How often, or how many ways: clarifying the relationship between non-suicidal self-injury and suicidality

Arch Suicide Res. 2013;17(4):397-415. doi: 10.1080/13811118.2013.802660.


This study clarified the association of maladaptive, potentially self-damaging behaviors with suicidality. Specifically, we examined whether greater frequency (i.e., how often) or greater versatility (i.e., how many ways) of several self-damaging behaviors, including non-suicidal self-injury (NSSI), substance use, and disordered eating, increased risk for suicide. Participants who engaged in NSSI (N = 142) completed questionnaires assessing suicidal and self-damaging behavior at baseline and engagement in suicidal behaviors (e.g., ideation, attempts, talking about suicide) 3 months later. Results suggest that the versatility rather than frequency of self-damaging behaviors is most robustly associated with suicide risk. Engaging in multiple methods of NSSI and using a greater number of illicit substances were positively associated with suicide risk. Further, versatility of NSSI interacted with depression to predict suicide risk at 3-month follow-up such that highly depressed participants who engaged in more methods of NSSI exhibited highest risk, whereas those who engaged in more methods with low depression exhibited the lowest risk.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Feeding and Eating Disorders / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Self-Injurious Behavior / psychology*
  • Substance-Related Disorders / psychology*
  • Suicidal Ideation*
  • Suicide, Attempted / psychology*
  • Surveys and Questionnaires
  • Young Adult