Risk factors and self-harm

Today, I discuss three very different but related articles, all related to self-harm, though this first one also examines violence directed at others. Sheehan, Bounoua, Stumps, Miglin, Huerta & Sadeh (2023) published “Neurobiological Metric of Cortical Delay Discounting Differentiates Risk for Self- and Other-Directed Violence among Trauma-Exposed Individuals” in Journal of Psychopathology and Clinical Science. Here are the edited abstract and impact statements:

Self- and other-directed violence (SDV/ODV) contribute to elevated rates of mortality. Early trauma exposure shows robust positive associations with these forms of violence but alone does not distinguish those at heightened risk for later engagement in SDV/ODV. Novel assessment metrics could aid early identification efforts for individuals with vulnerabilities to violence perpetration. This study examined a novel neurobiological measure of impulsive choice for reward as a potential moderator of associations between childhood trauma exposure and lifetime SDV/ODV. A high-risk community sample of 177 adults (89 men; 50.3%) were assessed for childhood trauma exposure, engagement in SDV (e.g., suicide attempts), and ODV (e.g., assault). A cortical delay discounting (C-DD) measure was created using a multivariate additive model of gray matter thickness across both hemispheres, previously found to be positively associated with susceptibility to impulsivity and externalizing disorders. Childhood trauma exposure was positively associated with ODV and SDV; however, these relationships differed as a function of C-DD. Engagement in ODV increased as scores on C-DD increased, and SDV increased as scores on C-DD decreased. Furthermore, moderation revealed biological sex differences, as the association between childhood trauma and SDV depended on C-DD for women but not for men. Findings from the present work demonstrate that risk conferred by childhood trauma exposure to violence varied as a function of a C-DD. Together, these findings point to the utility of neurobiological markers of impulsive decision-making for differentiating risk for violence among individuals with a history of trauma exposure. 

Childhood trauma exposure is associated with increased negative health outcomes including a greater likelihood of engagement in violence perpetration onto oneself and others. However, trauma exposure on its own does not determine who might be at greatest risk for later violence later in life. Our findings suggest that a neurobiological measure representing an individual’s vulnerability toward impulsive decision-making was able to differentiate individuals at elevated risk for violence among those with a history of trauma exposure.

Here’s an example of delay discounting: If a person is given the choice of picking between $900 right now or $1000 in six months, there is a high probability that they pick the first choice. They would rather lose $100 than to wait for six months. This is a very simple example of temporal discounting. If we call this a proxy measure of impulsive decision-making, then this study found that, in women, childhood trauma and self-directed violence depended on impulsive decision-making. The next study looks at suicidal ideation in youth of color. Molock et al. (2023) published “Culturally Responsive Assessment of Suicidal Thoughts and Behaviors in Youth of Color” in American Psychologist. The edited abstract and impact statements follow:

The significance of youth suicide as a public health concern is underscored by the fact that it is the second-leading cause of death for youth globally. While suicide rates for White groups have declined, there has been a precipitous rise in suicide deaths and suicide-related phenomena in Black youth; rates remain high among Native American/Indigenous youth. Despite these alarming trends, there are very few culturally tailored suicide risk assessment measures or procedures for youth from communities of color. This article attempts to address this gap in the literature by examining the cultural relevancy of currently widely used suicide risk assessment instruments, research on suicide risk factors, and approaches to risk assessment for youth from communities of color. It also notes that researchers and clinicians should consider other, nontraditional but important factors in suicide risk assessment, including stigma, acculturation, and racial socialization, as well as environmental factors like health care infrastructure and exposure to racism and community violence. The article concludes with recommendations for factors that should be considered in suicide risk assessment for youth from communities of color.

Suicide rates are increasing in youth of color. Yet, the prevailing approach to assessment of suicide risk in youth comes from decades of research that has not prioritized culturally responsive approaches that consider unique risk and protective factors for youth of color. This article outlines initial steps toward a culturally responsive suicide risk assessment.

I like the list of factors and see them as applying both to youth of color and LGBTQ+ individuals, the subject of the next article. Cano-Gonzalez, Charak, Ronzón-Tirado & Cantu (2023) published “The Role of Complex Posttraumatic Stress Disorder in the Associations between Minority Stressors and Self-Reported Suicide Likelihood in LGBTQ+ adults” in Traumatology. Here’s the edited abstract:

Lesbian, gay, bisexual, trans, and queer individuals (LGBTQ+) report higher rates of suicide-related behaviors when compared to heterosexual cisgender individuals. The minority stress theory proposes that the suicide risk disparities among LGBTQ+ individuals may be explained by the additional exposure to stressors unique to their minority sexual orientation and gender identity. However, less is known about the mechanism of minority stressors and suicide risk among trauma-exposed LGBTQ+ individuals. The present study aimed to explore the role of the International Classification of Diseases, version-11 posttraumatic stress disorder (PTSD) and complex PTSD (disturbances in self-organization [DSO] + PTSD) in the associations between minority stressors and suicide intent in a sample of 229 trauma-exposed LGBTQ+ adults from Spain. Mediation analyses were conducted in Mplus 8.4 to test the impact of PTSD and DSO on the association between minority stressors and the self-reported likelihood of suicide intent. Results indicated that the cumulative daily cisheterosexist experiences had an impact on the likelihood of suicide intent through DSO. Specifically, gender expression-related harassment, and isolation due to sexual/gender identity increased the DSO symptoms, which, in turn, increased the likelihood of suicide behavior. Exploring minority stressors and targeting the components related to DSO, such as negative self-concept, affective dysregulation, and disturbances in relationships, may help clinicians in improving interventions aimed at reducing suicide-related behaviors in LGBTQ+ adults. 

A fairly large sample with a helpful conclusion. It makes sense that disturbances in self-organization and PTSD are common in LGBTQ+ adults and that clinicians need to look for signs of complex PTSD when these clients present with depression symptoms.