What happens to adolescents who self-harm?


Self-harm, in the form of self-cutting or deliberate ingestion, is common and is a strong predictor of completed suicide, although the vast majority of self-harming adolescents do not kill themselves. The accurate natural history is, however, unknown. A 15-year cohort study of 1943 schoolchildren age 14–15 years in Victoria, Australia were followed from adolescence (mean age 15.9 years) to 29 years of age.[1] This produced a stratified random sample of 1802 adolescents, of whom 149 (8%) reported self-harm through questionnaires and telephone interviews. More girls (10%) than boys (6%) reported self-harm. Self-cutting and burns were the commonest forms of self-harm in both girls and boys. During adolescence, self-harm was independently associated with symptoms of depression and anxiety, antisocial behaviour (delinquency), and misuse of alcohol, cannabis and cigarettes. There was a substantial reduction in self-harm by late adolescence (see Fig. 1). Young adults who continued to self-harm were more likely to have depression and anxiety. One weakness of the study was that no attempt was made to identify if any of the adolescents had committed suicide. The authors conclude that most adolescent self-harming behaviour resolves spontaneously, but early detection of common mental disorders in adolescence could help prevent suicide in young adults.[1]

Figure 1.

Proportion of participants reporting self-harm at follow-up (with 95% confidence interval).

Reviewers: David Isaacs, david.isaacs@health.nsw.gov.au; Kenneth Nunn, Children's Hospital at Westmead