The Difference And Prediction Of Thoughts And Behaviors Of Non-Suicidal Self-Injury By Fluctuations In Affective States And Self-Reported Psychological Factors

Objective:Non-Suicidal Self-Injury(NSSI)is a serious behavioral problem commonly seen in adolescents,and the appearance of NSSI behavior greatly increases the risk of future suicide,making it an important public health issue that cannot be ignored.Although research in recent years has significantly increased our understanding of distal risk factors for NSSI,such as psychosocial factors,little is known about the short-term/proximal factors(such as emotional fluctuations,cognitive fluctuations)that predict NSSI ideation and behavior.Additionally,there are few relevant studies on the interpretation and differentiation of self-injurious thoughts and behaviors in a longitudinal real-world environment.This study attempts to elucidate the predictive role of different emotional state fluctuations as real-time factors in NSSI ideation,and the interpretation and differentiation of common psychological factors for NSSI ideation and behavior.Methods:This study used an ecological momentary assessment method to obtain intensive longitudinal data from a sample of outpatient adolescents who had experienced NSSI behavior last year or currently had a high risk of suicide.Participants completed up to four signal assessments per day for 14 consecutive days.A total of 4,928 response data were collected(overall compliance rate of 79.3%),including 346 incidents of NS SI ideation and 110 incidents of NS SI behavior.Data analysis utilized a dynamic structural equation modeling framework to construct a multilevel vector autoregression model to explain the results.Results:The study results showed that positive and negative emotions were significantly associated with self-injury ideation during the same assessment period(0.106[-0.144,-0.068],0.256[0.216,0.298]).Over the entire assessment period,negative emotions higher than individual average levels predicted short-term changes in NSSI ideation(0.083[0.037,0.127]).In addition,although both negative and positive emotional fluctuations showed short-term predictive effects on NSSI behavior(0.203[0.063,0.356],-0.161[-0.318,0.000]),after controlling for the predictive effect of NSSI ideation on NSSI behavior,neither of them remained significant.Analysis of NSSI ideation models and NSSI behavior models that included the same psychological factors showed that there were more significant factors in the NSSI ideation model than in the NSSI behavior model,and only two factors,suicide risk(0.067[0.038,0.096],0.459[0.204,0.672])and emotion regulation difficulties(0.011[0.004,0.018],0.018[0.003,0.035]),independently predicted self-injury ideation and behavior within 14 days.Conclusions:This study provides preliminary evidence that emotional fluctuations may uniquely predict NSSI ideation rather than NSSI behavior,and highlights the shared short-term predictive factors of emotional regulation difficulty and suicide risk for NSSI ideation and behavior.Considering that these processes may involve different developmental processes with different predictive factors,these findings suggest the need to distinguish the development of NSSI ideation from the progression from NSSI ideation to behavior,which may provide more detailed and targeted support and intervention for high-risk teenagers in the future.