Nonsuicidal self-injury as a mediator between dissociative experiences and suicide risk in adolescents: Insights from a clinical setting

A burgeoning body of evidence suggests a higher prevalence of nonsuicidal self-injury (NSSI) behaviors among adolescents. This study aimed to examine the comorbid internalizing symptoms and suicidal behaviors, along with associations between dissociative experiences and suicide risk in adolescents attending a psychiatric outpatient unit in Ankara, Türkiye. The study included 81 adolescents aged 12-18 years, who engaged in NSSI and sought treatment at a psychiatric outpatient clinic. Psychiatric evaluations were conducted through semi-structured clinical interviews. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, and suicide risk was measured using the Suicide Probability Scale. Additionally, internalizing symptoms and dissociative experiences were evaluated using the Revised Children's Anxiety and Depression Scale-Child Version and the Adolescent Dissociative Experiences Scale, respectively. Moderate to high correlations were found among suicide risk, dissociation, NSSI severity, anxiety and internalizing scores. Mediation analysis revealed that NSSI significantly mediated the relationship between dissociation and suicide risk. These findings indicate that assessing both dissociation and NSSI could provide valuable insights into comprehending and addressing adolescent suicide, thereby facilitating the development of targeted interventions to mitigate the effects of dissociative experiences.