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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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“Although potentially limited by self-report, Hawton et al. (2002) found that 6.9 percent of 15 and 16-year-olds from 41 schools within three counties self-harmed.”
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“Deliberate self-harm is one of the symptoms of anxiety and/or depression and is common among young people, particularly girls (Hawton et al. 2002).”
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“Consistent with the surveys of adolescents in England and Scotland (Hawton et al., 2002; O’Connor et al., 2009), self-harm cases reported significantly lower self-esteem on the RSES than control participants, (large effect size) (see Table 2).”
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“6% of these episodes resulted in presentation to hospital.(11) In Canada, the Ontario Child Health Study showed that 5% to 10% of boys and 10% to 20% of girls aged 12 to 16 years reported suicidal behaviour within a 6-month period.”
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“Recent school-based research in the UK and Australia suggests that much more self-harm in children and adolescents occurs in the community and does not come to medical attention (Hawton et al., 2002; De Leo & Heller, 2004; Hawton et al., 2006).”
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“In line with similar studies, the number of female suicide attempts [78–82] as well as self-harm cases [83,84] also exceeded that of males in the present study.”
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What is Known About the Role of Friendship in Adolescent Self-Harm? A Review and Thematic Synthesis
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“An association has been found between reports of adolescent females’ own self-harm and recent self-harm by friends (Hawton et al., 2002).”
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“Although the focus of this article is people who present themselves to ‘acute hospitals’ for medical treatment following self-injury, it is important to remember that the majority of people who self-injure do not go to hospital (Hawton et al, 2002; Meltzer et al, 2002).”
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Whitlock, J. L., & Rodham, K. (2013) · Cited by 13
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Gmitrowicz, A., Kostulski, A., Kropiwnicki, P., & Zalewska-Janowska, A. M. (2014) · Acta Dermato Venereologica · doi:10.2340/00015555-1690 · Cited by 14
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“This is also consistent with the Hawton et al. (2002) community survey which found self cutting was the most reported method of self harm.”
ResultStudents who self‐harm: a case study of prevalence, awareness and response in an English university
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“Hawton et al. (2002) used an anonymous self-report questionnaire with over 6000 pupils aged 15–16 in 41 secondary schools in England: 13.2% of respondents reported a ‘lifetime history of deliberate self-harm’, with just under 7% of respondents reporting having deliberately self-harmed (according to…”
BackgroundMethodInfluentialBorderline personality disorder traits and sexuality: Bridging a gap in the literature
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“While the association between alcohol use and DSH has been previously reported,(2,5) others have refuted this association.”
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“adolescents has been estimated to be approximately 7%, with one third of this number involving self-poisoning (Hawton et al., 2002).”
BackgroundDuffy, D. F. (2006) · Psychiatry · doi:10.1053/j.mppsy.2006.05.003 · Cited by 11
Kelvin, R. G. (2005) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2005.00120.x · Cited by 11
The scope of the problem: physical symptoms of depression.
Dantz, B., Ashton, A. K., D’Mello, D. A., Hefner, J. E., Leon, F. G., Matson, G. A., Montano, C. B., Pradko, J. F., Sussman, N., & Winsberg, B. G. (2003) · PubMed · Cited by 11
Tanaka, R., Ando, S., Kiyono, T., Minami, R., Endo, K., Miyashita, M., Yamasaki, S., Kanata, S., Fujikawa, S., Hiraiwa‐Hasegawa, M., et al. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02183-y · Cited by 10
“Although the measurement method was similar to that of previous studies[2, 3, 48, 49], it is a limitation that we did not use validated questionnaires to assess SH.”
MethodDibaj, I. S., Tørmoen, A. J., Klungsøyr, O., Morken, K. T. E., Haga, E., Dymbe, K. J., & Mehlum, L. I. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02602-8 · Cited by 13
“…referring to “pat-terns of emotional experience or expression that interfere with goal-directed activity” [1], is associated with increased risks of deliberate self-harm [DSH; nonfatal self-injury with or without suicidal intent [2] and lower quality of life and functioning in adulthood [3].”
Villet egenskade blant ungdom: nye forskningsresultater og konsekvenser for forebyggende arbeid
Ystgaard, M. (2015) · Suicidologi/Nytt i suicidologi · doi:10.5617/suicidologi.1855 · Cited by 10
Liljedahl, S. I., Daukantaité, D., Kleindienst, N., Wångby‐Lundh, M., & Westling, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1147206 · Cited by 10
Camp, J., Hunt, K., & Smith, L. M. (2023) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x23000211 · Cited by 11
“Furthermore, suicidal and non-suicidal self-harm were grouped together due to difficulties making clear distinctions between the nature of, and often multiple motivations behind, these behaviours, similar to previous studies (e.g. Hawton et al ., 2002; Ougrin et al ., 2015).”
ResultCrossed fused ectopic left kidney
Hochwald, O. (2004) · Archives of Disease in Childhood · doi:10.1136/adc.2003.047647 · Cited by 10
Body Piercing and Self-Mutilation: A Multifaceted Relationship
Wessel, A. (2014) · American Journal of Applied Psychology · doi:10.11648/j.ajap.20140304.14 · Cited by 12
“Self-harm appears to be more common in females than in males, though some studies have concluded that there are no differences between the genders regarding the incidence of self-mutilation [11, 13].”
Self-harm in first-episode psychosis
Patel, K., & Upthegrove, R. (2009) · Psychiatric Bulletin · doi:10.1192/pb.bp.108.020362 · Cited by 10
Douglas, B. (2009) · Cited by 10
Culture and mental disorders: suicidal behaviour
Fortune, S. A., & Hawton, K. E. (2007) · Cambridge University Press eBooks · doi:10.1017/cbo9780511543609.021 · Cited by 10
Self-citationLundh, L., Wångby‐Lundh, M., & Ulander, J. (2009) · Interpersona An International Journal on Personal Relationships · doi:10.5964/ijpr.v3isupp1.71 · Cited by 10
Therapeutic services for sexually abused children and young people: scoping the evidence base
Allnock, D. S., & Hynes, P. (2011) · Cited by 10
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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