A network analysis on self-harming and problematic smartphone use - The role of self-control, internalizing and externalizing problems in a sample of self-harming adolescents

Frequency-specific network connectivity impairments linked to suicide attempts in major depressive disorder during the GO/NOGO task

BACKGROUND

Major depressive disorder (MDD) is a main risk factor of suicide, emphasizing the urgent need for understanding the neurobiological mechanisms underlying suicide attempts (SAs) in depressive patients. We hypothesized that aberrant frequency-specific functional connectivity patterns underlying an executive and inhibition task might be associated with SA in depression.

METHODS

The current study enrolled 143 subjects including 43 healthy controls and 87 patients with MDD (43 patients with SA and 44 without SA), who attended a GO/NOGO task during the magnetoencephalography recording. Time-frequency features in the whole-brain sensors and frequency-specific brain network connectivity patterns were estimated. Behavioral data was recorded during the tasks and neurocognitive assessments were conducted.

RESULTS

The SA group exhibited poorest behavioral and neurocognitive assessments performances. Decreased alpha/beta oscillations of the GO condition and increased alpha/beta oscillations of NOGO condition were observed in the SA group. Hypo-activated frontal-limbic connectivity in the alpha band and frontal-occipital connectivity in the beta band were observed in the SA group during the GO trials, meanwhile, hyper-activated frontal-temporal connectivity in the alpha band and frontal-parietal connectivity in the beta band were associated with SA during the NOGO trials. Frequency-specific features were correlated with the severity of suicide risk, neurocognitive assessments, and could be used to predict potential SAs.

CONCLUSIONS

Neuroimaging and neurocognitive evidences supported altered alpha/beta oscillations and connectivity patterns associated with SA in depression, suggesting that depressive patients with SA might exhibit impaired cognitive control functions.

The Association Between Internet Addiction and Non-Suicidal Self-Injury Among Adolescents: A Meta-Analysis

BACKGROUND

Internet addiction and non-suicidal self-injury (NSSI) have emerged as prominent psychological concerns among adolescents. Despite numerous investigations into the relationship between these two behaviors, the findings remain inconsistent. This study aims to elucidate the relationship between Internet addiction and NSSI among adolescents.

METHODS

Thirteen databases, including PubMed, Web of Science, PsycINFO, Embase, Cochrane, Scopus, ProQuest, CINAHL, MEDLINE, SinoMed, CNKI, Wanfang, and VIP, were systematically searched, covering the period from inception to October 2024. Two independent reviewers conducted study screening, data extraction, and quality evaluation of the included studies. The statistical software STATA 18.0 was utilized to conduct data analysis.

RESULTS

Forty-one studies were included from a total of 835 articles retrieved from the databases, encompassing a sample of 284,786 adolescents. A random effects model was utilized for pooled analysis, revealing a moderate positive association between Internet addiction and NSSI (r = 0.23, 95% CI = 0.20-0.27). Furthermore, adolescents' gender, age, and the measurement tools employed played moderating roles in the relationship between Internet addiction and NSSI. However, neither the publication year, the region, nor the adjusted versus unadjusted effect sizes moderated the relationship between the two.

CONCLUSIONS

A moderate positive link exists between Internet addiction and NSSI among adolescents. Future preventive measures against NSSI among adolescents should focus more on those with internet addiction, assisting them in overcoming their addiction and establishing healthy online behavior patterns. Additionally, future longitudinal studies are needed to explore the dynamic changes between Internet addiction and NSSI among adolescents.

Altered brain structure and function correlate with non-suicidal self-injury in children and adolescents with transdiagnostic psychiatric disorders

Non-suicidal self-injury (NSSI) is a prevalent mental problem among children and adolescents, cutting across psychiatric disorders. Studies in specific disorders such as depression and ADHD have revealed associations with alterations in brain regions responsible for reward processing and emotion regulation. However, it remains largely unknown whether such associations are shared among different disorders. Here, we aimed to examine brain structural and functional associations with NSSI in a transdiagnostic psychiatric cohort of children and adolescents. A total of 386 patients (age = 10.72 ± 3.53, range = 5.04 to 21.22) diagnosed primarily with ADHD, autism and generalized anxiety disorder from the Healthy Brain Network study were included. Using linear regression models, we examined brain volumes (N = 386) and functional connectivities (N = 277) associated with NSSI and whether potential alterations could moderate/mediate the links between internalizing/externalizing symptoms and NSSI. We found that increased severity of NSSI was associated with decreased bilateral putamen volumes, and reduced connectivities of the left putamen with bilateral regions of temporoparietal junction and of the right putamen with the left temporoparietal junction, demonstrating the role of putamen in NSSI behavior. Moreover, some of these associations played moderating roles: in patients with lower putamen volumes or weaker functional connectivities, increased internalizing/externalizing symptoms were associated with higher NSSI severity. Our findings suggest that transdiagnostic NSSI is linked to structural alterations and functional dysfunctions in putamen, highlighting that putamen may serve as a neural marker of NSSI and as a potential target for neuromodulation treatments across mental conditions.

Research Review: Sex differences in the clinical correlates of nonsuicidal self-injury in adolescents - a systematic review

BACKGROUND

Nonsuicidal self-injury (NSSI), or 'the deliberate, self-inflicted destruction of body tissue…without suicidal intent and for purposes not culturally sanctioned', is a robust predictor of future suicide-related behavior and therefore a modifiable target for suicide prevention. The prevalence of NSSI is rising in adolescents, particularly among females; however, it is unknown whether sex differences also exist in the clinical and psychosocial factors associated with NSSI. Understanding how the correlates of NSSI differ by sex is important for developing tailored treatments. This study systematically reviews sex differences in the clinical and psychosocial correlates of NSSI among adolescents.

METHODS

MEDLINE and PsycINFO were searched using the keywords 'adolescents', 'self-injury', and 'sex factors' and synonyms for English-language articles published between January 1, 2000 and May 10, 2022. We included studies that presented original data on NSSI, included adolescents ages 10-19, reported sex differences, and explicitly defined self-injury as that done without suicidal intent. Fifty-seven studies containing 54 unique samples were included. Data were summarized by sex and recorded by: (a) characteristics of NSSI, (b) clinical and psychosocial correlates of NSSI, and (c) associations with suicide.

RESULTS

We used data on NSSI from 54 unique samples of adolescents worldwide. Males more commonly used violent methods of NSSI, such as burning, and were more likely to be physically aggressive and experience substance abuse. Females more commonly self-injured by cutting, and their NSSI was more likely to be repetitive and associated with emotional distress. In both sexes, NSSI was associated with adverse childhood experiences (ACEs) such as sexual abuse/violence and bullying. NSSI was predictive of suicide in females but not males.

CONCLUSIONS

Data from 22 countries and 352,516 participants suggest important sex differences in the clinical and psychosocial factors associated with NSSI among adolescents that future assessment and treatment strategies ought to consider.

The emotional surge: in-depth qualitative exploration of rumination and emotional turbulence in non-suicidal self-injurers

Non-suicidal self-injury (NSSI) is an emerging pathological condition among emerging adults, causing significant distress and hindering daily life functioning. The increasing prevalence of NSSI highlights its importance as a crucial area requiring clinical attention. To devise effective interventions for managing NSSI, it is important to identify the factors contributing to its onset and maintenance. Therefore, the current study aims to explore emotional and cognitive factors to provide a holistic understanding of NSSI in emerging adults in the Pakistani context. For this purpose, a qualitative study was conducted using in-depth, semi-structured interviews with N = 10 self-injurers (mean age: 22.2 years) recruited through purposive sampling. Participants had engaged in self-injury at least five times in the past year without suicidal intent. The arm was identified as the most common site for self-injury, with cutting being the most frequently used method. Data from the transcribed interviews were analyzed using Braun and Clarke's reflexive thematic analysis. Three main themes-'emotional turbulence,' 'low distress tolerance,' and 'rumination'-and nine subthemes emerged, highlighting the emotional and cognitive factors contributing to the initiation and maintenance of NSSI. The findings of this study provide valuable insights into the emotional and cognitive dimensions of NSSI in emerging Pakistani adults. These insights will aid in treatment planning and in selecting appropriate strategies for reducing and ultimately eradicating NSSI.

Clarifying the relationship between insecure attachment and problematic social media use across platforms: a network analysis

BACKGROUND

Despite evidence suggesting that insecure attachment is a significant risk factor for Problematic Social Media Use (PSMU), there remains a lack of comprehensive studies exploring this relationship, and a unified understanding of its role has yet to be established.

METHODS

We employed network analysis to construct an integrated model for examining the complex interrelations between negative emotions, trait and state attachment, motives, and PSMU across three platforms (i.e., WeChat, Sina Weibo, and TikTok), as well as for identifying potential mediating variables between attachment and PSMU. Data were collected from 685 young adults via online self-reported questionnaires.

RESULTS

We found that negative emotions are positively correlated with insecure trait and state attachment but have a negligible direct relationship with PSMU. The conformity motive and state attachment security emerged as important central nodes when measured by strength, closeness, and betweenness. Moreover, attachment states and motives were found to be clustered. Such strong interrelationships were also evident between insecure attachment and PSMU, while trait attachment anxiety and avoidance were observed to be related to PSMU across various platforms.

CONCLUSIONS

Our findings promote a deeper understanding of the relationship between insecure attachment and PSMU from a cross-platform perspective and offer novel insights into the mechanisms underlying their co-occurrence, which may guide the development of effective interventions for healthier social media engagement.

Changes in Smartphone Usage among Adolescents and Associated Subjective Health Concerns: A Secondary Analysis of the Korea Youth Risk Behavior Survey

BACKGROUND

We evaluated changes in the smartphone use rate and time among Korean adolescents and their awareness of associated health problems.

METHODS

This study was a secondary analysis of the Korea Youth Risk Behavior Survey (2020-2023) conducted by the Korean Disease Control and Prevention Agency. The total number of enrolled adolescents aged 12-18 years was 214,526.

RESULTS

The weekly smartphone usage rate increased from 96.4% to 97.1% (p = 0.03), with no significant changes observed in weekend usage. The average smartphone use time was 4.7 h on weekdays (p = 0.17) and 6.6 h on weekends (p = 0.37). Middle school adolescents had a higher weekday use rate than high school adolescents, but the average smartphone use time was significantly less. By 2023, the proportion of adolescents with overdependence was 28% (n = 14,672). Additionally, 11.8% (n = 6255) responded that they had experienced health problems due to smartphone use.

CONCLUSIONS

The longer they used their smartphones for on the weekends, the more likely they considered their health to be worse. In conclusion, our youth population needs to be educated on the proper use of smartphones.

The impact of depressive and anxious symptoms on non-suicidal self-injury behavior in adolescents: a network analysis

PURPOSE

Conceptualizing adolescent NSSI and emotional symptoms as a system of causal elements could provide valuable insights into the development of non-suicidal self-injury (NSSI) in adolescent. This study aimed to explore the intricate relationship between NSSI, depressive symptoms, and anxious symptoms in adolescents, identifying key symptoms to establish a theoretical foundation for targeted and effective interventions addressing NSSI behaviors in this population.

METHODS

A total of 412 adolescents with NSSI behaviors were selected from outpatients. Generalized anxious disorder scale (GAD-7) and patient health questionnaire (PHQ-9) were employed to measure anxious symptoms and depressive symptoms, respectively. The adolescent non-suicidal self-injury assessment questionnaire (ANSSIAQ) was used to evaluate NSSI of adolescent. Using network analysis, the NSSI、depressive symptoms and anxious symptoms network were constructed to identify the most central symptoms and the bridge symptoms within the networks.

RESULTS

The findings revealed that the NSSI functional nodes "coping with sadness and disappointment" and "relieving stress or anxious" exhibited the strongest correlation, with a regularized partial correlation coefficient was 0.401. The symptoms "having a desire to harm oneself and unable to stop" and the node "depressive symptoms" had the highest strength centrality in the network, and their strength centrality indices were 1.267 and 1.263, respectively. The bridge nodes were "having a desire to harm oneself and unable to stop" and "expressing one's despair and hopelessness", with expected impact indices of 0.389 and 0.396, respectively.

CONCLUSION

In adolescents, the network revealed a closer connection between NSSI and depressive symptoms. "The desire to not stop hurting oneself" is not only broadly connected to other nodes but also could activate other nodes to maintain NSSI behavior. In light of these findings, precise targets for pharmacological treatment, psychotherapy, physical therapy, etc., are identified for adolescents with NSSI. Targeting this specific aspect in interventions may contribute to preventing and reducing NSSI behavior in adolescents.

Determination of the cutoff point for Smartphone Application-Based Addiction Scale for adolescents: a latent profile analysis

BACKGROUNDS

The Smartphone Application-Based Addiction Scale (SABAS) is a validated 6-item measurement tool for assessing problematic smartphone use (PSU). However, the absence of established cutoff points for SABAS hinders its utilities. This study aimed to determine the optimal cutoff point for SABAS through latent profile analysis (LPA) and receiver operating characteristic curve (ROC) analyses among 63, 205. Chinese adolescents. Additionally, the study explored whether PSU screening with SABAS could effectively capture problematic social media use (PSMU) and internet gaming disorder (IGD).

METHOD

We recruited 63,205. adolescents using cluster sampling. Validated questionnaires were used to assess PSMU, IGD, and mental health (depression, anxiety, sleep disturbances, well-being, resilience, and externalizing and internalizing problems).

RESULTS

LPA identified a 3-class model for PSU, including low-risk users (38.6%, n = 24,388.), middle-risk users (42.5%, n = 26,885.), and high-risk users (18.9%, n = 11,932.). High-risk users were regarded as "PSU cases" in ROC analysis, which demonstrated an optimal cut-off point of 23 (sensitivity: 98.1%, specificity: 96.8%). According to the cutoff point, 21.1% (n = 13,317.) were identified as PSU. PSU adolescents displayed higher PSMU, IGD, and worse mental health. PSU screening effectively captured IGD (sensitivity: 86.8%, specificity: 84.5%) and PSMU (sensitivity: 84.5%, specificity: 80.2%).

CONCLUSION

A potential ideal threshold for utilizing SABAS to identify PSU could be 23 (out of 36). Employing SABAS as a screening tool for PSU holds the potential to reliably pinpoint both IGD and PSMU.

The Effect of Loneliness on Non-Suicidal Self-Injury Behavior in Chinese Junior High School Adolescents: A Moderated Mediation Model

Purpose

This study explore the interaction between loneliness and non-suicidal self-injury behaviors (hereinafter "NSSI"), and to further examine the mediating role of self-control and the moderating role of social connection.

Methods

A total of 414 junior high school students (age 14.05±0.84) in Sichuan province in China were investigated on their loneliness, self-control, social connection and NSSI by questionnaire.

Results

(1) there was a significant positive correlation between loneliness and NSSI; (2) self-control played a mediating role in the relationship between loneliness and NSSI; and (3) after controlling for gender, family structure, and family economic level, the social connectedness played a moderating role in the relationship between loneliness and NSSI, as well as between self-control and NSSI.

Conclusion

The results verify the relationship between loneliness and NSSI, expands and deepens the internal logical relationship between them, and provides a reference that can be used in the future for the prevention and intervention of NSSI in adolescents.

Association of parent-child relationship quality and problematic mobile phone use with non-suicidal self-injury among adolescents

BACKGROUND

Non-suicidal self-injury behavior (NSSI) is a common mental health threat among adolescents. Poor parent-child relationship (PCR) and problematic mobile phone use (PMPU) are risk factors for NSSI. We aimed to explore the impact of PCR quality, PMPU, and their interaction effects on NSSI among adolescents in China, as well as the sex difference.

METHOD

A survey was conducted among school students in 4 provinces in China between 2017 and 2018. The study included 14,500 valid participants. The students' general demographic characteristics was collected, and further data on PCR quality, PMPU, and NSSI were obtained through self-rated questionnaire. Chi-square test, binomial logistic regression models, and the Andersson Excel were used for data analysis.

RESULTS

The 12-month prevalence of NSSI was 27.3%. Lower PCR quality and PMPU were significantly associated with NSSI, respectively. The low PCR + yes PMPU group had the greatest association with NSSI, followed by the high PCR + yes PMPU group, low PCR + no PMPU group. Moreover, in low father-child relationship + yes PMPU group, females had a higher risk of NSSI than males; in high mother-child relationship + yes PMPU group, females had a higher risk of NSSI than males. Additive interaction analysis indicated that mother-child relationship quality and PMPU were associated with increased risks of NSSI, in the subgroup of males.

CONCLUSIONS

The findings underline the importance of simultaneously studying the quality of PCR and PMPU for a comprehensive understanding of NSSI behavior, and especially highlights the significance of maternal relationship quality.

Association between mobile phone addiction, chronotype and nonsuicidal self-injury among adolescents: A large-scale study in China

BACKGROUND

Nonsuicidal self-injury (NSSI) is a serious public health and clinical problem, particularly for adolescents, and may link to problematic smartphone use (PSU) and chronotype. This study examines the independent and interaction effects of PSU and chronotype on NSSI among adolescents and identified gender differences in these associations.

METHODS

A total of 21,357 students aged 11-19 were recruited using stratified cluster sampling across five representative provinces in China and completed standard questionnaires to record details of PSU, chronotype, and NSSI.

RESULTS

A total of 38.1 % of students reported having engaged in NSSI and 17.7 % had PSU. PSU and chronotype were significantly associated with NSSI among adolescents, and this relationship was stronger in females. Interaction analysis indicated that E-type and PSU were interactively associated with increased risks of NSSI.

CONCLUSION

The findings suggest that E-type and PSU can increase the risk of NSSI both independently and interactively. Therefore, they should be considered in intervention programs for NSSI, especially for females.

An investigation of the relationships between suicidal ideation, psychache, and meaning in life using network analysis

BACKGROUND

Previous studies have investigated the relationships between psychache or meaning in life and suicidal ideation based on sum score of corresponding scale. However, this practice has hampered the fine-grained understanding of their relationships. This network analysis study aimed to conduct a dimension-level analysis of these constructs and the relationships among them in a joint framework, and identify potential intervention targets to address suicidal ideation.

METHODS

Suicidal ideation, psychache, and meaning in life were measured using self-rating scales among 738 adults. A network of suicidal ideation, psychache, and meaning in life was constructed to investigate the connections between dimensions and calculate the expected influence and bridge expected influence of each node.

RESULTS

"Psychache" was positively linked to "sleep" and "despair", while "presence of meaning in life" had negative associations with "psychache", "despair", and "pessimism". The most important central nodes were "sleep" and "despair", and the critical bridge nodes were "presence of meaning in life" and "psychache".

CONCLUSION

These preliminary findings uncover the pathological pathways underlying the relationships between psychache, meaning in life, and suicidal ideation. The central nodes and bridge nodes identified may be potential targets for effectively preventing and intervening against the development and maintenance of suicidal ideation.

More than the aggregation of its components: Unveiling the associations between anxiety, depression, and suicidal behavior in adolescents from a network perspective

BACKGROUND

Facing multiple changes, adolescents are prone to have anxiety and depression concurrently, which would accompany a particularly high risk for suicide. However, most previous studies have ignored the heterogeneity of the components and used latent variable methods to explore the associations between these core variables, resulting in a lack of component-level discussions.

METHOD

Using a large sample of 9300 adolescents (Mean_age = 13.51; SD_age = 1.33; 49.82 % females), two network pathways of anxiety and depression and the associations between these variables and suicidal behavior were constructed. The central components and the stability of both networks were also identified.

RESULTS

Considering the network of anxiety and depression, there were two strong bridging symptoms of sleep problems and palpitation or tachycardia. The symptoms of depression showed a more vital centrality than anxiety, and the central symptoms were tachycardia, worthlessness, fatigue, and feeling of choking. For the network of suicidal behavior and symptoms of anxiety and depression, besides sleep problems, the edge linking lifetime suicide ideation and attempt and the frequency of suicide ideation in the past year was also a strong edge. Worthlessness connected symptoms of anxiety and depression with suicidal behavior. The central components were tachycardia, worthlessness, the frequency of suicidal ideation over the past year, and fatigue. Additionally, both networks had higher stability in terms of edge and centrality.

CONCLUSION

Based on the identified relevant strong bridging and central components, effective therapies would target these components first, which would lead to the alleviating effects on other components.

Escaping negative moods and concentration problems play bridge roles in the symptom network of problematic smartphone use and depression

Background

Problematic smartphone use (PSU) has become an issue of great concern in the age of smartphones. PSU is associated with emotional problems, one of which is depression, as shown by empirical studies. However, previous studies have been limited in that they have focused solely on the total score for symptoms of PSU and depression while ignoring the symptomatic heterogeneity of these two concepts.

Method

This study filled this gap by exploring links between symptoms of PSU and depression among 1,849 university students (59.17% female participants, 17-23 years old). Network analysis was utilized to reveal symptom connections, central symptoms, and bridge symptoms between PSU and depression.

Results

(1) A total of 17 of 81 symptom connections (about 21%) between PSU and depression existed in the symptom network. For example, "self-control failure" for PSU was positively correlated with "concentration problems" for depression; (2) "recklessly continuing" for PSU and "fatigue" for depression were central symptoms within the PSU symptom network and depression symptom network, respectively; (3) "escaping negative moods" for PSU and "concentration problems" for depression were bridge symptoms. The former was maximumly connected with the depression symptoms and the latter was maximumly connected with the PSU symptoms; and (4) gender had very minimal influence on the network characteristics.

Conclusion

The results are in keeping with the central idea of the compensatory internet use theory that excessive smartphone use may be a coping strategy for depressed emotions derived from escaping motivation. Moreover, concentration problems may be a mediator explaining how negative emotions (e.g., depression) cause PSU, which is undefined in current internet use theories. Finally, symptom connections, central symptoms, and bridge symptoms could be potential targets for the prevention and intervention of PSU and depression in young adults.

Association between Smartphone Addiction and Suicide

OBJECTIVE

This study aimed to explore the associations between smartphone overdependence (smartphone addiction) and suicidal ideation and attempts among Korean adolescents to acknowledge the risk of smartphone overuse.

METHODS

Data were obtained from the results of the 2020 Korea Youth Risk Behavior Web-based Survey. Smartphone addiction was categorized into three groups: adolescents who scored less than 23 were categorized as the general user group and formed the reference, those with scores of 23-30 were categorized as the potential-risk user group, and those with scores higher than 31 were categorized under the high-risk user group. Suicidal ideation and suicide attempt were identified as dependent variables in the present study. Multiple logistic regression was used to analyze the relationship between SA and suicidal ideation and suicide attempt status among Korean adolescents.

RESULTS

This study included 41,173 general users of smartphones, 12,142 potential-risk users, and 1633 high-risk users from among 54,948 adolescents who were middle- and high-school students. Adolescents with potentially risky smartphone use showed a higher likelihood of suicidal ideation (OR: 1.50, CI: 1.42-1.60). Similarly, adolescents with high-risk smartphone use showed a significant risk of suicidal ideation (OR: 2.49, CI: 2.21-2.81) and suicide attempt (OR: 1.87, CI: 1.48-2.37) compared to the adolescents who were general users.

CONCLUSION

Our study results encourage parents and social workers to acknowledge that adolescents' smartphone addiction leads to a higher risk to their mental health, wherein they may engage in suicidal ideation and even resort to a suicide attempt.