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Lee CHJ, Hernández Ortiz JM, Glenn CR, Kleiman EM, Liu RT. An evaluation of emotion recognition, emotion reactivity, and emotion dysregulation as prospective predictors of 12-month trajectories of non-suicidal self-injury in an adolescent psychiatric inpatient sample. J Affect Disord 2024; 358:302-308. [PMID: 38423368 DOI: 10.1016/j.jad.2024.02.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Little is known about trajectories of NSSI. We aimed to identify NSSI trajectories in adolescent psychiatric inpatients and emotional processes that differentiate between trajectories. METHODS Participants were 180 adolescents (71.7 % female; mean age of 14.89 years, SD = 1.35) from a psychiatric inpatient facility. NSSI was assessed at their index hospitalization, as well as 6, and 12 months after discharge. Emotion recognition, emotion reactivity, and emotion dysregulation were assessed at baseline. Latent class mixture modeling was used to identify different NSSI trajectories and ANOVAs were used to evaluate predictors of the trajectories. RESULTS Analyses yielded three NSSI trajectories. These included a stable low-frequency class (90.53 % of sample), a stable moderate-frequency class, and a class characterized by high-frequency NSSI at baseline but that largely resolves by 6-month follow-up. After adjustments for multiple comparisons were made, only emotion regulation at baseline differentiated between the trajectories, with greater overall emotion dysregulation and greater emotional non-acceptance (a facet of emotion dysregulation) characterizing the initially high-frequency class and the stable moderate-frequency class more than the stable low-frequency class (ps < .05). Difficulties engaging in goal-directed behavior when distressed characterized the stable moderate-frequency NSSI class more than the stable low-frequency class (p < .05). Limitations The study sample consists predominantly of female and White adolescents and thus may not generalize to other demographic groups. CONCLUSIONS The current findings suggest that interventions involving emotion regulation with adolescents who engage in NSSI would particularly benefit from a focus on increasing acceptance of emotional experiences.
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Affiliation(s)
- Ching-Hua Julie Lee
- Harvard T.H. Chan School of Public Health, United States of America; Tsaotun Psychiatric Center, Ministry of Health and Welfare, Taiwan
| | | | - Catherine R Glenn
- Department of Psychology, Old Dominion University, United States of America; Virginia Consortium Program in Clinical Psychology, United States of America
| | - Evan M Kleiman
- Department of Psychology, Rutgers University, United States of America
| | - Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital, United States of America; Department of Psychiatry, Harvard Medical School, United States of America; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, United States of America.
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Wilson R, Jennings A, Redaniel MT, Samarakoon K, Dawson S, Lyttle MD, Savović J, Schofield B. Factors associated with repeat emergency department visits for mental health care in adolescents: A scoping review. Am J Emerg Med 2024; 81:23-34. [PMID: 38631148 DOI: 10.1016/j.ajem.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The aim of this review was to identify factors associated with multiple visits to emergency department (ED) services for mental health care in adolescents. METHODS Electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and ProQuest Dissertations & Thesis Global) were searched for evidence that presented an association between risk factors or correlates of multiple visits to the emergency departmental for mental health care by 10-24 year olds. High impact use was defined as at least one return ED visit for mental health care. Primary studies of any quantitative design were included, with no exclusions based on language or country and all possible risk factors were considered. Data were extracted and synthesised using quantitative methods; frequencies of positive, negative and null associations were summarised for categories of potential risk factors. RESULTS Sixty-five studies were included in the review. Most studies were from North America and reported a wide range of measures of high impact ED use, the most common being a binary indicator of multiple ED visits. Sex/gender and age were the most frequently reported risk factors. Measure of previous or concurrent access to mental health care was consistently positively associated with high impact use. Having private health insurance, compared with public or no insurance, was generally negatively associated with high impact use. Proxy measures of socioeconomic position (SEP) showed associations between lower SEP and more high impact use in a small number of studies. No other factors were consistently or uniformly associated with high impact use. CONCLUSIONS The review identified a substantial evidence base but due to the variability in study design and measurement of both risk factors and outcomes, no consistent risk factors emerged. More research is needed, particularly outside North America, using robust methods and high quality routinely collected data.
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Affiliation(s)
- Rebecca Wilson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | | | - Maria Theresa Redaniel
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Kithsiri Samarakoon
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Mark D Lyttle
- University of the West of England, Bristol, UK; Bristol Royal Hospital for Children, Bristol, UK.
| | - Jelena Savović
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
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Sumlin E, Hill R, Asim N, Busby D, Brown JL, Sharp C. Quantifying the Representation of Black Adolescents in Suicide Intervention Research. Res Child Adolesc Psychopathol 2024; 52:159-168. [PMID: 37702875 DOI: 10.1007/s10802-023-01113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/14/2023]
Abstract
This systematic review aimed to quantify the representation of Black youth in U.S. suicide intervention research. Specifically, we sought to evaluate Black youth representation in terms of (a) equity of inclusion (i.e., the inclusion of Black youth in research study samples at a rate consistent with the overall national rate of Black adolescents in the US) and (b) equity of intervention efficacy (i.e., evaluating the presence of racial disparities in intervention efficacy/effect sizes). In addition, we aimed to evaluate whether an association existed between funding status of research and representation of Black youth in studies, and to provide recommendations for future research in this area. To this end, the present study extracted and analyzed demographic information of studies included in recent meta-analyses conducted by Robinson and colleagues (2018), which were not previously analyzed, in addition to new literature published between September 2017 and January 2021. Results showed that the prevalence of Black youth included in studies was representative (14.67%; ntotal = 4451, nBlack = 664), with a median inclusion rate of 13%; however, absolute sample and group sizes were so small that it precluded comparison of differential treatment outcomes for Black youth. Thus, out of 22 studies identified, only one was able to investigate treatment outcomes for suicide in Black youth specifically. This study points to the conclusion that without adequately powered studies, disparities in treatment efficacy for Black youth cannot be compared or addressed, and the existing disparity in suicidal outcomes for Black youth will grow even larger.
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Affiliation(s)
- E Sumlin
- University of Houston, Houston, TX, USA
| | - R Hill
- Louisiana State University, Baton Rouge, LA, USA
| | - N Asim
- University of Houston, Houston, TX, USA
| | - D Busby
- University of Texas Medical Branch Galveston, Galveston, TX, USA
| | - J L Brown
- Purdue University, Lafayette, IN, USA
| | - C Sharp
- University of Houston, Houston, TX, USA.
- University of the Free State, Bloemfontein, South Africa.
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4
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Zhang Y, Zhang Y, Hu D, Liu Y, Ding X, Xu K, Wu M, Wang J. The experiences of emergency hospital care among adolescents and young adults with self-harm: A systematic review and thematic synthesis of qualitative evidence. Int Emerg Nurs 2023; 69:101297. [PMID: 37348238 DOI: 10.1016/j.ienj.2023.101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/17/2023] [Accepted: 04/17/2023] [Indexed: 06/24/2023]
Abstract
QUESTION The incidence of self-injurious behavior in adolescents and young adults is on the rise. Seeking care in the emergency department after self-injurious behavior is one way they signal for help. The purpose of this systematic evaluation was to synthesize the best available qualitative research evidence on young people's experiences of emergency department visits following self-harm behaviors and their need for emergency medical services. STUDY SELECTION AND ANALYSIS Eleven databases were retrieved with predefined search terms from database construction to February 4, 2022. Literature was screened according to inclusion and exclusion criteria and quality assessment. FINDINGS Eleven studies yielded fifty-five findings that were summarized into eight categories and aggregated into three composite statements: (1) positive emergency department experience; (2) negative emergency department experience; and (3) desire for help. CONCLUSIONS Young people with a history of self-injurious behavior have a mixed sense of experience in the emergency department. The sense of negative experience makes patients feel dissatisfied and disappointed with healthcare services, and positive experiences can help them seek further help. The emergency departments should improve the diagnosis and treatment model of self-injured adolescent patients to ensure that they receive effective and high-quality medical resources.
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Affiliation(s)
- Yan Zhang
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yinying Zhang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Deying Hu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Yilan Liu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoping Ding
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ke Xu
- West China Medical Center, Sichuan Medical University, Chengdu, Sichuan, China
| | - Minge Wu
- Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shanxi, China
| | - Jiaqing Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Zhao YL, Liu ZH, Li YY, Liu DL, Yi JN. The lived experiences of parents providing care to young people who self-harm: A meta-aggregative synthesis of qualitative studies. Int J Ment Health Nurs 2023; 32:402-419. [PMID: 36408959 DOI: 10.1111/inm.13095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/22/2022]
Abstract
Self-harm, which affects the whole family system, is an international public health concern. Empirical evidence supports the efficacy of interventions incorporating a family/parent training component for self-injurious thoughts and behaviours, and a quantitative synthesis of these empirical studies has been undertaken and updated. A qualitative synthesis of the experiences of parents whose child self-harms remains limited. This report aimed to systematically review qualitative research about the experiences, preferences, and expectations of parents whose children self-harmed. A comprehensive search was conducted across ten databases and four grey literature sources, along with the manual search of reference lists and relevant websites. Study screening, data extraction, and quality appraisal were all performed by two independent researchers. Twenty-four articles, two of which were mixed-methods studies, were included and analysed using a meta-aggregation approach. Five synthesized findings were identified: initial negative reactions to the discovery of their child's self-harm, the ongoing impact of self-harm on parents and the wider family, parents' various coping strategies, parents' negative experiences with mental health professionals expectations, and the lack of and need for psychoeducational resources. Our review finds that parents express keen interest in engaging with the treatment process, and our results support family-based therapy. However, with the overwhelming emotions most parents experience, clinicians should approach them with sensitivity, empathy and finesse. Psychoeducational self-help resources should also be made readily available to parents who are reluctant to seek help.
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Affiliation(s)
- Yan-Li Zhao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhi-Hua Liu
- Psychotherapy Department, Zhengzhou Eighth People's Hospital, Zhengzhou, China
| | - Ying-Ying Li
- Hematology Department, Henan Provincial People's Hospital, Zhengzhou, China
| | - Dong-Ling Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Jing-Na Yi
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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Liu W, Hu Z, Liu Z, Zhang F, Ding Y, Shui Y, Yang Z, Cheng W. Age- and sex-dependent increase in self-harm among adolescents with mental health problems in East China during COVID-19 related society-wide isolation. Front Public Health 2023; 11:1129123. [PMID: 36969633 PMCID: PMC10036048 DOI: 10.3389/fpubh.2023.1129123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectiveThe COVID-19 pandemic has raised concerns about child and adolescent mental health issues, such as self-harm. The impact of society-wide isolation on self-harming behaviors among adolescents in China is unclear. In addition, adolescents of different ages and sexes have varying abilities to cope with environmental changes. However, these differences are rarely considered in self-harm studies. We aimed to characterize the age- and sex-dependent effects of COVID-19-related society-wide isolation on self-harm among adolescents in East China.MethodsWe collected 63,877 medical records of children and adolescents aged 8–18 who had an initial visit to Shanghai Mental Health Center in China between 2017 and 2021 and charted annual self-harm rates for each age and sex. Using interrupted time series analysis, we modeled global and seasonal trends and the effect of COVID-19-related society-wide isolation on self-harm rates.ResultsFemales aged 10–17 and males aged 13–16 exhibited significantly increasing trends in self-harm rate (pfdr < 0.05) in the past 5 years. Eleven-year-old females in 2020 showed a self-harm rate (37.30%) that exceeded the peak among all ages in 2019 (age 13, 36.38%). The COVID-19-related society-wide isolation elevated self-harm rates in female patients aged 12 [RR 1.45 (95% CI 1.19–1.77); pfdr = 0.0031] and 13 years [RR 1.33 (95% CI 1.15–1.5); pfdr = 0.0031], while males were less affected. Further, females with emotional disorders dominated the increased self-harm rates.ConclusionSociety-wide isolation has had a significant impact on early adolescent females in East China, especially for those with emotional disturbances, and has brought forward the peak in adolescent self-harm rates. This study calls for attention to the risk of self-harm in early adolescents.
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Affiliation(s)
- Wenjing Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhishan Hu
- Laboratory of Psychological Heath and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Zhang
- Department of Psychological Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Ding
- Laboratory of Psychological Heath and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Shui
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi Yang
- Laboratory of Psychological Heath and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Zhi Yang
| | - Wenhong Cheng
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychological Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wenhong Cheng
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Goodman D, Pletch A, Paul P, Anderson E, Kverno K. Nonsuicidal Self-Injury: A Nurse-Led Quality Improvement Project to Address Self-Harm. J Psychosoc Nurs Ment Health Serv 2022; 60:7-10. [PMID: 35244492 DOI: 10.3928/02793695-20220208-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nonsuicidal self-injury (NSSI) behaviors, such as cutting, scratching, or more severe injuries, are frequently comorbid with neurodevelopmental, intellectual, trauma, personality, and major depressive disorders, complicating treatment and placing added care burdens on hospital nursing staff and advanced practice nurses. Although specific psychopharmacological treatment guidelines and approved medications for NSSI are non-existent, patients are treated with medications approved for co-morbid disorders and behavioral interventions targeting intrapersonal (poor emotional self-regulation) and interpersonal (communication of distress) functions. The current article describes a nurse-led quality improvement project, using the Plan-Do-Study-Act cycle, in a case example. Outcomes include improved staff competencies and policies, yet we remain challenged in implementing planned actions that add additional time burdens to already stretched care providers. [Journal of Psychosocial Nursing and Mental Health Services, 60(3), 7-10.].
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Wang P, Li C, Del Sol-Calderón P, Mallol L, Hernández-Álvarez E, Donoso-Navarro E, Gil-Ligero M, Rosado-Garcia S, Sánchez-Lòpez AJ, Martín-Moratinos M, Bella-Fernández M, Blasco-Fontecilla H. Biosignature of self-injury behaviors in adolescence: Role of β-endorphin in an acute inpatient unit. Front Psychiatry 2022; 13:933275. [PMID: 36046158 PMCID: PMC9421366 DOI: 10.3389/fpsyt.2022.933275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Self-injurious behavior (SIB) (either non-suicidal self-injury, NSSI; or suicide attempts, SA) is a common reason for adolescent psychiatric emergency hospitalizations. Altered basal serum β-endorphin (BE) levels have been reported in adults with a history of SIB, but information is lacking in adolescents. We analyzed the psychoclinical profile and serum BE level of 39 adolescents admitted to the acute unit at a hospital in Spain due to SIB. The Mean (SD) serum BE level was high (190.53 ± 74.83). Regarding time sequence, the onset age of NSSI and SA were related (p < 0.001). The older the onset age of NSSI, the shorter the transition between NSSI and the onset of SA behavior (p = 0.05), but this difference does not lead the variation of BE (p = 0.81). Patients diagnosed with depression had lower serum BE levels than adolescents with other diagnoses (p = 0.03). Although adolescents who seem to be addicted to SIB had higher levels of BE, this finding was not statistically significant. The relationship between serum BE levels and SIB in adolescents requires further investigation.
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Affiliation(s)
- Ping Wang
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Chao Li
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Pablo Del Sol-Calderón
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Leticia Mallol
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Elena Hernández-Álvarez
- Department of Clinical Biochemistry, Puerta de Hierro University Hospital, IDIPHISA, Madrid, Spain
| | | | - María Gil-Ligero
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Silvia Rosado-Garcia
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Antonio José Sánchez-Lòpez
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain.,Neuroimmunology Unit, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Marina Martín-Moratinos
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Marcos Bella-Fernández
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain.,Department of Psychology, Pontifical University of Comillas, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain.,Center of Biomedical Network Research on Mental Health (CIBERSAM), Madrid, Spain.,Korian, Paris, France
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Self-injury from early adolescence to early adulthood: age-related course, recurrence, and services use in males and females from the community. Eur Child Adolesc Psychiatry 2021; 30:937-951. [PMID: 32572615 PMCID: PMC8140957 DOI: 10.1007/s00787-020-01573-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/08/2020] [Indexed: 01/26/2023]
Abstract
Adolescent self-injury is a widespread public health problem, but long-term longitudinal studies from European countries are rare. Self-injury in males and sex differences are poorly understood. This study describes the prevalence, frequency, age-related course, and recurrence of, and mental health services use related to adolescent self-injury. Data came from a Swiss prospective-longitudinal cohort study (N = 1482). Adolescents (52% male) reported frequency of self-injury and mental health services use (including reasons for and types of services use, hospitalizations) at ages 13, 15, 17, and 20. Between ages 13-20, 27% of adolescents reported self-injury at least once. In males, prevalence decreased from 12 to 5%; in females self-injury peaked at age 15 (16%) and then decreased (11% at age 20). In males, recurrence of self-injury increased after age 15 (from odds ratio [OR] < 3 to OR > 10); in females, recurrence was high from age 13 onwards (OR > 5). Predictors of recurrence included childhood/early adolescent internalizing symptoms and early self-injury onset. Typically, less than half of adolescents with self-injury used mental health services. Males with self-injury used services mainly for externalizing problems, learning difficulties, and attention/concentration problems; females for depression or self-injury, family problems, and victimization. Types of services used changed with age, and adolescents with self-injury had increased rates of hospitalization. There are notable sex differences in the longitudinal course of self-injury and reasons for related mental health services use. Treating early internalizing symptoms could be a promising target for preventing recurrent self-injury. Males are at particular risk of not receiving adequate treatment for self-injury.
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