Adolescent non-suicidal self-injury during the COVID-19 pandemic: a prospective longitudinal study of biological predictors of maladaptive emotion regulation

Abstract

Background: Current theory holds that risk for adolescent non-suicidal self-injury (NSSI) emerges from interactions between vulnerability in developing biological systems and experience of stressors. The current study considers whether multiple levels of measurement of the physiological response to environmental threat could prospectively predict NSSI outcomes during the COVID-19 pandemic, a shared, time-locked stressor. Methods: Prior to the onset of the COVID-19 pandemic, 64 female adolescents with a range of NSSI histories completed a protocol that measured hypothalamic-pituitary-adrenal axis response to a social stressor, amygdala emotion-evoked activation, amygdala volume, and frontolimbic resting-state functional connectivity. Adolescents reported on NSSI behavior, emotion regulation, and perceived stress during the COVID-19 pandemic (June 2020). Multinomial logistic regression was used to measure how pre-pandemic biomarkers predicted mid-pandemic NSSI group status: persistence of NSSI (N=21), cessation of NSSI (N=26), and no history of NSSI (N=17). Linear regressions explored how pre-pandemic biomarkers predicted mid-pandemic difficulties in emotion regulation and perceived stress. Follow-up analyses considered other risk outcomes as well as across-level interactions. Results: Higher pre-pandemic cortisol response to stress prospectively predicted continued NSSI but lower difficulties in emotion regulation during the pandemic. Greater pre-pandemic amygdala emotion-evoked activation predicted persistent NSSI and heightened perceived stress during the pandemic. Conclusions: Findings suggest how patterns in key biological threat response systems may confer vulnerability for risk outcomes including NSSI engagement in adolescent females in the context of a shared, novel, naturally-occurring stressor. Divergence in predictive patterns (e.g. greater pre-pandemic cortisol responses predict lower rates of NSSI but greater difficulties with emotion regulation) underscore the importance of multi-level, longitudinal approaches for appreciating the nuances in changes over time in the interface between developing neurobiological systems and experiential stress in at-risk adolescents.