Parent and peer relationships as longitudinal predictors of adolescent non-suicidal self-injury onset

A mobile-based, single-session intervention to empower parents of adolescents hospitalised for non-suicidal self-injury: A mixed-methods randomised controlled trial

Background

Adolescents hospitalised for non-suicidal self-injury (NSSI) represent a particularly severe subset within psychiatric care. The NSSI imposes significant challenges on parents, including lack of knowledge, ineffective coping strategies, and negative emotions, exacerbated by stigma. Parental empowerment is crucial for supporting adolescent recovery; however, current interventions often neglect parents. Single-session interventions (SSIs) may offer an accessible and promising approach to address this gap.

Methods

This mixed-methods study assessed the short-term effects of project CSH-P: a mobile-based, self-guided SSI aimed at empowering parents of adolescents hospitalised for NSSI. 88 participants were randomly assigned to CSH-P (n = 46) or control group (n = 42). Online assessments measuring knowledge, attitudes, and stigma were administered at baseline, immediately post-intervention, and one week later. Additionally, semi-structured individual interviews were conducted with participants who received CSH-P post-intervention.

Results

Compared to the control group, participants who received CSH-P showed significant improvements in NSSI-related knowledge (Cohen's d = .42, p = .027) and more positive attitudes toward their adolescents (Cohen's d = - .31, p = .047). Qualitative findings confirmed these results, with parents reporting highly positive engagement and perceived empowerment across cognitive, emotional, and behavioural dimensions. Furthermore, parents provided constructive feedback for further enhancing the intervention's impact.

Conclusions

Project CSH-P demonstrates the potential to enhance parental empowerment in managing adolescent self-injurious behaviours. Its brevity, low cost, and ease of dissemination make it a promising strategy for widely applicable prevention and treatment efforts. Future research should explore the long-term sustainability of these improvements and assess the broader impact on parenting practices and adolescent treatment outcomes.

Childhood Maternal Warmth, Social Safety Schemas, and Adolescent Mental and Physical Health

Importance

Although early maternal warmth strongly predicts adolescent health, questions remain about the biopsychosocial mechanisms underlying this association.

Objective

To understand how maternal warmth at 3 years of age shapes adolescent social safety schemas at 14 years of age and physical and mental health at 17 years of age.

Design, Setting, and Participants

The Millennium Cohort Study tracks approximately 19 200 children born from late 2000 to early 2002 in the UK. Participants were assessed from ages 3 to 17 years.

Exposure

Low maternal warmth (eg, lack of praise, negative tone of voice when speaking to the child) and maternal harshness (eg, using physical restraint, grabbing the child) were independently coded during a home visit (age 3 years).

Main Outcomes and Measures

Social safety (age 14 years) was measured by children's responses to 3 items (eg, "I have family and friends who help me feel safe, secure and happy"). Physical health was self-reported on a scale ranging from 1 (excellent) to 5 (poor) (age 17 years). Psychological distress (age 17 years) was assessed using the 6-item Kessler Psychological Distress Scale. Psychiatric problems (age 17 years) was a latent variable composed of self-disclosed clinical diagnosis of depression/anxiety, self-harm, and suicidal behaviors.

Results

The present sample included 8540 youths (52% female; 3.0% Black or Black British, 2.8% Indian, 6.7% Pakistani and Bangladeshi, 2.8% Mixed, 83% White, and 1.6% other). Data were analyzed from March 2024 to September 2024 using structural equation modeling. In models controlling for sex, ethnicity, income, neighborhood disadvantage, maternal mental health, and early cognitive ability, the paths from childhood maternal warmth (but not harshness) to social safety schemas at 14 years of age (b = 0.03; P < .001) and physical health at 17 years of age (b = 0.05; P = .02) were significant, suggesting that early maternal warmth enhances subsequent perceived social safety and physical health. Additionally, the paths from negative social safety schemas at 14 years of age to poorer physical health (b = 0.50; P < .001), psychological distress (b = 5.37; P < .001), and psychiatric problems (b = 0.21; P < .001) at 17 years of age were significant, suggesting that greater perceived social safety prospectively predicts better health. Social safety at 14 years of age mediated 20% to 100% of the effect of early maternal warmth on physical health, psychological distress, and psychiatric problems at 17 years of age (b = 0.01-0.15; P < .001 for all).

Conclusions and Relevance

These results show that early-life maternal warmth affected adolescent health by influencing perceptions of social safety. Improving parent-child relationships and enhancing youths' perceptions of social safety may thus improve adolescent health.

The Vicious Cycle of Peer Stress and Self-Directed Violence Among Chinese Left-Behind Adolescents: The Mediating Role of Relative Deprivation

The association between peer stress and self-directed violence has been supported by various studies, but the mechanisms underlying the association are still unclear, especially for left-behind adolescents. In addition, most of the existing studies have neglected the negative interpersonal consequences of self-directed violence. Based on the transactional model of development and relative deprivation theory, this study examined the reciprocal relationship between peer stress and self-directed violence in left-behind and non-left-behind adolescents, as well as the bidirectional mediating role of relative deprivation. A total of 1258 adolescents (683 left-behind adolescents) participated in this 10-month study with three consecutive follow-ups. Results of cross-lagged analyzes revealed that for left-behind adolescents but not non-left-behind adolescents: first, there is a vicious bidirectional cycle of peer stress and self-directed violence; second, this cycle is mediated by relative deprivation; and third, both the vicious cycle and the mediation remain consistent across different genders or educational stages. The findings highlight the need to focus on challenges such as peer stress and self-directed violence among left-behind adolescents and suggest that interventions targeting relative deprivation may break the vicious cycle between peer stress and self-directed violence in this subgroup.

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.

An Investigation of the Longitudinal Bidirectional Associations Between Interactive Versus Passive Social Media Behaviors and Youth Internalizing Difficulties. A Within-Person Approach

Ongoing concerns about the mental health of young people have intensified interest in the role of social media, with research suggesting that the nature of social media behaviors-whether interactive or passive-may differentially impact mental health. However, the bidirectional relationships between specific types of social media use and internalizing difficulties (anxiety and depression) remain underexplored, particularly at the within-person level over time. Data were extracted from the Dutch population-based Longitudinal Internet Studies for the Social Sciences (LISS) panel. Four yearly studies assessing time spent on interactive (communication) and passive use of social media in October (2019-2022) and four annual studies evaluating internalizing difficulties (anxiety and depression) in November (2019-2022) were used. Respondents who were 16- 25 years old in October 2019 (N = 321; M = 20.49; SD = 2.94; 61.7% female). Random Intercept Cross Lagged Path Models were used to analyze the data. There were no significant associations between passive social media use and internalizing difficulties at the within-person level over time. Within-person interactive use was associated with decreases in internalizing difficulties at one time point (2021 to 2022). The results provide marginal evidence that distinct social media behaviors are prospective factors associated with internalizing difficulties in young people.

Exploring the effect of family function on non-suicidal self-injury among Chinese adolescents in different family socioeconomic status

BACKGROUND

Non-suicidal self-injury (NSSI) among adolescents represents an alarming public health concern worldwide. Both family function and family socioeconomic status (SES) were found to play important roles in adolescent NSSI engagement. However, the effects of family function on NSSI among adolescents in different family SES are not well evidenced.

AIMS

This study aimed to explore how family functions (adaptation, partnership, growth, affection, and resolve) affect NSSI among adolescents in different family SES levels.

METHODS

Data used in this study was derived from the Students' Mental Health Network Project (SMHN), a survey conducted among 8,872 pairs of adolescent-caregivers in a city in central China. Socio-demographic characteristics, family function, NSSI, adverse life events, and depressive symptoms were measured among adolescents. Family SES were generated from caregivers self-reported information using principal component analysis. Chi-square test and multivariate binary logistic regression analyses were adopted to analyze the effects of family function on NSSI.

RESULTS

It revealed that 10.2% of adolescents reported engaging in NSSI in the past 12 months. Poor family function and high family SES were positively associated with NSSI. Partnership, both adaptation and affection, resolve were NSSI-protective factors for adolescents in low, middle, high family SES, respectively.

CONCLUSIONS

Efforts to address NSSI should acknowledge the association between family function and NSSI among adolescents in different family SES levels.

The influence of family resilience on non-suicidal self-injury among Chinese adolescents: The mediating roles of mindfulness and individual resilience

Previous research has documented that family-related supportive factors (e.g., family resilience) can protect adolescents from risky behaviors. However, the data regarding the potential psychological mechanism linking family resilience and non-suicidal self-injury (NSSI) remain scarce. This study aimed to explore the possible serial mediational roles of mindfulness and individual resilience in the relationship between family resilience and NSSI. A sample including 548 Chinese adolescents (Mage = 16.10, SD = 1.61; 50.9 % male) with a six-month interval and two waves (Time 1, T1 - September 25, 2023 - October 13, 2023; Time 2, T2 - March 9, 2024 - March 22, 2024) of follow-up was used in the present study. Results showed that, within the examined model, mindfulness at T2 mediated the relation between family resilience at T1 and NSSI at T2; individual resilience at T2 mediated the association between family resilience at T1 and NSSI at T2; and the relationship between family resilience at T1 and NSSI at T2 was fully serially mediated by mindfulness and individual resilience at T2. The findings suggest that family resilience may reduce the likelihood of NSSI by enhancing adolescents' mindfulness and individual resilience. Future interventions aimed at reducing NSSI may benefit from incorporating strategies to strengthen family resilience, promote mindfulness practices, and enhance individual resilience in adolescents.

Building stronger bonds: The impact of family support and communication on suicidal behaviors among Black men who have sex with men

INTRODUCTION

It has been well documented that men who identify with a sexual orientation other than heterosexual are at a greater risk for suicide-related outcomes. What is less known are the protective factors that can reduce such negative outcomes and contribute to their resilience.

METHODS

This study used data collected between December 1, 2021, and January 2022 to understand how family factors contribute to or prevent depression symptoms and suicide outcomes among young Black men who have sex with men (BMSM) ages 18 to 29 (N = 400). A path analysis was conducted to explore the direct and indirect effects of suicide attempts.

RESULTS

Surprisingly, there were nuanced findings that showed having a family member or friend die by suicide was indirectly associated with suicide planning and suicide attempts. It was also unexpectedly noted that there was a positive relationship between higher rates of depressive symptoms and higher levels of support from family members.

CONCLUSIONS

The population focused on in this study is understudied and has unique needs. Identifying familial support may not automatically reduce the thoughts and plans of young BMSM, which is an example of why their intersecting marginalized identities must be considered when conducting further research, creating interventions, and providing therapeutic services.

Non-suicidal self-injury in inpatient and outpatient adolescents: disentangling psychopathology and interactive family dynamics

Background

Non-suicidal self-injury (NSSI) is defined as a transdiagnostic phenomenon that has well increased in the latest years, especially in the adolescent population. It has been associated with suicidality, alexithymia, emotion dysregulation, and psychosocial impairment, as well as family issues. The choice of level of care (i.e., hospitalization versus outpatient visit) depends on a number of factors that relate not only to suicidal risk but also to severity of individual's psychosocial functioning, the ability of family environment to support treatment choices and to contain child, as well as the need for ongoing monitoring of the young patient. A scarcity of studies has compared outpatients with inpatients, both of them engaging in NSSI.

Methods

the current study aimed to further expand knowledge regarding features that characterize young self-harmers who receive different levels of care, with particular attention on psychopathological, family, and NSSI-related characteristics, as well as suicidality. The current research included 56 inpatients and 56 outpatients with NSSI, paired for gender, age, and psychiatric diagnosis. Instruments investigating psychopathology, emotion dysregulation, alexithymia, psychosocial functioning, and interactive family dynamics were administered. Descriptive statistics, parametric and non-parametric inferential statistics were applied.

Results

study findings highlighted that inpatients engaging in NSSI reported lifetime suicidality, clinical level of externalizing and internalizing problems, more severe alexithymia, emotion dysregulation, and impaired psychosocial functioning compared to outpatients engaging in self-harming. Furthermore, when compared to outpatients' families, inpatients' families were more capable of adhering to rules and time of the family play situation (the Lausanne Trilogue Play procedure) and fixing interactive mistakes through activities. On the contrary, in the inpatient group, global performance, role implication, parental scaffolding, child's involvement and self regulation tend to decline, while parental conflicts tend to rise over the four part scenario of the family play.

Conclusion

these findings confirmed a more severe global picture of young inpatients engaging in self-harming, suggesting that NSSI may be the expression of this larger psychopathological picture. In addition, the study highlighted the need for a multi-informant and multimethod clinical assessment, which should include evaluation of family context and co-parenting system, especially for hospitalized young patients engaging in self-harm.

Exploring adolescent suicidal trajectories: The intersection of race/ethnicity, gender, and social connectedness

INTRODUCTION

Understanding adolescent racial/ethnic and gender disparities in suicidal ideation and attempts longitudinally can help curb future suicidal risk.

METHODS

Survey data (1994-2008) from the Longitudinal Study of Adolescent to Adult Health (Add Health study, n = 18,887) examined racial/ethnic and gender ideation and attempt disparities over four waves of data from across the United States (51% female; 51% White; Mage = 17.43 years at Wave 1). Repeated-measures latent class analyses described how ideation and attempt patterns present longitudinally and how racial/ethnic minority groups predict different classes based on each wave and age-appropriate social supports (i.e., parents, peers).

RESULTS

Those most at-risk disclosed ideation and some attempt risk in early adolescence (Waves 1 and 2) and mostly identified as female. The second most prevalent group first disclosed ideation in their 20s and predominately identified as non-Hispanic White females. Peer connections were not significant for most groups except for non-Hispanic White males in Wave 3, while Black females who reported stronger school connections had decreased ideation and attempt rates in Wave 1 but not 2 (just 1 year later). A negative link between social supports and high-risk ideation and attempt classes was found among Black females, non-Hispanic Whites, and Latinos overall.

CONCLUSIONS

As the United States becomes more diverse, understanding the unique ideation and attempt disparities are crucial. Tailoring interventions to include risk and protective mechanisms among intersectional communities could eradicate disparities. Longitudinal studies can illuminate how protective and risk factors can change over time and even within and among racial/ethnic and gender groups.

The influence of parenting styles and coping strategies on anxiety symptoms in adolescents: a comparative study of groups with and without non-suicidal self-injury behavior

Background

During the COVID-19 pandemic, the global incidence of non-suicidal self-injury (NSSI) has been increasing year by year, especially among adolescents, and it is highly correlated with the level of anxiety among teenagers, particularly within Chinese cultural contexts where parenting styles significantly influence adolescent behavior.

Objective

This study examines the role of culturally-influenced parenting styles and adolescent coping strategies in relation to anxiety and NSSI behavior, aiming to clarify these multivariate interactions for better understanding and intervention.

Methods

A cross-sectional survey was conducted with NSSI-diagnosed adolescents from Affiliated Kangning Hospital, Ningbo, China, and healthy adolescents from urban schools. Data on background, parenting styles, coping strategies, and anxiety levels were analyzed using chi-square tests, independent sample t-tests, MANOVA, and regression analysis.

Results

Adolescents with NSSI reported higher anxiety levels, more punishment and interference, and less emotional warmth from their fathers compared to the non-NSSI group (p < 0.001). The NSSI group also relied more on emotion-oriented coping strategies, while the non-NSSI group favored problem-oriented approaches (p < 0.001). Multivariate analyses confirmed significant effects of NSSI behavior, parenting styles, and coping strategies on anxiety levels.

Conclusion

This study found that the anxiety levels of NSSI adolescents were significantly higher than those of non-NSSI adolescents in China, which was closely related to less emotional warmth from parents, more punishment and interference, and emotion-focused coping strategies. The results demonstrate that family environment and coping strategies play a critical role in NSSI behavior and anxiety levels, highlighting the importance of emphasizing emotional support and positive coping strategies in the prevention and intervention of NSSI behavior.

Prospectively predicting 6-month risk for non-suicidal self-injury among adolescents after psychiatric hospitalization based on a predictive model

Background

It is challenging to predict the occurrence of non-suicidal self-injury (NSSI) among adolescents over short periods. Moreover, the predictive value of indices for NSSI remains elusive. Thus, this study aimed to identify predictors of NSSI within 6 months among adolescents after psychiatric hospitalization by establishing a risk assessment model.

Methods

A total of 632 high-risk participants were included in this study. The distribution characteristics of adolescent NSSI were initially assessed through a cross-sectional survey, following which risk factors were identified using logistic regression analysis. The risk score method was then used to construct a 6-month risk assessment model for NSSI. Lastly, the predictive effect of the model was evaluated by indicators such as the area under the receiver operating characteristic (ROC) curve and the positive predictive value.

Results

After 6 months, 412 cases of NSSI were identified. According to the logistic regression model, the frequency of relapses, medication status, and NSSI history were identified as influencing factors. Higher scores on the Impulsive Behavior Scale and Pittsburgh Sleep Quality Index were associated with a higher risk of NSSI. Conversely, higher scores on the Pain and Belief Perception Scale were correlated with a lower risk of NSSI. Moreover, the area under the ROC curve for the predictive model was 0.9989, with a 95% confidence interval of (0.9979, 0.9999), highlighting its high predictive ability and accuracy. The predictive model was validated using 78 patients, yielding an area under the ROC curve of 0.9703 and a 95% confidence interval of (0.9167, 0.9999), demonstrating outstanding predictability.

Conclusion

These results collectively showed that the predictive model could accurately predict adolescent NSSI. Thus, the model's primary variables may be applied to predict the risk of NSSI in the clinical setting.

Assessing the contributions of gender, clinical symptoms, and psychometric traits to non-suicidal self-injury behaviors in Chinese adolescents: a nomogram approach

BACKGROUND

Non-suicidal self-injury (NSSI) behaviors among adolescents with mood disorders represent a significant global public health concern. This study aimed to assess the prevalence and identify key predictors of NSSI behaviors in Chinese adolescents diagnosed with depressive or bipolar disorders, addressing a critical gap in the literature.

METHOD

Data from 2343 participants in the Chinese Adolescent Depression Cohort (CADC) were analyzed. The study employed a comprehensive approach, utilizing medical records, clinical assessments, and validated psychometric instruments. Statistical analyses included chi-square tests, logistic regression, and ROC curve analyses, culminating in the development of a predictive nomogram.

RESULTS

The prevalence of NSSI behaviors was strikingly high at 73.32%. Significant predictors included female gender (AOR = 2.14, 95% CI [1.70, 2.68]), presence of hallucinations (AOR = 1.52, 95% CI [1.18, 1.97]), borderline personality features (AOR = 1.03, 95% CI [1.01, 1.08]), and childhood trauma (AOR = 1.02, 95% CI [1.01, 1.03]). The study's key contribution is a predictive nomogram with an AUC of 0.74, demonstrating good efficacy in predicting NSSI behaviors.

CONCLUSION

This research reveals an alarmingly high prevalence of NSSI behaviors in Chinese adolescents with mood disorders and identifies critical predictors spanning demographic, clinical, and psychometric domains. The developed nomogram offers a novel approach for risk assessment, highlighting the importance of comprehensive evaluations in adolescent mental healthcare. These findings have significant implications for developing targeted interventions and improving risk assessment strategies in clinical practice.

Association between childhood emotional abuse and non-suicidal self-injury among Guangxi adolescents in China: A moderated mediation model

BACKGROUND

Childhood Emotional Abuse (CEA) is a known risk factor for Non Suicidal Self-injury (NSSI), which could have devastating repercussions. This study aimed to establish whether Parent-Child Attachment (PCA) and depressive symptoms mediated the CEA-NSSI relationship, as well as whether school connectedness moderated both the direct and indirect relationships between CEA and NSSI.

METHODS

Between November and December 2022, 7447 Chinese adolescents in high schools were surveyed through multi-stage cluster random sampling. The participants completed self-reported questionnaires that assessed CEA, PCA, depressive symptoms, school connectedness, and NSSI. Relationships between these variables were examined through moderated mediation analysis using SPSS macro-PROCESS.

RESULTS

After controlling for sociodemographic variables, we found that CEA correlated positively with NSSI through two different pathways: the mediating role of depressive symptoms and the chain-mediating role of both PCA and depressive symptoms. Moreover, school connectedness could moderate the direct and indirect relationships between CEA and NSSI.

LIMITATIONS

The study's cross-sectional design does not allow for causal inferences.

CONCLUSIONS

Overall, PCA, depressive symptoms, and school connectedness could affect the CEA-NSSI relationship.

The prevalence of self-injury in adolescence: a systematic review and meta-analysis

In the past 10 years, there has been a growing interest in self-injurious behavior (SIB) among adolescents. The lifetime prevalence of SIB is between 16 and 22% in community sample with females more likely to engage in SIB. There are conflicting results about the global distribution of the prevalence of SIB and whether the SIB has increased in the 21st century. Our aim in the current study was to conduct a systematic search of and meta-analysis on the prevalence of SIB in adolescents over the past 5 years' worth of published papers and to examine gender, continental, and year differences. We conducted a systematic search in June 2020 of six databases (PubMed, Scopus, Web of Science, OVID Medline, PsycINFO, EBSCO) with three main search terms: "self-injurious behavior," "prevalence," and "adolescence." Article inclusion criteria were (a) written in English; (b) published between January 1, 2015, and June 18, 2020; and (c) focused on a community sample. Titles and abstracts of the articles were screened first. Then, the relevant full texts were read, and those that met the inclusion criteria were collected. We used Comprehensive Meta-Analysis software was used to conduct the analyses. After the screening process 97, articles were included in the meta-analysis. The age of the samples ranged from 11.00 to 18.53 years. The overall average prevalence of nonsuicidal self-injury in the studies was 16%. There was a significant gender difference: females reported a higher prevalence than males (19.4% and 12.9%, respectively). A significantly higher prevalence was found among Asian articles than those from other continents (19.5% and 14.7%, respectively). The prevalence of SIB did not change significantly between 2013 and 2018. The current research draws attention to the high prevalence of SIB among adolescents, especially among females and those living in Asia. It is important to address this behavior, both in terms of prevention and intervention.

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.

Prevalence and associated factors of cigarette smoking and substance use among university entrance test-taking students: A GIS-based study

BACKGROUND

Numerous studies have examined substance use and smoking behavior among adolescents and university students. However, little is known about these behaviors among students undergoing university entrance tests, a critical transition period from adolescence to adulthood. The entrance test can significantly affect students' mental health, potentially leading to substance use. This study aims to investigate the prevalence of cigarette smoking and substance use among students taking these exams and the associated factors.

METHODS

A cross-sectional survey was carried out on September 4th and 11th, 2022 to collect data from 1,480 university entrance test-taking students using a convenience sampling technique. Chi-square tests and logistic regression were conducted using SPSS software. Besides, GIS mapping was used to visualize the distribution of substance use and smoking behavior across districts via ArcGIS.

RESULTS

The study found a 10% prevalence of current tobacco smoking and 4% substance use. Females (OR = 1.98; 95% CI: 1.38-2.85), urban residence (OR = 2.03; 95% CI: 1.42-2.88), repeater (OR = 1.45; 95% CI: 1.02-2.06), anxiety (OR = 1.55, 95% CI: 1.10-2.19), burnout (OR = 1.51, 95% CI: 1.00-2.12), and suicidal behavior (OR = 1.57; 95% CI: 1.03-2.40) were the significant factors for cigarette use. Whereas the urban residence (OR = 1.91; 95% CI: 1.11-3.31), anxiety (OR = 2.47, 95% CI: 1.45-4.20), and suicidal behavior (OR = 2.76; 95% CI: 1.55-4.92) significantly increased the risk of substance use. GIS analysis revealed males varied in substance use and females in tobacco smoking by district. Repeat test-takers were associated with district variations in both smoking and substance use.

CONCLUSIONS

Educational institutions, public health authorities, and policymakers must implement mental health support and substance use prevention programs for students. Integrating mental health education, providing resources, and enforcing regulations can promote healthier coping strategies and reduce substance use risks among students.

Does Bullying Victimization Accelerate Adolescents' Non-suicidal Self-injury? The Mediating Role of Negation Emotions and The Moderating Role of Submissive Behavior

Based on general strain theory, the current study examined whether bullying victimization was significantly related to adolescents' non-suicidal self-injury and whether negation emotions mediated this association and submissive behavior moderated this mediation process. A total of 1,984 adolescents completed a series of anonymous questionnaires regarding bullying victimization, negative emotions, non-suicidal self-injury, and submissive behavior. Results showed that bullying victimization was significantly and positively associated with non-suicidal self-injury and this relation was partially mediated by negative emotions. Submissive behavior moderated the relation between bullying victimization and non-suicidal self-injury as well as negation emotions and non-suicidal self-injury. Specifically, the victims of bullying with high submissive behavior were more likely to develop non-suicidal self-injury. Adolescents who had higher negative emotions were at greater risk of engaging in non-suicidal self-injury when they also had high submissive behavior. The positive association between negative emotions and non-suicidal self-injury was stronger in females than males.

Suicidal incidence and gender-based discrepancies in prolonged grief disorder: insights from a meta-analysis and systematic review

Background

In the aftermath of bereavement, our research explores the subtleties of Prolonged Grief Disorder (PGD), focusing particularly on its correlation with suicidal behaviors and their variation across genders. This study seeks to elucidate the impact of gender on these behaviors among individuals suffering from PGD, thereby enhancing our understanding and facilitating the development of tailored therapeutic interventions.

Methods

By November 24th, 2023, we had rigorously reviewed key databases such as PubMed, Web of Science, Cochrane Library, PsycINFO, and Embase. Independently, two researchers conducted detailed interviews and filled out questionnaires with participants to gather demographic information and record instances of prolonged grief disorder. The study also meticulously tracked occurrences of suicidal ideation, suicide attempts, suicide deaths, and self-injury among the participants.

Results

The findings indicate that 22.34% of males reported suicidal ideation (95% CI: 21.33-23.35), a figure that rises to 26.84% among females (95% CI: 25.99-27.69). Notably, 12.11% of males attempted suicide (95% CI: 11.49-12.72), marginally surpassing the 9.60% observed in females (95% CI: 9.17-10.04). More striking disparities were observed in suicide deaths, with rates for males at 3.66% (95% CI: 3.32-4.00) compared to a notably higher 7.12% for females (95% CI: 6.44-7.81). Furthermore, the incidence of self-injury was lower among males, at 2.48% (95% CI: 2.03-2.94), than in females, who reported a rate of 5.09% (95% CI: 4.69-5.49). These patterns underscore the critical need for gender-specific interventions aimed at reducing these significant disparities.

Conclusion

This study distinctly underscores the profound impact of gender on the manifestation of suicidal behaviors in individuals afflicted with prolonged grief disorder. It reveals that females are more prone to suicidal ideation, self-injury, and suicide deaths, while males predominantly exhibit a higher incidence of suicide attempts and risk-taking behaviors. These unmediated trends highlight the necessity for gender-specific clinical interventions tailored to address particular behaviors and modify prevalent patterns that typically resist conventional approaches.

Systematic review registration

PROSPERO (york.ac.uk), identifier CRD42023480035.

Peer relationships, adolescent anxiety, and life satisfaction: a moderated mediation model in Turkish and syrian samples

Prior studies comparing Syrian refugee adolescents to their native peers in the same region have found higher anxiety and lower life satisfaction. Therefore, identifying regulatory variables is crucial for implementing support programs. This study examined the mediating effect of peer relationships and the moderating effect of being a refugee or native adolescent on the relationship between adolescent anxiety and life satisfaction across different samples. Participants and setting: The study included 2,336 adolescents aged 11-19 (M = 14.79, SD = 1.04). Participants completed the Screen for Child Anxiety Related Disorders, Satisfaction with Life Scale, and Strengths and Difficulties Questionnaire. The mediation and moderation effects were analyzed with the path analysis codes written on Mplus 8.3. SPSS 26 was used for descriptive statistics and group comparisons. The findings showed that peer relationships mediate adolescent anxiety and life satisfaction, and this relationship is moderated according to whether the participants are native adolescents or refugee adolescents. This study highlights the significant associations between peer relationships, adolescent anxiety, and life satisfaction and the moderating role of the participant identity. The findings may inform psychological interventions to improve Syrian refugee adolescents' mental health and well-being. These findings may also have implications for policies and programs aimed at supporting the integration of Syrian refugee adolescents in host communities.

Influence of stress on self-injury among Chinese left-behind adolescents is not cast in stone: Synergistic roles of family protective factors

BACKGROUND

Left-behind adolescents are vulnerable to stressful life events and often engage in nonsuicidal self-injury (NSSI), which is a growing public concern in China. However, little is known about the synergistic protective effect of family resources on the relationship between stressful life events and NSSI in these adolescents.

OBJECTIVE

Based on theories of family socialization and resilience, the aim of this study was to examine the synergistic protective role of maternal knowledge and mother-child cohesion in buffering the effect of stressful life events on NSSI in father-absent left-behind adolescents.

METHODS

This study used two-wave longitudinal data. The analytical sample included 673 adolescents (Mage = 13.47 ± 1.11 years, 48 % male) who were enlisted from 4 junior high schools in rural China. Respondents completed questionnaires on stressful life events, parental knowledge, parent-child cohesion, and NSSI at two-time points.

RESULTS

The effects of stressful life events on NSSI were significant in father-absent left-behind adolescents. Additionally, maternal knowledge moderated the associations between stressful life events and NSSI in father-absent left-behind adolescents. Moreover, maternal knowledge and mother-child cohesion were found to play synergistic protective roles in the relationship between stressful life events and NSSI. In father-absent left-behind adolescents, only high maternal knowledge and high-quality mother-child cohesion could eliminate the negative effect of stressful life events on NSSI.

CONCLUSION

The findings underscore the synergistic protective roles of maternal knowledge and mother-child cohesion in buffering the negative effect of stressful life events on NSSI in father-absent left-behind adolescents. Both maternal knowledge and mother-child cohesion should be considered in interventions aimed at reducing NSSI in these adolescents.

Network analysis of the relationship between non-suicidal self-injury, depression, and childhood trauma in adolescents

BACKGROUND

Non-suicidal self-injury seriously harm the physical and mental health of adolescents. The aim of the current study was to explore the relationship between non-suicide self-injury, depression, and childhood trauma from the perspective of symptoms in adolescents.

METHODS

A cross-sectional survey was conducted in four junior high middle schools and collected 2640 valid questionnaires. There were 1329 male students and 1311 female students. The age of the participants ranged from 11 to 17 years old, with a mean age of 13.3 (± 0.94) years. Non-suicidal self-injury (NSSI), depressive symptoms, and childhood trauma were assessed using the Adolescent Self-Harm Scale, the Childhood Depression Scale, and the Childhood Trauma Questionnaire, respectively. A network analysis was performed.

RESULTS

In the network, NSSI, depressive symptoms, and childhood trauma were closely related. Negative self-esteem in the depressive symptoms and emotional abuse in childhood were the most central nodes. Negative self-esteem and negative mood were directly connected to NSSI, other nodes of depressive symptoms appeared to be indirectly connected to NSSI through these two nodes. Emotional abuse was the only node in childhood trauma categories directly connected to NSSI. Nodes of other categories of childhood trauma (physical neglect, physical abuse, emotional neglect, and sexual abuse) were indirectly connected to NSSI through emotional abuse.

CONCLUSIONS

NSSI, depression, and childhood trauma of teenagers were closely related. Individuals who have suffered emotional abuse in childhood were more likely to have depressive symptoms and NSSI. Improving negative self-esteem and negative emotions and reducing emotional abuse may be beneficial in alleviating depression and reducing NSSI in adolescents.

Positive effects of parent-child group emotional regulation and resilience training on nonsuicidal self-injury behavior in adolescents: a quasi-experimental study

Background

Nonsuicidal self-injury (NSSI) among adolescents is a growing global concern. However, effective interventions for treating NSSI are limited.

Method

A 36-week quasi-experimental study design of parent-child group resilience training (intervention group) for adolescents aged 12-17 years was used and compared with treatment-as-usual (control group). The primary endpoint was the frequency of NSSI assessed with the Ottawa Self-Injury Inventory (OSI), and the secondary endpoints were the levels of depression, hope, resilience, and family adaptability and cohesion as assessed by the 24-item Hamilton depression rating scale (HAMD-24), Herth Hope Scale (HHS), Connor-Davidson Resilience Scale (CD-RISC), and Family Adaptability and Cohesion Evaluation Scale, second edition (FACES-II-CV), respectively.

Result

A total of 118 participants completed the trial. Both groups showed a significant reduction in NSSI frequency after 12, 24, and 36 weeks of intervention (p< 0.05), although the intervention group did not differ significantly from the control group. After 12, 24, and 36 weeks of intervention, the CD-RISC, HHS, HAMD-24, and FACES-II-CV scores in the intervention and control groups improved over baseline (p< 0.05). Furthermore, the intervention group had higher scores on the CD-RISC, HHS, and FACES-II-CV and lower scores on the HAMD-24 than the control group after 12, 24, and 36 weeks of intervention (p  < 0.05).

Conclusion

Parent-child group emotional regulation and resilience training showed promise as treatment options for NSSI among adolescents, leading to increased hope, resilience, and improved family dynamics among NSSI teens. Moreover, NSSI frequency significantly decreased in the intervention group compared to baseline.

Deliberate self-harm among pediatric psychiatric inpatients in China: A single-center retrospective study

BACKGROUND

For children and adolescents, deliberate self-harm (DSH) is becoming a mental health problem of concern. Despite several studies on the prevalence and factors of DSH in the world, there is little information on DSH among children and adolescents in China. This study explores the prevalence, types, associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.

AIM

To understand the situation of DSH among hospitalized children and adolescents and its related factors.

METHODS

In this study, we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019, extracted the demographic and clinical data of all patients, and analyzed clinical risk factors of DSH.

RESULTS

A total of 239 (16.90%) patients engaged in at least one type of DSH in our study. Cutting (n = 115, 48.12%) was the most common type of DSH. Females (n = 171, 71.55%) were more likely to engage in DSH than males (n = 68, 28.45%). DSH was positively associated with depressive disorders [OR = 3.845 (2.196-6.732); P < 0.01], female [OR = 2.536 (1.815-3.542); P < 0.01], parental marital status [OR = 5.387 (2.254-12.875); P < 0.01] and negative family history of psychiatric illness [OR = 7.767 (2.952-20.433); P < 0.01], but not with occupation, substance use and history of physical abuse.

CONCLUSION

Our findings suggest that for patients with depression, females, an abnormal marriage of parents, and no history of mental illness, attention should be paid to the occurrence of DSH.

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.

Psychological/behavioral interventions for emerging adults with chronic pain

Background

Emerging adults, of whom significant numbers report chronic pain, are characterized as having unique needs and challenges. Psychological/behavioral treatments found to be beneficial for reducing pain outcomes in children and adults are understudied in emerging adults. Following a systematic review of the literature, our objective is to report on quantitative studies of psychological/behavioral interventions for chronic pain in emerging adults.

Method

We conducted a search of six databases (Cochrane Central Register of Controlled Trials, Google Scholar, ProQuest, PsycINFO, PubMed, and Web of Science) and reference sections in dissertations and systematic reviews to 4/29/2023. Keywords and phrases were search term combinations of "chronic/persistent pain", "emerging/young adults," and "intervention/treatment" using Boolean logic.

Results

Our review resulted in identifying 37 articles, of which 2 duplicates were removed, and 31 were further excluded by a screening process based on various inclusionary and exclusionary criteria. The search yielded four studies on psychological/behavioral interventions (yoga, acceptance and commitment therapy and relaxation), all of which positively affected the pain experience and/or pain-related outcomes. These studies presented issues in design such as not being blinded or randomized, having a small sample size, and potential confounds that were not reported or examined.

Discussion

The low number of studies reveals a large gap in the literature and is a call-to-action to further expand our understanding of effective and safer psychological/behavioral therapies for chronic pain in emerging adults. Successful pain management during this developmental phase may help young adults achieve positive trajectories for personal, occupational, relational, and health aspects of their lives.

A machine learning algorithm-based model for predicting the risk of non-suicidal self-injury among adolescents in western China: A multicentre cross-sectional study

The prevalence of non-suicidal self-injurious (NSSI) in adolescents is high. However, few studies exist to predict NSSI in this population. This study employed a machine learning algorithm to develop a predictive model, aiming to more accurately assess the risk of NSSI in Chinese adolescents. Sociodemographic, psychological data were collected in 50 schools in western China. We constructed eXtreme Gradient Boosting (XGBoost) model and multivariate logistic regression model to predict the risk of NSSI and nomograms are plotted. Data from 13,304 adolescents were used for model development, with an average age of 13.00 ± 2.17 years; 617 individuals (4.6 %) reported non-suicidal self-injury (NSSI) behaviors. The results of the XGBoost model showed that depression and anxiety were the top two predictors of NSSI in adolescents. The results of the multivariate logistic regression model showed that the risk factors for adolescent NSSI behaviors include: gender (being female), Age, Living with whom (father), History of psychiatric consultation, Stress, Depression, Anxiety, Tolerance, Emotion abreaction. The XGBoost prediction and multivariate logistic regression model showed good predictive ability. Nomograms can serve as clinical tools to assist in intervention measures, helping adolescents reduce NSSI behaviors and improve their mental and physical well-being.

Beyond the Surface: Teachers' Perceptions and Experiences in Cases of Non-Suicidal Self-Injury Among High School Students

Non-suicidal self-injury (NNSI) among adolescents is a significant concern. This study aimed to explore teachers' perceptions and experiences in cases of NSSI among their students. This qualitative-phenomenological study used in-depth, semi-structured interviews conducted with 27 teachers from high-schools in Israel. Thematic analysis was used to identify patterns and themes. Theme 1 highlighted the emotional impact of discovering self-injury incidents, including panic, confusion, and helplessness. Theme 2 focused on teachers' limited professional support and their need for training and guidance. Theme 3 explored teachers' desire to help students and their strategies for building connections and providing empathy, sometimes despite emotional detachment. Theme 4 emphasized the importance of involving parents and the need for effective communication. This study emphasizes the importance of providing teachers comprehensive training to address NSSI effectively. These findings provide a better understanding of teachers' experiences and underscore the need for enhanced support systems.

Consanguinity and Nonsuicidal Self-Injury in Depressed Patients: New Risk Factors and Risk Prediction Models

Objective

The aim of the study was to identify the risk factors associated with nonsuicidal self-injurious (NSSI) behavior in patients with depressive disorders and develop predictive models utilizing these influencing factors as predictors, followed by validation of the constructed models for their efficacy.

Methods

Patients with depression disorders admitted to Wuhan Mental Health Center from 2020 to 2021 were included using retrospective analysis. Patients who exhibited one or more items on the NSSI behavior rating questionnaire were categorized into the NSSI group, while those without any such behaviors were assigned to the non-NSSI group. Patients in both groups were categorized separately based on gender, age, personality traits, and interpersonal relationships. The above data were analyzed using multiple logistic regression analysis. Prediction models were constructed, receiver operating characteristic (ROC) curves were produced and model accuracy was calculated.

Results

A total of 237 patients were included in this study, with 122 patients assigned to the NSSI group and 115 patients assigned to the non-NSSI group. By comparing the baseline data of the patients in the 2 groups, the results revealed statistically significant differences between the 2 groups in terms of age, grades at school, early childhood parenting style, Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Experiences in Close Relationships Scale (ECRS) (P＜.05). However, no statistically significant differences were observed for the remaining indicators (P＞.05). The results of the multiple logistic regression model showed that grades at school, early childhood parenting style, HAMD, HAMA, and ECRS scores were risk factors. The ROC model was constructed using school performance, childhood parenting style, HAMD, HAMA, and ECRS scores as predictors. The findings indicated that the ECRS score was the best predictor of NSSI, and it had a sensitivity of 91.8% and specificity of 70.5% for an area of 0.967.

Conclusion

ECRS was utilized as a predictor to evaluate the NSSI inclination of depressed patients with commendable sensitivity and specificity. Furthermore, early childhood parenting style, HAMD, HAMA, and ECRS scores were identified as risk factors for NSSI. For individuals at high risk who exhibit these aforementioned risk factors, clinical diagnosis and treatment should be approached with caution.

Perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers: a qualitative study

BACKGROUND

The prevalence of non-suicidal self-injury among adolescents has increased over the years. Most parents, however, are poorly informed and confused about this behavior. Sharing caretaking experiences with parents in similar situations seems to be beneficial. Nevertheless, few researchers have explored the views of parents who share their caretaking experiences with peers.

AIM

This study aimed to investigate the perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers as well as the motivations for and barriers to this behavior.

METHODS

This qualitative study adopted a purposive sampling method. Participants (16 mothers and 2 fathers) were recruited from the mental health center of a tertiary hospital in Chengdu, Sichuan, China. A total of 18 semistructured face-to-face individual interviews were conducted. All interviews were audio-recorded and analyzed thematically using NVivo 11.

RESULTS

Three themes and nine subthemes were identified: (1) sharable caretaking experiences: reflection and transformation, self-emotional management, and diversified support; (2) motivations for sharing: empathy, reciprocity, and meaning; and (3) barriers to sharing: inadequate knowledge, low self-identity, and concerns for children.

CONCLUSION

Parents accumulate a wealth of experience during their long-term care of adolescents with repeated non-suicidal self-injury. Although most parents are willing to share their caretaking experiences with peers, there are several barriers. Therefore, in order to increase parents' motivation to share, psychological education is necessary.

Off track or on? Associations of positive and negative life events with the continuation versus cessation of repetitive adolescent nonsuicidal self-injury

OBJECTIVE

This study examined how patterns of repetitive (≥5 instances) nonsuicidal self-injury (NSSI) associate with measures of resilience and life events retrospectively reported to have occurred within the last year, 1 to <5 years ago, and 5 to <10 years ago.

METHOD

Life events reported by 557 young adults (mean [SD] age 25.3 [0.68]; 59.2% women) were classified as positive, negative, or profoundly negative based on their relationship to participants' mental health and well-being. We subsequently examined how these categories, together with resilience, were cross-sectionally associated with reporting no NSSI, and the (full/partial) cessation/continuation of repetitive NSSI from adolescence to young adulthood.

RESULTS

Repetitive NSSI in adolescence was associated with (profoundly) negative life events. Relative to cessation, NSSI continuation was significantly associated with more kinds of negative life events (odds ratio [OR] = 1.79) and fewer kinds of positive life events 1 to <5 years ago (OR = 0.65) and tended to be associated with lower resilience (b = -0.63, p = 0.056). Neither life events nor resilience significantly differentiated individuals reporting full or partial cessation.

CONCLUSION

Resilience appears important for the cessation of repetitive NSSI, but contextual factors must still be considered. Assessing positive life events in future studies holds promise.

Parenting in the early years and self-harm in adolescence: The role of control and reward systems in childhood

BACKGROUND

Research suggests that early parenting may contribute to the development of self-harm but this has not been examined longitudinally. In this study, we explored the relationship between early parenting and self-harm in adolescence and considered whether (1) emotion regulation and (2) decision-making in childhood mediate the relationship between early parenting and self-harm.

METHOD

Using longitudinal data from the Millennium Cohort Study (MCS), we tested mediation models exploring the relationship between early parenting and self-harm in adolescence via emotion regulation and decision-making. Parenting was assessed at age 3 with measures of conflict, closeness and discipline. The trajectories of independence & self-regulation and emotional dysregulation were modelled from ages 3 to 7 years through latent growth curve analysis, with individual predicted slope and intercept values used in the mediation models. Decision-making (deliberation time, total time, delay aversion, quality of decision making, risk adjustment, risk-taking) was assessed using the Cambridge Gambling Task (CGT) at age 11.

RESULTS

In our sample (n = 11,145), we found no evidence of a direct association between early parenting and self-harm in adolescence. However, there were indirect effects of parenting (conflict and closeness) on self-harm via the slope of emotional dysregulation. Furthermore, delay aversion was positively associated with self-harm in adolescence.

LIMITATIONS

It must be acknowledged that we cannot determine causality and that self-report measures of parenting are vulnerable to several biases.

CONCLUSION

The findings support early identification and interventions for children exhibiting chronic emotional dysregulation and decision-making characterised by a bias for smaller, immediate over larger, delayed rewards.

Developmental pathways of repetitive non-suicidal self-injury: predictors in adolescence and psychological outcomes in young adulthood

BACKGROUND

Much longitudinal research has been carried out on non-suicidal self-injury (NSSI) during the last decades, but there still is a lack of studies of the individual developmental pathways of NSSI from adolescence into young adulthood. The aim of the present study was to investigate individual developmental pathways of repetitive non-suicidal self-injury (repNSSI) from adolescence into young adulthood, including adolescent predictors and psychological outcomes in young adulthood. Three developmental pathways were targeted: stable adolescence-limited repNSSI; repNSSI prolonged into young adulthood; and late-onset repNSSI; with no repNSSI as comparison.

METHODS

Data were taken from a cohort of compulsory school students (N = 1064) in grades 7-8 in a Swedish municipality. The cohort was followed longitudinally, and this study included all individuals (n = 475) with NSSI data from three waves: T1 (when they were 13-15 years old); T2 (one year later); and T3 (ten years later). RepNSSI was operationalized as self-reports of at least 5 instances of NSSI during the past six/twelve months.

RESULTS

The two pathways that involved stable repNSSI were observed significantly more often than expected by chance, with the strongest overrepresentation for the Prolonged RepNSSI pathway. Still, most adolescents who engaged in stable repNSSI stopped this before reaching young adulthood. Those who stopped did not, however, show a significantly better psychological adjustment in young adulthood than those who continued. Compared to participants with no repNSSI, participants who had stopped still reported significantly more stress, anxiety, and emotional dysregulation. As to the prediction of late onset NSSI, the findings were less robust, but sporadic NSSI at T1 and poor sleep at T2 were significant predictors, whereas depressive symptoms fell just short of significance at both timepoints.

CONCLUSIONS

The present results indicate that among adolescents who engage in stable adolescent repNSSI (1) significantly more individuals than expected by chance still engage in repNSSI ten years later, and (2) those who stop engaging in repNSSI do not show significantly better psychological adjustment than those who still engage in it. The present findings also indicate that late onset of repNSSI as reported in young adulthood to some extent is predictable from symptom measures ten years earlier.

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.

Psychological well-being and associated factors among parents of adolescents with non-suicidal self-injury: a cross-sectional study

Background

Non-suicidal self-injury (NSSI) impacts not only adolescents who engage in it but also their parents. However, there has been limited research into the psychological well-being of these parents. This cross-sectional study aims to investigate the symptoms of anxiety and depression among parents of adolescents who engaged in NSSI in China and the factors associated with them.

Methods

A total of 400 parents of adolescents with NSSI were included. Socio-demographic information of these parents was collected. The Generalized Anxiety Disorder 7-item (GAD-7), the Patient Health Questionnaire 9-item (PHQ-9), and the Connor-Davidson Resilience Scale (CD-RISC) were used to assess symptoms of anxiety, depression, and psychological resilience, respectively.

Results

The majority of the parents were female (83.5%), married (86.3%), and had a senior high school or equivalent and lower education level (67.1%). The study found that 35.3% of the parents experienced clinically significant symptoms of anxiety (GAD-7 ≥ 7) and 40.1% had clinically significant symptoms of depression (PHQ-9 ≥ 7). Parents with larger ages and lower levels of psychological resilience were more likely to experience symptoms of anxiety and depression (p < 0.05). Parents who reported bad parent-child relationships showed a higher level of anxiety.

Conclusion

This study provides important insights into the symptoms of anxiety and depression among parents of adolescents with NSSI. Parental age, parent-child relationship, and psychological resilience were associated with symptoms of anxiety and depression in these parents. Implications for the development of interventions aimed at addressing symptoms of anxiety and depression in parents of adolescents with NSSI were discussed.

Childhood temperament as a predictor of adolescent nonsuicidal self-injury

Previous cross-sectional work has consistently found associations between neuroticism and impulsivity and nonsuicidal self-injury (NSSI). However, there are few longitudinal studies of personality risk factors for NSSI. In this study, we examined associations between individual differences in temperament at age 3 and NSSI from ages 9 to 15. At age 3, 559 preschool-aged children (54% male; Mage = 42.2 months [SD = 3.10]) completed laboratory assessments of temperament. Parents also completed questionnaires about their child's temperament. Children completed a diagnostic interview assessing NSSI engagement at ages 9, 12, and 15. By the age 15 assessment, 12.4% of adolescents reported engaging in NSSI. In univariate models, we found that higher levels of observed sadness and maternal-reported sadness and anger were associated with increased risk for NSSI. In multivariate models, female sex and maternal-reported anger were significantly associated with greater likelihood of NSSI. Laboratory observed sadness and impulsivity were associated with a higher likelihood of NSSI. This work extends the literature on personality risk factors associated with NSSI by finding longitudinal associations between early childhood negative affect and later NSSI engagement during adolescence.

Current status of nonsuicidal injuries and associated factors among junior high school students in Hainan Province, China: a cross-sectional study

BACKGROUND

To summarize the general status of nonsuicidal self-injury (NSSI) behaviour and the characteristics of junior high school students and to determine the risk factors associated with NSSI behaviour.

METHODS

Five middle schools in the rural and urban areas of Hainan Province were randomly selected for this cross-sectional study, and junior high school students were administered questionnaires, including the General Sociodemographic Questionnaire, Ottawa Self-Injury Scale, Anxiety Self-Rating Scale, Depression Self-Rating Scale, Adolescent Lifestyle Scale, and Parenting Style Scale.

RESULTS

The NSSI rate among junior high school students in Hainan Province was 28.9%, with a higher prevalence among girls than boys (P < 0.05). The age range was 11-16 years, with a mean age of 13.08 ± 0.911 years. The most common form of self-injury was scratching/bruising, followed by hitting oneself, pulling out hair, biting, head banging, and cutting. The NSSI methods of scratching/bruising, hitting oneself and cutting more commonly occurred in girls than boys (P < 0.05). The most common sites of self-injury were the face, scalp, lips, forearm/elbow, axilla/wrist, hands/fingers, and thighs/knees. Significant differences were observed in the distribution of self-injury sites (nose, lips, genitals, and axillae/wrists) between the two genders (p < 0.05). The most important motivation for undertaking NSSI behaviours was to release negative emotions. The risk factors affecting NSSI behaviours were female gender (OR = 1.793), depression (OR = 1.961), anxiety (OR = 1.495), interpersonal relationship factors (OR = 1.099), academic stress factors (OR = 1.062), maternal emotional warmth (OR = 0.97), and maternal overinterference (OR = 1.036).

CONCLUSIONS

The NSSI rate among junior high school students in Hainan was 28.9%, affecting girls more than boys. The form and site of self-injury between boys and girls were significantly different. The motivation for committing self-injurious behaviours was mainly to regulate bad emotions. Risk factors for NSSI behaviours included female gender, anxiety, depression, interpersonal relationship factors, academic stress factors, and maternal emotional overinterference, while maternal emotional warmth was a protective factor.

Neural Reactivity to Social Punishment Predicts Future Engagement in Nonsuicidal Self-injury Among Peer-Rejected Adolescents

BACKGROUND

Rates of nonsuicidal self-injury (NSSI) increase dramatically in adolescence. Affective reactivity and adverse social experiences have been linked to NSSI, but less is known about whether these factors may separately or interactively predict NSSI, especially longitudinally. This study combined functional magnetic resonance imaging and a sociometric measure to test whether a combination of neural (e.g., amygdala) reactivity to social punishment and peer-nominated peer acceptance/rejection predicts NSSI longitudinally in adolescence. Amygdala reactivity was examined as a potential neural marker of affective reactivity to social punishment, which may heighten NSSI risk in contexts of social adversity.

METHODS

One hundred twenty-five adolescents (63 female) completed a social incentive delay task during neuroimaging and school-based peer nominations to measure peer acceptance/rejection. NSSI engagement was assessed at baseline and 1-year follow-up.

RESULTS

Greater amygdala reactivity to social punishment predicted greater NSSI engagement 1 year later among adolescents with high peer rejection. This effect for the amygdala was specific to social punishment (vs. reward) and held when controlling for biological sex and pubertal development. Exploratory analyses found that ventral striatum reactivity to social reward and punishment similarly interacted with peer rejection to predict NSSI but that amygdala connectivity with salience network regions did not.

CONCLUSIONS

Amygdala reactivity to social punishment, in combination with high peer rejection, may increase NSSI risk in adolescence, possibly via heightened affective reactivity to adverse social experiences. Objective measures of neurobiological and social risk factors may improve prediction of NSSI, while therapeutic approaches that target affective reactivity and increase prosocial skills may protect against NSSI in adolescence.

Canada's Student Mental Health Network: Protocol for a Comprehensive Program Evaluation

BACKGROUND

Prevalence estimates for mental health-related problems, including above-average stress, psychological distress, and symptoms of mental illnesses have increased significantly among Canadian postsecondary students. As demand for downstream mental treatment has surpassed many institutions' abilities to deliver timely care, there is a need for innovative upstream supports that foster mental health promotion and mental illness prevention among this population.

OBJECTIVE

Supported by an extensive network of student volunteers, Canada's Student Mental Health Network is a virtual, one-stop shop for centralized mental health education and evidence-based resources tailored to postsecondary students. This article describes a protocol for the comprehensive evaluation of the Network.

METHODS

Development of the Network was developed using a participatory action research framework. Network content is created and curated by students and reviewed by subject matter experts. The proposed program evaluation will include both a formative process evaluation and a summative impact assessment to determine the feasibility, acceptability, and utility of the Network in addition to assessing change in the 3 primary outcomes of interest: mental health literacy, perceived social support, and help-seeking behavior. Participants will be recruited directly from the Network website using a "rolling" recruitment approach to allow for continuous data collection and evaluation. A combination of qualitative (ie, interviews) and quantitative (ie, surveys) methods of data collection will be used.

RESULTS

The process of evaluation of the Network will begin in September 2022, collecting data for 1 year. In September 2023, the impact evaluation will begin using the same follow-up schedule. Data collection will then remain ongoing to facilitate the continued evaluation of the Network. Reports detailing evaluation data will be released annually.

CONCLUSIONS

The Network is a novel and innovative method of delivering universal mental health promotion to Canadian postsecondary students by providing centralized and freely accessible mental health education and resources, created by students and validated by subject matter experts. The continued creation and curation of resources for the Network will be ongoing to meet the evolving needs of the target population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/41521.

Comparisons of mental health symptoms, treatment access, and self-harm behaviors in rural adolescents before and during the COVID-19 pandemic

The COVID-19 pandemic disrupted the lives of adolescents worldwide, and research on the mental health effects are ongoing. Adolescents living in rural areas of the United States were already known to be at a disadvantage in terms of access to mental health services, as well as elevated rates of mental health concerns and self-harm risk. Research on how these factors may have changed since the pandemic began is needed to better understand which areas saw the biggest impact and where we can best direct resources to assist youth. Data from the current study were taken from a project examining adolescent mental health and self-harm risk. The pandemic disrupted the timeline for the study resulting in data being collected in two separate waves: before (n = 695) and after (n = 206) the pandemic began. Comparisons were made between these two samples on multiple factors including depression, anxiety, emotion dysregulation, alcohol and substance use, experiencing of bullying, overall impairment, mental health services access, and self-harm. Results indicated that adolescents in the pandemic sample were more likely to have seen a counselor and been hospitalized for a mental health reason, and were more likely to have experienced past-year suicide thoughts and plans than adolescents in the pre-pandemic sample. The pandemic sample also showed more depression and anxiety symptoms, greater emotion dysregulation, and greater intensity of recent suicide ideation. Implications for assisting youth through post-pandemic times are discussed.

Harsh parenting and adolescent non-suicidal self-injury: A moderated mediation model of alienation and cognitive reappraisal

OBJECTIVE

Harsh parenting has been shown to be associated with non-suicidal self-injury (NSSI) in adolescents. Based on the integrated theoretical model of the development of NSSI and the cognitive-emotional model of NSSI, we proposed a moderated mediation model to investigate "how" and "when" harsh parenting is associated with adolescent NSSI. Specifically, we tested whether feelings of alienation mediated the association between harsh parenting and NSSI, and whether this indirect effect was weakened by cognitive reappraisal as an adaptive emotion regulation strategy.

METHODS

A total of 1638 Chinese adolescents (54.7 % girls; ages 12-19 years) completed self-report questionnaires in their classrooms. The questionnaires assessed harsh parenting, feelings of alienation, cognitive reappraisal skills, and incidents of NSSI.

RESULTS

Path analyses showed that harsh parenting positively predicted NSSI, and alienation mediated this association. Both the direct effect of harsh parenting on NSSI and the indirect effect through alienation were moderated by cognitive reappraisal. Specifically, cognitive reappraisal skills weakened the direct and indirect associations between harsh parenting and NSSI.

CONCLUSIONS

Adolescents may benefit from interventions that decrease feelings of alienation and increase cognitive reappraisal strategies to reduce the risk of NSSI in the context of harsh parenting.

Longitudinal relation between maladaptive parenting and nonsuicidal self-injury among Chinese early adolescents: The roles of internalizing symptoms and FKBP5 gene variation

BACKGROUND

While increasing research has effectively documented that maladaptive parenting is a significant risk factor for adolescent nonsuicidal self-injury, the process mechanism and gene-by-environment interaction in this relation among Chinese early adolescents are still poorly understood.

METHODS

In this study, a multi-informant longitudinal design was applied to investigate the indirect effect of internalizing symptoms in the relation between maladaptive parenting and nonsuicidal self-injury, and to examine how FKBP5 gene variation moderates these association. A total of 1718 Chinese Han early adolescents (44.30 % girls; M_age at Wave 1 = 10.35) and their parents participated this study.

RESULTS

The results showed that maladaptive parenting significantly predicts adolescent nonsuicidal self-injury after six months. Maladaptive parenting was also indirectly related to nonsuicidal self-injury via internalizing symptoms. Moreover, using a cumulative genetic score approach, the results showed that FKBP5 gene variation moderates the predictive effect of maladaptive parenting on internalizing symptoms and also moderates the indirect effect of internalizing symptoms between maladaptive parenting and nonsuicidal self-injury. These effects were more salient among adolescents with high (versus low) FKBP5 gene related cumulative genetic score linked to heightened stress reactivity.

LIMITATIONS

Our study only obtained two waves of data. Three waves of data would be more suitable for examining a mediation model.

CONCLUSION

This study reveals the process mechanism between maladaptive parenting and nonsuicidal self-injury and highlights the significance of gene-by-environment interaction to explain the emergence of nonsuicidal self-injury among adolescents.

An RDoC-based approach to adolescent self-injurious thoughts and behaviors: The interactive role of social affiliation and cardiac arousal

Recent theoretical models have posited that increases in self-injurious thoughts and behaviors (SITBs) during adolescence may be linked to failures in biological stress regulation in contexts of social stress. However, there is a lack of data examining this hypothesis during the transition to adolescence, a sensitive period of development characterized by changes across socioaffective and psychophysiological domains. Building on principles from developmental psychopathology and the RDoC framework, the present study used a longitudinal design in a sample of 147 adolescents to test whether interactions among experiences of social (i.e., parent and peer) conflict and cardiac arousal (i.e., resting heart rate) predicted adolescents' engagement in SITBs (i.e., nonsuicidal self-injury, NSSI; and suicidal ideation; SI) across 1-year follow-up. Prospective analyses revealed that adolescents experiencing a combination of greater peer, but not family, conflict and higher cardiac arousal at baseline showed significant longitudinal increases in NSSI. In contrast, social conflict did not interact with cardiac arousal to predict future SI. Findings indicate that greater peer-related interpersonal stress in adolescents may increase risk for future NSSI among youth with physiological vulnerabilities (i.e., higher resting heart rate) that may be markers of maladaptive stress responses. Future research should examine these processes at finer timescales to elucidate whether these factors are proximal predictors of within-day SITBs.

An investigation of self-injury in female adolescents: a qualitative study

This study aimed to investigate the phenomenon of self-injury among female adolescents. The research was qualitative, and the sampling method was purposive non-random; the sample size was 20 Iranian girl adolescents aged 13-15 years who had experienced non-suicidal self-injury. Data were collected through semi-structured interviews. The data analysis process was performed during three coding steps (open, axial, selective), through which the basic codes and categories were identified. Study results indicate that the main factors in adolescents' self-injury were individual or psychological (thoughts, emotions, and behaviors) and social (peers, family, communication with different gender, communication with others, media/cyberspace, school, and economic). In the former, the role of emotions was remarkable, while in the latter, the family played a key role. Further, results revealed that communication within the family was an important motivating and sustentative factor in adolescents' self-injury. The results can help counselors in working with adolescents who self-injure; results can also be used in the development and implementation of treatment plans.

The Relationship Between Bullying Victimization and Perpetration and Non-suicidal Self-injury: A Systematic Review

Experience of bullying may be a significant risk factor for non-suicidal self-injury (NSSI). This study had three aims: to systematically investigate the association between bullying and NSSI, analyze the possible mechanisms underlying the two phenomena, and evaluate any differences between bullying victimization and bullying perpetration with respect to NSSI. A systematic search about the association between bullying victimization and perpetration and NSSI was conducted using specific databases (PubMed, Scopus, Science Direct). The following keywords were used in all database searches: "bullying" AND "NSSI" OR "peer victimization" and NSSI. The searches in PubMed, Scopus and Science Direct revealed a total of 88 articles about bullying or peer victimization and NSSI. However, only 29 met our inclusion criteria and were used for the present review. Overall, all studies examined victimization; four studies also evaluated the effects of perpetration and one included bully-victims. According to the main findings, both being a victim of bullying and perpetrating bullying may increase the risk of adverse psychological outcomes in terms of NSSI and suicidality in the short and the long run. To the best of our knowledge, this is the first review to systematically evaluate the relation between bullying victimization/perpetration and NSSI. The main results support a positive association. Future research should evaluate the possible role of specific mediators/moderators of the association between experience of bullying and NSSI.

[Psychopathological correlates of depression with non-suicidal self-harm in non-psychotic mental illnesses of adolescence]

OBJECTIVE

To determine the main clinical and psychopathological features of the relationship between depressive states and non-suicidal self-injury (NSSI) in mental illnesses of the non-psychotic register in adolescence.

MATERIAL AND METHODS

Clinical data of 128 patients (77 males and 51 females), who presented with depressive states and NSSI in non-psychotic mental disorders during adolescence, were analyzed. The patients were examined at the Clinic of the Mental Health Research Center during the period 2020-2023. The mean age of the patients was 19±4.1 years.

RESULTS

Based on the data from studying depression and NSSI in adolescence, we developed a typology, identifying three variants of affect and auto-aggressive activity interactions. The affect-dominant type (25.8%) was characterized by a predominance of affective pathology (p<.05), with the occurrence of impulsive NSSI (45.5%) and demonstrative NSSI (30.3%) (p<0.05). The personality-dominant type (43.0%) was based on pathocharacterological abnormalities (60.0%), where NSSI were represented by impulsive (25.5%), depersonalizing (27.3%), and addictive variants (32.7%) (p<0.05). The reciprocal type (31.3%) exhibited pronounced polymorphism, combining high affect variability with a tendency towards auto-aggressive behavior of varying severity and manifestations of NSSI (p<0.05). In terms of nosological distribution, schizotypal disorder predominated (45.0%) followed by predominantly borderline personality disorder (30.0%) and bipolar affective disorder (25.0%) (p<0.05). In terms of nosological distribution, schizotypal disorder predominated (45.0%), followed by predominantly borderline personality disorder (30.0%) and bipolar affective disorder (25.0%) (p<0.05).

CONCLUSION

Three types of correlation between depression and NSSI were identified, the formation of which was due to the pathoplastic influence of the age factor, nosological affiliation and a certain, including pathological personality structure. Statistically significant regularities between variants of NSSI and types of their interrelation were revealed. The results can be considered as differential diagnostic and prognostic markers of their further trajectories and, therefore, contribute to the creation of new therapeutic strategies, timely diagnosis and earlier intervention.

Peer victimization, depression, and non-suicidal self-injury among Chinese adolescents: the moderating role of the 5-HTR2A gene rs6313 polymorphism

BACKGROUND

Peer victimization is a crucial risk predictor for adolescent non-suicidal self-injury (NSSI). However, adolescent NSSI reactions to peer victimization exhibit large individual differences. This study explored whether depression mediated the association between peer victimization and adolescent NSSI, and whether this mediating path was moderated by the 5-HTR2A gene rs6313 polymorphism.

METHODS

A total of 667 adolescents (Mean_age = 12.81, SD = 0.48) completed questionnaires regarding peer victimization, depression, and NSSI. Genomic DNA was extracted from saliva and buccal cells from each participant.

RESULTS

The results showed that the positive relation between peer victimization and adolescent NSSI was mediated by depression. Moreover, the triple interaction between peer victimization, rs6313 polymorphism, and gender on adolescent depression was significant. And the triple interaction between depression, rs6313 polymorphism, and gender on adolescent NSSI was also significant. Specifically, the risk effect of peer victimization on adolescent NSSI through increased depression was stronger for female adolescents with CC genotype than for female adolescents with CT or TT genotype, and male adolescents with CT or TT genotype. However, the indirect effect was nonsignificant for male adolescents with CC genotype.

CONCLUSIONS

These findings promote the etiological understanding of adolescent NSSI, highlighting the mediating and moderating effect between peer victimization and NSSI, and adding evidence supporting the relationship between the 5-HTR2A gene rs6313 polymorphism, depression and adolescent NSSI.

The influence of parenting style and coping behavior on nonsuicidal self-injury behavior in different genders based on path analysis

Background

Nonsuicidal self-injury (NSSI) behaviors-an important factor that profoundly affects the physical and mental health of young people-are induced by complex and diverse factors, while showing significant differences at the gender level. We examined mediating behaviors among parenting styles, students' coping styles, and endogenous and exogenous influencing variables of adolescents' NSSI behaviors.

Methods

In this cross-sectional study, Secondary school students in Ningbo, Zhejiang Province, China (n = 2,689; F/M:1532/1157) were surveyed for basic attributes, parenting styles, coping styles, and NSSI behaviors. After the initial screening of the sample data, several external derivatives were screened based on the single factor analysis method. On this basis, the construction of path analysis models under multivariate multiple elicitations was carried out.

Results

The overall prevalence of NSSI was 15.16%, and the incidence of NSSI in boys was lower than that in girls (OR = 0.334, 95% CI [0.235-0.474]). The path analysis model data fit well; the indicators of female and male part are: CFI = 0.913/0.923, GFI = 0.964/0.977, SRMR = 0.055/0.047, RMSEA = 0.097/0.069 with 90% confidence interval (CI) [0.084-0.111]/[0.054-0.084]. For female, when negative coping style and extreme education affect NSSI respectively, the standardized path coefficient values are 0.478 (z = 20.636, P = 0.000 < 0.01) and 0.151 (z = 6.524, P = 0.000 < 0.01) respectively, while for male, the corresponding values become 0.225 (z = 7.057, P < 0.001) and 0.104 (z = 3.262, P < 0.001).

Conclusion

In particular, we investigated the mediating effects of gender-specific NSSI influences and found that NSSI behaviors were strongly associated with environmental variables and individual factors, especially family parenting style and adolescent coping style, which influenced NSSI in a gender-specific manner. The results showed that males were the target of both positive and negative parenting styles, whereas females were more likely to choose negative coping styles directed towards emotions in response to external stimuli, and instead showed a more significant predisposition towards NSSI behaviors. This phenomenon seems to be influenced by multilevel factors such as sociocultural, individual value identity, and physiological structure differences. In the path analysis model with the introduction of mediating effects, the influence of gender differences on NSSI behavior becomes more pronounced under the interaction of multiple factors: women seem to be more significantly influenced by the external derivatives in the internal derivatives than male subjects, and are more likely to trigger NSSI behavior under the interaction of multiple factors. These findings effectively reveal the significant role of different end-influencing factors in NSSI behaviors at the level of gender differences, which can provide effective theoretical support to prevent and treat NSSI behaviors in adolescents.