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Reproductive Health in Multiple Sclerosis

Best practices for management of women with MS call for regular, consistent communication with premenopausal patients about their fertility goals. Clinicians should keep up with evolving knowledge regarding the use of disease-modifying treatments (DMTs) before, during, and after pregnancy, and physicians who care for patients with MS may also want to develop a referral relationship […]

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Reproductive Health in Multiple Sclerosis

Best practices for management of women with MS call for regular, consistent communication with premenopausal patients about their fertility goals. Clinicians should keep up with evolving knowledge regarding the use of disease-modifying treatments (DMTs) before, during, and after pregnancy, and physicians who care for patients with MS may also want to develop a referral relationship with one or more trusted OB-GYN colleagues.

Clinicians should not delay postpartum DMT resumption in women at elevated risk of active disease, Graham and colleagues emphasized.

Part 7: The Challenge of Cognitive Changes in Multiple Sclerosis
Read previous installments in this series:
Clinicians should consult the NIH’s LactMed database for detailed information about drugs and breastfeeding. The database includes information on the levels of drugs in breast milk and infant blood, and the possible adverse effects in nursing infants.
Many people living with the degenerative neurological disease multiple sclerosis (MS) are premenopausal women. This means clinicians will likely care for many patients with MS who are planning to be pregnant someday or are currently pregnant.
“Whether pregnancy has a true protective effect on the MS course due to transient immunosuppression, or whether it represents a bias derived from female patients with milder MS being more inclined towards childbearing and causing those with more aggressive MS to avoid pregnancy, warrants further investigation,” he wrote.
MS itself is not an indication that a pregnancy is high risk, but referral to or co-managing with a maternal-fetal medicine specialist can be important, especially since patients with MS may be on multiple medications for symptom management.
“When disease is highly active before initiation of B-cell–depleting therapy and it is necessary to minimize time off DMT, the patient may receive a B-cell–depleting therapy and then attempt pregnancy after 1 to 3 months,” the authors wrote. “The rationale is that based on half-life, these therapies are eliminated 3.5 to 4.5 months after an infusion. Placental transfer of immunoglobulin G is minimal in the first trimester, so the risk of fetal exposure in the second trimester is low if conception occurs 3 to 6 months after the last dose of B-cell–depleting therapy.”
The Possibility of Postpartum Relapse
In conjunction with the widespread move from escalation therapy to early aggressive treatment, women who take a higher-efficacy treatment (HET) before conceiving may have less long-term disability: “Preconception use of DMTs whose pharmacodynamic effects outlast their pharmacokinetic effects (i.e., induction therapies and B-cell–depleting therapies) may reduce the incidence of relapses in the pre-pregnancy period while offering some protection from peripartum/postpartum relapses,” Graham and co-authors said.
However, the short-term implications of pregnancy in MS are more complicated. Various studies have shown that about one-third of patients relapse in the first 3 months after delivery and about half do so in the first 6 months after delivery, although more recent studies have suggested a lower actual postpartum relapse risk.
A 2019 review in JAMA Neurology found a reduced rate of postpartum MS relapses among women who were breastfeeding compared with those who were not breastfeeding, and the benefit was stronger when women breastfed exclusively. The researchers concluded that breastfeeding was associated with a 43% lower rate of postpartum relapse, although they could not exclude the possibility of confounding factors.
Pregnancy does not appear to have long-term negative effects on the disease course of MS or its progression of disability, Villaverde-González said. “There is some evidence that pregnancy after MS onset could have a favorable long-term effect on the course of MS, as women who deliver one or more children after MS onset appear to have a slower disability progression than nulliparous women with MS.”
A 2024 review emphasized the importance of shared decision-making between clinician and patient. “Conversations about intent for family planning should happen at every visit and in the active decision-making phase should involve the patient’s multidisciplinary team, including their neurologist, obstetric team, and primary physician,” wrote Edith L. Graham, MD, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues.

  • Monoclonal antibodies: alemtuzumab (Lemtrada), 4 months; ocrelizumab (Ocrevus), 6 months; ofatumumab (Kesimpta), 6 months; ublituximab (Briumvi), 6 months; and rituximab (MabThera; off label for MS), 12 months
  • Sphingosine-1-phosphate (S1P) receptor modulators: ponesimod (Ponvory), 1 week; siponimod (Mayzent), 10 days; fingolimod (Gilenya), 2 months; ozanimod (Zeposia), 3 months
  • Small molecules: oral cladribine (Mavenclad), 6 months; teriflunomide (Aubagio), until blood plasma concentration is <0.02 mg/L
  • Large molecules: glatiramer acetate (Copaxone), none; and interferon beta, none

According to a 2023 review, intravenous B-cell–depleting therapies may give prolonged protection against MS relapse for 6-9 months after administration of the last dose.
Graham and colleagues said the main risk factors for postpartum relapse of MS include younger maternal age, higher number of relapses before and during pregnancy, higher preconception disability based on Expanded Disability Status Scale score, lack of preconception DMT use, and discontinuation of DMTs known to induce rebound disease activity.
Part 5: Early Aggressive Treatment May Work Best in Newly Diagnosed Multiple Sclerosis
Part 4: Case Study: Sudden Blurred Vision in a Young Woman
“Women with MS may be able to breastfeed while on monoclonal antibody treatments, including ocrelizumab, natalizumab, and ofatumumab, with low risk to the infant. Monoclonal antibodies are detected at trace levels in milk and further are likely to be partially destroyed in the infant’s gastrointestinal tract,” the team wrote. “New data continue to support the use of anti-CD20 monoclonal antibodies during breastfeeding, with infants exposed to ocrelizumab and rituximab throughout breastfeeding showing normal growth and development with no unexpected severe or frequent infections.”
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B-cell–depleting monoclonal antibodies can also be used as bridge therapies to stabilize disease activity prepartum, peripartum, or postpartum for patients discontinuing fingolimod or natalizumab, the team added. “This underscores the importance of pregnancy planning discussions with patients throughout the MS management process.”
Current FDA washout guidelines include the following:
Key Points
Part 1: Early Diagnosis Can Mean Better Outcomes in Multiple Sclerosis
Historically, physicians discouraged women with MS from getting pregnant, but that changed with the publication of a landmark study in 1998, which established that pregnancy does not worsen MS in the long term. Although many people with MS who are pregnant have a decrease in disease activity during pregnancy, they have an increased risk of relapse during the first 3 months postpartum.
Exactly how long the washout period should be is still the subject of research. “HET seems to represent a particularly effective way of managing inflammatory activity before and after pregnancy,” the team wrote. “It can therefore be expected that women with MS of childbearing potential will increasingly receive HETs as first-line therapy, and it is critical to educate clinicians about the safety of these medications during gestation and lactation.”
Folic acid and prenatal vitamins should be used as in all pregnancies, and vitamin D supplementation should be used in agreement with the patient’s obstetrician. MRI during pregnancy after the first trimester is considered safe, but gadolinium enhancement should be avoided since it does cross the placenta.
Part 9: Improving Multiple Sclerosis Care for Black Patients
People with MS are not limited to a specific type of obstetric anesthesia and no type is contraindicated due to the MS. Patients and obstetric providers should choose pain relief based on obstetric criteria.
DMTs and Washout Periods
“Medical Journeys” is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. “Medical Journeys” chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.
Establish Communication Early
Part 6: How Progressive Multiple Sclerosis Differs From Relapsing-Remitting MS
Part 3: The Deep and Multidimensional Connection Between Multiple Sclerosis and Depression
Part 2: How Does Multiple Sclerosis Start?
Part 8: Case Study: What Is the Cause of This Right-Sided Numbness, Headache, and Blurred Vision?
Managing MS During Pregnancy
In a 2022 review, Ramón Villaverde-González, MD, of Hospital General Universitario José María Morales Meseguer in Murcia, Spain, noted that MS does not alter fertility and has no impact on fetal development, the course of pregnancy, or childbirth.
Many neurologists recommend that newly diagnosed patients receive a DMT immediately after diagnosis and that they should be stable on the drug for at least a year before attempting to conceive, based on evidence from the PRIMS study indicating that the level of disease activity in the year prior to pregnancy predicts the risk of postpartum relapse.
One thing to emphasize with patients with MS considering pregnancy is that most of today’s DMTs are contraindicated during pregnancy and require a washout period due to their known and suspected teratogenic effects. It is important to educate patients on whether or not the specific DMT they are on is safe for use during pregnancy as some are not.
Some clinicians administer IV corticosteroids or IV immunoglobulin to prevent postpartum disease relapses, although the clinical benefit remains unclear. Clinicians may want to consider postpartum physical therapy for pelvic floor rehabilitation in patients with MS and should closely monitor patients for postpartum depression, given that people with MS are more likely to experience depression than the general population.
The same vaccination schedule used for the general pregnant population applies here, said Villaverde-González. These vaccinations include inactivated influenza, inactivated diphtheria, tetanus, and acellular pertussis (Tdap), and mRNA COVID-19 vaccines.

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Dedicated to Mental Health

COURTESY PHOTOSUNAPEE SOFTBALL PLAYED Woodsville at home and both teams dedicated the game toward mental health awareness through Morgan’s Message. Taylor Goodspeed is the student-athlete ambassador. Morgan’s Message amplifies stories, resources and expertise to confront student-athlete mental health, builds a community by and for athletes, and provides a platform for advocacy.  1

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Dedicated to Mental Health

COURTESY PHOTO
SUNAPEE SOFTBALL PLAYED Woodsville at home and both teams dedicated the game toward mental health awareness through Morgan’s Message. Taylor Goodspeed is the student-athlete ambassador. Morgan’s Message amplifies stories, resources and expertise to confront student-athlete mental health, builds a community by and for athletes, and provides a platform for advocacy. 


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Wild chimpanzees give first aid to each other

For wounded chimpanzees, help sometimes comes in the form of first aid — care rendered not by humans but by other chimps. New research reveals the nature and prevalence of these rarely witnessed events. Thirty years of observations in Uganda’s Budongo Forest reveal that chimp-administered health care — both ape-to-ape care and self-care — happens […]

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Wild chimpanzees give first aid to each other

For wounded chimpanzees, help sometimes comes in the form of first aid — care rendered not by humans but by other chimps.

New research reveals the nature and prevalence of these rarely witnessed events. Thirty years of observations in Uganda’s Budongo Forest reveal that chimp-administered health care — both ape-to-ape care and self-care — happens frequently there, say primatologist Elodie Freymann of the University of Oxford and colleagues. She suspects these behaviors, occasionally glimpsed outside of Budongo, are widespread among chimps.

Chimps’ healing ways also hint at the possible origins of a similar impulse in humans.

Concern for other apes’ well-being “offers evidence that some of the foundations of human medicine — recognizing suffering, applying treatments and caring for others — are not uniquely human, but part of our deep evolutionary heritage,” says Christine Webb, a primatologist at Harvard University who was not involved in the research.

From the 1990s through 2022, 34 incidents of self-care were recorded at Budongo, Freymann and colleagues report May 14 in Frontiers in Ecology and Evolution. Some were hygienic acts, like wiping with leaves after bowel movements or mating. Several others resembled first aid applied after attacks by other chimps, or being caught in human-laid snares. Licking wounds and dabbing them with leaves were the most observed acts of self-care. Some saliva and plants contain antimicrobial compounds that might prevent infection, the researchers say.

In seven other instances, a chimp helped another chimp. And the helping hand wasn’t extended just to kin but also to unrelated individuals in need.

In one extraordinary display, a male freed an unrelated female from a snare set for game, probably saving her life. Snares frequently entangle chimps in Budongo and elsewhere in Africa, Freymann says, and it’s well-documented that the apes help free each other.

“The fact that chimpanzees treat not only themselves but also others suggests a level of social awareness that is too often underestimated,” Webb says. “It hints at an empathic sensitivity that we typically reserve for our own species.”

Freymann saw that sensitivity in two young unrelated males — one pressing his lips to and licking the other’s wound — behavior that wasn’t without risk. “I thought, wow, that’s potentially dangerous for them, that’s potentially exposing him to pathogens or contagious diseases,” Freymann says. “But he’s doing it anyway. You see camaraderie … maybe they will one day be rivals, and they’re literally licking each other’s wounds,” she says.

The origins of this apparent altruism is unclear, but Freymann saw firsthand how health care behaviors might spread from ape to ape. In 2021, a chimp named Kirabo put chewed-up bark on his wounded knee, while a youngster looked on attentively. It was “an indication that the chimp is trying to socially learn something,” Freymann says. She also found an incident recorded from 2008, in which a young female named Night, observing her mother Nambi nurse a vaginal injury after a violent attack, copied the technique — applying a chewed and folded leaf to Nambi’s swollen area.

For most injured chimps in Budongo, however, a helping hand doesn’t come, Freymann says — and she doesn’t yet understand why. “If chimps sometimes know how to help others get out of snares, for example, why aren’t they helping all chimps get out?” she asks. “Why are they being selective about this care, and why do some chimps seem to warrant it, while others don’t?”

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Vote for Messenger/Herald girls athlete of week

Vote below for the Messenger/Herald girls athlete of the week. The poll is for performances from May 5 to May 10. The poll runs from 3 p.m. Monday until 3 p.m. Wednesday. Please send athlete of week nominations for next week’s poll to mhorn@gannett.com. High school baseball Ross’ Cam Joseph knows you’re not off base […]

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Vote for Messenger/Herald girls athlete of week


Vote below for the Messenger/Herald girls athlete of the week.

The poll is for performances from May 5 to May 10. The poll runs from 3 p.m. Monday until 3 p.m. Wednesday.

Please send athlete of week nominations for next week’s poll to mhorn@gannett.com.

Candidates

Ariah Farrar had four hits, including a home run and a double, as Clyde softball topped Carey.

Effie Schulte won the 200 and was part of two first-place relays for Oak Harbor at the Ottawa County Meet.

Olivia Emerson hit for the cycle as Port Clinton softball beat Margaretta.

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Kentucky Derby

AI-assisted summaryThe Horseracing Integrity and Safety Authority fined Junior Alvarado $62,000 and suspended him for two days.Alvarado used his crop eight times, exceeding the permitted six strikes, resulting in a doubled penalty due to a prior violation.This story has been updated after a spokesperson from the Horseracing Integrity and Safety Authority issued a statement that […]

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Kentucky Derby

AI-assisted summaryThe Horseracing Integrity and Safety Authority fined Junior Alvarado $62,000 and suspended him for two days.Alvarado used his crop eight times, exceeding the permitted six strikes, resulting in a doubled penalty due to a prior violation.This story has been updated after a spokesperson from the Horseracing Integrity and Safety Authority issued a statement that jockey Junior Alvarado hasn’t filed an official appeal as of Monday night.Jockey Junior Alvarado reportedly is appealing his fine and suspension given to him by the Horseracing Integrity and Safety Authority. Alvarado’s agent, Mike Sellitto, said the ruling is under appeal, according to Byron King of Bloodhorse.com.

On Monday night, The Courier Journal received a statement from an HISA spokesperson that no official appeal has been filed.

This past Friday, the Kentucky Board of Stewards issued an Order imposing a penalty against Jockey, Junior Alvarado for violating HISA’s riding crop rule in the Kentucky Derby.  The Stewards concluded that Mr. Alvarado violated HISA Rule 2280(b)(2) by using the riding crop more than the permitted amount during the Kentucky Derby. The penalty for such violations depends on the class of the violation (i.e., the number of uses of the riding crop above the permitted amount) and the amount of the purse.  In this case, Mr. Alvarado was found to have committed a Class 3 Violation in the Kentucky Derby, for which the applicable fine is 10% of the Jockey’s portion of the purse or $1,000, whichever is greater.  Mr. Alvarado’s winning mount fee was $310,000, which equates to a $31,000 fine. 

The ruling: HISA Ruling – R000722167

However, Mr. Alvarado’s fine was doubled pursuant to an escalating penalty structure for repeat riding crop violations within the previous 180 days. The escalating penalty structure was implemented to deter repeated riding crop violations and in furtherance of the safety and welfare of Covered Horses.  A copy of HISA Rule 2282 is available here: Rule-2000-Series_05.02.25.pdfRiding crop penalties may be appealed for a hearing before the Internal Adjudication Panel which will consist of three active stewards from other jurisdictions.All jockey crop fines collected go towards supporting the jockey mental health program we have put in place with Onrise, an athlete specific mental health platform.Mr. Alvarado has not yet appealed the ruling.Alvarado was fined $62,000 and suspended two days as the result of excessive crop use during his winning ride on Sovereignty in the Kentucky Derby on May 3 at Churchill Downs.

HISA ruled Alvarado used his crop eight times on Sovereignty, when the rule is that jockeys may use their crops no more than six times.

The penalty is 10% of the jockey’s earnings from the race — which would be $31,000 for the Kentucky Derby — and a one-day suspension. Since this was Alvarado’s second violation in the last 180 days, his penalty was doubled.

On Courier Journal columnist C.L. Brown‘s podcast, Alvarado said, “I forgot it was a rule. … I was seeing my dream coming true right in front of me. The whip rule was the last thing I had in my mind. I have to pay the consequences, I guess.”

Sovereignty will not run in the Preakness on May 17 and is expected to return for the final leg of the Triple Crown, the Belmont on June 7 at Saratoga.

Reach sports reporter Prince James Story at pstory@gannett.com and follow him on X at @PrinceJStory.

This story was updated to add a gallery.  

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Examine the relationship between self

This study found that participants reported a significant amount of self-injury, averaging 109.27, highlighting a substantial engagement in these behaviors, often driven by difficulties in managing emotions. Participants demonstrated varying coping strategies, reflected in average scores of 40 for cognitive emotion regulation and 63.72 for behavioral emotion regulation. Crucially, we observed strong negative correlations between […]

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Examine the relationship between self

This study found that participants reported a significant amount of self-injury, averaging 109.27, highlighting a substantial engagement in these behaviors, often driven by difficulties in managing emotions. Participants demonstrated varying coping strategies, reflected in average scores of 40 for cognitive emotion regulation and 63.72 for behavioral emotion regulation. Crucially, we observed strong negative correlations between both cognitive regulation (r = -0.64, p = 0.001) and behavioral regulation (r = -0.73, p = 0.001) and self-injury. This means that poorer cognitive regulation and more pronounced behavioral regulation were linked to higher instances of self-injury. Further analysis, using multiple regression, confirmed that these two emotion regulation styles accounted for 42% of the variation in self-injury, with behavioral regulation showing a particularly strong predictive effect. In essence, these results emphasize the critical role of emotion regulation interventions in supporting adolescents vulnerable to self-injury.

The present study revealed a concerning prevalence of self-injury among Iranian adolescent athletes. While self-injurious behavior can be transient, this study, conducted at a specific point in time, offers a valuable snapshot of prevalence within this population. This finding aligns with broader research indicating the presence of self-injury among youth. In this line, it is estimated that 3–7% of adolescents meet the criteria for self-injury [33]. Previous studies have shown that 32% of children and adolescents suffer from some type of anxiety disorder [34]. This suffering can be due to lack of self-confidence, low self-esteem, or feelings of hopelessness due to poor social and academic performance [35]. Studies indicate that between 30% and 50% of these cases of anxiety in adolescents are associated with another type of behavioral disorder such as self-injurious behavior, aggressive behaviors, eating disorders, and conduct disorder [36]. Furthermore, 80% of adolescents with these conditions do not receive any professional treatment or care [37]. Therefore, it is essential to prioritize attention to adolescents, particularly regarding self-injurious behaviors.

Furthermore, results of the present study indicated a significant negative relationship between cognitive emotion regulation and self-injury. This suggests that improved cognitive emotion regulation skills may serve as a protective factor against self-injury. This aligns with theoretical frameworks of self-injury, such as the experiential avoidance model [38], and the cognitive-emotional model [39, 40], which emphasize the role of poor cognitive emotion regulation in self-injury. These models posit that difficulties in cognitive emotion regulation contribute to self-injury by hindering individuals’ ability to manage distressing emotions effectively.

In the specific context of adolescent athletes, the interplay between cognitive and behavioral emotion regulation and self-injury may exhibit unique characteristics [23]. While general models highlight the protective role of strong emotion regulation, the high-pressure environment of competitive sports could potentially exacerbate emotion regulation deficits [1]. Athletes may experience intense performance anxiety, pressure to succeed, and fear of failure, which could overwhelm their coping mechanisms. Additionally, the emphasis on physical strength and emotional resilience within sports culture might discourage athletes from seeking help for emotional distress, leading to maladaptive coping strategies like self-injury. Therefore, it might be the reason that adolescent athletes may face heightened challenges in emotion regulation compared to non-athlete populations.

Furthermore, the present findings resonate with Hasking, Whitlock, Voon and Rose [40] cognitive-emotional model of self-injury. This model incorporates the role of specific cognitions about self-injury alongside emotional experience and regulation. Individuals exhibiting heightened emotional reactivity, difficulty tolerating distress, and impaired emotion regulation, coupled with a belief in their inability to resist self-injurious urges and an expectation of positive outcomes from self-injury, demonstrate a higher likelihood of engaging in these behaviors. Conversely, individuals without a history of self-injury typically possess stronger self-efficacy beliefs regarding their ability to resist such urges [40].

On the other hand, the present study found a significant negative relationship between behavioral emotion regulation and self-injury. Previous study on behavioral emotion regulation and self-injury has almost exclusively focused on the idea that poor behavioral emotion regulation are risk factors for self-injury [18, 24]. The present study showed that behavioral emotion regulation and self-injury actually have a bidirectional and inverse relationship, such that engaging in self-injury may impair emotion regulation. This finding is consistent with personal accounts of individuals with a history of self-injury who are often afraid that disclosing self-injury will damage their relationships with coaches, teammate and family [5, 41, 42]. The present finding can be explained by the theory of emotional processes in the psychophysiological arousal model [43]. Defective processes in emotion analysis can play a significant role in self-injurious behavior. Unstable, impulsive, and out-of-control emotions can lead to self-injury and suicide. Pervious systematic review studies [19, 36] identified higher rates of self-injury among individuals with unstable emotions. Therefore, it seems that behavioral regulation and attention to healthy behavioral coping styles can play a significant role in reducing self-injury. Our finding is in line with Adrian, Zeman and Veits [44] and Sim, Adrian, Zeman, Cassano and Friedrich [45]. As a result, access to behavioral and cognitive emotion regulation strategies, defined as “beliefs and behaviors to use when a person is upset,” is important. Our finding, consistent with the claim of Gratz and Roemer [46] showed that after controlling for other aspects of impaired emotion regulation, a significant association with self-injury remained.

The results of the present study showed that cognitive and behavioral emotion regulation can predict the level of self-injury. Adolescents with poor emotion regulation usually report self-injury [40]. Consistent with previous research [47, 48], the present study found significant negative correlations between emotion regulation and self-injury. These findings suggest that poorer behavioral and cognitive emotion regulation is associated with increased self-injury. However, given the cross-sectional design of this study, we can only establish associations, not causal pathways. Further longitudinal or experimental research is needed to determine the direction and nature of this relationship.

In therapeutic interventions for adolescent athletes who engage in self-injury, it’s beneficial to prioritize the development of stronger, more supportive relationships with coaches and peers. Specifically, fostering trust, open communication, and a sense of warmth within these key relationships can be a valuable component of the intervention [24, 49]. In addition, addressing cognitive and behavioral emotion regulation appears promising for reducing adolescent self-injury. Educational programs that frame self-injury as a maladaptive emotional regulation strategy may enhance coaches’ and teammates’ understanding, facilitating more effective support for adolescents struggling with emotions like fear or sadness. Furthermore, prioritizing coaches’ self-care may prove beneficial. While this study confirms the predictive power of emotion regulation in relation to self-injury, further investigation is needed to elucidate the specific mechanisms and contextual factors that exacerbate the link between emotion dysregulation and self-injury [24].

This finding is consistent with previous research showing that difficulty in regulating behavioral and cognitive emotion is a predictor of self-injury [46]. According to various theories, a person who has difficulty in emotion regulation is more likely to self-injure. This claim is consistent with the experiential avoidance model [38] and general emotion regulation models [5]. Self-injury is used as a tool of maladaptive emotional expression in some adolescents. This strategy will not be effective and negative emotions will continue and even become dominant. One of the important factors in the continuation of self-injury is the belief in the inefficiency of emotion regulation. This distinction is very important clinically, because it points to the possibility of reconstructing cognitions about the effectiveness of emotion regulation as an important aspect of self-injury treatment. As a result, the present study has the clinical benefit value of emotional regulation in an adolescent athlete.

While this study provides valuable insights into the relationship between emotion regulation and self-injury among Iranian adolescent athletes, it is important to acknowledge the limitations regarding generalizability. The findings may not be directly applicable to non-athlete adolescents or those from different cultural backgrounds. Cultural variations in emotion regulation strategies and self-injury motivations could significantly influence the observed associations. For example, the unique stressors and cultural norms within the Iranian athletic context may contribute to specific patterns of emotion regulation and self-injury that differ from those seen in other populations. Therefore, caution is warranted when extrapolating these results to broader populations. Future research should explore these relationships in diverse samples to enhance the generalizability of the findings. The current study suggests that coaches and teammates could play a role in intervention efforts, given their frequent interaction with adolescent athletes. However, it’s important to acknowledge that this suggestion is based on the context of the athletic environment rather than direct empirical evidence within this study. The role of parental influence, school-based mental health services, and professional therapeutic interventions was not explicitly examined, which limits our understanding of the broader support network. Future research should investigate the efficacy of multi-faceted intervention approaches, including the involvement of parents, school counselors, and mental health professionals, to develop comprehensive and effective support systems for adolescent athletes at risk of self-injury. A more thorough exploration of these diverse intervention strategies would enhance the practical implications of our findings and inform the development of targeted support programs. Furthermore, third limitation of this study is the absence of a confirmatory factor analysis to re-evaluate the structural validity of the Self-Injurious Behaviors Scale, Behavioral Emotion Regulation Questionnaire, and Cognitive Emotion Regulation Questionnaire within our specific adolescent athlete population. While these scales have demonstrated adequate validity in previous research, including studies with adolescent samples, we did not specifically assess their factor structure within this unique group. Therefore, while we relied on established validity from prior studies, future research should consider examining the factor structure of these instruments within adolescent athlete populations to ensure their applicability and accuracy in this context.

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Lima native shares story of survival and hope during Mental Health Awareness Month

LIMA, Ohio (WLIO) — It’s a topic many shy away from, but a group of local agencies is working to bring it into the light during Mental Health Awareness Month 2025. Gehle has written a book titled Strength Beyond the Shadows, detailing his journey from pain to healing. Big Brothers Big Sisters of West Central Ohio, […]

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Lima native shares story of survival and hope during Mental Health Awareness Month


LIMA, Ohio (WLIO) — It’s a topic many shy away from, but a group of local agencies is working to bring it into the light during Mental Health Awareness Month 2025.







Lima native shares story of survival and hope during Mental Health Awareness Month

Gehle has written a book titled Strength Beyond the Shadows, detailing his journey from pain to healing.


Big Brothers Big Sisters of West Central Ohio, CASA, and other community organizations have joined together to host a special event featuring Lima native Seth Gehle, who is sharing his powerful story of overcoming childhood trauma. Gehle, who endured years of abuse and neglect, has written a book titled Strength Beyond the Shadows, detailing his journey from pain to healing. He will speak at a public symposium at Perry Local Schools on Friday, May 16.

Organizers hope the event will encourage those who work with or support youth, as well as members of the community, to attend and be inspired by Gehle’s resilience.







Lima native shares story of survival and hope during Mental Health Awareness Month

The symposium will be held from 9 a.m. to noon at Perry Local Schools, with doors opening at 8:30 a.m.


“What you’re going through currently, you do not have to let that define you,” said Portia Smith, executive director of Big Brothers Big Sisters of West Central Ohio. “You can be whoever you want to be. You can get where you need to be, and you have support surrounding you — just like Seth mentioned in his book, that he had to depend on the community to get him where he’s at now.”

The symposium will be held from 9 a.m. to noon at Perry Local Schools, with doors opening at 8:30 a.m. Gehle will begin speaking at 9 a.m., followed by a question-and-answer session.

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