The first population-based study published Online First in The Lancet to chart the course of self-harm from adolescence to young adulthood in detail shows that about 1 in 12 young people self-harm as adolescents, with the balance tilting towards girls. The study, conducted by Dr Paul Moran at King’s College London, Institute of Psychiatry in the UK and Professor George C Patton at the Centre for Adolescent Health at the Murdoch Children’s Research Institute in Melbourne, Australia and their Australian team reveals that in 90% of individuals self-harm will resolve spontaneously, whilst 10% continue into young adulthood.
Self-harm is one of the most significant predictors of committed suicide and a global health problem that is particularly common in women between the ages of 15 to 24 years, with rates appearing to be increase.
From 1992 to 2008, researchers assessed participants from Victoria in Australia, with the average age of 15 years during the entry period (1992 to 1993) and an average age of 29 years at the follow-up endpoint in 2008. Data was collected at 9 different time periods, including the start- and final endpoint.
In the adolescent phase 149 (8%) from a total of 1,802 participants reported self-harm, with 10% more girls self-harming compared with 6% of boys, meaning that compared with boys, girls have a 60% higher risk of conducting self-harm.
Researchers noted a significant reduction in the frequency of self-harm during late adolescence and by the age of 29 years, fewer than 1% of the participants reported to self-harm.
To assess the continuity of self-harm, the researchers conducted a detailed examination of 1,652 participants who had observations in both time periods. >From the total of 1,652 participants 136 reported self-harming during adolescence, with 122 (90%) reporting that they no longer self-harmed in young adulthood and just 14 (10%), 13 female and one male, reporting they continued to harm themselves.
The most common form of self-harm in adolescents was self-cutting or burning, whilst other methods included poisoning/overdose and self-battery, however, the researchers did not observe a predominant method amongst young adults.
Adolescent self-harm incident rates were independently linked to various triggers, such as symptoms of depression and anxiety, which accounted for a 3.7 times increased risk compared with adolescents with no depression or anxiety. Antisocial behavior and high-risk alcohol use both accounted for double the risk, whilst the use of cannabis almost doubled the risk, and cigarette-smokers had a 2•4 times increased risk of self-harm.
Depressed or anxious adolescents were about six times more likely to self-harm compared with those who did not suffer from depression or anxiety.
In a concluding statement the researchers say:
“Our findings suggest that most adolescent self-harming behavior 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 unrecognized component of suicide prevention in young adults.”
Professor Keith Hawton, Director of the Centre for Suicide Research at the University of Oxford, UK and Professor Rory C O’Connor from the Suicidal Behavior Research Group at the University of Stirling in the UK, say in a linked comment that a significant factor is whether those individuals who are likely to continue self-harming as they get older can be more clearly defined. Hawton and O’Connor 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 behavior in early adulthood.”
Written by Petra Rattue