Psychosocial Outcomes From COVID-19 Not Pronounced Among Adolescents With NSSI

Among adolescents with depression and emotional regulation difficulties, the psychosocial consequences of COVID-19 were more pronounced than the same-age study participants with a history of nonsuicidal self-injury.

Psychosocial consequences from COVID-19 more greatly affected adolescents with depression and emotional regulation difficulties than those with a history of nonsuicidal self-injury (NSSI). These study results were published in Child and Adolescent Psychiatry and Mental Health.

Third-year high school students (N=1602) attending 110 schools in Sweden were recruited during home study between 2020 and 2021. In 3 waves, students were sent questionnaires about the psychosocial effects of COVID-19.

The study population comprised 56.4% girls, they had a mean age of 18.1 (SD, 0.6) years, 70.3% were in a theoretical study program, 88.0% of their mothers worked, 87.1% of their fathers worked, 76.2% had a good family financial situation, and 62.2% were living with both parents.

Overall, 488 individuals reported a history of NSSI. The NSSI group had a higher proportion of girls, more were enrolled in practical study, fewer reported a good family financial situation, and fewer lived with both parents compared with those reporting no NSSI (all P <.001).

[A]dolescents with experience of NSSI perceived more negative psychosocial consequences of [COVID-19] than adolescents without NSSI experience.

In the survey, more individuals with NSSI agreed that COVID-19 affected them a lot (74.8% vs 68.1%; P =.02), they felt more alone than before (55.5% vs 38.5%; P <.001), they found discussions about worries with friends more difficult (32.2% vs 18.0%; P <.001), they found it more difficult to contact nonfamily adults to discuss worries (32.0% vs 17.0%; P <.001), they were more worried about their home situation (20.9% vs 7.1%; P <.001), their support or treatment was interrupted (24.0% vs 8.8%; P <.001), and they felt at-home education was not working for them (42.2% vs 307%; P <.001) compared with the non-NSSI group, respectively.

Despite these trends, self-reported NSSI did not predict negative psychosocial consequences from COVID-19 (t, 1.44; P =.15).

Predictors for perceiving negative psychosocial outcomes included self-reported depression (t, 5.86; P <.001), self-reported difficulties with emotional regulation (t, 5.23; P <.001), enrollment in a theoretical study program (t, 2.84; P =.005), having a neutral family financial situation (t, 2.42; P =.02), and a poor family financial situation (t, 2.24; P =.03).

These characteristics explained 23.2% of the variance in perceived impacts from COVID-19 (F[12,1589], 40.09; P <.001) and the fit of the model was not improved by adding NSSI (P =.015).

In an interaction and moderator analysis, a significant interaction between depressive symptoms and NSSI on COVID-19 consequences was observed (β, -0.21; P <.001) but not between emotional regulation difficulties and NSSI (β-0.04; P =.05).

The major limitation of this study was that the cross-sectional design did not allow for causative inferences to be made.

Study authors concluded, “[A]dolescents with experience of NSSI perceived more negative psychosocial consequences of [COVID-19] than adolescents without NSSI experience. In this cross-sectional study, NSSI experience in itself did not, however, independently predict psychosocial [COVID-19] consequences when other variables were controlled for, whereas other variables, such as symptoms of depression and difficulties with emotion regulation did.”


Zetterqvist M, Landberg Å, Jonsson LS, Svedin CG. The psychosocial consequences of covid‑19 in adolescents with nonsuicidal self‑injury. Child Adolesc Psychiatry Ment Health. Published online March 4, 2023. doi:10.1186/s13034-023-00566-2