Abstract
OBJECTIVES: Non-suicidal self-injury (NSSI) behaviors poses a serious threat to the mental health of adolescents. This study aims to examine how trait anxiety influences NSSI behaviors in adolescents and to explore the potential parallel mediating effects of maladaptive cognitive emotion regulation strategies and impulsivity in this relationship. METHODS: Adolescents with NSSI behaviors treated at the Fourth People's Hospital of Huaihua between December 2020 and December 2021 were recruited as participants. A total of 500 questionnaires were distributed, including the Adolescent NSSI Assessment Questionnaire, the Barratt Impulsiveness Scale, the Chinese version of the Cognitive Emotion Regulation Questionnaire (maladaptive strategies subscale), and the Trait Anxiety Inventory. All scales demonstrated good reliability and validity. Statistical analyses such as descriptive statistics, common method bias testing, reliability and validity assessment, correlation analyses, multiple linear regression, path analysis, and mediation analysis were performed using SPSS software, and the SPSSPRO platform. RESULTS: A total of 376 valid questionnaires were collected. No significant common method bias was detected. Pearson correlation analyses indicated significant positive correlations among all scale scores (all P<0.001). Multiple linear regression analysis showed that, after controlling for demographic factors, trait anxiety, maladaptive cognitive emotion regulation strategies, and impulsivity all significantly and positively predicted adolescent NSSI behavior (R(2)=0.369). Path analysis revealed 5 significant pathways: Trait anxiety → maladaptive cognitive emotion regulation strategies, trait anxiety → impulsivity, maladaptive cognitive emotion regulation strategies → NSSI behaviors, impulsivity → NSSI behaviors, and trait anxiety → NSSI behaviors (all P<0.001). The model demonstrated good fit (χ(2)/df=1.651, normed fit index=0.995, comparative fit index=0.998, goodness of fit index=0.995, root mean square error of approximation=0.042). Parallel mediation analysis indicated that, with demographic variables controlled, the total effect of trait anxiety on NSSI behaviors was 0.501. The direct effect was 0.239 (47.7% of the total effect). The mediating effect through maladaptive cognitive emotion regulation strategies was 0.177 (35.3%), and the mediating effect through impulsivity was 0.085 (17.0%). The mediating effect of maladaptive cognitive emotion regulation strategies was significantly greater than that of impulsivity (95% confidence interval 0.012 to 0.176). CONCLUSIONS: Trait anxiety directly predicts NSSI behaviors in adolescents and indirectly affects NSSI through parallel mediating effects of maladaptive cognitive emotion regulation strategies and impulsivity. Among these mediators, maladaptive cognitive emotion regulation strategies play a more prominent mediating role in the relationship between trait anxiety and NSSI behaviors.