Skip to main content
SpringerLink
Log in

Nonsuicidal Self-injury, Suicide Planning, and Suicide Attempts Among High-risk Adolescents Prior to Psychiatric Hospitalization

Research on Child and Adolescent Psychopathology volume 49, pages 1503–1511 (2021)Cite this article

Abstract

The purpose of this study was to understand the trajectories of nonsuicidal self-injury (NSSI) and suicide plans (SP) in the 90 days prior to inpatient hospitalization, understand the role of NSSI and SP in predicting suicide attempts (SA) on a given day, and to test the interaction between NSSI and SP in predicting same-day SA. Participants included 69 adolescents (77% female, 65% white, 77% Non-Hispanic/Latinx, Mage = 15.77 SDage = 1.00) from an inpatient psychiatric unit. Past 90 day NSSI, SP, and SA were measured using the Columbia Suicide Severity Rating Scale and Timeline Follow Back. First, mixed effect models were conducted to assess trajectories of NSSI and SP leading up to inpatient hospitalization. The odds of NSSI remained relatively stable prior to hospitalization (OR = 1.01, 95% CI [1.00,1.02]). The odds of SP increased in the 90 days prior to hospitalization (OR = 1.04, 95% CI [1.02,1.05]) with each day associated with a 4% increase in the odds of making a SP. Second, random effect models were conducted to predict the odds of same-day SA from NSSI and SP. When adolescents endorsed either NSSI (OR = 2.99, p < .001) or a SP (OR = 77.13, p < .001) there was elevated odds of same-day SA. However, the presence of both NSSI and SP on a given day did not increase risk of SA on that same day. For this high-risk clinical sample of suicidal adolescents who drink alcohol, odds of SP increased in the days leading up to psychiatric hospitalization, but NSSI remained stable. On days when adolescents reported NSSI or SP, they had an increased odds of same-day SA. These results underscore the importance of frequent monitoring of NSSI and SP among high-risk adolescents who drink alcohol to prevent suicide attempts.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

39,95 €

Price includes VAT (Finland)

Data Availability

Data is available upon request.

References

  • Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., & Brent, D. A. (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(8), 772–781. https://doi.org/10.1016/j.jaac.2011.04.003

    Article  PubMed  PubMed Central  Google Scholar 

  • Azevedo-Filho, A., & Shachter, R. D. (1994). Laplace’s method approximations for probabilistic inference in beliefnetworks with continuous variables. In R. Lopes de Manaras & D. Poole (Eds.), Uncertainty in Artificial Intelligence, 28–36. https://doi.org/10.1016/b978-1-55860-332-5.50009-2

  • Bagge, C. L., Littlefield, A. K., & Glenn, C. R. (2017). Trajectories of affective response as warning signs for suicide attempts: an examination of the 48 hours prior to a recent suicide attempt. Clinical Psychological Science, 5(2), 259–271. https://doi.org/10.1177/2167702616681628

  • Bagge, C. L., & Sher, K. J. (2008). Adolescent alcohol involvement and suicide attempts: toward the development of a conceptual framework. Clinical Psychology Review, 28, 1283–1296. https://doi.org/10.1016/j.cpr.2008.06.002

  • Barrocas, A. L., Giletta, M., Hankin, B. L., Prinstein, M. J., & Abela, J. R. Z. (2014). Nonsuicidal Self-Injury in Adolescence: Longitudinal Course, Trajectories, and Intrapersonal Predictors. Journal of Abnormal Child Psychology, 43(2), 369–380. https://doi.org/10.1007/s10802-014-9895-4

    Article  Google Scholar 

  • Brausch, A. M., & Muehlenkamp, J. J. (2018). Perceived effectiveness of NSSI in achieving functions on severity and suicide risk. Psychiatry Research, 265, 144–150. https://doi.org/10.1016/j.psychres.2018.04.038

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, R. C., & Plener, P. L. (2017, March 1). Non-suicidal Self-Injury in Adolescence. Current Psychiatry Reports, 19. https://doi.org/10.1007/s11920-017-0767-9

  • Burke, T. A., Jacobucci, R., Ammerman, B. A., Piccirillo, M., McCloskey, M. S., Heimberg, R. G., & Alloy, L. B. (2018). Identifying the relative importance of non-suicidal self-injury features in classifying suicidal ideation, plans, and behavior using exploratory data mining. Psychiatry Research, 262, 175–183. https://doi.org/10.1016/j.psychres.2018.01.045

    Article  PubMed  PubMed Central  Google Scholar 

  • Donohue, B., Strada, M. J., Silver, N. C., Azrin, N. H., Teichner, G., & Murphy, H. (2004). Psychometric evaluation of self- and collateral timeline follow-back reports of drug and alcohol use in a sample of drug-abusing and conduct-disordered adolescents and their parents. Psychology of Addictive Behaviors, 18(2), 184–189. https://doi.org/10.1037/0893-164X.18.2.184

    Article  PubMed  Google Scholar 

  • Fox, K. R., Harris, J. A., Wang, S. B., Millner, A. J., Deming, C. A., & Nock, M. K. (2020). Self-Injurious Thoughts and Behaviors Interview-Revised: Development, reliability, and validity. Psychological Assessment, 32(7), 677–689. https://doi.org/10.1037/pas0000819

    Article  PubMed  Google Scholar 

  • Glenn, C. R., Lanzillo, E. C., Esposito, E. C., Santee, A. C., Nock, M. K., & Auerbach, R. P. (2017). Examining the Course of Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors in Outpatient and Inpatient Adolescents. Journal of Abnormal Child Psychology, 45(5), 971–983. https://doi.org/10.1007/s10802-016-0214-0

    Article  PubMed  PubMed Central  Google Scholar 

  • Grandclerc, S., De Labrouhe, D., Spodenkiewicz, M., Lachal, J., & Moro, M.-R. (2016). Relations between Nonsuicidal Self-Injury and Suicidal Behavior in Adolescence: A Systematic Review. PLoS One, 11(4), e0153760. https://doi.org/10.1371/journal.pone.0153760.

    Article  PubMed  PubMed Central  Google Scholar 

  • Guerry, J. D., & Prinstein, M. J. (2009). Longitudinal Prediction of Adolescent Nonsuicidal Self-Injury: Examination of a Cognitive Vulnerability-Stress Model. Journal of Clinical Child & Adolescent Psychology, 39(1), 77–89. https://doi.org/10.1080/15374410903401195

    Article  Google Scholar 

  • Hamza, C. A., & Willoughby, T. (2015). Nonsuicidal Self-Injury and Affect Regulation: Recent Findings From Experimental and Ecological Momentary Assessment Studies and Future Directions. Journal of Clinical Psychology, 71(6), 561–574. https://doi.org/10.1002/jclp.22174

    Article  PubMed  Google Scholar 

  • Jacobs, D. G., Baldessarini, R. J., Conwell, Y., Fawcett, J. A., Horton, L., Meltzer, H., … Simon, R. I. (2010). PRACTICE GUIDELINE FOR THE Assessment and Treatment of Patients With Suicidal Behaviors.

  • Joiner, T. E., Ribeiro, J. D., & Silva, C. (2012). Nonsuicidal Self-Injury, Suicidal Behavior, and Their Co-occurrence as Viewed Through the Lens of the Interpersonal Theory of Suicide. Current Directions in Psychological Science, 21(5), 342–347. https://doi.org/10.1177/0963721412454873

    Article  Google Scholar 

  • Joiner, T. E., Steer, R. A., Brown, G., Beck, A. T., Pettit, J. W., & Rudd, M. D. (2003). Worst-point suicidal plans: a dimension of suicidality predictive of past suicide attempts and eventual death by suicide. Behaviour Research and Therapy, 41(12), 1469–1480. https://doi.org/10.1016/S0005-7967(03)00070-6

    Article  PubMed  Google Scholar 

  • Kassahun, W., Neyens, T., Molenberghs, G., Faes, C., & Verbeke, G. (2012). Modeling overdispersed longitudinal binary data using a combined beta and normal random-effects model. Archives of Public Health, 70(1). https://doi.org/10.1186/0778-7367-70-7

  • Kim, Y., Choi, Y. K., & Emery, S. (2013). Logistic regression with multiple random effects: A simulation study of estimation methods and statistical packages. American Statistician, 67(3), 171–182. https://doi.org/10.1080/00031305.2013.817357

    Article  Google Scholar 

  • Kleiman, E. M., Glenn, C. R., & Liu, R. T. (2019). Real-Time Monitoring of Suicide Risk among Adolescents: Potential Barriers, Possible Solutions, and Future Directions. Journal of Clinical Child & Adolescent Psychology, 48(6), 934–946. https://doi.org/10.1080/15374416.2019.1666400

    Article  Google Scholar 

  • Klonsky, E. D., Glenn, C. R., Styer, D. M., Olino, T. M., & Washburn, J. J. (2015). The functions of nonsuicidal self-injury: converging evidence for a two-factor structure. Child and Adolescent Psychiatry and Mental Health, 9(1), 44. https://doi.org/10.1186/s13034-015-0073-4

    Article  PubMed  PubMed Central  Google Scholar 

  • Klonsky, E. D., & May, A. M. (2015). The Three-Step Theory (3ST): A New Theory of Suicide Rooted in the “Ideation-to-Action” Framework. In International Journal of Cognitive Therapy, 8.

  • Levy, S., Sherritt, L., Harris, K., Gates, E. C., Holder, D. W., Kulig, J. W., & Knight, J. R. (2004). Test-retest reliability of adolescents’ self-report of substance use. https://doi.org/10.1097/01.ALC.0000134216.22162.A5

  • Martin-Willett, R., Helmuth, T., Abraha, M., Bryan, A. D., Hitchcock, L., Lee, K., & Bidwell, L. C. (2020). Validation of a multisubstance online Timeline Followback assessment. Brain and Behavior, 10(1). https://doi.org/10.1002/brb3.1486

  • McManama O’Brien, K. H., Aguinaldo, L. D., White, E., Sellers, C. M., & Spirito, A. (2017). A Brief Alcohol Intervention During Inpatient Psychiatric Hospitalization for Suicidal Adolescents. Cognitive and Behavioral Practice. https://doi.org/10.1016/J.CBPRA.2017.04.002

    Article  Google Scholar 

  • McManama O’Brien, K. H., Sellers, C. M., Battalen, A. W., Ryan, C. A., Maneta, E. K., Aguinaldo, L. D., & Spirito, A. (2018). Feasibility, acceptability, and preliminary effects of a brief alcohol intervention for suicidal adolescents in inpatient psychiatric treatment. Journal of Substance Abuse Treatment, 94, 105–112. https://doi.org/10.1016/j.jsat.2018.08.013

    Article  PubMed  Google Scholar 

  • Muehlenkamp, J. J. (2014). Distinguishing between suicidal and nonsuicidal self-injury. In M. K. Knock (Ed.), Oxford library of psychology. The Oxford handbook of suicide and self-injury (pp. 23–46). Oxford University Press.

  • Nock, M. K. (Ed.). (2009). Understanding nonsuicidal self-injury: Origins, assessment, and treatment. https://doi.org/10.1037/11875-000

  • Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., & Williams, D. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry, 192(2), 98–105. https://doi.org/10.1192/bjp.bp.107.040113

    Article  Google Scholar 

  • Nock, M. K., & Prinstein, M. J. (2004). A Functional Approach to the Assessment of Self-Mutilative Behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890. https://doi.org/10.1037/0022-006X.72.5.885

    Article  Google Scholar 

  • O’Connor, R. C., & Kirtley, O. J. (2018, September 5). The integrated motivational-volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society B: Biological Sciences, 373. https://doi.org/10.1098/rstb.2017.0268

  • Oquendo, M. A., & Mann, J. J. (2008, June). Suicidal Behavior: A Developmental Perspective. Psychiatric Clinics of North America, 31, xiii. https://doi.org/10.1016/j.psc.2008.03.001

  • Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults. American Journal of Psychiatry, 168(12), 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704

    Article  Google Scholar 

  • Prinstein, M. J., Nock, M. K., Simon, V., Aikins, J. W., Cheah, C. S. L., & Spirito, A. (2008). Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization. Journal of Consulting and Clinical Psychology, 76(1), 92–103. https://doi.org/10.1037/0022-006X.76.1.92

    Article  PubMed  PubMed Central  Google Scholar 

  • Rabe-Hesketh, S., & Skrondal, A. (2012). Multilevel and Longitudinal Modeling Using Stata, Volumes I and II, Third Edition (Third). StataCorp LP.

  • Ribeiro, J. D., Franklin, J. C., Fox, K. R., Bentley, K. H., Kleiman, E. M., Chang, B. P., & Nock, M. K. (2016). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies. Psychological Medicine, 46(2), 225–236. https://doi.org/10.1017/S0033291715001804

    Article  PubMed  Google Scholar 

  • Schilling, E. A., Aseltine, R. H., Glanovsky, J. L., James, A., & Jacobs, D. (2009). Adolescent alcohol use, suicidal ideation, and suicide attempts. Journal of Adolescent Health, 44, 335–341. https://doi.org/10.1016/j.jadohealth.2008.08.006

  • Sellers, C. M., Díaz-Valdés, A., Oliver, M. M., Simon, K. M., & O’Brien, K. H. M. M. (2021). The relationship between alcohol and cannabis use with nonsuicidal self-injury among adolescent inpatients: Examining the 90 days prior to psychiatric hospitalization. Addictive Behaviors, 114. https://doi.org/10.1016/j.addbeh.2020.106759

  • Sellers, C. M., Diaz-Valdes Iriarte, A., Wyman Battalen, A., & O’Brien, K. H. M. M. (2019). Alcohol and marijuana use as daily predictors of suicide ideation and attempts among adolescents prior to psychiatric hospitalization. Psychiatry Research, 273, 672–677. https://doi.org/10.1016/j.psychres.2019.02.006

  • Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. (2007). Rebuilding the Tower of Babel: A Revised Nomenclature for the Study of Suicide and Suicidal Behaviors Part 2: Suicide-Related Ideations, Communications, and Behaviors. Suicide and Life-Threatening Behavior, 37(3), 264–277. https://doi.org/10.1521/suli.2007.37.3.264

    Article  PubMed  Google Scholar 

  • Sobell, L. C., & Sobell, M. B. (1995). Alcohol Timeline Followback User’s Manual. Addiction Research Foundation.

    Google Scholar 

  • Sobell, Linda C., & Sobell, M. B. (1992). Timeline Follow-Back. In Measuring Alcohol Consumption 41–72. https://doi.org/10.1007/978-1-4612-0357-5_3

  • Tang, J., Yu, Y., Wu, Y., Du, Y., Ma, Y., Zhu, H., & Liu, Z. (2011). Association between Non-Suicidal Self-Injuries and Suicide Attempts in Chinese Adolescents and College Students: A Cross-Section Study. PLoS ONE, 6(4), e17977. https://doi.org/10.1371/journal.pone.0017977

    Article  PubMed  PubMed Central  Google Scholar 

  • Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227, 759–769. https://doi.org/10.1016/J.JAD.2017.11.073

    Article  PubMed  Google Scholar 

  • Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S., Selby, E. A., & Joiner, T. E. (2010). The Interpersonal Theory of Suicide. Psychological Review, 11(2), 576–600. https://doi.org/10.1037/a0018697

    Article  Google Scholar 

  • Wichstr⊘m, L. (2009). Predictors of Non-Suicidal Self-Injury Versus Attempted Suicide: Similar or Different? Archives of Suicide Research, 13(2), 105–122. https://doi.org/10.1080/13811110902834992.

    Article  Google Scholar 

  • Zhang, X., & Wu, L. T. (2014). Suicidal ideation and substance use among adolescents and young adults: A bidirectional relation? Drug and Alcohol Dependence, 142, 63–73. https://doi.org/10.1016/j.drugalcdep.2014.05.025

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by the American Foundation for Suicide Prevention [YIG-1–097-13, PI: O’Brien, Mentor: Spirito] and the National institute on Alcohol Abuse and Alcoholism [R34AA025763, PI: O’Brien].

Author information

Authors and Affiliations

  1. Department of Psychiatry, Boston Children’s Hospital, Boston, MA, 02115, US

    Christina M. Sellers, Adeline Wyman Battalen & Kimberly H. McManama O’Brien

  2. School of Social Work, College of Social Science, Policy, and Practice (CSSPP), Simmons University, Boston, MA, 02115, US

    Christina M. Sellers

  3. Faculty of Humanities, Society and Health Research Center, Universidad Mayor, 7750000, Santiago, Chile

    Antonia Díaz-Valdés

  4. Department of Psychology, University of Rochester, Rochester, NY, 14627, US

    Andrew C. Porter & Catherine R. Glenn

  5. Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14627, US

    Catherine R. Glenn

  6. Department of Psychology, Old Dominion University, Norfolk, VA, 23529, US

    Catherine R. Glenn

  7. Department of Psychology and Neurosciences, The University of North Carolina At Chapel Hill, Chapel Hill, NC, 27599, Raleigh, US

    Adam Bryant Miller

  8. Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, US

    Kimberly H. McManama O’Brien

Authors
  1. Christina M. Sellers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonia Díaz-Valdés
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew C. Porter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catherine R. Glenn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adam Bryant Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adeline Wyman Battalen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kimberly H. McManama O’Brien
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Sellers, O’Brien, Glenn, and Porter conceived the study and determined the methodology. Díaz-Valdés conducted the study analyses with support from Miller. Sellers and Wyman Battalen collected all study data. All authors contributed to the first draft of the manuscript and all authors have approved the final manuscript.

Corresponding author

Correspondence to Christina M. Sellers.

Ethics declarations

Conflicts of Interest

The authors declare that they have no conflict of interest to report.

Ethical Approval

All procedures performed in this study, involving human participants, were approved by the overseeing Institutional Review Board and in accordance with ethical standards.

Informed Consent

Informed consent/assent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sellers, C.M., Díaz-Valdés, A., Porter, A.C. et al. Nonsuicidal Self-injury, Suicide Planning, and Suicide Attempts Among High-risk Adolescents Prior to Psychiatric Hospitalization. Res Child Adolesc Psychopathol 49, 1503–1511 (2021). https://doi.org/10.1007/s10802-021-00830-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-021-00830-z

Search

Navigation