Non-Suicidal Self-Injury and Suicidal Ideation: What is the Connection?

Introduction: Non-suicidal self-injury (NSSI) is relatively common among adolescents, ranging from 5% to 40% in community samples, and evidence suggests the prevalence is increasing. Several studies have shown an association between NSSI and suicidal ideation (SI). However, very few have examined the overlap between these two risky behaviors using statewide, representative samples. Methods: In 2005, Maine added a self-injury question to the high school Youth Risk Behavior Survey (YRBS). We defined NSSI as past year intentional self-harm without wanting to die and SI as considering suicide, making a plan to attempt suicide, or attempting suicide in the past year. Students were grouped as: (1) neither NSSI nor SI; (2) NSSI alone; (3) SI alone; or (4) both NSSI and SI. We examined the association between these groups and demographic characteristics and risk behaviors, including depression, bullying, and sexual assault. Results: One in five Maine high school students engaged in NSSI and 18.0% reported SI. Half of those with NSSI also reported SI. Those who reported both reported higher rates of cigarette, alcohol, and drug use and sexual activity. They also reported higher rates of depression, lack of parental support, and past physical assault by dating partner. One in three of those who reported both NSSI and SI did not receive help when feeling depressed compared to 9.5% of those reporting neither. Conclusions: High school students reporting non-suicidal self-injury should be screened for suicidal ideation and the presence of other unhealthy behaviors.