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. 2020 May 14;20(1):234.
doi: 10.1186/s12888-020-02587-z.

Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review

Emmanuel N-B Quarshie  1 , Mitch G Waterman  2 , Allan O House  3
Affiliations

Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review

Emmanuel N-B Quarshie et al. BMC Psychiatry. .

Abstract

Background: Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10-25 years) in sub-Saharan Africa.

Method: We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence.

Results: Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% - 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% - 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% - 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5-14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% - 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm.

Conclusion: Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.

Keywords: Adolescents; Attempted suicide; Self-harm; Sub-Saharan Africa; Suicide.

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Conflict of interest statement

EQ authored two of the cross-sectional studies included in this review. We declare no other competing interests.

Figures

Fig. 1
Fig. 1
Lifetime prevalence estimates of self-harm
Fig. 2
Fig. 2
12-month prevalence estimates of self-harm
Fig. 3
Fig. 3
6-month prevalence estimates of self-harm
Fig. 4
Fig. 4
1-month prevalence estimates of self-harm
Fig. 5
Fig. 5
Median and interquartile range (IQR) of prevalence estimates of adolescent self-harm in sub-Saharan Africa. Source: Map created by authors, based on the list of countries within the sub-regional division of sub-Saharan Africa by the United Nations Statistics Division’s classification (list accessed on January 20, 2019: https://unstats.un.org/unsd/methodology/m49/)
See this image and copyright information in PMC

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