Investigation of the relationship of non-suicidal self-injury with impulsivity, emotion regulation, resilience and executive functions in adolescents with depressive disorder

Objective: This study aimed to examine the relationship of non-suicidal self-injury (NSSI) with clinical and sociodemographic characteristics, severity of depression, impulsivity, emotion regulation, resilience, and executive functions by comparing depressive patients with NSSI, depression patients without NSSI and healthy adolescents. Method: The study was conducted at Manisa Celal Bayar University Faculty of Medicine Department of Child and Adolescent Psychiatry Outpatient Clinic between September 2020 and April 2021. The sample of the study consists of adolescents aged 12-18 and a parent. 43 adolescents who have NSSI at least once in the last 1 year and meet the diagnostic criteria for depressive disorder as a result of the clinical interview, are included in the depression group with NSSI, 41 adolescents who do not have NSSI and meet the diagnostic criteria for depressive disorder, are included in the depression group without NSSI, and 38 age-gender-matched healthy adolescents were included in the healthy control group. All participants administered the Schedule for Affective Disorders and Schizophrenia for School-Age Children-the Present and Lifetime Version-DSM-5 and the Depression Rating Scale for Children-Revised Form. All adolescents participating in the study completed the Sociodemographic Data Form, DSM-5 Level-2 Depression Scale-Child Form (DEP), Difficulties in Emotion Regulation Scale (DERS), Barrat Impulsiveness Scale-11 (BIS-11), and The Child and Youth Resilience Measure-12 (CYRM-12); adolescents with NSSI also completed the Inventory of Statements About Self Injury. Wisconsin Card Sorting Test (WCST), Stroop Test and Cued Go/NoGo Task were administered to all adolescents by the researcher. One parent of each adolescent participating in the study completed the Behavior Rating Inventory of Executive Functions-Parent Form (BRIEF). Results: Adolescents in the depression group with NSSI reported the highest rate of domestic violence and marital problems in the family, while adolescents in the healthy control group reported the lowest rate. It was determined that the adolescents in the depression group with NSSI smoked regularly at a significantly higher rate than the adolescents in the other two groups, reported more history of suicidal ideation, plan and attempt, and suicide history in their friends. It was determined that the most common method of NSSI in adolescents with NSSI was hitting oneself against a hard surface, hitting oneself, and cutting oneself was the second most common method. When the DEP, BIS-11 and BRIEF subscale and total scores were compared, no significant difference was found between the depression groups with and without NSSI, but it was found to be significantly higher than the scores of the healthy control group (p<0.01). The DERS aim, impulsivity and clarity subscale scores were found to be significantly higher adolescents in the depression group with NSSI than those in the other groups, and the CYRM-12 scores were found to be significantly lower (p<0.01). While the DERS strategy, nonacceptance and awareness subscale scores were similar in the depression groups, they were found to be significantly lower in the healthy control group (p<0.05). When the WCST, Stroop Test and Cued Go/NoGo Task data were compared, no difference was found between the depression groups, but it was found that the adolescents in these groups performed worse than those in the healthy control group (p<0.05). In the logistic regression analysis of the variables that have an effect on NSSI, the DERS impulsivity subscale score and suicidal ideation were found to be statistically significant (p<0.05). As a result of the analyzes related to NSSI functions, DEP total score and DERS strategy subscale score were correlated with automatic functions, while DEP total score and BIS-11 motor impulsivity subscale score were correlated with social functions (p<0.01). In the multiple linear regression analysis performed to determine the variables affecting NSSI functions, DERS strategy subscale score was found to be effective on automatic functions, and DEP total score and BIS-11 motor impulsivity subscale score were found to be effective on social functions (p<0.05). In the evaluation of the scales used in our study in the case group, while the DEP, DERS, BIS-11 and BRIEF scales were positively correlated with each other, a negative correlation was found between CYRM-12 and all other scales. Conclusions: Adolescents in the depression group with NSSI were different from the adolescents in the other groups in terms of marital problems in the family, domestic violence, regular smoking, history of suicidal ideation, plans and attempts, and suicide history in friends. It was concluded that adolescents with NSSI have difficulties in emotion regulation, they have less skills in initiating goal-directed behavior during negative emotions, clarifying emotional response and controlling impulsive behaviors, and their psychological resilience is low. Results of scales and laboratory tests assessing impulsivity and executive functions, did not find a relationship with NSSI, it was concluded that the deficits found were associated with depression. As a result of the analysis of the factors affecting NSSI, it was determined that having suicidal thoughts and having difficulty in controlling impulsive behaviors increase the risk of NSSI. In addition, it was concluded that as the difficulties experienced in emotion regulation strategies increased in adolescents with NSSI, autonomic functions were used more, and as the severity of depression and motor impulsivity increased, social functions were used more. It was determined that executive function deficits increased as the severity of depression, impulsivity and difficulties in emotion regulation increased, and psychological resilience was negatively related to all these variables. There is a need for more comprehensive studies investigating the relationship of NSSI with executive functions and other variables in order to determine the underlying factors of NSSI and to take necessary measures to prevent this behavior.