A Longitudinal Study of Nonsuicidal Self-Injury in Offspring at High Risk for Mood Disorder

Abstract

Objective To determine the demographic and clinical predictors of nonsuicidal self-injury and to examine the longitudinal relationship between nonsuicidal self-injury and suicide attempt. Method This was a longitudinal cohort study of the familial transmission of suicidal behavior. The sample consisted of probands with DSM-IV mood disorder (n = 212), 54.2% of whom were suicide attempters, and their offspring aged at least 10 years (n = 352), followed for a mean of 3.8 years. Personal, parental, and familial characteristics were assessed annually to identify the most parsimonious subset of these variables associated with nonsuicidal self-injury, the primary outcome. Data were collected between August 1998 and August 2007. Results Of 352 offspring, 7.4% (n = 26) engaged in nonsuicidal self-injury during follow-up. In the final model examining predictors at baseline, the most severe time point, and the time point prior to nonsuicidal self-injury, only predictors from the most proximal time point were significant, namely younger age (odds ratio [OR] = 0.75, P = .002), diagnosis of current major depression (OR = 5.09, P < .001), and suicidal ideation (OR = 1.46, P = .02). In 2 of the 3 single time point models, baseline nonsuicidal self-injury was the most significant predictor of nonsuicidal self-injury during follow-up. Suicide attempt was predicted by both baseline nonsuicidal self-injury and suicide attempt, but when both were included in the model, nonsuicidal self-injury was a significant predictor (OR = 7.50, P = .009), but suicide attempter was not (OR = 3.78, P = .08); offspring aggression (OR = 1.11, P = .01) predicted suicide attempt but not nonsuicidal self-injury. Parental histories of nonsuicidal self-injury, suicide attempt, and abuse were not predictive of nonsuicidal self-injury. Conclusions Nonsuicidal self-injury may be an earlier manifestation of a shared diathesis with suicide attempt, consisting of depression and suicidal ideation, and that diathesis may lead to suicidal behavior in the face of greater offspring aggression and family pathology. The apparent bidirectional temporal relationship between nonsuicidal self-injury and suicide attempt may be explained by this shared diathesis.

Meta-analysis of risk factors for nonsuicidal self-injury

“…Using available statistics, the average age of participants was 21.32 (SD = 4.41). Seven of the 16 unique samples were adult, eight adolescent, and two were mixed (i.e., *Tuisku et al, 2014; *Cox et al, 2012). Because only two studies employed a mixed adolescent and adult sample, and those samples comprised primarily of adolescents, the two mixed-age studies were coded as adolescent.…”

“…Lifetime prevalence rates of these behaviors range from 5.5–17% in community samples (among teens and adults respectively; Swannell, Martin, Page, Hasking, & St. John, 2014) and 50% in clinical samples (DiClemente, Ponton, & Hartley, 1991; Penn, Esposito, Schaeffer, Fritz, & Spirito, 2003). In addition to being dangerous in its own right, NSSI may be a risk factor for future suicidal behaviors (e.g., Asarnow et al, 2011; Bryan, Bryan, Ray-Sannerud, Etienne, & Morrow, 2014; *Cox et al, 2012; Goldstein et al, 2012; Whitlock et al, 2013; *Wilkinson, Kelvin, Roberts, Dubicka, & Goodyer, 2011; Guan, Fox, & Prinstein, 2012). Given the dangerousness and prevalence of these behaviors, it is concerning that no intervention has been consistently shown to reduce NSSI compared to an active control group (see Brausch & Girresch, 2012; Glenn, Franklin, & Nock, 2015; Gonzales & Bergstrom, 2013; Nock, 2010; Washburn et al, 2012).…”

Correlates of Nonsuicidal Self-Injury and Suicide Attempts among Tertiary Care, Emergency Department Patients

“…The finding that people who present to ED services with NSSI are more likely to have experienced early life adversity and have psychiatric comorbidity than people who present with no self-harm or suicidal ideation is consistent with the current literature. Previous research has found that NSSI is associated with childhood physical and sexual abuse, 12,13 having an anxiety disorder, 10,23 depression, 4,5,10 SUD, 9,10 aggression, 5 and suicidal ideation. 4,5 However, the only study that directly compared the correlates of SA and NSSI was that of Nock and Kessler.…”

Adversidad psicosocial, salud mental y suicidio en adolescentes: ¿estamos haciendo lo suficiente para atender a esta población?

“…8 En años recientes, dentro del estudio de la conducta suicida, se ha incorporado la evaluación de las autolesiones sin un fin suicida (NSSI, por sus siglas en inglés), es decir aquellas lesiones que obedecen al acto de auto-infligirse deliberadamente dolor y daño en los tejidos de un individuo en ausencia de ideación suicida, ha cobrado mayor interés debido a que se presenta frecuentemente en adolescentes y se asocia con una mayor severidad de la psicopatología. 9 La evidencia científica ha mostrado que entre los adolescentes que presentan algún tipo de NSSI existe un mayor riesgo tanto de intentar como de consumar el suicidio. 10 Al respecto, un estudio publicado en el 2006 mostró que 70 % de los adolescentes que presentan NSSI tenía al menos el antecedente de un intento suicida previo; el 55% de la misma muestra manifestaba el antecedente de múltiples intentos suicidas.…”

“…11 Recientemente se ha mostrado también que los intentos suicidas dentro del grupo de hijos de padres con psicopatología son predichos con mayor fuerza cuando los adolescentes presentan NSSI en comparación con un intento suicida previo. 9 Los adolescentes con NSSI con frecuencia presentan trastornos afectivos, ansiosos, alimentarios, trastornos externalizados e incluso trastornos por uso de sustancias. 10 La identificación y el desarrollo de instrumentos clinimétricos para la población adolescente que podría encontrarse especialmente en un riesgo elevado para presentar conducta suicida, es un tema que debe ser abordado en futuras investigaciones.…”