BACKGROUND

Non-suicidal self-injury (NSSI) in adolescents has a complex etiology and a wide range of negative consequences. This study aimed to assess the interactions between NSSI and sleep quality and cytokines and explore the association of these factors with cognitive flexibility.

METHODS

A cross-sectional survey was conducted from January 2022 to September 2024 in Qingdao, China. Adolescent Non-Suicidal Self-Injury Assessment Questionnaire, Pittsburgh Sleep Quality Index, and Wisconsin Card Sorting Test 128 card version were used to assess the NSSI, sleep quality, and cognitive flexibility. Levels of 12 serum cytokines were measured. Network analysis was performed by R software (version 4.4.1) to identify the central nodes and bridging symptoms of the network and all nodes' association with cognitive flexibility.

RESULTS

A total of 337 adolescents with depressive disorders were included in the study. In the NSSI-Sleep Quality-Cytokines Network "Intentional scratches", "IL-12p70", and "Intentionally hitting oneself with fists or harder objects" were central nodes in the network. Furthermore, sleep-related variables such as "Sleep disturbance" and "Sleep duration" were identified as bridge symptoms. No direct association between NSSI and cognitive flexibility was observed.

LIMITATIONS

The cross-sectional design, reliance on self-reported data, and restricted geographic sample limit the ability to establish causal relationships and generalize the findings.

CONCLUSION

IL-12p70 plays a significant role in the development of NSSI among adolescents with depressive disorders. Sleep problems facilitate the interaction between NSSI and cytokines. Cognitive flexibility may be related to NSSI through indirect pathways.