Differentiating Nonsuicidal Self‐Injury (NSSI) From Suicide Attempts in Adolescents: A Pilot Study

ABSTRACT Background Differentiating between nonsuicidal self‐injury (NSSI) and suicide attempts (SA) in adolescents is crucial due to distinct underlying motivations, treatment needs, and potential outcomes associated with each behavior. This study explores biomarkers, specifically β ‐endorphin and endocannabinoids [anandamide (AEA), 2‐arachidonoylglycerol (2‐AG), N‐palmitoylethanolamide (PEA), and oleoylethanolamide (OEA)], in adolescents admitted for NSSI and/or SA. Objectives We aimed to explore potential differences in different variables among adolescents hospitalized for NSSI, SA, or both. Method This pilot study enrolled 68 adolescents admitted for NSSI and/or SA at Puerta de Hierro University Hospital. Excluding those with endocrine issues, participants underwent clinical assessments, blood collection, and serum analysis for ACTH, cortisol, and β ‐endorphin, with endocannabinoids measured via LC–MS. Clinical tools, such as the MINI Kid and CTQ and statistical analyses via SPSS and Stata aimed to elucidate behavioral and biological differences between NSSI and SA groups. Results No sociodemographic factor differentiated the groups. Gestational diabetes and depression during pregnancy were more frequent in the NSSI group ( p = 0.047 and p = 0.003, respectively). Abnormal presentation at birth was overrepresented in the SA group ( p = 0.001). Familial antecedents of either suicide or SB were more frequently reported in the NSSI + SA group ( p = 0.027 and p = 0.035, respectively). Blood PEA and β ‐endorphin were significantly elevated in the SA group ( p < 0.006 and 0.014, respectively). Discussion This study identified shared risk factors across NSSI and SA, with distinct variables for each group, including β ‐endorphin and PEA biomarker elevations linked to SA.