Childhood Abuse, Neglect Linked With Nonsuicidal Self-Injury

A review and meta-analysis published in Lancet Psychiatry found that childhood sexual, emotional, and physical abuse and neglect, but not emotional neglect, are strongly associated with nonsuicidal self-injury in adolescents.

Self-injury — deliberate and direct destruction of bodily tissue without suicidal intent — has received increased focus over the past 10 years. Although in most cases self-injury ceases after a few years, in approximately 20% of cases it persists for more than 5 years. Early intervention is particularly pressing because nonsuicidal self-injury is a stronger predictor of suicide than a history of suicidal behavior.

The researchers selected 71 reports for inclusion in the meta-analysis. 

Where possible, they excluded from individual studies children who had a history of suicide attempt. The aim was to assess self-injury as a distinct behavior and clearly measure its association with childhood mistreatment in children and adolescents (age <18) and in adults (age ≥18).

Results indicate that screening for a history of childhood mistreatment can help assess the risk for nonsuicidal self-injury in males as well as females. Such screening might also be particularly beneficial when performed in a community setting as opposed to a clinical setting, in which other clinical outcomes such as depression and bipolar disease are also seen as resulting from childhood mistreatment.

The researchers also note that although self-injury was seen most often in adolescents, the maltreatment is not more strongly associated with that age group but might confer a long-term risk that extends into adolescence and adulthood. This review highlights the need to be aware of emotional abuse — the most common form of abuse — when assessing the risk for nonsuicidal self-injury.

Reference

Liu RT, Scopelliti KM, Pittman SK, Zamora AS. Childhood maltreatment and non-suicidal self-injury: a systematic review and meta-analysis [published online November 28, 2017]. Lancet Psychiat. doi:10.1016/S2215-0366(17)30469-8