Non-suicidal self-injury in Chinese population: a scoping review of prevalence, method, risk factors and preventive interventions

Adolescent non-suicidal self-injury: The moderating influence of social support utilization on depression

BACKGROUND

Adolescence is a period marked by physiological and psychological imbalances, which pose an increased risk for adolescents with major depressive disorder (MDD) to commit non-suicidal self-injury (NSSI).

AIM

To investigate the moderating role of social support utilization in depression and NSSI among adolescents with MDD.

METHODS

This cross-sectional study enrolled 314 adolescents with MDD (258 with NSSI, 56 without) from a Chinese tertiary psychiatric hospital (2021-2023). Participants completed validated scales, including the self-esteem scale, the Barratt impulsiveness scale, the self-rating depression scale, and the teenager social support rating scale. Logistic regression and hierarchical regression analyses were used to examine predictors of NSSI and the moderating effect of social support utilization.

RESULTS

Results showed that the NSSI group had higher depression levels, lower self-esteem, and greater impulsivity. While overall social support was higher in the NSSI group, social support utilization significantly moderated the depression-NSSI relationship. Specifically, higher utilization levels weakened the association between depression and NSSI (β = -0.001, P < 0.05).

CONCLUSION

These findings suggest that effective utilization of social support, rather than its mere presence, is crucial in reducing NSSI risk among depressed adolescents.

Development of an explainable machine learning model for predicting depression in adolescent girls with non-suicidal self-injury: A cross-sectional multicenter study

Non-suicidal self-injury (NSSI) in adolescent girls is a critical predictor of subsequent depression and suicide risk, yet current tools lack both accuracy and clinical interpretability. We developed the first explainable machine learning model integrating multicenter psychosocial data to predict depression among Chinese adolescent girls with NSSI, addressing the critical need for culturally tailored risk stratification tools. In this cross - sectional observational study, our model was developed using data from 14 hospitals. We used five categories of data as predictors, including individual, family, school, psychosocial, and behavioral and lifestyle factors. We compared seven machine learning models and selected the best one to develop final model and the Shapley Additive exPlanations (SHAP) method were used to explain model prediction. The Random Forest (RF) model was compared against six other machine learning algorithms. We assessed the discrimination using the area under receiver operating characteristic (AUROC) with 95 % CIs. Using the development dataset (n = 1163) and predictive model building process, a simplified model containing only the top 20 features had similar predictive performance to the full model, the RF model outperformed six algorithms (AUROC = 0.964 [0.945-0.975]), demonstrating superior discriminative power and robustness. The top ten risk predictors were Borderline personality, Rumination, Perceived stress, Hopelessness, Self-esteem, Sleep quality, Loneliness, Resilience, Parental care, and Problem-focused coping. We developed a three-tiered, color-coded web-based clinical tool to operationalize predictions, enabling real-time risk stratification and personalized interventions. Our study bridges machine learning and clinical interpretability to advance precision mental health interventions for vulnerable adolescent populations.

EEG Signatures and Effects of Mindfulness Approaches in Adolescents With Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a recurring behavior most prevalent among adolescents in which one intentionally harms one's tissues and organs without the intent of death, which has a complex pathophysiology and lacks established interventions. As NSSI has been linked to deficits in cognitive control, mindfulness training that enhances this process may be beneficial. In this study, using electroencephalography (EEG), we examined the neural mechanisms underpinning NSSI and the impact of mindfulness interventions by analyzing brain activity before, during, and after a 10-min brief breath-focused meditation session in adolescents with NSSI. We demonstrate that adolescent NSSI patients show a lower correct rejection rate and sensitivity in an emotional go/no-go task that reflects deficits in cognitive control compared to healthy controls, along with reduced P3 amplitude and theta power. A brief deep breath meditation intervention, but not natural breath meditation intervention, restored the decreased no-go theta power in NSSI patients. Analysis of microstates and neural network of resting-state EEG during meditation showed that properties of microstate D reflecting activation of the attention network differed between intervention strategies and predicted NSSI remission at 1-month follow-up. These findings provided evidence for inhibition deficits in adolescents with NSSI, suggest a role of P3 and theta power in identifying NSSI, support the therapeutic benefits of brief meditation, and reveal novel electrophysiological markers of NSSI diagnosis, intervention effects, and outcomes.

A Predictive Nomogram for Suicide Attempts in Chinese Adolescents With Both Non-Suicidal Self-Injury and Suicidal Ideation

INTRODUCTION

Non-suicidal self-injury (NSSI) and suicidal ideation (SI) are prevalent and co-occurring among adolescents, serving as critical predictors of suicide. This study aimed to develop a predictive model and nomogram for suicide attempts (SA) in Chinese adolescents with mood disorders exhibiting NSSI and SI.

METHODS

Data were collected from 134 participants. Predictors were selected via LASSO regression from data collected using the Self-Injurious Thoughts and Behaviors Interview-Revised and self-report scales, followed by multivariate logistic regression to build the nomogram. Model performance was assessed through discriminatory ability, calibration curves, and clinical decision analysis.

RESULTS

Adolescents with SA history had fewer education years, higher prevalence and future likelihood of self-injurious thoughts and behaviors, earlier NSSI onset, more frequent and severe NSSI, and more intense and persistent SI compared to those without SA. Three key predictors for SA were identified: NSSI emotion regulation scores, average SI persistence duration, and history of interrupted attempts. The developed nomogram exhibited robust predictive accuracy with an AUC of 0.756.

DISCUSSION

This study presents a predictive model for suicide risk in adolescents with mood disorders exhibiting NSSI and SI. The model demonstrates high predictive accuracy and clinical applicability, offering a practical tool for clinicians to prioritize high-risk cases and guide personalized interventions.

The roles of negative mood, impulsivity, and executive dysfunction in non-suicidal self-injury behaviors among Chinese middle school students

BACKGROUND

Previous studies have identified negative mood, impulsivity, and executive dysfunction as potential risk factors for non-suicidal self-injury (NSSI) in adolescents. However, the interplay of these factors and their gender-specific effects on NSSI remain unclear.

METHODS

In 2023, a sample of 1084 middle school students (Mage = 13.33; Nboy=574, Ngirl=510) completed psychological assessments measuring negative mood, impulsivity, executive dysfunction, and NSSI thoughts and behaviors over the past year.

RESULTS

(1) All variables were significantly correlated (all p values < 0.05); (2) Negative mood (β = 0.007, p = 0.002 for boys; β = 0.408, p < 0.001 for girls) and executive dysfunction (β = 0.209, p < 0.001 for boys; β = 0.124, p = 0.041 for girls) significantly predicted NSSI thoughts in both genders, whereas impulsivity showed no predictive effect; (3) Gender differences emerged in NSSI behaviors: negative mood (β = 0.395, p < 0.001) and impulsivity (β = 0.132, p = 0.005) were significant predictors among girls, whereas executive dysfunction (β = 0.200, p < 0.001) was a strong predictor among boys; (4) Impulsivity moderated the association between NSSI thoughts and NSSI behaviors in girls (β = 0.562, p < 0.001), but not in boys (β = -0.079, p = 0.390).

CONCLUSION

The influencing factors of NSSI behaviors exhibit notable gender differences. Tailored interventions should prioritize negative mood and impulsivity in girls, while addressing executive dysfunction in boys. Additionally, girls with high impulsivity and NSSI thoughts warrant closer monitoring, as they may be at a greater risk of engaging in NSSI behaviors.

The Relationship Between Identity Confusion and Adolescent Non-Suicidal Self-Injury: The Mediating Role of Psychological Distress and the Moderating Role of Life History Strategy

Previous research has shown that an increase in identity confusion is associated with a higher risk of non-suicidal self-injury (NSSI) in adolescents. Based on the identity-NSSI interplay model, we tested psychological distress as a mediator of this association. Based on the life history theory, we tested whether a slow life history strategy could weaken this mediation process. Five hundred and eighty-two Chinese middle school students (Mage = 13.75, SD = 0.67) completed questionnaires regarding identity confusion, psychological distress, life history strategy, and NSSI in May 2024. The results of structural equation modeling showed that identity confusion significantly predicted adolescent NSSI, and psychological distress mediated the association. Life history strategy moderated the second stage of the indirect effect (i.e., the relationship between psychological distress and NSSI). Specifically, the slower the life history strategy, the weaker the indirect effect of identity confusion on NSSI through psychological distress. These findings highlight the value of integrating life history strategy into research on adolescent NSSI.

Study pressure and self harm in Chinese primary school students: the effect of depression and parent-child relationships

Background

Self-harm has become a significant and increasing global problem in children and adolescents. In this study, we tested a moderated mediation model to examine the impact of study pressure and depression, and one protective factor, good parent-child relationship, on self harm.

Methods

A self-report Questionnaire survey was conducted among 33,285 primary school students from 3rd-6th grade (mean age = 10.36 years, SD = 1.24, 51.7% girls) in Shapingba District Chongqing, China. The survey assessed study pressure, depression, parent-child relationship, and self harm behaviors.

Results

The reporting rates of self-harm and depression in grades 3-6 of primary school were 12.7% and 16.3%, respectively. Both moderate and high study pressure were significantly associated with an increased risk of self-harm, with depression acting as a mediator (indirect effects: moderate study pressure = 0.045, high study pressure = 0.125, p < 0.001). Furthermore, a good parent-child relationship weakened the association between study pressure and self-harm, thus self harm on moderate study pressure (β=-0.057) and on high study pressure (β=-0.032) are lower than those without the moderator of a good parent-child relationship(β=0.116; β=0.168), as well as between study pressure and depression.

Conclusions

This study is the first to conduct a self-harm survey in the largest population-based sample of Chinese primary school students. The results highlight the importance of monitoring study pressure, fostering a positive parent-child relationship, and managing depressive symptoms to support students' mental health. These findings enhance our understanding of the development of self-harm behaviors and can inform the design of targeted intervention programs aimed at reducing self-harm among primary school students.

Network Structure and Core Features of Cognitive Emotion Regulation Strategies in Chinese Adolescents with NSSI

Purpose

Little research has focused on identifying the dynamic relationship and core features of cognitive emotion regulation strategies (CERS) that critically contribute to the onset and maintenance of NSSI. This study aims to investigate the CERS network structure in Chinese adolescents with NSSI through network analysis, identifying the core strategies within this network.

Patients and Methods

A total of 2711 Chinese adolescents (50.5% female, mean age = 12.89 ± 0.73 years) were assessed using the CERQ. Independent t-tests were conducted to compare CERS scores between adolescents with and without NSSI. Network analysis was performed to identify core CERS and to explore differences in the networks between the two groups.

Results

A total of 1065 adolescents (39.28%) reported engaging in NSSI at least once within the past six months. Among adolescents with NSSI, catastrophizing (strength = 1.32, betweenness = 1.98, closeness = 0.45) and rumination (strength = 1.18, betweenness = 1.10, closeness = 2.02) emerged as the most central CERS. In contrast, among adolescents without NSSI, catastrophizing (strength = 1.79, betweenness = 1.00, closeness = 0.08), rumination (strength = 0.34, betweenness = 1.00, closeness = 1.02), and positive reappraisal (strength = 0.57, betweenness = 1.50, closeness = 1.50) were identified as central CERS. Significant differences in network structure, global strength, and centrality were observed between the two groups, reflecting distinct patterns of CERS.

Conclusion

NSSI is associated with tightly connected, rigid CERS networks. Targeted interventions should focus on reducing catastrophizing and enhancing positive reappraisal to disrupt these rigid cognitive emotion regulation patterns, ultimately mitigating the risk of NSSI.

Intrinsic Links Between Non-Suicidal Self-Injury and Sleep Quality and Cytokines: A Network Analysis Based on Chinese Adolescents with Depressive Disorders

Background

Non-suicidal self-injury (NSSI) in adolescents has a complex etiology and a wide range of negative consequences. This study aimed to assess the interactions between NSSI and sleep quality and cytokines and explore the association of these factors with cognitive flexibility.

Methods

A cross-sectional survey was conducted from January 2022 to September 2024 in Qingdao, China. Adolescent Non-Suicidal Self-Injury Assessment Questionnaire, Pittsburgh Sleep Quality Index, and Wisconsin Card Sorting Test 128 card version were used to assess the NSSI, sleep quality, and cognitive flexibility. Levels of 12 serum cytokines were measured. Network analysis was performed by R software (version 4.4.1) to identify the central nodes and bridging symptoms of the network and all nodes' association with cognitive flexibility.

Results

A total of 337 adolescents with depressive disorders were included in the study. In the NSSI-Sleep Quality-Cytokines Network "Intentional scratches", "IL-12p70", and "Intentionally hitting oneself with fists or harder objects" were central nodes in the network. Furthermore, sleep-related variables such as "Sleep disturbance" and "Sleep duration" were identified as bridge symptoms. No direct association between NSSI and cognitive flexibility was observed.

Limitations

The cross-sectional design, reliance on self-reported data, and restricted geographic sample limit the ability to establish causal relationships and generalize the findings.

Conclusion

IL-12p70 plays a significant role in the development of NSSI among adolescents with depressive disorders. Sleep problems facilitate the interaction between NSSI and cytokines. Cognitive flexibility may be related to NSSI through indirect pathways.

Impact of parental marital status on self-harm in Chinese primary school students: the mediating role of depression and the moderating effect of classmate relationships

Background

Self-harm is an increasing global public health concern, with a growing prevalence in younger children. This study investigates the associations between parental marital status and self-harm behaviors among primary school students, with a focus on the mediating role of depressive symptoms and the moderating effect of classmate relationships.

Methods

A cross-sectional survey was conducted among 33,285 students (grades 3-6; mean age = 10.36 years) in the Shapingba District of Chongqing, China, from September to December 2020. Self-report measures included the Children's Depression Inventory (CDI), general demographic data, self-harm behaviors, and parental marital status. Data were analyzed using SPSS 26.0 for descriptive statistics and Mplus 8.1 for structural equation modeling (SEM), assessing the effects of parental marital status on self-harm.

Results

The reporting rates of depression and self-harm in grades 3-6 of primary school are 16.3% and 12.7%, respectively. Parental separation exhibited a more pronounced overall impact on self-harm (β = 0.120) compared to divorce (β = 0.105). Positive classmate relationships mitigated the indirect effect of separation on self-harm mediated by depression, reducing it from 0.098 to 0.072. Additionally, these relationships attenuated the direct effect of divorce on self-harm, decreasing it from 0.088 to 0.043. Depression significantly mediates the relationship between parental separation and children's self-harm, with direct and indirect effects accounting for 53% (β = 0.057) and 47% (β = 0.063) of the total effect, respectively.

Conclusion

The marital status of parents, especially in cases of separation, has a significant impact on self-harm behaviors among primary school students, with depression acting as a key mediating factor. Supportive classmate relationships can alleviate this effect, highlighting their importance in mental health interventions. These findings offer valuable insights for the development of policies aimed at reducing self-harm and enhancing psychological well-being among children.

Understanding Social Influence of Non-Suicidal Self-Injury: The Interplay of Peer Networks and Adolescent Behavior

Adolescents' non-suicidal self-injury (NSSI) could be influenced by their friends' NSSI and by their own social position within peer networks. However, prior research has examined these effects separately and has primarily focused on middle-to-late adolescence. It remains unclear how friends' NSSI relates to adolescents' NSSI under different social positions and how these effects differ across different age stages. This study examined both the independent and interactive effects of the number of friends engaging in NSSI, the number of claiming friends, and the extent of bridging different peer groups on adolescents' NSSI behaviors within classroom-based social networks. The sample included 9581 Chinese adolescents (44.6% girls, Mage = 13.72, SD = 1.87) from 221 classroom-based friendship networks, comprising 4248 early adolescents and 5333 middle-to-late adolescents. Social network analyses were used to extract network-related indicators, while general linear mixed models were employed to test the hypotheses. Results revealed that adolescents with more friends engaging in NSSI faced a higher risk of engaging in NSSI themselves; however, this risk decreased for adolescents with more claiming friends, irrespective of age. Adolescents who acted as bridges between different peer groups and had an above-average number of claiming friends were more likely to engage in NSSI, but this was only the case in early adolescence. These findings suggest NSSI can spread through friendship networks, with social connections influencing how likely adolescents are to be affected. Incorporating social network assessments into mental health screenings might facilitate early identification and prevention of NSSI among youth.

Impaired response inhibition to negative emotional stimuli in depressed adolescents with non-suicidal self-injury: a neurophysiological perspective

Background

Non-suicidal self-injury (NSSI) is an increasingly recognized clinical and public health issue among adolescents. This behavior exhibits certain addictive characteristics, leading it to be classified as a behavioral addiction. Response inhibition is believed to play a role in the occurrence of addictive behaviors and is often impaired in the context of negative emotional states. In this study, we compared the behavioral performance, ERP time-domain and time-frequency characteristics among depressed adolescents with NSSI, depressed adolescents, and healthy controls when exposed to negative emotional stimuli. The aim was to investigate the impact of negative emotional stimuli on the response inhibition in depressed adolescents with NSSI, clarify the role of response inhibition in NSSI behaviors, and provide neurophysiological evidence for its underlying mechanisms.

Methods

Seventy-one depressed adolescents with NSSI (MDD+NSSI group: 12 males, 59 females; mean age: 14.37 years), 55 depressed adolescents (MDD group: 24 males, 31 females; mean age: 15.29 years) and 25 healthy subjects (HC group, 13 males, 12 females, mean age: 15.72 years) were recruited to perform a two-choice oddball task related to negative emotional cues. All participants completed a self-administered questionnaire to gather demographic information. A trained psychiatrist administered the Hamilton Depression Scale (HAMD-17) to assess depression severity and used the Ottawa Self-Injury Inventory (OSI) to assess self-injury. Multichannel EEG was recorded continuously from 64 scalp electrodes using the Curry 8 system. EEG signal preprocessing and analysis was performed offline using the EEGLAB toolbox in MATLAB. The ERP time-domain features related to response inhibition were extracted from the difference waves, converted to the time-frequency features using the short-time Fourier transform (STFT), and the time-frequency values of the region of interest (ROI) were extracted and statistically analyzed.

Results

Under exposure to negative emotional stimuli, depressed adolescents with NSSI exhibited significantly larger P300 amplitudes compared to both depressed adolescents and healthy controls. Moreover, depressed adolescents with NSSI showed significant event-related synchronization (ERS) in the Delta and Theta bands of FCz electrode from 0 to 0.6 seconds, and event-related desynchronization (ERD) in the Theta and Alpha bands of Pz electrode from 0.2 to 1.2 seconds, collectively reflecting functional processes associated with response inhibition.

Conclusions

Depressed adolescents with NSSI showed increased P3d amplitudes, enhanced Delta/Theta ERS, and heightened Theta/Alpha ERD when receiving negative emotional stimuli, suggesting that depressed adolescents with NSSI have impaired response inhibition, which may contribute to the development of NSSI.

Non-suicidal self-injury in Chinese adolescents: longitudinal associations with negative life events and life satisfaction

Objectives

The relationship between negative life events, life satisfaction, and nonsuicidal self-injury has been demonstrated in adolescence, but no study has examined the longitudinal associations between the three over time. The present study hypothesized that negative life events play a mediating role in the relationship between life satisfaction and non-suicidal self-injury over time.

Methods

A total of 268 junior high school students participated in three questionnaires with an interval of half a year and completed questionnaires investigating the Adolescents Self-Harm Scale, the Adolescent Self-Rating Life Events Checklist, and the Satisfaction with Life Scale.

Results

The results indicated a significant predictive role of negative life events in non-suicidal self-injury over time and the prospective effect of life satisfaction on negative life events in adolescence. Negative life events play an intertemporal mediation in the relationship between life satisfaction and non-suicidal self-injury.

Conclusion

As a clear non-suicidal self-injury risk factor, negative life events can significantly predict non-suicidal self-injury in adolescence whether it is horizontal or vertical. Junior high school students who are exposed to more negative life events are more likely to have non-suicidal self-injury behaviors and the negative life events have a certain lagging effect on non-suicidal self-injury. Due to the prospective effect of life satisfaction on negative life events in adolescents, negative life events play a mediation in the relationship between life satisfaction and non-suicidal self-injury over time.

Interventions for suicidal and self-injurious related behaviors in adolescents with psychiatric disorders: a systematic review and meta-analysis

As a leading cause of adolescent death, suicidal and self-injurious related behaviors (SSIRBs) is a devastating global health problem, particularly among patients with psychiatric disorders (PDs). Previous studies have shown that multiple interventions can alleviate symptoms and reduce risks. This review aimed to provide a systematic summary of interventions (i.e., medication, physical therapy, psychosocial therapy) for the treatment of SSIRBs among Chinese adolescents with PDs. From inception to September 17, 2023, twelve databases (PubMed, CINAHL, ScienceDirect, PsycINFO, EMBASE, Cochrane Library, Clinical Trial, Web of Science, CEPS, SinoMed, Wanfang and CNKI) were searched. We qualitatively and quantitatively synthesized the included studies. Standardized mean differences (SMDs), risk ratios and their 95% confidence intervals (CIs) used the Der Simonian and Laird random-effects model. Fifty-two studies covering 3709 eligible participants were included. Overall, the commonly used interventions targeting SSIRBs and negative feelings in PDs adolescents with SSIRBs included psychosocial therapy (e.g., cognitive behavioral therapy), medication (e.g., antidepressants), and physiotherapy (e.g., repetitive transcranial magnetic stimulation). Importantly, quetiapine fumarate in combination with sodium valproate (SV) had positive effects on reducing self-injury behaviors score [SMD: -2.466 (95% CI: -3.305, -1.628), I2 = 88.36%], depression [SMD: -1.587 (95% CI: -2.505, -0.670), I2 = 90.45%], anxiety [SMD: -1.925 (95% CI: -2.700, -1.150), I2 = 85.23%], impulsivity [SMD: -2.439 (95% CI: -2.748, -2.094), I2 = 0%], as well as its safety in comparison with SV alone. No significant difference of adverse reactions was found by low-dose QF (P > 0.05). This review systematically outlined the primary characteristics, safety and effectiveness of interventions for Chinese PDs adolescents with SSIRBs, which could serve as valuable evidence for guidelines aiming to formulate recommendations.

Longitudinal Associations Between Negative Body Image, Self-Disgust, and Nonsuicidal Self-Injury Among Chinese Adolescents: Disentangling Between- and Within-Person Effects

Nonsuicidal self-injury (NSSI) and negative body image are both highly prevalent among adolescents, and there are theoretically proposed reciprocal associations between them. However, previous research has not differentiated between stable personal traits and time-varying state levels when examining these associations, and the underlying mechanisms remain unclear. To address these gaps, this study investigated the longitudinal associations between negative body image, self-disgust, and NSSI among Chinese adolescents, disentangling the between- and within-person effects by employing random intercept cross-lagged panel models (RI-CLPMs). A total of 515 Chinese adolescents (50.7% boys; baseline Mage = 12.34 years, SD = 0.47) participated in a four-wave longitudinal study with 6-month intervals. The results indicated that, at the between-person level, higher levels of self-disgust were associated with more NSSI and more concerns about general appearance, facial appearance, shortness, and fatness, but were not associated with concerns about thinness. At the within-person level, general appearance concern and NSSI positively predicted each other over time through self-disgust. Concerns about facial appearance, shortness, and fatness all positively predicted self-disgust, which in turn positively predicted NSSI over time, but not vice versa. These findings highlight the stable and trait-like associations between self-disgust, NSSI, and most negative body image dimensions. Self-disgust is worth considering as a target for intervention, as it plays a mediating role in the long-term associations between negative body image and NSSI.

Gender-Specific Trajectories of Non-Suicidal Self-Injury among Adolescents: Predictive Roles of Distal and Proximal Risk Factors

Non-suicidal self-injury (NSSI) is considered a strong risk factor for suicide. Although NSSI is prevalent among adolescents and varies by gender, few studies have examined the gender-specific trajectory of NSSI and its predictors. This study examined the trajectory of NSSI among Chinese adolescent boys and girls separately, and the roles of distal (i.e., childhood maltreatment and its specific subtypes) and proximal risk factors (i.e., emotional dysregulation, peer victimization) on their trajectories. A total of 3290 Chinese adolescents (Mage = 13.08; SD = 0.84; 57.6% boys) participated in assessments at three time points. Latent class growth models identified three trajectories for boys: Low stable (92.5%), moderate increasing (5.0%) and high decreasing (2.5%). Four trajectories were identified for girls: Low stable (87.9%), moderate increasing (7.6%), high decreasing (3.0%) and high stable (1.5%). Multinomial logistic regression analyses revealed that both emotional dysregulation and emotional abuse predicted the trajectories of moderate increasing, high decreasing and high stable for girls, as well as predicted moderate increasing and high decreasing trajectories for boys. Peer victimization served as a significant risk factor predicting the moderate increasing and high decreasing trajectories only for girls, while overall childhood maltreatment was a remarkable predictor for the moderate increasing and high decreasing trajectories of boys. The findings highlighted the importance of gender differences in understanding the progression of NSSI and the key predictors, informing effective strategies for prevention and intervention.

The effect of depression on non-suicidal self-injury and psychological status in adolescents with unipolar and bipolar disorders

OBJECTIVE

To investigate the effects of depression on non-suicidal self-injury (NSSI) and related psychological conditions in adolescents with unipolar disorder (UD) and bipolar disorder (BD), and to provide a basis for accurate prevention and intervention of NSSI behaviors in adolescents.

METHODS

This cross-sectional study collected data from adolescents aged 12-18 years with depressive episodes who exhibited NSSI behaviors and attended the psychiatric outpatient clinic of Huangshi City Psychiatric Specialized Hospital from 2018 to 2023. Depressive episodes were clinically diagnosed by two psychiatrists according to the ICD-10.

RESULTS

In terms of NSSI behavioral patterns and severity, adolescents with UD displayed more frequent behaviour of intentionally burning themselves with cigarettes and had more instances of self-inflicted suicidal thoughts that were not carried out compared to those with BD, and the differences between the two groups were statistically significant (P < 0.05). For psychological status, Nurses' Global Assessment of Suicide Risk (NGASR) scores were significantly higher in adolescents with BD than in those with UD (P < 0.05). There was a significant negative correlation between anxiety scores and the frequency of NSSI in adolescents with BD (P < 0.05); that is, the more anxious the adolescents with BD, the lower the frequency of NSSI. The NGASR scores of adolescents with UD and BD were significantly and positively correlated with the frequency of NSSI occurrences (P < 0.05); higher NGASR scores of adolescents with UD and BD corresponded with higher frequencies of NSSI.

CONCLUSION

The differences in NSSI behaviors between adolescents with UD and those with BD were statistically significant in terms of self-injury method and severity. Adolescents with UD experienced more severe consequences related to NSSI behaviors. Regarding psychological conditions, adolescents with BD are at a higher risk of suicide. An inverse relationship was observed between anxiety severity and the frequency of NSSI in adolescents with BD; severe anxiety was associated with lower NSSI frequency. Additionally, higher suicide risk was associated with a higher frequency of NSSI in adolescent patients with either UD or BD. Therefore, different prevention and intervention measures are needed to address NSSI behaviors in adolescents with UD and BD.

The mediating role of rumination in the relationship between insomnia and non-suicidal self-injury of college students

Introduction

Non-suicidal self-injury (NSSI) is a high-risk factor for suicide, which is widespread among college students and is closely associated with psychological issues. Insomnia tends to cause mental instability, and chronic insomnia can trigger severe mood swings, including anxiety, depression, and irritability. It can also lead to memory loss and metabolic disorders. College students are in a critical period of self-development, with significant vulnerability to insomnia and NSSI. This study investigated the influence of insomnia on NSSI among college students and examined the significance of rumination as a mediating factor.

Methods

Using random cluster sampling, we selected 667 college students from Jiangsu, China, and evaluated them using the Athens Insomnia Scale (AIS), Adolescent Self-Injury Scale (ASIS), and Ruminative Responses Scale (RRS). The significance of the mediating effect of rumination on the relationship between insomnia and NSSI among college students was tested using Bootstrap methods.

Results

The fact that the students were only children was statistically significant for rumination scores (p < 0.05). The results showed a significant positive correlation among insomnia, NSSI, and rumination (r = 0.198, 0.737, 0.243, respectively; p < 0.001). Insomnia of college students affects NSSI directly and indirectly through rumination.

Conclusion

Rumination fully mediated the relationship between insomnia and NSSI among college students, indicating an indirect influence of insomnia on NSSI. Total effect value is 0.192. Rumination plays a complete mediating role in the relationship between insomnia and NSSI among college students, with a mediating effect of 84.21%.

Prediction of non-suicidal self-injury (NSSI) among rural Chinese junior high school students: a machine learning approach

AIMS

Non-suicidal self-injury (NSSI) is a serious issue that is increasingly prevalent among children and adolescents, especially in rural areas. Developing a suitable predictive model for NSSI is crucial for early identification and intervention.

METHODS

This study included 2090 Chinese rural children and adolescents. Participants' sociodemographic information, symptoms of anxiety as well as depression, personality traits, family environment and NSSI behaviors were collected through a questionnaire survey. Gender, age, grade, and all survey results except sociodemographic information were used as relevant factors for prediction. Support vector machines, decision tree and random forest models were trained and validated by the train set and valid set, respectively. The metrics of each model were tested and compared to select the most suitable one. Furthermore, the mean decrease Gini index was calculated to measure the importance of relevant factors.

RESULTS

The prevalence of NSSI was 38.3%. Out of the 6 models assessed, the random forest model demonstrated the highest suitability in predicting the prevalence of NSSI. It achieved sensitivity, specificity, AUC, accuracy, precision, and F1 scores of 0.65, 0.72, 0.76, 0.70, 0.57, and 0.61, respectively. Anxiety and depression were the top two contributing factors in the prediction model. Neuroticism and conflict were the factors that contributed the most to personality traits and family environment, respectively, in terms of prediction. In addition, demographic factors contributed little to the prediction in this study.

CONCLUSION

This study focused on Chinese children and adolescents in rural areas and demonstrated the potential of using machine learning approaches in predicting NSSI. Our research complements the application of machine learning methods to psychiatric and psychological problems.

A latent profile analysis of cognitive emotion regulation strategies in relation to negative emotions and NSSI among Chinese junior high school students

BACKGROUND

Little is known about the latent profiles of cognitive emotion regulation strategy (CERS) and its relationship with negative emotions and Non-Suicidal Self-Injury (NSSI) in Chinese junior high school students, although CERS is thought to be strongly associated with emotional-behavioral problems in adolescents.

METHODS

A total of 2807 junior high school students in Yunnan Province, China, were selected for the study. They were measured with the Cognitive Emotion Regulation Questionnaire (CERQ), the Non-Suicidal Self-Injury Questionnaire, and the Depression-Anxiety-Stress Scale. Latent profile analysis was used to explore latent profiles of CERS among students, and the one-way ANOVA or c2 test was used to explore the relationship between the profiles and depression, anxiety, stress or NSSI.

RESULTS

(1) Latent profile analysis revealed five CERS types: 'Maladaptive group' (32.25%), 'Moderate adaptive-low maladaptive group' (24.68%), 'Rigid group' (19.73%), 'High adaptive-moderate maladaptive group' (14.42%), and 'Sensitive group' (8.82%). (2) The multivariable logistic regression analyses showed that with increasing age (OR = 0.812, 95% CI = 0.66-0.99, p < 0.05), junior high school students were less likely to be in the 'Moderate adaptive-low maladaptive group', and males (OR = 0. 698, 95% CI = 0.52-0.94, p < 0.05) were less likely to be classified as 'Moderate adaptive-low maladaptive group'; (3) ANOVA and c2 test results showed that the differences between the different latent profiles of junior high school students on anxiety, depression, stress and NSSI indicators were statistically significant (p < 0.05). The 'Sensitive group' had the highest risk of emotional-behavioral problems and the 'Moderate adaptive-low maladaptive group' had the lowest risk of emotional-behavioral problems.

CONCLUSION

Negative emotions and NSSI in junior high school students are closely related to their CERS profiles, and it is important to use targeted strategies to prevent and intervene in emotional-behavioral problems for individuals with different CERS subtypes.

Effectiveness of psychodrama on mental health outcomes based on Chinese samples: A systematic review and meta-analysis of randomized controlled studies

Background

Psychodrama (PD), supported by extensive global research, is increasingly becoming a vital method for alleviating psychological symptoms and promoting mental well-being in diverse populations across China. However, comprehensive evidence based on rigorous interventions is currently lacking.

Methods

This article systematically reviews the literature on randomized controlled experimental intervention studies of PD in the Chinese Mainland from 1982 to 2023.

Findings

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, this article included seven studies (N = 332, 25 effect sizes). The results demonstrate that PD interventions have a promotional effect (standardized mean difference SMD = 0.768, 95% CI [0.591, 0.946]) across different age groups and settings in randomized controlled trial interventions. In accordance with previous literature, we categorized the effect sizes into two major groups: illness reduction (IR) and health promotion (HP). Subgroup analysis based on these two categories revealed consistent findings. In the IR category, the overall effect size was notably significant (SMD = -0.711, 95% CI [-0.976, -0.446]), and in the HP category, the overall effect was also highly significant (SMD = 0.889, 95% CI [0.705, 1.074]). This finding aligns with previous research in other nations, supporting the significant effectiveness of PD as a counseling method in alleviating psychological illnesses and promoting mental health within the Chinese context.

Conclusion

PD serves not only as a therapeutic tool but also as a preventive and developmental intervention. Moving forward, there is a call for increased emphasis on standardized and randomized controlled experimental studies to further the advancement of PD within China.

The role of the bilateral inferior frontal gyrus in non-suicidal self-injury (NSSI) among depressed adolescents: A functional near-infrared spectroscopy (fNIRS) study during verbal fluency tasks

BACKGROUND

The diagnosis and treatment of adolescents engaging in non-suicidal self-injury (NSSI) have been a clinical focus. We examined the hemodynamic changes in verbal fluency tasks (VFT) of adolescents with depression and NSSI, and its association with NSSI indexes.

METHODS

Seventy-three adolescents with depression and NSSI and sixty-nine healthy controls (HCs) were employed. The VFT was performed by functional near-infrared spectroscopy (fNIRS). Independent-sample t-test, correlation analysis, and liner regression were measured.

RESULTS

In the VFT, reduced hemodynamic changes were found in the NSSI group, including thirteen channels. Totally seven ROIs were defined according to which brain region these channels had the largest coverage and other channels that also belonged to it. They are the right inferior frontal gyrus (RIFG, t = -2.53, FDR corrected p = 0.02), right middle frontal gyrus (RMFG, t = -3.47, FDR corrected p = 0.002), right superior frontal gyrus (RSFG, t = -2.98, FDR corrected p = 0.005), left middle frontal gyrus (LMFG, t = -3.26, FDR corrected p = 0.002), left inferior frontal gyrus (LIFG, t = -2.80, FDR corrected p = 0.001), left precentral gyrus (LPrCG, t = -2.22, FDR corrected p = 0.03), and left supramarginal gyrus (LSMG, t = -2.20, FDR corrected p = 0.03). Negative correlations were found between the frequency of NSSI and the bilateral IFG (RIFG, r = -0.28, p = 0.01; LIFG, r = -0.26, p = 0.03). BDI and BAI have positive correlations with the frequency of NSSI (BDI: r = 0.42, FDR corrected p < 0.001; BAI: r = 0.41, FDR corrected p < 0.001), but results of liner regression showed that both of them do not affect the association between the frequency of NSSI and hemodynamic changes in bilateral IFG (RIFG, p = 0.01; LIFG, p = 0.04).

CONCLUSION

Adolescents with depression and NSSI have worse performance in the VFT, and lower activation in the bilateral IFG may represent a higher frequency of NSSI. These results help physicians enhance the understanding of adolescents with depression and NSSI.

Physical activity and non-suicidal self-injurious behavior in Chinese adolescents: the chain mediating role of psychological capital and relative deprivation

Introduction

Physical activity has been shown to alleviate negative emotions. We examined whether physical activity is associated with lower non-suicidal self-injurious behavior in adolescents and the mediating and chain-mediating roles of psychological capital and relative deprivation in this association.

Methods

451 secondary school students (44.57% girls; ages 13-19) completed the Physical Activity Rating Scale, Adolescent Non-Suicidal Self-Injurious Behavior Scale, Psychological Capital Scale, and Adolescent Relative Deprivation Scale in their classrooms. In addition, this study used SPSS 26.0 for statistical data analysis and the SPSS macro program PROCESS 4.1 to explore the mediation role.

Results

Regression-based analyses showed that higher psychological capital and lower relative deprivation individually and sequentially mediated the association between physical activity and lower NSSI.

Conclusion

These findings contribute to a deeper understanding of how and why physical activity affects adolescents' non-suicidal self-injurious behaviors. At the same time, the result may provide new insights into prevention and intervention efforts for non-suicidal self-injurious behaviors in adolescents.

A nomogram for predicting non-suicide self-injury in youth depression patients: a longitudinal analysis

Non-suicidal self-injury (NSSI) behavior is a common issue in youth with depression while lacks a prognostic prediction model. This study aims to develop a nomogram for NSSI in youth with depression. A total of 701 patients were included in the analysis based a youth depression cohort. They were further divided into a training set and a validation set. The Lasso regression and binary logistic regression were used to select variables for the nomogram. The nomogram's discrimination, calibration, accuracy, clinical applicability, and generalization involved the use of metrics such as the area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow (HL) test, Brier score, calibration curve, decision curve analysis (DCA), and internal validation. The Delong test was employed to compare the ROC performance between the two models. These patients had an average age of 19.3+/-3.3 years, and 101 (20.6%) individuals reported NSSI. Five risk factors for NSSI were identified: age, age at first medication, previous instances of NSSI, academic stress score in the Adolescent Self-rating Life Events Check List (ASLEC), and somatic anxiety of the 14 item Hamilton Anxiety Rating Scale (HAMA-14). The training set and validation set of binary logistic regression-based model showed good discrimination (area under the curve (AUC) 0.781, 95% CI: 0.735 ~ 0.827; and 0.757, 95% CI: 0.682 ~ 0.831, respectively), calibration (P = 0.421 and 0.175, respectively), and accuracy (Brier score 0.119 to 0.155 and 0.109 to 0.168, respectively). A prognostic nomogram was developed and validated to assist clinicians in predicting NSSI of youth with depression.

Cortical morphological alterations in adolescents with major depression and non-suicidal self-injury

BACKGROUND

Non-suicidal self-injury (NSSI) involves repetitive self-harm without suicidal intent and is common among adolescents, often linked to major depressive disorder (MDD). NSSI can lead to physical harm, cognitive impairments, interpersonal issues, violent behavior, and increased risks of psychological disorders and suicide attempts later in life.

METHODS

Voxel-based morphometry (VBM) and surface-based morphometry (SBM) were performed on 44 NSSI patients and 44 healthy controls (HCs). Differences in GMV, CT, and cortical complexity were compared using the two-sample t-tests and correlated with neuropsychological scales.

RESULTS

NSSI patients exhibited significant GMV atrophy in multiple regions, including the left insula, left anterior cingulate cortex, left putamen, left middle frontal gyrus, and right superior frontal gyrus showing increased GMV in the cerebellum posterior lobe. NSSI patients had increased CT in multiple left hemisphere regions and decreased CT in the right middle frontal gyrus. Additionally, they exhibited reduced cortical complexity, including decreased SD in the right frontal gyrus, and lower GI in the left insula. There were no significant differences between the two groups in terms of fractal dimension (FD). NSSI patients showed negative correlation between the CT of the right middle frontal gyrus and the anger dimension of the BPAQ, as well as the SD of the right superior frontal gyrus and the hostility dimension of the BPAQ.

CONCLUSION

NSSI patients have significant structural changes in the insular cortex, prefrontal cortex, precentral and postcentral gyrus, temporal lobe, putamen, and anterior cingulate cortex, offering a morphological perspective on the pathophysiology of NSSI in MDD.

Mobile phone addiction and self-injury in adolescents with MDD: mediation by self-esteem and depression, and the failure of usage restrictions

BACKGROUND

Previous studies have suggested a significant association between mobile phone addiction (MPA) and non-suicidal self-injury (NSSI) in general adolescents. However, limited research has analyzed this relationship in clinical populations, such as those with major depressive disorder (MDD), and the potential mediation mechanisms remain unclear.

METHODS

This cross-sectional observational study analyzed data from 2343 adolescents with MDD (77.9% females; mean age = 14.99 years, SD = 1.65). Using mediation models, we explored the roles of self-esteem and depression severity (measured by Patient Health Questionnaire-9) in the relationship between MPA and NSSI. Additionally, we evaluated the associations between existing school-implemented mobile phone usage policies and levels of MPA, self-esteem, depression symptoms, and NSSI.

RESULTS

MPA was significantly associated with NSSI, with low self-esteem and increased depression severity almost entirely mediating this effect (log-odds = 0.016, 95%CI = 0.02-0.013). Subdomains of MPA, including inability to control craving, feelings of anxiety, and productivity loss, followed similar mediation models, while the subdomain of withdrawal/escape had a partial effect mediated by depression severity. Additionally, enforced restrictions on mobile phone usage in schools did not show positive effects on related variables and even exacerbated MPA by increasing cravings and reducing productivity.

CONCLUSION

Our study suggests that MPA in adolescents with MDD may be an important risk factor for NSSI occurrence, and that reducing the negative impact of mobile phone usage on self-esteem and depressive symptoms, rather than simply restricting usage, may be crucial for effective intervention.

Factors associated with informal and formal help-seeking among Asian adolescents with nonsuicidal self-injury

Although nonsuicidal self-injury (NSSI) is prevalent among adolescents and is associated with an increased risk of adverse outcomes, many adolescents with NSSI do not seek help. However, there is a lack of research on the factors that may increase the likelihood of help-seeking, especially within Asia. To address this gap, the present study examined whether certain factors were associated with informal and formal help-seeking - specifically gender, severity of NSSI, functions of NSSI and authoritative parenting. 121 adolescents (Mage = 16.2 years, 71.1% female) were recruited from specialist outpatient clinics and inpatient psychiatric wards from a public hospital in Singapore. One caregiver per adolescent was also recruited. Data from self-report questionnaires were analysed using logistics regression analyses. The results suggest that the severity of NSSI increases the likelihood of informal help-seeking, while adolescents who have parents with more authoritative parenting style are less likely to seek informal help. Gender and functions of NSSI were not found to be associated with help-seeking. The findings from this study can guide professionals in their efforts to encourage help-seeking within Asian populations, as well as inform prevention and treatment programs for Asian adolescents with NSSI.

Predicting non-suicidal self-injury among Chinese adolescents: The application of ten algorithms of machine learning

Background and aims

High non-suicidal self-injury (NSSI) prevalence among adolescents is a global health issue. However, current prediction models for adolescent NSSI rely on a limited set of algorithms, resulting in biased predictions. Therefore, the aim of this study is to develop multiple machine learning models to enhance prediction accuracy and mitigate biases among Chinese adolescents.

Methods

A total of 4487 junior and senior high school students in China were recruited. Multiple algorithms were included, such as logistic regression, decision tree, support vector machine, Naive Bayes, multi-layer perceptron, K-nearest neighbors, and ensemble learning algorithm like random forest, bagging, AdaBoost, and stacking to build predictive models. Data processing techniques, including standardization and the synthetic minority oversampling technique, were employed to optimize the predictive model. The model was trained on 70 % of the data, reserving 30 % for testing.

Results

The ten prediction models achieved a good performance, with area under the receiver operating characteristic curve (AUC) scores above 0.700 in the test set. The stacking and random forest models achieved AUC scores of 0.904 and 0.898, respectively. The prediction performance of the Naive Bayes model was relatively poor. The top five important variables were resilience, bully, suicidal ideation, internet addiction, and depression.

Conclusions

The ensemble machine learning algorithm showed promising results predicting NSSI among adolescents. Such algorithms should be recommended for future NSSI research to enhance predictive accuracy. Identification of important features in NSSI prediction can help develop screening protocols and lay a foundation for clinical diagnosis and intervention in adolescent populations.

Cybervictimization and Non-Suicidal Self-Injury Among Chinese College Students: an Exploration Through the Lens of Experiential Avoidance Model

Purpose

Non-suicidal self-injury (NSSI) is a growing public health concern among college students, with cybervictimization (CV) emerging as a significant contributing factor. Grounded in the experiential avoidance theory, this study investigates the mediating roles of cognitive fusion and negative emotions in the relationship between CV and NSSI, providing new insights into these key variables.

Methods

A convenience sample of 457 undergraduate students (29% male; mean age 18.36±0.66 years) from two universities in Fujian Province participated in this study. Data were collected using the Cyberbullying Victimization Scale, Cognitive Fusion Questionnaire, Positive and Negative Affect Schedule, and Non-Suicidal Self-Injury Scale. Descriptive statistics and Pearson correlation analysis were conducted using SPSS 25.0, while the mediating effects were analyzed using Process 3.5.

Results

(1) Significant positive correlations were found among CV, cognitive fusion, negative emotions, and NSSI (p < 0.01). (2) CV was directly associated with NSSI (β = 0.22, p < 0.001) and positively predicted both cognitive fusion (β = 0.17, p < 0.001) and negative emotions (β = 0.15, p < 0.01). Additionally, cognitive fusion (β = 0.16, p < 0.01) and negative emotions (β = 0.11, p < 0.05) significantly predicted NSSI. (3) Mediation analyses revealed that cognitive fusion and negative emotions mediated the CV-NSSI relationship through three pathways: CV→cognitive fusion→NSSI (mediation effect = 0.026), CV→negative emotions→NSSI (mediation effect = 0.02), and CV→cognitive fusion→negative emotions→NSSI (mediation effect = 0.01).

Conclusion

The study confirms that CV influences NSSI indirectly through cognitive fusion and negative emotions, supporting the experiential avoidance model. These findings underscore the importance of addressing cognitive and emotional processes in interventions aimed at reducing NSSI among college students.

Effect of Parenting Style, attachment to parents and self-compassion on the occurrence and recovery motivation for non-suicidal self-injury in adolescents

Background

Non-suicidal self-injury (NSSI) is a worldwide mental health problem that deserves thorough investigation. This study aims to explore the effect of parenting styles, attachment to parents, and self-compassion on the occurrence of non-suicidal self-injury (NSSI) behavior in adolescents and whether these factors influence their recovery motivation.

Methods

A total of 132 adolescents who had engaged in NSSI within the last year and 72 adolescents who had never engaged in NSSI were recruited from the Shenzhen Kangning Hospital and from primary and secondary schools and communities. Differences in the Hamilton Depression Scale (HAMD), Inventory of Parent and Peer Attachment (IPPA), Egma Minn av. Bardndosnauppforstran (EMBU), and Self-Compassion Scale (SCS) of participants were compared. A binary logistic model was established to measure the odds ratios of these variables on the occurrence of NSSI. In the NSSI adolescent sample, separate binary logistic models were created with NSSI impulse inhibition, NSSI resistance activity, and NSSI recovery motivation as dependent variables and with parenting styles, attachment to parents, and self-compassion as independent variables.

Results

Compared with adolescents with no NSSI behavior, those who had engaged in NSSI within the past year had higher scores on the HAMD, as well as higher EMBU-negative father parental behavior (punishment, excessive interference, rejection, and overprotection), EMBU-negative mother parental behavior (excessive interference, rejection, and punishment), and SCS negative self-compassion scores. Moreover, adolescents with NSSI had lower EMBU-father emotional warmth, EMBU-mother emotional warmth, IPPA-attachment to father, IPPA-attachment to mother, and SCS positive self-compassion scores. Current depressive symptoms and maternal punishment are risk factors for NSSI in adolescents, while positive self-compassion was a protective factor. Positive self-compassion can positively predict NSSI impulse inhibition, NSSI resistance activity, and NSSI recovery motivation. However, we unexpectedly found that the father's emotional warmth negatively predicts NSSI resistance activity.

Conclusion

This study found that positive self-compassion has a significant impact on the prevention of and recovery from NSSI behavior in adolescents.

Self-Compassion as a Mediator Linking Sleep Disturbances with Non-Suicidal Self-Injury: A Four-Wave, Cross-Lagged Study

Objective

This longitudinal study examined the reciprocal relationship between sleep disturbances with non-suicidal self-injury and whether self-compassion mediates these associations.

Methods

A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students at the baseline. This study spanned six waves with a six-month interval between each wave. Data from the last four waves were used because self-compassion or non-suicidal self-injury was not measured in the first two waves. The cross-lagged panel models were used to examine the longitudinal dynamic relationships between sleep disturbances, self-compassion, and non-suicidal self-injury.

Results

The results showed that all the auto-regressive paths were significant. For the cross-lagged paths, there was a reciprocal relation between sleep disturbances and self-compassion. Importantly, self-compassion played a longitudinal mediating role in the prediction from sleep disturbances to non-suicidal self-injury (indirect effect = 0.007 to 0.009, all p values < 0.001).

Conclusion

Psychological interventions targeting improved sleep quality and self-compassion may hold great promise for reducing the incidence of non-suicidal self-injury.

Association between sports-related concussions and the risk of self-injury thoughts and behaviors: Who, and under what circumstances?

BACKGROUND

Understanding the association between sport-related concussions and the risk of suicidal and non-suicidal self-injury thoughts and behaviors (SITBs), including non-suicidal self-injury (NSSI), suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA), is crucial for suicide prevention. We aimed to identify the circumstances in which individuals with or without a concussion are vulnerable to SITBs.

METHODS

The cross-sectional study included 85,469 students from 63 Chinese university with a mean age of 19.6 years. Firstly, propensity score matching, and inverse probability of treatment weighting (IPTW) were used to match the concussion and non-concussion group based on a range of biological, social, and psychological factors. Subsequently, multivariable logistic regression and a decision tree algorithm were employed to evaluate the interaction and cumulative impact of these risk factors and concussion on the probability of SITBs.

RESULTS

In the unmatched sample, concussion exposures were associated with all SITBs, with NSSI (OR, 1.41), SI (OR, 1.10), SP (OR, 1.23), and SA (OR, 1.28). However, the matched and weighted sample only had a significant association with NSSI and SI. The decision tree model revealed that, in the unmatched sample, among individuals without depressive symptoms or childhood emotional abuse, the risk of concussion on SITBs increased from 45.5 % to 65.2 % (χ2, 9.370; adjusted P = .002) after experiencing sexual abuse and verbal bullying. In the matched sample, the risk increased from 46.2 % to 64.6 % (χ2, 6.848; adjusted P = .009).

CONCLUSION

Our study revealed that individuals who suffered concussions exhibited a significantly higher risk of SITBs.

Factors and pathways of non-suicidal self-injury in children: insights from computational causal analysis

Background

Non-suicidal self-injury (NSSI) has become a significant public health issue, especially prevalent among adolescents. The complexity and multifactorial nature of NSSI necessitate a comprehensive understanding of its underlying causal factors. This research leverages the causal discovery methodology to explore these causal associations in children.

Methods

An observational dataset was scrutinized using the causal discovery method, particularly employing the constraint-based approach. By integrating machine learning and causal inference techniques, the study aimed to determine direct causal relationships associated with NSSI. The robustness of the causal relationships was evaluated using three methods to construct and validate it: the PC (Peter and Clark) method, Fast Causal Inference (FCI) method, and the GAE (Graphical Autoencoder) method.

Results

Analysis identified nine nodes with direct causal relationships to NSSI, including life satisfaction, depression, family dysfunction, sugary beverage consumption, PYD (positive youth development), internet addiction, COVID-19 related PTSD, academic anxiety, and sleep duration. Four principal causal pathways were identified, highlighting the roles of lockdown-induced lifestyle changes, screen time, positive adolescent development, and family dynamics in influencing NSSI risk.

Conclusions

An in-depth analysis of the factors leading to Non-Suicidal Self-Injury (NSSI), highlighting the intricate connections among individual, family, and pandemic-related influences. The results, derived from computational causal analysis, underscore the critical need for targeted interventions that tackle these diverse causative factors.

Longitudinal relationship between harsh parenting and adolescent non-suicidal self-injury: The roles of basic psychological needs frustration and self-concept clarity

BACKGROUND

Harsh parenting has been shown to be associated with adolescents' non-suicidal self-injury (NSSI) behavior. However, less is known about the mechanism underlying the association.

OBJECTIVE

The aim of this study was to use a one-year longitudinal design to investigate the mediating role of basic psychological needs frustration and the moderating role of self-concept clarity in the association between harsh parenting and NSSI.

METHODS

Three waves of data (called T1, T2 and T3) were collected 6 months apart, between April 2021 and 2022, in a sample of 786 Chinese adolescents (52.0 % girls; Mage at Wave 1 = 13.27 years). Structural equation model was used to test a longitudinal moderated mediation model, with gender, age and baseline NSSI as covariates.

RESULTS

The results showed process of mediation in which T1 harsh parenting was longitudinally and positively associated with T3 NSSI through T2 basic psychological needs frustration. Furthermore, moderated mediation analyses revealed that T2 self-concept clarity buffered the adverse impact of T2 needs frustration on T3 NSSI, thereby mitigating the mediation process.

CONCLUSIONS

The findings support the self-determination theory, and suggest that fostering adolescents' self-concept clarity and satisfying their psychological needs may be useful in programs designed to lower the risk of NSSI.

Can digital self-harm relate to suicidal thoughts and behaviors beyond physical self-harm?

BACKGROUND

Digital self-harm (DiSH) is a recently identified self-harm distinct from physical self-harm (PSH, also known as non-suicidal self-injury, NSSI). Although prior research has shown that DiSH was associated with suicidal thoughts and behaviors (STBs), it was still unclear whether DiSH has a unique association with STBs after controlling for PSH.

METHOD

A cross-sectional survey was conducted on Chinese college students. The lifetime prevalence of DiSH and PSH, the functions of DiSH, recent suicide experiences (including suicide ideation, plans, and attempts), anxiety and depression were examined. A total of 5281 participants were analyzed.

RESULTS

A total of 10.83% of participants had ever engaged in DiSH, and 1.59% of participants reported histories of both DiSH and PSH. Among participants with a history of PSH, 30.11% engaged in DiSH. Engagement in DiSH was significantly associated with suicide ideation (SI), suicide plans (SPs), and suicide attempts (SAs). More importantly, participants who engaged in both DiSH and PSH showed higher odds of SI and SPs compared to those who had only engaged in PSH. Regarding the functions of DiSH, using DiSH for self-punishment was associated with SI and SPs, and using DiSH for sensation seeking was associated with SPs and SAs. Similar results were found for the association between DiSH and anxiety and depression.

CONCLUSIONS

Our findings suggest that DiSH has a unique association with the risks of STBs beyond PSH. Early identification and intervention for DiSH are crucial, even for individuals who already engage in PSH.

Psychosocial interventions for suicidal and self-injurious-related behaviors among adolescents: a systematic review and meta-analysis of Chinese practices

Background

Suicidal and self-injurious-related behaviors (SSIRBs) are a serious public health challenge in China. However, a comprehensive systematic review of psychosocial interventions for SSIRBs among Chinese adolescents has not been performed. To fill this gap, this systematic review and meta-analysis aimed to examine psychosocial interventions for SSIRBs among Chinese adolescents.

Methods

Eight international (PubMed, EMBASE, Cochrane Library, ScienceDirect, Clinical Trial, CINAHL, PsycINFO, and Web of Science) and four Chinese (Wanfang, SinoMed, CEPS, and CNKI) databases were searched from inception to 31 January 2023. Data extraction and quality assessment were independently conducted by two groups of researchers. Qualitative synthesis and meta-analysis were both used.

Results

The initial search yielded 16,872 titles. Of the 649 full texts reviewed, 19 intervention articles focusing on SSIRBs met the inclusion criteria. Thirteen out of the 19 included studies involved cognitive-behavioral therapy (CBT). Seven non-suicidal self-injury (NSSI) studies assessing self-injurious behaviors were included (six short-term studies and three long-term studies). Compared with long-term interventions [-1.30 (95% CI: -1.84, -0.76)], short-term psychosocial interventions had a higher standardized mean difference (SMD) value [1.86 (95% CI: -2.72, -0.99)]. Meta-regression showed an inverse relationship between the treatment response and sample size (slope = 0.068, Z = 2.914, p = 0.004) and proportion of females (slope = 1.096, Z = 5.848, p < 0.001). Subgroup analyses showed that compared with the "less than 1 month" group [-0.494 (-0.783, -0.205)], in the "immediate postintervention" group, the pooled estimate was significantly lower [-2.800 (-4.050, -1.550), p < 0.001].

Conclusion

Our review systematically summarized the key characteristics and effectiveness of existing psychosocial interventions for SSIRBs among Chinese adolescents. Short-term psychosocial interventions for NSSI were significantly effective in reducing self-injurious behavior scores, especially in the immediate postintervention period. More favorable treatment responses could be observed in both male and small samples.

Does the need for uniqueness lead to non-suicidal self-injury? The mediation of depression and the moderation of gender

Objective

Based on the integrated theoretical model of the development and maintenance of non-suicidal self-injury (NSSI) and gender role theory, this study investigated the longitudinal impact of the need for uniqueness on NSSI among adolescents, and the mediating role of depression and the moderating role of gender.

Participants

A total of 1,166 middle school students (Mean age = 13.04, SDage = 0.78, range = 11-16) from a city in central China was recruited to complete the Need for Uniqueness Scale, Depression Scale, and Adolescent Self-Injury Questionnaire at two waves. The participants included 475 boys and 457 girls.

Methods

Convenience sampling was used, and a longitudinal study (2 time points with a 6-month interval) was conducted to test our hypotheses. SPSS 25.0 was used to evaluate reliability, and to calculate descriptive statistics and Pearson correlation. PROCESS version 3 was used to test longitudinal relationships among the need for uniqueness, depression and NSSI, and construct a moderated mediation model.

Results

Results revealed that T1 need for uniqueness in adolescents was significantly positively associated with T2 NSSI and T2 depression, and T2 depression was significantly positively associated with T2 NSSI. After controlling for gender, T1 need for uniqueness positively predicted T2 NSSI. Furthermore, the mediation analysis demonstrated that the pathway linking T1 need for uniqueness to T2 NSSI through T2 depression was statistically significant. Moreover, gender moderated the indirect effect from T2 depression to T2 NSSI in the association between T1 need for uniqueness and T2 NSSI. Compared to boys in the same situation, girls who are susceptible to depression were more likely to commit NSSI.

Conclusion

This study demonstrated that the need for uniqueness in adolescents longitudinally predicts NSSI through the mediating role of depression and gender moderates the indirect effect from depression to NSSI. The current study not only suggests that the need for uniqueness is a risk factor for NSSI among adolescents, but also provides an empirical basis for the prevention and intervention of NSSI.