Zhao Lin, Wang Shijian, Li Jingya, Kong Linghua, Zheng Doudou, Yang Ying
Child and Adolescent Psycho-behavioral Medicine Center, Shandong Mental Health Center, Shandong University, Jinan, Shandong, 250014, China.
School of Mental Health, Jining Medical University, Jining, Shandong, 272013, China.
BMC Psychiatry. 2025 Jul 15;25(1):704. doi: 10.1186/s12888-025-07129-z.
Non-suicidal self-injury (NSSI) has become increasingly prevalent, with its impact growing more severe among adolescents. Addictive NSSI typically manifests through higher frequencies, more severe injuries, and a broader range of affected body areas, potentially leading to trauma, disability, or even suicide. This study aims to explore the complex network relationships among adolescent attachment, anxiety, and NSSI addiction, offering new insights into the mechanisms underlying NSSI addiction in adolescents.
A total of 1169 adolescent patients with NSSI were enrolled. Demographic questionnaires, the Ottawa Self-Injury Inventory, the Inventory of Parent and Peer Attachment, and the Multidimensional Anxiety Scale for Children were administered for assessment. The complex network relationships among symptoms were analyzed using undirected network analysis and directed Bayesian network analysis, followed by causal inference.
The core symptom nodes in the network model included four dimensions of anxiety symptoms: MASC2 (harm avoidance), MASC3 (social anxiety), MASC4 (separation anxiety), and MASC1 (physical symptoms), as well as Peer3 (peer alienation) related to attachment relationships. Undirected network analysis indicated that the key bridging nodes for NSSI addiction were Peer3 (peer alienation) and MASC1 (physical symptoms). Directed acyclic graph (DAG) analysis further confirmed this relationship, demonstrating that these two key bridging nodes directly influence NSSI addiction. Additionally, DAG analysis revealed that MASC3 (social anxiety) indirectly influences NSSI addiction by affecting Peer3 (peer alienation) and MASC1 (physical symptoms).
Physical anxiety symptoms and peer alienation directly influence NSSI addiction among adolescents. Additionally, social anxiety indirectly influences NSSI addiction by affecting physical anxiety and peer alienation.
非自杀性自伤行为（NSSI）日益普遍，其对青少年的影响愈发严重。成瘾性NSSI通常表现为更高的频率、更严重的伤害以及更广泛的身体受影响区域，可能导致创伤、残疾甚至自杀。本研究旨在探讨青少年依恋、焦虑与NSSI成瘾之间的复杂网络关系，为青少年NSSI成瘾的潜在机制提供新见解。
共纳入1169例患有NSSI的青少年患者。采用人口统计学调查问卷、渥太华自伤行为量表、父母与同伴依恋量表以及儿童多维焦虑量表进行评估。使用无向网络分析和有向贝叶斯网络分析对症状之间的复杂网络关系进行分析，随后进行因果推断。
网络模型中的核心症状节点包括焦虑症状的四个维度：MASC2（回避伤害）、MASC3（社交焦虑）、MASC4（分离焦虑）和MASC1（身体症状），以及与依恋关系相关的Peer3（同伴疏离）。无向网络分析表明，NSSI成瘾的关键桥梁节点是Peer3（同伴疏离）和MASC1（身体症状）。有向无环图（DAG）分析进一步证实了这种关系，表明这两个关键桥梁节点直接影响NSSI成瘾。此外，DAG分析显示，MASC3（社交焦虑）通过影响Peer3（同伴疏离）和MASC1（身体症状）间接影响NSSI成瘾。
身体焦虑症状和同伴疏离直接影响青少年的NSSI成瘾。此外，社交焦虑通过影响身体焦虑和同伴疏离间接影响NSSI成瘾。
