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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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“Early findings utilizing broad definitions of impulsivity did not identify a relationship (Hawton et al., 2002; Herpertz et al., 1997), and it has been suggested that it may be due to not distinguishing between specific facets of impulsivity (Peterson & Fischer, 2012).”
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“This is because this information is easily achievable from patient records rather than requiring direct patient contact (26, 27), which is more difficult, costly, and has many ethical implications.”
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“Discussion Relative frequencies of various methods used for self-harm have varied over time, and they do vary by setting, population type, and country [19].”
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“In a survey of 41 schools in England, suicidal ideation in the past year was reported by 863 of 5737 pupils aged 15 and 16 years (Hawton, 2002).”
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“In males the factors were suicidal behaviour in friends and family members, drug use and low self esteem [4].”
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A prospective study of suicide and self-harm among young carers using an Australian cohort
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“Inclusion criteria were a history of deliberate self-harm (Hawton et al., 2002) for at least 2 years with at least five incidents occurring during the last 6months.”
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“For example, many investigators use the term of DSH to differentiate self-harm and suicide-related behaviour and to conceptualize that self-harm is the antithesis of suicidal attempts (24,25), while others have not been able to differentiate the aim of self-harm and the aim to die (26,27,28,29).”
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“Self-harming behaviors are often related to other mental health issues, in particular anxiety and depression (Hawton et al., 2002).”
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“…identified as a behaviour resistant to treatment efforts (Zila & Kiselica, 2001), and since only a small proportion of young people who cut are seen by health agencies (Hawton et al., 2002), trying to intervene with this behaviour directly through health agencies is unlikely to be very successful.”
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“Although DSH can be serious and a predictor of suicide (9), few patients apply to a professional institution (1,10).”
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Goulbourne, M., Brink, F. W., Xia, X., Steelesmith, D. L., Ruch, D. A., Bridge, J. A., Lo, C. B., & Fontanella, C. A. (2025) · JAACAP Open · doi:10.1016/j.jaacop.2025.04.002 · Cited by 7
“32 The study further found that several factors associated with DSH in this population also varied based on sex.”
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“The collaborators of the CASE Study developed a manual of guidelines to aid in the categorisation of adolescents’ responses in order to determine if the criteria of SH were met (for full details, refer to Hawton et al., 2002).”
BackgroundMethodResultInfluentialNorthern Ireland lifestyle and coping survey
O’Connor, R. C., Rasmussen, S. A., & Hawton, K. E. (2010) · Cited by 5
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Gholamzadeh, S., Zahmatkeshan, M., Zarenezhad, M., Ghaffari, E., & Hoseni, S. (2017) · Journal of Forensic and Legal Medicine · doi:10.1016/j.jflm.2017.07.003 · Cited by 5
How to communicate with children and young people in distress
Conn, R., Monsell, A., & Bruce, H. (2017) · BMJ · doi:10.1136/sbmj.j1696 · Cited by 5
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Gargiulo, A. (2020) · Europe’s Journal of Psychology · doi:10.5964/ejop.v16i1.1883 · Cited by 8
“The Behaviours of Self-Harm at School Starting from the first school study (Ross & Heath, 2002), much of the research aims at investigating self-harming behaviour in adolescence was carried out in schools (De Leo & Heller, 2004; Hawton et al., 2002; Madge et al., 2008; O’Connor et al., 2009), showing a prevalence of b…”
BackgroundCorrelates and predictors of self-harm in a prospective sample of sexually assaulted adolescents
Valencia‐Agudo, F., Kramer, T., Clarke, V., Goddard, A., & Khadr, S. N. (2020) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104520920332 · Cited by 5
“Self-harm was defined as any act to deliberately harm oneself regardless of the intention and included cutting, scratching, overdosing, jumping from heights, and so on (Hawton et al., 2002).”
BackgroundInfluentialGender and Mental Health: Are There Differences?
Damodaran, D. K., & Varghese Paul, K. (2016) · International Journal of Indian Psychology · doi:10.25215/0302.133 · Cited by 5
Social support may prevent self‐cutting in adolescence: A 5‐year follow‐up study
Rissanen, M., Kekkonen, V., Kraav, S., Kivimäki, P., Laukkanen, E., Hintikka, J., & Tolmunen, T. (2021) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12341 · Cited by 5
Deliberate Self Poisoning at National Poisoning Control Centre
Bashir, F., Ara, J., & Kumar, S. (2014) · Journal of Liaquat University of Medical & Health Sciences · Cited by 5
Caracterização do perfil de participantes de um grupo de automutilação no facebook
Silva, A. C., & Botti, N. C. L. (2018) · Salud & Sociedad · doi:10.22199/s07187475.2018.0002.00003 · Cited by 5
Self-Injurious Behaviors in Adolescents with Borderline Personality Disorder
Gratz, K. L., Dixon–Gordon, K. L., & Tull, M. T. (2014) · Springer eBooks · doi:10.1007/978-1-4939-0591-1_14 · Cited by 6
Characteristics of Self-harm Behaviour among Identified Self-harming Youth in Care
Grenville, J., Goodman, D., & Macpherson, A. (2011) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-011-9361-2 · Cited by 5
“In addition to confirming DSH as a highly prevalent phenomenon in the general youth population, research also suggests DSH is more common among female youth (De Leo and Heller 2004; Goodman 2005; Hawton et al. 2002; Madge et al. 2008; Matsumoto et al. 2008; Morey et al. 2008; Nixon et al. 2008).”
BackgroundResultInfluentialStanley, N., Manthorpe, J., & Gillespie, L. D. (2008) · Academic Psychiatry · doi:10.1176/appi.ap.32.2.92 · Cited by 5
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Maharajh, H. D., & Seepersad, R. (2010) · Health · doi:10.4236/health.2010.24055 · Cited by 5
“While some authorities [19,23,24] have commented on the low lethality of derma-abusers, the boundaries appear to be blurred.”
BackgroundOvercoming aggression : musing on mindfulness and self-control
Yusainy, C. (2013) · Nottingham ePrints (University of Nottingham) · Cited by 5
Harm, Interrupted: Self-Injury Narratives and Same Sex Attraction
Estefan, A. (2008) · Griffith Research Online · doi:10.25904/1912/380 · Cited by 5
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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