Background:

Community-based research indicates that over 10% of adolescents aged 15-16 have self-harmed at some point their lives (1). As only a small proportion of young people who self-harm seek formal help, further research is required at a population level to explore potentially modifiable factors associated with this behaviour (1,2). There has been limited prospective research predicting adolescent self-harm in community samples, particularly in the UK (3-7). Functions of self-harm vary between people, and over time; including being a short-term release of passing distress, or an aspect of an enduring mental illness.

Self-harm is a strong predictor of later suicide (8-9) and further self-harm (10-11). The prevalence of self-harm varies by gender in adolescents, with substantially higher rates in girls (1-6). For example, a cross-sectional school-based survey in Oxfordshire reported that 11.2% of females and 3.2% of males aged 15-16 years had self-harmed in the previous year (1). This contrasts with the incidence of suicide being 3-4 times higher in males complared with females. The relationship between self-injurious behaviour and gender is not entirely clear. Self-harm may serve a different function for young males and females.

Analysis included in EK's recently submitted PhD examined data from longitudinal school-based study examining risk and protective factors for self-harm in a sample of 1023 East London adolescents (Research with East London Adolescents; Community Health Survey; www.relachs.org). Cross-sectional associations between self-harm and sub-clinical psychological distress, such as borderline scores on the SDQ, and longitudinal associations between self-harm, conduct problems (SDQ) and depressive symptoms (assessed with the Short Moods and Feelings Questionnaire), illustrated that self-harm may relate to different aspects of mental health, as well as different levels of symptom severity.

There was some evidence for a gender difference in the relationships between mental health and self-harm, with an association between previous depressive symptoms and self-harm in boys (OR 6.40, 95%CI 2.14-20.60, p=0.01), which was not evident in girls. The sample size limited the analysis and there was insufficient power to explore this further, thus research with a larger sample is required. Gaining more insight into whether adolescent self-harm has different implications in young males and females has potential to inform targeted interventions and responses to self-harm. Associations between self-harm and sub-threshold psychological distress may imply that interventions need to focus on general emotional health and well-being, not necessarily the recognition of and response to diagnosable mental health problems. The proposed analysis would examine gender differences in relationships between mental health in early adolescence (11-13 years) and self-harm at age 16.

Proposed analysis:

This proposal will constitute part of an application (by EK, mentored by DG and JK) for a 1 year ESRC postdoctoral fellowship, in which a limited amount of additional research related to PhD may be undertaken in addition to writing papers for publication from doctoral research.

The proposed analysis will aim to examine data already collected as part of ALSPAC, addressing two main research questions:

(i) Which aspects of mental health measured at ages 11 and 13 have prospective associations with self-harm at age 16?

(ii) Are there gender differences in the associations between mental health and self-harm?

Multivariable logistic regression would be used to examine associations with self-harm reported at age 16+, by gender. Potential predictors would include self-harm at age 11, assessed as a part of Borderline Personality Disorder, and subscales from psychological measures (DAWBA and SDQ) assessing depressive symptoms, emotional problems, conduct problems and oppositional behaviour at ages 11 and 13. Additionally, demographic data, and personality factors such as sensation seeking, locus of control and self-concept may be relevant to consider.

References:

1. Hawton, K. et al (2002) 'Deliberate self harm in adolescents: self report survey in schools in England', British Medical Journal, 325; 1207-11.

2. Fortune, S. et al (2008) 'Help seeking before and after episodes of self-harm: a descriptive study in school pupils in England', BMC Public Health, 8:369.

3. Evans, E. et al (2004) 'Factors associated with suicidal phenomena in adolescents: A systematic review of population-based studies', Clinical Psychology Review, 24:957-79.

4. Patton, G. et al (1997) 'Adolescent suicidal behaviours: a population-based study of risk', Psychological Medicine, 27: 715-24.

5. Young, R. et al (2006) 'Prevalence of deliberate self-harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study', British Medical Journal, 332: 1058-61.

6. Martin, G. et al (2005) 'Perceived academic performance, self-esteem and locus of control as indicators of need for assessment of adolescent suicide risk: implications for teachers', Journal of Adolescence, 28:75-87.

7. Haavisto, A. et al (2005) 'Factors associated with ideation and acts of deliberate self-harm among 18 year old boys', Social Psychiatry and Psychiatric Epidemiology, 40:912-21.

8. Hawton, K. et al (1999) 'Suicide in young people: a study of 174 cases, aged under 25 years, based on coroners' and medical records', British Journal of Psychiatry, 175:1-6.

9. Cooper, J. et al (2005) 'Suicide After Deliberate Self-Harm: A 4-Year Cohort Study', American Journal of Psychiatry, 162(2):297-303.

10. Hawton, K. et al (2000) 'Deliberate self-harm in adolescents in Oxford, 1985-1995', Journal of Adolescence, 23: 47-55.

11. Hawton, K. et al (2003) 'Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990-2000', Journal of Child Psychology and Psychiatry, 44(8): 1191-1198.