Combined transcranial direct current and repetitive transcranial magnetic stimulation for adolescent non-suicidal self-injury

doi:10.5498/wjp.118371

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World Journal of Psychiatry

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2220-3206

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World J Psychiatry. Sep 19, 2026; 16(9): 118371
Published online Sep 19, 2026. doi: 10.5498/wjp.118371

Table 1 Comparison of baseline characteristics among three groups, n (%)/mean ± SD

Variable	Combination group (n = 86)	rTMS group (n = 92)	Control group (n = 78)	F/χ²	P value
Gender (male/female)	22/64	25/67	18/60	0.486	0.784
Age (years)	15.4 ± 1.7	15.2 ± 1.8	15.6 ± 1.6	1.125	0.326
Illness duration (months)	19.2 ± 9.6	18.5 ± 10.2	20.1 ± 9.8	0.625	0.536
NSSI onset age (years)	13.1 ± 1.4	13.3 ± 1.5	13.0 ± 1.6	0.862	0.424
Self-injury frequency (times/month)	8.5 ± 4.2	8.2 ± 4.5	8.8 ± 4.0	0.456	0.635
Primary self-injury method				0.562	0.755
Cutting	62 (72.1)	68 (73.9)	55 (70.5)
Other	24 (27.9)	24 (26.1)	23 (29.5)
Comorbid depression	52 (60.5)	54 (58.7)	45 (57.7)	0.142	0.932
Comorbid anxiety disorder	35 (40.7)	38 (41.3)	30 (38.5)	0.152	0.927
Childhood trauma history	48 (55.8)	50 (54.3)	42 (53.8)	0.068	0.967
Previous psychotherapy history	28 (32.6)	30 (32.6)	24 (30.8)	0.076	0.963
SHI score (points)	29.5 ± 7.2	28.8 ± 6.8	29.2 ± 7.0	0.225	0.799
BDI-II score (points)	27.2 ± 8.5	26.5 ± 8.2	27.0 ± 8.8	0.168	0.845
BAI score (points)	25.6 ± 7.8	24.8 ± 7.5	25.2 ± 8.0	0.245	0.783
BIS-11 score (points)	73.5 ± 11.2	72.8 ± 10.8	74.2 ± 11.5	0.358	0.699
DERS score (points)	110.5 ± 19.2	108.6 ± 18.5	111.2 ± 20.1	0.425	0.654
CTQ score (points)	48.6 ± 12.5	47.8 ± 11.8	49.2 ± 12.2	0.298	0.743

CTQ: Childhood Trauma Questionnaire; rTMS: Repetitive transcranial magnetic stimulation; SHI: Self-Harm Inventory; BIS-11: Barratt Impulsiveness Scale-11; BDI-II: Beck Depression Inventory-II; DERS: Difficulties in Emotion Regulation Scale; BAI: Beck Anxiety Inventory; NSSI: Non-suicidal self-injury.

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Table 2 Comparison of scale scores before and after treatment among three groups (mean ± SD, points)

Measure	Time	Combination group (n = 86)	rTMS group (n = 92)	Control group (n = 78)	F value	P value
SHI	Pre-treatment	29.5 ± 7.2	28.8 ± 6.8	29.2 ± 7.0	0.225	0.799
	Post-treatment	10.8 ± 4.8^a	15.2 ± 5.5^a	19.6 ± 6.2^a	52.36	< 0.001
	Improvement	18.7 ± 5.2	13.6 ± 4.8	9.6 ± 4.5	68.52	< 0.001
BDI-II	Pre-treatment	27.2 ± 8.5	26.5 ± 8.2	27.0 ± 8.8	0.168	0.845
	Post-treatment	12.5 ± 5.6^a	16.8 ± 6.2^a	20.5 ± 7.0^a	35.62	< 0.001
	Improvement	14.7 ± 4.8	9.7 ± 4.2	6.5 ± 3.8	72.86	< 0.001
BAI	Pre-treatment	25.6 ± 7.8	24.8 ± 7.5	25.2 ± 8.0	0.245	0.783
	Post-treatment	11.2 ± 4.8^a	15.5 ± 5.6^a	18.8 ± 6.2^a	38.56	< 0.001
	Improvement	14.4 ± 4.5	9.3 ± 4.0	6.4 ± 3.6	78.25	< 0.001
BIS-11	Pre-treatment	73.5 ± 11.2	72.8 ± 10.8	74.2 ± 11.5	0.358	0.699
	Post-treatment	54.2 ± 9.5^a	60.5 ± 10.2^a	66.8 ± 11.0^a	32.15	< 0.001
	Improvement	19.3 ± 5.8	12.3 ± 5.2	7.4 ± 4.5	95.62	< 0.001
DERS	Pre-treatment	110.5 ± 19.2	108.6 ± 18.5	111.2 ± 20.1	0.425	0.654
	Post-treatment	70.5 ± 14.2^a	82.6 ± 15.8^a	95.5 ± 17.2^a	48.26	< 0.001
	Improvement	40.0 ± 10.5	26.0 ± 9.2	15.7 ± 8.5	125.8	< 0.001

^aP < 0.01 vs pre-treatment within group.

rTMS: Repetitive transcranial magnetic stimulation; SHI: Self-Harm Inventory; BIS-11: Barratt Impulsiveness Scale-11; BDI-II: Beck Depression Inventory-II; DERS: Difficulties in Emotion Regulation Scale; BAI: Beck Anxiety Inventory.

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Table 3 Clinical efficacy comparison among three groups, n (%)

Group	Cases	Recovery	Marked improvement	Improvement	No response	Overall response rate (%)
Combination group	86	28 (32.6)	32 (37.2)	16 (18.6)	10 (11.6)	88.4^a^,^b
rTMS group	92	18 (19.6)	26 (28.3)	23 (25.0)	25 (27.2)	72.8^b
Control group	78	8 (10.3)	15 (19.2)	20 (25.6)	35 (44.9)	55.1

^aP < 0.05 vs repetitive transcranial magnetic stimulation group.

^bP < 0.05 vs control group.

rTMS: Repetitive transcranial magnetic stimulation.

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Table 4 Univariate logistic regression analysis of treatment response

Variable	B	SE	OR (95%CI)	Wald	P value
Gender (male = 1)	-0.125	0.285	0.88 (0.50-1.54)	0.192	0.661
Age	0.086	0.092	1.09 (0.91-1.30)	0.875	0.350
Illness duration	-0.042	0.018	0.96 (0.93-0.99)	5.445	0.020
Treatment regimen (control as reference)				22.56	< 0.001
rTMS group	0.785	0.312	2.19 (1.19-4.04)	6.325	0.012
Combination group	1.652	0.365	5.22 (2.55-10.68)	20.48	< 0.001
Comorbid depression (yes = 1)	0.625	0.268	1.87 (1.10-3.16)	5.445	0.020
Comorbid anxiety disorder (yes = 1)	0.312	0.265	1.37 (0.81-2.30)	1.385	0.239
Childhood trauma history (yes = 1)	-0.485	0.262	0.62 (0.37-1.03)	3.426	0.064
Baseline SHI score	0.025	0.022	1.03 (0.98-1.07)	1.292	0.256
Baseline BDI-II score	0.018	0.018	1.02 (0.98-1.05)	1.000	0.317
Baseline BIS-11 score	-0.028	0.014	0.97 (0.95-1.00)	4.000	0.046
Baseline DERS score	-0.022	0.008	0.98(0.96-0.99)	7.563	0.006

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Table 5 Multivariate logistic regression analysis of treatment response

Variable	B	SE	OR (95%CI)	Wald	P value
Treatment regimen (control as reference)				19.86	< 0.001
rTMS group	0.695	0.325	2.00 (1.06-3.79)	4.572	0.033
Combination group	1.581	0.388	4.86 (2.28-10.36)	16.62	< 0.001
Illness duration	-0.038	0.019	0.96 (0.93-0.99)	4.000	0.046
Comorbid depression	0.652	0.295	1.92 (1.08-3.42)	4.882	0.027
Baseline DERS score	-0.020	0.009	0.98 (0.96-0.99)	4.938	0.026

Model χ² = 48.56, P < 0.001. Hosmer-Lemeshow test χ² = 6.825, P = 0.556. Nagelkerke R² = 0.256. rTMS: Repetitive transcranial magnetic stimulation; DERS: Difficulties in Emotion Regulation Scale; OR: Odds ratio; CI: Confidence interval.

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Table 6 Multiple linear regression analysis of Self-Harm Inventory score improvement

Variable	B	SE	β	t	P value
Constant	2.856	2.125	-	1.344	0.180
Treatment regimen (control as reference)
rTMS group	3.856	0.825	0.285	4.674	< 0.001
Combination group	8.562	0.862	0.612	9.932	< 0.001
Baseline SHI score	0.325	0.058	0.286	5.603	< 0.001
Baseline BIS-11 score	0.125	0.038	0.185	3.289	0.001
Childhood trauma history (yes = 1)	-2.156	0.752	-0.156	-2.867	0.005

F = 48.56, P < 0.001. Adjusted R² = 0.485. rTMS: Repetitive transcranial magnetic stimulation; SHI: Self-Harm Inventory; BIS-11: Barratt Impulsiveness Scale-11.

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Citation: Liu HZ, Liu WG, Fu HQ, Lv H, Liu C, Li CX. Combined transcranial direct current and repetitive transcranial magnetic stimulation for adolescent non-suicidal self-injury. World J Psychiatry 2026; 16(9): 118371
URL: https://www.wjgnet.com/2220-3206/full/v16/i9/118371.htm
DOI: https://dx.doi.org/10.5498/wjp.118371

Liu HZ, Liu WG, Fu HQ, Lv H, Liu C, Li CX. Combined transcranial direct current and repetitive transcranial magnetic stimulation for adolescent non-suicidal self-injury. World J Psychiatry 2026; 16(9): 118371 [DOI: 10.5498/wjp.118371]

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