Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 23;3(3):e12148.
doi: 10.1002/jcv2.12148. eCollection 2023 Sep.

Autonomic dysregulation and self-injurious thoughts and behaviours in children and young people: A systematic review and meta-analysis

Alessio Bellato  1 , Muskaan Aleeza Admani  2 , Camila Deak  3 , Luis Carlos Farhat  3 , Maria Carolina Fontana Antunes de Oliveira  3 , Rebeca Vasconcelos  4 , Margherita Malanchini  2 , Elizabeth Shephard  3   5 , Giorgia Michelini  2   6
Affiliations

Autonomic dysregulation and self-injurious thoughts and behaviours in children and young people: A systematic review and meta-analysis

Alessio Bellato et al. JCPP Adv. .

Abstract

Background: Self-injurious thoughts and behaviours (SITBs) have been associated with dysfunction of the Autonomic Nervous System (ANS) in children and young people, suggesting that objective ANS measures may aid assessment of suicide risk, but a systematic synthesis of this literature is currently lacking.

Methods: Following a pre-registered protocol (PROSPERO CRD42022327605), we conducted a systematic search of PubMed, Medline, Embase, PsycINFO, and Web of Science, for empirical studies published until 10th May 2022 that compared indices of ANS functioning in individuals aged 0-25 years with versus without SITBs, or reported continuous associations between ANS measures and SITBs. Study quality was assessed with the Newcastle-Ottawa Scales. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models.

Results: Twenty studies (1979 participants) were included in our systematic review, with 16 included in meta-analyses. Results suggested that SITBs were associated with altered cardiac indices of arousal (g = -0.328, p < 0.001), which was driven by lower heart rate variability in individuals with SITBs (g = -0.375, p = 0.025). Overall results for electrodermal activity were not significant (g = 0.026, p = 0.857), but subgroup analyses showed increased activity in studies of individuals who engaged specifically in non-suicidal self-harm (g = 0.249, p = 0.014) but decreased activity in the remaining studies (g = -0.567, p = 0.004).

Conclusions: Our systematic review and meta-analysis found evidence of reduced parasympathetic regulation as well as more tentative evidence of altered electrodermal activity in children and young people displaying SITBs. Future longitudinal studies should test the clinical utility of these markers for detecting and monitoring suicide risk.

Keywords: arousal; autonomic; electrodermal; heart rate variability; self‐harm; suicide.

PubMed Disclaimer

Conflict of interest statement

Elizabeth Shephard and Giorgia Michelini both serve on the JCPP Advances Editorial Advisory Board. The remaining authors declare they have no competing or potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flowchart.
FIGURE 2
FIGURE 2
Forest plot of effect sizes for studies investigating cardiac measures. CI, confidence interval; RE, random effect.
FIGURE 3
FIGURE 3
Forest plot of effect sizes for studies investigating electrodermal activity/reactivity. CI, confidence interval; RE, random effect.
See this image and copyright information in PMC

References

    1. Aldrich, J. T. , Wielgus, M. D. , & Mezulis, A. H. (2018). Low physiological arousal and high impulsivity as predictors of self‐injurious thoughts and behaviors among adolescents. Journal of Adolescence, 62, 55–60. 10.1016/j.adolescence.2017.11.006 - DOI - PubMed
    1. Bellato, A. , Arora, I. , Hollis, C. , & Groom, M. J. (2020). Is autonomic nervous system function atypical in attention deficit hyperactivity disorder (ADHD)? A systematic review of the evidence. Neuroscience & Biobehavioral Reviews, 108, 182–206. 10.1016/j.neubiorev.2019.11.001 - DOI - PubMed
    1. Bellato, A. , Sesso, G. , Milone, A. , Masi, G. , & Cortese, S. (2023). Systematic review and meta‐analysis: Altered autonomic functioning in youths with emotional dysregulation. Journal of the American Academy of Child & Adolescent Psychiatry. 10.1016/j.jaac.2023.01.017 - DOI - PubMed
    1. Biswas, T. , Scott, J. G. , Munir, K. , Renzaho, A. M. N. , Rawal, L. B. , Baxter, J. , & Mamun, A. A. (2020). Global variation in the prevalence of suicidal ideation, anxiety and their correlates among adolescents: A population based study of 82 countries. eClinicalMedicine, 24. 10.1016/j.eclinm.2020.100395 - DOI - PMC - PubMed
    1. Bridge, J. A. , Goldstein, T. R. , & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47(3–4), 372–394. 10.1111/j.1469-7610.2006.01615.x - DOI - PubMed