title: The association of non-suicidal self-injury and suicidal behavior according to DSM-5 in adolescent psychiatric inpatients.
abstract: Non-suicidal self-injury (NSSI) and suicidal behaviors frequently occur among adolescent psychiatric patients. Although those behaviors are distinct with regards to intent, NSSI has been shown to be an important risk-factor for suicide attempts. However, the association of NSSI and Suicidal Behavior Disorder (SBD) according to DSM-5 criteria has not yet been investigated. For investigating distinctive features and mutual risk-factors of NSSI-disorder and SBD, adolescent psychiatric inpatients (N=111, aged 12-19 years; 65.8% females) were interviewed using the Self-Injurious-Thoughts-And-Behaviors-Interview-German (SITBI-G). NSSI started significantly earlier in life (M=12.5 years, SD=2.2) than first suicide attempts (M=14.1 years, SD=2.0). Patients meeting NSSI-disorder and/or SBD were significantly more likely to be female and to be diagnosed with an affective disorder. NSSI-disorder and SBD seem to have several distinctive features (i.e. age of onset or frequency), but also seem to share certain mutual risk-factors (i.e. affective disorders, female gender). While both NSSI and SBD seem to be maintained by mainly automatic negative reinforcement, positive automatic and social functions were rated significantly higher for NSSI. Most importantly, NSSI seems to be a strong risk factor for the occurrence of SBD (even when controlling for suicidal ideation) and should therefore always be assessed when dealing with psychiatric adolescent patients.
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Groschwitz
authors.affiliation: Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kaess
authors.affiliation: Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Gloria
authors.initials: G
authors.lastname: Fischer
authors.affiliation: Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Ameis
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany.
authors.forename: Ulrike M E
authors.initials: UM
authors.lastname: Schulze
authors.affiliation: Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Romuald
authors.initials: R
authors.lastname: Brunner
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany; Department of Child and Adolescent Psychiatry/Psychotherapy, Vivantes Klinikum, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Koelch
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany. Electronic address: paul.plener@uniklinik-ulm.de.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Plener
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D011567:Psychiatric Department, Hospital; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000523:psychology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology; D055815:Young Adult
keywords: NSSI; Self-harm; Suicidal Behavior Disorder; Youth.