For teens facing war anxiety, self-harm thoughts linked distress to suicide attempts

A study of 215 adolescents in Mahshahr found that self-injurious thoughts may help explain how psychological distress and preoccupation with death relate to reported suicide attempts.

Abstract editorial illustration accompanying the article: For teens facing war anxiety, self-harm thoughts linked distress to suicide attempts

Editorial illustration — not from the study.

Researchers studied 215 adolescents aged 15 to 18 living in Mahshahr, Iran, who scored above a threshold for war anxiety. Using questionnaire responses and a statistical model of direct and indirect relationships, they examined psychological distress, death obsession, self-injurious thoughts and reported suicide attempts.

Psychological distress was directly associated with suicide attempts and with self-injurious thoughts. Death obsession was associated with self-injurious thoughts, and both psychological distress and death obsession were indirectly associated with suicide attempts through those thoughts.

What the study found

The study found positive, statistically significant direct associations between psychological distress and reported suicide attempts, and between self-injurious thoughts and reported suicide attempts. Psychological distress and death obsession were also each positively and significantly associated with self-injurious thoughts. The indirect associations of both psychological distress and death obsession with suicide attempts through self-injurious thoughts were statistically significant. However, death obsession did not have a statistically significant direct association with suicide attempts in the final structural model.

Why self-harm thoughts matter

The findings suggest that assessing self-injurious thoughts could be important when identifying adolescents experiencing war anxiety who may be at elevated risk of suicide attempts, particularly those reporting psychological distress or recurring thoughts about death. The researchers say preventive and therapeutic efforts should include early identification and modification of these thoughts.

Evidence and caveats

This was a non-experimental, correlational study using structural equation modeling, not a test of whether one factor causes another. The 215 participants were selected voluntarily online from adolescents aged 15 to 18 in Mahshahr who met the study's war-anxiety screening threshold. Because the data were collected at one time through self-report questionnaires, the study cannot establish the timing or cause of the relationships, and responses may have been affected by disclosure concerns or misunderstanding. Voluntary online sampling and the single-county sample also limit how widely the findings can be generalized.

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