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

G. Kiekens*, P. Hasking, M. Boyes, L. Claes, P. Mortier, R. P. Auerbach, P. Cuijpers, K. Demyttenaere, J. G. Green, R. C. Kessler, I. Myin-Germeys, M. K. Nock, R. Bruffaerts

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

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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.

Original languageEnglish
Pages (from-to)171-179
Number of pages9
JournalJournal of Affective Disorders
Volume239
Early online date30 Jun 2018
DOIs
Publication statusPublished - 15 Oct 2018

Funding

In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis, he was a consultant for Johnson & Johnson Wellness and Prevention, Shire and Takeda, and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Dr. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. The other authors report no biomedical financial interests or potential conflicts of interest. The authors wish to thank the student services of KU Leuven and Curtin University for their assistance in data collection and two anonymous reviewers for their constructive comments on an earlier version of this manuscript. This research was supported in part by grants from the Research Foundation Flanders [ 11N0514N (PM) , 11N0516N (PM) , 1114717N (GK) ], King Baudouin Foundation [ 2014‐J2140150‐102905 (RB) ], Curtin University [ CIPRS/HSFIRS (GK) ], and the Department of Health, Government of Western Australia [ Independent Researcher Infrastructure Support Award (MB) ].

FundersFunder number
Curtin University of TechnologyCIPRS/HSFIRS (GK)
Fonds Wetenschappelijk Onderzoek11N0516N, 1114717N, 11N0514N
Department of Health, Government of Western AustraliaIndependent Researcher Infrastructure Support Award (MB)
Koning Boudewijnstichting2014‐J2140150‐102905

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