An Analysis of Nonsuicidal Self-Injury Among Children and Adolescents in Inpatient Psychiatric Hospitals and Units in Pennsylvania


  • Elizabeth Kukielka, PharmD, MA, RPH Patient Safety Authority



nonsuicidal self-injury, self-injurious behavior, patient safety, inpatient, children, adolescents, autism spectrum disorder


Nonsuicidal self-injury (NSSI), which is defined as the direct, deliberate destruction of one’s own body tissue to inflict harm or pain without an underlying suicidal intent, is common among adolescents in both the community and the clinical setting. Although NSSI does not always progress to or predict future suicidal behaviors, there is believed to be a link between the two, which makes this an important patient safety concern. We queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) and identified 640 patient safety events involving NSSI among children and adolescents in the inpatient psychiatric setting that occurred in 2019. Most patients were female (71%; 457 of 640), and they ranged in age from 5 to 17 years. The most common methods of NSSI were hitting, punching, kicking, or body slamming a surface; scratching or cutting self with fingernails or an object; and head banging. Most patients sustained only minor injuries as a result of NSSI. Interpersonal interactions, including family, peer, and healthcare provider interactions, were among the most common contributors to NSSI. Few event reports (n=47) explicitly stated that the patient had a diagnosis of autism spectrum disorder (ASD), but we did conduct a subgroup analysis of these patients to identify relevant trends and found that they most often were male (64%; 30 of 47) and that head banging and hitting self were the most common methods of self-harm. In order to keep patients safe during inpatient stays in psychiatric facilities or units, future research should focus on prevention strategies that reduce risk of NSSI among children and adolescents, as well as the potential for immediate harm and future mortality.

Author Biography

Elizabeth Kukielka, PharmD, MA, RPH, Patient Safety Authority

Elizabeth Kukielka ( is a patient safety analyst on the Data Science and Research team at the Patient Safety Authority. Before joining the PSA, she was a promotional medical writer for numerous publications, including Pharmacy Times and The American Journal of Managed Care. Kukielka also worked for a decade as a community pharmacist and pharmacy manager, with expertise in immunization delivery, diabetes management, medication therapy management, and pharmacy compounding.



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Black-and-white photo of the foot of a girl sitting on concrete steps



How to Cite

Kukielka, E. (2020). An Analysis of Nonsuicidal Self-Injury Among Children and Adolescents in Inpatient Psychiatric Hospitals and Units in Pennsylvania. Patient Safety, 2(3), 30–41.



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