Self-injurious Thoughts Research Articles

Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth

The current review provides an evidence base update of psychosocial treatments for self-injurious thoughts and behaviors (SITBs) in youth. A systematic search was conducted of 2 major scientific databases (PsycInfo and PubMed) and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) published prior to June 2018. The search identified 26 RCTs examining interventions for SITBs in youth: 17 were included in the 2015 review and 9 trials were new to this update. The biggest change since the prior review was the evaluation of Dialectical Behavior Therapy for adolescents (DBT-A) as the first Level 1: Well-established intervention for reducing deliberate self-harm (composite of nonsuicidal and suicidal self-injury) and suicide ideation in youth and Level 2: Probably efficacious for reducing nonsuicidal self-injury and suicide attempts. Five other interventions were rated as Level 2: Probably efficacious for reducing SITBs in youth, with the new addition of Integrated Family Therapy. This evidence base update indicates that there are a few promising treatments for reducing SITBs in youth. Efficacious interventions typically include a significant family or parent training component as well as skills training (e.g., emotion regulation skills). Aside from DBT-A, few treatments have been examined in more than one RCT. Given that replication by independent research groups is needed to evaluate an intervention as Well-established, future research should focus on replicating the five promising interventions currently evaluated as Probably efficacious. In addition, an important future direction is to develop brief efficacious interventions that may be scalable to reach large numbers of youth.

Effects of self-injurious thoughts and behaviors and sexual risk-taking behaviors through emotional control

BackgroundCollege students are at increased risk for self-injurious thoughts and behaviors (SITB) and sexual risk behaviors (SRB). Although students with a history of SITB appear to be more prone to SRB, the mechanisms linking these risk behaviors remain largely unexplored. Previous research points to emotional control (EC), defined as one's awareness and adaptability of emotions, as a potential mechanism explaining the relationship between SITB and SRB.1 MethodsData included 722 college students attending two different universities in the northeast and southeast regions of the United States. Multiple group structural equation models were fit to estimate the direct and indirect effects of history of SITB (suicidal ideation, attempt, and nonsuicidal self-injury) and EC on SRB jointly across men and women. ResultsFindings supported indirect relationships between SITB and SRB through dysregulated EC, with type of SITB and patterns of SRB differing between men and women. For women, history of suicidal ideation and nonsuicidal self-injury were indirectly related to increased SRB through dysregulated EC. For men, history of suicidal ideation showed an indirect relationship on SRB through EC. LimitationsAlthough this study employed random sampling, limitations include a cross-sectional design, which does not allow for causal inference, and reliance on self-report assessment data. ConclusionsCollege students with a history of SITB who experience dysregulated EC may be more likely to engage in risky sexual behavior. Clinicians working with college students should concomitantly consider suicide and self-injury with SRB and consider interventions to improve EC.

Intolerance of Uncertainty Moderates the Association Between Potentially Morally Injurious Events and Suicide Ideation and Behavior Among Combat Veterans.

Exposure to potentially morally injurious events (PMIEs) among combat veterans has been acknowledged as significant stressful combat events that may lead to mental health problems, including self-injurious thoughts and behavior (SITB). However, few studies have examined the risk and protective factors that can explain the conditions in which PMIEs may contribute to the development and maintenance of SITB. In the current study, we aimed to examine the association between PMIEs and SITB among combat veterans and explore the moderating roles of intolerance of uncertainty (IU) in this association. A volunteer sample of 191 Israeli combat veterans was recruited during 2017. Participants completed validated self-report questionnaires in a cross-sectional study. Results indicated that two separate measures of PMIEs, the Perceived Perpetration by Oneself and Others subscale of the Moral Injury Events Scale (MIES) and the Causes subscale of the Moral Injury Questionnaire (MIQ-Causes), were positively associated with higher levels of SITB. Moreover, beyond the contributions of reserve duty, posttraumatic stress symptoms, and depressive symptoms, MIQ-Causes scores significantly predicted current SITB. Importantly, under low and average levels of inhibitory IU, significant positive effects were revealed for the MIQ-Causes on current SITB, R² = .34. Although veterans exposed to PMIEs are more prone to SITB, even years after their release from military service, their IU may temper the link between experiences of PMIEs and SITB.

Psychopathy and suicide: The mediating effects of emotional and behavioral dysregulation

Self-injurious thoughts and behaviors are positively associated with secondary psychopathy (impulsive-antisocial behaviors) and negatively associated or unrelated to primary psychopathy (interpersonal-affective deficits). While there is evidence that both psychopathy subtypes are associated with the capability for suicide (i.e., pain tolerance, fearlessness about death), a critical risk factor for moving an individual from suicidal ideation to suicidal action, only secondary psychopathy possesses traits associated with both suicidal desire and capability. The following study investigated if certain cognitive, affective, and behavioral features underlying secondary psychopathy could explain the distinct patterns in suicide-related outcomes. In a sample of 201 male and female offenders, we found the association between secondary psychopathy and future suicidal intention was best explained by the indirect path of emotion dysregulation, rumination, recent suicidal ideation, and non-suicidal self-injury (NSSI). Primary psychopathy correlated with NSSI, a key component in acquiring the capability for suicide, but not suicidal ideations or intention. Results are consistent with ideation-to-action models of suicide, whereby suicidal desire and capability independently contribute to suicidal action.

Predicting status along the continuum of suicidal thoughts and behavior among those with a history of nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) and suicidal thoughts and behavior often co-occur, representing a growing public health concern. Despite extensive research examining suicidal thoughts and behavior among those who engage in NSSI, there is a lack of research investigating factors that, when considered together, can differentiate individuals along the continuum of suicidal thoughts and behavior (no history, suicidal ideation, suicide plan, suicide attempt). This study sought to address this question using a sample of 1178 college students with NSSI history (68.70% female). Discriminant function analysis was conducted including the following predictors: NSSI characteristics, negative affect difficulties, and behavioral and demographic risk factors for suicidal thoughts and behavior. Results suggest that self-disclosure of suicidal ideation, number of lifetime NSSI methods, NSSI frequency, depressive symptoms, and age most parsimoniously differentiate study groups. Those who use a greater number of NSSI methods and acts, paired with higher depressive symptoms and repeated self-disclosure of suicidal ideation are most likely to have a suicide attempt history; decreases in these variables suggest membership within less severe groups. Furthermore, older age may be related to greater suicidality. Findings suggest that the evaluation and co-occurrence of these variables may contribute to a more accurate suicide risk assessment.

Anxious and Overwhelming Affects and Repetitive Negative Thinking as Ecological Predictors of Self-Injurious Thoughts and Behaviors

Nonsuicidal self-injury (NSSI) refers to purposely injuring one’s body without suicidal intent via methods such as cutting or hitting oneself, and is a serious health concern that has been linked to detrimental behavioral and physical health consequences. One of the primary reasons that people report engaging in NSSI is that it appears to help them cope with intense affective states and upsetting thoughts, both of which they perceive as unbearable at the time. However, empirical investigation into the affective and cognitive states preceding NSSI has been limited, especially during daily life. The current study utilized ecological momentary assessment to measure multiple daily recordings of negative affect, repetitive negative thinking (RNT), and NSSI thoughts and behaviors among a community sample of adolescents and young adults (N = 47). Findings indicated that anxiety and feeling overwhelmed predicted NSSI most strongly when RNT was elevated, suggesting that these three factors may interact in a process creating an aversive affective state that self-injurers attempt to “escape” by engaging in NSSI.

Adolescent Victimization and Self-Injurious Thoughts and Behaviors: A Genetically Sensitive Cohort Study.

ObjectiveVictimized adolescents have an increased risk of self-injurious thoughts and behaviors. However, poor understanding of causal and non-causal mechanisms underlying this observed risk limits the development of interventions to prevent premature death in adolescents. This study tested whether pre-existing family-wide and individual vulnerabilities account for victimized adolescents’ increased risk of self-injurious thoughts and behaviors.MethodParticipants were 2,232 British children followed from birth to 18 years of age as part of the Environmental Risk Longitudinal Twin Study. Adolescent victimization (maltreatment, neglect, sexual victimization, family violence, peer/sibling victimization, cyber victimization, and crime victimization) was assessed through interviews with participants and co-informant questionnaires at the 18-year assessment. Suicidal ideation, self-harm, and suicide attempt in adolescence were assessed through interviews with participants at 18 years.ResultsVictimized adolescents had an increased risk of suicidal ideation (odds ratio [OR] 2.40, 95% CI 2.11–2.74), self-harm (OR 2.38, 95% CI 2.10–2.69), and suicide attempt (OR 3.14, 95% CI 2.54–3.88). Co-twin control and propensity score matching analyses showed that these associations were largely accounted for by pre-existing familial and individual vulnerabilities, respectively. Over and above their prior vulnerabilities, victimized adolescents still showed a modest increase in risk for suicidal ideation (OR 1.45, 95%CI 1.10–1.91) and self-harm (OR 1.50, 95% CI 1.18–1.91) but not for suicide attempt (OR 1.28, 95% CI 0.83–1.98).ConclusionRisk for self-injurious thoughts and behaviors in victimized adolescents is explained only in part by the experience of victimization. Pre-existing vulnerabilities account for a large proportion of the risk. Therefore, effective interventions to prevent premature death in victimized adolescents should not only target the experience of victimization but also address pre-existing vulnerabilities.

Review of the literature on self-injurious thoughts and behaviours in gender-diverse children and young people in the United Kingdom.

International literature suggests that gender-diverse people are at increased risk of thoughts and acts of self-injury compared to their cisgender peers. The current review aimed to investigate the prevalence of self-injurious thoughts and behaviours (SITBs) among children and young people (CYP) in the United Kingdom identifying as a gender not typically associated with the sex they were assigned at birth and, further, to examine relevant prevalence rates of SITBs reported both in academic and grey literature. In total, seven studies were included in the review and indicated an increased prevalence of SITBs among gender-diverse CYP compared to the general population. However, methodological limitations and significant heterogeneity in the rates of SITBs reported require that the available literature be interpreted with some caution. Important factors to consider when interpreting SITB rates, as well as recommendations for future research, are discussed.

Possibilities of Psychological Intervention on Social Networks

Abstract Introduction: Nowadays we are looking for help and answers to our questions more and more often on the Internet. People use social networks to search for communities or groups whose members experience similar difficulties. These are often online groups that focus on psychological problems, domestic violence, etc. Members receive instant feedback and at the same time, due to the online disinhibition effect, they do not feel the fear, shame or worries they would feel in personal contact (Griffiths, 2005). The content of such self-help groups is not always helpful, but may rather induce pathological behaviour. However, the group administrator can influence the atmosphere in the group and its content itself (Niwa & Mandrusiak, 2012). Purpose: The purpose of this research was to find a space to perform professional psychological interventions inside online self-help groups on social networks. The concept of a field worker was used in this research. The field worker offers helping services to clients in an environment natural to them and where the worker can provide the client with emergency help during the crisis and prevent other clients from offering risk advices (Ambrózová, Vitálošová, & Labáth, 2006). Methods: We have conducted qualitative research using the method of content-frequency analysis. The sample for this study consisted of 10 closed online self-help groups focusing on topics such as depression, anxiety disorder, domestic violence, self-injurious and suicidal thoughts and tendencies, etc. For the purpose of this research we created an online group moderated by professionals, focusing on similar topics of mental disorders. Conclusions: The research results indicated that group members exchanged useful information (35.43%), described their current difficulties they were experiencing (32.33%), shared their own experiences (10.53%), and also published information on what had helped them manage the difficult feelings and situations they had been experiencing (6.39%). However, we also identified risky statements and threatening recommendations in posts and comments. Based on the results, we outlined the possibilities of online field worker interventions and described techniques of interventions that the professional can use for the benefit of group members.

Non-Suicidal self-injury and suicide in depressed Adolescents: Impact of peer victimization and bullying

Background: While prior research has demonstrated that peer victimization and bully perpetration contribute to non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs), it remains unclear whether these interpersonal processes differentiate self-injuring adolescent suicide ideators and attempters. Methods: The study included adolescents aged 13–18 years (n = 223; M = 15.31, SD = 1.34) recruited from an acute inpatient program. Participants were divided into two groups: (1) NSSISI (n = 106): endorsed past year NSSI, current suicide ideation, and no lifetime suicide attempts and (2) NSSISI+SA (n = 117): endorsed past year NSSI, current suicide ideation, and lifetime suicide attempts. Adolescents completed clinical interviews (i.e., mental disorders, NSSI, and STBs) and self-report measures assessing peer victimization, bully perpetration, and depression severity. Results: NSSISI+SA youth reported higher levels of peer victimization and bully perpetration than NSSISI youth (ps < 0.01, ds = 0.36–0.37). Among the NSSISI+SA youth, bully perpetration was associated with a greater number of past month suicide attempts (p = 0.02, RR = 1.07). Only peer victimization was associated with greater NSSI behaviors in the past month (p = 0.04, RR = 1.01). Limitations: The study is cross-sectional, and reports of peer victimization and bully perpetration rely on self-report assessment. ConclusionsPeer victimization and bully perpetration differentiated adolescent suicide ideators and attempters, highlighting the need to address bully perpetration in addition to peer victimization in suicide interventions and research.

Prevalence of Self-Injurious Thoughts and Behaviors in Transgender Individuals With Eating Disorders: A National Study

PurposeThis study examined prevalence of self-injurious thoughts and behaviors (SITBs) in transgender individuals with eating disorders, as compared to cisgender individuals with eating disorders and transgender individuals without eating disorders. MethodsData were analyzed from 365,749 individuals (median age 21 years, 71.8% White/Caucasian, 34.9% male, 64.9% female, and 0.2% transgender) who participated in American College Health Association-National College Health Assessment, an annual national assessment of college student health, from 2008 to 2011. ResultsRates of past-year nonsuicidal self-injury, suicidal ideation, and suicide attempts were elevated in transgender participants with eating disorders (74.8%, 75.2%, and 74.8%, respectively), as compared to cisgender participants with eating disorders and transgender participants without eating disorders. Follow-up logistic regression analyses indicated these differences were statistically significant above and beyond the effects of demographic variables and depression. ConclusionsResults found extremely high rates of SITBs in transgender individuals with eating disorders. This combination of identities, each associated with SITBs, may have a compounding effect.

4.38 Adolescent Victimization and Self-Injurious Thoughts and Behaviors: A Genetically Sensitive Cohort Study

Victimized adolescents have an elevated risk of self-injurious thoughts and behaviors. However, poor understanding of causal and noncausal mechanisms underlying this observed risk limits the development of interventions to prevent premature death among adolescents. We tested whether preexisting familywide and individual vulnerabilities account for victimized adolescents’ elevated risk of self-injurious thoughts and behaviors.

I Want You to Want Me: Interpersonal Stress and Affective Experiences as Within-Person Predictors of Nonsuicidal Self-Injury and Suicide Urges in Daily Life.

To investigate near-term risk for self-injurious urges, we evaluated how within-person changes in internalizing and externalizing negative affect, as well as interpersonal rejection and criticism, impact subsequent nonsuicidal self-injury (NSSI) and suicide urges in daily life. Young adult women (N=62) from an ongoing community cohort study with past-year self-injurious thoughts completed a 21-day ecological momentary assessment protocol. We used multilevel path analyses to model within-person effects of negative affect and interpersonal stress on subsequent suicide and NSSI urges within several hours. When modeled simultaneously, within-person changes in internalizing, but not externalizing, negative affect predicted later self-injurious urges. Rejection and criticism predicted later self-injurious urges, with rejection showing a unique relationship to NSSI urges specifically. Effects of rejection and criticism on later NSSI and suicide urges were mediated by internalizing negative affect; rejection also retained a significant direct effect on NSSI urges. Interpersonal stressors may be potent near-term risk factors for self-injurious urges by increasing internalizing negative affect among vulnerable individuals. The direct role of rejection and criticism on self-injurious urges is less clear, particularly for suicide. These findings have implications for understanding processes underlying self-injurious urges, as well as designing real-time interventions for these experiences in daily life.

Self-injury group psychotherapy intervention for young offenders: a pilot study

ABSTRACTObjective: Self-injury (SI) is a significant and growing problem with the prison estate and a particularly acute issue with young offenders. Despite this, there are no evidence-based interventions for Young Offenders with SI difficulties. The Self-Injury Group Psychotherapy Intervention (SIGPI) was developed to target this.Method: Drawing on existing evidence, the group was developed and piloted on a sample of 12 male Young Offenders (mean age 19.85 years) in custody with a history of SI. Participants were measured on observable SI behaviour, SI thoughts and urges and psychological distress. A within subject design was utilised with measures at baseline, 6 months and 1 year.Results: At 12 months follow-up, a significant reduction in SI acts, time spent on SI monitoring, severity of urges and difficulty resisting SI. Psychological distress was also reduced.Conclusions: SIGPI could be a potentially promising intervention and further investigation into its efficacy is warranted.

Suicidal Thoughts and Behaviors: Prevalence and Association with Distal and Proximal Factors in Spanish University Students.

We report on the prevalence of suicidal thoughts and behaviors in Spanish university students and their risk and protective factors (distal/proximal; individual/environmental). First-year university students completed an online survey including Self-Injurious Thoughts and Behaviors Interview (SITBI) items, the screening version of the Columbia-Suicide Severity Rating Scale (C-SSRS) along with adversities and positive relationships during childhood/adolescence, recent stressful experiences, and lifetime mental disorders. Nested logistic regression models were estimated and areas under the curve (AUC) compared. A total of 2,118 students completed the survey (mean age=18.8 [SD=1.4]years; 55.4% female). Twelve-month prevalence of suicide ideation (SI) was 9.9%, plans, 5.6%, and attempts, 0.6%. Risk factors of 12-month SI were as follows: parental psychopathology (OR=1.7, 95% CI 1.2-2.5); sexual assault (OR=5.6, 95% CI 1.4-22.1); lifetime mood disorder (OR=5.2, 95% CI 3.5-7.7); and lifetime anxiety disorder (OR=1.7, 95% CI: 1.1-2.5). Childhood positive relationships protected from SI were as follows: peers/others (OR=0.6, 95% CI 0.4-0.9 for the second highest tertile) and family (OR=0.4, 95% CI 0.3-0.7 for the highest tertile). AUC of the final model was 0.82 (SE=0.015). Our results indicate a high prevalence of SI among Spanish university students and identify protective and risk factors from a comprehensive conceptual model.

The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors

BackgroundTheoretical and empirical literature suggests that non-suicidal self-injury (NSSI) is an important correlate of suicide risk. The present study was designed to evaluate: (a) whether NSSI is associated with increased odds of subsequent onsets of suicidal thoughts and behaviors (STB) independent of common mental disorders, (b) whether NSSI is associated with increased risk of transitioning from suicide ideation to attempt, and (c) which NSSI characteristics are associated with STB after NSSI. MethodUsing discrete-time survival models, based on retrospective age of onset reports from college students (n = 6,393, 56.8% female), we examined associations of temporally prior NSSI with subsequent STB (i.e., suicide ideation, plan, and attempt) controlling mental disorders (i.e., MDD, Broad Mania, GAD, Panic Disorder, and risk for Alcohol Dependence). NSSI characteristics associated with subsequent STB were examined using logistic regressions. ResultsNSSI was associated with increased odds of subsequent suicide ideation (OR = 2.8), plan (OR = 3.0), and attempt (OR = 5.5) in models that controlled for the distribution of mental disorders. Further analyses revealed that NSSI was associated with increased risk of transitioning to a plan among those with ideation, as well as attempt among those with a plan (ORs = 1.7–2.1). Several NSSI characteristics (e.g., automatic positive reinforcement, earlier onset NSSI) were associated with increased odds of experiencing STB. LimitationsSurveys relied on self-report, and thus, there is the potential for recall bias. ConclusionsThis study provides support for the conceptualization of NSSI as a risk factor for STB. Investigation of the underlying pathways accounting for these time-ordered associations is an important avenue for future research.

Problematic alcohol use and suicidal ideation among firefighters: A multi-study investigation of the explanatory roles of perceived burdensomeness and thwarted belongingness

BackgroundFirefighters are at increased risk for both problematic alcohol use and suicidality. Research has found that problematic alcohol use is related to suicidality among this population; however, limited data exist regarding what might account for this association. The present two-study investigation (1) examined the association between suicidality and problematic alcohol use among two large samples of firefighters and (2) tested whether interpersonal theory of suicide constructs—perceived burdensomeness (PB) and thwarted belongingness (TB)—serve as indirect indicators of this relationship. MethodsParticipants in Study 1 were 944 U.S. firefighters (12.5% female); participants in Study 2 were 241 U.S. women firefighters. Participants completed the Interpersonal Needs Questionnaire, Alcohol Use Disorders Identification Test, and the Depressive Symptom Inventory-Suicidality Subscale (Study 1) or the Self-Injurious Thoughts and Behaviors Interview-Short Form (Study 2). Bias-corrected bootstrap indirect effects path analyses were utilized. ResultsIn Study 1, more problematic alcohol use was significantly associated with more severe career suicidal ideation via PB but not TB. In Study 2, problematic alcohol use was associated with career suicidal ideation via both PB and TB. PB seems to account for the relationship between problematic alcohol use and career suicidal ideation among male and female firefighters. LimitationsLimitations include use of a cross-sectional design, use of retrospective measures of suicidal ideation, and our findings derived from subsamples of two existing datasets. ConclusionsFindings suggest that PB and TB may explain the relationship between problematic alcohol use and suicidal ideation, but that this effect is discrepant based on gender.

Common genetic contributions to high-risk trauma exposure and self-injurious thoughts and behaviors

Prior research has documented shared heritable contributions to non-suicidal self-injury (NSSI) and suicidal ideation (SI) as well as NSSI and suicide attempt (SA). In addition, trauma exposure has been implicated in risk for NSSI and suicide. Genetically informative studies are needed to determine common sources of liability to all three self-injurious thoughts and behaviors, and to clarify the nature of their associations with traumatic experiences. Multivariate biometric modeling was conducted using data from 9526 twins [59% female, mean age = 31.7 years (range 24-42)] from two cohorts of the Australian Twin Registry, some of whom also participated in the Childhood Trauma Study and the Nicotine Addiction Genetics Project. The prevalences of high-risk trauma exposure (HRT), NSSI, SI, and SA were 24.4, 5.6, 27.1, and 4.6%, respectively. All phenotypes were moderately to highly correlated. Genetic influences on self-injurious thoughts and behaviors and HRT were significant and highly correlated among men [rG = 0.59, 95% confidence interval (CI) (0.37-0.81)] and women [rG = 0.56 (0.49-0.63)]. Unique environmental influences were modestly correlated in women [rE = 0.23 (0.01-0.45)], suggesting that high-risk trauma may confer some direct risk for self-injurious thoughts and behaviors among females. Individuals engaging in NSSI are at increased risk for suicide, and common heritable factors contribute to these associations. Preventing trauma exposure may help to mitigate risk for self-harm and suicide, either directly or indirectly via reductions in liability to psychopathology more broadly. In addition, targeting pre-existing vulnerability factors could significantly reduce risk for life-threatening behaviors among those who have experienced trauma.

Personality styles and self-harm in adolescents of the city of Arequipa

The objective of this research was to determine the relationship between personality styles and self-injury. The sample was of 997 students between 13 and 18 years old (M=15.24 years), who attended between third and fifth of secondary school in public and private schools of the city of Arequipa. The research design was of the transversal, descriptive - correlational type. The Millon Adolescent Personality Inventory (MAPI), the Sub-Scale of Self-injury and Self-injury Thoughts (SIBTI), and a sociodemographic survey were used. The results indicated that there is a prevalence of 34.9% in relation to self-injurious thoughts, while 27.9% of those evaluated have self-harmed, with the average age of onset of self-injury being 12.61 years. The main triggers are negative mood (48.2%) and family problems (39.9%). Likewise, we found that sensitive personality styles (r = .293; p<.001), inhibited (r = .203; p<.001), violent (r = .149; p<.001) are those that more are associated with self-injurious behaviors. It is concluded that sensitive, inhibited and violent personality styles are linked to a higher prevalence of self-injury in adolescents in the city of Arequipa.

Non-suicidal self-injury and suicidal thoughts and behaviors: A study of the explanatory roles of the interpersonal theory variables among military service members and veterans.

Research has identified non-suicidal self-injury (NSSI) as a robust correlate of suicidal thoughts and behaviors; however, little is known regarding why these constructs may be related. Consistent with the interpersonal theory of suicide, this study investigated thwarted belongingness (TB), perceived burdensomeness (PB), and capability for suicide (CS) as explanatory links in the association between NSSI, ideation, and suicide attempt history. Military service members and veterans (N = 973; agemean = 29.9 years, 78.8% male, 63.8% Caucasian/White) completed measures of lifetime NSSI and suicide attempts; current suicidal ideation; TB, PB, and CS; and related psychiatric symptoms. Bootstrap moderated mediation analyses were employed to examine whether (a) TB moderated the mediating effect of PB on NSSI and ideation, (b) PB moderated the mediating effect of TB on NSSI and ideation, and (c) CS moderated the mediating effect of TB and PB on NSSI and attempts. TB and PB significantly accounted for the relationship between lifetime NSSI and current ideation. TB did not moderate the mediating effect of PB on NSSI and ideation, and PB did not moderate the mediating effect of TB. However, CS significantly moderated the mediating effects of TB and PB on NSSI and attempt history. The interpersonal theory of suicide hypotheses were partially supported. Consistent with the theory, the interaction of TB and PB only explained NSSI and attempt history among service members with high levels of CS. TB and PB only individually explained the association between lifetime NSSI and recent suicidal ideation. Prospective studies are warranted to replicate these findings across other military samples. (PsycINFO Database Record