medical help. Such findings support the distinction between NSSI, which tends to refer to actions involving tissue damage such as self-cutting [2,6], and self-harm with suicidal intent, which is most closely associated with overdosing. However, a strong association was observed between self-harm without a desire to die the most recent time and suicidal thoughts and plans, with over a third having had suicidal thoughts, and approximately 9% having made plans to kill themselves. This resonates with previous findings that, although individuals who self-harm with suicidal intent are at the highest risk of suicidal thoughts and attempts, those who engage in NSSI are also at significantly higher risk than those who do not self-harm at all [2,6,9]. Further, this elevated risk of suicidal thoughts and plans increases as the self-harm becomes more frequent, thus those who self-harm the most frequently are potentially at the most risk for suicide [32]. The nature and direction of the relationship between self-harm and suicidal thoughts remains unclear. It may be that suicidal thoughts lead the individual to self-harm – either to enact or to reduce the urge [11] - or that self-harm causes psychological distress which then contributes to suicidal thoughts [33], or that the
