1 - (IOP 8) Psychiatric Predictors of First-onset Non-suicidal Self-injurious Behaviors During Preadolescence: Longitudinal Associations in a US Population-based Study

Introduction: Non-suicidal self-injury (NSSI), defined as deliberate self-harm without intent to die, is a robust predictor of prospective engagement in suicide behavior. Yet, research on risk factors for NSSI in preadolescence is scant, despite rising rates of NSSI in this group. Therefore, research that seeks to identify risk factors associated with preadolescent NSSI is needed.

Methods: Data were drawn from the Adolescent Brain and Cognitive Development Study (ABCD; data release 5.1) and included participants under 13 years old at their two-year follow-up (n = 9,940) with no prior history of NSSI or suicide attempts. NSSI and psychiatric current and lifetime psychiatric disorders were assessed using parent and child reports from the computerized Kiddie Schedule for Affective disorders and Schizophrenia – Present and Lifetime Version. A series of bivariate and multivariate logistic regression analyses examined current and lifetime psychiatric predictors of first-onset NSSI and transitions from NSSI to suicide attempts, controlling for age, sex, and baseline suicidal ideation. Additionally, psychiatric treatment utilization during first-onset of NSSI was examined using cross-tabulations.

Results: Among youth without baseline NSSI (n = 8,745), 7.59% experienced first-onset NSSI before adolescence. Lifetime and current diagnoses of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD), along with lifetime post-traumatic stress disorder (PTSD) predicted first-onset NSSI in multivariate models. Among preadolescents with first-onset NSSI and no prior suicidal behavior (n = 827), 5.93% attempted suicide at a subsequent time point; however, no psychiatric diagnoses predicted this transition. NSSI was associated with increased odds of developing multiple psychiatric disorders, including MDD, anxiety, and behavioral disorders. Only 30.86% of preadolescents with first-onset NSSI received mental health services within the year of onset.

Discussion: Findings underscore the need for early identification and intervention strategies targeting NSSI in preadolescents. The association of NSSI with psychiatric disorders highlights the importance of comprehensive mental health assessments in this population. The lack of specific psychiatric predictors for the transition from NSSI to SA suggests that all youth exhibiting NSSI behaviors should be closely monitored for potential escalation to suicidal behaviors. Furthermore, the underutilization of mental health services among youth with NSSI indicates a gap in service provision, emphasizing the need for increased access to and engagement in appropriate mental health care. Future research should focus on developing targeted interventions to address NSSI and its associated risks in this preadolescent population, as well as strategies to improve mental health service utilization among affected youth.