Differential pathways from childhood mistreatments to self-harm and suicidal ideation.

Self-harm and suicidal behavior range among the most prominent public health concerns in children and adolescents. The term “self-harm” commonly includes both direct and indirect self-damage with and without suicidal intent; whereas, the term “self-injury” refers to direct self-damage only but again regardless of its intent. Self-harm has a mean prevalence of 18% worldwide [1], and a study investigating the life-time prevalence of self-injury among European adolescents found rates up to 39% [2]. Suicidal ideation and suicide attempts have been reported in about 12% and 4% of adolescents, respectively [3]. The particular importance of adolescent self-harm is underlined by the fact that it is often associated with suicidal ideation and behavior, and that it is one of the strongest risk factors predicting suicidal behavior [4] and death by suicide later in life [5].