Nonsuicidal Self-Injury and Suicidal Behavior: A Latent Class Analysis among Young Adults

Chloe A Hamza,Teena Willoughby,Jerson Laks

doi:10.1371/journal.pone.0059955

Abstract

Although there is a general consensus among researchers that engagement in nonsuicidal self-injury (NSSI) is associated with increased risk for suicidal behavior, little attention has been given to whether suicidal risk varies among individuals engaging in NSSI. To identify individuals with a history of NSSI who are most at risk for suicidal behavior, we examined individual variability in both NSSI and suicidal behavior among a sample of young adults with a history of NSSI (N = 439, Mage = 19.1). Participants completed self-report measures assessing NSSI, suicidal behavior, and psychosocial adjustment (e.g., depressive symptoms, daily hassles). We conducted a latent class analysis using several characteristics of NSSI and suicidal behaviors as class indicators. Three subgroups of individuals were identified: 1) an infrequent NSSI/not high risk for suicidal behavior group, 2) a frequent NSSI/not high risk for suicidal behavior group, and 3) a frequent NSSI/high risk for suicidal behavior group. Follow-up analyses indicated that individuals in the ‘frequent NSSI/high risk for suicidal behavior’ group met the clinical-cut off score for high suicidal risk and reported significantly greater levels of suicidal ideation, attempts, and risk for future suicidal behavior as compared to the other two classes. Thus, this study is the first to identity variability in suicidal risk among individuals engaging in frequent and multiple methods of NSSI. Class 3 was also differentiated by higher levels of psychosocial impairment relative to the other two classes, as well as a comparison group of non-injuring young adults. Results underscore the importance of assessing individual differences in NSSI characteristics, as well as psychosocial impairment, when assessing risk for suicidal behavior.

Highlights

Nonsuicidal self-injury (NSSI) refers to the direct and deliberate destruction or alteration of bodily tissue in the absence of suicidal intent [1], and includes behaviors such as self-cutting, carving, burning and hitting [2]
Preliminary Analyses Overall, among our sample of 439 self-injuring young adults, 5.9% of participants had engaged in NSSI once, 15.8% engaged in the behavior 2–4 times, 24% engaged in the behavior 5–10 times, 33.0% engaged in the behavior 11–50 times, 7.1% engaged in the behavior 51–100 times and 14.2% engaged in the behavior more than 100 times
Class 3 was the only group that met the clinical cut-off for high suicide risk on the SBQ-R, which is why this group was labeled the high risk for suicidal behavior group

Summary

Introduction

Nonsuicidal self-injury (NSSI) refers to the direct and deliberate destruction or alteration of bodily tissue in the absence of suicidal intent [1], and includes behaviors such as self-cutting, carving, burning and hitting [2]. NSSI is a clinical health concern, as recent estimates indicate that as many as 12–38% of young adults report lifetime histories of NSSI [6,7,8]. 35–72% of self-injuring young adults report current engagement in NSSI [10,11,12], which has led researchers to conclude that NSSI is a widely occurring health concern among university students. Given the high prevalence of NSSI among community-based samples, identifying individuals with a history of NSSI who are at risk for suicidal behavior is of critical importance to researchers, clinicians and health care providers [20]. We examined whether self-injurers with varying degrees of suicidal risk differed on several psychosocial indices

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