title: An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany. paul.plener@uniklinik-ulm.de
authors.forename: P L
authors.initials: PL
authors.lastname: Plener
authors.forename: G
authors.initials: G
authors.lastname: Libal
authors.forename: F
authors.initials: F
authors.lastname: Keller
authors.forename: J M
authors.initials: JM
authors.lastname: Fegert
authors.forename: J J
authors.initials: JJ
authors.lastname: Muehlenkamp
mesh_terms: D000293:Adolescent; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States