Nonsuicidal Self-Injury as a Predictor of Suicidal Behavior in Depressed Adolescents

Conventional wisdom has viewed suicidal behavior as much more ominous than nonsuicidal self-injury.The thoughtful and clearly written article in this issue by Wilkinson and colleagues (1) from the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT) should make us view nonsuicidal self-injury more seriously, as it was a stronger predictor of future suicidal behavior than was a previous history of a suicide attempt.While this may be surprising, it is not an isolated finding.Previous studies have found that nonsuicidal self-injury predicts persistence of suicidal ideation and that these two types of self-destructive behaviors are highly associated, especially in clinical populations (2).There are at least three possible explanations for this relationship: nonsuicidal self-injury and suicidal behavior are on the same spectrum of self-destructive behavior; nonsuicidal selfinjury and suicidal behavior have similar correlates; or engaging in nonsuicidal self-injury somehow predisposes to suicidal behavior.