Addressing Adolescent Non-Suicidal Self -Injury in Nurse Practitioner Curriculum: What Students Need to Know

Suicidal and self-injurious behaviors in youth are a major public health concern. For youth ages 10 to 24, suicide is the third leading cause of death, and almost one in six high school students (grades 9-12) reported seriously considering suicide in the past year (Centers for Disease Control and Prevention, 2012). A related but distinct phenomenon, non-suicidal self-injury (NSSI), has received increasing attention as research evidence has highlighted the unique characteristics of this phenomenon. Lifetime prevalence rates of NSSI ranging from 13% to 45% have been reported in community-based samples of United States youth (Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Plener, Libal, Keller, Fegert, & Muehlenkamp, 2009). NSSI is characterized by significant morbidity and is associated with increased risk for mortality via suicide attempts (Wilkinson & Goodyer, 2011).  Indeed, people who deliberately harm themselves are at a 30-fold increased risk for suicide when compared to those who do not self-harm (Cooper et al., 2005). 

NSSI refers to the direct, deliberate destruction of body tissue in the absence of lethal intent (Nock & Favazza, 2009).  Youth are thought to engage in NSSI in order to influence the behaviors of others and/or to manage their internal emotions (Lloyd-Richardson et al., 2007).  Over the last decade, the knowledge base related to NSSI has made significant advances by documenting the unique characteristics and functions of NSSI in both psychiatric in-patient and community-based samples of youth (Jacobson & Gould, 2007; Nock, 2010; Nock, Prinstein, & Sterba, 2009). Despite these advances, however, there are currently no evidence-based pharmacological or psychological treatments for NSSI (Nock, 2010). This presents a challenge for NP educators who must address this prevalent phenomenon and discuss assessment and management of NSSI. The purposes of this activity are to summarize current evidence related to non-suicidal self-injury in youth and to describe innovative strategies for integration of this knowledge into nurse practitioner curriculum. This content is particularly well suited for family, psych-mental health and pediatric NP programs. Currently utilized treatments and screening tools will be discussed and innovative teaching strategies will be suggested to facilitate the incorporation of NSSI into current NP curriculum.