The complex relationship between NSSI exposure and suicidal risk: Insights from a short-term longitudinal study

Adolescent suicide has become a critical global public health issue. While non-suicidal self-injury (NSSI) is closely associated with suicide, the role of NSSI exposure remains unclear. This study aims to explore possible mechanisms among NSSI exposure, NSSI engagement, and future suicidal risk.

A total of 2,155 Chinese middle school students (47.9 % girls; M = 13.38 years, SD = 0.66) participated in the study. During the first survey, they reported demographic information, NSSI exposure, and NSSI engagement. Three months later, they completed follow-up assessments on suicidal risk and depressive symptoms.

Our results revealed three distinct relational patterns between NSSI exposure, NSSI engagement, and future suicidal risk: (1) NSSI exposure is associated with future suicidal risk through the mediating role of NSSI engagement (indirect effect = 0.145, SE = 0.02, 95 % CI [0.107, 0.183]); (2) NSSI exposure independently impact suicidal risk without NSSI engagement (β = 0.046, SE = 0.018, t = 2.299, p < 0.05); (3) NSSI exposure amplifies the predictive effect of NSSI engagement (β = 0.053, SE = 0.014, t = 3.844, p < 0.001, 95 % CI [0.023, 0.010]).

Our findings highlight the importance of interpersonal exposure, rather than media exposure, in these pathways. This study uncovers multiple pathways through which NSSI exposure influences suicidal risk, offering preliminary evidence for targeted prevention strategies.