Examining the Course of Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors in Outpatient and Inpatient Adolescents
- 614 Downloads
Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) among youth are major public health concerns. Although a growing body of research has focused on the complex association between nonsuicidal and suicidal self-injury, the temporal relationship between these two classes of behaviors is unclear. The current study addresses this empirical gap by examining the course of SITBs in adolescents receiving outpatient (N = 106; 82.1 % female) and inpatient (N = 174; 75.9 % female) treatment. SITBs (co-occurrence, age-of-onset, and time lag between SITBs) and major psychiatric disorders were assessed at a single time point with well-validated structured interviews. Adolescents in both clinical samples reported high co-occurrence of SITBs: most adolescents reported both lifetime nonsuicidal self-injury (NSSI) and suicidal thoughts. A similar temporal pattern of SITBs was reported in the two samples: thoughts of NSSI and suicide ideation had the earliest age-of-onset, followed by NSSI behaviors, suicide plans, and suicide attempts. However, the age-of-onset for each SITB was younger in the inpatient sample than in the outpatient sample. In terms of time lag between SITBs, suicide ideation occurred on average before initial engagement in NSSI, suggesting that pathways to NSSI and suicidal behavior may occur simultaneously rather than in succession from nonsuicidal to suicidal self-injury. Results also indicated that the time to transition between SITBs was relatively fast, and that a key period for intervention and prevention is within the first 6–12 months after the onset of suicidal thinking. Taken together, these findings have important implications for understanding the time-lagged relationship between nonsuicidal and suicidal self-injury.
KeywordsSelf-injury Nonsuicidal self-injury Suicide Suicide attempts Adolescence
Compliance with Ethical Standards
The research was partially supported by grants from the National Institute of Mental Health (F32MH097354 [CRG]; K23MH097786 [RPA]), the Rolfe Fund (RPA), the Tommy Fuss Fund (RPA), the Simches Fund (RPA), and with support from the John D. and Catherine T. MacArthur Foundation (MKN).
Conflict of Interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., et al. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TORDIA study. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 772–781.CrossRefPubMedPubMedCentralGoogle Scholar
- Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the National Comorbidity Survey–Adolescent Supplement: prevalence, correlates, and treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 37–44.CrossRefPubMedGoogle Scholar
- Centers for Disease Control and Prevention (CDC). (2010). Web-based Injury Statistics Query and Reporting System (WISQARS). National Center for Injury Prevention and Control, CDC. Available from URL www.cdc.gov/injury/wisqars/index.html.Google Scholar
- Centers for Disease Control and Prevention (CDC). (2015). Injury Center: Violence prevention—suicide prevention: Youth suicide. Retrieved from www.cdc.gov/violenceprevention/suicide/youth_suicide.html.
- Giletta, M., Prinstein, M. J., Abela, J. R., Gibb, B. E., Barrocas, A. L., & Hankin, B. L. (2015). Trajectories of suicide ideation and nonsuicidal self-injury among adolescents in mainland China: peer predictors, joint development, and risk for suicide attempts. Journal of Consulting and Clinical Psychology, 83, 265–279.CrossRefPubMedGoogle Scholar
- Maciejewski, D. F., Creemers, H. E., Lynskey, M. T., Madden, P. A., Heath, A. C., Statham, D. J., et al. (2014). Overlapping genetic and environmental influences on nonsuicidal self-injury and suicidal ideation: different outcomes, same etiology? JAMA Psychiatry, 71, 699–705.CrossRefPubMedPubMedCentralGoogle Scholar
- Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 980–989.CrossRefPubMedPubMedCentralGoogle Scholar
- Nock, M. K., Borges, G., & Ono, Y. (2012). Suicide: global perspectives from the WHO world mental health surveys. New York, NY: Cambridge University Press.Google Scholar
- Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 70, 300–310.CrossRefPubMedGoogle Scholar
- Sheehan, D., Shytle, D., Milo, K., Janavs, J., & Lecrubier, Y. (2009). Mini international neuropsychiatric interview for children and adolescents (M.I.N.I. Kid), English version 6.0. Tampa, FL: University of South Florida College of Medicine.Google Scholar
- van Alphen, N. R., Stewart, J. G., Esposito, E. C., Pridgen, B., Gold, J., & Auerbach, R. P. (in press). Predictors of rehospitalization for depressed adolescents admitted to acute psychiatric treatment. The Journal of Clinical Psychiatry. Google Scholar
- Wilkinson, P., Kelvin, R., Roberts, C., Dubicka, B., & Goodyer, I. (2011). Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the adolescent depression antidepressants and psychotherapy trial (ADAPT). American Journal of Psychiatry, 168, 495–501.CrossRefPubMedGoogle Scholar
- Zetterqvist, M., Lundh, L. G., Dahlström, Ö., & Svedin, C. G. (2013). Prevalence and function of non-suicidal self-injury (NSSI) in a community sample of adolescents, using suggested DSM-5 criteria for a potential NSSI disorder. Journal of Abnormal Child Psychology, 41, 759–773.CrossRefPubMedGoogle Scholar