***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE We examined whether a shortened form of dialectical behavior therapy , dialectical behavior therapy for adolescents ( DBT-A ) is more effective than enhanced usual care ( EUC ) to reduce self-harm in adolescents . METHOD This was a r and omized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were r and omly allocated to either DBT-A or EUC .  Assessment s of self-harm , suicidal ideation , depression , hopelessness , and symptoms of borderline personality disorder were made at baseline and after 9 , 15 , and 19 weeks ( end of trial period ) , and frequency of hospitalizations and emergency department visits over the trial period were recorded . RESULTS Treatment retention was generally good in both treatment conditions , and the use of emergency services was low . DBT-A was superior to EUC in reducing self-harm , suicidal ideation , and depressive symptoms . Effect sizes were large for treatment outcomes in patients who received DBT-A , whereas effect sizes were small for outcomes in patients receiving EUC . Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation , whereas no mediation effects were found on the other outcomes or for total treatment time . CONCLUSION DBT-A may be an effective intervention to reduce self-harm , suicidal ideation , and depression in adolescents with repetitive self-harming behavior . Clinical trial registration information-Treatment for Adolescents With Deliberate Self Harm ; http:// Clinical Trials.gov/ ; NCT00675129 Nonsuicidal self-injury ( NSSI ) has become a significant public health problem . Although numerous studies have examined cross-sectional psychological correlates of NSSI , there has been little research examining predictors of NSSI over time . The present study examined cross-sectional and longitudinal correlates of NSSI in 81 young adult self-injurers ( M age=19 , 74.1 % female , 51.9 % Caucasian ) , 51 of whom were followed up 1 year later . At baseline , participants completed self-report measures of NSSI , Axis-I disorders , borderline personality disorder ( BPD ) , and impulsivity , as well as an implicit measure of NSSI attitudes and identity . One year later , participants completed a Timeline Followback Method whereby they indicated their engagement in NSSI over the previous 12 months . Analyses replicated many known cross-sectional correlates of NSSI , including symptoms of several Axis-I disorders and BPD . However , many of these same variables failed to predict the course of NSSI over the 1-year follow-up . The only variables to prospect ively predict NSSI were past NSSI ( i.e. , frequency , methods , and recency of NSSI ) , participants ' behavioral forecast of their engagement in future NSSI , and BPD features . Findings suggest that many cross-sectional correlates of NSSI may not be useful for predicting subsequent NSSI . Instead , NSSI severity and BPD features appear to best predict continued engagement in NSSI Why do people 's impulse controls  break down during emotional distress ? Some theories propose that distress impairs one 's motivation or one 's ability to exert self-control , and some postulate self-destructive intentions arising from the moods . Contrary to those theories , Three experiments found that believing that one 's bad mood was frozen ( unchangeable ) eliminated the tendency to eat fattening snacks  ( Experiment 1 ) , seek  immediate gratification  ( Experiment 2 ) , and engage in  frivolous procrastination  ( Experiment 3 ) . The implication is that when people are upset , they indulge immediate impulses to make themselves feel better , which amounts to giving short-term affect regulation priority over other self-regulatory goals PURPOSE Little is known about the clinical characteristics and motivations for engaging in  non-suicide self-injury ( NSSI  ) behaviors  in adolescence . The aim of this study was to examine the prevalence , characteristics and functions of NSSI among adolescents in community setting s , and to explore risk factors related to this behavior . SUBJECTS AND METHODS Two hundred and seventy-five adolescents aged 12 to 17 were recruited r and omly from different High Schools in Israel . They completed self-report question naires assessing NSSI ( Ottawa Self-Injury Inventory ) , depression ( Children 's Depression Inventory - CDI ) and impulsivity ( Barratt Impulsiveness Scale - BIS-II ) . RESULTS In the past year , 20.7 % of the participants reported engaging NSSI at least once . Among them , 42.1 % declared they are still engaging in NSSI at the present . Motives for NSSI were internal emotion regulation reasons , external emotion regulation reasons for social influences . In addition , the NSSI group reported significantly higher levels of depressive , impulsivity and suicidal ideations . Depressive symptoms were found as significant predictors of NSSI in the future . DISCUSSION AND CONCLUSIONS High rates of NSSI among community adolescents were found . Depression , impulsivity and suicidal ideation were found significantly related to NSSI . Mental health professionals in schools and in primary care should routinely assess NSSI among adolescents BACKGROUND Suicide is the third-leading cause of death among adolescents and nonsuicidal self-harm occurs in 13%-45 % of individuals within this age group , making these phenomena major public health concerns . Lesbian , gay , bisexual , and transgender ( LGBT ) youth particularly are at risk for engaging in these behaviors . Nevertheless , relatively little is known about the specific risk factors associated with suicidal ideation and self-harm behaviors in the population . PURPOSE This study provides a longitudinal evaluation of the relative contributions of general and LGBT-specific risk factors as well as protective factors to the occurrence of suicidal ideation and self-harm in an ethnically diverse sample of LGBT youth . METHODS A community sample of 246 LGBT youth ( aged 16 - 20 years ) was followed prospect ively over five time points at regular 6-month intervals . Participants completed a baseline structured interview assessing suicide attempt history and question naires measuring gender nonconformity , impulsivity , and sensation-seeking . At follow-up assessment s , participants completed a structured interview assessing self-harm and question naires for suicidal ideation , hopelessness , social support , and LGBT victimization . Data were collected from 2007 to 2011 , and HLM analyses were conducted in 2011 . RESULTS A history of attempted suicide ( p=0.05 ) ; impulsivity ( p=0.01 ) ; and prospect i ve LGBT victimization ( p=0.03 ) and low social support ( p=0.02 ) were associated with increased risk for suicidal ideation . Suicide attempt history ( p<0.01 ) ; sensation-seeking ( p=0.04 ) ; female gender ( p<0.01 ) ; childhood gender nonconformity ( p<0.01 ) ; and prospect i ve hopelessness ( p<0.01 ) and victimization ( p<0.01 ) were associated with greater self-harm . CONCLUSIONS General and LGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth , which may , in part , account for the higher risk of these phenomena observed in this population Self-mutilative behavior ( SMB ) is presented as a specific form of inwardly directed aggressiveness which is thought to be associated with problems of impulse control . Conceptual problems concerning impulsivity and impulsive aggression are discussed . Among different forms of dyscontrolled behavior , SMB is of special heuristic interest because of distinction can be made between patients committing impulsive and those committing premeditated self-harming actions . Psychometric and biological measures of impulsivity and aggressiveness were assessed in  self-mutilators  in comparison to depressives and normal prob and s. Self-mutilators were differentiated into two subgroups , those with an impulsive ( ISMB ) and those with a premeditated ( PSMB ) form of SMB , and depressives were also differentiated into two subgroups , those with a history of suicide attempts and those without . Only patients with ISMB ( and depressives with a history of suicide attempts ) showed an enduring tendency towards dyscontrolled patterns of behavior and cognition ; therefore , SMB can not be generally regarded as an indicator of high impulsivity or an impulse control disorder . Measures of impulsivity and aggressiveness did not behave analogically to each other and aggressive or autoaggressive modes of behavior should not be generally used as an index of impulsivity . A reduction of serotonergic activity , proved by a blunted prolactin response to D-fenfluramine , was found in all patient-groups in comparison to normal prob and s. Prolactin response after  D-fenfluramine  challenge turned out to be most blunted among self-mutilators with ISMB and among depressives with a history of suicide attempts Background An earlier r and omised controlled trial demonstrated improved treatment engagement in adolescents who received Therapeutic Assessment ( TA ) versus Assessment As Usual ( AAU )  , following an emergency presentation with self-harm . Objectives To determine 2-year outcomes for the same adolescents focusing on frequency of Accident and Emergency ( A&E ) self-harm presentations and treatment engagement . Method Patients in the TA groups ( n=35 ) and the AAU group ( n=34 ) were followed up 2 years after the initial assessment . Their primary and secondary care electronic records were analysed . Results There was no significant difference in the frequency of self-harm result ing in A&E presentations between the two groups ( OR 0.69 , 95 % CI 0.23 to 2.13 , p=0.53 ) . Treatment engagement remained higher in the TA group than the AAU group . Conclusions TA is not associated with a lower frequency of A&E self-harm presentations . The effect of TA on engagement is maintained 2 years after the initial assessment . Interventions to reduce self-harm in adolescents are needed . Trial registration IS RCT N 81605131 , http://www.controlled-trials.com/IS RCT Research suggests that self-control , affective lability , and negative urgency are associated with deliberate self-harm , problematic alcohol consumption , and eating problems . Few studies have fully examined how negative urgency might uniquely explain the effects of self-control and affective lability on these outcomes , as compared to other impulsivity-related traits . This was the goal of the current study . Of an initial group of 734 undergraduate students , 29 % indicated a history of deliberate self-harm . These 215 individuals were r and omly matched with a group of non-self-harmers ( total N=430 ; mean age=22.36 , SD=6.59 ; 76.2 % female ) . Self-harmers showed higher rates of alcohol use ( F(2 , 186)=5.48 , p<.001 ) and eating problems ( F(2 , 186)=7.74 , p<.001 ) . In a structural equation model , negative urgency was significantly associated with self-harming frequency ( β=3.81 , p<.001 ) , variety of self-harm methods ( β=5.79 , p<.001 ) , the number of years of self-harming ( β=2.75 , p<.001 ) , problematic alcohol use ( β=1.80 , p<.05 ) , and eating problems ( β=3.99 , p<.001 ) . Negative urgency was positively associated with affective lability ( β=7.71 , p<.001 ) and negatively associated with self-control ( β=-13.59 , p<.001 ) . Negative urgency is the only impulsivity-related trait that is a common risk factor associated with increased self-harm , problematic alcohol use , and eating problems 
    Output:
    
Specifically , lifetime non-suicidal self-injury was most consistently associated with mood-based impulsivity-related traits .
However , cognitive facets of impulsivity ( relating to difficulties maintaining focus or acting without forethought ) differentiated current self-harm from past self-harm .
These facets also distinguished those with thoughts of self-harm ( ideation ) from those who acted on thoughts ( enaction ) .
The findings suggested that mood-based impulsivity is related to the initiation of self-harm , while cognitive facets of impulsivity are associated with the maintenance of self-harm .
In addition , behavioural impulsivity is most relevant to self-harm under conditions of negative affect .
Collectively , the findings indicate that distinct impulsivity facets confer unique risks across the life-course of self-harm .
From a clinical perspective , the review suggests that interventions focusing on reducing rash reactivity to emotions or improving self-regulation and decision making may offer most benefit in supporting those who self-harm