Abstract
Objective
Non-suicidal self-injury (NSSI) has a higher prevalence in adolescents with depressive disorders than in community adolescents. This study examined the differences in NSSI behaviors between adolescents with unipolar depression (UD) and those with bipolar depression (BD).
Methods
Adolescents with UD or BD were recruited from 20 general or psychiatric hospitals across China. The methods, frequency, and function of NSSI were assessed by Functional Assessment of Self-Mutilation. The Beck Suicide Ideation Scale was used to evaluate adolescents’ suicidal ideation, and the 10-item Kessler Psychological Distress Scale to estimate the anxiety and depression symptoms.
Results
The UD group had higher levels of depression (19.16 vs.17.37, F=15.23, P<0.001) and anxiety symptoms (17.73 vs.16.70, F=5.00, P=0.026) than the BD group. Adolescents with BD had a longer course of NSSI than those with UD (2.00 vs.1.00 year, Z=−3.39, P=0.001). There were no statistical differences in the frequency and the number of methods of NSSI between the UD and BD groups. Depression (r=0.408, P<0.01) and anxiety (r=0.391, P<0.01) were significantly and positively related to NSSI frequency.
Conclusion
Adolescents with BD had a longer course of NSSI than those with UD. More importantly, NSSI frequency were positively and strongly correlated with depression and anxiety symptoms, indicating the importance of adequate treatment of depression and anxiety in preventing and intervening adolescents’ NSSI behaviors.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Nock MK. Self-injury. Annu Rev Clin Psychol, 2010,6:339–363
Zhou J, Zhang J, Huang Y, et al. Associations between coping styles, gender, their interaction and non-suicidal self-injury among middle school students in rural west China: A multicentre cross-sectional study. Front Psychiatry, 2022,13:861917
Yu L, Zhao J, Zhao T, et al. Multicenter analysis on the non-suicidal self-injury behaviors and related influencing factors–A case study of left-behind children in northeastern Sichuan. J Affect Disord, 2022,320:161–168
Swannell SV, Martin GE, Page A, et al. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav, 2014,44(3):273–303.
Wan Y, Chen J, Sun Y, et al. Impact of Childhood Abuse on the Risk of Non-Suicidal Self-Injury in Mainland Chinese Adolescents. PLoS One, 2015,10(6):e0131239
Tang J, Yang W, Ahmed NI, et al. Stressful Life Events as a Predictor for Nonsuicidal Self-Injury in Southern Chinese Adolescence: A Cross-Sectional Study. Medicine (Baltimore), 2016,95(9):e2637
McManus S, Gunnell D, Cooper C, et al. Prevalence of non-suicidal self-harm and service contact in England, 2000-14: repeated cross-sectional surveys of the general population. Lancet Psychiat, 2019,6(7):573–581
Griffin E, McMahon E, McNicholas F, et al. Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007–2016. Soc Psychiatry Psychiatr Epidemiol, 2018,53(7):663–671
Morgan C, Webb RT, Carr MJ, et al. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. BMJ, 2017,18(359):j4351
Castaldo L, Serra G, Piga S, et al. Suicidal behaviour and non-suicidal self-injury in children and adolescents seen at an Italian paediatric emergency department. Ann Ist Super Sanita, 2020,56(3):303–314
Wang Y, Zhou X, Cao B, et al. The psychological characteristics and risk factors of suicidal attempt among mood disorders adolescents accompany with non-suicidal self-injury: A multi-center study. J Affect Disord, 2022,298:301–307
Guertin T, Lloyd-Richardson E, Spirito A, et al. Self-mutilative behavior in adolescents who attempt suicide by overdose. J Am Acad Child Adolesc Psychiatry, 2001,40(9):1062–1069
Duarte TA, Paulino S, Almeida C, et al. Self-harm as a predisposition for suicide attempts: A study of adolescents’ deliberate self-harm, suicidal ideation, and suicide attempts. Psychiatry Res, 2020,287:112553
I. MV, Cieslik EC, Serbanescu I, et al. Altered Brain Activity in Unipolar Depression Revisited: Meta-analyses of Neuroimaging Studies. JAMA Psychiat, 2017,74(1):47–55
Phillips ML, Kupfer DJ. Bipolar disorder diagnosis: challenges and future directions. Lancet, 2013,381(9878):1663–1671
Mitchell PB, Goodwin GM, Johnson GF, et al. Diagnostic guidelines for bipolar depression: a probabilistic approach. Bipolar Disord, 2008,10(1 Pt 2):144–152
Han KM, De Berardis D, Fornaro M, et al. Differentiating between bipolar and unipolar depression in functional and structural MRI studies. Prog Neuropsychopharmacol Biol Psychiatry, 2019,91:20–27
Sampaio-Junior B, Tortella G, Borrione L, et al. Efficacy and Safety of Transcranial Direct Current Stimulation as an Add-on Treatment for Bipolar Depression: A Randomized Clinical Trial. JAMA Psychiatry, 2018,75(2):158–166
Patel RS, Onyeaka H, Youssef NA. Suicidal ideation and attempts in unipolar versus bipolar depression: analysis of 131,740 adolescent inpatients nationwide. Psychiatry Res, 2020,291:113231
Moreno C, Hasin DS, Arango C, et al. Depression in bipolar disorder versus major depressive disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Bipolar Disord, 2012,14(3):271–282
Smith DJ, Craddock N. Unipolar and bipolar depression: different of the same? Br J Psychiatry, 2011,199(4):272–274
S Janowsky D, Morter S, Hong L, et al. Myers Briggs Type Indicator and Tridimensional Personality Questionnaire differences between bipolar patients and unipolar depressed patients. Bipolar Disord, 1999,1(2):98–108
Carballo JJ, Llorente C, Kehrmann L, et al. Psychosocial risk factors for suicidality in children and adolescents. Eur Child Adolesc Psychiatry, 2020,29(6):759–776
Mars B, Heron J, Klonsky ED, et al. Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study. Lancet Psychiat, 2019,6(4):327–337
Goodwin FK, Jamison KR. Manic-Depressive Illness. Bipolar Disorders and Recurrent Depression. Oxford (Oxford University Press), 2009,70:435
Tondo L, Lepri B, Baldessarini RJ. Suicidal risks among 2826 Sardinian major affective disorder patients. Acta Psychiatr Scand, 2007,116(6):419–428
Hales SA, Deeprose C, Goodwin GM, et al. Cognitions in bipolar affective disorder and unipolar depression: imagining suicide. Bipolar Disord, 2011,13(7–8):651–661
Novick DM, Swartz HA, Frank E. Suicide attempts in bipolar I and bipolar II disorder: a review and meta-analysis of the evidence. Bipolar Disord, 2010,12(1):1–9
Mittal Vijay A, Walker Elaine F. Diagnostic and Statistical Manual of Mental Disorders. Psychiatry Res, 2011,189:158–159
Qu D, Wang Y, Zhang Z, et al. Psychometric Properties of the Chinese Version of the Functional Assessment of Self-Mutilation (FASM) in Chinese Clinical Adolescents. Front Psychiatry, 2022,12:755857
A.T. Beck, M. Kovacs, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol, 1979,47(2):343–352
Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med, 2002,32(6):959–976
Ren Q, Li Y, Chen DG. Measurement invariance of the Kessler Psychological Distress Scale (K10) among children of Chinese rural-to-urban migrant workers. Brain Behav, 2021,11(12):e2417
Akiskal HS, Walker P, Puzantian VR, et al. Bipolar outcome in the course of depressive illness: phenomenologic, familial, and pharmacologic predictors. J Affect Disord, 1983,5(2):115–128
Brunner R, Kaess M, Parzer P, et al. 3038-Characteristics of non-suicidal self-injury and suicide attempts among adolescents in Europe: results from the european research consortium seyle. Eur Psychiatry, 2013,28(S1):1–1
Müller A, Claes L, Smits D, et al. Prevalence and Correlates of Self-Harm in the German General Population. PLoS One, 2016,11(6):e0157928
Ayhan G, Arnal R, Basurko C, et al. Suicide risk among prisoners in French Guiana: prevalence and predictive factors. BMC Psychiatry, 2017,17(1):156
Ibrahim N, Amit N, Suen MW. Psychological factors as predictors of suicidal ideation among adolescents in Malaysia. PLoS One, 2014,9(10):e110670
Mitchell PB, Wilhelm K, Parker G, et al. The clinical features of bipolar depression: a comparison with matched major depressive disorder patients. J Clin Psychiatry, 2001,62(3):212–216; quiz 17
Parker G, Roy K, Wilhelm K, et al. The nature of bipolar depression: implications for the definition of melancholia. J Affect Disord, 2000,59(3):217–224
Nock MK, Prinstein MJ. A functional approach to the assessment of self-mutilative behavior. J Consult Clin Psychol, 2004,72(5):885–890
Chapman AL, Gratz KL, Brown MZ. Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behav Res Ther, 2006,44(3):371–394
Selby EA, Franklin J, Carson-Wong A, et al. Emotional cascades and self-injury: investigating instability of rumination and negative emotion. J Clin Psychol, 2013,69(12):1213–1227
Hilt LM, Cha CB, Nolen-Hoeksema S. Nonsuicidal self-injury in young adolescent girls: moderators of the distress-function relationship. J Consult Clin Psychol, 2008,76(1):63–71
Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev, 2007,27(2):226–239
Barrocas AL, Giletta M, Hankin BL, et al. Nonsuicidal self-injury in adolescence: longitudinal course, trajectories, and intrapersonal predictors. J Abnorm Child Psychol, 2015,43(2):369–380
Porcelli S, Kasper S, Zohar J, et al. Social dysfunction in mood disorders and schizophrenia: Clinical modulators in four independent samples. Prog Neuropsychopharmacol Biol Psychiatry, 2020,99:109835
Rolls ET. The functions of the orbitofrontal cortex. Brain Cogn, 2004,55(1):11–29
Hornak J, Rolls E, Wade D. Face and voice expression identification in patients with emotional and behavioural changes following ventral frontal lobe damage. Neuropsychologia, 1996,34(4):247–261
Rolls ET. The orbitofrontal cortex and emotion in health and disease, including depression. Neuropsychologia, 2019,128:14–43
Phillips ML, Swartz HA. A critical appraisal of neuroimaging studies of bipolar disorder: toward a new conceptualization of underlying neural circuitry and a road map for future research. Am J Psychiatry, 2014,171(8):829–843
Brown RC, Plener PL, Groen G, et al. Differential Neural Processing of Social Exclusion and Inclusion in Adolescents with Non-Suicidal Self-Injury and Young Adults with Borderline Personality Disorder. Front Psychiatry, 2017,8:267
Groschwitz RC, Plener PL, Groen G, et al. Differential neural processing of social exclusion in adolescents with non-suicidal self-injury: An fMRI study. Psychiat Res-Neuroim, 2016,255:43–49
Osuch E, Ford K, Wrath A, et al. Functional MRI of pain application in youth who engaged in repetitive non-suicidal self-injury vs. psychiatric controls. Psychiatry Res, 2014,223(2):104–112
Plener PL, Bubalo N, Fladung AK, et al. Prone to excitement: adolescent females with Non-suicidal self-injury (NSSI) show altered cortical pattern to emotional and NSS-related material. Psychiatry Res, 2012,203(2–3):146–152
Vega D, Ripollés P, Soto À, et al. Orbitofrontal overactivation in reward processing in borderline personality disorder: the role of non-suicidal self-injury. Brain Imaging Behav, 2018,12(1):217–228
Bresin K, Schoenleber M. Gender differences in the prevalence of nonsuicidal self-injury: A meta-analysis. Clin Psychol Rev, 2015,38:55–64
Lloyd-Richardson EE, Perrine N, Dierker L, et al. Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med, 2007,37(8):1183–1192
Gandhi A, Luyckx K, Adhikari A, et al. Non-suicidal self-injury and its association with identity formation in India and Belgium: A cross-cultural case-control study. Transcult Psychiatry, 2021,58(1):52–62
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
All authors declare that there are no conflicts of interest.
Additional information
This work was supported by the Sanming Project of Medicine in Shenzhen (No. SZSM202011014), Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties (No. SZGSP013), Shenzhen Key Medical Discipline Construction Fund (No. SZXK072), and Shenzhen Science and Technology Research and Development Fund for Sustainable Development Project (No. KCXFZ20201221173613036).
Rights and permissions
About this article
Cite this article
Wang, Tw., Gong, J., Wang, Y. et al. Differences in Non-suicidal Self-injury Behaviors between Unipolar Depression and Bipolar Depression in Adolescent Outpatients. CURR MED SCI 43, 998–1004 (2023). https://doi.org/10.1007/s11596-023-2772-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11596-023-2772-z