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


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


METHODS
Two universities in the northeastern United States in the spring of 2005.


METHODS
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.


METHODS
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.
Whitlock
Janis
J
Department of Human Development, Family Life Development Center, Cornell University, Ithaca, New York, USA. jlw43@cornell.edu
Knox
Kerry L
KL
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D003210:Concept Formation; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009511:New England / Q000453:epidemiology; D011581:Psychological Tests; D000297:Psychology, Adolescent; D018570:Risk Assessment; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D013334:Students / Q000523:psychology*; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014495:Universities; D014947:Wounds and Injuries / Q000150:complications / Q000523:psychology; D000092864:Suicide Prevention