Now, a new meta-analysis of 38 studies finds consistent results and themes: that people engage in self-injury and/or think about suicide to alleviate some types of stress; and that the perceived stress relief that results from thoughts and behaviors indicates potential for therapy and other interventions.

Over the past 10 years, researchers have started to ask people at risk of suicide to complete surveys multiple times per day. This type of data allows for researchers to understand the thoughts, emotions and behaviors that precede self-injurious thoughts and actions. The 天美影视传媒 conducted the data aggregation of these types of studies involving more than 1,600 participants around the world. It was published April 28 in .

鈥淢any researchers have been collecting this data and testing for the same finding, but there were mixed findings across studies. We wanted to see if we saw this effect when we combined these datasets,鈥� said , lead author of the meta-analysis and a UW doctoral student in clinical psychology.

With suicide and the role of self-harm, or non-suicidal self-injury (NSSI), as a risk factor, Kuehn and his team wanted to look collectively at separate studies of NSSI and suicidal thoughts. By analyzing data of individual participants in these studies, the UW researchers found that high levels of emotional distress precede both self-injury and suicidal thoughts, followed by reduced stress.

Researchers point to additional data on suicide 鈥� that , for example 鈥� and consistent findings from the meta-analysis that stress precedes self-injury.

They say this can inform prevention and intervention efforts, such as learning how to replace self-injury and suicidal thoughts with other means of reducing stress.

鈥淭he good news is that we have effective behavioral interventions, such as cognitive behavioral therapy and dialectical behavioral therapy, which teach skills for managing intense emotions to replace self-injurious thoughts and behaviors. Increasing access to these types of treatments is likely to reduce the prevalence of them,鈥� Kuehn said.

One limit of the meta-analysis, researchers said, is that participants in the various studies were predominantly young white women. Further research into self-injury and related thoughts and behaviors should focus on increasing the age, gender and racial and ethnic diversity of study samples. In addition, the meta-analysis found only modest evidence that stress, while a connection to self-harm, could be used as a means for predicting when an individual might injure themselves. Future studies could try to identify more precisely when and how stress leads to self-injurious thoughts and behaviors.

The research was funded by the National Institute of Mental Health. Co-authors were Jonas Dora, Katherine Foster, Frank Song, Michele Smith and Kevin King of the UW Department of Psychology; and Melanie Harned of the UW Department of Psychiatry and Behavioral Sciences and the Veterans Affairs Puget Sound Health Care System.

For more information, contact Kuehn at kskuehn@uw.edu.

In early March 2020, the 天美影视传媒 became the first four-year U.S. university to transition to online-only classes due to the COVID-19 pandemic.

severe consequences of these physical distancing measures. To understand how this change affected college students’ mental health, UW researchers surveyed 147 UW students over the 2020 spring quarter, which began shortly after the university transitioned to online-only classes. The team compared the students’ responses to a previous survey of 253 students in spring quarter 2019.

The researchers didn’t see much change in average levels of students’ depressive symptoms, anxiety, stress or loneliness between 2019 and 2020 or between the beginning and the end of spring quarter 2020. But these average values were masking large differences in students’ individual pandemic experiences. In general, students who used more problem-focused forms of coping 鈥� creating plans, focusing on positive aspects, etc. 鈥� experienced fewer mental health symptoms than those who disengaged or ignored a situation that was bothering them.

The researchers June 28 in PLOS ONE.

“During the pandemic, the challenges of online learning were entwined with social isolation, family demands and socioeconomic pressures,” said lead author , an affiliate associate professor in the UW Information School. “There鈥檚 not a simple answer to the question of how students were affected: Some experienced intense distress while others were unscathed.”

For the past four years, this team has spent spring quarter studying what factors contribute to undergraduates’ overall mental health and well-being. Students are invited to continue participating in each spring quarter study, and the researchers also recruit new students each time. In a previous paper, the researchers found that experiencing discrimination events altered student behavior, such as the amount of sleep or exercise a student got following the event.

For the 2020 cohort, the team used three different survey methods to monitor student health. First, they sent large surveys at the beginning and end of spring quarter. Then participants received two shorter surveys each week that asked them to reflect on how they felt 鈥� in terms of stress, loneliness, depressive symptoms 鈥� in the moment.

In general, students who reported more mental health symptoms at the beginning of the pandemic continued to experience elevated symptoms during the pandemic.

鈥淧roblem-focused coping protected students from the harmful effects of stress (anxiety and depression, for example), even though students who used more problem-focused strategies reported more stress,” said co-author , a UW doctoral student in clinical psychology.

“What these findings suggest is that students who coped by actively confronting their challenges, rather than avoiding them, still experienced highly stressful events over the course of the pandemic. However, they were protected from the mental health consequences,” Kuehn said. “It may not always feel pleasant or easy to confront the challenges of daily life, particularly during a pandemic, but doing so is likely to be highly beneficial in terms of reducing anxiety and depressive symptoms.”

Finally, at the end of spring quarter, the team conducted 90-minute in-depth interviews over Zoom with a subset of participants to gain deeper insight into their experiences.

The students described a range of challenges that interfered with learning:

• Decreased interaction with faculty and peers 鈥� students mentioned that having fewer opportunities to interact with faculty and peers left them feeling less engaged. Some students said they felt like part-time students, even when they had full course loads
• No shared learning environments 鈥� students spoke longingly of a table in a dorm or a spot in the library where they used to gather with classmates for impromptu study sessions
• Family needs 鈥� family members’ requests or noise often interrupted studying and even test-taking. Family needs, such as caregiving, were a particular challenge to learning for first-generation college students
• Interrupted autonomy 鈥� some students felt “trapped” back at home and described difficult “power dynamics” with their parents
• Well-being and mental health 鈥� many students described disrupted sleep, decreased motivation, and said that they felt depressed or anxious for periods of time. Students’ feelings of detachment from school sometimes contributed to depression. Similarly, worry about grades sometimes cascaded into anxiety and insomnia that, in turn, made it harder to focus

Students also developed strategies to combat these challenges, including:

• Self-learning 鈥� students used independent online research to figure out answers to their questions and made up their own experiments to explore what they were learning in class
• Structuring routines and environments 鈥� many students created fixed schedules for studying or used physical calendars to mark timelines and assignments
• Learning with peers 鈥� students created remote study groups and held informal remote co-working sessions that combined homework with personal conversations, which helped keep them on task
• Participating more in online spaces 鈥� many students found it less daunting to ask questions in online classes than in large lecture halls, others found it easier to participate in online office hours and meetings with advisers
• Using communication platforms for emotional wellbeing 鈥� some students used telehealth or meditation apps, but almost all of them used video communication to check in with their friends. Students emphasized that these connections were critical for their mental health

“On an optimistic note, students are emerging with critical skills for learning and maintaining connectedness with peers over a distance,” Morris said. “These active coping skills, which include things such as initiating virtual co-working sessions, leveraging online functions to participate in class and checking in on friends in an emotionally sensitive way, will have continued value as we resume in-person and hybrid models of education.”

The team plans to follow students through all four years of their time at the UW. The first study cohort graduated this year, and the second cohort will graduate in spring 2022.

Additional co-authors are Jennifer Brown, an alumnus of the UW school of public health who is the research coordinator for this project; , a professor in the UW School of Social Work; and , UW doctoral students in the Paul G. Allen School of Computer Science & Engineering; , a doctoral student in the Information School; , a UW professor of electrical and computer engineering; , professor and dean of the UW Information School; , a researcher at Google; and , a professor in the Allen School. This research was funded by the National Science Foundation, the National Institute of Mental Health, Google, the Allen School, UW Department of Electrical & Computer Engineering, the UW College of Engineering and the UW Population Health Initiative.

For more information, contact Morris at margiemm@uw.edu.

Grant numbers: EDA-2009977, CHS-2016365, CHS-1941537, F31MH117827