Non-Suicidal Self-Injury in Depressed Adolescents: A Social-Cognitive Deficit or an Emotional Response?

Non-suicidal self-injury (NSSI) has been identified as a prevalent behavior among adolescents, particularly those with major depressive disorder (MDD). The present study sought to examine differences in neurocognition, social cognition, negative urgency (NU)-the tendency to act impulsively in response to negative emotions-and anxiety among adolescents with MDD and NSSI, MDD without NSSI, and healthy controls.

A total of 204 adolescents (aged 11-17 years; 161 girls [78.9%], 43 boys [21.1%]) were divided into three groups: (1) MDD with NSSI, (2) MDD without NSSI, and (3) healthy controls. Participants completed psychiatric assessments, computerized neurocognitive tests, emotion recognition tasks, and self-report measures of NU and anxiety. Data were analyzed using SPSS 22. Descriptive statistics included frequencies for categorical variables and medians for continuous variables. Group comparisons were performed using chi-square-based tests and the Kruskal-Wallis test. Logistic regression identified predictors of NSSI, with significance set at p < .05.

Adolescents with MDD exhibited significant deficits in executive function and episodic memory, as well as elevated NU and anxiety, compared to healthy controls. Furthermore, adolescents with MDD and NSSI reported significantly higher levels of anxiety (particularly panic symptoms) and NU compared to those with MDD alone.

These findings suggest that emotional difficulties, particularly impulsivity and panic symptoms, play a crucial role in NSSI among adolescents with MDD rather than cognitive disturbance, highlighting potential targets for prevention and intervention efforts.