Combined nonsuicidial and suicidal self-injurious behavior: transnosological role of family history and adverse childhood experiences

The combination of non-suicidal self-injurious behavior (NSSI) and suicide attempts (SA) is the most pronounced variant of self-harming behavior and is associated with a significant increase in the risk of suicide. However, insufficient information is available on the complex transnosological influence of adverse childhood experiences (ACE) and family history (FH) of mental, somatic and substance abuse disorders and self-injurious behavior on the risk of developing a combination of NSSI and SA. Aim of the study. To evaluate the transnosological association of ACE and FH with a combination of NSSI and SA in patients with affective disorders and schizophrenia spectrum disorders. Patients and methods. The sample consisted of 465 patients (63.9% women), median (Q1-Q3) age 28 (23-38) years, with affective disorders (75.3%) and schizophrenia spectrum disorders. A combination of NSSI and SA was reported by 21.5% (n=100) of patients. Sociodemographic characteristics and information on FH were collected during a clinical interview. ACE was assessed using the Adverse Childhood Experiences International Questionnaire (ACE-IQ). Between-group comparisons were conducted, and regression analysis was used to comprehensively assess the association of FH, ACE, gender, age, and diagnostic group with the combination of NSSI and SA. Results. Patients with a combination of NSSI and SA more often reported FH with suicide attempts (25.0% vs. 6.8%, p<0.001), as well as such types of ACE as physical abuse (33.8% vs. 11.4%, p<0.001), emotional abuse (59.0% vs. 32.8%, p<0.001), domestic violence (74.4% vs. 59.2%, p=0.015), emotional neglect (67.9% vs. 35.5%, p<0.001), bullying (39.7% vs. 20.3%, p<0.001), deprivation (divorce or death) of parents (60.3% vs. 43.6%, p=0.01). Logistic regression revealed significant associations with suicide attempts (OR=3.212, p=0.003), physical abuse (OR=2.515, p=0.01), emotional neglect (OR=2.122, p=0.016), age (for each year, OR=0.905, p<0.001) with a combination of SA and NSSI. Conclusions. The obtained results demonstrate the presence of a complex transnosological interaction of hereditary and environmental factors in the development of a combination of NSSI and SA, which indicates the need to consider them when studying self-harming behavior. The results of this study can serve as a basis for further research into the transnosological biological mechanisms of the development of NSSI and suicidal behavior. This will potentially allow for the creation of more accurate predictive models of high suicide risk and the development of targeted preventive measures for vulnerable patient groups.