Predicting the trajectory of non-suicidal self-injury among adolescents

Non-suicidal self-injury (NSSI) is common among adolescents receiving inpatient psychiatric treatment and the months post-discharge is a high-risk period for self-injurious behavior. Thus, identifying predictors that shape the course of post-discharge NSSI may provide insights into ways to improve clinical outcomes. Accordingly, we used machine learning to identify the strongest predictors of NSSI trajectories drawn from a comprehensive clinical assessment.

The study included adolescents (N = 612; females n = 435; 71.1%) aged 13-19-years-old (M = 15.6, SD = 1.4) undergoing inpatient treatment. Youth were administered clinical interviews and symptom questionnaires at intake (baseline) and before termination. NSSI frequency was assessed at 1-, 3-, and 6-month follow-ups. Latent class growth analyses were used to group adolescents based on their pattern of NSSI across follow-ups.

Three classes were identified: Low Stable (n = 83), Moderate Fluctuating (n = 260), and High Persistent (n = 269). Important predictors of the High Persistent class in our regularized regression models (LASSO) included baseline psychiatric symptoms and comorbidity, past-week suicidal ideation (SI) severity, lifetime average and worst-point SI intensity, and NSSI in the past 30 days (bs = 0.75-2.33). Only worst-point lifetime suicide ideation intensity was identified as a predictor of the Low Stable class (b = -8.82); no predictors of the Moderate Fluctuating class emerged.

This study found a set of intake clinical variables that indicate which adolescents may experience persistent NSSI post-discharge. Accordingly, this may help identify youth that may benefit from additional monitoring and support post-hospitalization.