Examining the role of suicide crisis syndrome between nonsuicidal self-injury and suicidal ideation in adolescents.

Suicide among adolescents is becoming increasingly concerning, with nonsuicidal self-injury (NSSI) as an important proximal predictor of suicidal ideation. However, it remains unclear whether suicide crisis syndrome (SCS), a new construct serving as an imminent warning sign of suicide, can explain the underlying mechanism between NSSI and suicidal ideation and enhance the prediction of prospective suicidal ideation. This study included 1018 Chinese adolescents (50.1% female, Mage = 13.17 [SD = 1.09]) who completed four waves of monthly assessment on NSSI, SCS, and suicidal ideation at one-month intervals. Random-intercept cross-lagged panel modeling analyses indicated that the prospective association between NSSI and suicidal ideation was mediated by SCS total score (standardized indirect βs ≥ 0.037) and its entrapment (standardized indirect βs ≥ 0.050), affective disturbance (standardized indirect βs ≥ 0.035), and loss of cognitive control (standardized indirect βs ≥ 0.022) dimensions. Meanwhile, generalized linear mixed model tree analyses showed that simultaneously using NSSI and SCS dimensions as predictors can enhance the accuracy in predicting suicidal ideation one month later. These results provide insights that may connect the Nonsuicidal to Suicidal Self-Injury Pathway Model and the Narrative-Crisis Model of Suicide, with implications for the assessment of adolescent suicide risk.