E-ISSN : 2733-4538
Suicide is a pathological behavior that requires academic and clinical attention because it cannot be undone once accomplished. Prevention of suicide is especially important in South Korea, as the suicide rate is alarmingly high. This study aimed to investigate the relationship between non-suicidal self-injury and suicide attempt considering the roles of the acquired capability for suicide and suicidal desire, which are the concepts proposed in the interpersonal psychological theory, the latest theory of suicide. A total 91 psychiatric patients with reported depressive symptoms provided data on non-suicidal self-injury, acquired capability for suicide, suicidal desire, and the number of lifetime suicide attempts using self-report inventories. Additionally we used a pressure algometer and structured interview. Results indicated that non-suicidal self-injury significantly predicted suicide attempt, mediated by pain tolerance, which is one of the subcomponents of acquired capability for suicide. Furthermore, suicidal desire moderated the relationship between pain tolerance and suicide attempt. Lastly, pain tolerance mediated the relationship between non-suicidal self-injury and suicide attempt when suicidal desire was high but not when suicidal desire was low. Results were still significant after controlling for the effects of smoking and depressive symptoms. Implications and limitations of the study are discussed.
Aiken, L. S., West, S. G., & Reno, R. R. (1991). Multiple regression:Testing and interpreting interactions. Newbury Park, CA: Sage.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). Washington, DC: American Psychiatric Association.
Andover, M. S., & Gibb, B. E. (2010). Non-suicidal self-injury, attempted suicide, and suicidal intent among psychiatric inpatients. Psychiatry Research, 178, 101-105.
Anestis, M. D., Bagge, C. L., Tull, M. T., & Joiner, T. E. (2011). Clarifying the role of emotion dysregulation in the interpersonalpsychological theory of suicidal behavior in an undergraduate sample. Journal of Psychiatric Research, 45, 603-611.
Anestis, M. D., & Capron, D. W. (2016). An investigation of persistence through pain and distress as an amplifier of the relationship between suicidal ideation and suicidal behavior. Journal of Affective Disorders, 196, 78-82.
Anestis, M. D., & Joiner, T. E. (2011). Examining the role of emotion in suicidality: Negative urgency as an amplifier of the relationship between components of the interpersonal–psychological theory of suicidal behavior and lifetime number of suicide attempts. Journal of Affective Disorders, 129, 261-269.
Brausch, A. M., & Gutierrez, P. M. (2010). Differences in non-suicidal self-injury and suicide attempts in adolescents. Journal of Youth and Adolescence, 39, 233-242.
Briere, J., & Gil, E. (1998). Self‐mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68(4), 609-620.
Brown, M. Z., Comtois, K. A., & Linehan, M. M. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111, 198-202.
Bryan, C. J. (2011). The clinical utility of a brief measure of perceived burdensomeness and thwarted belongingness for the detection of suicidal military personnel. Journal of Clinical Psychology, 67, 981-992.
Bryan, C. J., Cukrowicz, K. C., West, C. L., & Morrow, C. E. (2010). Combat experience and the acquired capability for suicide. Journal of Clinical Psychology, 66, 1044-1056.
Bryan, C. J., Morrow, C. E., Anestis, M. D., & Joiner, T. E. (2010). A preliminary test of the interpersonal-psychological theory of suicidal behavior in a military sample. Personality and Individual Differences, 48, 347-350.
Christensen, H., Batterham, P. J., Soubelet, A., & Mackinnon, A. J. (2013). A test of the interpersonal theory of suicide in a large community-based cohort. Journal of Affective Disorders, 144, 225-234.
Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1, 16-29.
Didham, R. C., McConnell, D. W., Blair, H. J., & Reith, D. M. (2005). Suicide and self‐harm following prescription of SSRIs and other antidepressants: Confounding by indication. British Journal of Clinical Pharmacology, 60, 519-525.
Favaro, A., Santonastaso, P., Monteleone, P., Bellodi, L., Mauri, M., Rotondo, A., . . ., & Maj, M. (2008). Self-injurious behavior and attempted suicide in purging bulimia nervosa: Associations with psychiatric comorbidity. Journal of Affective Disorders, 105, 285-289.
Favazza, A. R. (1996). Bodies under siege: Self-mutilation and body modification in culture and psychiatry. (2nd ed.). Baltim ore, MD:Johans Hopkins University Press.
Fishbain, D. (2000). Evidence-based data on pain relief with antidepressants. Annals of Medicine, 3, 305-316.
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010). Antidepressant drug effects and depression severity: A patient-level meta-analysis. Journal of the American Medical Association, 303, 47-53.
Fragoso, Y. D., Frota, E. R. C., Lopes, J. S., Noal, J. S., Giacomo, M. C., Gomes, S., . . . Finkelsztejn, A. (2010). Severe depression, suicide attempts, and ideation during the use of interferon beta by patients with multiple sclerosis. Clinical Neuropharmacology, 33, 312-316.
Franklin, J. C., Aaron, R. V., Arthur, M. S., Shorkey, S. P., & Prinstein, M. J. (2012). Nonsuicidal self-injury and diminished pain perception: The role of emotion dysregulation. Comprehensive Psychiatry, 53, 691-700.
George, S. E., Page, A. C., Hooke, G. R., & Stritzke, W. G. (2016). Multifacet assessment of capability for suicide: Development and prospective validation of the Acquired Capability with Rehearsal for Suicide Scale. Psychological Assessment, 28, 1452-1464.
Glenn, C. R., & Klonsky, E. D. (2009). Social context during nonsuicidal self-injury indicates suicide risk. Personality and Individual Differences, 46, 25-29.
Groschwitz, R. C., & Plener, P. L. (2012). The neurobiology of nonsuicidal self-injury (NSSI): A review. Suicidology Online, 3, 24-32.
Guertin, T., Lloyd-Richardson, E., Spirito, A., Donaldson, D., & Boergers, J. (2001). Self-mutilative behavior in adolescents who attempt suicide by overdose. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1062-1069.
Hamza, C. A., Stewart, S. L., & Willoughby, T. (2012). Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrated model. Clinical Psychology Review, 32, 482-495.
Hawkins, K. A., Hames, J. L., Ribeiro, J. D., Silva, C., Joiner, T. E., & Cougle, J. R. (2014). An examination of the relationship between anger and suicide risk through the lens of the interpersonal theory of suicide. Journal of Psychiatric Research, 50, 59-65.
Hayes, A. F. (2016). The PROCESS macro for SPSS and SAS. URL:http://www.processmacro.org/index.html (visited on 12/07/2017).
Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Publications.
Hemmingsson, T., & Kriebel, D. (2003). Smoking at age 18-20 and suicide during 26 years of follow-up up— How can the association be explained?. International Journal of Epidemiology, 32, 1000-1004.
Jacobson, C. M., Muehlenkamp, J. J., Miller, A. L., & Turner, J. B. (2008). Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. Journal of Clinical Child & Adolescent Psychology, 37, 363-375.
Jo, M. H. (2010). Evaluation of Interpersonal psychological model of suicide in Korean army (Unpublished master’s thesis). Korea University, Seoul, Korea.
Joiner, T. (2007). Why people die by suicide. Cambridge, MA: Harvard University Press.
Joiner, T. E. Jr., Rudd, M. D., & Rajab, M. H. (1997). The Modified Scale for Suicidal Ideation: Factors of suicidality and their relation to clinical and diagnostic variables. Journal of Abnormal Psychology, 106, 260.
Joiner, T. E. Jr., Sachs-Ericsson, N. J., Wingate, L. R., Brown, J. S., Anestis, M. D., & Selby, E. A. (2007). Childhood physical and sexual abuse and lifetime number of suicide attempts: A persistent and theoretically important relationship. Behaviour Research and Therapy, 45, 539-547.
Joiner, T. E. Jr., Van Orden, K. A., Witte, T. K., Selby, E. A., Ribeiro, J. D., Lewis, R., & Rudd, M. D. (2009). Main predictions of the interpersonal-psychological theory of suicidal behavior: Empirical tests in two samples of young adults. Journal of Abnormal Psychology, 118, 634-646.
Kessler, R. C., Berglund, P., Borges, G., Nock, M., & Wang, P. S. (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. Journal of the American Medical Association, 293, 2487-2495.
Kim, J. H. (2014). Influence of acquired capabilities for suicide on adolescents’ suicide attempt (Unpublished master’s thesis). Yeungnam University, Kyungsan, Korea.
Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: Prevalence, sociodemographics, topography and functions. Psychological Medicine, 41, 1981-1986.
Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122, 231-237.
Klonsky, E. D., & Muehlenkamp, J. J. (2007). Self‐injury: A research review for the practitioner. Journal of Clinical Psychology, 63, 1045-1056.
Klonsky, E. D., Oltmanns, T. F., & Turkheimer, E. (2003). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. American Journal of Psychiatry, 160(8), 1501-1508.
Kwon, H. J. (2014). Exploration of emotional and cognitive factors influencing non-suicidal self-injury (Unpublished master’s thesis). Seoul University, Seoul, Korea.
Kwon, Y. S., Lee, H. Y., Kim, S. C., & Hyun, M. H. (2016). The Effects of thwarted interpersonal needs on perceived sense of no meaning and purpose about life and physical pain tolerance. The Korean Journal of Health Psychology, 21, 877-893.
Law, K. C., Khazem, L. R., Jin, H. M., & Anestis, M. D. (2017). Non-suicidal self-injury and frequency of suicide attempts: The role of pain persistence. Journal of Affective Disorders, 209, 254-261.
Lee, C. S. (2011). A study of the reliability and validity of the Colombia-Suicide Severity Rating Scale in Korea (Unpublished master’s thesis). Inje University, Kimhae, Korea.
Linehan, M. M. (1986). One population or two?. Annals of the New York Academy of Sciences, 487, 16-33.
Lloyd, E. E., Kelley, M. L., & Hope, T. (1997, April). Self-mutilation in a community sample of adolescents: Descriptive characteristics and provisional prevalence rates. Poster session presented at annual meeting of the Society for Behavioral Medicine, New Orleans, LA.
Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37, 1183-1192.
Matney, J., Westers, N. J., Horton, S. E., King, J. D., Eaddy, M., Emslie, G. J., . . ., & Stewart, S. M. (2018). Frequency and methods of nonsuicidal self-injury in relation to acquired capability for suicide among adolescents. Archives of Suicide Research, 22, 91-105.
Muehlenkamp, J. J., & Gutierrez, P. M. (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.
Muehlenkamp, J. J., & Gutierrez, P. M. (2007). Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Archives of Suicide Research, 11, 69-82.
Muehlenkamp, J. J., Swenson, L. P., Batejan, K. L., & Jarvi, S. M. (2015). Emotional and behavioral effects of participating in an online study of nonsuicidal self-injury: An experimental analysis. Clinical Psychological Science, 3, 26-37.
Nock, M. K. (2009). Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18, 78-83.
Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 339-363.
Nock, M. K., Joiner, T. E., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents:Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144, 65-72.
Nock, M. K., & Kessler, R. C. (2006). Prevalence of and risk factors for suicide attempts versus suicide gestures: Analysis of the National Comorbidity Survey. Journal of Abnormal Psychology, 115, 616-623.
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885.
Park, Y. S. (2017). The interaction effects between personality and interpersonal needs in predicting current suicide ideation (Unpublished master’s thesis). Sogang University, Seoul, Korea.
Phillips, M. R. (2010). Rethinking the role of mental illness in suicide. Unpublished manuscript.
Plener, P. L., Libal, G., Keller, F., Fegert, J. M., & Muehlenkamp, J. J. (2009). An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychological Medicine, 39, 1549-1558.
Posner, K., Brodsky, B., Yershova, K., Buchanan, J., & Mann, J. (2014). The classification of suicidal behavior. In M. Nock (Ed.), The Oxford handbook of suicide and self-injury (pp. 7-22). Oxford, UK: Oxford University Press.
Posner, K., Oquendo, M. A., 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.
Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, 36, 717-731.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879-891.
Ribeiro, J. D., Witte, T. K., Van Orden, K. A., Selby, E. A., Gordon, K. H., Bender, T. W., & Joiner, T. E. Jr. (2014). Fearlessness about death: The psychometric properties and construct validity of the revision to the Acquired Capability for Suicide Scale. Psychological Assessment, 26, 115-126.
Rudd, M. D. (1989). The prevalence of suicidal ideation among college students. Suicide and Life‐Threatening Behavior, 19, 173-183.
Smith, P. N., Cukrowicz, K. C., Poindexter, E. K., Hobson, V., & Cohen, L. M. (2010). The acquired capability for suicide: A comparison of suicide attempters, suicide ideators, and non‐suicidal controls. Depression and Anxiety, 27, 871-877.
Smith, P. N., Wolford-Clevenger, C., Mandracchia, J. T., & Jahn, D. R. (2013). An exploratory factor analysis of the Acquired Capability for Suicide Scale in male prison inmates. Psychological Services, 10, 97-105.
Solomon, R. L. (1980). The opponent-process theory of acquired motivation: The costs of pleasure and the benefits of pain. American Psychologist, 35, 691.
Stanley, B., Winchel, R., Molcho, A., Simeon, D., & Stanley, M. (1992). Suicide and the self-harm continuum: Phenomenological and biochemical evidence. International Review of Psychiatry, 4, 149-155.
Tang, J., Yu, Y., Wu, Y., Du, Y., Ma, Y., Zhu, H., . . . Liu, Z. (2011). Association between non-suicidal self-injuries and suicide attempts in Chinese adolescents and college students: A cross-section study. PLoS One, 6, e17977.
Thomas, H. V., Crawford, M., Meltzer, H., & Lewis, G. (2002). Thinking life is not worth living. Social Psychiatry and Psychiatric Epidemiology, 37, 351-356.
Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. Jr. (2012). Thwarted belongingness and perceived burdensomeness:Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24, 197.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575-600.
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. Jr. (2008). Suicidal desire and the capability for suicide:tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72-83.
Van Orden, K. A., Witte, T. K., James, L. M., Castro, Y., Gordon, K. H., Braithwaite, S. R., . . ., & Joiner, T. E. Jr. (2008). Suicidal ideation in college students varies across semesters: The mediating role of belongingness. Suicide and Life-Threatening Behavior, 38, 427-435.
Van Ree, J. M., Niesink, R. J., Van Wolfswinkel, L., Ramsey, N. F., Van Furth, W. R., Vanderschuren, L. J., . . ., & Van den Berg, C. L. (2000). Endogenous opioids and reward. European Journal of Pharmacology, 405, 89-101.
Whitlock, J., Muehlenkamp, J., & Eckenrode, J. (2008). Variation in nonsuicidal self-injury: Identification and features of latent classes in a college population of emerging adults. Journal of Clinical Child & Adolescent Psychology, 37, 725-735.
Wilcox, H. C., Arria, A. M., Caldeira, K. M., Vincent, K. B., Pinchevsky, G. M., & O’Grady, K. E. (2012). Longitudinal predictors of past-year non-suicidal self-injury and motives among college students. Psychological Medicine, 42, 717-726.
Wilkinson, P., Kelvin, R., Roberts, C., Dubicka, B., & Goodyer, I. (2011). Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT). American Journal of Psychiatry, 168, 495-501.
Willoughby, T., Heffer, T., & Hamza, C. A. (2015). The link between nonsuicidal self-injury and acquired capability for suicide: A longitudinal study. Journal of Abnormal Psychology, 124, 1110.
Witte, T. K., Joiner, T. E., Brown, G. K., Beck, A. T., Beckman, A., Duberstein, P., & Conwell, Y. (2006). Factors of suicide ideation and their relation to clinical and other indicators in older adults. Journal of Affective Disorders, 94, 165-172.
Wong, Y. J., Koo, K., Tran, K. K., Chiu, Y. C., & Mok, Y. (2011). Asian American college students' suicide ideation: A mixedmethods study. Journal of Counseling Psychology, 58, 197.
World Health Organization. (2014). Preventing Suicide: a global imperative (pp. 7-11). Geneva, Switzerland: WHO Press.