Non-Suicidal Self-Injury-Related Implicit Cognition Among Chinese Adolescents: The Roles of Psychological Flexibility...

Adolescence is a critical period for the onset of non-suicidal self-injury (NSSI). Current detection methods primarily rely on self-reports, which may be subjective and yield inaccurate results. The widely used implicit tool was not designed for NSSI and has certain limitations. Furthermore, few studies in China have employed implicit test to assess NSSI among non-clinical adolescents. Although individual characteristics (e.g., psychological flexibility) and microsystem factors (e.g., school climate) have well-established associations with self-reported NSSI, their influence on implicit NSSI remains unclear. To address these gaps, this study employed a novel implicit measure specifically developed for NSSI to distinguish Chinese adolescents with and without NSSI and to examine its predictive validity for future NSSI behavior. Additionally, the study analyzed the effects of psychological flexibility and school climate on implicit NSSI. In this longitudinal study, 502 adolescents (55.5% female; mean age = 14.25 years, SD = 1.65) completed the implicit NSSI test and self-report measures at baseline. Six months later, 399 adolescents (56.7% female; mean age = 14.25 years, SD = 1.61) from baseline completed follow-up self-report measures. Results indicated that adolescents with NSSI had significantly higher implicit NSSI scores than those without NSSI; however, the implicit NSSI did not significantly predict future NSSI. Regression analyses revealed significant negative effects of psychological flexibility and school climate on implicit NSSI. Network analysis showed that implicit NSSI was most strongly associated with baseline self-reported NSSI, followed by school bullying, while no significant associations were found with the subdimensions of psychological flexibility. Student-student relationships emerged as the strongest node in the network, followed by self-reported NSSI and defusion. These findings suggest that both implicit and self-reported measures should be considered for early detection of NSSI. Implicit NSSI representing a distinct construct from self-reported NSSI, may be effectively reduced by improving school climate and psychological flexibility. By integrating implicit and self-reported NSSI, this study provides new insights for understanding, preventing, and intervening NSSI in school settings.