To study the characteristics of pain empathy ability in adolescents with depression and non-suicidal self-injury (NSSI). Methods: Thirty-four patients with adolescent depression accompanied by NSSI (case group) and 27 healthy controls matched in age, gender, and education level (control group) were included. The frequency and severity of self-injury in patients were assessed with the Adolescent Self-Harm Questionnaire; empathy ability was evaluated using the Chinese version of the Interpersonal Reactivity Index (IRI-C); pain empathy ability was assessed using a pain empathy paradigm, with task accuracy, reaction time, and pain rating scores as indicators of pain empathy; Pearson correlation analysis was used to analyze the relationship between patients’pain judgment and left-right judgment accuracy, reaction time, pain rating scores, and scores on the Adolescent Self-Harm Questionnaire and IRI-C factors. Results: The case group scored lower than the control group on the perspective taking and fantasy subscales of the IRI-C scale (P< 0.05). In the pain judgment task, the accuracy of pain picture judgment in the case group was lower than that in the control group (P<0.05); in the left-right judgment task, the accuracy of pain picture judgment in the case group was also lower than that in the control group (P<0.05). In the case group, there was a positive correlation between scores on the Adolescent Self-Harm Questionnaire and reaction time to pain pictures in the pain judgment task (P<0.01), and a negative correlation with accuracy (P<0.05); in the IRI-C, personal distress scores were negatively correlated with reaction time (P<0.05, while perspective taking, empathy concern, and personal distress were positively correlated with judgment accuracy (P<0.01). Conclusion: Adolescents with depression and NSSI have reduced pain empathy ability.