Self-harm in young people

Abstract

Self-harm is a common problem among young people with many presenting to clinical services via general hospitals, but many more do not come to the attention of clinical services at all. Self-harm is strongly associated with completed suicide so it is extremely important that patients are assessed and treated for this problem effectively. Despite the scale of the problem in young people, there is a very limited evidence base on what interventions may help them to recover from self-harm. The evidence is discussed here and some recommendations are made about how to engage clinically with young people who self-harm from assessment to therapeutic intervention. WHAT IS SELF-HARM AND WHAT IS THE SCALE OF THE PROBLEM IN YOUNG PEOPLE?Self-harm (self-poisoning or self-injury regardless of the motivation or intent associated with the act) is common in young people.1 Here, 'young people' refers to anyone from age 11 up to the age of 25 years, since psychologists and neuroscientists now suggest this as the most appropriate cut-off for late-adolescence. Hospital-based data demonstrate that self-harm is most common in 15-24-year-olds, with females presenting more frequently than males.2 However, hospital-based statistics are likely to be the 'tip of the iceberg', with many more episodes occurring in the community that do not come to medical attention; community-based studies estimate that around 10% of young people have self-harmed. Self-harm is often repeated; in young people presenting to hospital for self-harm around half will have a history of prior harm and 18% will repeat the behaviour within a year (and present to hospital) again. Self-harm is strongly linked to completed suicide with 40-60% of those who die by suicide having self-harmed in the past, making it the strongest predictor of eventual suicide. 4 In one consecutive case series study, 80% of young people who died by suicide had self-harmed in the preceding year. 5As Owens et al 4 put it, 'suicide risk among self-harm patients is hundreds of times higher than the general population'. Suicide is the second commonest cause of death in young people globally. 6 Importantly, and of significant clinical relevance, is the recent research demonstrating that self-cutting in young people who self-harm is a significant risk factor for completed suicide as is being male, having previously self-harmed and having received psychiatric treatment.7 Given these associations, it is vitally important that young people seen by a clinician (in any setting) for self-harm are taken seriously and are cared for competently and compassionately.

Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS)

“…Around 40–60% of those who die by suicide have previously self-harmed meaning that their risk of suicide is hundreds of times higher than the general population (Owens et al, 2002). Suicide is the second largest cause of mortality in young people globally and so it is important to understand factors which lead to these behaviours (Townsend, 2014). …”

“…Research indicates that it is associated with multiple psychological, social and biological factors (Hawton et al, 2012, Townsend, 2014). However, the factors associated with self-destructive behaviour (Non-Suicidal Self-Injury) are commonly examined in isolation (or with a few other factors), over long time periods (commonly 12 months), which limits their predictive utility (Fox et al, 2015).…”

Self-harm and life problems: findings from the Multicentre Study of Self-harm in England

“…Self-harm and suicidality are important clinical and societal issues globally [1][2][3]. Self-harm is the strongest factor associated with future non-fatal self-harm and suicide [4,5]: one in 25 patients presenting to hospital for self-harm die by suicide in the following 5 years [6].…”

Public perceptions of self-harm—A test of an attribution model of public discrimination.

“…However, these rates represent conservative "tip-of-theiceberg" estimates of the extent of the behavior (McMahon et al, 2014;Townsend, 2014). Research from community samples indicates that rates of engagement with emergency medical services are low (Hawton, Rodham, Evans, & Weatherall, 2002;Madge et al, 2008;Whitlock, Eckenrode, & Silverman, 2006).…”