The role of self-evaluation in non-suicidal self-injury among adolescents with depressive disorder
10.3760/cma.j.cn113661-20250103-00007
- VernacularTitle:青少年抑郁障碍患者自我评价影响非自杀性自伤行为的机制分析
- Author:
Feng ZHU
1
;
Xuna YANG
;
Xia DU
;
Dan WANG
;
Qing TIAN
Author Information
1. 苏州市广济医院儿少精神科，苏州 215137
- Publication Type:Journal Article
- Keywords:
Depressive disorder;
Adolescents;
Non-suicidal self-injury;
Self-evaluation;
Perceived stress;
Chain mediation effect
- From:
Chinese Journal of Psychiatry
2025;58(7):533-541
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the internal mechanism by which self-evaluation influences non-suicidal self-injury (NSSI) in adolescent patients with depressive disorder.Methods:Clinical data from 214 adolescent patients with depressive disorder hospitalized at Suzhou Guangji Hospital from March 2022 to January 2024 were prospectively collected. According to the DSM-5 diagnostic criteria for NSSI, participants were divided into an NSSI group (158 cases [38 males, 120 females, age 12-17 (14.2±1.5) years]) and a non-NSSI group (56 cases [20 males, 36 females, age 12-18 (14.5±1.8) years]). A self-developed basic information questionnaire was used to collect demographic data. Standardized tools including the Self-rating Depression Scale (SDS), Inventory of Parent and Peer Attachment (IPPA), Self-acceptance Questionnaire (SAQ), and Perceived Stress Scale-10 (PSS-10) were used to assess their depression level, parental attachment level, self-evaluation/acceptance level, perceived stress level, and other relevant psychological characteristics. Differences in psychological characteristics between the two groups were compared. Logistic regression, correlation analysis, and mediation effect models were used to explore the relationships between variables and NSSI and their mechanisms.Results:The NSSI group had significantly higher total scores on the SDS (41.3±7.7 vs. 34.4±9.3) and PSS-10 (25.5±6.1 vs. 21.3±6.5) than the non-NSSI group ( F=29.12, F=18.17, respectively; all P<0.001). Conversely, the NSSI group had significantly lower total scores on the SAQ (31.2±8.8 vs. 35.9±8.9) and IPPA (56.3±13.6 vs. 63.4±13.8) compared to the non-NSSI group ( F=11.24, F=10.84, respectively; all P<0.001). Stepwise logistic regression analysis identified depression level (SDS total score, OR=1.12, 95% CI: 1.05-1.19), self-evaluation (SAQ subscale score, OR=1.17, 95% CI: 1.04-1.31), and perceived stress (PSS-10 total score, OR=1.11, 95% CI: 1.01-1.22) as predictors of NSSI (all P<0.05). Chain mediation analysis showed that self-evaluation had a significant positive direct effect ( β=0.025, P<0.01) and a negative indirect effect ( β=-0.038, P<0.001) on NSSI, with a negative total effect ( β=-0.012, P<0.05). The indirect effect was realized through three pathways: a single mediation pathway of self-evaluation via perceived stress ( β=-0.016), a single mediation pathway of self-evaluation via depression ( β=-0.011), and a chain mediation pathway of self-evaluation via perceived stress and depression ( β=-0.011) (all P<0.05). Conclusion:Self-evaluation influences NSSI behavior through a dual mechanism involving both direct and indirect effects. The indirect protective effect is primarily achieved by reducing perceived stress and depression levels.
