Network perspective on childhood trauma and non-suicidal self-injury behaviors and functions in adolescents with depressive disorders

Abstract

BACKGROUND

Childhood trauma is a well-established risk factor for non-suicidal self-injury (NSSI) in adolescents with depressive disorder. However, whether trauma subtypes relate differently to specific NSSI behaviors and their underlying functional motivations are unclear. Understanding these patterns is crucial for identifying the pathways linking early adverse experiences to self-injury. We hypothesized that distinct trauma subtypes associate differently with specific NSSI behaviors and functional motivations.

AIM

To investigate the network linking childhood trauma, NSSI behaviors, and functional motivations in adolescents with depressive disorder.

METHODS

We conducted a cross-sectional study of 427 adolescents aged 12-18 years with depressive disorders in the psychiatric ward of a general hospital. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire-Short Form, and NSSI behavior and functional motivation with the adolescent NSSI Assessment Questionnaire. A Gaussian graphical model with graphical least absolute shrinkage and selection operator regularization was applied to estimate the network structure and central and bridge indices.

RESULTS

The network contained 29 nonzero edges. Emotional abuse (EA) showed the highest centrality (expected influence = 1.42). The strongest trauma-NSSI association was between EA and non-damaging self-injury (NDSI; weight = 0.10). NDSI demonstrated the highest bridge expected influence of 1.75. Of the functional motivations, automatic negative reinforcement showed the strongest association with emotion expression (weight = 0.43). The network structure exhibited good accuracy, with adequate stability of the centrality estimates (correlation stability coefficient = 0.75).

CONCLUSION

Childhood trauma is distinctly associated with NSSI behaviors and functions. EA and NDSI are the key nodes that may inform symptom-level understanding of adolescents with depressive disorders.

Keywords: Depressive disorders; Adolescents; Network analysis; Childhood trauma; Non-suicidal self-injury; Functional motivations

Core Tip: This study used network analysis to reveal symptom-level associations between childhood trauma, non-suicidal self-injury behaviors, and functional motivations in adolescents with depressive disorders. Emotional abuse was identified as the most central trauma subtype and non-damaging self-injury as the most critical bridge node connecting childhood trauma with non-suicidal self-injury behavior-function system. The findings highlight specific trauma-behavior pathways and underscore the value of network-based models for identifying clinically meaningful intervention targets beyond traditional total-score approaches.