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. 2023 Aug 29;36(4):e100946.
doi: 10.1136/gpsych-2022-100946. eCollection 2023.

Potential mechanisms of non-suicidal self-injury (NSSI) in major depressive disorder: a systematic review

Baichuan Wu  1 , Huifeng Zhang  1 , Jinghong Chen  2   3 , Jiaye Chen  1 , Zhifen Liu  4 , Yuqi Cheng  5 , Tifei Yuan  2 , Daihui Peng  1
Affiliations

Potential mechanisms of non-suicidal self-injury (NSSI) in major depressive disorder: a systematic review

Baichuan Wu et al. Gen Psychiatr. .

Abstract

Background: Non-suicidal self-injury (NSSI) is a frequent and prominent phenomenon in major depressive disorder (MDD). Even though its prevalence and risk factors are relatively well understood, the potential mechanisms of NSSI in MDD remain elusive.

Aims: To review present evidence related to the potential mechanisms of NSSI in MDD.

Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, articles for this systematic review were searched on Medline (through PubMed), Embase (through Elsevier), PsycINFO (through OVID) and Web of Science databases for English articles, as well as China National Knowledge Infrastructure (CNKI), SinoMed, Wanfang Data, and the Chongqing VIP Chinese Science and Technology Periodical (VIP) Databases for Chinese articles published from the date of inception to 2 August 2022. Two researchers (BW, HZ) independently screened studies based on inclusion and exclusion criteria and assessed their quality.

Results: A total of 25 157 studies were searched. Only 25 of them were ultimately included, containing 3336 subjects (1535 patients with MDD and NSSI, 1403 patients with MDD without NSSI and 398 HCs). Included studies were divided into 6 categories: psychosocial factors (11 studies), neuroimaging (8 studies), stress and hypothalamic-pituitary-adrenal (HPA) axis (2 studies), pain perception (1 study), electroencephalogram (EEG) (2 studies) and epigenetics (1 study).

Conclusions: This systematic review indicates that patients with MDD and NSSI might have specific psychosocial factors, aberrant brain functions and neurochemical metabolisms, HPA axis dysfunctions, abnormal pain perceptions and epigenetic alterations.

Keywords: depressive disorder, major; self-injurious behavior.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart of the search for relevant English references. MDD, major depressive disorder; NSSI, non-suicidal self-injury.
Figure 2
Figure 2
Flowchart of the search for relevant Chinese references. MDD, major depressive disorder; NSSI, non-suicidal self-injury.
Figure 3
Figure 3
Potential mechanisms of NSSI in MDD. In this figure, we included 6 domains of 25 studies and hypothesised a potential model. Epigenetic alterations as well as childhood maltreatment might play a role in the dysfunction of neural activity, pain perception, HPA axis and psychosocial problems, which were associated with the behaviours of NSSI in patients with MDD. HPA, hypothalamic-pituitary-adrenal; MDD, major depressive disorder; NSSI, non-suicidal self-injury.
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