Loneliness, non-suicidal self-injury, and friendship quality among Chinese left-behind adolescents: The role of parent-child cohesion

Background: Loneliness is common among left-behind adolescents and can affect their friendship quality both negatively and positively. Most studies have focused on the negative effect of loneliness on friendship. However, loneliness may also motivate adolescents to seek close connections with peers through certain ways, that is, loneliness may indirectly positively influence friendship quality, which has not been explored. To address this gap, based on the life history theory and the interpersonal function model of non-suicidal injury (NSSI), this study aimed to examine the positive impact of loneliness on friendship quality via NSSI among left-behind adolescents. Moreover, given that NSSI is a severe health concern that should be prevented, the protective role of parent-child cohesion was also examined. Methods: A two-wave dataset was used. Participants comprised 1,013 adolescents (539 left-behind and 474 non-left-behind adolescents) completed self-report surveys that addressed loneliness, NSSI, friendship quality, and parent-child cohesion. Results: For left-behind adolescents, loneliness could affect friendship quality not only negatively but also positively through NSSI; increased loneliness predicted more NSSI which, in turn, was associated with high friendship quality. Moreover, the moderating effect of parent-child cohesion was significant. For non-left-behind adolescents, neither the direct nor the indirect positive effect through NSSI between loneliness and friendship quality was found. Limitations: All measures were based on self-reports. Cohesions with caregivers were not included. Conclusions: Findings advance our understanding of the relationships between loneliness, NSSI, and friendship quality among left-behind adolescents. They provide important implications for future interventions by addressing the role of high parent-child cohesion.