Deliberate self-harm in adolescents during COVID-19: The roles of pandemic-related stress, emotion regulation difficulties, and social distancing

Abstract

The objective of this study was to conduct an ecologically valid test of etiological models of deliberate self-harm (DSH) during the COVID-19 pandemic. Using a sample of Canadian adolescents, we investigated: (1) the association between COVID-19-related stress and DSH; (2) whether emotion regulation (ER) difficulties mediated/moderated this association, including whether these effects differed by age; and (3) whether the mediating/moderating effects of ER difficulties were stronger among socially distanced youth. Canadian adolescents (N = 809) aged 12-18 were recruited on social media and completed an online survey. COVID-19-related stress was associated with recent DSH. Nonacceptance of emotional responses and limited access to ER strategies fully mediated this association. The indirect effect through nonacceptance of emotional responses was stronger among more socially distanced youth, whereas the indirect effect through limited access to ER strategies was stronger among older and more socially distanced youth. COVID-19-related stress and ER difficulties did not interact to predict DSH, nor did age or social distancing moderate these interactions. These results align with etiological models proposing central roles for stress and ER difficulties in DSH. Furthermore, this study underscores a need to support adolescents, particularly older teens with reduced in-person interactions, in adaptively coping with pandemic-related stress.

Non-Suicidal Self-Injury in Adolescence: The Role of Pre-Existing Vulnerabilities and COVID-19-Related Stress

“…This study’s findings suggest an indirect effect of pre-existing vulnerabilities on NSSI through higher levels of COVID-19-related stress. First, it is important to note that in contrast with concerns raised about an increase in NSSI during the pandemic (e.g., Robillard et al, 2021 ), the current study found no evidence that the prevalence or average frequency of NSSI increased during the pandemic. Instead, only adolescents with pre-existing vulnerabilities emerged to be at higher risk for NSSI during the pandemic.…”

“…Recent work raised concerns about whether COVID-19-related stress may increase the risk for self-injurious behaviors among adolescents. Existing evidence comes primarily from studies that used cross-sectional designs conducted with high school students from Canada (Robillard et al, 2021 ), Taiwan (Tang et al, 2021 ), Sweden (Zetterqvist et al, 2021 ), and with hospitalized adolescents (Du et al, 2021 ). Only few studies used short-term longitudinal designs with follow-ups conducted only a few months into the COVID-19 pandemic with Chinese children (Zhang et al, 2020 ) and adolescents (Xiao et al, 2022 ), and with American high school students (Carosella et al, 2021 ; Schwartz-Mette et al, 2022 ).…”

Generation COVID-19 and bodily disorders: Hyperbolic narratives and a developmental psychopathology perspective

“…Similarly, WHO (6) and other international health agencies (7), together with a certain number of studies (8)(9)(10)(11)(12)(13)(14) reported an increase in depression and anxiety among adolescents in COVID-19 time, but also a rise in bodily disorders, such as non-suicidal self-injury and eating disorders. These data, if absolutized, shed a dark light on the future of mental health of youth.…”

“…Regarding this matter, just a few studies so far have tried to identify the mediating/moderating effect of risk factors in the relationship between pandemic and emerging or worsening of NSSI or EDs. As for NSSI, Robillard et al (13), for example, using a sample of Canadian adolescents, report that the relationship between COVID-19 pandemic stress and NSSI was fully mediated by two dimensions of emotion regulation (ER) difficulties, namely non-acceptance of emotional responses and limited access to ER strategies. Similarly, Tang et al (27), using a sample of Taiwan teenagers, suggest that the NSSI group during the pandemic mostly consisted of girls scoring significantly higher in neuroticism, depression, impulsivity, alexithymia, virtual social support, dissatisfaction with academic performance, and lower in subjective wellbeing, self-esteem, actual social support, as well as family function than the non-NSSI group.…”

Development and Evaluation of an eLearning Training Module to Improve United Kingdom Secondary School Teachers’ Knowledge and Confidence in Supporting Young People Who Self-Harm

“…There is a pressing need to develop strategies to address the rising prevalence of self-harm in YP, as highlighted in a range of international policy documents (World Health Organization, 2013). This is needed now, more than ever before, given the negative impact of the coronavirus pandemic on YP's mental health, with a reported increase in self-harm during the pandemic (Carr et al, 2021;Robillard et al, 2021;Zetterqvist et al, 2021).…”