Objectives: We used data from a large sample of Canadian adolescents during the COVID-19 pandemic to conduct an ecologically valid test of etiological models of deliberate self-harm (DSH). Specifically, the study objectives were to: (1) investigate the association between COVID-19-related stress and DSH, (2) test whether dimensions of emotion regulation (ER) difficulties mediated and moderated this association, including whether these effects differed by age, and (3) examine whether the mediating and moderating effects of ER difficulties were stronger for youth who engaged in more social distancing. Methods: 809 Canadian adolescents aged 12 to 18 were recruited via social media websites and completed online surveys from June 17 to July 31, 2020. Results: COVID-19-related stress was positively associated with recent DSH. Lack of emotional clarity, nonacceptance of emotional responses, and limited access to ER strategies mediated the association between COVID-19-related stress and DSH. The magnitude of these indirect effects did not differ by age. Although COVID-19-related stress and ER difficulties did not interact to predict DSH, there was a significant three-way interaction between lack of emotional awareness, COVID-19-related stress, and age. Finally, the indirect effect of COVID-19-related stress on DSH through limited access to ER strategies was stronger for youth who engaged in more social distancing. Conclusions: Overall, these findings align with etiological models that propose central roles for stress and ER difficulties in the development of DSH. Findings also underscore a need to support adolescents, particularly those with reduced in-person social contact, in adaptively coping with stress generated by pandemics.
Deliberate Self-Harm in Adolescents During COVID-19: The Roles of Pandemic-Related Stress, Emotion Regulation Difficulties, and Social Distancing
