Overview and aims:
Self-harm is a major public health concern, but there is disagreement over how it should be defined. Some researchers argue that a distinction can be made between self-harm that occurs with intent to die (suicide attempts) and self-harm that occurs with no intent to die (termed non suicidal self-harm NSSH). However, others argue that they are the same behaviour and are best conceptualised along a continuum of severity.
The aims of this study were to:
- identify whether there are differences in the risk factors for self-harm with and without suicidal intent in adolescence.
- identify whether there are differences in early adult outcomes for those who have self-harmed with and without suicidal intent in adolescence.
Sample:
Participants for this study were from the Avon Longitudinal study of Parents and Children (ALSPAC). This is a birth cohort study which enrolled over 14,000 pregnant mothers in Avon, UK in 1991/1992. ALSPAC participants have been followed up regularly since birth via questionnaires and research clinics. This study focused on assessments of self-harm with and without suicidal intent at age 16 years. Nearly 5,000 young people completed the study questionnaire at age 16 years.
What did we do?
The first part of the study looked to identify factors which distinguished between adolescents who had harmed themselves with and without suicidal intent at age 16 years. We looked at lots of different risk factors including IQ, socioeconomic position, early adverse experiences, mental health, personality, and behaviour, and exposure to self-harm in others. For the second part of the study, we investigated whether there were differences in early adult outcomes among those who had self-harmed with and without suicidal intent. We looked at mental health problems, substance use and educational and occupational outcomes.
What did we find?
We found that 12% of 16 years olds had engaged in non-suicidal self-harm alone and 7% had made at least one suicide attempt. In terms of risk factors, we identified some that were common (associated with both suicidal and non-suicidal self-harm) and some that were specific to one type of self-harm only. We also found some associations that were in the opposite direction; for example, higher IQ and maternal education were associated with an increased risk of non-suicidal self-harm but a decreased risk of suicidal self-harm.
In terms of outcomes, we found that adolescents who had self-harmed were at increased risk of developing mental health problems, future self-harm, and problem substance misuse compared to those who had not self-harmed. Risks were generally stronger in those who had self-harmed with suicidal intent, but outcomes were also poor among those who had self-harmed without suicidal intent. These findings emphasise the need for early identification and treatment of adolescents who self-harm, regardless of the level of suicidal intent.
Project team:
- University of Bristol, UK: Becky Mars; Jon Heron; John Macleod; Kate Tilling and David Gunnell (PI)
- University of Oxford: Keith Hawton; Catherine Crane
- University College London: Glyn Lewis
Funders/Supporters
This study was funded by the Medical Research Council
Publications and other outputs:
Mars B, Heron J, Crane C, Hawton K, Kidger J, Lewis G, Macleod J, Tilling K, Gunnell D. Differences in risk factors for self-harm with and without suicidal intent: findings from the ALSPAC cohort. Journal of Affective Disorders. 2014 Oct;168:407-14. doi: 10.1016/j.jad.2014.07.009
Mars B, Heron J, Crane C, Hawton K, Lewis G, Macleod J, Tilling K, Gunnell D. Clinical and social outcomes of adolescent self harm: population based birth cohort study. BMJ. 2014 Oct 21;349:g5954. doi: 10.1136/bmj.g5954.
Contact for further details: Becky.mars@bristol.ac.uk