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Deliberate self harm in adolescents: self report survey in schools in England
Open accessAbstract
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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“Such evidence challenges the findings of a strand of psychological research that argues that risky behaviours are indicators of low self-esteem (Hawton et al. 2002, Reininger et al. 2003, Wild et al. 2004).”
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“Around 10% of adolescents, predominantly females, report having selfharmed (Hawton et al. 2002; Madge et al. 2008), and suicide, primarily by males, is the second most frequent cause of death in young people (Patton et al.”
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ResultThe Presentation of Self-Harm Recovery: A Thematic Analysis of YouTube Videos
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“This gender imbalance is consistent with research indicating that self-harm is more common in females than males (Carr et al. 2016; Hawton et al. 2002), as well as research specifically on self-harm videos on YouTube, indicating that 95% of the hundred most viewed videos were uploaded by women (Lewis et al.”
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“The underlying principle for adopting this approach is that it helps researchers to get back personalized statements from respondents after posing a series of questions and statements to them (Hawton et al., 2002).”
BackgroundService use in adolescents at risk of depression and self-harm: prospective longitudinal study
Sayal, K. S., Yates, N., Spears, M. R., & Stallard, P. N. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0843-y · Cited by 26
“For example, only around one in eight adolescents who self-harm present for medical attention to hospitals [4, 6, 7].”
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“Self-harm is commonly classi fi ed into two categories: self-harm with suicidal intent (attempted suicide) and self-harm without suicidal intent (non-suicidal self-injury, NSSI) (5 – 7).”
Harkess-Murphy, E., Macdonald, J. B., & Ramsay, J. (2012) · Psychology Health & Medicine · doi:10.1080/13548506.2012.712706 · Cited by 23
“Some researchers have opted to explicitly define self-harm for participants with a pre-defined set of behaviours such as burning and cutting included in this criteria (O'Connor et al, 2009 ; Hawton, Rodham, Evans, & Weatherall, 2002 ).”
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Self-citationThe Mediatory Role of Maladaptive Schema Modes Between Parental Care and Non-Suicidal Self-Injury
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“services (Hawton et al., 2002).”
BackgroundInfluentialDeliberate Self-harm among Young People Begins to Increase at the Very Early Age: a Nationwide Study
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The role of dissociation and abuse among adolescents who self-harm
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Assessing the risk of self-harm in an adult offender population: an incidence cohort study
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“Among the general population (who do not routinely present at accident and emergency), physical self-harm is more common, with cutting being the most common form.(25)”
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“…programs directly focusing on NSSI have not been developed, and some may be wary of implementing such a program for fear of increasing the prominence of the behaviour in their school (Hawton, Rodham, Evans, & Weatherall, 2002; Taiminen, Kallio-Soukainen, Nokso-Koivisto, Kaljonen, & Helenius, 1998).”
Pisinger, V. S. C., Hawton, K. E., & Tolstrup, J. S. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-1031-x · Cited by 22
“International community-based studies show that around 5-20% of adolescents, with considerable more girls than boys, report having self-harmed [3-8], and according to hospital records the prevalence seems to be rising [9].”
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A History of Self-Harm in Britain
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“These coping strategies were used in the large school-based survey designed by Hawton et al. (2002) to investigate self-harm in adolescence.”
MethodDeliberate self-poisoning in children.
Krishnakumar, P., Geeta, M. G., & Gopalan, A. V. (2005) · PubMed · Cited by 22
Assessment of adolescent self-harm
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Examining the Discourse of Mental Illness in a Corpus of Online Advice-Seeking Messages
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“A standard definition was used to allocate patients to either the self-harm or no self-harm group, based on any past self-initiated acts (such as self-cutting, poisoning or jumping from a height) intended to cause self-harm (Hawton et al., 2002).”
MethodMasculinidad-feminidad y salud mental
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“All variables were theoretically derived for adolescents in previous school-based studies (Brunner et al. 2014; Hawton et al. 2002; Mars et al. 2014; McMahon et al. 2010; Taliaferro et al. 2012) or systematic review (Hawton et al.”
BackgroundMethodResultInfluentialDyslexia: Investigating Self-Harm and Suicidal Thoughts/Attempts as a Coping Strategy
Alexander‐Passe, N. (2015) · Journal of Psychology & Psychotherapy · doi:10.4172/2161-0487.1000224 · Cited by 25
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International Perspectives on the Epidemiology and Aetiology of Suicide and Self‐Harm
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“In contrast, SH may be more closely linked to other factors such as impulsivity or low self-esteem [37, 53].”
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“This type of assessment could also potentially be used in conjunction with local knowledge of other risk factors, such as previous self-harm, history of self-harm by friends or family, quality of social relationships, stressful life events, and known history of abuse [3,15,56-58].”
BackgroundChao, Q., Yang, X., & Luo, C. (2015) · American Journal of Men s Health · doi:10.1177/1557988315579096 · Cited by 20
“Wang, 2010) but is contrary to findings from studies in Western countries concerning sex differences in the prevalence of self-injurious behaviors (Hawton et al., 2002; Whitlock, Eckenrode, & Silverman, 2006), as well as the suicidal facts by sex reported in China: The suicide rate in China is higher among women than…”
ResultAdolescents with suicidal behaviour: attendance at A&E and six month follow-up
Bolger, S., O'Connor, P. J., Malone, K. M., & Fitzpatrick, C. (2004) · Irish Journal of Psychological Medicine · doi:10.1017/s0790966700008405 · Cited by 20
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“These behaviours include suicidal ideation and suicide attempt (often referred to as deliberate self-harm; DSH), both with, and without, intention of dying (Hawton et al. 2002).”
BackgroundKaess, M., Brunner, R. M., Parzer, P., Edanackaparampil, M., Schmidt, J. S., Kirisgil, M., Fischer, G., Wewetzer, C., Lehmkuhl, G., & Resch, F. (2016) · Psychopathology · doi:10.1159/000448481 · Cited by 21
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A cross-sectional study of non-suicidal self-injury in a Chinese adolescent inpatient cohort
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Repeated self-harm in young people: a review
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Substance abuse by children and young people
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Deliberate Self‐Harm in Adolescents Aged 12–18: A Cross‐Sectional Survey of 18,104 Students
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“Thirdly, only a fraction of youth engaged in DSH seek or receive help (Hawton et al. 2002; Pagès et al. 2004).”
InfluentialA comparison of methods of self-harm without intent to die: Cutting versus self-poisoning
Chartrand, H., Kim, H., Sareen, J., Mahmoudi, M., & Bolton, J. M. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.07.009 · Cited by 20
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“The importance of this area of whole school and multiagency co-operation has been confirmed by the tragic suicides and attempts at self-harm of pupils who experience bullying and stress at school (Hawton et al, 2002).”
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Teaching Therapeutic Assessment for self‐harm in adolescents: Training outcomes
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Self-mutilation as expressed in self-figure drawings in adolescent sexual abuse survivors
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An Analysis of Parent-Female Adolescent Relationships in Female Adolescent Suicides
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Common Presenting Problems for Young People Attending the Emergency Department
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“In the CASE self-report studies from England and Norway ( Hawton et al. 2002; Ystgaard et al. 2003), it was found that about 7% of the girls had cut themselves.”
BackgroundInfluentialLatzman, R. D., Gratz, K. L., Young, J. N., Heiden, L. J., Damon, J. D., & Hight, T. L. (2009) · Journal of Youth and Adolescence · doi:10.1007/s10964-009-9462-4 · Cited by 18
“Meta-analytic results (examining published studies through December, 2000) of studies examining suicide-related phenomenon and SIB among adolescents in the general population (Evans et al. 2005), as well as more recent empirical school-based investigations of self-reported SIB among youth in school settings ( Hawton e…”
ResultDeliberate self harm in children
Krishnakumar, P., Geeta, M. G., & Riyaz, A. (2010) · Indian Pediatrics · doi:10.1007/s13312-011-0084-z · Cited by 18
“The association between stress and DSH in adolescents is well documented [1,3,13,17,19].”
BackgroundResultInfluentialCoping Strategies in Adolescents Who Self-Harm
Guerreiro, D. F., Figueira, M. L., Cruz, D., & Sampaio, D. (2014) · Crisis · doi:10.1027/0227-5910/a000289 · Cited by 24
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“Although most episodes of self-harm do not result in a hospital admission (6), it accounts for over 200,000 attendances to Emergency Departments (EDs) in England every year (7).”
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Prognoses after self-harm in youth: exploring the gender factor
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Choi, W.-S., Han, J., & Hong, H. J. (2023) · Journal of Medical Internet Research · doi:10.2196/46254 · Cited by 17
“In addition, considering that self-harm is more common in female adolescents [47], this association might have been more pronounced in females than that in males.”
Welche Probleme berichten Jugendliche mit selbstverletzendem Verhalten?
Vonderlin, E., Haffner, J., Behrend, B., Brunner, R. M., Parzer, P., & Resch, F. (2011) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000047 · Cited by 17
Association of anger with bulimic and other impulsive behaviours among non‐clinical women and men
Peñas‐Lledó, E., Fernández, J. D. D., & Waller, G. (2004) · European Eating Disorders Review · doi:10.1002/erv.588 · Cited by 17
Impulsivity in Non-Suicidal Self-Injurious Adolescents in China
Yu, L., Xiao, L., & Guangrong, J. (2013) · Acta Psychologica Sinica · doi:10.3724/sp.j.1041.2013.00320 · Cited by 19
Dealing with difficult days: Functional coping dynamics in self-harm ideation and enactment
Nielsen, E., Sayal, K. S., & Townsend, E. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.08.036 · Cited by 23
Public perceptions of self-harm—A test of an attribution model of public discrimination.
Nielsen, E., & Townsend, E. (2017) · Stigma and Health · doi:10.1037/sah0000090 · Cited by 21
“The demographic characteristics and method of injury were guided by the literature and aimed to be representative of community selfharm (Bergen et al., 2010; Hawton, Harriss, & Rodham, 2010; Hawton et al., 2002; McDougall, Armstrong, & Trainor, 2010).”
MethodInternetabhängigkeit, Suizidalität und selbstverletzendes Verhalten – Ein systematisches Review
Steinbüchel, T., Herpertz, S., Külpmann, I., Kehyayan, A., Dieris-Hirche, J., & Wildt, B. T. T. (2017) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/s-0043-120448 · Cited by 19
“Impulsivität spielt bei der Pathogenese von IA, Suizidalität und NSSV auch unabhängig voneinander eine wichtige Rolle, da viele Handlungen aus einer Belastungssituation heraus ohne hinreichende Würdigung der langfristigen Konsequenzen erfolgen [33, 45, 46].”
BackgroundKandsperger, S., Jarvers, I., Ecker, A., Schleicher, D., Madurkay, J., Otto, A., & Brunner, R. M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.634346 · Cited by 17
NILSSON, M. H. L., Lundh, L., & Westling, S. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2744 · Cited by 23
“this study we use the term deliberate self-harm (DSH) according to Hawton et al. (2002) who define DSH as a deliberate self-harming act with non-fatal outcome, such as self-cutting, jumping from a height,”
BackgroundMethodManagement of common behaviour and mental health problems
El-Radhi, A. S. (2015) · British Journal of Nursing · doi:10.12968/bjon.2015.24.11.586 · Cited by 17
“In a school survey in England, 13% of adolescents (more commonly females) experienced self-harm (Hawton et al, 2002).”
BackgroundStewart, S. L., Baiden, P., Theall, L., & den Dunnen, W. (2013) · Child & Youth Care Forum · doi:10.1007/s10566-013-9225-y · Cited by 20
Suicidal and Self-Harm Behaviors in Chronic Pain Patients
Okifuji, A., & Benham, B. (2011) · Journal of Applied Biobehavioral Research · doi:10.1111/j.1751-9861.2011.00065.x · Cited by 17
Promoting young people's wellbeing: A review of research on emotional health
Edwards, L. (2003) · Cited by 17
International Perspectives on the Epidemiology and Etiology of Suicide and Self‐Harm
Windfuhr, K. L., Steeg, S., Hunt, I. M., & Kapur, N. (2016) · Wiley eBooks · doi:10.1002/9781118903223.ch2 · Cited by 18
NILSSON, M. H. L., Lundh, L., Westrin, Å., & Westling, S. (2021) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2021.1894094 · Cited by 23
“● Ingested a non-ingestible substance or object (Hawton et al., 2002).”
BackgroundHealth Communication and Psychological Distress: Exploring the Language of Self-harm
Harvey, K., & Brown, B. J. (2012) · Canadian Modern Language Review/ La Revue canadienne des langues vivantes · doi:10.3138/cmlr.1103 · Cited by 16
Ferrer, L., & Kirchner, T. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.04.017 · Cited by 12
“Recent reviews suggest that self-harm behavior is much more frequent in female adolescents than in males and that its frequency increases from age 12 onwards [30,31,26].”
BackgroundWalker, T. (2009) · Counselling and Psychotherapy Research · doi:10.1080/14733140902909174 · Cited by 16
“This is between 50 and 100 times greater than the rate of suicide in the general population (Hawton et al, 2002 ; Owens, Horrocks, & House, 2002 ).”
BackgroundEvren, C., Evren, B., Bozkurt, M., & Can, Y. (2014) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2013.872699 · Cited by 16
Media influences on suicidal behaviour: An interview study of young people in New Zealand
Collings, S., Fortune, S. A., Steers, D., Currey, N., Hawton, K. E., Wang, J., & Slim, B. M. M. (2011) · Cited by 16
Self-citationNonsuicidal Self-Injury of Adolescents
Lovell, S., & Clifford, M. W. (2016) · Clinical Pediatrics · doi:10.1177/0009922816666854 · Cited by 16
“For instance, only a fraction of adolescents who engage in self-injury seek or receive help.(35) As evidenced throughout this discussion, there is variability in reported gender differences for NSSI.”
BackgroundCarter, T., Latif, A., Callaghan, P., & Manning, J. C. (2018) · Journal of Clinical Nursing · doi:10.1111/jocn.14361 · Cited by 16
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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