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. 2025 Sep;54(9):2168-2179.
doi: 10.1007/s10964-025-02183-y. Epub 2025 Apr 13.

Non-Suicidal Self-Injury and Depressive Symptoms During Adolescence: Testing Directionality

Lauree Tilton-Weaver  1 , Rebecca Schwartz-Mette  2
Affiliations

Non-Suicidal Self-Injury and Depressive Symptoms During Adolescence: Testing Directionality

Lauree Tilton-Weaver et al. J Youth Adolesc. 2025 Sep.

Abstract

As risk for both non-suicidal self-injury and depression increases at adolescence, it is critically important to clarify equivocal findings regarding the temporal ordering of these health concerns. Addressing the limitations of past research, which included the use of only two data waves and analyses that do not account for within-person variance, the aim in this study was to examine the temporal ordering of non-suicidal self-injury and depressive symptoms during adolescence. Two independent samples were examined. One sample (first used by Marshall et al., 2013) consisted of 799 Swedish adolescents (11 to 15 years, Mage = 13.18, SD = 0.74; 51% girls). The second sample was a later cohort of adolescents from the same area (N = 2760; aged 12 to 18 years, Mage = 13.75, SD = 0.74; 49% girls). Analyses were two-part cross-lagged panel models (CLPMs) and random-intercept cross-lagged panel models (RI-CLPMs) to account for the semi-continuous distribution of NSSI and to determine if traditional lagged models were adequate for estimating within-person temporal ties. The results suggest that traditional CLPMs had inadequate fits to data. RI-CLPMs showed significant within-person, transactional associations between depressive symptoms and NSSI. Specifically, NSSI at a mean age around 13 years was associated with increases in depressive symptoms one year later, which were in turn associated with increases in NSSI when the average age was about 15 years old. Subsequently, lags suggested the potential for maintenance of comorbid distress. These results suggest that efforts to reduce depression and NSSI during adolescence need to begin in early adolescence, with a focus on adaptive responses to distressing emotional experiences.

Keywords: Adolescence; Bidirectional; Depressive symptoms; Non-suicidal self-injury; Transactional.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: The authors declare no competing interests. Ethical Approval: The data used in this study were collected after obtaining ethical approval from the Uppsala Regional Ethics Board (7 Schools #2007/094; 3 Cities #2013/384). The data collections and this study were conducted in accordance with the ethical standards defined by the 1964 Declaration of Helsinki and Swedish guidelines in force at the time of data collection. This study conforms to the guidelines set out by the Swedish Research Council ((Vetenskapsrådet). Ethics approval included the use of passive parental consent and active adolescent assent. Informed Consent: For both data sets, passive consent was used for parents (approved by the ethics board) and active assent for adolescents. Specifically, prior to each annual data collection, parents were informed through mail about the study, the procedures it entailed, and their right to decline participation for their children. They were able to decline participation through email, mail, phone, or a postage-paid card. Adolescents provided their assent by filling out questionnaires, after a presentation about the study, in which they were provided information about the study purpose, what participation entailed, their rights as research participants, and the manner in which their data would be anonymized and protected. The data are maintained in full compliance with EU General Data Protection Regulation (GDPR, EU, 2016/679) and Swedish laws governing the protecting of personal information (Data Protection Act, 2018:218; Data Protection Regulation, 2018:219), which supplemented the EU GDPR.

Figures

Fig. 1
Fig. 1
Significant cross-lagged paths from RI-CLPMs. NSSI continuous component (Sample 1). NSSI binary component (Sample 2)
See this image and copyright information in PMC

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