# The Role of Limited Emotion Regulation Strategies on Nonsuicidal Self-injury and Suicide Attempts among Chinese Adolescents: A Network Analysis Based on Jiangxi Province

## TL;DR

This study explores how limited emotion regulation strategies and personal distress relate to self-injury and suicide attempts in Chinese adolescents.

## Contribution

The novel use of network analysis to identify key factors linking nonsuicidal self-injury and suicide attempts in adolescents.

## Key findings

- Emotion regulation strategies were the strongest influence node in both networks.
- Personal distress was the strongest bridge influence node.
- Significant differences were found in specific self-injury behaviors and their connections in the network.

## Abstract

Background: Nonsuicidal self-injuries (NSSIs) are an important contributing factor to adolescent suicide, and various shared factors influence the risk of both NSSIs and suicide attempts (SAs). Both are important predictors of suicide and are part of a continuum of suicidal behaviors. Further exploration of the relationship between adolescent NSSI and SA may facilitate suicide prevention efforts. Methods: An online survey was conducted among 9,140 participants. Network analysis methods were used to explore expected influence (EI), bridge expected influence (BEI), edge weights, and differences between adolescents that have and have not attempted suicide (NSSI-SA and NSSI-NoSA, respectively). Results: Of the 9,140 participants, 7,030 completed the questionnaire, yielding a participation rate of 76.91%. Participants with at least one NSSI were retained, with 2,496 (35.50%) included in the network analysis. The strongest EI node for both networks was “emotion regulation strategies” (E = 1.389 and 1.393), and that for BEI was “personal distress” (Interpersonal Reactivity Index—personal distress; E = 0.497 and 0.492). Network comparisons revealed significant differences in NSSI 4 (“intentionally hitting walls, tables, and other hard objects”; E(Δ) = −0.384, P < 0.001), significant differences in BEI with regard to “perspective taking” (Interpersonal Reactivity Index—perspective taking; E(Δ) = −0.215, P < 0.001), and significant differences in edge weights between NSSI 4 and NSSI 5 (“intentionally hurting oneself by hitting with a fist, palm, or hard object”; E(Δr) = −0.173, P < 0.001). Conclusions: Our study suggests that interventions in the form of emotion regulation strategies can alleviate symptoms throughout the entire network. Attention should be paid to instances when NSSI 4 and NSSI 5 behaviors co-occur frequently.