{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:51:17Z","timestamp":1785927077770,"version":"3.56.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non-suicidal self-injury (NSSI) is highly prevalent during adolescence and is consistently associated with suicidal ideation (SI) and suicide attempts (SA). Although numerous psychological, social, and neurobiological correlates of the NSSI\u2013suicidal behavior relationship have been investigated, current evidence remains fragmented, and the extent to which these correlates are specific to NSSI rather than reflecting broader psychopathology remains unclear. This narrative review aimed to synthesize current evidence on the psychological, social, and neurobiological correlates of the NSSI\u2013suicidal behavior relationship in adolescents, while highlighting methodological limitations and future research priorities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A structured literature search was conducted in PubMed, Web of Science, PsycINFO, and China National Knowledge Infrastructure (CNKI) to identify relevant studies published between January 2010 and June 2025. Studies involving adolescent populations that examined NSSI, suicidal ideation, suicide attempts, or their psychological, social, or neurobiological correlates were included. Consistent with the methodology of a narrative review, studies were selected based on conceptual relevance without formal risk-of-bias assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Current evidence consistently identifies NSSI as a significant risk marker for suicidal ideation and suicide attempts, although the predominantly observational nature of the literature precludes causal inference. Psychological correlates include cognitive flexibility and acquired capability for suicide; social correlates include family functioning, peer influences, and sex differences; and neurobiological studies implicate alterations in the hypothalamic\u2013pituitary\u2013thyroid (HPT) axis, hypothalamic\u2013pituitary\u2013adrenal (HPA) axis, and endogenous opioid system. Dialectical behavior therapy (DBT) demonstrates the strongest evidence for reducing both NSSI and suicidal behaviors in adolescents. However, interpretation of the available evidence is limited by cross-sectional designs, inconsistent definitions and measurements, biological heterogeneity, and inadequate control for psychiatric comorbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The relationship between NSSI and suicidal behavior in adolescents is shaped by interacting psychological, social, and neurobiological factors rather than a single mechanism. Current evidence also highlights the importance of distinguishing factors associated with the emergence of suicidal ideation from those related to the transition from ideation to suicide attempts. Future prospective, multi-method studies integrating these domains while accounting for psychiatric comorbidity are needed to clarify developmental pathways and improve risk assessment and intervention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1867397","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:37:03Z","timestamp":1785926223000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological, social, and neurobiological correlates of non-suicidal self-injury and suicidal behavior in adolescents: a narrative review"],"prefix":"10.3389","volume":"17","author":[{"given":"Mengyao","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Clinical Medicine, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongli","family":"Sun","sequence":"additional","affiliation":[{"name":"Sixth Department of Psychiatry, Weifang Mental Health Center","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2018.06.033","article-title":"The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors","volume":"239","author":"Kiekens","year":"2018","journal-title":"J Affect Disord"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s10862-008-9107-z","article-title":"Assessing the functions of non-suicidal self-injury: Psychometric properties of the inventory of statements about self-injury (ISAS)","volume":"31","author":"Klonsky","year":"2009","journal-title":"J Psychopathol Behav Assess"},{"key":"B3","volume-title":"Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition","year":"2013"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2018.06.018","article-title":"Prevalence and characteristics of self-harm in adolescents: Meta-analyses of community-based studies 1990-2015","volume":"57","author":"Gillies","year":"2018","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16224581","article-title":"Global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents between 1989 and 2018: A meta-analysis","volume":"16","author":"Lim","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"B6","volume-title":"Suicide Worldwide in 2021: Global Health Estimates","year":"2025"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796017000488","article-title":"Prevalence of suicidal behaviour and associated factors in a large sample of Chinese adolescents","volume":"28","author":"Liu","year":"2019","journal-title":"Epidemiol Psychiatr Sci"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(22)00193-6","article-title":"Prevalence of suicidal ideation and self-harm behaviours in children aged 12 years and younger: a systematic review and meta-analysis","volume":"9","author":"Geoffroy","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/camh.12692","article-title":"Understanding the impact of children\u2019s and young people\u2019s self-harm on parental well-being: a systematic literature review of qualitative and quantitative findings","volume":"29","author":"Martin","year":"2024","journal-title":"Child Adolesc Ment Health"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101437","article-title":"The experiences and needs of supporting individuals of young people who self-harm: a systematic review and thematic synthesis","volume":"48","author":"Mughal","year":"2022","journal-title":"eClinicalMedicine"},{"key":"B11","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1007\/s00787-025-02886-4","article-title":"Parents\u2019 stress and distress in the face of their children\u2019s self-injurious thoughts and behaviors: a scoping review","volume":"35","author":"Simon","year":"2026","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2024.03.002","article-title":"Economic cost of U.S. suicide and nonfatal self-harm","volume":"67","author":"Peterson","year":"2024","journal-title":"Am J Prev Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2022.100341","article-title":"The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990\u20132019: findings from the global burden of disease study 2019","volume":"16","author":"Castelpietra","year":"2022","journal-title":"Lancet Reg Health - Eur"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0276070","article-title":"Suicide capability within the ideation-to-action framework: A systematic scoping review","volume":"17","author":"Bayliss","year":"2022","journal-title":"PLoS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1037\/a0018697","article-title":"The interpersonal theory of suicide","volume":"117","author":"Van Orden","year":"2010","journal-title":"Psychol Rev"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1434191","article-title":"Nonsuicidal self-injury as the gateway and consequence of suicidal ideation among adolescents: a cross-lagged regression analysis","volume":"15","author":"Xu","year":"2024","journal-title":"Front Psychiatry"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1002-0152.2025.05.004","article-title":"Mediating role of cognitive flexibility between non-suicidal self-injury and suicide attempts in adolescents with depression","volume":"51","author":"Wang","year":"2025","journal-title":"Chin J Nerv Ment Dis"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci13050755","article-title":"Persistent non-suicidal self-injury and suicidality in referred adolescents: a longitudinal study exploring the role of cyclothymic temperament","volume":"13","author":"Masi","year":"2023","journal-title":"Brain Sci"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2022.12.040","article-title":"For better or worse?: the role of cognitive flexibility in the association between nonsuicidal self-injury and suicide attempt","volume":"158","author":"Park","year":"2023","journal-title":"J Psychiatr Res"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2024.115925","article-title":"Pain tolerance as a \u2018barrier\u2019 to nonsuicidal self-injury: a longitudinal study","volume":"336","author":"Boyne","year":"2024","journal-title":"Psychiatry Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.jad.2020.09.036","article-title":"Pain sensitivity and plasma beta-endorphin in adolescent non-suicidal self-injury","volume":"278","author":"Van Der Venne","year":"2021","journal-title":"J Affect Disord"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.70244","article-title":"The role of suicidal motivations in foreseeing suicide risk in nonsuicidal self-injury adolescent population","volume":"33","author":"Wisniewski","year":"2026","journal-title":"Clin Psychol Psychother"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2025.1546751","article-title":"The mediating role of cognitive flexibility in the relationship between social support and non-suicidal self-injury among adolescents: a multicenter cross-sectional study","volume":"16","author":"Wang","year":"2025","journal-title":"Front Psychol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-025-10591-4","article-title":"The associations between cognitive flexibility and suicidal thoughts and behaviors: a systematic review and meta-analysis","volume":"49","author":"Zhu","year":"2025","journal-title":"Cognit Ther Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1016\/j.jad.2023.07.075","article-title":"Cognitive inflexibility and suicidal ideation among adolescents following hospitalization: the moderating role of life stress","volume":"339","author":"Cheek","year":"2023","journal-title":"J Affect Disord"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1080\/13811118.2024.2372616","article-title":"Trauma exposure moderates the link between cognitive flexibility and suicide risk in pre-adolescent children","volume":"29","author":"Chen","year":"2025","journal-title":"Arch Suicide Res"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2023.115067","article-title":"Cognitive flexibility in inpatient children and adolescents with a history of suicide attempts","volume":"321","author":"Itzhaky","year":"2023","journal-title":"Psychiatry Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s13034-024-00742-y","article-title":"Prevalence of unhealthy behaviors and their associations with non-suicidal self-injury, suicidal ideation and suicide attempt among chinese adolescents","volume":"18","author":"Lai","year":"2024","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.03.021","article-title":"Age and gender effects on non-suicidal self-injury, and their interplay with psychological distress","volume":"306","author":"Wilkinson","year":"2022","journal-title":"J Affect Disord"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s00038-018-1196-1","article-title":"Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies","volume":"64","author":"Miranda-Mendizabal","year":"2019","journal-title":"Int J Public Health"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1111\/sltb.70060","article-title":"Investigating early predictive correlates of suicide among adolescent longitudinal survey participants after nearly three decades: reviewing national death index records of add health suicide decedents from 2022","volume":"55","author":"Feigelman","year":"2025","journal-title":"Suicide Life Threat Behav"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.03.108","article-title":"Self-injury and suicidal ideation among chinese adolescents involved in different subtypes of aggression: the role of gender","volume":"355","author":"Cheng","year":"2024","journal-title":"J Affect Disord"},{"key":"B33","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.jad.2023.03.034","article-title":"Longitudinal relation between maladaptive parenting and nonsuicidal self-injury among chinese early adolescents: the roles of internalizing symptoms and FKBP5 gene variation","volume":"331","author":"Zhou","year":"2023","journal-title":"J Affect Disord"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1080\/20008066.2025.2542045","article-title":"The mediating roles of stressful life events and negative affect in the relationship between childhood maltreatment and non-suicidal self-injury among clinical adolescents","volume":"16","author":"He","year":"2025","journal-title":"Eur J Psychotraumatol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.12.111","article-title":"The impact of sexual abuse in childhood on adolescents\u2019 non-suicidal self-injury behavior: a moderated mediation model","volume":"373","author":"Fan","year":"2025","journal-title":"J Affect Disord"},{"key":"B36","doi-asserted-by":"publisher","first-page":"4257","DOI":"10.1186\/s12889-025-25594-9","article-title":"Effect of cumulative family risk on non-suicidal self-injury among chinese adolescents: a longitudinal moderated mediation model","volume":"25","author":"Xu","year":"2025","journal-title":"BMC Public Health"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/jad.12279","article-title":"Impacts of difficulties with emotion regulation on the longitudinal relationship between peer victimization and changes in adolescent nonsuicidal self-injury","volume":"96","author":"Li","year":"2024","journal-title":"J Adolesc"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jpsychires.2025.04.052","article-title":"The complex relationship between NSSI exposure and suicidal risk: insights from a short-term longitudinal study","volume":"187","author":"Wang","year":"2025","journal-title":"J Psychiatr Res"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1359400","article-title":"A cross-sectional study of non-suicidal self-injury in adolescent depression: association with demographic characteristics and physiological indicators","volume":"15","author":"He","year":"2024","journal-title":"Front Psychiatry"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S452643","article-title":"Gender differences of antioxidant system and thyroid function in depressed adolescents with non-suicidal self-injury","volume":"20","author":"Zhang","year":"2024","journal-title":"Neuropsychiatr Dis Treat"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.1071563","article-title":"Relationship between thyroid hormone and sex hormone levels and non-suicidal self-injury in male adolescents with depression","volume":"13","author":"Ma","year":"2022","journal-title":"Front Psychiatry"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1080\/13811118.2022.2066494","article-title":"Assessment of plasma-endogenous opioid neuropeptide levels and psychometric properties of non-suicidal self-injury in adolescents","volume":"27","author":"Cakin Memik","year":"2023","journal-title":"Arch Suicide Res"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2024.116142","article-title":"Longitudinal associations between beta-endorphin, nonsuicidal self-injury and comorbid psychopathology","volume":"340","author":"Kao","year":"2024","journal-title":"Psychiatry Res"},{"key":"B44","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.jad.2023.06.041","article-title":"Physiological response to pain in female adolescents with nonsuicidal self-injury as a function of severity","volume":"339","author":"Van Der Venne","year":"2023","journal-title":"J Affect Disord"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12051924","article-title":"Do cortisol and dehydroepiandrosterone influence motivational factors for non-suicidal self-injury in female adolescents","volume":"12","author":"Piarulli","year":"2023","journal-title":"J Clin Med"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2024.107093","article-title":"Two-year course of non-suicidal self-injury in an adolescent clinical cohort: the role of childhood adversity in interaction with cortisol secretion","volume":"167","author":"Reichl","year":"2024","journal-title":"Psychoneuroendocrinology"},{"key":"B47","doi-asserted-by":"publisher","first-page":"68","DOI":"10.3969\/j.issn.1006-7795.2024.01.012","article-title":"Study on suicide attempts and changes in HPT axis and HPA axis functions in adolescent patients with non-suicidal self-injury","volume":"45","author":"Wang","year":"2024","journal-title":"J Cap Med Univ"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2024.01.012","article-title":"Remission, recovery, relapse, and recurrence rates for suicide attempts and nonsuicidal self-injury for suicidal youth treated with dialectical behavior therapy or supportive therapy","volume":"63","author":"Berk","year":"2024","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1016\/j.jaac.2021.01.016","article-title":"Dialectical behavior therapy for suicidal self-harming youth: emotion regulation, mechanisms, and mediators","volume":"60","author":"Asarnow","year":"2021","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291721001355","article-title":"Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis","volume":"51","author":"Kothgassner","year":"2021","journal-title":"Psychol Med"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1007\/s10964-024-02119-y","article-title":"Family functioning and NSSI urges among Chinese adolescents: a three-wave chain multiple mediation model","volume":"54","author":"Xue","year":"2025","journal-title":"J Youth Adolesc"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1867397\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:37:06Z","timestamp":1785926226000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1867397\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":51,"alternative-id":["10.3389\/fpsyt.2026.1867397"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1867397","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]},"article-number":"1867397"}}