Unveiling core clinical features of self-harm: A network and mediation analysis study among Chinese psychiatric adolescents

Background and aims: Self-harm imposes a substantial burden among adolescents, yet targeted interventions remain limited. This study examined the interrelationships among clinically relevant characteristics of self-harm outcomes, non-suicidal motives (NSMs), addictive features (AF), self-injury methods (SIMs), and suicidality (SUI), to identify core clinical features for more precise intervention. Methods: A total of 547 adolescent patients (13-19 years) who had engaged in self-harm during the past year were recruited from two Chinese hospitals. Self-report questionnaires assessed NSMs, AF, SUI, frequencies of non-suicidal self-injury (NSSI) and suicidal self-injury (SSI), and SIMs. Exploratory factor analysis (EFA) was used as a data-driven approach to identify patterns of co-occurrence among SIMs. Network and exploratory mediation analyses were subsequently conducted to evaluate statistical interrelationships among clinical features. Results: Among participants, 69.8% engaged in both NSSI and SSI. EFA identified two empirically derived groupings of SIMs: self-injury using external tools (SIET) and self-injury involving direct bodily actions (SIDBA). Network analysis identified AF as the strongest bridge symptom and SIET with the highest node strength. Exploratory mediation analyses suggested that AF statistically accounted for substantial proportions of the associations between NSMs and multiple self-harm related outcomes, including NSSI (41.3%), SSI (75.0%), SIET (62.3%), SIDBA (45.4%), and SUI (75.7%). Discussion and Conclusions: AF and SIET emerged as important clinically relevant features of self-harm. Greater attention to these features may help improve clinical assessment and targeted intervention for adolescents with self-harm.