A Mechanistic Analysis of the Transition from Nonsuicidal to Suicidal Self-Injury in Adolescents.

/ABSTRACT Nonsuicidal self-injury (NSSI) is the single strongest prospective predictor of suicidal behavior, yet only one longitudinal study has examined mechanisms that may be facilitating the transition from nonsuicidal to suicidal self-injury. Notably, adolescents may be a particularly high-risk group as both NSSI and suicide behavior often first occur during this developmental period. The onset of NSSI often precedes that of suicidal behavior, making it a key prevention target in adolescents. As 60% of individuals with a history of NSSI do not transition to suicidal behavior, the proposal aims to elucidate which factors predict transition risk among this high-risk subgroup (Aim 1). This proposal also aims to identify the underlying mechanisms of the relationship between NSSI and suicidal behavior, focusing on four candidate mediating processes underlying the NSSI to suicide attempt (SA) transition (intrapersonal distress, social connection, emotion regulation, and self-view) (Aim 2). We will leverage a multi- method approach to assess NSSI severity and candidate mediating factors by employing a traditional longitudinal design combined with burst ambulatory assessments, novel computer vision methodology to obtain an objective clinical assessment of NSSI severity, behavioral tasks, and gold-standard measures. Adolescents aged 13-17 will be followed for a 2-year period to capture the emergence of SAs in the sensitive period following recent NSSI onset. The research team, led by ESI MPIs Taylor Burke and Brooke Ammerman and supported by Co-Is Richard Liu, Ross Jacobucci, and Thomas Serre, brings exceptional proficiency to this project. They possess extensive expertise in adolescent self-injurious thoughts and behaviors, utilizing innovative data collection methodologies, including ecological momentary assessment and computer vision analysis of medical images, as well as the application of sophisticated data analysis strategies. Their combined knowledge also extends to understanding risk relationships among individuals with underrepresented identities and addressing the ethical and privacy concerns unique to high-risk populations. The potential impact of this ESI R01 proposal is significant. Findings will provide valuable information regarding the role and timescale of modifiable risk factors in the nonsuicidal to suicidal self-injury transition, facilitating the development of targeted suicide prevention interventions tailored for this high-risk adolescent population. This proposal is strongly in line with NIMH’s focus on suicide prevention research, as well as NIMH’s Strategic Goal 2 to “examine mental illness trajectories.” With its use of innovative computer vision methodology to objectively assess NSSI severity, this proposal is also in line with Strategy 2.2.B Interest Area 3. Project Number: 1R01MH143695-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: Brooke Ammerman (+1 co-PI) | Institution: UNIVERSITY OF WISCONSIN-MADISON, MADISON, WI | Award Amount: $822,352 | Activity Code: R01 | Study Section: Psychosocial Development, Risk and Prevention Study Section[PDRP] View on NIH RePORTER: https://reporter.nih.gov/project-details/11335149