Psychological Medicine

Original Articles

An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA

P. L. Plenera1 c1, G. Libala2, F. Kellera1, J. M. Fegerta1 and J. J. Muehlenkampa3

a1 Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany

a2 Department of Child and Adolescent Psychiatry, University of Basel, Switzerland

a3 Department of Psychology, University of North Dakota, USA


Background This study examined the prevalence of non-suicidal self-injury (NSSI), suicide attempts, suicide threats and suicidal ideation in a German school sample and compared the rates with a similar sample of adolescents from the midwestern USA by using cross-nationally validated assessment tools.

Method Data were provided from 665 adolescents (mean age 14.8 years, s.d.=0.66, range 14–17 years) in a school setting. Students completed the Self-Harm Behavior Questionnaire (SHBQ), the Ottawa Self-Injury Inventory (OSI) and a German version of the Center for Epidemiological Studies–Depression Scale (CES-D).

Results A quarter of the participants (25.6%) endorsed at least one act of NSSI in their life, and 9.5% of those students answered that they had hurt themselves repetitively (more than four times). Forty-three (6.5%) of the students reported a history of a suicide attempt. No statistically significant differences were observed between the German and US samples in terms of self-injury or suicidal behaviors.

Conclusions By using the same validated assessment tools, no differences were found in the prevalence and characteristics of self-injury and suicidal behaviors between adolescents from Germany and the USA. Thus, it seems that NSSI has to be understood as worldwide phenomenon, at least in Western cultures.

(Received May 30 2008)

(Revised November 19 2008)

(Accepted December 11 2008)

(Online publication January 27 2009)


c1 Address for correspondence: Dr P. L. Plener, Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, D-89075 Ulm, Germany. (Email: