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J Affect Disord. 2018 Oct 15;239:171-179. doi: 10.1016/j.jad.2018.06.033. Epub 2018 Jun 30.

The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors.

Author information

1
Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium; School of Psychology, Curtin University, Perth, Australia. Electronic address: Glenn.Kiekens@kuleuven.be.
2
School of Psychology, Curtin University, Perth, Australia.
3
Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium.
4
Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.
5
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
6
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
7
School of Education, Boston University, Boston, MA, USA.
8
Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, MA, USA.
9
Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.
10
Department of Psychology, Harvard University, Cambridge, MA, USA.
11
Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium; Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, USA.

Abstract

BACKGROUND:

Theoretical and empirical literature suggests that non-suicidal self-injury (NSSI) is an important correlate of suicide risk. The present study was designed to evaluate: (a) whether NSSI is associated with increased odds of subsequent onsets of suicidal thoughts and behaviors (STB) independent of common mental disorders, (b) whether NSSI is associated with increased risk of transitioning from suicide ideation to attempt, and (c) which NSSI characteristics are associated with STB after NSSI.

METHOD:

Using discrete-time survival models, based on retrospective age of onset reports from college students (n = 6,393, 56.8% female), we examined associations of temporally prior NSSI with subsequent STB (i.e., suicide ideation, plan, and attempt) controlling mental disorders (i.e., MDD, Broad Mania, GAD, Panic Disorder, and risk for Alcohol Dependence). NSSI characteristics associated with subsequent STB were examined using logistic regressions.

RESULTS:

NSSI was associated with increased odds of subsequent suicide ideation (OR = 2.8), plan (OR = 3.0), and attempt (OR = 5.5) in models that controlled for the distribution of mental disorders. Further analyses revealed that NSSI was associated with increased risk of transitioning to a plan among those with ideation, as well as attempt among those with a plan (ORs = 1.7-2.1). Several NSSI characteristics (e.g., automatic positive reinforcement, earlier onset NSSI) were associated with increased odds of experiencing STB.

LIMITATIONS:

Surveys relied on self-report, and thus, there is the potential for recall bias.

CONCLUSIONS:

This study provides support for the conceptualization of NSSI as a risk factor for STB. Investigation of the underlying pathways accounting for these time-ordered associations is an important avenue for future research.

PMID:
30014957
DOI:
10.1016/j.jad.2018.06.033

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