Factors associated with deliberate self-harm among Irish adolescents

National Suicide Research Foundation, Cork, Republic of Ireland.
Psychological Medicine (Impact Factor: 5.94). 11/2010; 40(11):1811-9. DOI: 10.1017/S0033291709992145
Source: PubMed


Deliberate self-harm (DSH) is a major public health problem, with young people most at risk. Lifetime prevalence of DSH in Irish adolescents is between 8% and 12%, and it is three times more prevalent among girls than boys. The aim of the study was to identify the psychological, life-style and life event factors associated with self-harm in Irish adolescents.
A cross-sectional study was conducted, with 3881 adolescents in 39 schools completing an anonymous questionnaire as part of the Child and Adolescent Self-harm in Europe (CASE) study. There was an equal gender balance and 53.1% of students were 16 years old. Information was obtained on history of self-harm life events, and demographic, psychological and life-style factors.
Based on multivariate analyses, important factors associated with DSH among both genders were drug use and knowing a friend who had engaged in self-harm. Among girls, poor self-esteem, forced sexual activity, self-harm of a family member, fights with parents and problems with friendships also remained in the final model. For boys, experiencing bullying, problems with schoolwork, impulsivity and anxiety remained.
Distinct profiles of boys and girls who engage in self-harm were identified. Associations between DSH and some life-style and life event factors suggest that mental health factors are not the sole indicators of risk of self-harm. The importance of school-related risk factors underlines the need to develop gender-specific initiatives in schools to reduce the prevalence of self-harm.

Download full-text


Available from: Ivan J Perry,
21 Reads
  • Source
    • "Self-harm in adolescents and young adults represents an important public health issue [1]. Community surveys indicate that around 5 to 10% of adolescents report self-harm over the last year [2-5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Self-harm is common in adolescents, but it is often unreported and undetected. Available screening tools typically ask directly about self-harm and suicidal ideation. Although in an ideal world, direct enquiry and open discussion around self-harm would be advocated, non-psychiatric professionals in community settings are often reluctant to ask about this directly and disclosure can be met with feeling of intense anxiety. Training non-specialist staff to directly ask about self-harm has limited effects suggesting that alternative approaches are required. This study investigated whether a targeted analysis of negative emotions and self-esteem could identify young adolescents at risk of self-harm in community settings. Data were collected as part of a clinical trial from young people in school years 8--11 (aged 12--16) at eight UK secondary schools (N = 4503 at baseline, N = 3263 in prospective analysis). The Short Mood and Feelings Questionnaire, Revised Child Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, personal failure (Children's Automatic Thoughts Scale), and two items on self-harm were completed at baseline, 6 and 12 months. Following a process of Principal Components Analysis, item reduction, and logistic regression analysis, three internally reliable factors were identified from the original measures that were independently associated with current and future self-harm; personal failure (3 items), physical symptoms of depression/anxiety (6 items), positive self-esteem (5 items). The summed score of these 14 items had good accuracy in identifying current self-harm (AUC 0.87 girls, 0.81 boys) and at six months for girls (0.81), and fair accuracy at six months for boys (AUC 0.74) and 12 months for girls (AUC 0.77). A brief and targeted assessment of negative emotions and self-esteem, focusing on factors that are strongly associated with current and future self-harm, could potentially be used to help identify adolescents who are at risk in community settings. Further research should assess the psychometric properties of the items identified and test this approach in more diverse community contexts.
    BMC Public Health 06/2013; 13(1):604. DOI:10.1186/1471-2458-13-604 · 2.26 Impact Factor
  • Source
    • "Unlike some western studies [9–11] in which psychiatric and personality disorders are referred to as predominant DSH antecedents, some Indian urban studies [12, 13] have pointed out that many people who come to clinical attention after DSH do not have any designated Axis I (DSM IV) psychiatric disorder; rather they are stressed by psychosocial factors like adjustment problems or social and situational factors. Few recent western and other studies also highlighted the fact that mental health factors are “not the sole indicators of risk of self-harm” [14, 15]; on the contrary, the life events and psychosocial factors [16] play a significant role in DSH behaviours. Detailed psychiatric assessment of self-harm patients is always difficult, and especially so at the primary care level. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of mental illness in nonfatal deliberate self-harm (DSH) is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India. Data were collected by using a specially designed DSH register, Explanatory Model Interview Catalogue (EMIC), and clinical interview. Psychiatric diagnosis was made following the DSM-IV guidelines. The majority of subjects were young females (74.2%) and married (65.2%). Most of them (69.7%) were uncertain about their "intention to die," and pesticide poisoning was the commonest method (95.5%). Significant male-female differences were found with respect to education level, occupation, and venue of the DSH attempt. Typical stressors were conflict with spouse, guardians, or in-laws, extramarital affairs, chronic physical illness, and failed love affairs. The major depressive disorder (14.6%) was the commonest psychiatric diagnosis followed by adjustment disorder (6.7%); however 60.7% of the cases had no psychiatric illness. Stressful life situations coupled with easy access to lethal pesticides stood as the risk factor. The sociocultural dynamics behind suicidal behaviour and community-specific social stressors merit detailed assessment and timely psychosocial intervention. These findings will be helpful to design community-based mental health clinical services and community action in the region.
    06/2013; 2013(5):486081. DOI:10.1155/2013/486081
    • "Previous Irish surveys reported that factors shared by girls and boys who self-harm relate to substance misuse and knowing others who engage in DSH (McMahon, et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Little information exists on the levels of psychiatric disorders among substance abusing adolescents in Ireland. The aim of the study is examine the pattern of psychiatric disorders and explore for gender differences among adolescents with a substance use disorder (SUD) in Ireland. A cross-sectional descriptive study and retrospective review of medical records on the 144 most recent admissions at the Youth Drug and Alcohol (YoDA) service, Dublin was carried out. Overall, 48% of the patients had a lifetime history of psychiatric disorders. Deliberate self-harm (DSH) was the most common condition (27.1%), followed by attention deficit hyperactivity disorder (20.8%) and depression (10.4%). Conduct disorder and oppositional defiant disorder were infrequently diagnosed. Compared with boys, the girls were more likely to have a lifetime history of psychiatric disorders (odds ratio 3.7; p = 0.005). These findings provide the first prevalence data on psychiatric disorders in a clinically representative sample of Irish adolescents with SUDs. Adolescent addiction services should have the skills to assess and manage co-occurring mental health problems. There is a need for further studies to examine DSH among adolescents with SUDs.
    Mental Health and Substance Use dual diagnosis 05/2013; 6(2):124-132. DOI:10.1080/17523281.2012.693519
Show more