Research report: Network analysis of non-suicidal self-injury risk: school bullying, depressive symptoms, and psychotic-like experiences in 15,968 Chinese students

A cross-sectional network analysis of 15,968 students aged 12–24 in Hunan province, China, identified psychotic-like experiences and depressive symptoms as statistical links between school bullying victimisation and non-suicidal self-injury. The study found a well-connected network of symptoms, but its design cannot establish which factors caused the observed relationships. Researchers recruited students through convenience sampling between October 2021 and October 2022 and administered an online questionnaire covering demographic characteristics, school bullying victimisation, psychotic-like experiences, depressive symptoms and non-suicidal self-injury.

The analysis examined estimated relationships among individual indicators rather than testing only broad, summary-level risk factors. Non-suicidal self-injury is a major public health concern, the researchers wrote, although several factors associated with it have complex interactions and joint effects that remain unclear. The network analysis provided a symptom-level view of these relationships by assessing connectivity among the measured indicators and identifying nodes with comparatively high bridge strength.

No node was isolated, and the network showed robust overall connectivity. The indicator for being distracted by distant sounds, labelled P12 in the analysis, had the highest estimated strength centrality among the nodes. Paranoid thoughts, labelled P14, and suicidal ideation, labelled D9, showed relatively high bridge strength, indicating their estimated capacity to connect different symptom domains within the network.

These network metrics do not by themselves show that a symptom causes non-suicidal self-injury or is an effective stand-alone screening indicator. The bridge-strength results instead identify symptoms that may be useful targets for further investigation of cross-domain relationships. The researchers said highly connected and bridge nodes may inform future screening, risk assessment and longitudinal research.

The network analysis also found that the node for verbal bullying victimisation had no direct estimated link to any non-suicidal self-injury indicator. Instead, a chain-mediation model identified psychotic-like experiences and depressive symptoms as intermediate factors in the statistical relationship between verbal bullying victimisation and non-suicidal self-injury. This pathway describes conditional associations and does not demonstrate a causal mechanism.

Because the study was cross-sectional, the questionnaire captured bullying exposure, symptoms and self-injury at one point rather than tracking changes over time. Convenience sampling and the restriction to students in one Chinese province also limit how broadly the results can be generalised. The findings therefore cannot determine the direction of influence among bullying, psychotic-like experiences, depressive symptoms, suicidal ideation and self-injury.

Within those limits, the study’s central result is that bullying, psychological distress and self-injury indicators did not appear as separate or isolated domains. Instead, they formed an interconnected system in which psychotic-like experiences and depressive symptoms statistically linked verbal bullying victimisation to non-suicidal self-injury. The results offer a symptom-level map for future research, not proof of causation or a validated clinical intervention.

Subject of Research: Symptom-level network analysis of bullying, psychological distress and non-suicidal self-injury among students in Hunan, China

Article Title: Network analysis of non-suicidal self-injury risk: school bullying, depressive symptoms, and psychotic-like experiences in 15,968 Chinese students

Article References: Liu, Q., Zhao, L., Liao, A., Zhang, S., Yang, X., Yuan, L., Chen, X., & He, Y. (2026). Network analysis of non-suicidal self-injury risk: school bullying, depressive symptoms, and psychotic-like experiences in 15,968 Chinese students. BMC Psychology. https://doi.org/10.1186/s40359-026-05579-y

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05579-y

Keywords: non-suicidal self-injury, school bullying, depressive symptoms, psychotic-like experiences, suicidal ideation, network analysis, Chinese students, chain mediation, cross-sectional study, Network, analysis, non-suicidal