Identifying candidate mechanisms of comorbidity in disordered eating and posttraumatic stress disorder symptoms among U.S. veterans: A network analytic approach.

OBJECTIVE: Comorbidity between posttraumatic stress disorder (PTSD) and disordered eating (DE) symptoms is common, reflecting a possible reciprocal relationship between these disorders. Network analysis may reveal candidate mechanisms underlying their comorbidity and highlight important treatment targets. METHOD: Two national samples of U.S. veterans endorsing trauma exposure self-reported PTSD and DE symptoms. The discovery sample included veterans from all service eras (n = 434). The validation sample included recently separated post-9/11 veterans (n = 507). We fit graphical lasso models to evaluate the network structure of PTSD factors based on the seven-factor "hybrid" model and DE symptoms within each sample. We used strength scores to identify the most central symptoms within the networks and identified bridge symptoms connecting PTSD and DE features. We tested for network invariance between self-identified men and women within each sample and across the studies. RESULTS: PTSD and DE symptoms clustered as expected within networks for each sample. The strongest nodes in the networks included both PTSD and DE features. The strongest bridge symptoms in both studies included overevaluation of shape and weight, negative affect, and avoidance. Networks were invariant across men and women in each sample and largely invariant across samples. CONCLUSIONS: Cross-sectional network models of PTSD and DE symptoms largely replicated across national samples of U.S. veterans and between men and women within samples. Cognitive features of both disorders, along with avoidance, may partially underlie comorbidity and represent potential treatment targets. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nonsuicidal self-injury methods among U.S. Veterans: Latent class analysis and associations with psychosocial outcomes.

Nonsuicidal self-injury (NSSI) is a debilitating concern among U.S. veterans, with wall/object-punching commonly endorsed as an NSSI method. We examined how this behavior relates to other NSSI methods and psychosocial outcomes. We conducted a latent class analysis (LCA) of NSSI methods among 1,138 Gulf War Era veterans, (77.9% male), 21.7% of whom endorsed lifetime NSSI. We categorized classes based on their associations with age, sex, combat and military sexual assault exposure, then examined the association of class membership with psychosocial indicators. LCA results supported four classes: 1) High punching/banging NSSI (2.5%); 2) Multimethod NSSI methods (6.3%); 3) High-risk, multimethod NSSI (3.1%); and 4) Low-risk NSSI (88.1%). Psychosocial indicators (suicide attempt, ideation, possible depressive or posttraumatic stress disorders, poor psychosocial functioning) were worse for members of the NSSI classes versus those in the low-risk group. A subset of U.S. veterans may engage in NSSI primarily via punching/banging methods. All patterns of NSSI engagement were associated with negative psychosocial outcomes relative to those in the low-risk class of the behavior.

Associations between DSM-5 posttraumatic stress disorder Criterion E2 endorsement and selected self-destructive behaviors in recent-era veterans: A focus on disordered eating.

Revisions to the posttraumatic stress disorder (PTSD) criteria in the DSM-5 included a new criterion in the alterations in arousal and reactivity cluster (i.e., engagement in reckless and self-destructive behaviors; Criterion E2). Despite its clinical significance, little is known about how this symptom corresponds to engagement in specific direct and indirect self-harm behaviors. We examined associations between E2 and self-reported recent engagement in direct and indirect self-harm behaviors, including disordered eating, which is not included in the prototypical E2 symptom scope, in a trauma-exposed sample of 1,010 recent-era veterans (61.5% self-identified women, 38.5% self-identified men). We also tested whether gender moderated these associations. We repeated analyses in a subsample of participants with clinically elevated PTSD symptoms. Participants self-reported past-month PTSD symptoms (PCL-5) as well as past-month nonsuicidal self-injury, suicidal ideation, suicide planning, fasting, purging, binge eating, compulsive exercise, and problematic alcohol and drug use. We found no evidence for moderation by gender for any of the behaviors examined in the main sample. However, after controlling for gender and demographic covariates, weighted logistic regressions showed small, significant associations between E2 score and direct self-harm behaviors, substance use, purging, and binge eating, aORs = 1.30-1.91. Criterion E2 was linked to behaviors included in the typical symptom scope (self-directed violence, substance use) and those that are not (disordered eating behaviors). Comprehensive screening for self-destructive behaviors, including disordered eating, among veteran men and women who endorse Criterion E2 is indicated.

Postdeployment mental health concerns and family functioning in veteran men and women.

OBJECTIVE: Despite growing numbers of veteran women, it is unclear whether the impact of common postdeployment mental health concerns on key aspects of family functioning varies by gender. We examined whether associations between PTSD, depression, and problematic alcohol use and intimate relationship quality and parenting self-efficacy differed among men and women in a large, gender-balanced sample of post-9/11 veterans. METHOD: Participants included 2,348 veterans (51.49% women) of the wars in Iraq and Afghanistan who were part of a larger study of gender differences in effects of wartime deployment. Veterans who were married or in a relationship (n = 1,536, 49.09% women) reported overall relationship quality. Veterans with children under age 18 (n = 1,049; 51.57% women) self-reported on their sense of efficacy as parents. All participants reported symptoms of PTSD, depression, and problematic alcohol use. We used a series of hierarchical linear regressions to test gender as a moderator of each postdeployment mental health concern and the family functioning constructs of interest. RESULTS: Each postdeployment mental health concern was associated with reduced relationship quality and parenting self-efficacy, and these associations were largely consistent across gender. However, links between reduced parenting self-efficacy and increased PTSD and depressive symptoms were stronger in women compared with men. CONCLUSIONS: Postdeployment mental health concerns are associated with impairment in key family relationships for both veteran men and women. This impact may be particularly profound for parenting self-efficacy among female veterans, highlighting the potential importance of targeted interventions in this domain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The transition to civilian life: Impact of comorbid PTSD, chronic pain, and sleep disturbance on veterans' social functioning and suicidal ideation.

OBJECTIVE: Trauma-exposed veterans may be more likely to experience posttraumatic stress disorder (PTSD), chronic pain, and sleep disturbance together rather than in isolation. Although these conditions are independently associated with distress and impairment, how they relate to social functioning and suicidal ideation (SI) when experienced comorbidly is not clear. METHOD: Using longitudinal data on 5,461 trauma-exposed U.S. veterans from The Veterans Metrics Initiative study and self-reported disorders, we assessed (a) the extent to which PTSD co-occurs with sleep disturbance and chronic pain (CP); (b) the relationship of PTSD in conjunction with sleep disturbance and chronic pain with later social functioning and SI; and (c) the extent to which social functioning mediates the impact of multimorbidity on SI. RESULTS: At approximately 15 months postseparation, 90.5% of veterans with probable PTSD also reported sleep disturbance and/or CP. Relative to veterans without probable PTSD, veterans with all 3 conditions (n = 907) experienced the poorest social functioning (B = -.56, p < .001) and had greater risk for SI (OR = 3.78, p < .001); Social functioning partially mediated the relationship between multimorbidity and SI. However, relative to those with PTSD alone, sleep disturbance and CP did not confer greater risk for SI. CONCLUSIONS: Although these findings underscore the impact of PTSD on functioning and SI, they also highlight the complexity of multimorbidity and the importance of bolstering social functioning for veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gender differences in direct and indirect associations of trauma types with disordered eating in a national U.S. veteran sample.

OBJECTIVE: Disordered eating (DE) in military veterans has been linked to trauma exposure, but the mechanisms underlying this association remain unclear. The current study documented the direct associations of DE with multiple trauma types in a gender-balanced sample of veterans and examined indirect associations of trauma and DE via self-reported PTSD symptoms and concerns about shape and weight. METHOD: Participants included 1,187 veterans (50% women, 46% men, 4% another) from multiple service eras. Sampling weights were applied to enhance representativeness to the national veteran population. RESULTS: Gender-stratified, weighted models revealed associations of premilitary, warfare, and postseparation trauma with DE in men and associations of premilitary, military sexual (MST), and postseparation trauma with DE in women. Monte Carlo estimation of indirect effects showed support for indirect associations of premilitary, warfare, and postseparation-related trauma/stressor exposure with DE via PTSD symptoms among men; postseparation stressors were also indirectly associated with DE via shape and weight concerns. Among women, each trauma type was indirectly associated with DE via shape and weight concerns but not PTSD symptoms. When trauma exposures were examined concurrently, MST and postseparation trauma exposure were uniquely associated with DE via shape and weight concerns among women. Only the indirect association of postseparation trauma/stressor exposure with DE via shape and weight concerns was significant among men. CONCLUSIONS: Findings support the need for gender-specific interventions that target different mechanisms contributing to DE symptoms among veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Posttraumatic Cognitions Inventory (PTCI): Psychometric evaluation in veteran men and women with trauma exposure.

The Posttraumatic Cognitions Inventory (PTCI) is a self-report measure of negative posttraumatic cognitions, which is an important construct in the development and maintenance of posttraumatic stress disorder (PTSD). Evidence for the most appropriate PTCI item and factor structure is mixed, and this measure has not been extensively studied in veterans. The present study examined the psychometric properties of the PTCI in two national samples of veteran men and women. Participants in Sample 1 (veterans from all service eras) and Sample 2 (recently separated veterans) completed the PTCI and additional measures of mental health symptoms. Confirmatory factor analyses indicated that a brief version of the PTCI (PTCI-9; 3-factor, nine-item) was a superior fit relative to other examined factor structures. Consistent with the original conceptualization of the measure, these factors were labeled: Negative cognitions about self, negative cognitions about the world, and self-blame. Scores on the PTCI-9 were differentially associated with the PTSD symptom clusters and with scores on self-report measures of external comorbidities. PTCI-9 scores were higher among individuals with trauma exposure and with a probable PTSD diagnosis. There was evidence of full (Sample 1) and partial (Sample 2) scalar invariance across men and women. Overall, the present study supports the use of the PTCI-9 as a measure of negative cognitions; however, scores may not be specific to PTSD and may represent a global negative thinking style. Even so, the PTCI-9 appears to be a suitable and abbreviated measure that could be used with veterans in research and clinical practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Low levels of discriminant validity between self-report measures of self-esteem, shame, and self-criticism: Implications for the measurement of self-evaluation and creation of the Negative Self-Evaluation Scale.

This article examined the discriminant and convergent validity of commonly used self-report measures of self-criticism, self-esteem, and shame. A confirmatory factor analysis (CFA) using multiple self-report measures of each construct showed low levels of discriminant validity between self-reported self-esteem, shame, and self-criticism and instead demonstrated correspondingly high levels of shared variance. However, bifactor analyses on the items across each measure suggested that self-report measures of self-esteem, shame, and self-criticism may contain distinct characteristics that are underrepresented in current measures of each construct. Based on the factor loadings in item-level bifactor analyses, a new measure, the Negative Self-Evaluation Scale (NSES), was constructed to improve the assessment of the unique characteristics of shame, self-esteem, and self-criticism. Implications for current and future practices concerning the measurement of each construct are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Latent profile analyses of disordered eating behaviors and nonsuicidal self-injury among Vietnamese adolescents.

OBJECTIVE: Comorbidity of disordered eating (DE) behaviors and nonsuicidal self-injury (NSSI) is linked to increased functional impairment. The present study identified subtypes of DE and NSSI comorbidity in a non-Western, low- and middle-income country where there has been particularly little research in this area. METHOD: Latent profile analyses (LPA) were conducted to identify patterns of subgroup comorbidity in self-reported DE behaviors and NSSI behaviors, in a sample of Vietnamese high-school students (N = 1451, 51% female). Parallel-process LPA was used to predict NSSI subgroup membership from DE subgroup membership. RESULTS: A seven-class LPA model was identified for DE: (1) Low frequencies of all DE behaviors; (2) Frequent levels of all DE behaviors; (3) Frequent fasting and purging behaviors; (4) Frequent binge eating only; (5) Moderate binge eating; (6) Moderate fasting and purging behaviors; (7) Exercise and fasting. A two-class (high versus low) model was identified for NSSI. Odds of membership in the high-NSSI class were significantly increased for all DE classes except the class characterized by moderate binge eating. Odds of belonging to the high-NSSI class were highest for those in DE classes involving purging behaviors. Males predominated in classes characterized by high behavior dysregulation. DISCUSSION: DE and NSSI represent important clinical concerns among Vietnamese youth in urban contexts, and males may show particular vulnerability for certain risk behaviors. The association of classes of DE behaviors to NSSI was particularly strong for classes that involved purging, highlighting the importance of this specific behavior for understanding comorbidity of DE and NSSI. PUBLIC SIGNIFICANCE: Disordered eating and nonsuicidal self-injury (NSSI; hurting oneself without intending to die) commonly co-occur. There has been less research on disordered eating and NSSI among individuals from non-Western or low/middle-income countries. We examined patterns of these behaviors in a school-based sample of Vietnamese adolescents. We found that patterns of disordered eating distinguished by purging showed particular links to NSSI, which could have implications for screening and treatment.

Nonsuicidal self-injury in veterans: Prevalence, clinical characteristics, and gender differences from a national cohort.

Nonsuicidal self-injury (NSSI) is a robust predictor of suicidal thoughts and behaviors; however, while there are typically only small differences observed in the prevalence of NSSI between men and women, this condition has been largely overlooked and underestimated among men. Assessing NSSI methods more common in men may address misidentification as well as allow for more precise NSSI prevalence estimates. Survey data from a national sample of Gulf War I-Era veterans (N = 1063) was used to estimate the prevalence of NSSI and compare prevalence of NSSI methods between men and women veterans. Demographic and clinical correlates of NSSI engagement were also examined. The national lifetime prevalence rate of NSSI among Gulf War I-Era veterans was 22.40%, whereas the past year prevalence rate was 8.10%. In both men and women, wall/object punching was the most common NSSI method endorsed across the lifetime. Men had slightly higher overall NSSI prevalence rates compared with women. This study highlights the need to systematically assess NSSI, particularly among veterans, to better identify, and consequently treat, NSSI in men. This is the first available prevalence estimate of NSSI to include the assessment of wall/object punching in a national sample of adult veterans.

Predictors of nonfatal suicide attempts within 30 days of discharge from psychiatric hospitalization: Sex-specific models developed using population-based registries.

BACKGROUND: Risk for nonfatal suicide attempts is heightened in the month after psychiatric hospitalization discharge. Investigations of factors associated with such attempts are limited. METHODS: We conducted a case-subcohort study using data from Danish medical, administrative, and social registries to develop sex-specific risk models using two machine learning methods: classification trees and random forests. Cases included individuals who received a diagnostic code for a nonfatal suicide attempt within 30 days of discharge following a psychiatric hospitalization between January 1, 1995 and December 31, 2015 (n = 3166, 56.5% female). The comparison subcohort consisted of a 5% random sample of individuals living in Denmark (n = 24,559, 51.3% female) on January 1, 1995 who had a psychiatric hospitalization during the study period. RESULTS: Histories of self-poisoning, substance-related disorders, and eating disorders were important predictors of nonfatal suicide attempt among women, with notable interactions observed between age, self-poisoning history, and other characteristics (e.g., medication use). Self-poisoning, substance-related disorders, and severe stress reactions were among the most important variables for men, with key interactions noted between self-poisoning history, age, major depressive disorder diagnosis, and prescription classes. LIMITATIONS: Findings are based on Danish administrative data, which may be subject to inaccuracies, missingness, etc. It is unclear whether results would generalize to other populations. CONCLUSIONS: Markers of behavioral dysregulation were important predictors of nonfatal suicide attempts in the 30 days after psychiatric hospitalization discharge for both sexes. Examining risk markers for nonfatal suicide attempt following discharge is important to enhance support for this vulnerable population.

Longitudinal associations of trauma exposure with disordered eating: Lessons from the Great Smoky Mountains Study.

Disordered eating is prevalent among trauma survivors, yet little is known about mechanisms underlying this relation. We explored cross-sectional and longitudinal associations of trauma exposure and posttraumatic stress disorder symptoms (PTSD) with disordered eating among 1,420 community-based youth participating in the Great Smoky Mountain Study. Participants were interviewed about trauma exposure, PTSD symptoms, and disordered eating at regular intervals throughout childhood, adolescence, and early adulthood. Our findings confirmed associations of all forms of trauma exposure (violent, sexual, and other) with disordered eating symptoms in childhood and adulthood, although the pattern of results varied by disordered eating symptom and trauma exposure type. Only non-sexual, non-violent trauma exposure in childhood had significant associations with any disordered eating symptoms in adulthood. Within childhood, trauma exposures but not PTSD symptoms showed significant longitudinal associations with bulimia nervosa symptoms and sustained appetite changes and preoccupation with eating. In adulthood, PTSD symptoms but not trauma exposures showed significant longitudinal associations only with bulimia nervosa symptoms. The association of specific PTSD clusters on bulimia nervosa symptoms was significant for reexperiencing, whereas hyperarousal symptoms trended toward significance. The impact of trauma exposures on disordered eating may vary by developmental period.

Latent Class Analysis of Self-directed Violence and Indirect Self-harm Behaviors: Gender Differences and Associations With Mental Health Symptoms.

OBJECTIVE: This study aimed to (1) examine whether the latent class structure of individuals engaging in self-directed violence and indirect self-harm behaviors (eg, substance use, disordered eating) varied by gender in a sample of US veterans, and (2) test the associations of posttraumatic stress disorder (PTSD) and depressive symptoms with the resulting classes. STUDY DESIGN: Cross-sectional data from 3581 veterans, ages 18-50 (51.9% identified as women) were analyzed. Veterans self-reported histories of self-directed violence, substance use, and disordered eating. Latent class analysis and latent class regression were used to explore class structure by gender and examine association of class membership with PTSD and depressive symptoms. RESULTS: A 4-class model was supported in the sample. Class 1 (20.0%) was characterized by substance use and self-directed violent thoughts and behaviors. Class 2 (8.3%) was characterized by substance use, disordered eating, and self-directed violent thoughts and behaviors. Class 3 (12.6%) was distinguished by indirect self-harm behaviors (substance use and disordered eating). Class 4 (59.6%) reflected low likelihood of behavioral dysregulation. Classes were partially invariant across gender; endorsement of substance use behaviors was generally higher for men in each class. Comorbid clinically significant depressive and PTSD symptoms were associated with the class characterized by highest behavioral dysregulation. CONCLUSIONS: Self-directed violent thoughts and behaviors present comorbidly with indirect self-harm in men and women veterans, although patterns of indirect self-harm behaviors differ slightly by gender. Such comorbidity may be associated with more severe presentations of psychiatric concerns.

Longitudinal relations of self-criticism with disordered eating behaviors and nonsuicidal self-injury.

OBJECTIVE: Self-criticism has been proposed as a transdiagnostic predictor of disordered eating and nonsuicidal self-injury (NSSI). First, this study explored cross-sectional associations of multiple disordered eating behaviors, NSSI, and self-criticism. Second, it tested longitudinal relations of self-criticism with disordered eating and NSSI, adjusting for baseline levels of both behaviors. METHODS: In Sub-study 1, undergraduates (N = 251, 79.5% female, Mage = 19.1 years) completed self-report measures of disordered eating, NSSI, and self-criticism at baseline and after 8 weeks. In Sub-study 2, community-based young adults with histories of disordered eating, NSSI, or both (N = 517, 88.8% female, Mage = 24.7 years) completed measures of disordered eating, NSSI, and self-criticism at baseline and after 4 weeks. All measures were completed online. RESULTS: In Sub-study 1, both disordered eating and NSSI showed significant cross-sectional associations with self-criticism, and self-criticism was significantly related to binge eating, fasting, and NSSI at follow-up. In Sub-study 2, both behaviors again showed significant cross-sectional associations with self-criticism. Self-criticism showed significant longitudinal relations with fasting, purging, and excessive exercise. Longitudinal relations of self-criticism with NSSI varied across disordered eating behaviors. DISCUSSION: NSSI showed cross-sectional associations with a range of disordered eating behaviors. Self-criticism reflects a common correlate of both disordered eating and NSSI. Evidence supported transdiagnostic longitudinal impact of self-criticism across multiple forms of disordered eating but provided more limited support for impacts on NSSI.

Are Aspects of Twitter Use Associated with Reduced Depressive Symptoms? The Moderating Role of In-Person Social Support.

In a two-wave, 4-month longitudinal study of 308 adults, two hypotheses were tested regarding the relation of Twitter-based measures of online social media use and in-person social support with depressive thoughts and symptoms. For four of five measures, Twitter use by in-person social support interactions predicted residualized change in depression-related outcomes over time; these results supported a corollary of the social compensation hypothesis that social media use is associated with greater benefits for people with lower in-person social support. In particular, having a larger Twitter social network (i.e., following and being followed by more people) and being more active in that network (i.e., sending and receiving more tweets) are especially helpful to people who have lower levels of in-person social support. For the fifth measure (the sentiment of Tweets), no interaction emerged; however, a beneficial main effect offset the adverse main effect of low in-person social support.

Simultaneously examining negative appraisals, emotion reactivity, and cognitive reactivity in relation to depressive symptoms in children.

Prior theory and research have linked negative appraisals (NA), emotion reactivity (ER), and cognitive reactivity (CR) to depression; however, few studies have examined whether even two of these constructs simultaneously, but none have done so in child or adolescent populations. A total of 571 youths (ages 9-13) completed a novel procedure in which all three constructs were assessed in response to the same personally relevant, hypothetical, peer victimization events. Multilevel modeling enabled the extraction of dynamic, within-person, latent-variable measures of NA, ER, and CR. All three constructs were related to children's depressive symptoms in ways that were commensurate with most (but not all) theoretical frameworks. Gender and age differences also emerged. Support for an NA-predicts-ER-predicts-CR model suggests ways that these constructs can be integrated into a more complete, transtheoretical understanding of the cognitive-emotional substrate of depression in children.

Self-Criticism as a Transdiagnostic Process in Nonsuicidal Self-Injury and Disordered Eating: Systematic Review and Meta-Analysis.

Nonsuicidal self-injury (NSSI) and disordered eating (DE) are highly comorbid and may be regarded as belonging to a spectrum of self-harm behaviors. We investigated self-criticism as a transdiagnostic correlate of these behaviors, in keeping with etiological theories of both NSSI and DE. We reviewed the literature and meta-analyzed the relation of self-criticism to both NSSI (15 studies; 17 effect sizes) and DE (24 studies; 29 effect sizes). Results showed equivalent, moderate-to-large effects for the relation of self-criticism to NSSI (r = .38; CI: .29-.46) and DE (r = .40; CI: .34-.45). The relation of NSSI to self-criticism generalized across multiple potential moderators. DE behavior type moderated the relation of self-criticism to DE, with a stronger relation emerging for purging than restriction. Findings support self-criticism as a possible candidate for transdiagnostic pathways to self-harm.

Self-Evaluation and Depressive Symptoms: A Latent Variable Analysis of Self-esteem, Shame-proneness, and Self-criticism.

This paper examined the unique associations of latent self-esteem with symptoms of depression, over-and-above latent shame-proneness (study 1) and latent self-criticism (study 2), among two samples of undergraduate students. In study 1, confirmatory factor analysis (CFA) showed convergent and discriminant validity for most measures of shame-proneness and self-esteem. Shame-proneness and self-esteem (taken separately) were strongly related to depressive symptoms. Controlling for each other, self-esteem but not shame-proneness remained associated with depressive symptoms. In study 2, CFA showed convergent validity but not discriminant validity for measures of self-criticism and low self-esteem. Self-esteem and self-criticism (taken separately) were strongly related to depressive symptoms. Controlling for each other, however, neither construct was significantly associated with depressive symptoms. Findings suggest that (a) self-esteem and shame-proneness have good discriminant validity, (b) self-esteem is uniquely related to depressive symptoms above and beyond shame-proneness, and (c) self-report measures of self-criticism and self-esteem have poor discriminant validity.

Does nonsuicidal self-injury prospectively predict change in depression and self-criticism?

Few studies have investigated nonsuicidal self-injury (NSSI) as a predictor of outcomes other than suicidal self-injury, severely limiting our understanding of this behavior's full range of consequences. Three independent studies were used to examine the prospective association between NSSI and two outcomes: depressive symptoms and self-criticism. Data were collected from samples of (1) adults with past-month NSSI, (2) adults with lifetime NSSI, and (3) adults with past-year NSSI. Studies included one-month and six-month follow-up periods. Results were tested in an internal meta-analysis. Results suggested that NSSI did not prospectively predict changes in self-criticism. No changes in depressive symptoms were seen over shorter follow-up periods; however, NSSI predicted increases in depressive symptoms at six-month follow-up in one sample. The internal meta-analysis indicated a null relationship between NSSI and prospective internalizing symptoms. Future research should replicate these findings and examine a broader range of outcomes of NSSI to better understand its complex relationship to psychopathology.

The Online Social Support Scale: Measure development and validation.

A new measure, the Online Social Support Scale, was developed based on previous theory, research, and measurement of in-person social support. It includes four subscales: Esteem/Emotional Support, Social Companionship, Informational Support, and Instrumental Support. In college and community samples, factor analytic and item response theory results suggest that subtypes of in-person social support also pertain in the online world. Evidence of reliability, convergent validity, and discriminant validity provide excellent psychometric support for the measure. Construct validity accrues to the measure vis-à-vis support for three hypotheses: (a) Various broad types of Internet platforms for social interactions are differentially associated with online social support and online victimization; (b) similar to in-person social support, online social support offsets the adverse effect of negative life events on self-esteem and depression-related outcome; and (c) online social support counteracts the effects of online victimization in much the same way that in-person friends in one social niche counterbalance rejection in other social niches. (PsycINFO Database Record