Deliberate self harm in adolescents: self report survey in schools in England

doi:10.1136/bmj.325.7374.1207

BMJ 2002;325:1207-1211 ( 23 November )

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Deliberate self harm in adolescents: self report survey in schools in England

Keith Hawton, professor of psychiatry, ^a Karen Rodham, research fellow, ^a Emma Evans, research assistant, ^a Rosamund Weatherall, medical statistician. ^b

^a Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, ^b Centre for Statistics in Medicine, Institute of Health Sciences, Headington, Oxford OX3 7LF

Correspondence to: K Hawton keith.hawton{at}psychiatry.ox.ac.uk

Objective: To determine the prevalence of deliberateself harm in adolescents and the factors associated withit.
Design: Cross sectional survey using anonymous selfreportquestionnaire.
Setting: 41 schools inEngland.
Participants: 6020 pupils aged 15 and 16years.
Main outcome measure: Deliberate selfharm.
Results: 398 (6.9%) participants reported an act ofdeliberate 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 inmales (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1to 4.9). In females the factors included in a multivariate logisticregression 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 suicidalbehaviour in friends and family members, drug use, and low selfesteem.
Conclusions: Deliberate self harm is common in adolescents,especially females. School based mental health initiatives areneeded. These could include approaches aimed at educating schoolpupils about mental health problems and screening for those atrisk.

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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