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Developmental Trajectories of Nonsuicidal Self-Injury and Risk for Suicide Attempt
Amanda J Thompson1, Katherine Sarkisian1, Elyse N Llamocca1,2
1The Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
JAACAP Open
|February 25, 2026
Summary
Youth with persistent nonsuicidal self-injury (NSSI) face higher suicide attempt (SA) risk. Early identification of NSSI trajectories and associated risk factors is crucial for targeted prevention strategies in at-risk youth.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Public Health
Background:
- Nonsuicidal self-injury (NSSI) onset in youth is linked to elevated suicide attempt (SA) risk, particularly with early onset or persistent behaviors.
- Identifying specific NSSI trajectories and associated risk factors is critical for effective early suicide risk identification and prevention strategies.
Purpose of the Study:
- To identify distinct trajectories of NSSI among youth.
- To determine characteristics that predict which NSSI trajectories youth follow.
- To compare the risk of SA across identified NSSI trajectories.
Main Methods:
- Utilized latent-class growth modeling on a subsample (N=2,524) from the Adolescent Brain Cognitive Development (ABCD) Study.
- Retrospectively identified youth with at least one NSSI event before typical onset, followed for 4 years (ages 9-14) using 5 annual assessments.
- Analyzed predictors of group membership and SA risk, including sex, psychopathology, family conflict, and positive parenting.
Main Results:
- Two distinct NSSI trajectories were identified: an earlier-onset group (15%) with limited NSSI and a later-onset group (85%) with moderate risk for multiple NSSI endorsements.
- The later-onset group exhibited a significantly higher likelihood of suicide attempts (21%) compared to the earlier-onset group (17%).
- Sex, psychopathology, family conflict, and positive parenting were significant predictors of both NSSI trajectory group membership and SA risk.
Conclusions:
- While both early-onset and persistent NSSI in youth are associated with high SA risk, persistent NSSI confers a slightly elevated risk.
- Youth and family characteristics can forecast NSSI trajectories, highlighting the need for continued monitoring and intervention for children with NSSI.
- Findings underscore the importance of public health awareness regarding SA risk in youth with NSSI and support targeted interventions.
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