Interaction among negative mood, sleep, and diet habits in adolescents with non-suicidal self-injury: A cross-sectional network analysis

Non-suicidal self-injury (NSSI) is a serious public health problem that can lead to adverse effects such as cognitive impairment, poor interpersonal relationships and violent crime. The progress of preventing and treating NSSI in adolescents depends on other changeable risk factors, such as negative mood, sleep, and diet habits. However, the risk factors for adolescent NSSI remain unclear. Therefore, this study explores the key factors influencing adolescents' NSSI behavior through the use of network analysis. The study recruited 4040 middle school students aged 12–18 years old. From November 1st, 2023 to January 1st, 2024, paper questionnaires were utilized to investigate the participants' basic conditions, negative mood, NSSI, sleep conditions, and diet habits. Network analysis was used to explore the interrelationship among risk factors and discover the core factor. In the network structure of adolescents with NSSI behavior, the most correlated nodes were negative emotions (CDI2) and low self-esteem (CDI3). Compared with adolescents without NSSI behavior, adolescents with NSSI behavior showed prominent anxiety symptoms related to injury avoidance (MASC1) and social anxiety (MASC2). Anhedonia (CDI1) was both the central node and the bridge node of the network. The cross-sectional design of this study couldn't clarify the causal inference between independent variables and results. Anhedonia is the key factor affecting adolescents' emotion regulation. Furthermore, we hypothesize that adolescent NSSI is an emotional disorder, and anhedonia plays an important role in preventing and intervening in adolescents' NSSI behavior. •The sample size is large (>3000 people).•Our study uses the network analysis to provide some support for the study of risk factors of NSSI.•Our study provides targeted intervention symptoms and their potential effects to address NSSI. Adolescents with NSSI behavior have more severe anhedonia, which is a core symptom.