Suicide and Self-Harm in Youth

Suicide and self-harm in young people encompass a range of self-injurious thoughts and behaviours, from suicidal ideation and attempts to non-suicidal self-injury. Suicide is among the leading causes of death in adolescence worldwide, and self-harm is a common and clinically important behaviour strongly associated with mood disorders, although it also arises from factors beyond mood.

Definition

Suicide is the act of intentionally causing one's own death; suicidal behaviour spans ideation, planning, and attempts, while self-harm denotes intentional self-injury that may or may not be accompanied by suicidal intent, including non-suicidal self-injury performed without intent to die.

Scope

The entry covers the conceptual distinctions among suicidal ideation, suicide attempts, completed suicide, and non-suicidal self-injury; the epidemiology and risk factors in young people; and the relationship of these behaviours to mood disorders. It is a reference description of the phenomena and the research about them, and explicitly does not provide assessment, prevention, or treatment instructions.

Core questions

• How are suicidal ideation, suicide attempts, completed suicide, and non-suicidal self-injury conceptually distinguished?
• What is the relationship between mood disorders and self-harm or suicide in young people?
• What risk and protective factors are associated with suicidal behaviour in adolescence?

Key concepts

• Suicidal ideation, attempt, and completed suicide
• Non-suicidal self-injury
• Distinction between self-harm and suicidal intent
• Repetition and escalation of self-harm
• Mood disorders as a major risk factor
• Risk and protective factors

Mechanisms

Suicidal behaviour is understood through frameworks that distinguish the development of suicidal ideation from the transition to suicidal acts. O'Connor and Nock describe how psychological factors such as defeat, entrapment, hopelessness, and impaired problem-solving contribute to the emergence of ideation, while factors such as impulsivity, access to means, and prior self-harm influence the move to attempts. Mood disorders, particularly depression, are among the strongest correlates, but self-harm can also occur as a means of regulating distress without intent to die.

Clinical relevance

Self-harm and suicidal behaviour are leading contributors to mortality and morbidity in young people and are closely linked to mood disorders, making their conceptual understanding central to the youth mental-health literature. This entry is descriptive and is explicitly not a basis for risk assessment, crisis response, or treatment of any individual; concerns about a specific person should be addressed by qualified clinical or emergency services.

Epidemiology

Suicide is consistently among the leading causes of death in adolescents and young adults worldwide, and self-harm is common in this age group, with non-suicidal self-injury frequently beginning in early adolescence. Prior self-harm is one of the strongest predictors of later self-harm and suicide, and the elevated mortality associated with mental disorders, quantified in the meta-analysis by Walker and colleagues, is driven substantially by suicide.

Evidence & guidelines

The evidence base includes synthetic reviews of adolescent self-harm and suicide (Hawton and colleagues) and of the psychology of suicidal behaviour (O'Connor and Nock), as well as the meta-analysis by Bridge and colleagues examining suicidality in pediatric antidepressant trials. These are cited to describe how risk and the relationship to treatment have been studied, not to provide clinical direction.

History

Self-harm and suicide in young people moved from the margins of psychiatry to a central public-health concern over recent decades, with growing recognition that self-harm with and without suicidal intent are common and prognostically important. Debate over treatment-emergent suicidality, crystallised by analyses such as Bridge and colleagues of pediatric antidepressant trials, further sharpened attention to suicide risk in youth mental-health care.

Debates

How are non-suicidal self-injury and suicidal behaviour related?

Whether non-suicidal self-injury and suicidal behaviour are distinct phenomena or points on a continuum is debated; they differ in intent yet non-suicidal self-injury is a robust predictor of later suicide attempts, complicating their separation.

Key figures

• Keith Hawton
• Rory O'Connor
• Matthew Nock
• Jeffrey Bridge

Seminal works

• hawton-2012
• oconnor-2014
• bridge-2007

Frequently asked questions

Is self-harm the same as a suicide attempt?

Not necessarily; self-harm refers to intentional self-injury that may or may not involve intent to die, and non-suicidal self-injury is performed without suicidal intent, although prior self-harm is a strong predictor of later suicide attempts.

How are suicide and self-harm related to mood disorders?

Mood disorders, especially depression, are among the strongest correlates of suicidal behaviour and self-harm in young people, which is why these outcomes are studied alongside the mood disorders, though they also arise from other factors.