Predicting repeat self-harm in children

BackgroundRepeated self-harm represents the single strongest risk factor for suicide. To date no study with full national coverage has examined the pattern of hospital repeated presentations due to self-harm among young people.MethodsData on consecutive self-harm presentations were obtained from the National Self-Harm Registry Ireland. Socio-demographic and behavioural characteristics of individuals aged 10–29 years who presented with self-harm to emergency departments in Ireland (2007–2014) were analysed. Risk of long-term repetition was assessed using survival analysis and time differences between the order of presentations using generalised estimating equation analysis.ResultsThe total sample comprised 28,700 individuals involving 42,642 presentations. Intentional drug overdose was the most prevalent method (57.9%). Repetition of self-harm occurred in 19.2% of individuals during the first year following a first presentation, of whom the majority (62.7%) engaged in one repeated act. Overall, the risk of repeated self-harm was similar between males and females. However, in the 20–24-year-old age group males were at higher risk than females. Those who used self-cutting were at higher risk for repetition than those who used intentional drug overdose, particularly among females. Age was associated with repetition only among females, in particular adolescents (15–19 years old) were at higher risk than young emerging adults (20–24 years old). Repeated self-harm risk increased significantly with the number of previous self-harm episodes.Time differences between first self-harm presentations were detected. Time between second and third presentation increased compared to time between first and second presentation among low frequency repeaters (patients with 3 presentations only within 1 year following a first presentation). The same time period decreased among high frequency repeaters (patients with at least 4 to more than 30 presentations).ConclusionYoung people with the highest risk for repeated self-harm were 15–19-year-old females and 20–24-year-old males. Self-cutting was the method associated with the highest risk of self-harm repetition. Time between first self-harm presentations represents an indicator of subsequent repetition. To prevent risk of repeated self-harm in young people, all individuals presenting at emergency departments due to self-harm should be provided with a risk assessment including psychosocial characteristics, history of self-harm and time between first presentations.

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“…Moreover, a repeat self-harm episode is most likely to occur in the first months following a hospital presentation [14–16]. …”

Section: Introductionmentioning

confidence: 99%

Risk of repeated self-harm and associated factors in children, adolescents and young adults

et al. 2016

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“…In this study, individuals with a history of alcohol or drug misuse, emotional, sexual or physical abuse, neglect, or mental health problems were more likely to repeat self-harm than those who did not. Again, these are significant factors in other studies (Chitsabesan et al, 2003;Cyr, McDuff, Wright, Thériault, & Cinq-Mars, 2005).…”

Section: Discussionmentioning

confidence: 90%

“…These are recorded as significant factors in previous research focusing on repeat self-harm in young people (Hawton et al, 1999;Vajda & Steinbeck, 2000). Parental mental health, in particular, has been shown to be one of the strongest predictors of repeat self-harm in children (Chitsabesan et al, 2003). The suggestion might be that poor parental mental health may lead directly to problems in the young person and further episodes of self-harm to occur.…”

Section: Discussionmentioning

confidence: 95%

“…They demonstrated that those who were most likely to repeat self-harm within a year presented initially with substance abuse, nonaffective psychotic disorders, chronic medical conditions, or a history of sexual abuse. Evidence also suggests that there is an increased risk of repeat self-harm where there is depression, poor family functioning, or a history of mental health problems within the family (Chitsabesan, Harrington, Harrington, & Tomenson, 2003;Hawton et al, 1999).…”

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confidence: 95%

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Repeat Self-Harm among Children and Adolescents Referred to a Specialist Service

Pluck

Anderson

Armstrong

et al. 2013

Journ Child Adol Trauma

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or self-poisoning, irrespective of suicidal intent) is common among young people. We studied 586 consecutive referrals (474 individuals) to a specialist self-harm service over five years. We found that young people who repeated self-harm, compared to those that did not, tended to have complex family and personal histories including mental illness, substance misuse, and child abuse. Although many factors are likely to interact, regression analyses revealed factors that act independently as predictors of repeat self-harm. These included being female, not having both biological parents as the main caregivers, and caregivers that appeared uncooperative. Other significant independent factors were multiple social agencies being involved, if the young person used more than one method of self-harm or abused alcohol.

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“…However, relatively few studies have prospectively investigated the extent to which psychosocial and psychological factors are predictive of repeat self‐harm behavior among adolescents (Fliege, Lee, Grimm, & Klapp, ). Prospective research suggests that family dysfunction and poor parental mental health are risk factors for repeated self‐harm (Chitsabesan, Harrington, Harrington, & Tomenson, ; O'Connor et al., ); however, little attention has been paid to the role of attachment in repetition of self‐harm.…”

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confidence: 99%

The Role of Attachment Style in Predicting Repetition of Adolescent Self‐Harm: A Longitudinal Study

Glazebrook

Townsend

Sayal

2015

Suicide & Life Threat Behav

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This study investigated whether insecure attachment is associated with poorer outcomes at 6-month follow-up in adolescents who self-harm. At baseline the Child Attachment Interview was administered to 52 adolescents (13-17 years) referred to specialist child and adolescent mental health services and with a recent history of self-harm. Participants also completed self-report measures of selfharm, peer attachment, anxiety, and depression and were administered the means end problem-solving task. Self-harm behavior and problem-solving skills were assessed again at 6-month follow-up. At baseline, 14 (27%) were securely attached to their mothers. In the 49 (94%) adolescents followed-up, those with insecure maternal attachment and insecure peer attachment were more likely to have repeated self-harm. In addition, securely attached adolescents showed greater improvement in problem-solving skills. These findings indicate that secure maternal and peer attachments may help recovery from self-harm, possibly by supporting the acquisition of problem-solving skills, and highlights the importance of social connections and attachments for youth with a history of self-harm.

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Predicting repeat self-harm in children

Cited by 30 publications

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Risk of repeated self-harm and associated factors in children, adolescents and young adults

Risk of repeated self-harm and associated factors in children, adolescents and young adults

Repeat Self-Harm among Children and Adolescents Referred to a Specialist Service

The Role of Attachment Style in Predicting Repetition of Adolescent Self‐Harm: A Longitudinal Study

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