Relationship between facial emotion recognition and non-suicidal self injury in adolescents with depression: A multicenter cross-sectional study from China

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Adolescent depression is highly co-occurring with non-suicidal self-injury (NSSI). Exploring the relationship between NSSI and facial emotion recognition is crucial for early intervention in adolescents with depression. This study used a multi-center cross-sectional design (14 psychiatric hospitals in 9 provinces of China). The Patient Health Questionnaire-9 (PHQ-9) and Functional Assessment of Self-Mutilation (FASM) were used to evaluate depression and NSSI respectively. Six emotions including neutral, angry, disgusted, fearful, happy, sad and surprised were used for testing. Spearman correlation analysis and binary logistic regression analysis were used to explore the relationship between NSSI and emotion recognition. This study recruited 1644 adolescent depression patients, of whom 76.2 % (1252/1644) reported NSSI behavior and had significantly higher PHQ-9 scores than adolescents without NSSI behavior ( p < 0.001). “Cut or carved on your skin” was more common in the choice of method (87.6 %). The age curve showed that girls have more NSSI in each age group, and the peak incidence of NSSI in girls was higher than that in boys. Compared with the non-NSSI group, the NSSI group exhibited higher accuracy in recognizing aversive emotions. In addition, PHQ-9 scores were significantly correlated with the recognition of neutral( P < 0.001), angry( P = 0.011), and happy( P = 0.008). Furthermore, PHQ-9 scores (P < 0.001) and Surprised facial emotion recognition scores ( P = 0.026) showed significant correlations with NSSI behavior. NSSI is common in adolescents with depression, and the emotional recognition ability of NSSI patients has decreased, especially in identifying neutral, happy, and angry emotions. Similarly, depression further exacerbates the risk of NSSI. • This study included patients from outpatient and inpatient psychiatric clinics of 14 psychiatric hospitals in 9 provinces of China. • This study was divided into two groups and a control group was set up to increase the credibility of the research results. • This article discussed the basic characteristics of the NSSI group, emotion recognition, and factors related to NSSI, and provided an understanding of how emotional face recognition ability affects interpersonal communication and leads to non-suicidal self-injury.

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