Non-suicidal self-injury (NSSI) — when people purposefully hurt themselves without a conscious suicidal intent — is relatively common among Iraq and Afghanistan veterans, according to a new study.
The study, published in Psychiatry Research, also found that veterans who deliberately hurt themselves were more likely to engage in suicidal behavior.
Researchers said they hoped NSSI could serve as a marker for identifying which veterans are most likely to attempt suicide.
The study, conducted by Dr. Nathan Kimbrel, a research psychologist at the Durham VA Medical Center, included 151 Iraq and Afghanistan veterans at the Central Texas VA Health Care System. Of those, 14 percent reported a history of NSSI.
The researchers excluded veterans with schizophrenia or bipolar disorder, but they included a higher-than-average proportion of veterans with PTSD. In the final study group, 35 percent had PTSD, 21 percent had depression, and eight percent had alcohol use disorder. More than 90 percent were male and 67 percent were white.
After identifying suicidal ideation via a standardized screening questionnaire, the researchers further classified the participants as having either passive or active suicidal ideation.
According to Kimberly, passive suicidal ideation could be described as wishing you would go to sleep and not wake up. Active suicidal ideation is characterized by actually thinking about specific ways to end one’s life.
Kimbrel found that NSSI was most strongly associated with active suicidal ideation. Specifically, Iraq and Afghanistan veterans who reported a history of NSSI were five times more likely to engage in active suicidal ideation, compared with veterans without a history of NSSI.
“These are people who are purposefully engaging in bodily harm, but the intent is not to commit suicide,” he said. “There are many reasons why they do this, but this behavior is associated with increased odds of eventually attempting suicide.”
While cutting is the most commonly thought-of form of NSSI, Kimbrel notes there are a “wide range of non-suicidal self-injurious behaviors that veterans might be engaging in that clinicians should be aware of, such as burning or hitting oneself.”
“Among veterans, burning and hitting appear to be the specific forms of NSSI most strongly associated with suicidal ideation,” he added.
Veterans who reported burning themselves were 17 times more likely to engage in suicidal ideation, compared with veterans who did not report NSSI. Veterans who reported hitting themselves were nearly eight times more likely to have suicidal ideation.
“Obviously, the rates of suicidal ideation that we identified among veterans engaging in these forms of NSSI were much higher than what we typically see among patients seeking treatment for PTSD,” said Kimbrel.
Kimbrel’s hope is that by expanding suicidal assessments of veterans to include NSSI information, providers can better identify those at high risk for suicide long before they ever make an attempt.
“If we can identify veterans engaging in NSSI early on, then hopefully we can begin to change their trajectory and put them onto a more positive course,” he said.
“There are treatments that can help. The most important thing is to get veterans at increased risk for suicide into treatment as soon as possible.”