Emotional dysregulation, internalizing symptoms, and self-injurious and suicidal behavior: Structural equation modeling analysis

Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) among youth are major public health concerns. Although a growing body of research has focused on the complex association between nonsuicidal and suicidal self-injury, the temporal relationship between these two classes of behaviors is unclear. The current study addresses this empirical gap by examining the course of SITBs in adolescents receiving outpatient (N=106; 82.1% female) and inpatient (N=174; 75.9% female) treatment. SITBs (co-occurrence, age-of-onset, and time lag between SITBs) and major psychiatric disorders were assessed at a single time point with well-validated structured interviews. Adolescents in both clinical samples reported high co-occurrence of SITBs: most adolescents reported both lifetime nonsuicidal self-injury (NSSI) and suicidal thoughts. A similar temporal pattern of SITBs was reported in the two samples: thoughts of NSSI and suicide ideation had the earliest age-of-onset, followed by NSSI behaviors, suicide plans, and suicide attempts. However, the age-of-onset for each SITB was younger in the inpatient sample than in the outpatient sample. In terms of time lag between SITBs, suicide ideation occurred on average before initial engagement in NSSI, suggesting that pathways to NSSI and suicidal behavior may occur simultaneously rather than in succession from nonsuicidal to suicidal self-injury. Results also indicated that the time to transition between SITBs was relatively fast, and that a key period for intervention and prevention is within the first 6-12months after the onset of suicidal thinking. Taken together, these findings have important implications for understanding the time-lagged relationship between nonsuicidal and suicidal self-injury.

Adolescence is a critical period for the development of self-regulatory behaviors, with emotional dysregulation, impulsivity, and substance use emerging as significant factors associated with self-injury and suicidal thoughts and behaviors. This study aims to investigate the prevalence and patterns of non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts in a community-based sample of adolescents. A sample of 1526 adolescents aged 12–16 was analyzed using Latent Profile Analysis (LPA), identifying two distinct behavioral profiles: the Substance Use with Non-Problematic Gaming (37.4%) profile, characterized by alcohol, cannabis, and nicotine use, and the Moderate Problematic Gaming with Minimal Substance Use (62.6%) profile, associated with problematic video game use and minimal substance use. Overall, 36% of participants reported engaging in NSSI, 27.2% reported suicidal ideation, and 3.21% reported suicide attempts within the past year. Ordinal regression analysis indicated that adolescents in the SUP group exhibited higher levels of emotional dysregulation, impulsivity, and behavioral difficulties, significantly increasing their odds of suicide attempts (OR 2.24, p < 0.02). Additionally, emotional dysregulation independently doubled the risk of suicide attempts (OR 2.01, p < 0.001). This study provides a detailed risk profile for adolescent self-injury and suicide-related behaviors in school settings. Despite the limitations of a non-clinical sample, the findings underscore the importance of early prevention efforts targeting emotional dysregulation and impulsivity. Future research should consider longitudinal approaches to better understand the developmental trajectories of NSSI and suicidal behaviors in adolescents, particularly in high-risk, marginalized populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-025-02712-x.

Background: It is necessary to understand that self-harm is the most common behavior in both suicide and non-suicidal self-injury (NSSI) though those are not interrelated. Both result in physical damage to better or cope, whereas behaviors related to suicide are undertaken to end the capacity to feel at all by ending one’s life. Aim: The aim of the study was to explore NSSI behavior and emotional dysregulation among college students and find relationship between NSSI behavior and emotional dysregulation. Methods: A descriptive cross-sectional survey was carried out and total 896 college students were selected by multistage cluster sampling method from one district of Karnataka, India. The data was collected using FASM and DERS tool. Results: The study revealed that 21.9% of the participants were found to have NSSI behavior. Participants were having both minor behavior (66.84%) and severe behavior (71.94%) of NSSI. Mean age of onset of NSSI behavior was 16.88 years. The present study found significant relationship between NSSI behavior and emotional dysregulation (t value: 4.19, p value: &lt;0.01). Participants were having emotional dysregulation with mean value of 100.32. International Journal of Scientific Research in Engineering and Management (IJSREM) Volume: 07 Issue: 10 | October - 2023 SJIF Rating: 8.176 ISSN: 2582-3930 © 2023, IJSREM | www.ijsrem.com DOI: 10.55041/IJSREM26329 | Page 2 Conclusion: The findings of the study show the need to increase the awareness and understanding of NSSIs and to plan targeted interventions among college youth. An information booklet on emotion regulation strategies was developed by the researcher to improve students’ knowledge and awareness. Keywords NSSI (Non-suicidal self-injury), Emotional dysregulation, FASM (Functional Assessment of Self-Mutilation) questionnaire, DERS (Difficulties in Emotional Regulation Scale)

In Australia, adolescent suicidal and non-suicidal self-injury (NSSI) behaviours have been steadily increasing over that past two decades. However, existing research on the geographic distribution of these behaviours in Australia largely focuses on adults, suicides, or uses pre-COVID-19 data. This study aimed to map and describe the geographic regions where ambulance attendances for adolescent suicidal and NSSI behaviours are occurring. Data from the National Ambulance Surveillance System were used to analyse three-year averages and per capita rates of ambulance attendances for adolescents (12-17 years) across local government areas in New South Wales (NSW), Victoria, and Tasmania from 2021 to 2023. The three-year annual average of ambulance attendances for adolescent suicidal behaviour and NSSI were 6,504 in NSW (35.94 per 10,000), 4,017 in Victoria (25.61 per 10,000), and 444 in Tasmania (44.86 per 10,000). Nearly 90% of attendances required transport to hospital, and over 50% occurred outside traditional service hours. Results identified that Major Cities and high socioeconomic status (SES) local government areas (LGAs), were significantly less likely to have higher rates of ambulance attendances for adolescent suicidal and NSSI behaviours. This study highlights substantial variability across three eastern states of Australia where adolescent suicidal and NSSI behaviours are occurring, demonstrating the need for accessible after-hours mental health support, and that regional and lower SES LGA's are disproportionately impacted. Given the concerning state of adolescent mental health in Australia, this study highlights the need for targeted, data-informed responses to reduce the current reliance on emergency care.

Non-suicidal self-injury and suicidal behavior are prevalent in young adults, and often constitute a continuum of self-destructiveness. Not all those who self-injure, however, engage in suicidal behaviors with intent to die, perhaps due to protective intrapersonal characteristics. We examined the role of one such potential buffer, social problem-solving ability, as a moderator of the association between non-suicidal self-injury and suicidal thoughts and attempts, hypothesizing that individuals with greater social problem-solving ability would report fewer suicidal behaviors in relation to self-harm. An ethnically diverse sample was recruited from a large, Northeastern urban university, and completed self-report questionnaires assessing non-suicidal self-injury, suicidal behaviors, and social problem-solving ability. Multivariate hierarchical regression analyses were conducted. For the entire sample, individuals with higher social problem-solving abilities reported fewer suicidal behaviors associated with non-suicidal self-injury. In ethnically stratified analyses, social problem-solving significantly moderated the relationship between self-injury and suicidal behaviors for Whites and Hispanics only. Promotion of problem-solving skills may weaken the linkage between self-injury and potential for future suicidal behaviors for some individuals; however, culture-specific differences in this effect may exist.

Numerous studies revealed increased rates of mental health problems in veterinarians all over the world and a related higher risk in death by suicide. Several research has focused on the mental health status in veterinary medicine students and a recent publication from Germany reported a 4.2 times higher suicide risk for veterinary medicine students compared to the general population of the same age range. The aim of this study was to evaluate the prevalence of suicidality (suicidal ideation and suicidal attempts) in Austrian veterinary medicine students and to identify underlying risk factors. The hypothesis is that there is a high prevalence of suicidal behavior among Austrian veterinary medicine students as well as an association between high depression rates and suicidal behavior and a relation between non-suicidal self-injury (NSSI) and suicidal behavior. A total of 430 Austrian veterinary medicine students (29.11% of the total population of Austrian veterinary medicine students, 85.8% female, mean age 23.14years) filled out an online questionnaire regarding their mental health status, including symptoms of depression (PHQ-9), NSSI, and suicidal behavior (SBQ-R) between November 2022 and January 2023. In 55% of the evaluated questionnaires, students got above the cut-off for clinically relevant symptoms of depression, in 20.6% for suicidal behavior, and 31.2% reported non-suicidal self-injury. There was a 6.5 times higher risk to experience suicidal behavior for those who exceeded the cut-off for clinically relevant depressive symptoms and a 4.9 times higher risk for those who engaged in NSSI. Further findings of this study showed significant associations between loneliness, high stress, the (preferred) specialization in zoo- and wildlife medicine, and the male gender with suicidality. In conclusion, Austrian veterinary medicine students are at high risk for suicidal behavior especially when it comes to underlying mental health problems such as depression, NSSI, high stress, or experiencing loneliness.

Although diagnostically distinct from suicidal behaviour and, by definition, not intended to cause death, nonsuicidal self-injury (NSSI) remains one of the strongest predictors of suicide. NSSI and suicidal behaviour appear to share a suicidal state of mind, marked by detachment from life and ambivalence toward death. This study investigates suicidal risk in adolescents with NSSI by examining suicidal motivations and regulatory needs linked to psychache and by exploring their contribution to suicidal behaviour. A sample of 134 adolescents with active suicidal ideation, self-harm or recent suicide attempts was assessed using self-report measures and structured interviews. Associations between suicidal ideation, motivations and NSSI features were explored using linear regressions. Logistic regressions tested links between suicidal motivations and suicidal attempts in a filtered NSSI subsample. A hierarchical logistic regression compared the associative value of suicidal motivations and personality disorder criteria on suicidal behaviour. Suicidal ideation and motivations were significantly associated with NSSI variables. In the NSSI subsample, interpersonal influence and low fear were linked to suicide attempts. Suicidal motivations showed greater predictive power for suicidal behaviour than personality disorder traits, improving model accuracy. These findings suggest that assessing suicidal motivations in adolescents with NSSI may enhance clinical risk evaluation and support more targeted interventions.

Despite increasing concern over the prevalence of non-suicidal self-injury (NSSI) among adolescents, there is debate about its classification as a stand-alone psychiatric diagnosis. This study investigated the patterns, co-occurrence, and correlates of NSSI and other suicidal behaviors among a representative community sample of in-school adolescents. A cross-sectional survey of 2,317 adolescents was conducted. Participants were asked to self-report NSSI, suicidal ideation, suicide attempt, and psychosocial conditions over the past 12months. Logistic regression and cumulative logit modeling analyses were conducted to investigate the different and similar correlates among these self-harm behaviors. The age-standardized prevalence rates of NSSI among male and female adolescents were estimated to be 13.4 and 19.7%, respectively, compared with 11.1 and 10.1% for male and female suicide attempt. Only a small proportion engaged in NSSI exclusively in the past year. NSSI by burning or reckless and risky behaviors, frequent drinking, and sexual experience were associated with increasing severity level of suicidal behaviors among individuals with NSSI. NSSI is prevalent among in-school adolescents in Hong Kong. However, it co-occurs with suicidal ideation and suicide attempt. High lethality of NSSI, frequent drinking habit, and lifetime sexual experience are suggested to be indicators for screening potential suicide attempters among those having NSSI.

Self-injurious behaviors in posttraumatic stress disorder: An examination of potential moderators

Psychopathological profiles of adolescent presenting to emergency departments following a suicide attempt: A comprehensive analysis.

Exposure to suicide and suicidal behaviors among Hong Kong adolescents

Recent studies have found a higher incidence of suicidal ideation/plan/attempt and non-suicidal self-injurious behavior among smokers (Poorolajal et al., 2016; Marin et al., 2020). People with mental health problems have been shown to be one of the most smoking populations (Szatkowski et al, 2015). At the same time, the presence of a mental disorder is an independent predictor of the occurrence of suicidal ideation (Klonsky et al, 2017). An important question about the impact of nicotine consumption on the course of self-Injurious thoughts and behaviors in persons with non-psychotic mental disorders remains unclear. The aim of the study is to evaluate the influence of tobacco smoking (TS) on the risk of lifetime suicidal plan (SP), attempt (SA) and nonsuicidal self-injury (NSSI) in patients with nonpsychotic mental disorders (NPMD) and suicidal ideation (SI). Four hundred and 78 consecutive patients with NPMD and SI were included. All patients were evaluated by a psychiatrist, underwent Self-Injurious Thoughts and Behaviors Interview (SITBI) as well as semi-structured interview designed to gather information on demographic and biographical features. Mann-Whitney, chi-square test and stepwise logistic regression were used as statistical methods. The mean age of the sample was 28 (11.46) and most of the patients were female 417 (97.2%). Lifetime TS was reported by 324 (67.8%) patients. We found no differences between smokers and non-smokers in age, gender, educational and occupational statuses, as well as the diagnoses of mental disorders and their number (Tab.1). SP, SA and NSSI were significantly more common in patients with lifetime tobacco smoking history. No significant differences were found in age of onset of self-injurious thoughts and behavior, and total number of SP, SA and NSSI between lifetime smokers and non-smokers (Tab. 2) Stepwise logistic regression analysis revealed an association of lifetime TS with lifetime SA and NSSI, but not with SP (Tab: 3). In consistence with previous studies (Sankaranarayanan et al., 2015; Marin et al., 2020), our results suggested that lifetime tobacco smoking is strongly associated with an increased risk of suicidal and non-suicidal self-injurious behavior. Moreover, we showed suggested that tobacco smoking involved in transition from ideation to action. It is proposed that smoking may increase the risk of suicide through a biological pathway - decreasing the activity of the serotonergic system of hippocampus, reduce brain serotonin function and activate of the hypothalamo-pituitary-adrenal axis (HPA). Thus, nicotine may be able to activate the attenuated responsiveness of the HPA axis to psychological stress (Poorolajal et al, 2016). History of lifetime TS in patients with NPMD and SI is associated with an increased risk of suicidal and nonsuicidal self-injurious behavior.

Extensive literature documents that adverse childhood experiences increase risk for non-suicidal self-injury (NSSI) and suicide behaviors among adolescents. However, few studies have examined patterns of co-occurring family based adversities, whether distinct patterns of adversity are differentially associated with NSSI and suicide behaviors, and if social support can offset the impact of adversity for these behaviors. This study used a statewide school-based sample that was 50.1% female, 71% non-Hispanic White, and evenly divided by grade (9th grade N = 39,682; 11th grade N = 33,966). Latent class analysis identified three mutually exclusive, homogeneous subgroups of co-occurring familial adversities; low or no family based adversity, parental dysfunction but low maltreatment, and parental dysfunction plus maltreatment. The relationships between membership in the identified subgroups and past year NSSI, suicidal ideation, and suicide attempt were assessed separately for 9th graders (average age = 14) and 11th graders (average age = 17). Although membership in the parent dysfunction plus maltreatment class was associated with the highest odds of NSSI, suicidal ideation, and suicide attempt, membership in either class of familial adversity elevated risk for these behaviors compared to membership in the low or no adversity class. Whether the protective effects of perceived peer and teacher social support moderated these associations and varied across age groups was also explored. The findings suggest that peer and teacher social support can promote positive outcomes even for youth living in stressful family conditions and that the protective effects of social support increase as the number of sources of support expands.

A burgeoning body of evidence suggests a higher prevalence of nonsuicidal self-injury (NSSI) behaviors among adolescents. This study aimed to examine the comorbid internalizing symptoms and suicidal behaviors, along with associations between dissociative experiences and suicide risk in adolescents attending a psychiatric outpatient unit in Ankara, Türkiye. The study included 81 adolescents aged 12–18 years, who engaged in NSSI and sought treatment at a psychiatric outpatient clinic. Psychiatric evaluations were conducted through semi-structured clinical interviews. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, and suicide risk was measured using the Suicide Probability Scale. Additionally, internalizing symptoms and dissociative experiences were evaluated using the Revised Children’s Anxiety and Depression Scale-Child Version and the Adolescent Dissociative Experiences Scale, respectively. Moderate to high correlations were found among suicide risk, dissociation, NSSI severity, anxiety and internalizing scores. Mediation analysis revealed that NSSI significantly mediated the relationship between dissociation and suicide risk. These findings indicate that assessing both dissociation and NSSI could provide valuable insights into comprehending and addressing adolescent suicide, thereby facilitating the development of targeted interventions to mitigate the effects of dissociative experiences.

Poor interpersonal relationships are one of the risk factors for non-suicidal self-injury (NSSI) and suicidal behaviors among adolescents. Previous studies have mostly focused on a single interpersonal perspective, and it remains uncertain how the cumulative interpersonal risk across time and domains interacts with NSSI and suicide. The current study employed cross-lagged panel models (CLPM) and random intercept cross-lagged panel models (RI-CLPM) to investigate the interaction among cumulative interpersonal risk, NSSI, and suicide attempts at both the between-person and within-person levels, while examining sex differences in these relationships. A total of 1038 Chinese adolescents (47.0% girls; baseline Mage = 12.35 years, SD = 0.52) participated in a four-wave longitudinal survey with 6-months intervals. The results showed that at the between-person level, there were reciprocal predictive relationships between cumulative interpersonal risk, NSSI and suicide attempts. At the within-person level, changes in NSSI affected changes in cumulative interpersonal risk, and suicide attempts exhibited a reciprocal relationship with cumulative interpersonal risk and NSSI, with significant sex differences observed. These findings underscore the stable and trait-like associations between cumulative interpersonal risk, NSSI and suicide attempts. Given these findings, to reduce the occurrence of suicide among adolescents, it is essential to target interventions aimed tat enhancing their interpersonal adaptability.