The Relationships Between Nonsuicidal Self-Injury, Connectedness, and Suicide Risk in Youth Presenting to the Emergency Department

Abstract

Objective

Nonsuicidal self-injury (NSSI), defined as harming one’s own body without suicidal intent, is a strong risk factor for suicidal thoughts and behaviors in adolescents. One promising protective factor that can mitigate suicide risk conferred by NSSI is connectedness. This study aimed to examine the association between connectedness (family, school, peer, and overall), NSSI, and suicide risk in pediatric emergency department patients.

Method

This is a secondary analysis of data from the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study. Youth ages 12 to 17 years completed questions on demographics; past-year NSSI history; the Ask Suicide-Screening Questions (ASQ) tool; and 2 items each on family, school, and peer connectedness. Overall connectedness was a composite of the 6 items. Multivariable logistic regressions assessed the associations between connectedness, NSSI, and suicide risk.

Results

Data were analyzed from 5,406 participants (55.2% female, 45.9% non-Hispanic White, mean [SD] age = 15.0 [1.7]). Out of all participants, 23.3% (1,258/5,406) screened positive for suicide risk, and 18.1% (981/5,406) reported past-year NSSI history. For every 1-point increase from mean family connectedness, the odds of screening positive for suicide risk decreased by 62% (odds ratio 0.38, 95% CI 0.31-0.46) for youth with NSSI and 70% (odds ratio 0.30, 95% CI 0.27-0.34) for youth without NSSI (difference: z = 1.96, p = .05).

Conclusion

Connectedness was protective against suicide risk across the sample regardless of NSSI history. However, family connectedness was less protective for youth with NSSI compared with youth without NSSI. Future research should examine connectedness in greater detail and the quality of different relationships that could be protective for at-risk youth.

Plain language summary

Nonsuicidal self-injury (NSSI), the act of harming one’s own body without suicidal intent, is a strong risk factor for suicidal thoughts and behaviors (STBs) in adolescents. One important protective factor that can decrease suicide risk and NSSI is connectedness. This study aimed to examine relations among types of connectedness (family, school, peer and overall), NSSI, and suicide risk in pediatric emergency department patients. All domains of connectedness (family, school, peer and overall) were found to be associated with lower suicide risk, regardless of NSSI history. However, family connectedness was associated with less of a buffering effect for youth with NSSI compared to youth without NSSI. System-level interventions that strengthen family, school, and peer networks have the potential to reduce youth suicidality risk.