Cited by 139Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbusePersonality Disorders and Psychopathology

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Adolescent self-injurers: comparing non-ideators, suicide ideators, and suicide attempters.

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Stewart, Jeremy G., Esposito, Erika C., Glenn, Catherine R., Gilman, Stephen E., Pridgen, Bryan, Gold, Joseph, Auerbach, Randy P.·2017·Journal of Psychiatric Research

DOI 10.1016/j.jpsychires.2016.09.031PMC PMC5204373

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Abstract

Adolescent non-suicidal self-injury (NSSI) and suicidality are serious health concerns; however, factors that contribute to the transition from NSSI to suicide ideation and suicide attempts are unclear. To address this gap, we investigated whether demographic characteristics, child maltreatment, and psychiatric factors are associated with the level suicidality among adolescents with a history of self-injury. Participants were three groups of adolescent inpatient self-injurers (n = 397, 317 female), aged 13-18 years (M = 15.44, SD = 1.36): (a) non-ideators (n = 96; no current suicide ideation and no lifetime suicide attempts), (b) suicide ideators (n = 149; current ideation and no lifetime attempts), and (c) suicide attempters (n = 152; current ideation and at least one lifetime attempt). Participants completed interviews assessing psychiatric diagnoses, suicidality, and NSSI characteristics, as well as questionnaires on childhood trauma, psychiatric symptoms, and risky behavior engagement. Depression severity was associated with greater odds being a suicide ideator (p < 0.001, OR = 1.04) and an attempter (p < 0.001, OR = 1.05) compared to a non-ideator. Suicide attempters used more NSSI methods and reported greater risky behavior engagement than non-ideators (p = 0.03, OR = 1.29 and p = 0.03, OR = 1.06, respectively) and ideators (p = 0.015, OR = 1.25 and p = 0.04, OR = 1.05, respectively); attempters used more severe NSSI methods (e.g., burning). Our results identify a wide range of risk markers for increasing lethality in a sample at high risk for suicide mortality; future research is needed to refine risk assessments for adolescent self-injurers and determine the clinical utility of using risk markers for screening and intervention.

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Influential
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“…risk factors for adolescent STBs (depression, hopelessness, and psychiatric disorders) are associated with suicidal thinking but do not distinguish those who have and have not made a prior attempt (Allison et al., 2021; Alqueza et al., 2023; Stewart, Esposito, et al., 2017; Stewart et al., 2019).”
BackgroundMethod
Association between Concussions and Suicidal Behaviors in Adolescents
Wangnoo, T., Zavorsky, G. S., & Owen‐Smith, A. A. (2018) · Journal of Neurotrauma · doi:10.1089/neu.2018.5721 · Cited by 18
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May, A. M., Czyz, E. K., & West, B. T. (2020) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2020.04.018 · Cited by 18
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Xu, Z., Li, N., Kong, Y., Lin, L., Liu, Y., Zhang, H., He, Y., & Zhao, S. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1434191 · Cited by 17
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Gouveia‐Pereira, M., Duarte, E., Gomes, H. S., da Silva, C. T., & Santos, N. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114400 · Cited by 20
“It is known that DSH diversity and STBs are associated (Andover et al., 2012; Duarte et al., 2020; Kiekens et al., 2018; Stewart et al., 2017).”
Background
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Mittermeier, S., Seidel, A., Scheiner, C., Kleindienst, N., Romanos, M., & Buerger, A. (2024) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-023-00699-4 · Cited by 20
Climate change and suicide epidemiology: a systematic review and meta-analysis of gender variations in global suicide rates
Chen, D.-D., Tu, J.-H., Ling, K.-N., Jin, X., & Huang, H. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1463676 · Cited by 16
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Duarte, E., Gouveia‐Pereira, M., & Gomes, H. S. (2019) · Psychiatric Quarterly · doi:10.1007/s11126-019-09660-1 · Cited by 16
Childhood maltreatment influences suicidal behavior: Rumination mediates and regulatory emotional self-efficacy moderates
Wu, C., Zong, Z., Huang, T.-T., Yu, L.-X., & Sun, Q. (2022) · Death Studies · doi:10.1080/07481187.2022.2132319 · Cited by 15
“, 2014), posttraumatic stress (Stewart et al., 2017), borderline personality traits (Kealy et al.”
Background
Cyberbullying and Traditional Bullying Victimization, Depressive Symptoms, and Suicidal Ideation Among Chinese Early Adolescents: Cognitive Reappraisal and Emotion Invalidation as Moderators
Zhou, J., Zhao, H., & Zou, Y. (2023) · Social Science Computer Review · doi:10.1177/08944393231192237 · Cited by 17
“Moreover, depressive symptoms present one of the most researched psychosocial predictors of suicidal risk (Franklin et al., 2017), ranked second only to previous suicide attempts as the most powerful predictor of suicidal behaviors during adolescence (Stewart et al., 2017).”
Background
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Etherson, M. E., Lee, S., Loney, K. J., Steward, I. P., Ward, J., McClelland, H., Kandola, A. A., Mendes, J. A. D. A., Hollis, C. P., Townsend, E., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0326381 · Cited by 15
Theta oscillatory dynamics serving cognitive control index psychosocial distress in youth
Schantell, M. D., Taylor, B. K., Mansouri, A., Arif, Y., Coutant, A. T., Rice, D. L., Wang, Y., Calhoun, V. D., Stephen, J. M., & Wilson, T. W. (2023) · Neurobiology of Stress · doi:10.1016/j.ynstr.2023.100599 · Cited by 14
“…during adolescence and early adulthood may be particularly susceptible to disruptions in cognitive control and thereby difficulties in emotional regulation and the potential emergence of psychopathology (Stewart et al., 2017; Merrick et al., 2017; Dube et al., 2001; Gloger et al., 2021).”
Background
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Schweren, L. J. S., Rasing, S. P. A., Kammeraat, M., Middelkoop, L. A., Werner, R., Mérelle, S. Y. M., Garcia, J. M., Creemers, D. H. M., & van Veen, S. M. P. (2025) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2024.4006 · Cited by 11
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“NSSI frequency – consistent with literature suggesting the relative importance of meth-ods over frequency (Stewart et al., 2017).”
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Psychological pain and sociodemographic factors classified suicide attempt and non-suicidal self-injury in adolescents
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Predicting the trajectory of non‐suicidal self‐injury among adolescents
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Karimi, S., Pirmoradi, M., Ashouri, A., & Aghebati, A. (2021) · Iranian Journal of Psychiatry and Clinical Psychology · doi:10.32598/ijpcp.26.4.2955.2.1 · Cited by 10
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“In turn, self-injury severity, including lethality and frequency – especially of cutting – is a strong predictor of later ideation and attempts (O ’ Loughlin et al., 2021; Stewart et al., 2017b).”
Gender differences of suicides in children and adolescents: Analysis of 167 suicides in a Mexican population from 2003 to 2013
Aguilar-Velázquez, D. G., González‐Castro, T. B., Tovilla‐Zárate, C. A., Juárez‐Rojop, I. E., López‐Narváez, M. L., Fresán, A., Hernández‐Díaz, Y., & Guzmán‐Priego, C. G. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.09.083 · Cited by 10
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“NSSI not only causes physical damage to adolescents, but also greatly harms their psychology, including increasing the likelihood of certain diseases, various psychological and behavioral disorders, and even suicidal behavior (6, 7).”
Background
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“Completed suicide is associated with previous suicide attempts, suicidal ideation [10, 11], and NSSI [12, 13].”
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Environmental Stressors May Drive Inflammation and Alter Neurocircuitry to Promote Suicidal Behavior
Mościcki, E. K., & Umhau, J. C. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1007-2 · Cited by 8
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“Moreover, a representative sample of adolescent self-injurers demonstrated that adolescent self-injury increases the risk for future suicidal behaviors (Stewart et al., 2017).”
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Changes in suicide capability during short-term partial hospital treatment
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Childhood maltreatment and nonsuicidal self-injury among younger Chinese prisoners: the mediating role of self-esteem
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Theoretical Models Linking NSSI to Suicide
Victor, S. E., Christensen, K., & Trieu, T. H. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197611272.013.3 · Cited by 5
School Bullying Victimization and Suicidal Tendency Among Chinese Adolescents: The Mediating Role of Internalizing Problems and Non-Suicidal Self-Injury
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“Furthermore, both quantitative research and qualitative research have shown positive correlations between NSSI and suicidal tendency (Kessler et al., 2015; Stewart et al., 2017; Taliaferro et al., 2019; Victor & Klonsky, 2014).”
Background
Análisis cienciométrico sobre tendencias de investigación del riesgo suicida en la infancia y la adolescencia
Núñez, C., Tabares, Á. S. G., Méndez, J. H. M., Arbeláez, A. C. M., Velez, I. G. O., & Caballo, V. E. (2024) · Ciencias Psicológicas · doi:10.22235/cp.v18i1.3362 · Cited by 4
PTSD symptoms and self-injury behaviors among Iranian soldiers: the mediator roles of rumination and social support
Neyshabouri, M. D., Dolatshahi, B., & Mohammadkhani, P. (2020) · Cogent Psychology · doi:10.1080/23311908.2020.1733333 · Cited by 5
“growing prevalence of this issue in the past few years (Stewart et al., 2017).”
Background
Differentiating Between Youth with a History of Suicidal Thoughts, Plans, and Attempts
Rivers, A. S., Winston‐Lindeboom, P., Atte, T., Rosen, P., Wintersteen, M. B., Watkins, N. K., Tien, A. Y., & Diamond, G. S. (2023) · School Mental Health · doi:10.1007/s12310-023-09575-0 · Cited by 4
Clarifying the relationship between physical injuries and risk for suicide attempt in a Swedish national sample
Stephenson, M. E., Ohlsson, H., Lannoy, S., Sundquist, J., Sundquist, K., & Edwards, A. C. (2024) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13675 · Cited by 4
“3,4 9 While prior research has considered the effects of some individual PPEs, such as non-suicidal self-injury 10 – 13 and physical and sexual abuse, 14 – 16 less is known about the relationship between physical injuries and suicidal behavior.”
Background
What predicts suicidality among people who self-injure? Evidence for acquired capability via pain habituation and NSSI severity
Hepp, J., Rose, S., Trull, T. J., & Carpenter, R. W. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.121028 · Cited by 3
Can clinician’s risk assessments distinguish those who disclose suicidal ideation from those who attempt suicide?
Barker, J., Oakes-Rogers, S., Lince, K., Taylor, A., Keddie, R., Bruce, H., Selvarajah, S., Fish, D., Aspen, C., & Leddy, A. (2023) · Death Studies · doi:10.1080/07481187.2023.2192532 · Cited by 3
“…historical suicide attempts and NSSI are key determinants of acquired suicidal capability, with cross-sectional evidence supporting the ability of NSSI to distinguish ideators and attempters (Burke et al., 2018; Stewart et al., 2017b), their longitudinal exploration is an important research gap.”
Background
Understanding the distribution of recent deliberate self-harm among young LGBTQ+ australians
Lim, G., Amos, N., Anderson, J., Norman, T. L., Power, J., Jones, J. B., & Bourne, A. (2024) · Psychology and Sexuality · doi:10.1080/19419899.2024.2439354 · Cited by 3
“Namely, DSH has been convincingly associated with future suicidality (Burke et al., 2018; Stewart et al., 2017) and is thought to habituate young persons to the process of inflicting self-injury, thereby increasing the lethality of future suicidal behaviours (Joiner et al., 2012).”
Neural circuit for Non-Suicidal Self-Injury and Causal Clinical Validation.
Wang, S., Wu, Y., Wang, W.-J., Zhang, J.-H., Geng, F., Li, Q.-Q., Xiao, G., Zu, M.-D., Nie, J., Ni, L.-P., et al. (2025) · Behavioural Brain Research · doi:10.1016/j.bbr.2025.115736 · Cited by 3
The Prevalence and Correlates of Suicidality in a Sample of Adolescents in Guangdong, China
Yan, P., Ren, Y., Li, M., Lin, M., Xu, S., Liu, J., Zhou, G., Xu, L., & You, J. (2020) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2020.39.02.77 · Cited by 5

Authors: Stewart, J. G., Esposito, E. C., Glenn, C. R., Gilman, S. E., Pridgen, B., Gold, J., & Auerbach, R. P.
Affiliations: Harvard University (US)
University of Rochester (US)
National Institutes of Health (US)
Corresponding author: Stewart, Jeremy G.
ORCID: Stewart, Jeremy G.
Esposito, Erika C.
Glenn, Catherine R.
Gilman, Stephen E.
Auerbach, Randy P.
Venue: Journal of Psychiatric Research
Publisher: Elsevier BV
Published: 2017-01
Volume: 84
Pages: 105-112
ISSN: 0022-3956 (ISSN-L)
DOI: 10.1016/j.jpsychires.2016.09.031
PMC: PMC5204373
OpenAlex: W2529681323
Cited by: 139
References: 54
Citations by year: 2026: 9 · 2025: 15 · 2024: 19 · 2023: 14 · 2022: 15 · 2021: 24 · 2020: 11 · 2019: 14 · 2018: 11 · 2017: 7
FWCI: 14.27
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychiatric Research (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (K23MH097786)
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, adolescent self-injury, suicidal ideation, suicide attempts, suicide lethality, depression severity, child abuse, risk-taking, self-injury methods, suicide risk markers, psychiatric comorbidity
MeSH terms: Adolescent, Analysis of Variance, Depression, Female, Humans, Inpatients, Interview, Psychological, Male, Psychiatric Status Rating Scales, Surveys and Questionnaires, Risk-Taking, Suicide, Attempted, Multivariate Analysis, Self-Injurious Behavior, Suicidal Ideation

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Adolescent self-injurers: comparing non-ideators, suicide ideators, and suicide attempters.

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