The association between nonsuicidal and suicidal self-injurious behaviors: A systematic review and expanded theoretical model
Nonsuicidal self-injury (NSSI) is one of the strongest predictors of suicidal behavior. Despite this, the field still has a limited understanding of the mechanisms by which this relationship is conferred. As there has been a proliferation of research in this area over the past decade, an updated systematic review of the empirical research examining potential factors driving the relationship between NSSI and suicide-related outcomes is needed to move the field forward. We identified only 18 studies examining moderators or mediators of the relationship. Research to date does little to improve our understanding of the robust, prospective relationship between NSSI and suicide outcomes, highlighting a foundational gap in both the empirical and theoretical literature. Thus, we propose the Nonsuicidal to Suicidal Self-Injury Pathway Model, an expanded theoretical model of this relationship drawing on extant theory and empirical research, as well as discuss future directions for work in this area.