Reciprocal Effect between Depressive Symptoms and Adolescent Non-suicidal self-injury before and after COVID-19: A Longitudinal Study (preprint)

ABSTRACT

Background Non-suicidal   self-injury (NSSI) is a common psychological and behavioral problem among   adolescents and has now become a major public health problem for adolescents.   Since the COVID-19 outbreak in 2019, it has caused various mental health   problems, such as anxiety, depression, and mental burnout, contributing to a   severe mental health crisis globally. Thus far, a few studies recorded the   temporal change in adolescents’ psychological status during the COVID-19   pandemic as well as that with the implementation of large-scale public health   intervention methods, and this study adds to the evidence. Methods Based on   the Chengdu Positive Child Development (CPCD) survey, the baseline dataset   was collected in December 2019, and the first follow-up of the CPCD was conducted   in July 2020. A total of 6,023 adolescents aged 10-19 were recruited from   five primary and middle schools. Two independent autoregressive cross-lagged   models were used to test the bidirectional relationship between NSSI and   depressive symptoms in adolescents; logistic regression analysis was used to   explore the predictors of NSSI implementation in adolescents with depressive   symptoms, which could provide an entry point for behavioral interventions to   NSSI. Results The   prevalence of depressive symptoms among our participants was 32.69% at   baseline, and 34.27% at follow-up. The occurrence rate of NSSI in adolescents   who may have depressive symptoms was 44.34%%, and that during the pandemic   was 53.44%. The difference was statistically significant (P <   0.05). The results of the binary logistic analysis showed that among   adolescents, gender, duration of the online class, depression mood, place of   residence, and self-perception of relationship with caregivers were the risk   factors for NSSI (or > 1, β> 0), and daily sleep hours positive mood   was the protective factor (or < 1, β< 0).  The lag effect of adolescent depression on   their NSSI behavior is significant, which means that based on controlling the   adolescent baseline NSSI, the deeper the adolescent depression degree, the   more frequent their NSSI behavior (β=0.26, P<0.01). At the same time,   adolescents' NSSI behavior also had a lagging effect on depressive symptoms,   and adolescents with self-injury behavior were more likely to be depressed (β=0.02, P<0.01). Depression and   NSSI are mutual(β=0.77,   P<0.05；β=0.27,   P<0.01). Conclusions The   increased depressive symptoms among adolescents exacerbated their NSSI   behaviors and hurt their mental health during COVID-19. Screening for   depression should be carried out early to serve as a warning sign in   preventing and reducing NSSI in adolescents.