Non-suicidal self-injury and subsequent suicide attempts and death: A protocol for a systematic review of temporally ordered evidence
- 1Grace Abbott School of Social Work, College of Public Affairs and Community Service, University of Nebraska at Omaha, Omaha, Nebraska, United States of America
- 2Population Research Institute, Center for Health Ageing, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- 3School of Public Health, University College Cork, Cork, Ireland
Abstract
Background: Non-suicidal self-injury (NSSI) is a prevalent and clinically significant behaviour, particularly among adolescents and young adults, and is strongly associated with suicidal behaviour. However, existing reviews have often combined heterogeneous outcomes, including suicidal ideation, plans, attempts, and death, limiting the identification of clinically meaningful pathways. Objective: This protocol describes a systematic review that aims to synthesise evidence on the temporally ordered relationship between NSSI and subsequent suicide attempts or death, and to examine whether characteristics of NSSI are associated with increased risk or severity of later suicidal behaviour. Methods: This protocol is reported in accordance with PRISMA-P 2015 and registered with the Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/EA4M6). A comprehensive search will be conducted in MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science. Eligible studies will include prospective and retrospective observational studies demonstrating temporal ordering between NSSI and subsequent suicide attempts or death. Studies focusing solely on suicidal ideation will be excluded. Data extraction and risk-of-bias assessment will be conducted independently by two reviewers using Joanna Briggs Institute tools. Due to anticipated heterogeneity, findings will be synthesised using a structured narrative approach. Conclusion: This review will provide a focused synthesis of evidence on the relationship between NSSI and subsequent suicidal outcomes, addressing gaps related to temporality, outcome specificity, and severity. The findings are expected to inform clinical formulation, safety planning, and future research on suicide prevention by improving understanding of factors associated with subsequent suicidal behaviour.
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BibTeX
@article{sadath2026nonsuicidal,
title = {{Non-suicidal self-injury and subsequent suicide attempts and death: A protocol for a systematic review of temporally ordered evidence}},
author = {Anvar Sadath and Muhammed Thalil and Susan Reay and Jaiden Davis and Zubair Kabir},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0357977},
url = {https://doi.org/10.1371/journal.pone.0357977},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Non-suicidal self-injury and subsequent suicide attempts and death: A protocol for a systematic review of temporally ordered evidence
AU - Anvar Sadath
AU - Muhammed Thalil
AU - Susan Reay
AU - Jaiden Davis
AU - Zubair Kabir
PY - 2026
DA - 2026/09/10
JO - PLOS One
DO - 10.1371/journal.pone.0357977
UR - https://doi.org/10.1371/journal.pone.0357977
AB - Background: Non-suicidal self-injury (NSSI) is a prevalent and clinically significant behaviour, particularly among adolescents and young adults, and is strongly associated with suicidal behaviour. However, existing reviews have often combined heterogeneous outcomes, including suicidal ideation, plans, attempts, and death, limiting the identification of clinically meaningful pathways. Objective: This protocol describes a systematic review that aims to synthesise evidence on the temporally ordered relationship between NSSI and subsequent suicide attempts or death, and to examine whether characteristics of NSSI are associated with increased risk or severity of later suicidal behaviour. Methods: This protocol is reported in accordance with PRISMA-P 2015 and registered with the Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/EA4M6). A comprehensive search will be conducted in MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science. Eligible studies will include prospective and retrospective observational studies demonstrating temporal ordering between NSSI and subsequent suicide attempts or death. Studies focusing solely on suicidal ideation will be excluded. Data extraction and risk-of-bias assessment will be conducted independently by two reviewers using Joanna Briggs Institute tools. Due to anticipated heterogeneity, findings will be synthesised using a structured narrative approach. Conclusion: This review will provide a focused synthesis of evidence on the relationship between NSSI and subsequent suicidal outcomes, addressing gaps related to temporality, outcome specificity, and severity. The findings are expected to inform clinical formulation, safety planning, and future research on suicide prevention by improving understanding of factors associated with subsequent suicidal behaviour.
SN - 1932-6203
ER -