A Narrative Approach to Understanding and Using the Role of Hope in Adolescent and Emerging Adult Non-Suicidal Self-Injury

Abstract

Background: Non-suicidal self-injury (NSSI) is highly prevalent in adolescence and represents a maladaptive coping strategy. Insufficient attention has been paid to NSSI as a critical factor for suicide, the second leading cause of death in adolescents and young adults. Hopelessness frequently factors into suicide and suicide attempts. Aims: We consider NSSI from the clinician’s perspective in assessment, case formulation and treatment considerations with the added perspective for the role of hopefulness in NSSI and suicide. Method: Google and PubMed databases were searched to consider the role hopefulness plays in both NSSI and suicide of youth and young adults in assessment, clinical course, interventions, and outcome. Key words included adolescents, adults, children, NSSI, hope, assessment, treatment, clinical course, and outcome. Reverse citations were also conducted to assure timeliness. Results: Increasing attention has been paid to stratification of commonly considered risk factors for suicide and suicide attempts in the target population. Rationale for considering NSSI as a critical suicide risk factor and for hope’s role in the continuum of suicidal behavior is documented and emphasized. Relevant models for suicide are described to support and provide clinicians guidance to consider NSSI and hopefulness in case formulation, determining safety, and developing useful interventions for youth engaging in or contemplating NSSI and/or suicide. Conclusions: NSSI is a major risk factor for suicide in youth. Hope plays major roles in NSSI and suicide and should be considered in assessment, case formulation, and interventions in youth manifesting NSSI and suicidal, ideation, and behavior.