Intended for healthcare professionals


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

BMJ 2002; 325 doi: (Published 23 November 2002) Cite this as: BMJ 2002;325:1207
  1. Keith Hawton, professor of psychiatry (keith.hawton{at},
  2. Karen Rodham, research fellowa,
  3. Emma Evans, research assistanta,
  4. Rosamund Weatherall, medical statisticianb
  1. a Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
  2. b Centre for Statistics in Medicine, Institute of Health Sciences, Headington, Oxford OX3 7LF
  1. Correspondence to: K Hawton
  • Accepted 5 September 2002


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

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

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


  • Funding The Community Fund provided £242 000 ($378 633; €382 572).

  • Competing interests None declared.

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