{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:13:04Z","timestamp":1781284384036,"version":"3.54.1"},"reference-count":47,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T00:00:00Z","timestamp":1703376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health Research Applied Research Collaboration Northwest London","award":["ISCIII JR22\/00011"],"award-info":[{"award-number":["ISCIII JR22\/00011"]}]},{"name":"National Institute for Health Research Applied Research Collaboration Northwest London","award":["PD-SPH-2015"],"award-info":[{"award-number":["PD-SPH-2015"]}]},{"name":"Carlos III Health Research Institute","award":["ISCIII JR22\/00011"],"award-info":[{"award-number":["ISCIII JR22\/00011"]}]},{"name":"Carlos III Health Research Institute","award":["PD-SPH-2015"],"award-info":[{"award-number":["PD-SPH-2015"]}]},{"name":"National Institute for Health Research and the School for Public Health Research","award":["ISCIII JR22\/00011"],"award-info":[{"award-number":["ISCIII JR22\/00011"]}]},{"name":"National Institute for Health Research and the School for Public Health Research","award":["PD-SPH-2015"],"award-info":[{"award-number":["PD-SPH-2015"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Mental disorders are a major problem among young people. To identify early risk factors of self-injurious thoughts and behaviours (SITB) among young adults with mental health problems, this case\u2013control study drew data from the Clinical Practice Research Datalink (CPRD), a primary care database covering 8% of the UK population. We explored the role of early factors (presenting at 8\u201314 years old) for suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) in young adulthood (age 18\u201325 years) by performing logistic regressions. Our sample consisted of 219,581 participants, of which 6.51% had at least one SITB in young adulthood. Early risk factors for SITB included early NSSI, suicidal ideation, sexual abuse, behavioural problems, and mood and psychotic symptoms. Frequency of GP visits had a protective effect. Lack of access to mortality data, ethnicity, and socioeconomic status was a limitation of the current study. In conclusion, early symptoms in late childhood\/early adolescence can be the start of long-standing problems going into adult life. The training of primary care providers in suicide risk assessment and proper co-ordination with child and adolescent mental health services are crucial for suicide prevention.<\/jats:p>","DOI":"10.3390\/bs14010016","type":"journal-article","created":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T20:42:30Z","timestamp":1703450550000},"page":"16","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Early Risk Factors for Self-Injurious Thoughts and Behaviours: A UK Population-Based Study of 219,581 People"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2019-9099","authenticated-orcid":false,"given":"Alejandro","family":"Porras-Segovia","sequence":"first","affiliation":[{"name":"Division of Psychiatry, Department of Brain Sciences, Imperial College London, London W12 7T, UK"},{"name":"Health Research Institute Fundaci\u00f3n Jim\u00e9nez D\u00edaz, 28040 Madrid, Spain"},{"name":"Department of Psychiatry, University Hospital Rey Juan Carlos, 28933 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Pascual-Sanchez","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, Department of Brain Sciences, Imperial College London, London W12 7T, UK"},{"name":"CAMHS Enhanced Treatment Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geva","family":"Greenfield","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna-Marie","family":"Creese","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3787-2083","authenticated-orcid":false,"given":"Sonia","family":"Saxena","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dougal","family":"Hargreaves","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dasha","family":"Nicholls","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, Department of Brain Sciences, Imperial College London, London W12 7T, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,24]]},"reference":[{"key":"ref_1","unstructured":"WHO (2022, September 12). Suicide. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/suicide."},{"key":"ref_2","first-page":"20l13702","article-title":"If suicide were COVID-19: A neglected cause of premature death","volume":"82","author":"Courtet","year":"2021","journal-title":"J. Clin. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Merayo-Cano, J.M., Porras-Segovia, A., and Baca-Garc\u00eda, E. (Rev. Psiquiatr. Salud Ment, 2022). COVID-19 impact vs. suicide impact in Spain, Rev. Psiquiatr. Salud Ment, epub ahead of print.","DOI":"10.1016\/j.rpsm.2022.05.006"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1037\/bul0000084","article-title":"Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research","volume":"143","author":"Franklin","year":"2017","journal-title":"Psychol Bull."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1146\/annurev-clinpsy-021815-093204","article-title":"Suicide, suicide attempts, and suicidal ideation","volume":"12","author":"Klonsky","year":"2016","journal-title":"Annu. Rev. Clin. Psychol"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1111\/sltb.12437","article-title":"An Empirical Test of the Three-Step Theory of Suicide in U.K. University Students","volume":"49","author":"Dhingra","year":"2019","journal-title":"Suicide Life Threat. Behav."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1111\/sltb.12887","article-title":"Maltreatment history and reasons for self-injurious behavior among adolescents engaged in non-suicidal self-injury versus adolescents who attempted suicide","volume":"52","author":"Jenkins","year":"2022","journal-title":"Suicide Life-Threat. Behav."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.cpr.2014.03.005","article-title":"Correlates of suicide attempts among self-injurers: A meta-analysis","volume":"34","author":"Victor","year":"2014","journal-title":"Clin. Psychol Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1080\/07448481.2019.1583655","article-title":"Factors associated with emotional distress and suicide ideation among international college students","volume":"68","author":"Taliaferro","year":"2020","journal-title":"J. Am. Coll. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1037\/spq0000188","article-title":"The distinction between exclusivity and comorbidity within NSSI","volume":"32","author":"Goldberg","year":"2017","journal-title":"Sch. Psychol. Q."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.3389\/fpsyg.2017.01946","article-title":"Nonsuicidal self-injury: A systematic review","volume":"8","author":"Cipriano","year":"2017","journal-title":"Front. Psychol."},{"key":"ref_12","first-page":"3437","article-title":"Suicidal-related behaviors and quality of life according to gender in adolescent Mexican high school students","volume":"20","year":"2015","journal-title":"Cienc. Saude Coletiva"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"16r10732","DOI":"10.4088\/JCP.16r10732","article-title":"Psychological Pain in Suicidality: A Meta-Analysis","volume":"79","author":"Ducasse","year":"2018","journal-title":"J. Clin. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"111","DOI":"10.2147\/NDT.S229530","article-title":"The Health-Related Quality of Life, Work Productivity, Healthcare Resource Utilization, and Economic Burden Associated with Levels of Suicidal Ideation Among Patients Self-Reporting Moderately Severe or Severe Major Depressive Disorder in a National Survey","volume":"17","author":"Benson","year":"2021","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1753-2000-6-11","article-title":"The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: Distinguishing risk factors and psychosocial correlates","volume":"6","author":"Andover","year":"2012","journal-title":"Child Adolesc. Psychiatry Ment. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1027\/0227-5910\/a000664","article-title":"Suicide and suicide prevention from a global perspective","volume":"41","author":"Arensman","year":"2020","journal-title":"Crisis"},{"key":"ref_17","first-page":"168","article-title":"Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization\u2019s World Mental Health Survey Initiative","volume":"6","author":"Kessler","year":"2007","journal-title":"World Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jpsychires.2022.04.021","article-title":"Impulsivity as a mediator between childhood maltreatment and suicidal behavior: A systematic review and meta-analysis","volume":"151","year":"2022","journal-title":"J. Psychiatr. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1001\/archpsyc.59.8.741","article-title":"Childhood Adversities, Interpersonal Difficulties, and Risk for Suicide Attempts During Late Adolescence and Early Adulthood","volume":"59","author":"Johnson","year":"2002","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1017\/S003329179900135X","article-title":"Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood","volume":"30","author":"Fergusson","year":"2000","journal-title":"Psychol. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.eclinm.2019.09.007","article-title":"Identification of children at risk for mental health problems in primary care-development of a prediction model with routine health care data","volume":"15","author":"Koning","year":"2019","journal-title":"EClinicalMedicine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1176\/appi.ajp.159.6.909","article-title":"Contact with mental health and primary care providers before suicide: A review of the evidence","volume":"159","author":"Luoma","year":"2002","journal-title":"Am. J. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/ije\/dyv098","article-title":"Data resource profile: Clinical Practice Research Datalink (CPRD)","volume":"44","author":"Herrett","year":"2015","journal-title":"Int. J. Epidemiol."},{"key":"ref_24","unstructured":"(2022, November 22). Clinical Practice Research Datalink (CPRD). Available online: https:\/\/cprd.com\/."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ejpsy.2021.02.002","article-title":"Theoretical models of suicidal behaviour: A systematic review and narrative synthesis","volume":"35","year":"2021","journal-title":"Eur. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3389\/fpsyg.2016.00130","article-title":"Real-time monitoring of non-linear suicidal dynamics: Methodology and a demonstrative case report","volume":"7","author":"Fartacek","year":"2016","journal-title":"Front. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1027\/0227-5910\/a000464","article-title":"Investigating the Dynamics of Suicidal Ideation","volume":"39","author":"Hallensleben","year":"2018","journal-title":"Crisis"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.psychres.2019.03.038","article-title":"Do suicide attempters and suicide ideators differ in capability for suicide?","volume":"275","author":"Paashaus","year":"2019","journal-title":"Psychiatry Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1037\/ccp0000626","article-title":"Does fearlessness about death mediate the association between NSSI and suicide attempts? A longitudinal study of over 1000 high-risk individuals","volume":"89","author":"Harris","year":"2021","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_31","first-page":"398","article-title":"Dissecting the suicide phenotype: The role of impulsive-aggressive behaviours","volume":"30","author":"Turecki","year":"2005","journal-title":"J. Psychiatry Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1038\/mp.2017.123","article-title":"Toward fine-grained phenotyping of suicidal behavior: The role of suicidal subtypes","volume":"22","author":"Bernanke","year":"2017","journal-title":"Mol. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1093\/epirev\/mxn002","article-title":"Suicide and suicidal behavior","volume":"30","author":"Nock","year":"2008","journal-title":"Epidemiol. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1521\/suli.2007.37.2.238","article-title":"Self-mutilation and coping strategies in a college sample","volume":"37","author":"Andover","year":"2007","journal-title":"Suicide Life-Threat. Behav."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1080\/13811110701247602","article-title":"The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature","volume":"11","author":"Jacobson","year":"2007","journal-title":"Arch. Suicide Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1080\/13811110903479086","article-title":"An examination of non-suicidal self-injury in men: Do men differ from women in basic NSSI characteristics?","volume":"14","author":"Andover","year":"2010","journal-title":"Arch. Suicide Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.cpr.2015.02.009","article-title":"Gender differences in the prevalence of nonsuicidal self-injury: A meta-analysis","volume":"38","author":"Bresin","year":"2015","journal-title":"Clin. Psychol. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1046\/j.1467-8624.2003.00643.x","article-title":"Adolescents\u2019 emotion regulation in daily life: Links to depressive symptoms and problem behavior","volume":"74","author":"Silk","year":"2003","journal-title":"Child Dev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1037\/abn0000290","article-title":"Dark personality traits and impulsivity among adolescents: Differential links to problem behaviors and family relations","volume":"126","author":"Dubas","year":"2017","journal-title":"J. Abnorm. Psychol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1080\/13811118.2018.1494651","article-title":"Attachment and Non-Suicidal Self-Injury among Young Adolescents: The Indirect Role of Behavioral Problems","volume":"23","author":"Cassels","year":"2019","journal-title":"Arch. Suicide Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.comppsych.2017.02.005","article-title":"The influence of personality traits and emotional and behavioral problems on repetitive nonsuicidal self-injury in a school sample","volume":"74","author":"Weizenegger","year":"2017","journal-title":"Compr. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1111\/j.1469-7610.1994.tb01236.x","article-title":"Adult outcomes of childhood and adolescent depression. III. Links with suicidal behaviours","volume":"35","author":"Harrington","year":"1994","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1001\/jamapsychiatry.2018.0174","article-title":"Association of childhood irritability and depressive\/anxious mood profiles with adolescent suicidal ideation and attempts","volume":"75","author":"Orri","year":"2018","journal-title":"JAMA Psychiatry"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.schres.2021.07.029","article-title":"A systematic review of suicide and suicide attempts in adolescents with psychotic disorders","volume":"235","author":"Barbeito","year":"2021","journal-title":"Schizophr. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1007\/s00787-020-01593-6","article-title":"Mediators of the association between psychotic experiences and future non-suicidal self-injury and suicide attempts: Results from a three-wave, prospective adolescent cohort study","volume":"30","author":"Hielscher","year":"2021","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"618","DOI":"10.4065\/mcp.2009.0583","article-title":"Sexual abuse and lifetime diagnosis of psychiatric disorders: Systematic review and meta-analysis","volume":"Volume 85","author":"Chen","year":"2010","journal-title":"Mayo Clinic Proceedings"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1515\/ijamh-2013-0053","article-title":"Child sexual abuse and the pathophysiology of suicide in adolescents and adults","volume":"25","author":"Sher","year":"2013","journal-title":"Int. J. Adolesc. Med. Health"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/14\/1\/16\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:41:22Z","timestamp":1760132482000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/14\/1\/16"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,24]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["bs14010016"],"URL":"https:\/\/doi.org\/10.3390\/bs14010016","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,24]]}}}