High-school students and self-injurious thoughts and behaviours: clues of emotion dysregulation

Abstract

Background: Suicide attempts and self-harm in adolescence are a major public health concern: they are among the main causes of disability-adjusted life-years worldwide, with severe long-term health consequences in terms of mental illness and psychiatric hospitalisation and a significantly increased risk of suicide. Several studies recently focused on the hypothesis that adolescents may be particularly vulnerable to emotional dysregulation and on the relation between problems with emotion regulation and suicidal and self-harming behaviours. Italian epidemiological data about prevalence of these behaviours at the community level are lacking. Our study aimed to estimate the prevalence of self-injurious thoughts and behaviours (SITBs) in a representative sample of community adolescents, and to examine the association between SITBs and the emotional and behavioural profiles.

Methods: Anonymous self-report questionnaires were completed by 1507 students aged 11-18 years from 24 high schools in the North-eastern Italian region of Friuli Venezia Giulia. Information was collected on SITBs, on the socio-environmental context, and on the psychological profile ('Achenbach's YSR questionnaire 11-18, Multidimensional Test of Self-harm and Multi-Attitude Suicide Tendency Scale).

Results: Overall, 11.1% of adolescents reported self-harming behaviours without suicide ideation or attempts, 6.4% declared having thought to suicide without acting a suicide attempt or self-harm, 1.4% declared having attempted suicide and really thought to take away their life. Access to health services following a suicide thought, a self-harming behaviour or suicide attempt was infrequent, particularly for suicide ideation. At the YSR, all the SITBs groups reported high scores in almost all scales, with the most evident differences in the self-harming groups in which adolescents reported significantly higher scores in all scales, both internalising and externalising. An emotion dysregulation profile was found in almost all the groups.

Conclusions: This study provides us with an estimate of the prevalence of SITBs in the adolescent population and confirms the importance of further investigating the association between SITBs and emotion dysregulation. The naturalistic setting of community studies appears to be useful for studies in this field, and it allows to approach the onerous and often neglected issue of adolescent suicidality.

Keywords: Adolescence; Emotion dysregulation; Self-harm; Self-injurious; Suicide.

Fig. 1

Flow chart describing how the sample of adolescents was obtained

Fig. 2

Distribution of the answers to the “Self-harming” questionnaire. Each percentage reported is on the total number of subjects

Fig. 3

Emotional and behavioural profile, scale-specific results. The emotional and behavioural profiles of each group, based on answers to the YSR questionnaire, are represented; the mean scores for each scale of the profile are reported

Fig. 4

Dysregulation profile (YSR-DP). The percentage of subjects with DP is reported for each group. The group for which this percentage is significantly different compared to the “Negatives” group (NegSA/SI/SH) is identified with the asterisk sign (*)

Fig. 5

Multidimensional Test of Self-Esteem (TMA). For each group, results about different dimensions of self-esteem (IR = interpersonal relationship; CC = capacity of context control; Em = emotivity; Sc = school success; FL = family life; Bo = Body perception) are reported. Below the profiles, the dimensions with significantly lower scores, compared to the group Neg SA/SI/SH, are highlighted in grey squares