Past research identifies a number of risk factors for adolescent self-harm, but often fails to account for overlap between these factors. This study investigated the underlying, broader concepts by identifying different psychological profiles among adolescents. We then compared new self-harm rates over a six-month period across different psychological profiles. Australian high school students (n = 326, 68.1% female) completed a questionnaire including a broad range of psychological and socioenvironmental risk and protective factors. Non-hierarchical cluster analysis produced six groups with different psychological profiles at baseline and rate of new self-harm at follow-up. The lowest rate was 1.4% in a group that appeared psychologically healthy; the highest rate was 37.5% in a group that displayed numerous psychological difficulties. Four groups with average self-harm had varied psychological profiles including low impulsivity, anxiety, impulsivity, and poor use of positive coping strategies. Identifying multiple profiles with distinct psychological characteristics can improve detection, guide prevention, and tailor treatment.
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Armiento, J. S., Hamza, C. A., & Willoughby, T. (2014). An examination of disclosure of nonsuicidal self-injury among university students. Journal of Community and Applied Social Psychology, 24(6), 518–533. doi:10.1002/casp.
Bagley, C., & Mallick, K. (2001). Normative data and mental health construct validity for the Rosenberg self-esteem scale in British adolescents. International Journal of Adolescence and Youth, 9(2–3), 117–126. doi:10.1080/02673843.2001.9747871.
Best, R. (2006). Deliberate self-harm in adolescence: Report of a research project in some English schools. Paper presented to the European Conference on Educational Research. European Conference on Educational Research: Geneva. https://core.ac.uk/download/files/97/244236.pdf.
Barker, E. D., Arseneault, L., Brendgen, M., Fontaine, N., & Maughan, B. (2008). Joint development of bullying and victimization in adolescence: Relations to delinquency and self-harm. Journal of the American Academy of Child & Adolescent Psychiatry, 47(9), 1030–1038.
Bracken-Minor, K. L., McDevitt-Murphy, M. E., & Parra, G. R. (2012). Profiles of non-suicidal self-injurers and associated patterns of alcohol use. Journal of Psychopathology and Behavioral Assessment, 34(4), 552–563. doi:10.1007/s10862-012-9306-5.
Brunner, R., Kaess, M., Parzer, P., Fischer, G., Carli, V., Hoven, C. W., et al. (2014). Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: A comparative study of findings in 11 European countries. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 55(4), 337–348. doi:10.1111/jcpp.12166.
Booth-Kewley, S., Larson, G. E., & Miyoshi, D. K. (2007). Social desirability effects on computerized and paper-and-pencil questionnaires. Computers in Human Behavior, 23(1), 463–477. doi:10.1016/j.chb.2004.10.020.
Chisholm, K., Patterson, P., Torgerson, C., Turner, E., Jenkinson, D., & Birchwood, M. (2016). Impact of contact on adolescents’ mental health literacy and stigma: The SchoolSpace cluster randomised controlled trial. BMJ Open, 6(2), e009435 doi:10.1136/bmjopen-2015-009435.
De Leo, D., & Heller, T. S. (2004). Who are the kids who self-harm? An Australian self-report school survey. Medical Journal of Australia, 181(3), 140–144.
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75.
Duke, N., Ireland, M., & Borowsky, I. W. (2005). Identifying psychosocial problems among youth: Factors associated with youth agreement on a positive parent-completed PSC-17. Child: Care, Health and Development, 31(5), 563–573. doi:10.1111/j.1365-2214.2005.00551.x.
Fliege, H., Lee, J. R., Grimm, A., & Klapp, B. F. (2009). Risk factors and correlates of deliberate self-harm behavior: A systematic review. Journal of Psychosomatic Research, 66(6), 477–493. doi:10.1016/j.jpsychores.2008.10.013.
Folkman, S., Lazarus, R., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50(5), 992–1003.
Fortune, S. A., & Hawton, K. (2005). Deliberate self-harm in children and adolescents: A research update. Current Opinion in Psychiatry, 18(4), 401–406. doi:10.1097/01.yco.0000172059.55778.c9.
Frost, M., Casey, L., & Rando, N. (2015). Self-injury, help-seeking, and the Internet: Informing online service provision for young people. Crisis, 37(1), 68–76. doi:10.1027/0227-5910/a000346.
Guerreiro, D. F., Figueira, M. L., Cruz, D., & Sampaio, D. (2015). Coping strategies in adolescents who self-harm. Crisis, 36(1), 31–37. doi:10.1027/0227-5910/a000289.
Haavisto, A., Sourander, A., Multimäki, P., Parkkola, K., Santalahti, P., Helenius, H., et al. (2005). Factors associated with ideation and acts of deliberate self-harm among 18-year-old boys: A prospective 10-year follow-up study. Social Psychiatry and Psychiatric Epidemiology, 40(11), 912–921. doi:10.1007/s00127-005-0966-2.
Hamza, C. A., & Willoughby, T. (2013). Nonsuicidal self-injury and suicidal behavior: A latent class analysis among young adults. Plos One, 8(3), e59955. doi:10.1371/journal.pone.0059955.
Hall, B., & Place, M. (2010). Cutting to cope—a modern adolescent phenomenon. Child: Care, Health and Development, 36(5), 623–629. doi:10.1111/j.1365-2214.2010.01095.x.
Hasking, P., Rees, C. S., Martin, G., & Quigley, J. (2015). What happens when you tell someone you self-injure? The effects of disclosing NSSI to adults and peers. BMC Public Health, 15(1039), doi:10.1186/s12889-015-2383-0.
Hawton, K., Harriss, L., & Rodham, K. (2010). How adolescents who cut themselves differ from those who take overdoses. European Child & Adolescent Psychiatry, 19(6), 513–523. doi:10.1007/s00787-009-0065-0.
Hawton, K., Saunders, K. E., & O’Connor, R. (2012). Self-harm and suicide in adolescents. The Lancet, 379(9834), 2373–2382. doi:10.1016/S0140-6736(12)60322-5.
Hay, C., & Meldrum, R. (2010). Bullying victimization and adolescent self-harm: Testing hypotheses from general strain theory. Journal of Youth and Adolescence, 39(5), 446–459. doi:10.1007/s10964-009-9502-0.
Heerde, J. A., Toumbourou, J. W., Hemphill, S. A., Herrenkohl, T. I., Patton, G. C., & Catalano, R. F. (2015). Incidence and course of adolescent deliberate self-harm in Victoria, Australia, and Washington State. Journal of Adolescent Health, 57(5), 537–544. doi:10.1016/j.jadohealth.2015.07.017.
Heisel, M. J., & Flett, G. L. (2004). Purpose in life, satisfaction with life, and suicide ideation in a clinical sample, 26(2).
Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research, 11(2), 129–147. doi:10.1080/13811110701247602.
Jarvi, S., Jackson, B., Swenson, L., Crawford, H. (2013). The impact of social contagion on non-suicidal self-injury: A review of the literature. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 17(1), 1–19. doi:10.1080/13811118.2013.748404.
Jiang, Y., Perry D. K., & Hesser J. E. (2010). Suicide patterns and association with predictors among Rhode Island public high school students: A latent class analysis. American Journal of Public Health, 100(9), 1701–1707. doi:10.2105/AJPH.2009.183483.
Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
Juhnke, G. A., Granello, D. H., & Granello, P. F. (2011). Suicide, self-injury, and violence in the schools: Assessment, prevention, and intervention strategies. Hoboken, N.J.: Wiley.
Juhnke, G. A., Granello, D. H., & Granello, P. F. (2012). Suicide, self-injury, and violence in the schools: Assessment, prevention, and intervention strategies. Hoboken, NJ: Wiley.
Kaminski, J. W., Puddy, R. W., Hall, D. M., Cashman, S. Y., Crosby, A. E., & Ortega, L. A. G. (2010). The relative influence of different domains of social connectedness on self-directed violence in adolescence. Journal of Youth and Adolescence, 39(5), 460–473. doi:10.1007/s10964-009-9472-2.
Kapur, N., Cooper, J., O’Connor, R. C., & Hawton, K. (2013). Non-suicidal self-injury v. attempted suicide: New diagnosis or false dichotomy? British Journal of Psychiatry, 202(5), 326–328. doi:10.1192/bjp.bp.112.116111.
Kleiman, E. M., & Beaver, J. K. (2016). A meaningful life is worth living: Meaning in life as a suicide resiliency factor. Psychiatry Research, 210(3), 934–939. doi:10.1016/j.psychres.2013.08.002.
Klineberg, E., Kelly, M. J., Stansfeld, S. A., & Bhui, K. S. (2013). How do adolescents talk about self-harm: A qualitative study of disclosure in an ethnically diverse urban population in England. BMC Public Health, 13(572), doi:10.1186/1471-2458-13-572.
Klonsky, E. D., & Olino, T. M. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: A latent class analysis. Journal of Consulting and Clinical Psychology, 76(1), 22–27. doi:10.1037/0022-006X.76.1.22.
Knightsmith, P. (2015). Self-harm and eating disorders in schools: A guide to whole-school strategies and practical support. London, Philadelphia: Jessica Kingsley Publishers.
Kobau, R., Sniezek, J., Zack, M. M., Lucas, R. E., & Burns, A. (2010). Well-being assessment: An evaluation of well-being scales for public health and population estimates of well-being among US adults. Applied Psychology: Health and Well-Being, 2(3), 272–297. doi:10.1111/j.1758-0854.2010.01035.x.
Kraemer, H. C., Stice, E., Kazdin, A., Offord, D., & Kupfer, D. (2001). How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. American Journal of Psychiatry, 158(6), 848–856.
LaBrie, J., Earleywine, M., Lamb, T., & Shelesky, K. (2006). Comparing electronic-keypad responses to paper-and-pencil questionnaires in group assessments of alcohol consumption and related attitudes. Addictive Behaviors, 31(12). doi:10.1016/j.addbeh.2006.03.004.
Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1994). Psychosocial risk factors for future adolescent suicide attempts. Journal of Consulting and Clinical Psychology, 62(2), 297–305.
Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37(8), 1183–1192. doi:10.1017/S003329170700027X.
Lofthouse, N., & Yager-Schweller, J. (2009). Nonsuicidal self-injury and suicide risk among adolescents. Current Opinion in Pediatrics, 21(5), 641–645. doi:10.1097/MOP.0b013e3283306825.
Lundh, L., Wångby-lundh, M., & Ulander, J. (2009). Emotional tone in young adolescents’ close relationships and its association with deliberate self-harm. Interpersona, 3(1), 111–138.
Madge, N., Hawton, K., McMahon, E. M., Corcoran, P., De Leo, D., De Wilde, E. J., et al. (2011). Psychological characteristics, stressful life events and deliberate self-harm: Findings from the child & adolescent self-harm in. Europe (CASE) study. European Child and Adolescent Psychiatry, 20(10), 499–508. doi:10.1007/s00787-011-0210-4.
Madge, N., Hewitt, A., Hawton, K., de Wilde, E. J., Corcoran, P., Fekete, S., et al. (2008). Deliberate self-harm within an international community sample of young people: Comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. Journal of child psychology and psychiatry, and allied disciplines, 49(6), 667–677. doi:10.1111/j.1469-7610.2008.01879.x.
Mars, B., Heron, J., Crane, C., Hawton, K., Kidger, J., Lewis, G., et al. (2014). Differences in risk factors for self-harm with and without suicidal intent: Findings from the ALSPAC cohort. Journal of Affective Disorders, 168(2014), 407–414. doi:10.1016/j.jad.2014.07.009.
Martin, J., Bureau, J. F., Yurkowski, K., Lafontaine, M. F., & Cloutier, P. (2016). Heterogeneity of relational backgrounds is associated with variation in non-suicidal self-injurious behavior. Journal of Abnormal Child Psychology, 44(3), 511–522. doi:10.1007/s10802-015-0048-1.
McVey-Noble, M. E., Khlemlani-Patel, S., & Neziroglu, F. (2006). When your child is cutting: A parent’s guide to helping children overcome self-injury. Oakland, CA: New Harbinger Publications.
Moran, P., Coffey, C., Romaniuk, H., Olsson, C., Borschmann, R., Carlin, J. B., & Patton, G. C. (2012). The natural history of self-harm from adolescence to young adulthood: A population-based cohort study. The Lancet, 379(11), 236–243. doi:10.1016/S0140-6736(11)61141-0.
Morgan, H. G. (1979). Death wishes? The understanding and management of deliberate self-harm. Chichester: Wiley.
Muehlenkamp, J. J., Walsh, B. W., & McDade, M. (2010). Preventing non-suicidal self-injury in adolescents: The signs of self-injury program. Journal of Youth and Adolescence, 39(3), 306–314. doi:10.1007/s10964-009-9450-8.
Neto, F. (1993). The satisfaction with life scale: Psychometric properties in an adolescent sample. Journal of Youth and Adolescence, 22(2), 125–134. doi:10.1007/BF01536648.
O’Connor, R. C., Rasmussen, S., Miles, J., & Hawton, K. (2009). Self-harm in adolescents: Self-report survey in schools in Scotland. British Journal of Psychiatry, 194(1), 68–72. doi:10.1192/bjp.bp.107.047704.
O’Donnell, L., O’Donnell, C., Wardlaw, D. M., & Stueve, A. (2004). Risk and resiliency factors influencing suicidality among urban African American and Latino youth. American Journal of Community Psychology, 33(1–2), 37–49. doi:10.1023/B:AJCP.0000014317.20704.0b.
Ougrin, D., & Boege, I. (2013). The self harm questionnaire: A new tool designed to improve identification of self harm in adolescents. Journal of Adolescence, 36(1), 221–225. doi:10.1016/j.adolescence.2012.09.006.
Owens, D., Kelley, R., Munyombwe, T., Bergen, H., Hawton, K., Cooper, J., et al. (2015). Switching methods of self-harm at repeat episodes: Findings from a multicentre cohort study. Journal of Affective Disorders, 180(2015), 44–51. doi:10.1016/j.jad.2015.03.051.
Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez, L. (1998). Patterns of positive and negative religious coping with major life stressors. Journal for the Scientific Study of Religion, 37(4), 710–724. doi:10.1086/250095.
Perry, Y., Petrie, K., Buckley, H., Cavanagh, L., Clarke, D., Winslade, M., et al. (2014). Effects of a classroom-based educational resource on adolescent mental health literacy: A cluster randomised controlled trial. Journal of Adolescence, 37(7), 1143–1151. doi:10.1016/j.adolescence.2014.08.001.
Piko, B. (2001). Gender differences and similarities in adolescents’ ways of coping. The Psychological Record, 51(2), 223–235.
Plante, T. G., Vallaeys, C. L., Sherman, A. C., & Wallston, K. A. (2002). The development of a brief version of the Santa Clara strength of religious faith questionnaire. Pastoral Psychology, 50(5), 359–368. doi:10.1023/A:1014413720710.
Rigby, K., & Slee, P. T. (1993). Dimensions of interpersonal relation among Australian children and implications for psychological well-being. Journal of Chemical Information and Modeling, 133(1), 33–42. doi:10.1017/CB O9781107415324.004.
Robinson, J., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., & O’Brien, M. (2013). A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide-related behavior in young people. Crisis, 34(3), 164–182. doi:10.1027/0227-5910/a000168.
Robinson, J., Gook, S., Yuen, H. P., McGorry, P. D., & Yung, A. R. (2008). Managing deliberate self-harm in young people: An evaluation of a training program developed for school welfare staff using a longitudinal research design. BMC Psychiatry, 8, 75. doi:10.1186/1471-244X-8-75.
Robinson, J., Hetrick, S. E., & Martin, C. (2011). Preventing suicide in young people: Systematic review. Australian and New Zealand Journal of Psychiatry, 45(1), 3–26.
Robinson, J., McCutcheon, L., Browne, V., & Witt, K. (2016). Looking the other way: Young people and self-harm. Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne.
Roffman, J. G., Pagano, M. E., & Hirsch, B. J. (2001). Youth functioning and experiences in inner-city after-school programs among age, gender, and race groups. Journal of Child and Family Studies, 10(1), 85–100. doi:10.1023/A.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.
Rubenstein, J. L., Halton, A., Kasten, L., Rubin, C., & Stechler, G. (1998). Suicidal behavior in adolescents: Stress and protection in different family contexts. The American Journal of Orthopsychiatry, 68(2), 274–284. doi:10.1037/h0080336.
Somer, O., Bildik, T., Kabukçu-Başay, B., Güngör, D., Başay, Ö., & Farmer, R. F. (2015). Prevalence of non-suicidal self-injury and distinct groups of self-injurers in a community sample of adolescents. Social Psychiatry and Psychiatric Epidemiology, 50(7), 1163–1171. doi:10.1007/s00127-015-1060-z.
Stallard, P., Spears, M., Montgomery, A. A., Phillips, R., & Sayal, K. (2013). Self-harm in young adolescents (12-16 years): Onset and short-term continuation in a community sample. BMC Psychiatry, 13(1), 328. doi:10.1186/1471-244X-13-328.
Stanford, S., & Jones, M. P. (2010). How much detail needs to be elucidated in self-harm research?. Journal of Youth and Adolescence, 39(5), 504–513. doi:10.1007/s10964-009-9492-y.
Stanford, S., & Jones, M. P. (2012). Psychological profile in an adolescent community sample: Its relation to self-harm. In A. M. Columbia (Ed.), Advances in psychology research (pp. 77–92). New York: Nova Science Publishers.
Stanford, S., & Jones, M. P. (2015). Finding focus in adolescent self-harm research: A literature review to guide research into risk and protective factors for self-harm. Manuscript Submitted for Publication.
Swenson, P. L. (2003). A psychometric study of the Rosenberg Self-Esteem Scale: An investigation of gender differences. Retrieved from https://open.library.ubc.ca/cIRcle/collections/831/items/1.0053822.
Taliaferro, L. A., & Muehlenkamp, J. J., (2014). Risk and protective factors that distinguish adolescents who attempt suicide from those who only consider suicide in the past year. Suicide and Life-Threatening Behavior, 44(1), 6–22. doi:10.1111/sltb.12046.
Thullen, M. J., Taliaferro, L. A., & Muehlenkamp, J. J. (2015). Suicide ideation and attempts among adolescents engaged in risk behaviors: A latent class analysis. Journal of Research on Adolescence, 26(3), 587–594. doi:10.1111/jora.12199.
Tolmunen, T., Rissanen, M.-L., Hintikka, J.,Maaranen, P., Honkalampi, K., Kylmä, J., & Laukkanen, E. (2008). Dissociation, self-cutting, and other self-harm behavior in a general population of Finnish adolescents. The Journal of Nervous and Mental Disease, 196(10), 768–771. doi:10.1097/NMD.0b013e3181879e11.
Townsend, E., Wadman, R., Sayal, K., Armstrong, M., Harroe, C., Majumder, P., et al. (2016). Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS). Journal of Affective Disorders, 206, 161–168. doi:10.1016/j.jad.2016.07.004.
Vaux, A. (1988). Social Support: Theory, Research, and Intervention. New York: Praeger.
Wadman, R., Clarke, D., Sayal, K., Vostanis, P., Armstrong, M., Harroe, C., et al. (2016). An interpretative phenomenological analysis of the experience of self-harm repetition and recovery in young adults. Journal of Health Psychology, http://doi.org/10.1177/1359105316631405.
Wasserman, D., Hoven, C. W., Wasserman, C., Wall, M., Eisenberg, R., Hadlaczky, G., et al. (2015). School-based suicide prevention programmes: The SEYLE cluster-randomised, controlled trial. The Lancet, 385(9977), 1536–1544. doi:10.1016/S0140-6736(14)61213-7.
White, D., Leach, C., Sims, R., Atkinson, M., & Cottrell, D. (1999). Validation of the hospital anxiety and depression scale for use with adolescents. British Journal of Psychiatry, 175(5), 452–454.
Whitlock, J. L., Muehlenkamp, J., & Eckenrode, J. (2008). Variation in nonsuicidal self-injury: Identification and features of latent classes in a college population of emerging adults. Journal of Clinical Child and Adolescent Psychology, 37(4), 725–735. doi:10.1080/15374410802359734.
Wilcox, H. C., Arria, A. M., Caldeira, K. M., Vincent, K. B., Pinchevsky, G. M., & O’Grady, K. E. (2012). Longitudinal predictors of past-year non-suicidal self-injury and motives among college students. Psychological Medicine, 42(4), 717–726. doi:10.1017/S0033291711001814.
Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., & Pena, J. B. (2008). Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology, 76(1), 104–115. doi:10.1037/0022-006X.76.1.104.
Yoshimasu, K., Kiyohara, C., & Miyashita, K., (2008). Suicidal risk factors and completed suicide: Meta-analyses based on psychological autopsy studies. Environmental Health and Preventive Medicine, 13(5), 243–256. doi:10.1007/s12199-008-0037-x.
Zigmond, A. S., & Snaith, R. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.
S.S. participated in writing, design, and analysis, and carried out the data collection. M.J. contributed to writing, design, and analysis. J.H. provided clinical guidance and feedback on the manuscript. All authors read and approved the final manuscript.
Conflict of Interest
The authors declare that they have no competing interests.
The study was reviewed and approved by the Macquarie University Human Research Ethics Committee, reference number 5201400575.
The project was approved by the School Principal, Executive and school counsellors in each school. Parents and students provided opt-in informed consent at the first time point; this consent covered the baseline and follow-up survey. At the follow-up, parents were provided the full study information and the opportunity to opt-out on behalf of their teen, and students again provided opt-in informed consent.
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Stanford, S., Jones, M.P. & Hudson, J.L. Appreciating Complexity in Adolescent Self-Harm Risk Factors: Psychological Profiling in a Longitudinal Community Sample. J Youth Adolescence 47, 916–931 (2018). https://doi.org/10.1007/s10964-017-0721-5
- Risk factors
- Psychological profiles