Association between psychotic experiences and non-accidental self-injury: results from a nationally representative survey of adolescents

  • Emily HielscherEmail author
  • Melissa Connell
  • David Lawrence
  • Stephen R. Zubrick
  • Jennifer Hafekost
  • James G. Scott
Original Paper



The association between psychotic experiences (PEs) and non-accidental self-injury (NASI; including self-harm and suicide attempts) is well established, although variables influencing this relationship have not been comprehensively examined. This study aimed to investigate (1) the cross-sectional PE–NASI association before and after adjustment for confounders, and (2) the individual contribution of each confounding and potentially mediating variable to the association.


A random sample of Australian adolescents aged 14–17 years (n = 1998) completed self-report questions regarding any self-harm, suicidality or PEs experienced in the past 12 months in 2013–2014 as part of the Young Minds Matter Survey, a national household survey. We conducted logistic regression analyses to investigate the association between NASI and PEs, after controlling for confounders (sociodemographics, substance use, and parental mental illness) as well as the influence of potential mediators (major depression, bullying, psychological distress, sleep, self-esteem, disordered eating behaviour, social isolation, and intervention factors).


Except for special messages, all PE subtypes (auditory and visual hallucinatory experiences [HEs], and two of the three delusional experiences [DEs]) were associated with NASI after adjustment for confounders (OR range: 2.60–5.21). Depression and psychological distress significantly influenced all PE–NASI associations, where depression appeared to fully explain the DE–NASI association, and partially attenuate the HE–NASI association. Variables such as parental mental illness, disordered eating behaviour, and social isolation had negligible effects in nearly all self-harm and attempted suicide models.


Adolescents reporting any PE in the past 12 months reported increased likelihood of NASI in the same time period and, auditory HEs in particular, were strongly and independently associated with self-harm and suicide attempts. These results highlight the importance of PEs as indicators of risk of self-injurious behaviour among Australian youth.


Psychotic experiences Self-injurious behaviour Self-harm Suicide Adolescents 



The authors wish to express their gratitude to the 6310 families who participated in the survey. The authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article: The second Australian Child and Adolescent Survey of Mental Health and Wellbeing was funded by the Australian Government Department of Health. Emily Hielscher is supported by the Dr F and Mrs ME Zaccari Scholarship, Australia. Associate Professor James Scott is supported by a National Health and Medical Research Council Practitioner Fellowship Grant (Grant number 1105807). Professor Zubrick is supported by a Centre of Excellence grant from the Australian Research Council (CE140100027).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical clearance

The research protocol for the study was approved by the Australian Government Department of Health Human Research Ethics Committee, and The University of Western Australia Human Research Ethics Committee. Therefore, the study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. With permission from their parent or carer, the young person aged 14–17 years was given a copy of the Youth Information Brochure, reassured that their responses would be confidential and asked if they would like to participate. Consenting youth were given the use of a CASI tablet computer and, wherever possible, completed the questionnaire in private at the same time that the parent or carer was being interviewed in person.

Supplementary material

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Supplementary material 4 (DOCX 76 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
  2. 2.Queensland Centre for Mental Health Research (QCMHR)The Park Centre for Mental HealthBrisbaneAustralia
  3. 3.School of Public Health, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
  4. 4.Metro North Mental Health, Royal Brisbane and Women’s HospitalHerstonAustralia
  5. 5.Graduate School of EducationThe University of Western AustraliaPerthAustralia
  6. 6.Telethon Kids InstituteThe University of Western AustraliaWest PerthAustralia
  7. 7.Centre for Child Health ResearchThe University of Western AustraliaPerthAustralia

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