Distinct Psychological Profiles of Adolescent Psychiatric Outpatients With Non-Suicidal Self-Injury Stratified by Suicidal Ideation.

Background

Non-suicidal self-injury (NSSI) is a critical clinical marker in early psychiatric intervention for adolescents. It often co-occurs with suicidal ideation (SI), but it remains unclear which component-NSSI or SI-more accurately reflects the underlying psychological burden.

Methods

In this retrospective cross-sectional study, 417 adolescent outpatients (13-18 years) were classified into four groups: no NSSI/no SI (n = 292), SI without NSSI (n = 66), NSSI without SI (n = 31) and NSSI with SI (n = 28). At intake, participants completed the QIDS (depressive symptoms; QIDS_noSI), HQ-25 (social withdrawal), TACS-22 (modern-type depressive traits) and BRS (resilience). Group differences were tested using ANOVA with variance-robust procedures as needed.

Results

Non-suicidal self-injury (NSSI) was present in 14.1% of participants, and suicidal ideation (SI) was endorsed by 22.5%. Depressive symptom severity (excluding suicidal ideation) was higher in both groups with SI regardless of their NSSI status; furthermore, among adolescents with NSSI, the presence of SI was associated with greater depressive severity. Social withdrawal was elevated primarily in adolescents who reported SI without NSSI compared to those with neither behaviour. Scores for modern-type depressive traits were also higher in the two groups experiencing SI. Psychological resilience showed only a marginal overall group effect.

Conclusions

In routine outpatient settings, psychological profiles often attributed to NSSI were more strongly driven by the presence of SI. These findings suggest that for early intervention, stratifying adolescent patients by SI status-rather than focusing on NSSI alone-is essential for identifying those with greater depressive burden and social withdrawal. This approach allows for more precise risk assessment and individualised care planning at the point of initial clinical contact.