Skip to main content

Adolescent self-harm and suicidal behavior and young adult outcomes in indigenous and non-indigenous people


The aim of this study was to examine the associations between self-harm and suicidal behavior in indigenous Sami and non-Sami adolescents and mental health and social outcomes in young adulthood. Data were obtained by linking the Norwegian Patient Registry (2008–2012), the National Insurance Registry (2003–2013), and the Norwegian Arctic Adolescent Health Study, a school-based survey inviting all 10th grade students in North Norway (2003–2005). In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage, of whom 9.2% were indigenous Sami. Multivariable logistic regression was used to explore the associations between self-harm only, suicidal ideation with and without self-harm, and suicide attempts in adolescence (≤16-year-old), and later mental health disorders, long-term medical, social welfare benefit receipt, or long-term unemployment in young adulthood. Self-harm and suicidal behavior in Sami and non-Sami adolescents were associated with increased risk of later mental health disorders, long-term welfare benefit receipt, and long-term unemployment. These associations were attenuated by adolescent psychosocial problems. No major differences between the indigenous Sami participants and their non-Sami peers were found. Young suicide attempters experienced the highest risk, with adolescent suicide attempts being significantly associated with all four adult outcomes after adjustment. Self-harm and suicidal behavior in adolescence are markers of mental health disorders and unfavorable social outcomes in young adulthood, mostly accounted for by adolescent psychosocial problems. In contrast to other indigenous peoples, no indigenous health disparities were found, indicating that the indigenous Sami adolescents were not worse off.

This is a preview of subscription content, access via your institution.


  1. 1.

    Hawton K, Saunders KEA, O’Connor RC (2012) Self-harm and suicide in adolescents. Lancet 379:2373–2382.

    Article  PubMed  Google Scholar 

  2. 2.

    World Health Organization (2012) Public health action for the prevention of suicide. WHO Retrieved on 12 Dec 2013 From doi: 9789241503570

  3. 3.

    Turecki G, Brent DA (2016) Suicide and suicidal behaviour. Lancet 387:1227–1239.

    Article  Google Scholar 

  4. 4.

    King M, Smith A, Gracey M (2009) Indigenous health part 2: the underlying causes of the health gap. Lancet 374:76–85.

    Article  PubMed  Google Scholar 

  5. 5.

    Kessler RC, Borges G, Walters EE (1999) Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 56:617–626.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Cash SJ, Bridge JA (2009) Epidemiology of youth suicide and suicidal behavior. Curr Opin Pediatr 21:613–619.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Shain B (2016) Suicide and suicide attempts in adolescents. Pediatrics.

    Article  PubMed  Google Scholar 

  8. 8.

    Gould MS, Greenberg T, Velting DM, Shaffer D (2003) Youth suicide risk and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 42:386–405.

    Article  PubMed  Google Scholar 

  9. 9.

    McKean AJS, Pabbati CP, Geske JR, Bostwick JM (2018) Rethinking lethality in youth suicide attempts: first suicide attempt outcomes in youth ages 10–24. J Am Acad Child Adolesc Psychiatry 57:786–791.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Muehlenkamp JJ, Claes L, Havertape L, Plener PL (2012) International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health 6:10.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Young TK, Revich B, Soininen L (2015) Suicide in circumpolar regions: an introduction and overview. Int J Circumpolar Health 75:1–8.

    Article  Google Scholar 

  12. 12.

    Webster PC (2016) Canada’s Indigenous suicide crisis. Lancet 387:2494.

    Article  PubMed  Google Scholar 

  13. 13.

    Leenaars AA (2006) Suicide among indigenous peoples: introduction and call to action. Arch Suicide Res 10:103–115.

    Article  PubMed  Google Scholar 

  14. 14.

    Mulder R, Newton-howes G, Coid JW (2016) The futility of risk prediction in psychiatry. Br J Psychiatry.

    Article  PubMed  Google Scholar 

  15. 15.

    Chan MKY, Bhatti H, Meader N et al (2016) Predicting suicide following self-harm: systematic review of risk factors and risk scales. Br J Psychiatry.

    Article  PubMed  Google Scholar 

  16. 16.

    Silviken A (2009) Prevalence of suicidal behaviour among indigenous Sami in northern Norway. Int J Circumpolar Health 68:204–211.

    Article  PubMed  Google Scholar 

  17. 17.

    Kvernmo S, Rosenvinge JH (2009) Self-mutilation and suicidal behaviour in Sami and Norwegian adolescents: prevalence and correlates. Int J Circumpolar Health 68:235–248.

    Article  PubMed  Google Scholar 

  18. 18.

    Omma L, Sandlund M, Jacobsson L (2013) Suicidal expressions in young Swedish Sami, a cross-sectional study. Int J Circumpolar Health.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Reigstad B, Kvernmo S (2017) Concurrent adversities and suicide attempts among Sami and non-Sami adolescents: the Norwegian Arctic Adolescent Study (NAAHS). Nord J Psychiatry 71:425–432.

    Article  PubMed  Google Scholar 

  20. 20.

    Bolton S-L, Elias B, Enns MW et al (2014) A comparison of the prevalence and risk factors of suicidal ideation and suicide attempts in two American Indian population samples and in a general population sample. Transcult Psychiatry 51:3–22.

    Article  PubMed  Google Scholar 

  21. 21.

    Chachamovich E, Kirmayer LJ, Haggarty JM et al (2015) Suicide among Inuit: results from a large, epidemiologically representative follow-back study in Nunavut. Can J Psychiatry 60:268–275.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Azzopardi PS, Sawyer SM, Carlin JB et al (2017) Health and wellbeing of Indigenous adolescents in Australia: a systematic synthesis of population data. Lancet.

    Article  PubMed  Google Scholar 

  23. 23.

    Copeland WE, Goldston DB, Costello EJ (2017) Adult associations of childhood suicidal thoughts and behaviors: a prospective, longitudinal analysis. J Am Acad Child Adolesc Psychiatry 56:958–965.e4.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL (2005) Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood. Psychol Med 35:983–993.

    Article  Google Scholar 

  25. 25.

    Reinherz HZ, Tanner JL, Berger SR et al (2006) Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30. Am J Psychiatry 163:1226–1232.

    Article  PubMed  Google Scholar 

  26. 26.

    Goldman-Mellor SJ, Caspi A, Harrington H et al (2014) Suicide attempt in young people. JAMA Psychiatry 71:119.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Brière FN, Rohde P, Seeley JR et al (2015) Adolescent suicide attempts and adult adjustment. Depress Anxiety 32:270–276.

    Article  PubMed  Google Scholar 

  28. 28.

    Herba CM, Ferdinand RF, van der Ende J, Verhulst FC (2007) Long-Term associations of childhood suicide ideation. J Am Acad Child Adolesc Psychiatry 46:1473–1481.

    Article  PubMed  Google Scholar 

  29. 29.

    Nrugham L, Holen A, Sund AM (2015) Prognosis and psychosocial outcomes of attempted suicide by early adolescence: a 6-year follow-up of school students into early adulthood. J Nerv Ment Dis 203:294–301.

    Article  PubMed  Google Scholar 

  30. 30.

    The Norwegian Institute of Public Health. Youth Studies. Accessed 14 Sept 2019

  31. 31.

    The Norwegian Directorate of Health (2008) The Norwegian Patient Registry. Accessed 14 Sept 2019

  32. 32.

    Eckhoff C, Straume B, Kvernmo S (2017) Multisite musculoskeletal pain in adolescence and later mental health disorders: a population-based registry study of Norwegian youth: the NAAHS cohort study. BMJ Open 7:e012035.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Eckhoff C, Straume B, Kvernmo S (2017) Multisite musculoskeletal pain in adolescence as a predictor of medical and social welfare benefits in young adulthood: The Norwegian Arctic Adolescent Health Cohort Study. Eur J Pain 21:1697–1706.

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Goldston DB, Erkanli A, Daniel SS et al (2016) Developmental trajectories of suicidal thoughts and behaviors from adolescence through adulthood. J Am Acad Child Adolesc Psychiatry 55:400–407.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Nock MK, Green JG, Hwang I et al (2013) Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents. JAMA Psychiatry 70:300.

    Article  Google Scholar 

  36. 36.

    Røysamb E, Schwarzer R, Jerusalem M (1998) Norwegian version of the general perceived self-efficacy scale. Accessed 14 Sept 2019

  37. 37.

    Eckhoff C, Kvernmo S (2014) Musculoskeletal pain in Arctic indigenous and non-indigenous adolescents, prevalence and associations with psychosocial factors: a population-based study. BMC Public Health 14:617.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Alsaker FD, Olweus D, Dundas I (1991) A growth curve approach to the study of parental relations and depression in adolescence. In: Paper Presented Biannual Meeting of the Society Research on Child Development, Seattle

  39. 39.

    Derogatis L, Rickels K, Uhlenhuth E et al (1974) The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci (Basel) 19:1–15

    CAS  Article  Google Scholar 

  40. 40.

    Strand BH, Dalgard OS, Tambs K, Rognerud M (2003) Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nord J Psychiatry 57:113–118.

    Article  Google Scholar 

  41. 41.

    Statistics Norway (2003). Norwegian Standard Classification of Education Revised 2000. Accessed 14 Sept 2019

  42. 42.

    Kvernmo SE, Heyerdahl S (1996) Ethnic identity in aboriginal Sami adolescents: the impact of the family and the ethnic community context. J Adolesc 19:453–463

    CAS  Article  Google Scholar 

  43. 43.

    Normann T. Ungdoms levekår (norwegian). Living conditions of youth (title in english).

  44. 44.

    OECD Long-term unemployment rate. Accessed 14 Sept 2019

  45. 45.

    OECD Youth unemployment rate. Accessed 14 Sept 2019

  46. 46.

    Chen H, Cohen P, Chen S (2010) How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat Simul Comput 39:860–864.

    Article  Google Scholar 

  47. 47.

    Lewinsohn PM, Rohde P, Seeley JR (1996) Adolescent suicidal ideation and attempts: prevalence, risk factors, and clinical implications. Clin Psychol Sci Pract 3:25–46.

    Article  Google Scholar 

  48. 48.

    Silviken A, Kvernmo S (2007) Suicide attempts among indigenous Sami adolescents and majority peers in Arctic Norway: prevalence and associated risk factors. J Adolesc 30:613–626.

    Article  PubMed  Google Scholar 

  49. 49.

    OECD (2008) Jobs for youth. OECD, Norway

    Google Scholar 

Download references


Data from the Norwegian Patient Register (NPR) have been used in this publication. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian Patient Register is intended or should be inferred.


This work was funded by the Sami Norwegian National Advisory Unit on Mental Health and Substance Use (SANKS). UiT The Arctic University of Norway, the Centre for Sami Health Research, and the Norwegian Institute of Public Health funded the NAAHS study. The registry linkage was funded by the University Hospital of North Norway and Nordland Hospital. The authors would like to thank all the participants of the NAAHS study.

Author information



Corresponding author

Correspondence to Christian Eckhoff.

Ethics declarations

Conflict of interest

CE has received research support from the Sami Norwegian National Advisory Unit on Mental Health and Substance Use (SANKS). MTS and SK report no financial or potential conflicts of interest.


The students and their parents were given written information about the study, and the students provided written consent. The Norwegian Data Inspectorate and the school authorities approved the NAAHS. The Regional Medical Ethical Committee approved the NAAHS and the registry linkage. The Norwegian Institute of Public Health and Statistics Norway carried out the linkage.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Eckhoff, C., Sørvold, M.T. & Kvernmo, S. Adolescent self-harm and suicidal behavior and young adult outcomes in indigenous and non-indigenous people. Eur Child Adolesc Psychiatry 29, 917–927 (2020).

Download citation


  • Suicidal behavior
  • Adolescent
  • Indigenous
  • Epidemiology
  • Longitudinal