The Impact of Recent Life Events, Internalizing Symptoms, and Emotion Regulation on the Severity of Non-Suicidal Self-Injury in Adolescents: A Mediation Analysis

Abstract

Background

Previous studies have demonstrated a strong association between recent stressful life events and non-suicidal self-injury (NSSI) among adolescents. Internalizing symptoms and difficulty in emotion regulation (DER) may mediate this relationship. This study aimed to investigate the relationship between recent stressful life events and NSSI severity in adolescents and the potential moderating role of internalizing symptoms and DER.

Methods

A total of 224 adolescent inpatients (78.6% female) participated in the study, with an age range of 12–18 years old. Data on recent stressful life events, internalizing symptoms, DER, and NSSI behaviors were collected using a clinician-rated questionnaire. A structural equation model was used to test the hypothesized model.

Results

The rate of NSSI reporting among adolescents in the past 12 months was 65.18%. Recent stressful life events were found to be directly associated with NSSI severity (β = 0.128, P = 0.023). A chain-mediating effect between recent stressful life events and NSSI was also confirmed (β = 0.034, P = 0.023), with DER and internalizing symptoms playing a chain-mediating role and DER having a significantly indirect association with NSSI through internalizing symptoms.

Conclusion

Recent stressful life events appear to play a role in the etiology of NSSI, particularly punishment and interpersonal relationship events that warrant special attention. DER and internalizing symptoms play a chain-mediating role in the relationship between life events and NSSI. Reducing recent stressful life events, screening for internalizing symptoms, and improving emotion regulation may decrease NSSI behavior among adolescents.

Keywords:

• non-suicidal self-injury
• adolescents
• recent stressful life events
• internalizing symptoms
• difficulty in emotion regulation
• structural equation model

Abbreviations

NSSI, non-suicidal self-injury; DER, difficulty in emotion regulation; DSM-5, Diagnostic and Statistical Manual of Mental Disorders, 5th edition; SEM, structural equation model; DSM-IV, American Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; CI, confidence interval; SD, Standard Deviation; DERS, Difficulties in Emotion Regulation Scale; ASLEC, Adolescent Self-Rating Life Events Check List; PHQ-9, Patient Health Questionnaire-9; GAD-7, General Anxiety Disorder-7; CRSNSSI, Clinician-Rated Severity of Non-Suicidal Self-Injury; IRF, Interpersonal Relationship Factor; LPF, Learning Pressure Factor; PF, Punishment Factor; LF, Loss Factor; HAF, Health Adaption Factor.

Data Sharing Statement

The datasets generated and/or analyzed during the current study are not publicly available due to privacy or ethical restrictions but are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The study was conducted by the Declaration of Helsinki and approved by the ethics committee of Hangzhou First People’s Hospital, affiliated with West Lake University School of Medicine (IRB: 2020-K008–01, January 2020). The parent or legal guardian provided written informed consent to participate in this study, with the assent of the adolescents.

Disclosure

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This manuscript has not been published nor is it being considered for publication elsewhere.

Additional information

Funding

This work was funded by National Natural Science Foundation of China (grant number: 81971277; 82271570) and the medical and health research project of Zhejiang province (2023KY920).