The Psychosocial Correlates of Non-suicidal Self-Injury Within a Sample of Adolescents With Mood Disorder

Sex differences in brain metabolites of unmedicated depressed adolescents with non-suicidal self-injury: a proton magnetic resonance spectroscopy study

BACKGROUND

Gender differences in non-suicidal self-injury (NSSI) among adolescents with major depressive episodes (MDE) may exist, but the underlying neurobiological mechanisms remain unclear.

METHODS

171 unmedicated MDE adolescent patients with NSSI (NSSI group), 71 unmedicated MDE adolescent patients without NSSI (non-NSSI group), and 32 healthy controls (HC) were included. The 24-item Hamilton Depression Rating Scale (24-HDRS) was used to assess depressive symptoms. Bilateral metabolic ratios of N-acetyl aspartate (NAA) and choline-containing compounds (Cho) to creatine (Cr) in the prefrontal cortex (PFC), anterior cingulated cortex (ACC), lenticular nucleus (LN), and thalamus were obtained by proton magnetic resonance spectroscopy (1H-MRS) at 3.0 T.

RESULTS

A significant interaction effect between biological sex and the group can be found in the Cho/Cr of the right thalamus, in which males with NSSI showed significantly lower Cho/Cr than those without (p = 0.01), and males had higher Cho/Cr of the right thalamus than females in the non-NSSI group (p = 0.002). A significant correlation between the risk of NSSI and the Cho/Cr of the right thalamus can only be found in male MDE adolescents (p = 0.002), instead of in females. The binary logistic regression showed a significant negative association between the Cho/Cr of the right thalamus and the risk of NSSI in males (p = 0.02).

CONCLUSIONS

There is a sex-specific association between the neurochemical metabolisms and the NSSI risk. The Cho/Cr of the right thalamus may increase the risk of NSSI in MDE male adolescents, which can be a specific biomarker for NSSI risk the in MDE male adolescents.

Psychological experiences of parents of adolescent patients with non-suicidal self-injury: a qualitative study based on Bronfenbrenner's ecological systems theory

BACKGROUND

Non-suicidal self-injury (NSSI)-an increasingly serious mental health issue among adolescents-is closely associated with several mental illnesses. Qualitative studies on parents of adolescents with NSSI behaviors in China-despite some advancements-have neglected to explore it as a result of individual-environment interactions. This qualitative study aimed to investigate the psychological experiences of parents of adolescent patients with NSSI based on Bronfenbrenner's ecological systems theory, thus placing NSSI among adolescents in its corresponding social context.

METHODS

This qualitative study was conducted using face-to-face semistructured interviews between April and September 2024. The questions were set based on the Bronfenbrenner's ecological systems theory before the interview. Parents of adolescent inpatients with NSSI were recruited from the mental health department of a tertiary hospital in northern China. Colaizzi's seven-step method was used to organize, analyze, and extract the themes from the data.

RESULTS

Eighteen parents were interviewed. The following four main themes emerged from the interview data: micro-system-coexistence of caregiver distress and growth (persistent negative emotions, positive experiences after self-adjustment, learning about mental illness, and improved disease management capabilities); meso-system-lifestyle changes (forced abandonment of social life, influence on other children, financial burden, and change in family atmosphere); exo-system-weak support system (limited resources of psychiatric services and desire for more supports); and macro-system-cultural environment.

CONCLUSIONS

The social ecosystem of parents of adolescents with NSSI is undesirable. Psychological intervention, online and offline extension services, and the dissemination of professional knowledge may help improve the mental health level and care ability of parents of adolescents with NSSI, thereby reducing adolescent self-injurious behaviors.

The mediating role of cognitive flexibility in the relationship between social support and non-suicidal self-injury among adolescents: a multicenter cross-sectional study

Background

Non-suicidal self-injury (NSSI) is a prevalent and concerning behavior among adolescents worldwide, particularly in China. This study aimed to investigate the relationships between social support, cognitive flexibility, and NSSI, and to examine the potential mediating role of cognitive flexibility in the association between social support and NSSI among adolescents.

Method

A multicenter cross-sectional study was conducted with 2,109 adolescents (aged 12-18 years, mean age 15.00 ± 1.65 years, 52.3% female) recruited from 14 psychiatric hospitals/outpatient clinics. Participants completed self-report measures of social support and NSSI, along with a cognitive flexibility assessment using the Wisconsin Card Sorting Test. Structural equation modeling was employed to test the hypothesized mediation model.

Results

Social support was negatively associated with NSSI frequency (β = -0.11, p < 0.001) and positively related to cognitive flexibility (β = 0.09, p < 0.001). The mediation effect of cognitive flexibility was statistically significant [β = -0.01, 95% CI (-0.01, -0.01)] accounting for 8.33% of the total effect of social support on NSSI. Multi-group analysis revealed that the association between social support and cognitive flexibility was stronger in females (β = 0.11, p < 0.001) compared to males (β = 0.02, p > 0.05).

Conclusion

This multicenter study provides evidence for the protective roles of social support and cognitive flexibility against NSSI in adolescents. The findings suggest that cognitive flexibility partially mediates the relationship between social support and NSSI, with notable gender differences. These results highlight the importance of enhancing both social support and cognitive flexibility in interventions aimed at reducing NSSI among adolescents.

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.

Rumination, loneliness, and non-suicidal self-injury among adolescents with major depressive disorder: The moderating role of resilience

Adolescents often experience negative emotions, such as depression and anxiety, due to rapid biological, cognitive, and social changes during this developmental stage. In recent years, the non-suicidal self-injury (NSSI) among adolescents with Major Depressive Disorder (MDD) has garnered increasing attention, with rumination identified as a significant risk factor for its occurrence. This study established a moderated mediation model to examine the impact of rumination on NSSI among adolescents with MDD and its underlying mechanisms. The final research sample consisted of 1,601 adolescents with MDD (18.2% males, mean age = 14.85 years, SD = 1.65) from 14 psychiatric/general hospitals across nine provinces in China. Participants completed self-report questionnaires assessing NSSI, rumination, loneliness, and resilience. Results indicated that rumination contribute to NSSI via loneliness during adolescence, whereas resilience may buffer the adverse effects of rumination on NSSI, implying the potential effectiveness of reducing loneliness and promoting resilience in the intervention and prevention of NSSI. These findings further illuminate the mechanisms underlying the development of NSSI, aiding in its prediction and prevention among adolescents, thereby assisting them in better coping with emotional and behavioral developmental challenges during adolescence.

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 of self-harm and suicidality with psychiatric co-occurring conditions in autistic individuals: a systematic review and pooled analysis

Background

Autistic individuals frequently experience psychiatric co-occurring conditions, but the association with self-harm/suicidality according to these conditions was not yet elucidated. We aimed to summarize the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic people.

Methods

We systematically searched PubMed, Scopus, Embase, Web of Science, and Cochrane Database of Systematic Reviews until June 4, 2024 (PROSPERO registration number: CRD42023412860). Observational studies were included that provided information to calculate the odds ratio (OR) regarding the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic individuals. We summarized the identified associations by presenting OR range or meta-analyzing when 7 or more estimates are available.

Findings

The systematic search found 20 eligible studies with 301,841 participants. Our findings suggested that autistic individuals with any psychiatric disorder (k = 1; OR 3.55; 95% CI 1.27-9.98), ADHD (k = 3; OR range: 1.07-1.65), or mood disorder (k = 1; OR 1.26; 95% CI 1.05-1.51) may be associated with higher odds of self-harm than those without these conditions. We identified potential positive associations between suicidality and the following co-occurring conditions: any psychiatric disorder (k = 1; OR 11.65; 95% CI 10.68-12.71), psychotic disorder (k = 4; OR range: 1.95-10.97), mood disorder (k = 3; OR range: 1.75-9.82), bipolar disorder (k = 2; OR range: 2.55-4.95), depressive disorder (k = 10; pooled OR 2.29; 95% CI 1.39-3.77), trauma- and stress-related disorder (k = 2; OR range: 1.28-10.47), and adjustment disorder (k = 1; OR 3.52; 95% CI 2.89-4.28).

Interpretation

We found psychiatric co-occurring conditions that may be associated with higher odds of self-harm/suicidality in autistic individuals. However, our findings should be interpreted with caution considering the limited number of included studies. We suggested that clinicians should remain vigilant for autistic individuals with psychiatric co-occurring conditions for their potentially higher likelihood of self-harm and suicidality.

Funding

This research was supported by a grant of the R&D project, funded by the National Center for Mental Health (grant number: MHER22A01).

Self-esteem buffers the stress sensitizing effect of childhood maltreatment on adolescent nonsuicidal self-injury

BACKGROUND

Adversity in childhood increases the risk of psychopathology, perhaps by influencing sensitivity to recent stressful life events (SLEs). However, little is known about the stress-sensitizing effect of childhood adversity on nonsuicidal self-injury (NSSI), whether stress sensitization exists in specific types of SLEs, and the stress-buffering effect of self-esteem. This study aimed to investigate whether exposure to child maltreatment increases adolescent's vulnerability to the effects of dependent and independent SLEs on later NSSI and whether self-esteem buffers this risk.

METHODS

We conducted a two-wave study with 18-month intervals. 601 Chinese adolescents completed self-report measures of child maltreatment, SLEs, self-esteem, and NSSI.

RESULTS

Results supported the stress sensitization hypothesis for child maltreatment regarding dependent SLEs, with dependent SLEs significantly predicting later NSSI only in maltreated adolescents. Moreover, self-esteem buffered the relationship between dependent SLEs and NSSI in maltreated adolescents but amplified the relationship in non-maltreated adolescents. In the maltreated group, dependent SLEs predicted increased NSSI only in those with low self-esteem. In contrast, in the control group, dependent SLEs were significantly associated with NSSI in individuals with high self-esteem.

LIMITATIONS

We did not collect information on the timing of exposure to child maltreatment. Future studies that assess child maltreatment during critical periods of development may be able to identify sensitive period in which maltreatment sensitizes individuals to stress in adolescents.

CONCLUSION

Findings provide preliminary evidence that child maltreatment has a stress-sensitizing effect on adolescent NSSI. Improving self-esteem may mitigate the associations between SLEs and NSSI in adolescents exposed to child maltreatment.

Non-suicidal self-injury in adolescents with mood disorders and the roles of self-compassion and emotional regulation

Objective

We aimed to investigate the characteristics and psychological mechanism of non-suicidal self-injury (NSSI) in adolescents with mood disorders. We examined how self-compassion and emotional regulation affected NSSI and tested the mediating role of self-compassion in the link between emotional regulation and NSSI.

Method

We recruited outpatient and inpatient adolescent patients with bipolar and related disorders or depressive disorders (DSM-5), with a focus on NSSI. We also recruited healthy controls from the community. We collected demographic and clinical data. The Adolescent Self-injury Questionnaire, Self-compassion Scale (SCS), and Emotion Regulation Questionnaire (ERQ) were used to assess the frequency and severity of NSSI, level of self-compassion, and emotional regulation.

Results

In total, we recruited 248 adolescent patients with mood disorders (N = 196 with NSSI, and 52 without NSSI) and 212 healthy controls. NSSI was significantly associated with the female sex, lower levels of education and less use of cognitive reappraisal strategies, lower levels of self-warmth, and higher levels of self-coldness. Multivariate analysis of variance showed that there were significant differences in the scores of ERQ, cognitive reassessment score, and the scores of SCS among the three groups, but no statistical differences in expressive suppression score among the three groups. Self-warmth had a mediating effect between cognitive reappraisal and NSSI behavior.

Conclusion

NSSI is prevalent among adolescent patients with mood disorders in clinical settings, especially among girls and those with lower levels of education and less cognitive reappraisal strategies. More clinical attention is needed. Self-compassion and its factors may mediate the association between emotional regulation and NSSI. Clinical implications and future research directions were discussed.

The effects of family environment cognition and its difference perceived by adolescents and their parents on the treatment effect of non-suicidal self-injury behaviors in adolescents: a 1-year prospective cohort study

Introduction

Family environment is the primary environment for adolescent growth and development, which is believed to have an important impact on the occurrence of non-suicidal self-injury (NSSI) behavior in adolescents. This study aimed to explore the effects of family environment cognition and cognitive differences perceived by adolescents and their parents on the treatment effects of NSSI in adolescents and to provide more potential perspectives for NSSI treatment.

Methods

A one-year prospective longitudinal sub-cohort investigation was carried out among 199 adolescents engaged in NSSI and one of their important guardians from the Longitudinal Psychosomatic Disease Study (LoPDS). The NSSI behaviors of adolescents were evaluated at 3 months, 6 months and 1 year after enrollment. The family environment scale (FES) and NSSI Behavior Questionnaire were used as assessment tools for family environment and adolescents NSSI behaviors. Multiple linear regression was used to investigate the role of family environment perception difference in the treatment effect of adolescent NSSI.

Results

After one year of follow-up, the perceived self-injury impulse score in recent 2 weeks, self-injury impulse frequency in recent 2 weeks, total number of self-injury in recent 2 weeks decreased significantly. The higher the adolescent family cohesion (Beta: 1.130, 95% CI: 0.886,1.373; p=0.032), parental family expressiveness (Beta: 0.818, 95% CI: 0.375,1.260; p=0.037) and parental family active-recreational orientation score (Beta: 0.609, 95% CI: 0.236,0.981; p=0.048), the better the treatment effect. However, higher adolescent family conflict (Beta: -0.838, 95% CI: -1.377,-0.298; p=0.024) were associated with lower treatment outcomes. The greater the cognitive difference between parents and adolescents in family cohesion (Beta: -1.307, 95% CI: -2.074,-0.539; p=0.014) and family conflict(Beta: -0.665, 95% CI: -0.919,-0.410; p=0.037), the worse the therapeutic effect of NSSI might be.

Discussion

There were certain differences in the cognition of family relationships between parents and adolescents, and subjective family relationship cognition and cognitive differences had a significant effect on the treatment effect of NSSI in adolescents. Helping them identify the cause of cognitive differences and conducting systematic family therapy from the points of difference may be another perspective to improve the treatment effect of NSSI in adolescents.

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

Non-suicidal self-injury behavior (NSSI) is a serious public health concern that requires immediate attention. Despite the high prevalence of NSSI among the Chinese population, there is a significant gap in research on the comprehensive picture of this field. Therefore, a scoping review was conducted to investigate the prevalence, methods, risk factors, and preventive intervention programs related to NSSI in China. The review found that the estimated lifetime prevalence of NSSI among Chinese youth population is alarmingly high at 24.7% (N = 1,088,433). Common methods of NSSI include scratching, hitting, and biting. Additionally, the review synthesized 249 risk factors based on the biopsychosocial-ecological framework, highlighting the urgent need for intervention. However, only 12 empirical studies focus on NSSI prevention or intervention programs were included. These findings underscore the necessity for more clinical practices and larger studies to identify effective interventions and ultimately alleviate the burden of NSSI on the Chinese population.

Funding

This review was supported by Humanity and Social Science Youth foundation of Ministry of Education (22YJCZH018), Science and Technology Innovation 2030 (STI2030-Major Projects:2021ZD0200702), National Natural Science Foundation of China (81825009), and Shuimu Tsinghua Scholar. No funding agencies were involved in the data collection, data analysis, and writing of this paper.

Stressful life events and non-suicidal self-injury among Chinese adolescents: A moderated mediation model of depression and resilience

Stressful life events are associated with an increased risk of non-suicidal self-injury (NSSI) in adolescence, but the mechanisms explaining this association are unclear. Based on the experiential avoidance model of NSSI, and the protective factor model of resilience, the current study tested depression as a mediator and resilience as a moderator of this association. Chinese adolescents (N = 643; M_age = 15.91; 52.10 % female), anonymously completed self-report measures in classrooms. Results showed that stressful life events was linked to adolescent NSSI in part because of adolescent depression, and resilience was a protective factor that buffered this effect. These findings can inspire practitioners to pay attention to the interaction of risk factors and protective factors when providing prevention and intervention for adolescent NSSI.