Teenagers at Greatest Risk of Self-harming Could Be Identified a Decade Earlier

Dawn O'Shea

June 18, 2021

Researchers at the University of Cambridge suggest self-harm can be predicted almost a decade before it begins.

The team, based at the MRC Cognition and Brain Sciences Unit, found that while sleep problems and low self-esteem were common risk factors, there were two distinct profiles of young people who self-harm.

They identified adolescents who reported self-harm at age 14 years, from a nationally representative UK birth cohort of approximately 11,000 individuals. Machine learning was used to identify whether there were distinct profiles of young people who self-harm. The results are published in the  Journal of the American Academy of Child and Adolescent Psychiatry.

The team identified two distinct subgroups among young people who self-harm, with significant risk factors present as early as age five years, nearly a decade before they reported self-harming. While both groups were likely to experience sleep difficulties and low self-esteem at age 14 years, other risk factors differed between the two groups.

The first group showed a long history of poor mental health and bullying before they self-harmed, and their caregivers were more likely to have mental health issues of their own.

For the second group, however, their self-harming behaviour was harder to predict early in childhood. One of the key signs was a greater willingness to take part in risk-taking behaviour. Other research suggests these tendencies may predispose the individual towards spending less time to consider alternate coping methods and the consequences of self-harm. Factors related to their relationships with their peers were also important for this subgroup, including feeling less secure with friends and family at age 14 years and a greater concern about the feelings of others as a risk factor at age 11 years.

The researchers say that their findings suggest that it may be possible to predict which individuals are most at risk of self-harm up to a decade ahead of time, providing a window to intervene.

Co-author, Dr Duncan Astle said: "The current approach to supporting mental health in young people is to wait until problems escalate. Instead, we need a much better evidence base so we can identify who is at most risk of mental health difficulties in the future, and why. This offers us the opportunity to be proactive, and minimise difficulties before they start."

"Our results suggest that boosting younger children’s self-esteem, making sure that schools implement anti-bullying measures, and providing advice on sleep training, could all help reduce self-harm levels years later."

"Our research gives us potential ways of helping this newly-identified second subgroup. Given that they experience difficulties with their peers and are more willing to engage in risky behaviours, then providing access to self-help and problem-solving or conflict regulation programmes may be effective."

Uh S, Dalmaijer ES, Siugzdaite R, Ford TJ, Astle DE. Two Pathways to Self-Harm in Adolescence. J Am Acad Child Adolesc Psychiatry. 2021 May 7 [Epub ahead of print]. doi: 10.1016/j.jaac.2021.03.010. PMID: 34130904

This article originally appeared on Univadis, part of the Medscape Professional Network.

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