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

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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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“The strong relationship between NSSI and emotion dysregulation [13,14], low social support [3,10,11,15], and global psychological distress [15e17] suggest that these and related variables, such as cognitive style [18], sense of meaning in life [3,4], mental health history [16,19], and trauma history [15,20,21], may me…”
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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: Whitlock, Janis
Muehlenkamp, Jennifer
Eckenrode, John
Purington, Amanda
Barreira, Paul
Kress, Victoria
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
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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Nonsuicidal Self-Injury as a Gateway to Suicide in Young Adults

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