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Identifying clinical risk factors correlated with addictive features of non-suicidal self-injury among a consecutive psychiatric outpatient sample of adolescents and young adults

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Abstract

Non-suicidal self-injury (NSSI) is an issue primarily of concern in adolescents and young adults. Recent literature suggests that persistent, repetitive, and uncontrollable NSSI can be conceptualized as a behavioral addiction. The study aimed to examine the prevalence of NSSI with addictive features and the association of this prevalence with demographic and clinical variables using a cross-sectional and case–control design. A total of 548 outpatients (12 to 22 years old) meeting the criteria for NSSI disorder of DSM-5 were enrolled and completed clinical interviews by 4 psychiatrists. NSSI with addictive features were determined by using a single-factor structure of addictive features items in the Ottawa self-injury inventory (OSI). Current suicidality, psychiatric diagnosis, the OSI, the revised Chinese Internet Addiction Scale, the Childhood Trauma Questionnaire, and the 20-item Toronto Alexithymia Scale were collected. Binary logistic regression analyses were used to explore associations between risk factors and NSSI with addictive features. This study was conducted from April 2021 to May 2022. The mean age of participants was 15.93 (SD = 2.56) years with 418 females (76.3%), and the prevalence of addictive NSSI was 57.5% (n = 315). Subjects with addictive NSSI had a higher lifetime prevalence of nicotine and alcohol use, a higher prevalence of current internet addiction, suicidality, and alexithymia, and were more likely to have physical abuse/neglect, emotional abuse, and sexual abuse than NSSI subjects without addictive features. Among participants with NSSI, the strongest predictors of addictive features of NSSI were female (OR = 2.405, 95% CI 1.512–3.824, p < 0.0001), alcohol use (OR = 2.179, 95% CI 1.378–3.446, p = 0.001), current suicidality (OR = 3.790, 95% CI 2.351–6.109, p < 0.0001), and psysical abuse in childhood (OR = 2.470, 95% CI 1.653–3.690, p < 0.0001). Nearly 3 out of 5 patients (12–22 years old) with NSSI met the criteria of NSSI with addictive features in this psychiatric outpatients sample. Our study demonstrated the importance of the necessity to regularly assess suicide risk, and alcohol use, as well as focus more on females and subjects who had physical abuse in childhood to prevent addictive NSSI.

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The data that support the findings of this study are available on request from the corresponding author.

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Funding

This work was supported by the National Natural Science Foundation of China [Grant Number 82001405] and the Hunan Natural Science Foundation Youth Program [Grant Number 2021JJ40979] to Huixi Dong.

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  1. Wang Ying and Yidong Shen contributed equally as co-first authors.

Authors and Affiliations

  1. Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China

    Wang Ying, Furong Jiang, Fangru Yang, Jianling Li, Xiao Qian, Wenfeng Luo & Huixi Dong

  2. Department of Psychiatry, and National Clinical Research Center for Mental. Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China

    Yidong Shen, Jianjun Ou & Hui Chen

  3. Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

    Gang Wang

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Contributions

HD and YW were responsible for writing the manuscript. HD and GW were responsible for study design. HC provided the Chinese OSI scale. FJ and LW were responsible for recruiting the participants. HD, FY, JL, QX made psychiatric diagnoses. HD, YW, YS and JO were involved in statistical analysis, editing, and revising the manuscript. HD were responsible for the critical revision of the manuscript.

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Correspondence to Huixi Dong.

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The research protocol and consent procedures were approved by the Hunan Ethics Committee of the Xiangya Hospital of Central South University. Written informed consent was obtained from all enrolled participants. The procedures were in accord-ance with the Helsinki Declaration of 1975, as revised in 1983.

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Ying, W., Shen, Y., Ou, J. et al. Identifying clinical risk factors correlated with addictive features of non-suicidal self-injury among a consecutive psychiatric outpatient sample of adolescents and young adults. Eur Arch Psychiatry Clin Neurosci 274, 291–300 (2024). https://doi.org/10.1007/s00406-023-01636-4

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