To examine the cognitive-affective mechanisms underlying non-suicidal self-injury (NSSI) in adolescents and identify central and bridging elements for clinical intervention strategies.
Approach:
Participants: 4,023 adolescents were recruited through an epidemiological survey, with 1,387 reporting NSSI in the past 12 months.
Measures: NSSI was assessed using the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire. Experiential avoidance was measured using the Acceptance and Action Questionnaire-II, and cognitive fusion was assessed with the Cognitive Fusion Questionnaire.
Network Analysis: Network analysis was conducted to map the cognitive-affective network structure and identify central and bridge nodes.
Key Findings:
Thought distress emerged as the most central node in the cognitive-affective network (Expected Influence = 1.13).
Key bridging nodes included painful thoughts, emotional interference, rumination, and task disruption.
The EI stability coefficient was 0.75, indicating good reliability.
Network structure was invariant across sex.
Interpretation:
Thought distress is central to the cognitive-affective network of adolescent NSSI, with specific nodes linking cognitive and affective processes.
Limitations:
The study relied on self-reported measures, which may introduce bias related to personal perceptions.
The cross-sectional design limits causal inferences about the relationships between variables.
Conclusion:
The findings highlight potential intervention targets to disrupt maladaptive cognitive-affective patterns in adolescents engaging in NSSI.
Interviews with hospital leaders and employed physicians highlighted financial pressures, perceived care-integration benefits, and unresolved operational tensions following acquisition.
