Non-Suicidal self-injury and suicide in depressed Adolescents: Impact of peer victimization and bullying

Background: : While prior research has demonstrated that peer victimization and bully perpetration contribute to non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs), it remains unclear whether these interpersonal processes differentiate self-injuring adolescent suicide ideators and attempters. Methods: : The study included adolescents aged 13-18 years (n=223; M=15.31, SD=1.34) recruited from an acute inpatient program. Participants were divided into two groups: (1) NSSISI (n=106): endorsed past year NSSI, current suicide ideation, and no lifetime suicide attempts and (2) NSSISI+SA (n=117): endorsed past year NSSI, current suicide ideation, and lifetime suicide attempts. Adolescents completed clinical interviews (i.e., mental disorders, NSSI, and STBs) and self-report measures assessing peer victimization, bully perpetration, and depression severity. Results: : NSSISI+ SA youth reported higher levels of peer victimization and bully perpetration than NSSISI youth (ps<0.01, ds=0.36-0.37). Among the NSSISI+ SA youth, bully perpetration was associated with a greater number of past month suicide attempts (p=0.02, RR=1.07). Only peer victimization was associated with greater NSSI behaviors in the past month (p=0.04, RR=1.01). Limitations: : The study is cross-sectional, and reports of peer victimization and bully perpetration rely on self-report assessment. Conclusions: Peer victimization and bully perpetration differentiated adolescent suicide ideators and attempters, highlighting the need to address bully perpetration in addition to peer victimization in suicide interventions and research.