Understanding Comorbidity Between Non-Suicidal Self-Injury and Depressive Symptoms in a Clinical Sample of Adolescents: A Network Analysis

Abstract

Background Non-suicidal self-injury (NSSI) and depression often co-occur among adolescents with more severe clinical symptoms. This study examined the network structures of NSSI and depressive symptoms in adolescents. Methods Participants were recruited in the psychiatric outpatient clinics of three tertiary hospitals between April 10 and July 10, 2023. All participants been already found with self-injury behaviors in outpatient when enrolled. NSSI diagnostic criteria and Patient Health Questionnaire-9 (PHQ-9) were utilized to collect NSSI and depressive symptoms separately. We performed a network analysis to visualize the correlation between each symptom and to identify core and bridging symptoms in comorbidities. Results A total of 248 patients were enrolled in the study, with a mean age of 15.48 (SD = 1.62). Based on the PHQ-9 scores and grades, our results showed that the incidence of depression in adolescents with non-suicidal self-injury behavior was relatively high (N=235, 94.76%), with the majority having severe depression. The network analysis revealed that nodes D-6 “feeling bad, failing or letting yourself or your family down”, D-1 “little interest or pleasure” and D-4 “feeling tired” were the most vital and most central symptoms. The most crucial bridging symptom is the node NSSI-8 “frequent thinking about self-injury”, which connects the NSSI to the depression comorbid network. Conclusion This study offers a significant symptom-level conceptualization of the association between NSSI and depressive symptoms in a clinical sample of adolescents, which not only enhances our understanding of the comorbid but also identifies potential treatment targets to prevent and treat comorbidity between adolescent NSSI and depression.

Non-Suicidal Self-Injury (NSSI) Patterns in Adolescents from a Romanian Child Psychiatry Inpatient Clinic

“…We consider it of utmost importance to thoroughly evaluate the presence of psychiatric comorbidities in individuals who engage in NSSI, as it has important implications for treatment planning and intervention. Psychiatric comorbidities can also increase the risk of NSSI-related complications, including suicidal behaviour [ 34 , 35 , 36 ]. Integrated treatments that target both NSSI and co-occurring psychiatric disorders, such as dialectical behaviour therapy (DBT) or cognitive-behavioural therapy (CBT), may be particularly effective in reducing self-harm behaviours and improving overall mental health outcomes [ 37 , 38 , 39 ].…”