Childhood Maltreatment, Stressful Life Events, Cognitive Emotion Regulation Strategies, and Non-suicidal Self-Injury in Adolescents and Young Adults With First-Episode Depressive Disorder: Direct and Indirect Pathways

Abstract

IntroductionChildhood maltreatment (CM), stressful life events (SLE), and cognitive emotion regulation strategies (CERS) have been considered crucial in the development of non-suicidal self-injury (NSSI) and major depressive disorder (MDD), but the pathways of this association are not clear. We aim to identify direct effects of CM and SLE on NSSI and depression severity and its indirect effects via CERS in adolescents and young adults with a diagnosis of MDD.MethodsA total of 114 patients (aged 14–24 years) with first episode MDD were included and further divided into the NSSI group (n = 56) and non-NSSI group (n = 58) according to the DSM-5 criteria. Diagnostic interviews and self-report measures were conducted to assess CM, SLE, CERS, and diagnose NSSI. Severity of depressive symptoms was measured using the Hamilton Rating Scale (HAMD). The structural equation model was used to assess the pathways.ResultsMDD patients with NSSI had more frequent family history of mental illness, more experience of CM and SLE, more serious depression, less use of adaptive CERS, and more use of maladaptive CERS. In the final structural equation model (χ2 = 4.82, df = 6, p = 0.57, CFI = 1.0, TLI = 1.10, and RMSEA = 0), the experience of CM and SLE showed a significant indirect effect on NSSI through adaptive CERS. CM and SLE only had direct effects on depression severity.ConclusionsNSSI are prevalent in adolescents and young adults with MDD and highly intertwined with CM, SLE, and CERS. Adaptive CERS, not maladaptive CERS may be a possible mechanism relating CM and SLE to NSSI in MDD patients.

Association between childhood maltreatment and social functioning in individuals with affective disorders: A systematic review and meta‐analysis

“…There is a large body of evidence related to neurobiological changes stemming from CM, 6,48,49 including alterations in the development and functioning of brain regions that may determine emotional reactivity to stressful life events (e.g., the hypothalamicpituitary-adrenal axis). 50,51,50 Such neurobiological alterations and stress-related vulnerability may underpin impairments in (social) cognitive function, 52 emotion regulation 53 and processing 54,55 in individuals with BD 56 and MDD 57 that are highly relevant to effective social engagement. In turn, the neurocognitive sequelae of CM are postulated to affect how the social architecture 43 is constructed across development, including a reduction in the quality and quantity of relationships in an individual's social network.…”

Identification of suicidality in patients with major depressive disorder via dynamic functional network connectivity signatures and machine learning

“…Therefore, multimodal imaging should be considered in the future to investigate diagnostic efficiency. Although structured interviews are commonly used and reliable evaluation methods to assess patients’ suicidal risk [ 86 , 87 ], other suicidal risk assessment scales, such as the Nurses’ Global Assessment of Suicide Risk (NGASR), should be jointly used to assess the suicidality of MDD patients in the future [ 88 , 89 ].…”

Association of Four Medication Classes and Non-suicidal Self-injury in Adolescents with Affective Disorders – A Retrospective Chart Review

“…Especially childhood maltreatment -except for emotional neglect -is associated with NSSI [12]. Adolescents and young adults with major depressive symptoms and NSSI experienced more childhood adversity than adolescents and young adults with a major depressive disorder alone [13,14]. Of note, stressful life events within the family are more common in early (11-15 years) than in mid (15-17 years) adolescence [15].…”