Non-suicidal self-injury after a suicide attempt: different trajectories, different levels of vulnerability

A longitudinal study examines how non-suicidal self-injury evolves during the year following a suicide attempt and its relationship with suicide reattempt risk

Not all non-suicidal self-injury follows the same course after a suicide attempt. Some individuals do not engage in it, others begin during follow-up, others stop over time, and a more vulnerable subgroup continues to engage in it. According to a new study published in Journal of Affective Disorders, these differences may be clinically relevant for understanding the risk of future suicide attempts.

The study followed 685 adults for 12 months after they had been treated in emergency services following a suicide attempt. Researchers identified four trajectories of non-suicidal self-injury: persistent absence, onset during follow-up, remission, and persistence over time. The most common pattern was the continued absence of self-injury. In contrast, 17% of participants showed persistent non-suicidal self-injury between the initial assessment and the 12-month follow-up.

This latter group displayed a particularly complex clinical profile, characterized by greater psychological distress, more extensive trauma histories, higher impulsivity, and greater acquired capability for suicide—a concept referring to habituation to pain, bodily harm, or fear of death. One particularly noteworthy finding was that individuals who developed non-suicidal self-injury during follow-up tended to reattempt suicide sooner. In contrast, among those with persistent self-injury, post-traumatic stress disorder emerged as a relevant predictor of suicide reattempt during follow-up.

One of the study’s most important contributions is the finding that non-suicidal self-injury does not appear to have a single clinical meaning. For some individuals, it may function as a way of managing intense emotions or temporarily reducing psychological distress. However, the authors caution against interpreting this as a stable protective effect. Persistent self-injury was associated with greater clinical vulnerability and indicators of more severe psychological difficulties.

The findings suggest that, following a suicide attempt, non-suicidal self-injury should not be viewed as a static characteristic. Rather, its course over time may provide valuable information about different levels of vulnerability and clinical risk.

Original study:

Arqueros, M., Diaz-Marsá, M., Suarez-Soto, E., de la Torre-Luque, A., Andreo-Jover, J., Ayad-Ahmed, W., et al. (2026). Post-attempt NSSI patterns and timing of reattempt: Descriptive trends and adjusted hazard over 12 months. Journal of Affective Disorders, 403, 121399. https://doi.org/10.1016/j.jad.2026.121399