Background: Childhood maltreatment (CM) is recognized as one of the primary factors increasing the risk of non-suicidal self-injury (NSSI).Objectives: This study aims to further understand the impact of different types of CM on the mechanisms underlying NSSI risk by examining the potential mediating roles of mentalization and depression.Method: A self-report survey was conducted with 1645 Chinese youths (933 males, 712 females; mean age = 18.25, SD = 0.64) to evaluate their experiences of CM, depression, mentalization, and NSSI frequency over the past year. Structural equation modelling was utilized to examine the direct and indirect pathways linking CM to NSSI risk via mentalization and depression.Results: The study found that emotional abuse, physical abuse, mentalization, and depression had significant direct effects on NSSI risk. Moreover, mentalization and depression mediated the relationship between emotional abuse and NSSI risk, while emotional neglect and physical neglect indirectly influenced NSSI risk only through depression. Physical abuse had a significant direct effect on NSSI risk, whereas sexual abuse did not show any direct or indirect effects.Conclusions: The findings suggest that childhood emotional abuse has a markedly different impact compared to other forms of CM. Interventions focused on improving mentalization may be particularly effective in addressing the effects of emotional abuse, mitigating depression, and reducing the risk of NSSI.

Adolescent depression is highly co-occurring with non-suicidal self-injury (NSSI). Exploring the relationship between NSSI and facial emotion recognition is crucial for early intervention in adolescents with depression.

This study used a multi-center cross-sectional design (14 psychiatric hospitals in 9 provinces of China). The Patient Health Questionnaire-9 (PHQ-9) and Functional Assessment of Self-Mutilation (FASM) were used to evaluate depression and NSSI respectively. Six emotions including neutral, angry, disgusted, fearful, happy, sad and surprised were used for testing. Spearman correlation analysis and binary logistic regression analysis were used to explore the relationship between NSSI and emotion recognition.

This study recruited 1644 adolescent depression patients, of whom 76.2 % (1252/1644) reported NSSI behavior and had significantly higher PHQ-9 scores than adolescents without NSSI behavior (p < 0.001). "Cut or carved on your skin" was more common in the choice of method (87.6 %). The age curve showed that girls have more NSSI in each age group, and the peak incidence of NSSI in girls was higher than that in boys. Compared with the non-NSSI group, the NSSI group exhibited higher accuracy in recognizing aversive emotions. In addition, PHQ-9 scores were significantly correlated with the recognition of neutral(P < 0.001), angry(P = 0.011), and happy(P = 0.008). Furthermore, PHQ-9 scores (P < 0.001) and Surprised facial emotion recognition scores (P = 0.026) showed significant correlations with NSSI behavior.

NSSI is common in adolescents with depression, and the emotional recognition ability of NSSI patients has decreased, especially in identifying neutral, happy, and angry emotions. Similarly, depression further exacerbates the risk of NSSI.

Non-suicidal self-injury (NSSI), deliberate damage to body tissue with no intent to die, is not engaged with suicidal intent but is the most reliable predictor of later suicidal behaviour. This makes efforts to reduce self-injury critical. Emergency departments can be the gateways to care for many people who have self-injured and optimal sites for interventions that promote recovery. However, emergency nurses have anecdotally reported that they lack training and feel ill-equipped to provide care for patients who self-injure. In this open label trial (where both participants and researchers were aware who received the intervention), all nurses in a metropolitan emergency department were invited to complete a multi-modal training programme designed to improve their knowledge, attitudes, confidence, and resilience, and reduce burnout related to caring for patients who self-injure. We also invited nurses to provide feedback in one-on-one interviews. Sixty nurses completed self-report measures at pre, post (immediately following training), and 1-month following training. Gains were seen immediately post-training in knowledge, empathy, self-compassion, and resilience, while reductions were seen in negative attitudes and burnout. In all cases these changes were maintained at 1-month follow-up. Eighteen nurses participated in interviews, who reported on the impact of the training on improving understanding of NSSI and confidence in working with patients who self-injure at both a personal and institutional level. They also identified barriers to implementing training, many of which require system-level changes within the health system. Findings suggest that training integrated within emergency settings can have a significant impact, not only on knowledge and confidence but on the wellbeing of emergency staff working with patients who self-injure.

We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI).

A qualitative study nested within a controlled feasibility trial.

Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis.

Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents.

Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.

Previous studies have linked ADHD with self-harm, but the processes underlying this association are not fully understood. This research aims to investigate the role of sleep disturbances as a potential pathway between ADHD diagnosis and self-harm behaviors.

The study included 90 youth aged between 11 and 18 years, divided into two groups: a case group of 45 youth diagnosed with ADHD and a control group of 45 youth without ADHD. Both groups completed the Inventory of Statements About Self-Injury to evaluate self-harm behaviors and the Sleep Disturbance Scale for Children to assess sleep disturbances. A path analysis was conducted to examine whether a significant proportion of the association between ADHD and self-harm was shared with sleep disturbances, while controlling for gender, youth education, family income, maternal education, and overall anxiety and depression scores.

An ADHD diagnosis was significantly associated with sleep disturbances (β = .62, p < .001) and self-harm behaviors (β = .35, p = .03). Additionally, sleep disturbances were significantly linked to self-harm (β = .51, p = .002) and played a significant role in the association between ADHD and self-harm (indirect effect β = .32, p = .001).

These findings suggest that sleep disturbances account for a substantial proportion of the shared variance in the association between ADHD and self-harm. While the cross-sectional design limits causal interpretations, these results highlight the importance of addressing sleep issues in clinical care for ADHD to potentially reduce self-harm risks and improve outcomes for at-risk youth.

In trying to better understand why certain individuals self-injure, researchers have proposed high emotional reactivity for negative emotions may influence vulnerabilities and predispose individuals to react to stressful situations in a dysregulated manner, thus engaging in non-suicidal self-injury (NSSI). However, the role of emotional reactivity for positive emotions in those with a history of NSSI is still unclear. Thus, the present study sought to examine group differences in the reactivity of (a) negative and (b) positive emotions in young adults with and without a history of NSSI engagement, and (c) to evaluate whether the reactivity of positive emotions could predict NSSI engagement when controlling for reactivity of negative emotions. The sample consisted of 96 female students who reported engaging in NSSI within the past 2 years (Mage = 20.28 years, SD = 1.65) and an age-matched female comparison group with no NSSI history (Mage = 20.43 years, SD = 1.76). Results from separate MANOVAs indicated individuals with a history of NSSI reported higher negative reactivity across all aspects (emotional intensity, sensitivity, and persistence) than the comparison group, Wilk's λ = .86, F (3,188) = 10.65, p < .001, partial η2 = .145; however, no significant differences emerged for positive reactivity, Wilk's λ = .99, F (3,188) = 0.52, p = .669. Moreover, a logistic regression revealed that persistence of negative emotions was the only significant predictor of NSSI, Wald χ2 (1) = 4.54, p = .03. The present results highlight the importance of the persistence of negative emotions for individuals who engage in NSSI. Furthermore, the current study provides the first suggestion of no significant differences in positive emotional reactivity between individuals with and without NSSI; underlining the importance of focusing on negative emotional reactivity in clinical practice as well as using positive emotions to "undo" the effect of negative emotions.

Non-suicidal self-injury (NSSI) not only causes direct physical harm but also severely impacts mental health, increasing the risks of psychological disorders, behavioral issues, and suicidal tendencies. With the widespread use of the internet and electronic communication tools on smartphones, such as social media and instant messaging applications, cyberbullying has become increasingly prevalent. However, research on the relationship between cyberbullying and NSSI remains relatively limited at present.

This research was conducted in Nantong City, Jiangsu Province, from July to September 2024, utilizing a convenience sampling method with 1,751 participants. Propensity Score Matching (PSM) was employed to control for confounding factors, while causal mediation analysis was used to assess the mediating effects of anxiety, depression, stress, and loneliness between cyberbullying and NSSI.

In this study, 557 participants (31.8%) reported having experienced cyberbullying, Cyberbullying significantly increases NSSI odds through direct and indirect effects, mediated by anxiety (ACME = 0.08, ADE = 0.22, mediated proportion = 0.28), loneliness (ACME = 0.04, ADE = 0.26, mediated proportion = 0.14), stress (ACME = 0.05, ADE = 0.24, mediated proportion = 0.18), and depression (ACME = 0.06, ADE = 0.24, mediated proportion = 0.19).

This study explores the relationship between cyberbullying, mental health issues (depression, anxiety, stress, loneliness), and NSSI. Findings show cyberbullying directly and indirectly increases NSSI risk, with loneliness as a key mediator. Despite insights, the study has limitations, suggesting a need for more rigorous designs and comprehensive data.

Non-suicidal self-injury (NSSI) represents a prevalent and significant mental health difficulty experienced by young adults. Few efforts have explored lived experience perspectives concerning the impact of NSSI stigma, despite long-standing recognition that NSSI is highly stigmatised and recent calls for more research in this area. New insights would be fruitful in identifying which manifestations of stigma are most germane to people who engage in NSSI and what stigma-related supports they may need. Accordingly, the present study sought to understand lived experience perspectives regarding the impact of NSSI stigma.

A total of 97 young adults with a mean age of 19.32 years (standard deviation [SD] = 2.17) participated in the present study. Participants completed an online survey, including open-ended questions asking about how they have been impacted by NSSI stigma and how they believe people are generally impacted by such stigma. Reflexive thematic analysis was used to analyse text-based responses.

Our analysis yielded four themes, namely: Shamed into Silence; Unspoken but Sensed Stigma; Anticipation and Avoidance of Stigma, Enduring Shadow of Stigma. These implicate internal forms of stigma - namely, self and anticipated stigma. Collectively, such stigma fomented a significant and often ongoing psychosocial burden involving shame and disclosure reluctance. Participants also perceived external stigma from others, highlighting both verbal and non-verbal considerations therein.

The current findings highlight several psychosocial consequences of NSSI stigma for individuals with lived experience. In this way, this study adds to a growing body of work illustrating the value of lived experience perspectives in NSSI research and has important implications for research, anti-stigma work, and clinical practice.

Adolescent sexual offending is a complex and multifaceted issue; however, existing research is predominantly derived from Western contexts, leading to gaps in understanding these behaviors in underrepresented regions. Criminal characteristics, psychiatric diagnoses, and cognitive factors, which are recognized to affect offending trajectories and reporting patterns, may differ in these underexplored contexts.

The objective of the research is to categorize male adolescents with a history of perpetration of sexual offenses based on the age of their victims (peer/adult vs. child) and to conduct a comparative analysis of their psychiatric diagnoses, socio-demographic profiles, intelligence scores, and offense characteristics in a forensic setting in Türkiye.

The study includes 119 male juveniles referred for criminal responsibility evaluations-43 with child victims and 76 with peer victims. Both groups displayed borderline to low-average IQ scores, with intellectual disability as a common diagnosis. The most common offence in both groups is qualified sexual assault. In the majority of cases, the initiation of judicial proceedings occurs as a result of the family complaints. Alcohol and substance use disorders were less prevalent than reported in Western samples, potentially reflecting cultural and religious influences. The majority of the perpetrators were school dropouts, suggesting that educational disruptions may have played a significant role in the perpetrators' backgrounds.

The findings highlight the importance of implementing tailored interventions that address cognitive impairments and social skills deficits. Identifying the factors that contribute to school dropout and implementing preventive measures may prove to be an effective strategy for preventing future criminal behavior and promoting healthier adolescent development.

Non-suicidal self-injury (NSSI) is highly prevalent in recent years, but the genetic architecture remains unknown. We perform a multitrait analysis of genome-wide association study on NSSI, incorporating self-harm and suicide attempt. Common genetic variants account for 6.03% of NSSI variance. Three risk loci are associated with NSSI at 7q31.2 (rs62474683), DCC (rs4372758), and LCA5L/GET1/GET1-SH3BGR (rs2837022). Increased expression levels of GET1/SH3BGR in hippocampus relates to NSSI risk. Fine-mapping identifies seven likely causal variants, and colocalization with rs4281987 and rs2837022 evidences SH3BGR/GET1 expression in hippocampus to NSSI. In an independent sample, polygenic risk score for NSSI is associated with children's NSSI behavior, suicidal ideation, and suicide attempt (odds ratios [ORs]: 1.14-1.37). Reduction in right temporal pole volume mediates NSSI genetic liability for children's NSSI behavior. Walking for pleasure and exercises like swimming and bowling reduces NSSI risk, whereas smoking increases it. This study elucidates the NSSI genetic basis and its impact on children's emotions, behavior, and brain structure.

Grounded in the 24-Hour Activity Cycle framework, this study aimed to quantify dose-response thresholds for seven daily behaviors-sleep, napping, low to high intensity physical activity, sedentary time, and screen time-and to evaluate their associations with mental health problems and self-injurious thoughts or behaviors in Chinese adolescents.

Between 2022 and 2023, data were collected from 33,397 Chinese students to examine lifestyle patterns and mental health. Adjusted logistic regression estimated associations between behavioral categories and four mental-health outcomes, and generalized additive models captured dose-response relationships.

Compared with non-nappers, adolescents who napped 60-90 min daily had 16 % lower odds of suicidal risk (OR 0.84; 95 % CI 0.73-0.97) and other outcomes, while moderate-intensity exercise on at least one to two days per week was associated with up to 31 % reduction in odds across all mental health outcomes. Conversely, sleep under 7 h, daily sedentary time equal or over 7 h, and screen time exceeding 4 h were linked to higher risk of adverse outcomes. Generalized Additive Models revealed significant nonlinear dose-response relationships and identified a threshold lifestyle profile for all four mental health outcomes. This profile includes more than 40 minutes of napping per day, a sleep duration ranging from a minimum optimal value of 7.5 hours to a maximum of 10.5 hours per day, at least two days per week of moderate exercise, and no more than 4.4 hours of screen time per day.

These results provide evidence for school-based programs aimed at fostering healthier daily routines, ultimately promoting the mental health and resilience of children and adolescents.

Non-suicidal self-injury (NSSI) poses a significant challenge to the health and well-being of children and adolescents, with prior studies suggesting a strong association with experiences of school bullying. While mindfulness has been identified as a protective factor against NSSI, its mediating role in the relationship between school bullying and NSSI remains insufficiently investigated. Using a representative sample from Yunnan Province, China, this study aims to contribute to the understanding of the relationship between school bullying, NSSI, and mindfulness.

A population-based sample of 5897 adolescents in two places of Yunnan Province were surveyed by using self-administered questionnaires. Logistic regression model was used to measure the association between school bullying and NSSI. Path model was further fitted to examine the mediation of mindfulness in the association between school bullying and NSSI.

The lifetime NSSI prevalence in our study sample was 34.6% (95% CI: 30.3%-39.0%). School bullying was associated with an increased risk of NSSI (OR = 2.02, 95% CI: 1.68-2.43), while a higher mindfulness score was associated with a reduced NSSI risk (OR = 0.98, 95% CI: 0.97-0.99). Path analysis showed mindfulness significantly mediated the relationship between school bullying and NSSI, accounting for 34.0% of the total association. Among all dimensions of mindfulness, mindfulness observing, describing, and acting with awareness significantly mediated the association, with acting with awareness showing the strongest mediation.

The findings indicate a positive correlation between school bullying and NSSI, with mindfulness serving as a significant mediator in this association. Enhancing mindfulness among children and adolescents could be an effective strategy to mitigate school bullying associated NSSI.

The aim of the current study is to examine the relationship between nonsuicidal self-injury (NSSI) and resilience. Resilience has been identified as a critical area for further investigation in the context of NSSI. Resilience has been conceptualized in different ways over the years, from psychological resilience, with a focus on the individual's problem/deficiency, into a dynamic, cultural, interactive process in which people's biological, psychological, social, and ecological systems work together to help them cope with challenges and maintain or improve their mental well-being.

For this systematic review was searched within PubMed, PsycINFO, the Cochrane Library, and Web of Science for currently published studies on the relationship between NSSI and resilience to provide a summary, following the Preferred Reporting Items for Meta-analysis and Meta-Analysis. Second, it determines the magnitude of this relationship by calculating a random effects size, using the meta-package of R.

Included were 17 studies with a total sample size of 12,273 participants (Mage = 17.56, range: 12.93-27.50, SD = 3.95; female: 59.5%) and a NSSI sample size of 4,767 (38.8%). The pooled results indicate a small to moderate relationship between resilience and NSSI, with a random effects model effect size of 0.28 (95% CI: 0.10; 0.47), with higher levels or the presence of NSSI associated with lower levels of resilience. Most studies measured psychological resilience. Several reporting the moderator and mediator function of resilience, whereby higher resilience reduces the odds of developing NSSI in the case of stressful or traumatic events. A minority of studies reported effect sizes per resilience factor. Of which problem solving/coping and emotional reactivity were predominantly reported.

Resilience is related to NSSI. However, it also shows that resilience is mostly measured as a psychological and individual concept. This is contrary to the multimodal perspective of resilience as well as the multimodal and non-linear nature of the recovery process of NSSI. Therefor this review highlights the need for a holistic approach with a shift in focus to a multimodal perspective. More research is needed to understand the role of resilience within the nonlinear recovery process. This research should include the voices of people with lived experience.

Nonsuicidal self-injury (NSSI) behavior is significantly prevalent in both adolescents and psychiatric populations, particularly in individuals with major depressive disorder. NSSI can be considered a result of risky decision making in response to negative emotions, where individuals choose self-harm over other less harmful alternatives, suggesting a potential decision-making deficit in those engaging in NSSI. This study delves into the complex relationship between NSSI and depression severity in decision making and its cognitive underpinnings.

We assessed decision behaviors in 57 patients with major depressive disorder and NSSI, 42 patients with major depressive disorder without NSSI, and 142 healthy control participants using the Balloon Analog Risk Task, which involves risk taking, learning, and exploration in uncertain scenarios. Using computational modeling, we dissected the nuanced cognitive dimensions influencing decision behaviors. A novel statistical method was developed to elucidate interaction effects between NSSI and depression severity.

Contrary to common perceptions, we found that individuals with NSSI behaviors were typically more risk averse. There was also a complex interaction between NSSI and depression severity in shaping risk-taking behaviors. As depressive symptoms intensified, the individuals with NSSI began to perceive less risk and behave more randomly.

This research provides new insights into the cognitive aspects of NSSI and depression, highlighting the importance of considering the influence of comorbid mental disorders when investigating the cognitive underpinnings of such behaviors, especially in the context of prevalent cross-diagnostic phenomena such as NSSI behaviors.

Eating disorders (EDs) and non-suicidal self-injury (NSSI) are both phenomena with onset in adolescence. Their co-occurrence is associated with higher symptom severity and an elevated risk of suicide. In this meta-analysis, we examine the lifetime prevalence of NSSI in youth with EDs.

We searched PsycInfo, PubMed and previously published systematic reviews for studies reporting on lifetime NSSI prevalence among children and adolescents (19 years or younger) with an ED (anorexia nervosa, bulimia nervosa, binge eating or other specified feeding and EDs) published until June 2024. A generalized linear mixed model meta-analysis was performed to estimate the pooled prevalence. Meta-regressions and multivariate meta-analyses were conducted to estimate separate prevalence rates based on ED diagnosis and care frame (e.g., inpatient vs. outpatient), respectively.

Fifteen studies comprising 3311 children and adolescents were included. Pooled lifetime NSSI prevalence across all ED diagnoses was 34.2% [CI: 27.5%-41.7%]. Heterogeneity was large (I2 = 93.8%). Lifetime NSSI prevalence rates were significantly higher for participants with bulimia nervosa (53.6%) and those with anorexia nervosa binge-eating/purging type (51.9%) than for participants with anorexia nervosa restrictive type (15.8%).

The small number of studies and the large heterogeneity limit the conclusiveness of this meta-analysis. Results suggest an even higher prevalence of lifetime NSSI in adolescents with an ED than in adults with an ED. The results support previous findings indicating higher prevalence rates of NSSI for EDs associated with binge eating and purging behaviours than for restrictive EDs.

Evidence to support approaches to reducing self-harm (SH) and suicide in prison settings is lacking, despite increased risk in these settings. This study aims to describe a pilot trial of a health service-improvement initiative intended to provide a structured framework to support mental health clinicians in assessing and managing risk of SH /suicide in a prison setting.

The authors examined all clinically reported SH incidents in a prison mental health unit over a three-year period. In the third year, the authors piloted a novel intervention, the Suicide/Self-Harm, Legal, Individual, Psychiatric, Safety Plan (SLIPS) framework, aimed at reducing SH and suicide behaviours. Routinely recorded data from clinical notes were used to examine both incidents of SH as well as reported thoughts of SH.

No statistically significant reduction in the number of SH incidents was observed. An increase in patients reporting thoughts of SH to staff was seen in the post-SLIPS period, potentially reflecting an improvement in patient-staff engagement. Implementation of the intervention was challenging, with just under 20% of individuals in the unit receiving an SLIP assessment or safety plan.

This study focused on a unique population of patients in a prison mental health screening unit and used a novel structured professional judgement approach to developing a framework for supporting clinicians to undertake the difficult job of assessing and managing SH and suicide risk in prison.

Adolescence is a critical period for the development of self-regulatory behaviors, with emotional dysregulation, impulsivity, and substance use emerging as significant factors associated with self-injury and suicidal thoughts and behaviors. This study aims to investigate the prevalence and patterns of non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts in a community-based sample of adolescents. A sample of 1526 adolescents aged 12-16 was analyzed using Latent Profile Analysis (LPA), identifying two distinct behavioral profiles: the Substance Use with Non-Problematic Gaming (37.4%) profile, characterized by alcohol, cannabis, and nicotine use, and the Moderate Problematic Gaming with Minimal Substance Use (62.6%) profile, associated with problematic video game use and minimal substance use. Overall, 36% of participants reported engaging in NSSI, 27.2% reported suicidal ideation, and 3.21% reported suicide attempts within the past year. Ordinal regression analysis indicated that adolescents in the SUP group exhibited higher levels of emotional dysregulation, impulsivity, and behavioral difficulties, significantly increasing their odds of suicide attempts (OR 2.24, p < 0.02). Additionally, emotional dysregulation independently doubled the risk of suicide attempts (OR 2.01, p < 0.001). This study provides a detailed risk profile for adolescent self-injury and suicide-related behaviors in school settings. Despite the limitations of a non-clinical sample, the findings underscore the importance of early prevention efforts targeting emotional dysregulation and impulsivity. Future research should consider longitudinal approaches to better understand the developmental trajectories of NSSI and suicidal behaviors in adolescents, particularly in high-risk, marginalized populations.

The analysis of clustering characteristics of disease risk factors makes for the formulation of corresponding prevention and control policies, but the risk factors for non-suicidal self-injury (NSSI) behaviors in adolescents is not covered, so this study is intended to explore the clustering characteristics of risk factors for NSSI behaviors in adolescents in the multi-center primary and secondary schools in western China.

Utilizing random cluster sampling method, a total of 13,784 primary and secondary school students who met the research standards were randomly selected as the survey subjects from January 2020 to January 2021, and the clustering situation of the seven risk factors (depression, anxiety, stress, low social support, tolerance, avoidance, and emotional venting) among the students was analyzed. The characteristics of the respondents with a high clustering degree of risk factors for NSSI behaviors were also identified with the hierarchical logistic regression analysis.

4.2% of the adolescents in western China were detected with NSSI behaviors in the past year; the risk factors were grouped into 4 clusters, ranging from level 0 to level 3, with each level including 7692 (55.8%), 3847 (27.9%), 1303 (9.5%) and 941 (6.8%) of the survey subjects, respectively. The results of the Cochran-Armitage trend test analysis showed that there existed a linear trend between the clustering degree of risk factors and the detection rate of NSSI behaviors (P<0.000); according to the hierarchical Logistic regression analysis, the clustering degree of risk factors for NSSI behaviors was higher in the adolescents whose parents divorced and remarried 1.21(0.016~0.373) and whose fathers received only primary school education or below 1.23 (0.005~0.404). By contrast, the degree was lower in the adolescents who are male 0.93(-0.132~-0.003) and had never attended boarding school 0.83(-0.286~-0.096), whose parents were not divorced 0.80 ( -0.367~-0.072 ), and whose fathers were farmers 0.87(-0.271~0.006).

The risk factors for NSSI behaviors in adolescents are in clusters. As the risk factors continue to cluster, NSSI behaviors can be detected more easily in adolescents. With respect to the endeavors to prevent and control NSSI behaviors in adolescents, more attention should be focused on the mental health of the adolescents who are female and attend boarding schools, whose parents have broken marriages, and whose fathers have low literacy.

With its susceptibility in victimized populations and the potential for suicidality, non-suicidal self-injury (NSSI) is among the most severe health concerns in college students, indicating an urgency to explore its antecedents and interventions. The present study aims to examine the relationship between bullying victimization and NSSI and the mediating roles of internal shame, external shame, depressive symptoms, and PTSD symptoms based on the general strain theory, the vulnerability-stress theory, and the transactional stress theory. By adopting a three-time-point design with 6-month intervals, hypotheses were tested using data from 634 Chinese college students (374 female; Mage = 18.97). Through a structural equation modeling approach, the study found that bullying victimization was positively correlated with NSSI via internal shame and depressive symptoms. However, this study found no evidence for the mediating association of either external shame or PTSD symptoms in the examined relationship. Through a lens of emotion-driven mechanism, this study contributes to understanding the roles of internal shame and depressive symptoms in NSSI intervention strategies among victims of bullying. The results also illuminate the differentiation of the mechanisms of internal and external shame and the discrepancy between depressive symptoms and PTSD symptoms as two types of post-traumatic symptomatology.

This study examined the effects of interparental conflict on non-suicidal self-injury in middle school students and investigated the mediating role of self-esteem and the moderating role of regulatory emotional self-efficacy. A total of 1,072 middle school students were recruited to participate in this study and anonymously completed the Children's Perception of Interparental Conflict Scale, Self-esteem Scale, Regulatory Emotional Self-efficacy Scale, and Adolescent Self-Injury Questionnaire. The results were as follows: (1) Interparental conflict positively predicted non-suicidal self-injury in middle school students; (2) self-esteem mediated the relationship between interparental conflict and non-suicidal self-injury; (3) the relationship between self-esteem and non-suicidal self-injury was moderated by regulatory emotional self-efficacy. These findings provide a new avenue for reducing and preventing non-suicidal self-injury among middle school students.

As risk for both non-suicidal self-injury and depression increases at adolescence, it is critically important to clarify equivocal findings regarding the temporal ordering of these health concerns. Addressing the limitations of past research, which included the use of only two data waves and analyses that do not account for within-person variance, the aim in this study was to examine the temporal ordering of non-suicidal self-injury and depressive symptoms during adolescence. Two independent samples were examined. One sample (first used by Marshall et al., 2013) consisted of 799 Swedish adolescents (11 to 15 years, Mage = 13.18, SD = 0.74; 51% girls). The second sample was a later cohort of adolescents from the same area (N = 2760; aged 12 to 18 years, Mage = 13.75, SD = 0.74; 49% girls). Analyses were two-part cross-lagged panel models (CLPMs) and random-intercept cross-lagged panel models (RI-CLPMs) to account for the semi-continuous distribution of NSSI and to determine if traditional lagged models were adequate for estimating within-person temporal ties. The results suggest that traditional CLPMs had inadequate fits to data. RI-CLPMs showed significant within-person, transactional associations between depressive symptoms and NSSI. Specifically, NSSI at a mean age around 13 years was associated with increases in depressive symptoms one year later, which were in turn associated with increases in NSSI when the average age was about 15 years old. Subsequently, lags suggested the potential for maintenance of comorbid distress. These results suggest that efforts to reduce depression and NSSI during adolescence need to begin in early adolescence, with a focus on adaptive responses to distressing emotional experiences.

Transgender and gender diverse (TGD) individuals experience gender-related distal (i.e., discrimination, victimization, rejection, non-affirmation) and proximal (i.e., internalized transphobia, expectation of rejection, and identity nondisclosure) stressors, which increase their risk for non-suicidal self-injury (NSSI). Yet, there is a paucity of research examining the prevalence, characteristics, and correlates of NSSI in TGD populations.

A convenient sample of Hungarian TGD adults (N = 202; M = 29.60, SD = 10.27; 39.6% gender diverse individuals, 35.6% trans men, 24.8% trans women) took part in an online, questionnaire-based, cross-sectional survey. Gender minority stressors and several aspects of NSSI (i.e., prevalence, frequency, number of methods, and motivations) were assessed.

Results showed a high lifetime (n = 142, 70.3%) and past-month (n = 48, 33.8%) prevalence of NSSI, with trans men (n = 55, 76.4%) and gender diverse individuals (n = 59, 73.8%) reporting higher lifetime prevalence than trans women (n = 28, 56.0%). Those who engaged in NSSI previously were significantly younger compared to those without NSSI. Structural equation model (SEM), examining the associations among gender minority stressors and functions of NSSI, revealed that proximal stressors mediated the link between distal stressors and intrapersonal functions of NSSI. Regarding interpersonal functions, neither distal nor proximal stressors were significant predictors.

Findings suggest that trans men and gender diverse individuals, and younger TGD individuals are at greater risk for NSSI. Intrapersonal functions of NSSI and their potential association with proximal stressors should be carefully considered and assessed in clinical practice. Interventions targeting these specific associations should be developed and implemented to provide culturally sensitive care to TGD population.

Non-suicidal self-injury (NSSI) and depressive symptoms are two major public health issues among adolescents. Moreover, they can often co-occur, which can lead to additional negative outcomes, such as suicidal behaviors. Therefore, this study aimed to explore the comorbidity patterns of NSSI and depressive symptoms and provide valuable insights for future interventions.

This study examined the relationship between NSSI and depressive symptoms via a cross-lagged panel network (CLPN). A total of 866 Chinese junior high school students (39.80% girls, Mage = 12.73 years, SD = 0.43) completed measurements during three time points.

Comorbidity rates of NSSI and depressive symptoms ranged from 10.51 to 15.13% among the adolescents. Moreover, results of the CLPN indicated that somatic and retarded activity, depressive affect, and lack of positive affect were strongly and positively associated with multiple NSSI behaviors. Conversely, burning from the NSSI cluster could negatively predict somatic and retarded activity and depressive affect. In addition, somatic and retarded activity and depressed affect were bridge symptoms that linked the comorbidity between NSSI and depressive symptoms.

These results demonstrate a negative reinforcement feedback pathway between NSSI and depressive symptoms, which provides evidence for intrapersonal negative reinforcement of NSSI. Furthermore, these findings identify the core and bridge symptoms between NSSI and depressive symptoms, which can provide new ideas for subsequent intervention treatments.

Non-suicidal self-injury (NSSI) is a common and serious injury behavior in children and adolescents, however, its treatment remains controversial. Here, using network meta-analysis (NMA), we compared and ranked all available therapeutic treatment interventions to explore the best treatment strategy for NSSI in children and adolescents.

We searched PubMed, Embase, the Cochrane Library and PsycINFO for randomized controlled trials used to reduce the frequency of NSSI in children and adolescents from database inception until Jan. 11, 2025. Primary outcomes were efficacy and acceptability. We estimated summary odds ratios (ORs) with credible intervals (CIs) in random effects models.

We included 28 trials comprising 6496 participants. Dialectical behavior therapy (DBT) was better than other interventions. In subgroup analysis, pharmacotherapy and psychotherapy significantly aggravated the frequency of NSSI in depression (OR = 1.53; 95% CI: 1.10 to 2.14); however, these interventions significantly reduced NSSI in patients with self-harm (OR = 0.53; 95% CI: 0.30 to 0.96). We also found that NSSI was significantly increased in the first 3 months when using SSRIs in treatment but was significantly reduced after 3 months.

Psychotherapy seems to be a better choice than pharmacotherapy, especially DBT. DBT was associated with a better reduction in the frequency of NSSI than treatment as usual, with high confidence of evidence. NSSI is frequently used to combat depression symptoms, suggesting that clinicians should pay greater attention to depression symptoms to reduce NSSI, especially in the first 3 months of treatment with SSRIs.

Non-suicidal self-injury (NSSI) is a common and serious mental health concern among young adults. It is also highly stigmatised, which can impede disclosure and recovery. To advance the literature on NSSI stigma, we explored what young adults who self-injure believe different age-groups (i.e., young adults, parents, middle-aged, and older adults) think about NSSI and people who self-injure.

Participants (n = 187) with a mean age of 19.07 (SD = 1.52) took part in an online survey and answered open-ended questions about the above beliefs. Responses were examined via reflexive thematic analysis.

Findings yielded three primary themes namely: They Just Don't Get It, Ignorance is Bliss, and Willing to Lend a Helping Hand. Overall, our results indicate that all age-groups asked about are believed to harbour stigmatising views (e.g., NSSI is selfish and attention-seeking, people who self-injure are weak and crazy). Perceptions regarding the prominence of these beliefs, however, varied across age-groups.

Expectancy beliefs and differences in anticipated stigma across age groups may stem from prior experiences with others and may play a role in disclosure. The present findings thus have implications for research, anti-stigma initiatives, and supportive practices.

Although nonsuicidal self-injury (NSSI) is more common among military veterans than adult civilians, little is known about NSSI disorder among veterans.

The present study explored NSSI characteristics among veterans meeting criteria for current NSSI disorder (N = 41) and the relationship between NSSI methods and functions.

Participants reported a pattern of past-year NSSI engagement characterized by frequent and severe NSSI, a short interval between NSSI urges and behavior, and moderate or greater subjective distress and interference in family relationships, social relationships, and work/school. Psychiatric comorbidities were common, and nearly half of participants reported a suicide attempt history. Participants used an average of four NSSI methods, the most common being wall-punching (85.4%), and endorsed an average of eight distinct functions of NSSI, predominantly for intrapersonal reasons. Regardless of the specific method used, the most common reason that veterans with NSSI disorder engaged in NSSI was to help themselves cope with negative emotions.

Findings suggest certain NSSI characteristics are similar among veterans and civilians with current NSSI disorder (e.g., NSSI functions) and differ between them (e.g., NSSI methods). Further research is necessary in order to replicate and expand upon these findings with nationally representative samples and better understand NSSI functions among veterans.

This study investigated the mediating effects of perceived opportunity in adversity and PTSD symptoms in the relationship between relationship loss and non-suicidal self-injury (NSSI) in adolescence.

Adolescent relationship loss can have lasting negative effects on development and later life, and may particularly increase the risk of NSSI. The consequences of relationship loss vary depending on the individual's perception and psychological responses. However, the mechanisms by which adolescent relationship loss leads to NSSI are not yet clear, and research on the role of perceived opportunity in adversity and PTSD symptoms in this context is limited.

The convenience sample included 201 college students who had experienced both relationship loss and NSSI during adolescence. Data were collected using four self-report measures (relationship loss, perceived opportunity in adversity, PTSD symptoms, and NSSI) and analyzed using structural equation modeling (SEM).

PTSD symptoms partially mediated the relationship between relationship loss and NSSI. In addition, perceived opportunity in adversity and PTSD symptoms sequentially mediated the relationship between relationship loss and NSSI. On the other hand, perceived opportunity in adversity did not mediate the relationship between relationship loss and NSSI.

Reducing PTSD symptoms may mediate the impact of adolescent relationship loss on NSSI, while the bidirectional nature of perceived opportunity in adversity warrants attention. Counselors and educators should implement strategies to alleviate PTSD symptoms and develop programs that leverage the positive aspects of perceived opportunity in adversity to mitigate negative outcomes.

Non-suicidal self-injury (NSSI) is prevalent among adolescent populations worldwide, yet its neuropathological mechanisms remain unclear. This study aimed to investigate brain functional differences in NSSI patients by utilizing large-scale functional networks and examining their correlation with clinical outcomes. Cross-sectional clinical and functional magnetic resonance imaging (fMRI) data were collected from 42 patients and 47 healthy controls. Independent component analysis (ICA) was utilized to investigate changes in both intra-network and inter-network functional connectivity. We then investigated the potential association between functional network connectivity and clinical self-injurious behavior. The results revealed significant abnormalities in intra-network functional connectivity within the left middle cingulum gyrus, right angular gyrus, and middle frontal gyrus in patients with NSSI. Additionally, we found altered inter-network connectivity patterns, particularly between higher-order cognitive networks and primary sensory networks, suggesting potential disruptions in multisensory integration and emotional regulation in these patients. This study revealed significant alterations in large-scale functional network connectivity in adolescents with depression and NSSI, particularly in networks related to emotion regulation and cognitive control. These findings provide novel perspectives on the neurobiological mechanisms of NSSI and suggest possible avenues for early intervention and treatment.

Relative deprivation is associated with non-suicidal self-injury; however, the mechanisms underlying this association have been largely unexplored. Based on relative deprivation theory, the functional model of non-suicidal self-injury, and the organism-environment interaction model, the current study examined the mediating role of emotional symptoms and moderating role of deviant peer affiliation to determine how and when relative deprivation is associated with non-suicidal self-injury.

Participants were 601 Chinese early adolescents who completed self-report scales measuring relative deprivation, emotional symptoms, non-suicidal self-injury, and deviant peer affiliation at three time points over the course of 12 months.

The results showed that relative deprivation at Wave 1 was positively associated with non-suicidal self-injury at Wave 3, and emotional symptoms at Wave 2 fully mediated this association. Furthermore, deviant peer affiliation at Wave 3 moderated the pathway from emotional symptoms to subsequent non-suicidal self-injury in the mediated model. Specifically, emotional symptoms significantly predicted an increase in non-suicidal self-injury but only in early adolescents with high deviant peer affiliation.

Our findings can encourage educators to consider the interaction between individual and peer factors when providing interventions for early adolescents who engage in non-suicidal self-injury.

Nonsuicidal self-injury (NSSI) is a common phenomenon; a recent meta-analysis of studies conducted among non-clinical adolescents reported a global lifetime prevalence rate of 22.0%. NSSI results in significant impairment and is associated with negative outcomes later in young adulthood. There is, however, a dearth of research on the occurrence of NSSI in Singapore's youth population. Past studies examining NSSI behaviours among youths in Singapore were conducted using clinical samples, which tend to report a higher prevalence compared to community samples. The present study aims to establish the prevalence of NSSI and examine its associated sociodemographic and psychosocial correlates in the general youth population.

This study included 2600 youths aged 15-35 years who participated in the National Youth Mental Health Study, a nationwide cross-sectional survey of the mental health status of youths in Singapore. The Deliberate Self-Harm Inventory and Depression Anxiety Stress Scales Short Form were used to assess NSSI behaviours and mental health symptoms. Data on coping strategies, perceived social support and resilience were also collected.

The lifetime prevalence of NSSI among youths in Singapore was 25.0%, and the 12-month prevalence was found to be 6.8%. The median age of onset for lifetime NSSI was 14 years. Significantly higher odds of lifetime NSSI were observed among youths aged 15-29 years, females, and youths with lower educational attainment. Youths with severe and extremely severe symptoms of depression and anxiety and those with greater use of avoidance coping strategy were associated with higher odds of lifetime NSSI. Higher resilience scores were associated with lower odds of lifetime NSSI.

1 in 4 youths in Singapore had engaged in self-injurious behaviour at least once in their lifetime. Screening and early intervention programs could be targeted at the more vulnerable youth groups such as those in early- and mid- adolescence. Potential areas for future research and interventions could include resilience building and educating youths on adaptive coping strategies. The limitations of the cross-sectional study design and the use of self-reported data should be considered when interpreting the study findings.

Non-suicidal self-injury (NSSI) is a public health problem throughout the world. Nurses are usually the first caregivers in the mental health team who deal with people with NSSI. Since the consequences of self-injury are associated with its care and treatment, nurses' attitudes towards these people are an important issue. This study aimed to develop and test a scale to measure nurses' attitudes towards patients with non-suicidal self-injury in the Farsi language.

A methodological survey.

In this methodological study, to scale preparation, psychometric steps were performed on a questionnaire based on the results of a qualitative study and literature review. Exploratory Factor Analysis was conducted to identify the underlying structure of the scale.

The results of the psychometric evaluation showed that the scale included the 22-item NANSSI in four dimensions, including negativism about the consequences of caring, adopting a counselling approach, violating caring norms, and perceptions about self-injury. By Cronbach's alpha equal to 0.75, its reliability is estimated. This scale showed a good validity and reliability, which is applicable to evaluate quality of care for patients with non-suicidal self-injury.

No patient or public contribution.

Cyberbullying victimization during adolescence may induce an increased risk for non-suicidal self-injury (NSSI). However, the longitudinal mediating mechanism underlying the association of cyberbullying victimization with adolescents' NSSI over time has not been studied fully.

The current study aimed to examine the longitudinal mediating mechanism underlying relationship between cyberbullying victimization and NSSI. Based on Nock's (2009) integrated developmental model of NSSI, this study explored the mediating effects of psychological distress and maladaptive beliefs following cyberbullying victimization in this relationship.

A total of 773 Chinese adolescents (48.4 % males, T3 mean age = 16.37 ± 0.49 years) participated in this study and completed self-report questionnaires.

We employed a three-wave (called T1, T2, and T3) longitudinal design. The participants completed all of the questionnaires at T1, completed questionnaires on psychological distress and maladaptive beliefs at T2, and completed the NSSI list at T3. Correlation analysis, structural equation modeling (SEM), and a bootstrap procedure were used to test our expectations.

Correlation analysis indicated that cyberbullying victimization, maladaptive beliefs, psychological distress, and NSSI were significantly and positively correlated with each other. The results of mediation analysis revealed that early cyberbullying victimization (T1) had a direct association with adolescents' subsequent NSSI (T3), and early cyberbullying victimization (T1) indirectly predicted adolescents' subsequent NSSI (T3) via the parallel and sequential mediating effects of maladaptive beliefs (T2) and psychological distress (T2).

Victims of cyberbullying are often prone to engaging in NSSI. Interventions that target students with NSSI should focus on intervening in their maladaptive beliefs and psychological distress following cyberbullying victimization.

Many people who engage in non-suicidal self-injury (NSSI) do not access support from health services, and evidence regarding the effectiveness of interventions is mixed. Despite this, NSSI prevalence rates decrease from adolescence into adulthood. Little is known about what helps alleviate difficulties with NSSI beyond psychological or medical intervention. This study sought to understand factors influencing naturalistic improvements in NSSI.

Semi-structured interviews were conducted over video call with 16 participants who believed their difficulties with NSSI had improved due to factors not attributed to psychological or medical intervention. Interviews were audio recorded and transcribed verbatim for analysis.

A reflexive thematic analysis revealed four main themes. Increased insight into NSSI experiences promoted self-compassion and self-acceptance and enabled participants to reflect on the conflicting role of NSSI. Safe and supportive relationships helped alleviate loneliness, and developing alternative coping strategies enhanced feelings of control over self-injury. Creating a life guided by personal values promoted independence, choice, and self-esteem.

The findings of the study highlight several internal and external naturalistic processes deemed meaningful in improving difficulties with NSSI. Clinical implications include the importance of developing and embedding these approaches within services and interventions to improve outcomes for individuals who self-injure while promoting a person-centred approach.

Suicide is a public health problem worldwide, especially among adolescents. Chile is one of the Latin American countries with the highest suicide rates; however, few studies have investigated the risk factors for suicide attempts in this specific population. We aimed to describe the suicidal behaviour of Chilean adolescents and to explore the factors associated with suicide attempts and reattempts in this population.

Adolescents (10-19 years) with a diagnosis of psychiatric disorders were recruited in the Maule region, Chile, between 2018 and 2021. Sociodemographic and clinical variables were collected. Logistic regression was performed to explore the association between these variables and suicide attempts.

Factors associated with increased odds of suicide attempts included age, sexual orientation, Adverse Childhood Events (ACEs) and past and current symptomatology. Factors that decreased the odds of suicide attempts were previous psychotherapy or pharmacological treatment, responsiveness and warmth from mother and father. Active symptoms at the time of assessment increased the odds of reattempting suicide.

In our sample, clinical and trauma-related factors emerged as the most important factors in predicting suicide attempts. Although age, sexual orientation and family dysfunction also played a notable role, positive relationships with parents seemed to be protective. In addition, current symptoms of stress, anxiety and depression significantly increased the likelihood of reattempts. These findings provide valuable knowledge about suicidality in Chile, although further research is needed to expand the evidence in our media.

Non-suicidal self-injury (NSSI) is a significant clinical concern in adolescents. The goal of this study was to evaluate the efficacy of group interpersonal psychotherapy (G-IPT) combined with treatment as usual (TAU) compared with TAU alone in treating adolescents with NSSI. A randomized controlled trial was conducted in a psychiatric outpatient clinic in Hubei Province, China, involving 52 adolescents 12 to 17 years of age diagnosed with NSSI. Participants were randomly assigned to either the G-IPT combined with TAU group (n=26), who received 12 additional G-IPT sessions, or the TAU-alone group (n=26). Outcomes were assessed using the Ottawa Self-Injury Inventory (OSI), 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Interpersonal Disturbances Scale (IDS), and Interpersonal Communication Scale (ICS) at pre-treatment [Time Zero (T0)], immediately after completion of G-IPT, or 12 weeks after baseline assessment in the TAU group [Time 1 (T1)], and 3 months after treatment [Time 2 (T2)]. Forty-eight participants completed all assessments. The primary outcomes included a reduction in NSSI frequency and an increase in participants' ability to resist NSSI. Results demonstrated reductions in the OSI item "NSSI in the last month" at T1 (P<0.001) and T2 (P=0.008), as well as significant improvements in the OSI item "Strength to resist NSSI" (P<0.001 at T1; P=0.001 at T2). Significant between-group and interaction effects were observed, indicating that G-IPT combined with TAU was more effective than TAU alone in reducing NSSI behaviors. These findings underscore the potential of G-IPT as an effective adjunct to TAU in clinical settings for adolescent NSSI intervention.

Understanding of nonsuicidal self-injury relies almost exclusively on adolescent and emerging adult samples. We investigated the prevalence of lifetime and past-year nonsuicidal self-injury among New Zealanders aged 16-75 years and above, before evaluating if established associations between nonsuicidal self-injury, and demographic and psychological characteristics generalise to adults.

New Zealand adults (n = 4906; median age 55-59 years; 55.5% female) completed a cross-sectional survey assessing lifetime and past-year nonsuicidal self-injury, psychological distress, self-esteem, emotion dysregulation, and social desirability susceptibility.

Nonsuicidal self-injury was common among adults; 25.6% participants reported ever self-injuring and 10.7% had done so at least once in the past year. Women and younger participants were more likely to report lifetime self-injury. Although younger participants were also more likely to report past-year self-injury than older participants, this age effect was attenuated for men (b = -0.09) compared to women (b = -0.18). Self-esteem (odds ratios 0.74, 0.74), psychological distress (odds ratios 1.09, 1.16), emotion dysregulation (odds ratios 2.05, 1.88), and desire to manage others' impressions of oneself (odds ratios 0.88, 0.85) were uniquely associated with both lifetime and past-year nonsuicidal self-injury, respectively, and these effects were not moderated by age.

Although self-injury was most common among emerging adults, adults of all ages reported self-injuring. Individuals with a greater desire to manage how others perceive them appeared to underreport their nonsuicidal self-injury. While men were less likely than women to self-injure, they may also be more likely to continue self-injuring over adulthood, suggesting that the developmental factors which drive self-injury cessation among adults differ for men and women.

Nonsuicidal self-injury (NSSI) is one of the strongest predictors of suicidal behavior. Despite this, the field still has a limited understanding of the mechanisms by which this relationship is conferred.

We conducted a systematic review of the empirical research examining potential factors driving (i.e., moderators, mediators) the relationship between NSSI and suicidal behavior to address this gap in the literature.

We identified only 15 studies examining moderators or mediators of this relationship, examining 40 unique mediators and 22 unique moderators. Three prominent weaknesses were identified in the reviewed literature: (1) limited intersection with existing theoretical models of the NSSI - suicidal behavior relationship, (2) little replication of findings across studies (i.e., only four mediators and four moderators assessed in multiple studies), and (3) only one of the included studies utilized a prospective design. Research to date does little to improve our understanding of the theoretical or prospective relationship between NSSI and suicidal behavior, highlighting a foundational gap in the literature.

We propose the Nonsuicidal to Suicidal Self-Injury Pathway Model, a new conceptual model of the relationship between NSSI and suicidal behavior, drawing on extant theory and empirical research; we discuss future directions for work in this area.

Increasing evidence has shown an increased risk of non-suicidal self-injury (NSSI) in left-behind children and adolescents (LBCAs). However, a systematic summary of studies comparing the risk of NSSI between LBCAs and non-LBCAs in China is lacking.

To investigate the risk of NSSI among LBCAs in China.

We performed a systematic search of Embase, PubMed, and Web of Science from initiation to October 25, 2024, for all relevant studies of NSSI and LBCAs. The effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CI). Sensitivity analyses were conducted to further confirm the stability of the findings.

A total of 10 studies with 165276 children and adolescents were included in this study. LBCAs had significantly higher rates of NSSI compared with non-LBCAs (OR = 1.33, 95%CI: 1.19-1.49), with high heterogeneity observed (I 2 = 77%, P < 0.001). Further sensitivity analyses were consistent with the primary analysis (OR = 1.29, 95%CI: 1.21-1.39, I 2 = 0%).

LBCAs are found to be at an increased risk of NSSI compared with children and adolescents of non-migrants. More attention and intervention are urgently needed for LBCAs, especially those living in developing countries.