Impulsivity in Adolescents with MDD and Non-Suicidal Self-Injury: A Multimodal Assessment Using Psychometric, Behavioral, and Neurophysiological Measures

Impulsivity in Adolescents with MDD and Non-Suicidal Self-Injury: A Multimodal Assessment Using Psychometric, Behavioral, and Neurophysiological Measures | 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 Impulsivity in Adolescents with MDD and Non-Suicidal Self-Injury: A Multimodal Assessment Using Psychometric, Behavioral, and Neurophysiological Measures Yuqiong He, Tingyu Yang, Kun Zhang, Shuxian Wu, Chunxiang Huang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7548791/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Objective: This study aims to explore the impulsivity traits across various dimensions and their neuro-electrophysiological features in adolescent depressed patients withnon-suicidal self-injury (NSSI) via scale assessments, behavioral tasks, and event-related potentials (ERPs). Methods: A case-control study was conducted, enrolling depressed adolescent patients with NSSI (NSSI group), depressed adolescent patients without NSSI (non-NSSI group), and healthy controls. The Barratt Impulsivity Scale (BIS-11), go/no-go task, and ERPs were utilized to assess different dimensions of impulsivity. Results: Both the NSSI group and the non-NSSI group demonstratedsignificantly higher total scores and subscale scores on the BIS-11 compared to the healthy control scores than the HC group in the total score and subscale scores of the BIS-11, especially in the motor impulsivity subscale in the motorimpulsivity subscale ( p < 0.05). The NSSI group had lower accuracy in the go task than the non-NSSI and HC groups, with a statistically significant difference ( p =0.009); notably, the significant difference was more pronounced between the NSSI and HC groups( p =0.008). No significant differences were found in the latency and amplitude of N2 and P3 waves among the three groups ( p > 0.05). The severity of NSSI over the past 1 month, 6 months, and 12 months was positively correlated with the motor impulsivity subscale and the total score of the BIS (r=0.198 to 0.417, p < 0.001). In contrast, it was negatively correlated with the accuracy of the go task (r=-0.248 to -0.193, p < 0.001). Conclusion: Adolescent depressed patients with NSSI showed increased self-reported and behaviorally measured motor impulsivity, and these changes were strongly associated with the severity of NSSI. non-suicidal self-injury adolescent with major depression disorder impulsivity go/on-go task Figures Figure 1 Figure 2 Introduction Non-suicidal self-injury (NSSI) refers to the deliberate, direct damage to body tissues without suicidal intent. This behavior encompasses various actions, such as cutting, scratching, or burning the skin. Additionally, it includes indirect forms, such as forcefully striking hard surfaces (e.g., walls), which can result in injury to the skin or bones ( 1 ). The prevalence of NSSI among Chinese students is a growing public health concern that warrants urgent attention. A comprehensive analysis encompassing 420 studies and 160,348 participants specifically focusing on Chinese students has indicated that the pooled prevalence rate of NSSI stands at 22.37%, with females exhibiting a higher prevalence (21.9%) compared to males (20.6%)( 2 ). Although NSSI typically occurs in the absence of suicidal intent, a growing body of evidence indicates that it constitutes a significant risk factor for suicide attempts( 3 – 5 ). Moreover, NSSI is strongly associated with subsequent suicidal behavior, highlighting its critical role in the trajectory of self-harm towards more life-threatening actions( 3 – 5 ). Recent research has revealed a time-dependent relationship between the onset of NSSI and future suicidal behavior, demonstrating that an earlier initiation of NSSI is significantly associated with an elevated risk of future suicide attempts( 6 ). Although not all individuals who engage in NSSI progress to suicidal behavior, many experience elevated emotional distress and persistent difficulties in emotion regulation( 7 ). Given the widespread occurrence of NSSI and its far-reaching detrimental consequences, pinpointing the risk factors associated with NSSI engagement has emerged as an urgent and paramount research priority. Numerous factors have been identified as influencing the occurrence of NSSI, among which impulsivity stands out as a particularly critical contributor. Accumulating evidence suggests that individuals who engage in NSSI tend to display heightened impulsivity, a trait that appears to be more pronounced in clinical populations than in the general public ( 8 ). Impulsivity is typically defined as a tendency to respond rapidly and spontaneously to internal or external cues, often without a sufficient consideration of the potential negative consequences of one’s actions, either for themselves or for others( 9 ). Impulsivity can be assessed at multiple levels. The most basic approach involves self-report questionnaires, while more objective assessments utilize behavioral tasks. At the neurophysiological level, event-related potentials (ERPs) provide a direct and sensitive measure of impulsivity-related brain activity. Many individuals who engage in NSSI report acting on the impulse almost immediately after the thought arises, with little delay between ideation and behavior. This rapid transition has led researchers to propose that heightened impulsivity may play a pivotal role in the emergence and manifestation of NSSI behaviors. Professor Nock emphasized that individuals with elevated impulsivity may be at increased risk of NSSI, particularly during emotionally challenging situations, as such acts can be carried out quickly and without substantial forethought or planning ( 10 ) . Despite the theory that impulsivity increases of NSSI, whether individuals with NSSI exhibit higher levels of impulsivity remains a controversial topic. Some researchers argue that individuals with NSSI may display increased impulsivity by self-reported( 11 , 12 ), while others maintain contrasting views ( 13 – 15 ). Janis et al ( 11 ) discovered that adolescents and adults who engage in NSSI reported higher levels of self-reported impulsivity compared to those who do not engage in NSSI. Matera ( 12 ) reported there was a potential link between higher self-reported impulsivity and NSSI behaviors inpatients with NSSI. Tschan et al found that the patients with BPD engaged in NSSI reported higher levels of impulsivity than the non-NSSI group( 15 ). However, Claes et al ( 13 ) reported there was no significant difference in self-reported impulsivity between anorexia nervosa (AN) patients with NSSI and without NSSI. The contradictory outcome also emerges in the impulsivity of behavioral measurement. Claes’s result shown anorexia nervosa (AN) patients with NSSI reported they have higher impulsivity of behavioral measurement than those who without NSSI( 13 ). However, Janis et al’ s ( 11 ) and Tschan et al’ s ( 15 ) found there was no significant difference in the behavioral tasks between NSSI group and non-NSSI group. Lutz et al( 14 ) discovered that adolescents with repetitive NSSI are associated with increased behavioral compulsivity but not with behavioral impulsivity. Limited research explored the neurophysiological assessed impulsivity. One study in college students has pointed out that college students who engage in NSSI exhibit elevated impulsivity in ERPs( 16 ). It was observed that the N2 amplitude of the no-go response in college students with NSSI was notably higher in the prefrontal region compared to students without NSSI, and the N2 latency was longer in the NSSI group than in the control group. Another study revealed that the children with a history of NSSI exhibited significantly more negative ΔFN (i.e., FN to losses minus FN to gains) than children without NSSI, which was associated with enhanced impulsivity( 17 ). The existing literature presents conflicting findings, with some studies suggesting a strong association between NSSI and elevated impulsivity, while others have failed to replicate these results. This divergence of evidence has led to ongoing debates regarding the nature and extent of the link between NSSI and impulsivity in different dimensions, highlighting the need for further research to clarify this complex relationship. In the present study, our objective was to comprehensively examine impulsivity across various dimensions in adolescents with non-suicidal self-injury (NSSI) and ascertain whether they display elevated levels of this trait. Our central hypothesis posits that recurrent NSSI is intricately linked to impulsivity. We anticipated this association would manifest through alterations in self-reported impulsivity scores, observable behavioral disinhibition, and distinct patterns within event-related potential (ERP) recordings. Material and methods Participants Between October 2020 and December 2021, adolescents diagnosed with major depressive disorder (MDD) was recruited from the Children and Adolescent Psychiatry Department of the Second Xiangya Hospital, Central South University. All MDD patients met the following criteria:1) Aged 12–17 years; 2) Met DSM-V diagnostic criteria for depression, with a Hamilton Rating Scale for Depression (HAMD-17) score ≥ 17 and Young Mania Rating (YMRS) score ≤ 5; 3) Right-handed with normal uncorrected or corrected vision; 4) Capable of understanding informed consent form and study procedures. Participants in the NSSI group had engaged in NSSI ≥ 5 times with in the past 12 months, with at least one incident in the past month( 18 ). Those with no history of NSSI were assigned to the non-NSSI group. MDD patients were excluded if they: 1) Had a suicide attempt within the past month; 2) Had organic mental disorders, schizophrenia, mental retardation, autism, tic disorder, personality disorder, substance or drug dependence and other mental disorders; 3) Had physical diseases affecting the assessment and testing; 4) had a history of craniocerebral trauma, epilepsy and other relevant conditions. For comparison, healthy adolescents were recruited from high schools in Changsha City as controls. Inclusion criteria for healthy controls:1) Aged 12–17 years; 2) No current or past history of mental disorders (confirmed via the Mini International Neuropsychiatric Interview for Children and Adolescents [MINI-KID]); 3) No history of NSSI; 4) No family history of mental disorder; 5) Right-handed, with normal or corrected-to-normal vision; 6) Capable of understanding the informed consent form and study procedures. The exclusion criteria for healthy controls: 1) Physical illnesses impacting assessments or testing; 2) History of cranial trauma, epilepsy, or other relevant medical conditions; 3) Any other conditions hindering study completion. This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University. Prior to enrollment, written informed consent was obtained from all participants and their legal guardians. All participants underwent clinical interviews and assessments conducted by two certified child psychiatrists who had completed standardized training before the study began. Procedures General demographic and background information was collected for for all the participants, including gender, age, family history of mental disorders, only child status, and years of education. Additionally, for patients with MDD, additional clinical data were gathered, including the number of depressive episodes and the type of depression (recurrent vs. first episode). The Mini International Neuropsychiatric Interview for Children and Adolescents, 5th edition (MINI-Kid 5.0) was used to exclude adolescents with MDD who had comorbid psychiatric disorders and to screen healthy controls for any psychiatric diagnoses. The 17-item Hamilton Rating Scale for Depression (HAMD-17)( 19 ) and Young Mania Rating Scale (YMRS)( 20 ) were employed as part of the inclusion criteria for the MDD group. The frequency of NSSI, assessed using the Ottawa Self-Injury Inventory (OSI), was also included as an inclusion criteria ( 21 ). Self-reported impulsivity was measured using the Chinese version of the Barratt Impulsivity Scale (BIS-11), which consists of three subscales: non-planning impulsivity subscale, motor impulsivity subscale, and attentional impulsivity subscale. Each subscale contains 10 items, rated on a 4-point Likert scale ranging from 1 (rarely or never) to 4 (almost always) ( 22 ). Behavioral task and event-related potentials The ERP task (go/on-go paradigm) was designed using E-prime 2.0 Basic Standard Edition. A total of 180 facial images—45 negative, 90 neutral, and 45 positive —were selected from the Chinese Facial Affective Picture System (CFAPS)( 23 ). The experiment included one brief practice session followed by three main experiment blocks. Each formal block contained 120 trails, consisting of 90 go trials and 30 no-go trials. Emotional (positive and negative) and neutral facial stimuli were presented randomly, with occurrence probabilities of 25% for negative, 25% for positive, and 50% for neutral stimuli. Each trial began with a 50 ms black screen, followed by the presentation of a facial image for 1000ms. Participants were instructed to respond by pressing the space bar for each image unless the current image matched the one immediately before it, in which case they were to withhold their response. The instruction provided to participants was as follows: “You will view various face pictures. Press the space bar each time you see a picture. If the current picture matches the previous one, no key press is needed.” A black screen was then shown for approximately 1500 ms before the next trial began. This sequence was repeated throughout the session, and the entire task lasted approximately 15 minutes. This paradigm has been previously used to assess impulsivity in earlier studies. ERP data were recorded using a 64-channel EEG system (Braincap), with electrodes positioned according to the international 10–20 system and FCz used as the reference electrode. Data were collected using Recorder software at a sampling rate of 5000 Hz. Scalp impedance was maintained below 5 kΩ throughout the recording. 2) Behavioral and EEG data preprocessing Behavioral data, including the accuracy of go and no-go tasks as well as the reaction time for go trials, were extracted from the behavioral data using E-Prime 2.0.1.0.8 for subsequent statistical analysis. The pretreatment of EEG data was conducted using the EEGLAB platform (2013b) within Matlab2013b. The ERP data underwent the following preprocessing steps: lower the sample rate into 500 Hz; band-pass filtering (high-pass filter ≥ 1Hz, low-pass filter ≤ 45Hz) and notch filtering (48-52Hz); epoch segmentation (from 0.5 s before to 1.2 s after stimulus onset); removal of noisy epochs ((identified manually based on head movement artifacts); spherical interpolation for bad channels ( 24 ); artifact removal —including ocular and electrocardiographic artifacts—using independent component analysis (ICA) in EEGLAB ( 25 ), re-reference to the bilateral mastoids, and removal of extreme-value segments with voltage amplitudes exceeding ± 100 µV. All preprocessing steps were conducted by a trained researcher. According to previous research( 26 – 28 ), the N2 component typically emerges around 90–110 ms post-stimulus in the prefrontal lobe, while the P3 component is predominantly observed in the frontal lobe or frontocentral lobe in both adults and children. In the present study, the N2 component was analyzed electrodes Fz and Cz, and the P3 component at electrodes Cz and Pz. To enable further comparisons, the mean amplitude of N2 and P3 components were calculated with a time window defined by the mean latency ± one standard deviation. Only correct trials were included in the averaged ERPs for analysis. In the present study, the N2 component was analyzed at electrodes Fz and Cz, and the P3 component at electrodes Cz and Pz. To enable further comparisons, the mean amplitudes of the N2 and P3 components were calculated within a time window defined by the mean latency ± one standard deviation. Only correct trials were included in the ERP averaging for analysis. Statistical analysis Statistical analyses were conducted using SPSS 26.0. Continuous variables were represented as mean (M) ± standard deviation (SD), while categorical variables were represented by frequency (n). Single-factor ANOVA and Chi-square test were employed for the analysis. Post hoc tests utilized pairwise comparisons and Bonferroni corrections. Repeated measures ANOVA (group × condition × electrode) was used to compare the different components b across various groups. With groups as a between-subjects factor, while channels and type of condition (go vs no-go) as within-subjects factors. Greenhouse–Geisser correction was applied for ANOVA analysis. P values were two-sided with a significance level of 0.05. Spearman correlation analysis was used to explore the relationship between the severity of NSSI and impulsivity., with a significance level set at α = 0.05. Results Comparison of general demographic and clinical data among the three groups A total of 145 participants were included in the study and categorized into three groups: the NSSI group (n = 50; 12 males, 38 females), the non-NSSI group (n = 45; 16 males, 29 females), and the healthy control (HC) group (n = 50; 25 males, 25 females). Statistical analysis revealed a significant difference in gender distribution among the three groups ( p = 0.026). Post hoc analysis indicated a significant difference between the HC and NSSI groups ( p = 0.007), while no significant differences were found between the NSSI and non-NSSI groups (p = 0.217), or between the HC and non-NSSI groups (p = 0.156) (see Table 1 ). Table 1 Comparison of demographic and clinical data among the three group variables NSSI (N = 50) non-NSSI (N = 45) HC (N = 50) χ 2 /F/པ p n/ M ± SD n/ M ± SD n/ M ± SD gender(male/female) 12/38 16/29 25/25 7.315 0.026 a Only child(yes/no) 19/31 14/31 13/37 1.673 0.433 age(yeas) 14.75 ± 1.41 14.77 ± 1.21 15.19 ± 1.54 1.555 0.215 Education time(year) 8.56 ± 1.36 8.56 ± 1.20 9.16 ± 1.77 2.754 0.067 depression episodes 1.06 ± 0.31 1.04 ± 0.21 - -0.281 0.779 depression type (Recurrent/first episode) 2/48 2/43 - 0.012 0.914 Family history (Yes/No/missing value) 6/43/1 3/39/3 - 0.661 0.416 HAMD 21.84 ± 3.73 21.64 ± 3.89 - -0.259 0.796 YMRS 0.98 ± 1.44 1.25 ± 2.07 - 0.738 0.468 Medication or not(yes/no) 15/35 6/39 - 3.821 0.051 Note： M:mean；SD：Standard deviation；a：NSSI group vs HC group，b:non-NSSI group vs HC group，c:NSSI group vs non-NSSI group（Bonferroni corrected p＜0.05) No significant differences were found among the three groups in other demographic variables, including age, years of education, and only-child status (p > 0.05). Additionally, there were no significant differences between the non-NSSI and NSSI groups in clinical characteristics such as the number of depression episodes, type of depression, family history of mental disorders, HAMD score, YMRS score, and medication history ( p > 0.05) (refer to Table 1 ). Comparison of self-reported impulsivity and behavioral impulsivity among the three groups Adolescents in NSSI group exhibited higher total scores of BIS compared to those in the non-NSSI and HC groups. Post hoc analysis revealed statistically significant differences between the NSSI and HC groups, as well as between the non-NSSI and HC groups ( p 0.05). Regarding the motor impulsivity subscale, adolescents in the NSSI group had significantly higher scores than those in the non-NSSI group, who in turn scored higher than the HC group. Statistical analysis revealed significant differences among all three groups: between NSSI and HC, non-NSSI and HC, and NSSI and non-NSSI ( p < 0.05). In terms of task performance, the accuracy of go task in the NSSI group was lower compared to both the non-NSSI and HC groups, with a statistically significant overall difference ( p = 0.009). pairwise comparisons showed a significant difference only between the NSSI and HC groups ( p = 0.008). For the no-go task, the NSSI group also exhibited lower accuracy compared to the non-NSSI and HC groups, but the difference was not statistically significant (p = 0.329). Additionally, the non-NSSI group had a shorter response time in the go task compared to the NSSI and HC groups, though this difference was not statistically significant (p = 0.145) (Table 2 ). Table 2 Comparison of self-reported impulsivity and behaviorally assessed among the three groups NSSI non-NSSI HC variables M ± SD M ± SD M ± SD F p Total score of BIS 68.28 ± 7.41 64.10 ± 7.90 62.32 ± 8.11 7.480 0.001 a,b MIS 25.20 ± 3.56 23.10 ± 3.66 20.43 ± 3.08 23.392 <0.001 a,b,c AIS 20.72 ± 3.52 19.60 ± 3.82 20.38 ± 3.79 1.089 0.339 NPIS 22.36 ± 3.29 21.40 ± 3.32 21.51 ± 3.43 1.167 0.314 Go ACC 0.88 ± 0.10 0.91 ± 0.09 0.93 ± 0.05 4.914 0.009 a No-go ACC 0.77 ± 0.12 0.76 ± 0.15 0.80 ± 0.10 1.123 0.329 Go RT 524.18 ± 65.62 511.32 ± 64.55 537.93 ± 51.63 1.959 0.145 Note： M:mean；SD：Standard deviation；MIS: motor impulsivity subscale; AIS: attentional impulsivity subscale; NPIS: non-planning impulsivity subscale; Go ACC：accuracy of go task；No-go ACC：accuracy of no-go task; Go RT：response time of go task，a：NSSI group vs HC group，b:non-NSSI group vs HC group，c:NSSI group vs non-NSSI group（Bonferroni corrected p＜0.05） Comparison of go/no-go latency and amplitude among three groups Repeated measurement ANOVA was conducted to compare the latency of N2 and P3 across different electrode and task conditions. Table 3 presents the detailed latencies and amplitudes of N2 and P3 at various electrodes. The main effect of group on N2 latency was not significant (F = 2.337, η²=0.032, p = 0.100). However, further analysis revealed a significant effect of task condition at electrode Cz: N2 latency was longer during the no-go task (323.22 ± 15.32 ms) than during the go task (320.55 ± 15.42 ms), and this difference was significant (F = 4.623, p = 0.033)(Table 3 and Supplementary Table 1). Table 3 Effects of different factors on different conditions and electrodes Effect F P N2 Latency Group(NSSI, non-NSSI,HC) 2.337 0.1 Conditions(go,nogo) 4.022 0.047 Electrodes(Fz,Cz) 2.607 0.109 Group(NSSI, non-NSSI,HC)*conditions 0.144 0.866 Group(NSSI, non-NSSI,HC)*Electrodes 0.999 0.371 Group*conditions*Electrodes 1.619 0.357 Amplitude Group(NSSI, non-NSSI,HC) 0.171 0.835 conditions(go,nogo) 148.247 <0.001 Electrodes(Fz,Cz) 197.4 <0.001 Group*conditions*Electrodes 4.335 0.015 Group(NSSI, non-NSSI,HC)*Electrodes 2.036 0.134 Group(NSSI, non-NSSI,HC)*conditions 2.091 0.127 P3 latency Group(NSSI, non-NSSI,HC) 3.353 0.038 conditions(go,nogo) 3.871 0.051 Electrodes(Fz,Pz) 21.588 <0.001 Group(NSSI, non-NSSI,HC)*conditions 0.849 0.43 Group(NSSI, non-NSSI,HC)*Electrodes 1.467 0.234 Group*conditions*Electrodes 0.115 0.891 Amplitude Group(NSSI, non-NSSI,HC) 0.171 0.835 conditions(go,nogo) 148.247 <0.001 Electrodes(Fz,Pz) 197.4 <0.001 Group*conditions*Electrodes 4.335 0.015 Group(NSSI, non-NSSI,HC)*Electrodes 2.036 0.134 Group(NSSI, non-NSSI,HC)*conditions 2.091 0.127 A significant main effect of group was observed in P3 latency (F = 3.353, η²=0.046, p = 0.038). Subsequent analysis indicated that at electrode Cz, P3 latency was significantly longer in the no-go task (536.14 ± 32.17 ms) compared to the go task (527.72 ± 28.99 ms) (F = 8.251, p = 0.005). However, no significant in P3 latency were observed among the three groups ( p > 0.05)(Table 3 and Supplementary Table 1). Regarding N2 amplitude, the main effect of group was not significant (F = 0.181, η²=0.003, p = 0.835). Further analysis indicated that N2 amplitude at electrodes Fz and Cz was significantly smaller during the no-go task compared to the go task ( p < 0.001). Similarly, the main effect of group on P3 amplitude was not significant (F = 0.833, η²=0.012, p = 0.437)(Table 3 and Supplementary Table 1). However, the P3 amplitude at electrodes Cz and Pz was significantly larger in the no-go task than in the go task ( p 0.05). Although the NSSI group showed smaller P3 amplitudes at Cz and Pz compared to the non-NSSI and HC groups during the no-go task, these differences did not reach statistical significance ( p > 0.05) (Table 3 and Fig. 2 ). Correlation analysis between NSSI severity and impulsivity The severity of NSSI over the past 1 month, 6 months and 12 months was positively correlated with motor impulsivity subscale and the total BIS score (r = 0.198–0.417, p < 0.001). In contrast, the severity of NSSI across the same time intervals was negatively correlated with the accuracy of go task (r=-0.248 _ -0.193, p < 0.05) (Table 4 ). In contrast, NSSI severity across the same time intervals was negatively correlated with go task accuracy (r = − 0.248 to − 0.193, p < 0.05) (see Table 4 ). Table 4 Correlation analysis between NSSI severity and impulsivity NSSI Past 1 month Past 6 month Past 12 month Total score of BIS 0.283** 0.228** 0.198* MIS 0.417** 0.372** 0.345** Go ACC -0.225** -0.248** -0.193* Note: MIS: motor impulsivity subscale ; Go ACC：accuracy of go task；**：＜0.001；*：＜0.05 Discussion Depressed adolescent patients with NSSI reported higher impulsivity Our results align with prior research ( 29 – 32 ), demonstrating that adolescent MDD patients with NSSI exhibited higher scores on the BIS total and motor impulsivity subscale compared to both MDD patients without NSSI and healthy controls. Furthermore, our study revealed a positive correlation between higher impulsivity scores and the severity of past NSSI, particularly for motor impulsivity, consistent with earlier findings ( 33 ). Specifically, Cassels et al( 33 ) discovered that the impulsivity independently predicted the initiation of new NSSI incidents, surpassing other risk factors. As outlined in the introduction section ( 10 ), NSSI can often occur spontaneously and with minimal preparation. Consequently, individuals with high motor impulsivity may be more prone to engaging in NSSI rapidly, especially when influenced by strong emotions or other precipitating factors. Previous research( 33 , 34 ) indicated that highly impulsive individuals frequently exhibit emotional dysregulation, attention deficits, and deficiencies in perseverance and planning skills. All these traits, particularly emotional dysregulation, have been established as significant risk factors for NSSI( 35 , 36 ). Depressed adolescent patients with NSSI exhibit higher behavioral impulsivity Adolescent MDD patients with NSSI showed the lowest accuracy rate on go task, t indicating the highest omission errors., They were followed by adolescent MDD patients without NSSI and then healthy controls, with a significant difference specifically observed between adolescent MDD patients with NSSI and healthy controls. Furthermore, omission errors negatively correlation with the severity of prior NSSI. Adolescent MDD patients with NSSI also displayed a lower accuracy rate in the no-go task (i.e., higher commission errors), however, this difference among the three groups was not statistically significant. This aligns with a prior study( 37 ), which found no significant variances in behavioral impulsivity in individuals with NSSI compared to adolescents without NSSI. Nevertheless, our findings contrast with a previous study ( 16 ) that observed higher omission and commission errors in college students with NSSI compared to healthy control. The accuracy of go task is linked to sustained attention, while the accuracy of no-go task reflects executive control and impulse suppression, with reaction time indicating the speed of information processing. Our findings indicate that adolescent MDD patients, regardless of NSSI status, exhibit impaired sustained attention compared to healthy controls, with more pronounced impairment seen in those with NSSI. This could be partly attributed to the fact that both groups of adolescent MDD patients were diagnosed with moderate to severe MDD, a condition known to involve cognitive deficits and severe attention impairments. Additionally, previous study( 38 ) demonstrated that individuals with NSSI demonstrate a more cognitive significant flexibility deficit, independent of core disease symptoms, compared to those without NSSI. No significant difference was observed in neuro-physiologically assessed impulsivity Our findings further revealed that the P3 amplitude during the no-go task was smaller in adolescent MDD patients with NSSI compared to both adolescent MDD patients without NSSI and healthy controls. Additionally, the N2 amplitude during the same task was greater in adolescent MDD patients with NSSI than in those without NSSI and healthy controls. However, this latter variance was not statistically significant, presenting a deviation from some prior research outcomes. For instance, Yu et al( 16 ) observed a significantly higher N2 amplitude during the no-go task in college students with NSSI compared to those without NSSI, which would aligning with our initial hypothesis. Conversely, their study did not identify a difference in P3 amplitude between college students with and without NSSI during no-go task. The N2 component, primarily localized in the frontal lobe, contributes to error detection and conflict monitoring. In contrast, the P3 component predominantly reflects the behavioral process of response inhibition, effectively representing the psychological phenomenon of impulsivity( 39 ). Although our study did not uncover statistically significant differences in N2 and P3 between individuals with NSSI and healthy controls, we did observe a decline trend in N2 and P3 in adolescents MDD who engaged in NSSI during no-go tasks. The likely reason for these non-significant results could be attributed to our study's relatively small sample size, increasing the sample size may reveal significant differences. Furthermore, it's plausible that neuro-electrophysiological alterations related to impulsivity exist in adolescent MDD patients with NSSI, even if these alterations do not manifest as significant damage to neural potentials. Limitations While our study explored impulsivity among adolescent MDD with NSSI from a multi-dimensional perspective, several limitations should be acknowledged. First, although ERPs offer excellent temporal resolution, their lack precise spatial resolution. Integrating functional magnetic resonance imaging (fMRI) could help localize the specific brain regions responsible for generating ERP components, such as the N2 and P3 waves. Second, the sample size of this study was relatively small, underscoring the need for larger, well-matched cohorts in future research to enhance the generalizability and validity of the findings. Lastly, the retrospective assessment of NSSI within a cross-sectional design may be subject to recall bias. To address this, a longitudinal follow-up study is planned to monitor dynamic changes in impulsivity over time, particularly in relation to the progression or remission of NSSI with age. Conclusions Elevated self-reported and behaviorally assessed motor impulsivity have been observed in adolescent patients experiencing both MDD and Non-Suicidal Self- NSSI. These alterations demonstrate a close link with the severity of NSSI. Nevertheless, it's worth noting that such changes in impulsivity may not result in significant neurological damage. Declarations Funding This work was supported by the Natural Science Foundation of Changsha City (KQ2502193), the STI 2030—Major Projects (2022ZD0209102), and the Scientific Research Launch Project for new employees of the Second Xiangya Hospital of Central South University. Author Contribution Yuqiong He collected, collated, and analyzed data and were key contributing authors of the manuscript. Tingyu Yang, Kun Zhang, and Shuxian Wu collected data and assisted with the revision of the manuscript. Chunxiang Huang, Xueping Gao and Xuerong Luo assisted in patient recruitment and drafting of the paper. Yaru Zhang and Xilong Cui managed and supervised the study, revised the manuscript, and performed clinical assessment of the severity of symptoms. All authors have contributed to and approved the final manuscript. Acknowledgement The authors thank all the participants and their guardians for their participation in this study and continuous support. References Brown RC, Plener PL. Non-suicidal Self-Injury in Adolescence. Current psychiatry reports. 2017;19(3):20. Lang J, Yao Y. Prevalence of nonsuicidal self-injury in chinese middle school and high school students: A meta-analysis. Medicine. 2018;97(42):e12916. Andover MS, Morris BW, Wren A, Bruzzese ME. 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Westlund Schreiner M, Klimes-Dougan B, Mueller BA, Eberly LE, Reigstad KM, Carstedt PA, et al. Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity. Journal of affective disorders. 2017;221:47-55. Hamilton M. A rating scale for depression. Journal of neurology, neurosurgery, and psychiatry. 1960;23(1):56-62. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. The British journal of psychiatry : the journal of mental science. 1978;133:429-35. Nixon MK, Levesque C, Preyde M, Vanderkooy J, Cloutier PF. 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. 2015;9:26. Lu CF, Jia CX, Xu AQ, Dai AY, Qin P. Psychometric characteristics of Chinese version of Barratt Impulsiveness Scale-11 in suicides and living controls of rural China. Omega. 2012;66(3):215-29. Zhao D, Gu R, Tang P, Yang Q, Luo YJ. Incidental emotions influence risk preference and outcome evaluation. Psychophysiology. 2016;53(10):1542-51. Delorme A, Makeig S. EEGLAB: an open source toolbox for analysis of single-trial EEG dynamics including independent component analysis. Journal of neuroscience methods. 2004;134(1):9-21. Jung TP, Makeig S, Westerfield M, Townsend J, Courchesne E, Sejnowski TJ. Removal of eye activity artifacts from visual event-related potentials in normal and clinical subjects. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2000;111(10):1745-58. Cragg L, Fox A, Nation K, Reid C, Anderson M. Neural correlates of successful and partial inhibitions in children: an ERP study. Developmental psychobiology. 2009;51(7):533-43. Yin J, Yuan K, Feng D, Cheng J, Li Y, Cai C, et al. Inhibition control impairments in adolescent smokers: electrophysiological evidence from a Go/NoGo study. Brain imaging and behavior. 2016;10(2):497-505. Jonkman LM, Sniedt FL, Kemner C. Source localization of the Nogo-N2: a developmental study. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2007;118(5):1069-77. Costa RPO, Peixoto A, Lucas CCA, Falcão DN, Farias J, Viana LFP, et al. Profile of non-suicidal self-injury in adolescents: interface with impulsiveness and loneliness. Jornal de pediatria. 2021;97(2):184-90. Gatta M, Dal Santo F, Rago A, Spoto A, Battistella PA. Alexithymia, impulsiveness, and psychopathology in nonsuicidal self-injured adolescents. Neuropsychiatric disease and treatment. 2016;12:2307-17. Huang YH, Liu HC, Tsai FJ, Sun FJ, Huang KY, Chiu YC, et al. Correlation of impulsivity with self-harm and suicidal attempt: a community study of adolescents in Taiwan. BMJ open. 2017;7(12):e017949. Rodav O, Levy S, Hamdan S. Clinical characteristics and functions of non-suicide self-injury in youth. European psychiatry : the journal of the Association of European Psychiatrists. 2014;29(8):503-8. Cassels M, Neufeld S, van Harmelen AL, Goodyer I, Wilkinson P. Prospective Pathways From Impulsivity to Non-Suicidal Self-Injury Among Youth. Archives of suicide research : official journal of the International Academy for Suicide Research. 2022;26(2):534-47. McHugh CM, Chun Lee RS, Hermens DF, Corderoy A, Large M, Hickie IB. Impulsivity in the self-harm and suicidal behavior of young people: A systematic review and meta-analysis. Journal of psychiatric research. 2019;116:51-60. Wolff JC, Thompson E, Thomas SA, Nesi J, Bettis AH, Ransford B, et al. Emotion dysregulation and non-suicidal self-injury: A systematic review and meta-analysis. European psychiatry : the journal of the Association of European Psychiatrists. 2019;59:25-36. Maxfield BL, Pepper CM. Impulsivity and Response Latency in Non-Suicidal Self-Injury: The Role of Negative Urgency in Emotion Regulation. The Psychiatric quarterly. 2018;89(2):417-26. Kim JS, Kang ES, Bahk YC, Jang S, Hong KS, Baek JH. Exploratory Analysis of Behavioral Impulsivity, Pro-inflammatory Cytokines, and Resting-State Frontal EEG Activity Associated With Non-suicidal Self-Injury in Patients With Mood Disorder. Frontiers in psychiatry. 2020;11:124. Nilsson M, Lundh L, Westrin Å, Westling S. Executive functioning in psychiatric patients with deliberate self-harm, as compared with a psychiatric and a healthy comparison group. Journal of clinical and experimental neuropsychology. 2021;43(3):225-37. Nguyen AT, Moyle JJ, Fox AM. N2 and P3 modulation during partial inhibition in a modified go/nogo task. International journal of psychophysiology : official journal of the International Organization of Psychophysiology. 2016;107:63-71. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 18 Dec, 2025 Reviews received at journal 12 Dec, 2025 Reviews received at journal 09 Dec, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers agreed at journal 14 Nov, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers invited by journal 24 Sep, 2025 Editor assigned by journal 22 Sep, 2025 Submission checks completed at journal 17 Sep, 2025 First submitted to journal 06 Sep, 2025 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. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":23215,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the ERP experimental task\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7548791/v1/72ce6614ac80a2e701c9aa31.jpg"},{"id":93074739,"identity":"0d1871e7-2e0f-4cff-812d-d7b3ef8c4f2b","added_by":"auto","created_at":"2025-10-08 18:41:34","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":189485,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of ERP graphs in Fz, Cz and Pz among the three groups of subjects\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7548791/v1/4084d1bc653892d32a140908.jpg"},{"id":93074841,"identity":"9ba78417-7727-40ad-892b-78820f8ba878","added_by":"auto","created_at":"2025-10-08 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This behavior encompasses various actions, such as cutting, scratching, or burning the skin. Additionally, it includes indirect forms, such as forcefully striking hard surfaces (e.g., walls), which can result in injury to the skin or bones (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The prevalence of NSSI among Chinese students is a growing public health concern that warrants urgent attention. A comprehensive analysis encompassing 420 studies and 160,348 participants specifically focusing on Chinese students has indicated that the pooled prevalence rate of NSSI stands at 22.37%, with females exhibiting a higher prevalence (21.9%) compared to males (20.6%)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough NSSI typically occurs in the absence of suicidal intent, a growing body of evidence indicates that it constitutes a significant risk factor for suicide attempts(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Moreover, NSSI is strongly associated with subsequent suicidal behavior, highlighting its critical role in the trajectory of self-harm towards more life-threatening actions(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Recent research has revealed a time-dependent relationship between the onset of NSSI and future suicidal behavior, demonstrating that an earlier initiation of NSSI is significantly associated with an elevated risk of future suicide attempts(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although not all individuals who engage in NSSI progress to suicidal behavior, many experience elevated emotional distress and persistent difficulties in emotion regulation(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Given the widespread occurrence of NSSI and its far-reaching detrimental consequences, pinpointing the risk factors associated with NSSI engagement has emerged as an urgent and paramount research priority.\u003c/p\u003e\u003cp\u003eNumerous factors have been identified as influencing the occurrence of NSSI, among which impulsivity stands out as a particularly critical contributor. Accumulating evidence suggests that individuals who engage in NSSI tend to display heightened impulsivity, a trait that appears to be more pronounced in clinical populations than in the general public (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Impulsivity is typically defined as a tendency to respond rapidly and spontaneously to internal or external cues, often without a sufficient consideration of the potential negative consequences of one\u0026rsquo;s actions, either for themselves or for others(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Impulsivity can be assessed at multiple levels. The most basic approach involves self-report questionnaires, while more objective assessments utilize behavioral tasks. At the neurophysiological level, event-related potentials (ERPs) provide a direct and sensitive measure of impulsivity-related brain activity. Many individuals who engage in NSSI report acting on the impulse almost immediately after the thought arises, with little delay between ideation and behavior. This rapid transition has led researchers to propose that heightened impulsivity may play a pivotal role in the emergence and manifestation of NSSI behaviors. Professor Nock emphasized that individuals with elevated impulsivity may be at increased risk of NSSI, particularly during emotionally challenging situations, as such acts can be carried out quickly and without substantial forethought or planning (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eDespite the theory that impulsivity increases of NSSI, whether individuals with NSSI exhibit higher levels of impulsivity remains a controversial topic. Some researchers argue that individuals with NSSI may display increased impulsivity by self-reported(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), while others maintain contrasting views (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Janis et al (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) discovered that adolescents and adults who engage in NSSI reported higher levels of self-reported impulsivity compared to those who do not engage in NSSI. Matera (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) reported there was a potential link between higher self-reported impulsivity and NSSI behaviors inpatients with NSSI. Tschan et al found that the patients with BPD engaged in NSSI reported higher levels of impulsivity than the non-NSSI group(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, Claes et al (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) reported there was no significant difference in self-reported impulsivity between anorexia nervosa (AN) patients with NSSI and without NSSI. The contradictory outcome also emerges in the impulsivity of behavioral measurement. Claes\u0026rsquo;s result shown anorexia nervosa (AN) patients with NSSI reported they have higher impulsivity of behavioral measurement than those who without NSSI(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, Janis et al\u0026rsquo;\u003csup\u003es\u003c/sup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and Tschan et al\u0026rsquo;\u003csup\u003es\u003c/sup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) found there was no significant difference in the behavioral tasks between NSSI group and non-NSSI group. Lutz et al(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) discovered that adolescents with repetitive NSSI are associated with increased behavioral compulsivity but not with behavioral impulsivity. Limited research explored the neurophysiological assessed impulsivity. One study in college students has pointed out that college students who engage in NSSI exhibit elevated impulsivity in ERPs(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). It was observed that the N2 amplitude of the no-go response in college students with NSSI was notably higher in the prefrontal region compared to students without NSSI, and the N2 latency was longer in the NSSI group than in the control group. Another study revealed that the children with a history of NSSI exhibited significantly more negative ΔFN (i.e., FN to losses minus FN to gains) than children without NSSI, which was associated with enhanced impulsivity(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe existing literature presents conflicting findings, with some studies suggesting a strong association between NSSI and elevated impulsivity, while others have failed to replicate these results. This divergence of evidence has led to ongoing debates regarding the nature and extent of the link between NSSI and impulsivity in different dimensions, highlighting the need for further research to clarify this complex relationship. In the present study, our objective was to comprehensively examine impulsivity across various dimensions in adolescents with non-suicidal self-injury (NSSI) and ascertain whether they display elevated levels of this trait. Our central hypothesis posits that recurrent NSSI is intricately linked to impulsivity. We anticipated this association would manifest through alterations in self-reported impulsivity scores, observable behavioral disinhibition, and distinct patterns within event-related potential (ERP) recordings.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eBetween October 2020 and December 2021, adolescents diagnosed with major depressive disorder (MDD) was recruited from the Children and Adolescent Psychiatry Department of the Second Xiangya Hospital, Central South University. All MDD patients met the following criteria:1) Aged 12\u0026ndash;17 years; 2) Met DSM-V diagnostic criteria for depression, with a Hamilton Rating Scale for Depression (HAMD-17) score\u0026thinsp;\u0026ge;\u0026thinsp;17 and Young Mania Rating (YMRS) score\u0026thinsp;\u0026le;\u0026thinsp;5; 3) Right-handed with normal uncorrected or corrected vision; 4) Capable of understanding informed consent form and study procedures. Participants in the NSSI group had engaged in NSSI\u0026thinsp;\u0026ge;\u0026thinsp;5 times with in the past 12 months, with at least one incident in the past month(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Those with no history of NSSI were assigned to the non-NSSI group. MDD patients were excluded if they: 1) Had a suicide attempt within the past month; 2) Had organic mental disorders, schizophrenia, mental retardation, autism, tic disorder, personality disorder, substance or drug dependence and other mental disorders; 3) Had physical diseases affecting the assessment and testing; 4) had a history of craniocerebral trauma, epilepsy and other relevant conditions. For comparison, healthy adolescents were recruited from high schools in Changsha City as controls. Inclusion criteria for healthy controls:1) Aged 12\u0026ndash;17 years; 2) No current or past history of mental disorders (confirmed via the Mini International Neuropsychiatric Interview for Children and Adolescents [MINI-KID]); 3) No history of NSSI; 4) No family history of mental disorder; 5) Right-handed, with normal or corrected-to-normal vision; 6) Capable of understanding the informed consent form and study procedures. The exclusion criteria for healthy controls: 1) Physical illnesses impacting assessments or testing; 2) History of cranial trauma, epilepsy, or other relevant medical conditions; 3) Any other conditions hindering study completion.\u003c/p\u003e\u003cp\u003eThis study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University. Prior to enrollment, written informed consent was obtained from all participants and their legal guardians. All participants underwent clinical interviews and assessments conducted by two certified child psychiatrists who had completed standardized training before the study began.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eProcedures\u003c/h3\u003e\n\u003cp\u003eGeneral demographic and background information was collected for for all the participants, including gender, age, family history of mental disorders, only child status, and years of education. Additionally, for patients with MDD, additional clinical data were gathered, including the number of depressive episodes and the type of depression (recurrent vs. first episode). The Mini International Neuropsychiatric Interview for Children and Adolescents, 5th edition (MINI-Kid 5.0) was used to exclude adolescents with MDD who had comorbid psychiatric disorders and to screen healthy controls for any psychiatric diagnoses. The 17-item Hamilton Rating Scale for Depression (HAMD-17)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and Young Mania Rating Scale (YMRS)(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) were employed as part of the inclusion criteria for the MDD group. The frequency of NSSI, assessed using the Ottawa Self-Injury Inventory (OSI), was also included as an inclusion criteria (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Self-reported impulsivity was measured using the Chinese version of the Barratt Impulsivity Scale (BIS-11), which consists of three subscales: non-planning impulsivity subscale, motor impulsivity subscale, and attentional impulsivity subscale. Each subscale contains 10 items, rated on a 4-point Likert scale ranging from 1 (rarely or never) to 4 (almost always) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eBehavioral task and event-related potentials\u003c/h3\u003e\n\u003cp\u003eThe ERP task (go/on-go paradigm) was designed using E-prime 2.0 Basic Standard Edition. A total of 180 facial images\u0026mdash;45 negative, 90 neutral, and 45 positive \u0026mdash;were selected from the Chinese Facial Affective Picture System (CFAPS)(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The experiment included one brief practice session followed by three main experiment blocks. Each formal block contained 120 trails, consisting of 90 go trials and 30 no-go trials. Emotional (positive and negative) and neutral facial stimuli were presented randomly, with occurrence probabilities of 25% for negative, 25% for positive, and 50% for neutral stimuli.\u003c/p\u003e\u003cp\u003eEach trial began with a 50 ms black screen, followed by the presentation of a facial image for 1000ms. Participants were instructed to respond by pressing the space bar for each image unless the current image matched the one immediately before it, in which case they were to withhold their response. The instruction provided to participants was as follows: \u0026ldquo;You will view various face pictures. Press the space bar each time you see a picture. If the current picture matches the previous one, no key press is needed.\u0026rdquo; A black screen was then shown for approximately 1500 ms before the next trial began. This sequence was repeated throughout the session, and the entire task lasted approximately 15 minutes. This paradigm has been previously used to assess impulsivity in earlier studies.\u003c/p\u003e\u003cp\u003eERP data were recorded using a 64-channel EEG system (Braincap), with electrodes positioned according to the international 10\u0026ndash;20 system and FCz used as the reference electrode. Data were collected using Recorder software at a sampling rate of 5000 Hz. Scalp impedance was maintained below 5 kΩ throughout the recording.\u003c/p\u003e\u003cp\u003e2) Behavioral and EEG data preprocessing\u003c/p\u003e\u003cp\u003eBehavioral data, including the accuracy of go and no-go tasks as well as the reaction time for go trials, were extracted from the behavioral data using E-Prime 2.0.1.0.8 for subsequent statistical analysis. The pretreatment of EEG data was conducted using the EEGLAB platform (2013b) within Matlab2013b. The ERP data underwent the following preprocessing steps: lower the sample rate into 500 Hz; band-pass filtering (high-pass filter\u0026thinsp;\u0026ge;\u0026thinsp;1Hz, low-pass filter\u0026thinsp;\u0026le;\u0026thinsp;45Hz) and notch filtering (48-52Hz); epoch segmentation (from 0.5 s before to 1.2 s after stimulus onset); removal of noisy epochs ((identified manually based on head movement artifacts); spherical interpolation for bad channels (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e); artifact removal \u0026mdash;including ocular and electrocardiographic artifacts\u0026mdash;using independent component analysis (ICA) in EEGLAB (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), re-reference to the bilateral mastoids, and removal of extreme-value segments with voltage amplitudes exceeding\u0026thinsp;\u0026plusmn;\u0026thinsp;100 \u0026micro;V. All preprocessing steps were conducted by a trained researcher.\u003c/p\u003e\u003cp\u003eAccording to previous research(\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), the N2 component typically emerges around 90\u0026ndash;110 ms post-stimulus in the prefrontal lobe, while the P3 component is predominantly observed in the frontal lobe or frontocentral lobe in both adults and children. In the present study, the N2 component was analyzed electrodes Fz and Cz, and the P3 component at electrodes Cz and Pz. To enable further comparisons, the mean amplitude of N2 and P3 components were calculated with a time window defined by the mean latency\u0026thinsp;\u0026plusmn;\u0026thinsp;one standard deviation. Only correct trials were included in the averaged ERPs for analysis.\u003c/p\u003e\u003cp\u003eIn the present study, the N2 component was analyzed at electrodes Fz and Cz, and the P3 component at electrodes Cz and Pz. To enable further comparisons, the mean amplitudes of the N2 and P3 components were calculated within a time window defined by the mean latency\u0026thinsp;\u0026plusmn;\u0026thinsp;one standard deviation. Only correct trials were included in the ERP averaging for analysis.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were conducted using SPSS 26.0. Continuous variables were represented as mean (M)\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), while categorical variables were represented by frequency (n). Single-factor ANOVA and Chi-square test were employed for the analysis. Post hoc tests utilized pairwise comparisons and Bonferroni corrections. Repeated measures ANOVA (group \u0026times; condition \u0026times; electrode) was used to compare the different components b across various groups. With groups as a between-subjects factor, while channels and type of condition (go vs no-go) as within-subjects factors. Greenhouse\u0026ndash;Geisser correction was applied for ANOVA analysis. \u003cem\u003eP\u003c/em\u003e values were two-sided with a significance level of 0.05. Spearman correlation analysis was used to explore the relationship between the severity of NSSI and impulsivity., with a significance level set at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eComparison of general demographic and clinical data among the three groups\u003c/h2\u003e\u003cp\u003eA total of 145 participants were included in the study and categorized into three groups: the NSSI group (n\u0026thinsp;=\u0026thinsp;50; 12 males, 38 females), the non-NSSI group (n\u0026thinsp;=\u0026thinsp;45; 16 males, 29 females), and the healthy control (HC) group (n\u0026thinsp;=\u0026thinsp;50; 25 males, 25 females). Statistical analysis revealed a significant difference in gender distribution among the three groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026). Post hoc analysis indicated a significant difference between the HC and NSSI groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007),\u003c/p\u003e\u003cp\u003ewhile no significant differences were found between the NSSI and non-NSSI groups (p\u0026thinsp;=\u0026thinsp;0.217), or between the HC and non-NSSI groups (p\u0026thinsp;=\u0026thinsp;0.156) (see 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 demographic and clinical data among the three group\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=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNSSI\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003enon-NSSI\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHC\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/F/པ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\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\u003en/ M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en/ M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en/ M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\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\u003egender(male/female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12/38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16/29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25/25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.026\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly child(yes/no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19/31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14/31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13/37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.673\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.433\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eage(yeas)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.555\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.215\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation time(year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003edepression episodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.281\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.779\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003edepression type (Recurrent/first episode)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2/48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2/43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.914\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily history (Yes/No/missing value)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6/43/1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3/39/3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.661\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.416\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHAMD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.84\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.259\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.796\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYMRS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.738\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.468\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedication or not(yes/no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15/35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6/39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.821\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote： M:mean；SD：Standard deviation；a：NSSI group vs HC group，b:non-NSSI group vs HC group，c:NSSI group vs non-NSSI group（Bonferroni corrected p＜0.05)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNo significant differences were found among the three groups in other demographic variables, including age, years of education, and only-child status (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Additionally, there were no significant differences between the non-NSSI and NSSI groups in clinical characteristics such as the number of depression episodes, type of depression, family history of mental disorders, HAMD score, YMRS score, and medication history (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eComparison of self-reported impulsivity and behavioral impulsivity among the three groups\u003c/h3\u003e\n\u003cp\u003eAdolescents in NSSI group exhibited higher total scores of BIS compared to those in the non-NSSI and HC groups. Post hoc analysis revealed statistically significant differences between the NSSI and HC groups, as well as between the non-NSSI and HC groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, the difference between non-NSSI and NSSI groups was not significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Regarding the motor impulsivity subscale, adolescents in the NSSI group had significantly higher scores than those in the non-NSSI group, who in turn scored higher than the HC group. Statistical analysis revealed significant differences among all three groups: between NSSI and HC, non-NSSI and HC, and NSSI and non-NSSI (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eIn terms of task performance, the accuracy of go task in the NSSI group was lower compared to both the non-NSSI and HC groups, with a statistically significant overall difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). pairwise comparisons showed a significant difference only between the NSSI and HC groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008). For the no-go task, the NSSI group also exhibited lower accuracy compared to the non-NSSI and HC groups, but the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.329). Additionally, the non-NSSI group had a shorter response time in the go task compared to the NSSI and HC groups, though this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.145) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\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 self-reported impulsivity and behaviorally assessed among the three groups\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\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNSSI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003enon-NSSI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\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\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal score of BIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68.28\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.32\u0026thinsp;\u0026plusmn;\u0026thinsp;8.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.480\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.001\u003csup\u003ea,b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003ea,b,c\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.339\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNPIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.51\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.314\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGo ACC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.914\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.009\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo-go ACC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.329\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGo RT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e524.18\u0026thinsp;\u0026plusmn;\u0026thinsp;65.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e511.32\u0026thinsp;\u0026plusmn;\u0026thinsp;64.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e537.93\u0026thinsp;\u0026plusmn;\u0026thinsp;51.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote： M:mean；SD：Standard deviation；MIS: motor impulsivity subscale; AIS: attentional impulsivity subscale; NPIS: non-planning impulsivity subscale; Go ACC：accuracy of go task；No-go ACC：accuracy of no-go task; Go RT：response time of go task，a：NSSI group vs HC group，b:non-NSSI group vs HC group，c:NSSI group vs non-NSSI group（Bonferroni corrected p＜0.05）\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eComparison of go/no-go latency and amplitude among three groups\u003c/h3\u003e\n\u003cp\u003eRepeated measurement ANOVA was conducted to compare the latency of N2 and P3 across different electrode and task conditions. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the detailed latencies and amplitudes of N2 and P3 at various electrodes. The main effect of group on N2 latency was not significant (F\u0026thinsp;=\u0026thinsp;2.337, η\u0026sup2;=0.032, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.100). However, further analysis revealed a significant effect of task condition at electrode Cz: N2 latency was longer during the no-go task (323.22\u0026thinsp;\u0026plusmn;\u0026thinsp;15.32 ms) than during the go task (320.55\u0026thinsp;\u0026plusmn;\u0026thinsp;15.42 ms), and this difference was significant (F\u0026thinsp;=\u0026thinsp;4.623, p\u0026thinsp;=\u0026thinsp;0.033)(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Supplementary Table\u0026nbsp;1).\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\u003eEffects of different factors on different conditions and electrodes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEffect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\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\u003eN2\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eLatency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.337\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConditions(go,nogo)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElectrodes(Fz,Cz)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.607\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)*conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.866\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)*Electrodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.371\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup*conditions*Electrodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.619\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.357\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eAmplitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.835\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econditions(go,nogo)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e148.247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElectrodes(Fz,Cz)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e197.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup*conditions*Electrodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.335\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)*Electrodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.134\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)*conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.127\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP3\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003elatency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.353\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econditions(go,nogo)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.871\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElectrodes(Fz,Pz)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.588\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)*conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.849\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)*Electrodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.234\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup*conditions*Electrodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.891\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eAmplitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.835\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econditions(go,nogo)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e148.247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElectrodes(Fz,Pz)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e197.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup*conditions*Electrodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.335\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)*Electrodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.134\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup(NSSI, non-NSSI,HC)*conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.127\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\u003eA significant main effect of group was observed in P3 latency (F\u0026thinsp;=\u0026thinsp;3.353, η\u0026sup2;=0.046, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.038). Subsequent analysis indicated that at electrode Cz, P3 latency was significantly longer in the no-go task (536.14\u0026thinsp;\u0026plusmn;\u0026thinsp;32.17 ms) compared to the go task (527.72\u0026thinsp;\u0026plusmn;\u0026thinsp;28.99 ms) (F\u0026thinsp;=\u0026thinsp;8.251, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). However, no significant in P3 latency were observed among the three groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Supplementary Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eRegarding N2 amplitude, the main effect of group was not significant (F\u0026thinsp;=\u0026thinsp;0.181, η\u0026sup2;=0.003, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.835). Further analysis indicated that N2 amplitude at electrodes Fz and Cz was significantly smaller during the no-go task compared to the go task (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, the main effect of group on P3 amplitude was not significant (F\u0026thinsp;=\u0026thinsp;0.833, η\u0026sup2;=0.012, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.437)(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Supplementary Table\u0026nbsp;1). However, the P3 amplitude at electrodes Cz and Pz was significantly larger in the no-go task than in the go task (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No statistically significant group differences were found in P3 amplitude across the three groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Although the NSSI group showed smaller P3 amplitudes at Cz and Pz compared to the non-NSSI and HC groups during the no-go task, these differences did not reach statistical significance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCorrelation analysis between NSSI severity and impulsivity\u003c/h2\u003e\u003cp\u003eThe severity of NSSI over the past 1 month, 6 months and 12 months was positively correlated with motor impulsivity subscale and the total BIS score (r\u0026thinsp;=\u0026thinsp;0.198\u0026ndash;0.417, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, the severity of NSSI across the same time intervals was negatively correlated with the accuracy of go task (r=-0.248 _ -0.193, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In contrast, NSSI severity across the same time intervals was negatively correlated with go task accuracy (r = \u0026minus;\u0026thinsp;0.248 to \u0026minus;\u0026thinsp;0.193, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (see 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\u003eCorrelation analysis between NSSI severity and impulsivity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNSSI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePast 1 month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePast 6 month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePast 12 month\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal score of BIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.283**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.228**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.198*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.417**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.372**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.345**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGo ACC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.225**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.248**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.193*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: MIS: motor impulsivity subscale ; Go ACC：accuracy of go task；**：＜0.001；*：＜0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003eDepressed adolescent patients with NSSI reported higher impulsivity\u003c/b\u003e Our results align with prior research (\u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), demonstrating that adolescent MDD patients with NSSI exhibited higher scores on the BIS total and motor impulsivity subscale compared to both MDD patients without NSSI and healthy controls. Furthermore, our study revealed a positive correlation between higher impulsivity scores and the severity of past NSSI, particularly for motor impulsivity, consistent with earlier findings (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Specifically, Cassels et al(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) discovered that the impulsivity independently predicted the initiation of new NSSI incidents, surpassing other risk factors. As outlined in the introduction section (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), NSSI can often occur spontaneously and with minimal preparation. Consequently, individuals with high motor impulsivity may be more prone to engaging in NSSI rapidly, especially when influenced by strong emotions or other precipitating factors. Previous research(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) indicated that highly impulsive individuals frequently exhibit emotional dysregulation, attention deficits, and deficiencies in perseverance and planning skills. All these traits, particularly emotional dysregulation, have been established as significant risk factors for NSSI(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eDepressed adolescent patients with NSSI exhibit higher behavioral impulsivity\u003c/h2\u003e\u003cp\u003eAdolescent MDD patients with NSSI showed the lowest accuracy rate on go task, t indicating the highest omission errors., They were followed by adolescent MDD patients without NSSI and then healthy controls, with a significant difference specifically observed between adolescent MDD patients with NSSI and healthy controls. Furthermore, omission errors negatively correlation with the severity of prior NSSI. Adolescent MDD patients with NSSI also displayed a lower accuracy rate in the no-go task (i.e., higher commission errors), however, this difference among the three groups was not statistically significant. This aligns with a prior study(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), which found no significant variances in behavioral impulsivity in individuals with NSSI compared to adolescents without NSSI.\u003c/p\u003e\u003cp\u003eNevertheless, our findings contrast with a previous study (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) that observed higher omission and commission errors in college students with NSSI compared to healthy control. The accuracy of go task is linked to sustained attention, while the accuracy of no-go task reflects executive control and impulse suppression, with reaction time indicating the speed of information processing. Our findings indicate that adolescent MDD patients, regardless of NSSI status, exhibit impaired sustained attention compared to healthy controls, with more pronounced impairment seen in those with NSSI. This could be partly attributed to the fact that both groups of adolescent MDD patients were diagnosed with moderate to severe MDD, a condition known to involve cognitive deficits and severe attention impairments. Additionally, previous study(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) demonstrated that individuals with NSSI demonstrate a more cognitive significant flexibility deficit, independent of core disease symptoms, compared to those without NSSI.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eNo significant difference was observed in neuro-physiologically assessed impulsivity\u003c/h2\u003e\u003cp\u003eOur findings further revealed that the P3 amplitude during the no-go task was smaller in adolescent MDD patients with NSSI compared to both adolescent MDD patients without NSSI and healthy controls. Additionally, the N2 amplitude during the same task was greater in adolescent MDD patients with NSSI than in those without NSSI and healthy controls. However, this latter variance was not statistically significant, presenting a deviation from some prior research outcomes. For instance, Yu et al(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) observed a significantly higher N2 amplitude during the no-go task in college students with NSSI compared to those without NSSI, which would aligning with our initial hypothesis. Conversely, their study did not identify a difference in P3 amplitude between college students with and without NSSI during no-go task.\u003c/p\u003e\u003cp\u003eThe N2 component, primarily localized in the frontal lobe, contributes to error detection and conflict monitoring. In contrast, the P3 component predominantly reflects the behavioral process of response inhibition, effectively representing the psychological phenomenon of impulsivity(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Although our study did not uncover statistically significant differences in N2 and P3 between individuals with NSSI and healthy controls, we did observe a decline trend in N2 and P3 in adolescents MDD who engaged in NSSI during no-go tasks. The likely reason for these non-significant results could be attributed to our study's relatively small sample size, increasing the sample size may reveal significant differences. Furthermore, it's plausible that neuro-electrophysiological alterations related to impulsivity exist in adolescent MDD patients with NSSI, even if these alterations do not manifest as significant damage to neural potentials.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eWhile our study explored impulsivity among adolescent MDD with NSSI from a multi-dimensional perspective, several limitations should be acknowledged. First, although ERPs offer excellent temporal resolution, their lack precise spatial resolution. Integrating functional magnetic resonance imaging (fMRI) could help localize the specific brain regions responsible for generating ERP components, such as the N2 and P3 waves. Second, the sample size of this study was relatively small, underscoring the need for larger, well-matched cohorts in future research to enhance the generalizability and validity of the findings. Lastly, the retrospective assessment of NSSI within a cross-sectional design may be subject to recall bias. To address this, a longitudinal follow-up study is planned to monitor dynamic changes in impulsivity over time, particularly in relation to the progression or remission of NSSI with age.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eElevated self-reported and behaviorally assessed motor impulsivity have been observed in adolescent patients experiencing both MDD and Non-Suicidal Self- NSSI. These alterations demonstrate a close link with the severity of NSSI. Nevertheless, it's worth noting that such changes in impulsivity may not result in significant neurological damage.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis work was supported by the Natural Science Foundation of Changsha City (KQ2502193), the STI 2030\u0026mdash;Major Projects (2022ZD0209102), and the Scientific Research Launch Project for new employees of the Second Xiangya Hospital of Central South University.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYuqiong He collected, collated, and analyzed data and were key contributing authors of the manuscript. Tingyu Yang, Kun Zhang, and Shuxian Wu collected data and assisted with the revision of the manuscript. Chunxiang Huang, Xueping Gao and Xuerong Luo assisted in patient recruitment and drafting of the paper. Yaru Zhang and Xilong Cui managed and supervised the study, revised the manuscript, and performed clinical assessment of the severity of symptoms. All authors have contributed to and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank all the participants and their guardians for their participation in this study and continuous support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBrown RC, Plener PL. Non-suicidal Self-Injury in Adolescence. Current psychiatry reports. 2017;19(3):20.\u003c/li\u003e\n\u003cli\u003eLang J, Yao Y. Prevalence of nonsuicidal self-injury in chinese middle school and high school students: A meta-analysis. Medicine. 2018;97(42):e12916.\u003c/li\u003e\n\u003cli\u003eAndover MS, Morris BW, Wren A, Bruzzese ME. The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates. 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Brain sciences. 2021;11(8).\u003c/li\u003e\n\u003cli\u003eClaes L, Fagundo AB, Jim\u0026eacute;nez-Murcia S, Ag\u0026uuml;era Z, Giner-Bartolome C, Granero R, et al. Is non-suicidal self-injury related to impulsivity in anorexia nervosa? Results from self-report and performance-based tasks. European eating disorders review : the journal of the Eating Disorders Association. 2015;23(1):28-33.\u003c/li\u003e\n\u003cli\u003eLutz NM, Chamberlain SR, Goodyer IM, Bhardwaj A, Sahakian BJ, Jones PB, et al. Behavioral measures of impulsivity and compulsivity in adolescents with nonsuicidal self-injury. CNS spectrums. 2022;27(5):604-12.\u003c/li\u003e\n\u003cli\u003eTschan T, Peter-Ruf C, Schmid M, In-Albon T. Temperament and character traits in female adolescents with nonsuicidal self-injury disorder with and without comorbid borderline personality disorder. Child and adolescent psychiatry and mental health. 2017;11:4.\u003c/li\u003e\n\u003cli\u003eYu， L, Xiao Ling, Jiang G. 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The British journal of psychiatry : the journal of mental science. 1978;133:429-35.\u003c/li\u003e\n\u003cli\u003eNixon MK, Levesque C, Preyde M, Vanderkooy J, Cloutier PF. 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. 2015;9:26.\u003c/li\u003e\n\u003cli\u003eLu CF, Jia CX, Xu AQ, Dai AY, Qin P. Psychometric characteristics of Chinese version of Barratt Impulsiveness Scale-11 in suicides and living controls of rural China. Omega. 2012;66(3):215-29.\u003c/li\u003e\n\u003cli\u003eZhao D, Gu R, Tang P, Yang Q, Luo YJ. Incidental emotions influence risk preference and outcome evaluation. Psychophysiology. 2016;53(10):1542-51.\u003c/li\u003e\n\u003cli\u003eDelorme A, Makeig S. EEGLAB: an open source toolbox for analysis of single-trial EEG dynamics including independent component analysis. Journal of neuroscience methods. 2004;134(1):9-21.\u003c/li\u003e\n\u003cli\u003eJung TP, Makeig S, Westerfield M, Townsend J, Courchesne E, Sejnowski TJ. Removal of eye activity artifacts from visual event-related potentials in normal and clinical subjects. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2000;111(10):1745-58.\u003c/li\u003e\n\u003cli\u003eCragg L, Fox A, Nation K, Reid C, Anderson M. Neural correlates of successful and partial inhibitions in children: an ERP study. Developmental psychobiology. 2009;51(7):533-43.\u003c/li\u003e\n\u003cli\u003eYin J, Yuan K, Feng D, Cheng J, Li Y, Cai C, et al. Inhibition control impairments in adolescent smokers: electrophysiological evidence from a Go/NoGo study. Brain imaging and behavior. 2016;10(2):497-505.\u003c/li\u003e\n\u003cli\u003eJonkman LM, Sniedt FL, Kemner C. Source localization of the Nogo-N2: a developmental study. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2007;118(5):1069-77.\u003c/li\u003e\n\u003cli\u003eCosta RPO, Peixoto A, Lucas CCA, Falc\u0026atilde;o DN, Farias J, Viana LFP, et al. Profile of non-suicidal self-injury in adolescents: interface with impulsiveness and loneliness. Jornal de pediatria. 2021;97(2):184-90.\u003c/li\u003e\n\u003cli\u003eGatta M, Dal Santo F, Rago A, Spoto A, Battistella PA. Alexithymia, impulsiveness, and psychopathology in nonsuicidal self-injured adolescents. Neuropsychiatric disease and treatment. 2016;12:2307-17.\u003c/li\u003e\n\u003cli\u003eHuang YH, Liu HC, Tsai FJ, Sun FJ, Huang KY, Chiu YC, et al. Correlation of impulsivity with self-harm and suicidal attempt: a community study of adolescents in Taiwan. BMJ open. 2017;7(12):e017949.\u003c/li\u003e\n\u003cli\u003eRodav O, Levy S, Hamdan S. Clinical characteristics and functions of non-suicide self-injury in youth. European psychiatry : the journal of the Association of European Psychiatrists. 2014;29(8):503-8.\u003c/li\u003e\n\u003cli\u003eCassels M, Neufeld S, van Harmelen AL, Goodyer I, Wilkinson P. Prospective Pathways From Impulsivity to Non-Suicidal Self-Injury Among Youth. Archives of suicide research : official journal of the International Academy for Suicide Research. 2022;26(2):534-47.\u003c/li\u003e\n\u003cli\u003eMcHugh CM, Chun Lee RS, Hermens DF, Corderoy A, Large M, Hickie IB. Impulsivity in the self-harm and suicidal behavior of young people: A systematic review and meta-analysis. Journal of psychiatric research. 2019;116:51-60.\u003c/li\u003e\n\u003cli\u003eWolff JC, Thompson E, Thomas SA, Nesi J, Bettis AH, Ransford B, et al. Emotion dysregulation and non-suicidal self-injury: A systematic review and meta-analysis. European psychiatry : the journal of the Association of European Psychiatrists. 2019;59:25-36.\u003c/li\u003e\n\u003cli\u003eMaxfield BL, Pepper CM. Impulsivity and Response Latency in Non-Suicidal Self-Injury: The Role of Negative Urgency in Emotion Regulation. The Psychiatric quarterly. 2018;89(2):417-26.\u003c/li\u003e\n\u003cli\u003eKim JS, Kang ES, Bahk YC, Jang S, Hong KS, Baek JH. Exploratory Analysis of Behavioral Impulsivity, Pro-inflammatory Cytokines, and Resting-State Frontal EEG Activity Associated With Non-suicidal Self-Injury in Patients With Mood Disorder. Frontiers in psychiatry. 2020;11:124.\u003c/li\u003e\n\u003cli\u003eNilsson M, Lundh L, Westrin \u0026Aring;, Westling S. Executive functioning in psychiatric patients with deliberate self-harm, as compared with a psychiatric and a healthy comparison group. Journal of clinical and experimental neuropsychology. 2021;43(3):225-37.\u003c/li\u003e\n\u003cli\u003eNguyen AT, Moyle JJ, Fox AM. N2 and P3 modulation during partial inhibition in a modified go/nogo task. International journal of psychophysiology : official journal of the International Organization of Psychophysiology. 2016;107:63-71.\u003c/li\u003e\n\u003c/ol\u003e"}],"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":"child-and-adolescent-psychiatry-and-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caph","sideBox":"Learn more about [Child and Adolescent Psychiatry and Mental Health](http://capmh.biomedcentral.com)","snPcode":"13034","submissionUrl":"https://submission.nature.com/new-submission/13034/3","title":"Child and Adolescent Psychiatry and Mental Health","twitterHandle":"@IACAPAP","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"non-suicidal self-injury, adolescent with major depression disorder, impulsivity, go/on-go task","lastPublishedDoi":"10.21203/rs.3.rs-7548791/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7548791/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: This study aims to explore the impulsivity traits across various dimensions and their neuro-electrophysiological features in adolescent depressed patients withnon-suicidal self-injury (NSSI) via scale assessments, behavioral tasks, and event-related potentials (ERPs).\u003c/p\u003e\n\u003cp\u003eMethods: A case-control study was conducted, enrolling depressed adolescent patients with NSSI (NSSI group), depressed adolescent patients without NSSI (non-NSSI group), and healthy controls. The Barratt Impulsivity Scale (BIS-11), go/no-go task, and ERPs were utilized to assess different dimensions of impulsivity.\u003c/p\u003e\n\u003cp\u003eResults: Both the NSSI group and the non-NSSI group demonstratedsignificantly higher total scores and subscale scores on the BIS-11 compared to the healthy control scores than the HC group in the total score and subscale scores of the BIS-11, especially in the motor impulsivity subscale in the motorimpulsivity subscale (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05). The NSSI group had lower accuracy in the go task than the non-NSSI and HC groups, with a statistically significant difference (\u003cem\u003ep\u003c/em\u003e =0.009); notably, the significant difference was more pronounced between the NSSI and HC groups(\u003cem\u003ep\u003c/em\u003e =0.008). No significant differences were found in the latency and amplitude of N2 and P3 waves among the three groups (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05). \u0026nbsp;The severity of NSSI over the past 1 month, 6 months, and 12 months was positively correlated with the motor impulsivity subscale and the total score of the BIS (r=0.198 to 0.417, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). In contrast, it was negatively correlated with the accuracy of the go task (r=-0.248 to -0.193, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eConclusion: Adolescent depressed patients with NSSI showed increased self-reported and behaviorally measured motor impulsivity, and these changes were strongly associated with the severity of NSSI.\u003c/p\u003e","manuscriptTitle":"Impulsivity in Adolescents with MDD and Non-Suicidal Self-Injury: A Multimodal Assessment Using Psychometric, Behavioral, and Neurophysiological Measures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 18:39:43","doi":"10.21203/rs.3.rs-7548791/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-18T09:31:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-12T13:56:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T15:12:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272835318121068242314547921184381153550","date":"2025-11-17T08:05:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276655182779466877091673230212375127383","date":"2025-11-14T09:54:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267415910157489797817148897207290593186","date":"2025-10-02T22:06:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T02:55:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-22T09:10:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-17T14:10:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Child and Adolescent Psychiatry and Mental Health","date":"2025-09-06T06:24:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"child-and-adolescent-psychiatry-and-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caph","sideBox":"Learn more about [Child and Adolescent Psychiatry and Mental Health](http://capmh.biomedcentral.com)","snPcode":"13034","submissionUrl":"https://submission.nature.com/new-submission/13034/3","title":"Child and Adolescent Psychiatry and Mental Health","twitterHandle":"@IACAPAP","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"690d5d7b-2fa4-4bd0-8bdc-eb80b960676e","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-26T10:10:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 18:39:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7548791","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7548791","identity":"rs-7548791","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}