[Longitudinal relationships among anxiety, depression, non-suicidal self-injury, and distress tolerance in adolescents: A cross-lagged network analysis].
Adolescence is a critical period with a high incidence of psychological problems. Anxiety, depression, and non-suicidal self-injury (NSSI) are relatively common among adolescents and can affect their physical and mental health. This study aims to investigate the dynamic temporal interactions among anxiety, depression, NSSI, and distress tolerance in adolescents using three waves of longitudinal follow-up data and cross-lagged network analysis. This study also aims to quantify the relative importance of each variable in the network and its cross-time predictive effects, thereby providing empirical evidence for early prevention and precision intervention in adolescent mental health.
Cluster sampling was used to recruit first-year students from 3 public junior high schools and first-year students from 3 public senior high schools in Yiyang, Hunan Province. Three follow-up surveys were conducted at T1, T2, and T3, with 6-month intervals between assessments. A total of 1 621 adolescents who completed all 3 surveys with valid responses were included. The assessment tools included the simplified Chinese version of the Depression Anxiety Stress Scale-21, the Tolerance for Mental Pain Scale (TMPS)-10, and the Ottawa Self-Injury Inventory.
Repeated-measures analysis of variance showed that from T1 to T2, the total score of distress tolerance and scores for tolerating distress and managing distress significantly decreased, whereas the scores for anxiety, depression, and NSSI thoughts and behaviors in the past month significantly increased. From T2 to T3, the total score of distress tolerance and the score for tolerating distress significantly decreased, while the scores for anxiety and NSSI thoughts in the past month significantly decreased (all P<0.05). Cross-lagged network analysis revealed that in the T1→T2 network, managing distress had the highest out-expected influence (out-EI=-2.01) and showed strong negative predictive effects on both anxiety and depression. In the T2→T3 network, managing distress still had the highest out-expected influence (out-EI=-1.67) and continued to negatively predict anxiety and depression, while NSSI behavior in the past month positively predicted anxiety and depression.
The relationships among anxiety, depression, NSSI, and distress tolerance in adolescents are dynamic and stage-specific. The ability to manage distress is a protective factor against anxiety and depression in adolescents, although its predictive effect weakens over time. In contrast, NSSI behavior gradually becomes a risk factor for depression at later stages. Therefore, improving adolescents' ability to manage distress, especially at an early stage, and intervening in NSSI behavior may effectively reduce anxiety and depression levels.
Cluster sampling was used to recruit first-year students from 3 public junior high schools and first-year students from 3 public senior high schools in Yiyang, Hunan Province. Three follow-up surveys were conducted at T1, T2, and T3, with 6-month intervals between assessments. A total of 1 621 adolescents who completed all 3 surveys with valid responses were included. The assessment tools included the simplified Chinese version of the Depression Anxiety Stress Scale-21, the Tolerance for Mental Pain Scale (TMPS)-10, and the Ottawa Self-Injury Inventory.
Repeated-measures analysis of variance showed that from T1 to T2, the total score of distress tolerance and scores for tolerating distress and managing distress significantly decreased, whereas the scores for anxiety, depression, and NSSI thoughts and behaviors in the past month significantly increased. From T2 to T3, the total score of distress tolerance and the score for tolerating distress significantly decreased, while the scores for anxiety and NSSI thoughts in the past month significantly decreased (all P<0.05). Cross-lagged network analysis revealed that in the T1→T2 network, managing distress had the highest out-expected influence (out-EI=-2.01) and showed strong negative predictive effects on both anxiety and depression. In the T2→T3 network, managing distress still had the highest out-expected influence (out-EI=-1.67) and continued to negatively predict anxiety and depression, while NSSI behavior in the past month positively predicted anxiety and depression.
The relationships among anxiety, depression, NSSI, and distress tolerance in adolescents are dynamic and stage-specific. The ability to manage distress is a protective factor against anxiety and depression in adolescents, although its predictive effect weakens over time. In contrast, NSSI behavior gradually becomes a risk factor for depression at later stages. Therefore, improving adolescents' ability to manage distress, especially at an early stage, and intervening in NSSI behavior may effectively reduce anxiety and depression levels.