Beyond Suicide Attempts: Non-Suicidal Self-Injury and its Association with Depression and Substance use in First-Episode Psychosis

Abstract

Background: Non-suicidal self-injury (NSSI) is clinically distinct from suicidal behavior but may coexist with substantial psychiatric morbidity. Data on NSSI in first-episode psychosis (FEP) remain limited.Objective: To describe the prevalence of NSSI in FEP and examine its association with depressive symptoms and substance use.Methods: This cross-sectional study included 144 adults with FEP attending psychiatry outpatient or inpatient services at S.S.G. Hospital, Vadodara. NSSI was assessed using the Columbia-Suicide Severity Rating Scale, depression using the Calgary Depression Scale for Schizophrenia (CDSS), psychotic symptoms using the Positive and Negative Syndrome Scale, and insight using the Birchwood Insight Scale. Categorical associations were examined using chi-square tests; forward-likelihood-ratio regression was also reported.Results: NSSI was present in 40/144 patients (27.8%), marginally exceeding actual suicide attempts (27.1%). CDSS ≥6 was observed in 38/40 patients with NSSI (95.0%) and 66/104 without NSSI (63.5%; χ²=14.23, p<0.001). Continuous CDSS score remained significant in regression (B=0.181, Exp(B)=1.198, 95% CI 1.101–1.304, p<0.001). The unadjusted substance-use comparison was not significant (χ²=10.71, p=0.22), although the regression table reported a significant overall substance-use term (Wald=9.614, p=0.047).Conclusion: NSSI affected more than one-quarter of patients with FEP and was strongly associated with depressive symptom burden. Substance-use findings require cautious interpretation because unadjusted and regression results differed.