Research on Risk Factors of Self-Harm in Children and Adolescents

Certain childhood risk factors, such as early self-harm, suicidal thoughts, sexual abuse, behavioral issues, and mood or psychotic disorders, can increase the likelihood of self-harm or suicidal behavior in young adulthood, according to a case-control study in Behavioral Sciences.

The review found that frequent visits to the doctor may help protect against serious mental health issues. Consistent check-ups and support may help spot problems early and prevent them from getting worse.

It also stresses the need to address cases of NSSI (non-suicidal self-injury), which is a known risk factor for future suicide attempts. Suicide is a major global health issue, as it ranks as the fourth leading cause of death among individuals aged 15 to 29.

Understanding the Research

This study looked at a large group of people from the United Kingdom who had mental health issues and were treated by their primary care doctors.

The data came from a database called the Clinical Practice Research Datalink (CPRD), which includes details like sociodemographic information, GP (general practitioner) visits, and medical records from as far back as 1987.

The study included 219,581 people born between 1979 and 2003. To be part of the study, participants needed to have the following at ages 18-24: a mental health disorder, SITB (self-injurious thoughts or behaviors), and a referral to mental health services. Moreover, they have had at least one GP visit.

Here are the simplified findings:

• NSSI: 2.83% of participants had GP visits for NSSI
• Suicidal Ideation: 3.42% of participants had GP visits for suicidal thoughts
• Suicide Attempts: 0.89% of the sample had GP visits for suicide attempts

Here are the identified risk factors:

• For NSSI: Previous NSSI, suicidal thoughts, sexual abuse, behavioral problems, mood symptoms, and psychotic symptoms.
• For Suicidal Ideation: Previous NSSI, suicidal thoughts, sexual abuse, behavioral problems, mood symptoms, and psychotic symptoms.
• For Suicide Attempts: Previous NSSI, sexual abuse, behavioral problems, and older age at the first GP visit. (Female gender and more frequent GP visits during childhood were linked to a lower risk of suicide attempts.)

Practical Strategies for Parents and Caregivers

Based on the study’s findings, below are some practical tips for parents and caregivers to help address early risk factors for self-harm and suicidal ideation in children and teens:

• Look for early signs. Seeing signs of self-harm in teens can sometimes be difficult since young people may try to hide what they’re doing. They might conceal self-injury by cutting themselves in areas that are hard to see, such as their stomachs or inner thighs. Other signs that could indicate self-harm include changes in their mood or behavioral shifts that show they’re experiencing emotional distress.
• Regular well-child visits. Since more frequent general practitioner visits were linked to a lower risk of suicide attempts, then regular well-child visits serve as a useful preventive measure. The American Academy Of Pediatrics (AAP) recommends one well-child visit per year for children and adolescents 3 years and older.
• Create a “safety plan.” A safety plan is a tool used by therapists to help children and teens who have thoughts of suicide or self-harm. It starts by recognizing triggers and instructs them to identify activities or techniques that will help calm them down. We offer a Safety Plan Worksheet which therapists, parents, and caregivers can download and print out for the child they’re supporting.
• Teach healthy coping. Help them explore ways to manage their stress and emotions. This includes having regular conversations with them so they can feel comfortable expressing their concerns, engaging in regular exercise, and pursuing hobbies or pleasant activities that serve as healthy distractions.
• Encourage the use of coping statements. Positive statements like “I am worthy of healing” and “It is not a weakness to ask for help” will remind them of how important it is to be kind and compassionate towards themselves. Our Coping Statements Handouts Bundle includes 12 handouts filled with coping statements for depression, trauma, and more.

As an additional tip, the authors of the study recommend training primary care providers in identifying suicide risk and working closely with child and adolescent mental health services. “This collaboration is crucial for suicide prevention,” they wrote.

For more resources to support young people, check out our Depression Worksheets and Coping Skills Worksheets.