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Xiao Q, Song X, Huang L, Hou D, Huang X. Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: A meta-analysis. Front Psychiatry 2022; 13:912441. [PMID: 36032224 PMCID: PMC9399519 DOI: 10.3389/fpsyt.2022.912441] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adolescents with immature mind and unstable emotional control are high-risk groups of non-suicidal self-injury (NSSI) behavior. We meta-analyzed the global prevalence of NSSI and prevalence of NSSI characteristics in a non-clinical sample of adolescents between 2010 and 2021. Methods A systematic search for relevant articles published from January 1, 2010 to June 30, 2021 was performed within the scholarly database search engines of CBM, CNKI, VIP, Wanfang, PubMed, Web of Science, PsycINFO, and Embase. Eligibility criteria were as follows: provided cross-sectional data on the prevalence of NSSI; the subjects were non-clinical sample adolescents; and a clear definition of NSSI was reported. We used the following definiton of NSSI as our standard: the deliberate, self-inflicted destruction of body tissue, such as cutting, burning, and biting, without attempted suicide. The quality evaluation tool for cross-sectional studies recommended by the JBI was used. The global prevalence of NSSI was calculated based on the random-effects model by Comprehensive Meta-analysis version 3.0. Subgroup analyses were performed to compare the prevalence according to sex, living place, smoking or drinking history, and family structure. Results Sixty-two studies involving 264,638 adolescents were included. The aggregate prevalence of NSSI among a non-clinical sample of adolescents was similar between over a lifetime (22.0%, 95% CI 17.9-26.6) and during a 12-month period (23.2%, 95% CI 20.2-26.5). Repetitive NSSI was more common than episodic NSSI (20.3% vs. 8.3%) but the frequency of mild injury (12.6%) was similar to that of moderate injury (11.6%). Multiple-method NSSI occurred slightly more often compared than one-method NSSI (16.0% vs. 11.1%). The top three types of NSSI in adolescents were banging/hitting (12.0%, 95% CI 8.9-15.9), pinching (10.0%, 95% CI 6.7-14.8), and pulling hair (9.8%, 95% CI 8.3-11.5), and the least common type was swallowing drugs/toxic substances/chemicals (1.0%, 95% CI 0.5-2.2). Subgroup analyses showed that being female, smoking, drinking, having siblings, and belonging to a single-parent family may be linked to higher prevalence of NSSI. Conclusion This meta-analysis found a high prevalence of NSSI in non-clinical sample of adolescents, but there are some changes in severity, methods, and reasons. Based on the current evidence, adolescents in modern society are more inclined to implement NSSI behavior by a variety of ways, which usually are repetitive, and moderate and severe injuries are gradually increasing. It is also worth noting that adolescents with siblings or in single-parent families are relatively more likely to implement NSSI behavior due to maladjustment to the new family model. Future research needs to continue to elucidate the features and risk factors of NSSI so as to intervene in a targeted way. Limitation The limitation of this study is that the heterogeneity among the included studies is not low, and it is mainly related to Chinese and English studies. The results of this study should be used with caution. Systematic review registration [www.crd.york.ac.uk/prospero/], identifier [CRD42022283217].
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Affiliation(s)
- Qingqing Xiao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaozhen Song
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Lijuan Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Dandan Hou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xuehua Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
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Moreira ÉDS, Vale RRMD, Caixeta CC, Teixeira RAG. Automutilação em adolescentes: revisão integrativa da literatura. CIENCIA & SAUDE COLETIVA 2020; 25:3945-3954. [DOI: 10.1590/1413-812320202510.31362018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo Trata-se de uma revisão integrativa da literatura acerca dos conhecimentos produzidos pela comunidade científica sobre automutilação em adolescentes no período de janeiro de 2012 a junho de 2017. A busca foi realizada nas bases de dados SCIELO e Portal CAPES, em português, inglês e espanhol com amostra final de 71 artigos. Este estudo mostrou grande número de publicações a nível internacional, com destaque para artigos epidemiológicos e fragilidade na publicação de estudos de intervenção que investiguem a eficácia de terapias e programas de prevenção.
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Epstein S, Roberts E, Sedgwick R, Polling C, Finning K, Ford T, Dutta R, Downs J. School absenteeism as a risk factor for self-harm and suicidal ideation in children and adolescents: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2020; 29:1175-1194. [PMID: 30989389 PMCID: PMC7116080 DOI: 10.1007/s00787-019-01327-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/30/2019] [Indexed: 11/29/2022]
Abstract
Self-harm and suicidal ideation in children and adolescents are common and are risk factors for completed suicide. Social exclusion, which can take many forms, increases the risk of self-harm and suicidal ideation. One important marker of social exclusion in young people is school absenteeism. Whether school absenteeism is associated with these adverse outcomes, and if so to what extent, remains unclear. To determine the association between school absenteeism and both self-harm (including completed suicide) and suicidal ideation in children and adolescents, we conducted a systematic review of observational studies. We conducted meta-analysis and report a narrative synthesis where this was not possible. Meta-analysis of cross-sectional studies showed that school absenteeism was associated with an increased risk of self-harm [pooled adjusted odds ratio (aOR) 1.37, 95% confidence interval 1.20-1.57, P = 0.01] and of suicidal ideation (pooled aOR 1.20, 95% CI 1.02-1.42, P = 0.03). A small number of studies showed that school absenteeism had a longitudinal association with both adverse outcomes. Heterogeneity in the exposure and outcome variables, study design and reporting was prominent and limited the extent to which it was appropriate to pool results. School absenteeism was associated with both self-harm and suicidal ideation in young people, but this evidence was derived from a small number of cross-sectional studies. Further research into the mechanisms of this association could help to inform self-harm and suicide prevention strategies at clinical, school and population levels.
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Affiliation(s)
- Sophie Epstein
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.
| | - Emmert Roberts
- South London and Maudsley NHS Foundation Trust, London, UK
- National Addiction Centre, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Rosemary Sedgwick
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Catherine Polling
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Rina Dutta
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Johnny Downs
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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Gillies D, Christou MA, Dixon AC, Featherston OJ, Rapti I, Garcia-Anguita A, Villasis-Keever M, Reebye P, Christou E, Al Kabir N, Christou PA. Prevalence and Characteristics of Self-Harm in Adolescents: Meta-Analyses of Community-Based Studies 1990-2015. J Am Acad Child Adolesc Psychiatry 2018; 57:733-741. [PMID: 30274648 DOI: 10.1016/j.jaac.2018.06.018] [Citation(s) in RCA: 196] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/26/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide meta-analytic estimates of self-harm from all community-based studies of adolescents from 1990 through 2015, estimates of suicidal risk, and characteristics including age profile, frequency, types, seeking help, and reasons. METHOD Databases, bibliographies, and the internet were searched for cross-sectional and cohort studies of 12- to 18-year-olds. Meta-analytic estimates of the prevalence and characteristics of self-harm, risk of suicidal behaviors, and rates comparing different methods were calculated. RESULTS One hundred seventy-two datasets reporting self-harm in 597,548 participants from 41 countries were included. Overall lifetime prevalence was 16.9% (95% CI 15.1-18.9), with rates increasing to 2015. Girls were more likely to self-harm (risk ratio 1.72, 95% CI 1.57-1.88). The mean age of starting self-harm was 13 years, with 47% reporting only 1 or 2 episodes and cutting being the most common type (45%). The most frequent reason was relief from thoughts or feelings. Slightly more than half sought help, but for most this was from a friend. Suicidal ideation (risk ratio 4.97) and attempts (risk ratio 9.14) were significantly higher in adolescents who self-harmed, but this was higher with more frequent self-harm. Methodologic factors also were associated with higher rates of self-harm. CONCLUSION Interventions that can lower suicidal risk should be made available to adolescents who self-harm frequently as soon as possible. Preventative interventions that help adolescents deal with negative feelings should be instituted at the onset of puberty. Because friends are frequently asked for support, interventions also should be developed for peer groups.
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Affiliation(s)
- Donna Gillies
- Western Sydney Local Health District, Sydney, Australia.
| | | | | | | | - Iro Rapti
- University Hospital of Ioannina, Greece
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Breet E, Bantjes J, Lewis I. Substance use and self-harm: a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital. BMC Health Serv Res 2018; 18:157. [PMID: 29510710 PMCID: PMC5840832 DOI: 10.1186/s12913-018-2963-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 02/26/2018] [Indexed: 11/21/2022] Open
Abstract
Background Substance use is a potentially modifiable risk factor for suicidal behaviour. Little is known about the epidemiology of substance use among self-harm patients in South Africa. This study set out to collect epidemiological data about the prevalence, correlates, and patterns of medical service utilisation among self-harm patients who used substances at the time of self-injury. Methods Data from 238 consecutive self-harm patients treated at an urban hospital in South Africa were analysed using bivariate and multivariate statistics. Results Approximately 20% of patients reported substance use at the time of self-harm. When compared to other self-harm patients, higher rates of patients who had used substances: had depressed levels of consciousness on admission; utilised more medical resources and required longer hospital admissions; cited relationship difficulties and financial concerns as reasons for their self-harm; reported a previous episode of self-harm; and intended to die as a result of their injuries. Although the observed differences were not statistically significant (p > 0.05), the proportional differences were congruent with international literature. Conclusion Acute use of substances among self-harm patients warrants more focused research and clinical attention particularly in the context of reducing utilisation of scarce medical resources. Electronic supplementary material The online version of this article (10.1186/s12913-018-2963-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elsie Breet
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, Cape Town, 7602, South Africa.
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, Cape Town, 7602, South Africa
| | - Ian Lewis
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Hettiarachchi LV, Kinner SA, Tibble H, Borschmann R. Self-Harm among Young People Detained in the Youth Justice System in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E209. [PMID: 29373512 PMCID: PMC5858278 DOI: 10.3390/ijerph15020209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/03/2022]
Abstract
Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries) have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age 15.0 years, SD = 2.3) detained in the youth justice system in Sri Lanka. Structured face-to-face questionnaires assessed demographic characteristics, family and social background, substance use, self-harm history (including frequency, method, and intention), bullying victimization, physical and sexual abuse (victimization and perpetration), and exposure to self-harm/suicide by others. Seventy-seven participants (43%) reported a lifetime history of self-harm, 19 of whom (25%) who reported doing so with suicidal intent. Fifty participants (65% of those with a history of self-harm) reported engaging in self-harm impulsively, with no prior planning. A history of self-harm was associated with being female, prior sexual abuse victimization, prior exposure to self-harm by friends, and a lifetime history of self-harm ideation. High rates of substance use, bullying victimization, parental incarceration, and exposure to suicide were reported across the sample. Young people detained in the youth justice system in Sri Lanka are a vulnerable group with high rates of self-harm, substance use, and psychosocial risk factors. Strategies for identifying and preventing self-harm, and targeted psychological interventions designed specifically to address impulsivity, may contribute to more positive outcomes in this marginalised population.
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Affiliation(s)
- Lushan V Hettiarachchi
- Forensic Psychiatric Unit, National Institute of Mental Health, Colombo 10620, Sri Lanka.
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne 3052, Australia.
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
- Mater Research Institute-UQ, University of Queensland, Brisbane 4072, Australia.
- Griffith Criminology Institute, Griffith University, Brisbane 4111, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia.
| | - Holly Tibble
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne 3052, Australia.
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE58AF, UK.
- Department of Psychiatry, University of Melbourne, Melbourne 3010, Australia.
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Aggarwal S, Patton G, Reavley N, Sreenivasan SA, Berk M. Youth self-harm in low- and middle-income countries: Systematic review of the risk and protective factors. Int J Soc Psychiatry 2017; 63:359-375. [PMID: 28351292 DOI: 10.1177/0020764017700175] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Self-harm (defined here as an act of intentionally causing harm to own self, irrespective of the type, motive or suicidal intent) is one of the strongest antecedents of suicide in youth. While there have been a number of studies of youth self-harm in low- and middle-income countries (LMICs), there is currently no systematic review of studies of prevalence rates and risk and protective factors. AIM To systematically review the evidence relating to the prevalence rates and forms of self-harm in youth in LMICs and its relationship to family economic status, family functioning, relationship with the peer group, social relationships and academic performance. METHODS Electronic searches of three databases, MEDLINE, PsycINFO and Scopus, were performed. In total, 27 school-, community- and hospital-based studies evaluating self-harm in LMICs with youth focus (with participants between 12 and 25 years) were included. RESULTS The self-harm was divided into suicidal and non-suicidal depending on the nature of self-harm. The 12-month prevalence rates of non-suicidal self-harm varied from 15.5% to 31.3%, and the range of suicidal behaviour rates was from 3.2% to 4.7%. Banging and hitting were the most common in the community-based studies, followed by cutting, scratching and wound picking. Self-poisoning with pesticides was most commonly reported in hospital-based studies. Risk factors for self-harm were family conflict, peer groups with members indulging in self-harm, truancy and school absenteeism. Protective factors were having an understanding family, having friends and higher school competence. Risk factors for suicidal thoughts and attempts were lack of close friends and history of suicide by a friend. CONCLUSION The 12-month prevalence rates of youth self-harm in LMICs are comparable to high-income countries (HICs). The profile of risk and protective factors suggests that family-based interventions could be useful in treatment and prevention. Future studies should aim for greater consistency in assessment methods and the constructs under evaluation.
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Affiliation(s)
- Shilpa Aggarwal
- 1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - George Patton
- 2 Department of Pediatrics, Royal Children's Hospital, Parkville, VIC, Australia.,3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Nicola Reavley
- 3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | | | - Michael Berk
- 1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,4 Orygen: The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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