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David Baxter

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Is Self-injurious Behavior Related to Suicide in Young Adults?
by William T. Basco, Jr., MD, FAAP
Medscape Pediatrics. 2007
10/10/2007

The Relationship Between Self-injurious Behavior and Suicide in a Young Adult Population
Whitlock J and Knox KL.
Arch Pediatr Adolesc Med. 2007;161:634-640.

Summary
The authors of this study surveyed college students to provide more population-based estimates of self-injurious behavior (SIB). The authors note that much of the data on SIB prevalence was obtained from clinical populations, not general populations, possibly inflating estimates of prevalence and perhaps obscuring the relationship of SIB to suicidal ideation or suicide attempts.

One theory is that SIB is a coping mechanism for some individuals when they can no longer deal with stressful situations. However, it is not clear whether SIB is part of a spectrum of suicidal behaviors, or whether people who use SIB are distinct from the population who has suicidal ideation or who have attempted suicide.

The authors tested the hypothesis that subjects with SIB would be at increased risk for suicidality even after controlling for other factors and that the frequency of SIB would correlate with measures of suicidality. The subjects were 2875 students at 2 universities who replied to an online survey (37% response rate). The survey collected demographic information, involved mental health assessment questions, and also assessed risk factors for suicide and SIB. The survey also asked the subjects who had practiced SIB whether they did so in as a prelude to suicide or as an attempt to commit suicide.

Data included assessments of degree of suicidality (eg, thought about it, had a plan, had a gesture, had an attempt); measures of past trauma and current and past distress; along with protective factors -- a measure of "attraction to life" and a measure of social support available. The sample was 56% female; 64% white, 17% Asian/Asian American, 4% black; 91.5% heterosexual, 2.1% gay/lesbian, and 6.4% bisexual.

Twenty-four percent of respondents had experienced emotional abuse, 11% had experienced sexual abuse, and 6.3% had experienced physical abuse. Approximately 25% of the entire sample reported a history of ever practicing SIB, expressing suicidality or suicide attempt, or both.

There was a spectrum of SIB frequency among those who had ever practiced SIB, with ? of those who practiced SIB doing so only once, 47% having had 2-10 incidents, and the remainder experiencing more than 10 incidents. Forty percent of the subjects who had practiced SIB also had suicidality (60% had SIB without suicidality).

Overall, the true control group who had practiced neither SIB nor had suicidality were less likely to have experienced trauma or abuse and were less likely to express psychological distress. In multivariate analyses, any history of SIB raised the odds that an individual would also express suicidality (adjusted OR 3.4, 95% CI 2.5-4.6). After adjustment, 1 incident of SIB was not significantly associated with suicidality, but there was an overall increasing odds of suicidality with SIB increase in frequency.

For example, those who practiced SIB 2-10 times had an adjusted OR for suicidality of 3.4. However, for subjects who practiced SIB 11-50 times had adjusted OR for suicidality of 10.4 (95% CI 5.3-20.2). Other factors that remained associated with suicidality in multivariate analyses were black race/ethnicity (aOR 2.3), bisexual individuals (aOR 3.7), those with history of sexual (aOR 1.8) or emotional (aOR 2.4) abuse, along with those who expressed current psychological distress and those with eating disorders.

Subjects who had support options and higher "attraction to life" had decreased odds of suicidal ideation or behavior. The authors also found that any history of SIB also was associated with all forms of suicidal behaviors, from ideation, to plan, to gesture, to attempts.

The authors conclude that these data support their hypothesis that for some individuals, SIB is on the spectrum of suicidal behaviors and should serve as a marker for those at increased risk for suicide should SIB and other coping mechanisms become insufficient. They suggest that the presence of SIB should lead providers to assess for suicidality.

Viewpoint
This article serves as an excellent follow-up to coverage of a platform session on adolescent SIB and suicide that was presented at the 2006 Pediatric Academic Societies meeting. The fact that suicide is a leading cause of death among US adolescents means that this is a topic for every provider who cares for children. Generalist practitioners should know the "warning signs" of potential suicide, and many are included as covariates in this study -- eating disorders, youth struggling with sexual orientation questions, and now based more firmly on the results of this study, a history of self-injurious behavior.

Abstract
 

ladylore

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Its my understanding that self-harm behaviour stems from feelings of being severely numb and the person needs to feel something. Other reasons for self harm are to "let the pressure" out as the are in emotional pain and its an attempt to lessen the feelings. And it is also veiwed as a distraction tool - physically hurting is preferable to emotionally hurting. It isn't that the person wants to die, they want the emotional pain to stop.

This is my understanding of self-harm. But thank goodness people can be taught how to soothe themselves instead of self-harm when feelings are strong.
 

iam*who*iam

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my self-harm started at 13. i believe it helped me to NOT commit suicide, even though there were a lot of times i was suicidal too.

it mostly just helped me get through the really hard times.

the idea of it being related to suicide, i mean, it is possible, but most the time i don't think that is the case.

it's more related to stress and not being able to verbalize what you are feeling, or what might even be bothering you.

also, not having learned proper ways to cope with stress.
 

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