| Objective:To understand the characteristics of non-suicidal self-injury(NSSI)behavior among depressed Chinese adolescents and explore the relationship between school bullying and NSSI behavior.Method:The study utilized baseline data from the Chinese Adolescent Depression Cohort(CADC)recruited between December 2020 and December 2021 from 14hospitals across 9 provinces in China.Participants were 12-18 years old outpatients and inpatients who met the depression episode criteria in the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5).The self-administered demographic questionnaire,Multidimensional Peer-Victimization Scale,The Coping Style Scale for Middle School Students,Emotion Regulation Questionnaire for Children and Adolescents and Chinese version of the Functional Assessment of Self-Mutilation were used to investigate the sociodemographic characteristics,NSSI behavior,school bullying,use of coping style and emotion regulation strategies among depressed adolescents.SPSS 23.0 and PROCESS program Model 6(version3.3)were used for data analysis.Using Harman factor analysis tested common method deviation tests and using the Kolmogorov-Smirnov tested the normality.Using median(interquartile range)to describe non-normal distribution data,Mann-Whitney U-test and Kruskal-Wallis H-test were used for comparison of differences between different groups of data.Using constituent ratio and rates to describe categorical variables,and chi-square tests were used for comparison.Spearman correlation analysis was used to explore the correlation between school bullying,coping style,emotion regulation and frequency of NSSI among depressed adolescents.Finally,the SPSS macro PROCESS program Model 6(version 3.3)was used to conduct the analysis of the chain mediating role of coping style and emotion regulation in school bullying and frequency of NSSI.Result:A total of 2343 depressed adolescents with a mean age of 14.99(?)1.65 years were included in this study.Of these,517(22.1%)were males and 1826(77.9%)were females.1643(70.1%)were diagnosed with unipolar depression,345(14.7%)with bipolar depression,and 355(15.2%)with depressive states.(1)Frequency of NSSI:The mean frequency of NSSI among depressed adolescents was 9.65.The three most commonly used NSSI methods among depressed adolescents were intentional cutting or scratching of the skin,intentional hitting oneself,and hitting or banging one’s head against a hard object.The frequency of NSSI was higher in females compared to males(Z=-9.017,P<0.001).The frequency of NSSI decreased from elementary school to middle school and then to high school/vocational school(χ~2=99.761,P<0.001).The frequency of NSSI was higher in non-only children compared to only children(Z=-2.739,P=0.006).Depressed adolescents with left-behind experience had higher frequency of NSSI compared to those without left-behind experience(Z=-2.876,P=0.004).Depressed adolescents living in rural areas had higher frequency of NSSI compared to urban depressed adolescents(Z=-2.203,P=0.028).The frequency of NSSI decreased when depressed adolescents living with other relatives/nannies,living with parents/grandparents,and boarding adolescents(χ~2=8.713,P=0.013).Compared to depressed adolescents whose parents were divorced/separated/deceased,whose parents were married had lower frequency of NSSI(Z=-3.037,P=0.002).Depressed adolescents with a history of school bullying had higher frequency of NSSI(Z=-8.020,P<0.001)and engaged in a greater variety of NSSI methods(Z=-8.042,P<0.001)compared to those without a history of school bullying.(2)School bullying:Among depressed adolescents,the detection rate of school bullying was 85.70%.The most common form of school bullying experienced by adolescents was verbal bullying.The detection rate of school bullying was higher in females compared to males(χ~2=5.909,P=0.015).The detection rate of school bullying decreased from elementary school to middle school and then to high school/vocational school(χ~2=22.245,P<0.001).Non-only children had a higher detection rate of school bullying compared to only children(χ~2=4.423,P=0.035).Depressed adolescents with left-behind experience had a higher detection rate of school bullying compared to those without left-behind experience(χ~2=8.863,P=0.003).(3)Coping style:Among depressed adolescents,the average score for problem-oriented coping style was 43.49,and males have higher scores compared to females.The average score for emotion-oriented coping style was 45.20,and females have higher scores compared to males.(4)Emotion Regulation:Among depressed adolescents,the average score for cognitive reappraisal was 16.12,and males had higher scores compared with females.In expressive suppression,depressed adolescents had an average score of 13.80,and males had higher scores compared to females.(5)Correlation of school bullying,frequency of NSSI,coping style and emotion regulation:Spearman correlation analysis showed that school bullying was positively correlated with frequency of NSSI(r=0.335,P<0.001).School bullying was correlated with coping style,school bullying was negatively correlated with problem-oriented coping style(r=-0.234,P<0.001)and positively correlated with emotion-oriented coping style(r=0.191,P<0.001).School bullying was associated with emotion regulation,it was negatively associated with cognitive reappraisal(r=-0.207,P<0.001)and positively associated with expressive suppression(r=0.082,P<0.001).Problem-oriented coping style was positively correlated with cognitive reappraisal(r=0.643,P<0.001),negatively correlated with expression suppression(r=-0.117,P<0.001),and negatively correlated with frequency of NSSI(r=-0.303,P<0.001).Emotion-oriented coping style was negatively correlated with cognitive reappraisal(r=-0.096,P<0.001),positively correlated with expression suppression(r=0.132,P<0.001),and positively correlated with frequency of NSSI(r=0.170,P<0.001).Cognitive reappraisal was negatively correlated with frequency of NSSI(r=-0.285,P<0.001)and expression suppression was positively correlated with frequency of NSSI(r=0.121,P<0.001).(6)Mediating effects of coping style:(1)Mediating effect of problem-oriented coping style:Problem-oriented coping style partially mediated the relationship between school bullying and frequency of NSSI.(2)Mediating effect of emotion-oriented coping style:Emotion-oriented coping style partially mediated the effect between school bullying and frequency of NSSI.(7)Mediating effect of emotion regulation:(1)Mediating role of cognitive reappraisal:Cognitive reappraisal partially mediated the relationship between school bullying and frequency of NSSI.(2)Mediating effect of expressive suppression:Expressive suppression partially mediated the relationship between school bullying and frequency of NSSI.(8)Chain mediating role of coping styles and emotion regulation:(1)Problem-oriented coping style and cognitive reappraisal have a chain mediating role between school bullying and frequency of NSSI.(2)Emotion-oriented coping style and expressive suppression have a chain mediating role between school bullying and frequency of NSSI.Conclusion:School bullying can influence the frequency of NSSI in depressed adolescents,and coping style and emotion regulation have a mediating role in this relationship.Specifically,coping style and emotion regulation can not only affect the relationship between school bullying and frequency of NSSI alone,but also mediate this relationship through the path way of school bullying→coping style→emotion regulation→frequency of NSSI.The results of this study suggested that NSSI behavior can be effectively reduced by preventing school bullying among adolescents.Helping adolescents to choose more effective coping style and emotion regulation strategy is one of the effective measures to reduce the frequency of NSSI in depressed adolescents and to reduce repeated NSSI behavior in depressed adolescents. |
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