BACKGROUND:Resilience is increasingly conceptualized as a dynamic process rather than a static trait. The Mount Sinai Resilience Scale (MSRS) captures this process by assessing the frequency and subjective efficacy of malleable resources employed to manage stress. This study aimed to validate the Chinese MSRS (C-MSRS) and investigate the psychometric and network features of resilience in healthy and clinical populations. METHODS:The MSRS was translated and administered to 600 healthy adults and 95 patients. We utilized Exploratory and Confirmatory Factor Analyses, reliability and validity assessments, network analysis, and quadrant analysis to evaluate the psychometric properties and characterize clinical resilience profiles. RESULTS:The C-MSRS demonstrated satisfactory psychometric properties, yielding a 21-item, five-factor model. Network analysis identified the "Meaning and Purpose" dimension (specifically hope and growth mindset) as the central hub, functioning as a "motivational engine" that integrates other resilience resources. Clinical profiling revealed distinct phenotypes: depression was characterized by global deficits consistent with amotivation and helplessness (low frequency/low efficacy), whereas anxiety patients exhibited preserved motivational drive in social connections. Furthermore, "Meaning and Purpose" emerged as a core transdiagnostic factor negatively correlated with symptom severity. CONCLUSIONS:The C-MSRS is a robust, process-oriented instrument for the Chinese context. Our findings highlight resilience as an active, cognition-motivated process organized around hope and growth mindset. By capturing distinct resilience deficits in depression versus anxiety, the C-MSRS offers a precise tool for dissecting resilience mechanisms and guiding targeted interventions.

BackgroundChildhood trauma is an early stressor for adolescent depression. Previous studies have reported a link between childhood trauma and non-suicidal self-injury (NSSI) behaviors; however, the underlying associations among these variables remain unclear.MethodUsing the Chinese Version of the Functional Assessment of Self-Mutilation, Childhood Trauma Questionnaire Short Form, Pittsburgh Sleep Quality Index, and Generalized Anxiety Disorder-7 scale (GAD-7) as research instruments, we evaluated adolescents with depression who met the ICD-10 criteria for depressive episodes (n = 2,308) from the outpatient clinic of 12 psychiatric hospitals in China.ResultsThe scores of sleep disturbance, GAD symptoms, childhood trauma, and their subtypes for the adolescents with depression in the NSSI group were higher than those in the non-NSSI group. Pearson correlation analysis revealed that childhood trauma and its subtypes showed significant positive correlations with NSSI severity, sleep disturbance, and GAD symptoms. PROCESS-based mediation analysis and SEM-based sensitivity analyses showed significant statistical indirect associations between childhood trauma and NSSI behavior through sleep disturbance, GAD symptoms, and the sequential pathway involving sleep disturbance and GAD symptoms. After excluding general confounding factors, emotional abuse, physical abuse, sexual abuse, and physical neglect were significantly associated with NSSI severity in the cross-sectional regression model.ConclusionIt is essential to remain alert to the increased risk of NSSI behavior among adolescents with depression, particularly those who have experienced different types of childhood trauma. Special consideration should be given to the impact of clinical symptoms such as sleep disturbance and GAD symptoms, and early intervention should be implemented to mitigate or reduce the possibility of NSSI behavior.

Non-suicidal self-injury (NSSI) is highly prevalent among adolescents with major depressive disorder (MDD), yet the developmental and sex-related mechanisms underlying its occurrence and severity remain poorly understood. This study examined the effects of age and sex on NSSI occurrence and frequency in a large clinical cohort (N = 2,343) of Chinese adolescents diagnosed with MDD. Mediation analyses assessed self-esteem, depression, and anxiety as potential pathways linking age and sex to NSSI. Females had significantly higher NSSI prevalence (OR = 2.53) and frequency than males, while NSSI engagement decreased with age (OR = 0.808/year for NSSI occurrence). Self-esteem and depression partially mediated the effect of sex on NSSI occurrence, whereas self-esteem largely explained sex differences in NSSI frequency. Age-related declines in NSSI were mediated by self-esteem only in early adolescence, suggesting distinct developmental mechanisms across age groups. In late adolescence, age was directly protective for NSSI occurrence, independent of psychological variables. These findings highlight self-esteem as a critical factor influencing NSSI severity, with implications for sex- and age-specific intervention strategies. Future research should explore longitudinal trajectories and causal relationships to refine targeted prevention efforts for adolescents at risk of NSSI.

Depression disorder is a global health crisis, due to its high prevalence. Yet clinical treatments are inadequate. Uncovering the neural correlates of depression remission is a vital step toward developing effective therapies. Using a method termed therapeutic network mapping, we performed secondary analyses on the data of 16 longitudinal experiments and found that the network of the amygdala was commonly modulated by three antidepressant therapies (pharmacotherapy, electroconvulsive therapy, and magnetic seizure therapy). This therapeutic network was i) validated by two independent treatment datasets of patients with depression and a prospective preclinical experiment on male rats, ii) associated with networks of depression-related genes, neurotransmitters, and cognitions, and iii) also the target network of deep brain stimulation and repetitive transcranial magnetic stimulation (rTMS). Finally, a longitudinal rTMS experiment indicated that strengthened therapeutic network connectivity is associated with higher depressant alleviation. Taken together, our findings demonstrate that distinct antidepressant therapies act on a common network with potential targets for developing effective therapies. This study demonstrated that distinct antidepressant therapies act on a common brain network. It explains previous heterogeneous findings across therapies and may be adopted to guide precision repetitive transcranial magnetic stimulation.

OBJECTIVE:To examine the efficacy of intermittent theta burst stimulation (iTBS) for depressive symptoms and anhedonia in adolescents with depression, and explore potential moderators of treatment response. METHODS:We conducted a randomized controlled trial enrolling 60 adolescents (11-19 years) with depression from a tertiary hospital in Anhui Province, China; with participant-and assessor-blinding, whereas TMS operators were not. Participants were allocated by an independent researcher using a computer-generated random number list to active iTBS (n = 30) or sham stimulation (n = 30). The intervention was delivered over two weeks (10 treatment days), with three sessions per weekday(30 sessions total). Clinical assessments were performed at baseline and post-intervention using standardized instruments: the Hamilton Depression Rating Scale-17 items (HAMD-17), Hamilton Anxiety Rating Scale-14 items (HAMA-14), and Temporal Experience of Pleasure Scale (TEPS). Treatment effects were examined using 2 × 2 repeated-measures ANOVA, and exploratory moderation was examined using PROCESS Model 1 with 5000 bootstrap resamples, with Holm-Bonferroni correction applied across five interaction tests. RESULTS:Baseline clinical scale scores were comparable between groups (P > 0.05). Following treatment, significant group× time interactions indicated greater improvement in the active iTBS group than sham on depressive symptoms (HAMD-17: F = 40.300, P < 0.001) and anxiety symptoms (HAMA-14: F = 23.802, P < 0.001). Significant group× time interactions were also observed for TEPS total and its four subscales (P < 0.05). In exploratory moderation analyses, the Group×baseline TEPS-AA interaction was nominally significant(P = 0.014) but did not survive Holm-Bonferroni correction(adjusted P = 0.070). CONCLUSION:iTBS was feasible and associated with greater short-term improvements in depressive symptoms and anhedonia in adolescents compared with sham stimulation. Exploratory analyses indicated that baseline hedonic traits (particularly abstract anticipatory pleasure) may be related to differential treatment response, but moderation effects should be interpreted cautiously given multiple-testing correction and require confirmation in adequately powered trials with longer follow-up. These findings support further investigation of iTBS for adolescent depression and the prospective evaluation of candidate predictors of response. Generalizability may be limited by the single-center design and the accelerated treatment schedule.

BACKGROUND:Apathy, depression and anhedonia are clinically overlapping constructs, which hinders diagnostic clarity and treatment development. This study aimed to comprehensively characterise these syndromes to identify a core set of non-redundant symptoms that maximally dissociate them and to investigate the psychological nature of key distinguishing features. METHODS:Data from seven datasets (N=4578) of healthy individuals and patients with major depressive disorder were analysed using the Apathy Motivation Index, Beck Depression Inventory and Snaith-Hamilton Pleasure Scale. A machine-learning algorithm identified the most informative, non-redundant items for dissociating 'pure' apathy, depression and anhedonia. The nature of emotional apathy was further investigated with follow-up studies. RESULTS:Although substantial symptom overlap existed, 'pure' syndromes were present. Factor analysis revealed a robust five-factor structure, separating depression, anhedonia and three distinct apathy domains (behavioural, social and emotional). Machine learning identified 10 core symptoms that differentiated the pure syndromes with high accuracy (area under the curve >0.90) and could also identify well the presence of each syndrome in individuals suffering from two or more syndromes. Emotional apathy negatively correlated with depression and was specifically associated with reduced affective empathy and a diminished sensitivity to the intensity of negative facial emotions, rather than with alexithymia or antidepressant-induced emotional blunting. CONCLUSIONS:Apathy, depression and anhedonia are dissociable constructs with distinct symptom signatures. Emotional apathy is a unique dimension which provides a novel target for research. A 10-item Apathy-Depression-Anhedonia Measure developed here provides a pragmatic tool for rapid, precise phenotyping to guide more personalised therapeutic strategies.

ObjectiveTo explore the effect of group cognitive behavior therapy on cognitive flexibility in college students with high obsessive-compulsive symptoms.MethodsFifty-eight college students were randomly divided into an experimental group and control group (29 in each group). The experimental group was treated with group cognitive behavior therapy (twice a week for 4 weeks) whereas the control group was untreated. Before and after the intervention, the two groups of students were tested with the obsessive-compulsive scale OCI-R, cognitive flexibility scale CFI, acceptance and action questionnaire AAQ-II, and the cognitive fusion questionnaire CFQ to evaluate the effect after the intervention.ResultsIn the total score of obsessive-compulsive scale, the interaction between measurement time and groups was significant (F(1,56) = 17.563, p < 0.001). The post-test score of the experimental group was significantly lower than that of the pre-test score, and there was no significant difference in the control group before and after the intervention. In the total score of the cognitive flexibility scale, the interaction between measurement time and groups was significant (F(1,56) = 6.616, p < 0.05). The post-test score of the experimental group was significantly higher than the pre-test score, and there was no significant difference in the control group before and after the intervention. In the second edition of the action questionnaire and the cognitive fusion questionnaire, the interaction between measurement time and groups was significant (F(1,56) = 18.887, p < 0.001). The post-test score of the experimental group was significantly lower than that of the pre-test, and there was no significant difference in the control group before and after the intervention.ConclusionTaken together, our results show that group cognitive-behavioral therapy significantly improved the cognitive flexibility of college students with high obsessive-compulsive symptoms, resulting in a significant reduction of these symptoms.

Purpose:Major depressive disorder (MDD) is a widespread mental health condition with significant global impact. Exploring the gender differences in the interplay between thyroid function, aggression, and impulsivity offers valuable insights into its multifactorial nature and management. Patients and Methods:A cross-sectional study was conducted at Anhui Mental Health Center and included 113 MDD patients (56 males, 57 females) and 102 healthy controls (45 males and 57 females). Thyroid function was assessed through serum thyroid hormone levels, and impulsivity and aggression were measured using the Buss-Perry Aggression Questionnaire (BPAQ) and Barratt's Impulsiveness Scale version 11 (BIS). Potential confounding factors such as age, education, and Hamilton Depression Rating Scale (HAMD) scores were adjusted for. Results:Both male and female MDD patients showed significant changes in serum thyrotropin levels (F(1,213)=10.996, p=0.001), impulsivity (F(1,213)=151.521, p<0.05), and aggression (F(1,213)=44.411, p<0.05) compared to healthy controls. MANCOVA revealed significant differences in attentional impulsivity, motor impulsivity, physical aggression, anger, hostility, and self-directed aggression (all p<0.05). Moreover, significant differences between genders were observed in these areas (all p<0.05). In males, TSH levels were inversely related to several behavioral dimensions (all p<0.05), while no such correlation was found in females. Conclusion:This study highlights the role of thyroid function, especially TSH levels, in influencing impulsivity and aggression in male MDD patients, suggesting a gender-specific physiological-behavioral relationship. The findings contribute to the development of gender-specific treatment strategies. In the future, longitudinal studies with larger sample sizes should be conducted to explore molecular mechanisms for more personalized treatments.

Objective: Emotion dysregulation is one of the core causes of non-suicidal self-injury (NSSI). However, little is known about the effects of emotion regulation and rumination on NSSI behaviors in adolescents with depressive disorder. Methods: In total, 1782 depressed adolescents (1464 females and 318 males) completed questionnaires on rumination, emotion regulation, and NSSI, with an average age of 14.85. Participants were recruited from the outpatient and inpatient wards of 14 hospitals across the country. Results: NSSI behavior frequency was positively correlated with rumination and negatively correlated with emotion regulation. Cognitive reappraisal and expression inhibition play a significant mediating role in the relationship between rumination and NSSI. Conclusion: Among adolescents with depression, rumination has an impact on the frequency of NSSI behavior, and the relationship between the two is mediated by emotional regulation. The results indicate that intervention with adaptive emotion regulation strategies in adolescent depression patients may reduce the frequency of NSSI, especially in adjusting cognitive evaluation.

BACKGROUND:Major depressive disorder (MDD) represents a prevalent mental health condition characterized by profound cognitive and emotional disturbances. Emerging evidence suggests sex differences in how these symptoms interact with cognitive deficits, yet the mechanisms remain unclear. Traditional methods have limitations in capturing these complex interactions. This research employs network analysis to investigate and contrast the interrelationships between depressive symptoms and cognitive functions in male and female individuals diagnosed with MDD, offering new insights into sex-specific patterns within the disorder. METHODS:A cohort of 375 inpatients diagnosed with MDD, comprising 148 males and 227 females, was recruited for the study. Clinical evaluations encompassed the 24-item Hamilton Depression Rating Scale (HDRS-24) and an extensive array of neurocognitive assessments targeting domains such as attention, memory, processing speed, and executive function. Gaussian graphical models (GGMs) were employed to construct networks of depressive symptoms and cognitive functions, focusing on identifying central and bridge symptoms within these networks. RESULTS:The network analysis revealed distinct patterns in the interaction of depressive symptoms and cognitive functions between males and females. In males, sleep disturbance and processing speed emerged as central features, while in females, psychomotor retardation, working memory, and processing speed were more prominent. Sleep disturbance was identified as the key bridge symptom in males, whereas psychomotor retardation and working memory served as bridge symptoms in females. Despite these differences, no significant sex differences were found in global network strength or structure. CONCLUSION:This study elucidated distinct patterns in the network relationships between depressive symptoms and cognitive functions among male and female patients diagnosed with MDD. These findings suggest that although the overall impact of MDD on cognitive function is consistent across sexes, the pathways through which these effects manifest differ. This underscores the need for tailored therapeutic strategies that target these sex-specific network features to optimize treatment outcomes in MDD patients.

OBJECTIVE:Suicidal ideation (SI) in major depressive disorder (MDD) is closely associated with thyroid dysfunction and abnormal brain activity, yet their interplay remains insufficiently understood. Compared to healthy controls, this study investigates the relationship between thyroid function and dynamic brain activity in MDD patients with (SI-MDD) and without SI (nSI-MDD). METHODS:210 MDD patients and 103 healthy controls underwent thyroid function assessment and fMRI scanning. We computed the dynamic amplitude of low-frequency fluctuations (dALFF), which reflects neural activity patterns, and used one-way ANCOVA with post-hoc tests to identify group-level differences. RESULTS:Our findings show that SI-MDD patients had significantly higher TSH levels and lower T3 levels compared to nSI-MDD and healthy controls (p < 0.05). Additionally, SI-MDD patients displayed reduced dALFF in regions critical for emotional and cognitive control, including the right orbitofrontal inferior gyrus (R.Orb.IFG) and right anterior cingulate cortex (R.ACC). Notably, T3 levels were positively correlated with dALFF in the R.Orb.IFG (r = 0.318, p = 0.001), while TSH levels were negatively correlated with dALFF in the R.ACC (r = -0.316, p = 0.001). CONCLUSION:Our findings offer insight into associations between thyroid dysfunction and brain activity in SI-MDD, suggesting that thyroid biomarkers may have a role in understanding and managing SI, although these results need to be confirmed with further research.

This study established a network structure between problematic smartphone use (PSU) and poor sleep quality (PSQ) to explore their symptomatic relationship in adolescents with depression. The data were obtained from the baseline data of the Chinese Adolescent Depression Cohort, which included depressed adolescents aged between 12 and 18 years. PSU and PSQ were assessed via the Mobile Phone Addiction Index (MPAI) and Pittsburgh Sleep Quality Index (PSQI). This study utilized network analysis to identify the core and bridge symptoms between PSU and PSQ. The core symptom of the network was ‘Anxiety and craving’ in the PSU. The symptoms ‘Anxiety and craving’, ‘Daytime dysfunction’ and ‘Sleep disturbances’ could function as bridges between PSU and PSQ. The symptom ‘Anxiety and craving’ played the most important role in the interaction between PSU and PSQ. It affects ‘Sleep disturbances’ that contribute to the harm of problematic smartphone use to sleep quality. The symptom ‘Daytime dysfunction’ of PSQ was the most severely affected by PSU. Interventions that target regulating negative emotion and reducing daytime tiredness would be more effective in managing problematic smartphone use and improving sleep quality. Not applicable.

Objective：The prevalence of mental health problems among medical students is higher than that of students in other disciplines and continues to increase, which may pose a risk to medical students in their subsequent studies and careers. This study adopts a Group Problem Manager Plus (PM+) intervention with medical students and investigates its effectiveness. The study demonstrates the effectiveness of Group PM+ at treating depressed mood and mental health illnesses, providing an important theoretical and experimental basis for new therapies to improve the physical and mental health of medical students. Methods: (1) Participants: Fifty-two participants were recruited through online distribution of the scale and randomly divided into an experimental group (received 5 weekly sessions of the Group PM+ intervention) and a control group (sharing psychology knowledge online only) after interviewing each participant individually. (2) Scales: The participants in both groups completed pre- and post-tests that included the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), UCLA Loneliness Scale, Toronto Alexithymia Scale (TAS), and Chinese version of the Interpersonal Reactivity Index (IRI-C). Results: (1) The results of the repeated measures ANOVA showed a significant improvement in depressed mood in Group PM+ (F1,43 = 10.460, P = 0.002) and significantly improved anxiety (F1,43 = 19.007, P < 0.001). (2) The Group PM+ intervention also diminished feelings of loneliness due to depressed mood and partially improved alexithymia. Conclusions: (1) Group PM+ interventions can effectively treat depression and anxiety in medical students, alleviate feelings of loneliness, and reduce alexithymia in this population.

Background and Hypothesis There is a huge heterogeneity of magnetic resonance imaging findings in schizophrenia studies. Here, we hypothesized that brain regions identified by structural and functional imaging studies of schizophrenia could be reconciled in a common network.Study Design We systematically reviewed the case-control studies that estimated the brain morphology or resting-state local function for schizophrenia patients in the literature. Using the healthy human connectome (n = 652) and a validated technique "coordinate network mapping" to identify a common brain network affected in schizophrenia. Then, the specificity of this schizophrenia network was examined by independent data collected from 13 meta-analyses. The clinical relevance of this schizophrenia network was tested on independent data of medication, neuromodulation, and brain lesions.Study Results We identified 83 morphological and 60 functional studies comprising 7389 patients with schizophrenia and 7408 control subjects. The "coordinate network mapping" showed that the atrophy and dysfunction coordinates were functionally connected to a common network although they were spatially distant from each other. Taking all 143 studies together, we identified the schizophrenia network with hub regions in the bilateral anterior cingulate cortex, insula, temporal lobe, and subcortical structures. Based on independent data from 13 meta-analyses, we showed that these hub regions were specifically connected with regions of cortical thickness changes in schizophrenia. More importantly, this schizophrenia network was remarkably aligned with regions involving psychotic symptom remission.Conclusions Neuroimaging abnormalities in cross-sectional schizophrenia studies converged into a common brain network that provided testable targets for developing precise therapies.

Previous studies have suggested a significant association between mobile phone addiction (MPA) and non-suicidal self-injury (NSSI) in general adolescents. However, limited research has analyzed this relationship in clinical populations, such as those with major depressive disorder (MDD), and the potential mediation mechanisms remain unclear. This cross-sectional observational study analyzed data from 2343 adolescents with MDD (77.9

Background:Heterogeneous findings among anxiety disorder studies have hindered elucidation of the underlying pathophysiology and the development of mechanism-based therapies. Purpose:To determine whether structural MRI findings in anxiety disorder studies converge on a common network with therapeutic significance. Materials and Methods:In this retrospective study, a systematic literature search of PubMed and Web of Science databases was performed to identify coordinates of gray matter atrophy in patients with anxiety disorder. Atrophy coordinates were then mapped to an anxiety network constructed from the resting-state functional MRI (rs-fMRI) data of 652 healthy participants using "coordinate network mapping" and validated by specificity tests. The causal association of this network to anxiety symptoms was tested in a cohort of patients with brain lesions and emergent anxiety symptoms. The potential therapeutic utility of this anxiety network was then assessed by examining the clinical efficacy of network-targeted repetitive transcranial magnetic stimulation (rTMS) among a separate anxiety disorder cohort. Statistical analyses of images were performed using nonparametric tests and corrected for family-wise error. Results:Sixteen studies comprising 453 patients with anxiety (245 females; mean age ± [SD], 31.4 ± 8.71 years) and 460 healthy controls (238 females; 31.7 ± 10.08 years) were included in the analysis. Atrophy coordinates were mapped to an anxiety network with a hub region situated primarily within the superficial amygdala. Lesions associated with emergent anxiety symptoms exhibited stronger connectivity within this anxiety network than lesions not associated with anxiety (t = 2.99; P = .004). Moreover, the connectivity strength of rTMS targets in the anxiety network was correlated with the improvements of anxiety symptom after treatment (r = .42, P = .02). Conclusions:Heterogeneous gray matter atrophy among patients with anxiety disorder localize to a common network that may serve as an effective therapeutic target.

Importance Auditory verbal hallucinations (AVH) are a common symptom of schizophrenia, increasing the patient's risks of suicide and violence. Repetitive transcranial magnetic stimulation (rTMS) is a potential treatment for AVH. Objective To investigate the effect of imaging-navigated rTMS on AVH in patients with schizophrenia. Design, Setting, and Participants This 6-week, double-blind, sham-controlled, randomized clinical trial was performed at the Anhui Mental Health Center, Hefei, China, from September 1, 2016, to August 31, 2021. Participants included 66 patients with AVH and schizophrenia. Data were analyzed from May 1, 2022, to March 31, 2023. Interventions Participants were randomly assigned 1:1 to either imaging-navigated active or sham rTMS over the left temporoparietal junction for 2 weeks. Main Outcomes and Measures The primary outcome measured improvements in AVH from baseline to week 2 and week 6 using the Auditory Hallucination Rating Scale (AHRS) scores. In addition, the TMS-induced electric field strength was used to estimate improvements in AVH as a secondary outcome. Results A total of 62 participants (33 women [53%]; mean [SD] age, 27.4 [9.2] years) completed the 2-week treatments. Of these, 32 were randomized to the active rTMS group (18 women [56%]; mean [SD] age, 26.9 [9.2] years) and 30 to the sham treatment group (15 women [50%]; mean [SD] age, 27.8 [9.4] years). In the intention-to-treat analyses, patients receiving active rTMS showed a significantly greater reduction in AHRS scores compared with those receiving sham treatment at week 2 (difference, 5.96 [95% CI, 3.42-8.50]; t = 4.61; P < .001; Cohen d, 1.17 [95% CI, 0.62-1.71]). These clinical effects were sustained at week 6. Additionally, a stronger TMS-induced electric field within a predefined AVH brain network was associated with greater reductions in AHRS scores (B = 3.12; t = 3.58; P = .002). No serious adverse event was observed. Conclusions and Relevance The findings of this randomized clinical trial suggest that imaging-navigated rTMS may effectively and safely alleviate AVH in patients with schizophrenia. Findings also suggest that the electric field strength in the individualized AVH network is a vital parameter for optimizing the efficacy of the rTMS protocol.

Objective: Non -suicidal self -injury (NSSI) behavior is very common in adolescents with depression, and childhood trauma is considered one of the distal risk factors for its exacerbation. Rumination caused by adverse traumatic experiences, which can be transferred through NSSI behavior, can alleviate symptoms of depression in adolescents. The current research focuses on the relationship between the three, further exploring whether rumination is a mediator in the relationship between childhood trauma and NSSI behavior on the basis of previous studies, and provides some suggestions for future early intervention for adolescents with depression. Methods: A total of 833 adolescent patients with depression who met the DSM-5 criteria for depressive episode were recruited from 12 hospitals in China. The Chinese version of the Function Assessment of Self -mutilation, Childhood Trauma Questionnaire, and Rumination Inventory were used as research tools. Results: The scores of childhood trauma and rumination in adolescents with depression in the NSSI group were higher than those in the non-NSSI group. A Pearson's correlation analysis showed that childhood trauma was positively correlated with rumination (r=0.165, P<0.01), different types of childhood trauma were significantly positively correlated with rumination and its three factors, and these results were statistically significant. Rumination partially mediated the relationship between childhood trauma and NSSI behavior in depressed adolescent patients (effect size=0.002), and the effect in female participants (effect size=0.003), was greater than that in male participants (effect size=0.002). Conclusion: Childhood trauma and rumination were key factors for NSSI behavior in adolescents with depression. Childhood trauma not only has a direct effect on NSSI behavior in adolescent depression, but also plays an indirect effect on NSSI behavior through rumination.

Objective Non-suicidal self-injury (NSSI) behaviors are prevalent in adolescents and have adverse effects on physical and mental health. However, little is known about the relationship between NSSI and alexithymia, or the underlying mechanisms that could explain this relationship. This study aimed to elucidate the current status of NSSI in adolescent depression, and analyze the relationship between alexithymia, loneliness, resilience, and adolescent depression with NSSI, so as to provide a theoretical basis for psychotherapeutic interventions. Method The study sample involved inpatients and outpatients from 12 hospitals across China and adolescents with depression who met the DSM-5 diagnostic criteria for depression episode. The following scales were used: The Functional Assessment of Self-Mutilation, Toronto Alexithymia Scale, UCLA Loneliness Scale, and Connor Davidson Resilience Scale. Results The detection rate of NSSI in adolescents with depression from 2021.01.01-2022.01.01 was 76.06% (1782/2343). Spearman’s correlation analysis revealed a significant correlation between alexithymia, loneliness, resilience and NSSI in depressed adolescents, and the results of the non-parametric test showed that the differences between the two groups for each factor were statistically significant. Binary logistic regression results showed that alexithymia (B = 0.023, p = 0.003, OR = 1.023, 95% CI: 1.008–1.038) and depression (B = 0.045, p < 0.001, OR = 1.046, 95% CI: 1.026–1.066) are risk factors for NSSI, resilience (B = − 0.052, p < 0.001, OR = 0.949, 95% CI: 0.935 − 0.964) is a protective factor for NSSI. Alexithymia directly predicted NSSI and also indirectly influenced NSSI through the mediated effect of resilience. Loneliness moderates the first half of the path of this mediated model. Conclusion The present study confirms a moderated mediation effect: Alexithymia can have an impact on NSSI behaviors in depressed adolescents through the mediating role of resilience. Loneliness, as a moderating variable, moderated the first half of the pathway of the mediating model. We discuss perspectives for future research and interventions based on the findings of the study.