Cited by 1,008Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseInjury Epidemiology and Prevention

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Deliberate self harm in adolescents: self report survey in schools in England

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Hawton, Keith, Rodham, Karen, Evans, Emma, Weatherall, Rosamund·2002·BMJ

DOI 10.1136/bmj.325.7374.1207PMC PMC135492

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Abstract

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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Background
Suicide and deliberate self-harm in children and adolescents
Fortune, S. A., & Hawton, K. E. (2005) · Current Paediatrics · doi:10.1016/j.cupe.2005.08.008 · Cited by 31
Self-citation
Alcohol use and psychiatric comorbid disorders predict deliberate self-harm behaviour and other suicidality among depressed adolescent outpatients in 1-year follow-up
Tuisku, V., Pelkonen, M. U. I., Kiviruusu, O. H., Karlsson, L., & MARTTUNEN, M. J. (2011) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2011.631030 · Cited by 31
Seeking Secrecy
Chandler, A. (2017) · Young · doi:10.1177/1103308817717367 · Cited by 31
“Evidence is sparse for the relationship between self-harm among young people and suicide, as most adolescent self-harm is not treated in hospital (Hawton et al., 2002).”
Background
Self-harm
Kapur, N., Steeg, S., & Moreton, A. (2020) · doi:10.1093/med/9780198713005.003.0126 · Cited by 30
Depression in adolescents: gender differences in Oman and Egypt.
Afifi, M. M. (2006) · PubMed · Cited by 30
Gender Inequality and Its Effects in Females Torture Survivors
Kira, I. A., Ashby, J. S., Lewandowski, L., Smith, I. E., & Odenat, L. (2012) · Psychology · doi:10.4236/psych.2012.34050 · Cited by 30
“On the other hand, GD that favors male dominant actors, does not only make them less vulnerable, but also empowers them to act aggressively and display more externalizing symptoms (e.g., Mejia, 2005, Scott, 1998; Hawton et al., 2002; Parker & Roy, 2001; Linzer et al., 1996).”
Background
The development of a randomised controlled trial testing the effects of an online intervention among school students at risk of suicide
Robinson, J., Hetrick, S. E., Cox, G., Bendall, S., Yung, A. R., Yuen, H. P., Templer, K., & Pirkis, J. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-155 · Cited by 30
“Suicidal youth are six times more likely to have a psychiatric disorder than non-suicidal youth [9-11].”
Background
Cannabis Use and Deliberate Self-Harm in Adolescence: A Comparative Analysis of Associations in England and Norway
Rossow, I. M., Hawton, K., & Ystgaard, M. (2009) · Archives of Suicide Research · doi:10.1080/13811110903266475 · Cited by 30
“Data collection took place in the years 2000 and 2001 (for more details see Hawton, Rodham, Evans et al, 2002 ; Ystgaard, Reinholdt, Husby et al, 2003 ).”
Self-citation
Self‐injury in Japanese junior and senior high‐school students: Prevalence and association with substance use
Matsumoto, T., & Imamura, F. (2008) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2007.01783.x · Cited by 30
Prevalence of over-the-counter drug-related overdoses at Accident and Emergency departments in Northern Ireland - a retrospective evaluation
Wazaify, M., Kennedy, S., Hughes, C. M., & McElnay, J. C. (2005) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/j.1365-2710.2004.00607.x · Cited by 29
“The second most popular OTC drug ingested in intentional overdose was aspirin (7Æ2%); however, this was slightly less than that reported in Oxford in 1995 (12%) (18).”
Result
Using routine clinical and administrative data to produce a dataset of attendances at Emergency Departments following self-harm
Polling, C., Tulloch, A. D., Banerjee, S., Cross, S., Dutta, R., Wood, D. M., Dargan, P. I., & Hotopf, M. H. (2015) · BMC Emergency Medicine · doi:10.1186/s12873-015-0041-6 · Cited by 29
“Data for ED presentations cannot be considered to represent all self-harm occurring in an area, as it is known that many individuals who self-harm, especially those who self-injure, do not seek medical treatment [15].”
Background
Eating disorders and suicide ideation: the mediating role of depression and aggressiveness
Miotto, P., & Preti, A. (2007) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2007.01.006 · Cited by 28
“2% for lifetime [1].”
Relationship of self-mutilative behaviours with severity of borderline personality, childhood trauma and impulsivity in male substance-dependent inpatients
Evren, C., Cinar, O., Evren, B., & Çelik, S. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.03.017 · Cited by 29
“Impulsivity is considered as a temperamental risk factor for substance use (Acton, 2003) and as an independent risk factor for SM (Hawton et al., 2002).”
Background
The association between general childhood psychopathology and adolescent suicide attempt and self-harm: A prospective, population-based twin study.
O’Reilly, L. M., Pettersson, E., Quinn, P. D., Klonsky, E. D., Lundström, S., Larsson, H., Lichtenstein, P., & D'Onofrio, B. M. (2020) · Journal of Abnormal Psychology · doi:10.1037/abn0000512 · Cited by 32
My Body and Me: Self-Injurious Behaviors and Body Modifications in Eating Disorders—Preliminary Results
Iannaccone, M., Cella, S., Manzi, S. A., Visconti, L., Manzi, F., & Cotrufo, P. (2013) · Eating Disorders · doi:10.1080/10640266.2013.761087 · Cited by 29
The prevalence and correlates of self-harm in pregnant women with psychotic disorder and bipolar disorder
Taylor, C. L., van Ravesteyn, L. M., den Berg, M. P. L., Stewart, R. J., & Howard, L. M. (2016) · Archives of Women s Mental Health · doi:10.1007/s00737-016-0636-2 · Cited by 32
“Pregnancy”
Self-poisoning during pregnancy as a model for teratogenic risk estimation of drugs
Czeizel, A., Gidai, J., Petik, D., Timmermann, G., & Horváth–Puhó, E. (2008) · Toxicology and Industrial Health · doi:10.1177/0748233708089020 · Cited by 29
Preliminary evaluation of an intensive integrated individual and family therapy model for self-harming adolescents
Wijana, M. B., Enebrink, P., Liljedahl, S. I., & Ghaderi, A. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1947-9 · Cited by 28
Longitudinal effects of psychological symptoms on non-suicidal self-injury: a difference between adolescents and young adults in China
WanShao-Jun, Y.-H., & Chen, X. (2015) · Cited by 28
Feasibility of Dialectical Behavior Therapy with Suicidal and Self-Harming Adolescents with Multi-Problems: Training, Adherence, and Retention
Tørmoen, A. J., Grøholt, B., Haga, E., Brager-Larsen, A. T., Miller, A. L., Walby, F. A., Stanley, B., & Mehlum, L. I. (2014) · Archives of Suicide Research · doi:10.1080/13811118.2013.826156 · Cited by 35
Changes in associations between psychosocial factors and suicide attempts by adolescents in Greece from 1984 to 2007
Kokkevi, A., Rotsika, V., Arapaki, A., & Richardson, C. (2010) · European Journal of Public Health · doi:10.1093/eurpub/ckq160 · Cited by 28
Do young women with tattoos have lower self-esteem and body image than their peers without tattoos? A non-verbal repertory grid technique approach
Kertzman, S., Kagan, A., Hegedish, O., Лапидус, Р., & Weizman, A. (2019) · PLoS ONE · doi:10.1371/journal.pone.0206411 · Cited by 30
Intra/interpersonal Functions of Non-suicidal Self-injury in Adolescents with Major Depressive Disorder: The Role of Emotion Regulation, Alexithymia, and Childhood Traumas
Torun, Y. T., Gül, H., Yaylalı, F. H., & Gül, A. (2021) · Psychiatry · doi:10.1080/00332747.2021.1989854 · Cited by 27
Predicting prolonged non-suicidal self-injury behaviour and suicidal ideations in adolescence – the role of personal and environmental factors
Bulat, L. R., Sušac, N., & Ajduković, M. (2023) · Current Psychology · doi:10.1007/s12144-023-04404-8 · Cited by 31
“Hawton et al. (2012) claimed that 12-month recidivism of self-harm episodes occurred in 15–25% of hospitalized adolescents, and repetition is also common in non-clinical samples (Hawton, 2002), although in current literature there are lack of studies that focus only on non-clinical samples.”
Background
Self‐Harm in Young Offenders
Borschmann, R., Coffey, C., Moran, P., Hearps, S. J. C., Degenhardt, L. J., Kinner, S. A., & Patton, G. C. (2014) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12096 · Cited by 27
Clinical Correlates and Repetition of Self-Harming Behaviors Among Female Adolescent Victims of Sexual Abuse
Cyr, M., McDuff, P., Wright, J. C., Thériault, C., & Cinq-Mars, C. (2005) · Journal of Child Sexual Abuse · doi:10.1300/j070v14n02_03 · Cited by 27
“Similarly, in a study involving more than 2,700 adolescent girls, Hawton et al. (2002) reported that those sexually abused were more than four times as likely to report self-harming behavior.”
Background
Receipt of Help After Deliberate Self-Harm Among Adolescents: Changes Over an Eight-Year Period
Rossow, I. M., & Wichstrøm, L. (2010) · Psychiatric Services · doi:10.1176/ps.2010.61.8.783 · Cited by 27
Changes in parenting strategies after a young person’s self-harm: a qualitative study
Ferrey, A. E., Hughes, N. D., Simkin, S., Locock, L., Stewart, A., Kapur, N., Gunnell, D., & Hawton, K. E. (2016) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-016-0110-y · Cited by 27
“Selfharm in adolescents in the general population is far more common in girls than boys [1].”
BackgroundSelf-citation
Predicting repeated self-harm or suicide in adolescents and young adults using risk assessment scales/tools: a systematic review protocol
Harris, I. M., Beese, S. E., & Moore, D. (2019) · Systematic Reviews · doi:10.1186/s13643-019-1007-7 · Cited by 36
Parental conceptions of self‐mutilation among Finnish adolescents
Rissanen, M., Kylmä, J., & Laukkanen, E. (2008) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2007.01214.x · Cited by 27
The Violence of the Cut: Gendering Self-Harm
Chandler, A., & Simopoulou, Z. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094650 · Cited by 28
“In contrast, in community studies (often educational settings), using self-report measures, around 60% of young people who report self-harm describe self-cutting [15,16].”
Result
Sexual assault while too intoxicated to resist: a general population study of Norwegian teenage girls
Pape, H. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-406 · Cited by 26
“The original 15-item scale has been tested in both clinical and college student samples [35-37], and the selection of the six items was based on previous general population studies of adolescents [38,39].”
Method
Outpatient Dialectical Behavior Therapy for Adolescents Engaged in Deliberate Self-Harm: Conceptual and Methodological Considerations
Freeman, K. R., James, S., Klein, K. P., Mayo, D., & Montgomery, S. (2015) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-015-0412-6 · Cited by 26
An Examination of Cutting and Other Methods of DSH among Children and Adolescents Presenting to an Outpatient Psychiatric Clinic in New Zealand
Fortune, S. A. (2006) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104506064984 · Cited by 26
A sequence analysis of patterns in self‐harm in young people with and without experience of being looked after in care
Wadman, R., Clarke, D. D., Sayal, K. S., Armstrong, M., Harroe, C., Majumder, P., Vostanis, P., & Townsend, E. (2017) · British Journal of Clinical Psychology · doi:10.1111/bjc.12145 · Cited by 33
“Self-harm Participants were asked to report the methods of self-harm they had used (ever) using an adapted checklist (Hawton et al., 2002).”
Method
Factors associated with the development of self-harm amongst a socio-economically deprived cohort of adolescents in Santiago, Chile
Spears, M. R., Montgomery, A. A., Gunnell, D., & Araya, R. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0767-y · Cited by 27
Affective temperaments and self-harm in adolescents: A cross-sectional study from a community sample
Guerreiro, D. F., Sampaio, D., Rihmer, Z., Gonda, X., & Figueira, M. L. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.07.034 · Cited by 25
“, 2011) and exposure to SH and suicide of others (family and friends) is also strongly associated (De Leo and Heller, 2004; Hawton et al., 2002; O′Connor et al., 2009a).”
BackgroundResult
The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents—A Network Approach
Győri, D., Farkas, B. F., Horváth, L. O., Komáromy, D., Mészáros, G., Szentiványi, D., & Balázs, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18041840 · Cited by 29
“Their study was based on the following definition: DSH is an act with a non-fatal outcome in which an individual deliberately initiates a behaviour (such as self-cutting or jumping from height), ingests a substance (medicines/drugs), or ingests a non-ingestible substance or object with intent to harm the self [33].”
BackgroundInfluential
Utilization and Acceptability of Formal and Informal Support for Adolescents Following Self-Harm Before and During the First COVID-19 Lockdown: Results From a Large-Scale English Schools Survey
Geulayov, G., Borschmann, R., Mansfield, K. L., Hawton, K. E., Moran, P., & Fazel, M. S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.881248 · Cited by 31
Self-citation
How can we stop our children from hurting themselves? Stages of change, motivational interviewing, and exposure therapy applications for non-suicidal self-injury in children and adolescents.
Kamen, D. G. (2009) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100874 · Cited by 25

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
DOI: 10.1136/bmj.325.7374.1207
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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Deliberate self harm in adolescents: self report survey in schools in England

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