Self-Harm Among School-Going Adolescent Survivors of Sexual Violence Victimisation: A Cross-Sectional Study

Abstract

Background: A growing body of evidence from high-income contexts suggests a strong association between sexual violence victimisation and self-harm and eventual suicide. However, both sexual violence and self-harm among adolescents are still less researched in sub-Saharan African countries, including Ghana.Objectives: To estimate the 12-month prevalence of self-harm, and to describe the associated factors and reported reasons for self-harm among school-going adolescent survivors of sexual violence victimisation during the previous 12 months in urban Ghana.Methods: Analytic data came from a regional-based representative cross-sectional survey including in-school youth (N = 1,723) conducted in 2017 within the Greater Accra Region of Ghana. Of these, 297 (17.2%) self-reported sexual violence victimisation in the previous 12 months; this proportion of the participants (n = 297) was the focus of the current study. Items measuring sexual violence victimisation, self-harm, and correlates were adopted from the 2012 Ghana WHO–Global School-based Student Health Survey and the Child and Adolescent Self-harm in Europe Study. Data analysis involved multivariable logistic regression models.Results: The estimate of self-harm ideation during the previous 12 months was 45.8% (95% CI: 40–52), whereas the estimate of self-harm behaviour was 38.7% (95% CI: 33–44). About two in five of the participants who reported self-harm wanted to die by their last episode of the behaviour. While bullying victimisation was associated with increased odds of self-harm ideation (aOR = 1.97, 95% CI 1.17, 3.31, p = 0.010) and behaviour (aOR = 2.76, 95% CI 1.59, 4.80, p < 0.001), weekly alcohol use (aOR = 2.56, 95% CI 1.32, 4.93, p = 0.005), conflict with parents (aOR = 2.30, 95% CI 1.28, 4.12, p = 0.005), and physical abuse victimisation (aOR = 1.80, 95% CI 1.03, 3.15, p = 0.037) showed strong associations with increased odds of self-harm behaviour in the past 12 months.Conclusions: The evidence underscores the need for both universal and targeted multi-level intervention and prevention programmes to mitigate the offence of sexual violence and reduce the chances of self-harm among adolescent survivors of sexual violence in urban Ghana.

Thoughts of self-harm in adolescents: Relationship with violence in the Dominican Republic

“…Our results are supported by evidence that sexual violence victimization is associated with high rates of self-harm thoughts and behaviors [ 39 , 40 ]. This shows the profound impact that experiences with sexual violence can have on the mental health of adolescent girls in the DR. Our study also found that the most common perpetrators of sexual violence were current or former romantic partners, indicating that adolescent dating violence (ADV) may have a significant impact on the mental health of adolescent females, which aligns with studies signaling adolescent women as the most vulnerable group for IPV [ 26 ].…”

Self-harm in sexually abused adolescents: The role of posttraumatic symptoms, emotional impulsivity, and negative cognition.

“…This proportion is significantly higher than the 51% of 14-to 18-year-olds recruited through schools who reported engaging in intentional NSSI in the past year (Ammerman & Brown, 2018) or the 30% of a South Korean community sample who reported engaging in self-injurious behavior (Son et al, 2021). It was also significantly higher than the 38.7% reported self-harm among 297 adolescents who had experienced sexual violence victimization out of 1,723 surveyed in the WHO-Global School-based Student Health Survey in Ghana (Quarshie, 2021). Because the participants in this study were adolescents referred for treatment after experiencing sexual abuse, it may be appropriate to compare them to a clinical population.…”

“…Negative experiences such as trauma and childhood maltreatment are considered common socioenvironmental predictors of all types of self-harm (Nock, 2010; Serafini et al, 2017). Sexual abuse, in particular, is one of the strongest risk factors for both suicidal and nonsuicidal self-harm in adolescence (El Nagar et al, 2022; Quarshie, 2021; Soylu & Alpaslan, 2013). One study reported that more than 60% of people who experienced sexual abuse in childhood have had suicidal ideation, and 24.5% have attempted suicide (Soylu & Alpaslan, 2013).…”