Self-Harm, Suicidality Among Adolescents Associated With Poor Outcomes, Recurrent Clinical Care

Razor blade
Razor blade
Youth who engage in self-harm should be a prioritized group for assessment and targeted treatment.

Self-harm in adolescents is associated with an increased risk for adverse outcomes, according to study data published in the Journal of Childhood Psychology and Psychiatry.

Researchers conducted both a cross-sectional case control study and a longitudinal cohort study using regional and national registry data in Sweden. Data from children and adolescents seen at child and adolescent mental health services (CAMHS) in Stockholm county were documented in the regional Pastill Register. The Pastill Register was then linked with national Swedish registers by personal identification number to obtain data on psychiatric inpatient care, prescribed psychotropic drugs, and any record of criminal convictions.

Participants for the case control study were children and adolescents between the ages of 4 and 18 years who had been in clinical contact with CAHMS between 2011 and 2015 (n=25,161). Cases were identified as individuals who presented with self-harm only (n=1027) or with self-harm and suicidality (n=1099). Controls were patients presenting at CAHMS for reasons other than suicidality or self-harm (n=21,199). The longitudinal study employed a similar sampling strategy,  except that participants were individuals who had terminated their contract with CAMHS between 2011 and 2015 (n=6120). The cohort sample included 261 individuals with self-harm, 363 individuals with self-harm and suicidality, and 4746 clinical controls without either symptom. Individuals in the longitudinal cohort were followed from the time of termination until the study conclusion in December 2015.

In the case-control study, both case groups had a higher number of clinical care visits, lower global functioning, and an increased risk for 1 or more comorbid mental disorder compared with controls (all P ≤.001). Additionally, both case groups presented with increased psychosocial problems, including relational family problems and a greater likelihood of psychotropic medication use (all P ≤.001). In most analyses, patients with self-harm and suicidality had worse outcomes compared with patients with self-harm alone. The longitudinal study indicated similar outcomes: both case groups had elevated risk for alcohol misuse, psychotropic drug use, and recurrent clinical care (all P <.001). Patients with self-harm and suicidality also had higher rates of drug misuse, social welfare recipiency, and criminal activity (all P <.001) compared with other study groups. The hazard ratio (HR) for recurrent clinical care because of self-harm was significantly higher in the self-harm and suicidality group (HR, 23.1; 95% CI, 17.0-31.4) compared with the self-harm only group (HR, 3.9; 95% CI, 2.3-6.7).

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These data highlight the increased risk for adverse outcomes among adolescents with self-harm. Suicidality compounds these risks and is associated in particular with recurrent clinical care for self-harm. Youth with self-harm should be a “prioritized group” for assessment and targeted treatment, researchers concluded, particularly those who also have suicidality.  


Bjureberg J, Ohlis A, Ljótsson B, et al. Adolescent self-harm with and without suicidality: cross-sectional and longitudinal analyses of a Swedish regional register [published online September 12, 2018]. J Child Psychol Psychiatry. doi:10.1111/jcpp.12967