# Developmental Trajectories of Nonsuicidal Self-Injury and Risk for Suicide Attempt

## TL;DR

This study finds that youth with later-onset nonsuicidal self-injury are more likely to attempt suicide than those with earlier-onset self-injury.

## Contribution

The study identifies distinct developmental trajectories of nonsuicidal self-injury and their association with suicide attempt risk in youth.

## Key findings

- Youth with later-onset NSSI (age 11.63) had higher suicide attempt rates (21%) than earlier-onset (age 9.83, 17%).
- Sex, mental health, family conflict, and parenting predicted NSSI trajectories and suicide risk.
- Persistent NSSI was linked to higher suicide attempt risk compared to early-onset NSSI.

## Abstract

Suicide attempt (SA) risk is especially high among youth with early nonsuicidal self-injury (NSSI) onset and persistent NSSI. Still, few youth experience persistent NSSI, and few attempt suicide. Identifying which youth follow specific NSSI trajectories and which NSSI trajectories are at higher risk for SA has strong potential to inform more targeted early suicide risk identification and prevention. The present study aimed to identify NSSI trajectories, identify characteristics forecasting which NSSI trajectories youth followed, and compare SA risk across trajectories.

A subsample of youth (N = 2,524) with at least 1 NSSI event before typical onset was retrospectively identified. Youth were followed for 4 years (ages 9-14 years) using the first 5 annual assessments from the Adolescent Brain Cognitive Development℠ (ABCD) Study (release 5.1).

Latent-class growth modeling identified 2 subgroups of youth following distinct NSSI trajectories. The earlier-onset group (15%, mean [SD] age at onset = 9.83 [0.59] years) experienced baseline limited NSSI. The later-onset group (85%, mean [SD] age at onset =11.63 [1.60] years) had moderate risk for more than 1 NSSI endorsement. The later-onset group was significantly more likely to attempt suicide than the earlier-onset group (21% vs. 17% reported ≥1 SAs). Sex, psychopathology, family conflict, and positive parenting predicted group membership and SA risk.

SA risk among youth with early-onset or persistent NSSI was high; however, risk was slightly higher for youth with persistent NSSI. Whereas youth and family characteristics may forecast which NSSI trajectories youth follow, clinical implications of this research support children with NSSI are at risk for SA and may need continued monitoring and intervention. Findings support promoting broad public health awareness of SA risk in youth with NSSI.

Using longitudinal data from the Adolescent Brain Cognitive Development℠ (ABCD) study, this study aimed to identify factors associated with nonsuicidal self-injury (NSSI) and suicide attempt among youth with at least one NSSI event prior to age 14 (N = 2,524). Youth with later onset of NSSI (mean age 11.63 years) were more likely to report multiple episodes of NSSI and to attempt suicide than youth with earlier-onset NSSI (mean age 9.83 years). Sex, mental health problems, family conflict, and positive parenting were associated with age of onset of NSSI and risk of suicide attempt.