The role of impulsivity in self-harming and suicidal behavior: An integrative review
DOI:
https://doi.org/10.59464/2359-4632.2026.4164Keywords:
Self-Harm, Behavior Analysis, Suicide, Impulsivity, Self-ControlAbstract
Objectives: To verify the influence of impulsivity in the emission of suicidal behaviors and nonsuicidal self-injuries in people from 13 to 25 years old, along with the development of self-control repertoire as a form of prevention, from the perspective of Behavior Analysis. Methods: An integrative research of the literature was conducted in the databases PubMed, SciELO, ScienceDirect and Virtual Health Library, with the use of the keyword “Impulsivity”, which was combined with the keywords “Self-Harm”, “Behavior Analysis”, “Suicide” and “Self-Control”, using search prompts to include studies that met the established selection criteria. The selected articles were empirical and research studies, along with book chapters, published between 2015 and 2025 in the Portuguese and English languages. Results: it was verified that impulsivity is present in many cases of suicidal behaviors and nonsuicidal self-injuries in this age group, but there is no direct and constant correlation between them. Furthermore, a large diversity of conceptions of impulsivity was noted in the literature, and there were few studies regarding protective factors, focusing mostly on risk factors. Conclusion: Though there is no direct correlation, these behaviors are often impulsive, and when identified as such, the encouragement of self-control is a valuable intervention. Therefore, it is recommended that more studies are realized focusing on the functional analysis of nonsuicidal self-injury and suicidal behaviors, and protective factors that could decrease their frequency.
References
Organização Mundial da Saúde. Suicide [Internet]. [Local desconhecido]: OMS; 2025
Ministério da Saúde. Panorama dos suicídios e lesões autoprovocadas no Brasil de 2010 a 2021. Boletim Epidemiológico. 2024;55(4):1-18
Alves FJO, Fialho E, Araújo JAP, Naslund JA, Barreto ML, Patel V. Machado DB. The rising trends of self-harm in Brazil: an ecological analysis of notifications, hospitalisations, and mortality between 2011 and 2022. Lancet Reg Health Am. 2024;31(100691): 1-11. DOI: https://doi.org/10.1016/j.lana.2024.100691
Lovero KL, Santos PF, Come AX, Wainberg ML, Oquendo MA. Suicide in Global Mental Health. Curr Psychiatry Rep. 2023;25:255-62. DOI: https://doi.org/10.1007/s11920-023-01423-x
Lopes PV, Pedreira PA, Martínez-Sánchez L, Cruz JMG, Luna CB, Herrero FN, et al. Self-injury and suicidal behavior in children and youth population: Learning from the pandemic. An Pediatr (Engl Ed.). 2023;98(3): 204-12. DOI: https:/doi.org//10.1016/j.anpede.2022.11.005
McEvoy D, Brannigan R, Cooke L, Butler E, Walsh C, Arensman E, Clarke M. Risk and protective factors for self-harm in adolescents and young adults: An umbrella review of systematic reviews. J Psychiatr Res. 2023;168:353-80. DOI: https://doi.org/10.1016/j.jpsychires.2023.10.017
Saini V, Fisher WW, Betz AM, Piazza CC. Análise Funcional: História e Métodos. In: Fisher WW, Piazza CC, Roane HS, organizadores. Manual de Análise do Comportamento Aplicada. Porto Alegre: Artmed; 2025. p. 206-28
Moreira MB, Medeiros CA. Princípios Básicos de Análise do Comportamento. Porto Alegre: Artmed; 2019
Gonçalves FL. Comportamento Impulsivo: Definição e Pesquisas. Comportamento em Foco. 2017;6:21-32
Oermann MH, Knafl KA. Strategies for completing a successful integrative review. NA&E. 2021;31:65-8. DOI: https://doi.org/10.1111/nae2.30
Marcondes R, Silva SLR. O protocolo PRISMA 2020 como uma possibilidade de roteiro para revisão sistemática em ensino de Ciências. RBPG. 2022;18(39):1-19. DOI: https://doi.org/10.21713/rbpg.v18i39.1894
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):1-9. DOI: https://doi.org/10.1136/bmj.n71
McHugh CM, Lee RSC, Hermens DF, Corderoy A, Large M, Hickie IB. Impulsivity in the self-harm and suicidal behavior of young people: A systematic review and meta-analysis. J Psychiatr Res. 2019;116:51-60. DOI: https://doi.org/10.1016/j.jpsychires.2019.05.012
Lockwood J, Daley D, Townsend E, Sayal K. Impulsivity and self-harm in adolescence: a systematic review. Eur Child Adolesc Psychiatry. 2017;26(4):387-402. DOI: https://doi.org/10.1007/s00787-016-0915-5
Hamza CA, Willoughby T, Heffer T. Impulsivity and nonsuicidal self-injury: A review and meta-analysis. Clin Psychol Rev. 2015;38:13-24. DOI: https://doi.org/10.1016/j.cpr.2015.02.010
Liu RT, Trout ZM, Hernandez EM, Cheek SM, Gerlus N. A behavioral and cognitive neuroscience perspective on impulsivity, suicide, and non-suicidal self-injury: Meta-analysis and recommendations for future research. Neurosci Biobehav Rev. 2017;83:440-50. DOI: https://doi.org/10.1016/j.neubiorev.2017.09.019
Arango-Tobón OE, Tabares ASG, Serrano SJO. Structural Model of Suicidal Ideation and Behavior: Mediating Effect of Impulsivity. An Acad Bras Cienc. 2021;93(suppl 4):1-14. DOI: https://doi.org/10.1590/0001-3765202120210680
Sanz-Gómez S, Vera-Varela C, Alacreu-Crespo A, Perea-González MI, Guija JA, Giner L. Impulsivity in fatal suicide behaviour: A systematic review and meta-analysis of psychological autopsy studies. Psychiatry Res. 2024;337:1-12. DOI: https://doi.org/10.1016/j.psychres.2024.115952
Willems YE, Boesen N, Li J, Finkenauer C, Bartels M. The heritability of self-control: A meta-analysis. Neurosci Biobehav Rev. 2019;100:324-34. DOI: https://doi.org/10.1016/j.neubiorev.2019.02.012
Valencia-Agudo F, Burcher GC, Ezpeleta L, Kramer T. Nonsuicidal self-injury in community adolescents: A systematic review of prospective predictors, mediators and moderators. J. Adolesc. 2018;65:25-38. DOI: https://doi.org/10.1016/j.adolescence.2018.02.012
Chia AYY, Hartanto A, Wan TS, Teo SSM, Sim L, Kasturiratna KTAS. The impact of childhood sexual, physical and emotional abuse and neglect on suicidal behavior and non-suicidal self-injury: A systematic review of meta-analyses. Psychiatry Res Commun. 2025;5(1):1-19. DOI: https://doi.org/10.1016/j.psycom.2025.100202
Liu RT, Scopelliti KM, Pittman SK, Zamora AS. Childhood maltreatment and non-suicidal self-injury: a systematic review and meta-analysis. Lancet Psychiatry. 2018;5(1):51-64. DOI: https://doi.org/10.1016/s2215-0366(17)30469-8
Wang Y, Li X, Ng CH, Xu D, Hu S, Yuan T. Risk factors for non-suicidal self-injury (NSSI) in adolescents: A meta-analysis. EClinicalMedicine. 2022;46:1-12. DOI: https://doi.org/10.1016/j.eclinm.2022.101350
Cheek SM, Reiter-Lavery T, Goldston DB. Social rejection, popularity, peer victimization, and self-injurious thoughts and behaviors among adolescents: A systematic review and meta-analysis. Clin Psychol Rev. 2020;82:1-20. DOI: https://doi.org/10.1016/j.cpr.2020.101936
Chen Z, Liao X, Yang J, Tian Y, Peng K, Liu X, Li Y. Association of screen-based activities and risk of self-harm and suicidal behaviors among young people: A systematic review and meta-analysis of longitudinal studies. Psychiatry Res. 2024;338:1-15. DOI: https://doi.org/10.1016/j.psychres.2024.115991
Ng QX, Yong BZJ, Ho CYX, Lim DY, Yeo W. Early life sexual abuse is associated with increased suicide attempts: An update meta-analysis. J Psychiatr Res. 2018;99:129-41. DOI: https://doi.org/10.1016/j.jpsychires.2018.02.001
Sousa GS, Santos MSP, Silva ATP, Perrelli JGA, Sougey EB. Revisão de literatura sobre suicídio na infância. Ciênc. saúde colet. 2017;22(9):3099-3110. DOI: https://doi.org/10.1590/1413-81232017229.14582017
Rodríguez-Blanco L, Carballo JJ, Baca-García E. Use of Ecological Momentary Assessment (EMA) in Non-Suicidal Self-Injury (NNSI): A systematic review. Psychiatry Res. 2018;263:212-9. DOI: https://doi.org/10.1016/j.psychres.2018.02.051
Sheehy K, Noureen A, Khaliq A, Dhingra K, Husain N, Pontin EE et al. An examination of the relationship between shame, guilt and self harm: A systematic review and meta-analysis. Clin Psychol Rev. 2019;73(101779):1-13. DOI: https://doi.org/10.1016/j.cpr.2019.101779
Coimbra DG, Silva ACP, Sousa-Rodrigues CF, Barbosa FT, Figueredo DS, Santos JLA et al. Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. J Affect Disord. 2016;196:125-37. DOI: https://doi.org/10.1016/j.jad.2016.02.036
Winstone L, Heron J, Kirtley OJ, Moran P, Muehlenkamp J, O’Connor R et al. Ecological Momentary Assessment of Self-Harm Thoughts and Behaviors: Systematic Review of Constructs From the Integrated Motivational-Volitional Model. JMIR Ment Health. 2024;11:1-38. DOI: https://doi.org/10.2196/63132
Rahman F, Webb RT, Wittkowski A. Risk factors for self-harm repetition in adolescents: A systematic review. Clin Psychol Rev. 2021;88:1-32. DOI: https://doi.org/10.1016/j.cpr.2021.102048
Bentley KH, Cassiello-Robbins CF, Vittorio L, Sauer-Zavala S, Barlow DH. The association between nonsuicidal self-injury and the emotional disorders: A meta-analytic review. Clin Psychol Rev. 2015;37:72-88. DOI: https://doi.org/10.1016/j.cpr.2015.02.006
McClelland H, Loney KJ, Platt S. Psychological factors associated with suicide attempt and suicide death in Scotland: A systematic review. J Affect Disord Rep. 2024;15:1-12. DOI: https://doi.org/10.1016/j.jadr.2023.100711
Ongeri L, Theuri C, Nyawira M, Penninx BWJH, Tijdink JK, Kariuki SM, et al. Risk of suicidality in mental and neurological disorders in low and middle-income countries: A systematic review and meta-analysis. Compr Psychiatry. 2023;123:1-11. DOI: https://doi.org/10.1016/j.comppsych.2023.152382
Richard-Devantoy S, Olié E, Guillaume S, Courtet P. Decision-making in unipolar or bipolar suicide attempters. J Affect Disord. 2016;190:128-36. DOI: https://doi.org/10.1016/j.jad.2015.10.001
Torre-Luque A, Pemau A, Ayad-Ahmed W, Borges G, Fernandez-Sevillano J, Garrido-Torres N, et al. Risk of suicide attempt repetition after an index attempt: A systematic review and meta-analysis. Gen Hosp Psychiatry. 2023;81:51-6. DOI: https://doi.org/10.1016/j.genhosppsych.2023.01.00
Athey A, Shaff J, Kahn G, Brodie K, Ryan TC, Sawyer H, et al. Association of substance use with suicide mortality: An updated systematic review and meta-analysis. Drug Alcohol Depend Rep. 2025;14:1-11. DOI: https://doi.org/10.1016/j.dadr.2024.100310
Escelsior A, Murri MB, Corsini GP, Serafini G, Aguglia A, Zampogna D et al. Cannabinoid use and self-injurious behaviours: A systematic review and meta-analysis. J Affect Disord. 2021;278:85-98. DOI: https://doi.org/10.1016/j.jad.2020.09.020
Wardle H, Kesaite V, Tipiing S, McManus S. Changes in severity of problem gambling and subsequent suicide attempts: a longitudinal survey of young adults in Great Britain, 2018-20. Lancet Public Health. 2023;8(3):e217-25. DOI: https://doi.org/10.1016/S2468-2667(23)00008-7
Capuzzi E, Caldiroli A, Capellazzi M, Tagliabue I, Buoli M, Clerici M. Biomarkers of suicidal behaviors: A comprehensive critical review. Adv Clin Chem. 2020;96:179-216. DOI: https://doi.org/10.1016/bs.acc.2019.11.005
O’Connor DB, Gartland N, O’Connor RC. Stress, cortisol and suicide risk. Int Rev Neurobiol. 2020;152:101-30. DOI: https://doi.org/10.1016/bs.irn.2019.11.006
Serafini G, Trabucco A, Corsini G, Escelsior A, Amerio A, Aguglia A, et al. The potential of microRNAs as putative biomarkers in major depressive disorder and suicidal behavior. Biomark Neuropsychiatry. 2021;5:1-15. DOI: https://doi.org/10.1016/j.bionps.2021.100035
Neupane SP, Daray FM, Ballard ED, Galfalvy H, Itzhaky L, Segev A, et al. Immune-related biomarkers and suicidal behaviors: A meta-analysis. Eur Neuropsychopharmacol. 2023;75:15-30. DOI: https://doi.org/10.1016/j.euroneuro.2023.05.009
Sharma R, Tikka SK, Yadav AK, Bhute AR, Dhamija P, Bastia BK. Cerebrospinal fluid monoamine metabolite concentrations in suicide attempt: A meta-analysis. Asian J Psychiatr. 2021;62:1-8. DOI: https://doi.org/10.1016/j.ajp.2021.102711
Vasupanrajit A, Jirakran K, Tunvirachaisakul C, Maes M. Suicide attempts are associated with activated immune-inflammatory, nitro-oxidative, and neurotoxic pathways: A systematic review and meta-analysis. J Affect Disord. 2021;295:80-92. DOI: https://doi.org/10.1016/j.jad.2021.08.015
Hepp J, Carpenter RW, Störkel LM, Schmitz SE, Schmahl C, Niedtfeld I. A systematic review of daily life studies on non-suicidal self-injury based on the four-function model. Clin Psychol Rev. 2020;82(101888):1-21. DOI: https://doi.org/10.1016/j.cpr.2020.101888
Hielscher E, Whitford TJ, Scott JG, Zopf R. When the body is the target – Representations of one’s own body and bodily sensations in self-harm: A systematic review. Neurosci Biobehav Rev. 2019;101:85-112. DOI: https://doi.org/10.1016/j.neubiorev.2019.03.007
Kazan D, Calear AL, Batterham PJ. The impact of intimate partner relationships on suicidal thoughts and behaviours: A systematic review. J Affect Disord. 2016;190:585-98. DOI: https://doi.org/10.1016/j.jad.2015.11.003
Conner KR, Kearns JC, Denneson LM. Qualitative analysis of hospital patient narratives of warning signs on the day of their suicide attempt. Gen Hosp Psychiatry. 2022;79:146-51. DOI: https://doi.org/10.1016/j.genhosppsych.2022.11.00
Turton H, Berry K, Danquah A, Pratt D. The relationship between emotion dysregulation and suicide ideation and behaviour: A systematic review. J Affect Disord Rep. 2021;5:1-13. DOI: https://doi.org/10.1016/j.jadr.2021.100136
Boer K, Hopkins L, Kehoe M, Whitehead R, Nedeljkovic M, Meyer D. A systematic review of the facilitators and barriers for the implementation of co-designed youth suicide and self-harm interventions. Child Youth Serv Rev. 2025;171:1-8. DOI: https://doi.org/10.1016/j.childyouth.2025.108191
Lu J, Huang J, Gao W, Wang Z, Yang N, Luo Y, et al. Interventions for suicidal and self-injurious related behaviors in adolescents with psychiatric disorders: a systematic review and meta-analysis. Transl Psychiatry. 2025;15:1-22. DOI: https://doi.org/10.1038/s41398-025-03278-7
Dionnet V, Dubertret C, Hammerstein C, Hermand M. The effects of meditation on adolescent suicidal behavior. A systematic review. Ann Med Psychol. (Paris). 2025. DOI: https://doi.org/10.1016/j.amp.2025.02.009
Barjasteh-Askari F, Davoudi M, Amini H, Ghorbani M, Yaseri M, Yunesian M et al. Relationship between suicide mortality and lithium in drinking water: A systematic review and meta-analysis. J Affect Disord. 2020;264:234-41. DOI: https://doi.org/10.1016/j.jad.2019.12.027
Ki M, Lapierre S, Gim B, Hwang M, Kang M, Dargis L et al. A systematic review of psychosocial protective factors against suicide and suicidality among older adults. Int Psychogeriatr. 2024;36(5):346-70. DOI: https://doi.org/10.1017/s104161022300443x
Reynolds CR, Altmann RA, Allen DN. Behavioral Assessment. In: Reynolds CR, Altmann RA, Allen DN, authors. Mastering Modern Psychological Testing: Theory & Methods. Berlin: Springer Nature; 2021. p. 427-59
Lint AH, Walsh RFL, Sheehan AE, Cheek SM, Liu RT. A multi-method evaluation of trait and state-sensitive impulsivity in relation to impulsiveness of suicide attempts and non-suicidal self-injury in an adolescent clinical sample. J Mood Anxiety Disord. 2026;15(100190):1-8. DOI: https://doi.org/10.1016/j.xjmad.2026.100190
Rozanov V. Stress and Epigenetics in Suicide. [place unknown]: Academic Press, 2017
Batista JR, Tourinho EZ. Interpretação Analítico-Comportamental do Autocontrole Emocional. Interação Psicol. (Online). 2012;16(2):249-59. DOI: https://doi.org/10.5380/psi.v16i2.16884
Nock MK. Self-Injury. Annu Rev Clin Psychol. 2010;6:339-63. DOI: https://doi.org/10.1146/annurev.clinpsy.121208.131258
O’Connor RC. Towards an Integrated Motivational-Volitional Model of Suicidal Behaviour. In: O’Connor RC, Platt S, Gordon J, editors. International Handbook of Suicide Prevention: Research, Policy and Practice. New Jersey: John Wiley & Sons; 2011. p. 181-98
Moitra M, Santomauro D, Degenhardt L, Collins PY, Whiteford H, Vos T, Ferrari A. Estimating the risk of suicide associated with mental disorders: A systematic review and meta-regression analysis. J Psychiatr Res. 2021;137:242-9. DOI: https://doi.org/10.1016/j.jpsychires.2021.02.053
Hawton K, Saunders KEA, O’Connor RC. Self-Harm and Suicide in Adolescents. Lancet. 2012;379(9834):2373-82. DOI: https://doi.org/10.1016/s0140-6736(12)60322-5
Rocha TML, Cavalcante FML, Aragão JMN. Fatores de risco para suicídio em adolescentes. JHEP. 2023;3(3):1-23. DOI: https://doi.org/10.59483/rfpp.v3n3.74
Mullins N, Kang J, Campos AI, Coleman JRI, Edwards AC, Galfalvy H et al. Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors. Biol Psychiatry. 2022;91(3):313-27. DOI: https://doi.org/10.1016/j.biopsych.2021.05.029
Ghosh D, Raj S, Singh T, Verma SK, Arya YK. Implementing mindfulness-based cognitive therapy on dynamics of suicidal behavior: Understanding the efficacy and challenges. In: Martin CR, Patel VB, Preedy VR. Handbook of Cognitive Behavioral Therapy by Disorder. Cambridge: Academic Press; 2023. p.281-92
Schwartz TL, Sachdeva S. Integrando Psicoterapia e Psicofarmacologia: Desfechos, endofenótipos e os fundamentos teóricos sobre eficácia. In: Oliveira IR, Stahl SM, Schwartz TL, organizadores. Integrando Psicoterapia e Psicofarmacologia: Manual para Clínicos. São Paulo: Artmed; 2014. p. 1-25
Figel FC, Bredemeier J. Ambientes Nutridores como modalidade de Prevenção Universal do Suicídio. In: Scavacini K, Silva DR, organizadores. Atualizações em Suicidologia: Narrativas, Pesquisas e Experiências. São Paulo: Instituto Vita Alere; 2021. p. 14-35
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