Non-suicidal Self-injury In Adolescents Research Articles

Anxiety symptoms mediates the influence of cybervictimization on adolescent non-suicidal self-injury: The moderating effect of self-control

BackgroundNon-suicidal self-injury (NSSI) has received increased attention as a major public health problem among adolescents. However, there is a lack of evidence testing the longitudinal association between cybervictimization and NSSI as well as its underlying mediating and moderating mechanisms. The current study investigated the potential mediator (i.e., anxiety symptoms) and moderator (i.e., self-control) of the relation between cybervictimization and NSSI over a 12-month period. MethodsThree waves of data (called T1, T2 and T3) were collected 6 months apart, between November 2018 and 2019. 1987 Chinese adolescents completed self-report measures in their classrooms. SEM was used to test a moderated mediation model, with gender, age and childhood trauma and baseline measures as covariates. ResultsThe results found a longitudinal association between cybervictimization and NSSI as well as the mediating role of anxiety symptoms in explaining this association. Moderated mediation analyses revealed that greater cybervictimization contributed to anxiety symptoms, which in turn predicted increased levels of NSSI only among adolescents with lower self-control. LimitationsMeasures of study variables were self-reported, and generalizability may be limited by a sample of adolescents from school in China. ConclusionsThe present study demonstrated that the indirect effect of anxiety symptoms in the association between cybervictimization and NSSI was conditioned by self-control. These results have implications for preventative interventions aimed toward reducing NSSI for at-risk adolescents.

Resting state prefrontal cortex oxygenation in adolescent non-suicidal self-injury – A near-infrared spectroscopy study

IntroductionNeural alterations in limbic and prefrontal circuits in association with self-injurious behavior have been studied primarily in adult borderline personality disorder (BPD). In adolescent patients, research is still sparse. Here, we used resting functional near-infrared spectroscopy (NIRS) to examine oxygenation of the prefrontal cortex (PFC) and its association with symptom severity in adolescents engaging in non-suicidal self-injury (NSSI) and matched healthy controls (HC). MethodsAdolescents (12–17 years) with recurrent episodes of NSSI (n = 170) and healthy controls (n = 43) performed a low-demanding resting-state vanilla baseline task. Mean oxygenation of the PFC and functional connectivity within the PFC, were measured using an 8-channel functional NIRS system (Octamon, Artinis, The Netherlands). Various clinical variables derived from diagnostic interviews and self-reports were included in statistical analyses to explore potential associations with PFC oxygenation and connectivity. ResultsAdolescents with NSSI showed significantly decreased PFC oxygenation compared to HC, as indexed by oxygenated hemoglobin. Lower PFC oxygenation was associated with greater adverse childhood experiences and less health-related quality of life (HRQoL). While there was no evidence for alterations in PFC connectivity in adolescents engaging in NSSI compared to HC, increased PFC connectivity in the full sample was associated with greater adverse childhood experience, greater BPD pathology, greater depression severity and psychological burden in general, as well as lower HRQoL. ConclusionThis study is the first to examine PFC oxygenation using NIRS technology in adolescents engaging in NSSI. Overall, results indicate small effects not specific to NSSI. Clinical implications of these findings and recommendations for further research are discussed.

Identifying Biological Signatures of N-Acetylcysteine for Non-Suicidal Self-Injury in Adolescents and Young Adults.

The prevalence of non-suicidal self-injury (NSSI) is high in adolescents and young adults. However, there is a paucity of evidence-based treatments to address this clinical problem. An open-label, pilot study in the target population showed that treatment with oral N-acetylcysteine (NAC), a widely available dietary supplement, was associated with reduction in NSSI frequency. In preparation for a biologically informed design of an efficacy trial, a critical preliminary step is to clarify NAC’s biological signatures, or measures of the mechanisms underlying its clinical effects. Toward that end, we propose a 2-stage project to investigate NAC’s biological signatures (changes in glutathione (GSH) and/or glutamate (Glu)) in women with NSSI. The first stage; a double-blind randomized placebo-controlled study will focus on identifying the optimal dose to achieve meaningful change in GSH and Glu during short-term (4 weeks) NAC treatment in 36 women aged 16–24 years with NSSI. Go/No-go criteria to determine if the study will progress to the second stage include pre-specified changes in brain and blood measures of GSH. Changes in the brain GSH are measured through magnetic resonance spectroscopy (MRS). The dose for the stage 2 will be selected based on the biological changes and the tolerability observed in the stage 1. The stage 2 will seek to replicate the biological signature findings in an 8-week trial in a new patient cohort, and examine the relationships among biological signatures, NAC pharmacokinetics and clinical response. This 2-stage project is unique as it unifies clinical psychiatric measurements, quantitative MRS and pharmacological approaches in the first placebo-controlled clinical trial of NAC in young women with NSSI.Trial registration:The stage 1 trial protocol has been registered on https://clinicaltrials.gov/ with ClinicalTrials.gov ID “NCT04005053” (Registered on 02 July 2019. Available from: https://clinicaltrials.gov/ct2/show/NCT04005053).

The Difficulty of Case Management or Counseling for Non-suicidal Self-injury in Adolescents: Focused on the Factors in the Community

Purpose: This qualitative study is aimed to explore the factors in the aspect of the community that made it difficult for field experts to conduct counseling and case management. Methods: A total of four focus group interviews composed of 15 field experts including nurses were conducted. Results: A theme, six categories and 22 subcategories were derived. As for the theme, it was found that legal, educational, and environmental systems reflecting non-suicidal self-injury of the characteristics in adolescents were insufficient. In the legal aspect, the defect of the parental education legal system, the reality of having to rely on parental consent when supporting adolescents with non-suicidal self-injury; in the educational aspect, the lack of manuals and education for counseling and case management for adolescents with non-suicidal self-injury; in the environmental aspects, the defect of economic burden and support, a lack of information systems for various organizations in the local community, absence of a dedicated support system for adolescent with non-suicidal self-injury and a lack of human and physical resources. Conclusion: Based on the results of this study, there needs to be a responsible institution that can comprehensively manage the non-suicidal self-injury of adolescents, and efforts to develop the competence of community nurses.

Development of the Japanese version of the inventory of statements about self-injury and classification of nonsuicidal self-injury in adolescents based on its functions

Development of the Japanese version of the inventory of statements about self-injury and classification of nonsuicidal self-injury in adolescents based on its functions

Association between parenting and non-suicidal self-injury among adolescents in Yunnan, China: a cross-sectional survey.

BackgroundNon-suicidal self-injury (NSSI) among adolescents is prevalent and its rate has increased in recent years worldwide. Previous studies had investigated the association between parenting and childhood NSSI, but little is known about the relationship between parental rearing and repetition and severity of NSSI. The aim of this study was to investigate associations of parenting with NSSI and its repetition and severity in a representative adolescent sample from southwestern China.MethodsIn this cross-sectional study, a sample of 2,705 adolescents (F/M: 1,245/1,460; mean age: 13.4 ± 2.2 years) was recruited from 14 randomly selected schools in Lincang municipality, Yunnan province, China. A self-report questionnaire was used to collect data. The Adolescent Non-Suicidal Self-Injury Function Assessment Scale and the short Chinese Egna Minnen av Barndoms Uppfostran (s-EMBU-C) were used to evaluate NSSI behaviors and parenting style, respectively. Univariate and multivariate logistic regression models were adopted to examine association between parenting and NSSI.ResultsOverall lifetime prevalence of NSSI was 47.1% (95% CI [36.2–58.0]), with self-cutting being the most common form (23.5% (95% CI [19.3–27.7])), followed by hitting hard objects (23.4% (95% CI [20.2–26.7])) and pulling hairs (20.9% (95% CI [18.8–22.6])). In multiple logistic regression analyses, NSSI was positively associated with high level of father’s rejection (OR: 1.32 (95% CI [1.01–1.72])), high level of mother’s rejection (OR: 1.76 (95% CI [1.46–2.13])), low level of mother’s emotional warmth (OR: 1.42 (95% CI [1.15–1.75])), and high level of mother’s overprotection (OR: 1.74 (95% CI [1.49–2.03])), repeated NSSI was positively associated with low level of father’s emotional warmth (OR: 1.39 (95% CI [1.10–1.75])) and high level of mother’s overprotection (OR: 1.79 (95% CI [1.33–2.41])), and severe NSSI was positively associated with low level of father’s emotional warmth (OR: 1.64 (95% CI [1.11–2.43])) and high level of mother’s rejection (OR: 2.16 (95% CI [1.71–2.71])).ConclusionNSSI is common among adolescents in southwestern China. Negative parenting styles are associated with NSSI, repeated NSSI, and severe NSSI. The development of intervention measures for preventing or reducing NSSI among Chinese adolescents in school settings should consider parenting styles.

청소년의 정서적 학대 경험이 비자살적 자해에 미치는 영향: 초기부적응도식과 정서조절곤란의 이중매개효과

청소년의 정서적 학대 경험이 비자살적 자해에 미치는 영향: 초기부적응도식과 정서조절곤란의 이중매개효과

유년기 무효화 환경과 고통 감내력 부족이 청소년의 비자살적 자해에 미치는 영향 : 자기표현의 매개된 조절효과

본 연구는 유년기 무효화 환경, 고통 감내력 부족이 청소년의 비자살적 자해에 미치는 영향과 자기표현의 매개된 조절효과를 확인하고자 실시하였다. 이를 위해 경기도에 재학 중인 13∼19세 청소년을 대상으로 수집한 730명의 자료를 분석하였다. 통계분석은 SPSS V24.0을 이용하였고, 연구 결과는 다음과 같다. 유년기 무효화 환경 경험이 많을수록 비자살적 자해가 증가하고, 고통 감내력이 부족해질수록 비자살적 자해가 증가하지만, 자기표현은 비자살적 자해를 감소시키는 것으로 나타났다. 유년기 무효화 환경은 비자살적 자해에 미치는 영향에서 고통 감내력 부족이 매개역할을 하고, 자기표현이 조절역할을 하는 것으로 나타났다. 마지막으로 자기표현의 매개된 조절효과를 확인하였다. 이러한 결과를 바탕으로 본 연구의 의의와 제한점에 대해 논의하였다.

An Exploration of the Relationship between Interpersonal Needs and Nonsuicidal Self-Injury in Adolescents

Nonsuicidal self-injury has become a worrying phenomenon among adolescents worldwide, emphasising the need for increasing public health awareness and exploration of the factors associated with this behaviour. This study was framed using Joiner’s Interpersonal–Psychological Theory of Suicide and Nock and Prinstein’s four-function model of nonsuicidal self-injury. The aim of this study was to explore the relationship between the interpersonal needs constructs of Joiner’s theory and nonsuicidal self-injury and is motivated by the need to explore the contagion of self-injury. A cross-sectional convenience sampling method was used to obtain a sample of 216 adolescents, who were recruited from four schools in the greater Durban area, South Africa. Regression analyses were performed to establish whether a relationship exists between the interpersonal needs constructs and nonsuicidal self-injury. The results indicated a positive relationship between perceived burdensomeness and the occurrence of nonsuicidal self-injury in this sample, thereby illuminating thwarted interpersonal needs as a contributor to the occurrence of nonsuicidal self-injury in adolescents.

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

BackgroundFrequent nightmares and depression are associated with non-suicidal self-injury (NSSI) in adolescents. Little is known about the mediating role of depression in the nightmare-NSSI link. This study explores the longitudinal mediating effect of depression on the relationship between frequent nightmares and NSSI as well as the moderating effect of gender using a three-wave longitudinal design. MethodsParticipants were adolescents from the Shandong Adolescent Behavior and Health Cohort who were surveyed at baseline, 1 year later, and 2 years later. A self-administered questionnaire was used to measure nightmare frequency, depression, and NSSI. Structural equation modeling and multiple-group analysis were used to test the mediating effect of depression and the moderating effect of gender. Covariates included demographics and earlier measures of depression and NSSI. ResultsAmong 6995 participants, 3399 (48.6%) were females, mean age was 14.86 (SD = 1.50) years at baseline. Frequent nightmares had a significant mediation effect on NSSI through depression (Bab = 0.06, 95% CI = 0.02–0.10) after controlling for demographics and earlier measures of depression and NSSI. Gender had no significant moderating effect on the nightmare-NSSI association. LimitationsAll data were collected by self-report. ConclusionsThe association between frequent nightmares and NSSI in adolescents was partially mediated by depression. Frequent nightmares and depression should be assessed and treated to prevent self-harm in adolescents.

Cyberbullying Victimization and Non-suicidal Self-Injurious Behavior Among Chinese Adolescents: School Engagement as a Mediator and Sensation Seeking as a Moderator.

Although a large body of research has indicated that cyberbullying victimization is a crucial risk factor for adolescent non-suicidal self-injury (NSSI) behavior, the mediating and moderating mechanisms underlying this relationship remain unclear. To address this research gap, this study, based on the social control theory and the organism-environment interaction model, was designed to test whether school engagement mediated the relationship between cyberbullying victimization and adolescent NSSI and whether this mediating effect was moderated by sensation seeking. A sample of 1,102 adolescents (Mage = 13.17; SD = 0.69) anonymously completed the questionnaires. The results showed that the positive association between cyberbullying victimization and adolescent NSSI was mediated by school engagement. Moreover, this indirect link was significant for adolescents with high-level sensation seeking but non-significant for adolescents with low-level sensation seeking. These findings highlight school engagement as a potential mechanism linking cyberbullying victimization to adolescent NSSI, and high sensation seeking was an important risk factor to amplify this indirect effect. Intervention programs aimed at reducing NSSI among adolescents may benefit from the current research.

The Impact of Adverse Childhood Experiences on Therapy Outcome in Adolescents Engaging in Nonsuicidal Self-Injury.

Objective: Nonsuicidal self-injury (NSSI) is a prevalent and clinically significant behavior. There is a substantial association between adverse childhood experiences (ACEs) and NSSI. However, there are no studies investigating the impact of ACEs on NSSI treatment (psychotherapy) outcome. The aim of this secondary analysis of a randomized controlled trial (RCT) on psychotherapy of NSSI was to investigate the relationship between ACEs and treatment outcome in adolescents engaging in NSSI.Method: A sample of 74 adolescent outpatients engaging in repetitive NSSI (incidents on ≥ 5 days within the last 6 months) was recruited for a RCT. ACEs were assessed by the Childhood Experience of Care and Abuse (CECA) interview before treatment onset. Based on the CECA, participants were divided in two groups: with a history of ACEs (n = 30) and without a history of ACEs (n = 44). Frequencies of NSSI, depression, and suicide attempts as well as quality of life were measured at three points in time: before treatment onset (baseline; T0), 4 (T1), and 10 months (T2) after treatment onset.Results: Both participants with and without ACEs were able to reduce the frequency of NSSI significantly [χ2(1) = 26.72; p < 0.001]. Surprisingly, participants with ACEs reached a significantly greater reduction in NSSI frequency within the past 6 months compared to participants without ACEs [χ2(1) = 5.08; p = 0.024]. There were also substantial and similar improvements regarding depressive symptoms, suicide attempts and quality of life in both groups.Conclusion: ACEs seem to positively predict treatment response in psychotherapy for adolescent NSSI. This is contrary to prior research suggesting ACE as an unfavorable prognostic factor in the treatment of mental disorders.Clinical Trial Registration: Short term therapy in adolescents with self-destructive and risk-taking behaviors; http://www.drks.de; DRKS00003605.

Predictors of non-suicidal self-injury cessation in adults who self-injured during adolescence

Most studies of non-suicidal self-injury (NSSI) investigate individuals who are currently self-injuring. The current study aimed to identify factors associated with continuation or cessation of NSSI from adolescence to adulthood. Adult participants (n = 724) completed an online cross-sectional survey of their experiences of NSSI in adolescence, the functions served by NSSI, and measures of current role functioning and psychological well-being. The functions of NSSI in adolescence significantly predicted cessation or continuation of NSSI in adulthood. Intrapersonal functions of NSSI increased the likelihood of ongoing self-harm, whereas interpersonal functions of NSSI increased the likelihood of cessation of self-harm in adulthood. Cessation of NSSI was also associated with increasing age and having previously received mental health treatment. Participants who had ceased NSSI in adulthood reported lower rates of psychological distress, greater life satisfaction, were more likely to be engaged in work and had achieved a higher level of education overall. The study was cross-sectional and relied on retrospective accounts of those participants who had ceased NSSI. The vast majority of participants were female and Australian, so generalizability beyond this population must consider this limitation. Many individuals who engage in NSSI in adolescence successfully cease self-harming by adulthood. Cessation of NSSI is associated with better psychological well-being and higher role functioning. Ongoing NSSI from adolescence to adulthood is likely where NSSI serves intrapersonal functions. Clinical intervention must be a priority in such cases.

27.1 NONSUICIDAL SELF-INJURY AND ITS RELATIONSHIP TO SUICIDAL BEHAVIOR: AN OVERVIEW

The objectives of this presentation are to: 1) provide an evidence-based overview of nonsuicidal self-injury (NSSI) as it relates to suicidal behavior and theories of suicide; 2) present the issues facing clinicians in various settings related to recognition, assessment, and interventions for NSSI in children and adolescents; and 3) familiarize clinicians with salient risk and protective factors that enhance prevention of suicide in adolescents and emerging adults manifesting NSSI.

Pain sensitivity and plasma beta-endorphin in adolescent non-suicidal self-injury

BackgroundBeta-endorphin (BE) has been suggested to play a central role as to why people engage in NSSI. To our knowledge, no study has systematically assessed this potential relationship in adolescents with NSSI. Methods94 adolescents with NSSI (according to DSM-5 criteria) and 35 healthy controls (HC) were enrolled. All participants received heat pain stimulation, with pain threshold and tolerance measured in °C. Plasma BE levels were assessed. Sociodemographic and clinical characteristics were obtained via semi-structured interviews and self-report questionnaires. ResultsAdolescents with NSSI showed increased pain thresholds (t(127)=2.071, p=.040), lower pain intensity (t(114)==2.122, p=.036) and lower plasma BE levels (t127==3.182, p=.002) compared to HC. Groups did not differ on pain tolerance (t(127)=0.911, p=.364). Greater pain threshold correlated positively with borderline personality disorder (BPD) symptoms (r=0.182, p=.039), while pain intensity (r=-0.206, p=.033) and BE levels (r=-0.246, p=.007) correlated negatively with depression severity. No significant relationship was found between pain threshold and plasma BE (r=-0.013, p=.882). LimitationsFuture studies should implement repeated plasma BE measures to assess BE release in association with pain in NSSI. Validity of plasma BE measures compared to central measures should be considered. Assessing the association between pain sensitivity (PS) and BE in a naturalistic setting presents a promising avenue for future research in NSSI. ConclusionsFindings support both reduced PS and basal opioid deficiency as independent biological correlates and potential risk-factors for NSSI. Further longitudinal and experimental studies are needed to investigate the role of BE levels and PS as well as their potential association.

High-frequency ecological momentary assessment of emotional and interpersonal states preceding and following self-injury in female adolescents

Non-suicidal self-injury (NSSI) is a considerable health problem among adolescents. Affect regulation by means of self-injury may promote the maintenance of NSSI. However, existing findings have limited ecological validity. The present study aimed to assess emotional and interpersonal states preceding and following incidents of NSSI in female adolescents. Adolescents with NSSI-disorder completed ecological momentary assessments of affective and interpersonal states on an hourly basis for multiple days. Multilevel mixed-effect regression analyses were conducted to assess antecedences and consequences of acts of self-injury. Data from n = 73 female adolescents covering a total of 52 acts of self-injury were available for analyses. The urge to self-injure on the between subject-level and negative affect on the within-level were best predictors of self-injury. Surprisingly, self-injury increased negative affect and decreased feelings of attachment (mother only) in the following hour. In line with findings in adults, results illustrate the important association between negative affect and self-injury in female adolescents. However, the occurrence of NSSI itself was related to concurrent increases in negative affect, and even prospectively predicted a consecutive increase in negative affect. Therefore, improvements of negative affect following (or during) self-injury, as previously reported, are at best short-lived (< 1 h).

Non-suicidal self-injury in adolescence: Longitudinal evidence of recursive associations with adolescent depression and parental rejection

IntroductionNon-suicidal self-injury (NSSI) has been acknowledged as a major public health concern among adolescents. However, the complex association between parental rejection and NSSI is not entirely understood and the existing literature does not address the underlying mechanism of adolescent depressive symptoms in explaining the process. MethodsThree waves of data (called T1, T2 and T3) were collected 6 months apart, between November 2018 and 2019, in a sample of 1987 Chinese adolescents (56.1% males; ages 10 to 14, M = 12.32, SD = 0.53). Two separate autoregressive cross-lagged models were used to examine the bidirectional association between parental rejection and NSSI as well as the role of depressive symptoms in bidirectional mediation. ResultsThere was strong evidence of bidirectional effects between parental rejection and NSSI at both 6-month intervals. Parental rejection at T1/T2 positively predicted NSSI at T2/T3, and, vice versa, NSSI at T1/T2 positively predicted parental rejection at T2/T3. Furthermore, we found that the reciprocal association between parent rejection and NSSI was mediated by adolescent depressive symptoms. ConclusionsThe present study found reciprocal associations between parental rejection and NSSI, and further demonstrated that the bidirectional process was mediated by depressive symptoms. The findings from this study are of great interest as they help to inform the development of future prevention and intervention strategies for NSSI.

Parents' Attitudes Toward and Experience of Non-Suicidal Self-Injury in Adolescents: A Qualitative Study.

BackgroundNon-suicidal self-injury (NSSI) is prevalent in adolescents and brings a series of serious consequences to their well-being. However, little is known about parents’ attitude toward NSSI in Chinese adolescents. The study aims to investigate the parents’ attitudes toward and perceptions of adolescents who have engaged in NSSI behaviors, and the impact of NSSI on their parents.MethodsPurposive sampling was used in the study. The biological parents of adolescents with NSSI were recruited from the psychiatric ward of a tertiary hospital in China. Semi-structured interviews were conducted which contained three aspects, that is the history of NSSI, the process of seeking or maintaining help and the impacts on the family. Each interview typically lasted 40–50 min. All of the interviews were audio-recorded. Their responses were analyzed by the thematic analysis.ResultsTwenty participants completed the interview, consisting of 16 mothers and 4 fathers. Three themes and eight sub-themes were extracted: (1) the attitudes to children’s NSSI behaviors (ignorance, shame, and stereotype); (2) coping strategies of parents (the initial response to adolescents’ NSSI, and the way of help-seeking); (3) the impacts on family (altered parenting and communication styles, limited personal lives, and increased psychological pressure).ConclusionThe results showed that parents lack the knowledge about NSSI and its treatment and are suffering great emotional stress. It is recommended to expand the popularization of knowledge of NSSI in adolescents and more interventions adapted to China’s sociocultural climate are required for the well-being of parents and NSSI in adolescents.

Anti-Suicide Function of Nonsuicidal Self-Injury in Female Inpatient Adolescents.

BackgroundThere have been numerous studies investigating the relationship between nonsuicidal self-injury (NSSI) and suicidality. On the one side, NSSI is an important risk factor for suicidality, including suicidal thoughts and behaviors. On the other side, it has been suggested that one function of NSSI might be as a coping mechanism that can help individuals in the short term avoid suicide. The present study investigated the relationship between suicidality and NSSI in female inpatient adolescents, focusing on NSSI as an anti-suicide strategy.MethodsSubjects were 56 female adolescents, aged 12–18 years (M = 15.95 years, SD = 1.27), recruited from different inpatient child and adolescent psychiatric units. All participants fulfilled the DSM-5 research criteria for nonsuicidal self-injury disorder (NSSI-D). To assess suicidality, NSSI-D, and current and past diagnoses, a structured clinical interview was conducted.ResultsNSSI as a short-term coping strategy for avoiding suicide was indicated by one third (32.1%) of the participants. Before participants engaged in NSSI, the anti-suicide function was reported more frequently than reducing interpersonal problems (d = -.59). Getting relief from negative emotions and inducing positive feelings were reported at the same frequency as avoiding suicide before NSSI. Participants engaging in NSSI to avoid suicide and those reporting other functions did not significantly differ regarding other NSSI characteristics, suicidality, or psychopathology. Results indicate that the anti-suicide function significantly predicts the duration of current suicidal ideation (β = .557).ConclusionThis study provides preliminary support for the idea that NSSI is frequently used by female adolescents with NSSI-D to avoid suicide. Given the high co-occurrence of NSSI and suicidality, our results underline the importance of clinical assessment of suicidality and several NSSI functions, including the anti-suicide function, in adolescents with NSSI.

Childhood emotional abuse and adolescent nonsuicidal self-injury: The mediating role of identity confusion and moderating role of rumination

ObjectiveAccording to Nock’s (2009) integrated model, nonsuicidal self-injury (NSSI) is caused by the interplay of distal environmental and proximal intrapersonal risk factors. Based on this theory, the current study tested a moderated mediation model of family and individual characteristics to investigate how they impact adolescent NSSI. Specifically, we examined whether identity confusion mediated the association between childhood emotional abuse and NSSI, and whether this indirect effect was moderated by rumination. Methods949 Chinese adolescents anonymously filled out questionnaires regarding emotional abuse, identity confusion, rumination, and NSSI. ResultsThe results revealed that childhood emotional abuse was positively associated with NSSI, and this association was mediated by identity confusion. Rumination intensified the association between childhood emotional abuse and identity confusion, as well as the association between childhood emotional abuse and NSSI. ConclusionsThese findings highlight the need to consider family and individual factors simultaneously when evaluating risks associated with adolescent NSSI and have important implications for the prevention and intervention of NSSI.