Stressful life events and depressive symptom severity associated with suicide planning among adolescents with depression and non-suicidal self-injury: a cross-sectional study

BACKGROUND: Adolescent suicide is a major global public health concern. Suicide planning represents a critical transition in the suicidal process among adolescents with depression and non-suicidal self-injury (NSSI). Stressful life events and sleep disturbances are common in this population; however, their relative contributions to suicide planning remain unclear. This study aimed to examine the associations of stressful life events, insomnia symptoms, and emotional symptoms with suicide planning among adolescents with depression and NSSI. METHODS: This cross-sectional study included 100 adolescents with depression and NSSI. Suicide planning within the past month was assessed using the suicide plan item (Q4) of the Mini-International Neuropsychiatric Interview. Stressful life events, insomnia symptoms, depressive symptoms, anxiety symptoms, and lifetime history of suicide attempt were assessed using clinical interview items and self-report measures. Multivariable logistic regression analyses were conducted to identify factors independently associated with suicide planning. RESULTS: Among the participants, 57 (57.0%) reported suicide planning within the past month. Adolescents with suicide planning showed significantly greater exposure to stressful life events, higher insomnia symptom burden, and more severe depressive and anxiety symptoms compared with those without suicide planning. Stressful life events were significantly associated with insomnia symptom burden (standardized β = 0.36, p < 0.001). In the fully adjusted logistic regression model, stressful life events (OR = 1.07, 95% CI: 1.02-1.12, p = 0.007) and depressive symptoms (OR = 1.16, 95% CI: 1.02-1.31, p = 0.019) were independently associated with suicide planning, whereas insomnia symptoms were not independently associated with suicide planning. CONCLUSIONS: Among adolescents with depression and NSSI, stressful life events and depressive symptom severity are independently associated with suicide planning. These findings highlight the importance of addressing psychosocial stressors and depressive symptoms in suicide risk assessment and prevention strategies for high-risk adolescents.