Emotional Abuse as an Upstream Factor Influencing Non-Suicidal Self-Injury in Depressed Adolescents: A Network Analysis

Objective: To construct a network model depicting non-suicidal self-injury (NSSI) and its influencing factors in adolescents diagnosed with depression, identify the core symptoms within this network, explore the potential causal pathways, and generate hypotheses for future research. Methods: A sample of 705 adolescent patients with depressive disorders was recruited and assessed using three standardized questionnaires, namely the Childhood Trauma Questionnaire, the Aggression Questionnaire, and the Adolescent Self-Injury Questionnaire. Undirected network analysis, coupled with directed Bayesian network analysis, was employed to elucidate the interrelationships among symptoms. Results: In the network of NSSI-related influencing factors in adolescents with depression, emotional abuse, hostility, sexual abuse, and emotional neglect are important influencing factors. Hostility and anger serve as bridges that connect NSSI to other influencing factors. In the Bayesian network, emotional abuse is shown to precede other symptoms, such as hostility and anger; conversely, NSSI and physical aggression were positioned at the periphery of the network, indicating a greater reliance on other symptoms for their occurrence. Emotional abuse demonstrated the strongest associations with the greatest number of other problems in the network, indicating that emotional abuse plays a crucial role. Conclusion: Emotional abuse plays an important role in the network model of NSSI of adolescent depression patients and its influencing factors.