Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis.
Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt.



We searched 6 databases until June 2015.



1. Assessment of any previous SITB [a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm] as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated.



From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR=22.53, 95%CI: 18.40-27.58). Suicide attempts were also associated with a history of previous SITB (OR=3.48, 95%CI: 2.71-4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%.



There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts.



Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.
Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
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Castellví
Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Lucas-Romero
Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
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A
Miranda-Mendizábal
Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
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O
Parés-Badell
Area of Preventive Medicine and Public Health. University of Cadiz, Spain.
J
J
Almenara
Morales Meseguer Hospital, Murcia, Spain.
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I
Alonso
Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
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MJ
Blasco
Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell, Spain.
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A
Cebrià
Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, Spain; Mental Health and Psychiatric Care Research Unit. BioDonosti Health Research Institute, Spain.
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A
Gabilondo
Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain; Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain.
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M
Gili
Department of Statistics and Operative Research. University of Cádiz. Spain.
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Lagares
Department of Health Psychology, Miguel Hernandez University of Elche, Spain.
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JA
Piqueras
Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain; Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain.
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Roca
Department of Health Psychology, Miguel Hernandez University of Elche, Spain.
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J
Rodríguez-Marín
Department of Health Psychology, Miguel Hernandez University of Elche, Spain.
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Rodríguez-Jimenez
Department of Health Psychology, Miguel Hernandez University of Elche, Spain.
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Soto-Sanz
Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain. Electronic address: jalonso@imim.es.
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Alonso
D000293:Adolescent; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000150:complications / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology; D055815:Young Adult
Adolescents; Non-suicidal self-injury; Self-harm; Suicide; Youths