Depression is present in 35% of adolescents who commit suicide. It is crucial that we identify which of these depressed adolescents are at greatest suicide risk. Suicide attempts are strongly associated with suicide risk, and therefore commonly used as a proxy measure. Non-suicidal self-injury (NSSI) is often seen as being less serious than suicide attempts.

To determine which clinical and psychosocial factors in depressed adolescents at baseline predict both suicide attempts and non-suicidal self-injury over 28 weeks follow-up.

Adolescents with major depressive disorder (n=164) taking part in the Adolescent Depression Antidepressants and Psychotherapy Trial were evaluated. Clinical symptoms, family and friendship functioning, suicide attempts and non-suicidal self-injury were recorded at baseline.

Suicidal and non-suicidal self-harm were measured during 28 weeks follow-up.

High suicidality, non-suicidal self-injury and poor family function at entry were significant independent predictors of suicide attempts occurring over 28 weeks follow-up. NSSI was the strongest predictor of suicide attempts (adjusted OR=3.2, p=0.006). NSSI over follow-up was independently predicted by non-suicidal self-injury (adjusted OR=20, p<0.0005), increased hopelessness, anxiety disorder, and being younger and female at entry.