Relationship between alexithymia, loneliness, resilience and non-suicidal self-injury in adolescents with depression: a multi-center study

Adolescent campus bullying and non-suicide self-injury: chain mediating effect of negative affect and sleep quality

Aim

This study aimed to explore the chain mediating role of negative affect and sleep quality between campus bullying and non - suicidal self - injury (NSSI) among adolescents.

Methods

569 adolescents were selected through convenience sampling. Participants completed the Olweus Bully/Victim Questionnaire, Positive and Negative Affect Schedule, Pittsburgh Sleep Quality Index, and Adolescent Non - suicidal Self - injury Assessment Questionnaire.

Results

Our result showed significant positive correlations among campus bullying, negative affect, sleep quality and NSSI. Negative affect and sleep quality were identified as independent and sequential mediators in the relationship between campus bullying and NSSI.

Conclusion

These findings elucidate the mechanisms linking campus bullying to NSSI, providing a preliminary basis for exploring the causal relationships among these variables. this study offers theoretical support for future research and inform the development of targeted interventions to reduce NSSI and improve the overall mental health of adolescents in China.

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

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The impact of alexithymia, anxiety, social pressure, and academic burnout on depression in Chinese university students: an analysis based on SEM

BACKGROUND

With societal development and increasing talent demands, college students face escalating pressures primarily stemming from academic burdens, uncertainties about the future, and complex social environments. These pressures have profound effects on mental health, particularly negatively impacting emotions and behavior. In this context, depressive symptoms are becoming increasingly prevalent among college students. Given the potential links between emotional disorders, anxiety, social pressure, and academic burnout, this study aims to explore how these factors collectively influence depression in college students.

METHODS

This study utilized a questionnaire approach, resulting in 599 valid responses. The collected data were analyzed using Smart-PLS for SEM to investigate the relationships among the variables.

RESULTS

The SEM analysis indicated that the comprehensive model explained 83.2% of the variance in depression. Alexithymia significantly positively predicted anxiety and social pressure. Academic burnout significantly positively influenced social pressure, anxiety, and depression. Anxiety played a partial mediating role in the impact of alexithymia and academic burnout on depression. Social pressure and alexithymia did not have a significant positive impact on depression. In addition, there is a significant gender difference in the impact of academic burnout on depression, with the path coefficient for males being significantly higher than that for females.

CONCLUSION

This study validated the complex relationships among alexithymia, anxiety, social pressure, academic burnout, and depression. As an emotional expression disorder, alexithymia not only directly impacts anxiety levels in college students but also indirectly affects depression through anxiety. Furthermore, the positive influence of academic burnout on anxiety and depression indicates that excessive academic burdens are significant sources of mental health issues for college students. This research offers new insights into understanding college students' mental health issues, aiming to provide more comprehensive intervention strategies for their psychological well-being.

The effects of student bullying on non-suicidal self-injurious behavior in rural adolescents: the chain-mediated effects of alexithymia and ruminate thinking

Bullying among students is a significant risk factor for non-suicidal self-injury (NSSI), which can adversely impact the physical and mental health development of individuals. To explore the mechanisms by which student bullying affects adolescent non-suicidal self-injury, 701 adolescents were selected as participants. The assessment tools included the Bullying Questionnaire, Toronto Alexithymia Scale, Ruminative Responses Scale, and Adolescents Non-suicidal Self-injury Assessment Questionnaire, which were used to measure the experiences of bullying, levels of alexithymia, rumination tendencies, and the severity of non-suicidal self-injury, respectively. This study aimed to examine whether there is a chain mediation effect of alexithymia and rumination in the relationship between student bullying and non-suicidal self-injury. The results indicated that: (1) Student bullying has a significant positive impact on adolescent non-suicidal self-injury (63.62%) and indirectly influences it through alexithymia and rumination (12.69%); (2) There are gender differences in the chain mediation effect between student bullying and non-suicidal self-injury, with the chain mediation effect of rumination and alexithymia being significantly greater in females (0.12) compared to males (0.06). This study not only provides a cognitive-emotional perspective and a gender difference perspective on the effects of bullying on adolescent non-suicidal self-injury but also focuses on rural adolescents, who often face more physical and mental health issues. Therefore, the conclusions enrich the understanding of the complex mechanisms between student bullying and non-suicidal self-injury, offering new theoretical guidance for preventing bullying and intervening with victims of bullying.

Alexithymia in people with tattoos

Introduction

Tattoos are a form of body modifications. Alexithymia is a complex personality structure that includes emotional and cognitive deficits such as difficulty in recognizing and describing feelings.

Aim

To assess the prevalence of alexithymia among tattooed individuals. Moreover, we aimed to check if the type of tattoo is related to alexithymia.

Material and methods

This was a cross-sectional survey, conducted on 403 individuals from Poland. 200 of them had tattoos and were assigned to the study group, and 203 of them had no tattoos and were assigned to the control group.

Results

Most respondents (24%) had one tattoo. Most tattoos (29.8%) were situated on forearms and palms, had a plant motif (21.8%) and were done to express personality of the respondents (20.7%). In the research group 80 (19.9%) respondents were classified as alexithymic ones. Out of them, 47 (11.7%) individuals had tattoos and 33 (8.9%) belonged to the non-tattooed group. 35 (17.5%) respondents with non-verbal tattoos were screened as alexithymic while 12 (6%) individuals with verbal, personal tattoos were classified as alexithymic ones (p < 0.05). Twenty-two (11%) respondents who did their tattoos for psychological reasons and 25 (12.5%) individuals who did their tattoos for aesthetic reasons were classified as alexithymic (NS).

Conclusions

Subjects with tattoos should be regarded as a group with increased prevalence of alexithymia. Individuals with non-verbal tattoos had a higher tendency to be screened as alexithymic as alexithymic ones. Motivation for getting the tattoo does not seem to have a significant impact on the prevalence of alexithymia.

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

Background and aims

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

Methods

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

Results

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

Conclusions

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

The association between child maltreatment, cognitive reappraisal, negative coping styles, and non-suicidal self-injury in adolescents with major depressive disorder

BACKGROUND

Non-suicidal self-injury (NSSI) is a significant public health concern among adolescents with major depressive disorders (MDD). Although previous research has linked child maltreatment (CM) to NSSI, the precise mechanisms remain unclear. This study aims to investigate the association between CM, cognitive reappraisal (CR), negative coping styles (NC) and NSSI in adolescents with MDD, from the perspectives of both Latent Variable Theory and the Network Theory of Mental Disorder.

METHODS

A sample of 651 adolescents with MDD was recruited from January to December 2023. Data on CM, CR, NC, and NSSI were collected through paper-based self-reported questionnaires. Data analysis primarily involved structural equation modeling and network analysis.

RESULTS

The reporting rate of NSSI among adolescents with MDD was 48.2%. CM showed a significant positive correlation with NSSI. NSSI was affected by CM through three paths: the mediating role of CR, the mediating role of NC, and the chain mediating role of both CR and NC. Emotional abuse (EA) was the central node, while NSSI, EA, and "The urge to cry quietly when faced with troubles"(NC10) were the key bridge nodes.

CONCLUSIONS

This study is the first to use both structural equation modeling and network analysis to explore the explore the relationship between CM, CR, NC, and NSSI in adolescents with MDD, providing a theoretical basis for future early prevention and targeted interventions for adolescents with MDD.

The associations of social health, self-injurious thoughts and behaviors with or without childhood trauma: A UK biobank study

BACKGROUND

Childhood trauma was known to increase risks of social isolation, loneliness and self-injurious thoughts and behaviors in adulthood. The aim of this study was to examine the protect and risk factors of social health, self-injurious thoughts and behaviors between adults with or without childhood trauma.

METHOD

This was a cross-sectional study comprising of 145,043 participants enrolled in the UK Biobank. Childhood trauma was determined by the Childhood Trauma Screener. Social health included social isolation, loneliness and emotional support. Outcomes of self-injurious thoughts and behaviors included suicide ideation, suicide attempt and non-suicidal self-injury (NSSI). Demographic data, self-reported morbidities and other confounding variables were covariates. Stata 17.0 and SPSS 27.0 was used to analysis data.

RESULTS

Compared with participants without childhood trauma, there was no protective effect of emotional support for NSSI in participants with childhood trauma (β-value difference = 0.334, p = 0.008). The risk effect of loneliness for suicide ideation, suicide attempt and NSSI were also weaker in participants experiencing childhood trauma (p<0.05). Social isolation was no longer a risk factor for NSSI in all participants, while loneliness remained as a threat (p < 0.05).

LIMITATIONS

Many variables were measured using core items of the scale in UK Biobank, meanwhile, the childhood trauma data collected in adulthood may have recall bias.

CONCLUSIONS

Adults reported childhood trauma were less vulnerable to self-injurious thoughts and behaviors when experiencing loneliness, but they could also not be protected from NSSI through emotional support. Emotional dysregulation caused by childhood trauma may contribute to this.

Cultural Dimensions Moderate the Association between Loneliness and Mental Health during Adolescence and Younger Adulthood: A Systematic Review and Meta-Analysis

Cultural factors, such as country or continent, influence the relationship between loneliness and mental health. However, less is known about how cultural dimensions moderate this relationship during adolescence and younger adulthood, even if these dimensions manifest as country or continent differences. This study aims to examine the potential influence of Hofstede's cultural dimensions on this relationship using a three-level meta-analysis approach. A total of 292 studies with 291,946 participants aged 10 to 24 were included in this study. The results indicate that cultural dimensions, such as individualism vs. collectivism, indulgence vs. restraint, power distance, and long-term vs. short-term orientation, moderated the associations between loneliness and social anxiety, stress, Internet overuse, and negative affect. The association between loneliness and mental health was not moderated by cultural dimensions, such as masculinity and uncertainty avoidance. These findings suggest that culture's influence on the association between loneliness and mental health is based on a domain-specific mechanism.

A meta-analysis on the lifetime and period prevalence of self-injury among adolescents with depression

Background

Adolescents are vulnerable to mental disorders due to physiological, psychosocial, and cognitive changes during this critical developmental stage. Depression, in particular, can lead to high-risk behaviors such as self-injury (SI) and suicide. This study aims to estimate the pooled prevalence of SI behaviors among adolescents with depression.

Materials and methods

We systematically searched databases including EMBASE, Scopus, PubMed, and Web of Sciences for relevant articles published on adolescents with depression from January 1, 2000, to January 1, 2024. The quality assessment of the studies was conducted using the Joanna Briggs Institute (JBI) criteria. The global prevalence of SI was calculated based on a random effects model using Stata software version 17.

Results

Our analysis included 29 studies involving 12,934 adolescents. The lifetime prevalence of SI was 52% (95% Confidence Interval [CI]: 41-64), while the period prevalence was 57% (95% CI: 49-64). Notably, a significant relationship was observed between the prevalence of SI and the year of publication of articles (p = 0.002). Furthermore, publication bias was not significant for both lifetime prevalence (p = 0.281) and period prevalence (0.358).

Conclusion

The prevalence of self-injurious behaviors in adolescents with depression is alarmingly high, with more than half of adolescents having engaged in these high-risk behaviors during their lifetime or within the last year. Given the associated risk of suicide, it is crucial to identify individuals at risk and provide timely interventions.

Correlation Analysis of Non-Suicidal Self-Injury Behavior with Childhood Abuse, Peer Victimization, and Psychological Resilience in Adolescents with Depression

BACKGROUND

In recent years, the number of adolescents with depression has been increasing annually, with individuals often exhibiting non-suicidal self-injury (NSSI) behavior. The purpose of this study is to investigate the family (childhood abuse), school (peer victimization), and individual (psychological resilience) factors of adolescents with depression with or without NSSI (the Chinese version of the Functional Assessment of Self-Mutilation [C-FASM] scale), and to analyze the correlation between the above psychological and social factors and the frequency of NSSI, to provide a basis for NSSI prevention and intervention in adolescents with depression.

METHODS

We recruited 355 adolescents with depressive symptoms to participate in this study and divided them into Group NSSI (N = 227) and Group no-NSSI (n-NSSI) (N = 128) based on the C-FASM scale. The Short-Form Childhood Trauma Questionnaire (CTQ-SF), Multidimensional Peer Visualization Scale (MPVS), and Resilience Scale for Chinese Adolescents (RISC) scores were compared between two groups of adolescents. Pearson correlation coefficient was used to analyze the correlation between NSSI frequency and the above scores.

RESULTS

Emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, and total CTQ-SF score in Group NSSI were significantly higher than those in Group n-NSSI (all p < 0.001). Physical victimization, verbal victimization, social manipulation, attacks on property, and total MPVS score in Group NSSI were significantly higher than those in Group n-NSSI (p < 0.001, p < 0.001, p = 0.009, p < 0.001, p < 0.001). Goal concentration, emotion regulation, positive perception, family support, interpersonal assistance, and total RISC score in Group NSSI were significantly lower than those in Group n-NSSI (all p < 0.001). The frequency of NSSI was significantly positively correlated with emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, and total CTQ-SF score (r = 0.366, p < 0.001; r = 0.411, p < 0.001; r = 0.554, p < 0.001; r = 0.220, p = 0.001; r = 0.255, p < 0.001; r = 0.673, p < 0.001). The frequency of NSSI was significantly positively correlated with physical victimization, verbal victimization, social manipulation, attacks on property, and total MPVS score (r = 0.418, p < 0.001; r = 0.455, p < 0.001; r = 0.447, p < 0.001; r = 0.555, p = 0.001; r = 0.704, p < 0.001). The frequency of NSSI was significantly negatively correlated with goal concentration, emotion regulation, positive perception, family support, interpersonal assistance, and total RISC score (r = -0.393, p < 0.001; r = -0.341, p < 0.001; r = -0.465, p < 0.001; r = -0.272, p = 0.001; r = -0.160, p = 0.016; r = -0.540, p < 0.001).

CONCLUSIONS

Our findings highlight the importance of family (childhood abuse), school (peer victimization), and individual (psychological resilience) factors for NSSI in depressed adolescents, and these factors are closely related to NSSI frequency.

IMPLICATIONS FOR PRACTICE

Maintaining a good family environment, solving the problem of peer victimization at school, and developing corresponding measures to improve psychological resilience are of great significance for improving the mental health of depressed adolescents and reducing the risk of NSSI.

Predictors of non-suicidal self-injury in adolescents with depressive disorder: the role of alexithymia, childhood trauma, and body investment

Purpose

This study analyzes the relationship of alexithymia, childhood trauma, and body investment to non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder and whether they have predictive and diagnostic value for non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder.

Patients and methods

A total of 225 patients with a diagnosis of adolescent depressive disorder were included in the study and were divided into two groups according to the DSM-5 criteria: 98 cases without NSSI and 127 cases with NSSI. Compare the demographic data, 24-item Hamilton Depression Scale (HAMD-24), 20-item Toronto Alexithymia Scale (TAS-20), Childhood Trauma Questionnaire-Short Form (CTQ-SF), and Body Investment Scale (BIS) scores between two groups. Binary logistic regression was used to analyze the independent risk factors contributing to NSSI behaviors in adolescents with depression, and establish four predictive models. Based on the models' predictive probability, the ROC curves were plotted to calculate the value of the predictive diagnostic effect.

Results

The group without NSSI had lower scores than the group with NSSI on HAMD-24 total score, TAS-20 total score, difficulty identifying feelings, difficulty describing feelings, and externally focused thinking, as well as lower scores on CTQ-SF total score, physical neglect, emotional neglect, physical abuse, and emotional abuse. In contrast, the BIS total score, body image feelings and attitudes, body care, and body protection factor scores were higher for the group without NSSI. The BIS body care factor score and the CTQ-SF emotional abuse factor score were significantly linked with adolescents diagnosed with depressive disorder who exhibited NSSI behaviors. These results provide a good diagnostic model for adolescents with depressive disorder.

Conclusion

Low levels of body care and childhood emotional abuse may independently contribute to the implementation of NSSI in adolescents with depressive disorder. Body investment and childhood trauma are valuable in diagnosing and predicting NSSI behaviors and should be considered as potentially important factors in clinical treatment.

Family intimacy and adaptability and non-suicidal self-injury: a mediation analysis

BACKGROUND

Current research has been focusing on non-suicidal self-injury (NSSI) behaviors among adolescents with depression. Although family intimacy and adaptability are considered protective factors for NSSI, evidence supporting this relationship is lacking.

OBJECTIVE

This study aims to examine the mechanisms operating in the relationship between family intimacy and adaptability and NSSI behaviors among adolescents.

METHODS

A self-administered general demographic information questionnaire, the Behavioral Functional Assessment Scale for Non-Suicidal Self-Injury, the Family Intimacy and Adaptability Scale, the Connor-Davidson Resilience Scale, and the Self-Assessment of Depression Scale were distributed among adolescents with depression in three tertiary hospitals in Jiangsu Province.

RESULTS

The relationship between family intimacy and adaptability and NSSI was assessed among 596 adolescents with depression. The results revealed the following: (1) Family intimacy and adaptability were negatively correlated with NSSI behavior. (2) Psychological resilience and depression levels acted as chain mediators in the relationship between family intimacy and adaptability and NSSI behavior.

CONCLUSIONS

Enhancing psychological resilience, controlling depressive symptoms, and reducing depression severity among adolescents by improving their family intimacy and adaptability are conducive to preventing and mitigating their NSSI behaviors.

The Effect of Bullying Victimization on Adolescent Non-Suicidal Self-Injury: The Mediating Roles of Alexithymia and Self-Esteem

Background & Aim

Non-suicidal self-injury (NSSI) in adolescents is a serious public health issue influenced by the interaction of multiple factors. The purpose of this study was to investigate the multiple mediating roles of alexithymia and self-esteem in the association between bullying victimization and NSSI in a sample of Chinese adolescents.

Methods

A survey of 1299 adolescents from two public middle schools in Henan Province, China, was undertaken. Data were collected using the Chinese version of the Delaware bullying victimization scale-student (DBVS-S), the Toronto Alexithymia-20 Scale (TAS-20-C), the Rosenberg self-esteem scale (RSES), and the adolescent self-injury questionnaire. Besides, we performed a structural equation modeling (SEM) with latent variables using AMOS 26.0 to examine the relationship between variables and the mediating effects.

Results

The SEM analysis found that not only can bullying victimization directly impact NSSI, but that alexithymia and self-esteem have a chain mediating effect in the association between bullying victimization and NSSI. This mediating effect contributed 22.47% to the total effect.

Conclusion

These findings validate bullying victimization, alexithymia, and low self-esteem are important variables that affect NSSI among Chinese adolescents. Educators need to implement some prevention and intervention strategies to ameliorate the campus atmosphere and adolescents' mental health aimed at avoiding NSSI behavior in adolescence.

Understanding Comorbidity Between Non-Suicidal Self-Injury and Depressive Symptoms in a Clinical Sample of Adolescents: A Network Analysis

Background

Non-suicidal self-injury (NSSI) and depression often co-occur among adolescents with more severe clinical symptoms. This study examined the network structures of NSSI and depressive symptoms in adolescents.

Methods

Participants were recruited in the psychiatric outpatient clinics of three tertiary hospitals between April 10 and July 10, 2023. All participants been already found with self-injury behaviors in outpatient when enrolled. NSSI diagnostic criteria and Patient Health Questionnaire-9 (PHQ-9) were utilized to collect NSSI and depressive symptoms separately. We performed a network analysis to visualize the correlation between each symptom and to identify core and bridging symptoms in comorbidities.

Results

A total of 248 patients were enrolled in the study, with a mean age of 15.48 (SD = 1.62). Based on the PHQ-9 scores and grades, our results showed that the incidence of depression in adolescents with non-suicidal self-injury behavior was relatively high (N=235, 94.76%), with the majority having severe depression. The network analysis revealed that nodes D-6 "feeling bad, failing or letting yourself or your family down", D-1 "little interest or pleasure" and D-4 "feeling tired" were the most vital and most central symptoms. The most crucial bridging symptom is the node NSSI-8 "frequent thinking about self-injury", which connects the NSSI to the depression comorbid network.

Conclusion

This study offers a significant symptom-level conceptualization of the association between NSSI and depressive symptoms in a clinical sample of adolescents, which not only enhances our understanding of the comorbid but also identifies potential treatment targets to prevent and treat comorbidity between adolescent NSSI and depression.