Adolescent non-suicidal self-injury during the COVID-19 pandemic: A prospective longitudinal study of biological predictors of maladaptive emotion regulation.

BACKGROUND: Non-suicidal self-injury (NSSI) in adolescence is thought to stem from interactions between vulnerability in developing biological systems and experience of stressors. The current study assesses whether multiple levels of the stress system's response to threat could prospectively predict NSSI engagement during the COVID-19 pandemic, a shared, time-locked stressor. METHODS: Participants were 64 female adolescents (ages 12-16) from community and clinical settings who were oversampled for NSSI histories. Prior to the onset of the COVID-19 pandemic, adolescents completed a protocol that measured hypothalamic-pituitary-adrenal axis response to a social stressor (via salivary cortisol), amygdala volume, amygdala emotion-evoked activation, and frontolimbic resting-state functional connectivity. During early months of the pandemic (Summer 2020), measures of NSSI behavior (Inventory of Statements About Self-Injury), emotion regulation difficulties (Difficulties in Emotion Regulation Scale), perceived stress (Perceived Stress Scale), and pandemic-related stressors (Epidemic Pandemic Impacts Inventory) were collected. Multinomial logistic regression was used to assess if pre-pandemic biomarkers predicted mid-pandemic NSSI engagement: persistence of NSSI (Persist; N = 21), cessation of NSSI (Desist; N = 26), and no history of NSSI (Never; N = 17). Linear regressions explored if pre-pandemic biomarkers predicted mid-pandemic difficulties in emotion regulation and perceived stress. RESULTS: Higher pre-pandemic overall cortisol response to stress and amygdala emotion-evoked activation characterized adolescents who persisted in NSSI, compared to those who desisted. These findings remained significant when controlling for pandemic related stressors. Lower prepandemic cortisol reactivity predicted more difficulties in emotion regulation during the pandemic. This finding did not remain significant after controlling for pandemic related stressors. CONCLUSIONS: Findings suggest that patterns in key biological threat response systems may confer vulnerability for risk outcomes including NSSI engagement in adolescent females in the context of a shared, novel, naturally-occurring stressor. The results point to the importance of multi-level, longitudinal approaches for understanding the interface between developing neurobiological systems and experiential stress in at-risk adolescents. Identified patterns give insight into potential risk assessment strategies based on an understanding of the multi-level threat response.

Non-suicidal self-injury in the context of COVID-19: The importance of psychosocial factors for female adolescents

Background The COVID-19 pandemic presents a unique context in which to study the impact of protective and risk factors for non-suicidal self-injury (NSSI) in adolescents under circumstances of heightened stress. Methods Female participants (N=91, aged 12-16) enrolled in an ongoing study of NSSI completed self-report questionnaires that assessed NSSI recency, internalizing symptoms (anxiety, depressive), stress perception (stress, family conflict, loneliness), and coping resources (emotion regulation, friend and family support). Parents reported on experiences during the pandemic (family's financial status, health, and schooling). We compared protective and risk factors among three groups of adolescents: those with no history of NSSI (Never), those who did not (Desist) continue to engage in NSSI in the early months of the COVID-19 pandemic, and those with a history of NSSI who did (Persist). Results Participants in the Persist group reported higher levels of perceived stress and loneliness and lower family support than those in the Desist group. A larger set of coping resources (emotion regulation difficulties, friend support) also differed between the Persist and Never NSSI groups. These findings largely remained significant when controlling for possible contributing factors. Limitations A strength is the longitudinal study design. Limitations include the inability to assess changes in rate of NSSI engagement, small sample size, inclusion of only female participants, reliance primarily on self-report, and a design not suitable for making causal inferences. Conclusions In the context of the COVID-19 pandemic, factors such as family support may protect against NSSI engagement and offer avenues for treatment.