Not all risk factors are equal: Personality functioning and self-injury in adolescent suicidality

While personality pathology and childhood trauma are established correlates of adolescent suicidality, it remains unclear which factors differentiate between suicidal ideation and suicide attempts.

In a clinical inpatient sample of 570 adolescents (age: M = 15.2 years, SD = 1.37; 22% male, 78% female), we assessed personality functioning (ICD-11 framework), identity diffusion, childhood trauma, non-suicidal self-injury disorder, and categorical personality disorders (ICD-10 framework) using structured interviews and validated questionnaires. Group differences were examined across adolescents with suicide attempts, suicidal ideation only, and no suicidal symptoms. Logistic regression analyses tested the independent contribution of these factors to suicidal status.

Adolescents with suicidal symptoms showed significantly higher impairments in personality functioning, higher identity diffusion, more childhood trauma, and a higher prevalence of personality disorders than non-suicidal adolescents. However, adolescents with suicidal ideation only and those with suicide attempts did not differ on these variables. In contrast, non-suicidal self-injury was most prevalent among adolescents with suicide attempts and emerged as the strongest independent correlate of suicidal status (OR = 2.84, 95% CI [1.74, 4.61]).

Impairments in personality functioning and childhood trauma appear to reflect general vulnerability factors for adolescent suicidality, whereas non-suicidal self-injury may represent a factor that is more closely associated with suicidal attempts. Targeting self-injurious behavior may be critical for identifying and intervening in adolescents at risk of acting on suicidal thoughts.