Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.
Early Interv Psychiatry. 2019 Apr;13(2):194-201. doi: 10.1111/eip.12461. Epub 2017 Jul 18.
Non-suicidal self-injury (NSSI) is a recognized indicator of suicide risk. Yet, the ubiquity of this behaviour in borderline personality disorder (BPD) limits its utility as a predictor of risk. Consequently, this study aimed to elucidate the relationship between other features of NSSI, including frequency and severity, and suicide attempts.
Participants included 107 youth (15 to 25 year olds) with BPD who were assessed for BPD severity, depressive symptoms, 12-month frequency of NSSI and suicide attempts, as well as the levels of treatment sought following each self-harm event.
Three-quarters (75.7%) of youth with BPD reported NSSI and two-thirds (66.4%) reported a suicide attempt over the previous 12 months. The frequency of NSSI over the previous 12 months did not show a linear or quadratic relationship with the number of suicide attempts when adjusting for severity of depression, impulsivity and interpersonal problems. NSSI severity was not associated with more frequent suicide attempts. Only impulsivity and depression were uniquely predictive of suicide attempt frequency. A relative increase in the frequency and severity of NSSI occurred in the months prior to a suicide attempt.
The prevalence of NSSI and suicide attempts among youth presenting for their first treatment of BPD appear to be perilously high, considerably higher than rates reported by adults with BPD. Findings suggest that clinicians should give more weight to average levels of impulsivity and depression, rather than the absolute frequency and severity of NSSI, when assessing for risk of suicide attempts. Notwithstanding this, a relative increase in the frequency and severity of NSSI appears to be predictive of a forthcoming suicide attempt.
非自杀性自伤（NSSI）是自杀风险的公认指标。然而，边缘型人格障碍（BPD）中这种行为的普遍性限制了其作为风险预测指标的效用。因此，本研究旨在阐明 NSSI 的其他特征（包括频率和严重程度）与自杀企图之间的关系。
参与者包括 107 名患有 BPD 的年轻人（15 至 25 岁），他们接受了 BPD 严重程度、抑郁症状、12 个月内 NSSI 和自杀企图的频率以及每次自残事件后寻求治疗的程度的评估。
四分之三（75.7%）的 BPD 年轻人报告在过去 12 个月内有 NSSI，三分之二（66.4%）报告有自杀企图。在调整抑郁、冲动和人际关系问题严重程度后，过去 12 个月内 NSSI 的频率与自杀企图的数量之间没有线性或二次关系。NSSI 的严重程度与更频繁的自杀企图无关。只有冲动和抑郁对自杀企图的频率具有独特的预测作用。在自杀企图前的几个月，NSSI 的频率和严重程度相对增加。
在首次接受 BPD 治疗的年轻人中，NSSI 和自杀企图的患病率似乎非常高，远高于 BPD 成年患者的报告率。研究结果表明，临床医生在评估自杀企图的风险时，应更加重视冲动和抑郁的平均水平，而不是 NSSI 的绝对频率和严重程度。尽管如此，NSSI 频率和严重程度的相对增加似乎预示着即将发生的自杀企图。
