Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-29T19:38:30.156Z Has data issue: false hasContentIssue false
  • English
  • Français

An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA

Published online by Cambridge University Press:  27 January 2009

P. L. Plener ,
G. Libal ,
F. Keller ,
J. M. Fegert  and
J. J. Muehlenkamp
P. L. Plener*
Affiliation:
Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany
G. Libal
Affiliation:
Department of Child and Adolescent Psychiatry, University of Basel, Switzerland
F. Keller
Affiliation:
Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany
J. M. Fegert
Affiliation:
Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany
J. J. Muehlenkamp
Affiliation:
Department of Psychology, University of North Dakota, USA
*
*Address for correspondence: Dr P. L. Plener, Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, D-89075 Ulm, Germany. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

This study examined the prevalence of non-suicidal self-injury (NSSI), suicide attempts, suicide threats and suicidal ideation in a German school sample and compared the rates with a similar sample of adolescents from the midwestern USA by using cross-nationally validated assessment tools.

Method

Data were provided from 665 adolescents (mean age 14.8 years, s.d.=0.66, range 14–17 years) in a school setting. Students completed the Self-Harm Behavior Questionnaire (SHBQ), the Ottawa Self-Injury Inventory (OSI) and a German version of the Center for Epidemiological Studies–Depression Scale (CES-D).

Results

A quarter of the participants (25.6%) endorsed at least one act of NSSI in their life, and 9.5% of those students answered that they had hurt themselves repetitively (more than four times). Forty-three (6.5%) of the students reported a history of a suicide attempt. No statistically significant differences were observed between the German and US samples in terms of self-injury or suicidal behaviors.

Conclusions

By using the same validated assessment tools, no differences were found in the prevalence and characteristics of self-injury and suicidal behaviors between adolescents from Germany and the USA. Thus, it seems that NSSI has to be understood as worldwide phenomenon, at least in Western cultures.

Keywords

Adolescentsdeliberate self-harm (DSH)non-suicidal self-injury (NSSI)prevalenceself-injuring behavior (SIB)
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 9 , September 2009 , pp. 1549 - 1558
Copyright
Copyright © 2009 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Brunner, R, Parzer, P, Haffner, J, Steen, R, Roos, J, Klett, M, Resch, F (2007). Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Archives of Pediatrics and Adolescent Health 161, 641–649.CrossRefGoogle ScholarPubMed
Cloutier, P, Humphreys, L (2008). Measurement of nonsuicidal self-injury in adolescents. In Self-Injury in Youth (ed. Nixon and, M. K.Heath, N. L.), pp. 115–142. Routledge: New York.Google Scholar
Csorba, J, Szelesne, EF, Steiner, P, Farkas, L, Nemeth, A (2005). Symptom specificity of adolescents with self-injurious behavior. Psychiatria Hungarica 20, 456–462.Google ScholarPubMed
Favaro, A, Ferrara, S, Santonastaso, P (2007). Self-injurious behavior in a community sample of young women: relationship with childhood abuse and other types of self-damaging behaviors. Journal of Clinical Psychiatry 68, 122–131.CrossRefGoogle Scholar
Favazza, AR (1998). The coming of age of self-mutilation. Journal of Nervous and Mental Disease 186, 259–268.CrossRefGoogle ScholarPubMed
Fliege, H, Kocalevent, RD, Walter, OB, Gratz, KL, Gutierrez, PM, Klapp, BF (2006). Three assessment tools for deliberate self-harm and suicide behaviour: evaluation and psychopathological correlates. Journal of Psychosomatic Research 61, 113–121.CrossRefGoogle ScholarPubMed
Friedman, RA (2006). Uncovering an epidemic – screening for mental illness in teens. New England Journal of Medicine 355, 2717–2719.CrossRefGoogle ScholarPubMed
Gould, MS, Marrocco, FA, Kleinmann, M, Thomas, JG, Mostkoff, K, Cote, J, Davies, M (2005). Evaluating iatrogenic risk of youth suicide screening programs. Journal of the American Medical Association 293, 1635–1643.CrossRefGoogle ScholarPubMed
Gratz, KL (2006). Risk factors for deliberate self-harm among female college students: the role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. American Journal of Orthopsychiatry 76, 238–250.CrossRefGoogle ScholarPubMed
Gutierrez, PM, Osman, A (2008). Adolescent Suicide: An Integrated Approach to the Assessment of Risk and Protective Factors. Northern Illinois University Press: DeKalb, IL.Google Scholar
Gutierrez, PM, Osman, A, Barrios, FX, Kopper, BA (2001). Development and initial validation of the self-harm behavior questionnaire. Journal of Personality Assessment 77, 475–490.CrossRefGoogle ScholarPubMed
Hawton, K, Bergen, H, Casey, D, Simkin, S, Palmer, B, Coooper, J, Kapur, N, Horrocks, J, House, A, Lilley, R, Noble, R, Owens, D (2007). Self-harm in England: a tale of three cities. Social Psychiatry and Psychiatric Epidemiology 42, 513–521.CrossRefGoogle Scholar
Hawton, K, Rodham, K, Evans, E, Weatherall, R (2002). Deliberate self-harm in adolescents: self-report survey in schools in England. British Medical Journal 325, 1207–1211.CrossRefGoogle ScholarPubMed
Heath, NL, Nixon, MK (2008). Assessment of nonsuicidal self-injury in youth. In Self-Injury in Youth (ed. Nixon and, M. K.Heath, N. L.), pp. 143–170. Routledge: New York.Google Scholar
Jacobson, CM, Gould, M (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature. Archives of Suicide Research 11, 129–147.CrossRefGoogle ScholarPubMed
Joiner, T (2005). Why People Die by Suicide. Harvard University Press: Cambridge, MA.Google Scholar
Kirkcaldy, BD, Brown, J, Siefen, RG (2006). Disruptive behaviour disorders, self harm and suicidal ideation among German adolescents in psychiatric care. International Journal of Adolescent Medicine and Health 18, 597–614.CrossRefGoogle ScholarPubMed
Laye-Gindhu, A, Schonert-Reichl, KA (2005). Nonsuicidal self-harm among community adolescents: understanding the ‘whats’ and ‘whys’ of self-harm. Journal of Youth and Adolescence 34, 447–457.CrossRefGoogle Scholar
Lloyd-Richardson, EE, Perrine, N, Dierker, L, Kelley, ML (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine 37, 1183–1192.CrossRefGoogle Scholar
Lundh, LG, Karim, J, Quilisch, E (2007). Deliberate self-harm in 15-year-old adolescents: a pilot study with a modified version of the Deliberate Self-Harm Inventory. Scandinavian Journal of Psychology 48, 33–41.CrossRefGoogle ScholarPubMed
Madge, N, Hewitt, A, Hawton, K, de Wilde, EJ, Corcoran, P, Fekete, S, van Heeringen, K, De Leo, D, Ystgaard, M (2008). Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-Harm in Europe (CASE) study. Journal of Child Psychology and Psychiatry 49, 667–677.CrossRefGoogle ScholarPubMed
Mitchell, KJ, Ybarra, ML (2007). Online behaviour of youth who engage in self-harm provides clues for preventive intervention. Preventive Medicine 45, 392–396.CrossRefGoogle ScholarPubMed
Muehlenkamp, JJ (2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry 75, 324–333.CrossRefGoogle ScholarPubMed
Muehlenkamp, JJ, Gutierrez, PM (2004). An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide and Life-Threatening Behavior 34, 12–23.CrossRefGoogle Scholar
Muehlenkamp, JJ, Gutierrez, PM (2007). Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Archives of Suicide Research 11, 69–82.CrossRefGoogle ScholarPubMed
Nada-Raja, S, Skegg, K, Langley, J, Morrison, D, Sowerby, P (2004). Self-harmful behaviors in a population-based sample of young adults. Suicide and Life-Threatening Behavior 34, 177–186.CrossRefGoogle Scholar
Nixon, MK, Cloutier, PF, Aggarwal, S (2002). Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 41, 1333–1341.CrossRefGoogle ScholarPubMed
Nock, MK, Joiner, TE Jr., Gordon, KH, Lloyd-Richardson, E, Prinstein, MJ (2006). Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Research 30, 65–72.CrossRefGoogle Scholar
Nock, MK, Kessler, RC (2006). Prevalence and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. Journal of Abnormal Psychology 115, 616–623.CrossRefGoogle ScholarPubMed
Patton, GC, Harris, R, Carlin, JB, Hibbert, ME, Coffey, C, Schwartz, M, Bowes, G (1997). Adolescent suicidal behaviours: a population-based study of risk. Psychological Medicine 27, 715–724.CrossRefGoogle ScholarPubMed
Patton, GC, Hemphill, SA, Beyers, JM, Bond, L, Toumbourou, JW, McMorris, BJ, Catalano, RF (2007). Pubertal stage and deliberate self-harm in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 46, 508–514.CrossRefGoogle ScholarPubMed
Portzky, G, De Wilde, EJ, van Heeringen, K (2008). Deliberate self harm in young people: differences in prevalence and risk factors between The Netherlands and Belgium. European Child and Adolescent Psychiatry 17, 179–186.CrossRefGoogle ScholarPubMed
Posner, K, Oquendo, MA, Gould, M, Stanley, B, Davies, M (2007). Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. American Journal of Psychiatry 164, 1035–1043.CrossRefGoogle ScholarPubMed
Rodham, K, Hawton, K, Evans, E (2004). Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 43, 80–87.CrossRefGoogle Scholar
Ross, S, Heath, N (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence 31, 67–77.CrossRefGoogle Scholar
Silverman, MM, Berman, AL, Sanddal, ND, O'Carroll, PW, Joiner, TE (2007). Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications and behaviors. Suicide and Life-Threatening Behavior 37, 264–277.CrossRefGoogle Scholar
Skegg, K, Nada-Raja, S, Moffitt, TE (2004). Minor self-harm and psychiatric disorder: a population-based study. Suicide and Life-Threatening Behavior 34, 187–196.CrossRefGoogle ScholarPubMed
Sourander, A, Aromaa, M, Pihlakoski, L, Haavisto, A, Rautava, P, Helenius, H, Sillanpaa, M (2006). Early predictors of deliberate self-harm among adolescents. A prospective follow-up study from age 3 to age 15. Journal of Affective Disorders 93, 87–96.CrossRefGoogle ScholarPubMed
Tigges, BB (2003). Parental consent and adolescent risk behavior research. Journal of Nursing Scholarship 35, 283–289.CrossRefGoogle ScholarPubMed
Whitlock, J, Eckenrode, J, Silverman, D (2006). Self-injurious behaviors in a college population. Pediatrics 117, 1939–1948.CrossRefGoogle Scholar
Whitlock, J, Knox, KL (2007). The relationship between self-injurious behaviour and suicide in a young adult population. Archives of Pediatrics and Adolescent Medicine 161, 634–640.CrossRefGoogle Scholar
Whitlock, J, Powers, JL, Eckenrode, J (2006). The virtual cutting edge: the internet and adolescent self-injury. Developmental Psychology 42, 407–417.CrossRefGoogle ScholarPubMed
Young, R, Sweeting, H, West, P (2006). Prevalence of deliberate self-harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study. British Medical Journal 332, 1058–1061.CrossRefGoogle ScholarPubMed
Young, R, van Beinum, M, Sweeting, H, West, P (2007). Young people who self-harm. British Journal of Psychiatry 191, 44–49.CrossRefGoogle ScholarPubMed
Zoroglu, SS, Tuzun, U, Sar, V, Tutkun, H, Savacs, HA, Ozturk, M, Alyanak, B, Kora, ME (2003). Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation. Psychiatry and Clinical Neurosciences 57, 119–126.CrossRefGoogle ScholarPubMed