Network of Cognitive, Emotional, and Pain Perception Factors Linked to Non-Suicidal Self-Injury Thoughts and Behaviors in Chinese Adolescents

Background The cognitive-emotional model posits that negative self-concepts and maladaptive emotional regulation are key factors contributing to Non-Suicidal Self-Injury (NSSI). However, the interplay between pain perception, pain management, and these cognitive and emotional factors in the context of NSSI remains unclear. In this study, we employed a network approach to investigate the network structures of these factors related to NSSI thoughts and behaviors among Chinese adolescents. Additionally, we examined how depressive symptoms might moderate these associations. Methods A sample of 2756 adolescents validly completed self-report questionnaires about their emotional experiences, self-cognition, pain perception, depression level and frequency of NSSI. Network analyses were used to examine the interrelationship between NSSI, emotional experiences, self-cognition and pain perception. A network comparison test was further conducted between Non-depression proneness (Non-DP) group and depression proneness (DP) group. Results Among the cognitive-emotional-pain factors network, cognitive (i.e., early maladaptive schemas), pain perception (i.e., tolerance for mental pain) as well as NSSI thoughts were the main factors most strongly associated with NSSI behavior. A network comparison test showed that, compared to the Non-DP group, the DP group exhibited a negative association between pain endurance and NSSI thoughts, additionally, NSSI thoughts had higher centrality in the DP group’s network. Conclusions Our study highlighted the significant roles of cognitive and pain perception factors in adolescent NSSI behavior, supporting the cognitive-emotional-pain theoretical hypothesis. Additionally, these findings underscore the importance of mental pain tolerance and NSSI thoughts in understanding NSSI in depressed adolescents, offering new perspectives for prevention strategies.