An Analysis of Nonsuicidal Self-Injury Among Children and Adolescents in Inpatient Psychiatric Hospitals and Units in Pennsylvania

Abstract

Nonsuicidal self-injury (NSSI) is defined as the direct, deliberate destruction of one’s own body tissue to inflict harm or pain without an underlying suicidal intent. NSSI may include such behaviors as cutting, scratching, biting, hitting, and head banging, and excludes suicidal gestures, accidental injuries, indirect self-harm behaviors (e.g., eating disorders or drug abuse), and socially accepted forms of body modification (e.g., piercing or tattooing). NSSI typically begins in adolescents around 13 or 14 years of age, and lifetime prevalence in the adolescent and young adult population is estimated to be 15% to 20%. Although NSSI does not always progress to or predict future suicidal behaviors, there is believed to be a link between the two, which makes this an important patient safety concern. NSSI has been observed in both the community and the clinical setting, although rates of NSSI are higher within the psychiatric population. NSSI may present as a symptom of numerous psychiatric conditions, including anxiety disorders; mood disorders; substance abuse; eating disorders; and personality disorders, such as borderline personality disorder (BPD).5 Although clinicians once considered NSSI primarily in the context of BPD, NSSI was added as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in 2013. In 2019, analysts at the Patient Safety Authority (PSA) conducted and published a study of events submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) involving patient self-harm in the nonpsychiatric setting.8 However, an analysis of events in PA-PSRS involving selfharm, and more specifically NSSI, in the psychiatric setting had yet to be undertaken. In this study, we conducted an indepth review and analysis of patient safety events involving NSSI among children and adolescents in the inpatient psychiatric setting that took place in 2019. The purpose of this study was to examine patient-specific factors, such as age and gender, as well as other contributing circumstances, such as interpersonal interactions, that may precipitate NSSI in this patient population.