Journal of Childhood

Introduction
Adolescence is associated with physical, cognitive, socio-emotional, and environmental changes and is considered one of the most critical stages of identity formation. Self-injurious behavior (SIB) is one of the most serious mental health challenges in adolescents worldwide. This behavior, which involves deliberate and direct actions to harm to own body without suicidal intention, has an increasing prevalence among adolescents and has consequences such as depression, anxiety, personality disorders, and even suicide attempts. Therefore, identifying the predisposing and predictive factors of this behavior is an undeniable necessity for designing effective preventive and therapeutic interventions.
Based on theoretical foundations, two key cognitive-emotional constructs have been associated with SIB. The first construct is difficulty in emotion regulation, which, according to Gratz and Roemer (2004), is defined as maladaptive ways of responding to emotions and includes components such as lack of emotional clarity, difficulty controlling impulsive behavior, limited access to effective emotion regulation strategies, difficulty engaging in goal-directed behaviors, and non-acceptance of emotional responses. The second construct is self-compassion, which according to Neff's theory (2023) consists of three pairs of positive components: self-kindness/self-judgment, shared humanity/isolation, and mindfulness/over-identification. Despite extensive theoretical emphasis, few studies in Iran have simultaneously examined and compared the contribution of each component of these two constructs in predicting SIB among adolescents aged 14-18 years. Therefore, the present study aimed to predict SIB based on difficulty in emotion regulation and self-compassion in adolescent students in Zanjan, Iran.

Research Methods
This is a correlational study using predictive modeling. The study population included all students aged 14-18 years in Zanjan city during the 2023-2024 academic year. Using a multi-stage cluster sampling method, schools were first selected from different districts of Zanjan, and then classrooms were randomly selected from each school. Ultimately, 550 students entered the study. Inclusion criteria were residing in Zanjan city, age 14-18 years, no use of psychiatric medications in the last three months, no simultaneous participation in other counseling and psychotherapy sessions, and written informed consent from both students and parents.
Data collection instruments included three standardized questionnaires: The Inventory of Statements About Self-Injury (ISAS) developed by Klonsky and Glenn (2009) with 39 items and two behavioral and functional sections (score range: 0-78); the 16-item Difficulties in Emotion Regulation Scale (DERS) developed by Bjureberg et al. (2016) with five subscales including lack of emotional clarity (2 items), difficulty engaging in goal-directed behaviors (3 items), difficulty controlling impulsive behavior (3 items), limited access to emotion regulation strategies (5 items), and non-acceptance of emotional responses (3 items) (score range: 16-96); the Self-Compassion Scale-Short Form (SCS-SF) developed by Raes et al. (2011) with 12 items and six two-dimensional subscales including self-kindness (2 items) versus self-judgment (2 items), common humanity (2 items) versus isolation (2 items), and mindfulness (2 items) versus over-identification (2 items) (score range: 11-60). 
Data were analyzed using Pearson’s correlation test (to examine simple linear relationships) and multivariate regression analysis with simultaneous method (to predict SIB based on difficulty in emotion regulation and self-compassion) in SPSS software, version 25. Prior to main analyses, the assumptions including normality of data distribution tested by Kolmogorov-Smirnov test (P>0.05), independence of errors tested by Durbin-Watson test (values around 1.5-2.5), absence of multicollinearity among predictor variables (variance inflation factor<5 and tolerance>0.2), and homogeneity of variances were confirmed.

Results
After excluding incomplete and distorted questionnaires, data from 500 participants (274 girls with a mean age of 17.2 years and 226 boys with a mean age of 17.1 years) were analyzed. The results of Pearson’s correlation test showed a positive and significant correlation between the total DERS score and ISAS score (r=0.44, P<0.01). Additionally, all components of DERS including lack of emotional clarity (r=0.31), difficulty engaging in goal-directed behaviors (r=0.33), difficulty controlling impulsive behavior (r=0.41), limited access to emotion regulation strategies (r=0.45), and non-acceptance of emotional responses (r=0.32) showed positive and significant correlations with ISAS score (P<0.01). On the other hand, results showed a negative and significant correlation between the total SCS-SF score and ISAS score (r=-0.37, P<0.01). The SCS-SF components of self-kindness (r=-0.27), common humanity (r=-0.30), and mindfulness (r=-0.41) also had negative and significant correlations with ISAS score, while self-judgment (r=0.39), isolation (r=0.28), and over-identification (r=0.33) showed positive and significant correlations with the ISAS score (P<0.01).
The results of multivariate regression analysis indicated that the regression model with 12 predictors (six components of SCS-SF and five components of DERS along with their total scores) was significantly able to predict SIB (F=36.70, P<0.001). The adjusted R-squared showed that the predictors together explained approximately 53% of the variance in SIB. All components of DERS positively and significantly predicted SIB (beta coefficients ranging from 0.17 to 0.26; P<0.05). Among the components of SCS-SF, self-kindness (β=-0.14), common humanity (β=-0.14), mindfulness (β=-0.21), and the total score (β=-0.17) negatively and significantly predicted SIB, while  self-judgment (β=0.19) and isolation (β=0.14) positively and significantly predicted SIB (P<0.05).

Conclusion
In summary, SIB in adolescents is a direct consequence of inability to regulate emotions and the lack of a self-compassionate attitude. Difficulty in emotion regulation is a strong and multidimensional risk factor for SIB among adolescents. In contrast, self-compassion serves as a key protective factor. Accordingly, designing integrated intervention programs in schools consisting of two phases is recommended. The first phase should involve teaching emotion regulation skills (identifying emotions, controlling impulsivity, and alternative strategies), and the second phase should focus on strengthening self-compassion skills (kind letter-writing, normalizing experiences, and mindfulness exercises). The present study had some limitations including the use of a cross-sectional design (which does not allow causal conclusions), samples limited to Zanjan city (reducing generalizability), and the use of self-report instruments (potential social desirability bias). Therefore, conducting longitudinal studies, including samples from other cities, and using clinical interviews alongside questionnaires are recommended for future research. 

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval from the Research Ethics Committee of Islamic Azad University, Abhar Branch (Code: IR.IAU.ABHAR.REC.1404.004). Informed consent was obtained from participants and their parents, explaining the study objectives to them, respecting their right to withdraw from the study, and maintaining confidentiality of their information.

Funding
This article was extracted from the doctoral dissertation of Foolad Asa in the field of counseling at Islamic Azad University, Abhar Branch. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
Conceptualization, methodology, investigation, and writing original draft: Foolad Asa; Supervision, methodology, validation, analysis, and project administration: Fatemeh Alijani; Review & editing, and visualization: Jafar Pouyamanesh and Mojtaba Amiri Majd.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the students who participated in this research for their cooperation.


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