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. 2014 Oct 21:349:g5954.
doi: 10.1136/bmj.g5954.

Clinical and social outcomes of adolescent self harm: population based birth cohort study

Becky Mars  1 , Jon Heron  2 , Catherine Crane  3 , Keith Hawton  4 , Glyn Lewis  5 , John Macleod  2 , Kate Tilling  2 , David Gunnell  2
Affiliations

Clinical and social outcomes of adolescent self harm: population based birth cohort study

Becky Mars et al. BMJ. .

Abstract

Objectives: To investigate the mental health, substance use, educational, and occupational outcomes of adolescents who self harm in a general population sample, and to examine whether these outcomes differ according to self reported suicidal intent.

Design: Population based birth cohort study.

Setting: Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort of children born in 1991-92.

Participants: Data on lifetime history of self harm with and without suicidal intent were available for 4799 respondents who completed a detailed self harm questionnaire at age 16 years. Multiple imputation was used to account for missing data.

Main outcome measures: Mental health problems (depression and anxiety disorder), assessed using the clinical interview schedule-revised at age 18 years, self reported substance use (alcohol, cannabis, cigarette smoking, and illicit drugs) at age 18 years, educational attainment at age 16 and 19 years, occupational outcomes at age 19 years, and self harm at age 21 years.

Results: Participants who self harmed with and without suicidal intent at age 16 years were at increased risk of developing mental health problems, future self harm, and problem substance misuse, with stronger associations for suicidal self harm than for non-suicidal self harm. For example, in models adjusted for confounders the odds ratio for depression at age 18 years was 2.21 (95% confidence interval 1.55 to 3.15) in participants who had self harmed without suicidal intent at age 16 years and 3.94 (2.67 to 5.83) in those who had self harmed with suicidal intent. Suicidal self harm, but not self harm without suicidal intent, was also associated with poorer educational and employment outcomes.

Conclusions: Adolescents who self harm seem to be vulnerable to a range of adverse outcomes in early adulthood. 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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: the research was funded by the Medical Research Council); no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Flowchart of attrition and self harm outcomes in Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort
See this image and copyright information in PMC

Comment in

References

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