Prevalence and Correlates of Self-Injury among Adolescents: A Cross-Sectional Study
DOI:
https://doi.org/10.12970/2310-8231.2022.10.02Keywords:
Non-suicidal self-injury, deliberate self-harm, self-mutilation, self-injurious behavior, self-destructive behaviorAbstract
Introduction: Non-suicidal self-injury (NSSI) is defined as a deliberate and voluntary self-inflicted physical damage without suicidal intent. However, the risk of suicide is significantly higher among those who have previously engaged in NSSI. Adolescents are at risk for developing this type of behavior, as elevated levels of impulsivity and emotional reactivity are present due to brain developmental processes.
Methods: A cross-sectional survey that collected data from a sample of 140 adolescents from two Brazilian public schools in august of 2018. The prevalence of self-injury was calculated, and related factors were analyzed, such as sex, socioeconomic status, age of onset, recurrence, intention to die and healthcare assistance.
Results: The prevalence of self-injury was 25% (n = 35) in the sample. Girls were seven times more likely to practice self-injury than boys (OR 7.42; 95% CI 2.80-19.66; p<0.001). However, boys were more likely to have intention to die, recurrence, absence of pain, and no healthcare assistance. The age of onset was 13 to 15 years for most cases. More than one third of participants reported multiple episodes of self-injury (five episodes or more) and they were 13 times more likely to have intention to die (OR 13.2; 95% CI 1.44-120.69; p=0.010). Only one person reported using medication on a daily basis (selective serotonin reuptake inhibitor) and 28.6% reported undergoing professional healthcare assistance.
Conclusion: Self-injury is a prevalent behavior in adolescents, that potentially results in psychological and physical impairments. Further research to achieve a better understanding of clinical and epidemiological features of self-injury is essential so that more effective preventive and therapeutic interventions can be developed to target the needs of young people worldwide.
References
Brown RC, Plenner PL. Non-suicidal Self-Injury in Adolescence. Curr Psychiatry Rep 2017: 19(20). https://doi.org/10.1007/s11920-017-0767-9
Grandclerc S, De Labrouhe D, Spodenkiewicz M, Lachal J, Moro MR. Relations between Nonsuicidal Self-Injury and Suicidal Behavior in Adolescence: A Systematic Review. PLoS One 2016; 4(11). https://doi.org/10.1371/journal.pone.0153760
Plener PL, Schumacher TS, Munz LM, Groschwitz RC. The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature. Borderline Personal Disord Emot Dysregulation 2015; 2(2). https://doi.org/10.1186/s40479-014-0024-3
Heerde JA, Toumbourou JW, Hemphill SA, Herrenkohl TI, Patton GC, Catalano RF. Incidence and course of adolescent deliberate self-harm in Victoria, Australia, and Washington State, USA. J Adolesc Health 2015; 57(5): 537-44. https://doi.org/10.1016/j.jadohealth.2015.07.017
Hawton K, James A. Suicide and deliberate self harm in young people. BMJ 2005; 330(7496): 891-4. https://doi.org/10.1136/bmj.330.7496.891
World Health Organization (WHO). Adolescent mental health [Internet] 2018 [cited 2018 Oct 4]. Available from: http: //www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
Swannell SV, Martin GE, Page A, Hasking P, St John NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav 2014; 44: 273-303. https://doi.org/10.1111/sltb.12070
Brunner R, Kaess M, Parzer P, Fischer G, Carli V, Hoven CW, et al. Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: a comparative study of findings in 11 European countries. J Child Psychol Psychiatry 2014; 55: 337-48. https://doi.org/10.1111/jcpp.12166
Giletta M, Scholte R, Engels R, Ciairano S, Prinstein M. Adolescent non-suicidal self-injury: A cross-national study of community samples from Italy, the Netherlands and the United States. Psychiatry Res 2015; 197(0): 66-72. https://doi.org/10.1016/j.psychres.2012.02.009
Giusti JS. Automutilação: características clínicas e comparação com pacientes com transtorno obsessivo-compulsivo. [dissertation]. São Paulo: Universidade de São Paulo 2013.
Turner BJ, Austin SB, Chapman AL. Treating Nonsuicidal Self-Injury: A Systematic Review of Psychological and Pharmacological Interventions. Can J Psychiatry 2014; 59(11): 576-85. https://doi.org/10.1177/070674371405901103
Pawłowska B, Potembska E, Zygo M, Olajossy M, Dziurzyńska E. Prevalence of self-injury performed by adolescents aged 16-19 years. Psychiatr Pol 2016; 50(1): 29-42. https://doi.org/10.12740/PP/36501
Cipriano A, Cella S, Cotrufo P. Nonsuicidal Self-injury: A Systematic Review. Front Psychol 2017; 8(1946). https://doi.org/10.3389/fpsyg.2017.01946
Pattison EM, Kahan J. The deliberate self-harm syndrome. Am J Psychiatry 1983; 140(7): 867-72. https://doi.org/10.1176/ajp.140.7.867
Bernnardi M, McMahon E, Corcoran P, Griffin E, Arensman E. Risk of repeated self-harm and associated factors in children, adolescents and young adults. BMC Psychiatry 2016; 16(421). https://doi.org/10.1186/s12888-016-1120-2
Serafini G, Canepa G, Adavastro G, Nebbia J, Murri M, Erbuto D, et al. The Relationship between Childhood Maltreatment and Non-Suicidal Self-Injury: A Systematic Review. Front Psychiatry 2017; 8(149). https://doi.org/10.3389/fpsyt.2017.00149
Greydanus D, Shek D. Deliberate Self-harm and Suicide in Adolescents. Keio J Med 2009; 58(3): 144-51. https://doi.org/10.2302/kjm.58.144
Morey C, Corcoran P, Arensman E, Perry I. The prevalence of self-reported deliberate self harm in Irish adolescentes. BMC Public Health 2008; 8(79). https://doi.org/10.1186/1471-2458-8-79
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. 2013. https://doi.org/10.1176/appi.books.9780890425596
Castilho P, Gouveia JP, Bento E. Auto-criticismo, vergonha interna e dissociação: a sua contribuição para a patoplastia do auto-dano em adolescentes. Psychologica 2010; II(52): 331-60. https://doi.org/10.14195/1647-8606_52-2_14
Osuch E, Ford K, Wrath A, Bartha R, Neufeld R. Functional MRI of pain application in youth who engaged in repetitive non-suicidal self-injury vs. psychiatric controls. Psychiatry Res 2014; 223(2): 104-12. https://doi.org/10.1016/j.pscychresns.2014.05.003
