The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents-A Network Approach

Abstract

Although earlier research has highlighted that psychiatric disorders significantly impair patients' quality of life (QoL), few studies have examined the relationship between nonsuicidal self-injury (NSSI) and QoL. Our aim was to investigate whether QoL mediates the mental disorder-NSSI relationship, and to study the QoL ratings agreement of self and parents in a clinical population of adolescents. We involved 202 adolescents from Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, aged 13-18 years. All participants completed the Deliberate Self-Harm Inventory, Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen, and the Mini International Neuropsychiatric Interview Kid. To map the interrelationship between the NSSI, mental disorders, and QoL dimensions, Mixed Graphical Models were estimated. Adolescents with a history of NSSI rated their QoL to be significantly lower than adolescents without NSSI. Self and parents' QoL ratings are closer in the NSSI sample than in the no-NSSI sample. Among all QoL dimensions, only family problems had a direct significant association with NSSI engagement. Our results highlight that, contrary to our hypothesis, the presence of mental disorders mediates the relationship between most QoL dimensions and the occurrence of NSSI. Our results draw attention to the potential causal effect of environmental factors (e.g., peer problems) on mental disorders that, in turn, result in NSSI. The present paper highlights the importance of network modelling in clinical research.

Keywords: adolescents; mental disorders; network approach; non-suicidal self-injury; parent-report; quality of life; self-report.

Figure 1

Association between QoL dimensions and NSSI. QoL_school—QoL school dimension, QoL_family—QoL family dimension, QoL_peers—QoL peer relations dimension, QoL_alone—QoL alone activity dimension, QoL_phys—QoL physical health dimension, QoL_mental—QoL mental health dimension, QoL_global—QoL global well-being dimension, NSSI—nonsuicidal self-injury.

Figure 2

Association between QoL dimensions, mental disorders and NSSI. QoL_school—QoL school dimension, QoL_family—QoL family dimension, QoL_peers—QoL peer relations dimension, QoL_alone—QoL alone activity dimension, QoL_phys—QoL physical health dimension, QoL_mental—QoL mental health dimension, QoL_global—QoL global well-being dimension, NSSI—nonsuicidal self-injury, Mood—mood disorders, Anxiety—anxiety disorders, Att_disr—attention-disruptive disorders, Subst—substance use disorders, Psycho—psychotic disorders, Suicid—suicidality.

Figure 3

Robustness check-association between QoL dimensions, mental disorders and NSSI for different hyperparameters. QoL_school—QoL school dimension, QoL_family—QoL family dimension, QoL_peers—QoL peer relations dimension, QoL_alone—QoL alone activity dimension, QoL_phys—QoL physical health dimension, QoL_mental—QoL mental health dimension, QoL_global—QoL global well-being dimension, NSSI—nonsuicidal self-injury, Mood—mood disorders, Anxiety—anxiety disorders, Att_disr—attention-disruptive disorders, Subst—substance use disorders, Psycho—psychotic disorders, Suicid—suicidality.