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Cited by 618Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbusePersonality Disorders and Psychopathology

Nonsuicidal self-injury as a gateway to suicide in young adults

Whitlock, Janis, Muehlenkamp, Jennifer, Eckenrode, John, Purington, Amanda, Baral Abrams, Gina, Barreira, Paul, Kress, Victoria·2013·Journal of Adolescent Health
DOI 10.1016/j.jadohealth.2012.09.010
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Abstract

Purpose To investigate the extent to which nonsuicidal self-injury (NSSI) contributes to later suicide thoughts and behaviors (STB) independent of shared risk factors.Methods One thousand four hundred and sixty-six students at five U.S. colleges participated in a longitudinal study of the relationship between NSSI and suicide. NSSI, suicide history, and common risk/protective factors were assessed annually for three years. Analyses tested the hypotheses that the practice of NSSI prior to STB and suicide behavior (excluding ideation) reduced inhibition to later STB independent of shared risk factors. Analyses also examined factors that predicted subsequent STB among individuals with NSSI history.Results History of NSSI did significantly predict concurrent or later STB (AOR 2.8, 95%, CI 1.9-4.1) independent of covariates common to both. Among those with prior or concurrent NSSI, risk of STB is predicted by > 20 lifetime NSSI incidents (AOR 3.8, 95% CI, 1.4-10.3) and history of mental health treatment (AOR 2.2, 95% CI, 1.9-4.6). Risk of moving from NSSI to STB is decreased by presence of meaning in life (AOR .6, 95% CI, .5-.7) and reporting parents as confidants (AOR, .3, 95% CI, .1-.9).Conclusions NSSI prior to suicide behavior serves as a "gateway" behavior for suicide and may reduce inhibition through habituation to self-injury. 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.

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Crossref · 10.1016/j.jadohealth.2012.09.010

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  • The only previous longitudinal study found self-harm frequency to be an important predictor of suicidal behaviour among adolescents who engage in non-suicidal self-harm; other factors identified were reduced social connectedness and sense of meaning in life, and increased levels of mental health treatment.

    “The only previous longitudinal study21 also found self-harm frequency to be an important predictor of suicidal behaviour among adolescents who engage in non-suicidal self-harm. Other factors identified were reduced social connectedness and sense of meaning in life, and increased levels of mental health treatment.”

    From Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study (2019) · cites this paper as [21]

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Authors
Whitlock, J., Muehlenkamp, J., Eckenrode, J., Purington, A., Baral Abrams, G., Barreira, P., & Kress, V.
Affiliations
  • Cornell University (US)
  • University of Wisconsin–Eau Claire (US)
  • Harvard University (US)
  • Youngstown State University (US)
Corresponding author
Whitlock, Janis
ORCID
Venue
Journal of Adolescent Health
Publisher
Elsevier BV
Published
2013-04
Volume
52
Issue
4
Pages
486-492
ISSN
1054-139X (ISSN-L)
DOI
10.1016/j.jadohealth.2012.09.010
OpenAlex
W2169646043
Cited by
618
References
33
Citations by year
2026: 33 · 2025: 53 · 2024: 41 · 2023: 70 · 2022: 45 · 2021: 69 · 2020: 59 · 2019: 45 · 2018: 50 · 2017: 45 · 2016: 40 · 2015: 35 · 2014: 24 · 2013: 7 · 2012: 1
FWCI
24.37
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Adolescent Health (publishedVersion)
  • PubMed (publishedVersion)
Funders
American Foundation for Suicide Prevention
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
non-suicidal self-injury, suicidal behavior, suicidal ideation, young adults, university students, meaning in life, psychotherapy, suicide risk factors
MeSH terms
Mental Disorders, Habituation, Psychophysiologic, Humans, Inhibition, Psychological, Life Change Events, Longitudinal Studies, Mothers, Parent-Child Relations, Risk, Risk Factors, Social Adjustment, Students, Suicide, United States, Self-Injurious Behavior, Suicidal Ideation

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