Skip to main content Accessibility help

An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA

  • P. L. Plener (a1), G. Libal (a2), F. Keller (a1), J. M. Fegert (a1) and J. J. Muehlenkamp (a3)...



This study examined the prevalence of non-suicidal self-injury (NSSI), suicide attempts, suicide threats and suicidal ideation in a German school sample and compared the rates with a similar sample of adolescents from the midwestern USA by using cross-nationally validated assessment tools.


Data were provided from 665 adolescents (mean age 14.8 years, s.d.=0.66, range 14–17 years) in a school setting. Students completed the Self-Harm Behavior Questionnaire (SHBQ), the Ottawa Self-Injury Inventory (OSI) and a German version of the Center for Epidemiological Studies–Depression Scale (CES-D).


A quarter of the participants (25.6%) endorsed at least one act of NSSI in their life, and 9.5% of those students answered that they had hurt themselves repetitively (more than four times). Forty-three (6.5%) of the students reported a history of a suicide attempt. No statistically significant differences were observed between the German and US samples in terms of self-injury or suicidal behaviors.


By using the same validated assessment tools, no differences were found in the prevalence and characteristics of self-injury and suicidal behaviors between adolescents from Germany and the USA. Thus, it seems that NSSI has to be understood as worldwide phenomenon, at least in Western cultures.


Corresponding author

*Address for correspondence: Dr P. L. Plener, Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, D-89075 Ulm, Germany. (Email:


Hide All
Brunner, R, Parzer, P, Haffner, J, Steen, R, Roos, J, Klett, M, Resch, F (2007). Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Archives of Pediatrics and Adolescent Health 161, 641649.
Cloutier, P, Humphreys, L (2008). Measurement of nonsuicidal self-injury in adolescents. In Self-Injury in Youth (ed. Nixon and, M. K.Heath, N. L.), pp. 115142. Routledge: New York.
Csorba, J, Szelesne, EF, Steiner, P, Farkas, L, Nemeth, A (2005). Symptom specificity of adolescents with self-injurious behavior. Psychiatria Hungarica 20, 456462.
Favaro, A, Ferrara, S, Santonastaso, P (2007). Self-injurious behavior in a community sample of young women: relationship with childhood abuse and other types of self-damaging behaviors. Journal of Clinical Psychiatry 68, 122131.
Favazza, AR (1998). The coming of age of self-mutilation. Journal of Nervous and Mental Disease 186, 259268.
Fliege, H, Kocalevent, RD, Walter, OB, Gratz, KL, Gutierrez, PM, Klapp, BF (2006). Three assessment tools for deliberate self-harm and suicide behaviour: evaluation and psychopathological correlates. Journal of Psychosomatic Research 61, 113121.
Friedman, RA (2006). Uncovering an epidemic – screening for mental illness in teens. New England Journal of Medicine 355, 27172719.
Gould, MS, Marrocco, FA, Kleinmann, M, Thomas, JG, Mostkoff, K, Cote, J, Davies, M (2005). Evaluating iatrogenic risk of youth suicide screening programs. Journal of the American Medical Association 293, 16351643.
Gratz, KL (2006). Risk factors for deliberate self-harm among female college students: the role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. American Journal of Orthopsychiatry 76, 238250.
Gutierrez, PM, Osman, A (2008). Adolescent Suicide: An Integrated Approach to the Assessment of Risk and Protective Factors. Northern Illinois University Press: DeKalb, IL.
Gutierrez, PM, Osman, A, Barrios, FX, Kopper, BA (2001). Development and initial validation of the self-harm behavior questionnaire. Journal of Personality Assessment 77, 475490.
Hawton, K, Bergen, H, Casey, D, Simkin, S, Palmer, B, Coooper, J, Kapur, N, Horrocks, J, House, A, Lilley, R, Noble, R, Owens, D (2007). Self-harm in England: a tale of three cities. Social Psychiatry and Psychiatric Epidemiology 42, 513521.
Hawton, K, Rodham, K, Evans, E, Weatherall, R (2002). Deliberate self-harm in adolescents: self-report survey in schools in England. British Medical Journal 325, 12071211.
Heath, NL, Nixon, MK (2008). Assessment of nonsuicidal self-injury in youth. In Self-Injury in Youth (ed. Nixon and, M. K.Heath, N. L.), pp. 143170. Routledge: New York.
Jacobson, CM, Gould, M (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature. Archives of Suicide Research 11, 129147.
Joiner, T (2005). Why People Die by Suicide. Harvard University Press: Cambridge, MA.
Kirkcaldy, BD, Brown, J, Siefen, RG (2006). Disruptive behaviour disorders, self harm and suicidal ideation among German adolescents in psychiatric care. International Journal of Adolescent Medicine and Health 18, 597614.
Laye-Gindhu, A, Schonert-Reichl, KA (2005). Nonsuicidal self-harm among community adolescents: understanding the ‘whats’ and ‘whys’ of self-harm. Journal of Youth and Adolescence 34, 447457.
Lloyd-Richardson, EE, Perrine, N, Dierker, L, Kelley, ML (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine 37, 11831192.
Lundh, LG, Karim, J, Quilisch, E (2007). Deliberate self-harm in 15-year-old adolescents: a pilot study with a modified version of the Deliberate Self-Harm Inventory. Scandinavian Journal of Psychology 48, 3341.
Madge, N, Hewitt, A, Hawton, K, de Wilde, EJ, Corcoran, P, Fekete, S, van Heeringen, K, De Leo, D, Ystgaard, M (2008). Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-Harm in Europe (CASE) study. Journal of Child Psychology and Psychiatry 49, 667677.
Mitchell, KJ, Ybarra, ML (2007). Online behaviour of youth who engage in self-harm provides clues for preventive intervention. Preventive Medicine 45, 392396.
Muehlenkamp, JJ (2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry 75, 324333.
Muehlenkamp, JJ, Gutierrez, PM (2004). An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide and Life-Threatening Behavior 34, 1223.
Muehlenkamp, JJ, Gutierrez, PM (2007). Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Archives of Suicide Research 11, 6982.
Nada-Raja, S, Skegg, K, Langley, J, Morrison, D, Sowerby, P (2004). Self-harmful behaviors in a population-based sample of young adults. Suicide and Life-Threatening Behavior 34, 177186.
Nixon, MK, Cloutier, PF, Aggarwal, S (2002). Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 41, 13331341.
Nock, MK, Joiner, TE Jr., Gordon, KH, Lloyd-Richardson, E, Prinstein, MJ (2006). Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Research 30, 6572.
Nock, MK, Kessler, RC (2006). Prevalence and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. Journal of Abnormal Psychology 115, 616623.
Patton, GC, Harris, R, Carlin, JB, Hibbert, ME, Coffey, C, Schwartz, M, Bowes, G (1997). Adolescent suicidal behaviours: a population-based study of risk. Psychological Medicine 27, 715724.
Patton, GC, Hemphill, SA, Beyers, JM, Bond, L, Toumbourou, JW, McMorris, BJ, Catalano, RF (2007). Pubertal stage and deliberate self-harm in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 46, 508514.
Portzky, G, De Wilde, EJ, van Heeringen, K (2008). Deliberate self harm in young people: differences in prevalence and risk factors between The Netherlands and Belgium. European Child and Adolescent Psychiatry 17, 179186.
Posner, K, Oquendo, MA, Gould, M, Stanley, B, Davies, M (2007). Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. American Journal of Psychiatry 164, 10351043.
Rodham, K, Hawton, K, Evans, E (2004). Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 43, 8087.
Ross, S, Heath, N (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence 31, 6777.
Silverman, MM, Berman, AL, Sanddal, ND, O'Carroll, PW, Joiner, TE (2007). Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications and behaviors. Suicide and Life-Threatening Behavior 37, 264277.
Skegg, K, Nada-Raja, S, Moffitt, TE (2004). Minor self-harm and psychiatric disorder: a population-based study. Suicide and Life-Threatening Behavior 34, 187196.
Sourander, A, Aromaa, M, Pihlakoski, L, Haavisto, A, Rautava, P, Helenius, H, Sillanpaa, M (2006). Early predictors of deliberate self-harm among adolescents. A prospective follow-up study from age 3 to age 15. Journal of Affective Disorders 93, 8796.
Tigges, BB (2003). Parental consent and adolescent risk behavior research. Journal of Nursing Scholarship 35, 283289.
Whitlock, J, Eckenrode, J, Silverman, D (2006). Self-injurious behaviors in a college population. Pediatrics 117, 19391948.
Whitlock, J, Knox, KL (2007). The relationship between self-injurious behaviour and suicide in a young adult population. Archives of Pediatrics and Adolescent Medicine 161, 634640.
Whitlock, J, Powers, JL, Eckenrode, J (2006). The virtual cutting edge: the internet and adolescent self-injury. Developmental Psychology 42, 407417.
Young, R, Sweeting, H, West, P (2006). Prevalence of deliberate self-harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study. British Medical Journal 332, 10581061.
Young, R, van Beinum, M, Sweeting, H, West, P (2007). Young people who self-harm. British Journal of Psychiatry 191, 4449.
Zoroglu, SS, Tuzun, U, Sar, V, Tutkun, H, Savacs, HA, Ozturk, M, Alyanak, B, Kora, ME (2003). Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation. Psychiatry and Clinical Neurosciences 57, 119126.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed