Network perspective on rumination and non-suicidal self-injury among adolescents with depressive disorders

BACKGROUND Non-suicidal self-injury (NSSI) is common among adolescents with depressive disorders and poses a major public health challenge. Rumination, a key cognitive feature of depression, includes different subtypes that may relate to NSSI through distinct psychological mechanisms. However, how these subtypes interact with specific NSSI behaviors remains unclear. AIM To examine associations between rumination subtypes and specific NSSI behaviors in adolescents. METHODS We conducted a cross-sectional study with 305 hospitalized adolescents diagnosed with depressive disorders. The subjects ranged from 12-18 years in age. Rumination subtypes were assessed using the Ruminative Response Scale, and 12 NSSI behaviors were evaluated using a validated questionnaire. Network analysis was applied to explore symptom-level associations and identify central symptoms. RESULTS The network analysis revealed close connections between rumination subtypes and NSSI behaviors. Brooding was linked to behaviors such as hitting objects and burning. Scratching emerged as the most influential NSSI symptom. Symptom-focused rumination served as a key bridge connecting rumination and NSSI. CONCLUSION Symptom-focused rumination and scratching were identified as potential intervention targets. These findings highlight the psychological significance of specific cognitive-behavioral links in adolescent depression and suggest directions for tailored prevention and treatment. However, the cross-sectional, single-site design limits causal inference and generalizability. Future longitudinal and multi-center studies are needed to confirm causal pathways and verify the generalizability of the findings to broader adolescent populations.