There are several noteworthy limitations that should be considered when interpreting these findings. First, measures were self-reported and may reflect biases, especially underreporting of sensitive information. Second, the data represent students in a high-risk urban community and may not generalize to adolescents in other communities or countries or those who have dropped out of school. The U.S. community where the study was conducted was particularly resource poor and may be limited in terms of available mental health services and general care. Third, analyses are based on cross-sectional data, which do not allow temporal ordering between correlates and outcomes. Accordingly, the analyses simply address the extent to which psychosocial correlates were associated with the outcome variable of interest. Fourth, the study did not assess other potential confounders or mediators that may have been important in the associations examined. Several important factors such as the use of coping strategies, cognitive functioning and communication strategies in addition to past help-seeking were not available within the existing dataset but could have been helpful in the explanation of factors associated with self-harm and suicide attempt. Finally, many of the measures included in the analyses were based on single items rather than comprehensive scales.
