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Original Research April 8, 2026

Nonsuicidal Self-Injury and Its Association With Suicidal Ideation and Negative Affect: A 12-Month Ecological Momentary Assessment

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J Clin Psychiatry 2026;87(2):25m16072

Abstract

Objective: The desire to self-harm (DSH) is a key predictor of nonsuicidal self-injury (NSSI), which is also linked to negative affect, suicidal ideation (SI), and interpersonal difficulties. However, studies on these relationships are scarce and often limited by short follow-up periods. The aim of this study was to explore the relationship between DSH and NSSI during a 12-month follow-up and to test whether SI, negative affect, and negative interpersonal experiences are risk factors for NSSI.

Methods: Adult outpatients were recruited in hospitals in Spain for presenting SI and/or a suicide attempt. The variables were registered by ecological momentary assessment (EMA) through a mobile application during a 12-month follow-up. Mixed models were used to test the association between variables.

Results: A total of 106 patients were analyzed. We found a statistically significant positive relationship between mean DSH and the occurrence of NSSI episodes (OR=1.026, 95% CI=1.005–1.046). Furthermore, higher negative affect (P=.009) and negative interpersonal experience (P<.001) were related with NSSI but showed a negative slope. Thus, NSSI patients had higher negative affect and negative interpersonal experience that decreased across the follow-up. With regard to specific emotions, restlessness, sadness, and hopelessness behaved similarly to the general variable of negative affect. By contrast, passive SI and anxiety showed a positive slope across the follow-up. Finally, intraindividual variability of SI was positively related with intraindividual mean of DSH (P<.001).

Conclusion: These results highlight the relevance of DSH in understanding NSSI. They also show the variation in the levels of SI, negative affect, and negative interpersonal experiences and their associations with NSSI. Future research should explore how to translate EMA-based monitoring into actionable suicide prevention programs implemented in routine care.

J Clin Psychiatry 2026;87(2):25m16072

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