European Child & Adolescent Psychiatry

, Volume 28, Issue 3, pp 329–339 | Cite as

Adolescent personality traits, low self-esteem and self-harm hospitalisation: a 15-year follow-up of the Norwegian Young-HUNT1 cohort

  • Asbjørn JunkerEmail author
  • Hans Morten Nordahl
  • Johan Håkon Bjørngaard
  • Ottar Bjerkeset
Original Contribution


Affective disorders are closely related to self-harm and suicidal behaviours. Less is known about how adolescent personality traits and self-esteem influence the development of later self-harm. We examined associations between personality traits such as neuroticism, psychoticism and extroversion, and self-esteem, in adolescence, and the risk of future self-harm hospitalisation. Baseline information from 13 to 19-year-old participants in the Norwegian Young-HUNT1 study in 1995–97 (n = 8965) was linked to endpoint data recorded from participants’ hospital records, describing self-harm hospitalisation episodes within the catchment area. Crude and adjusted hazard ratios (HR) were estimated by Cox regression analyses. A one-unit increase on the 0–6 scale for neuroticism was associated with a HR of 1.29, 95% confidence interval (CI) 1.14–1.47. Corresponding HR for psychoticism was 1.30, 95% CI 1.03–1.63 per unit increase, and for extroversion risk was reduced (HR 0.89, 95% CI 0.77–1.04). Positive perception of self-esteem was more strongly associated with reduced risk of self-harm hospitalisation (HR per unit increase on the 0–12 scale was 0.74, 95% CI 0.68–0.82). Additional adjustment for alcohol use and symptoms of combined anxiety and depression symptoms attenuated effect estimates, in particular for neuroticism (HR 1.13, 95% CI 0.96–1.32) and psychoticism (HR 1.07, 95% CI 0.82–1.40). In contrast, self-esteem associations remained largely the same after adjustment. Our results indicate that brief assessments of personality and self-esteem might add additional relevant information, and could be included as a supplement to standard suicidal risk assessment in adolescents.


Self-harm Hospitalisation Adolescence Personality traits Self-esteem 



Nord-Trøndelag Hospital Trust employees Geir Anders By Lervåg, Ingrid Lundstadsveen and Unni Veie Lynum helped with the recording of outcome data (self-harm hospitalisations). The Nord-Trøndelag Health Study (The HUNT Study) is a collaboration between HUNT Research Centre (Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology), Nord-Trøndelag County Council, Central Norway Health Authority, and the Norwegian Institute of Public Health. This was not an industry supported study. The work was supported by the Norwegian University of Science and Technology (Grant no. 2015/3436/NRS).

Compliance with ethical standards

Ethical standards

This study was approved by the Regional Committee for Medical and Health Research Ethics (2010/1924-3). All participants gave written informed consent to use Young-HUNT1 data in medical research, including a parental consent for participants younger than 16 years.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Hawton K, Harriss L, Hall S, Simkin S, Bale E, Bond A (2003) Deliberate self-harm in Oxford, 1990–2000: a time of change in patient characteristics. Psychol Med 33(6):987–995PubMedGoogle Scholar
  2. 2.
    Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Townsend E, van Heeringen K, Hazell P (2015) Interventions for self-harm in children and adolescents. Cochrane Database Syst Rev. Google Scholar
  3. 3.
    Hawton K, Hall S, Simkin S, Bale L, Bond A, Codd S, Stewart A (2003) Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990–2000. J Child Psychol Psychiatry 44(8):1191–1198PubMedGoogle Scholar
  4. 4.
    Hawton K, Fagg J, Simkin S, Bale E, Bond A (1997) Trends in deliberate self-harm in Oxford, 1985–1995. Implications for clinical services and the prevention of suicide. Br J Psychiatry 171:556–560PubMedGoogle Scholar
  5. 5.
    O’Carroll PW, Berman AL, Maris RW, Moscicki EK, Tanney BL, Silverman MM (1996) Beyond the tower of Babel: a nomenclature for suicidology. Suicide Life Threat Behav 26(3):237–252PubMedGoogle Scholar
  6. 6.
    Silverman MM, Berman AL, Sanddal ND, O’Carroll PW, Joiner TE (2007) Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 37(3):264–277. PubMedGoogle Scholar
  7. 7.
    Lloyd-Richardson EE, Perrine N, Dierker L, Kelley ML (2007) Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med 37(8):1183–1192. PubMedPubMedCentralGoogle Scholar
  8. 8.
    Bjärehed J, Wångby-Lundh M, Lundh L-G (2012) Nonsuicidal self-injury in a community sample of adolescents: subgroups, stability, and associations with psychological difficulties. J Res Adolesc 22(4):678–693. Google Scholar
  9. 9.
    Muehlenkamp JJ, Claes L, Havertape L, Plener PL (2012) International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health 6:10. PubMedPubMedCentralGoogle Scholar
  10. 10.
    Kapur N, Cooper J, O’Connor RC, Hawton K (2013) Non-suicidal self-injury v. attempted suicide: new diagnosis or false dichotomy? Br J Psychiatry 202(5):326–328. PubMedGoogle Scholar
  11. 11.
    Singhal A, Ross J, Seminog O, Hawton K, Goldacre MJ (2014) Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage. J R Soc Med 107(5):194–204. PubMedPubMedCentralGoogle Scholar
  12. 12.
    Black DW, Blum N, Pfohl B, Hale N (2004) Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention. J Pers Disord 18(3):226–239. PubMedGoogle Scholar
  13. 13.
    Evans E, Hawton K, Rodham K, Deeks J (2005) The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies. Suicide Life Threat Behav 35(3):239–250PubMedGoogle Scholar
  14. 14.
    Nada-Raja S, Skegg K, Langley J, Morrison D, Sowerby P (2004) Self-harmful behaviors in a population-based sample of young adults. Suicide Life Threat Behav 34(2):177–186. PubMedGoogle Scholar
  15. 15.
    Schmidtke A, Bille-Brahe U, DeLeo D, Kerkhof A, Bjerke T, Crepet P, Haring C, Hawton K, Lonnqvist J, Michel K, Pommereau X, Querejeta I, Phillipe I, Salander-Renberg E, Temesvary B, Wasserman D, Fricke S, Weinacker B, Sampaio-Faria JG (1996) Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatr Scand 93(5):327–338PubMedGoogle Scholar
  16. 16.
    Wichstrom L (2009) Predictors of non-suicidal self-injury versus attempted suicide: similar or different? Arch Suicide Res 13(2):105–122. PubMedGoogle Scholar
  17. 17.
    Matsumoto T, Imamura F (2008) Self-injury in Japanese junior and senior high-school students: prevalence and association with substance use. Psychiatry Clin Neurosci 62(1):123–125. PubMedGoogle Scholar
  18. 18.
    Taliaferro LA, Muehlenkamp JJ (2015) Risk factors associated with self-injurious behavior among a national sample of undergraduate college students. J Am Coll Health 63(1):40–48. PubMedGoogle Scholar
  19. 19.
    Plener PL, Schumacher TS, Munz LM, Groschwitz RC (2015) The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature. Borderline Personal Disord Emot Dysregul 2:2. PubMedPubMedCentralGoogle Scholar
  20. 20.
    Skegg K (2005) Self-harm. Lancet 366(9495):1471–1483. PubMedGoogle Scholar
  21. 21.
    Nock MK (2010) Self-injury. Annu Rev Clin Psychol 6:339–363. PubMedGoogle Scholar
  22. 22.
    Brezo J, Paris J, Turecki G (2006) Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatr Scand 113(3):180–206. PubMedGoogle Scholar
  23. 23.
    McCrae RR, John OP (1992) An introduction to the five-factor model and its applications. J Pers 60(2):175–215PubMedGoogle Scholar
  24. 24.
    Eysenck HJ (1992) The definition and measurement of psychoticism. Pers Individ Differ 13(7):757–785. Google Scholar
  25. 25.
    Eysenck HJ, Eysenck SBG (1975) Manual of the Eysenck Personality Questionnaire (junior and adult). Hodder and Stoughton, LondonGoogle Scholar
  26. 26.
    Caruso JC, Witkiewitz K, Belcourt-Dittloff A, Gottlieb JD (2001) Reliability of Scores from the Eysenck Personality Questionnaire: a Reliability Generalization Study. Educ Psychol Measur 61(4):675–689. Google Scholar
  27. 27.
    Allroggen M, Kleinrahm R, Rau TA, Weninger L, Ludolph AG, Plener PL (2014) Nonsuicidal self-injury and its relation to personality traits in medical students. J Nerv Ment Dis 202(4):300–304. PubMedGoogle Scholar
  28. 28.
    Lockwood J, Daley D, Townsend E, Sayal K (2016) Impulsivity and self-harm in adolescence: a systematic review. Eur Child Adolesc Psychiatry. PubMedPubMedCentralGoogle Scholar
  29. 29.
    Di Pierro R, Sarno I, Perego S, Gallucci M, Madeddu F (2012) Adolescent nonsuicidal self-injury: the effects of personality traits, family relationships and maltreatment on the presence and severity of behaviours. Eur Child Adolesc Psychiatry 21(9):511–520. PubMedGoogle Scholar
  30. 30.
    DeShong HL, Tucker RP, O’Keefe VM, Mullins-Sweatt SN, Wingate LR (2015) Five factor model traits as a predictor of suicide ideation and interpersonal suicide risk in a college sample. Psychiatry Res 226(1):217–223. PubMedGoogle Scholar
  31. 31.
    Fergusson DM, Woodward LJ, Horwood LJ (2000) Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychol Med 30(1):23–39PubMedGoogle Scholar
  32. 32.
    Fergusson DM, Beautrais AL, Horwood LJ (2003) Vulnerability and resiliency to suicidal behaviours in young people. Psychol Med 33(1):61–73PubMedGoogle Scholar
  33. 33.
    Hankin BL, Abela JR (2011) Nonsuicidal self-injury in adolescence: prospective rates and risk factors in a 2(1/2) year longitudinal study. Psychiatry Res 186(1):65–70. PubMedPubMedCentralGoogle Scholar
  34. 34.
    Sowislo JF, Orth U (2013) Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychol Bull 139(1):213–240. PubMedGoogle Scholar
  35. 35.
    Robins RW, Tracy JL, Trzesniewski K, Potter J, Gosling SD (2001) Personality correlates of self-esteem. J Res Pers 35(4):463–482Google Scholar
  36. 36.
    Hawton K, James A (2005) Suicide and deliberate self harm in young people. BMJ 330(7496):891–894. PubMedPubMedCentralGoogle Scholar
  37. 37.
    Ystgaard M, Reinholdt NP, Husby J, Mehlum L (2003) Deliberate self harm in adolescents. Tidsskr Nor Laegeforen 123(16):2241–2245PubMedGoogle Scholar
  38. 38.
    O’Connor RC, Rasmussen S, Hawton K (2009) Predicting deliberate self-harm in adolescents: a six month prospective study. Suicide Life Threat Behav 39(4):364–375. PubMedGoogle Scholar
  39. 39.
    Boden JM, Fergusson DM, Horwood LJ (2008) Does adolescent self-esteem predict later life outcomes? A test of the causal role of self-esteem. Dev Psychopathol 20(1):319–339. PubMedGoogle Scholar
  40. 40.
    Holmen TL, Bratberg G, Krokstad S, Langhammer A, Hveem K, Midthjell K, Heggland J, Holmen J (2014) Cohort profile of the Young-HUNT Study, Norway: a population-based study of adolescents. Int J Epidemiol 43(2):536–544. PubMedGoogle Scholar
  41. 41.
    Junker A, Bjorngaard JH, Gunnell D, Bjerkeset O (2014) Sleep problems and hospitalization for self-harm: a 15-year follow-up of 9000 Norwegian adolescents. The Young-HUNT Study. Sleep 37(3):579–585. PubMedPubMedCentralGoogle Scholar
  42. 42.
    Eysenck SBG, Eysenck HJ, Barrett P (1985) A revised version of the psychoticism scale. Personality Individ Differ 6(1):21–29. Google Scholar
  43. 43.
    Rosenberg M (1962) The association between self-esteem and anxiety. J Psychiatr Res 1(2):135–152. PubMedGoogle Scholar
  44. 44.
    Ystgaard M (1993) Sårbar ungdom og sosial støtte: en tilnærming til forebygging av psykisk stress og selvmord. Senter for sosialt nettverk og helseGoogle Scholar
  45. 45.
    Sandanger I, Sørensen T, Nordkyst P, Universitetet IO (2004) Ubevisst sjeleliv og bevisst samfunnsliv: psykisk helse i en sammenheng: festskrift til Tom Sørensen på hans 60-årsdag. Universitetet i Oslo Nordkyst psykiatri, OsloGoogle Scholar
  46. 46.
    Strand BH, Dalgard OS, Tambs K, Rognerud M (2003) Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nord J Psychiatry 57(2):113–118. PubMedGoogle Scholar
  47. 47.
    Junker A, Bjorngaard JH, Bjerkeset O (2017) Adolescent health and subsequent risk of self-harm hospitalisation: a 15-year follow-up of the Young-HUNT cohort. Child Adolesc Psychiatry Ment Health 11:25. PubMedPubMedCentralGoogle Scholar
  48. 48.
    Strandheim A, Holmen TL, Coombes L, Bentzen N (2009) Alcohol intoxication and mental health among adolescents–a population review of 8983 young people, 13–19 years in North-Trondelag, Norway: the Young-HUNT Study. Child Adolesc Psychiatry Ment Health 3(1):18. PubMedPubMedCentralGoogle Scholar
  49. 49.
    StataCorp LLC (2016) STATA. Data analysis and statistical software. Accessed 01 Feb 2017
  50. 50.
    Jeronimus BF, Kotov R, Riese H, Ormel J (2016) Neuroticism’s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants. Psychol Med 46(14):2883–2906. PubMedGoogle Scholar
  51. 51.
    Aldinger M, Stopsack M, Ulrich I, Appel K, Reinelt E, Wolff S, Grabe HJ, Lang S, Barnow S (2014) Neuroticism developmental courses–implications for depression, anxiety and everyday emotional experience; a prospective study from adolescence to young adulthood. BMC Psychiatry 14:210. PubMedPubMedCentralGoogle Scholar
  52. 52.
    Mykletun A, Bjerkeset O, Dewey M, Prince M, Overland S, Stewart R (2007) Anxiety, depression, and cause-specific mortality: the HUNT study. Psychosom Med 69(4):323–331. PubMedGoogle Scholar
  53. 53.
    Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJ, ten Have M, Stein MB (2005) Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Arch Gen Psychiatry 62(11):1249–1257. PubMedGoogle Scholar
  54. 54.
    van de Laar M, Verbeek I, Pevernagie D, Aldenkamp A, Overeem S (2010) The role of personality traits in insomnia. Sleep Med Rev 14(1):61–68. PubMedGoogle Scholar
  55. 55.
    Bjorngaard JH, Bjerkeset O, Romundstad P, Gunnell D (2011) Sleeping problems and suicide in 75,000 Norwegian adults: a 20 year follow-up of the HUNT I study. Sleep 34(9):1155–1159. PubMedPubMedCentralGoogle Scholar
  56. 56.
    Baetens I, Claes L, Willem L, Muehlenkamp J, Bijttebier P (2011) The relationship between non-suicidal self-injury and temperament in male and female adolescents based on child- and parent-report. Personal Individ Differ 50(4):527–530. Google Scholar
  57. 57.
    Goodwin RD, Fergusson DM, Horwood LJ (2003) Neuroticism in adolescence and psychotic symptoms in adulthood. Psychol Med 33(6):1089–1097PubMedGoogle Scholar
  58. 58.
    Martin G, Thomas H, Andrews T, Hasking P, Scott JG (2015) Psychotic experiences and psychological distress predict contemporaneous and future non-suicidal self-injury and suicide attempts in a sample of Australian school-based adolescents. Psychol Med 45(2):429–437. PubMedGoogle Scholar
  59. 59.
    Gray JA, McNaughton N (2000) The neuropsychology of anxiety: an enquiry into the functions of the septohippocampal system, 2nd edn. Oxford University Press, OxfordGoogle Scholar
  60. 60.
    Ohmann S, Schuch B, Konig M, Blaas S, Fliri C, Popow C (2008) Self-injurious behavior in adolescent girls. Association with psychopathology and neuropsychological functions. Psychopathology 41(4):226–235. PubMedGoogle Scholar
  61. 61.
    Klein DN, Kotov R, Bufferd SJ (2011) Personality and depression: explanatory models and review of the evidence. Annu Rev Clin Psychol 7:269–295. PubMedPubMedCentralGoogle Scholar
  62. 62.
    Hawton K, Saunders KE, O’Connor RC (2012) Self-harm and suicide in adolescents. Lancet 379(9834):2373–2382. PubMedGoogle Scholar
  63. 63.
    Jylha P, Mantere O, Melartin T, Suominen K, Vuorilehto M, Arvilommi P, Leppamaki S, Valtonen H, Rytsala H, Isometsa E (2010) Differences in neuroticism and extraversion between patients with bipolar I or II and general population subjects or major depressive disorder patients. J Affect Disord 125(1–3):42–52. PubMedGoogle Scholar
  64. 64.
    Hirvikoski T, Jokinen J (2012) Personality traits in attempted and completed suicide. Eur Psychiatry 27(7):536–541. PubMedGoogle Scholar
  65. 65.
    Goodwin RD, Fergusson DM, Horwood LJ (2004) Panic attacks and psychoticism. AJ. Psychiatry 161(1):88–92. Google Scholar
  66. 66.
    Streiner DL (2003) Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess 80(1):99–103. PubMedGoogle Scholar
  67. 67.
    Eysenck HJ, Eysenck SBG (1994) Eysenck personality questionnaire (EPQ-R Adult): comprising the EPQ-Revised (EPQ-R) & EPQ-R Short Scale. EdITS/Educational and Industrial Testing Service, San DiegoGoogle Scholar
  68. 68.
    Heaven PC, Ciarrochi J, Leeson P, Barkus E (2013) Agreeableness, conscientiousness, and psychoticism: distinctive influences of three personality dimensions in adolescence. Br J Psychol 104(4):481–494. PubMedGoogle Scholar
  69. 69.
    Madge N, Hawton K, McMahon EM, Corcoran P, De Leo D, de Wilde EJ, Fekete S, van Heeringen K, Ystgaard M, Arensman E (2011) 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(10):499–508. PubMedGoogle Scholar
  70. 70.
    Dieserud G, Roysamb E, Ekeberg O, Kraft P (2001) Toward an integrative model of suicide attempt: a cognitive psychological approach. Suicide Life Threat Behav 31(2):153–168PubMedGoogle Scholar
  71. 71.
    Hjemdal O, Aune T, Reinfjell T, Stiles TC, Friborg O (2007) Resilience as a predictor of depressive symptoms: a correlational study with young adolescents. Clin Child Psychol Psychiatry 12(1):91–104. PubMedGoogle Scholar
  72. 72.
    Tatnell R, Kelada L, Hasking P, Martin G (2014) Longitudinal analysis of adolescent NSSI: the role of intrapersonal and interpersonal factors. J Abnorm Child Psychol 42(6):885–896. PubMedGoogle Scholar
  73. 73.
    Erol RY, Orth U (2011) Self-esteem development from age 14 to 30 years: a longitudinal study. J Pers Soc Psychol 101(3):607–619. PubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Mental Health, Faculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyTrondheimNorway
  2. 2.St. Olavs University Hospital, Nidaros DPSTrondheimNorway
  3. 3.Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyTrondheimNorway
  4. 4.Forensic Department and Research Centre BrøsetSt. Olavs University HospitalTrondheimNorway
  5. 5.Faculty of Nursing and Health SciencesNord UniversityLevangerNorway

Personalised recommendations