Adolescent self-harm and suicidal thoughts in the ALSPAC cohort: a self-report survey in England

Abstract

BackgroundSubstantial numbers of adolescents self-harm, but the majority of cases do not reach the attention of medical services, making community studies essential. The prevalence of suicidal thoughts and plans at this age, and the inter-relationships between suicidal thoughts, plans and self-harm remain largely unexplored.MethodCross-sectional analysis of self-reported questionnaire data collected from members of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, England. Respondents (n = 4810) were aged 16–17 years old and have been followed up since birth.ResultsAltogether 905 (18.8%) respondents had ever self-harmed. The prevalence of lifetime self-harm was higher in females (25.6%) than males (9.1%). The most commonly used method was self-cutting: this was used alone or in combination in 73.5% of episodes, compared to 10.0% who took overdoses alone or in combination with other methods. Of those who reported self-harm, 25.3% wanted to die during the most recent episode. Concurrent depression was associated with a greatly increased risk of self-harm (OR 5.43). Only 12.4% of participants sought medical help following their most recent episode of self-harm, although this figure was higher (30.1%) where self-harm was carried out with desire to die. Of the whole sample, 15.8% had ever thought of killing themselves, and 4.3% had ever made plans to kill themselves. Compared to those who had never self-harmed, those who had self-harmed but not wanted to die during the most recent episode were at increased risk of ever having had suicidal thoughts (37.6% compared to 7.8% χ2 =102.3, p < 0.001) and ever making suicidal plans (8.7% compared to 0.7%, χ2 =166.9, p < 0.001). As the frequency of self-harm increased, so did the risk of suicidal thoughts and plans.ConclusionsSelf-harm and suicidal thoughts are common among 16/17 year olds. Although the majority of self-harm behaviour is not accompanied by a desire to die, all self-harm regardless of motivation is associated with increased risk of suicidal thoughts and plans, particularly when it is carried out repeatedly.

Using Data Linkage to Investigate Inconsistent Reporting of Self-Harm and Questionnaire Non-Response

“…Community studies of self-harm are vital as the majority of self-harm episodes do not present to clinical services (Hawton, Rodham, Evans, & Weatherall, 2002;Kidger, Heron, Lewis, Evans, & Gunnell, 2012;Ystgaard et al, 2009). However, such studies are subject to a number of limitations such as misreporting and nonresponse (Grimes & Schulz, 2002), which can lead to bias in estimates of prevalence and measures of association.…”

“…Non-response and loss to follow-up occur more frequently among individuals with particular characteristics (Kidger et al, 2012;Wolke et al, 2009). For example, in the Early Developmental Stages of Psychopathology Study (Christl, Wittchen, Pfister, Lieb, & Bronisch, 2006), participation rates at follow-up were lower among those who had attempted suicide compared to those without suicidal thoughts or attempts.…”

“…Most have focused on suicide attempts, which comprise only a portion of episodes (Hawton et al, 2002;Kidger et al, 2012;Muehlenkamp & Gutierrez, 2004). Studies have reported inconsistency across different self-report methods, e.g., interviews vs. questionnaires (Bjärehed et al, 2013;O'Sullivan & Fitzgerald, 1998;Ougrin & Boege, 2013;Ross & Heath, 2002;Velting et al, 1998), and also when using the same self-report method across repeated assessments (Christl et al, 2006;Hart, Musci, Ialongo, Ballard, & Wilcox, 2013).…”

“…Self-harm was assessed via self-report questionnaire at age 16 years (mean age of respondents 16 years 8 months, standard deviation [SD] approximately 3 months). The postal questionnaire was sent to 9,383 participants of whom 4,855 (51.7%) returned it and 4,810 completed the self-harm items (Kidger et al, 2012). Ethical approval for the study was obtained from the ALSPAC Law and Ethics committee and local research ethics committees (NHS Haydock REC: 10= H1010=70).…”

Psychological Support of Adolescent after Autocastration: A Case Report

“…Published reports suggest a 13-18% lifetime prevalence of self-injurious behavior in young people [10,[23][24][25], but genital self-mutilation with poly-substance use in adolescence, to the best of our knowledge, has never been described. Moreover, we have not found any reports of psychological support of such patients before, during and after medical and psychiatric stabilization.…”