits simultaneous assessment of both these characteristics; the current study examined the psychometric properties of this measure in a sample of 149 young adults in a university student sample (82.6% girls, Mage = 19.43 years). Exploratory factor analyses revealed 4 functions factors (internal emotion regulation, social influence, external emotion regulation, and sensation seeking) and a single addictive features factor. Convergent evidence for the functions factor scores was demonstrated through significant correlations with an existing measure of NSSI functions and indicators of psychological well-being, risky behaviors, and context and frequency of NSSI behaviors. Convergent evidence was also shown for the addictive features scores, through associations with NSSI frequency, feeling relieved following NSSI, and inability to resist NSSI urges. Additional comment is made regarding the potential for addictive features of NSSI to be both negatively and positively reinforcing. Results show preliminary psychometric support for the OSI as a valid and reliable assessment tool to be used in both research and clinical contexts. The OSI can provide important information for case formulation and treatment planning, given the comprehensive and all-inclusive nature of its assessment capacities.

Adolescent non-suicidal self-injury (NSSI) in German-speaking countries: comparing prevalence rates from three community samples.

PURPOSE: Non-suicidal self-injury (NSSI) has been recognized as a significant mental health problem in adolescence with high prevalence rates. To date, there are few studies that compare rates of adolescent NSSI between different countries. Thus far no prevalence rates of adolescent NSSI have been reported for Austrian or Swiss community samples. METHODS: This study aimed to assess and compare rates of adolescent NSSI in school samples from Austria, Germany and Switzerland using the same assessment instrument (Ottawa Self-Injury Inventory; OSI). RESULTS: Within these countries, 6-month prevalence rates between 7.6 and 14.6% were found, with rates showing significant differences between countries (χ² = 16.54, p = 0.02). CONCLUSIONS: These results demonstrate with some variability the significant rates of NSSI in youth in a cross-country study.

Characteristics and co-occurrence of adolescent non-suicidal self-injury and suicidal behaviours in pediatric emergency crisis services.

During the potentially tumultuous adolescent period, non-suicidal self-injury (NSSI) and suicide attempts are relatively common, particularly amongst youth who present to mental health services. These phenomena frequently co-occur but their relationship is unclear. This study evaluated clinical data from 468 youth between the ages of 12 and 17 years (63.5% female) to determine the incidence of NSSI 24 h prior to presentation at emergency crisis services, evaluated the overlap between NSSI and suicide attempt, and examined the characteristics of different types of self-harm. Half of the adolescents presenting to emergency crisis services had self-harmed within the previous 24 h, with most of these (91%) classified as NSSI only. The percentage of youth with a suicide attempt was 5% and the co-occurrence of these two behaviours was 4%. Group differences in depressive symptoms, suicidal ideation and impulsivity were identified, with the co-occurring NSSI and suicide attempt group presenting with the highest level of psychopathology. This study underscores the necessity of assessing suicidal ideation and NSSI in all youth presenting to mental health services.

Early psychosis intervention service for children and youth: a retrospective chart review of the first four years.

AIMS: There are at present no published reports of outpatient Early Psychosis Intervention (EPI) service designed for children aged 16 years and under. The objectives of this study are to describe aspects of an outpatient paediatric EPI programme from the time period after the initial pilot and during its first 4 years of service with dedicated staffing. METHOD: This study employed a retrospective chart review model in which variables were operationalized and then extracted from existing patient medical records spanning a 4-year time period. Data were then analysed for frequency, mean and range values. RESULTS: Demographic characteristics and service profiles for 56 patients were collected. The majority were male (64.3%) and the mean age was 14.8 years (range: 9-17 years). The average number of days from referral to first in-person contact was 7.3 days. The most common discharge diagnosis was Bipolar Disorder (38.7%) followed by Psychosis Not Otherwise Specified (25.8%) in those with psychosis, whereas an anxiety disorder was the most common diagnosis in those who were not psychotic. The majority of discharged patients were able to be followed up by community-based services. Readmission and hospitalization rates for this EPI service were low. CONCLUSIONS: The findings of this study suggest that an EPI model of care extended to a younger age group can be implemented to provide early intervention to youth with a range of psychiatric disorders that present with psychotic symptoms.

Nonsuicidal self-harm in youth: a population-based survey.

BACKGROUND: Nonsuicidal self-harm includes cutting, scratching, burning and minor overdosing. There have been few studies that have examined the rate of self-harm and mental-health correlates among community-based youth. We performed a population-based study to determine the prevalence of nonsuicidal self-harm, its mental-health correlates and help-seeking behaviour. METHODS: We used data from the Victoria Healthy Youth Survey, a population-based longitudinal survey of youth aged 14-21 in Victoria, British Columbia. The survey included questions about the history, method, frequency, age of onset and help-seeking for nonsuicidal self-harm. Youth were interviewed between February and June 2005. Univariable group differences were analyzed using students t test for continuous data and chi2 for binary or categorical data. Multivariate analyses were conducted by use of multivariate analysis of variance and logistic regression. RESULTS: Ninety-six of 568 (16.9%) youth indicated that they had ever harmed themselves. Self-injuries such as cutting, scratching and self-hitting were the most common forms of nonsuicidal self-harm (83.2%). The mean age of onset was 15.2 years. Of those who reported nonsuicidal self-harm, 56% had sought help for this behaviour. Participants who reported 5 or more symptoms (out of 6) in a given symptom category were more likely than those who reported less than 5 symptoms to report nonsuicidal self-harm for the following categories: depressive mood (odds ratio [OR] 2.18, confidence interval [CI] 1.28-3.7) and problems with regulation of attention, impulsivity and activity (OR 2.24, CI 1.33-3.76). INTERPRETATION: We found a high lifetime prevalence of nonsuicidal self-harm. Many mental-health symptoms were associated with this behaviour, particularly those with depressive mood and attention-related problems. Just over half of youth reported seeking help for nonsuicidal self-harm. Clinicians who encounter youth should be vigilant to assess for this behaviour in youth who present with mental health issues.

Open-label pilot study of St. John's wort in adolescent depression.

AIM: Clinical experience suggests the use of alternative remedies, such as St. John's Wort (SJW), in adolescents with affective disorders is increasing. In view of the paucity of documented, well-established, and safe antidepressant medications for children and adolescents, it was important to investigate the potential usefulness of SJW in adolescents with major depressive disorders (MDD). METHODS AND RESULTS: An 8-week, open-label study evaluated the potential efficacy and safety of SJW (300 mg TID) in adolescents with MDD. Twenty-six patients, 12-17 years of age (mean age, 14.8 years) were enrolled in the study. Of the 11 patients who completed the study, 9 patients (82%) showed significant clinical improvement based on Clinical Global Improvement (CGI) change scores (treatment response was indicated by a clinical improvement rating of either very much improved or much improved at the final visit). Of the 15 patients (58%) who did not complete the study, 8 patients were noncompliant and 7 patients were discontinued because of persisting or worsening depression. Of the 8 noncompliant patients, at week 8, 2 patients (25%) remained unchanged, 1 patient (12.5%) was minimally improved, 4 patients (75%) were much improved, and 1 patient (12.5%) was very much improved, based on the CGI change score. CONCLUSION: Preliminary findings suggest that SJW is well tolerated and may be clinically effective in the treatment of some adolescents with mild depression. Controlled trials of SJW in adolescents with MDD are suggested.

Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents.

OBJECTIVE: The incidence of self-injurious behavior (SIB) in adolescent psychiatric inpatients has been reported to be as high as 61%, yet few data exist on the characteristics and functional role of SIB in this population. Because of the repetitive nature of SIB and its potential to increase in severity, features of SIB and its specific reinforcing effects were examined. METHOD: Participants were 42 self-injuring adolescents admitted to a hospital over a 4 month period. Data sources consisted of self-report questionnaires and medical chart review. RESULTS: Mean age was 15.7 +/- 1.5 years. Reported urges to self-injure were almost daily in 78.6% of the adolescents ( n= 33), with acts occurring more than once a week in 83.3% (n = 35). The two primary reasons endorsed for engaging in self-injury were "to cope with feelings of depression" (83.3%, n= 35) and "to release unbearable tension" (73.8%, n= 31). Of the sample, 97.6% ( n= 41) endorsed three or more addictive symptoms. CONCLUSIONS: SIB in hospitalized adolescents serves primarily to regulate dysphoric affect and displays many addictive features. Those with clinically elevated levels of internalized anger appear at risk for more addictive features of this behavior.