Symposia
Suicide and Self-Injury
Jennifer A. Poon, Ph.D.
Postdoctoral Fellow
Alpert Medical School of Brown University
Providence, Rhode Island
Roberto Lopez Jr., M.A.
Doctoral Candidate
George Mason University
Fairfax, Virginia
Lynne Marie-Shea, M.A.
Doctoral Candidate
Suffolk University
Boston, Massachusetts
Richard Liu, Ph.D.
Associate Professor
Massachusetts General Hospital/Harvard Medical School
Boston, Massachusetts
Linehan’s Biosocial Model contends that maladaptive behaviors primarily develop as a means of emotion regulation (ER); these behaviors are a product of the dynamic interaction between one’s biology (e.g., high emotional sensitivity) and an invalidating social context. Childhood trauma—particularly emotional, physical, and sexual abuse—represents an extreme form of invalidation that has been linked to ER problems. Both abuse and ER difficulties have also been linked to self-injurious thoughts and behaviors (SITBs), such as non-suicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SAs). Research has shown that ER difficulties mediate the association between abuse and psychopathology. However, less work has examined whether ER difficulties mediate the association between abuse and SITBs. Understanding the longitudinal relation between trauma and SITBs is key to developing effective prevention and intervention strategies. In the present study, ER difficulties were hypothesized to mediate the relation between child abuse history and SITBs at 18-month follow-up. Exploratory analyses were conducted to determine if specific forms of ER difficulties would function as mediators. Participants included 151 adolescent psychiatric inpatients (Mage = 15.05; 82% White; 84% cis-female). Youth reported on abuse at baseline (CTQ) and on ER difficulties at baseline and 12-month (DERS). SITBs were assessed at baseline and 18-month follow-up (SIQ-Jr; SITBI). Individual path models for each outcome (i.e., NSSI, SI, SA) were conducted in PROCESS while controlling for baseline levels of the respective outcome. Abuse history predicted 12-month ER difficulties, which subsequently predicted greater likelihood of engaging in NSSI at 18-months (b = .62, SE =.19, p < .003; b = .01, SE < .01, 95% CI: .004-.03). ER difficulties also mediated the relation between abuse and 18-month SI severity (R2 = .15; b = .19, SE = .04, p<.001; b = .12, SE = .04, 95% CI: .04-.22). ER difficulties did not mediate the relation between abuse and 18-month SAs, though null results may be the result of low base rates of SAs. Post hoc analyses revealed that difficulties engaging in goal-directed behavior and limited access to ER strategies mediated the relation between abuse and NSSI at 18-month follow-up. Results suggest that ER difficulties may be one mechanism underlying the relation between threat and SITBs. Treatments aimed at bolstering access to ER strategies and goal-directed behavior may help reduce SITB risk among youth who have experienced trauma.