Nonsuicidal Self-Injury as a Predictor of Suicidal Behavior in Depressed Adolescents
Abstract
Conventional wisdom has viewed suicidal behavior as much more ominous than nonsuicidal self-injury. The thoughtful and clearly written article in this issue by Wilkinson and colleagues (1) from the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT) should make us view nonsuicidal self-injury more seriously, as it was a stronger predictor of future suicidal behavior than was a previous history of a suicide attempt. While this may be surprising, it is not an isolated finding. Previous studies have found that nonsuicidal self-injury predicts persistence of suicidal ideation and that these two types of self-destructive behaviors are highly associated, especially in clinical populations (2). There are at least three possible explanations for this relationship: nonsuicidal self-injury and suicidal behavior are on the same spectrum of self-destructive behavior; nonsuicidal self-injury and suicidal behavior have similar correlates; or engaging in nonsuicidal self-injury somehow predisposes to suicidal behavior.
Nonsuicidal self-injury and suicide attempts have been grouped under the term deliberate self-harm because the two behaviors frequently co-occur. When nonsuicidal self-injury occurs in community samples, it is often sporadic and can occur without serious psychopathology. In contrast, in clinically referred populations, the observed frequency and severity of nonsuicidal self-injury are much greater than in community samples and nonsuicidal self-injury is…
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