Abstract
Cross-sectional studies and prospective studies with long follow-up periods (e.g., years) have shown that lower levels of social support are associated with nonsuicidal self-injury (NSSI) among adolescents. This study examined how short-term changes in social support may contribute to NSSI behavior and whether different sources of support (e.g., friends, family members) provide differential protective effects against NSSI. We examined fluctuations in NSSI and social support perceived from multiple sources among a sample of 118 high-risk adolescents hospitalized for serious self-harm risk. Participants provided daily reports of social support and any self-injurious behavior for the duration of their inpatient treatment (721 total observations, average observations per participant = 6.11). Multi-level models were used to assess variability in social support and how these fluctuations relate to whether or not an individual engages in NSSI. Over one-third of participants reported engaging in NSSI at least once during inpatient hospitalization and self-reported social support varied within person across sources of support (ICC range = 0.68–0.81). Support perceived from family members and inpatient unit staff was inversely associated with NSSI, but no relationship was found between NSSI and support from other patients on the unit or friends outside of the unit. These findings suggest that the protective effects of social support for NSSI vary over short periods of time and that support perceived from adults is particularly relevant among this high-risk clinical sample. This study represents an important step in identifying risk factors to improve the detection and prevention of NSSI among adolescent inpatients.
Similar content being viewed by others
References
Barrera, M. (1986). Distinctions between social support concepts, measures, and models. American Journal of Community Psychology, (4), 413–445. https://doi.org/10.1007/BF00922627. 14
Barrera, M., & Garrison-Jones, C. (1992). Family and peer social support as specific correlates of adolescent depressive symptoms. Journal of Abnormal Child Psychology, 20(1), 1–16. https://doi.org/10.1007/bf00927113
Bates, D., Mächler, M., Bolker, B., & Walker, S. (2015). Fitting Linear Mixed-Effects Models Using lme4. Journal of Statistical Software, 67(1), 1–48. https://doi.org/10.18637/jss.v067.i01
Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal Self-injury: A Systematic Review. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.01946
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310
Coppersmith, D. D. L., Kleiman, E. M., Glenn, C. R., Millner, A. J., & Nock, M. K. (2019). The dynamics of social support among suicide attempters: A smartphone-based daily diary study. Behaviour Research and Therapy, 120, 103348. https://doi.org/10.1016/j.brat.2018.11.016
Czyz, E. K., King, C. A., & Nahum-Shani, I. (2018). Ecological assessment of daily suicidal thoughts and attempts among suicidal teens after psychiatric hospitalization: Lessons about feasibility and acceptability. Psychiatry Research, 267, 566–574. https://doi.org/10.1016/j.psychres.2018.06.031
Czyz, E. K., Liu, Z., & King, C. A. (2012). Social connectedness and one-year trajectories among suicidal adolescents following psychiatric hospitalization. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology American Psychological Association Division, 53(2), 214–226. https://doi.org/10.1080/15374416.2012.651998. 41
d’Arbeloff, T. C., Freedy, K. R., Knodt, A. R., Radtke, S. R., Brigidi, B. D., & Hariri, A. R. (2018). Emotion Regulation and the Experience of Future Negative Mood: The Importance of Assessing Social Support. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02287
Darche, M. A. (1990). Psychological factors differentiating self-mutilating and non-self-mutilating adolescent inpatient females. Psychiatric Hospital, 21(1), 31–35
Deliberto, T. L., & Nock, M. K. (2008). An exploratory study of correlates, onset, and offset of non-suicidal self-injury. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 12(3), 219–231. https://doi.org/10.1080/13811110802101096
DiClemente, R. J., Ponton, L. E., & Hartley, D. (1991). Prevalence and correlates of cutting behavior: Risk for HIV transmission. Journal of the American Academy of Child & Adolescent Psychiatry, 30(5), 735–739. https://doi.org/10.1016/S0890-8567(10)80007-3
Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70(6), 1327–1343. https://doi.org/10.1037/0022-3514.70.6.1327
Gariépy, G., Honkaniemi, H., & Quesnel-Vallée, A. (2016). Social support and protection from depression: Systematic review of current findings in Western countries. The British Journal of Psychiatry: The Journal of Mental Science, 209(4), 284–293. https://doi.org/10.1192/bjp.bp.115.169094
Glenn, C. R., & Klonsky, E. D. (2011). Prospective prediction of nonsuicidal self-injury: A 1-year longitudinal study in young adults. Behavior Therapy, 42(4), 751–762. https://doi.org/10.1016/j.beth.2011.04.005
Guerry, J. D., & Prinstein, M. J. (2010). Longitudinal Prediction of Adolescent Nonsuicidal Self-Injury: Examination of a Cognitive Vulnerability-Stress Model. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology American Psychological Association Division, 53(1), 77–89. https://doi.org/10.1080/15374410903401195. 39
Hankin, B. L., & Abela, J. R. Z. (2011). Nonsuicidal self-injury in adolescence: Prospective rates and risk factors in a 2 ½ year longitudinal study. Psychiatry Research, 186(1), 65–70. https://doi.org/10.1016/j.psychres.2010.07.056
Heath, N. L., Ross, S., Toste, J. R., Charlebois, A., & Nedecheva, T. (2009). Retrospective analysis of social factors and nonsuicidal self-injury among young adults. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 41(3), 180–186. https://doi.org/10.1037/a0015732
House, J. S., Umberson, D., & Landis, K. R. (1988). Structures and Processes of Social Support. Annual Review of Sociology, 14(1), 293–318. https://doi.org/10.1146/annurev.so.14.080188.001453
Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 11(2), 129–147. https://doi.org/10.1080/13811110701247602
Jarvi, S., Jackson, B., Swenson, L., & Crawford, H. (2013). The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the Literature. Archives of Suicide Research, 17(1), 1–19. https://doi.org/10.1080/13811118.2013.748404
Jiang, Y., Ren, Y., Liu, T., & You, J. (2021). Rejection sensitivity and adolescent non-suicidal self-injury: Mediation through depressive symptoms and moderation by fear of self-compassion. Psychology and psychotherapy, 94, 481–496. https://doi.org/10.1111/papt.12293
Kleiman, E. (2017). EMAtools: Data Management Tools for Real-Time Monitoring/Ecological Momentary Assessment Data (0.1.3) [Computer software]. https://CRAN.R-project.org/package=EMAtools
Kleiman, E. M., & Liu, R. T. (2013). Social support as a protective factor in suicide: Findings from two nationally representative samples. Journal of Affective Disorders, 150(2), 540–545. https://doi.org/10.1016/j.jad.2013.01.033
Kleiman, E. M., Turner, B. J., Fedor, S., Beale, E. E., Huffman, J. C., & Nock, M. K. (2017). Examination of real-time fluctuations in suicidal ideation and its risk factors: Results from two ecological momentary assessment studies. Journal of Abnormal Psychology, 126(6), 726–738. https://doi.org/10.1037/abn0000273
Kleiman, E., Millner, A. J., Joyce, V. W., Nash, C. C., Buonopane, R. J., & Nock, M. K. (2019). Using Wearable Physiological Monitors With Suicidal Adolescent Inpatients: Feasibility and Acceptability Study. JMIR MHealth and UHealth, 0(0), e0. https://doi.org/10.2196/13725
Klineberg, E., Kelly, M. J., Stansfeld, S. A., & Bhui, K. S. (2013). How do adolescents talk about self-harm: A qualitative study of disclosure in an ethnically diverse urban population in England. Bmc Public Health, 13(1), 572. https://doi.org/10.1186/1471-2458-13-572
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226–239. https://doi.org/10.1016/j.cpr.2006.08.002
Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122(1), 231–237. https://doi.org/10.1037/a0030278
Klonsky, E. D., & Muehlenkamp, J. J. (2007). Self-injury: A research review for the practitioner. Journal of Clinical Psychology, 63(11), 1045–1056. https://doi.org/10.1002/jclp.20412
Lakey, B. (2010). Social support: Basic research and new strategies for intervention. Social psychological foundations of clinical psychology (pp. 177–194). The Guilford Press
Livesey, A. E. (2009). Self-harm in adolescent in-patients. Psychiatric Bulletin, 33(1), 10–12. https://doi.org/10.1192/pb.bp.107.016022
Lüdecke, D., Bartel, A., Schwemmer, C., Powell, C., & Djalovski, A. (2020). sjPlot: Data Visualization for Statistics in Social Science (2.8.3) [Computer software]. https://CRAN.R-project.org/package=sjPlot
Miller, A. B., Esposito-Smythers, C., & Leichtweis, R. N. (2015). Role of social support in adolescent suicidal ideation and suicide attempts. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 56(3), 286–292. https://doi.org/10.1016/j.jadohealth.2014.10.265
Muehlenkamp, J., Brausch, A., Quigley, K., & Whitlock, J. (2013). Interpersonal features and functions of nonsuicidal self-injury. Suicide & Life-Threatening Behavior, 43(1), 67–80. https://doi.org/10.1111/j.1943-278X.2012.00128.x
Nock, M. K. (2010). Self-Injury. Annual Review of Clinical Psychology, 6, 339–363. https://doi.org/10.1146/annurev.clinpsy.121208.131258
Nixon, M. K., Cloutier, P. F., & Aggarwal, S. (2002). Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 41(11), 1333–1341. https://doi.org/10.1097/00004583-200211000-00015
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890. https://doi.org/10.1037/0022-006X.72.5.885
Plener, P. L., Libal, G., Keller, F., Fegert, J. M., & Muehlenkamp, J. J. (2009). An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychological Medicine, 39(9), 1549–1558. https://doi.org/10.1017/S0033291708005114
Pollak, O. H., D’Angelo, E. J., & Cha, C. B. (2020). Does function predict persistence? Nonsuicidal self-injury among adolescents during and after hospitalization. Psychiatry Research, 286, 112839. https://doi.org/10.1016/j.psychres.2020.112839
R Core Team. (2016). R: The R Project for Statistical Computing. Foundation for Statistical Computing. https://www.r-project.org/
Raffaelli, M., Andrade, F. C. D., Wiley, A. R., Sanchez-Armass, O., Edwards, L. L., & Aradillas‐Garcia, C. (2013). Stress, Social Support, and Depression: A Test of the Stress-Buffering Hypothesis in a Mexican Sample. Journal of Research on Adolescence, 23(2), 283–289. https://doi.org/10.1111/jora.12006
Revelle, W. R. (2017). psych: Procedures for Personality and Psychological Research. https://www.scholars.northwestern.edu/en/publications/psych-procedures-for-personality-and-psychological-research
Sachs-Ericsson, N., Carr, D., Sheffler, J., Preston, T. J., Kiosses, D., & Hajcak, G. (2019). Cognitive reappraisal and the association between depressive symptoms and perceived social support among older adults. Aging & Mental Health, 0(0), 1–9. https://doi.org/10.1080/13607863.2019.1698516
Stewart, T., & Suldo, S. (2011). Relationships between social support sources and early adolescents’ mental health: The moderating effect of student achievement level. Psychology in the Schools, 48(10), 1016–1033. https://doi.org/10.1002/pits.20607
Swahn, M. H., Ali, B., Bossarte, R. M., Van Dulmen, M., Crosby, A., Jones, A. C., & Schinka, K. C. (2012). Self-Harm and Suicide Attempts among High-Risk, Urban Youth in the U.S.: Shared and Unique Risk and Protective Factors. International Journal of Environmental Research and Public Health, 9(1), 178–191. https://doi.org/10.3390/ijerph9010178
Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide & Life-Threatening Behavior, 44(3), 273–303. https://doi.org/10.1111/sltb.12070
Tatnell, R., Kelada, L., Hasking, P., & Martin, G. (2014). Longitudinal Analysis of Adolescent NSSI: The Role of Intrapersonal and Interpersonal Factors. Journal of Abnormal Child Psychology, 42(6), 885–896. https://doi.org/10.1007/s10802-013-9837-6
Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227, 759–769. https://doi.org/10.1016/j.jad.2017.11.073
Thoits, P. A. (1982). Conceptual, Methodological, and Theoretical Problems in Studying Social Support as a Buffer Against Life Stress. Journal of Health and Social Behavior, 23(2), 145–159. https://doi.org/10.2307/2136511. JSTOR
Turner, B. J., Cobb, R. J., Gratz, K. L., & Chapman, A. L. (2016). The role of interpersonal conflict and perceived social support in nonsuicidal self-injury in daily life. Journal of Abnormal Psychology, 125(4), 588–598. https://doi.org/10.1037/abn0000141
Vivona, J. M., Ecker, B., Halgin, R. P., Cates, D., Garrison, W. T., & Friedman, M. (1995). Self- and other-directed aggression in child and adolescent psychiatric inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 34(4), 434–444
Walsh, B. (2006). Treating Self-Injury: Second Edition: A Practical Guide. Guilford Press. https://www.guilford.com/books/Treating-Self-Injury/Barent-Walsh/9781462518876
Whitlock, J. L., Eckenrode, J., & Silverman, D. H. S. (2006). Self-injurious behaviors in a college population. Pediatrics. https://doi.org/10.1542/peds.2005-2543
Wichstrøm, L. (2009). Predictors of non-suicidal self-injury versus attempted suicide: Similar or different? Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 13(2), 105–122. https://doi.org/10.1080/13811110902834992
Wickham, H. (2020). ggplot2: Elegant Graphics for Data Analysis. Retrieved April 9, from https://ggplot2-book.org/
Wolff, J. C., Frazier, E. A., Esposito-Smythers, C., Becker, S. J., Burke, T. A., Cataldo, A., & Spirito, A. (2014). Negative cognitive style and perceived social support mediate the relationship between aggression and NSSI in hospitalized adolescents. Journal of Adolescence, 37(4), 483–491. https://doi.org/10.1016/j.adolescence.2014.03.016
Zetterqvist, M., Lundh, L. G., Dahlström, Ö., & Svedin, C. G. (2013). Prevalence and Function of Non-Suicidal Self-Injury (NSSI) in a Community Sample of Adolescents, Using Suggested DSM-5 Criteria for a Potential NSSI Disorder. Journal of Abnormal Child Psychology, 41(5), 759–773. https://doi.org/10.1007/s10802-013-9712-5
Zhand, N., Matheson, K., & Courtney, D. (2016). Self-harm in Child and Adolescent Psychiatric Inpatients: A Retrospective Study. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 25(3), 169–176
Funding
Research reported in this publication was supported by the National Institute of Mental Health (R21MH115293; EMK).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Dr. Evan Kleiman (author on this manuscript) is on the editorial board for Research on Child and Adolescent Psychopathology. All authors declare no other known conflicts of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kellerman, J., Millner, A.J., Joyce, V.W. et al. Social Support and Nonsuicidal Self-injury among adolescent Psychiatric Inpatients. Res Child Adolesc Psychopathol 50, 1351–1361 (2022). https://doi.org/10.1007/s10802-022-00931-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-022-00931-3