Effects of Decision Making and Impulsivity on the addictive Characteristics of Non-Suicidal Self-Injurious Behavior in Adolescents with Depressive Disorders

Effects of Decision Making and Impulsivity on the addictive Characteristics of Non-Suicidal Self-Injurious Behavior in Adolescents with Depressive Disorders | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Decision Making and Impulsivity on the addictive Characteristics of Non-Suicidal Self-Injurious Behavior in Adolescents with Depressive Disorders Yulian Jiang, Hang Yu, Quanming Zheng, Yuqiong Zhu, Qiyue Qin, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3856456/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Oct, 2024 Read the published version in BMC Psychiatry → Version 1 posted 10 You are reading this latest preprint version Abstract Objective Non-suicidal self-injurious (NSSI) behaviors pose a significant threat to the physical and psychological well-being of adolescents. This study investigated the addictive nature of NSSI behaviors and their association with impulsivity and decision-making, aiming to provide evidence-based insights for the development of multiple effective treatment interventions for adolescents with depressive disorders exhibiting addictive characteristics in their NSSI behaviors. Methods A total of 126 adolescent outpatients and inpatients diagnosed with depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria were selected and categorized into three groups: depression without NSSI ( n = 42), depression with NSSI without addictive characteristics ( n = 44), and depression with NSSI and addictive characteristics ( n = 40). The present study employed the Hamilton Depression Scale (HAMD-24), Chinese Revised Barratt Impulsiveness Scale Version 11 (BIS-11), Ottawa Self-Injury Inventory (OSI), and the Adolescent Non-Suicidal Self-Injury Questionnaire (ANSSIQ). Cognitive decision-making abilities were assessed using the Iowa Gambling Task (IGT). Results There were no significant differences observed in blocks 1 and 2 of the IGT among the three groups. However, the depression with NSSI addictive characteristics group exhibited significantly lower net scores in blocks 3, 4, and 5 of the IGT compared to both the depression without NSSI group and the depression with NSSI non-addictive characteristics group. The addictive characteristics of NSSI behaviors were positively correlated with the severity of NSSI behaviors, depression, and cognitive impulsiveness, and negatively correlated with the total net score of the IGT. In the mediation model, depression played a partial mediating role between cognitive impulsiveness and NSSI behavioral addiction characteristics. Conclusion Adolescents with depressive disorders exhibiting addictive NSSI behaviors demonstrate heightened cognitive impulsivity and exhibit poorer decision-making when presented with choices. Timely modulation of depressive symptoms can be effective in reducing the occurrence of the addictive characteristics of NSSI behaviors. adolescent depressive disorder NSSI addiction traits impulsivity decision making IGT Figures Figure 1 Figure 2 Figure 3 Figure 4 1 Introduction Depressive disorders constitute a prevalent health issue characterized by a complex array of symptoms and a strong association with suicide. The etiology of this disorder varies from one individual to another, causing considerable distress to affected individuals, their families, and society ( 1 ). The global prevalence of depression has been on the rise over the past few decades, placing a significant burden on public health worldwide ( 2 ). Research indicates that self-reported depressive symptoms affect approximately 34% of the global population at any given time, and cases of depressive disorders among adolescents continue to increase annually (3). In Uganda, a meta-analysis reported a 23.6% prevalence of depressive disorders among adolescents ( 4 ), while in China, the detection rate of depressive symptoms in adolescents stands at 28.4%, with a higher prevalence among girls compared to boys ( 5 ). Depressive disorders are typically characterized by persistent low mood, loss of energy, feelings of helplessness and hopelessness, self-blame, low self-esteem, and, in severe cases, self-injurious and suicidal behaviors. These symptoms not only impact academic performance and interpersonal relationships but also significantly influence the long-term development of adolescents. In 2009, Nock introduced the concept of Non-Suicidal Self-Injury (NSSI), which refers to the deliberate, purposeful harm inflicted upon one's own body tissues without any accompanying suicidal intent, a behavior that is culturally inappropriate. Self-injury often involves cutting with pocket knives and razor blades and commonly occurs during early adolescence ( 6 ). In 2013, the American Psychiatric Association (APA) included NSSI in Section 3 of the Diagnostic and Statistical Manual, 5th edition (DSM-5) ( 7 ). The prevalence of self-injury varies across different countries, ranging from 11.5–33.8%, with global data showing an increasing trend ( 8 ). A meta-analysis of Chinese adolescents found a self-injury prevalence of 21.9% ( 9 ). However, in patients with depressive disorders, the incidence of self-injury is reportedly significantly higher than in the general population, with a 51% incidence of NSSI behaviors among Chinese adolescents suffering from depression ( 10 ). Studies have suggested a strong correlation between self-injury and suicide attempts, indicating that self-injury can serve as a warning sign for suicide ( 11 ). Self-injury not only results in physical harm but also reflects underlying psychological and mental issues in adolescents. Beyond jeopardizing the physical and psychological development of adolescents, this behavior exerts a negative influence and financial strain on both the state and society. In recent years, growing concern has arisen regarding the potential addictive nature of NSSI. Individuals engaging in NSSI may experience a sense of euphoria, an intense impulse, intolerable feelings before self-injury, a sense of relief after self-injury, and an escalation in the severity of self-injury over time, akin to addiction. Some scholars have even proposed defining self-injury as an addiction ( 12 ). A study by Sarah examined NSSI addiction across six themes, encompassing the desire to engage in self-injury, the difficulty in stopping self-injury, relapse into self-injury, the use of self-injury as a coping mechanism, feelings of shame associated with self-injury, and a worsening pattern of behavior. The repetitive and uncontrollable nature of self-injury is considered indicative of addictive behavior ( 13 ). Notably, in the Chinese adolescent population, there is a strong association between addiction and NSSI ( 14 ). Several studies have linked persistent NSSI behaviors with issues such as internet addiction (15, 16), depressive disorders, anxiety disorders ( 17 ), substance addiction (18), and related disorders. Furthermore, persistent NSSI behavior significantly increases the risk of suicide ( 19 , 20 ), posing a grave threat to the physical and psychological health development of adolescents. Impulsivity is commonly defined as "behavior that occurs without thorough consideration and, in comparison to individuals with similar abilities and knowledge, often lacks consideration of the negative consequences of such behavior and may result from a rapid and unplanned response to internal or external stimuli" ( 21 ). Analyzing impulsivity from a cognitive perspective, it can be categorized into impulsive choice (preferring immediate small rewards over delayed larger rewards), impulsive behavior (inability to inhibit inappropriate motor responses), and impulsive decision-making (making risky or suboptimal choices in ambiguous situations) ( 22 ). Numerous studies have shown that impulsivity is closely associated with addictive behavior ( 23 ). Addiction has a significant impact on a person's decision-making, emotional stability, and behavioral control ( 24 ). However, there is limited research exploring the relationship between impulsivity, decision-making, and NSSI addiction. This study focused on investigating the connection between addictive traits in non-suicidal self-injurious behaviors and impulsivity and decision-making in adolescent patients with depressive disorders. Importantly, we sought to provide evidence-based medical insights for the development of multiple effective therapeutic interventions for adolescent patients with depressive disorders exhibiting addictive characteristics in NSSI behaviors. 2 Methods 2.1 Study design and participants Adolescent patients with depressive disorders who received treatment as outpatients or inpatients at a specialized psychiatric hospital in Anhui Province between June 2022 and August 2023 were selected. Inclusion criteria encompassed: ( 1 ) meeting the diagnostic criteria for depressive disorders as defined in DSM-5, confirmed by two attending-level or higher psychiatrists; ( 2 ) an age range of 12–18 years; (3) a Hamilton Depression Scale (HAMD-24) score of ≥ 20; ( 4 ) ability to participate in completing relevant questionnaires and scales; ( 5 ) obtaining informed consent from both the patient and their legal guardian. Exclusion criteria included: ( 1 ) the presence of serious somatic illnesses; ( 2 ) concurrent occurrence of other mental disorders, such as neurodevelopmental disorders; (3) secondary depressive disorders or bipolar disorders. Grouping method: The presence of NSSI behaviors was determined based on DSM-5 diagnostic criteria for NSSI, and the severity of NSSI behaviors was assessed using the Adolescent Non-Suicidal Self-Injury Questionnaire (ANSSIQ). Patients without confirmed NSSI behaviors were categorized into the "Depression Without NSSI" group. The addictive characteristics of NSSI behaviors were evaluated using the Ottawa Self-Injury Inventory (OSI). If a patient had ≥ 3 entries with a score of ≥ 2, their NSSI behaviors was considered to have addictive characteristics. Ultimately, patients with adolescent depressive disorders were categorized into three groups: "Depression Without NSSI" ( n = 42), "Depression with NSSI Non-Addictive Characteristics" ( n = 44), and "Depression with NSSI Addictive Characteristics" (n = 40) (Fig. 1 ). All participants comprehensively understood the purpose and content of this study, and they voluntarily agreed to and signed the informed consent form. The Ethics Committee of Bengbu Medical College granted approval for this study (Ethics Approval No. [2023] No. 661). 2.2 Measurement 2.2.1 General information questionnaire A self-administered general information questionnaire was used to collect demographic and clinical data. This questionnaire included information such as gender, age, years of education, parents' marital status, only child status, home address, family history of the disease, and any history of comorbidities related to other brain diseases or traumatic brain injuries. 2.2.2 Hamilton Depression Scale (HAMD-24) Comprising 24 items, this scale is a widely used tool for assessing depressive states clinically. It demonstrates good reliability and validity, effectively reflecting the severity of depression symptoms. The aggregate score is interpreted as follows: 20 suggests possible mild or moderate depression, and > 35 indicates possible severe depression( 25 ). In this study, the Cronbach's alpha coefficient for the scale was 0.877. 2.2.3 Chinese revised version of Barratt Impulsiveness Scale 11th (BIS-11) To ensure the effectiveness and reliability of measurement tools across different cultures and clinical samples, validation is crucial. The BIS-11 consists of 30 items, assessing impulsive personality in three dimensions: non-planning impulsiveness, motor impulsiveness, and cognitive impulsiveness. Responses are scored on a 5-point Likert scale (not, rarely, sometimes, often, and always). A higher score indicates greater impulsiveness( 26 ). After revision by Li Xianyun and colleagues ( 27 ), the Cronbach's alpha coefficient for this scale in this study was 0.910. 2.2.4 Ottawa self-injury inventory (OSI) The OSI is the primary assessment tool used to measure NSSI behaviors, including their functional and addictive characteristics( 28 ). After revision by Chen Hui and collaborators ( 29 ), the seven entries in the addiction section of the OSI were employed to assess the addictive characteristics of the NSSI. For instance, one criterion assesses if the frequency and severity of self-injury has increased over time; if there is a desire to reduce or control the behavior without success; and if the individual continues the behavior despite recognizing its harmful effects. Each entry is scored on a scale from 0 (never) to 4 (always), with higher scores indicating more addictive behavior. If a patient had ≥ 3 entries with a score of ≥ 2, their NSSI was considered to have addictive characteristics. 2.2.5 Adolescent Non-Suicidal Self-Injury Questionnaire (ANSSIQ) The ANSSIQ was employed to assess individuals' intentional self-harming behaviors without suicidal intent over a one-year period. The questionnaire comprises two subquestionnaires, with the Behavioral Questionnaire having 12 items categorized into two dimensions: no prominent tissue damage and prominent tissue damage. Each item is scored on a scale ranging from 0 (never) to 4 (always), with higher scores indicating more severe NSSI behaviors ( 30 ). In this study, the Cronbach's alpha coefficient was 0.921. 2.2.6 Iowa Gambling Task (IGT) The IGT is a laboratory task used to evaluate deficits in cognitive decision-making function ( 31 ). Before conducting the IGT, patients were instructed to select one card at a time from any of four decks of cards (A, B, C, D) with the objective of accumulating as much money as possible, thereby obtaining rewards. Each set of 40 cards, from which the subject drew one at a time, was displayed on the screen, providing feedback on winning and losing. Over the long term, Cards A/B are considered high-risk cards, while Cards C/D are considered low-risk cards. The entire experiment consists of five blocks, each containing 20 sessions, based on the order of card selection. The IGT data is primarily analyzed using the net score, which is calculated by subtracting the number of favorable cards selected by the patient in each module from the number of unfavorable cards selected, i.e., Net Score = (C + D) - (A + B). The patient's total net score and the net scores of the five blocks are analyzed; a lower score indicates higher impulsivity. By comparing the net scores and their trends in different blocks, the study analyzes patients' decision-making characteristics and their strategy adjustments in a gain-loss scenario. Several studies have demonstrated the IGT's validity in assessing decision-making function across various populations ( 32 ). 2.3 Investigation process and quality control The study subjects were assessed for diagnosis by two attending-level or higher psychiatrists. Subsequently, specially trained postgraduate psychiatrists provided a thorough explanation of the study's objectives and significance to both the subjects and their parents. To mitigate common methodological biases, this study employed well-established scales with high reliability and ensured anonymous scale completion. Each assessment took place in a separate, quiet psychometric room, with investigators receiving consistent training and adhering to standardized instructions. On average, each assessment lasted approximately 40 minutes. 2.4 Statistical analysis The data underwent statistical analysis using SPSS 27.0. Normality tests were conducted to ensure the data conformed to a normal distribution before performing parametric tests. Count data were presented as the number of cases (percentage) and compared using the χ2 test. Measurement data following a normal distribution were expressed as mean and standard deviation. One-way ANOVA was employed to compare measurement data between groups, and the LSD method was used for post-hoc comparisons between two groups. Pearson correlation analyses were conducted to examine associations between scales. Furthermore, multifactorial linear Pearson's correlation analysis was performed to explore the links between NSSI behavioral addiction characteristics and each variable. Multifactorial linear regression was employed to assess the association between NSSI behavioral addiction characteristics and the variables. The significance level for tests was set at α = 0.05. 3 Results 3.1 Common method bias test To evaluate common method biases in our data, an exploratory factor analysis was conducted using Harman's one-way test. The results revealed 21 factors with characteristic roots exceeding 1 in total, with the highest factor variance explained being 26.301%. This variance was below the 40% threshold, indicating the absence of significant common method bias ( 33 ). 3.2 Comparison of general information of the three groups Out of 126 patients meeting the inclusion criteria for adolescent depressive disorders, 42 (33.33%) were in the group with depression without NSSI, 44 (34.92%) in the group with depression with NSSI non-addictive characteristics, and 40 (31.75%) in the group with depression with NSSI addictive characteristics. Significant differences were observed in terms of gender, place of residence, and parental marriage status among the three groups. Specifically, the number of females exhibiting NSSI behaviors and addictive NSSI characteristics was significantly higher than that of males ( P < 0.05). Further details are provided in Table 1 . Table 1 Comparison of general information of the three groups categories Depression without NSSI group Depression with NSSI non-addictive group Depression with NSSI addiction group F/X2 P Age (years) 15.90 ± 1.56 15.39 ± 1.59 15.18 ± 1.49 2.442 0.091 Years of education 9.60 ± 1.55 9.16 ± 1.66 8.80 ± 1.74 2.395 0.095 Sex 10.825 0.004 male 16(38.1) 4(9.1) 8(20.0) female 26(61.9) 40(90.9) 32(80.0) residence 10.894 0.028 city 3(7.1) 5(11.4) 9(22.5) town 32(76.2) 23(52.3) 18(45.0) rural 7(16.7) 16(36.4) 13(32.5) an only child 4.428 0.109 yes 3(7.1) 10(22.7) 5(12.5) no 39(92.9) 34(77.3) 35(87.5) Parents' marriage 7.274 0.026 normal 34(81.0) 33(75.0) 22(55.0) divorcee 8(19.0) 11(25.0) 18(45.0) 3.3 Comparison of the three groups in terms of HAMD-24, BIS-11, and IGT Significant differences were observed among the three groups in terms of HAMD-24, BIS-11, and IGT. In the case of HAMD-24 and BIS-11, the group with depression with NSSI addictive characteristics scored significantly higher than the other two groups, suggesting greater severity of depression and impulsivity in this group. Regarding IGT, the net score for the group with depression with NSSI addictive characteristics was significantly lower than the other two groups. Notably, significant differences were observed among the three groups in block 3 ( F = 3.256, P < 0.05), block 4, and block 5 ( F = 7.277, F = 6.778; P < 0.05). These results indicate that the group with depression with NSSI addictive characteristics made more unfavorable choices in decision-making and exhibited higher levels of impulsive decision-making. However, no significant differences were observed among the three groups in blocks 1 and 2. For additional information, refer to Table 2 and Figs. 2 and 3 . Table 2 Comparison of the three groups in terms of each scale score and IGT categories Depression without NSSI group Depression with NSSI non-addictive group Depression with NSSI addiction group F P contrast ANSSIQ 0 13.32 ± 5.54 21.93 ± 8.89 140.209 2 > 1 OSI 0 6.59 ± 2.316 18.93 ± 4.790 411.9 2 > 1 HAMD-24 23.98 ± 2.59 33.20 ± 4.32 41.13 ± 6.27 142.445 2 > 1 BIS-11 55.02 ± 12.40 57.84 ± 11.89 70.25 ± 12.43 17.914 2, 3 > 1 non-planning impulsiveness 62.44 ± 19.79 67.10 ± 18.21 76.25 ± 17.50 5.866 0.004 3 > 2, 3 > 1 cognitive impulsiveness 54.94 ± 16.53 55.74 ± 15.11 68.56 ± 16.59 9.257 2, 3 > 1 motor impulsiveness 47.68 ± 13.14 50.68 ± 15.84 65.94 ± 13.76 19.063 2, 3 > 1 Net score of IGT -4.43 ± 16.17 -11.55 ± 20.95 -19.25 ± 22.83 5.545 0.005 1 > 2 > 3 Net score of block1 -3.00 ± 4.13 -4.59 ± 4.95 -3.20 ± 6.48 1.174 0.313 Net score of block2 -2.81 ± 5.93 -3.14 ± 5.75 -3.60 ± 6.47 0.177 0.838 Net score of block3 -0.57 ± 6.00 -1.68 ± 6.07 -3.95 ± 6.24 3.256 0.042 1 > 2 > 3 Net score of block4 1.24 ± 5.93 -1.14 ± 6.80 -4.10 ± 6.24 7.277 0.001 2 > 3, 1 > 3 Net score of block5 0.71 ± 4.84 -1.00 ± 7.44 -4.40 ± 6.57 6.778 0.002 2 > 3, 1 > 3 3.4 Correlational analysis of behavioral addiction characteristics of NSSI in adolescents with depressive disorders An examination of the NSSI behavioral addiction profile in adolescent patients with depressive disorders revealed several correlations: a positive correlation with NSSI behaviors ( r = 0.845, P < 0.01); a positive correlation with depression severity score ( r = 0.795, P < 0.01); a positive correlation with impulsiveness, non-planning impulsiveness, cognitive impulsiveness, and motor impulsiveness ( r = 0.465, r = 0.281, r = 0.342, r = 0.491, P < 0.01); and a negative correlation with the IGT total score ( r =-0.241, P < 0.01). More details are provided in Table 3 . Table 3 Correlation analysis of NSSI behavioral addiction characteristics in adolescents with depressive disorders 1 2 3 4 5 6 7 1 OSI 1 2 ANSSIQ 0.845** 1 3 HAMD-24 0.795** 0.798** 1 4 BIS-11 0.465** 0.365** 0.479** 1 5non-planning impulsiveness 0.281** 0.242** 0.341** 0.851** 1 6cognitive impulsiveness 0.342** 0.205* 0.332** 0.866** 0.716** 1 7motor impulsiveness 0.491** 0.426** 0.464** 0.626** 0.230** 0.304** 1 8 Net score of IGT -0.241** -0.127 -0.253** -0.095 -0.066 -0.101 -0.057 Note :* p <0.05, ** p <0.01 3.5 Linear Regression Analysis of Factors Influencing Behavioral Addiction Characteristics of NSSI in Adolescents with Depressive Disorders Next, we employed OSI scores as the dependent variable and examined various influences through linear regression. Our findings revealed that the severity of NSSI behaviors positively predicts the addictive characteristics of NSSI behaviors ( β = 0.468, t = 8.434, 95% CI = 0.358–0.578), severity of depression positively predicts the addictive characteristics of NSSI behaviors ( β = 0.219, t = 2.841, 95% CI = 0.066–0.372). Furthermore, cognitive impulsiveness positively predicted the addictive characteristics of NSSI behaviors ( β = 0.084, t = 2.761, 95% CI = 0.024–0.144), while the total net score of the IGT negatively predicted the addictive characteristics of NSSI behaviors ( β = -0.036, t = -2.068, 95% CI = -0.071–0.002). Detailed results are provided in Table 4 . Table 4 Linear regression analysis of factors influencing NSSI behavioral addiction characteristics in adolescents with depressive disorders Unstandardized factor Standardized factor β SE Beta t P 95% CI VIF R2 R2adj (constant) -9.644 2.142 -4.501 < 0.001 -13.886 -5.401 0.787 0.776 ANSSIQ 0.468 0.056 0.605 8.434 < 0.001 0.358 0.578 2.873 HAMD-24 0.219 0.077 0.219 2.841 0.005 0.066 0.372 3.32 non-planning impulsiveness -0.039 0.027 -0.091 -1.48 0.141 -0.092 0.013 2.114 cognitive impulsiveness 0.084 0.03 0.173 2.761 0.007 0.024 0.144 2.18 motor impulsiveness 0.048 0.025 0.094 1.92 0.057 -0.001 0.098 1.348 Net score of IGT -0.036 0.018 -0.091 -2.068 0.041 -0.071 -0.002 1.092 3.6 Mediating Effects of depression and cognitive impulsiveness between NSSI behavioral addiction characteristics The data were standardized and the mediating effect of depression in the relationship between Cognitive impulsiveness and NSSI behavioral addiction characteristics was analyzed using model4 in the PROCESS Bootstrap program. In the model, Cognitive impulsiveness was the independent variable, OSI was the dependent variable, and depression was the mediating variable. In the direct path, Cognitive impulsiveness positively predicted NSSI behavioral addiction characteristics ( β = 0.153, t = 3.506, 95% CI = 0.066–0.240); in the mediated path with depression as the mediating variable, the cognitive impulsiveness could positively predicted depression ( β = 0.114, t = 2.771, 95%CI = 0.032–0.196), depression significantly positively predicted NSSI behavioral addiction characteristics ( β = 0.578, t = 5.853, 95% CI = 0.382–0.774). More details are provided in Table 5 . Table 5 Mediating effects of depression and cognitive impulsiveness between NSSI behavioral addiction characteristics Raggression equation Integration fit index Significance of regression Result variables Prediction variables R R² F β t OSI Cognitive impulsiveness 0.361 0.130 12.289 0.153 3.506*** Depression Cognitive impulsiveness 0.293 0.086 7.678 0.114 2.771** OSI Cognitive impulsiveness 0.624 0.389 25.762 0.087 2.262* Depression 0.578 5.853*** Note :* p <0.05, *** p <0.001 Meanwhile, the effect values and confidence intervals of depression were estimated, and the upper and lower Bootstrap 95% confidence intervals did not contain 0. The results showed that depression mediated significantly between cognitive impulsiveness and NSSI behavioral addiction characteristics, with a significant indirect effect (43.14% of the total effect ). More details are provided in Table 6 and Fig. 4 . Table 6 Decomposition of total, direct and mediating effects Effect value Boot standard error BootLLCI BootULCI relative effect value Total effect 0.153 0.034 0.066 0.240 Direct effect 0.087 0.039 0.011 0.164 56.86% Indirect effect 0.066 0.027 0.021 0.125 43.14% 4. Discussion The results of this study highlight the gender disparities in adolescents with depressive disorders and NSSI addiction characteristics. Notably, the number of females exhibiting NSSI addiction characteristics was higher than that of males, which may be linked to the different emotional regulation and coping strategies among adolescents of different genders ( 34 , 35 ). Compared to males, females tend to experience a stronger sense of isolation, less flexible emotional regulation, and more pronounced internalized symptoms of mental illness ( 36 ). Consequently, it is crucial to pay greater attention to the emotional and behavioral challenges faced by adolescent females. Furthermore, the present study revealed that adolescents with depressive disorders and NSSI addiction characteristics living in towns and rural areas outnumbered those residing in cities, which may be attributed to lower parental education levels ( 37 ). Parental divorce and strained family relationships were identified as potential contributors to the onset of dysphoria and, subsequently, an increased likelihood of NSSI behaviors ( 38 , 39 ). In the present study, the group of adolescents with depression with NSSI addictive characteristics displayed higher depression scale scores and more severe depressive symptoms. Moreover, the NSSI behavioral addiction traits scores exhibited a positive correlation with the depression scale scores. Research has shown that poor emotional regulation is associated with the long-term maintenance of NSSI behaviors ( 40 ) and that emotional dysregulation is closely linked to NSSI addiction characteristics ( 41 ). In the mediation model, depression played a partial mediating role between cognitive impulsiveness and NSSI behavioral addiction characteristics. These emotional challenges may contribute to the development of addictive traits in NSSI behaviors. Therefore, in clinical practice, addressing the depressive mood in adolescent patients with depressive disorders promptly is crucial in reducing the likelihood of developing NSSI addiction characteristics. The group of adolescents with depression with NSSI addictive characteristics exhibited higher impulsivity scale scores compared to the other two groups, with higher scores indicating greater impulsivity. Previous studies have demonstrated that impulsivity independently predicts the occurrence of NSSI behaviors ( 42 ) and that heightened impulsivity is associated with more frequent NSSI ( 43 ). In correlation analyses, NSSI behavioral addiction characteristics displayed positive correlations with total impulsivity scores, non-planning impulsiveness, cognitive impulsiveness, and motor impulsiveness, with cognitive impulsiveness included in the linear regression model. Cognitive impulsiveness can positively predict the occurrence of NSSI addiction features. Frequent NSSI behaviors have been associated with cognitive impulsivity ( 44 ), highlighting the role of high impulsivity as a significant risk factor for NSSI addiction behaviors ( 45 ). Therefore, early identification and intervention with adolescents with high levels of impulsivity is beneficial in reducing delinquent behaviors and, in turn, promoting healthy adolescent physical and mental development. In the context of IGT, the group with NSSI addiction characteristics displayed lower net scores across the five blocks compared to the other two groups, indicating that the addiction characteristics group made more unfavorable decisions on the IGT. Research has suggested that the dorsolateral prefrontal cortex (DLPFC) plays a pivotal role in decision-making and that its influence on risk-taking behavior correlates with addiction ( 46 ). The addiction characteristics group not only performed poorly overall on the IGT but also exhibited a decreasing trend in net scores as the number of experiments increased, in contrast to the gradual increase observed in the other two groups. This suggests that the addiction characteristics group struggled to adjust their decision-making strategies to make more favorable choices and consistently preferred choices associated with larger short-term gains ( 47 ). In the present study, during correlation analyses and linear regression, OSI scores demonstrated a negative correlation with the total IGT scores. This suggests that individuals with addictive NSSI characteristics may have compromised expectations regarding negative outcomes when faced with risky choices, which could result in poor decision-making and unfavorable outcomes ( 48 ). However, it is important to acknowledge certain limitations of this study. It is highly conceivable that younger adolescents with limited comprehension abilities may face challenges in manipulating and understanding the IGT, potentially leading to experimental errors. Additionally, recall bias may have influenced the results when administering the scale. Furthermore, the predominance of female students in the study may impact the generalizability of the findings. Expanding the sample size in future studies is warranted to address these limitations. 4.1 Limitations While this study provides valuable insights, it is important to acknowledge certain limitations. Younger adolescents with limited comprehension abilities may face challenges in manipulating and understanding the IGT, potentially leading to experimental errors and introducing a risk of recall bias when administering the scale. Additionally, the overrepresentation of female students in the study may impact the generalizability of the findings. Expanding the sample size in future studies is warranted to address these limitations, as the study design does not establish causal relationships between impulsivity, decision-making, and the behavioral addiction characteristics of NSSI. Understanding the causal relationship within the individual psychological development process would require prospective research, and this study's exclusive focus on adolescents with depressive disorders resulted in a relatively small sample size. Future research should aim to replicate these findings within a larger and more diverse sample population. 5 Conclusion In conclusion, our findings suggest a relationship between impulsivity, decision-making and depression and the presence of NSSI behavioral addiction characteristics. Adolescents with depressive disorders exhibiting NSSI behavioral addictive traits displayed higher cognitive impulsiveness, indicating a higher level of impulsive decision-making. Timely modulation of depressive symptoms can be effective in reducing the occurrence of the addictive characteristics of NSSI behaviors. Declarations 6.1 Ethics approval and consent to participate The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of Bengbu Medical College with a medical ethics approval number of No. [2023] No. 661. Written informed consent was obtained from individual or guardian participants. 6.2 Consent for publication Not applicable. 6.3 Availability of data and materials All data generated or analysed during this study are included in this published article. 6.4 Competing interests The authors declare no competing interests. 6.5 Funding Project supported by the provincial Natural Science Foundation of Anhui Provincial Education Department Humanities and Social Science Key Project (SK2019A0181), Provincial Education Department Natural Science Key Project (grant number: 2022AH051512, 2022AH051430), Shanghai Key Laboratory of Psychotic Disorders Open Grant (13dz2260500), and Bengbu Medical College Key Laboratory of Addiction Medicine (29-3). All funders didn’t interfere in study design, collection, analysis, interpretation, or writing of the manuscript. Innovative training Program for Chinese College students (grant number: 202010367019), Innovative training Program for Chinese College students (grant number: 202210367021). 6.6 Authors' contributions JDL and WWJ provides research ideas and designs, JYL, ZJ, CRM and WW is responsible for data collection, and ZQM, ZYQ and QQY is responsible for data analysis and interpretation; JYL and YH write manuscripts, while WWJ critically modifies and supervises the knowledge content of the manuscripts; WCC, LTC and JCG is responsible for professional knowledge and technical support in statistics. All authors reviewed the manuscript. 6.7 Acknowledgements We thank Home for Researchers editorial team for language editing and proofreading service. 6.8 Authors' information Not applicable. References Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., McGorry, P., Reynolds, C. F., 3rd, Weissman, M. M., Chibanda, D., Dowrick, C., Howard, L. M., Hoven, C. W., Knapp, M., Mayberg, H. S., Penninx, B. W. J. H., … Wolpert, M. (2022). Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet (London,England), 399(10328), 957–1022. https://doi.org/10.1016/S0140-6736(21)02141-3 Piao, J., Huang, Y., Han, C., Li, Y., Xu, Y., Liu, Y., & He, X. (2022). Alarming changes in the global burden of mental disorders in children and adolescents from 1990 to 2019: a systematic analysis for the Global Burden of Disease study. European child & adolescent psychiatry, 31(11), 1827–1845. https://doi.org/10.1007/s00787-022-02040-4 Shorey, S., Ng, E. D., & Wong, C. H. J. (2022). Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis. The British journal of clinical psychology, 61(2), 287–305. https://doi.org/10.1111/bjc.12333 Kaggwa, M. M., Najjuka, S. M., Bongomin, F., Mamun, M. A., & Griffiths, M. D. (2022). Prevalence of depression in Uganda: A systematic review and meta-analysis. PloS one, 17(10), e0276552. https://doi.org/10.1371/journal.pone.0276552 Liu Furong, Song Xiaoqin, Shang Xiaoping, et al. A meta-analysis of detection rate of depression symptoms among middle school students. Chinese Mental Health Journal, 2020,34(02):123-128. Nock M. K. (2009). Why do People Hurt Themselves? New Insights Into the Nature and Functions of Self-Injury. Current directions in psychological science, 18(2), 78–83. https://doi.org/10.1111/j.1467-8721.2009.01613.x Plener, P. L., Kapusta, N. D., Brunner, R., & Kaess, M. (2014). Nicht-suizidales selbstverletzendes Verhalten (NSSV) und Suizidale Verhaltensstörung (SVS) im DSM-5 [Non-Suicidal Self-Injury (NSSI) and Suicidal Behavior Disorder in the DSM-5]. Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie, 42(6), 405–413. https://doi.org/10.1024/1422-4917/a000319 Mannekote Thippaiah, S., Shankarapura Nanjappa, M., Gude, J. G., Voyiaziakis, E., Patwa, S., Birur, B., & Pandurangi, A. (2021). Non-suicidal self-injury in developing countries: A review. The International journal of social psychiatry, 67(5), 472–482. https://doi.org/10.1177/0020764020943627 Gou Shuangyu, Du Meijie, Liu Xiaorong, et al. Meta-analysis of the detection rate of non-suicidal self-injury among Chinese adolescents. Modern Preventive Medicine, 2023,50(02):263-271. Xu Ziyao, Huang Yaling, Zhu Guangqiang, et al. Prevalence of non-suicidal self-injury behavior among Chinese adolescents with depression ： a Meta-analysis. Sichuan Mental Health, 2022,35(04):331-336. Ose, S. O., Tveit, T., & Mehlum, L. (2021). Non-suicidal self-injury (NSSI) in adult psychiatric outpatients - A nationwide study. Journal of psychiatric research, 133, 1–9. https://doi.org/10.1016/j.jpsychires.2020.11.031 Blasco-Fontecilla, H., Fernández-Fernández, R., Colino, L., Fajardo, L., Perteguer-Barrio, R., & de Leon, J. (2016). The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Frontiers in psychiatry, 7, 8. https://doi.org/10.3389/fpsyt.2016.00008 Sarah, Davis, Christopher, et al. Addiction to self‐harm? the case of online postings on self‐harm message boards [J].International Journal of Mental Health and Addiction, 2019, 17(4): 1020‐1035. Guo, Z., Liu, Y., Wang, C., Li, S., Yu, L., Wu, W., You, X., Zhang, Y., Teng, Z., & Zeng, Y. (2023). Exploring the association of addiction-related genetic factors with non-suicidal self-injury in adolescents. Frontiers in psychiatry, 14, 1126615. https://doi.org/10.3389/fpsyt.2023.1126615 Tang, J., Ma, Y., Lewis, S. P., Chen, R., Clifford, A., Ammerman, B. A., Gazimbi, M. M., Byrne, A., Wu, Y., Lu, X., Chang, H., Kang, C., Tiemeier, H., & Yu, Y. (2020). Association of Internet Addiction With Nonsuicidal Self-injury Among Adolescents in China. JAMA network open, 3(6), e206863. https://doi.org/10.1001/jamanetworkopen.2020.6863 Zhu, J., Qian, R., Zhong, H., Li, Y., Liu, X., & Ma, J. (2022). Factors influencing the addiction characteristics of non-suicidal self-injurious behaviors in adolescents: A case-control study. Frontiers in psychiatry, 13, 1033242. https://doi.org/10.3389/fpsyt.2022.1033242 Millon, E. M., Alqueza, K. L., Kamath, R. A., Marsh, R., Pagliaccio, D., Blumberg, H. P., Stewart, J. G., & Auerbach, R. P. (2022). Non-suicidal Self-injurious Thoughts and Behaviors Among Adolescent Inpatients. Child psychiatry and human development, 10.1007/s10578-022-01380-1. Advance online publication. https://doi.org/10.1007/s10578-022-01380-1 Ying, W., Shen, Y., Ou, J., Chen, H., Jiang, F., Yang, F., Li, J., Qian, X., Luo, W., Wang, G., & Dong, H. (2023). Identifying clinical risk factors correlated with addictive features of non-suicidal self-injury among a consecutive psychiatric outpatient sample of adolescents and young adults. European archives of psychiatry and clinical neuroscience, 10.1007/s00406-023-01636-4. Advance online publication. https://doi.org/10.1007/s00406-023-01636-4 Brager-Larsen, A., Zeiner, P., Klungsøyr, O., & Mehlum, L. (2022). Is age of self-harm onset associated with increased frequency of non-suicidal self-injury and suicide attempts in adolescent outpatients?. BMC psychiatry, 22(1), 58. https://doi.org/10.1186/s12888-022-03712-w Masi, G., Pisano, S., Sesso, G., Mazzullo, C., Berloffa, S., Fantozzi, P., Narzisi, A., Placini, F., Valente, E., Viglione, V., & Milone, A. (2023). Persistent Non-Suicidal Self-Injury and Suicidality in Referred Adolescents: A Longitudinal Study Exploring the Role of Cyclothymic Temperament. Brain sciences, 13(5), 755. https://doi.org/10.3390/brainsci13050755 International Society for Research on Impulsivity. (2019). What is impulsivity. Retrieved from http://www.impulsivity.org/index.htm MacKillop, J., Weafer, J., C Gray, J., Oshri, A., Palmer, A., & de Wit, H. (2016). The latent structure of impulsivity: impulsive choice, impulsive action, and impulsive personality traits. Psychopharmacology, 233(18), 3361–3370. https://doi.org/10.1007/s00213-016-4372-0 McMullin, S. D., Shields, G. S., Slavich, G. M., & Buchanan, T. W. (2021). Cumulative lifetime stress exposure predicts greater impulsivity and addictive behaviors. Journal of health psychology, 26(14), 2921–2936. https://doi.org/10.1177/1359105320937055 Karila, L., & Benyamina, A. (2019). Addictions [Addictions]. Revue des maladies respiratoires, 36(2), 233–240. https://doi.org/10.1016/j.rmr.2018.12.001 Sun Xiaoyan, Li Yixue, Yu Canqing, et al. Reliability and validity of depression scales of Chinese version ： a systematic review[J]. Chinese Journal of Epidemiology, 2017,38(01):110-116. Li Xianyun, Fei Lipeng, Xu Dong, et al. Reliability and validity of an adapted Chinese version of Barratt Impulsiveness Scale[J]. Chinese Mental Health Journal, 2011,25(08):610-615. Li, X., et al., The reliability and validity of the Chinese revised version of the Barratt Impulsiveness Scale in community and university populations. Chinese Mental Health Journal, 2011. 25(8): p. 6. Nixon, M. K., Levesque, C., Preyde, M., Vanderkooy, J., & Cloutier, P. F. (2015). The Ottawa Self-Injury Inventory: Evaluation of an assessment measure of nonsuicidal self-injury in an inpatient sample of adolescents. Child and adolescent psychiatry and mental health, 9, 26. https://doi.org/10.1186/s13034-015-0056-5 Chen, H., et al., Revision of the non-suicidal self-injury behavior scale for adolescents with mental disorder. Journal of Central South University (Medical Science), 2022, 47(3). Wan Yuhui, Liu Wan, Hao Jiahu, et al. Development and evaluation on reliability and validity of Adolescent Non-suicidal Self-injury Assessment Questionnaire[J]. Chinese Journal of School Health, 2018,39(2):170-173. Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50(1-3), 7–15. https://doi.org/10.1016/0010-0277(94)90018-3 Toplak, M. E., Sorge, G. B., Benoit, A., West, R. F., & Stanovich, K. E. (2010). Decision-making and cognitive abilities: A review of associations between Iowa Gambling Task performance, executive functions, and intelligence. Clinical psychology review, 30(5), 562–581. https://doi.org/10.1016/j.cpr.2010.04.002 Xiong HX, Zhang J, Ye BJ, et al. Model analysis of the effects of common method variation and its statistical control pathways[J]. Advances in Psychological Science, 2012, 20(05): 757-769. Li Guohua, Zhou Yongjie, Huang Wei, et al. Gender differences in non-suicidal self-injury behaviors among adolescents with mood disorders[J]. China Preventive Medicine, 2021,22(09):699-703. Thomas, D., & Bonnaire, C. (2023). Relationship Between Non-Suicidal Self-Injury and Emotion Dysregulation Among Male and Female Young Adults. Psychological reports, 332941231183336. Advance online publication. https://doi.org/10.1177/00332941231183336 Reinhardt, M., Kökönyei, G., Rice, K. G., Drubina, B., & Urbán, R. (2021). Functions of nonsuicidal self-injury in a Hungarian community adolescent sample: a psychometric investigation. BMC psychiatry, 21(1), 618. https://doi.org/10.1186/s12888-021-03613-4 Tang, J., Li, G., Chen, B., Huang, Z., Zhang, Y., Chang, H., Wu, C., Ma, X., Wang, J., & Yu, Y. (2018). Prevalence of and risk factors for non-suicidal self-injury in rural China: Results from a nationwide survey in China. Journal of affective disorders, 226, 188–195. https://doi.org/10.1016/j.jad.2017.09.051 Zhou, J., Zhang, J., Huang, Y., Zhao, J., Xiao, Y., Zhang, S., Li, Y., Zhao, T., Ma, J., Ou, N., Wang, S., Ou, Q., & Luo, J. (2022). Associations between coping styles, gender, their interaction and non-suicidal self-injury among middle school students in rural west China: A multicentre cross-sectional study. Frontiers in psychiatry, 13, 861917. https://doi.org/10.3389/fpsyt.2022.861917 Wang, Y., Luo, B., Hong, B., Yang, M., Zhao, L., & Jia, P. (2022). The relationship between family functioning and non-suicidal self-injury in adolescents: A structural equation modeling analysis. Journal of affective disorders, 309, 193–200. https://doi.org/10.1016/j.jad.2022.04.124 Khazaie, H., Khazaie, S., Zakiei, A., Dürsteler, K. M., Brühl, A. B., Brand, S., & Sadeghi-Bahmani, D. (2021). When Non-Suicidal Self-Injury Predicts Non-Suicidal Self-Injury and Poor Sleep-Results from a Larger Cross-Sectional and Quasi-Longitudinal Study. International journal of environmental research and public health, 18(24), 13011. https://doi.org/10.3390/ijerph182413011 Liu, J., Wang, Y., Liu, X., Li, J., & Xing, S. (2023). Experiencing stress impact on adolescent repetitive nonsuicidal self-injury: The Mediating role of emotion dysregulation and maladaptive cognitive schemas. Journal of affective disorders, 339, 392–399. https://doi.org/10.1016/j.jad.2023.07.074 Cassels, M., Neufeld, S., van Harmelen, A. L., Goodyer, I., & Wilkinson, P. (2022). Prospective Pathways From Impulsivity to Non-Suicidal Self-Injury Among Youth. Archives of suicide research: official journal of the International Academy for Suicide Research, 26(2), 534–547. https://doi.org/10.1080/13811118.2020.1811180 Turner, B. J., Baglole, J. S., Chapman, A. L., & Gratz, K. L. (2019). Experiencing and Resisting Nonsuicidal Self-injury Thoughts and Urges in Everyday Life. Suicide & life-threatening behavior, 49(5), 1332–1346. https://doi.org/10.1111/sltb.12510 Allen, K. J. D., Fox, K. R., Schatten, H. T., & Hooley, J. M. (2019). Frequency of nonsuicidal self-injury is associated with impulsive decision-making during criticism. Psychiatry research, 271, 68–75. https://doi.org/10.1016/j.psychres.2018.11.022 Liu, J., Gao, Y., Liang, C., & Liu, X. (2022). The potential addictive mechanism involved in repetitive nonsuicidal self-injury: The roles of emotion dysregulation and impulsivity in adolescents. Journal of behavioral addictions, 11(4), 953–962. https://doi.org/10.1556/2006.2022.00077 Hüpen, P., Habel, U., Votinov, M., Kable, J. W., & Wagels, L. (2023). A Systematic Review on Common and Distinct Neural Correlates of Risk-taking in Substance-related and Non-substance Related Addictions. Neuropsychology review, 33(2), 492–513. https://doi.org/10.1007/s11065-022-09552-5 Logge, W. B., Morley, K. C., Haber, P. S., & Baillie, A. J. (2023). Impaired Decision-Making and Skin Conductance Responses Are Associated with Reward and Punishment Sensitivity in Individuals with Severe Alcohol Use Disorder. Neuropsychobiology, 82(2), 117–129. https://doi.org/10.1159/000529156 Noël, X., Bechara, A., Dan, B., Hanak, C., & Verbanck, P. (2007). Response inhibition deficit is involved in poor decision making under risk in nonamnesic individuals with alcoholism. Neuropsychology, 21(6), 778–786. https://doi.org/10.1037/0894-4105.21.6.778 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Oct, 2024 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 21 Mar, 2024 Reviews received at journal 15 Mar, 2024 Reviewers agreed at journal 12 Mar, 2024 Reviews received at journal 25 Feb, 2024 Reviewers agreed at journal 15 Feb, 2024 Reviewers invited by journal 29 Jan, 2024 Editor assigned by journal 23 Jan, 2024 Editor invited by journal 17 Jan, 2024 Submission checks completed at journal 17 Jan, 2024 First submitted to journal 12 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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study.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3856456/v1/4c749f101bbd050ae9969943.png"},{"id":49835793,"identity":"f32b8be8-aea5-4ac1-962c-0da3753d810b","added_by":"auto","created_at":"2024-01-18 18:36:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15055,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the three groups in terms of each scale score and IGT\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-3856456/v1/65b6a2f51d43d0509b863eaa.png"},{"id":49835566,"identity":"786ee2ac-ca7a-4f6d-bb0d-2b8b0bb538b4","added_by":"auto","created_at":"2024-01-18 18:28:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":18134,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the net scores of the three groups in the five blocks of IGT\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-3856456/v1/4fc91c98bb18a12744d522fa.png"},{"id":49835567,"identity":"1efcb7aa-cdb9-4ad9-a789-5090ba992e46","added_by":"auto","created_at":"2024-01-18 18:28:27","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":20975,"visible":true,"origin":"","legend":"\u003cp\u003eMediation Model of Depression between Motor impulsiveness and NSSI Addiction\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-3856456/v1/413f38ba2615a164bb6e0374.png"},{"id":67149563,"identity":"b70a3027-2ef5-4e0f-8396-51eeb60eb3c6","added_by":"auto","created_at":"2024-10-21 16:13:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1607204,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3856456/v1/55a3a982-ce3d-4690-b211-e228d6e98b1e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Decision Making and Impulsivity on the addictive Characteristics of Non-Suicidal Self-Injurious Behavior in Adolescents with Depressive Disorders","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eDepressive disorders constitute a prevalent health issue characterized by a complex array of symptoms and a strong association with suicide. The etiology of this disorder varies from one individual to another, causing considerable distress to affected individuals, their families, and society (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The global prevalence of depression has been on the rise over the past few decades, placing a significant burden on public health worldwide (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Research indicates that self-reported depressive symptoms affect approximately 34% of the global population at any given time, and cases of depressive disorders among adolescents continue to increase annually (3). In Uganda, a meta-analysis reported a 23.6% prevalence of depressive disorders among adolescents (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e), while in China, the detection rate of depressive symptoms in adolescents stands at 28.4%, with a higher prevalence among girls compared to boys (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Depressive disorders are typically characterized by persistent low mood, loss of energy, feelings of helplessness and hopelessness, self-blame, low self-esteem, and, in severe cases, self-injurious and suicidal behaviors. These symptoms not only impact academic performance and interpersonal relationships but also significantly influence the long-term development of adolescents.\u003c/p\u003e \u003cp\u003eIn 2009, Nock introduced the concept of Non-Suicidal Self-Injury (NSSI), which refers to the deliberate, purposeful harm inflicted upon one's own body tissues without any accompanying suicidal intent, a behavior that is culturally inappropriate. Self-injury often involves cutting with pocket knives and razor blades and commonly occurs during early adolescence (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In 2013, the American Psychiatric Association (APA) included NSSI in Section \u003cspan refid=\"Sec13\" class=\"InternalRef\"\u003e3\u003c/span\u003e of the Diagnostic and Statistical Manual, 5th edition (DSM-5) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The prevalence of self-injury varies across different countries, ranging from 11.5\u0026ndash;33.8%, with global data showing an increasing trend (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A meta-analysis of Chinese adolescents found a self-injury prevalence of 21.9% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, in patients with depressive disorders, the incidence of self-injury is reportedly significantly higher than in the general population, with a 51% incidence of NSSI behaviors among Chinese adolescents suffering from depression (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Studies have suggested a strong correlation between self-injury and suicide attempts, indicating that self-injury can serve as a warning sign for suicide (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Self-injury not only results in physical harm but also reflects underlying psychological and mental issues in adolescents. Beyond jeopardizing the physical and psychological development of adolescents, this behavior exerts a negative influence and financial strain on both the state and society.\u003c/p\u003e \u003cp\u003eIn recent years, growing concern has arisen regarding the potential addictive nature of NSSI. Individuals engaging in NSSI may experience a sense of euphoria, an intense impulse, intolerable feelings before self-injury, a sense of relief after self-injury, and an escalation in the severity of self-injury over time, akin to addiction. Some scholars have even proposed defining self-injury as an addiction (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e). A study by Sarah examined NSSI addiction across six themes, encompassing the desire to engage in self-injury, the difficulty in stopping self-injury, relapse into self-injury, the use of self-injury as a coping mechanism, feelings of shame associated with self-injury, and a worsening pattern of behavior. The repetitive and uncontrollable nature of self-injury is considered indicative of addictive behavior (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Notably, in the Chinese adolescent population, there is a strong association between addiction and NSSI (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Several studies have linked persistent NSSI behaviors with issues such as internet addiction (15, 16), depressive disorders, anxiety disorders (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e17\u003c/span\u003e), substance addiction (18), and related disorders. Furthermore, persistent NSSI behavior significantly increases the risk of suicide (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e20\u003c/span\u003e), posing a grave threat to the physical and psychological health development of adolescents.\u003c/p\u003e \u003cp\u003eImpulsivity is commonly defined as \"behavior that occurs without thorough consideration and, in comparison to individuals with similar abilities and knowledge, often lacks consideration of the negative consequences of such behavior and may result from a rapid and unplanned response to internal or external stimuli\" (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Analyzing impulsivity from a cognitive perspective, it can be categorized into impulsive choice (preferring immediate small rewards over delayed larger rewards), impulsive behavior (inability to inhibit inappropriate motor responses), and impulsive decision-making (making risky or suboptimal choices in ambiguous situations) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Numerous studies have shown that impulsivity is closely associated with addictive behavior (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Addiction has a significant impact on a person's decision-making, emotional stability, and behavioral control (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e24\u003c/span\u003e). However, there is limited research exploring the relationship between impulsivity, decision-making, and NSSI addiction. This study focused on investigating the connection between addictive traits in non-suicidal self-injurious behaviors and impulsivity and decision-making in adolescent patients with depressive disorders. Importantly, we sought to provide evidence-based medical insights for the development of multiple effective therapeutic interventions for adolescent patients with depressive disorders exhibiting addictive characteristics in NSSI behaviors.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and participants\u003c/h2\u003e \u003cp\u003eAdolescent patients with depressive disorders who received treatment as outpatients or inpatients at a specialized psychiatric hospital in Anhui Province between June 2022 and August 2023 were selected. Inclusion criteria encompassed: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) meeting the diagnostic criteria for depressive disorders as defined in DSM-5, confirmed by two attending-level or higher psychiatrists; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) an age range of 12\u0026ndash;18 years; (3) a Hamilton Depression Scale (HAMD-24) score of \u0026ge;\u0026thinsp;20; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e) ability to participate in completing relevant questionnaires and scales; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e) obtaining informed consent from both the patient and their legal guardian. Exclusion criteria included: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the presence of serious somatic illnesses; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) concurrent occurrence of other mental disorders, such as neurodevelopmental disorders; (3) secondary depressive disorders or bipolar disorders.\u003c/p\u003e \u003cp\u003eGrouping method: The presence of NSSI behaviors was determined based on DSM-5 diagnostic criteria for NSSI, and the severity of NSSI behaviors was assessed using the Adolescent Non-Suicidal Self-Injury Questionnaire (ANSSIQ). Patients without confirmed NSSI behaviors were categorized into the \"Depression Without NSSI\" group. The addictive characteristics of NSSI behaviors were evaluated using the Ottawa Self-Injury Inventory (OSI). If a patient had\u0026thinsp;\u0026ge;\u0026thinsp;3 entries with a score of \u0026ge;\u0026thinsp;2, their NSSI behaviors was considered to have addictive characteristics. Ultimately, patients with adolescent depressive disorders were categorized into three groups: \"Depression Without NSSI\" (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;42), \"Depression with NSSI Non-Addictive Characteristics\" (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;44), and \"Depression with NSSI Addictive Characteristics\" (n\u0026thinsp;=\u0026thinsp;40) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e All participants comprehensively understood the purpose and content of this study, and they voluntarily agreed to and signed the informed consent form. The Ethics Committee of Bengbu Medical College granted approval for this study (Ethics Approval No. [2023] No. 661).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Measurement\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 General information questionnaire\u003c/h2\u003e \u003cp\u003eA self-administered general information questionnaire was used to collect demographic and clinical data. This questionnaire included information such as gender, age, years of education, parents' marital status, only child status, home address, family history of the disease, and any history of comorbidities related to other brain diseases or traumatic brain injuries.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Hamilton Depression Scale (HAMD-24)\u003c/h2\u003e \u003cp\u003eComprising 24 items, this scale is a widely used tool for assessing depressive states clinically. It demonstrates good reliability and validity, effectively reflecting the severity of depression symptoms. The aggregate score is interpreted as follows: \u0026lt;8 indicates an absence of depressive symptoms, \u0026gt;\u0026thinsp;20 suggests possible mild or moderate depression, and \u0026gt;\u0026thinsp;35 indicates possible severe depression(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In this study, the Cronbach's alpha coefficient for the scale was 0.877.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Chinese revised version of Barratt Impulsiveness Scale 11th (BIS-11)\u003c/h2\u003e \u003cp\u003eTo ensure the effectiveness and reliability of measurement tools across different cultures and clinical samples, validation is crucial. The BIS-11 consists of 30 items, assessing impulsive personality in three dimensions: non-planning impulsiveness, motor impulsiveness, and cognitive impulsiveness. Responses are scored on a 5-point Likert scale (not, rarely, sometimes, often, and always). A higher score indicates greater impulsiveness(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e26\u003c/span\u003e). After revision by Li Xianyun and colleagues (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e27\u003c/span\u003e), the Cronbach's alpha coefficient for this scale in this study was 0.910.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4 Ottawa self-injury inventory (OSI)\u003c/h2\u003e \u003cp\u003eThe OSI is the primary assessment tool used to measure NSSI behaviors, including their functional and addictive characteristics(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e28\u003c/span\u003e). After revision by Chen Hui and collaborators (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e29\u003c/span\u003e), the seven entries in the addiction section of the OSI were employed to assess the addictive characteristics of the NSSI. For instance, one criterion assesses if the frequency and severity of self-injury has increased over time; if there is a desire to reduce or control the behavior without success; and if the individual continues the behavior despite recognizing its harmful effects. Each entry is scored on a scale from 0 (never) to 4 (always), with higher scores indicating more addictive behavior. If a patient had\u0026thinsp;\u0026ge;\u0026thinsp;3 entries with a score of \u0026ge;\u0026thinsp;2, their NSSI was considered to have addictive characteristics.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.5 Adolescent Non-Suicidal Self-Injury Questionnaire (ANSSIQ)\u003c/h2\u003e \u003cp\u003eThe ANSSIQ was employed to assess individuals' intentional self-harming behaviors without suicidal intent over a one-year period. The questionnaire comprises two subquestionnaires, with the Behavioral Questionnaire having 12 items categorized into two dimensions: no prominent tissue damage and prominent tissue damage. Each item is scored on a scale ranging from 0 (never) to 4 (always), with higher scores indicating more severe NSSI behaviors (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In this study, the Cronbach's alpha coefficient was 0.921.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.2.6 Iowa Gambling Task (IGT)\u003c/h2\u003e \u003cp\u003eThe IGT is a laboratory task used to evaluate deficits in cognitive decision-making function (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Before conducting the IGT, patients were instructed to select one card at a time from any of four decks of cards (A, B, C, D) with the objective of accumulating as much money as possible, thereby obtaining rewards. Each set of 40 cards, from which the subject drew one at a time, was displayed on the screen, providing feedback on winning and losing. Over the long term, Cards A/B are considered high-risk cards, while Cards C/D are considered low-risk cards. The entire experiment consists of five blocks, each containing 20 sessions, based on the order of card selection. The IGT data is primarily analyzed using the net score, which is calculated by subtracting the number of favorable cards selected by the patient in each module from the number of unfavorable cards selected, i.e., Net Score = (C\u0026thinsp;+\u0026thinsp;D) - (A\u0026thinsp;+\u0026thinsp;B). The patient's total net score and the net scores of the five blocks are analyzed; a lower score indicates higher impulsivity. By comparing the net scores and their trends in different blocks, the study analyzes patients' decision-making characteristics and their strategy adjustments in a gain-loss scenario. Several studies have demonstrated the IGT's validity in assessing decision-making function across various populations (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Investigation process and quality control\u003c/h2\u003e \u003cp\u003eThe study subjects were assessed for diagnosis by two attending-level or higher psychiatrists. Subsequently, specially trained postgraduate psychiatrists provided a thorough explanation of the study's objectives and significance to both the subjects and their parents. To mitigate common methodological biases, this study employed well-established scales with high reliability and ensured anonymous scale completion. Each assessment took place in a separate, quiet psychometric room, with investigators receiving consistent training and adhering to standardized instructions. On average, each assessment lasted approximately 40 minutes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e \u003cp\u003eThe data underwent statistical analysis using SPSS 27.0. Normality tests were conducted to ensure the data conformed to a normal distribution before performing parametric tests. Count data were presented as the number of cases (percentage) and compared using the χ2 test. Measurement data following a normal distribution were expressed as mean and standard deviation. One-way ANOVA was employed to compare measurement data between groups, and the LSD method was used for post-hoc comparisons between two groups. Pearson correlation analyses were conducted to examine associations between scales. Furthermore, multifactorial linear Pearson's correlation analysis was performed to explore the links between NSSI behavioral addiction characteristics and each variable. Multifactorial linear regression was employed to assess the association between NSSI behavioral addiction characteristics and the variables. The significance level for tests was set at \u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.1 \u003cb\u003eCommon method bias test\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eTo evaluate common method biases in our data, an exploratory factor analysis was conducted using Harman's one-way test. The results revealed 21 factors with characteristic roots exceeding 1 in total, with the highest factor variance explained being 26.301%. This variance was below the 40% threshold, indicating the absence of significant common method bias (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison of general information of the three groups\u003c/h2\u003e \u003cp\u003eOut of 126 patients meeting the inclusion criteria for adolescent depressive disorders, 42 (33.33%) were in the group with depression without NSSI, 44 (34.92%) in the group with depression with NSSI non-addictive characteristics, and 40 (31.75%) in the group with depression with NSSI addictive characteristics. Significant differences were observed in terms of gender, place of residence, and parental marriage status among the three groups. Specifically, the number of females exhibiting NSSI behaviors and addictive NSSI characteristics was significantly higher than that of males (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Further details are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of general information of the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression without NSSI group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDepression with NSSI non-addictive group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepression with NSSI addiction group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF/X2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eresidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(76.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ean only child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(77.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents' marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(81.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edivorcee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Comparison of the three groups in terms of HAMD-24, BIS-11, and IGT\u003c/h2\u003e \u003cp\u003eSignificant differences were observed among the three groups in terms of HAMD-24, BIS-11, and IGT. In the case of HAMD-24 and BIS-11, the group with depression with NSSI addictive characteristics scored significantly higher than the other two groups, suggesting greater severity of depression and impulsivity in this group. Regarding IGT, the net score for the group with depression with NSSI addictive characteristics was significantly lower than the other two groups. Notably, significant differences were observed among the three groups in block 3 (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.256, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), block 4, and block 5 (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.277, \u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.778; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These results indicate that the group with depression with NSSI addictive characteristics made more unfavorable choices in decision-making and exhibited higher levels of impulsive decision-making. However, no significant differences were observed among the three groups in blocks 1 and 2. For additional information, refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the three groups in terms of each scale score and IGT\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression without NSSI group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDepression with NSSI non-addictive group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepression with NSSI addiction group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003econtrast\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANSSIQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21.93\u0026thinsp;\u0026plusmn;\u0026thinsp;8.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e140.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e18.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e411.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAMD-24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e41.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e142.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBIS-11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.02\u0026thinsp;\u0026plusmn;\u0026thinsp;12.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.84\u0026thinsp;\u0026plusmn;\u0026thinsp;11.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e70.25\u0026thinsp;\u0026plusmn;\u0026thinsp;12.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2, 3\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enon-planning impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.44\u0026thinsp;\u0026plusmn;\u0026thinsp;19.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e67.10\u0026thinsp;\u0026plusmn;\u0026thinsp;18.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e76.25\u0026thinsp;\u0026plusmn;\u0026thinsp;17.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2, 3\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecognitive impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.94\u0026thinsp;\u0026plusmn;\u0026thinsp;16.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e55.74\u0026thinsp;\u0026plusmn;\u0026thinsp;15.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e68.56\u0026thinsp;\u0026plusmn;\u0026thinsp;16.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2, 3\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emotor impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.68\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e50.68\u0026thinsp;\u0026plusmn;\u0026thinsp;15.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e65.94\u0026thinsp;\u0026plusmn;\u0026thinsp;13.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2, 3\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNet score of IGT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;16.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-11.55\u0026thinsp;\u0026plusmn;\u0026thinsp;20.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-19.25\u0026thinsp;\u0026plusmn;\u0026thinsp;22.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNet score of block1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-3.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNet score of block2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-3.14\u0026thinsp;\u0026plusmn;\u0026thinsp;5.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNet score of block3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNet score of block4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.24\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-4.10\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u0026thinsp;\u0026gt;\u0026thinsp;3, 1\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNet score of block5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u0026thinsp;\u0026gt;\u0026thinsp;3, 1\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Correlational analysis of behavioral addiction characteristics of NSSI in adolescents with depressive disorders\u003c/h2\u003e \u003cp\u003eAn examination of the NSSI behavioral addiction profile in adolescent patients with depressive disorders revealed several correlations: a positive correlation with NSSI behaviors (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.845, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01); a positive correlation with depression severity score (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.795, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01); a positive correlation with impulsiveness, non-planning impulsiveness, cognitive impulsiveness, and motor impulsiveness (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.465, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.281, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.342, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.491, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01); and a negative correlation with the IGT total score (\u003cem\u003er\u003c/em\u003e =-0.241, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). More details are provided in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation analysis of NSSI behavioral addiction characteristics in adolescents with depressive disorders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 OSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 ANSSIQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.845**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 HAMD-24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.795**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.798**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 BIS-11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.465**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.365**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.479**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5non-planning impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.281**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.242**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.341**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.851**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6cognitive impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.342**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.205*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.332**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.866**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.716**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7motor impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.491**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.426**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.464**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.626**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.230**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.304**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 Net score of IGT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.241**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.253**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote\u003c/em\u003e:*\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.5 Linear Regression Analysis of Factors Influencing Behavioral Addiction Characteristics of NSSI in Adolescents with Depressive Disorders\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNext, we employed OSI scores as the dependent variable and examined various influences through linear regression. Our findings revealed that the severity of NSSI behaviors positively predicts the addictive characteristics of NSSI behaviors (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.468, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.434, 95% CI\u0026thinsp;=\u0026thinsp;0.358\u0026ndash;0.578), severity of depression positively predicts the addictive characteristics of NSSI behaviors (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.219, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.841, 95% CI\u0026thinsp;=\u0026thinsp;0.066\u0026ndash;0.372). Furthermore, cognitive impulsiveness positively predicted the addictive characteristics of NSSI behaviors (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.084, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.761, 95% CI\u0026thinsp;=\u0026thinsp;0.024\u0026ndash;0.144), while the total net score of the IGT negatively predicted the addictive characteristics of NSSI behaviors (\u003cem\u003eβ\u003c/em\u003e = -0.036, \u003cem\u003et\u003c/em\u003e = -2.068, 95% CI = -0.071\u0026ndash;0.002). Detailed results are provided in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear regression analysis of factors influencing NSSI behavioral addiction characteristics in adolescents with depressive disorders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnstandardized factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c11\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eVIF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eR2adj\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-9.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-4.501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-13.886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-5.401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANSSIQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.873\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAMD-24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enon-planning impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecognitive impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emotor impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.348\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNet score of IGT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Mediating Effects of depression and cognitive impulsiveness between NSSI behavioral addiction characteristics\u003c/h2\u003e \u003cp\u003eThe data were standardized and the mediating effect of depression in the relationship between Cognitive impulsiveness and NSSI behavioral addiction characteristics was analyzed using model4 in the PROCESS Bootstrap program. In the model, Cognitive impulsiveness was the independent variable, OSI was the dependent variable, and depression was the mediating variable. In the direct path, Cognitive impulsiveness positively predicted NSSI behavioral addiction characteristics (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.153, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.506, 95% CI\u0026thinsp;=\u0026thinsp;0.066\u0026ndash;0.240); in the mediated path with depression as the mediating variable, the cognitive impulsiveness could positively predicted depression (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.114, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.771, 95%CI\u0026thinsp;=\u0026thinsp;0.032\u0026ndash;0.196), depression significantly positively predicted NSSI behavioral addiction characteristics (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.578, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.853, 95% CI\u0026thinsp;=\u0026thinsp;0.382\u0026ndash;0.774). More details are provided in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMediating effects of depression and cognitive impulsiveness between NSSI behavioral addiction characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRaggression equation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eIntegration fit index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSignificance of regression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResult variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrediction variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eR\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.506***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.678\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.771**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive impulsiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.262*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.853***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote\u003c/em\u003e:*\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMeanwhile, the effect values and confidence intervals of depression were estimated, and the upper and lower Bootstrap 95% confidence intervals did not contain 0. The results showed that depression mediated significantly between cognitive impulsiveness and NSSI behavioral addiction characteristics, with a significant indirect effect (43.14% of the total effect ). More details are provided in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDecomposition of total, direct and mediating effects\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffect value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBoot standard error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBootLLCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBootULCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003erelative effect value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56.86%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe results of this study highlight the gender disparities in adolescents with depressive disorders and NSSI addiction characteristics. Notably, the number of females exhibiting NSSI addiction characteristics was higher than that of males, which may be linked to the different emotional regulation and coping strategies among adolescents of different genders (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Compared to males, females tend to experience a stronger sense of isolation, less flexible emotional regulation, and more pronounced internalized symptoms of mental illness (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Consequently, it is crucial to pay greater attention to the emotional and behavioral challenges faced by adolescent females. Furthermore, the present study revealed that adolescents with depressive disorders and NSSI addiction characteristics living in towns and rural areas outnumbered those residing in cities, which may be attributed to lower parental education levels (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Parental divorce and strained family relationships were identified as potential contributors to the onset of dysphoria and, subsequently, an increased likelihood of NSSI behaviors (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present study, the group of adolescents with depression with NSSI addictive characteristics displayed higher depression scale scores and more severe depressive symptoms. Moreover, the NSSI behavioral addiction traits scores exhibited a positive correlation with the depression scale scores. Research has shown that poor emotional regulation is associated with the long-term maintenance of NSSI behaviors (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e40\u003c/span\u003e) and that emotional dysregulation is closely linked to NSSI addiction characteristics (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In the mediation model, depression played a partial mediating role between cognitive impulsiveness and NSSI behavioral addiction characteristics. These emotional challenges may contribute to the development of addictive traits in NSSI behaviors. Therefore, in clinical practice, addressing the depressive mood in adolescent patients with depressive disorders promptly is crucial in reducing the likelihood of developing NSSI addiction characteristics.\u003c/p\u003e \u003cp\u003eThe group of adolescents with depression with NSSI addictive characteristics exhibited higher impulsivity scale scores compared to the other two groups, with higher scores indicating greater impulsivity. Previous studies have demonstrated that impulsivity independently predicts the occurrence of NSSI behaviors (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e42\u003c/span\u003e) and that heightened impulsivity is associated with more frequent NSSI (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e43\u003c/span\u003e). In correlation analyses, NSSI behavioral addiction characteristics displayed positive correlations with total impulsivity scores, non-planning impulsiveness, cognitive impulsiveness, and motor impulsiveness, with cognitive impulsiveness included in the linear regression model. Cognitive impulsiveness can positively predict the occurrence of NSSI addiction features. Frequent NSSI behaviors have been associated with cognitive impulsivity (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e44\u003c/span\u003e), highlighting the role of high impulsivity as a significant risk factor for NSSI addiction behaviors (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Therefore, early identification and intervention with adolescents with high levels of impulsivity is beneficial in reducing delinquent behaviors and, in turn, promoting healthy adolescent physical and mental development.\u003c/p\u003e \u003cp\u003eIn the context of IGT, the group with NSSI addiction characteristics displayed lower net scores across the five blocks compared to the other two groups, indicating that the addiction characteristics group made more unfavorable decisions on the IGT. Research has suggested that the dorsolateral prefrontal cortex (DLPFC) plays a pivotal role in decision-making and that its influence on risk-taking behavior correlates with addiction (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e46\u003c/span\u003e). The addiction characteristics group not only performed poorly overall on the IGT but also exhibited a decreasing trend in net scores as the number of experiments increased, in contrast to the gradual increase observed in the other two groups. This suggests that the addiction characteristics group struggled to adjust their decision-making strategies to make more favorable choices and consistently preferred choices associated with larger short-term gains (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e47\u003c/span\u003e). In the present study, during correlation analyses and linear regression, OSI scores demonstrated a negative correlation with the total IGT scores. This suggests that individuals with addictive NSSI characteristics may have compromised expectations regarding negative outcomes when faced with risky choices, which could result in poor decision-making and unfavorable outcomes (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, it is important to acknowledge certain limitations of this study. It is highly conceivable that younger adolescents with limited comprehension abilities may face challenges in manipulating and understanding the IGT, potentially leading to experimental errors. Additionally, recall bias may have influenced the results when administering the scale. Furthermore, the predominance of female students in the study may impact the generalizability of the findings. Expanding the sample size in future studies is warranted to address these limitations.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Limitations\u003c/h2\u003e \u003cp\u003eWhile this study provides valuable insights, it is important to acknowledge certain limitations. Younger adolescents with limited comprehension abilities may face challenges in manipulating and understanding the IGT, potentially leading to experimental errors and introducing a risk of recall bias when administering the scale. Additionally, the overrepresentation of female students in the study may impact the generalizability of the findings. Expanding the sample size in future studies is warranted to address these limitations, as the study design does not establish causal relationships between impulsivity, decision-making, and the behavioral addiction characteristics of NSSI. Understanding the causal relationship within the individual psychological development process would require prospective research, and this study's exclusive focus on adolescents with depressive disorders resulted in a relatively small sample size. Future research should aim to replicate these findings within a larger and more diverse sample population.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eIn conclusion, our findings suggest a relationship between impulsivity, decision-making and depression and the presence of NSSI behavioral addiction characteristics. Adolescents with depressive disorders exhibiting NSSI behavioral addictive traits displayed higher cognitive impulsiveness, indicating a higher level of impulsive decision-making. Timely modulation of depressive symptoms can be effective in reducing the occurrence of the addictive characteristics of NSSI behaviors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e6.1 Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of Bengbu Medical College with a medical ethics approval number of\u0026nbsp;No. [2023] No. 661. Written informed consent was obtained from individual or guardian participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.2 Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.3 Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.4 Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.5 Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProject\u0026ensp;supported\u0026ensp;by\u0026ensp;the provincial\u0026ensp;Natural\u0026ensp;Science Foundation\u0026ensp;of Anhui Provincial Education Department Humanities and Social Science Key Project (SK2019A0181), Provincial Education Department Natural Science Key Project (grant number: 2022AH051512, 2022AH051430), Shanghai Key Laboratory of Psychotic Disorders Open Grant (13dz2260500), and Bengbu Medical College Key Laboratory of Addiction Medicine (29-3). All funders didn\u0026rsquo;t interfere in study design, collection, analysis, interpretation, or writing of the manuscript. Innovative training Program for Chinese College students (grant number: 202010367019), Innovative training Program for Chinese College students (grant number: 202210367021).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.6 Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJDL and WWJ provides research ideas and designs, JYL, ZJ, CRM and WW is responsible for data collection, and ZQM, ZYQ and QQY is responsible for data analysis and interpretation;\u0026nbsp;JYL\u0026nbsp;and\u0026nbsp;YH\u0026nbsp;write manuscripts, while WWJ critically modifies and supervises the knowledge content of the manuscripts; WCC, LTC and JCG is responsible for professional knowledge and technical support in statistics. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.7 Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Home for Researchers editorial team for language editing and proofreading service.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.8 Authors\u0026apos; information\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cem\u003eHerrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., McGorry, P., Reynolds, C. F., 3rd, Weissman, M. M., Chibanda, D., Dowrick, C., Howard, L. M., Hoven, C. W., Knapp, M., Mayberg, H. S., Penninx, B. W. J. H., \u0026hellip; Wolpert, M. (2022). Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet (London,England), 399(10328), 957\u0026ndash;1022. https://doi.org/10.1016/S0140-6736(21)02141-3\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003ePiao, J., Huang, Y., Han, C., Li, Y., Xu, Y., Liu, Y., \u0026amp; He, X. (2022). Alarming changes in the global burden of mental disorders in children and adolescents from 1990 to 2019: a systematic analysis for the Global Burden of Disease study. European child \u0026amp; adolescent psychiatry, 31(11), 1827\u0026ndash;1845. https://doi.org/10.1007/s00787-022-02040-4\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eShorey, S., Ng, E. D., \u0026amp; Wong, C. H. J. (2022). Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis. The British journal of clinical psychology, 61(2), 287\u0026ndash;305. https://doi.org/10.1111/bjc.12333\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eKaggwa, M. M., Najjuka, S. M., Bongomin, F., Mamun, M. A., \u0026amp; Griffiths, M. D. (2022). Prevalence of depression in Uganda: A systematic review and meta-analysis. PloS one, 17(10), e0276552. https://doi.org/10.1371/journal.pone.0276552\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eLiu Furong, Song Xiaoqin, Shang Xiaoping, et al. A meta-analysis of detection rate of depression symptoms among middle school students. Chinese Mental Health Journal, 2020,34(02):123-128.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eNock M. K. (2009). Why do People Hurt Themselves? New Insights Into the Nature and Functions of Self-Injury. Current directions in psychological science, 18(2), 78\u0026ndash;83. https://doi.org/10.1111/j.1467-8721.2009.01613.x\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003ePlener, P. L., Kapusta, N. D., Brunner, R., \u0026amp; Kaess, M. (2014). Nicht-suizidales selbstverletzendes Verhalten (NSSV) und Suizidale Verhaltensst\u0026ouml;rung (SVS) im DSM-5 [Non-Suicidal Self-Injury (NSSI) and Suicidal Behavior Disorder in the DSM-5]. Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie, 42(6), 405\u0026ndash;413. https://doi.org/10.1024/1422-4917/a000319\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eMannekote Thippaiah, S., Shankarapura Nanjappa, M., Gude, J. G., Voyiaziakis, E., Patwa, S., Birur, B., \u0026amp; Pandurangi, A. (2021). Non-suicidal self-injury in developing countries: A review. The International journal of social psychiatry, 67(5), 472\u0026ndash;482. https://doi.org/10.1177/0020764020943627\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eGou Shuangyu, Du Meijie, Liu Xiaorong, et al. Meta-analysis of the detection rate of non-suicidal self-injury among Chinese adolescents. Modern Preventive Medicine, 2023,50(02):263-271.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eXu Ziyao, Huang Yaling, Zhu Guangqiang, et al. Prevalence of non-suicidal self-injury behavior among Chinese adolescents with depression\u003c/em\u003e\u003cem\u003e：\u003c/em\u003e\u003cem\u003ea Meta-analysis. Sichuan Mental Health, 2022,35(04):331-336.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eOse, S. O., Tveit, T., \u0026amp; Mehlum, L. (2021). Non-suicidal self-injury (NSSI) in adult psychiatric outpatients - A nationwide study. Journal of psychiatric research, 133, 1\u0026ndash;9. https://doi.org/10.1016/j.jpsychires.2020.11.031\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eBlasco-Fontecilla, H., Fern\u0026aacute;ndez-Fern\u0026aacute;ndez, R., Colino, L., Fajardo, L., Perteguer-Barrio, R., \u0026amp; de Leon, J. (2016). The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Frontiers in psychiatry, 7, 8. https://doi.org/10.3389/fpsyt.2016.00008\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eSarah, Davis, Christopher, et al. Addiction to self‐harm? the case of online postings on self‐harm message boards [J].International Journal of Mental Health and Addiction, 2019, 17(4): 1020‐1035.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eGuo, Z., Liu, Y., Wang, C., Li, S., Yu, L., Wu, W., You, X., Zhang, Y., Teng, Z., \u0026amp; Zeng, Y. (2023). Exploring the association of addiction-related genetic factors with non-suicidal self-injury in adolescents. Frontiers in psychiatry, 14, 1126615. https://doi.org/10.3389/fpsyt.2023.1126615\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eTang, J., Ma, Y., Lewis, S. P., Chen, R., Clifford, A., Ammerman, B. A., Gazimbi, M. M., Byrne, A., Wu, Y., Lu, X., Chang, H., Kang, C., Tiemeier, H., \u0026amp; Yu, Y. (2020). Association of Internet Addiction With Nonsuicidal Self-injury Among Adolescents in China. JAMA network open, 3(6), e206863. https://doi.org/10.1001/jamanetworkopen.2020.6863\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eZhu, J., Qian, R., Zhong, H., Li, Y., Liu, X., \u0026amp; Ma, J. (2022). Factors influencing the addiction characteristics of non-suicidal self-injurious behaviors in adolescents: A case-control study. Frontiers in psychiatry, 13, 1033242. https://doi.org/10.3389/fpsyt.2022.1033242\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eMillon, E. M., Alqueza, K. L., Kamath, R. A., Marsh, R., Pagliaccio, D., Blumberg, H. P., Stewart, J. G., \u0026amp; Auerbach, R. P. (2022). Non-suicidal Self-injurious Thoughts and Behaviors Among Adolescent Inpatients. Child psychiatry and human development, 10.1007/s10578-022-01380-1. Advance online publication. https://doi.org/10.1007/s10578-022-01380-1\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eYing, W., Shen, Y., Ou, J., Chen, H., Jiang, F., Yang, F., Li, J., Qian, X., Luo, W., Wang, G., \u0026amp; Dong, H. (2023). Identifying clinical risk factors correlated with addictive features of non-suicidal self-injury among a consecutive psychiatric outpatient sample of adolescents and young adults. European archives of psychiatry and clinical neuroscience, 10.1007/s00406-023-01636-4. Advance online publication. https://doi.org/10.1007/s00406-023-01636-4\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eBrager-Larsen, A., Zeiner, P., Klungs\u0026oslash;yr, O., \u0026amp; Mehlum, L. (2022). Is age of self-harm onset associated with increased frequency of non-suicidal self-injury and suicide attempts in adolescent outpatients?. BMC psychiatry, 22(1), 58. https://doi.org/10.1186/s12888-022-03712-w\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eMasi, G., Pisano, S., Sesso, G., Mazzullo, C., Berloffa, S., Fantozzi, P., Narzisi, A., Placini, F., Valente, E., Viglione, V., \u0026amp; Milone, A. (2023). Persistent Non-Suicidal Self-Injury and Suicidality in Referred Adolescents: A Longitudinal Study Exploring the Role of Cyclothymic Temperament. Brain sciences, 13(5), 755. https://doi.org/10.3390/brainsci13050755\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eInternational Society for Research on Impulsivity. (2019). What is impulsivity. Retrieved from http://www.impulsivity.org/index.htm \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eMacKillop, J., Weafer, J., C Gray, J., Oshri, A., Palmer, A., \u0026amp; de Wit, H. (2016). The latent structure of impulsivity: impulsive choice, impulsive action, and impulsive personality traits. Psychopharmacology, 233(18), 3361\u0026ndash;3370. https://doi.org/10.1007/s00213-016-4372-0\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eMcMullin, S. D., Shields, G. S., Slavich, G. M., \u0026amp; Buchanan, T. W. (2021). Cumulative lifetime stress exposure predicts greater impulsivity and addictive behaviors. Journal of health psychology, 26(14), 2921\u0026ndash;2936. https://doi.org/10.1177/1359105320937055\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eKarila, L., \u0026amp; Benyamina, A. (2019). Addictions [Addictions]. Revue des maladies respiratoires, 36(2), 233\u0026ndash;240. https://doi.org/10.1016/j.rmr.2018.12.001\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eSun Xiaoyan, Li Yixue, Yu Canqing, et al. Reliability and validity of depression scales of Chinese version\u003c/em\u003e\u003cem\u003e：\u003c/em\u003e\u003cem\u003ea systematic review[J]. Chinese Journal of Epidemiology, 2017,38(01):110-116.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eLi Xianyun, Fei Lipeng, Xu Dong, et al. Reliability and validity of an adapted Chinese version of Barratt Impulsiveness Scale[J]. Chinese Mental Health Journal, 2011,25(08):610-615.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eLi, X., et al., The reliability and validity of the Chinese revised version of the Barratt Impulsiveness Scale in community and university populations. Chinese Mental Health Journal, 2011. 25(8): p. 6.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eNixon, M. K., Levesque, C., Preyde, M., Vanderkooy, J., \u0026amp; Cloutier, P. F. (2015). The Ottawa Self-Injury Inventory: Evaluation of an assessment measure of nonsuicidal self-injury in an inpatient sample of adolescents. Child and adolescent psychiatry and mental health, 9, 26. \u003cem\u003ehttps://doi.org/10.1186/s13034-015-0056-5\u003c/em\u003e\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eChen, H., et al., Revision of the non-suicidal self-injury behavior scale for adolescents with mental disorder. Journal of Central South University (Medical Science), 2022, 47(3).\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eWan Yuhui, Liu Wan, Hao Jiahu, et al. Development and evaluation on reliability and validity of Adolescent Non-suicidal Self-injury Assessment Questionnaire[J]. Chinese Journal of School Health, 2018,39(2):170-173.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eBechara, A., Damasio, A. R., Damasio, H., \u0026amp; Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50(1-3), 7\u0026ndash;15. https://doi.org/10.1016/0010-0277(94)90018-3\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eToplak, M. E., Sorge, G. B., Benoit, A., West, R. F., \u0026amp; Stanovich, K. E. (2010). Decision-making and cognitive abilities: A review of associations between Iowa Gambling Task performance, executive functions, and intelligence. Clinical psychology review, 30(5), 562\u0026ndash;581. https://doi.org/10.1016/j.cpr.2010.04.002\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eXiong HX, Zhang J, Ye BJ, et al. Model analysis of the effects of common method variation and its statistical control pathways[J]. \u003c/em\u003eAdvances in Psychological Science, \u003cem\u003e2012, 20(05): 757-769.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eLi Guohua, Zhou Yongjie, Huang Wei, et al. Gender differences in non-suicidal self-injury behaviors among adolescents with mood disorders[J]. China Preventive Medicine, 2021,22(09):699-703.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eThomas, D., \u0026amp; Bonnaire, C. (2023). Relationship Between Non-Suicidal Self-Injury and Emotion Dysregulation Among Male and Female Young Adults. Psychological reports, 332941231183336. Advance online publication. https://doi.org/10.1177/00332941231183336\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eReinhardt, M., K\u0026ouml;k\u0026ouml;nyei, G., Rice, K. G., Drubina, B., \u0026amp; Urb\u0026aacute;n, R. (2021). Functions of nonsuicidal self-injury in a Hungarian community adolescent sample: a psychometric investigation. BMC psychiatry, 21(1), 618. https://doi.org/10.1186/s12888-021-03613-4\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eTang, J., Li, G., Chen, B., Huang, Z., Zhang, Y., Chang, H., Wu, C., Ma, X., Wang, J., \u0026amp; Yu, Y. (2018). Prevalence of and risk factors for non-suicidal self-injury in rural China: Results from a nationwide survey in China. Journal of affective disorders, 226, 188\u0026ndash;195. https://doi.org/10.1016/j.jad.2017.09.051\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eZhou, J., Zhang, J., Huang, Y., Zhao, J., Xiao, Y., Zhang, S., Li, Y., Zhao, T., Ma, J., Ou, N., Wang, S., Ou, Q., \u0026amp; Luo, J. (2022). Associations between coping styles, gender, their interaction and non-suicidal self-injury among middle school students in rural west China: A multicentre cross-sectional study. Frontiers in psychiatry, 13, 861917. https://doi.org/10.3389/fpsyt.2022.861917\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eWang, Y., Luo, B., Hong, B., Yang, M., Zhao, L., \u0026amp; Jia, P. (2022). The relationship between family functioning and non-suicidal self-injury in adolescents: A structural equation modeling analysis. Journal of affective disorders, 309, 193\u0026ndash;200. https://doi.org/10.1016/j.jad.2022.04.124\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eKhazaie, H., Khazaie, S., Zakiei, A., D\u0026uuml;rsteler, K. M., Br\u0026uuml;hl, A. B., Brand, S., \u0026amp; Sadeghi-Bahmani, D. (2021). When Non-Suicidal Self-Injury Predicts Non-Suicidal Self-Injury and Poor Sleep-Results from a Larger Cross-Sectional and Quasi-Longitudinal Study. International journal of environmental research and public health, 18(24), 13011. https://doi.org/10.3390/ijerph182413011\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eLiu, J., Wang, Y., Liu, X., Li, J., \u0026amp; Xing, S. (2023). Experiencing stress impact on adolescent repetitive nonsuicidal self-injury: The Mediating role of emotion dysregulation and maladaptive cognitive schemas. Journal of affective disorders, 339, 392\u0026ndash;399. https://doi.org/10.1016/j.jad.2023.07.074\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCassels, M., Neufeld, S., van Harmelen, A. L., Goodyer, I., \u0026amp; Wilkinson, P. (2022). Prospective Pathways From Impulsivity to Non-Suicidal Self-Injury Among Youth. Archives of suicide research: official journal of the International Academy for Suicide Research, 26(2), 534\u0026ndash;547. https://doi.org/10.1080/13811118.2020.1811180\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eTurner, B. J., Baglole, J. S., Chapman, A. L., \u0026amp; Gratz, K. L. (2019). Experiencing and Resisting Nonsuicidal Self-injury Thoughts and Urges in Everyday Life. Suicide \u0026amp; life-threatening behavior, 49(5), 1332\u0026ndash;1346. https://doi.org/10.1111/sltb.12510\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eAllen, K. J. D., Fox, K. R., Schatten, H. T., \u0026amp; Hooley, J. M. (2019). Frequency of nonsuicidal self-injury is associated with impulsive decision-making during criticism. Psychiatry research, 271, 68\u0026ndash;75. https://doi.org/10.1016/j.psychres.2018.11.022\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eLiu, J., Gao, Y., Liang, C., \u0026amp; Liu, X. (2022). The potential addictive mechanism involved in repetitive nonsuicidal self-injury: The roles of emotion dysregulation and impulsivity in adolescents. Journal of behavioral addictions, 11(4), 953\u0026ndash;962. https://doi.org/10.1556/2006.2022.00077\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eH\u0026uuml;pen, P., Habel, U., Votinov, M., Kable, J. W., \u0026amp; Wagels, L. (2023). A Systematic Review on Common and Distinct Neural Correlates of Risk-taking in Substance-related and Non-substance Related Addictions. Neuropsychology review, 33(2), 492\u0026ndash;513. https://doi.org/10.1007/s11065-022-09552-5\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eLogge, W. B., Morley, K. C., Haber, P. S., \u0026amp; Baillie, A. J. (2023). Impaired Decision-Making and Skin Conductance Responses Are Associated with Reward and Punishment Sensitivity in Individuals with Severe Alcohol Use Disorder. Neuropsychobiology, 82(2), 117\u0026ndash;129. https://doi.org/10.1159/000529156\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eNo\u0026euml;l, X., Bechara, A., Dan, B., Hanak, C., \u0026amp; Verbanck, P. (2007). Response inhibition deficit is involved in poor decision making under risk in nonamnesic individuals with alcoholism. Neuropsychology, 21(6), 778\u0026ndash;786. https://doi.org/10.1037/0894-4105.21.6.778\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"adolescent depressive disorder, NSSI, addiction traits, impulsivity, decision making, IGT","lastPublishedDoi":"10.21203/rs.3.rs-3856456/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3856456/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eNon-suicidal self-injurious (NSSI) behaviors pose a significant threat to the physical and psychological well-being of adolescents. This study investigated the addictive nature of NSSI behaviors and their association with impulsivity and decision-making, aiming to provide evidence-based insights for the development of multiple effective treatment interventions for adolescents with depressive disorders exhibiting addictive characteristics in their NSSI behaviors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 126 adolescent outpatients and inpatients diagnosed with depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria were selected and categorized into three groups: depression without NSSI (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;42), depression with NSSI without addictive characteristics (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;44), and depression with NSSI and addictive characteristics (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;40). The present study employed the Hamilton Depression Scale (HAMD-24), Chinese Revised Barratt Impulsiveness Scale Version 11 (BIS-11), Ottawa Self-Injury Inventory (OSI), and the Adolescent Non-Suicidal Self-Injury Questionnaire (ANSSIQ). Cognitive decision-making abilities were assessed using the Iowa Gambling Task (IGT).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were no significant differences observed in blocks 1 and 2 of the IGT among the three groups. However, the depression with NSSI addictive characteristics group exhibited significantly lower net scores in blocks 3, 4, and 5 of the IGT compared to both the depression without NSSI group and the depression with NSSI non-addictive characteristics group. The addictive characteristics of NSSI behaviors were positively correlated with the severity of NSSI behaviors, depression, and cognitive impulsiveness, and negatively correlated with the total net score of the IGT. In the mediation model, depression played a partial mediating role between cognitive impulsiveness and NSSI behavioral addiction characteristics.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAdolescents with depressive disorders exhibiting addictive NSSI behaviors demonstrate heightened cognitive impulsivity and exhibit poorer decision-making when presented with choices. Timely modulation of depressive symptoms can be effective in reducing the occurrence of the addictive characteristics of NSSI behaviors.\u003c/p\u003e","manuscriptTitle":"Effects of Decision Making and Impulsivity on the addictive Characteristics of Non-Suicidal Self-Injurious Behavior in Adolescents with Depressive Disorders","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-18 18:28:22","doi":"10.21203/rs.3.rs-3856456/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-21T04:54:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-15T10:35:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9f6e8158-6897-4ed9-baa4-0dccaae89f29","date":"2024-03-12T22:31:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-25T12:38:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5197da1f-6dea-436e-b4e7-c414284809ad","date":"2024-02-15T12:44:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-01-29T11:06:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-01-24T04:19:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-01-17T05:54:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-17T05:50:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2024-01-12T09:40:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a159ef65-33d5-436c-bbd8-5104a9653db2","owner":[],"postedDate":"January 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T16:08:34+00:00","versionOfRecord":{"articleIdentity":"rs-3856456","link":"https://doi.org/10.1186/s12888-024-06121-3","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2024-10-18 15:57:57","publishedOnDateReadable":"October 18th, 2024"},"versionCreatedAt":"2024-01-18 18:28:22","video":"","vorDoi":"10.1186/s12888-024-06121-3","vorDoiUrl":"https://doi.org/10.1186/s12888-024-06121-3","workflowStages":[]},"version":"v1","identity":"rs-3856456","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3856456","identity":"rs-3856456","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}