Is Age of Self-Harm Onset Associated With Increased Frequency of Non-Suicidal Self-Injury and Suicide Attempts in Adolescent Outpatients?

Abstract

Background Self-harm in adolescents is an increasing public health concern and an important risk factor for suicide. We aimed to examine how age of self-harm onset in adolescents was associated with frequency of subsequent suicidal and non-suicidal self-harm (NSSI) episodes, and how age of onset and duration of self-harm may influence the frequency of self-harm. Methods Data from 103 adolescents with recurrent self-harm recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports, and analysed with negative binomial and hurdle models. Results A lower age of self-harm onset and a longer duration of self-harm were both significantly associated with increased frequency of subsequent episodes of NSSI and risk of a first suicide attempt. There was an increase in repeated suicide attempts when the age of onset of self-harm decreased and the duration increased, and dramatically more for long duration of NSSI before first suicide attempt. Conclusion Initiating self-harm behaviour at the youngest age had the highest risk of increased frequency of NSSI and suicide attempts. Longer duration of self-harm behaviour increased this risk. This underlines the importance of early identification of self-harm behaviour in adolescents, and the use of effective interventions.

Relationship of Social and Behavioral Characteristics to Suicidality in Community Adolescents With Self-Harm: Considering Contagion and Connection on Social Media

“…An "early onset" of SH (at or below ages 11-12) was neither a significant correlate of suicidality nor of SA history in the present study. When compared to Brager-Larsen et al (2021) in which the sample consisted of psychiatric outpatients, this result may be suggestive of the heightened importance of SH onset in suicidal risk among those with clinically significant symptoms; interacting with psychological distress (e.g., depression), SH started at an early age may possibly develop into more pervasive forms of SH which, in turn, aggravate the risk for suicidality. It may be that, for those without clinically meaningful symptoms, onset maintains a rather distal relationship to suicidality mainly via other aspects of SH (e.g., lifetime frequency, versatility, and severity) than being directly linked to the risk throughout the trajectory of SH.…”