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Prospective risk for suicidal thoughts and behaviour in adolescents with onset, maintenance or cessation of direct self-injurious behaviour

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Abstract

Direct self-injurious behaviour (D-SIB) is associated with suicidal behaviour and suicide risk. It is not known if D-SIB cessation reduces these risks. The aim of this study was to explore trajectories of D-SIB and their prospective influence on suicidal thoughts and behaviour during adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the Saving and Empowering Young Lives in Europe study were analysed. D-SIB and suicidal thoughts and behaviour were assessed at baseline (T0), 1- (T1) and 2-year follow-up (T2). Onset and maintenance of D-SIB between T0 and T1 were associated with a two to threefold increased odds ratio for suicidal thoughts and behaviour at T2. Suicidal thoughts and behaviour in those terminating D-SIB before T1 were similar compared to those with no life-time history of D-SIB. Late onset and maintenance of D-SIB prospectively indicate risk for suicidal thoughts and behaviour. This is the first study showing that D-SIB cessation reduces later risk for suicidal thoughts and behaviour in adolescence. Suicide prevention efforts should set one focus on reducing adolescent D-SIB.

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Acknowledgments

Financial Support The SEYLE project was supported through Coordination Theme 1 (Health) of the European Union Seventh Framework Program (FP7), Grant Agreement No. HEALTH-F2-2009-223091. The authors were independent of the funders in all aspects of study design, data analysis, and writing of this manuscript. The Project Leader and Coordinator of the SEYLE project is Professor in Psychiatry and Suicidology Danuta Wasserman, Karolinska Institutet (KI), Head of the National Centre for Suicide Research and Prevention of Mental Ill-Health and Suicide (NASP), at KI, Stockholm, Sweden. The project manager is Vladimir Carli, Senior Lecturer at the National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), KI, Stockholm, Sweden. Other members of the Executive Committee are Professor Marco Sarchiapone, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy; Professor of Child and Adolescent Psychiatry Christina Hoven and Anthropologist Camilla Wasserman, Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute and Mailman School of Public Health, Columbia University, New York, USA. The site leader of the German SEYLE project was Professor in Psychiatry Romuald Brunner and the site coordinator was Associate Professor Michael Kaess, both from the University of Heidelberg, Germany. The Medical Faculty of the University of Heidelberg supported the analyses. JK is supported by Physician-Scientist-Fellowship provided by the Medical School, University of Heidelberg, Germany.

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    Authors and Affiliations

    1. Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany

      Julian Koenig, Gloria Fischer-Waldschmidt, JiYeon Park & Michael Kaess

    2. Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany

      Romuald Brunner

    3. Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany

      Romuald Brunner, Gloria Fischer-Waldschmidt, Peter Parzer, Franz Resch & Michael Kaess

    4. Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany

      Paul L. Plener

    5. Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy

      Camilla Wasserman & Marco Sarchiapone

    6. Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA

      Camilla Wasserman

    7. National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden

      Vladimir Carli, Christina W. Hoven & Danuta Wasserman

    8. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA

      Christina W. Hoven

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    1. Julian Koenig
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    Correspondence to Michael Kaess.

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    J. Koenig and R. Brunner equally contributing first-authors.

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    Koenig, J., Brunner, R., Fischer-Waldschmidt, G. et al. Prospective risk for suicidal thoughts and behaviour in adolescents with onset, maintenance or cessation of direct self-injurious behaviour. Eur Child Adolesc Psychiatry 26, 345–354 (2017). https://doi.org/10.1007/s00787-016-0896-4

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