Deliberate self-harm in adolescents aged 12-18: a cross-sectional survey of 18,104 students

Deliberate self-harm among pediatric psychiatric inpatients in China: A single-center retrospective study

BACKGROUND

For children and adolescents, deliberate self-harm (DSH) is becoming a mental health problem of concern. Despite several studies on the prevalence and factors of DSH in the world, there is little information on DSH among children and adolescents in China. This study explores the prevalence, types, associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.

AIM

To understand the situation of DSH among hospitalized children and adolescents and its related factors.

METHODS

In this study, we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019, extracted the demographic and clinical data of all patients, and analyzed clinical risk factors of DSH.

RESULTS

A total of 239 (16.90%) patients engaged in at least one type of DSH in our study. Cutting (n = 115, 48.12%) was the most common type of DSH. Females (n = 171, 71.55%) were more likely to engage in DSH than males (n = 68, 28.45%). DSH was positively associated with depressive disorders [OR = 3.845 (2.196-6.732); P < 0.01], female [OR = 2.536 (1.815-3.542); P < 0.01], parental marital status [OR = 5.387 (2.254-12.875); P < 0.01] and negative family history of psychiatric illness [OR = 7.767 (2.952-20.433); P < 0.01], but not with occupation, substance use and history of physical abuse.

CONCLUSION

Our findings suggest that for patients with depression, females, an abnormal marriage of parents, and no history of mental illness, attention should be paid to the occurrence of DSH.

The longitudinal relationship between dissociative symptoms and self-harm in adolescents: a population-based cohort study

Previous studies have reported that dissociative symptoms (DIS) are associated with self-harm (SH) in adolescents. However, most of these studies were cross-sectional, which limits the understanding of their theoretical relationship. We aimed to investigate the longitudinal relationship between DIS and SH in the general adolescent population. We used data from the Tokyo Teen Cohort study (N = 3007). DIS and SH were assessed at times 1 and 2 (T1 and T2) (12 years of age and 14 years of age, respectively). DIS were assessed using the parent-report Child Behavior Checklist (CBCL), and severe dissociative symptoms (SDIS) were defined as a score above the top 10th percentile. The experience of SH within 1 year was assessed by a self-report questionnaire. The longitudinal relationship between DIS and SH was examined using regression analyses. Using logistic regression analyses, we further investigated the risk for SH at T2 due to persistent SDIS and vice versa. DIS at T1 tended to predict SH at T2 (odds ratio (OR) 1.11, 95% CI 0.99 to 1.25, p = 0.08), while SH at T1 did not predict DIS at T2 (B = - 0.03, 95% CI - 0.26 to 0.20, p = 0.81). Compared with adolescents without SDIS, those with persistent SDIS had an increased risk of SH at T2 (OR 2.61, 95% CI 1.28 to 5.33, p = 0.01). DIS tended to predict future SH, but SH did not predict future DIS. DIS may be a target to prevent SH in adolescents. Intensive attention should be given to adolescents with SDIS due to their increased risk of SH.

Relationships among cyberbullying, parental attitudes, self-harm and suicidal behavior among adolescents: results from a school-based survey in Vietnam

Background

The rapid and widespread development of social networking sites has created a venue for an increase in cyberbullying among adolescents. Protective mechanisms and actions must be considered, such as how proximal family factors can prevent self-harm and suicidal behaviors among adolescents exposed to cyberbullying. The present study examined the associations among cyberbullying, parental attitudes, self-harm, and suicidal behaviors after adjusting for confounding factors.

Methods

Data were obtained from a school-based survey of randomly selected grade 6 students (11 years old) performed in Hue City, Vietnam, in 2018. A total of 648 students were interviewed face-to-face using a structured questionnaire based on the Global School-based Student Health Survey (GSHS). Univariate, multivariable logistic regression analyses were performed at 95% confidence level.

Results

After adjusting for gender, perceived academic pressure, unhealthy behaviors, use of Internet devices, school bullying, and family living situation, a significantly higher risk of self-harm was detected among those who had experienced cyberbullying (adjusted odd ratio [AOR] = 2.97; 95% CI, 1.32–6.71). Parental acceptance retained a significant association with self-harm and suicidal behavior (P < 0.05) while parental concentration did not exhibit a significant association in a multivariable logistic regression model. In addition, suicidal ideation and suicidal planning were associated with an interaction effect between cyberbullying and parental concentration (AOR = 0.37; 95% CI, 0.15–0.94 and AOR = 0.23; 95% CI, 0.06–0.87, respectively).

Conclusion

Cyberbullying has become an important phenomenon associated with self-harm among young adolescents in developing countries, and parental acceptance in proxy of parental attitude was positively related with severe mental health issues among adolescents. Thus, sufficient attention in efforts to promote adolescent health should be focused on family factors in the digital era of developing countries.

Are Bullying Perpetration and Victimization Associated with Adolescent Deliberate Self-Harm? A Meta-Analysis

This study sought to appraise internationally published literature investigating bullying in its association with deliberate self-harm (DSH). A systematic review and series of meta-analyses using random effects models were conducted. A total of 68 effect sizes, analyzing data from 156,284 adolescents aged 11-19 years were examined. Results showed significant associations between both traditional bullying perpetration (OR 1.81, 95% CI [1.33, 2.47], p < .0001) and victimization (OR 2.34, 95% CI [1.89, 2.89], p < .0001) and DSH. Cyber-bullying victimization (OR 3.55, 95% CI [2.71, 4.65], p < .0001) and the co-occurrence of traditional and cyber-bullying victimization (OR 3.39, 95% CI [1.56, 7.37], p = .002) were also associated with DSH. Moderator analyses showed variation in results based on methodological- and sample-level variables. Findings suggested that exposure to bullying, either as perpetrators or victims, poses risks for DSH.

Association between bullying behavior, perceived school safety, and self-cutting: a Japanese population-based school survey

BACKGROUND

No previous population-based studies have examined associations between self-cutting, perceived school safety, and bullying behavior among East Asian adolescents.

METHOD

We examined whether bullying, victimization, and perceived school safety were associated with self-cutting by getting 1865 students with a mean age of 13.9 years (standard deviation 0.2 years) to complete questions on these variables. Psychiatric problems were assessed with the Strengths and Difficulties Questionnaire.

RESULTS

About 5.6% of males and 11.9% females had practiced self-cutting and when we controlled these results for psychiatric symptoms, self-cutting was associated with being both a bully and a victim among males and females. In addition, self-cutting was independently associated with perceived school safety among females. Those who felt unsafe at school and were victimized were much more likely to engage in self-cutting.

CONCLUSIONS

Self-cutting among Japanese adolescents was linked with bullying behavior and feeling unsafe at school. Secure school environments and school-based antibullying programs could help to prevent adolescent self-injurious behavior.

Deliberate self-harm among adolescent psychiatric outpatients in Singapore: prevalence, nature and risk factors

BACKGROUND

Deliberate self-harm (DSH) is a prominent mental health concern among adolescents. Few studies have examined adolescent DSH in non-Western countries. This study examines the prevalence, types and associated risk factors of DSH in a clinical sample of adolescents in Singapore.

METHODS

Using a retrospective review of medical records, demographic and clinical data were obtained from 398 consecutive adolescent psychiatric outpatients (mean age = 17.5 ± 1.4 years, range = 13-19 years) who presented at Changi General Hospital from 2013 to 2015.

RESULTS

23.1% (n = 92) of adolescents engaged in at least one type of DSH. Cutting was the most common type of DSH reported. Females were three times more likely to engage in DSH than males. DSH was positively associated with female gender (odds ratio [OR] 5.03), depressive disorders (OR 2.45), alcohol use (OR 3.49) and forensic history (OR 3.66), but not with smoking behaviour, living arrangement, parental marital status, past abuse or family history of psychiatric illness.

CONCLUSION

Interventions targeting adolescent DSH should also alleviate depressive symptoms, alcohol use and delinquent behaviours.

Self-harm in young people: Prevalence, associated factors, and help-seeking in school-going adolescents

Adolescent self-harm is recognized as a serious public health problem; however, there is little reliable comparative data on its prevalence or characteristics, or on the extent of help-seeking for self-harm. The aims of the present study were to determine the prevalence and associated factors of adolescent self-harm in an urban region in Ireland, and to investigate help-seeking behaviours for self-harm. This was a cross-sectional study of 856 school-going adolescents, employing an anonymous self-report questionnaire. A lifetime history of self-harm was reported by 12.1% of adolescents. Factors independently associated with self-harm included exposure to self-harm of a friend/family member. Professional help-seeking was uncommon prior to (9%) and after (12%) self-harm. Furthermore, only 6.9% of adolescents presented to hospital as a result of their last self-harm act. These findings indicate that self-harm is common in adolescents; however, seeking professional help is not a common phenomenon, and those who present to hospital represent the 'tip of the iceberg' of adolescent self-harm. Identifying the prevalence of self-harm and associated factors, in addition to help-seeking behaviours, in young people is important to determine the preventative programmes to target 'at-risk' groups. Mental health nurses have an important and increasing role to play in such school-based initiatives.

Impact of Childhood Abuse on the Risk of Non-Suicidal Self-Injury in Mainland Chinese Adolescents

Background

Childhood abuse has been associated with significant increases in non-suicidal self-injury (NSSI) behaviors in adolescents; however, only general definitions of this risk indicator have been examined. This study identified relationships between specific forms of childhood abuse and NSSI in mainland Chinese adolescents.

Method

A total of 14,221 cases were retained from an epidemiological study involving adolescents from junior and senior middle schools. Information relating to the perpetrator, perceived harm, timing of exposure to different types of childhood abuse, and NSSI were obtained. Logistic regression was used to analyze relationships between each form of childhood abuse and NSSI.

Results

Approximately 51.0% of the students reported at least one abusive childhood experience. Nearly one in four students (24.9%) reported that they had engaged in NSSI in the past 12 months. Each type of childhood abuse, occurring at any time within the first 16 years of life, especially in situations of continuous exposure, was significantly associated with NSSI. A significant graded relationship was found between number of abusive childhood experiences and NSSI. Students maltreated by parents or others were at high risk of engaging in NSSI, the risk was greater in students maltreated by both; students who had been exposed to childhood abuse with no perceived harm still demonstrated an elevated risk for NSSI. The pattern of associations did not vary by gender.

Conclusions

These findings suggest that experiencing any of various forms of childhood abuse should be considered a risk factor for NSSI during adolescence. Further research should focus upon psychosocial, neural, and genetic factors that might moderate or mediate the onset of NSSI in adolescents who have experienced childhood abuse.

Help-seeking behavior among Japanese school students who self-harm: results from a self-report survey of 18,104 adolescents

BACKGROUND

The aim of this study was to determine the prevalence of and factors associated with poor help-seeking among adolescents who self-harm and to explore the resources used for help.

METHODS

A cross-sectional survey using an anonymous questionnaire was conducted in 47 junior and 30 senior high schools in Japan. Adolescent self-harm was defined as an adolescent who had harmed himself or herself in the previous year, as in previous studies reported in Western countries. Poor help-seeking was defined as not consulting anyone despite reporting current psychological or somatic complaints. Information about sociodemographic and psychological factors possibly associated with help-seeking, such as suicidal thoughts, depression, anxiety, and psychotic-like experiences, was also collected. Regression analyses were performed to examine associated factors.

RESULTS

A total of 18,104 students (8620 aged 12-15 years, 9484 aged 15-18 years), accounting for 93% of all students in the relevant student classes, participated in the study. Two hundred and seventy-six (3.3%) junior and 396 (4.3%) senior high school students reported having self-harmed. Of these, 40.6% of adolescents in junior and 37.6% in senior high schools were classified as poor help-seeking. Poor help-seeking with regard to self-harm was significantly more common in those who reported not having consulted anyone about psychological problems (odds ratio 9.2, 95% confidence interval 4.6-18.4 in juniors; odds ratio 9.9, confidence interval 5.5-17.9 in seniors) and in those with current suicidal ideation (odds ratio 2.0, confidence interval 1.0-3.7 in juniors; odds ratio 1.9, confidence interval 1.1-3.4 in seniors). Family members were approached significantly less often as a resource for help by students who self-harmed than by those who did not, and school nurses were more often consulted by those who did self-harm.

CONCLUSION

Around 40% of adolescents who self-harmed in the previous year did not seek help. School-based mental health should screen students at risk of self-harm, and educate school nurses about preventative care.