Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study


There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose–response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from single-episode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated.

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The authors thank the European Commission Daphne Programme for providing funding for the coordination of this research, as well as the Community Fund in England, the Irish National Suicide Review Group, the National Office for Suicide Prevention and the Ireland Funds, QLD-Health and the Commonwealth of Australia, Department of Health and Ageing, and the Norwegian Foundation for Health and Rehabilitation, for funding national studies. We also acknowledge colleagues in the national centres who contributed to the work undertaken, including Udo Reulbach and Tony Fitzgerald for statistical advice, and pupils and schools that participated in the study.

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The authors declare that they have no conflict of interest.

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Correspondence to Nicola Madge.

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Madge, N., Hawton, K., McMahon, E.M. et al. Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study. Eur Child Adolesc Psychiatry 20, 499 (2011).

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  • Adolescence
  • Cross-cultural
  • Self-harm
  • Depression
  • Anxiety
  • Impulsivity
  • Self-esteem
  • Stressful life events
  • Psychological characteristics