Mindfulness

https://doi.org/10.1007/s12671-021-01815-1

ORIGINAL PAPER

Mindfulness, Self-compassion, Self-injury, and Suicidal thoughts

and Behaviors: a Correlational Meta-analysis
Megan Per1   · Emma Schmelefske1 · Kyla Brophy1 · Sara Beth Austin2 · Bassam Khoury1

Accepted: 11 December 2021

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021

Abstract
Objectives  While extant research indicates an inverse association between self-compassion and mindfulness with non-
suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs), estimates of magnitude remain unknown. The
present systematic review and meta-analysis aim to quantify the relationship between self-compassion and mindfulness
with engagement in NSSI and STBs.
Methods  Literature searches in four electronic databases (PsycINFO, MEDLINE, Scopus, ProQuest Dissertations, and The-
ses Global) were conducted. Effect sizes were estimated using pooled correlation coefficients and a random effects model.
Meta-regressions with mixed-effect models were used to determine the moderators of the associations.
Results  Sixty-eight independent samples from 62 different articles (N = 53,797) met inclusion criteria. Analyses yielded
a medium negative correlation between self-compassion and mindfulness with both NSSI and STBs. Among mindfulness
facets, the nonjudging, acting with awareness, and describing facets demonstrated the largest significant correlations with
both STBs and NSSI. The self-coldness dimension (vs self-warmth dimension) of self-compassion demonstrated the largest
correlation to STBs. There was a stronger negative correlation between self-compassion and mindfulness with engagement
in NSSI and STBs in adolescent samples (than in clinical and college student samples) and with STBs’ recency (reported
within the past 12 months vs lifetime). Associations between NSSI and STBs with self-compassion and mindfulness were
greater in lower-quality studies and studies with younger or male samples, although effect sizes remained modest.
Conclusions  Findings suggest that self-compassion and mindfulness may buffer against NSSI and STBs. Future study
regarding the efficacy and effectiveness of self-compassion and mindfulness-based interventions among NSSI and STB
populations is warranted.
Meta‑analysis registration  PROSPERO CRD42020167823.

Keywords  Suicide · Non-suicidal self-injury · Self-harm · Self-compassion · Mindfulness · Suicidal ideation · Suicide
attempt

Suicide and related behaviors are serious and often over-
looked worldwide public health problems (Bertolote &
Fleischmann, 2002; World Health Organization, 2017).
Annual suicide mortality exceeds 800,000 (World Health
Organization, 2018)—an alarming rate that grossly
underestimates the true death toll (Tøllefsen et al., 2012).
* Megan Per
megan.per@mail.mcgill.ca
1
Department of Educational and Counselling Psychology,
McGill University, Education Building, 3700 McTavish St
(Room 614), QC H3A 1Y2 Montreal, Canada
2
The Family Institute, Northwestern University, Evanston, IL,
USA
Age-adjusted suicide mortality has increased nearly 33%
since 2000 (Hedegaard & Warner, 2021) and is projected
to rise between 3 and 9% in the coming years (McIntyre &
Lee, 2020a, 2020b). Suicide has remained among the top
ten leading causes of death in North America for over three
decades, with rates occurring over 2.5 times that of homi-
cide (Centers for Disease Control and Prevention, 2018).
For every completed suicide, approximately 140 people
contemplate and 25–30 attempt to take their life (Centers
for Disease Control and Prevention, 2021; Weissman et al.,
1999). Suicide-related behaviors are associated with signifi-
cant morbidity and health care costs (adjusted annual US
rates of $93.5 billion; Shepard et al., 2016). Accurate suicide
prediction and prevention have been limited by challenges

13
Vol.:(0123456789)
 Mindfulness
within spanning methodology (Carpenter & Law, 2021),
decades of inconsistent nomenclature (Goodfellow et al.,
2020; Silverman et al., 2007), and an over-focus on psycho-
pathology (e.g., mental illness, loneliness, hopelessness).
Indeed, over 50 years of focused prevention efforts have
negligibly impacted suicide rates, and significant knowledge
gaps remain regarding underlying mechanisms and pathways
to suicide (Franklin et al., 2017).
Non-suicidal self-injury (NSSI), defined as the deliberate
and intentional destruction of one’s own bodily tissue with-
out suicidal intent and for reasons not socially sanctioned
(e.g., tattoos, body piercings; International Society for the
Study of Self-Injury, 2007), is distinct from but closely
associated with suicide. Those engaging in NSSI are at sig-
nificantly increased risk for suicidal thoughts and behav-
iors (STBs; Baer et al., 2020; Kiekens et al., 2018; Ribeiro
et al., 2016). NSSI—a frequent precursor to STBs and co-
occurring behavior (Hamza et al., 2012; Klonsky et al.,
2013)—is arguably the most robust predictor of attempted
suicide (Taliaferro & Muehlenkamp, 2014; Victor & Klon-
sky, 2014). A large, multi-site study conducted over 10 years
found that individuals who self-injure were between 30 and
100 times more likely to die by suicide than the general pop-
ulation (Hawton et al., 2015). NSSI may increase acquired
capacity for suicide via irreversible changes in habituation
to physiological pain and fear of death (Bender et al., 2012).
Researchers have called for greater study and understanding
of risk and resilience factors uniquely associated with NSSI
and STBs to better target prevention and intervention efforts
(Franklin et al., 2017; Hasking et al., 2019).
Predominant NSSI and suicide risk models (for reviews,
see Fox et al., 2015; Klonsky et al., 2018) have failed to
translate into efficacious prevention and intervention initia-
tives (Fox et al., 2020; Nielssen et al., 2017), in part due to
a narrow over-focus on pathology that overlooks resilience
and other protective factors as critical moderators of the
risk-outcome relationship. Resilience is a multidimensional
process involving transactions between intra- and interper-
sonal resources that increase adaptive coping capacity in the
face of adversity (Gallagher & Miller, 2018; Luthar & Cic-
chetti, 2000). Incorporating resilience into suicide research
is critical for contextualizing dynamics that underlie suicidal
phenomena and outcomes (Shahram et al., 2021). Resilience
serves as a crucial barrier to suicidality (Brailovskaia et al.,
2019; Sher, 2019), and preliminary evidence suggests it
accounts for greater variance in predicting STB remission
than do risk factors (Teismann et al., 2016).
Holistic consideration of relationships between NSSI
and STB risk and resilience factors add much-needed incre-
mental validity in understanding these complex phenomena
(Muehlenkamp & Brausch, 2019). Research on the rela-
tionship between NSSI and STBs and traditional resilience
proxies—i.e., life satisfaction (Muehlenkamp & Brausch,
13
2019), optimism and hope (Chang et al., 2017), treatment
compliance, and mental health service utilization (Rufino
et al., 2021)—has been mixed. Recent investigations suggest
that cultural factors (e.g., cultural sanctions, cultural idioms
related to distress) may play an extensive role in predicting
NSSI and STBs (Tang et al., 2018) over and above tradition-
ally studied protective factors (e.g., reasons for living; Chu
et al., 2019).
Mindfulness and self-compassion, two related culturally
adapted practices, have received increasing attention over
the past two decades for their potential to buffer against
NSSI and STBs (e.g., Bentley et al., 2017; Schmelefske
et al., 2020; Van Vliet & Kalnins, 2011). Within a Western
context, mindfulness is operationalized as the deliberate,
non-judgmental awareness of the present moment (Kabat-
Zinn, 2003). Employed widely in third wave therapies (e.g.,
Dialectical Behavior Therapy, and Acceptance and Commit-
ment Therapy) and as standalone approaches (e.g., Mindful-
ness-Based Stress Reduction, Mindfulness-Based Cognitive
Therapy), mindfulness-based interventions perform as well
as other evidence-based treatments for psychiatric condi-
tions (i.e., depression, substance use disorders) associated
with NSSI and STBs (Goldberg et al., 2018; Khoury et al.,
2013a).
In a related area, an overlapping but distinct construct to
mindfulness is self-compassion. While different definitions
of self-compassion exist in the current literature (see review
by Gilbert, 2017; Khoury, 2019; Strauss et al., 2016), self-
compassion is broadly considered to be theoretically adja-
cent to mindfulness (Khoury, 2019). A common operation-
alization based on the Self-Compassion Scale (SCS; Neff,
2003b) involves three interconnected dimensions: holding
painful thoughts in mindful awareness, showing kindness
towards oneself in the face of distress, and understand-
ing difficulties as part of a larger human experience (Neff,
2003a). Alternative conceptualizations of self-compassion
include Gu et al., (2020) five-dimensional model (recogniz-
ing suffering; understanding the universality of suffering;
feeling for the person suffering; tolerating uncomfortable
feelings; and motivation to act/alleviate suffering), and Gil-
bert’s dual component framework combining sensitivity to
one’s own suffering (compassionate engagement) with a
commitment to alleviate and prevent it (or compassionate
action; Gilbert & Mascaro, 2017; Gilbert et al., 2017).
Substantial evidence links mindfulness and self-com-
passion to psychological health and well-being, suggest-
ing an inverse correlation with psychological distress and
psychopathology. Posited factors underlying these rela-
tionships include facilitative effects of mindfulness and
self-compassion on autonomic regulation (e.g., decreas-
ing sympathetic hyperarousal and dorsal vagal activation),
emotion-focused coping (e.g., promoting awareness and
identification of affective states), and distress tolerance (e.g.,
Mindfulness
emotional acceptance; Basharpoor et al., 2021; Finlay-Jones
et al., 2015; Inwood & Ferrari, 2018; Ogden et al., 2006).
We know that there is a large body of electrophysiological,
neurobiological, and psychological evidence which indicates
that mindfulness and self-compassion affect mental health
outcomes by enhancing emotion regulation capacity (Inwood
& Ferrari, 2018; Lin et al., 2016; Lutz et al., 2014). We also
know NSSI and STBs are linked to emotion dysregulation
(Rajappa et al., 2012; You et al., 2018) and may function as
attempts to regulate and manage distressing affective expe-
riences. Indeed, for some, NSSI and STBs (Angelakis &
Gooding, 2020, 2021; Brereton & McGlinchey, 2020; Ellis
& Rufino, 2016) provide means of experiential avoidance—
i.e., escape behaviors aimed to attenuate the form, frequency,
and/or contexts associated with contacting/being present
with aversive internal experiences (e.g., physiological sen-
sations, emotions, thoughts, memories, action urges; Hayes
et al., 1996, p. 1154). Thus, experiential avoidance can be
understood as an emotion regulation strategy—one way to
manage emotions is to avoid them.
Taken together, these findings suggest that mindfulness
and self-compassion may target underlying functions of
NSSI and STBs. Mindfulness and self-compassion are likely
to increase psychological flexibility and expand coping rep-
ertoires in ways that reduce reliance on escape via self-injury
and STBs. Supporting this notion, a recent meta-analysis
found that mindfulness-based interventions led to moderate
reductions in suicidal ideation (Schmelefske et al., 2020)
and other psychological outcomes associated with suicide
(e.g., depression).
Despite growing interest in the clinical application and
utility of mindfulness and self-compassion on NSSI and
STBs, the relationships between these constructs remain
unclear. Recently, there has been a systematic review on
self-harm, suicidal ideation, and self-compassion (Cleare
et al., 2019). While laudable, this review did not quantify
these relationships, and examined suicidal ideation with-
out accounting for key-related constructs such as NSSI and
STBs. The present study addresses these important gaps and
adds to the literature by aiming to (1) quantify the corre-
lations between mindfulness, self-compassion, NSSI, and
STBs; (2) examine the impact of specific moderators (age,
gender, and study quality) on these relationships; and (3)
compare the mean correlations between subgroups (popula-
tion type, recency of STBs and NSSI).
Methods
Eligibility Criteria
Studies were eligible for inclusion in the review if they
(1) reported data on completed measures of mindfulness
and/or self-compassion; (2) assessed for NSSI and/or
STBs; (3) included original data; (4) reported correla-
tion coefficients (or other statistics when correlation
coefficients were not available, e.g., t-scores) between
mindfulness or self-compassion and NSSI (defined as
a deliberate non-suicidal act involving actual or poten-
tial tissue damage without suicidal intent) or suicidal
outcomes; (5) were available in English or French; and
(6) were published in a peer-reviewed journal article or
dissertation. Dissertations were included in an effort to
reduce publication bias by potentially including stud-
ies with null or negative results, which provides a more
comprehensive picture of the available research (Paez,
2017). When information was missing, authors were
contacted, and the study was included only if the neces-
sary data were obtained. Studies not explicitly differ-
entiating between self-injury with and without suicidal
intent were excluded. There were no restrictions on
study design or date; however, only baseline data were
used in the analyses.
Search Strategy
Articles were identified for inclusion via searches through
four electronic databases (PsycINFO, MEDLINE, Scopus,
and ProQuest Dissertations, and Theses Global). The ini-
tial search was conducted in PsycINFO (Ovid, 1806 to pre-
sent) and was peer-reviewed by Dr. Alberto Chiesa, Uni-
versity of Bologna. The search combined keywords and
Boolean operators related to NSSI or suicide and mindful-
ness or self-compassion. Several studies made use of the
same dataset and data was extracted when they reported
complementary data (e.g.,Watson-Singleton et al., 2018;
Wu et al., 2019). See Fig. 1 for a flow diagram of search
results.
Data assessing (1) NSSI and STBs and (2) mindful-
ness and self-compassion outcomes were extracted. STBs
and NSSI were measured continuously (e.g., frequency
of thoughts and behaviors) and/or categorically (e.g.,
endorsement of specific thoughts and behaviors) across
studies. Demographic information from included studies
was extracted and reported, and comprised of (a) publi-
cation characteristics (e.g., year of publication and name
of authors); (b) study characteristics (e.g., sample size,
sample type, geographic region); and (c) participant char-
acteristics (e.g., mean age, percentage of female partici-
pants, percentage of caucasian participants). Continuous
moderators (i.e., age, percentage of female and study qual-
ity) were examined with meta-regressions with the goal
of investigating how outcomes were affected by the mod-
erators. Subgroup analyses were conducted to compare
13
 Mindfulness

Fig. 1  PRISMA flow diagram

of screening process

Identification
Records idenfied through database
searching
(n = 1,296)

Records aer duplicates removed

(n = 841) original

Screening
Records screened Records excluded
(n = 841) (n = 641)

Full-text arcles assessed for Full-text arcles excluded: (n

eligibility = 138)
Eligibility

(n = 200) Did not report outcomes (n =

74)
Did not provide correlaons
(n = 38)
Duplicate sample (n = 21)
Cannot locate (n = 2)

Studies included in
Included

quantave synthesis (meta-

analysis)
(n = 68 studies; 62 arcles)

the correlations of the different samples (e.g., clinical vs Statistical Analyses

community).
Study Selection
Duplicates were removed using Endnote X8.2 and exported
to Rayyan, an online screening tool for systematic reviews
(Ouzzani et al., 2016). A non-blinded, standardized pro-
tocol was used to determine inclusion eligibility using the
aforementioned criteria by the first M. P. and second E. S.
authors. M. P. and E. S. separately assessed 15% (k = 129)
of the same articles following duplication removal. An inter-
rater agreement of 97.42% was achieved initially. Follow-
ing consideration of rationales for inclusion or exclusion,
consensus was reached through discussion. Thereafter, M.
P. and E. S. each independently assessed half of the remain-
ing articles. Any disagreements between reviewers about
whether a study should be included were resolved through
consultation with the last author, B. K.
Data were analyzed with Comprehensive Meta-Analysis, Ver-
sion 3.070 (Borenstein & Rothstein, 1999). Pearson correla-
tion coefficients of each sample were weighted by the inverse
of the corresponding sampling variance and converted into
Fisher’s transformation to account for sampling error (Hedges
& Olkin, 2014; Rosenthal & Rubin, 1988). A random effect
model more resilient to heterogeneity (Khoury et al., 2013b)
was used for aggregated r values and moderation analyses.
Classic fail-safe N analysis and funnel plots were computed to
assess publication bias across studies. These analyses estimate
the number of studies needed to cause significant aggregated
r values to be insignificant. Study quality was assessed using
the standardized critical appraisal tool (AXIS tool; Downes
et al., 2016) designed for non-experimental research. Risk of
bias was assessed by two independent reviewers (E. S. and M.
P.), who resolved disagreement by discussion or by involving
a third reviewer (B. K.).

13
Mindfulness
Results
Study Selection and Characteristics
One thousand two hundred and ninety-six articles were
retrieved from the initial search on June 30, 2021. Removal
of duplicates resulted in 841 articles. A total of 68 samples
(62 different articles) were included in the meta-analysis.
The combined number of participants was 53,797 and the
mean size of the sample was 791.13 (SD = 3,168.35; range
= 8–26,292). The mean age of the sample was 26.97 and
58.09% of the sample was female. The majority of the
studies were conducted in North America (64.71%) and
the majority of participants were Caucasian (58.93%). Of
the included studies, the majority were college students
(e.g., undergraduate students; 39.71%), followed by com-
munity/non-clinical samples (23.53%), clinical samples
(17.65%), then adolescents (16.18%). Risk of bias scores
ranged from 6 to 15 (mean = 11.77, SD = 1.86). See
Table 1 for detailed characteristics of individual studies.
Synthesis of Results
STBs showed a medium negative correlation (r = −.269)
with combined self-compassion and mindfulness (k = 55;
95% CI [−.302, −.236], p < .001), with high heterogene-
ity. Suicidal ideation had a medium negative correlation
(r = −.302; k = 34; 95% CI [−.357, −.244], p < .001)
with self-compassion and mindfulness combined and high
heterogeneity. Suicide attempts had a small-to-medium
negative correlation (r = −.209; k = 10; 95% CI [−.236,
−.183], p < .001), with mindfulness and self-compassion
combined and low heterogeneity.
The mindfulness facets and self-compassion dimensions
were also analyzed in relationship to STBs. Of the 11 studies
that analyzed the mindfulness facets and STBs, the nonjudg-
ing (r = −.270; 95% CI [−.327, −.212], p < .001) and the
acting with awareness facet (r = −.277; CI [−.329, −.0.223],
p < .001) had a medium negative correlation, and moderate
heterogeneity, with STBs. The describing facet had a small
negative effect (r = −.137; 95% CI [−.194, −.080], p < .001)
with STBs and moderate heterogeneity. The non-reacting
and observing facets were not significant. Regarding the
self-compassion dimensions, the self-warmth dimension had
a small negative effect (r = −.166) and moderate heteroge-
neity with STBs (k = 8; 95% CI [−.237, −.093], p < .001).
The self-coldness dimension had a small-to-moderate effect
(r = .239) and large heterogeneity with STBs (k = 7; 95% CI
[−.427, −.031], p = .025).
The aggregated random effects model for the relation-
ship between mindfulness and self-compassion outcomes,
and NSSI outcomes had a medium negative correlation (r
= −.267) with self-compassion and mindfulness combined
(k = 18; 95% CI [−.336, −.194], p < .001), with high het-
erogeneity. Mindfulness and self-compassion combined
had a medium negative correlation and high heterogene-
ity for NSSI frequency (r = −.285; k = 9; 95% CI [−.395,
−.167], p < .001). NSSI versatility had a small negative
correlation (r = −.176) with self-compassion and mindful-
ness combined (k = 3; 95% CI [−.250, −.100], p < .001),
with small heterogeneity. Table 2 presents the combined
random effects model, examining the relationship between
NSSI and suicide outcomes with self-compassion and
mindfulness. See Table 3 for the effect sizes for the self-
compassion dimensions with suicide and NSSI outcomes.
The mindfulness facets and self-compassion dimensions
were also analyzed in relationship to NSSI outcomes in four
studies. Similar to suicide outcomes, only the describing
(r = −.250; 95% CI [−.451, −.024], p = .030; small-to-
medium effect), acting with awareness (r = −.347; 95% CI
[−.548, −.108], p = .005; medium effect), and nonjudging
(r = −.399; 95% CI [−.633, −.098], p = .011; medium-to-
large effect) facets of mindfulness had a significant negative
effect, and high heterogeneity, with NSSI outcomes. The
non-reacting and observing facets were not significant. The
self-warmth and self-coldness dimensions of self-compas-
sion were not analyzed, as only two studies reported on these
subscales.
Subgroup Analyses
Subgroup analyses of both STBs reported within the last
12 months (r = −.278; k = 31; 95% CI [−.320, −.235], p
< .001) and lifetime history (r = −.256; k = 21; 95% CI
[−.312, −.198], p < .001) of STBs had a medium negative
correlation with self-compassion and mindfulness com-
bined, with high heterogeneity. STBs within clinical sam-
ples had a medium negative correlation with mindfulness
and self-compassion (r = −.247; k = 11; 95% CI [−.350,
−.139], p < .001), with medium heterogeneity. A small-to-
medium negative correlation was found in community sam-
ples (r = −.233; k = 13; 95% CI [−.293, −.171], p < .001),
with high heterogeneity to self-compassion and mindfulness
combined. College student samples had a medium negative
correlation (r = −.287; k = 21; 95% CI [−.337, −.235], p <
.001), with high heterogeneity, and adolescent samples had
a medium negative correlation (r = −.335; k = 8; 95% CI
[−.370, −.300], p < .001), with low heterogeneity, to self-
compassion and mindfulness combined.
Subgroup analyses of combined NSSI outcomes reported
within the last 12 months had a medium negative correla-
tion (r = −.257; k = 8; 95% CI [−.352, −.156], p < .001),
and lifetime NSSI history had medium negative correla-
tion (r = −.260; k = 12; 95% CI [−.350, −.165], p < .001),
13
 Table 1  Characteristics of included studies
Study Study design Publication type Participants (N) Country Mean age (SD) % female % Caucasian Study quality Outcomes Measures

13
Aalsma et al., Pilot study Journal article 10th–12th grade USA 15.2 (1.3) 79.1 37.2 13 Mindfulness MAAS-A and
(2020)a adolescents and suicidal SIQ
(18) ideation (SI)
8th–9th grade
adolescents
(25)
Ali (2014) Cross-sectional Dissertation Students with USA 16 (1.28) 50 66.7 13 Self-compas- SCS and subset
a behavioral sion (SC) and questions from
or emotional suicidality the YRBSS
disorder (12)
Anastasiades Cross-sectional Journal article Female under- USA 19.92 (1.58) 100 76.7 12 Mindfulness MAAS and BSS
et al., (2017) graduate and SI
students (928)
Argento et al., Brief mindful- Journal article University stu- Canada 20.17 (1.98) 100 54.9 13 Mindfulness SMS and ISAS
(2020) ness induction dents (144) and NSSI
Basharpoor Cross-sectional Journal article University stu- Iran 21.25 (2.76) 57.33 N/A 8 SC and SI SCS and BSS
et al., (2016) dents (150)
Bock et al., Cross-sectional Journal article University stu- USA 20.26 (2.55) 76.4 61.9 11 Mindfulness FFMQ and DSHI
(2021) dents (339) and NSSI
Bravo et al., Cross-sectional Journal article Military person- USA 32.74 (7.5) 44.5 62.4 12 Mindfulness FFMQ and IDAS:
(2018)a nel (407) and suicidality suicidality
College students 24.46 (8.66) 41.30 47.8 subscale
(310)
Brooks et al., Cross-sectional Journal article Black college USA 22.4 (5.6) 79.2 0 13 Mindfulness, FFMQ, BSS and
(2021) students (307) suicidality SBQ-R
and SI
Buitron et al., Cross-sectional Journal article Undergraduates USA 20.81 (3.96) 78.00 63.8 11 Mindfulness FFMQ and ASIQ
(2017) with moder- and SI
ate to severe
depressive
symptoms
(218)
Chassagne et al., Cross-sectional Journal article Students (1034) France Females: 20.1 79.11 N/A 9 Mindfulness French version of
(2020) (2) and SI the FFMQ and
Males: 20.6 3 items assess-
(2.2) ing suicide
ideation
Cheng et al., Cross-sectional Journal article Psychiatric USA 33.3 (11) 42.9 44.5 12 Mindfulness, FFMQ, BSS and
(2018) inpatients with SI, and sui- medical records
a history of cide attempts assessing
trauma expo- (SA) previous suicide
sure (119) attempts
Mindfulness
 Table 1  (continued)
Study Study design Publication type Participants (N) Country Mean age (SD) % female % Caucasian Study quality Outcomes Measures
Mindfulness

Chesin et al., A quasi-exper- Journal article High–suicide USA 41.7 (16.3) 80 N/A 11 Mindfulness, FFMQ, SCS-SF
(2016) imental pre– risk outpa- SC, and suici- and LEIDS-R:
post study tients (10) dality hopelessness/
suicidality
subscale
Chesin and Cas- Cross-sectional Journal article Undergraduate USA 19.7 (2.9) 63.5 42.8 12 Mindfulness, MAAS, BSS and
cardi (2019) students (780) SI, and SA 1 item assessing
previous suicide
attempts
Cladder-Micus Intervention Journal article Patients with The Netherlands 47.53 (11.67) 70.4 N/A 13 Mindfulness KIMS and
et al., (2018) three or more and suicidality LEIDS-R:
previous hopelessness/
depressive epi- suicidality
sodes (115) subscale
Cleare (2019)a Cross-sectional Dissertation Community (61) Scotland 28.4 (9.5) 49.2 80.3 13 Mindfulness, SCS, FFMQ-SF,
Longitudinal University stu- 22.9 (5.76) 75.7 93 13 SC, and SI and BPMS
survey study dents (514)
Exploratory/ Individuals with Range = 20–40 50 100 12
pilot qualita- and without
tive research a history of
NSSI
Collett et al., Cross-sectional Journal article Patients with UK 45.6 (12.1) 52 N/A 12 SC and SI SCS and BSS
(2016) persecutory
beliefs (21)
Collins et al., Cross-sectional Journal article University stu- Australia 25.98 (10.47) 69.96 77 11 Mindfulness, MAAS, SITBI
(2018) dents (233) SI, and sui- and 1 item
cidal intention assessing sui-
cidal intention
Dixon-Gordon Pilot study Journal article Women with North America 34.47 (11.83) 100 63.2 13 Mindfulness FFMQ and DSHI
et al., (2015) BPD (19) and NSSI
Dobbins (2014) Cross-sectional Dissertation Older adoles- USA 18.41 (.50) 59.6 57 13 Mindfulness FFMQ and DSHI
cents (111) and NSSI
Fang et al., Cross-sectional Journal article Undergraduate China N/A 60.9 N/A 15 Mindfulness MAAS and
(2019) medical stu- and suicidality SBQ-R
dents (2633)
Fang (2020) Cross-sectional Dissertation Undergraduate USA 19.37 (2.41) 76 88 14 SC and SI SCS and ASIQ
students (417)
Forkus et al., Cross-sectional Journal article Military veter- N/A 35.08 22.7 70.4 10 SC and NSSI SCS and DSHI
(2019) ans (203)

13
 Table 1  (continued)
Study Study design Publication type Participants (N) Country Mean age (SD) % female % Caucasian Study quality Outcomes Measures

13
Garisch and Longitudinal Journal Article Secondary stu- New Zealand 16.35 (0.62) 43 71.1 identified 13 Mindfulness CAMS-R and
Wilson (2015) survey dents (1162) as NZ Euro- and NSSI DSHI
pean
Hashemi et al., Cross-sectional Journal article Cardiovascular Iran 46.62 (15.45) 42.2 N/A 9 Mindfulness FFMQ and 3
(2018) patients (110) and SI items assessing
suicide ideation
Hasking et al., Cross-sectional Journal article Undergraduate Australia 20.99 (5.33) 76.8 N/A 11 SC, NSSI, and SCS-SF, ISAS
(2019) psychology SI and 2 items
students (415) assessing sui-
cidal ideation
Hatchel et al., Cross-sectional Journal article LGBTQ youth USA 15.91 (1.18) 70.2 74.3 12 SC and SI SCS-SF and 2
(2019) (934) items assessing
suicidal ideation
Jiang et al., Cross-sectional Journal article High school China 13.58 (1.04) 40.1 N/A 12 SC and NSSI SCS and 1 item
(2017) students (658) assessing NSSI
Kaniuka et al., Cross-sectional Journal article Undergraduate USA 21.81 (5.33) 67 87 9 SC and suici- SCS and SBQ-R
(2020b) students (338) dality
Kaniuka et al., Cross-sectional Journal article Sexual minority North America 26.25 (7.73) 46.2 79.6 13 SC and SI SCS-SF and
(2020a, b) adults (651) SIDAS
Kelley et al., Cross-sectional Journal article Military veter- USA 43.14 (12.23) 3.2 74.1 11 SC and suici- SCS-SF and
(2019) ans (189) dality IDAS: suicidal-
ity subscale
Kelliher-Rabon Cross-sectional Journal article Community USA 35.91 (11.77) 52 79.5 11 SC and suici- SCS and SBQ-R
et al. (2021)a (623) dality
Persons with 47.66 (13.19) 95.7 91.7 12
fibromyalgia
(419)
Persons with 61.28 (27.63) 64.3 91.9 12
or recovering
from cancer
(235)
Lamis and Cross-sectional Journal article Undergraduate USA 19.85 (1.66) 77.2 79.2 9 Mindfulness MAAS and
Dvorak (2014) students (552) and SI SAEI-28
Liu et al., Cross-sectional Journal article Adolescents’ China 14.94 (1.58) 52.9 0 14 SC and suicide SCS and Chinese
(2020) post-earth- risk version of the
quake (499) YRBSQ
Lu et al., (2019) RCT​ Journal article Left behind pri- China 11.86 (.71) 22.45 N/A 13 Mindfulness MAAS and
mary school and SI risk PANSI
students (49)
Mindfulness
 Table 1  (continued)
Study Study design Publication type Participants (N) Country Mean age (SD) % female % Caucasian Study quality Outcomes Measures
Mindfulness

MacIsaac Cross-sectional Dissertation No history of Canada No NSSI: 21.61 No NSSI: No NSSI: 52.06 12 Mindfulness, MAAS, DSHI,
(2019) NSSI (194) (5.85) 82.47 NSSI-Distal: SC, and NSSI ISAS and SCS-
History NSSI NSSI-Distal NSSI- 63.63 SF
(83) 20.43 (1.89) Distal: NSSI-Proximal:
NSSI-Proximal: 86.36 82.05
20.92 (2.91) NSSI-
Prox-
imal:
94.87
McMain et al., Randomized Journal article High suicide Canada 29.67 (8.62) 66 N/A 14 Mindfulness, KIMS, DSHI and
(2017) b trial risk in patients NSSI and SA LSASI
with BPD (84)
Mohammad- Cross-sectional Journal article Males with sub- Iran N/A 0 0 6 Mindfulness MAAS and SPS
khani et al., stance abuse and suicide
(2015) or dependence risk
in outpatient
setting and
prison (348)
Nagy (2017) Experimental Dissertation Undergraduate USA 19.37 (2.12) 74.2 73.8 14 SC and NSSI SCS and ISAS
psychology
students (233)
Paulus et al., Cross-sectional Journal article Latinos attend- USA 38.8 (11.4) 86.7 0 10 Mindfulness MAAS and
(2018) ing commu- and suicidality IDAS: suicidal-
nity-based ity subscale
primary health
care clinic
(391)
Per et al., (2021) Cross-sectional Journal article University Canada 23.98 (7.44) 82.2 49.01 13 SC, mindful- SCS, FFMQ, and
students and ness, and DSHI
community NSSI fre-
(343) quency
Possemato et al., RCT​ Journal article Veterans with USA 46.4 (16.3) 12.9 82.3 15 Mindfulness MAAS and
(2016) PTSD in and SI PHQ-9
primary care
(62)
Rabon et al., Cross-sectional Journal article Military veter- USA 49.9 (16.78) 30.9 85.2 13 SC and suici- SCS-SF and
(2019) ans (541) dality SBQ-R
Riquino (2019) Performance- Dissertation Individuals with USA 20.83 (2.07) 63.3 73.3 12 Mindfulness, FFMQ and SITBI
based task a history of SI, SA, and
engaging in frequency of
NSSI (30) NSSI

13
 Table 1  (continued)
Study Study design Publication type Participants (N) Country Mean age (SD) % female % Caucasian Study quality Outcomes Measures

13
Roush et al., Cross-sectional Journal article Psychiatric USA 36.17 (15.3) 46.6 80.5 14 Mindfulness FFMQ and BSS
(2018) inpatients and SI
(118)
Serrano et al., Cross-sectional Journal article Firefighters USA 38.5 (8.55) 5.3 75.1 12 Mindfulness FFMQ and
(2020) (865) and suicidality SBQ-R
Servaty-Seib Cross-sectional Journal article First-year USA 18.47 (.5) 63.9 72.2 11 SC, SI, and sui- SCS-SF and SIS
et al., (2021) university stu- cide actions
dents (665)
Shorey et al., Cross-sectional Journal article Women in a USA 32.3 (13.95) 100 96.3 13 Mindfulness MAAS and PAI
(2016) substance and SI
use treatment
facility (81)
Song and Bae Cross-sectional Journal article Korean college Korea 21.59 (2.07) 55.8 0 12 Mindfulness, Korean version of
(2020) students (355) SA and SI the FFMQ and
SSI
Stanley et al., Cross-sectional Journal article Firefighters USA 38.37 (8.53) 5.5 75.2 11 Mindfulness FFMQ and
(2019) (831) and suicidality SBQ-R
Tanaka et al., Cross-sectional Journal article Adolescents Canada 18.1 (1) N/A 27 13 SC and SA SCS and 1 item
(2011) receiving child assessing sui-
protection ser- cide attempts
vices (117)
Tucker et al., Cross-sectional Journal article Undergraduate USA 19.34 64.8 81 7 Mindfulness FFMQ and
(2014) psychology and SI HDSQ-SS
students (315)
Tuna and Gen- Multi-method, Journal article Undergraduate Turkey 21.07 (1.58) 60.0 0 10 SC and NSSI SCS (Turkish
çöz (2021) laboratory- students with translation) and
based design and without ISAS
a history of
NSSI (70)
Umphrey et al., Cross-sectional Dissertation College students USA 29 71 60.7 10 SC and SI SCS and CHRTS
(2021) (481)
Vigna (2016) Cross-sectional Dissertation High school stu- USA N/A 50.1 68.9 8 SC, SI, SA, and SCS-SF, 3
dents (1,882) NSSI items assess-
ing suicide
ideation, suicide
attempts, and
NSSI
Wang et al., Cross-sectional Journal article Gay men (445) Switzerland N/A 0 N/A 13 Mindfulness, MAAS and PSS
(2018) SI, suicide (3-items)
plans, and SA
Mindfulness
 Table 1  (continued)
Study Study design Publication type Participants (N) Country Mean age (SD) % female % Caucasian Study quality Outcomes Measures
Mindfulness

Warner (2015) Cross-sectional Dissertation College students USA 25.5 (7.8) 62.8 69.9 14 Mindfulness CAMS-R and 1
(26,292) and NSSI item assessing
NSSI
Watson-Sin- Analyzing scale Journal article African Ameri- USA 37.24 (12.24) 52 0 14 SC, mindful- SCS, FFMQ BSS
gleton et al., psychometric can clinical ness, and SI
(2018)b properties, sample (283)
cross-sectional
Wu et al., Longitudinal Journal article Secondary China 13.15 (1.1) 43.29 N/A 11 SC, NSSI, SI, SCS, 12 items
(2019)b survey school stu- and SA assessing
dents (813) NSSI and 2
items assessing
suicide ideation
and attempt
Xavier et al., Cross-sectional Journal article Adolescents Portugal 15.24 (1.64) 51.6 N/A 12 SC and NSSI SCS and RTSHIA
(2016) (643) (excluded
suicidal intent
responses)
Zeifman et al., Cross-sectional Journal article Ethnically Canada 21.04 (6.3) 83.1 36.9 13 SC and suici- SCS and SBQ-R
(2021) diverse dality
undergraduate
students (130)
Zeng et al., Cross-sectional Journal article Older adults China 51.72 (2.73) 46 0 8 Mindfulness MAAS and
(2017) (213) and SI SBQ-R
Zhang et al., Cross-sectional Journal article Students grade China 13.34 (.95) 47.8 0 11 SC and SI SCS and short
(2021) 7–9 (1,167) Chinese version
of the ASIQ
a
 Separate samples reported in one study
b
 Data received from two articles with the same sample
Abbreviations: ASIQ The Adult Suicide Ideation Questionnaire, BPMS The British Psychiatric Morbidity Survey, BSS Beck Suicide Ideation Scale, CAMS-R Cognitive and Affective Mindful-
ness Scale–Revised, CHRTS Concise Health Risk Tracking Scale, DSHI Deliberate Self-Harm Inventory, FFMQ Five Facet Mindfulness Scale, FASM The Functional Assessment of Self-
Mutilation Scale, HDSQ-SS Hopelessness Depression Symptom Questionnaire–Suicidality Subscale, IDAS Inventory of Depression and Anxiety Symptoms, ISAS Inventory of Statements about
Self-Injury, KIMS The Kentucky Inventory of Mindfulness Skills, LEIDS-R Leiden Index of Depression Sensitivity-Revised, LSASI Lifetime Suicide Attempt Self-Injury Interview, L-SASII
Lifetime Parasuicide Count, MAAS The Mindfulness Attention Awareness Scale, MAAS-A The Mindfulness Attention Awareness Scale-Adolescents, PAI The Personality Assessment Inventory,
PANSI The Positive and Negative Suicide Ideation, PSS Paykel Suicide Scale, RTSHIA Risk-Taking and Self-harm Inventory for Adolescents, SAEI-28 The Suicide Anger Expression Inven-
tory-28, SBQ-R Suicidal Behaviors Questionnaire-Revised, SCS Self-Compassion Scale, SHI Self-harm Inventory, SIDAS The Suicidal Ideation Attributes Scale, SIQ Suicide Ideation Question-
naire, SIQ-JR Suicide Ideation Questionnaire-Junior High School Version, SIS Suicidal Ideation Scale, SMS State Mindfulness Scale, SPS Suicide Probability Scale, SSI The Scale for Suicide
Ideation, YRBSQ Youth Risk Behavior Survey Questionnaire, YRBSS Youth Risk Behavior Surveillance Survey

13
13
Table 2  Effect sizes for the relationship between mindfulness and self-compassion with suicide and NSSI outcomes
Mindfulness Self-compassion
2
k r Z 95% C.I. Q I k r Z 95% C.I. Q I2

Combined suicide outcomes 35 −.230* −12.708 [−.264, −.196] 121.149 71.935 25 −.323* −10.794 [−.376, −.267] 175.726 86.342
Suicide ideation 23 −.255* −7.230 [−.320, −.188] 188.980 88.359 15 −.364* −8.036 [−.442, −.281] 154.326 90.928
Suicide attempts 6 −.201* −10.835 [−.236, −.165] 5.410 7.584 4 −.223* −8.986 [−.269, −.175] 1.659 0.000
Combined NSSI ­outcomesa 11 −.228* −4.399 [−.324, −.128] 184.981 94.594 9 −.369* −5.254 [−.487, −.238] 140.012 94.286

*indicates p < .001

a
 Outcomes include: frequency, versatility, and history. Column names: k = number of studies, r = average Pearson Correlation, Z = Wald test, CI = confidence interval of 95%, Q = Hedges’ Q
test for homogeneity; I2 = heterogeneity analysis in percentile

Table 3  Effect sizes for the relationship between mindfulness facets and self-compassion dimensions with suicide and NSSI outcomes
Suicide outcomes NSSI outcomes
2
k r Z 95% C.I. Q I k r Z 95% C.I. Q I2

FFMQ
  Acting with awareness 11 −.277*** −9.713 [−.329, −.223] 25.756 61.173 4 −.347** −2.793 [−.548, −.108] 30.163 90.054
  Describing 11 −.137*** −4.631 [−.194, −.080] 26.828 62.725 4 −.250* −2.166 [−.451, −.024] 24.696 87.852
  Nonjudging 11 −.270*** −8.759 [−.327, −.212] 30.072 66.747 4 −.399* −2.556 [−.633, −.098] 50.384 94.046
  Non-reacting 11 −.050 −1.115 [−.138, .038] 62.493 83.998 4 −.285 −1.410 [−.605, .114] 81.942 96.339
  Observing 11 −.006 −.090 [−.131, .119] 130.045 92.310 4 −.026 −.236 [−.235, .186] 20.924 85.662
SCS
Self-warmth 8 −.166*** −.166 [−.237, −.093] 15.679 55.353
Self-coldness 7 .239* −2.247 [−.427, −.031] 89.743 93.314

The self-warmth and self-coldness dimension of the SCS were not analyzed as only two studies reported subscales with NSSI outcomes
FFMQ Five Facet Mindfulness Scale, SCS Self-Compassion Scale
***p > .001; **p >.01; *p >.05
Mindfulness
Mindfulness

self-compassion and mindfulness combined, both with high

94.067
87.761
82.367
80.178
94.087
11.811
heterogeneity. Combined NSSI outcomes in community

I2
samples had a medium negative correlation (r = −.336)
with self-compassion and mindfulness combined (k = 3;

117.980
95% CI [−.594, −.016], p = .04), with high heterogeneity.

89.877
17.014
35.314
33.823
2.268
College samples had a small-to-medium negative correla-

Q
tion (r = −.220; k = 8; 95% CI [−.287, −.151], p < .001)
and adolescent samples had a medium negative correlation

[−.352, −.156]
[−.350, −.165]
[−.397, −.262]
[−.287, −.151]
[−.594, −.016]
[−.231, .168]
(r = −.331; k = 4; 95% CI [−.397, −.262], p < .001), with
self-compassion and mindfulness combined, both with high

95% C.I.
heterogeneity. Combined NSSI outcomes within clinical
samples were non-significant. See Table 4.

Moderation Analyses

−4.877
−5.240
−8.929
−6.120
−2.052
−.314
Z
The relationship between STBs and mindfulness and self-

Table 4  Sub-group analysis for sample type and recency of suicide and NSSI outcomes with mindfulness and self-compassion combined
compassion were negatively and weakly moderated by par-

−.257**
−.260**
−.331**
−.220**
NSSI outcomes

−.336*
ticipants’ mean age (k = 48; β = −.009, SE = 0.0009, p <

−.032
.001), gender (percentage of females in the sample; k = 51; β

r
= −.004, SE = 0.0003, p < .001), and study quality (k = 55;
β = −.024, SE = 0.002, p < .001). The relationship between

12
8
4
8
3
3
k
NSSI outcomes and mindfulness and self-compassion was
negatively moderated by mean age (k = 17; β = −.011, SE =

81.282
86.649
16.489
88.502
83.094
68.297
0.002, p < .001), gender (k = 17; β = −.004, SE = 0.0007, p
< .001), and study quality (k = 18; β = −.022, SE = 0.004,

2
I
p < .001).

160.275
149.805
173.951
70.982
31.543

8.382
Publication Bias Analysis
Q

The effect size for all analyses corresponded to a z-value

[−.320, −.235]
[−.312, −.198]
[−.370, −.300]
[−.337, −.235]
[−.293, −.171]
[−.350, −.139]

of −43.411 (p < .001); signifying at least 3,3291 studies

with null effect would be needed to invalidate our findings.
95% C.I.

A funnel plot was generated showing that 5 studies would

need to be added below the mean of the plot to achieve sym-
metry, suggesting that present results may represent slight
overrepresentation of the true relationship. Based on a ran-
−.10.348

−12.111
−17.238
−8.358
−7.238
−4.407

dom effects model, the new imputed mean would be −.286

(95% CI [−.318, −.253]). Although the imputed effect size
Z

is smaller than the original effect sizes, these results still

suggest the effect sizes are valid and robust.
Suicide outcomes

−.335**
−.287**
−.233**
−.247**

−.278*
−.256*
r

** indicates p < .001; * indicates p < .05

Discussion
31
21
21
13
11

8
k

Aggregating findings from 53,797 participants across 68

samples, this meta-analysis rigorously quantified rela-
Within 12-month outcomes

tionships between mindfulness, self-compassion, and

suicide-related outcomes (NSSI and STBs) in the extant
Adolescent sample
Lifetime outcomes

literature, and statistically evaluated important moderat-

College students
Clinical sample

ing factors of these relationships. Our methodology and

Community

findings provide necessary clarification regarding the role

of culturally adapted, resilience-based practices that may
have clinical importance for preventing and treating NSSI

13
 Mindfulness
and STBs. As expected, we found a negative association
between NSSI (r = −.267) and STB (r = −.269) out-
comes with mindfulness and self-compassion combined.
These results parallel findings from recent meta-analyses
on experiential avoidance (Angelakis & Gooding, 2021)
and self-criticism (Zelkowitz & Cole, 2019)—constructs
often operationalized as inverse to mindfulness and self-
compassion. Both studies found positive relationships and
effect size estimates between experiential avoidance with
STBs (moderate to large effect) and NSSI (small effect)
and self-criticism with NSSI (moderate-to-large effect),
providing convergent validation that mindfulness and self-
compassion may serve key functions in the etiology and
maintenance of suicide and engagement in NSSI.
Importantly, the significant negative relationships emerg-
ing between mindfulness and self-compassion with suicide
attempt history (r = −.209) and ideation (r = −.302) in the
present study align with previous research demonstrating
that mindfulness and self-compassion significantly lower
the risk of STBs (Chesin & Jeglic, 2016; Lamis & Dvorak,
2014). Indeed, frequency of NSSI engagement (i.e., how
often individuals report engaging in NSSI) had a medium
negative effect (r = −.285) on mindfulness and self-com-
passion. This finding suggests that those reporting NSSI his-
tories tend to be less mindful and self-compassionate than
those with no history. Similarly, NSSI versatility (i.e., how
many methods one uses to engage in NSSI) had a small
(r = −.176), negative relationship with mindfulness and
self-compassion combined, denoting that those employing
a greater diversity of NSSI methods endorse lower levels
of mindfulness and self-compassion than those using fewer
methods. While the importance of assessing NSSI frequency
and methods has been well-documented (given their asso-
ciation with suicide risk; see Paul et al., 2015; Turner et al.,
2013), relationships between NSSI frequency and versatility
have been largely ignored in meta-analyses (e.g., Batejan
et al., 2015) prior to this study.
We also sought to systematically quantify the relation-
ship between mindfulness facets and STBs. Nonjudging (r
= −.270), acting with awareness (r = −.277), and describ-
ing (r = −.137) were significantly negatively correlated
with STBs, while observing and non-reacting facets were
unrelated. Results between mindfulness facets and NSSI
outcomes paralleled suicide findings, showing significant
negative associations between NSSI and nonjudging (r =
−.399), acting with awareness (r = −.347), and describing
(r = −.250). Together, these results align with research to
date demonstrating that, of the mindfulness facets, levels
of non-judging and acting with awareness tend to be sig-
nificantly lower among those with histories of self-injurious
and STBs. These two facets have strong, negative associa-
tions with other psychological health indicators, including
affective symptoms (Carpenter et al., 2019), substance use
13
behaviors (Karyadi et al., 2014), and neuroticism (Hanley
& Garland, 2017).
In terms of self-compassion, weighted mean correlations
on SCS dimensions revealed that greater self-coldness (r =
.239) and lower levels of self-warmth (r = −.166) were sig-
nificantly linked to STBs. An insufficient number of studies
reporting subscale data (i.e., two) prevented us from ana-
lyzing self-warmth and self-coldness dimensions for NSSI
outcomes; this paucity highlights an important avenue for
future research. Given the mixed evidence pertaining to the
validity of the SCS total score (Brenner et al., 2017; Brenner
et al., 2018; Muris & Otgaar, 2020), our dimension-specific
investigation provides a crucial and nuanced picture regard-
ing the relationship between orthogonal dimensions of self-
compassion important for suicide outcomes. The particularly
robust relationship between self-coldness and STBs suggests
that those reporting high levels of self-criticism, feelings of
isolation, and identification with negatively labeled emotions
(self-coldness) may be especially susceptible to STBs.
A third objective of this meta-analysis was to examine
personal and temporal moderators by comparing mean
correlations between sample characteristics and outcome
recency, given evidence linking these with depressive symp-
toms and suicide (Kelliher-Rabon et al., 2018). Results from
the subgroup analyses revealed that individuals with a recent
history (i.e., within the past 12 months) of STBs (r = −.278)
scored slightly lower on measures of mindfulness and self-
compassion than those with any STBs’ lifetime history (r =
−.256). These findings may indicate that levels of mindful-
ness and self-compassion may be lower among those cur-
rently experiencing STBs. Surprisingly, NSSI lifetime (r =
−.260) and within 12 months (r = −.257) revealed mini-
mal differences among the correlations. Additional work is
needed to establish causal relationships between mindful-
ness and self-compassion on STBs and NSSI onset, mainte-
nance, and recovery.
Regarding cohort age, both NSSI (r = −.331) and STBs
(r = −.335) were negatively associated with self-compas-
sion and mindfulness in studies utilizing adolescent sam-
ples. Adolescence, a stressful developmental stage associ-
ated with notable increases in NSSI and STBs prevalence
(Andover et al., 2012; Brown & Plener, 2017), has been
understudied within literature on NSSI/suicide and mind-
fulness/self-compassion to date. Reflecting this dearth of
research, only 16.18% (k = 11) of studies in our meta-analy-
sis included adolescent samples. Nevertheless, our results—
the observed medium effect size among younger samples
and meta-regression on age—align with established links
between both self-compassion and mindfulness with risk
(mental illness, depression) and protective (secure attach-
ment, connectedness) factors for NSSI and STBs in adoles-
cents (Bluth & Blanton, 2014, 2015; Cunha et al., 2014; Neff
& McGehee, 2010). We obtained similar results for STBs (r
Mindfulness
= −.287) and NSSI (r = −.220) outcomes for studies using
college student samples. The college transition, marked by
a unique confluence of academic, social, developmental
stressors (Bewick et al., 2010; Morgan, 2017), is a time of
heightened risk for STBs and NSSI (for review, see Swan-
nell et al., 2014). Our findings supplement existing research
indicating that mindfulness and self-compassion may serve
as adaptive emotion regulation skills that help buffer col-
lege students from STBs and NSSI (John & Gross, 2004;
Vujanovic et al., 2010).
Negative correlations between mindfulness and self-
compassion with NSSI (r = −.336) and STBs (r = −.233)
emerged for studies on community samples. Among clini-
cal samples, we only found a similar inverse relationship (r
= −.247) between mindfulness/self-compassion and STB
outcomes. Notably, the three included studies examining
NSSI in clinical samples only assessed mindfulness (i.e.,
not self-compassion) and were nonsignificant. These find-
ings—particularly the magnitude of effect for our pooled
clinical sample—were surprising for several reasons. STBs
and NSSI are more prevalent in clinical populations (Fox
et al., 2015; Franklin et al., 2017; Horváth et al., 2020).
Data suggest that those receiving mental health treatment
experience more complex fears, blocks, and resistances to
self-compassion than their non-treated peers (Gilbert &
Mascaro, 2017; Kirby & Gilbert, 2019). Individuals with
several psychiatric diagnoses also have lower levels of self-
compassion compared with community samples (Castilho
et al., 2015; MacBeth & Gumley, 2012). Similarly, mind-
fulness is inversely related to psychopathology, including
depression (Tomlinson et al., 2018). Future studies should
continue to investigate the potential differences between
mindfulness and self-compassion with NSSI within clini-
cal and community samples given that mindfulness and
compassion-based interventions are administered differ-
ently between these clinical vs non-clinical groups (Kirby
& Gilbert, 2019).
We identified two additional moderating variables: study
quality and gender. Study quality score negatively moderated
outcomes, with lower quality studies showing higher effect
sizes (although this effect was weak). This methodologi-
cal caveat limits interpretations of the relationship between
mindfulness and self-compassion with STBs and NSSI and
signals a need for higher quality, more rigorously designed
investigations. For gender, there was a more robust relation-
ship between mindfulness and self-compassion with STB
and NSSI outcomes for males. Males tend to show mar-
ginally higher levels of self-compassion than females, an
effect qualified by ethnicity and gender role orientation
(Yarnell et al., 2019). The evidence regarding gender dif-
ferences in NSSI prevalence is mixed. Some researchers
have found that females are more likely to engage in NSSI
than males (e.g., Cheng et al., 2010; Whitlock et al., 2006),
while other researchers report negligible gender differences
(e.g., Garisch & Wilson, 2015; Heath et al., 2008; Serras
et al., 2010). Despite the mixed evidence regarding gender
differences in prevalence, research has suggested gender
differences may be found among the methods used and fre-
quency of engagement in NSSI. There is evidence suggest-
ing that women engage in NSSI more frequently (Garisch
& Wilson, 2015; Hawton & Harriss, 2008) and are more
likely to cut, whereas men are more likely to burn or self-
hit (Kuentzel et al., 2012). Gender differences have been
identified in STBs, with females exhibiting higher rates of
suicidal ideation and attempts than their male peers, who are
more than twice as likely to die by suicide (Cha et al., 2018;
May & Klonsky, 2016; Miranda-Mendizabal et al., 2019).
Recent evidence, however, indicates that the gender dispar-
ity in suicide mortality has narrowed over the past 40 years,
especially among younger age groups (Ruch et al., 2019).
Given the established gender differences for specific STBs
and NSSI outcomes, our gender moderator may reflect meta-
analysis pooling outcomes (i.e., pooling NSSI frequency,
NSSI as a dichotomous outcome, and NSSI versatility). It
would be interesting to look at the extent to which gender
influences the relationship between mindfulness and self-
compassion with specific suicidal (i.e., ideation, attempts)
and non-suicidal outcomes (frequency, methods used).
Limitations and Future Research
Important limitations must be considered when examining
the results of this meta-analysis. While correlational research
is an important first step in understanding the intersection
of mindfulness and self-compassion with NSSI and STBs,
replication, experimental study, and longitudinal research
are needed to establish causality. Another major limitation
of this meta-analysis pertains to the broad outcomes. For
example, suicidal phenomena encompass a wide range of
behaviors, from passive ideation, planning, and intent, to
(fatal and non-fatal) attempts. Given a high degree of vari-
ability in measures used, we pooled outcomes. Such hetero-
geneity among measures has been highlighted in prior NSSI
and STB reviews (Turner et al., 2014; Van Geel et al., 2014).
A majority of the studies (64.71%) included in this meta-
analysis were conducted in North America, female (58.09%),
and utilized Caucasian samples (58.93%) which limits the
generalizability of our findings to other countries, ethnic
groups, and gender identities. Important differences in NSSI
and STBs have been documented for different countries and
regions, racial/ethnic populations (Nock et al., 2008), and
gender identities (Di Giacomo et al., 2018; Liu et al., 2019).
This review underscores the overrepresentation of white,
CIS-gendered, North American participants in the current
literature. We encourage research in non-Western countries
and among other underrepresented minority groups.
13
 Mindfulness
It is noteworthy to mention that although no inclu-
sion or exclusion criteria were set regarding which self-
compassion measures studies used, all included studies
assessing self-compassion used the SCS (Neff, 2003b),
which operationalizes self-compassion as comprising three
negative (self-judgment, isolation, overidentification) and
three positive (self-kindness, common humanity, mindful-
ness) subscales. Recent studies suggest that the negative
self-compassion subscales may overlap with constructs
assessing psychological difficulties, maladaptive coping,
and psychopathology—these associations may inflate the
relationship between self-compassion and these constructs
(MacBeth & Gumley, 2012; Muris et al., 2018). Future
researchers should examine mood and/or other psycho-
pathology measures in tandem with self-compassion to
account for presence of an inflation effect (Muris et al.,
2018) or use alternate novel self-compassion measures
(i.e., the Sussex-Oxford Compassion for the Self Scale;
Gu et al., 2020) to better understand this relationship.
The negative relationship between self-compassion
and mindfulness with NSSI and STBs found in this meta-
analysis provides preliminary support that these constructs
may serve as buffers to self-injurious behaviors. Further
exploration via well-designed randomized controlled tri-
als is needed to help identify with specificity the benefits
and/or limitations of mindfulness- and self-compassion-
based therapies for NSSI and STBs. Particular attention to
the modification and reduction of harsh attitudes towards
the self (self-coldness), to taking a non-evaluative stance
towards inner experiences (nonjudging) and attending to
the present moment (acting with awareness), could be
particularly critical mindfulness components to explore
in conjunction with self-injury and suicide.
Acknowledgements  We would like to thank Carolina Bacalao
(research assistant) for her work on data extraction and Alberto Chiesa,
University of Bologna, for peer reviewing the search strategy.
Author Contribution  M. P. designed, wrote, and executed the study,
and analyzed the data. E. S. aided in the study design, data analysis,
and revising of the final manuscript. K. B. and S. B. A. contributed to
study design and assisted with writing, editing, and revising the final
manuscript. B. K. provided support with the entire design and write-
up of the study.
Declarations  10926​771.​2019.​17112​79
Ethics Approval and Consent to Participate  The manuscript describes
meta-analyses. It does not contain clinical studies or patient data.
Informed Consent  The manuscript describes meta-analyses.
Conflict of Interest  The authors declare no competing interests.
13
References
References are marked with an * are included in the
meta analysis
*
Aalsma, M. C., Jones, L. D., Staples, J. K., Garabrant, J. M., Gordon,
J. S., Cyr, L. R., Salgado, G. F., & Salyers, M. P. (2020). Mind-
body skills groups for adolescents with depression in primary
care: A pilot study. Journal of Pediatric Health Care, 34(5), 462-
469. https://​doi.​org/​10.​1016/j.​pedhc.​2020.​05.​003
*
Ali, A. (2014). We matter too! Suicidal thoughts and behaviors among
youth at a therapeutic day school. Dissertation: Chicago School
of Professional Psychology
*
Anastasiades, M. H., Kapoor, S., Wootten, J., & Lamis, D. A. (2017).
Perceived stress, depressive symptoms, and suicidal ideation
in undergraduate women with varying levels of mindfulness.
Archives of Women's Mental Health, 20(1), 129-138. https://​doi.​
org/​10.​1007/​s00737-​016-​0686-5
Andover, M. S., Morris, B. W., Wren, A., & Bruzzese, M. E. (2012).
The co-occurrence of non-suicidal self-injury and attempted sui-
cide among adolescents: Distinguishing risk factors and psycho-
social correlates. Child and Adolescent Psychiatry and Mental
Health, 6(1), 1–7. https://​doi.​org/​10.​1186/​1753-​2000-6-​11
Angelakis, I., & Gooding, P. (2020). Obsessive–compulsive disorder
and suicidal experiences: The role of experiential avoidance. Sui-
cide and Life-Threatening Behavior, 50(2), 359–371. https://​doi.​
org/​10.​1111/​sltb.​12593
Angelakis, I., & Gooding, P. (2021). Experiential avoidance in non-
suicidal self-injury and suicide experiences: A systematic review
and meta-analysis. Suicide and Life-Threatening Behavior.
https://​doi.​org/​10.​1111/​sltb.​12784
*
Argento, A., Simundic, A., Mettler, J., Mills, D. J., & Heath, N. L.
(2020). Evaluating the effectiveness of a brief mindfulness activ-
ity in university students with non-suicidal self-injury engage-
ment. Archives of Suicide Research, 1-15. https://​doi.​org/​10.​
1080/​13811​118.​2020.​18410​52
Baer, M. M., Tull, M. T., Forbes, C. N., Richmond, J. R., & Gratz, K.
L. (2020). Methods matter: Nonsuicidal self-injury in the form
of cutting is uniquely associated with suicide attempt severity in
patients with substance use disorders. Suicide and Life-Threaten-
ing Behavior, 50(2), 397–407. https://d​ oi.o​ rg/1​ 0.1​ 111/s​ ltb.1​ 2596
*
Basharpoor, S., Daneshvar, S., & Noori, H. (2016). The relation of
self-compassion and anger control dimensions with suicide idea-
tion in university students. International Journal of High Risk
Behaviors and Addiction, 5(4). https://​doi.​org/​10.​5812/​ijhrba.​
26165
Basharpoor, S., Mowlaie, M., & Sarafrazi, L. (2021). The relationships
of distress tolerance, self-compassion to posttraumatic growth,
the mediating role of cognitive fusion. Journal of Aggression,
Maltreatment & Trauma, 30(1), 70–81. https://​doi.​org/​10.​1080/​
Batejan, K. L., Jarvi, S. M., & Swenson, L. P. (2015). Sexual ori-
entation and non-suicidal self-injury: A meta-analytic review.
Archives of Suicide Research, 19(2), 131–150. https://​doi.​org/​
10.​1080/​13811​118.​2014.​957450
Bender, T. W., Anestis, M. D., Anestis, J. C., Gordon, K. H., & Joiner,
T. E. (2012). Affective and behavioral paths toward the acquired
capacity for suicide. Journal of Social and Clinical Psychology,
31(1), 81–100. https://​doi.​org/​10.​1521/​jscp.​2012.​31.1.​81
Bentley, K. H., Nock, M. K., Sauer-Zavala, S., Gorman, B. S., & Bar-
low, D. H. (2017). A functional analysis of two transdiagnos-
tic, emotion-focused interventions on nonsuicidal self-injury.
Mindfulness
Journal of Consulting and Clinical Psychology, 85(6), 632.
https://​doi.​org/​10.​1037/​ccp00​00205
Bertolote, J. M., & Fleischmann, A. (2002). A global perspective in
the epidemiology of suicide. Suicidologi, 7(2). https://​doi.​org/​
10.​5617/​suici​dologi.​2330
Bewick, B., Koutsopoulou, G., Miles, J., Slaa, E., & Barkham,
M. (2010). Changes in undergraduate students’ psychologi-
cal well-being as they progress through university. Studies in
Higher Education, 35(6), 633–645. https://​doi.​org/​10.​1080/​
03075​07090​32166​43
Bluth, K., & Blanton, P. W. (2014). Mindfulness and self-compas-
sion: Exploring pathways to adolescent emotional well-being.
Journal of Child and Family studies, 23(7), 1298–1309. https://​
doi.​org/​10.​1111/j.​1540-​4560.​2007.​00537.x
Bluth, K., & Blanton, P. W. (2015). The influence of self-compassion
on emotional well-being among early and older adolescent
males and females. The Journal of Positive Psychology, 10(3),
219–230. https://​doi.​org/​10.​1080/​17439​760.​2014.​936967
*
Bock, R. C., Berghoff, C. R., Baker, L. D., Tull, M. T., & Gratz, K.
L. (2021). The relation of anxiety to nonsuicidal self injury is
indirect through mindfulness. Mindfulness, 1-12. https://​doi.​
org/​10.​1007/​s12671-​021-​01660-2
Borenstein, M., & Rothstein, H. (1999). Comprehensive meta-anal-
ysis. Biostat.
Brailovskaia, J., Forkmann, T., Glaesmer, H., Paashaus, L., Rath, D.,
Schönfelder, A., Juckel, G., & Teismann, T. (2019). Positive
mental health moderates the association between suicide idea-
tion and suicide attempts. Journal of Affective Disorders, 245,
246–249. https://​doi.​org/​10.​1016/j.​jad.​2018.​11.​005
*
Bravo, A. J., Pearson, M. R., & Kelley, M. L. (2018). Mindfulness
and psychological health outcomes: A latent profile analysis
among military personnel and college students. Mindfulness,
9(1), 258-270. https://​doi.​org/​10.​1007/​s12671-​017-​0771-5
Brenner, R. E., Heath, P. J., Vogel, D. L., & Credé, M. (2017). Two
is more valid than one: Examining the factor structure of the
Self-Compassion Scale (SCS). Journal of Counseling Psychol-
ogy, 64(6), 696. https://​doi.​org/​10.​1037/​cou00​00211
Brenner, R. E., Vogel, D. L., Lannin, D. G., Engel, K. E., Seidman,
A. J., & Heath, P. J. (2018). Do self-compassion and self-cold-
ness distinctly relate to distress and well-being? A theoreti-
cal model of self-relating. Journal of Counseling Psychology,
65(3), 346. https://​doi.​org/​10.​1037/​cou00​00257
Brereton, A., & McGlinchey, E. (2020). Self-harm, emotion regula-
tion, and experiential avoidance: A systematic review. Archives
of Suicide Research, 24(sup1), 1–24. https://​doi.​org/​10.​1080/​
13811​118.​2018.​15635​75
*
Brooks, J. R., Lebeaut, A., Zegel, M., Walker, R. L., & Vujanovic,
A. A. (2021). Anxiety sensitivity and suicide risk: Mindfulness
as a psychological buffer for Black adults. Journal of Affective
Disorders, 289, 74-80. https://​doi.​org/​10.​1016/j.​jad.​2021.​04.​
012
Brown, R. C., & Plener, P. L. (2017). Non-suicidal self-injury in ado-
lescence. Current Psychiatry Reports, 19(3), 20. https://​doi.​org/​
10.​1007/​s11920-​017-​0767-9
*
Buitron, V., Hill, R. M., & Pettit, J. W. (2017). Mindfulness moderates
the association between perceived burdensomeness and suicide
ideation in adults with elevated depressive symptoms. Suicide
and Life-Threatening Behavior, 47(5), 580-588. https://​doi.​org/​
10.​1111/​sltb.​12314
Carpenter, T. P., & Law, K. C. (2021). Optimizing the scientific study
of suicide with open and transparent research practices. Suicide
and Life-Threatening Behavior, 51(1), 36–46. https://​doi.​org/​10.​
31234/​osf.​io/​edawp
Carpenter, J. K., Conroy, K., Gomez, A. F., Curren, L. C., & Hof-
mann, S. G. (2019). The relationship between trait mindful-
ness and affective symptoms: A meta-analysis of the Five Facet
Mindfulness Questionnaire (FFMQ). Clinical Psychology
Review, 74, 101785. https://​doi.​org/​10.​31234/​osf.​io/​edawp
Castilho, P., Pinto-Gouveia, J., & Duarte, J. (2015). Evaluating the
multifactor structure of the long and short versions of the self-
compassion scale in a clinical sample. Journal of Clinical Psy-
chology, 71(9), 856–870. https://​doi.​org/​10.​1002/​jclp.​22187
Centers for Disease Control and Prevention (CDC). (2018) Suicide
rates rising across the US. https://​www.​cdc.​gov/​media/​relea​ses/​
2018/​p0607-​suici​de-​preve​ntion.​html
Centers for Disease Control and Prevention (CDC). (2021) Facts about
Suicide. https://​www.​cdc.​gov/​suici​de/​facts/​index.​html
Cha, C. B., Franz, P. J., Guzmán, M. E., Glenn, C. R., Kleiman, E. M.,
& Nock, M. K. (2018). Annual research review: Suicide among
youth–epidemiology, (potential) etiology, and treatment. Journal
of Child Psychology and Psychiatry, 59(4), 460–482. https://d​ oi.​
org/​10.​1111/​jcpp.​12831
Chang, E. C., Martos, T., Sallay, V., Chang, O. D., Wright, K. M.,
Najarian, A. S.-M., & Lee, J. (2017). Examining optimism and
hope as protective factors of suicide risk in Hungarian college
students: Is risk highest among those lacking positive psycho-
logical protection? Cognitive Therapy and Research, 41(2),
278–288. https://​doi.​org/​10.​1007/​s10608-​016-​9810-0
*
Chassagne, J., Bronchain, J., Raynal, P., & Chabrol, H. (2020). L’effet
modérateur de la pleine conscience dispositionnelle dans la
relation entre symptomatologie dépressive, troubles de la per-
sonnalité limite et idéations suicidaires chez le jeune adulte.
L'Encéphale, 46(2), 110-114. https://​doi.​org/​10.​1016/j.​encep.​
2019.​11.​002
Cheng, H.-L., Mallinckrodt, B., Soet, J., & Sevig, T. (2010). Develop-
ing a screening instrument and at-risk profile for nonsuicidal self-
injurious behavior in college women and men. Journal of Coun-
seling Psychology, 57(1), 128. https://​doi.​org/​10.​1037/​a0018​206
*
Cheng, S., Banks, K., Bartlett, B. A., San Miguel, G., & Vujanovic,
A. A. (2018). Posttraumatic stress and mindfulness facets in
relation to suicidal ideation severity among psychiatric inpa-
tients. Mindfulness, 9(3), 761-772. https://​doi.​org/​10.​1007/​
s12671-​017-​0814-y
*
Chesin, M. S., & Cascardi, M. (2019). Cognitive-affective corre-
lates of suicide ideation and attempt: Mindfulness is negatively
associated with suicide attempt history but not state suicidality.
Archives of Suicide Research. https://​doi.​org/​10.​1080/​13811​118.​
2018.​14809​84
Chesin, M. S., & Jeglic, E. L. (2016). Factors associated with recurrent
suicidal ideation among racially and ethnically diverse college
students with a history of suicide attempt: The role of mindful-
ness. Archives of Suicide Research, 20(1), 29–44. https://d​ oi.o​ rg/​
10.​1080/​13811​118.​2015.​10044​88
*
Chesin, M. S., Benjamin-Phillips, C. A., Keilp, J., Fertuck, E. A.,
Brodsky, B. S., & Stanley, B. (2016). Improvements in execu-
tive attention, rumination, cognitive reactivity, and mindful-
ness among high–suicide risk patients participating in adjunct
mindfulness-based cognitive therapy: Preliminary findings. The
Journal of Alternative and Complementary Medicine, 22(8), 642-
649. https://​doi.​org/​10.​1089/​acm.​2015.​0351
Chu, J., Robinett, E. N., Ma, J. K., Shadish, K. Y., Goldblum, P., &
Bongar, B. (2019). Cultural versus classic risk and protective
factors for suicide. Death Studies, 43(1), 56–61. https://​doi.​org/​
10.​1080/​07481​187.​2018.​14300​85
*
Cladder-Micus, M., van Aalderen, J., Donders, A., Spijker, J., Vri-
jsen, J., & Speckens, A. (2018). Cognitive reactivity as outcome
and working mechanism of mindfulness-based cognitive therapy
for recurrently depressed patients in remission. Cognition and
Emotion, 32(2), 371-378. https://​doi.​org/​10.​1080/​02699​931.​
2017.​12857​53
*
Cleare, S. (2019). Exploring the role of self-compassion in self-harm
and suicidal ideation. Dissertation: University of Glasgow.
13
 Mindfulness
Cleare, S., Gumley, A., & O'Connor, R. C. (2019). Self-compassion,
self-forgiveness, suicidal ideation, and self-harm: A systematic
review. Clinical Psychology & Psychotherapy, 26(5), 511–530.
https://​doi.​org/​10.​1002/​cpp.​2372
*
Collett, N., Pugh, K., Waite, F., & Freeman, D. (2016). Negative
cognitions about the self in patients with persecutory delusions:
An empirical study of self-compassion, self-stigma, schematic
beliefs, self-esteem, fear of madness, and suicidal ideation. Psy-
chiatry Research, 239, 79-84. https://​doi.​org/​10.​1016/j.​psych​res.​
2016.​02.​043
* *
Collins, K. R., Stritzke, W. G., Page, A. C., Brown, J. D., & Wylde, T.
J. (2018). Mind full of life: Does mindfulness confer resilience to
suicide by increasing zest for life? Journal of Affective Disorders,
226, 100-107. https://​doi.​org/​10.​1016/j.​jad.​2017.​09.​043
Cunha, M., Martinho, M. I., Xavier, A. M., & Espirito-Santo, H.
(2014). Early memories of positive emotions and its relation-
ships to attachment styles, self-compassion and psychopathology
in adolescence. European Psychiatry, 28, 76444–76447. https://​
doi.​org/​10.​1016/​s0924-​9338(13)​76444-7
Di Giacomo, E., Krausz, M., Colmegna, F., Aspesi, F., & Clerici, M.
(2018). Estimating the risk of attempted suicide among sexual
minority youths: a systematic review and meta-analysis. JAMA
Pediatrics, 172(12), 1145–1152. https://​doi.​org/​10.​1001/​jamap​
ediat​rics.​2018.​2731
*
Dixon-Gordon, K. L., Chapman, A. L., & Turner, B. J. (2015). A
preliminary pilot study comparing dialectical behavior therapy
emotion regulation skills with interpersonal effectiveness skills
and a control group treatment. Journal of Experimental Psycho-
pathology, 6(4), 369-388. https://​doi.​org/​10.​5127/​jep.​041714
*
Dobbins, P. J. (2014). Five facets of mindfulness and deliberate self-
harm in older adolescents. Dissertation: Fielding Graduate
University
Downes, M. J., Brennan, M. L., Williams, H. C., & Dean, R. S. (2016).
Development of a critical appraisal tool to assess the quality
of cross-sectional studies (AXIS). BMJ Open, 6(12), e011458.
https://​doi.​org/​10.​1136/​bmjop​en-​2016-​011458
Ellis, T. E., & Rufino, K. A. (2016). Change in experiential avoidance
is associated with reduced suicidal ideation over the course of
psychiatric hospitalization. Archives of Suicide Research, 20(3),
426–437. https://​doi.​org/​10.​1080/​13811​118.​2015.​10939​83
*
Fang, J. (2020). Interpersonal needs and suicidal ideation: Moderat-
ing effects of self-compassion. Dissertation: University of South
Dakota
*
Fang, Y., Zeng, B., Chen, P., Mai, Y., Teng, S., Zhang, M., Zhao, J.,
Yang, X., & Zhao, J. (2019). Mindfulness and suicide risk in
undergraduates: Exploring the mediating effect of alexithymia.
Frontiers in Psychology, 10, 2106. https://d​ oi.o​ rg/1​ 0.3​ 389/f​ psyg.​
2019.​02106
Finlay-Jones, A. L., Rees, C. S., & Kane, R. T. (2015). Self-compas-
sion, emotion regulation and stress among Australian psycholo-
gists: Testing an emotion regulation model of self-compassion
using structural equation modeling. PloS one, 10(7), e0133481.
https://​doi.​org/​10.​1371/​journ​al.​pone.​01334​81
* *
Forkus, S. R., Breines, J. G., & Weiss, N. H. (2019). Morally injuri-
ous experiences and mental health: The moderating role of self-
compassion. Psychological Trauma: Theory, Research, Practice,
and Policy, 11(6), 630. https://​doi.​org/​10.​1037/​tra00​00446
Fox, K. R., Franklin, J. C., Ribeiro, J. D., Kleiman, E. M., Bentley, K.
H., & Nock, M. K. (2015). Meta-analysis of risk factors for non-
suicidal self-injury. Clinical Psychology Review, 42, 156–167.
https://​doi.​org/​10.​1016/j.​cpr.​2015.​09.​002
Fox, K. R., Huang, X., Guzmán, E. M., Funsch, K. M., Cha, C. B.,
Ribeiro, J. D., & Franklin, J. C. (2020). Interventions for suicide
and self-injury: A meta-analysis of randomized controlled tri-
als across nearly 50 years of research. Psychological Bulletin,
146(2), 117–1145. https://​doi.​org/​10.​1037/​bul00​00305
13
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E.
M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang,
B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts
and behaviors: A meta-analysis of 50 years of research. Psy-
chological Bulletin, 143(2), 187. https://​doi.​org/​10.​1037/​bul00​
00084
Gallagher, M. L., & Miller, A. B. (2018). Suicidal thoughts and behav-
ior in children and adolescents: An ecological model of resil-
ience. Adolescent Research Review, 3(2), 123–154. https://​doi.​
org/​10.​1007/​s40894-​017-​0066-z
Garisch, J. A., & Wilson, M. S. (2015). Prevalence, correlates, and
prospective predictors of non-suicidal self-injury among New
Zealand adolescents: Cross-sectional and longitudinal survey
data. Child and Adolescent Psychiatry and Mental Health, 9(1),
1-11. https://​doi.​org/​10.​1186/​s13034-​015-​0055-6
Gilbert, P. (2017). Definitions and controversies. In P. Gilbert (Ed.),
Compassion: Concepts, Research and Applications (pp. 3–15).
Taylor and Francis.
Gilbert, P., & Mascaro, J. (2017). Compassion: Fears, blocks, and
resistances: An evolutionary investigation. The Oxford handbook
of compassion science. https://​doi.​org/​10.​1093/​oxfor​dhb/​97801​
90464​684.​013.​29
Gilbert, P., Catarino, F., Duarte, C., Matos, M., Kolts, R., Stubbs, J.,
Ceresatto, L., Duarte, J., Pinto-Gouveia, J., & Basran, J. (2017).
The development of compassionate engagement and action scales
for self and others. Journal of Compassionate Health Care, 4(1),
1–24. https://​doi.​org/​10.​1186/​s40639-​017-​0033-3
Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wam-
pold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mind-
fulness-based interventions for psychiatric disorders: A system-
atic review and meta-analysis. Clinical Psychology Review, 59,
52–60. https://​doi.​org/​10.​31231/​osf.​io/​etghn
Goodfellow, B., Kõlves, K., & De Leo, D. (2020). Contemporary clas-
sifications of suicidal behaviors: A systematic literature review.
Crisis: The Journal of Crisis Intervention and Suicide Preven-
tion, 41(3), 179. https://​doi.​org/​10.​1111/​sltb.​12457
Gu, J., Baer, R., Cavanagh, K., Kuyken, W., & Strauss, C. (2020).
Development and psychometric properties of the Sussex-Oxford
compassion scales (SOCS). Assessment, 27(1), 3–20. https://d​ oi.​
org/​10.​1177/​10731​91119​860911
Hamza, C. A., Stewart, S. L., & Willoughby, T. (2012). Examining
the link between nonsuicidal self-injury and suicidal behavior:
A review of the literature and an integrated model. Clinical Psy-
chology Review, 32(6), 482–495. https://​doi.​org/​10.​1016/j.​cpr.​
2012.​05.​003
Hanley, A. W., & Garland, E. L. (2017). The mindful personality: A
meta-analysis from a cybernetic perspective. Mindfulness, 8(6),
1456–1470. https://​doi.​org/​10.​1007/​s12671-​017-​0736-8
*
Hashemi, R., Moustafa, A. A., Rahmati Kankat, L., & Valikhani, A.
(2018). Mindfulness and suicide ideation in Iranian cardiovascu-
lar patients: Testing the mediating role of patience. Psychologi-
cal Reports, 121(6), 1037-1052. https://​doi.​org/​10.​1177/​00332​
94117​746990
Hasking, P., Boyes, M. E., Finlay-Jones, A., McEvoy, P. M., & Rees,
C. S. (2019). Common pathways to NSSI and suicide ideation:
The roles of rumination and self-compassion. Archives of Sui-
cide Research, 23(2), 247-260. https://​doi.​org/​10.​1080/​13811​
118.​2018.​14688​36
*
Hatchel, T., Merrin, G. J., Espelage, & Dorothy. (2019). Peer vic-
timization and suicidality among LGBTQ youth: The roles of
school belonging, self-compassion, and parental support. Journal
of LGBT Youth, 16(2), 134-156. https://​doi.​org/​10.​1080/​19361​
653.​2018.​15430​36
Hawton, K., & Harriss, L. (2008). The changing gender ratio in occur-
rence of deliberate self-harm across the lifecycle. Crisis, 29(1),
4–10. https://​doi.​org/​10.​1027/​0227-​5910.​29.1.4
Mindfulness
Hawton, K., Bergen, H., Cooper, J., Turnbull, P., Waters, K., Ness,
J., & Kapur, N. (2015). Suicide following self-harm: Findings
from the multicentre study of self-harm in England, 2000–2012.
Journal of Affective Disorders, 175, 147–151. https://​doi.​org/​10.​
1016/j.​jad.​2014.​12.​062
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl,
K. (1996). Experiential avoidance and behavioral disorders: A
functional dimensional approach to diagnosis and treatment.
Journal of Consulting and Clinical Psychology, 64(6), 1152.
https://​doi.​org/​10.​1037/​0022-​006x.​64.6.​1152
Heath, N., Toste, J., Nedecheva, T., & Charlebois, A. (2008). An
examination of nonsuicidal self-injury among college students.
Journal of Mental Health Counseling, 30(2), 137–156. https://​
doi.​org/​10.​17744/​mehc.​30.2.​8p879​p3443​514678
Hedegaard, H., & Warner, M. (2021). Suicide mortality in the United
States, 1999-2019. 10.15620/cdc:101761
Hedges, L. V., & Olkin, I. (2014). Statistical methods for meta-analysis.
Academic press.
Horváth, L. O., Győri, D., Komáromy, D., Mészáros, G., Szentiványi,
D., & Balázs, J. (2020). Nonsuicidal self-injury and suicide:
The role of life events in clinical and non-clinical populations of
adolescents. Frontiers in Psychiatry, 11, 370. https://​doi.​org/​10.​
3389/​fpsyt.​2020.​00370
International Society for the Study of Self-Injury (ISSS) (2007). Defi-
nitional issues surrounding our understanding of self-injury.
Conference proceedings from the annual meeting.
Inwood, E., & Ferrari, M. (2018). Mechanisms of change in the rela-
tionship between self-compassion, emotion regulation, and men-
tal health: A systematic review. Applied Psychology: Health and
Well-Being, 10(2), 215–235. https://d​ oi.o​ rg/1​ 0.1​ 111/a​ phw.1​ 2127
*
Jiang, Y., You, J., Zheng, X., & Lin, M.-P. (2017). The qualities of
attachment with significant others and self-compassion protect
adolescents from non suicidal self-injury. School Psychology
Quarterly, 32(2), 143. https://​doi.​org/​10.​1037/​spq00​00187
John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emotion regu-
lation: Personality processes, individual differences, and life span
development. Journal of Personality, 72(6), 1301–1334. https://​
doi.​org/​10.​1111/j.​1467-​6494.​2004.​00298.x
Kabat-Zinn, J. (2003). Mindfulness-based stress reduction (MBSR).
Constructivism in the Human Sciences, 8(2), 73.
* *
Kaniuka, A. R., Job, S. A., Brooks, B. D., & Williams, S. L. (2020a).
Gratitude and lower suicidal ideation among sexual minority
individuals: Theoretical mechanisms of the protective role of
attention to the positive. The Journal of Positive Psychology,
1-12. https://​doi.​org/​10.​1080/​17439​760.​2020.​18188​14
*
Kaniuka, A. R., Kelliher-Rabon, J., Chang, E. C., Sirois, F. M., &
Hirsch, J. K. (2020b). Symptoms of anxiety and depression and
suicidal behavior in college students: Conditional indirect effects
of non-suicidal self-injury and self-compassion. Journal of Col-
lege Student Psychotherapy, 34(4), 316-338. https://​doi.​org/​10.​
1080/​87568​225.​2019.​16010​48
Karyadi, K. A., VanderVeen, J. D., & Cyders, M. A. (2014). A meta-
analysis of the relationship between trait mindfulness and sub-
stance use behaviors. Drug and Alcohol Dependence, 143, 1–10.
https://​doi.​org/​10.​1016/j.​druga​lcdep.​2014.​07.​014
*
Kelley, M. L., Bravo, A. J., Davies, R. L., Hamrick, H. C., Vinci, C.,
& Redman, J. C. (2019). Moral injury and suicidality among
combat-wounded veterans: The moderating effects of social con-
nectedness and self-compassion. Psychological Trauma: Theory,
Research, Practice, and Policy, 11(6), 621. https://​doi.​org/​10.​
1037/​tra00​00447
Kelliher-Rabon, J., Sirois, F. M., & Hirsch, J. K. (2018). Self-com-
passion and suicidal behavior in college students: Serial indi-
rect effects via depression and wellness behaviors. Journal of
American College Health, 66(2), 114–122. https://​doi.​org/​10.​
1080/​07448​481.​2017.​13824​98
*
Kelliher-Rabon, J., Sirois, F. M., Barton, A. L., & Hirsch, J. K. (2021).
Self-compassion and suicidal behavior: Indirect effects of depres-
sion, anxiety, and hopelessness across increasingly vulnerable
samples. Self and Identity, 1-21. https://​doi.​org/​10.​1080/​15298​
868.​2021.​18845​92
Khoury, B. (2019). Compassion: Embodied and embedded.
Mindfulness, 10(11), 2363–2374. https:// ​ d oi. ​ o rg/ ​ 1 0. ​ 1 007/​
s12671-​019-​01211-w
Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard,
V., Chapleau, M.-A., Paquin, K., & Hofmann, S. G. (2013a).
Mindfulness-based therapy: A comprehensive meta-analysis.
Clinical Psychology Review, 33(6), 763–771. https://​doi.​org/​10.​
1016/j.​cpr.​2013.​05.​005
Khoury, B., Lecomte, T., Gaudiano, B. A., & Paquin, K. (2013b).
Mindfulness interventions for psychosis: A meta-analysis. Schiz-
ophrenia Research, 150(1), 176–184. https://​doi.​org/​10.​1016/j.​
schres.​2013.​07.​055
Kiekens, G., Hasking, P., Boyes, M., Claes, L., Mortier, P., Auerbach,
R. P., Kessler, R. C., Myin-Germeys, I., Nock, M. K., & Bruf-
faerts, R. (2018). The associations between non-suicidal self-
injury and first onset suicidal thoughts and behaviors. Journal
of Affective Disorders, 239, 171–179. https://​doi.​org/​10.​1016/j.​
jad.​2018.​06.​033
Kirby, J. N., & Gilbert, P. (2019). Commentary regarding Wilson
et al.(2018) “effectiveness of ‘self-compassion’ related thera-
pies: A systematic review and meta-analysis.” All is not as it
seems. Mindfulness, 10(6), 1006–1016. https://​doi.​org/​10.​1007/​
s12671-​018-​1088-8
Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship
between nonsuicidal self-injury and attempted suicide: converg-
ing evidence from four samples. Journal of Abnormal Psychol-
ogy, 122(1), 231. https://​doi.​org/​10.​1037/​a0030​278
Klonsky, E. D., Saffer, B. Y., & Bryan, C. J. (2018). Ideation-to-action
theories of suicide: a conceptual and empirical update. Current
Opinion in Psychology, 22, 38–43. https://​doi.​org/​10.​1016/j.​
copsyc.​2017.​07.​020
Kuentzel, J. G., Arble, E., Boutros, N., Chugani, D., & Barnett, D.
(2012). Nonsuicidal self-injury in an ethnically diverse col-
lege sample. American Journal of Orthopsychiatry, 82(3), 291.
https://​doi.​org/​10.​1111/j.​1939-​0025.​2012.​01167.x
Lamis, D. A., & Dvorak, R. D. (2014). Mindfulness, nonattachment,
and suicide rumination in college students: The mediating role
of depressive symptoms. Mindfulness, 5(5), 487-496. https://d​ oi.​
org/​10.​1007/​s12671-​013-​0203-0
Lin, Y., Fisher, M. E., Roberts, S. M., & Moser, J. S. (2016). Decon-
structing the emotion regulatory properties of mindfulness: an
electrophysiological investigation. Frontiers in Human Neurosci-
ence, 10, 451. https://​doi.​org/​10.​3389/​fnhum.​2016.​00451
Liu, R. T., Sheehan, A. E., Walsh, R. F., Sanzari, C. M., Cheek, S. M.,
& Hernandez, E. M. (2019). Prevalence and correlates of non-
suicidal self-injury among lesbian, gay, bisexual, and transgender
individuals: A systematic review and meta-analysis. Clinical Psy-
chology Review, 74, 101783. https://​doi.​org/​10.​1016/j.​cpr.​2019.​
101783
*
Liu, A., Wang, W., & Wu, X. (2020). Understanding the relation
between self-compassion and suicide risk among adolescents in
a post-disaster context: Mediating roles of gratitude and posttrau-
matic stress disorder. Frontiers in Psychology, 11, 1541. https://​
doi.​org/​10.​3389/​fpsyg.​2020.​01541
*
Lu, R., Zhou, Y., Wu, Q., Peng, X., Dong, J., Zhu, Z., & Xu, W.
(2019). The effects of mindfulness training on suicide ideation
among left-behind children in China: A randomized controlled
trial. Child: Care, Health and Development, 45(3), 371-379.
https://​doi.​org/​10.​1111/​cch.​12650
Luthar, S. S., & Cicchetti, D. (2000). The construct of resilience: Impli-
cations for interventions and social policies. Development and
13
 Mindfulness
Psychopathology, 12(4), 857–885. https://d​ oi.o​ rg/1​ 0.1​ 017/s​ 0954​
57940​00041​56
Lutz, J., Herwig, U., Opialla, S., Hittmeyer, A., Jäncke, L., Rufer, M.,
et al. (2014). Mindfulness and emotion regulation—An fMRI
study. Social Cognitive and Affective Neuroscience, 9(6), 776–
785. https://​doi.​org/​10.​1093/​scan/​nst043
MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-
analysis of the association between self-compassion and psycho-
pathology. Clinical Psychology Review, 32(6), 545–552. https://​
doi.​org/​10.​1016/j.​cpr.​2012.​06.​003
*
MacIsaac, J. (2019). Group separation and classification of non-sui-
cidal self-injury in a university student population. Dissertation:
University of Windsor (Canada)
May, A. M., & Klonsky, E. D. (2016). What distinguishes suicide
attempters from suicide ideators? A meta-analysis of potential
factors. Clinical Psychology: Science and Practice, 23(1), 5.
https://​doi.​org/​10.​1037/​h0101​735
McIntyre, R. S., & Lee, Y. (2020a). Preventing suicide in the context of
the COVID-19 pandemic. World Psychiatry, 19(2), 250. https://​
doi.​org/​10.​1002/​wps.​20767
McIntyre, R. S., & Lee, Y. (2020b). Projected increases in suicide in
Canada as a consequence of COVID-19. Psychiatry Research,
290, 113104. https://​doi.​org/​10.​1016/j.​psych​res.​2020.​113492
*
McMain, S. F., Guimond, T., Barnhart, R., Habinski, L., & Streiner,
D. L. (2017). A randomized trial of brief dialectical behaviour
therapy skills training in suicidal patients suffering from border-
line disorder. Acta Psychiatrica Scandinavica, 135(2), 138-148.
https://​doi.​org/​10.​1111/​acps.​12664
Miranda-Mendizabal, A., Castellví, P., Parés-Badell, O., Alayo, I.,
Almenara, J., Alonso, I., Blasco, M. J., Cebrià, A., Gabilondo,
A., Gili, M., Lagares, C., Piqueras, J. A., Rodríguez-Jiménez,
T., Rodríguez-Marín, J., Roca, M., Soto-Sanz, V., Vilagut, G., &
Alonso, J. (2019). Gender differences in suicidal behavior in ado-
lescents and young adults: Systematic review and meta-analysis
of longitudinal studies. International Journal of Public Health,
64(2), 265–283. https://​doi.​org/​10.​1007/​s00038-​018-​1196-1
*
Mohammadkhani, P., Khanipour, H., Azadmehr, H., Mobramm, A.,
& Naseri, E. (2015). Trait mindfulness, reasons for living and
general symptom severity as predictors of suicide probability in
males with substance abuse or dependence. Iranian Journal of
Psychiatry, 10(1), 56.
Morgan, B. M. (2017). Stress management for college students: An
experiential multi-modal approach. Journal of Creativity in Men-
tal Health, 12(3), 276–288. https://​doi.​org/​10.​1080/​15401​383.​
2016.​12456​42
Muehlenkamp, J. J., & Brausch, A. M. (2019). Protective factors do not
moderate risk for past-year suicide attempts conferred by recent
NSSI. Journal of Affective Disorders, 245, 321–324. https://​doi.​
org/​10.​1016/j.​jad.​2018.​11.​013
Muris, P., & Otgaar, H. (2020). The process of science: A critical evalu-
ation of more than 15 years of research on self-compassion with
the Self-Compassion Scale. Mindfulness, 11(6), 1469–1482.
https://​doi.​org/​10.​1007/​s12671-​020-​01363-0
Muris, P., van den Broek, M., Otgaar, H., Oudenhoven, I., & Lennartz,
J. (2018). Good and bad sides of self-compassion: A face validity
check of the Self-Compassion Scale and an investigation of its
relations to coping and emotional symptoms in non-clinical ado-
lescents. Journal of Child and Family studies, 27(8), 2411–2421.
https://​doi.​org/​10.​1007/​s10826-​018-​1099-z
*
Nagy, L. M. (2017). An experimental investigation of the effects of
self-compassion and self-criticism on implicit associations with
non-suicidal self-injury. Dissertation: University of Kentucky
Neff, K. (2003a). Self-compassion: An alternative conceptualization of
a healthy attitude toward oneself. Self and Identity, 2(2), 85–101.
https://​doi.​org/​10.​1080/​15298​86030​9032
13
Neff, K. D. (2003b). The development and validation of a scale to
measure self-compassion. Self and Identity, 2(3), 223–250.
https://​doi.​org/​10.​1080/​15298​86030​9027
Neff, K. D., & McGehee, P. (2010). Self-compassion and psychological
resilience among adolescents and young adults. Self and Identity,
9(3), 225–240. https://​doi.​org/​10.​1080/​15298​86090​29793​07
Nielssen, O., Wallace, D., & Large, M. (2017). Pokorny's complaint:
The insoluble problem of the overwhelming number of false
positives generated by suicide risk assessment. BJPsych Bulletin,
41(1), 18–20. https://​doi.​org/​10.​1192/​pb.​bp.​115.​053017
Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C.,
& Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic
Reviews, 30(1), 133–154. https://d​ oi.o​ rg/1​ 0.1​ 093/e​ pirev/m ​ xn002
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A
sensorimotor approach to psychotherapy (norton series on inter-
personal neurobiology). WW Norton & Company.
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A.
(2016). Rayyan—A web and mobile app for systematic
reviews. Systematic Reviews, 5(1), 210. https://​doi.​org/​10.​1186/​
s13643-​016-​0384-4
Paez, A. (2017). Gray literature: An important resource in systematic
reviews. Journal of Evidence-Based Medicine, 10(3), 233–240.
https://​doi.​org/​10.​1111/​jebm.​12266
Paul, E., Tsypes, A., Eidlitz, L., Ernhout, C., & Whitlock, J. (2015).
Frequency and functions of non-suicidal self-injury: Associa-
tions with suicidal thoughts and behaviors. Psychiatry Research,
225(3), 276–282. https://d​ oi.o​ rg/1​ 0.1​ 016/j.p​ sychr​ es.2​ 014.1​ 2.0​ 26
*
Paulus, D. J., Kauffman, B. Y., Garey, L., Jardin, C., Manning, K.,
Bakhshaie, J., Garza, M., Ochoa-Perez, M., Lemaire, C., & Zvo-
lensky, M. J. (2018). Examining the synergistic effects of two
transdiagnostic vulnerability factors in relation to anxiety and
depressive symptoms and disorders among Latinos in a commu-
nity health care setting. Behavior Modification, 42(5), 661-683.
https://​doi.​org/​10.​1177/​01454​45517​725867
*
Per, M., Simundic, A., Argento, A., Khoury, B., & Heath, N. (2021).
Examining the relationship between mindfulness, self-compas-
sion, and emotion regulation in self-injury. Archives of Suicide
Research, 1-16. https://d​ oi.o​ rg/1​ 0.1​ 080/1​ 38111​ 18.2​ 021.1​ 88553​ 4
*
Possemato, K., Bergen-Cico, D., Treatman, S., Allen, C., Wade, M.,
& Pigeon, W. (2016). A randomized clinical trial of primary
care brief mindfulness training for veterans with PTSD. Journal
of Clinical Psychology, 72(3), 179-193. https://​doi.​org/​10.​1002/​
jclp.​22241
*
Rabon, J. K., Hirsch, J. K., Kaniuka, A. R., Sirois, F., Brooks, B. D.,
& Neff, K. (2019). Self-compassion and suicide risk in veterans:
When the going gets tough, do the tough benefit more from self-
compassion? Mindfulness, 10(12), 2544-2554. https://d​ oi.o​ rg/1​ 0.​
1007/​s12671-​019-​01221-8
Rajappa, K., Gallagher, M., & Miranda, R. (2012). Emotion dysregula-
tion and vulnerability to suicidal ideation and attempts. Cognitive
Therapy and Research, 36(6), 833–839. https://​doi.​org/​10.​1007/​
s10608-​011-​9419-2
Ribeiro, J., Franklin, J., Fox, K. R., Bentley, K., Kleiman, E. M.,
Chang, B., & Nock, M. K. (2016). Self-injurious thoughts and
behaviors as risk factors for future suicide ideation, attempts, and
death: A meta-analysis of longitudinal studies. Psychological
Medicine, 46(2), 225–236. https://​doi.​org/​10.​1017/​s0033​29171​
50018​04
*
Riquino, M. R. (2019). A mixed methods investigation of attention and
mindfulness among young adults with a history of nonsuicidal
self-injury. Dissertation: The University of Utah
Rosenthal, R., & Rubin, D. B. (1988). [Selection models and the file
drawer problem]: comment: assumptions and procedures in the
file drawer problem. Statistical Science, 3(1), 120–125. https://​
doi.​org/​10.​1214/​ss/​11770​13014
Mindfulness
*
Roush, J. F., Mitchell, S. M., Brown, S. L., & Cukrowicz, K. C. (2018).
Thwarted interpersonal needs mediate the relation between facets
of mindfulness and suicide ideation among psychiatric inpatients.
Psychiatry Research, 265, 167-173. https://​doi.​org/​10.​1016/j.​
psych​res.​2018.​04.​026
Ruch, D. A., Sheftall, A. H., Schlagbaum, P., Rausch, J., Campo, J. V.,
& Bridge, J. A. (2019). Trends in suicide among youth aged 10
to 19 years in the United States, 1975 to 2016. JAMA network
open, 2(5), e193886–e193886. https://​doi.​org/​10.​1001/​jaman​
etwor​kopen.​2019.​3886
Rufino, N. C., Fidalgo, T. M., Dos Santos, J. P., Tardelli, V. S., Lima,
M. G., Frick, L. P., Mirkovic, B., da Silveira, D. X., & Cohen,
D. (2021). Treatment compliance and risk and protective fac-
tors for suicide ideation to completed suicide in adolescents: A
systematic review. Brazilian Journal of Psychiatry. https://​doi.​
org/​10.​1590/​1516-​4446-​2020-​1026
Schmelefske, E., Per, M., Khoury, B., & Heath, N. (2020). The effects
of mindfulness-based interventions on suicide outcomes: A
meta-analysis. Archives of Suicide Research, 1-18. https://​doi.​
org/​10.​1080/​13811​118.​2020.​18337​96
*
Serrano, D. M., Rufino, K. A., Tran, J. K., & Vujanovic, A. A. (2020).
Association between sleep disturbances and suicide risk among
firefighters: The moderating role of mindfulness. Mindfulness,
11(12), 2793-2803. https://d​ oi.o​ rg/1​ 0.1​ 007/s​ 12671-0​ 20-0​ 1491-7
Serras, A., Saules, K. K., Cranford, J. A., & Eisenberg, D. (2010).
Self-injury, substance use, and associated risk factors in a multi-
campus probability sample of college students. Psychology of
Addictive Behaviors, 24(1), 119. https://​doi.​org/​10.​1037/​a0017​
210
*
Servaty-Seib, H. L., Williams, P., & Liew, C. H. (2021). Interpersonal
and intrapersonal predictors of suicidal thoughts and actions in
first-year college students. Journal of American College Health,
1-24. https://​doi.​org/​10.​1080/​07448​481.​2021.​19049​50
Shahram, S. Z., Smith, M. L., Ben-David, S., Feddersen, M., Kemp, T.
E., & Plamondon, K. (2021). Promoting “zest for life”: A system-
atic literature review of resiliency factors to prevent youth Ssui-
cide. Journal of Research on Adolescence, 31(1), 4–24. https://​
doi.​org/​10.​1111/​jora.​12588
Shepard, D. S., Gurewich, D., Lwin, A. K., Reed Jr., G. A., & Silver-
man, M. M. (2016). Suicide and suicidal attempts in the United
States: Costs and policy implications. Suicide and Life-Threaten-
ing Behavior, 46(3), 352–362. https://d​ oi.o​ rg/1​ 0.1​ 111/s​ ltb.1​ 2225
Sher, L. (2019). Resilience as a focus of suicide research and preven-
tion. Acta Psychiatrica Scandinavica, 140(2), 169–180. https://​
doi.​org/​10.​1111/​acps.​13059
*
Shorey, R. C., Elmquist, J., Wolford-Clevenger, C., Gawrysiak, M. J.,
Anderson, S., & Stuart, G. L. (2016). The relationship between
dispositional mindfulness, borderline personality features, and
suicidal ideation in a sample of women in residential substance
use treatment. Psychiatry Research, 238, 122-128. https://​doi.​
org/​10.​1016/j.​psych​res.​2016.​02.​040
Silverman, M. M., Berman, A. L., Sanddal, N. D., O'carroll, P. W., &
Joiner Jr., T. E. (2007). Rebuilding the tower of Babel: a revised
nomenclature for the study of suicide and suicidal behaviors. Part
2: Suicide-related ideations, communications, and behaviors.
Suicide and Life-Threatening Behavior, 37(3), 264–277. https://​
doi.​org/​10.​1521/​suli.​2007.​37.3.​264
* *
Song, H. S., & Bae, S. M. (2020). The moderating effects of the facets
of mindfulness on the relationship between daily life stress and
suicidal ideation among Korean college students. International
Journal of Mental Health and Addiction, 1-16. https://​doi.​org/​
10.​1007/​s11469-​020-​00345-6
*
Stanley, I. H., Boffa, J. W., Tran, J. K., Schmidt, N. B., Joiner, T. E.,
& Vujanovic, A. A. (2019). Posttraumatic stress disorder symp-
toms and mindfulness facets in relation to suicide risk among
firefighters. Journal of Clinical Psychology, 75(4), 696-709.
https://​doi.​org/​10.​1002/​jclp.​22748
Strauss, C., Taylor, B. L., Gu, J., Kuyken, W., Baer, R., Jones, F.,
& Cavanagh, K. (2016). What is compassion and how can we
measure it? A review of definitions and measures. Clinical
Psychology Review, 47, 15–27. https://​doi.​org/​10.​1016/j.​cpr.​
2016.​05.​004
Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N.
J. (2014). Prevalence of nonsuicidal self-injury in nonclinical
samples: Systematic review, meta-analysis and meta-regres-
sion. Suicide and Life-Threatening Behavior, 44(3), 273–303.
https://​doi.​org/​10.​1111/​sltb.​12070
Taliaferro, L. A., & Muehlenkamp, J. J. (2014). Risk and protective
factors that distinguish adolescents who attempt suicide from
those who only consider suicide in the past year. Suicide and
Life-Threatening Behavior, 44(1), 6–22. https://​doi.​org/​10.​1111/​
sltb.​12046
*
Tanaka, M., Wekerle, C., Schmuck, M. L., Paglia-Boak, A., & Team,
M. R. (2011). The linkages among childhood maltreatment,
adolescent mental health, and self-compassion in child welfare
adolescents. Child Abuse & Neglect, 35(10), 887-898. https://d​ oi.​
org/​10.​1016/j.​chiabu.​2011.​07.​003
Tang, J., Li, G., Chen, B., Huang, Z., Zhang, Y., Chang, H., Wu, C.,
Ma, X., Wang, J., & Yu, Y. (2018). Prevalence of and risk fac-
tors for non-suicidal self-injury in rural China: Results from a
nationwide survey in China. Journal of Affective Disorders, 226,
188–195. https://​doi.​org/​10.​1016/j.​jad.​2017.​09.​051
Teismann, T., Forkmann, T., Glaesmer, H., Egeri, L., & Margraf, J.
(2016). Remission of suicidal thoughts: Findings from a longitu-
dinal epidemiological study. Journal of Affective Disorders, 190,
723–725. https://​doi.​org/​10.​1016/j.​jad.​2015.​09.​066
Tøllefsen, I. M., Hem, E., & Ekeberg, Ø. (2012). The reliability of
suicide statistics: a systematic review. BMC Psychiatry, 12(1),
1–11. https://​doi.​org/​10.​1186/​1471-​244x-​12-9
Tomlinson, E. R., Yousaf, O., Vittersø, A. D., & Jones, L. (2018).
Dispositional mindfulness and psychological health: A system-
atic review. Mindfulness, 9(1), 23–43. https://​doi.​org/​10.​1007/​
s12671-​017-​0762-6
*
Tucker, R. P., O’Keefe, V. M., Cole, A. B., Rhoades-Kerswill, S.,
Hollingsworth, D. W., Helle, A. C., DeShong, H. L., Mullins-
Sweatt, S. N., & Wingate, L. R. (2014). Mindfulness tempers
the impact of personality on suicidal ideation. Personality and
Individual Differences, 68, 229-233. https://​doi.​org/​10.​1016/j.​
paid.​2014.​05.​001
*
Tuna, E., & Gençöz, T. (2021). Pain perception, distress tolerance
and self-compassion in Turkish young adults with and without
a history of non-suicidal self-injury. Current Psychology, 40(8),
4143-4155. https://​doi.​org/​10.​1007/​s12144-​020-​00634-2
Turner, B. J., Layden, B. K., Butler, S. M., & Chapman, A. L. (2013).
How often, or how many ways: Xlarifying the relationship
between non-suicidal self-injury and suicidality. Archives of
Suicide Research, 17(4), 397–415. https://d​ oi.o​ rg/1​ 0.1​ 080/1​ 3811​
118.​2013.​802660
Turner, B. J., Austin, S. B., & Chapman, A. L. (2014). Treating nonsui-
cidal self-injury: A systematic review of psychological and phar-
macological interventions. The Canadian Journal of Psychiatry,
59(11), 576–585. https://​doi.​org/​10.​1177/​07067​43714​05901​103
Umphrey, L. R., Sherblom, J. C., & Swiatkowski, P. (2021). Rela-
tionship of self-compassion, hope, and emotional control to per-
ceived burdensomeness, thwarted belongingness, and suicidal
ideation. Crisis: The Journal of Crisis Intervention and Suicide
Prevention, 42(2), 121. https://d​ oi.o​ rg/1​ 0.1​ 027/0​ 227-5​ 910/a​ 0006​
97
Van Geel, M., Vedder, P., & Tanilon, J. (2014). Relationship between
peer victimization, cyberbullying, and suicide in children and
13
 Mindfulness
adolescents: A meta-analysis. JAMA Pediatrics, 168(5), 435–
442. https://​doi.​org/​10.​1001/​jamap​ediat​rics.​2013.​4143
Van Vliet, K., & Kalnins, G. (2011). A compassion-focused approach
to nonsuicidal self-injury. Journal of Mental Health Counseling,
33(4), 295–311. https://d​ oi.o​ rg/1​ 0.1​ 7744/m
​ ehc.3​ 3.4.j​ 75403​ 38q2​
23t417
Victor, S. E., & Klonsky, E. D. (2014). Correlates of suicide attempts
among self-injurers: A meta-analysis. Clinical Psychology
Review, 34(4), 282–297. https://​doi.​org/​10.​1016/j.​cpr.​2014.​03.​
005
*
Vigna, A. (2016). Self-compassion as a resilience factor in gender
and sexual minority youth. Dissertation: The University of
Wisconsin-Madison
Vujanovic, A. A., Bonn-Miller, M. O., Bernstein, A., McKee, L. G.,
& Zvolensky, M. J. (2010). Incremental validity of mindfulness
skills in relation to emotional dysregulation among a young adult
community sample. Cognitive Behaviour Therapy, 39(3), 203–
213. https://​doi.​org/​10.​1080/​16506​07090​34416​30
*
Wang, J., Häusermann, M., & Ambresin, A.-E. (2018). Mindfulness
and other psycho-social resources protective against mental ill-
ness and suicidality among gay men. Frontiers in Psychiatry, 9,
361. https://​doi.​org/​10.​3389/​fpsyt.​2018.​00361
*
Warner, A. (2015). Mindfulness as a protective factor for the relation-
ship between self-injury and suicide. Dissertation: The Florida
State University
*
Watson-Singleton, N. N., Walker, J. H., LoParo, D., Mack, S. A.,
& Kaslow, N. J. (2018). Psychometric evaluation of the Five
Facet Mindfulness Questionnaire in a clinical sample of African
Americans. Mindfulness, 9(1), 312-324. https://​doi.​org/​10.​1007/​
s12671-​017-​0776-0
Weissman, M. M., Bland, R. C., Canino, G. J., Greenwald, S., Hwu,
H.-G., Joyce, P. R., Karam, E. G., Lee, C.-K., Lellouch, J.,
Lepine, J.-P., Newman, S. C., Rubio-Stipec, M., Wells, J. E.,
Wickramaratne, P. J., Wittchen, H.-U., & Yeh, E.-K. (1999).
Prevalence of suicide ideation and suicide attempts in nine coun-
tries. Psychological Medicine, 29(1), 9–17. https://​doi.​org/​10.​
1017/​s0033​29179​80078​67
Whitlock, J., Eckenrode, J., & Silverman, D. (2006). Self-injurious
behaviors in a college population. Pediatrics, 117(6), 1939–1948.
https://​doi.​org/​10.​1542/​peds.​2005-​2543
World Health Organization (2017). Preventing suicide: A resource
for media professionals. https://​apps.​who.​int/​iris/​handle/​10665/​
258814
13
World Health Organization. (2018). National suicide prevention strat-
egies: Progress, examples and indicators. https://​apps.​who.​int/​
iris/​handle/​10665/​279765.
*
Wu, N., Hou, Y., Chen, P., & You, J. (2019). Peer acceptance and non-
suicidal self-injury among Chinese adolescents: A longitudinal
moderated mediation model. Journal of Youth and Adolescence,
48(9), 1806-1817. https://​doi.​org/​10.​1007/​s10964-​019-​01093-0
*
Xavier, A., Pinto-Gouveia, J., & Cunha, M. (2016). The protective role
of self-compassion on risk factors for non-suicidal self-injury in
adolescence. School Mental Health, 8(4), 476-485. https://​doi.​
org/​10.​1007/​s12310-​016-​9197-9
Yarnell, L. M., Neff, K. D., Davidson, O. A., & Mullarkey, M. (2019).
Gender differences in self-compassion: Examining the role of
gender role orientation. Mindfulness, 10(6), 1136–1152. https://​
doi.​org/​10.​1007/​s12671-​018-​1066-1
You, J., Ren, Y., Zhang, X., Wu, Z., Xu, S., & Lin, M.-P. (2018). Emo-
tional dysregulation and nonsuicidal self-injury: A meta-analytic
review. Neuropsychiatry, 8(2). https://​doi.​org/​10.​4172/​neuro​
psych​iatry.​10003​99
*
Zeifman, R. J., Ip, J., Antony, M. M., & Kuo, J. R. (2021). On lov-
ing thyself: Exploring the association between self-compassion,
self-reported suicidal behaviors, and implicit suicidality among
college students. Journal of American college health, 69(4), 396-
403. https://​doi.​org/​10.​1080/​07448​481.​2019.​16791​54
Zelkowitz, R. L., & Cole, D. A. (2019). Self-criticism as a transdiag-
nostic process in nonsuicidal self-injury and disordered eating:
Systematic review and meta-analysis. Suicide and Life-Threaten-
ing Behavior, 49(1), 310–327. https://d​ oi.o​ rg/1​ 0.1​ 111/s​ ltb.1​ 2436
*
Zeng, W., Ma, Z., & Li, H. (2017). Mindfulness and suicidal idea-
tion in Chinese older adults: Perceived stress as mediator. Social
Behavior and Personality: an international journal, 45(5), 733-
740. https://​doi.​org/​10.​2224/​sbp.​5807
*
Zhang, H., Liu, M., & Long, H. (2021). Child maltreatment and sui-
cide ideation in rural China: The roles of self-compassion and
school belonging. Child and Adolescent Social Work Journal,
38(3), 325-335. https://​doi.​org/​10.​1007/​s10560-​020-​00679-z
Publisher’s Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.