Adolescent girls' stress responses as prospective predictors of self-injurious thoughts and behaviors: A person-centered, multilevel study

Abstract

Adolescent risk for self-injurious thoughts and behaviors (STBs) involves disturbance across multiple systems (e.g., affective valence, arousal regulatory, cognitive and social processes). However, research integrating information across these systems is lacking. Utilizing a multiple-levels-of-analysis approach, this person-centered study identified psychobiological stress response profiles and linked them to cognitive processes, interpersonal behaviors, and STBs. At baseline, adolescent girls (N = 241, M_age = 14.68 years, Range = 12-17) at risk for STBs completed the Trier Social Stress Test (TSST), questionnaires, and STB interviews. Positive affect (PA), negative affect (NA), and salivary cortisol (SC) were assessed before and after the TSST. STBs were assessed again during 3, 6, and 9 month follow-up interviews. Multitrajectory modeling of girls' PA, NA, and SC revealed four profiles, which were compared on cognitive and behavioral correlates as well as STB outcomes. Relative to normative, girls in the affective distress, hyperresponsive, and hyporesponsive subgroups were more likely to report negative cognitive style (all three groups) and excessive reassurance seeking (hyporesponsive only) at baseline, as well as nonsuicidal self-injury (all three groups) and suicidal ideation and attempt (hyporesponsive only) at follow-up. Girls' close friendship characteristics moderated several profile-STB links. A synthesis of the findings is presented alongside implications for person-centered tailoring of intervention efforts.

Keywords: adolescence; cortisol; negative affect; nonsuicidal self-injury; positive affect.

Figure 1.

Salivary cortisol, negative affect, and positive affect trajectories for the final four-group solution. Multitrajectory modeling (MTM) subgroups were identified using fourth-root transformed salivary cortisol and negative affect values. Raw salivary cortisol, negative affect, and positive affect values are displayed here for ease of interpretation and in the interest of cross-study communication.

Figure 2.

Plotted multinomial log odds and standard error bars depicting the likelihood of multitrajectory modeling (MTM) subgroup membership as a function of significant correlates and covariates. The Normative group was used as reference (i.e., X axis = 0).

Figure 3.

Plotted log odds and standard error bars depicting the likelihood of follow up self-injurious thoughts and behaviors as a function of multitrajectory modeling (MTM) subgroup membership. The Normative group was used as reference (i.e., X axis = 0).

Figure 4.

Moderation effects of perceived close friendship characteristics on subgroup membership to 3–9 month follow-up self-injurious behavior associations. Predicted probabilities plotted at 16th and 84th percentile values of the moderator for illustrative purposes.