Self-Injury and Suicide

The authors of a study of students in five American colleges concluded that nonsuicidal self-injury “serves as a ‘gateway’ behavior for suicidal thoughts and behaviors and may reduce inhibition through habituation to self-injury.” The International Society for the Study of Self-injury defines nonsuicidal self-injury (NSSI) as the “deliberate destruction or alteration of body tissue without a conscious suicidal intent.”

Sixty-three percent of students who reported suicidal thoughts or behaviors also reported NSSI. There was no difference in the percentages of students who reported that NSSI preceded suicidal thoughts or behavior and those who reported that NSSI followed suicidal thoughts or behavior.

Twenty percent of the students reported engaging in NSSI before experiencing suicidal thoughts or  behavior and 20 percent reported experiencing suicidal thoughts or behavior prior to engaging in NSSI. Another 11 percent of students reported that NSSI and suicidal thoughts or behavior occurred during the same one-year period.

Students who had been involved in more than five episodes of NSSI were four times as likely as other young people to report suicidal thoughts and behaviors, and 3.4 times as likely to report suicidal behavior (excluding thoughts).

Students who reported “a sense of meaning in life” and “parents as confidants” were less likely to move from NSSI to suicidal thoughts and behaviors than students who had engaged in NSSI but felt “less socially connected to critical supports (such as parents)” and had “a lower sense of meaning in life.” The authors concluded that “treatments focusing on enhancing perceived meaning in life and building positive relationships with others, particularly parents, may be particularly effective in reducing suicide risk among youth with a history of NSSI.” The authors also suggested that assessing self-injury during routine medical screenings may help identify adolescents and young adults at risk for more serious suicidal behaviors.

Whitlock, J., Muehlenkamp, J., Eckenrode, J., Purington, A., Baral Abrams, G., Barreira, P., & Kress, V. (2013). Nonsuicidal self-injury as a gateway to suicide in young adults. Journal of Adolescent Health 52(4), 486-42.