Related Factors And Grey Matter Volume Changes In Non-Suicidal Self-injury Behavior And Functions In Adolescents With Depression

ObjectivesTo explore the behavior and functions of non-suicidal self-injury(NSSI)and related factors in depressed adolescent patients,and further explore the association between different NS SI functions and brain gray matter volumes.Methods(1)A total of 163 outpatients and inpatients(89 patients with NSSI and 74 patients without NSSI)who met the diagnostic criteria for depressive disorder of DSM-5,and 107 age-and sexmatched normal controls were included.The Children’s Depression Inventory(CDI)was used to assess depression severity,Children’s Loneliness Scale(CLS)was used to assess loneliness,Defeat Scale(DS)was used to assess academic defeat,and Ottawa Self-Injury Inventory(OSI)was used to assess the behavior and functions of NSSI.Then,association between NSSI behavior and the related factors was performed by logistic regression analysis.Lastly,multiple linear regression analysis was used to explore the associations between functions of NSSI and risk factors.Then,associations between NSSI behavior and the related factors were performed by logistic regression analysis.Lastly,The stepwise multiple linear regression analysis was used to explore the associations between functions of NSSI and risk factors.(2)Thirty-five of these depressed adolescents with NSSI completed the assessments of NSSI functions,structural brain images,depression severity,loneliness,academic defeat and family environments.Subcortical volumes and cortical thickness were estimated with FreeSurfer.Mixed linear regressions were performed to examine associations between striatal structures(caudate,putamen,nucleus accumbens,pallidum)and NSSI functions,with age,gender,total intracranial volume,hemisphere and depression severity as covariates.The effect of environmental factors(sense of defeat in learning,parental conflict,aggression,anxiety and depression)and potential associations with cortical thickness and other subcortical volumes were also tested.Results(1)The CDI,CLS,and DS scores in depressive adolescents with NSSI were higher than those without NSSI and the normal control group.Higher academic defeat scores were risk factors for engaging NSSI.(2)Among the four functions,external emotional regulation represented the main reason for adolescents’NSSI.Negative mood scores in CDI was positively associated with internal emotion regulation scores,external emotion regulation scores,and sensation seeking factor scores in OSI;interpersonal problems scores in CDI was positively associated with social influence factor scores in OSI.Non-only children had higher sensation seeking factor scores in OSI.(3)Incresed external emotion regulation was significantly associated with smaller putamen volume.None of academic and family environment factors biased the association with putamen.No associations with other cortical or subcortical regions were observed.Conclusions(1)Among the depressed adolescents,those with higher academic defeat are more likely to engage NS SI.The majority of patients with external emotion regulation as the dominant function of NSSI,negative mood and interpersonal problems may be influential factors in NSSI functions.(2)Smaller putamen might be a potential biomarker of NSSI engagement for depressed adolescents when they regulated frustrated or angry emotions.The results have important clinical implications for exploring the pathophysiological mechanisms underlying the function of NSSI.