Article Summary
Clinical Summary: Nonsuicidal Self-Injury and Its Association With Suicidal Ideation and Negative Affect: A 12-Month Ecological Momentary Assessment
Adults discharged after a suicide attempt or severe suicidal ideation remain at risk for nonsuicidal self-injury, but clinicians often have little guidance on which day-to-day signals matter most. This study identifies repeated self-reported desire to self-harm, passive suicidal ideation, and negative affect as the clearest markers of NSSI risk during follow-up in a high-risk adult population.
Design
This is a prospective study
N
N = 106 participants
Population
Adult patients were invited to participate if they had presented with a suicide attempt or severe SI in the past month.
Duration
Study variables were monitored over 12 months using EMA via the app
Key Findings
- Participants who engaged in NSSI during follow-up had greater desire to self-harm (DSH) (F1,81 =9.81, P=.003), with mean =53.96, SD =33.65; mean DSH score on the day of NSSI was 59.00 (SD=22.74).
- The intraindividual mean of DSH discriminated NSSI with AUC=0.743, while DSH intraindividual variability was not associated with NSSI (Z=0.408, P=.683, OR=1.021, 95% CI=0.925–1.127) and showed AUC=0.563.
- NSSI was statistically significantly associated with higher negative affect (F1,94 =4.22, P=.043), with mean± SEM= 64.5±4.39 in the NSSI group versus mean± SEM= 54.8±1.79 in the non-NSSI group.
- Patients who engaged in NSSI had higher passive suicidal ideation than non-NSSI patients (NSSI×ideation type: F1,5097 =40.74, P<.001), with mean ±SEM=53.8±3.90 versus mean ±SEM=42.4±1.68; passive SI also increased across follow-up in the NSSI group (b [SE]=0.029 [0.014], t =2.30, P =.042).
- Within specific symptom domains, restlessness was higher in the NSSI group (mean ±SEM=69.6±5.23 vs mean ±SEM=45.1±1.40, P =.005), and lack of independence was also higher (mean ±SEM=66.7±5.71 vs mean±SEM=45.0 ±2.66, P=.032).
Clinical Bottom Line
In high-risk adults after a suicidal crisis, repeated reports of desire to self-harm, passive suicidal ideation, and elevated negative affect identify patients most likely to engage in NSSI during follow-up. Monitoring these signals should be part of post-discharge suicide prevention care.
Practice Implications
- Ask directly and repeatedly about desire to self-harm and passive suicidal ideation during follow-up after a suicide attempt or severe SI, because higher DSH and higher passive SI were the clearest NSSI-linked signals in this cohort.
- Pay added attention to patients with prominent negative affect, especially restlessness, because the NSSI group showed higher overall negative affect (64.5±4.39 vs 54.8±1.79) and higher restlessness (69.6±5.23 vs 45.1±1.40).
- Do not rely on variability in DSH alone to identify NSSI risk, as DSH variability was not associated with NSSI (P=.683) and had poor discrimination (AUC=0.563), whereas mean DSH performed better (AUC=0.743).
- Include interpersonal functioning in assessment, particularly feelings of lack of independence, which were higher in the NSSI group (66.7±5.71 vs 45.0 ±2.66), even though overall interpersonal problems were not associated with NSSI.
