Objective  This study aim to explore the core elements and internal correlations of the internalized stigma among the primary caregivers of adolescents with non-suicidal self-injury (NSSI), to provide references for formulating targeted intervention measures.

Methods  A cross-sectional survey design was adopted. The general information questionnaire and the Internalized Stigma of Mental Illness scale were used to investigate the primary caregivers of adolescents with NSSI who were hospitalized at The Fourth People's Hospital of Chengdu. Using R 4.4.2 software, a network model of internalized stigma was constructed through the graphical least absolute shrinkage and selection operator and the extended Bayesian information criterion, and central index analysis and gender subgroup network invariance test were conducted.

Results  A total of 374 caregivers were collected. The total score of the primary caregivers' internalized stigma was (55.99±10.89) points. Network analysis revealed that "being neglected", "unable to lead a good and meaningful life", "avoiding social interaction", and "being discriminated against" were the core elements. Gender subgroup analysis showed no significant differences in the network structure and overall connection strength of internalized stigma.

Conclusion The core characteristics of the internalized stigma among the primary caregivers of adolescents with NSSI are the lack of social support, negative expectations for the future, and social avoidance. Attention should be paid to the mental health of this group, and a supportive environment for family and society should be constructed to promote the healthy development of adolescents and their families.

1.Cummings JAF. Nonsuicidal self-injury[J]. Am J Nurs, 2023, 123(6): 44-47.

2.De Luca L, Pastore M, Palladino BE, et al. The development of non-suicidal self-injury (NSSI) during adolescence: a systematic review and Bayesian Meta-analysis[J]. J Affect Disord, 2023, 339: 648-659.

3.Tørmoen AJ, Myhre M, Walby FA, et al. Change in prevalence of self-harm from 2002 to 2018 among norwegian adolescents[J]. Eur J Public Health, 2020, 30(4): 688-692.

4.Paul, Howard A. Treating self-injury: a practical guide, by B. W. Walsh[J]. Child & Family Behavior Therapy, 2013, 35(3): 271-278.

5.Maggie L. 'We're not monsters … we're just really sad sometimes:' hidden self-injury, stigma and help-seeking[J]. Heal Sociol Rev, 2017, 27(1): 89-103.

6.Economou M, Bechraki A, Charitsi M. The stigma of mental illness: a historical overview and conceptual approaches[J]. Psychiatriki, 2020, 31(1): 36-46.

7.Meheli S, Banerjee D. Revisiting social stigma in non-suicidal self-injury: a narrative review[J]. Consort Psychiatr, 2022, 3(3): 6-19.

8.Curtis S, Thorn P, McRoberts A, et al. Caring for young people who self-harm: a review of perspectives from families and young people[J]. Int J Environ Res Public Health, 2018, 15(5): 950.

9.Hajizadeh A, Amini H, Heydari M, et al. How to combat stigma surrounding mental health disorders: a scoping review of the experiences of different stakeholders[J]. BMC Psychiatry, 2024, 24(1): 782.

10.张莎莎,张芳,孙丽华,等. 癫痫患儿照顾者心理弹性与照顾负担的关系:链式中介作用及其性别差异[J]. 军事护理, 2025, 42(8): 50-54. [Zhang SS, Zhang F, Sun LH, et al. The relationship between psychological resilience and caregiving burden in caregivers of children with epilepsy: Chain mediation effects and gender differences[J]. Military Nursing, 2025, 42(8): 50-54.]

11.Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure[J]. Psychiatry Res, 2003, 121(1): 31-49.

12.李强,高文珺,白炳清,等. 心理疾病内化污名量表初步应用 [J]. 中国临床心理学杂志, 2009, 17(2): 127-130. [Li Q, Gao  WJ, Bai  BQ, et al. Preliminary application of internalized stigma of mental illness scale[J]. Chinese Journal of Clinical Psychology, 2009, 17(2): 127-130.]

13.杨琳, 宋立升, 曹雍华, 等. 精神疾病内在病耻感调查表在精神分裂症患者中的信度和效度[J]. 临床精神医学杂志, 2012, 22(3): 166-168. [Yang L, Song LS, Cao YH, et al. The reliability and validity of internalized stigma of mental illness inventory in patients with schizophrenia[J]. Journal of Clinical Psychiatry, 2012, 22(3): 166-168.]

14.Friedman J, Hastie T, Tibshirani R. Sparse inverse covariance estimation with the graphical lasso[J]. Biostatistics, 2008, 9(3): 432-441.

15.Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: a tutorial paper[J]. Behav Res Methods, 2018, 50(1): 195-212.

16.Staniland L, Hasking P, Boyes M, et al. Stigma and nonsuicidal self-injury: application of a conceptual framework[J]. Stigma Health, 2021, 6(3): 312-323.

17.Hamza CA, Robinson K, Hasking PA, et al. Educational stakeholders’ attitudes and knowledge about nonsuicidal self-injury among university students: a cross-national study[J]. J Am Coll Health, 2023, 71(7): 2140-2150.

18.赵婕钰. 父母社会比较对初中生抑郁症状的影响机制及课程干预研究[D]. 南昌: 江西师范大学, 2024. [Zhao JY. A study of the mechanisms and curriculum intervention of parental social comparison on depressive symptoms in middle school students[D]. Nanchang: Jiangxi Normal University, 2024.]

19.陈晓,陶叶娟. 父母比较式教养及其与青少年自尊和抑郁的关系 [J].中国健康心理学杂志, 2016, 24(6): 907-912. [Chen X, Tao  YJ. Comparative parenting style and its relationship with self-esteem and depression of adolescents[J]. China Journal of Health Psychology, 2016, 24(6): 907-912.]

20.Xing H, Yao M, Zhu W, et al. The role of perceived parent social comparisons in adolescent academic social comparison, self-efficacy, and self-handicapping: a person-centered approach[J]. Curr Psychol, 2023, 42(18): 15600-15615.

21.Tamizi Z, Fallahi-Khoshknab M, Dalvandi A, et al. Caregiving burden in family caregivers of patients with schizophrenia: a qualitative study[J]. J Educ Health Promot, 2020, 9(1): 12.

22.Liu RT, Scopelliti KM, Pittman SK, et al. Childhood maltreatment and non-suicidal self-injury: a systematic review and Meta-analysis[J]. Lancet Psychiatry, 2018, 5(1): 51-64.

23.Ge Y, Xi X, Wang Z, et al. Parent-child communication and NSSI in depressed adolescents: the role of anxiety and emotional intelligence[J]. Clin Psychol Psychother, 2025, 32(5): e70124.

24.廖钰铃.情感忽视对高中生非自杀性自伤(NSSI)行为的影响及萨提亚模式干预研究[D]. 南昌: 江西师范大学, 2024. [Liao YL. The effect of emotional neglect on non-suicidal self-injury (NSSI) behavior of high school students and the intervention study of Satir model[D]. Nanchang: Jiangxi Normal University, 2024.]

25.Weller BE, Faulkner M, Doyle O, et al. Impact of patients' psychiatric hospitalization on caregivers: a systematic review[J]. Psychiatr Serv, 2015, 66(5): 527-535.

26.Whitlock J, Lloyd-Richardson E, Fisseha F, et al. Parental secondary stress: the often hidden consequences of nonsuicidal self-injury in youth[J]. J Clin Psychol, 2018, 74(1): 178-196.

27.Kandsperger S, Madurkay J, Schleicher D, et al. Treatment motivation and burden of stress among parents of adolescents with non-suicidal self-injury presenting to a child and adolescent psychiatric emergency service[J]. Psychopathology, 2023, 56(1-2): 148-161.

28.刘向明,刘情情,刁艳云,等. 青少年抑郁障碍自杀未遂患者父母的生活质量及影响因素[J]. 中国健康心理学杂志, 2022, 30(1): 18-21. [Liu XM, Liu QQ, Diao YY, et al. Quality of life of parents of adolescents with depression and attempted suicide and its influencing factors[J]. China Journal of Health Psychology, 2022, 30(1): 18-21.]

29.Zhang Y, Yang M, Guo X, et al. Quality of life in family caregivers of adolescents with depression in China: a mixed-method study[J]. Patient Prefer Adherence, 2020, 14: 1317-1327.

30.Marco JH, Gallego-Hernández de Tejada B, Guillén V, et al. Meaning in life buffers the association between perceived burdensomeness, thwarted belongingness, and frequency of non-suicidal self-injuries in Spanish adolescents[J]. J Clin Med, 2021, 10(21): 4867.

31.Frías VM, Fortuny JR, Guzmán S, et al. Stigma: the relevance of social contact in mental disorder[J]. Enferm Clin (Engl Ed), 2018, 28(2): 111-117.

32.Samtani S, Mahalingam G, Lam BCP, et al. Associations between social connections and cognition: a global collaborative individual participant data Meta-analysis[J]. Lancet Health Longev, 2022, 3(11): e740-e753.

33.Newman MG, Zainal NH. The value of maintaining social connections for mental health in older people[J]. Lancet Public Health, 2020, 5(1): e12-e13.

34.Morris N, Moghaddam N, Tickle A, et al. The relationship between coping style and psychological distress in people with head and neck cancer: a systematic review[J]. Psychooncology, 2018, 27(3): 734-747.