Non-suicidal self-injury (NSSI) is common among adolescents and is associated with substantial psychological distress and elevated suicide risk. From an ecological-developmental perspective, adolescent NSSI may arise from interacting influences across individual vulnerabilities, developmental adversity, family relationships, and social resources. However, most previous studies have examined these factors using variable-centered approaches, which may overlook psychosocial heterogeneity within clinical populations. This study aimed to examine three-year transitions in NSSI among psychiatric adolescents and to investigate whether multidomain psychosocial profiles identified at baseline were associated with these transition outcomes. A two-wave longitudinal cohort study was conducted among 432 adolescent psychiatric inpatients (mean age = 14.6 years; 81.3% female) with a three-year follow-up interval. NSSI was assessed at baseline and follow-up, and transitions were categorized as stable no NSSI, new-onset NSSI, remission, or persistence. Latent profile analysis was used to identify psychosocial profiles based on multidomain indicators including emotional symptoms, trauma exposure, stressful life events, psychosocial resources, coping styles, and perceived parenting. Multinomial logistic regression models examined predictors of transition outcomes. NSSI prevalence declined from 22.9% at baseline to 14.1% at follow-up. Transition patterns included stable no NSSI (64.1%), remission (21.8%), new onset (13.0%), and persistence (1.2%). Latent profile analysis identified three psychosocial subgroups: a lower-risk/high-resource profile, an intermediate-risk profile, and a high-stress/low-support profile. Transition distributions differed significantly across profiles, with the lower-risk profile showing the highest remission proportion and the high-stress/low-support profile showing the lowest remission proportion. In multivariable models, low household economic status (RRR = 2.64), personal suicide history (RRR = 2.96), and lower paternal emotional warmth (RRR = 0.52) independently predicted current NSSI, whereas greater childhood trauma (RRR = 0.35) and stressful life events (RRR = 0.68) were associated with lower odds of remission. NSSI among adolescents receiving psychiatric care shows heterogeneous transition patterns and distinct psychosocial profiles. Multidomain psychosocial characteristics, including socioeconomic adversity, prior suicidality, trauma exposure, life stress, and paternal emotional warmth, appear to be important correlates of NSSI transitions. These findings highlight the value of incorporating multidomain psychosocial assessment into clinical risk evaluation and intervention planning. Not applicable.
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