Deliberate self harm in adolescents: Self report survey in schools in England

Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford.
BMJ (online) (Impact Factor: 17.45). 12/2002; 325(7374):1207-11.
Source: PubMed


To determine the prevalence of deliberate self harm in adolescents and the factors associated with it.
Cross sectional survey using anonymous self report questionnaire.
41 schools in England.
6020 pupils aged 15 and 16 years.
Deliberate self harm.
398 (6.9%) participants reported an act of deliberate self harm in the previous year that met study criteria. Only 12.6% of episodes had resulted in presentation to hospital. Deliberate self harm was more common in females than it was in males (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1 to 4.9). In females the factors included in a multivariate logistic regression for deliberate self harm were recent self harm by friends, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem. In males the factors were suicidal behaviour in friends and family members, drug use, and low self esteem.
Deliberate self harm is common in adolescents, especially females. School based mental health initiatives are needed. These could include approaches aimed at educating school pupils about mental health problems and screening for those at risk.

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Available from: Keith Hawton, Apr 02, 2015
    • "Our study highlights that female adolescents were more likely to have suicidal and other self-harming behavior and ideation. This finding has been consistently shown in the literature (Hawton et al., 2002). Adolescent depression and hospital-treated self-harm may play a role, as the numbers are higher for female adolescents compared to males (Olfson et al., 2005), Of note is that sex difference did not reach significance levels when the regression was run for the suicide intent and the suicide attempt groups, suggesting that females are more likely to engage in ultimately non-lethal self-harming behavior without suicide intent, in contrast to a previous study where no significant gender difference was found in the frequency, duration or number of methods of NSSI (Nock et al., 2006). "
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    ABSTRACT: Adolescents comprise a unique and often challenging group of patients with diverse presentations to the Mental Health Services; suicidal behavior being one of them. The main aim of this naturalistic project was to investigate demographic and clinical correlates of adolescent suicidal and self-harm events, which may be of value to decision-making in clinical practice. All adolescents (n = 149) registered and actively managed by a specialist community mental health service in South London were included in the study. Clinical information from their files was used to determine suicidality/self-harm events. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) was utilised for classification purposes. Logistic regression was used to explore the effects of age, sex, diagnosis, medication, substance use (alcohol and/or cannabis) and ethnicity on suicidality/self-harming behaviors. Age, sex and use of psychotropic medication were identified to play a significant role in determining the risk of engaging in self-harming behavior. The risk was higher with increasing age and female sex. Medication seemed to have a protective effect. Reporting a 20% prevalence of non-suicidal self-injury (NSSI) in our population, we highlight the importance of NSSI as a distinct diagnostic category. Our findings have implications for risk assessment and appropriate decision-making in clinical settings. Results are translatable and relevant to other metropolitan areas.
    Journal of Mental Health 07/2015; 24(4):1-5. DOI:10.3109/09638237.2015.1022249 · 1.01 Impact Factor
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    • "The age pattern of self-harm complicates the picture and partly explains the misconceptions: among those coming to hospital because of self-harm, younger patients present with self-injury (mainly cutting) in higher proportions than do older people (Horrocks et al., 2003). In the community, the pattern of self-harm among adults, and especially older adults, is unknown but it is clear that teenagers undertake considerably more self-injury than self-poisoning – although they do also report a great many self-poisoning episodes (Hawton et al., 2002). In general, clinical and epidemiological research reports are based on hospital practice rather than primary care or community surveys. "
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    ABSTRACT: Self-poisoning and self-injury have widely differing incidences in hospitals and in the community, which has led to confusion about the concept of self-harm. Categorising self-harm simply by a method may be clinically misleading because many hospital-attending patients switch from one method of harm to another on subsequent episodes. The study set out to determine the frequency, pattern, determinants and characteristics of method-switching in self-harm episodes presenting to the general hospital. The pattern of repeated self-harm was established from over 33,000 consecutive self-harm episodes in a multicentre English cohort, categorising self-harm methods as poisoning, cutting, other injury, and combined methods. Over an average of 30 months of follow-up, 23% of people repeated self-harm and one-third of them switched method, often rapidly, and especially where the person was male, younger, or had self-harmed previously. Self-poisoning was far less likely than other methods to lead on to switching. Self-harm episodes that do not lead to hospital attendance are not included in these findings but people who self-harmed and went to hospital but were not admitted from the emergency department to the general hospital, or did not receive designated psychosocial assessment are included. People in the study were a mix of prevalent as well as incident cases. Method of self-harm is fluctuating and unpredictable. Clinicians should avoid false assumptions about people׳s risks or needs based simply on the method of harm. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 04/2015; 180:44-51. DOI:10.1016/j.jad.2015.03.051 · 3.38 Impact Factor
    • "All items of the ISSIQ-A were created after a careful literature review on selfharming behavior (e.g. Suyemoto, 1998; Ross and Heath, 2002; Nock and Prinstein, 2004; Joiner, 2005; Madge et al., 2008; Mangnall and Yurkovich, 2008; Messer and Fremouw, 2008; Scoliers et al., 2009; Madge et al., 2011) and their relationship with impulsivity (Simeon et al., 1992; Hawton et al., 2002; Claes et al., 2010; Madge et al., 2011) and suicide ideation (Hawton et al., 1999; Madge et al., 2008; Fliege et al., 2009). The first version of ISSIQ-A had 64 items, grouped into four modules: A-Impulse (16 items), B-Self-harm (14 items), C – functions (31 items) and D – Suicide ideation (three items). "
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    ABSTRACT: Non-suicidal self-injury (NSSI) is the deliberate, self-inflicted destruction of body tissue without suicidal intent and an important clinical phenomenon. Rates of NSSI appear to be disproportionately high in adolescents and young adults, and is a risk factor for suicidal ideation and behavior. The present study reports the psychometric properties of the Impulse, Self-harm and Suicide Ideation Questionnaire for Adolescents (ISSIQ-A), a measure designed to comprehensively assess the impulsivity, NSSI behaviors and suicide ideation. An additional module of this questionnaire assesses the functions of NSSI. Results of Confirmatory Factor Analysis (CFA) of the scale on 1722 youths showed items' suitability and confirmed a model of four different dimensions (Impulse, Self-harm, Risk-behavior and Suicide ideation) with good fit and validity. Further analysis showed that youth׳s engagement in self-harm may exert two different functions: to create or alleviate emotional states, and to influence social relationships. Our findings contribute to research and assessment on non-suicidal self-injury, suggesting that the ISSIQ-A is a valid and reliable measure to assess impulse, self-harm and suicidal thoughts, in adolescence. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    04/2015; 227(2-3). DOI:10.1016/j.psychres.2015.01.031
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