Search Results (138)

Background/Objectives: Non-suicidal self-injury (NSSI) in adolescence is associated with emotion dysregulation, experiential avoidance, psychiatric morbidity, and later suicidal risk. Interventions based primarily on acceptance and commitment therapy (ACT) target psychological flexibility, acceptance, cognitive defusion, and values-based action, whereas emotion regulation individual therapy for adolescents (ERITA) and internet-delivered emotion regulation individual therapy for adolescents (IERITA) principally target emotion dysregulation while incorporating selected acceptance-related and ACT-consistent components, making these approaches theoretically relevant to adolescent NSSI. Methods: We conducted a systematic review and exploratory meta-analysis informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. PubMed, Scopus, Web of Science, and EBSCO were searched on 10 April 2026. Eligible studies included adolescents or predominantly adolescent samples in which NSSI was the central clinical target or NSSI-specific outcomes were separately extractable and evaluated primarily ACT, ACT-informed, acceptance-based, ERITA, or IERITA interventions. Quantitative syntheses were restricted to controlled studies with extractable data. Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, and dedicated regional or gray literature sources were not searched; 15 reports remained unretrieved, so the evidence base may be incomplete. Results: Six full-text primary adolescent NSSI intervention studies met inclusion criteria: two controlled primarily ACT studies, one randomized ERITA feasibility trial, two uncontrolled ERITA feasibility/open studies, and one randomized IERITA trial. The strongest single-study evidence came from therapist-guided IERITA, which reduced masked assessor-rated NSSI frequency more than treatment as usual, with an incidence rate ratio of 0.34 (95% confidence interval [CI] 0.20 to 0.57). Two-study exploratory random-effects syntheses yielded estimates in the direction of benefit for continuous NSSI outcomes, Hedges’ g = −0.45 (95% CI −0.85 to −0.05; k = 2), and process outcomes, Hedges’ g = 1.25 (95% CI 0.83 to 1.68; k = 2). These estimates are hypothesis-generating and imprecise as estimates of a generalizable treatment effect because each synthesis contained only two clinically and methodologically heterogeneous studies. Although I² was 0% in both syntheses, these estimates are highly uncertain with only two studies and should not be interpreted as evidence of true homogeneity. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, certainty was moderate for the single masked clinician-rated IERITA outcome and very low for the pooled continuous NSSI and process-outcome evidence. Conclusions: Primarily ACT, ERITA, and IERITA interventions may be promising for adolescent NSSI, but the evidence remains preliminary and mostly of very low certainty. The pooled estimates are exploratory, hypothesis-generating, and imprecise and should not be interpreted as evidence of treatment efficacy. The strongest single-study evidence concerns therapist-guided IERITA and was rated as moderate in certainty, whereas the evidence for primarily ACT interventions and pooled process outcomes was very low in certainty and requires confirmation in larger preregistered randomized trials with standardized outcomes, longer follow-up, active comparators, and process measures. Full article

Non-suicidal self-injury (NSSI) is a significant public health concern among university students. Accumulating evidence suggests that deficits in executive function (EF) are associated with NSSI; however, little is known about how specific EF components relate to the specific psychological functions that motivate self-injury. This study aimed to investigate the fine-grained associations between EF dimensions and NSSI functions in university students with past-year NSSI using network analysis. Altogether, 1078 Chinese university students (82.6% female; Mage = 19.07, SD = 1.03) who had engaged in at least one NSSI behavior in the past year were enrolled. Executive function was assessed using the Adolescent Executive Function Scale, which measures three dimensions: inhibitory control, cognitive flexibility, and working memory. NSSI functions were assessed using the 19-item function subscale of the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire. A Gaussian graphical model was used to estimate the network. Expected influence (EI) and bridge expected influence (BEI) were computed to identify core nodes and bridge nodes, respectively. Of the 231 possible edges, 117 (50.65%) were non-zero, with the strongest within-community edge linking “coping with sadness and disappointment” (F3) and “expressing despair and hopelessness” (F4). Across communities, the most prominent edge was between “inhibitory control” and “having a desire to harm myself and cannot stop”. The three highest EI values were observed for “having a desire to harm myself and cannot stop,” “letting others make changes,” and “self-punishment”. “Inhibitory control” showed the highest BEI in the EF community, while “having a desire to harm myself and cannot stop” showed the highest BEI in the NSSI function community. Both EI and BEI demonstrated excellent stability (CS coefficients = 0.75). In university students with past-year NSSI, inhibitory control and the uncontrollable urge to self-injure function as critical bridge nodes linking executive dysfunction to NSSI functions, while self-punishment and interpersonal influence motives emerge as central drivers in the network. These findings highlight inhibitory control, the uncontrollable urge to self-injure, self-punishment, and interpersonal influence as promising targets for precision interventions aimed at disrupting the maladaptive cycle maintaining NSSI in this population. Full article

Background: Non-suicidal self-injury (NSSI) is highly prevalent during adolescence and is associated with a range of emotional, cognitive, and interpersonal vulnerabilities. Although prior research has identified key correlates such as emotion dysregulation, hopelessness, interpersonal distress, and attachment insecurity, these factors have largely been examined in isolation, limiting understanding of how they jointly contribute to NSSI. Methods: The present study examined the network structure of NSSI and associated vulnerability processes in a community sample of 2067 Spanish adolescents (M age = 14.62, SD = 1.80). A regularized partial correlation network (EBICglasso) was estimated, including NSSI frequency and functions, emotion dysregulation, hopelessness, perceived burdensomeness, thwarted belongingness, and attachment representations. Centrality and network stability were evaluated using standard indices and bootstrapping procedures. Results: The network revealed a differentiated structure of associations. Perceived burdensomeness and intrapersonal NSSI functions emerged as the most influential nodes, whereas emotion dysregulation occupied a key bridging position connecting attachment-related experiences, interpersonal vulnerability, and NSSI processes. In contrast, NSSI frequency and interpersonal functions showed a more peripheral role. Attachment security was negatively associated with core risk variables, consistent with a protective role within the network. Conclusions: Findings suggest that NSSI in adolescence is embedded within a system of interacting emotional and interpersonal processes, structured around the functional meaning of the behavior and key interpersonal appraisals. Emotion dysregulation emerged as a highly connected node linking multiple domains, while attachment was associated with several key variables within the network. These findings suggest potential targets for early identification and intervention, particularly focusing on emotion regulation, perceived burdensomeness, and intrapersonal functions of NSSI. Full article

Non-suicidal self-injury (NSSI) is a significant public health concern, with disproportionately higher prevalence among sexual and gender minority (SGM) populations compared to cisgender heterosexual individuals. While prior research has examined NSSI and related outcomes in SGM groups, evidence on specific risk and protective factors remains limited. This scoping review aimed to systematically map and synthesize risk and protective factors associated with NSSI in SGM populations. A systematic search was conducted in PubMed, Scopus, and Web of Science up to 2 February 2026. A total of 43 studies were included, the majority of which were conducted in the United States and employed cross-sectional designs. Data were charted and synthesized using a minority stress-informed socioecological framework. Findings indicate that NSSI is consistently associated with the co-occurrence of minority stress processes and intrapersonal vulnerabilities. Additional risk factors were identified across family, peer, and community domains. Protective factors were less frequently examined but included social support, family connectedness, school safety, and adaptive coping strategies. Overall, the findings suggest that NSSI among SGM populations is best understood as the result of interacting risk processes across multiple ecological levels. These results support a minority stress-informed, multi-level conceptualization of NSSI in SGM individuals and highlight the need for longitudinal research and greater focus on protective factors. Full article

Background/Objectives: Adolescent suicidal ideation and non-suicidal self-injury (NSSI) are major public health concerns, yet differences between active interventions are often modest. This retrospective study provides preliminary descriptive evidence regarding short-term symptom change across two school-based intervention pathways—Sandplay Therapy with Suicidal ideation and Self-injury Focused Engagement (SPT-SAFE) and a Dialectical Behavior Therapy-informed Brief Intervention (DBT-BI)—in a clinical sample of middle- and high-school adolescents with suicidal ideation and NSSI. Methods: Archival clinical records from 112 adolescents treated in a school-based suicide prevention center were analyzed retrospectively. The sample included 52 adolescents who received SPT-SAFE and 60 who received DBT-BI. Outcomes included suicidal ideation, NSSI frequency, depressive symptoms, anxiety, aggression, impulsiveness, and self-concept. Pre–post changes were examined using mixed-design ANOVAs, with baseline-adjusted ANCOVAs conducted as supplementary analyses. Given the retrospective and clinically assigned design, findings were interpreted as observational associations rather than causal treatment effects. Results: Both intervention groups showed significant pre–post improvements across multiple outcome domains. Overall between-group differences were limited. A nominal, uncorrected Group × Time interaction was observed for impulsiveness, with the DBT-BI group showing a descriptively larger pre–post decrease than the SPT-SAFE group. However, this effect was small and did not remain statistically significant after Bonferroni correction or Benjamini–Hochberg false discovery rate correction across the seven interaction tests. No other outcome showed a multiplicity-adjusted Group × Time interaction. Conclusions: The present study did not provide robust multiplicity-adjusted evidence for differential treatment effects between SPT-SAFE and DBT-BI. The nominal impulsivity finding should be interpreted only as a small, uncorrected exploratory signal for future hypothesis generation. The contribution of this study is therefore descriptive and preliminary, characterizing short-term symptom change in a treatment-engaged adolescent completer sample within a routine school-based service system, rather than supporting domain-specific comparative efficacy or domain-sensitive intervention planning. Full article

Adolescent self-harm, particularly non-suicidal self-injury (NSSI), is increasingly understood as a multidetermined behavior shaped by emotional, cognitive, and interpersonal processes. This focused, non-systematic narrative review examines cognitive–affective correlates of adolescent non-suicidal self-injury, while drawing on broader self-harm and suicidality-related evidence only where relevant to the cognitive–affective formulation. Particular attention is given to executive functioning, emotional processing, and social–emotional and interpersonal cognition. The evidence is strongest for emotional processing, especially difficulties in emotion regulation, rumination, cognitive reappraisal, alexithymia, and the identification and modulation of internal states. Executive functioning also appears clinically relevant, but the current findings support a selective rather than global impairment account, with the clearest evidence involving inhibitory control, impulsivity-related regulation, and decision-making under affective pressure. Social–emotional and interpersonal cognition is treated as an emerging and indirectly supported domain; much of the available evidence concerns interpersonal and relational constructs, such as interpersonal sensitivity, relational interpretation, emotional communication, and family–emotional context, rather than direct measures of theory of mind, social inference, or emotion recognition accuracy. Overall, adolescent self-harm is best understood as emerging from the interaction of emotional dysregulation, weakened behavioral control under distress, and difficulties in social–emotional meaning-making during a developmentally sensitive period. A cognitively informed developmental framework may help refine theory, improve clinical formulation, and guide future mechanism-oriented research. Full article

Non-suicidal self-injury (NSSI) is a major concern in adolescent mental health, yet the psychometric properties of the Inventory of Statements About Self-Injury (ISAS) have not previously been examined in a Greek adolescent inpatient sample. This preliminary study evaluated the internal consistency, factorial structure, and construct validity evidence of the ISAS in 95 Greek adolescents receiving inpatient psychiatric care (mean age = 14.69 years, SD = 1.30; 86.3% female). Data were obtained retrospectively from clinical records. Psychometric evaluation included Cronbach’s alpha coefficients, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and correlations with the Youth Self-Report (YSR). The ISAS showed satisfactory internal consistency at the higher-order factor level, with alpha coefficients of 0.82 for the interpersonal factor and 0.85 for the intrapersonal factor, although Autonomy and Interpersonal Boundaries showed weak reliability. EFA supported a broad two-factor intrapersonal–interpersonal structure. CFA findings were exploratory and mixed. The original CFA models showed inadequate fit, whereas exploratory modified and post hoc sensitivity models showed improved but non-definitive fit. Convergent validity evidence was modest and was supported by associations between the original broad ISAS intrapersonal score and YSR self-harm behavior, suicidal ideation, internalizing-related dimensions, and Total Problems. Discriminant-pattern evidence was limited. Overall, the findings provide preliminary support for the clinical usefulness of the ISAS as an adjunctive assessment tool in this population, but they do not constitute definitive validation. Further prospective validation in larger, more diverse, and independent samples is needed. Full article

Given the importance of friendships and the increased risk for suicide during adolescence, potential socialization of suicidality among peers is essential to examine. Data were obtained from 93 friendship dyads (N = 186) in a community-based, longitudinal study of adolescents (Mage = 15.68, SD = 1.49, 69.9% female, 86.6% white). Adolescents’ and friends’ suicide risk and frequency of non-suicidal self-injury (NSSI) were assessed at baseline and at 3-month and 6-month follow-up assessments. Cross-lagged, Actor–Partner Interdependence Models (CL-APIM) examined socialization effects over time with the nested, dyadic data. Results indicated that direct socialization of suicide risk did not occur within the whole sample. However, socialization of suicide risk was observed for friends of adolescents with a past-year history of NSSI. The findings underscore the potential for NSSI to function as a susceptibility marker for socialization of suicide risk within adolescent friendships. Current study strengths, limitations, and clinical implications are further discussed. Full article

Non-suicidal self-injury (NSSI) among adolescents is an important public health concern. This study examined the associations among physical activity (PA), psychological resilience (PR), and NSSI among 2257 junior high school students aged 12–17 years in central China. Using both variable-centered and person-centered approaches, the study found that higher PA and higher PR were related to lower NSSI. PR also partly accounted for the association between PA and NSSI, suggesting that resilience may be one pathway linking physical activity to reduced self-injury risk. Latent profile analysis identified three PA–PR profiles: low, moderate, and high. Adolescents in the low PA–PR profile reported the highest NSSI risk, whereas those in the high PA–PR profile reported the lowest risk. These findings suggest that interventions promoting PA and resilience may help reduce adolescent NSSI risk. Full article

Background/Objectives: Adolescent psychiatric inpatient units play a critical role in the management of severe psychiatric disorders and suicide risk. However, limited evidence exists regarding the clinical and familial factors that simultaneously influence suicidal ideation and treatment outcomes in hospitalized adolescents. This study aimed to identify demographic, diagnostic, and clinical predictors of suicidal ideation and clinical improvement among adolescents hospitalized in a tertiary child and adolescent psychiatry inpatient unit. Methods: This retrospective observational study included 75 adolescents aged 12–18 years who were hospitalized in a tertiary child and adolescent psychiatry inpatient unit between November 2023 and June 2025. Sociodemographic and clinical characteristics were obtained from medical records. Clinical improvement was evaluated using the Clinical Global Impression–Improvement (CGI-I) scale. Group comparisons were conducted using chi-square or Fisher’s exact tests for categorical variables and the Mann–Whitney U test for continuous variables. Multivariate logistic regression analyses were performed to determine independent predictors of suicidal ideation and clinical improvement. Results: Clinical improvement was evaluated in the full sample of adolescents (n = 75), and longer length of stay was independently associated with clinical improvement during hospitalization. Among adolescents admitted with suicidal ideation (n = 45), major depressive disorder, previous suicide attempt, irritability at admission, and fewer siblings were identified as independent predictors of suicidal ideation. In addition, female adolescents had higher rates of suicide attempts and non-suicidal self-injury, whereas psychotic disorders were more common among male adolescents. Conclusions: Suicidal ideation in hospitalized adolescents is strongly associated with affective pathology and prior suicidal behavior. Longer inpatient treatment duration appears to facilitate clinical improvement. These findings highlight the importance of early suicide risk stratification and adequate treatment duration in adolescent psychiatric inpatient care. Full article

Background: Youth mental health services increasingly encounter adolescents and young adults with complex affective presentations and trauma histories. Dissociation has been proposed as a clinically relevant marker within bipolar vulnerability pathways but remains underrecognized in early-intervention settings. This pilot study investigated the prevalence and clinical correlates of bipolar at-risk (BAR) status in a help-seeking youth sample, with specific focus on dissociative symptoms in this vulnerable population. Methods: A pilot study with a cross-sectional design was conducted in a specialized outpatient clinic for 14–25-year-olds. Seventy-six participants without Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision bipolar disorder completed a multidimensional assessment, including dissociative (Dissociative Experiences Scale version 2 [DES-II], Adolescent-DES [A-DES], Structured Clinical Interview for DSM Dissociative Disorders [SCID-D]), affective, anxiety, impulsivity, and prodromal symptom measures. BAR status (BAR+) was determined via clinical interview according to Bechdolf criteria. Clinically significant dissociation (DES+) was defined by established cut-offs at the DES-II and A-DES scales. Group comparisons, binary logistic regression and exploratory mediation analysis were performed. Results: In our sample, 44.7% of the participants met BAR+ criteria and 42.9% displayed clinically significant dissociation. Patients with BAR+ status more frequently reported familiar history of affective disorders, previous antidepressant use, loneliness, and non-suicidal self-injury. They displayed more severe depressive symptoms and impulsivity, as well as higher scores at all the affective temperament subscale except for hyperthymic. BAR+ patients displayed higher prevalence of dissociative symptoms than BAR− (51.6% vs. 24.2%; p = 0.045). Among the BAR+ subgroup, DES+ youths showed greater traumatic burden, depressive symptoms, and anxious temperament scores. Dissociation was associated with BAR+ status (OR 3.2) after adjusting for age, gender, and loneliness, while attentional impulsivity did not mediate this relationship. Conclusions: Dissociative symptomatology is highly prevalent among help-seeking youths and is directly associated with subthreshold bipolar-spectrum vulnerability. A dissociative BAR phenotype, marked by emotional instability and trauma exposure, may delineate a clinically complex subgroup, supporting the integration of dissociation-focused assessment into youth bipolar-risk staging and early-intervention protocols. Full article

Background/Objectives: Suicidal ideation and non-suicidal self-injury (NSSI) among elementary school students represent critical public health concerns that require develop-mentally appropriate, evidence-informed school-based interventions. This study con-ducted a retrospective comparative analysis of two school-based approaches—Sandplay Therapy with Suicidal Ideation and Self-Injury-Focused Engagement (SPT-SAFE) and a School-based Dialectical Behavior Therapy-informed Brief Intervention (DBT-BI)—for elementary school students presenting with suicidal ideation and NSSI. The objective was to describe pre–post-changes in key outcomes within each intervention and to explore whether outcome trajectories differed between the two approaches in a non-randomized, real-world school-based setting. Methods: This retrospective study analyzed archival clinical records from 109 elementary school students (SPT-SAFE: N = 59; DBT-BI: N = 50) who received services at a school-based suicide prevention center in South Korea between 2022 and 2024. Seven validated outcome measures assessed suicidal ideation, NSSI frequency, depression, anxiety, aggression, impulsiveness, and self-concept at pre- and post-intervention. Pre–post-changes and exploratory between-group differences were examined using 2 × 2 mixed-design ANOVAs (Group × Time interaction), with baseline-adjusted ANCOVAs conducted as complementary analyses. Suicidal ideation was operationalized using the SIQ-JR total score, and NSSI was operationalized using the FASM summed frequency index. Results: Both interventions were associated with significant reductions in suicidal ideation (F = 29.98, p < 0.001, partial η² = 0.219) and NSSI frequency (F = 15.95, p < 0.001, partial η² = 0.130), with large within-group effect sizes and no significant Group × Time interactions. Accordingly, between-group differences were limited and should be interpreted as exploratory rather than comparative–effectiveness evidence. Modest between-group differences favoring DBT-BI were observed for self-concept outcomes (F = 4.14, p = 0.044, partial η² = 0.037; d = −0.39). Conclusions: These findings suggest that both interventions were associated with pre–post-improvements in suicidal ideation and NSSI frequency within a school-based clinical context. Full article

Meaning in life (MIL) is recognized as a protective factor for adolescent mental health, being associated with reduced risks of depression, suicidal ideation, and non-suicidal self-injury. This study examined associations between attachment styles and MIL, with hopelessness and emotion dysregulation as potential mediators. Participants were 2067 Spanish adolescents (51.9% male, 48.1% female; M age = 14.62, SD = 1.80) who completed validated measures of attachment, emotion dysregulation, hopelessness, and MIL. Structural equation modeling indicated that secure attachment was associated with higher MIL both directly and indirectly through lower levels of hopelessness and emotion dysregulation. Disorganized attachment was not directly associated with MIL but was indirectly associated with MIL through these vulnerabilities. Hopelessness emerged as the strongest mediator, while emotion dysregulation was associated with satisfaction and meaning only. Findings highlight psychological vulnerabilities as pathways linking attachment to MIL, with implications for clinical and preventive strategies. Full article

Background: Non-suicidal self-injury (NSSI) is defined as the intentional damage to one’s body tissue without suicidal intent and for reasons that are not socially sanctioned. While NSSI has been widely studied in the general population, its clinical correlates and management in autism spectrum disorder (ASD) remain less clearly characterized, and it is often conflated with self-injurious behavior (SIB) described within restricted and repetitive behaviors (RRBs). In individuals with ASD, NSSI may be associated with emotional, behavioral, cognitive, social, medical, and demographic factors, and it differs from SIB typically observed among individuals with severe intellectual disabilities. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies published between 2000 and 2025 that assessed NSSI in individuals with a formal ASD diagnosis were included. Etiological/clinical correlates, explanatory mechanisms, and management challenges were examined. Sixteen studies were selected from PubMed, Scopus, and Web of Science. Findings were synthesized using narrative and thematic approaches. Results: The prevalence of NSSI among individuals with ASD ranged from 24% to 50%. Associated factors included emotion dysregulation (including alexithymia and affective distress), behavioral dysregulation (e.g., impulsivity/hyperactivity and aggression), sensory processing difficulties, communication and social impairments, and medical comorbidities (i.e., gastrointestinal and sleep problems), with preliminary evidence also implicating perinatal factors. NSSI was linked to emotion regulation, sensation seeking, and social communication processes. Early intervention and parental involvement were identified as protective factors. Conclusions: NSSI in ASD is a complex, multifactorial phenomenon frequently linked to emotion-regulation needs. Affective imbalance represents a central—though not exclusive—pathway. The review supports standardized terminology, function-based assessment, and clearer differentiation from SIB/RRBs, with implications for individualized interventions and sustained monitoring in persistent or severe cases. Routine screening for medical and sensory contributors may further improve case management and reduce preventable clinical burden. Full article

Background: Non-suicidal self-injury (NSSI) is a significant public health issue that threatens the physical and mental well-being of adolescents. Identifying associated factors is a crucial step toward effective intervention. Methods: This study analyzed data from 463 adolescents (42.12% boys; mean age = 16.21 years, range 12–18) to explore the relationships between NSSI, parental psychological control, self-disgust, and resilience. Results: Multivariate logistic regression indicated that parental psychological control, self-disgust, and resilience were significantly associated with NSSI. Furthermore, in the chain mediation model, self-disgust and resilience significantly mediated the relationship between parental psychological control and NSSI. Conclusions: This study examines the relationships between parental psychological control, self-disgust, resilience and NSSI in adolescents, providing theoretical insights and practical implications for developing intervention and prevention strategies. Full article