Non-suicidal self-injury and multidimensional mental health screening networks among ethnic minority adolescents in Ngawa Prefecture, China

Non-suicidal self-injury (NSSI) is an important adolescent mental health concern that often co-occurs with broader psychological difficulties. However, its position within multidimensional mental health screening domains remains unclear among ethnic minority adolescents in western China. This study examined the symptom-domain network linking NSSI with related mental health screening indicators. This cross-sectional school-based screening study included 2,353 adolescents from six junior and senior high schools. Fourteen symptom-domain variables across five mental health screening domains were analyzed using a Gaussian graphical model. Relative importance, sex-stratified subgroup, and sensitivity analyses were additionally conducted to examine explained variance, subgroup patterns, and robustness. The total-sample network showed a closely connected internalizing symptom structure, especially among separation anxiety symptoms, social anxiety symptoms, depressive symptoms, and obsessive-compulsive symptoms. NSSI was most strongly connected with depressive symptoms, generalized anxiety symptoms, and obsessive-compulsive symptoms. Depressive symptoms showed the highest centrality and contributed most to the explained variance of NSSI. In this study, NSSI was closely embedded within depressive, anxiety-related, and repetitive distress-related symptom domains. These findings support multidimensional, assessment-oriented school-based screening and stepped referral approaches.