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Examining the Course of Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors in Outpatient and Inpatient Adolescents

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Abstract

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.

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Notes

  1. In line with Bryan et al. (2015), we aimed to examine differences in the transition from suicidal thinking to suicidal action among those with and without a history of NSSI. However, in our two large clinical samples, the number of adolescents who had attempted suicide but not engaged in NSSI was very small (SA only: n = 11 across both samples), as compared to adolescents who had engaged in both NSSI and attempted suicide (NSSI + SA: n = 102 across both samples). Therefore, we did not have sufficient power for the proposed analyses.

  2. Gender differences in the age-of-onset of SITBs were examined. Across both samples, females had slightly earlier ages of onset than males, but this difference was only significant for the onset of: (a) suicide ideation in the outpatient sample: male (n = 16, M = 14.69, SD = 2.39); female (n = 78, M = 13.10, SD = 2.91), t(92) = 2.04, p = .044, Cohen’s d = 0.60, and (b) suicide attempts in the inpatient sample: male (n = 12, M = 15.42, SD = 1.83); female (n = 55, M = 14.07, SD = 1.88), t(65) = 2.25, p = .028, Cohen’s d = 0.73. However, these results should be interpreted with caution as both samples were predominantly female.

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Authors and Affiliations

  1. Clinical and Social Sciences in Psychology, University of Rochester, 460 Meliora Hall, Box 270266, Rochester, NY, 14627, USA

    Catherine R. Glenn & Angela C. Santee

  2. Department of Psychology, Brown University, Providence, RI, USA

    Elizabeth C. Lanzillo

  3. Department of Psychiatry, Harvard Medical School; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA

    Erika C. Esposito & Randy P. Auerbach

  4. Department of Psychology, Harvard University, Cambridge, MA, USA

    Matthew K. Nock

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  1. Catherine R. Glenn
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  2. Elizabeth C. Lanzillo
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  4. Angela C. Santee
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  5. Matthew K. Nock
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  6. Randy P. Auerbach
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Correspondence to Catherine R. Glenn.

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Funding

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).

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The authors declare that they have no conflicts of interest.

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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.

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

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Glenn, C.R., Lanzillo, E.C., Esposito, E.C. et al. Examining the Course of Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors in Outpatient and Inpatient Adolescents. J Abnorm Child Psychol 45, 971–983 (2017). https://doi.org/10.1007/s10802-016-0214-0

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