Study On The Relevance Of Non-suicidal Self-injury And Anhedonia Among Adolescents With Major Depressive Disorder

Objective: The prevalence of adolescent depressive disorder is increasing year by year,and more patients experienced non-suicidal selfinjury(NSSI).Current Studies have reported that NSSI is an independent risk factor for suicide,therefore we need pay attention to NSSI and explore the mechanism which could help to decrease the risk of suicide and further improve the poor prognostic outcome of depression.The purpose of this study is :(1)To investigate the relationship between NSSI and the severity of anhedonia among adolescent with major depressive disorder.(2)Combinating the pleasure-related scales and the Affective Incentive Delay Task(AID)and the Monetary Incentive Delay Task(MID)to explore the characteristics of anhedonia among adolescent with major depressive disorder and NSSI.Methods: In this study,we recruited 118 adolescents with depression as major depressive disorder group,including 68 patients with NSSI,50 patients without NSSI,and 50 healthy adolescents as healthy control group.Subsequently,5 patients who were changed their diagnosis to bipolar disorder due to changes in their condition,3 patients with suicide attempts,and 3 patients who refused to continue participating were excluded from major depressive disorder group,and 1 adolescent with epilepsy,1adolescent with mental retardation,and 3 adolescents with possible mood disorders were excluded from the healthy control group.Finally,59 in NSSI group,48 in NON-NSSI group,and 45 in HC group were included in the study.The study included adolescents with a DSM-5 diagnosis of major depressive disorder,whose depressive symptom severity was assessed by the Children’s Depression Inventory and the Hamilton Depression Scale。Then DSM-5 diagnosis of NSSI and the Columbia Suicide Severity Scale were used to distinguish between NSSI group and NON-NSSI group,and the occurrence of NSSI was investigated in the NSSI group using the Ottawa Self-injury Inventory(OSI).In addition,healthy adolescents who were studying in junior or senior high school and living in Changsha were recruited as healthy controls group(HC group).General demographic information,including gender,ethnicity,age,years of education,whether they were an only child,family type,and type of current long-term residence;the Temporal Experience Pleasure Scale to assess pleasure deficit symptoms;the Anticipatory and Consummatory Interpersonal Pleasure Scale to assess social pleasure deficit symptoms,all was collected for the NSSI,NON-NSSI,and HC groups.And the Affective Incentive Delay Task and the Monetary Incentive Delay Task to collect subjective anticipation-feedback assessments,and behavioral data.Graph Pad Prism 5.0 and IBM SPSS statistics 22.0 software were used for statistical analysis.Results: Through statistical analysis of the data of 59 in the NSSI group,48 in the NON-NSSI group,and 45 in the HC group,the following results were obtained:(1)The NSSI group(59.27±15.51,37.54±8.92)scored lower than the NON-NSSI(67.52±15.44,43.08±10.12)and HC group(78.02 ± 12.54,51.40 ± 7.58)on both the Temporal Experience Pleasure Scale and the Anticipatory and Consummatory Interpersonal Pleasure Scale,indicating that the NSSI group had more severe anhedonia symptoms than the NON-NSSI and HC group(all P<0.05).(2)In the anticipation-feedback assessment of the Affective Incentive Delay Task and the Monetary Incentive Delay Task,the NSSI group(AID,4.76±1.67,4.53 ± 1.30;MID:4.85 ± 1.69,4.44 ± 1.43)had lower anticipation scores than the HC group(AID:6.12 ± 1.49,5.37 ± 1.07;MID:7.41 ±1.35,5.60±1.08)in both the positive and neutral stimulus conditions(all P< 0.05),and the NON-NSSI group(5.23 ± 1.50;5.74 ± 1.67)had statistically significantly lower anticipation scores than the HC group only in the positive stimulus condition of the Monetary Incentive Delay Task(all P<0.05),the NSSI and NON-NSSI groups have statistically significant difference in the positive stimulus condition of the Monetary Incentive Delay Task(P=0.020),which indicates that both the NSSI and NONNSSI groups had lower anticipation of positive rewards than the HC group.(3)In the anticipation-feedback assessment of the Affective Incentive Delay Task and the Monetary Incentive Delay Task,there were no differences in anticipation scores between the three groups in the negative stimulus condition(all P>0.05),indicating that the NSSI,NON-NSSI,and HC groups had essentially the same level of anticipation of punishment.(4)The occurrence of the Ottawa Self-Injury Scale in the last month the frequency of the NSSI was significantly and negatively correlated with the Temporal Experience Pleasure Scale total score(r=-0.209),abstract anticipatory pleasure(r=-0.251),the Anticipatory and Consummatory Interpersonal Pleasure Scale total score(r=-0.215)and two subscales scores of group social interaction(r=-0.231)and social bonding and networking(r=-0.199),the positive stimulus and neutral stimulus anticipation scores of the Monetary Incentive Delay Task(r=-0.371～-0.309),and the feedback scores when the target was hit with the positive,neutral and negative stimulus(r=-0.484～-0.359),indicating that in adolescents with depression more severe anhedonia was associated with more frequent non-suicidal self-injury.Conclusion: In adolescent MDD patients,more severe anhedonia were associated with the recent frequently NSSI,and among adolescents major depressive disorder with NSSI patients reduced anhedonia dominated by abstract anticipatory pleasure,and in monetary stimuli,the difference in anticipatory also was more significant.