ArticleZhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences2026
[Longitudinal relationships among anxiety, depression, non
Article in Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesAdolescence is a critical period with a high incidence of psychological problems. Anxiety, depression, and non-suicidal self-injury (NSSI) are relatively common among adolescents and can affect their physical and mental health. This study aims to investigate the dynamic temporal interactions among anxiety, depression, NSSI, and distress tolerance in adolescents using three waves of longitudinal follow-up data and cross-lagged network analysis. This study also aims to quantify the relative importance of each variable in the network and its cross-time predictive effects, thereby providing empirical evidence for early prevention and precision intervention in adolescent mental health.
methodsCluster sampling was used to recruit first-year students from 3 public junior high schools and first-year students from 3 public senior high schools in Yiyang, Hunan Province. Three follow-up surveys were conducted at T1, T2, and T3, with 6-month intervals between assessments. A total of 1 621 adolescents who completed all 3 surveys with valid responses were included. The assessment tools included the simplified Chinese version of the Depression Anxiety Stress Scale-21, the Tolerance for Mental Pain Scale (TMPS)-10, and the Ottawa Self-Injury Inventory.
resultsRepeated-measures analysis of variance showed that from T1 to T2, the total score of distress tolerance and scores for tolerating distress and managing distress significantly decreased, whereas the scores for anxiety, depression, and NSSI thoughts and behaviors in the past month significantly increased. From T2 to T3, the total score of distress tolerance and the score for tolerating distress significantly decreased, while the scores for anxiety and NSSI thoughts in the past month significantly decreased (all
conclusionsThe relationships among anxiety, depression, NSSI, and distress tolerance in adolescents are dynamic and stage-specific. The ability to manage distress is a protective factor against anxiety and depression in adolescents, although its predictive effect weakens over time. In contrast, NSSI behavior gradually becomes a risk factor for depression at later stages. Therefore, improving adolescents' ability to manage distress, especially at an early stage, and intervening in NSSI behavior may effectively reduce anxiety and depression levels.
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