Social determinants and non-suicidal self-injury: cross-sectional analyses from the SESSAMO cohort project

Abstract

The effects of social determinants on adolescent mental health have been extensively studied, but their association with non-suicidal self-injury (NSSI) requires further investigation. The aim of this study was to analyze the association between individual Adverse Childhood Experiences (ACEs), their cumulative effect, and the impact of Stressful Life Events (SLEs) on the presence of NSSI. Depressive symptoms were analyzed as a potential mediator in this association. Cross-sectional analysis of 2,042 Spanish adolescents, aged 14–16, recruited for the SESSAMO project, a multi-center prospective cohort study. Exposure variables were collected, including ACEs, bullying and SLEs. To determine the presence of NSSI, a validated questionnaire was administered. The associations were analyzed through multivariate logistic regression models. The presence of emotional abuse, being a victim of bullying, parental mental disorders, and the significant psychological impact of SLEs were directly associated with NSSI. Participants with more than 5 ACEs had higher odds of engaging in NSSI (OR = 6.834; 95% CI = 3.658–12.769) compared to those without such experiences. The percentage of the mediation effect of depressive symptoms progressively increased with the level of impact of SLEs and the number of ACEs, accounting for 35.0% and 52.3% in the highest exposure categories, respectively. Screening for traumatic adversities, life psychosocial stressors and depressive symptoms in community settings could be beneficial for addressing them and reducing the risk of NSSI among adolescents.