A cross-sectional and longitudinal examination of adolescents’ emotion expression flexibility and their self-injurious thoughts and behaviors

Introduction Suicide is a leading cause of death among adolescents worldwide, yet, understanding of risks factors remains unclear. Past studies have shown that emotion regulation (ER) difficulties are associated with self-injurious thoughts and behaviors (SITBs) in teens but the vast majority of this research has focused on assessing broad ER abilities in response to negative emotions (using the Difficulties in Emotion Regulation Scale; DERS) as opposed to the specific ability to flexibly enhance or suppress emotional expression based on (positive and negative) social context. Therefore, the aim of this study was to investigate whether flexible modulation of emotions measured via the Flexible Regulation of Emotional Expression-Youth Scale (FREE-Y) is associated with teens’ non-suicidal self-injury (NSSI) and suicidal ideation (SI), the two most commonly experienced SITBs during adolescence. Methods In total, 165 adolescents ( M(SD) = 17.05(1.96) yrs, 66.67% female, 26.67% male, 6.67% non-binary) completed the FREE-Y and the DERS at baseline. They also reported on NSSI and SI at baseline, 3-month, and 6-month follow-up. Results We unexpectedly found low predictive utility of the FREE-Y while higher DERS scores were significantly associated with higher cross-sectional risk for SI recurrence after adjustment for clinical covariates. Regarding SI, exploratory post-hoc analyses focusing on FREE-Y subscales revealed that specifically higher negative suppression and lower positive enhancement were partly associated with SI severity at baseline and longitudinal SI recurrence, which was however not a robust pattern when controlling for covariates and false discovery rate. Discussion These unexpected findings highlight the need for future studies which further examine the predictive validity of the FREE-Y for clinical outcome measures such as NSSI and SI.