Population attributable risk of factors associated with the repetition of self-harm behaviour in young people presenting to clinical services: a systematic review and meta-analysis
- 539 Downloads
The repetition of hospital-treated self-harm by young people is common. However, little work has summarised the modifiable factors associated with this. A thorough understanding of those factors most strongly associated with repetition could guide the development of relevant clinical interventions. We systematically reviewed four databases (EMBASE, Medline, PubMed and PsycINFO) until 15 April 2016 to identify all observational studies of factors for the repetition of self-harm or suicide reattempts (together referred to as ‘self-harm behaviour’) in young people. We quantified the magnitude of association with odds ratios (OR) and 95% confidence intervals (CIs) and calculated the population attributable risk (PAR) and population preventable fraction (PPF) for modifiable factors to provide an indication of the potential impact in reducing subsequent self-harm behaviour in this population. Seventeen studies were included comprising 10,726 participants. Borderline personality disorder (OR 3.47, 95% CI 1.84–6.53; PAR 42.4%), any personality disorder (OR 2.54, 95% CI 1.71–3.78; PAR 16.3%), and any mood disorder (OR 2.16, 95% CI 1.09–4.29; PAR 42.2%) are important modifiable risk factors. Severity of hopelessness (OR 2.95, 95% CI 1.74–5.01), suicidal ideation (OR 2.01, 95% CI 1.43–2.81), and previous sexual abuse (OR 1.52, 95% CI 1.02–2.28; PAR 12.8%) are also associated with repetition of self-harm. We recommend that clinical services should focus on identifying key modifiable risk factors at the individual patient level, whilst the reduction of exposure to child and adolescent sexual abuse would also be a useful goal for public health interventions.
KeywordsChildren Adolescents Young people Self-harm Suicide
The authors gratefully acknowledge the help received by a research assistant, Humaria Maheen, in assisting with ancestry searching.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to declare.
Ethics approval statement
Ethical approval and participant consent were not required for this review, since the study involved review and analysis of previously published data.
Role of the funding source
This work was supported by the Victorian Department of Health and Human Services (DHHS) (Reference number: C4892). Individual authors would also like to acknowledge the following sources of funding: KW is funded by an American Foundation for Suicide Prevention Post-Doctoral Fellowship (Reference number: PDF-0-145-16), SH is funded by an Auckland Medical Research Foundation Douglas Goodfellow Repatriation Fellowship, JR is funded by an NHMRC Early Career Fellowship, and JP is funded by an NHMRC Senior Research Fellowship. Funders had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript.
- 2.Hawton K, Witt K, Taylor Salisbury T, Arensman E, Gunnell D, Hazell P, Townsend E, van Heeringen K (2016) Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 5:CD012189Google Scholar
- 4.Australian Institute of Health and Welfare (2013) Trends in hospitalised injury, Australia, 1999–00 to 2010–11. Injury Research and Statistics Series, number 86. Australian Institute of Health and Welfare, Canberra, ACTGoogle Scholar
- 12.Madge N, Hewitt A, Hawton K, Wilde EJD, Corcoran P, Fekete S, van Heeringen K, De Leo D, Ystgaard M (2008) Deliberate self-harm within an international community sample of young people: comparative findings from the Child and Adolescent Self-harm in Europe (CASE) Study. J Child Psychol Psychiatry 49(6):667–677CrossRefGoogle Scholar
- 13.World Health Organisation (2014) Preventing Suicide: a global imperative. World Health Organisation, GenevaGoogle Scholar
- 14.National Institute for Health and Care Excellence (2004) Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. National Instutute of Clinical Excellence, LondonGoogle Scholar
- 15.National Institute for Health and Care Excellence (2011) Self-harm: longer term management. National Collaborating Centre for Mental Health and the British Psychological Society, LeiceserGoogle Scholar
- 16.Royal College of Psychiatrists (2010) Self-harm, Suicide and Risk: Helping People who Self-Harm [college report: CR158]. Royal College of Psychiatrists, LondonGoogle Scholar
- 17.Carter G, Page A, Large M, Hetrick S, Milner A, Bendit N, Walton C, Draper B, Hazell P, Fortune S, Burns J, Patton G, Lawrence M, Dadd L, Robinson J, Christensen H (2016) Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm. Aust N Z J Psychiatry 50:939–1000CrossRefGoogle Scholar
- 22.Madge N, Hawton K, McMahon E, Corcoran P, De Leo D, De Wilde E, Fekete S, Van Heeringen K, Ystgaard M, Arensman E (2011) Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child and Adolescent Self-Harm in Europe (CASE) study. Eur Child Adolesc Psychiatry 20:499–508CrossRefGoogle Scholar
- 25.Moher D, Liberati A, Tetzlaff J, Altman D (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS ONE 6:e1000097Google Scholar
- 28.Beghi M, Rosenbaum J, Cerri C, Cornaggia C (2013) Risk factors for fatal and non-fatal repetition of suicide attempts: a literature review. Neuropsychiatr Dis Treat 9:1725–1736Google Scholar
- 37.Deeks J, Higgins J, Altman D (2011) Analysing data and undertaking meta-analyses. In: Higgins J, Green S (eds) Cochrane handbook of systematic reviews of interventions. The Cochrane Collaboration, LondonGoogle Scholar
- 42.BioStat (2014) Comprehensive Meta-Analysis (version 3.3.070). Biostat Corporation, Englewood, NJGoogle Scholar
- 43.National Heart Lung and Blood Institute (2014) Quality assessment tool for observational cohort and cross-sectional studies. http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort. Accessed 1 Apr 2016
- 44.Burns C, Cortell R, Wagner B (2008) Treatment compliance in adolescents after attempted suicide: a two-year follow-up study. J Am Acad Child Adolesc Psychiatry 47:948–957Google Scholar
- 55.Hultén A, Jiang G-X, Wasserman D, Hawton K, Hjelmeland H, De Leo D, Ostamo A, Salander Renberg E, Schmidtke A (2001) Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors. Eur Child Adolesc Psychiatry 10:161–169Google Scholar
- 56.Consoli A, Cohen D, Bodeau N, Guilé J-M, Mirkovic B, Knafo A, Mahé V, Laurent C, Renaud J, Labelle R, Breton J-J, Gérardin P (2015) Risk and protective factors for suicidality at 6-month follow-up in adolescent inpatients who attempted suicide: an exploratory model. Can J Psychiatry 60:s27–s36Google Scholar
- 62.McDermott B, Baigent M, Chanen A, Fraser L, Graetz B, Hayman N, Newman L, Parikh N, Peirce B, Proimos J, Smalley T, Spence S (2010) Clinical practice guidelines: depression in adolescents and young adults. Beyondblue: The National Depression Initiative, MelbourneGoogle Scholar
- 64.National Institute for Health and Care Excellence (2005) Depression in children and young people: identification and management in primary, community and secondary care [Clinical Practice Guidelines, no. 28]. British Psychological Society, LeicesterGoogle Scholar
- 67.Hawton K, Witt K, Taylor Salisbury T, Arensman E, Gunnell D, Townsend E, van Heeringen K, Hazell P (2015) Interventions for self-harm in children and adolescents. Cochrane Database Syst Rev 12:CD012013Google Scholar
- 71.Walsh K, Zwi K, Woolfenden S, Shlonsky A (2015) School-based education programmes for the prevention of child sexual abuse. Cochrane Database Syst Rev 4:CD004380Google Scholar