Abstract
Existing research on non-suicidal self-injury (NSSI) among adolescents has primarily concentrated on general risk factors, leaving a significant gap in understanding the specific NSSI characteristics that predict diverse psychopathological outcomes. This study aims to address this gap by using Random Forests to discern the significant predictors of different clinical outcomes. The study tracked 348 adolescents (64.7% girls; mean age = 13.31, SD = 0.91) over 6 months. Initially, 46 characteristics of NSSI were evaluated for their potential to predict the repetition of NSSI, as well as depression, anxiety, and suicidal risks at a follow-up (T2). The findings revealed distinct predictors for each psychopathology. Specifically, psychological pain was identified as a significant predictor for depression, anxiety, and suicidal risks, while the perceived effectiveness of NSSI was crucial in forecasting its repetition. These findings imply that it is feasible to identify high-risk individuals by assessing key NSSI characteristics, and also highlight the importance of considering diverse NSSI characteristics when working with self-injurers.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ammerman, B. A., Burke, T. A., Alloy, L. B., & McCloskey, M. S. (2016). Subjective pain during NSSI as an active agent in suicide risk. Psychiatry Research, 236, 80–85. https://doi.org/10.1016/j.psychres.2015.12.028.
Ammerman, B. A., Jacobucci, R., Kleiman, E. M., Uyeji, L. L., & McCloskey, M. S. (2018a). The relationship between nonsuicidal self-injury age of onset and severity of self-harm. Suicide and Life-Threatening Behavior, 48(1), 31–37. https://doi.org/10.1111/sltb.12330.
Ammerman, B. A., Jacobucci, R., & McCloskey, M. S. (2018b). Using exploratory data mining to identify important correlates of nonsuicidal self-injury frequency. Psychology of Violence, 8(4), 515–525. https://doi.org/10.1037/vio0000146.
Ammerman, B. A., Jacobucci, R., Turner, B. J., Dixon-Gordon, K. L., & McCloskey, M. S. (2020). Quantifying the importance of lifetime frequency versus number of methods in conceptualizing nonsuicidal self-injury severity. Psychology of Violence, 10(4), 442–451. https://doi.org/10.1037/vio0000263.
Baer, M. M., Tull, M. T., Forbes, C. N., Richmond, J. R., & Gratz, K. L. (2020). Methods matter: Nonsuicidal self-injury in the form of cutting is uniquely associated with suicide attempt severity in patients with substance use disorders. Suicide and Life-Threatening Behavior, 50(2), 397–407. https://doi.org/10.1111/sltb.12596.
Bjureberg, J., Kuja-Halkola, R., Ohlis, A., Lichtenstein, P., D’Onofrio, B. M., Hellner, C., & Cederlof, M. (2022). Adverse clinical outcomes among youths with nonsuicidal self-injury and suicide attempts: a longitudinal cohort study. Journal of Child Psychology and Psychiatry, 63(8), 921–928. https://doi.org/10.1111/jcpp.13544.
Brausch, A. M., & Muehlenkamp, J. J. (2018). Perceived effectiveness of NSSI in achieving functions on severity and suicide risk. Psychiatry Research, 265, 144–150. https://doi.org/10.1016/j.psychres.2018.04.038.
Breiman, L. (2001). Random forests. Machine Learning, 45(1), 5–32. https://doi.org/10.1023/a:1010933404324.
Bresin, K., & Gordon, K. H. (2013). Endogenous opioids and nonsuicidal self-injury: A mechanism of affect regulation. Neuroscience and Biobehavioral Reviews, 37(3), 374–383. https://doi.org/10.1016/j.neubiorev.2013.01.020.
Brickman, L. J., Ammerman, B. A., Look, A. E., Berman, M. E., & McCloskey, M. S. (2014). The relationship between non-suicidal self-injury and borderline personality disorder symptoms in a college sample. Borderline Personality Disorder and Emotion Dysregulation, 1, 14–14. https://doi.org/10.1186/2051-6673-1-14.
Brown, R. C., & Plener, P. L. (2017). Non-suicidal self-injury in adolescence. Current Psychiatry Reports, 19(3), 20. https://doi.org/10.1007/s11920-017-0767
Burke, T. A., Jacobucci, R., Ammerman, B. A., Piccirillo, M., McCloskey, M. S., Heimberg, R. G., & Alloy, L. B. (2018). Identifying the relative importance of non-suicidal self-injury features in classifying suicidal ideation, plans, and behavior using exploratory data mining. Psychiatry Research, 262, 175–183. https://doi.org/10.1016/j.psychres.2018.01.045.
Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. https://doi.org/10.1016/j.janxdis.2016.02.007.
Case, J. A. C., Burke, T. A., Siegel, D. M., Piccirillo, M. L., Alloy, L. B., & Olino, T. M. (2020). Functions of non-suicidal self-injury in late adolescence: A latent class analysis. Archives of suicide research: official journal of the International Academy for Suicide Research, 24, S165–S186. https://doi.org/10.1080/13811118.2019.1586607.
Dixon-Gordon, K. L., Turner, B. J., Haliczer, L. A., Gratz, K. L., Tull, M. T., & Chapman, A. L. (2022). Self-injury motives: A person-centered examination. Suicide & life-threatening behavior, 52(4), 812–827. https://doi.org/10.1111/sltb.12865.
Duprey, E. B., Oshri, A., & Liu, S. (2020). Developmental pathways from child maltreatment to adolescent suicide-related behaviors: The internalizing and externalizing comorbidity hypothesis. Development and Psychopathology, 32(3), 945–959. https://doi.org/10.1017/s0954579419000919.
Gardner, K. J., Paul, E., Selby, E. A., Klonsky, E. D., & Mars, B. (2021). Intrapersonal and interpersonal functions as pathways to future self-harm repetition and suicide attempts. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.688472
Glenn, C. R., & Klonsky, E. D. (2009). Social context during non-suicidal self-injury indicates suicide risk. Personality and Individual Differences, 46(1), 25–29. https://doi.org/10.1016/j.paid.2008.08.020.
Greene, D., Boyes, M., & Hasking, P. (2020). The associations between alexithymia and both non-suicidal self-injury and risky drinking: A systematic review and meta-analysis. Journal of Affective Disorders, 260, 140–166. https://doi.org/10.1016/j.jad.2019.08.088.
Hawton, K., Saunders, K. E. A., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. Lancet, 379(9834), 2373–2382. https://doi.org/10.1016/s0140-6736(12)60322-5.
He, X., Li, C., Qian, J., & Cui, H. (2010). Guangfanxing Jiaolü Liangbiao zai Zonghexing Yiyuan de Xindu he Xiaodu Yanjiu [Reliability and validity of a generalized anxiety scale in general hospital outpatients]. Shanghai Arch Psychiatry, 22(4), 200–203.
Holden, R. R., Mehta, K., Cunningham, E. J., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science-Revue Canadienne Des Sciences Du Comportement, 33(4), 224–231. https://doi.org/10.1037/h0087144.
Holden, R. R., Patterson, A. A., & Fekken, G. C. (2022). Childhood trauma and non-suicidal self-injury: Mental pain and depression as mediators in university and community samples? Personality and Individual Differences, 187, 111414. https://doi.org/10.1016/j.paid.2021.111414.
Hooley, J. M., & Franklin, J. C. (2018). Why do people hurt themselves? A new conceptual model of nonsuicidal self-injury. Clinical Psychological Science, 6(3), 428–451. https://doi.org/10.1177/2167702617745641.
Huang, Y., Zhu, C., Feng, Y., Ji, Y., Song, J., Wang, K., & Yu, F. (2022). Comparison of three machine learning models to predict suicidal ideation and depression among Chinese adolescents: A cross-sectional study. Journal of Affective Disorders, 319, 221–228. https://doi.org/10.1016/j.jad.2022.08.123.
Huen, J. M. Y., Yip, P. S. F., Osman, A., & Leung, A. N. M. (2022). The Suicidal Behaviors questionnaire-revised (SBQ-R) and its chinese version (C-ABQ-R): Further validity testing using the culture, comprehension, and translation bias procedure. Psychological Assessment, 34(7), 704–710. https://doi.org/10.1037/pas0001134.
International Society for the Study of Self-injury. (2018). What is self-injury? https://itriples.org/about-self-injury/what-is-self-injury.
Joormann, J., & Stanton, C. H. (2016). Examining emotion regulation in depression: A review and future directions. Behaviour Research and Therapy, 86, 35–49. https://doi.org/10.1016/j.brat.2016.07.007.
Kiekens, G., Hasking, P., Boyes, M., Claes, L., Mortier, P., Auerbach, R. P., Cuijpers, P., Demyttenaere, K., Green, J. G., Kessler, R. C., Myin-Germeys, I., Nock, M. K., & Bruffaerts, R. (2018). The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors. Journal of Affective Disorders, 239, 171–179. https://doi.org/10.1016/j.jad.2018.06.033.
Kiekens, G., Hasking, P., Bruffaerts, R., Alonso, J., Auerbach, R. P., Bantjes, J., Benjet, C., Boyes, M., Chiu, W. T., Claes, L., Cuijpers, P., Ebert, D. D., Mak, A., Mortier, P., O’Neill, S., Sampson, N. A., Stein, D. J., Vilagut, G., Nock, M. K., & Kessler, R. C. (2023). Non-suicidal self-injury among first-year college students and its association with mental disorders: results from the World Mental Health International College Student (WMH-ICS) initiative. Psychological Medicine, 53(3), 875–886. https://doi.org/10.1017/s0033291721002245.
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226–239. https://doi.org/10.1016/j.cpr.2006.08.002.
Klonsky, E. D., & Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: Psychometric properties of the inventory of statements about self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment, 31(3), 215–219. https://doi.org/10.1007/s10862-008-9107-z.
Klonsky, E. D., Glenn, C. R., Styer, D. M., Olino, T. M., & Washburn, J. J. (2015). The functions of nonsuicidal self-injury: converging evidence for a two-factor structure. Child and adolescent psychiatry and mental health, 9(1), 44. https://doi.org/10.1186/s13034-015-0073-4.
Klonsky, E. D., & May, A. M. (2015). The Three-Step Theory (3ST): A new theory of suicide rooted in the “Ideation-to-action” framework. International Journal of Cognitive Therapy, 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114.
Klonsky, E. D., & Olino, T. M. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: A latent class analysis. Journal of Consulting and Clinical Psychology, 76(1), 22–27. https://doi.org/10.1037/0022-006X.76.1.22.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9 - Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.
Lan, Z., Pau, K., Yusof, H. M., & Huang, X. (2022). The effect of emotion regulation on non-suicidal self-injury among adolescents: The mediating roles of sleep, exercise, and social support. Psychology Research and Behavior Management, 15, 1451–1463. https://doi.org/10.2147/prbm.S363433.
Lang, J., & Yao, Y. (2018). Prevalence of nonsuicidal self-injury in Chinese middle school and high school students: A meta-analysis. Medicine, 97(42), e12916. https://doi.org/10.1097/md.0000000000012916.
Leong, C. H., Wu, A. M. S., & Poon, M. M. (2014). Measurement of perceived functions of non-suicidal self-injury for Chinese adolescents. Archives of Suicide Research, 18(2), 193–212. https://doi.org/10.1080/13811118.2013.824828.
Lewis, S. P., Heath, N. L., Hasking, P. A., Hamza, C. A., Bloom, E. L., Lloyd-Richardson, E. E., & Whitlock, J. (2020). Advocacy for improved response to self-injury in schools: A call to action for school psychologists. Psychological Services, 17, 86–92. https://doi.org/10.1037/ser0000352.
Liu, R. T. (2023). The epidemiology of non-suicidal self-injury: lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England. Psychological Medicine, 53(1), 274–282. https://doi.org/10.1017/s003329172100146x.
Lucena, N. L., Rossi, T. A., Azevedo, L. M. G., & Pereira, M. (2022). Self-injury prevalence in adolescents: A global systematic review and meta-analysis. Children and Youth Services Review, 142. https://doi.org/10.1016/j.childyouth.2022.106634
MacPherson, H. A., Cheavens, J. S., & Fristad, M. A. (2013). Dialectical behavior therapy for adolescents: Theory, treatment adaptations, and empirical outcomes. Clinical Child and Family Psychology Review, 16(1), 59–80. https://doi.org/10.1007/s10567-012-0126-7.
Mandrekar, J. N. (2010). Receiver operating characteristic curve in diagnostic test assessment. Journal of Thoracic Oncology, 5(9), 1315–1316. https://doi.org/10.1097/JTO.0b013e3181ec173d.
Mars, B., Heron, J., Klonsky, E. D., Moran, P., O’Connor, R. C., Tilling, K., Wilkinson, P., & Gunnell, D. (2019). Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: A population-based birth cohort study. The Lancet Psychiatry, 6(4), 327–337. https://doi.org/10.1016/s2215-0366(19)30030-6.
Moriarty, A. S., Gilbody, S., McMillan, D., & Manea, L. (2015). Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. General Hospital Psychiatry, 37(6), 567–576. https://doi.org/10.1016/j.genhosppsych.2015.06.012.
Nock, M. K. (2010). Self-Injury. In S. NolenHoeksema, T. D. Cannon, & T. Widiger (Eds.), Annual Review of Clinical Psychology, Vol 6 (Vol. 6, pp. 339–363). https://doi.org/10.1146/annurev.clinpsy.121208.131258
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890. https://doi.org/10.1037/0022-006x.72.5.885.
Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The suicidal behaviors questionnaire-revised (sbq-r): Validation with clinical and nonclinical samples. Assessment, 8(4), 443–454. https://doi.org/10.1177/107319110100800409.
Pak, K. N., Nelson, J., Adams, L. M., & Fischer, S. (2021). Mixture modeling of nonsuicidal self-injury and binge eating: Behaviors and motives. Behavior Therapy, 52(5), 1265–1276. https://doi.org/10.1016/j.beth.2021.02.005.
Paul, E., Tsypes, A., Eidlitz, L., Ernhout, C., & Whitlock, J. (2015). Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors. Psychiatry Research, 225(3), 276–282. https://doi.org/10.1016/j.psychres.2014.12.026.
Penninx, B. W. J. H., Pine, D. S., Holmes, E. A., & Reif, A. (2021). Anxiety disorders. Lancet, 397(10277), 914–927. https://doi.org/10.1016/s0140-6736(21)00359-7.
Plummer, F., Manea, L., Trepel, D., & McMillan, D. (2016). Screening for anxiety disorders with the GAD-7 and GAD-2: A systematic review and diagnostic metaanalysis. General Hospital Psychiatry, 39, 24–31. https://doi.org/10.1016/j.genhosppsych.2015.11.005.
Poudel, A., Lamichhane, A., Magar, K. R., & Khanal, G. P. (2022). Non suicidal self injury and suicidal behavior among adolescents: co-occurrence and associated risk factors. Bmc Psychiatry, 22(1), 96. https://doi.org/10.1186/s12888-022-03763-z.
Ribeiro, J. D., Franklin, J. C., Fox, K. R., Bentley, K. H., Kleiman, E. M., Chang, B. P., & Nock, M. K. (2016). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies. Psychological Medicine, 46(2), 225–236. https://doi.org/10.1017/s0033291715001804.
Robinson, K., Garisch, J. A., & Wilson, M. S. (2021). Nonsuicidal self-injury thoughts and behavioural characteristics: Associations with suicidal thoughts and behaviours among community adolescents. Journal of Affective Disorders, 282, 1247–1254. https://doi.org/10.1016/j.jad.2020.12.201.
Shahwan, S., Sambasivam, R., Lau, J. H., Abdin, E., Zhang, Y., Teh, W. L., Gupta, B., Ong, S. H., Chong, S. A., & Subramaniam, M. (2020). A typology of nonsuicidal self-injury in a clinical sample: A latent class analysis. Clinical Psychology & Psychotherapy, 27(6), 791–803. https://doi.org/10.1002/cpp.2463.
Shen, Y., Zhang, W., Chan, B. S. M., Zhang, Y., Meng, F., Kennon, E. A., Wu, H. E., Luo, X., & Zhang, X. Y. (2020). Detecting risk of suicide attempts among Chinese medical college students using a machine learning algorithm. Journal of Affective Disorders, 273, 18–23. https://doi.org/10.1016/j.jad.2020.04.057.
Simone, A. C., & Hamza, C. A. (2020). Examining the disclosure of nonsuicidal self-injury to informal and formal sources: A review of the literature. Clinical Psychology Review, 82, 101907. https://doi.org/10.1016/j.cpr.2020.101907.
Somer, O., Bildik, T., Kabukcu-Basay, B., Gungor, D., Basay, O., & Farmer, R. F. (2015). Prevalence of non-suicidal self-injury and distinct groups of self-injurers in a community sample of adolescents. Social Psychiatry and Psychiatric Epidemiology, 50(7), 1163–1171. https://doi.org/10.1007/s00127-015-1060-z.
Sorgi, K. M., Ammerman, B. A., Cheung, J. C., Fahlgren, M. K., Puhalla, A. A., & McCloskey, M. S. (2021). Relationships between non-suicidal self-injury and other maladaptive behaviors: Beyond difficulties in emotion regulation. Archives of Suicide Research, 25(3), 530–551. https://doi.org/10.1080/13811118.2020.1715906.
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Loewe, B. (2006). A brief measure for assessing generalized anxiety disorder - The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092.
Stanley, B., Sher, L., Wilson, S., Ekman, R., Huang, Y.-Y., & Mann, J. J. (2010). Non-suicidal self-injurious behavior, endogenous opioids, and monoamine neurotransmitters. Journal of Affective Disorders, 124(1-2), 134–140. https://doi.org/10.1016/j.jad.2009.10.028.
Strobl, C., Malley, J., & Tutz, G. (2009). An introduction to recursive partitioning: Rationale, application, and characteristics of classification and regression trees, bagging, and random forests. Psychological Methods, 14(4), 323–348. https://doi.org/10.1037/a0016973.
Sun, F., Li, H., Song, W., Bao, J., & Zhen, Z. (2022). Patterns of psychological pain and self-harm behaviors in adolescents. Suicide and Life-Threatening Behavior, 52(5), 1012–1023. https://doi.org/10.1111/sltb.12898.
Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 44(3), 273–303. https://doi.org/10.1111/sltb.12070.
Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227, 759–769. https://doi.org/10.1016/j.jad.2019.08.072.
Victor, S. E., Styer, D., & Washburn, J. J. (2015). Characteristics of nonsuicidal self-injury associated with suicidal ideation: evidence from a clinical sample of youth. Child and adolescent psychiatry and mental health, 9, 20. https://doi.org/10.1186/s13034-015-0053-8.
Wang, W., Bian, Q., Zhao, Y., Li, X., Wang, W., Du, J., & Zhao, M. (2014). Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. General Hospital Psychiatry, 36(5), 539–544. https://doi.org/10.1016/j.genhosppsych.2014.05.021.
Whitlock, J., Exner-Cortens, D., & Purington, A. (2014). Assessment of nonsuicidal self-injury: Development and initial validation of the Non-suicidal Self-Injury Assessment Tool (NSSI-AT). Psychological Assessment, 26(3), 935–946. https://doi.org/10.1037/a0036611.
Zhu, J., Chen, Y., & Su, B. (2020). Non-suicidal self-injury in adolescence: Longitudinal evidence of recursive associations with adolescent depression and parental rejection. Journal of Adolescence, 84, 36–44. https://doi.org/10.1016/j.adolescence.2020.08.002.
Acknowledgements
The authors thank the National Natural Science Foundation of China for providing funding. We would like to express our gratitude to the school teachers who collaborated with us and the adolescents who participated in the survey. We also extend our thanks to the research assistants for their valuable assistance in conducting the study.
Funding
This work was supported by a grant from the National Natural Science Foundation of China (No. 32271115). funding sponsor had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Data sharing and declarationThe datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.
Author information
Authors and Affiliations
Contributions
Z.W. conceived of the study, participated in its design and coordination, and drafted the manuscript; Y.C. conceived of the study, and provided critical revision of the manuscript; Z.T. participated in the design of the study and performed the statistical analysis; M.Y. participated in the design and coordination of the study and performed the measurement; D.L. participated in the data management and helped to draft the manuscript; L.J. helped to checked and revised the manuscript; W.Z. participated in the design of the study, and played a critical role in the acquisition of funding for the project. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Ethical approval
The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics in Human Research Committee of Center for Studies of Psychological Application, School of Psychology, South China Normal University (protocol code:SCNU-PSY-2021-098).
Informed consent
All participants in this study provided informed consent.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Wang, Z., Chen, Y., Tao, Z. et al. Quantifying the Importance of Non-Suicidal Self-Injury Characteristics in Predicting Different Clinical Outcomes: Using Random Forest Model. J. Youth Adolescence 53, 1615–1629 (2024). https://doi.org/10.1007/s10964-023-01926-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10964-023-01926-z