Meilan Chen1, Yu Liu1, Xueping Wang1, Weigong Li2，Lin Lin2, Weijian Li2, Lingfeng Gao*

1 Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, School of Psychology, Zhejiang Normal University, Jinhua 321004, China (Email: glfpsy@zjnu.edu.cn)

2 Faculty of Psychology, Tianjin Normal University at Tianjin, NO. 393 Binshui West Road, Xiqing District, Tianjin 300387, China. 

 

Objective 

Traditional views typically consider nonsuicidal self-injury (NSSI) outcome behavior indicators (i.e. frequency) as risk factors for Self-Injurious Thoughts and Behaviors (SITBs), which is insufficient. For example, some people stopped NSSI because they don’t face trigging situations, but cognitively, they continued to perceive NSSI as a coping mechanism for managing distress. Therefore, examining individual variability in process indicators, particularly by incorporating changes at the cognitive level, is essential for more accurately predicting the risk of SITBs. The NSSI-Transtheoretical model (NSSI-TTM) plays an important and innovative role in understanding cognitive and behavioral changes of NSSI. In addition, the functions of NSSI can be defined as ‘consciously processed reasons for NSSI’. We propose that there are specific combinations between different change processes and functions. This study aims to investigate the combined effects of the processes of change in NSSI-related cognitions and behaviors, and their functional roles, on SITBs from a person-centered perspective.

Methods

The current study (n = 589 Chinese undergraduates) used latent profile analysis (LPA) to identify subgroups based on NSSI-Processes of Change (NSSI-POC) and Non-Suicidal Self-Injury-Assessment Tool (NSSI-AT) dimensions. Binary logistic regression was used to explore the relations of these subgroups with the risk of SITBs.

Results & Discussion

The LPA identified three subgroups: commit to change-low NSSI effectiveness (35.6%), resistance to change-low NSSI effectiveness (51.7%), and hesitant to change-emotion regular (12.7%). The resistance to change-low NSSI effectiveness group had the lowest frequency of NSSI and the lowest suicide risk, although the latter is not statistically significant. The individuals exhibited low-level NSSI behavior that does not impact daily life. It was used only occasionally to offset suicidal impulses, resulting in a lower risk of suicide. Individuals in hesitant to change-emotion regular group displayed the highest frequency of NSSI and the greatest suicide risk. Among the three functions, emotion regulation was the most significant barrier to individuals making changes, and a critical factor contributing to the risk of SITBs. 

Conclusions

The current study represents an important step for understanding association between specific combinations of NSSI progress of change and functions with SITBs. The results of the LPA identified three distinct subgroups in our undergraduate sample: change-low NSSI effectiveness, resistance to change-low NSSI effectiveness, and hesitant to change-emotion regular. Three subgroups showed different associations with SITBs. Finds highlight that the unique profile of progress of change and functions of NSSI should be considered when evaluating risk of SITBs.

Acknowledgement: This research was supported by the Zhejiang Educational Science Planning Project (No.2024SCG358), Zhejiang Province Philosophy and Social Science Planning Project (No.24NDQN22Z).

References

Kiekens, G., Hasking, P., Boyes, M., Claes, L., Mortier, P., Auerbach, R. P., . . . Bruffaerts, R. (2018). The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors. Journal of Affective Disorders, 239, 171-179. https://doi.org/10.1016/j.jad.2018.06.033

Kruzan, K. P., Whitlock, J., & Hasking, P. (2020). Development and initial validation of scales to assess Decisional Balance (NSSI-DB), Processes of Change (NSSI-POC), and Self-Efficacy (NSSI-SE) in a population of young adults engaging in nonsuicidal self-injury. Psychological Assessment, 32(7), 635-648. https://doi.org/10.1037/pas0000821