Zhang FF, Guo R, Chen SL, Yang W, Liang XL, Ma MF. Network perspective on rumination and non-suicidal self-injury among adolescents with depressive disorders. World J Psychiatry 2026; 16(1): 113130 [DOI: 10.5498/wjp.v16.i1.113130]
Corresponding Author of This Article
Ming-Fang Ma, Associate Chief Nurse, Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Yantaxi Road, Xi’an 710061, Shaanxi Province, China. mingfangma@163.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Observational Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 19, 2026 (publication date) through Dec 31, 2025
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Journal Information of This Article
Publication Name
World Journal of Psychiatry
ISSN
2220-3206
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhang FF, Guo R, Chen SL, Yang W, Liang XL, Ma MF. Network perspective on rumination and non-suicidal self-injury among adolescents with depressive disorders. World J Psychiatry 2026; 16(1): 113130 [DOI: 10.5498/wjp.v16.i1.113130]
Fang-Fang Zhang, Rui Guo, Si-Lan Chen, Wei Yang, Xing-Li Liang, Ming-Fang Ma, Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Zhang FF research and write a manuscript; Guo R, Chen SL and Yang W contributed to conceiving the research and analyzing data; Liang XL contributed to project administration; Ma MF designed and supervised the study, revised the manuscript critically for important intellectual content. All authors have read and approve the final manuscript.
Supported by Key Research and Development Program of Shaanxi Province, China, No. 2024SF-YBXM-078.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University (Approval No. XJTU1AF2021 LSK-029).
Informed consent statement: Written informed consent was obtained from all participants and their legal guardians.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at mingfangma@163.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Fang Ma, Associate Chief Nurse, Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Yantaxi Road, Xi’an 710061, Shaanxi Province, China. mingfangma@163.com
Received: August 19, 2025 Revised: September 9, 2025 Accepted: October 17, 2025 Published online: January 19, 2026 Processing time: 134 Days and 16.3 Hours
Abstract
BACKGROUND
Non-suicidal self-injury (NSSI) is common among adolescents with depressive disorders and poses a major public health challenge. Rumination, a key cognitive feature of depression, includes different subtypes that may relate to NSSI through distinct psychological mechanisms. However, how these subtypes interact with specific NSSI behaviors remains unclear.
AIM
To examine associations between rumination subtypes and specific NSSI behaviors in adolescents.
METHODS
We conducted a cross-sectional study with 305 hospitalized adolescents diagnosed with depressive disorders. The subjects ranged from 12-18 years in age. Rumination subtypes were assessed using the Ruminative Response Scale, and 12 NSSI behaviors were evaluated using a validated questionnaire. Network analysis was applied to explore symptom-level associations and identify central symptoms.
RESULTS
The network analysis revealed close connections between rumination subtypes and NSSI behaviors. Brooding was linked to behaviors such as hitting objects and burning. Scratching emerged as the most influential NSSI symptom. Symptom-focused rumination served as a key bridge connecting rumination and NSSI.
CONCLUSION
Symptom-focused rumination and scratching were identified as potential intervention targets. These findings highlight the psychological significance of specific cognitive-behavioral links in adolescent depression and suggest directions for tailored prevention and treatment. However, the cross-sectional, single-site design limits causal inference and generalizability. Future longitudinal and multi-center studies are needed to confirm causal pathways and verify the generalizability of the findings to broader adolescent populations.
Core Tip: For the first time, we applied network analysis to map symptom-level links between rumination subtypes and specific non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorders. Symptom-focused rumination emerged as the most influential bridge connecting cognitive and behavioral symptoms, while self-scratching was the most central NSSI behavior. These findings including: (1) Identify precise cognitive and behavioral targets; and (2) Offer a novel framework for developing tailored interventions that integrate cognitive restructuring with behavioral strategies to reduce NSSI in this vulnerable population.
