The first population-based study to chart in detail the course of self-harm from adolescence to young adulthood is published Online First by The Lancet today. It shows that around 1 in 12 young people self-harm as adolescents, with the balance skewed towards girls. Among those who self-harm, 90% will see their problem resolve spontaneously, whilst the other 10% continue to self-harm into young adulthood. The study is by Dr Paul Moran, King's College London, Institute of Psychiatry, UK, and Professor George C Patton, Centre for Adolescent Health at the Murdoch Children's Research Institute, Melbourne, Australia, and colleagues in Australia.
Self-harm is a global health problem, and is one of the strongest predictors of completed suicide. It is especially common among 15 year old women, a group in whom rates of serious self-harm seem to be rising. In this study, the authors followed a sample of young people from Victoria, Australia, from 1992 to 2008. The young people had a mean age of 15 years during the entry period of 1992-93, and a mean age of 29 years during the final wave of follow-up in 2008. Including the entry years and the final wave, there were nine time points or waves in which data was collected.
A total of 1802 participants responded in the adolescent phase, with 149 (8%) reporting self-harm. More girls (10%) than boys (6%) reported self-harm, translating to a 60% increased risk of self-harm in girls compared with boys. A substantial reduction in the frequency of self-harm during late adolescence was recorded and by age 29 years, less than 1% of participants reported self-harm. In order to look at the continuity of self-harm, the authors looked in detail at the 1652 participants who had observations in both time periods, 136 of whom reported self-harming during adolescence. Of these 136, 122 (90%) reported no further self-harm in young adulthood and only 14 (10%) reported continuing self-harm. Of the 14 who did continue with their self-harming behavior, 13 were female and one male. Self cutting/burning was the commonest form of self-harm for adolescents, with other methods of self-harm including poisoning/overdose and self-battery. No single form of self-harm predominated among young adults.
During adolescence, incident self-harm was independently associated with symptoms of depression and anxiety (3.7 times increased risk compared with no depression/anxiety), antisocial behaviour (doubling of risk), high-risk alcohol use (doubling of risk), cannabis use, (near-doubling of risk) and cigarette smoking (2•4 times increased risk). Adolescents who experienced depression or anxiety were around six times more likely to self-harm in young adulthood than adolescents without depression/anxiety.
The authors conclude: "Our findings suggest that most adolescent self-harming behaviour resolves spontaneously. However, young people who self-harm often have mental health problems that might not resolve without treatment, as evident in the strong relation detected between adolescent anxiety and depression and an increased risk of self-harm in young adulthood. Our findings suggest that the treatment of such problems might have additional benefits in terms of reducing the suffering and disability associated with self-harm in later years. Moreover, because of the association between self-harm and suicide, we suggest that the treatment of common mental disorders during adolescence could constitute an important and hitherto unrecognised component of suicide prevention in young adults."
In a linked Comment, Professor Keith Hawton, Director of the Centre for Suicide Research, University of Oxford, UK and Professor Rory C O'Connor, Suicidal Behaviour Research Group, University of Stirling, UK, say an important issue is whether individuals who are likely to continue to self-harm as they age can be more clearly defined.
They conclude: "The results of Moran and colleagues' study will offer some reassurance to parents of adolescents who self-harm and to health and educational agencies. Clinicians can offer encouragement to both young people who are self-harming and their families. Their findings raise important questions relevant to the prevention of persistent self-harm and the onset of self-harm and suicidal behaviour in early adulthood."
For Dr Paul Moran, King's College London, Institute of Psychiatry, UK, please contact Seil Collins, Press Office. T) +44 (0)20 7848 5377 / +44 (0)7979 728674 E) seil.collins@kcl.ac.uk
Professor George C Patton, Centre for Adolescent Health at the Murdoch Children's Research Institute, Melbourne, Australia. T) +61 3 9345 6598 E) george.patton@rch.org.au
Professor Keith Hawton, Centre for Suicide Research, University of Oxford, UK. T) +44 (0) 1865 738673 E) keith.hawton@psych.ox.ac.uk / hawton.pa@psych.ox.ac.uk
Journal
The Lancet