Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences
Par Zeng C, Liu J, Liu J et 1 autres.
Contenu en anglais
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Stressful events are important external risk factors for non-suicidal self-injury (NSSI) in adolescents. However, existing studies have insufficiently examined how stress influences the dynamic onset and remission of NSSI through individual internal vulnerability factors, as well as whether different sources of stress operate through distinct mechanisms. This study therefore uses a longitudinal follow-up design to systematically examine the pathways through which stressful events influence changes in adolescent NSSI via self-criticism and to further identify the specific effects of different types of stress.
Using cluster random sampling, 2 094 adolescents were followed longitudinally for 1 year. Two rounds of paper-based questionnaire surveys were conducted from March to April 2024 (T1) and from March to April 2025 (T2). Participants were assessed using the Adolescent Self-rating Life Events Checklist, the self-criticism subscale of the Chinese version of the Self-Compassion Scale, and the Adolescent Self-harm Behavior Scale. According to NSSI status at T1 and T2, participants were classified into 4 groups: the resistant group (no NSSI at T1/no NSSI at T2), the onset group (no NSSI at T1/NSSI at T2), the persistent group (NSSI at T1/NSSI at T2), and the remission group (NSSI at T1/no NSSI at T2). Model 1 and Model 2 were constructed using either the total T1 stress score or the scores of the five stress dimensions as independent variables, the T1 self-criticism score as the mediator, gender and only-child status as control variables, and "onset group vs. resistant group" and "remission group vs. persistent group," respectively, as binary dependent variables. Indirect-effect analyses were then performed.
Among the 2 094 adolescents, 999 (47.7%) were boys and 1 095 (52.3%) were girls, with an age range of 15 to 17 years and a mean age of (15.52±0.56) years. NSSI differed significantly by gender and only-child status (both P<0.05). The resistant, onset, persistent, and remission groups comprised 1 162, 221, 434, and 277 participants, respectively. In Model 1, stress significantly predicted self-criticism (β=0.362, 95% CI 0.314 to 0.408, P<0.001), and self-criticism significantly predicted NSSI onset (β=0.075, 95% CI 0.035 to 0.119, P<0.001). In Model 2, stress significantly predicted self-criticism (β=0.367, 95% CI 0.304 to 0.429, P<0.001), and self-criticism significantly predicted NSSI remission (β=-0.108, 95% CI -0.158 to -0.065, P<0.001). The indirect effects were significant in both Model 1 (β=0.027, 95% CI 0.012 to 0.044, P<0.001) and Model 2 (β=-0.039, 95% CI -0.061 to -0.023, P<0.001). However, the direct effects differed between the 2 models. In Model 1, stress directly predicted NSSI onset (β=0.065, 95% CI 0.032 to 0.102, P<0.001), whereas in Model 2, the direct effect of stress was not significant (β=-0.018, 95% CI -0.061 to 0.032, P=0.229). A parallel mediation model incorporating multiple dimensions of stress further indicated that interpersonal stress, academic stress, and adjustment problems indirectly predicted a higher likelihood of NSSI onset and a lower likelihood of NSSI remission through self-criticism, whereas the indirect effects of loss-related stress and punishment-related stress were not significant.
Self-criticism showed significant indirect effects in the associations of stress with both NSSI onset and remission. Self-criticism may function both as a risk factor through which stress contributes to the onset of NSSI and as a barrier to NSSI remission. The pathways through which different sources of stress influence NSSI via self-criticism appear to be source-specific. These findings provide an important theoretical basis for more targeted interventions for adolescent NSSI.
Publié dans Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences. Le résumé est reproduit tel qu’il a été publié et reste l’œuvre de ses auteurs ; lisez l’article complet à la source.
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