Skip to main content
SpringerLink
Log in

A Comparison of Adolescents Engaging in Self-Injurious Behaviors With and Without Suicidal Intent: Self-Reported Experiences of Adverse Life Events and Trauma Symptoms

  • Empirical Research
  • Published:
Journal of Youth and Adolescence Aims and scope Submit manuscript

Abstract

Research comparing adolescents engaging in suicidal and non-suicidal self-injury (NSSI), both separately and in combination, is still at an early stage. The purpose of the present study was to examine overlapping and distinguishable features in groups with different types of self-injurious behaviors, using a large community sample of 2,964 (50.6 % female) Swedish adolescents aged 15–17 years. Adolescents were grouped into six categories based on self-reported lifetime prevalence of self-injurious behaviors. Of the total sample, 1,651 (55.7 %) adolescents reported no self-injurious behavior, 630 (21.2 %) reported NSSI 1–4 times, 177 (6.0 %) reported NSSI 5–10 times, 311 (10.5 %) reported NSSI ≥ 11 times, 26 (0.9 %) reported lifetime prevalence of suicide attempt and 169 (5.7 %) adolescents reported both NSSI and suicide attempt. After controlling for gender, parental occupation and living conditions, there were significant differences between groups. Pairwise comparisons showed that adolescents with both NSSI and suicide attempt reported significantly more adverse life events and trauma symptoms than adolescents with only NSSI, regardless of NSSI frequency. The largest differences (effect sizes) were found for interpersonal negative events and for symptoms of depression and posttraumatic stress. Adolescents with frequent NSSI reported more adversities and trauma symptoms than those with less frequent NSSI. There were also significant differences between all the NSSI groups and adolescents without any self-injurious behavior. These findings draw attention to the importance of considering the cumulative exposure of different types of adversities and trauma symptoms when describing self-injurious behaviors, with and without suicidal intent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Andover, M. S., Morris, B. W., Wren, A., & Bruzzese, M. E. (2012). The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: Distinguishing risk factors and psychosocial correlates. Child and Adolescent Psychiatry and Mental Health, 6(11). doi:10.1186/1753-2000-6-11.

  • Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., et al. (2011). Suicide attempts and non suicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA study. Journal of the American Academy of Child and Adolescent Psychiatry, 50(8), 772–781.

    Article  PubMed  Google Scholar 

  • Boxer, P. (2010). Variations in risk and treatment factors among adolescents engaging in different types of deliberate self-harm in an inpatient sample. Journal of Clinical Child and Adolescent Psychology, 39(4), 470–480.

    Article  PubMed  Google Scholar 

  • Brausch, A. M., & Gutierrez, P. M. (2010). Differences in non-suicidal self-injury and suicide attempts in adolescents. Journal of Youth and Adolescence, 39, 233–242.

    Article  PubMed  Google Scholar 

  • Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47, 372–394.

    Article  PubMed  Google Scholar 

  • Briere, J. (1996). Trauma symptom checklist for children (TSCC) professional manual. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Bruffaerts, R., Demyttenaere, K., Borges, G., Haro, J. M., Chiu, W. T., Hwang, I., et al. (2011). Childhood adversities as risk factors for onset and persistence of suicidal behaviour. The British Journal of Psychiatry, 197, 20–27.

    Article  Google Scholar 

  • Cloutier, P., Martin, J., Kennedy, A., Nixon, M. K., & Muehlenkamp, J. J. (2010). Characteristics and co-occurrence of adolescent non-suicidal self-injury and suicidal behaviours in pediatric emergency crisis services. Journal of Youth and Adolescence, 39, 259–269.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Dougherty, D. M., Mathias, C. W., Marsh-Richard, D. M., Prevette, K. N., Dawes, M. A., Hatzis, E. S., et al. (2009). Impulsivity and clinical symptoms among adolescents with non-suicidal self-injury with or without attempted suicide. Psychiatry Research, 169, 22–27.

    Article  PubMed  Google Scholar 

  • Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007). Polyvictimization and trauma in a national longitudinal cohort. Development and Psychopathology, 19(1), 149–166.

    Article  PubMed  Google Scholar 

  • Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and preventive interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42(4), 386–405.

    Article  PubMed  Google Scholar 

  • Greenwald, R., & Rubin, A. (1999). Assessment of posttraumatic symptoms in children: Development and preliminary validation of parent and child scales. Research on Social Work Practice, 9(1), 61–75.

    Article  Google Scholar 

  • Guan, K., Fox, K. R., & Prinstein, M. J. (2012). Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. Journal of Consulting and Clinical Psychology, 80(5), 842–849.

    Google Scholar 

  • Guertin, T., Lloyd-Richardson, E., Spirito, A., Donaldson, D., & Boergers, J. (2001). Self-mutilative behavior in adolescents who attempt suicide by overdose. Journal of the American Child and Adolescent Psychiatry, 40(9), 1062–1069.

    Article  Google Scholar 

  • Hamza, C. A., Stewart, S. L., & Willoughby, T. (2012). Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrated model. Clinical Psychology Review, 32, 482–495.

    Article  PubMed  Google Scholar 

  • Hilt, L. M., Cha, C. B., & Nolen-Hoeksema, S. (2008). Nonsuicidal self-injury in young adolescent girls: Moderators of the distress-function relationship. Journal of Consulting and Clinical Psychology, 76(1), 63–71.

    Article  PubMed  Google Scholar 

  • Horesh, N., Nachshoni, T., Wolmer, L., & Toren, P. (2009). A comparison of life events in suicidal and nonsuicidal adolescents and young adults with major depression and borderline personality disorder. Comprehensive Psychiatry, 50, 496–502.

    Article  PubMed  Google Scholar 

  • Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research, 11(2), 129–147.

    Article  PubMed  Google Scholar 

  • Jacobson, C. M., Muehlenkamp, J. J., Miller, A. L., & Turner, J. B. (2008). Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. Journal of Clinical Child and Adolescent Psychology, 37(2), 363–375.

    Article  PubMed  Google Scholar 

  • Jiang, G-X., Floderus, B., & Wasserman, D. (2010). Självmord i Stockholms län och Sverige 1980–2008. Karolinska Institutets folkhälsoakademi 2010:30. På uppdrag av Stockholm läns landsting. Karolinska Institutet.

  • Joiner, T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey. Archives of General Psychiatry, 56, 617–626.

    Article  PubMed  Google Scholar 

  • King, C. A., & Merchant, C. R. (2008). Social and interpersonal factors relating to adolescent suicidality: A review of the literature. Archives of Suicide Research, 12, 181–196.

    Article  PubMed  Google Scholar 

  • Lang, C. M., & Sharma-Patel, K. (2011). The relation between childhood maltreatment and self-injury: A review of the literature on conceptualization and intervention. Trauma, Violence, & Abuse, 12(1), 23–37.

    Article  Google Scholar 

  • Lloyd, E. E., Kelley, M. L., & Hope, T. (1997). Self-mutilation in a community sample of adolescents: Descriptive characteristics and provisional prevalence rates. New Orleans, LA: Poster session at the annual meeting of the Society for Behavioral Medicine.

    Google Scholar 

  • Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37(8), 1183–1192.

    Article  PubMed  Google Scholar 

  • Lundh, L.-G., Wångby-Lundh, M., & Bjärehed, J. (2011a). Deliberate self-harm and psychological problems in young adolescents: Evidence of a bidirectional relationship in girls. Scandinavian Journal of Psychology, 52(5), 476–483.

    Article  PubMed  Google Scholar 

  • Lundh, L.-G., Wångby-Lundh, M., Paaske, M., Ingesson, S., & Bjärehed, J. (2011b). Depressive symptoms and deliberate self-harm in a community sample of adolescents: A prospective study. Depression Research and Treatment, 2011, Art. No. 935871. doi:10.1155/2011/935871.

  • Muehlenkamp, J. J. (2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry, 75(2), 324–333.

    Article  PubMed  Google Scholar 

  • Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6(10). doi:10.1186/1753-2000-6-10.

  • Muehlenkamp, J. J., Ertelt, T. W., Miller, A. L., & Claes, L. (2011). Borderline personality symptoms differentiate non-suicidal and suicidal self-injury in ethnically diverse adolescent outpatients. Journal of Child Psychology and Psychiatry, 52(2), 148–155.

    Article  PubMed  Google Scholar 

  • Muehlenkamp, J. J., & Gutierrez, P. M. (2007). Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Archives of Suicide Research, 11, 69–82.

    Article  PubMed  Google Scholar 

  • Nilsson, D., Gustafsson, P. E., Larsson, J. L., & Svedin, C.-G. (2010). Evaluation of the Linköping youth life experience scale. The Journal of Nervous and Mental Disease, 198(10), 768–774.

    Article  PubMed  Google Scholar 

  • Nilsson, D., Gustafsson, P. E., & Svedin, C. G. (2012). Polytraumatization and trauma symptoms in adolescent boys and girls: Interpersonal and noninterpersonal events and moderating effects of adverse family circumstances. Journal of Interpersonal Violence, 27(13), 2645–2664.

    Google Scholar 

  • Nilsson, D., Wadsby, M., & Svedin, C.-G. (2008). The psychometric properties of the trauma symptom checklist for children (TSCC) in a sample of Swedish children. Child Abuse and Neglect, 32, 627–636.

    Article  PubMed  Google Scholar 

  • Nock, M. K. (2010). Self-Injury. Annual Review of Clinical Psychology, 6, 339–363.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Joiner, T. E., Jr., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144, 65–72.

    Article  PubMed  Google Scholar 

  • Nock, M. K., & Kessler, R. C. (2006). Prevalence of and risk factors for suicide attempts versus suicide gestures: Analysis of the national comorbidity survey. Journal of Abnormal Psychology, 115(3), 616–623.

    Article  PubMed  Google Scholar 

  • Nock, M. K., & Prinstein, M. J. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114(1), 140–146.

    Article  PubMed  Google Scholar 

  • O’Carroll, P. W., Berman, A. L., Maris, R. W., Moscicki, E. K., Tanney, B. L., & Silverman, M. M. (1996). Beyond the tower of Babel: A nomenclature for suicidology. Suicide and Life-Threatening Behavior, 26(3), 237–252.

    PubMed  Google Scholar 

  • Pearson, E. S., & Hartley, H. O. (1954). Biometrika tables for statisticians (Vol. 1). New York: Cambridge University Press.

    Google Scholar 

  • Penn, J. V., Esposito, C. L., Schaeffer, L. E., Fritz, G. K., & Spirito, A. (2003). Suicide attempts and self-mutilative behavior in a juvenile correctional facility. Journal of the American Academy of Child and Adolescent Psychiatry, 42(7), 762–769.

    Article  PubMed  Google Scholar 

  • Plener, P. L., Libal, G., Keller, F., Fegert, J. M., & Muehlenkamp, J. J. (2009). An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychological Medicine, 39, 1549–1558.

    Article  PubMed  Google Scholar 

  • Random.org. http://www.random.org. Accessed 29 Dec 2010.

  • Statistics Sweden. (2011). http://www.ssd.scb.se/databaser/makro/start.asp. Accessed 8 Feb 2012.

  • Taliaferro, L. A., Muehlenkamp, J. J., Borowsky, I. W., McMorris, B. J., & Kugler, K. C. (2012). Factors distinguishing youth who report self-injurious behavior: A population-based sample. Academic Pediatrics, 12, 205–213.

    Article  PubMed  Google Scholar 

  • The Ethical Review Act. (2003). The act concerning the ethical review of research involving humans (SFS 2003:460). The Swedish Ministry of Education and Cultural Affairs.

  • The National Agency for Education (2010). http://www.skolverket.se/statistik-och-analys/2.1862/2.4391/2.4392. Accessed 29 Dec 2010.

  • Walsh, B. W. (2005). Treating self-injury: A practical guide. New York, NY: Guilford Press.

    Google Scholar 

  • Weierich, M. R., & Nock, M. K. (2008). Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury. Journal of Consulting and Clinical Psychology, 76(1), 39–44.

    Article  PubMed  Google Scholar 

  • WichstrØm, L. (2009). Predictors of non-suicidal self-injury versus attempted suicide: Similar or different? Archives of Suicide Research, 13(2), 105–122.

    Article  PubMed  Google Scholar 

  • Wilkinson, P. O. (2011). Nonsuicidal self-injury: A clear marker for suicide risk. Journal of the American Academy of Child and Adolescent Psychiatry, 50(8), 741–743.

    Article  PubMed  Google Scholar 

  • Wilkinson, P., Kelvin, R., Roberts, C., Dubicka, B., & Goodyer, I. (2011). Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the adolescent depression antidepressants and psychotherapy trial (ADAPT). The American Journal of Psychiatry, 168(5), 495–501.

    Article  PubMed  Google Scholar 

  • Zetterqvist, M., Lundh, L.-G., Dahlström, Ö., & Svedin, C. G. (2012). Prevalence and function of non-suicidal self-injury (NSSI) in a community sample of adolescents, using suggested DSM-5 criteria for a potential NSSI disorder. Submittet manuscript.

  • Zoroglu, S. S., Tuzun, U., Sar, V., Tutkun, H., Savaş, H. A., Ozturk, M., et al. (2003). Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation. Psychiatry and Clinical Neurosciences, 57, 119–126.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by grants to Maria Zetterqvist from Clas Groschinsky’s Memorial Foundation and Sven Jerring Foundation. Medical student Hanna Högberg provided valuable assistance during the data collection.

MZ conceived the study, participated in the design of the study, performed the data collection and the statistical analysis, helped to draft the manuscript; L-GL helped to draft the manuscript and revised it critically; CGS participated in the design of the study, helped to draft the manuscript and revised it critically. All authors read and approved the final manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry, Linköping University, 581 85, Linköping, Sweden

    Maria Zetterqvist & Carl Göran Svedin

  2. Child and Adolescent Psychiatric Clinic, University Hospital, 581 85, Linköping, Sweden

    Maria Zetterqvist

  3. Department of Psychology, Lund University, 221 00, Lund, Sweden

    Lars-Gunnar Lundh

Authors
  1. Maria Zetterqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lars-Gunnar Lundh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carl Göran Svedin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Zetterqvist.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zetterqvist, M., Lundh, LG. & Svedin, C.G. A Comparison of Adolescents Engaging in Self-Injurious Behaviors With and Without Suicidal Intent: Self-Reported Experiences of Adverse Life Events and Trauma Symptoms. J Youth Adolescence 42, 1257–1272 (2013). https://doi.org/10.1007/s10964-012-9872-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10964-012-9872-6

Keywords

Search

Navigation