Relationship between peer victimization and non-suicidal self-injury functions in adolescents with unipolar and bipolar depression： the pathway of loneliness

Abstract

BackgroundNon-suicidal self-injury （NSSI） behavior has become a major public health concern and can have significant implications for the physical and mental health of adolescents. Peer victimization is a risk factor for adolesents to have NSSI behavior， so exploring the relationship and underlying mechanism between peer victimization and NSSI functions will provide a promising strategy for the prevention and intervention of NSSI behavior.ObjectiveTo investigate the relationship between peer victimization and NSSI functions in adolescents with unipolar and bipolar depression， so as to provide references for the intervention of NSSI behavior in adolescent patients with unipolar and bipolar depression.MethodsUsing multi-stage stratified sampling， 940 adolescents with unipolar and bipolar depression who met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） criteria for bipolar depressive episodes or depressive disorders were selected from 14 psychiatric hospitals in China. All participations were assessed using Chinese version of the Functional Assessment of Self-Mutilation （C-FASM）， Multidimensional Peer-Victimization Scale （MPVS）， UCLA Loneliness Scale （UCLA-LS） and Patient Health Questionnaire-9 item （PHQ-9）. Pearson correlation coefficient was to assess the correlation among above scales， and the model fit and path coefficients for mediation were analyzed with model 4 in Process 4.0 for SPSS.ResultsA total of 698 （74.26%） adolescents with unipolar and bipolar depression completed the questionnaire survey. NSSI behavior was detected in 374 patients （53.58%）. Among adolescents with unipolar and bipolar depression and NSSI behavior， MPVS total score was positively correlated with the scores of NSSI emotion regulation function， attention-seeking function and social avoidance function in C-FASM （r=0.104， 0.130， 0.266， P<0.05 or 0.01）， UCLA-LS score also yielded a positive correlation with the scores of NSSI emotion regulation function， attention-seeking function and social avoidance function in C-FASM （r=0.321， 0.112， 0.246， P<0.05 or 0.01）， and UCLA-LS score was positively correlated with MPVS total score （r=0.241， P<0.01）. Loneliness demonstrated a complete mediating role in the relationship between peer victimization and emotion regulation function， with an indirect effect value of 0.033 （95% CI： 0.019~0.050） and an effect size of 73.33%. A partial mediating effect of loneliness was also observed for the relationship between peer victimization and social avoidance function， with an indirect effect value of 0.016 （95% CI： 0.007~0.025） and an effect size of 17.98%.ConclusionLoneliness may act as a mediator in the relationship between the peer victimization and the NISS emotion regulation and social avoidance functions in adolescents with unipolar and bipolar depression and NSSI behaviors. ［Funded by Guangzhou High-level Clinical Key Specialty （number， SZGSP013）］

Keywords

• peer victimization
• loneliness
• adolescent
• non-suicidal self-injury behavior
• depression