New Insights into Preventing Non-Suicidal Self-Injury Among Teens

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A recent study emphasized the importance of addressing negative automatic thoughts, emotional dysregulation and interpersonal factors, such as peer victimization, when developing interventions for adolescents at risk of NSSI.

Non-suicidal self-injury (NSSI), defined as deliberate acts of self-harm without the intention to die, among adolescents aged 12 to 18 years is a global public health concern, with a prevalence of 17.2%, and higher rates among females (19.7%) compared with males (14.8%). Associated with negative outcomes such as depression, anxiety, substance abuse and suicidal ideation, NSSI is influenced by both intrapersonal and interpersonal factors.

“Given the high comorbidity of NSSI with psychiatric disorders and its significant predictive value for future NSSI, early detection and intervention are of utmost importance,” wrote a team of investigators led by Jong-Sun Lee, PhD, associated with the Department of Psychology at Kangwon National University in South Korea.

During adolescence, both intrapersonal and interpersonal factors are significantly linked to NSSI, with one study demonstrating self-esteem, self-efficacy and cognitive reappraisal was able to mediate the relationship between insecure attachment and NSSI. It also showed family support was the best predictor of stopping NSSI, and a lack of support linked to the onset of NSSI.

The current study involving 881 South Korean adolescents and their parents aimed to classify children based on intrapersonal and interpersonal factors associated with NSSI. Children, ranging age from 11 to 16 years with a mean age of 13.91 years, were required to complete a self-reported, online questionnaire. The sample was comprised of 25.8% 6th graders, 25.85% 7th graders, 25.7% 8th graders and 23.5% 9th graders.

Investigators evaluated these factors using a comprehensive list of measurements including the Center for Epidemiological Studies Depression Scale for Children (CES-DC), the Automatic Thoughts Questionnaire (ATQ-N), the Ruminative Response Scale, the Difficulties in Emotion Regulation Scale—16 item version (DERS-16), Toronto Alexithymia Scale (TAS-20), the short form of the Buss-Perry Aggression Questionnaire (BPAQ-SF), the Body Investment Scale (BIS), the Perceived Stress Scale (PSS-10), the Self-Harm Screening Inventory (SHSI), the Peer-Victimization Scale & Bullying Behavior Scale (PVS & BBS), and the Family Adaptability and Cohesion Evaluation Scales-IV (FACES-IV).

Investigators identified three distinct groups based on these factors: a severe group (127 children), a moderate group (338 children) and a mild group (416 children).

Teens in the severe group had greater levels of negative cognition, emotional vulnerability, poor coping skills, perceived stress and peer victimization. This group also had weaker levels of factors that may prevent NSSI when compared with those in the mild and moderate groups.

Results were comparable with a previous study that showed the severe group, which was defined by high NSSI-high suicidality, had the poorest intrapersonal and interpersonal outcomes, such as greater internalizing and externalizing problems as well as less social support from friends and family. Negative cognitive patterns included automatic negative thoughts (“I’m so disappointed in myself”), brooding (“What am I doing to deserve this?”) and negative body image feeling (“I hate my body”).

A follow-up analysis showed significant differences among the three groups in both intrapersonal and interpersonal factors as well as the frequency of NSSI, with the severe group demonstrating the highest frequency of NSSI and the mild group reporting the lowest frequency.

“The identification of distinct subgroups based on intrapersonal and interpersonal factors allows for the development of targeted treatment interventions,” investigators concluded. “By tailoring treatment interventions, assessing and preventing risks, involving families, implementing school-based interventions, promoting resilience and ensuring follow-up and monitoring, clinicians can provide comprehensive and effective support for adolescents engaging in self-harm behaviors.”