Meta-Analysis Finds Childhood Abuse, Neglect Associated With Self-Injurious Behavior

Understanding patients’ history of childhood abuse or neglect may help determine their risk of non-suicidal self-injury, according to a meta-analysis published in the January issue of Lancet Psychiatry.

Non-suicidal self-injury—defined as direct and deliberate destruction of one’s own bodily tissue without suicidal intent—is estimated to affect more than 5% of adults, 17% of adolescents, and 30% of adolescents with a mental disorder. Moreover, non-suicidal self-injury is known to be one of the strongest predictors for future suicide attempts, Richard T. Liu, Ph.D., of Brown University and colleagues wrote. While most patients who engage in repeated self-injurious behavior stop within a few years, about one-fifth of patients develop a chronic pattern of self-injury.

The meta-analysis by Liu and colleagues included 71 studies that evaluated the association between childhood maltreatment (including sexual abuse, physical abuse, physical neglect, emotional abuse, and emotional neglect) and non-suicidal self-injury. The researchers found that overall childhood maltreatment was positively associated with non-suicidal self-injury (odds ratio [OR] = 3.42). The association was strongest for emotional abuse (OR = 3.03) and weakest for emotional neglect (OR = 1.84), although the analysis for emotional neglect included the fewest studies.

The association of maltreatment with non-suicidal self-injury was found to be stronger in community samples than in clinical samples, suggesting that “screening for history of childhood maltreatment might be of most benefit in community settings,” they wrote.

In an accompanying commentary, Lianne Schmaal, Ph.D., and Sarah Bendall, Ph.D., of Orygen and the University of Melbourne wrote that “Disclosure of past childhood maltreatment to a health professional can be a distressing experience. Because non-suicidal self-injury might function to distract from distress in some people, disclosures of distressing maltreatment have the potential to raise the risk of non-suicidal self-injury afterwards.” Therefore, such assessments should be done in accordance with principles of trauma-informed care.

For related information, see the American Journal of Psychiatry article “Association of a History of Child Abuse With Impaired Myelination in the Anterior Cingulate Cortex: Convergent Epigenetic, Transcriptional, and Morphological Evidence.”

(Image: iStock/Sasiistock)

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Depression in Early Adolescence May Alter Normal Brain Development

The brains of youth experiencing elevated depressive symptoms early in adolescence appear to develop differently from those experiencing depression in late adolescence, reports a study in the Journal of the American Academy of Child and Adolescent Psychiatry. Specifically, the MRI study found that cortical surface area was lower in youth with early depressive symptoms compared with those in the other groups.

“Our findings suggest that early adolescence is a particularly sensitive period for depressive symptoms to affect cortical surface area development and may provide a critical window for treatment of (subthreshold) depressive symptoms,” Lianne Schmaal, Ph.D., and colleagues wrote.

The study is part of the Orygen Adolescent Development Study, which is being conducted by Orygen, the National Centre of Excellence in Youth Mental Health based in Melbourne, Australia.

Cortical surface area is known to expand during adolescence, remain relatively stable in adulthood, and decrease with older age. The researchers collected structural MRI data from 149 adolescents from age 12 through 19. At each MRI visit, participants were asked about depressive symptoms, using the Center for Epidemiologic Studies Depression Scale (CES-D).

Three depressive symptom trajectories were identified among the participants: “low-stable” (n=97), a group with stable low levels of depression throughout the trial; “early-decreasing” (n=33), a group with moderate initial depressive symptoms that declined over time; and “late-increasing” (n=19), a group with increasing symptoms at each follow-up.

Females with early-decreasing symptoms showed lower anterior cingulate cortex (ACC) and orbitofrontal cortex (OFC) surface area compared with females with stable low levels of depression and with increasing symptoms across adolescence. Males with low stable and late increasing symptoms showed an increase of right OFC surface area, whereas males with early decreasing symptoms showed no such surface area expansion over time. 

The authors noted that because the trial did not include data beyond age 19, there is no way to know “whether the observed lower ACC and OFC surface area findings represent a delay in maturation, i.e., catching up when transitioning into adulthood, or whether these lower surface areas persist into adulthood.” Still, they added, “These findings may indicate that the experience of depressive symptoms early in adolescence, a critical period for surface area expansion, interrupts normal brain maturation of surface area.”

For related information, see the Psychiatric News article “Researchers Develop Composite Image of Brains of Youth With MDD.”

(Image: iStock/Hirkophoto)