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Cited by 294Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbusePersonality Disorders and Psychopathology

Risk factors for non-suicidal self-injury (NSSI) in adolescents: A meta-analysis

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Wang, Yu-Jing, Li, Xi, Ng, Chee H., Xu, Dong-Wu, Hu, Shaohua, Yuan, Ti-Fei·2022·eClinicalMedicine
DOI 10.1016/j.eclinm.2022.101350PMC PMC8938878
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Abstract

Background Non-suicidal self-injury (NSSI) in adolescents is a significant mental health problem around the world. Here, we performed a meta-analysis to systematically delineate the risk factors for NSSI. Method We searched Medline, Embase, Web of Science and Cochrane for relevant articles and abstracts published prior to 12 November 2021. Pooled odds ratios (ORs) and 95% confident intervals (CIs) were used to assess various risk factors, and publication bias was assessed by Egger's test, the trim and fill method and meta-regression. This study is registered with PROSPERO, CRD42021265885. Results A total of 25 articles were eventually included in the analysis. Eighty risk factors were identified and classified into 7 categories: mental disorders (ORs, 1·89; 95% CI, 1·60–2·24), bullying (ORs, 1·98; 95% CI, 1·32–2·95), low health literacy (ORs, 2·20; 95% CI, 1·63–2·96), problem behaviours (ORs, 2·36; 95% CI, 2·00–2·77), adverse childhood experiences (ORs, 2·49; 95% CI, 1·85–3.34), physical symptoms (ORs, 2·85; 95% CI, 1·36–5·97) and the female gender (ORs, 2·89; 95% CI, 2·43–3·43). The range of heterogeneity (I 2 ) was from 20·3% to 99·2%. Conclusion This meta-analysis found that mental disorders, low health literacy, adverse childhood experiences, bullying, problem behaviours, the female gender and physical symptoms appear to be risk factors for NSSI. Funding NSFC grant (81,822,017), National Key R&D Program of China (2020YFA0113600), Natural Science Foundation of Zhejiang Province, China (No. LY19H090015), Shenzhen-Hong Kong Institute of Brain Science - Shenzhen Fundamental Research Institutions (NYKFKT20190020), Shanghai Municipal Education Commission - Gaofeng Clinical Medicine Grant Support (20,181,715), Social Science Foundation of China (BIAl80167).

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  1. [1]Nock M.K. Self-injury Annu Rev Clin Psychol 6 2010 339 363 20192787
  2. [2]Bresin K. Gordon K.H. Endogenous opioids and nonsuicidal self-injury: a mechanism of affect regulation Neurosci Biobehav Rev 37 3 2013 374 383 23339875
  3. [3]Glenn C.R. Klonsky E.D. Nonsuicidal self-injury disorder: an empirical investigation in adolescent psychiatric patients J Clin Child Adolesc Psychol 42 4 2013 496 507 23682597 PMC4433043
  4. [5]Richmond-Rakerd L.S. Caspi A. Arseneault L. Adolescents who self-harm and commit violent crime: testing early-life predictors of dual harm in a longitudinal cohort study Am J Psychiatry 176 3 2019 186 195 30606048 PMC6397074
  5. [6]Wilkinson P.O. Qiu T. Neufeld S. Jones P.B. Goodyer I.M. Sporadic and recurrent non-suicidal self-injury before age 14 and incident onset of psychiatric disorders by 17 years: prospective cohort study Br J Psychiatry 212 4 2018 222 226 29514726 PMC7557859
  6. [7]Mars B. Heron J. Crane C. Clinical and social outcomes of adolescent self harm: population based birth cohort study BMJ 349 2014 g5954 25335825 PMC4205277
  7. [8]Byrne S. Morgan S. Fitzpatrick C. Deliberate self-harm in children and adolescents: a qualitative study exploring the needs of parents and carers Clin Child Psychol Psychiatry 13 4 2008 493 504 18927136
  8. [9]Tschan T. Ludtke J. Schmid M. In-Albon T. Sibling relationships of female adolescents with nonsuicidal self-injury disorder in comparison to a clinical and a nonclinical control group Child Adolesc Psychiatry Ment Health 13 2019 15 30923561 PMC6419840
  9. [11]Graae F. Tenke C. Bruder G. Abnormality of EEG alpha asymmetry in female adolescent suicide attempters Biol Psychiatry 40 8 1996 706 713 8894062
  10. [12]Hawton K. Saunders K.E.A. O'Connor R.C Self-harm and suicide in adolescents Lancet 2012 379 22726518
  11. [13]Fox K.R. Franklin J.C. Ribeiro J.D. Kleiman E.M. Bentley K.H. Nock M.K. Meta-analysis of risk factors for nonsuicidal self-injury Clin Psychol Rev 42 2015 156 167 26416295 PMC4772426
  12. [14]Li D. Yang R. Wan Y. Tao F. Fang J. Zhang S. Interaction of health literacy and problematic mobile phone use and their impact on non-suicidal self-injury among Chinese adolescents Int J Environ Res Public Health 16 13 2019 2366 PMC6651006 31277342
  13. [15]Rodav O. Levy S. Hamdan S. Clinical characteristics and functions of non-suicide self-injury in youth Eur Psychiatry 29 8 2014 503 508 24725924
  14. [16]Olfson M. Wall M. Wang M. Suicide after deliberate self-harm in adolescents and young adults Pediatrics 141 4 2018 e20173517 29555689
  15. [18]Whitlock J. Muehlenkamp J. Purington A. Nonsuicidal self-injury in a college population: general trends and sex differences J Am Coll Health 59 8 2011 691 698 21950249
  16. [19]Melendez J.C. Mayordomo T. Sancho P. Tomas J.M. Coping strategies: gender differences and development throughout life span Span J Psychol 15 3 2012 1089 1098 23156917
  17. [22]Mendelson T. Kubzansky L.D. Datta G.D. Buka S.L. Relation of female gender and low socioeconomic status to internalizing symptoms among adolescents: a case of double jeopardy? Soc Sci Med 66 6 2008 1284 1296 (1982) 18248868
  18. [23]Fox K.R. Millner A.J. Mukerji C.E. Nock M.K. Examining the role of sex in self-injurious thoughts and behaviors Clin Psychol Rev 66 2018 3 11 28993102
  19. [27]Selous C. Kelly-Irving M. Maughan B. Eyre O. Rice F. Collishaw S. Adverse childhood experiences and adult mood problems: evidence from a five-decade prospective birth cohort Psychol Med 50 14 2020 2444 2451 31583986
  20. [28]Gong J. Chan R.C.K. Early maladaptive schemas as mediators between childhood maltreatment and later psychological distress among Chinese college students Psychiatry Res 259 2018 493 500 29154171
  21. [30]Kuhlman K.R. Geiss E.G. Vargas I. Lopez-Duran N.L. Differential associations between childhood trauma subtypes and adolescent HPA-axis functioning Psychoneuroendocrinology 54 2015 103 114 25704913 PMC4384935
  22. [31]Russell A.E. Heron J. Gunnell D. Pathways between early-life adversity and adolescent self-harm: the mediating role of inflammation in the Avon Longitudinal Study of Parents and Children J Child Psychol Psychiatry 60 10 2019 1094 1103 31486089 PMC6771906
  23. [32]Andrews T. Martin G. Hasking P. Page A. Predictors of onset for non-suicidal self-injury within a school-based sample of adolescents Prev Sci 15 6 2014 850 859 23812886
  24. [33]Baiden P. Stewart S.L. Fallon B. The mediating effect of depressive symptoms on the relationship between bullying victimization and non-suicidal self-injury among adolescents: findings from community and inpatient mental health settings in Ontario, Canada Psychiatry Res 255 2017 238 247 28587863
  25. [34]Bandel S.L. Brausch A.M. Poor sleep associates with recent nonsuicidal self-injury engagement in adolescents Behav Sleep Med 18 1 2020 81 90 30472890 PMC6535134
  26. [35]Cox L.J. Stanley B.H. Melhem N.M. A longitudinal study of nonsuicidal self-injury in offspring at high risk for mood disorder J Clin Psychiatry 73 6 2012 821 828 22687609 PMC3563355
  27. [36]Giletta M. Scholte R.H. Engels R.C. Ciairano S. Prinstein M.J. Adolescent non-suicidal self-injury: a cross-national study of community samples from Italy, the Netherlands and the United States Psychiatry Res 197 1–2 2012 66 72 22436348 PMC3666103
  28. [37]Gromatsky M.A. He S. Perlman G. Klein D.N. Kotov R. Waszczuk M.A. Prospective prediction of first onset of nonsuicidal self-injury in adolescent girls J Am Acad Child Adolesc Psychiatry 59 9 2020 1049 1057 31445872
  29. [38]Jeong J.Y. Kim D.H. Gender differences in the prevalence of and factors related to non-suicidal self-injury among middle and high school students in South Korea Int J Environ Res Public Health 18 11 2021 5965 34199442 PMC8199576
  30. [39]Khoubaeva D. Dimick M. Timmins V.H. Clinical correlates of suicidality and self-injurious behaviour among Canadian adolescents with bipolar disorder Eur Child Adolesc Psychiatry 2021 34028609
  31. [40]Lanzillo E.C. Zhang I. Jobes D.A. Brausch A.M. The influence of cyberbullying on nonsuicidal self-injury and suicidal thoughts and behavior in a psychiatric adolescent sample Arch Suicide Res 2021 1 8 34520697
  32. [41]Larsson B. Sund A.M. Prevalence, course, incidence, and 1-year prediction of deliberate self-harm and suicide attempts in early Norwegian school adolescents Suicide Life Threat Behav 38 2 2008 152 165 18444774
  33. [42]Lauw M.S.M. Abraham A.M. Loh C.B.L. Deliberate self-harm among adolescent psychiatric outpatients in Singapore: prevalence, nature and risk factors Child Adolesc Psychiatry Ment Health 12 2018 35 29988957 PMC6035430
  34. [43]Liu X. Chen H. Bo Q.G. Fan F. Jia C.X. Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents Eur Child Adolesc Psychiatry 26 3 2017 271 279 27383464
  35. [44]Monto M.A. McRee N. Deryck F.S. Nonsuicidal self-injury among a representative sample of US adolescents, 2015 Am J Public Health 108 8 2018 1042 1048 29927642 PMC6050840
  36. [45]Nemati H. Sahebihagh M.H. Mahmoodi M. Non-suicidal self-injury and its relationship with family psychological function and perceived social support among Iranian high school students J Res Health Sci 20 1 2020 e00469 32814690 PMC7585761
  37. [46]Stewart S.L. Baiden P. Theall-Honey L. Examining non-suicidal self-injury among adolescents with mental health needs, in Ontario, Canada Arch Suicide Res 18 4 2014 392 409 24712902
  38. [47]Taliaferro L.A. McMorris B.J. Rider G.N. Eisenberg M.E. Risk and protective factors for self-harm in a population-based sample of transgender youth Arch Suicide Res 23 2 2019 203 221 29461934 PMC6102088
  39. [48]Tang J. Ma Y. Lewis S.P. Association of internet addiction with nonsuicidal self-injury among adolescents in China JAMA Network Open 3 6 2020 PMC7273191 32496567
  40. [49]Tsai M.H. Chen Y.H. Chen C.D. Hsiao C.Y. Chien C.H. Deliberate self-harm by Taiwanese adolescents Acta Paediatr 100 11 2011 e223 e226 21575057
  41. [50]Unlu G. Cakaloz B. Effects of perpetrator identity on suicidality and nonsuicidal self-injury in sexually victimized female adolescents Neuropsychiatr Dis Treat 12 2016 1489 1497 27382291 PMC4922799
  42. [51]Victor S.E. Hipwell A.E. Stepp S.D. Scott L.N. Parent and peer relationships as longitudinal predictors of adolescent non-suicidal self-injury onset Child Adolesc Psychiatry Ment Health 13 2019 1 30622642 PMC6317237
  43. [52]Wan Y.H. Chen R.L. Ma S.S. Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents Br J Psychiatry 214 3 2019 146 152 30477603 PMC6429251
  44. [53]Wang L. Liu X. Liu Z.Z. Jia C.X. Digital media use and subsequent self-harm during a 1-year follow-up of Chinese adolescents J Affect Disord 277 2020 279 286 32841829
  45. [54]Xie B. Fan B.F. Wang W.X. Li W.Y. Lu C.Y. Guo L. Sex differences in the associations of nonmedical use of prescription drugs with self-injurious thoughts and behaviors among adolescents: a large-scale study in China J Affect Disord 285 2021 29 36 33621712
  46. [55]Zhang S.C. Tao F.B. Wu X.Y. Tao S.M. Fang J. Low health literacy and psychological symptoms potentially increase the risks of non-suicidal self-injury in Chinese middle school students BMC Psychiatry 16 1 2016 327 27650034 PMC5028961

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Authors
Wang, Y.-J., Li, X., Ng, C. H., Xu, D.-W., Hu, S., & Yuan, T.-F.
Affiliations
  • Wenzhou Medical University (CN)
  • The University of Melbourne (AU)
  • First Affiliated Hospital Zhejiang University (CN)
  • Tongji University (CN)
Corresponding author
  • Hu, Shaohua
  • Yuan, Ti-Fei
ORCID
Venue
eClinicalMedicine
Publisher
Elsevier BV
Published
2022-04
Volume
46
Pages
101350
ISSN
2589-5370 (ISSN-L)
DOI
10.1016/j.eclinm.2022.101350
PMC
PMC8938878
OpenAlex
W4221048957
Cited by
294
References
10
Citations by year
2026: 88 · 2025: 91 · 2024: 66 · 2023: 34 · 2022: 15
FWCI
8.13
Type
journal article
Language
en
Open access
Licence
Locations
  • EClinicalMedicine (publishedVersion, cc-by-nc-nd)
  • SSRN Electronic Journal (acceptedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc-nd)
Funders
  • Natural Science Foundation of Zhejiang Province (LY19H090015)
  • National Key Research and Development Program of China (2020YFA0113600)
  • Shanghai Municipal Education Commission
  • National Natural Science Foundation of China (81,822,017)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
non-suicidal self-injury, adolescents, risk factors, mental illness, bullying, low health literacy, behavioral problems, adverse childhood experiences, somatic symptoms, female gender, gender differences, adolescent mental health

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