Skip to main content

Advertisement

Table 2 Risk factors for youth NSSI associated with parents

From: Parents of youth who self-injure: a review of the literature and implications for mental health professionals

Parent factor Design Location Measures Summary of findings
Parent Background Factors
Parent Socio-Economic Status
 Education CS [29, 42, 54, 56, 58]; L [36, 59] Belgium [29], Canada [54], China [56], Italy [42], Netherlands [42], Norway [58], United Kingdom [59], United States [36, 42] Researcher Derived Questionnaire [29, 36, 42, 54, 56, 58, 59] No differences in NSSI risk [36, 42, 54, 56, 58] Elevated risk for NSSI associated with lower parent education level [29] Lower maternal education during pregnancy weakly protected against NSSI risk in adolescence [59]
 Unemployment CS [3, 29, 33, 58] Belgium [29], Europe [33], Norway [58], Sweden [3] Researcher Derived Questionnaire [3, 29, 33, 58] No difference in NSSI risk [58] Elevated risk for NSSI associated with parent unemployment [3, 29, 33]
 Lower income CS [29, 56]; L [36, 59] Belgium [29], China [56], United Kingdom [59], United States [36] Researcher Derived Questionnaire [29, 36, 56, 59] No differences in NSSI risk [36, 56] Elevated risk for NSSI [29, 59]
 Financial problems CS [3, 58]; L [47] Finland [47], Norway [58], Sweden [3] Researcher Derived Questionnaire [3, 47, 58] Elevated risk for NSSI [3, 47, 58] Parents receiving social welfare benefits elevated risk for NSSI [58] Parental ownership of the house they live in was not associated with NSSI risk [58]
 Family social status L [47, 59, 60] China [60], Finland [47], United Kingdom [59] Researcher Derived Questionnaire [47, 59, 60] No differences in NSSI risk [47, 59, 60]
Family Structure
 Non-intact family CS [2, 3, 29, 32, 33, 45, 46, 50, 51, 54, 56, 58]; L [47] Belgium [29], Canada [54], China [56], England [45], Europe [33], Finland [47], Germany [32, 50], Norway [58], Sweden [3], United States [2, 46, 51] Researcher Derived Questionnaire [2, 3, 29, 32, 33, 4547, 50, 51, 54, 56, 58] No differences in NSSI risk [2, 29, 45, 46, 50] Elevated risk for NSSI [3, 32, 47, 54, 58] Elevated risk for NSSI associated with not living with biological parent [33] Elevated risk for NSSI associated with youth living with mother or father and a stepparent, or living with neither mother nor father [51] Elevated risk with single-parent family [56]
 Parents divorced CS [45, 67, 69]; L [47, 60] China [60], England [45], Finland [47, 67], Poland [69] Researcher Derived Questionnaire [45, 47, 60, 67, 69] No differences in NSSI risk [45, 67] Elevated risk for NSSI [69] Elevated NSSI risk associated with youth whose parents were divorced and remarried to other people [60] Not meeting with a divorced parent associated with NSSI risk among youth with ADHD [47]
Parent Health and Mental Health History
 Illness or disability CS [37, 54]; L [48] Canada [54], Germany [48], United States [37] Developmental Questionnaire [37]; Inclusion criteria [48]; Researcher Derived Questionnaire [54] No differences in NSSI risk associated with the number of miscarriages a mother has had [37] Trend toward significant NSSI risk associated with parent history of cancer [48] Elevated risk for NSSI associated with parent history of a serious illness or disability [54]
 Mental illness CS [40]; L [36] United States [36, 40] Beck hopelessness Scale [36]; Family History Screen [40]; Hamilton Depression Inventory [36]; Structured Clinical Interview for DSM-IV [36, 44]; Structured Clinical Interview for the DSM-IV Diagnosis of Personality Disorders [36] No differences in NSSI risk associated with parental history of mood disorders [40], depression, bipolar disorders, anxiety disorder, posttraumatic stress disorder, or cluster B personality disorder [36] Elevated risk for NSSI associated with lower depressive symptoms among youth of parents with a history of depression [36] Elevated risk for NSSI associated with maternal depression [44]
 NSSI/DSH, suicide ideation, suicide attempt L [36, 41] United Kingdom [41], United States [36] Columbia University suicide history form [36]; Life Event Questionnaire [41]; Medical Damage Lethality Scale [36]; Self-Injurious Behavior Scale [36] No differences in NSSI risk associated with parental history of suicide attempts [36, 41], suicide ideation, or NSSI/DSH [36]
 Alcohol and substance abuse L [36] United States [36] Structured Clinical Interview for DSM-IV [36] No differences in NSSI risk associated with parental history of alcohol or substance abuse [36]
 Parental stress CS [29] Belgium [29] Nijmeegse Vragenlijst voor Opvoedingssituaties [29] No difference in NSSI risk [29]
Parent Abuse History
 Abuse L [36] United States [36] Childhood Experiences Questionnaire [36]; Abuse Dimensions Inventory [36]; Demographic Questionnaire [36] No differences in NSSI risk for parent history of physical or sexual abuse [36]
Parent-Child Relationship Factors
Quality of Relationship
 Relationship quality CS [38]; L [12] Italy [38], United States [12] Inventory of Parent and Peer Attachment [12]; Youth Questionnaires [38] No differences in NSSI risk associated with relationship quality with fathers [38] Elevated risk for NSSI associated with lower overall relationship quality [12], and lower quality relationships with mothers [38] Higher NSSI frequency is associated with lower relationship quality with both mothers and fathers [38] NSSI predicted an increase in positive relationship quality both overall and with fathers [12]
 Connectedness with parents CS [62] United States [62] Minnesota Student Survey [62] Elevated risk for NSSI associated with less connectedness with parents [62]
 Attachment and alienation CS [68]; L [65, 72] Australia [65], United States [68, 72] Child Attachment Interview [68]; Adolescent Attachment Questionnaire [65]; Inventory of Parent and Peer Attachment—Alienation subscale [72] Elevated risk for NSSI onset and maintenance associated with attachment anxiety [65] Individuals who had ceased NSSI continued to have greater attachment anxiety compared to controls, but less than those who maintained NSSI [65] Attachment classification (secure, dismissing, preoccupied, disorganized) did not predict NSSI [68] The indirect path between parental criticism and NSSI risk through parental alienation accounted for much of the direct relation between parental criticism and NSSI youth from high-income families [72]
Support from Parents
 General support CS [23, 28, 29, 35, 61] Belgium [28, 29, 35], Netherlands [35], United States [23, 61] Parent Behavior Scale-Shortened Version (combines items assessing autonomy, positive parenting, reward, and rules) [29]; Child and Adolescent Social Support Scale (Parent Subscale) [23]; Level of Expressed Emotions Scale—Lack of emotional support subscale [28]; Relational Support Inventory [35]; Researcher Developed 5-item scale [61] No differences in NSSI risk [29] Elevated risk for NSSI associated with lower support from parents [23, 28, 35, 61] Interaction between support and parent behavioural control, such that high control and low support increased the change for NSSI [29] Lack of parental emotional support had a direct effect on NSSI frequency and an indirect effect through depressive symptoms [28] Parent support moderated the relation between bullying/victimization and NSSI, such that bullying/victimization and NSSI are only significantly related at low levels of parental support [35] Parent support moderated the relation between depressed mood and NSSI, such that among participants who engaged in bullying there is a stronger association between depressed mood and NSSI at low levels of parental support [35]
 Rule-setting L [30] Belgium [30] Parent Behavior Scale-Shortened Version (rule-setting subscale only) [30] NSSI predicted less future perceived parental rule-setting among adolescents with high psychological distress [30] Increased rule-setting associated with parent-reported awareness of youth’s NSSI [30]
 Positive parenting L [30] Belgium [30] Parent Behavior Scale-Shortened Version (positive parenting subscale only) [30] No differences in NSSI risk [30]
 Criticism CS [28, 70]; L [72] Belgium [28], United States [70, 72] Five Minute Speech Sample [70]; Multidimensional Perfectionism Scale—Parental Criticism subscale [72]; Level of Expressed Emotions Scale—Parental Criticism Subscale [28] Greater parental criticism associated with an elevated risk for NSSI presence in both boys and girls [70, 72], and with repeated NSSI in boys from high-income families [72] Adolescent self-criticism moderated the relation between parental criticism and NSSI such that adolescent self-criticism was associated with NSSI at borderline and high levels of parental criticism, but not at low levels of parental criticism [70] Parental criticism had only an indirect effect on NSSI frequency through self-criticism [28] An indirect path between parental criticism and NSSI risk through parental alienation accounted for much of the direct relation between parental criticism and NSSI risk among youth from high-income families [72]
 Invalidation CS [63] Singapore [63] Invalidating Childhood Environment Scale [63] Elevated risk for NSSI associated with greater parental invalidation [63]
 Expressed emotion CS [70] United States [70] Five Minute Speech Sample [70] No differences in NSSI risk associate with emotional over-involvement [70] Elevated risk for NSSI associated with greater expressed emotion [70]
 Interest, understanding attention CS [33]; L [47] Europe [33], Finland [47] Three items [33]; Self-Report Questionnaire [47] No differences in NSSI risk associated with parental interest for youth with ADHD [47] Elevated risk for NSSI associated with perception that parents do not pay attention to youth [33], and that parents do not understand the youth’s problems [33] NSSI risk higher for females, related to males, when reporting that parents do not understand youth’s problems [33]
 Parental hostility L [55] United Kingdom [55] Researcher-Developed Questionnaire [55] No differences in NSSI risk [55]
Discipline and Control
 Authoritative parenting CS [46] United States [46] 12-Item Scale [46] Authoritative parenting diminished the negative effects of bullying victimization on NSSI [46]
 Behavioural control CS [29]; L [30] Belgium [29, 30] Parent Behavior Scale-Shortened Version (combined punishment, harsh punishing, and neglect subscales [29]; or combined punishment and harsh punishing subscales [30]) No differences in NSSI risk when reported by parents [29] Elevated risk for NSSI associated with greater behavioural control when reported by youth [29] No unique risk in NSSI beyond other parenting variables [30] Interaction between behavioural control and support from parents, such that high control and low support increased the change for NSSI [29]
 Harsh parenting L [49, 52] Sweden [49], United States [52] Conflict Tactics Scale-Child Version [52]; Two measures capturing parents’ angry outbursts and coldness-rejection [49] Elevated risk for NSSI associated with harsher parenting [49] Trend towards elevated risk for NSSI associated with harsher parenting [52] No unique variance in NSSI predicted by harsh parenting when the model included peer victimization, though this was moderated by adolescent’s gender [49]
 Psychological control CS [29]; L [30] Belgium [29, 30] Psychological Control Scale [29, 30] No differences in NSSI risk when reported by parents [29] Elevated risk for NSSI associated with greater psychological control when reported by youth [29] No unique risk for NSSI beyond other parenting variables [30]
 Monitoring CS [61] United States [61] Researcher Developed 4-item Scale [61] Elevated risk for NSSI associated with lower parental monitoring [61]
 Emotion socialization CS [26] United States [26] Emotions as a child [26] Elevated risk for NSSI associate with punishing emotion socialization when combined with other family relational problems, though this risk may be mediated by emotion regulation [26]
Youth Affect Towards Parents
 Idealization of parents CS [38] Italy [38] Youth Questionnaire [38] Elevated risk for NSSI associated with idealization of mothers but not of father [38]
 Feelings towards parents CS [11] Sweden [11] Emotional Tone Index [11] Elevated risk for NSSI associated with absence of positive feelings, more negative feelings, and overall feelings (more negative and less positive feelings, combined) towards parents [11] No unique variance in NSSI predicted beyond that which was predicted by youth’s rumination/negative thinking ( [11]; Time 1) Unique variance in NSSI predicted beyond that which was predicted by youth’s rumination/negative thinking ([11]; Time 2)
 Dysphoric relations L [57] Sweden [57] Researcher-Derived Depression Index subscale [57] With fatigue, dysphoric relations to parents predicted NSSI [57]
 Academic expectations CS [63] Singapore [63] Academic Expectations Stress Inventory [63] Elevated risk for NSSI associated with greater stress from parental academic expectations [63]
Adverse Childhood Experiences
 Antipathy CS [50] Germany [50] Childhood Experiences of Care and Abuse Questionnaire [50] Elevated risk for NSSI associated with antipathy from both mothers and fathers [50] Paternal antipathy associated with interpersonal influence functions of NSSI [50]
 Maladaptive parenting L [55] United Kingdom [55] Researcher Derived Questionnaire [55] Parental hitting or shouting in preschool years predicted NSSI in adolescence [55]
 Abuse by parent CS [50, 58, 64] China [64], Germany [50], Norway [58] Childhood Experiences of Care and Abuse Questionnaire [50]; Conflict Tactics Scales Parent Child version [64]; Researcher Derived Questionnaire [58] Elevated risk for NSSI associated with verbal abuse by a parent [58] Elevated risk for NSSI associated with physical abuse by a parent [58, 64], and by fathers specifically [50] Maternal physical abuse predicted peer identification functions of NSSI [50]
 Physical neglect CS [34, 38, 50] Germany [50], Italy [34, 38] Boricua Child Interview [38]; Childhood Experiences of Care and Abuse Questionnaire [50]; Life-Stressor Checklist-Revised [34] No difference in NSSI risk associate with physical neglect [34] Elevated NSSI risk associated with physical neglect from mothers [50] Greater NSSI frequency, but not presence, was associated with physical neglect from a parent [38] Paternal neglect predicted peer identification functions of NSSI [50]
Family Systems Factors
Family Environment
 Family functioning CS [29, 43]; L [53] Belgium [29], China [53], United States [43] Chinese Family Assessment Inventory [53]; McMaster Family Assessment Device—General Functioning Subscale [43]; Vragenlijst Gezinsproblemen [29] No differences in NSSI risk when reported by youth [43], or parents [29] Elevated risk for NSSI associated with lower family functioning [53]
 Support CS [67, 69, 71]; L [27, 65, 66] Australia [27, 65], Finland [66, 67], Poland [69], United States [71] Multidimensional Scale of Perceived Social Support [27, 65]; Perceived Social Support Scale-Revised [66, 67]; Researcher Derived Questionnaire [69]; Survey of Children’s Social Support [71] No differences in NSSI risk [66, 69] Elevated risk for NSSI presence [27, 67, 71], onset and maintenance associated with lower support from parents [65] NSSI onset associated with a decrease in family support [65] NSSI cessation associated with an increase in family support over time, though individuals who had ceased NSSI continued to perceive lower levels of support from family relative to individuals with no NSSI history [65]
 Adaptability and cohesion CS [26, 51, 56], L [36] China [56], United States [26, 36, 51] Family Environment Scale [26]; Family Adaptability and Cohesion Evaluation Scale-II [36]; Family Cohesion and Adaptability Scale-Chinese Version [56]; Vaux Social Support Record [51] No differences in NSSI risk associated with family adaptability [36] Elevated risk for NSSI associated with greater family rigidity [56] Elevated risk for NSSI associated with lower family cohesion [26, 51, 56], though this risk may be mediated by emotion regulation [26] Elevated NSSI risk associated with lower family adaptability and cohesion among youth of parents with a history of depression [36]
 Conflict CS [26] United States [26] Family Environment Scale [26] Elevated risk for NSSI associated with greater family conflict, though this risk may be mediated by emotion regulation [26]
 Invalidation L [73] China [73] Family Invalidation Scale [73] Elevated risk for NSSI [73]
 Arguments between parents CS [45] England [45] Self-Report Questionnaire [45] No difference in NSSI risk [45]
 Loneliness CS [42] Italy [42], Netherlands [42], United States [42] Social and Emotional Loneliness Scale for Adults-Adapted [42] Elevated risk for NSSI associated with family-related loneliness among Dutch and US adolescents, but not among Italian adolescent [42] Elevated risk for repeated NSSI associated with family-related loneliness [42]
 Socializing with family L [47] Finland [47] Self-Report Questionnaire [47] Elevated risk for NSSI associated with youth with ADHD who socialize less with the family [47]
Adverse Childhood Experiences
 Domestic violence CS [34, 39, 58, 62], L [55] Italy [34, 38], Norway [58], United Kingdom [55], United States [39, 62] Life-Stressor Checklist-Revised [34]; Minnesota Student Survey [39]; Research Derived Questionnaire [55, 58]; Minnesota Student Survey [62] No difference in NSSI risk associated with witnessing family violence [39, 62] Elevated risk for NSSI associated with witnessing family violence [34] Elevated risk for NSSI associated with domestic violence in preschool years [55], and with witnessing parents being verbally or physically abused [58]
 Abuse CS [39, 69] Poland [69], United States [39] Minnesota Student Survey [39]; Researcher Derived Questionnaire [69] No differences in NSSI risk associated with sexual abuse in the family [69] Elevated risk for NSSI associated with both physical and sexual abuse by a household adult [39]
 Negative life events in the family CS [29] Belgium [29] Summation of 19 events (e.g., financial problems, death in the family) [29] No differences in NSSI risk when reported by parents [29]
 Death of a family member CS [45, 69] England [45], Poland [69] Researcher Derived Questionnaire [45, 69] No difference in NSSI risk [45, 69]
Family Health and Mental Health History
 Health problems CS [32] Germany [32] Researcher Derived Questionnaire [32] Elevated risk for occasional, but not repetitive, NSSI associated with some (but not many) health problems in the family [32]
 Mental illness CS [31, 37, 69] Poland [69], United States [31, 37] Personal and Family History Questionnaire [37]; Review of medical records [31]; Researcher Derived Questionnaire [69] No differences in NSSI risk associated with a family history of mental illness [31, 69], emotional or behavioural problems, depression, bipolar disorder, anxiety, eating disorder, schizophrenia, or Tourette’s [37]
 NSSI/DSH or suicide ideation CS [37, 45] England [45], United States [37] Personal and Family History Questionnaire [37]; Self-Report Questionnaire [45] No differences in NSSI risk associated with a family history of NSSI/DSH [37, 45] Elevated risk for NSSI associated with a family history of suicide ideation [37]
 Alcohol and substance abuse CS [37, 39, 62, 69] Poland [69], United States [37, 39, 62] Minnesota Student Survey [39]; Personal and Family History Questionnaire [37]; Population Based Survey [62]; Researcher Derived Questionnaire [69] No differences in NSSI risk associated with a family history of alcohol [69] or substance [62] abuse Elevated risk for NSSI associated with a family history of alcohol or substance abuse [37] Elevated risk for NSSI when alcohol or substance use caused problem [39]
 Criminality or violence CS [31, 37] United States [31, 37] Personal and Family History Questionnaire [37]; Review of medical records [31] Elevated risk for NSSI associated with both criminality [31] and violence [31, 37]
  1. CS cross-sectional and L longitudinal.