Combined transcranial direct current and repetitive transcranial magnetic stimulation for adolescent non-suicidal self-injury

doi:10.5498/wjp.118371

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Sep 19, 2026; 16(9): 118371
Published online Sep 19, 2026. doi: 10.5498/wjp.118371

Combined transcranial direct current and repetitive transcranial magnetic stimulation for adolescent non-suicidal self-injury

Huan-Zhen Liu, Wan-Gen Liu, Hou-Qiang Fu, Hao Lv, Chang Liu, Cheng-Xi Li

Huan-Zhen Liu, Wan-Gen Liu, Hou-Qiang Fu, Chang Liu, Cheng-Xi Li, Clinical Psychological Clinic, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China

Hao Lv, Outpatient Clinic, Cangzhou Boshi Youmian Comprehensive Outpatient Clinic, Cangzhou 061000, Hebei Province, China

Author contributions: Liu HZ designed the study, performed statistical analysis, and drafted the manuscript; Liu WG contributed to study design and critically revised the manuscript; Fu HQ and Liu C participated in data collection and neuromodulation treatments; Lv H was responsible for patient screening and clinical evaluations; Li CX assisted with statistical analysis and figure preparation. All authors approved the final manuscript.

AI contribution statement: No AI tools were used at any stage of manuscript preparation. The authors assume full responsibility for the integrity and scientific validity of this work.

Supported by Hebei Province Medical Science Research Project Plan, No. 20261305.

Institutional review board statement: The study protocol was reviewed and approved by the Medical Ethics Committee of Cangzhou Central Hospital, ethics approval No. 2025-143-01(z).

Informed consent statement: Due to the retrospective study, informed consent was waived by the Ethics Committee of Cangzhou Central Hospital. All patient data were anonymized prior to analysis, and no identifiable personal information was accessed or reported.

Conflict-of-interest statement: All authors declare that they have no conflict of interest related to this study.

Data sharing statement: No additional data are available.

Corresponding author: Huan-Zhen Liu, MD, Chief Physician, Clinical Psychological Clinic, Cangzhou Central Hospital, No. 16 Xinhua West Road, Yunhe District, Cangzhou 061000, Hebei Province, China. zhaoqi912@126.com

Received: January 16, 2026
Revised: February 10, 2026
Accepted: June 26, 2026
Published online: September 19, 2026
Processing time: 219 Days and 21.9 Hours

Abstract

BACKGROUND

Non-suicidal self-injury (NSSI) is prevalent among adolescents and associated with increased suicide risk. Current psychotherapy has limited efficacy, and no approved pharmacotherapy exists. Combined transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) targeting prefrontal-limbic dysfunction may offer a promising treatment approach, but evidence in adolescent NSSI is lacking.

AIM

To retrospectively analyze the clinical efficacy of tDCS combined with rTMS in treating NSSI in adolescents, and to explore factors influencing treatment outcomes.

METHODS

A retrospective study design was adopted. Clinical data from 256 adolescent NSSI patients treated at the psychology department of a tertiary hospital between December 2024 to December 2025 were collected. Based on treatment regimens, patients were divided into the combination group (tDCS + rTMS + psychotherapy, n = 86), the rTMS group (rTMS + psychotherapy, n = 92), and the control group (psychotherapy alone, n = 78). Changes in Self-Harm Inventory (SHI), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Barratt Impulsiveness Scale-11 (BIS-11), and Difficulties in Emotion Regulation Scale (DERS) scores before and after treatment were compared among the three groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with treatment response, and multiple linear regression was used to analyze factors influencing SHI score improvement.

RESULTS

After 6 weeks of treatment, SHI, BDI-II, BAI, BIS-11, and DERS scores significantly decreased in all three groups compared to baseline (P < 0.01), with the combination group showing greater improvement than the rTMS and control groups (P < 0.05). The overall response rate was 88.4% in the combination group, significantly higher than the rTMS group (72.8%) and control group (55.1%) (P < 0.01). Multivariate logistic regression showed that treatment regimen (combination therapy), baseline DERS score, illness duration, and comorbid depression were independent factors associated with treatment response (P < 0.05). Multiple linear regression showed that treatment regimen, baseline SHI score, baseline BIS-11 score, and childhood trauma history were independent predictors of SHI score improvement (P < 0.05).

CONCLUSION

tDCS combined with rTMS shows significant efficacy in treating adolescent NSSI. Patients with lower levels of emotion regulation difficulties, shorter illness duration, and comorbid depression respond better to combination therapy. Treatment regimen, baseline self-injury severity, and impulsivity level are important predictors of treatment outcomes.

Keywords: Transcranial direct current stimulation; Repetitive transcranial magnetic stimulation; Non-suicidal self-injury; Adolescents; Influencing factors; Logistic regression; Retrospective study

Core Tip: Non-suicidal self-injury in adolescents remains difficult to treat, and evidence for neuromodulation is limited. This retrospective study demonstrates that combined transcranial direct current stimulation and repetitive transcranial magnetic stimulation (rTMS) is associated with greater improvement in self-injury behaviors, emotional regulation, impulsivity, and affective symptoms compared with rTMS alone or psychotherapy. Moreover, baseline emotion regulation difficulty, illness duration, comorbid depression, and childhood trauma history were identified as important factors influencing treatment response, providing clinically relevant guidance for individualized intervention strategies.