Longitudinal Relationship Between Self-Disgust and Nonsuicidal Self-Injury Among Adolescents: The Chain Mediating Roles of Depression and Psychache.

Nonsuicidal Self-Injury as a Predictor of Suicidal Behavior in Depressed Adolescents

<p>Non-Suicidal Self-Injury (NSSI) is defined as the intentional, direct injury to body tissue, undertaken without suicidal intent, and for a purpose that is not socially or culturally sanctioned (International Society for the Study of Self-Injury, 2007; Klonsky & Muehlenkamp, 2007; Muehlenkamp, 2014). NSSI is prevalent in adolescent samples worldwide (Muehlenkamp, Claes, Havertape, & Plener, 2012; Swannell, Martin, Page, Hasking, & St John, 2014) and is typically considered a marker of wider distress. NSSI in adolescents has been associated with numerous poor mental health outcomes, including depression, anxiety, substance abuse, eating disorders, and attempted and completed suicide (Asarnow et al., 2011; Brunner et al., 2014; Claes, Soenens, Vansteenkiste, & Vandereycken, 2012; Fox et al., 2015; Glenn & Klonsky, 2011; Jacobson & Gould, 2007). In addition, research has demonstrated that perfectionism, defined as the setting of excessively high standards of performance (Frost, Marten, Lahart, & Rosenblate, 1990), is also commonly associated with substantial distress. Unfortunately, perfectionism in adolescents is thought to be on the rise (see Flett & Hewitt, 2014; Portesova & Urbanek, 2013) with many adolescents reporting multi-sourced and relentless pressure to perform highly and adhere to societal ideals. As such, individuals are setting excessively high goals for themselves, and increasingly worrying about the consequences of less than perfect performance. Similar to the research pertaining to NSSI, perfectionism has been shown to also be associated with a raft of poor outcomes including depression, anxiety, eating disorders, and general psychological distress (e.g., Boone, Braet, Vandereycken, & Claes, 2013; Claes et al., 2012; DiBartolo et al., 2007; Lombardo, Mallia, Battagliese, Grano, & Violani, 2013; Vartanian & Grisham, 2011). Research has shown an association between NSSI and perfectionism (e.g., Hoff & Muehlenkamp, 2009; O’Connor, Rasmussen, & Hawton, 2010). However, this literature is currently very limited and the relationship between NSSI and perfectionism is not well understood. In light of this, I set out to thoroughly explore if, and how, NSSI and perfectionism are related in New Zealand adolescents. Moreover, I aimed to gain insight into the mechanisms that could underpin such relationships. Of the four studies conducted, the first and second studies established a foundation for my research. Specifically, Study 1 meta-analyses synthesised data from 118 studies investigating the relationship between perfectionism and adaptive and maladaptive outcomes. These analyses demonstrated a robust relationship between negative perfectionism and maladaptive outcomes. More specifically, they revealed a significant, positive summary correlation for the relationship between negative perfectionism and self-injurious thoughts and behaviours. Study 2 aimed to define the most appropriate conceptualisation of perfectionism for research with New Zealand adolescents. This involved investigating the psychometric properties and factor structure of the Frost Multidimensional Perfectionism Scale (Frost et al., 1990) in 930 adolescents with a mean age of 14 years old. A hierarchical structure with two overarching components (positive perfectionism, negative perfectionism), comprised of four second-level components (concerns and doubts, parental pressure, personal standards, and organisation) was identified and adopted for all following research. Studies 3 and 4 investigated the cross-sectional and longitudinal relationships between NSSI and perfectionism. Study 3a specifically aimed to ascertain whether negative and positive perfectionism are associated with NSSI in New Zealand adolescents, based on survey data from 930 adolescents in their second year of high school. As expected, negative perfectionism was significantly associated with NSSI in females, however this relationship did not hold for males. On the other hand, positive perfectionism was associated with less engagement in NSSI in both males and females. This suggested that negative perfectionism may represent a risk factor for NSSI, while positive perfectionism may buffer against risk of NSSI. In addition, Study 3b investigated the relationships between perfectionism and the functions of NSSI, indicating that self-punishment functions are particularly relevant for perfectionistic adolescents. As the final component of the cross-sectional analyses, Study 3c illustrated that the association between perfectionism and NSSI is more accurately captured when the interaction between positive and negative perfectionism is also considered. Study 4 involved the examination of this relationship over time. To do so, another wave of data was collected, resulting in data matched across two times points for 608 adolescents. Longitudinal analyses demonstrated that negative perfectionism prospectively predicted NSSI one year later in females only. Moreover, again for only females, positive perfectionism predicted an increase in negative perfectionism over time. No significant longitudinal relationships were demonstrated for male adolescents. The ultimate aim of this research was to provide clinicians, school staff and parents with the information required to effectively identify at-risk adolescents, and thereby prevent the onset of NSSI and its vast associated negative outcomes. This research suggests that perfectionism is one such risk factor to be aware of. As such, it is argued that targeted prevention and intervention strategies for perfectionism will help prevent the onset and maintenance of NSSI in females, and are also likely to be of benefit to the wider mental wellbeing of New Zealand adolescents.</p>

In recent years, the prevalence of non-suicidal self-injury (NSSI) and suicidal ideation (SI) has been continuously increasing among adolescents, making it a global public health concern. While previous studies have identified a close relationship between NSSI and SI, few have delved into their reciprocal relationship and the underlying mechanisms. This study aimed to examine the longitudinal relation between NSSI and SI, and the mediating role of irritability in the bidirectional association. This study used the Brief Irritability Test (BIT), the Deliberate Self- Harm Inventory (DSHI), and the Beck Scale for Suicidal Ideation Chinese version (BSICV) in a three-wave longitudinal survey among 1711 Chinese adolescents (MAge = 14.44 years, SD = 1.35; 54.7% females), with 6-month intervals. Data were analyzed by using the random intercept cross-lagged panel model (RI-CLPM). The results revealed that: (1) At the between-person level, NSSI, irritability, and SI were all positively associated with one another. (2) Greater within-person NSSI predicted future greater SI and vice versa. (3) Greater within-person irritability predicted future greater SI and NSSI, and vice versa. (4) Irritability acted as a mediator in the bidirectional relations between NSSI and SI. The study proposed a dynamic and integrative perspective on the longitudinal relation among NSSI, irritability, and SI, emphasizing the evolving nature of these reciprocal relationships. These findings underscore the importance of addressing irritability in adolescents and highlight the need to enhance adolescents' emotional regulation skills to effectively mitigate the risk of NSSI and SI.

Nonsuicidal self-injury (NSSI) is a serious mental health issues among emerging adults. Despite previous theory positing the potential role of filial piety, a Chinese-culture specific psychosocial factor, in NSSI, yet few studies have investigated the association between them. This study aimed to examine the impacts of reciprocal and authoritarian filial piety (RFP/AFP) on emerging adults’ NSSI through positive/negative self-compassion (PSC/NSC). A total of 2,320 Chinese college students (58.6% females) were included. Three waves of longitudinal data were collected with six-month intervals. At Time 1, filial piety, self-compassion and NSSI were assessed. Then, self-compassion was assessed again at Time 2, and NSSI was assessed again at Time 3. Finally, structural equation model was established to test the research hypotheses. Our results indicated that RFP increased NSC and subsequently increased NSSI (β = .007, 95%CI = [.001, .015], p = .018), but predominantly decreased NSSI by increasing PSC (β = −0.014, 95%CI = [−0.023, −0.007], p < .001). Conversely, AFP decreased both PSC (β = .007, 95%CI = [.002, .014], p = .002) and NSC (β = −0.006, 95%CI = [−0.013, −0.001], p = .016), but predominantly increased NSSI more by decreasing PSC. These findings highlight the important role of filial piety in emerging adults’ NSSI and elucidate its dual effects on NSSI via self-compassion. Preliminary insights that may inform practical implications were provided by these findings.

BackgroundAdolescent non-suicidal self-injury (NSSI) is common and adolescence is the most common period of first self-injury, and the occurrence of NSSI is influenced by negative life events and emotional symptoms. The mediating role of emotional symptoms in the interaction between negative life events and NSSI has not been carefully investigated yet.MethodsFor middle school students in three schools in a Chinese province, the Adolescents Self-Harm Scale was used to investigate NSSI, the Adolescent Self-Rating Life Events Check List was used to investigate adolescent negative life events, and the Self-Rating Anxiety Scale and Self-Rating Depression Scale were used to assess their emotional symptoms. After the description of general data and the test for differences between groups, the relationship between negative life events, emotional symptoms and NSSI was analyzed using Pearson correlation analysis. Structural equation modeling was used to analyze the mediating role of emotions in negative life events and NSSI.ResultsA total of 2376 junior high school students completed this survey, which revealed an annual NSSI prevalence of 37.1% (n = 881) and a higher prevalence of NSSI among girls and rural adolescents. Among adolescents who developed NSSI, 67.4% (N = 594) used multiple means of self-injury. The most common means of self-injury was hair pulling (51.0%), and the most common NSSI purpose and external factors/events were venting bad emotions or feelings (57.5%) and poor academic performance (44.9%), respectively. Negative life events, emotional symptoms and NSSI were positively associated (P < 0.05). Structural equation modeling with negative life events, emotional symptoms and NSSI as variables showed that the model-fit index matched the data well, with RMSEA = 0.073, AGFI = 0.945, GFI = 0.980, CFI = 0.985, NFI = 0.982, TLI = 0.968, IFI = 0.985, and negative life events, emotional symptoms (anxiety, depression) and NSSI all had direct effects with standardized path coefficients of 0.16, 0.19, and 0.23, respectively, with negative life events playing an indirect role in NSSI through emotional symptoms and emotional symptoms playing an incomplete mediating role in negative life events and NSSI.ConclusionThe prevalence of NSSI was higher among Chinese junior high school students. Both negative life events and emotional symptoms were direct risk factors for NSSI. In addition, negative life events were also indirect risk factors for NSSI, and emotional symptoms played an incomplete mediating role in the relationship between the effects of negative life events and NSSI. This indicates that the combination of reducing the frequency of negative life events while maintaining individual emotional stability during adolescent development can effectively reduce the prevalence of NSSI in adolescents.

The factors associated with non-suicidal self-injury (NSSI) of adolescents have been widely researched. However, the underlying mechanism of the relationship between childhood trauma and NSSI is limited. This study aimed to explore the risk factors for NSSI among Chinese adolescents. Our hypothesis was that psychological sub-health (PSH) played a mediating role between childhood trauma and NSSI. The Childhood Trauma Questionnaire, the Multidimensional Sub-health Questionnaire of Adolescent, and the self-report NSSI were used to measure childhood trauma, PSH, and NSSI. Structural equation model (SEM) was performed to verify our hypothesis. The results showed that 33.9% of the participants in our survey had engaged in NSSI in the past year. Adolescents who were left-behind children or in primary schools were more likely to engage in NSSI. Additionally, 56.2% of the participants had moderate to severe childhood trauma, and 26.1% of the participants had PSH. Furthermore, childhood trauma and PSH would increase the risk of NSSI by 2 times (B = 0.79, p < 0.01) and 5 times (B = 1.64, p < 0.01), respectively. SEM was established (p = 0.512) and the goodness-of-fit indices were examined (CMIN/DF = 0.892; GFI = 0.997; AGFI = 0.992; NFI = 0.991; RFI = 0.980; IFI = 1.00; TLI = 1.00; CFI = 1.00; RMSEA < 0.001). The SEM indicated that childhood trauma positively predicted NSSI both directly and indirectly through PSH. PSH has been confirmed to have partial mediating effects between childhood trauma and NSSI. The assessment of PSH may be an operable and effective method to screen and predict NSSI. Meanwhile, the intervention of childhood trauma and PSH may effectively prevent and reduce the occurrence of NSSI among adolescents.

Peer relationship plays an important role in non-suicidal self-injury (NSSI). However, little is known about how and in what conditions peer relationship may influence NSSI. By integrating multiple theories (i.e., attachment theory, the emotional regulation model of self-compassion and NSSI, and the differential-susceptibility theory), the current study investigated two potential mediators (i.e., self-compassion and depressive symptoms) and one potential moderator (i.e., behavioral impulsivity) of the relation between peer acceptance and NSSI. Participants were 813 Chinese adolescents (43% female; Mage at Wave 1 = 13.15 years) from a two-wave longitudinal study with data spanning one year. The results revealed that the indirect pathways linking peer acceptance and NSSI were conditioned on the level of behavioral impulsivity. Specifically, for adolescents with lower levels of impulsivity, a higher level of peer acceptance was related to fewer depressive symptoms directly or indirectly through self-compassion; fewer depressive symptoms, in turn, were linked to fewer NSSI behaviors longitudinally. For adolescents with higher levels of behavioral impulsivity, peer acceptance was related to fewer NSSI behaviors only through self-compassion. Results indicate that increasing peer acceptance is important in reducing adolescent NSSI. Interventions designed to reduce adolescent NSSI may also be effective if they focus on promoting adolescent self-compassion, particularly for adolescents with higher levels of behavioral impulsivity.

Research has found that peer victimization is associated with adolescent nonsuicidal self-injury (NSSI) behavior; however, most of these studies ignored the association between these constructs at the within-person level. Additionally, the association between peer victimization and NSSI may vary among adolescents with different personal characteristics. With a longitudinal design, this study investigated whether and how emotion regulation (ER) difficulties moderate the relationship between peer victimization and changes in NSSI, with particular attention given to the unique moderating role of different dimensions of ER difficulties. The study sample comprised 3,561 adolescents aged between 10 and 17 years old (Mage = 13.22, SD = 0.85; 56.9% males). Self-report assessments were administered in December 2021 and June 2022 in Shanxi province, China. The latent change score model showed that the adolescent NSSI increased during our assessments, with peer victimization as a significant predictor. ER difficulties moderated the association between peer victimization and NSSI changes, but interestingly, in an unexpected pattern. Specifically, peer victimization significantly predicted NSSI changes among adolescents with low ER difficulties but not for those with high ER difficulties. Moreover, among the multiple dimensions of ER difficulties, only nonacceptance of emotional responses and limited access to emotion regulation strategies interacted with peer victimization to predict NSSI changes and showed interaction patterns similar to those at the overall level of ER difficulties. The current study revealed the moderating role of ER difficulties in the relationship between peer victimization and changes in NSSI. These findings provide intervention implications for adolescents who engage in NSSI.

Stuck in a cycle of harm? The impact of emotional abuse on bullying and non-suicidal self-injury in adolescents: the role of perceived social support and self-compassion.

The influence of relationship loss on non-suicidal self-injury in adolescence: The mediating effects of perceived opportunity in adversity and PTSD symptoms.

This thesis comprises an in-depth study into the role of shame, and shame-related functioning, in the development and maintenance of non-suicidal self-injury (NSSI) amongst adolescents and emerging adults. In the initial chapters of this thesis, I review the literature on NSSI, shame, and adolescent and emerging adult development and mental health outcomes through a developmental psychopathology approach, concluding with the presentation of a novel model linking shame to NSSI. Briefly, I posit that adverse experiences with caregivers in prior development, such as child maltreatment and invalidation, are linked to NSSI during adolescence and emerging adulthood, through an increased sensitivity and immediacy in experiencing shame (i.e. shame-proneness) and maladaptive styles of coping with shame. I also posit that these aspects of shame are responsible for the relationship between NSSI and various proximal risk factors of NSSI such as low body esteem, increased loneliness, and heightened psychological distress during these periods of development. I further explain how these aspects of shame are also functionally related to NSSI and how the model is consistent with both self-punishment and affect regulation pathways to NSSI. The two studies in this thesis were conceptualised to probe various aspects of this model. The aim of the first study was to test whether shame-proneness and an internalising manner of shame-coping could account for the relationships between adverse experiences with caregivers in prior development (i.e. child maltreatment, parental invalidation), proximal identity and interpersonal stressors (i.e. body esteem and loneliness respectively), heightened psychological distress and the likelihood and severity of engaging in NSSI amongst emerging adults. The aim of the second study was to test whether shame-proneness and an internalising manner of coping with shame could account for the long established relationships between parental invalidation, proximal psychological distress and the use of NSSI to regulate internal cognitive and affective states (i.e. self-targeted functions) amongst emerging adults. Cross-sectional data from both studies were obtained from a single sample of 748 emerging adults (age in years: M = 20.8, SD = 2.21, 71.7% female, NSSI history: n= 395) recruited throughout Australia who completed an online questionnaire assessing the constructs of interest across both studies. Structural equation modelling analyses findings in both studies suggested that the data from this sample was a good fit with the models tested in both studies. Specifically, the findings from the first study indicated that shame-proneness and internalising shame-coping styles significantly link adverse attachment experiences in earlier development to history of NSSI and NSSI severity in emerging adulthood. Further, current developmental identity and interpersonal stressors link shame-proneness to psychological distress, which is, in turn, linked to history and severity of NSSI through internalising shame-coping. In the second study, hypothesised indirect effects of parental invalidation and proximal psychological distress on NSSI through shame-proneness and internalised shame-coping were supported for five common self-targeting NSSI functions. Together, the findings from both studies established that the direct and indirect effects through shame on NSSI proposed in the thesis’ overarching theoretical model were present in the recruited sample, providing a case for further research to test the role of shame as a mediatory mechanism of NSSI amongst young people. The theory and research findings presented in this thesis contribute to a deeper developmental understanding of NSSI, highlight crucial pathways between adverse early caregiving experiences and NSSI, and illuminate important shame-based mechanisms that may be appropriate therapeutic targets for individuals at risk. Future research directions and clinical recommendations are discussed.

Depression as a mediator between frequent nightmares and non-suicidal self-injury among adolescents: a 3-wave longitudinal model

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

Although a large body of research has found associations between aggressive behavior and non-suicidal self-injury (NSSI), evidence for the directionality, underlying mechanisms, and potential gender differences in their associations remain unclear. To address the gaps, this study investigated the bidirectional relationship between aggressive behavior and NSSI, the mediating role of peer victimization (physical and relational victimization), and gender differences in these associations among a sample of Chinese adolescents. Using a longitudinal design, a total of 1394 Chinese adolescents (Mage = 13.39, SD = 0.59, 43.3% girls) completed surveys across three waves, with intervals of nine and six months, respectively. The results revealed that within the total sample, T1 aggressive behavior positively predicted T2 physical victimization, and T2 physical victimization positively predicted T3 NSSI. T1 NSSI positively predicted T2 relational victimization, and T2 relational victimization positively predicted T3 aggressive behavior. However, the indirect effect of T1 aggressive behavior on T3 NSSI mediated by T2 physical victimization was significant only for boys. The indirect effect of T1 NSSI on T3 aggressive behavior mediated by T2 relational victimization was significant only for girls. These findings highlighted the importance of considering the gender-specific process underlying the relationship between aggressive behavior and NSSI, thus guiding the development of gender-informed prevention and intervention strategies.

This longitudinal study examined the reciprocal relationship between sleep disturbances with non-suicidal self-injury and whether self-compassion mediates these associations. A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students at the baseline. This study spanned six waves with a six-month interval between each wave. Data from the last four waves were used because self-compassion or non-suicidal self-injury was not measured in the first two waves. The cross-lagged panel models were used to examine the longitudinal dynamic relationships between sleep disturbances, self-compassion, and non-suicidal self-injury. The results showed that all the auto-regressive paths were significant. For the cross-lagged paths, there was a reciprocal relation between sleep disturbances and self-compassion. Importantly, self-compassion played a longitudinal mediating role in the prediction from sleep disturbances to non-suicidal self-injury (indirect effect = 0.007 to 0.009, all p values < 0.001). Psychological interventions targeting improved sleep quality and self-compassion may hold great promise for reducing the incidence of non-suicidal self-injury.