The relationship between self-injurious behavior and suicide in a young adult population

Arch Pediatr Adolesc Med. 2007 Jul;161(7):634-40. doi: 10.1001/archpedi.161.7.634.


Objective: To test the hypothesis that self-injurious behavior (SIB) signals an attempt to cope with psychological distress that may co-occur or lead to suicidal behaviors in individuals experiencing more duress than they can effectively mitigate.

Design: Analysis of a cross-sectional data set of college-age students.

Setting: Two universities in the northeastern United States in the spring of 2005.

Participants: A random sample of 8300 students was invited to participate in a Web-based survey; 3069 (37.0%) responded. Cases in which a majority of the responses were missing or in which SIB or suicide status was indeterminable were omitted, resulting in 2875 usable cases. Exposure Self-injurious behavior.

Main outcome measures: Main outcome was suicidality; adjusted odds ratios (AORs) for suicidality by SIB status when demographic characteristics, history of trauma, distress, informal help-seeking, and attraction to life are considered.

Results: One quarter of the sample reported SIB, suicidality, or both; 40.3% of those reporting SIB also report suicidality. Self-injurious behavior status was predictive of suicidality when controlling for demographic variables (AOR, 6.2; 95% confidence interval [CI], 4.9-7.8). Addition of trauma and distress variables attenuated this relationship (AOR, 3.7; 95% CI, 2.7-4.9). Compared with respondents reporting only suicidality, those also reporting SIB were more likely to report suicide ideation (AOR, 2.8; 95% CI, 2.0-3.8), plan (AOR, 5.6; 95% CI, 3.9-7.9), gesture (AOR, 7.3; 95% CI, 3.4-15.8), and attempt (AOR, 9.6; 95% CI, 5.4-17.1). Lifetime SIB frequency exhibits a curvilinear relationship to suicidality.

Conclusions: Since it is well established that SIB is not a suicidal gesture, many clinicians assume that suicide assessment is unnecessary. Our findings suggest that the presence of SIB should trigger suicide assessment.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Adolescent
  • Adult
  • Concept Formation
  • Cross-Sectional Studies
  • Female
  • Health Surveys
  • Humans
  • Male
  • New England / epidemiology
  • Psychological Tests
  • Psychology, Adolescent*
  • Risk Assessment
  • Risk Factors
  • Self-Injurious Behavior / epidemiology*
  • Self-Injurious Behavior / psychology
  • Stress, Psychological / complications
  • Stress, Psychological / psychology
  • Students / psychology*
  • Suicide / psychology
  • Suicide / statistics & numerical data*
  • Suicide Prevention
  • Surveys and Questionnaires
  • Universities*
  • Wounds and Injuries / complications
  • Wounds and Injuries / psychology