The DOI matches its Crossref record; 33 of the 33 references it cites were found in a registry or an index.
Nonsuicidal Self-Injury as a Gateway to Suicide in Young Adults
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 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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KESSLER, R. C., ANDREWS, G., COLPE, L. J., HIRIPI, E., MROCZEK, D. K., NORMAND, S.-L. T., WALTERS, E. E., & ZASLAVSKY, A. M. (2002) · Psychological Medicine · doi:10.1017/s0033291702006074 · Cited by 10,327
Gratz, K. L., & Roemer, L. (2004) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/b:joba.0000007455.08539.94 · Cited by 8,942 · cited 1×
“optimism) [28], acceptance of emotion [29], sense of meaning in life [30], and perceived peer social isolation [31].”
BackgroundThe meaning in life questionnaire: assessing the presence of and search for meaning in life
Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006) · Journal of Counseling Psychology · doi:10.1037/0022-0167.53.1.80 · Cited by 4,843
A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies
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Discrete-Time Methods for the Analysis of Event Histories
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Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts
NOCK, M., JOINERJR, T., GORDON, K., LLOYDRICHARDSON, E., & PRINSTEIN, M. (2006) · Psychiatry Research · doi:10.1016/j.psychres.2006.05.010 · Cited by 1,617
Measurement of Deliberate Self-Harm: Preliminary Data on the Deliberate Self-Harm Inventory
Gratz, K. L. (2001) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/a:1012779403943 · Cited by 1,166 · cited 1×
“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…”
BackgroundKessler, R. C. (2005) · JAMA · doi:10.1001/jama.293.20.2487 · Cited by 1,101
Self-injurious behaviors in a college population
Whitlock, J., Eckenrode, J., & Silverman, D. (2006) · PEDIATRICS · doi:10.1542/peds.2005-2543 · Cited by 874
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Bechkova-Bushueva, D. V., Volodin, B. Y., & Petrov, D. S. (2026) · Bulletin of psychotherapy · doi:10.25016/2782-652x-2026-0-98-31-37
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Ruan, C., Chen, X., Wu, M., Dong, J., Cui, W., & Zhang, D. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122387
Gilemkhanova, E. N., Lushpaeva, I. I., & Khusainova, R. M. (2026) · Informatics and Education · doi:10.32517/0234-0453-2026-41-3-115-123
Marques, V., Boudreaux, E. D., Miller, I. W., Camargo, C. A., & Arias, S. A. (2026) · Archives of Suicide Research · doi:10.1080/13811118.2026.2724122
Suicidality and Eating Disorder
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Guo, Z., Liu, J., Chen, Q., Li, Z. H. U., Xie, S., Zhu, C., Yu, F., Ji, G., Wang, K., & Zhang, L. (2026) · Cognitive Therapy and Research · doi:10.1007/s10608-026-10785-4
Woo, S., Kim, H., & Kim, S. (2026) · Journal of Korean Medical Science · doi:10.3346/jkms.2027.42.e27
Cao, Y., Wang, J., Liu, X., Wang, X., Chen, W., Yu, Y., Gou, M., Li, W., Li, N., Tong, J., et al. (2026) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2026.10.041
Metadata
- 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)
- 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
- 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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