(PS9-A4) Multi-method Evaluation of Emotion Recognition, Emotion Reactivity, and Emotion Regulation as Prospective Predictors of 12-month NSSI Trajectories in a Adolescent Clinical Sample

Approximately 18% of adolescents have engaged in non-suicidal self-injury (NSSI; Muehlenkamp et al. 2012), and often use NSSI to manage emotional distress (Robinson et al., 2018). Among inpatient settings and adolescent samples, those who engage in NSSI consistently report poorer emotion regulation (ER) than their peers who do not engage in NSSI (Mackenzie & Gross, 2014). Further, NSSI severity has been associated with poorer ER (Gratz & Roemer, 2004). Despite the growing evidence, studies examining emotional processes in relation to NSSI within a longitudinal design is generally limited in that different trajectories in this behavior are often not examined. As such, the current study uses a novel and nuanced approach to examine emotional processes via multi-method assessments to predict NSSI trajectories in the 12 months post-discharge in psychiatrically hospitalized youth. Participants included 180 adolescents (M_age = 14.89; SD = 1.35; 71.7% female; 78.9% White; 55.0% heterosexual) recruited from an inpatient psychiatric unit. The Self-Injurious Thoughts and Behaviors Interview (SITBI; Nock et al., 2007) was administered as a measure of NSSI at baseline, 6-, and 12-months post-discharge. Baseline predictor measures consisted of: (i) a computer-based assessment of facial emotion recognition ability with youth and adult facial stimuli; (ii) a self-reported measure of emotional sensitivity, intensity, and persistence; and (iii) a self-report measure of multiple facets of emotion regulation. Latent growth curve analysis was conducted to identify subgroups of individuals based upon their trajectory of NSSI across the 12-month follow-up period. ANOVAs were then conducted to examine subgroup differences in emotion processing variables. Analyses yielded three NSSI trajectories over the 12-month follow-up: a stable low-to-moderate-frequency group, a stable moderate-frequency group, and a group characterized by high frequency of NSSI at baseline but resolution of NSSI by 6-month follow-up. After adjusting for multiple comparisons, only emotion regulation at baseline differentiated between the trajectories, with greater overall emotion dysregulation in the initially high-frequency group relative to the stable moderate-frequency group (p < .05), and greater emotional non-acceptance characterizing the initially high-frequency group and the stable moderate-frequency group more than the stable low-to-moderate-frequency group (ps < .05). Findings suggest that difficulties in emotional processing, specifically overall emotion regulation and emotional non-acceptance, differentiated between NSSI-frequency trajectories in psychiatrically acute adolescents. Given that NSSI is often engaged in as a means to manage emotional distress, emotion regulation skills training should be explored as part of treatment with youth during inpatient care, with a particular focus on increasing acceptance of emotional experiences. Skills training that teaches more adaptive emotional processes may contribute to a reduction in NSSI especially among youth projected to have a stable trajectory on continued engagement in NSSI.