Longitudinal Prediction of Adolescent Nonsuicidal Self-Injury: Examination of a Cognitive Vulnerability-Stress Model

Abstract

Virtually no longitudinal research has examined psychological characteristics or events that may lead to adolescent nonsuicidal self-injury (NSSI). This study tested a cognitive vulnerability-stress model as a predictor of NSSI trajectories. Clinically-referred adolescents (n = 143; 72% girls) completed measures of NSSI, depression, attributional style, and interpersonal stressors during baseline hospitalization. Levels of NSSI were reassessed 3, 6, 9, 15, and 18 months later. Latent growth curve analyses suggested that a cognitive vulnerability-stress interaction significantly predicted increases in NSSI between 9 and 18 months post-baseline. This association remained significant while considering the longitudinal association between depressive symptoms and NSSI; results were not significantly mediated by depressive symptoms at 9 months.

Notes

Note: NSSI = Nonsuicidal self-injury; CASQ-R = Children's Attributional Style Questionnaire – Revised; CDI = Child Depression Inventory.

^a Past year.

^b Equal variances not assumed.

^c Measured at baseline.

^d Past 9 months.

*p < .05. **p < .01. ***p < .001.

Note: Boys above diagonal, girls below. NSSI = Nonsuicidal self-injury; CASQ-R = Children's Attributional Style Questionnaire–Revised; LE-Interpersonal = interpersonal life events; CDI = Child Depression Inventory.

*p < .05. **p < .01. ***p < .001.

Note: Parameters reported in the table are unstandardized regression weights (and standard errors). NSSI = nonsuicidal self-injury; CASQ-R = Children's Attributional Style Questionnaire-Revised; LE-int = interpersonal life events; CDI = Child Depression Inventory.

*p < .05. **p < .001.

¹The negative association revealed between the cognitive vulnerability-stress interaction and the NSSI “maintenance slope” may seem counterintuitive. Recall that more negative (i.e., “depressogenic”) attributional styles are represented by more extreme negative numbers, whereas positive (i.e., “adaptive”) attributional styles are represented by increasing positive numbers (see the Methods section regarding Attributional Style for a more detailed explanation). Greater mean occurrences of stressful life events, on the other hand, are represented by increasing positive numbers. Therefore, for the multiplicative interaction term, more extreme negative numbers represent higher relative levels of risk (i.e., greater reported levels of cognitive vulnerability in conjunction with more numerous interpersonal stressors). Thus, our data indicate that higher levels of the cognitive vulnerability-stress interaction (i.e., greater negative terms) are longitudinally associated with increasing trajectories of NSSI (i.e., greater positive terms) between 9 and 18 months postbaseline. The converse association also follows.