Radhika J. Kothadia, MD PGY-3 General Psychiatry Resident Prisma Health/University of South Carolina School of Medicine Columbia, South Carolina
Kaustubh G. Joshi, MD Associate Professor of Clinical Psychiatry Associate Program Director, Forensic Psychiatry Fellowship Department of Neuropsychiatry and Behavioral Science University of South Carolina School of Medicine Columbia, South Carolina
Richard L. Frierson, MD Alexander G. Donald Professor of Clinical Psychiatry Vice Chair for Academic Affairs Program Director, Forensic Psychiatry Fellowship Department of Neuropsychiatry and Behavioral Science University of South Carolina School of Medicine Columbia, South Carolina
Disclosures The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
Although data regarding the prevalence of NSSI in adults are lacking, available studies report a 12-month prevalence of 0.9%2 and a lifetime prevalence of 5.5% to 5.9%.43 There is a significant overlap in risk factors for NSSI in adolescent and adult populations, but there are also many important differences. The static and dynamic risk factors for NSSI in adults are described in Table 3.44-66Table 444-66 summarizes the studies of NSSI in adults that we reviewed.
Static risk factors
Research findings regarding the prevalence of NSSI based on gender are varied. For years, it has been believed that women are more likely to engage in NSSI than men. Recent meta-analyses that have examined this relationship closely found that the gender difference is larger for clinical samples compared to community samples and more pronounced in younger individuals.11
As is the case with adolescents, there may be ethnic variations in rates of self-harm and NSSI among adults. A 2013 study by Chesin et al44 found that Asian and White young adults experience higher rates of NSSI than their Hispanic and Black counterparts. Evidence suggests that relative rates of self-harm for older South Asian adults are lower than in older White adults.15
Compared to heterosexual or cisgender individuals, members of sexual and gender minorities have a higher past-year and lifetime prevalence of NSSI.45 One study found that the weighted effect size between sexual orientation and NSSI had an OR of 3 (95% CI, 2.46 to 3.66), indicating a medium-to-large effect.46 Bisexual and transgender individuals appear to be at the highest risk for NSSI when compared to members of other sexual and gender minority groups.45 One review that included mostly cross-sectional studies found that individuals identifying as bisexual had up to 6 times the odds of engaging in NSSI when compared to those of other sexual orientations.47
Incarceration is a risk factor for NSSI. The rates of NSSI in criminal justice settings are higher (up to 61%) than in the general adult population (approximately 4%).48 Recent research found that NSSI serves similar functions in correctional and non-correctional settings, primarily to regulate emotions.48 However, there is also evidence of higher rates of NSSI being motivated by an attempt to influence the environment (ie, engaging in NSSI in order to be transferred to another prison unit) compared to NSSI in community settings.48
