Nonsuicidal self-injury (NSSI) is defined as deliberate, self-inflicted injury to oneself that occurs without suicidal intent and is not for socially or culturally sanctioned purposes. Recent studies have shown that up to 17% of community-sampled adolescents have engaged in NSSI at least once over their lifetime. While NSSI is concerning in its own right, NSSI has been associated with increased risk of mental health problems and subsequent risk for suicidal behaviors. However, most of our data on the prevalence and risk factors for NSSI is derived from studies of adolescents and young adults, and we have little data on the prevalence and predictors of NSSI in younger, preadolescent children.
Leveraging a rich source of data collected as part of the Adolescent Brain and Cognitive Development (ABCD) study, Taylor Burke, PhD, Associate Director of Suicide Research in the Division of Child and Adolescent Psychiatry at Mass General, and colleagues have examined sociodemographic characteristics, psychiatric disorders, and suicidal ideation (SI) in relation to NSSI in preadolescents. The research team analyzed data from the ABCD study, which includes a diverse, nationally representative sample of 11,875 youth 9 to 10 years of age.
The researchers assessed lifetime and past 2-week prevalence of NSSI. The K-SADS diagnostic interview was used to assess NSSI, suicidal ideation, and psychopathology. Sociodemographic Factors Associated with NSS
Sociodemographic Factors Associated with NSSI
In this nationally representative sample, Burke and colleagues observed high rates of NSSI among preadolescent youth. The lifetime prevalence of NSSI among preadolescents was 9.1%, and the past 2-week prevalence was 4.2%.
Several sociodemographic factors were associated with an increased likelihood of lifetime NSSI, including male sex and identifying as a sexual minority. Having unmarried parents and a low household income (< $25,000 per year) were also associated with higher rates of lifetime NSSI.
Psychiatric Disorders and NSSI
Major depressive disorder (MDD) emerged as the strongest single diagnostic predictor of NSSI, both cross-sectionally and temporally. Other psychiatric disorders associated with NSSI included oppositional defiant disorder (ODD), social anxiety, generalized anxiety disorder, posttraumatic stress disorder, and conduct disorder. In addition, greater psychiatric comorbidity increased the risk for lifetime NSSI in a dose-response fashion.
Suicidal ideation (SI) was robustly associated with NSSI history, even after adjusting for sociodemographic factors (OR 7.59; 95% CI 6.46–8.92; p < .001). The researchers also examined previous SI as a temporal predictor of recent NSSI onset. Previous SI predicted recent NSSI onset, even after controlling for child sex, race, and ethnicity (OR 4.19; 95% CI 3.04–5.79; p < .001).
Youth with a history of NSSI were more likely to receive mental health treatment than those without NSSI (OR 3.47; 95% CI 2.97–4.04; p < .001). However, over 60% of preadolescents with NSSI had no history of psychiatric care.
Implications and Recommendations
The ABCD study is the first national population-based U.S. large-scale study permitting the examination of prevalence and predictors of NSSI among preadolescents aged 9-10 years old. In preadolescents, the lifetime prevalence of NSSI was high (9.1%). Certain factors were associated with greater likelihood of NSSI, including male sex and identifying as a sexual minority. In sexual minority preadolescents, 1 in 4 children reported a lifetime history of NSSI.
While we tend to think of suicide and NSSI as being associated with depressive disorders, this large study indicates that NSSI is associated with a range of mental health disorders and comorbidity. Thus, NSSI may be better conceptualized as a transdiagnostic phenomenon that is associated with a spectrum of psychiatric disorders.
The high prevalence of NSSI among preadolescent children observed in this study and the wellestablished association between NSSI and subsequent mental health problems and suicidal behaviors highlight the critical need for early detection and intervention efforts targeting NSSI in preadolescents, particularly among high-risk groups, including those identifying as sexual minorities, and those from low-income or unmarried-parent households.
The study found that, while NSSI was common, more than 60% of preadolescents with NSSI had no history of psychiatric care. Screening efforts by pediatric healthcare providers could play a crucial role in identifying at-risk preadolescents and facilitating referrals to appropriate mental health services.
Given the transdiagnostic nature of NSSI and its associations with various psychiatric disorders, a comprehensive, transdiagnostic approach to treatment may be warranted for at-risk preadolescents. Additionally, the strong link between NSSI and suicidal ideation underscores the importance of addressing self-injurious thoughts and behaviors early to prevent potential escalation to suicidal behaviors.
This study provides a valuable contribution to the limited literature on NSSI in preadolescents and highlights the urgency of addressing this public health issue through early detection, intervention, and tailored treatment approaches, particularly in high-risk youth.
Read More
Burke TA, Bettis AH, Walsh RFL, Levin RY, Lawrence HR, Sheehan AE, Turnamian MR, Liu RT. Nonsuicidal Self-Injury in Preadolescents. Pediatrics. 2023 Dec 1; 152(6):e2023063918.
Liu RT, Walsh RFL, Sheehan AE, Cheek SM, Sanzari CM. Prevalence and Correlates of Suicide and Nonsuicidal Self-injury in Children: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022 Jul 1;79(7):718-726.
Taylor Burke, PhD is is the Director of Pediatric Computational Health in the Center for Precision Psychiatry at MGH, Associate Director of Suicide Research in the Division of Child and Adolescent Psychiatry at MGH, and an Assistant Professor of Psychology at Harvard Medical School. The primary aim of Dr. Burke’s research is to advance the prediction and prevention of self-injurious thoughts and behaviors (SITBs) among youth and young adults.
Richard T. Liu, PhD is the Director of Suicide Research in the Division of Child and Adolescent Psychiatry at MGH, Director of Big Data Studies in the Depression Clinical and Research Program at MGH, and an Associate Professor of Psychology at Harvard Medical School. The primary focus of his research is on depression, suicide, and non-suicidal self-injury (NSSI) in childhood through emerging adulthood, with a particular emphasis on characterizing dynamic processes of risk underlying onset and recurrence of these clinical concerns.
