While sadness was highly associated with both self-harm and suicide attempt, suicide attempt only and self-harm only, the students who reported both self-harm and suicide attempt had higher prevalence of child maltreatment, impulsivity and less parental support when compared to students who reported suicide attempt only, self-harm only. This is an intriguing finding and suggests that there may be a potentially unique pattern of risk among youth who express both self-harm and suicide attempt. Previous research has established a strong association between non-suicidal self-harm behaviors and suicidal behaviors that also show that self-harm is a major risk factor for suicide or suicidal behaviors [3,14,16,17,18,19,39]. Child maltreatment, in particular sexual abuse, has been reported as an important predictor of self-harm [2,3] which is also a strong finding of our study. However, our study extends the previous literature by documenting that in this population these factors are uniquely associated with reporting both self-harm and suicide attempt and not with suicide attempt without self-harm.
