An online dynamic nomogram for estimating NSSI behavior among adolescents with depressive disorder

BMC Psychiatry. 2026 May 20. doi: 10.1186/s12888-026-08175-x. Online ahead of print.

ABSTRACT

OBJECTIVE: Non-suicidal self-injury (NSSI) is highly prevalent among adolescents with depressive disorder and is associated with significantly worsened clinical outcomes. Previous researches have established a link between NSSI and impairments in emotion regulation. This study aimed to quantitatively investigate the relationship between specific emotion regulation strategies and NSSI, and to develop and validate a clinically applicable nomogram for estimating the likelihood of NSSI for individual patients in this population.

METHODS: We recruited 1946 adolescents with depressive disorder from January 2021 to December 2021. The participants were randomly divided into a training group (70%) for model development and a validation group (30%) for testing. Using multivariate regression analysis on the training data, we identified independent correlates of NSSI and constructed a nomogram. The model subsequently underwent internal and external validation to assess its discriminative ability, calibration, and clinical utility.

RESULTS: Multivariate analysis identified age, gender, cognitive reappraisal and PHQ-9 score as independent correlates for NSSI. These four candidates were applied to develop a nomogram. For internal validation, the p-value for the HL goodness of fit test was 0.218 (p > 0.05). The nomogram presented a C-statistic value of 73.4% (95%CI: 0.703-0.765), good calibration (Emax = 0.091, Eavg = 0.016, S:p = 0.826). Decision curve analysis suggested that the nomogram provided net benefit across a range of threshold probabilities (range: 19.9%-96.9%). For external validation using data in validation group, the p-value for the HL goodness of fit test was 0. 329 (p > 0.05). The C-statistic value was 73.4% (95%CI: 0.689-0.779), presenting good calibration (Emax = 0.052, Eavg = 0.025, S:p = 0.428) and a spectrum of estimated probabilities ranging 25.8% to 96.9%.

CONCLUSION: The proposed nomogram provides a clinically applicable tool for risk stratification of NSSI among adolescents with depressive disorder. Furthermore, it identifies two modifiable correlates-cognitive reappraisal capacity and depression severity-that were significantly associated with NSSI and could be explored as potential targets for future research.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42163177 | DOI:10.1186/s12888-026-08175-x