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Janis Whitlock, MPH, PhD; Kerry L. Knox, PhD

Arch Pediatr Adolesc Med. 2007;161(7):634-640.

Objective  To test the hypothesis that self-injurious behavior (SIB) signals an attempt to cope with psychological distress that may co-occur or lead to suicidal behaviors in individuals experiencing more duress than they can effectively mitigate.

Design  Analysis of a cross-sectional data set of college-age students.

Setting  Two universities in the northeastern United States in the spring of 2005.

Participants  A random sample of 8300 students was invited to participate in a Web-based survey; 3069 (37.0%) responded. Cases in which a majority of the responses were missing or in which SIB or suicide status was indeterminable were omitted, resulting in 2875 usable cases.

Exposure  Self-injurious behavior.

Main Outcome Measures  Main outcome was suicidality; adjusted odds ratios (AORs) for suicidality by SIB status when demographic characteristics, history of trauma, distress, informal help-seeking, and attraction to life are considered.

Results  One quarter of the sample reported SIB, suicidality, or both; 40.3% of those reporting SIB also report suicidality. Self-injurious behavior status was predictive of suicidality when controlling for demographic variables (AOR, 6.2; 95% confidence interval [CI], 4.9-7.8). Addition of trauma and distress variables attenuated this relationship (AOR, 3.7; 95% CI, 2.7-4.9). Compared with respondents reporting only suicidality, those also reporting SIB were more likely to report suicide ideation (AOR, 2.8; 95% CI, 2.0-3.8), plan (AOR, 5.6; 95% CI, 3.9-7.9), gesture (AOR, 7.3; 95% CI, 3.4-15.8), and attempt (AOR, 9.6; 95% CI, 5.4-17.1). Lifetime SIB frequency exhibits a curvilinear relationship to suicidality.

Conclusions  Since it is well established that SIB is not a suicidal gesture, many clinicians assume that suicide assessment is unnecessary. Our findings suggest that the presence of SIB should trigger suicide assessment.

Author Affiliations: From the Department of Human Development and the Family Life Development Center, Cornell University, Ithaca, New York (Dr Whitlock), and Department of Community and Preventive Medicine, University of Rochester, Rochester, New York (Dr Knox).

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