An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA

Psychol Med. 2009 Sep;39(9):1549-58. doi: 10.1017/S0033291708005114. Epub 2009 Jan 27.


Background: This study examined the prevalence of non-suicidal self-injury (NSSI), suicide attempts, suicide threats and suicidal ideation in a German school sample and compared the rates with a similar sample of adolescents from the midwestern USA by using cross-nationally validated assessment tools.

Method: Data were provided from 665 adolescents (mean age 14.8 years, S.D.=0.66, range 14-17 years) in a school setting. Students completed the Self-Harm Behavior Questionnaire (SHBQ), the Ottawa Self-Injury Inventory (OSI) and a German version of the Center for Epidemiological Studies-Depression Scale (CES-D).

Results: A quarter of the participants (25.6%) endorsed at least one act of NSSI in their life, and 9.5% of those students answered that they had hurt themselves repetitively (more than four times). Forty-three (6.5%) of the students reported a history of a suicide attempt. No statistically significant differences were observed between the German and US samples in terms of self-injury or suicidal behaviors.

Conclusions: By using the same validated assessment tools, no differences were found in the prevalence and characteristics of self-injury and suicidal behaviors between adolescents from Germany and the USA. Thus, it seems that NSSI has to be understood as worldwide phenomenon, at least in Western cultures.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cross-Cultural Comparison*
  • Cross-Sectional Studies
  • Female
  • Germany
  • Humans
  • Male
  • Psychometrics / statistics & numerical data
  • Reproducibility of Results
  • Self-Injurious Behavior / diagnosis
  • Self-Injurious Behavior / epidemiology*
  • Self-Injurious Behavior / psychology
  • Suicide, Attempted / psychology
  • Suicide, Attempted / statistics & numerical data*
  • Surveys and Questionnaires
  • United States