Research progress on influencing factors and biological mechanisms of non-suicidal self-injury in children and adolescents

Ya-Yun WANG; Xiao-Li FAN; Ye MA; Rong-Wang YANG

doi:10.7499/j.issn.1008-8830.2510085

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Chinese Journal of Contemporary Pediatrics ›› 2026, Vol. 28 ›› Issue (7) : 904-909. DOI: 10.7499/j.issn.1008-8830.2510085

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Research progress on influencing factors and biological mechanisms of non-suicidal self-injury in children and adolescents

Ya-Yun WANG ¹^,² ,
Xiao-Li FAN ¹ ,
Ye MA ¹ ,
Rong-Wang YANG ¹

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Abstract

Non-suicidal self-injury (NSSI) is a common psychological and behavioral problem among children and adolescents and an important predictor of suicidal behavior. Studies indicate that emotion regulation difficulties, impaired impulse control, psychiatric comorbidities, family adversity, and adverse social environments increase the risk of NSSI, while family, school, and peer support exert protective effects. The biological mechanisms underlying NSSI include genetic and epigenetic susceptibility, stress response and endocrine dysregulation, abnormalities in the opioid system and pain modulation, immune-inflammatory imbalance, and dysfunction of neural circuits related to emotion regulation, executive function, and reward processing. This review systematically summarizes the influencing factors and biological mechanisms of NSSI in children and adolescents to provide a reference for early identification, prevention, and intervention of NSSI.

Key words

Non-suicidal self-injury / Influencing factor / Biological mechanism / Child / Adolescent

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Ya-Yun WANG , Xiao-Li FAN , Ye MA , et al. Research progress on influencing factors and biological mechanisms of non-suicidal self-injury in children and adolescents[J]. Chinese Journal of Contemporary Pediatrics. 2026, 28(7): 904-909 https://doi.org/10.7499/j.issn.1008-8830.2510085

References

List( Publishing order | Descend order by publishing year | Descend order by cited within ) Chart analysis

[1]

Farkas

, Takacs

, Kollárovics

, et al. The prevalence of self-injury in adolescence: a systematic review and meta-analysis[J]. Eur Child Adolesc Psychiatry, 2024, 33(10): 3439-3458. PMCID: PMC11564408. DOI: 10.1007/s00787-023-02264-y .

https://www.ncbi.nlm.nih.gov/pubmed/37486387

Cited in this article [1]

[2]	Lang J, Yao Y. Prevalence of nonsuicidal self-injury in Chinese middle school and high school students: a meta-analysis[J]. Medicine (Baltimore), 2018, 97(42): e12916. PMCID: PMC6211880. DOI: 10.1097/MD.0000000000012916 . https://www.ncbi.nlm.nih.gov/pubmed/30335024 Cited in this article [1]

[3]

Geoffroy

, Bouchard

, Per

, et al. Prevalence of suicidal ideation and self-harm behaviours in children aged 12 years and younger: a systematic review and meta-analysis[J]. Lancet Psychiatry, 2022, 9(9): 703-714. DOI: 10.1016/S2215-0366(22)00193-6 .

https://www.ncbi.nlm.nih.gov/pubmed/35907406

Cited in this article [1]

[4]	Wolff JC, Thompson E, Thomas SA, et al. Emotion dysregulation and non-suicidal self-injury: a systematic review and meta-analysis[J]. Eur Psychiatry, 2019, 59: 25-36. PMCID: PMC6538442. DOI: 10.1016/j.eurpsy.2019.03.004 . https://www.ncbi.nlm.nih.gov/pubmed/30986729 Cited in this article [1]

[5]	敖成, 胡旺, 周凡, 等. 南昌市中学生求助行为与非自杀性自伤的关联[J]. 中国学校卫生, 2021, 42(4): 597-601. DOI: 10.16835/j.cnki.1000-9817.2021.04.027 . Cited in this article [1]

[6]

Warne

, Heron

, Mars

, et al. Emotional dysregulation in childhood and disordered eating and self-harm in adolescence: prospective associations and mediating pathways[J]. J Child Psychol Psychiatry, 2023, 64(5): 797-806. PMCID: PMC10152493. DOI: 10.1111/jcpp.13738 .

https://www.ncbi.nlm.nih.gov/pubmed/36541428

Cited in this article [1]

[7]

Liu

, Li

, Zhou

, et al. Non-suicidal self-injury in adolescents with mood disorders and the roles of self-compassion and emotional regulation[J]. Front Psychiatry, 2023, 14: 1214192. PMCID: PMC10764550. DOI: 10.3389/fpsyt.2023.1214192 .

https://www.ncbi.nlm.nih.gov/pubmed/38179248

Cited in this article [2]

[8]	Casey BJ, Getz S, Galvan A. The adolescent brain[J]. Dev Rev, 2008, 28(1): 62-77. PMCID: PMC2500212. DOI: 10.1016/j.dr.2007.08.003 . https://www.ncbi.nlm.nih.gov/pubmed/18688292 Cited in this article [1]

[9]

Ojala

, Kuja-Halkola

, Bjureberg

, et al. Associations of impulsivity, hyperactivity, and inattention with nonsuicidal self-injury and suicidal behavior: longitudinal cohort study following children at risk for neurodevelopmental disorders into mid-adolescence[J]. BMC Psychiatry, 2022, 22(1): 679. PMCID: PMC9635086. DOI: 10.1186/s12888-022-04311-5 .

https://www.ncbi.nlm.nih.gov/pubmed/36329415

Cited in this article [1]

[10]	Yan H, Yue W. Risk factors, theoretical models, and biological mechanisms of nonsuicidal self-injury: a brief review[J]. Interdiscip Nurs Res, 2023, 2(2): 112-120. PMCID: PMC10461723. DOI: 10.1097/NR9.0000000000000023 . https://www.ncbi.nlm.nih.gov/pubmed/37645376 Cited in this article [2]

[11]	Nock MK. Why do people hurt themselves? New insights into the nature and functions of self-injury[J]. Curr Dir Psychol Sci, 2009, 18(2): 78-83. PMCID: PMC2744421. DOI: 10.1111/j.1467-8721.2009.01613.x . https://www.ncbi.nlm.nih.gov/pubmed/20161092 Cited in this article [1]

[12]	Liu D, Qu D, Xu S, et al. Profile of childhood trauma subtypes associated with self-injurious thoughts and behaviors[J]. Psychol Trauma, 2024, 16(): S63-S71. DOI: 10.1037/tra0001544 . https://www.ncbi.nlm.nih.gov/pubmed/37650803 Cited in this article [1] Abstract Suppl 1

[13]

Predescu

, Calugar

, Sipos

. Cyberbullying and non-suicidal self-injury (NSSI) in adolescence: exploring moderators and mediators through a systematic review[J]. Children (Basel), 2024, 11(4): 410. PMCID: PMC11049228. DOI: 10.3390/children11040410 .

https://www.ncbi.nlm.nih.gov/pubmed/38671626

Cited in this article [1]

[14]	Burnell K, Trekels J, Prinstein MJ, et al. Adolescents' social comparison on social media: links with momentary self-evaluations[J]. Affect Sci, 2024, 5(4): 295-299. PMCID: PMC11624171. DOI: 10.1007/s42761-024-00240-6 . https://www.ncbi.nlm.nih.gov/pubmed/39649470 Cited in this article [1]

[15]	Tang J, Ma Y, Lewis SP, et al. Association of internet addiction with nonsuicidal self-injury among adolescents in China[J]. JAMA Netw Open, 2020, 3(6): e206863. PMCID: PMC7273191. DOI: 10.1001/jamanetworkopen.2020.6863 . https://www.ncbi.nlm.nih.gov/pubmed/32496567 Cited in this article [1]

[16]	Jin MK, Wang XY, Wang RX, et al. A systematic review and meta-analysis of factors related to non-suicidal self-injury among Chinese adolescents[J]. Psychiatry Res, 2023, 326: 115329. DOI: 10.1016/j.psychres.2023.115329 . https://www.ncbi.nlm.nih.gov/pubmed/37437488 Cited in this article [1]

[17]

Eggermont

, Bastin

, Luyckx

, et al. Do gender and age moderate the relationship between friendship quality and non-suicidal self-injury in community children and adolescents?[J]. Psychol Belg, 2021, 61(1): 315-326. PMCID: PMC8588898. DOI: 10.5334/pb.1067 .

https://www.ncbi.nlm.nih.gov/pubmed/34824862

Cited in this article [1]

[18]

Baker

, Wallander

, Elliott

, et al. Non-suicidal self-injury among adolescents: a structural model with socioecological connectedness, bullying victimization, and depression[J]. Child Psychiatry Hum Dev, 2023, 54(4): 1190-1208. PMCID: PMC10272275. DOI: 10.1007/s10578-022-01319-6 .

https://www.ncbi.nlm.nih.gov/pubmed/35178654

Cited in this article [1]

[19]

Ejlskov

, Antonsen

, Wulff

, et al. Multilevel interactions between family and neighbourhood socioeconomic indices in childhood and later risks of self-harm and violent criminality in Denmark: a national cohort study[J]. Lancet Public Health, 2023, 8(2): e99-e108. PMCID: PMC9896147. DOI: 10.1016/S2468-2667(22)00292-4 .

https://www.ncbi.nlm.nih.gov/pubmed/36709062

Cited in this article [1]

[20]

Xiao

, Song

, Huang

, et al. Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: a meta-analysis[J]. Front Psychiatry, 2022, 13: 912441. PMCID: PMC9399519. DOI: 10.3389/fpsyt.2022.912441 .

https://www.ncbi.nlm.nih.gov/pubmed/36032224

Cited in this article [1]

[21]

Cheng

, Hu

, Zhang

, et al. The influence of parenting style and coping behavior on nonsuicidal self-injury behavior in different genders based on path analysis[J]. PeerJ, 2022, 10: e14507. PMCID: PMC9745924. DOI: 10.7717/peerj.14507 .

https://www.ncbi.nlm.nih.gov/pubmed/36523466

Cited in this article [1]

[22]

Gromatsky

, Waszczuk

, Perlman

, et al. The role of parental psychopathology and personality in adolescent non-suicidal self-injury[J]. J Psychiatr Res, 2017, 85: 15-23. PMCID: PMC5191934. DOI: 10.1016/j.jpsychires.2016.10.013 .

https://www.ncbi.nlm.nih.gov/pubmed/27814456

Cited in this article [1]

[23]	Ge Y, Xi X, Wang Z, et al. Parent-child communication and NSSI in depressed adolescents: the role of anxiety and emotional intelligence[J]. Clin Psychol Psychother, 2025, 32(5): e70124. DOI: 10.1002/cpp.70124 . https://www.ncbi.nlm.nih.gov/pubmed/40898816 Cited in this article [1]

[24]

Wang

, Zheng

, Liu

, et al. Relationship between SIRT1 gene and adolescent depressive disorder with nonsuicidal self-injury behavior: based on gene methylation and mRNA expression[J]. Medicine (Baltimore), 2021, 100(31): e26747. PMCID: PMC8341318. DOI: 10.1097/MD.0000000000026747 .

https://www.ncbi.nlm.nih.gov/pubmed/34397817

Cited in this article [1]

[25]

Zheng

, Bi

, Zhang

, et al. Epigenetic alterations of the promoter region of the POMC Gene in adolescent depressive disorder patients with nonsuicidal self-injury behaviors[J]. Psychol Res Behav Manag, 2020, 13: 997-1008. PMCID: PMC7678717. DOI: 10.2147/PRBM.S272445 .

https://www.ncbi.nlm.nih.gov/pubmed/33235529

Cited in this article [1]

[26]	Kibitov AA, Mazo GE. Genetics and epigenetics of nonsuicidal self-injury: a narrative review[J]. Russ J Genet, 2023, 59(12): 1265-1276. DOI: 10.1134/S1022795423120037 . Cited in this article [1]

[27]

Guillot

, Kelly

, Phillips

, et al. BDNF and stress/mood-related interactions on emotional disorder symptoms, executive functioning, and deliberate self-harm[J]. J Psychiatr Res, 2023, 163: 195-201. PMCID: PMC10330730. DOI: 10.1016/j.jpsychires.2023.05.060 .

https://www.ncbi.nlm.nih.gov/pubmed/37220696

Cited in this article [1]

[28]

Zhou

, Gong

. Longitudinal relation between maladaptive parenting and nonsuicidal self-injury among Chinese early adolescents: the roles of internalizing symptoms and FKBP5 gene variation[J]. J Affect Disord, 2023, 331: 33-42. DOI: 10.1016/j.jad.2023.03.034 .

https://www.ncbi.nlm.nih.gov/pubmed/36934853

[29]

Liu

, Liu

, Wang

, et al. Harsh parenting and non-suicidal self-injury in adolescence: the mediating effect of depressive symptoms and the moderating effect of the COMT Val158Met polymorphism[J]. Child Adolesc Psychiatry Ment Health, 2021, 15(1): 70. PMCID: PMC8611980. DOI: 10.1186/s13034-021-00423-0 .

https://www.ncbi.nlm.nih.gov/pubmed/34814943

Cited in this article [1]

[30]

Reichl

, Brunner

, Bender

, et al. Adolescent nonsuicidal self-injury and cortisol response to the retrieval of adversity: a sibling study[J]. Psychoneuroendocrinology, 2019, 110: 104460. DOI: 10.1016/j.psyneuen.2019.104460 .

https://www.ncbi.nlm.nih.gov/pubmed/31585235

Cited in this article [1]

[31]

Klimes-Dougan

, Begnel

, Almy

, et al. Hypothalamic-pituitary-adrenal axis dysregulation in depressed adolescents with non-suicidal self-injury[J]. Psychoneuroendocrinology, 2019, 102: 216-224. DOI: 10.1016/j.psyneuen.2018.11.004 .

https://www.ncbi.nlm.nih.gov/pubmed/30590339

Cited in this article [1]

[32]

Koenig

, Lischke

, Bardtke

, et al. Altered psychobiological reactivity but no impairment of emotion recognition following stress in adolescents with non-suicidal self-injury[J]. Eur Arch Psychiatry Clin Neurosci, 2023, 273(2): 379-395. PMCID: PMC10070238. DOI: 10.1007/s00406-022-01496-4 .

https://www.ncbi.nlm.nih.gov/pubmed/36203100

Cited in this article [1]

[33]	Goreis A, Prillinger K, Bedus C, et al. Physiological stress reactivity and self-harm: a meta-analysis[J]. Psychoneuroendocrinology, 2023, 158: 106406. DOI: 10.1016/j.psyneuen.2023.106406 . https://www.ncbi.nlm.nih.gov/pubmed/37783020 Cited in this article [1]

[34]	van Hoorn AC. Could affect regulation via vagal nerve self- stimulation be a maintaining factor in non-suicidal self-harm?[J]. Med Hypotheses, 2020, 136: 109498. DOI: 10.1016/j.mehy.2019.109498 . https://www.ncbi.nlm.nih.gov/pubmed/31759305 Cited in this article [1]

[35]

Luo

, Dashti

, Sawyer

, et al. Pubertal hormones and mental health problems in children and adolescents: a systematic review of population-based studies[J]. EClinicalMedicine, 2024, 76: 102828. PMCID: PMC11472636. DOI: 10.1016/j.eclinm.2024.102828 .

https://www.ncbi.nlm.nih.gov/pubmed/39403116

Cited in this article [1]

[36]

Luking

, Hennefield

, Ortin-Peralta

, et al. Early pubertal timing, suicidality, and self-injurious behaviors in preadolescents: evidence for concurrent and emergent risk prediction[J]. J Am Acad Child Adolesc Psychiatry, 2025, 64(9): 1047-1055. PMCID: PMC12238291. DOI: 10.1016/j.jaac.2024.10.016 .

https://www.ncbi.nlm.nih.gov/pubmed/39798665

Cited in this article [2]

[37]	Stanley B, Sher L, Wilson S, et al. Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters[J]. J Affect Disord, 2010, 124(1-2): 134-140. PMCID: PMC2875354. DOI: 10.1016/j.jad.2009.10.028 . https://www.ncbi.nlm.nih.gov/pubmed/19942295 Cited in this article [1]

[38]

Störkel

, Karabatsiakis

, Hepp

, et al. Salivary beta-endorphin in nonsuicidal self-injury: an ambulatory assessment study[J]. Neuropsychopharmacology, 2021, 46(7): 1357-1363. PMCID: PMC8134499. DOI: 10.1038/s41386-020-00914-2 .

https://www.ncbi.nlm.nih.gov/pubmed/33398083

Cited in this article [1]

[39]	Jackson M, Foret BL, Fontenot J, et al. Molecular examination of the endogenous opioid system in rhesus macaque monkeys with self-injurious behavior[J]. J Neurosci Res, 2023, 101(1): 70-85. DOI: 10.1002/jnr.25128 . https://www.ncbi.nlm.nih.gov/pubmed/36131680 Cited in this article [1]

[40]	Koenig J, Thayer JF, Kaess M. A meta-analysis on pain sensitivity in self-injury[J]. Psychol Med, 2016, 46(8): 1597-1612. DOI: 10.1017/S0033291716000301 . https://www.ncbi.nlm.nih.gov/pubmed/26964517 Cited in this article [1]

[41]

Lalouni

, Fust

, Bjureberg

, et al. Augmented pain inhibition and higher integration of pain modulatory brain networks in women with self-injury behavior[J]. Mol Psychiatry, 2022, 27(8): 3452-3459. PMCID: PMC9708552. DOI: 10.1038/s41380-022-01639-y .

https://www.ncbi.nlm.nih.gov/pubmed/35691963

Cited in this article [1]

[42]	Boyne H, Hamza CA. Pain tolerance as a 'barrier' to nonsuicidal self-injury: a longitudinal study[J]. Psychiatry Res, 2024, 336: 115925. DOI: 10.1016/j.psychres.2024.115925 . https://www.ncbi.nlm.nih.gov/pubmed/38678744 Cited in this article [1]

[43]

Kao

, Mürner-Lavanchy

, von Stosch

, et al. Pain sensitivity as a state marker and predictor for adolescent non-suicidal self-injury[J]. Psychol Med, 2024, 54(9): 2291-2298. PMCID: PMC11413347. DOI: 10.1017/S0033291724000461 .

https://www.ncbi.nlm.nih.gov/pubmed/38465743

Cited in this article [1]

[44]

van der Venne

, Mürner-Lavanchy

, Höper

, et al. Physiological response to pain in female adolescents with nonsuicidal self-injury as a function of severity[J]. J Affect Disord, 2023, 339: 64-73. DOI: 10.1016/j.jad.2023.06.041 .

https://www.ncbi.nlm.nih.gov/pubmed/37390927

Cited in this article [1]

[45]

Kim

, Kang

, Bahk

, et al. 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[J]. Front Psychiatry, 2020, 11: 124. PMCID: PMC7057238. DOI: 10.3389/fpsyt.2020.00124 .

https://www.ncbi.nlm.nih.gov/pubmed/32174860

Cited in this article [1]

[46]	Kindler J, Koenig J, Lerch S, et al. Increased immunological markers in female adolescents with non-suicidal self-injury[J]. J Affect Disord, 2022, 318: 191-195. DOI: 10.1016/j.jad.2022.08.125 . https://www.ncbi.nlm.nih.gov/pubmed/36057292 Cited in this article [1]

[47]

Gjervig Hansen

, Köhler-Forsberg

, Petersen

, et al. Infections, anti-infective agents, and risk of deliberate self-harm and suicide in a young cohort: a nationwide study[J]. Biol Psychiatry, 2019, 85(9): 744-751. DOI: 10.1016/j.biopsych.2018.11.008 .

https://www.ncbi.nlm.nih.gov/pubmed/30563760

Cited in this article [1]

[48]

Cai

, Wang

, Hou

, et al. Association between non-suicidal self-injury and gut microbial characteristics in Chinese adolescent[J]. Neuropsychiatr Dis Treat, 2022, 18: 1315-1328. PMCID: PMC9255420. DOI: 10.2147/NDT.S360588 .

https://www.ncbi.nlm.nih.gov/pubmed/35799798

Cited in this article [1]

[49]

Lai

, Jiang

, Xu

, et al. Abnormal brain activity in nonsuicidal self-injury: a coordinate-based activation likelihood meta-analysis of functional neuroimaging studies[J]. Psychoradiology, 2021, 1(4): 249-256. PMCID: PMC11025552. DOI: 10.1093/psyrad/kkab020 .

https://www.ncbi.nlm.nih.gov/pubmed/38666222

Cited in this article [1]

[50]

Başgöze

, Demers

, Thai

, et al. A multilevel examination of cognitive control in adolescents with nonsuicidal self-injury[J]. Biol Psychiatry Glob Open Sci, 2023, 3(4): 855-866. PMCID: PMC10593942. DOI: 10.1016/j.bpsgos.2023.04.005 .

https://www.ncbi.nlm.nih.gov/pubmed/37881532

Cited in this article [1]