Emotion Expression Flexibility Shows Low Predictive Utility for Adolescent Self-Injury

In a cross-sectional and longitudinal investigation published in Frontiers in Psychiatry, researchers found unexpectedly low predictive utility for the Flexible Regulation of Emotional Expression-Youth Scale in forecasting adolescent non-suicidal self-injury and suicidal ideation.

Suicide remains a leading cause of death among adolescents worldwide, yet the precise understanding of underlying risk factors remains unclear. Previous empirical investigations have established that emotion regulation difficulties correlate with self-injurious thoughts and behaviors in teenagers. However, the vast majority of prior research has focused almost exclusively on broad emotion regulation difficulties experienced in response to negative emotions, typically assessed using the Difficulties in Emotion Regulation Scale developed by Gratz and Roemer in 2004. Researchers have less frequently examined whether the specific capacity to flexibly enhance or suppress emotional expression in reaction to varying positive and negative social contexts provides distinct clinical insight.

To address this gap, the research team designed an evaluation to determine whether the flexible modulation of emotional expression correlates with non-suicidal self-injury and suicidal ideation, which represent the two most commonly experienced forms of self-injurious thoughts and behaviors during adolescence. The investigators measured context-dependent emotional modulation using the Flexible Regulation of Emotional Expression-Youth Scale, or FREE-Y, established by Haag and colleagues in 2023.

The study cohort comprised a total of 165 adolescent participants who completed baseline assessments with a mean age of 17.05 years and a standard deviation of 1.96 years. In terms of reported demographic distribution, 66.67 percent of the sample identified as female, 26.67 percent identified as male, and 6.67 percent identified as non-binary. All 165 participants completed both the FREE-Y and the DERS questionnaires at the initial baseline evaluation. To capture longitudinal patterns over time, participants subsequently submitted follow-up reports detailing occurrences of non-suicidal self-injury and suicidal ideation at three-month and six-month intervals.

When analyzing the primary outcomes, the researchers unexpectedly observed low overall predictive utility for the FREE-Y regarding adolescent self-injurious thoughts and behaviors across the evaluation periods. By contrast, higher baseline scores on the Difficulties in Emotion Regulation Scale demonstrated a statistically significant association with an elevated cross-sectional risk for suicidal ideation recurrence. This significant relationship between higher DERS scores and suicidal ideation recurrence persisted even after the investigators statistically adjusted the model for relevant clinical covariates.

Regarding suicidal ideation specifically, the research team conducted exploratory post-hoc analyses targeting specific subscales within the FREE-Y instrument. These post-hoc examinations revealed that higher negative suppression along with lower positive enhancement were partially associated with suicidal ideation severity at baseline and with longitudinal suicidal ideation recurrence over the follow-up period. Nevertheless, the authors cautioned that this observed pattern was not robust when adjusting for confounding clinical covariates and controlling for the false discovery rate across statistical tests.

Consequently, the research team encouraged future investigations to further examine the predictive validity of the FREE-Y across diverse clinical outcome measures, particularly regarding non-suicidal self-injury and suicidal ideation in youth populations.

Subject of Research: Emotion expression flexibility and self-injurious thoughts and behaviors in adolescents

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

Article References: Bassing, M., Hohensee, N., Li, J., Vijan, A., & Cha, C. B. (2026). A cross-sectional and longitudinal examination of adolescents’ emotion expression flexibility and their self-injurious thoughts and behaviors. Frontiers in Psychiatry, 17, Article 1881801. https://doi.org/10.3389/fpsyt.2026.1881801

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1881801

Keywords: adolescent psychiatry, emotion expression flexibility, FREE-Y, Difficulties in Emotion Regulation Scale, DERS, non-suicidal self-injury, suicidal ideation, self-injurious thoughts and behaviors, negative suppression, positive enhancement, emotion regulation difficulties, longitudinal study, cross-sectional analysis, clinical covariates, false discovery rate, social context modulation, suicide risk factors