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

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.

Suicidal thoughts and behaviors among college students and same-aged peers: results from the World Health Organization World Mental Health Surveys

“…First, as documented here, the vast majority of STB emerge in adolescence prior to the typical age of college matriculation. This finding is consistent with previous research [11,12]. Thus, a shift of focus for primary prevention towards childhood-adolescence may be indicated.…”

“…If our findings are confirmed, college students may have lower STB than adolescents aged 13–18 years [11,12], and than the general adult population aged 18–64 years [10,13]. Direct comparisons with same-aged peers not in college revealed that low college student STB prevalence may be explained, in part, by reduced matriculation among non-students who report high rates of STB during secondary school and thus, fail to matriculate into college.…”

Annual Research Review: A meta‐analytic review of worldwide suicide rates in adolescents

“…A third finding from this review replicates a wellestablished trend that suicide rates are higher among older adolescents (Kõlves & De Leo, 2017;Roh et al, 2018) and young adults (Bridge et al, 2006;Cha et al, 2018) compared with younger adolescents. The age finding is also consistent with research describing the trajectories of suicidal thoughts and behaviors during adolescence, specifically that the onset of suicide ideation typically occurs during early adolescence (around ages 11-13) and, for a subgroup of youth, transitions to suicidal behavior during later adolescence (around age 15 or 16; Glenn et al, 2017;Nock et al, 2013). This previous research may suggest the existence of a developmental process (or set of processes) by which adolescents become more capable of engaging in suicidal behavior as they transition from early to later adolescence.…”

Prospective Investigation of the Interaction Between Social Problems and Neuropsychological Characteristics on the Development of Suicide Ideation

“…However, 16.7% ( n = 13) of participants endorsed suicidality at Time 3 of the study. This increase in SI is consistent with prior literature showing a sharp increase after age 12 which cannot be fully accounted for by psychological disorders (Glenn et al, ; Nock et al, ; Nock, Holmberg, Photos, & Michel, ). Endorsement of SI prior to Time 3 was not a significant predictor in any of the models so it was dropped from final analyses.…”