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April 28, 2022

New meta-analysis examines link between self-harm and stress

Nearly one-fifth of teens and young adults engage in self-injury, while just as many teens seriously consider attempting suicide. Both are considered a risk for suicidal behavior, but studies of why people harm themselves, or think about suicide, haven’t been examined in a comprehensive way.

Now, a new meta-analysis of 38 studies finds consistent results and themes: that people engage in self-injury and/or think about suicide to alleviate some types of stress; and that the perceived stress relief that results from thoughts and behaviors indicates potential for therapy and other interventions.

Over the past 10 years, researchers have started to ask people at risk of suicide to complete surveys multiple times per day. This type of data allows for researchers to understand the thoughts, emotions and behaviors that precede self-injurious thoughts and actions. The University of Washington conducted the data aggregation of these types of studies involving more than 1,600 participants around the world. It was published April 28 in Nature Human Behavior.

“Many researchers have been collecting this data and testing for the same finding, but there were mixed findings across studies. We wanted to see if we saw this effect when we combined these datasets,” said Kevin Kuehn, lead author of the meta-analysis and a UW doctoral student in clinical psychology.

With suicide a leading cause of death among youth and the role of self-harm, or non-suicidal self-injury (NSSI), as a risk factor, Kuehn and his team wanted to look collectively at separate studies of NSSI and suicidal thoughts. By analyzing data of individual participants in these studies, the UW researchers found that high levels of emotional distress precede both self-injury and suicidal thoughts, followed by reduced stress.

Researchers point to additional data on suicide — that a majority of people who die by suicide do not receive mental health treatment, for example — and consistent findings from the meta-analysis that stress precedes self-injury.

They say this can inform prevention and intervention efforts, such as learning how to replace self-injury and suicidal thoughts with other means of reducing stress.

“The good news is that we have effective behavioral interventions, such as cognitive behavioral therapy and dialectical behavioral therapy, which teach skills for managing intense emotions to replace self-injurious thoughts and behaviors. Increasing access to these types of treatments is likely to reduce the prevalence of them,” Kuehn said.

One limit of the meta-analysis, researchers said, is that participants in the various studies were predominantly young white women. Further research into self-injury and related thoughts and behaviors should focus on increasing the age, gender and racial and ethnic diversity of study samples. In addition, the meta-analysis found only modest evidence that stress, while a connection to self-harm, could be used as a means for predicting when an individual might injure themselves. Future studies could try to identify more precisely when and how stress leads to self-injurious thoughts and behaviors.

The research was funded by the National Institute of Mental Health. Co-authors were Jonas Dora, Katherine Foster, Frank Song, Michele Smith and Kevin King of the UW Department of Psychology; and Melanie Harned of the UW Department of Psychiatry and Behavioral Sciences and the Veterans Affairs Puget Sound Health Care System.

For more information, contact Kuehn at kskuehn@uw.edu.