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Deliberate self harm in adolescents: self report survey in schools in England
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Objective: To determine the prevalence of deliberate self harm in adolescents and the factors associated with it. Design: Cross sectional survey using anonymous self report questionnaire. Setting: 41 schools in England. Participants: 6020 pupils aged 15 and 16 years. Main outcome measure: Deliberate self harm. Results: 398 (6.9%) participants reported an act of deliberate self harm in the previous year that met study criteria. Only 12.6% of episodes had resulted in presentation to hospital. Deliberate self harm was more common in females than it was in males (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1 to 4.9). In females the factors included in a multivariate logistic regression for deliberate self harm were recent self harm by friends, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem. In males the factors were suicidal behaviour in friends and family members, drug use, and low self esteem. Conclusions: Deliberate self harm is common in adolescents, especially females. School based mental health initiatives are needed. These could include approaches aimed at educating school pupils about mental health problems and screening for those at risk. What is already known on this topic: Deliberate self harm is a common reason for presentation of adolescents to hospital Community studies from outside the United Kingdom have shown much greater prevalence of self harm in adolescents than hospital based studies What this study adds: Deliberate self harm defined according to strict criteria is common in adolescents, especially females Associated factors include recent awareness of self harm in peers, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem
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“the data corroborates the association between depression, anxiety and self-injury [73, 93–101]”
From A 'choice', an 'addiction', a way 'out of the lost': Exploring self-injury in autistic people without intellectual disability (2019) · cites this paper as [94]
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“This association has been shown cross-sectionally (Hawton et al., 2002; Hilt et al., 2008) and in one 3-year follow-up study (Sourander et al.”
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Jacob, N., Evans, R., & Scourfield, J. (2017) · Journal of Adolescence · doi:10.1016/j.adolescence.2017.08.001 · Cited by 73
A Compassion-Focused Approach to Nonsuicidal Self-Injury
Vliet, K. J. V., & Kalnins, G. R. C. (2011) · Journal of Mental Health Counseling · doi:10.17744/mehc.33.4.j7540338q223t417 · Cited by 72
The Best Friend and Friendship Group Influence on Adolescent Nonsuicidal Self-injury
You, J., Lin, M. P., Fu, K., & Leung, F. (2013) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-013-9734-z · Cited by 94
“We included gender as a moderator because gender differences have been found in both peer socialization and selection effects (Hawton et al. 2002; Prinstein et al. 2010).”
BackgroundDeliberate self-harm and childhood hyperactivity in junior high school students
Izutsu, T., Shimotsu, S., Matsumoto, T., Okada, T., Kikuchi, A., Kojimoto, M., Noguchi, H., & Yoshikawa, K. (2006) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-005-0520-5 · Cited by 72
“2% of female high-school students in the UK [22], 12% of female university students in the USA [11], 13.”
BackgroundExploring parents' responses to their child's deliberate self‐harm
Raphael, H., Clarke, G., & Kumar, S. (2006) · Health Education · doi:10.1108/09654280610637166 · Cited by 72
Borschmann, R., Barrett, B. M., Hellier, J. M., Byford, S., Henderson, C., Rose, D. S., Slade, M., Sutherby, K., SZMUKLER, G. I., Thornicroft, G., et al. (2013) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.112.117762 · Cited by 74
Hetrick, S. E., Robinson, J., Spittal, M. J., & Carter, G. L. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011024 · Cited by 75
Caring for Young People Who Self-Harm: A Review of Perspectives from Families and Young People
Curtis, S., Thorn, P., McRoberts, A., Hetrick, S. E., Rice, S., & Robinson, J. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15050950 · Cited by 92
Peterson, C. M., & Fischer, S. F. (2012) · Eating Behaviors · doi:10.1016/j.eatbeh.2012.05.007 · Cited by 80
Self-harm in British South Asian women: psychosocial correlates and strategies for prevention
Husain, M., Waheed, W., & Husain, N. (2006) · Annals of General Psychiatry · doi:10.1186/1744-859x-5-7 · Cited by 70
“A school based self report survey [23] of deliberate self harm carried out in England also show that 6.”
Congdon, P. D. (2012) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph10010158 · Cited by 68
“, [57]), and the nonlinear association may partly reflect that people from rural areas (with lesser accessibility to hospitals) are less likely to attend hospital, and those that do may be less likely to be admitted.”
BackgroundAdolescents Who Self Harm: A Comparison of Those Who Go to Hospital and Those Who Do Not
Hawton, K., Rodham, K., Evans, E., & Harriss, L. (2008) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2008.00485.x · Cited by 69
Self-citationKidger, J., Heron, J., Leon, D. A., Tilling, K. M., Lewis, G., & Gunnell, D. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.11.003 · Cited by 68
“Self-harm during adolescence is of concern due to its strong association with psychological distress and suicidal thoughts (Kidger et al., 2012a; Landstedt and Gillander Gadin, 2011; Hawton et al., 2002), and with future self-harm and completed suicide (Hawton and Zahl, 2003).”
Identifying deliberate self-harm in emergency department data.
Bethell, J., & Rhodes, A. E. (2009) · PubMed · Cited by 68
The Epigenetics of Suicide: Explaining the Biological Effects of Early Life Environmental Adversity
Labonté, B., & Turecki, G. (2010) · Archives of Suicide Research · doi:10.1080/13811118.2010.524025 · Cited by 75
“, Hawton, K., & Rodham, K. (2005). Suicidal phenomena and abuse in adolescents: A review of epidemiological studies.”
BackgroundNonsuicidal Self injury in Adolescents.
Peterson, J., Freedenthal, S. L., Sheldon, C., & Andersen, R. (2008) · PubMed Central · Cited by 67
Robinson, J., Pan Yuen, H., Martin, C., Hughes, A., Baksheev, G. N., Dodd, S., Bapat, S., Schwass, W., McGorry, P., & Yung, A. R. (2011) · Crisis · doi:10.1027/0227-5910/a000087 · Cited by 67
Suicide in Northern Ireland: epidemiology, risk factors, and prevention
O'Neill, S., & O'Connor, R. C. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30525-5 · Cited by 67
Patterns of non-suicidal self-injurious behaviours among college students in India
Kharsati, N., & Bhola, P. (2014) · International Journal of Social Psychiatry · doi:10.1177/0020764014535755 · Cited by 66
“, 2012), with some studies reporting females as more vulnerable (Dean, 2006; Evans, Hawton, Rodham, & Deeks, 2005; Hawton et al., 2002; Laye-Gindhu & Schonert-Reichl, 2005; Whitlock et al., 2006), while other studies reported no significant gender differences (Hilt, Cha, & NolenHoeksema, 2008; Nixon et al.”
BackgroundResultMaking sense of misfortune: Deservingness, self-esteem, and patterns of self-defeat.
Callan, M. J., Kay, A. C., & Dawtry, R. J. (2014) · Journal of Personality and Social Psychology · doi:10.1037/a0036640 · Cited by 75
Morey, Y., Mellon, D., Dailami, N., Verne, J., & Tapp, A. (2016) · Journal of Public Health · doi:10.1093/pubmed/fdw010 · Cited by 65
“Methods An anonymous self-report survey completed by 2000 adolescents aged 13–18 years across England.”
BackgroundResultInfluentialSUICIDE RISK IN ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Giupponi, G., Giordano, G., Maniscalco, I., Erbuto, D., Berardelli, I., Conca, A., Lester, D., Girardi, P., & Pompili, M. (2018) · Psychiatria Danubina · doi:10.24869/psyd.2018.2 · Cited by 66
Predicting Suicidal Risk in a Cohort of Depressed Children and Adolescents
Hetrick, S. E., Parker, A. G., Robinson, J., Hall, N., & Vance, A. L. A. (2011) · Crisis · doi:10.1027/0227-5910/a000095 · Cited by 64
Manca, M., Presaghi, F., & Cerutti, R. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.10.010 · Cited by 64
“In adolescence, some psychological and psychopathological correlates have been found to be more strongly associated with R-NSSI rather than with occasional NSSI; personality disorders, depression, drug and alcohol use, troubled relationships with peers and/or family members, and chronic psychosocial and behavioral pro…”
Stanford, S., & Jones, M. P. (2009) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2009.02067.x · Cited by 63
Understanding and Discovering Deliberate Self-harm Content in Social Media
Wang, Y., Tang, J., Li, J., Li, B., Wan, Y., Mellina, C., O’Hare, N., & Chang, Y. (2017) · International World Wide Web Conference (WWW) · doi:10.1145/3038912.3052555 · Cited by 63
“Existing efforts toward discovering and caring self-harm people. especially adolescents, have primarily relied on self report or friends/family [31, 17, 15].”
BackgroundInfluentialSuicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences
Chan, W. S. C., Law, C. K., Liu, K., Wong, P. W. C., Law, Y. W., & Yip, P. S. F. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0434-x · Cited by 63
“We assessed their perceived social support [6], perceived loneliness [15], impulsivity state [14, 29], perceived hopelessness [31], irrational belief [39], goal-directed thinking [32], reason for living [18], and coping mechanism [40].”
BackgroundResisting Urges to Self-Injure
Klonsky, E. D., & Glenn, C. R. (2008) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465808004128 · Cited by 62
“Hawton et al. (2002) reported that 10% of sexually abused males and almost 30% of sexually abused females had self-injured.”
BackgroundDeliberate Self-Harm, Substance Use, and Negative Affect in Nonclinical Samples: A Systematic Review
Moller, C. I., Tait, R. J., & Byrne, D. G. (2013) · Substance Abuse · doi:10.1080/08897077.2012.693462 · Cited by 61
“For example, survey data from England and also the Child and Adolescent Self-harm in Europe (CASE) Study found that only about 12% of self-harm cases led to hospital presentation (14).”
Background
Metadata
- Authors
- Hawton, K., Rodham, K., Evans, E., & Weatherall, R.
- Affiliations
- Warneford Hospital (GB)
- University of Oxford (GB)
- Corresponding author
- Hawton, Keith
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2002-11-23
- Volume
- 325
- Issue
- 7374
- Pages
- 1207-1211
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC135492
- OpenAlex
- W2123869797
- Cited by
- 1,008
- References
- 25
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 19 · 2023: 25 · 2022: 29 · 2021: 37 · 2020: 51 · 2019: 28 · 2018: 53 · 2017: 53 · 2016: 65 · 2015: 63 · 2014: 77 · 2013: 54 · 2012: 62
- FWCI
- 26.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
- Keywords
- self-harm, adolescents, prevalence, risk factors, sex differences, peer influence, drug abuse, depression, anxiety, impulsivity, low self-esteem, suicidal behavior, school mental health, hospital presentations
- MeSH terms
- Adolescent, Cross-Sectional Studies, England, Female, Humans, Male, Risk Factors, Prevalence, Multivariate Analysis, Self-Injurious Behavior, Sex Distribution
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