Nonsuicidal Self-Injury in Adolescents: An Explanatory Model of Contextual Factors

Abstract

Empirical studies have demonstrated that adolescents experience heightened and prolonged negative emotion prior to and during the act of nonsuicidal self injury (NSSI), and that self-injurers use NSSI as a strategy to regulate emotion. The influence of social contexts that elicit emotional reactivity and influence adolescent NSSI have seldom been investigated. The purpose of this dissertation research was to present and examine a contextual explanation of adolescent NSSI. The specific study aims were as follows: Aim 1: To test the posited mediating influence of emotional reactivity on non-suicidal self- injurious behavior as specified in the proposed theoretical model by examining direct and indirect associations with identified contextual factors – specifically childhood abuse, peer relationship quality, and family functioning; Aim 2: To test for moderating effects of contextual factors (family functioning and peer relationship quality) on the association between childhood abuse and emotional reactivity; Aim 3: To explore the influence of contextual experiences (childhood abuse, family functioning, peer relationship quality), and individual characteristics (emotion reactivity and depression) on case classification relative to non-suicidal self injury and/or suicidal behaviors. Using a cross-sectional correlational design and a sample of 799 students, ages 17 - 22 years were recruited from a university located in northern Taiwan. The proposed model (Aim 1) was tested using structural equation modeling, and moderating effects (Aim 2) were tested using multiple regression. The results for Aim 1 showed that the influence of childhood abuse on NSSI was partially mediated by emotional reactivity. Poor peer relationship quality uniquely predicted NSSI, however, low family functioning did not. There was no clear evidence that either family functioning or peer relationship quality served to moderate the effects of childhood abuse on emotional reactivity (Aim 2). Using latent class analysis (Aim 3), four distinct profiles of NSSI and suicidal behavior were identified. Individual characteristics (emotional reactivity, depression) and contextual experiences (childhood abuse, family function, peer relationship quality) were most strongly associated with the combined experience of NSSI and suicidal behavior. This dissertation research was designed to complement psychological models of self-injurious behavior with detailed attention to contextual factors. The findings will provide guidance for health professionals and researchers in understanding the pathways to self-injurious behavior among Taiwanese adolescents.