DOI: https://doi.org/10.21203/rs.3.rs-2819947/v1
Non-suicidal self-injury (NSSI) is a critical and widely recognized public issue that has been associated with various psychological problems, such as depression, anxiety, maladaptive behavior, and internet addiction, and is a significant predictor of suicide. In this study, we aimed to investigate the mediating effects of negative emotions and mobile phone addiction on self-consistency congruence and NSSI in college students by developing a model. The sample consisted of 1051 college students who completed the Self-Consistency Congruence Questionnaire, the NSSI Questionnaire, the Mobile Phone Addiction Questionnaire, and the Positive and Negative Emotions Questionnaire. Our findings revealed that self-consistency congruence was negatively associated with NSSI in college students. Mediation analysis demonstrated that self-consistency congruence indirectly influenced NSSI among college students through negative emotions and mobile phone addiction. These results suggest that self-consistency congruence can decrease the likelihood of NSSI by reducing negative emotions and mobile phone addiction.
Non-suicidal self-injury (NSSI) is an act of direct and intentional injury to bodily tissues that has no suicidal purpose and is not socially and culturally acceptable. It includes stabbing, burning, tearing, scratching, and other forms of self-injury [1, 2]and is characterized by repetitive, deliberate, and covert behavior [3, 4]. Non-suicidal self-injury has always been present, but it was not until the Diagnostic and Statistical Manual Fifth Edition that NSSI was incorporated into emerging, unclassified behaviors and patterns. In 2019, the China Health Commission, together with 12 government departments, also issued the Action Plan for the Mental Health of Children and Adolescents, putting adolescent mental health in a crucial position. Non-suicidal self-injury has attracted much attention in the field of mental health and clinical practice because of its universality and serious consequences [5, 6]. In recent years, the rate of non-suicidal self-injury behavior among college students has been increasing [7, 8]. Non-suicidal self-injury behaviors among college students not only directly harm their physical health, but affect their emotional, academic, and interpersonal relationships [9, 10]. They are associated with the development of negative emotions such as mobile phone addiction, anxiety and depression [11, 12], and is an important risk factor for predicting future suicidal behaviors [13, 14]. There are a large body of researches on the causes and interventions of non-suicidal self-injury in China, but little research on the cause of non-suicidal self-injury from the perspective of core personality. Therefore, it is very important to explore the effect of self-consistency congruence on non-suicidal self-injury among college students.
There are some researches on the relationship between self-consistency congruence and non-suicidal self-injury, but there is still a lack of systematic exploration on the mechanism of self-consistency congruence and non-suicidal self-injury in college students. Self-consistency congruence is a concept proposed by Rogers, which refers only to the internal unity and external coordination of the individual and is the core concept of his personality theory [15]. The individual will experience anxiety, tension, and entanglement if there is an excessive gap between the inner self and the outer experience, that is, a state of "disharmony" [16]. Rogers believed that self-disharmony will lead to various internal conflicts. It is an important cause of psychological disorders, which are often manifested as abnormal psychological processes or personality characteristics. So self-dissonance is a significant inducement of self-injury [17]. Studies have shown that while college students have better overall self-consistency congruence, more than 13% of them are still very discordant and should be taken seriously [18].
Therefore, we propose hypothesis 1:
H1: College students’ level of self-consistency congruence negatively predict non-suicidal self-injury.
Self-dissonance is based on cognitive control systems and focuses on internal-external, self-experience conflict [19]. Negative emotion, as a key factor in regulating cognitive control [20], is consistent with the degree of self-disharmony in connotation. Bianchi and Phillips found that mobile phone users exhibit behavioral characteristics of non-suicidal self-injury [21]. Therefore, introducing negative emotions and mobile phone addiction mediating variables and exploring their mediating pathways can better clarify how self-consistency congruence affects non-suicidal self-injury.
Negative affect (NA) refers to a subjective experience of being trapped in a low mood and unpleasant activation situation, involving a variety of upsetting emotions such as shame, anger, disgust, guilt, fear, depression, and anxiety [22, 23]. Given that the university stage is a period of rapid but imperfect self-awareness development, college students may encounter various self-discrepancy and inconsistent situations [24], which can lead to self-dissonance and negative emotions such as depression, anger, irritability, anxiety, fear, and interpersonal sensitivity [24, 25]. Therefore, higher levels of self-dissonance in college students may increase their likelihood of experiencing negative emotions [24], which, in turn, can worsen non-suicidal self-injury (NSSI) conditions [26].
Consistent with the general stress theory (GST) model [27], which proposes that stressors, negative emotions, and risky behaviors are interrelated, individuals may engage in risky behavior when they fail to value and cope with negative emotions effectively. This idea is supported by both emotional management theory and the Empirical Avoidance Model (EAM), which posit that individuals typically experience negative emotions before engaging in NSSI as a maladaptive strategy to alleviate distress [28, 29]. Moreover, empirical evidence suggests that negative emotions precede actual NSSI and that NSSI is often regarded as an inappropriate emotional regulation method to relieve negative emotions [30].
Therefore, we hypothesize that negative emotions mediate the effect of self-consistency congruence on NSSI among college students:
H2: Negative emotions play a mediating role in the effect among college students' self-consistency congruence on non-suicidal self-injury.
Mobile phone addiction refers to the excessive use of mobile phones to engage in internet-related activities, resulting in a strong desire and dependence on mobile phones and causing social and individual function impairments and withdrawal reactions [31]. College students have a high prevalence of mobile phone addiction [32–34]. Previous research has found a negative correlation between self-consistency congruence and mobile phone addiction among college students, indicating that those with high self-consistency congruence are less likely to be addicted to mobile phones [35, 36]. It is important to note that college students who are addicted to mobile phones may not necessarily enjoy using them, but rather use them as a means to temporarily escape from internal and external conflicts resulting from self-discordance [37]. However, this avoidance strategy exacerbates existing conflicts and negative emotions, creating a vicious cycle that fails to solve the problem. Additionally, high levels of mobile phone dependence may be associated with mental health problems [38], and addictive traits have been linked to higher rates of self-injury [39]. As a subtype of internet addiction, mobile phone addiction shares similar features and symptoms with other types of problematic network use [40, 41]. Furthermore, several studies have shown a correlation between problematic internet use and non-suicidal self-injury, with internet addiction predicting the occurrence of NSSI [42–44]. Based on these findings, we propose the following hypothesis:
H3: Mobile phone addiction mediates the relationship between self-consistency congruence and non-suicidal self-injury among college students.
Therefore, we propose the following intermediary model. (see Fig. 1)
Seven colleges and universities in Jiangxi Province utilized a random class sampling method to distribute questionnaires to 1100 college students. After removing random and invalid answers, 1051 valid questionnaires were obtained, resulting in an effective response rate of 92.8%. Of the participants, 516 were male (49.07%) and 520 were female (50.93%), with 309 freshmen (29.48%), 278 sophomores (26.44%), 266 juniors (25.27%), and 198 seniors (18.81%). Among the participants, 700 were only children (66.60%) and 351 were not (33.40%).
This study was approved by the Research Ethics Committee of First People's Hospital, and participants were provided with written informed consent forms prior to data collection. The consent forms included a brief description of the research project and informed participants that their information would be kept confidential with their names recorded, that their responses would be used only for research purposes, and that they were free to withdraw from the study at any time without penalty. The questionnaires were distributed in the same order, and well-trained postgraduate students collected the data. The participants completed the measures and brief questionnaires, taking approximately 25 minutes to finish.
According to Grace's definition of self-injury, this questionnaire was revised by Feng based on Zheng's self-injury questionnaire. The questionnaire includes 18 items and an open-ended project that uses the Life Event Scale to assess the impact of an event in two dimensions: frequency and degree of occurrence. However, only the top 18 items were analyzed in the data analysis, as only nine students filled out the questionnaire of open-ended. Each item assesses the number of self-injurious behaviors on a four-point scale, where 0 represents "never," 1 represents "once," 2 represents "twice to four times," and 3 represents "five times or more." Scores ranging from 0 to 3 are calculated for each answer. The degree of injury is divided into five levels, ranging from "none" (0 points) to "extremely severe" (4 points). The higher the score, the more severe the self-injury. In this study, the internal consistency coefficient of the questionnaire (alpha) was 0.88. Self-Consistency Congruence Scale
Wang developed a scale based on Rogers’ theory of self-concept[49], which reduced Rogers' seven dimensions to three: "dissonance between self and experience" (16 items), "self-flexibility" (12 items), and "self-rigidity" (7 items). The scale utilized a five-point scoring system where 1 represented "fully conformity," 2 represented "relative nonconformity," 3 represented "uncertainty," 4 represented "relative conformity," and 5 represented "not conformity." The "self-flexibility" dimension of the scale consisted of 12 reverse-scored items (2, 3, 5, 8, 11, 16, 18, 22, 30, 32, 35), where a higher score indicated a lower level of self-consistency congruence. To calculate the score for each dimension, respondents' answers were scored as follows: choosing 1 was awarded 5 points, choosing 2 was awarded 4 points, and so on. The sum of the three dimensions' scores represented the total self-consistency congruence score. A higher score indicated a lower level of self-consistency congruence for the individual. In this study, the internal consistency coefficient alpha was 0.86.
The Mobile Phone Addiction Inventory (MPAI) was originally compiled by Leung and later revised by Huang et al. [38, 45]. The scale is composed of 17 items, with each item scored on a 5-point rating scale (1 indicating "never," 2 indicating "occasionally," 3 indicating "sometimes," 4 indicating "often," and 5 indicating "always"). The scores represent the extent to which an individual is dependent on their mobile phone, with higher scores indicating greater dependence. In this study, the questionnaire exhibited high internal consistency, with a Cronbach's alpha coefficient of 0.89.
The scale used in this study was based on the Positive and Negative Affect Schedule (PANAS), originally developed by Watson et al. [23]. The original scale comprised 20 adjectives used to describe positive or negative emotions. In this study, 10 adjectives describing negative emotions (items 2, 4, 6, 7, 8, 11, 13, 15, 18, and 20) were selected to test the subjects. Respondents were asked to rate their own experience of these emotions in the last two weeks on a Likert 5 scale, with 1 indicating "almost none," 2 indicating "relatively less," 3 indicating "moderately," 4 indicating "more," and 5 indicating "extremely much." Previous research has demonstrated the reliability and validity of this scale. In this study, the internal consistency of the 10 selected items was high, with a Cronbach's alpha coefficient of 0.83.
The data were analyzed using SPSS 22.0 and the SPSS macro-PROCESS. Descriptive statistics were computed to provide an overview of the data, followed by Pearson's correlation coefficients to examine the relationships among the variables. Finally, PROCESS (Model 4) was utilized to test the multiple-mediation models involving self-consistency congruence and non-suicidal self-injury with respect to the association between mobile phone addiction and negative emotions.
As all the variables assessed and data collected in this study relied on self-reported methods, there is a possibility of bias. To minimize this potential bias, measures such as anonymity filling, class concentration tests, and reverse scoring were implemented. Following data collection, a Harman single-factor assay was conducted to assess the presence of common method bias. The results indicated that there were 10 factors with a factor load greater than 1, with the first factor accounting for 19.02% of the total variance. As this value was less than the 40% threshold, it suggests that there was no significant common method bias in this study.
Table 1 presents the means, standard deviations, and correlation coefficient matrices for all variables. The self-consistency congruence scores, which indicate a lower level of self-consistency congruence with higher scores, were found to be significantly positively correlated with non-suicidal self-injury. Additionally, self-consistency congruence scores were positively correlated with both mobile phone addiction and negative emotions, while negative emotions and mobile phone addiction were positively correlated with non-suicidal self-injury.
| SN | Variables | Mean | SD | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|---|---|
| 1 | Self-consistency Congruence | 89.45 | 13.23 | 1 | |||
| 2 | Mobile Phone Addiction | 46.42 | 13.5 | 0.38** | 1 | ||
| 3 | Negative Emotion | 22.73 | 6.73 | 0.42** | 0.56** | 1 | |
| 4 | Non-suicidal Self-injury | 21.27 | 13.28 | 0.17** | 0.21** | 0.23** | 1 |
| **=p < 0.01, SD Standard deviation | |||||||
The Model 4 mediation test in the SPSS macro program PROCESS developed by Hayes was used to test whether negative emotions and mobile phone addiction mediated the relationship between self-consistency congruence and non-suicidal self-injury[46]. The results showed the after controlling for gender and whether only child or non-only child, the level of self-consistency congruence significantly negatively predicted non-suicidal self-injury (β = 0.17, p < 0.001), negative emotions (β = 0.43, p < 0.001) and mobile phone addiction (β = 0.39, p < 0.001). Detailed results are shown in Table 2.
| 95%CI | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Result variables | Predictor variables | R | R² | F | p | β | Lower Bounds | Upper Bounds | t |
| Non-suicidal self-injury | Self-consistency congruence | 0.17 | 0.03 | 9.68*** | 0.00 | 0.17 | 0.11 | 0.23 | 5.36 |
| negative emotions | Self-consistency congruence | 0.43 | 0.18 | 74.63*** | 0.00 | 0.43 | 0.19 | 0.25 | 14.92 |
| Mobile phone addiction | Self-consistency congruence | 0.39 | 0.15 | 59.45*** | 0.00 | 0.39 | 0.34 | 0.46 | 13.35 |
| Non-suicidal self-injury | Self-consistency congruence | 0.25 | 0.06 | 13.28*** | 0.00 | 0.07 | 0.00 | 0.14 | 2.01 |
| Mobile phone addiction | 0.10 | 0.03 | 0.18 | 2.72 | |||||
| Negative emotions | 0.13 | 0.11 | 0.42 | 3.46 | |||||
| *=p < 0.05, **=p < 0.01, ***=p < 0.001 | |||||||||
Further analysis of the mediated effects showed that 95% of bootstrap confidence intervals across the model were [0.11, 0.23]. The 95% bootstrap confidence interval from self-consistency congruence to mobile phone addiction to non-suicidal self-injury pathway was [0.01, 0.09]. And the 95% bootstrap confidence interval from self-consistency congruence to negative emotions to non-suicidal self-injury pathway was [0.01, 0.13]. None of the confidence intervals contain 0. It indicates significant mediated effects. The indirect effect from self-consistency congruence to mobile phone addiction to non-suicidal self-injury pathway was 0.04. And from self-consistency congruence to negative emotions to non-suicidal self-injury pathway was 0.06. The detailed results are shown in Fig. 2 below.
The study revealed that the level of self-consistency congruence was a negative predictor of non-suicidal self-injury in college students, which is consistent with previous research findings [47]. A higher level of self-consistency congruence was associated with a lower incidence of non-suicidal self-injury. Self-consistency congruence, which reflects the harmony between an individual's experiences and their sense of self, is a crucial indicator for reducing negative emotions related to non-suicidal self-injury among college students. This finding provides insight into reducing non-suicidal self-injury among college students by focusing on enhancing self-consistency congruence through institutionalization and standardization. By establishing a standardized system that promotes self-consistency congruence, it may be possible to reduce negative emotions and mobile phone addiction, ultimately leading to a decrease in the incidence of non-suicidal self-injury.
When individuals experience dissonance between their self and experience, or dissonance within themselves, they often produce more negative emotions [24]. According to the Emotional Management Theory, individuals are more likely to engage in self-injury behavior in order to alleviate their negative emotions [29]. This study found that the lower the level of self-consistency congruence among college students, the higher the incidence of mobile phone addiction, which is consistent with the results of previous studies [48]. The main reason for college students' mobile phone addiction is that they often experience various internal and external conflicts, leading to self-dissonance. The mobile phone is used as a means to temporarily alleviate this disharmony, but it does not solve the underlying problem, and can even make it worse, leading to a vicious cycle. During the college years, students evaluate themselves from a more diverse perspective, but at the same time, their understanding of themselves is not always comprehensive and objective, which makes them more susceptible to dissonance between their ideals and reality, as well as between their current situations and prior experiences. They may experience tension, anxiety, stress, and other negative emotions as a result. When they struggle to deal with these accumulated unpleasant feelings, it is easy for them to engage in self-injury behavior as a coping mechanism [28]. Individuals with mobile phone addiction tend to spend less time engaging in interpersonal interactions and may be more likely to seek help from the virtual world or engage in self-isolation when they encounter problems, thus triggering more self-injury behavior.
This study explored the mediating mechanisms between self-consistency congruence and non-suicidal self-injury, and revealed that negative emotions and mobile phone addiction partially mediate this relationship among college students. However, there are some limitations to this study. Firstly, the sample only consisted of college students from Jiangxi province, which limits the generalizability of the findings. Future research can broaden the scope of the study population to reduce the impact of regional differences and increase the applicability of the study results. Secondly, this study was cross-sectional in nature, making it difficult to establish causal relationships. Therefore, future experimental studies can be conducted to examine the causal pathways between self-consistency congruence, negative emotions, mobile phone addiction, and non-suicidal self-injury.
(1) The level of self-consistency congruence negatively predicted non-suicidal self-injury among college students. Specifically, the lower the self-consistency congruence score, the higher the incidence of non-suicide self-injury.
(2) Self-consistency congruence reduces the occurrence of non-suicidal self-injury by mitigating negative emotions and mobile phone addiction, which serve as partial mediators between college students' self-consistency congruence and non-suicidal self-injury.
Acknowledgements
We would like to express our thanks to all of the participants in the present study.
Author’ contributions
Wang wrote the main manuscript text. Li has made significant contributions in the design, data analysis, and writing of his works. Hu made significant contributions to the design of data analysis and writing. Gao made significant contributions to the design and language refinement of their works. All listed authors have made substantial, direct, and intellectual contributions to this work and have been approved for publication.
Funding
Jiangxi Educational Science Planning Project(21YB008). Jiangxi University Humanities and Social Sciences Project(szzx21006).
Data Availability
The datasets used and/or analysed during the current study is available from the corresponding author on reasonable request.
Ethics approval and consent to participate
The study was approved by the Ethics Committee of Nanchang First People's Hospital in accordance with the declaration of Helsinki. Informed consent was obtained from each participant. All methods were carried out in accordance with relevant guidelines and regulations.
Consent for publication
Not applicable.
Conflict of Interest
The authors declare no conflicts of interest.