HBSC England is committed to studying issues which are relevant to young people’s lives. The study is tailored to cover important, up-to-date topics; for instance in the next HBSC England questionnaire we intend to include questions on cyberbullying and sleep in accordance with societal changes and gaps in current research. To coincide with the Association for Young People’s Health (AYPH) recent report on self-harm1, this blog post explains why HBSC England will be adding self-harm measures to the next survey round.
Self-harm is a complex behaviour to define; essentially it describes the intentional harming of one’s own body resulting in tissue damage2. It can involve many behaviours including cutting, burning, scratching and swallowing toxic substances. There is much debate surrounding the similarities between self-harm and suicide; researchers are divided as to whether self-harm has suicidal intent or not. Research demonstrating differences in the methods and frequency of those self-harming with the intent to kill themselves and those without3 offers support for defining self-harm as separate from suicidal ideation. The motivations for suicidal self-harm have also been shown to differ to those without suicidal intent; individuals with suicidal intent report self-harming in order to make others better off whereas non-suicidal individuals report self-harming as a way of expressing anger and to punish themselves4. However, others believe distinguishing between the two behaviours is both problematic and irrelevant. It is difficult to establish suicidal intent, and there is a consistent link between self-harm and suicide5,6; consequently researchers suggest self-harm should encompass all self-harming behaviours irrespective of intent. Defining self-harm is also made increasingly more difficult because a variety of terms are used to coin the behaviour, including self-injury, self-poisoning, para-suicide and self-mutilation.
Research has consistently shown that self-harm is a behaviour predominantly carried out by adolescents7,8; it is also more common among females than males8. The exact prevalence of self-harm is unknown; however it is estimated around 10% of adolescents report having self-harmed8. Self-harm is typically carried out in private and kept hidden, so it is very difficult to measure prevalence. Often prevalence rates have been based on hospital admissions for self-harm, but this is not an effective measure as many self-harmers do not require or seek hospital treatment. Consequently, the exact prevalence of self-harm is unknown; and could feasibly be much higher than current estimations.
The HBSC England team will include questions on self-harm in their next survey; since we want to both strengthen the evidence base around the prevalence of self-harm, and also analyse the factors in a young person’s life that may correlate with this behaviour. The aim is to not simply report the prevalence of self-harm among young people but wishes to contribute to the current understanding of the behaviour. Since the HBSC study examines young people’s lives in their broad social context and includes questions about a wide variety of aspects of young people’s lives including family, school, friends and the community; the breadth of the study makes it possible to understand self-harm in more detail. We can establish relationships between self-harm and other important factors in young people’s lives; this will help to identify factors which put them at risk of self-harming and factors which protect young people from self-harming. Recently ChildLine reported a 68% increase in children seeking help for self-harm from 2011 – 20129. This increase may suggest that self-harm is on the increase, which makes it even more important that self-harm continues to receive research attention so we can begin to fully understand the behaviour. The HBSC England team hopes the inclusion of self-harm measures in the HBSC study will allow them to make a contribution to the knowledge and understanding of self-harm among adolescents.
1 Hagell, A. (2013). Adolescent self-harm: AYPH Research Summary No. 13. Association for Young People's Health (AYPH) & ChiMat.
2 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.
3 Nagy, E., & Páli, E. (2009). Clinical diagnoses, characteristics of risk behaviour, differences between suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injury. European child & adolescent psychiatry, 18(5), 309-320.
4 Brown, M. Z., Comtois K. A., Linehan, M. M. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. J Abnormal Psychology, 111, 198–202.
5 Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jones, K. & Appleby, L. (2005). Suicide after deliberate self-harm: a 4-year cohort study. Am J Psychiatry, 162, 297– 303.
6 Nock, M. K., Joiner, T. E., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry research, 144(1), 65-72.
7 Hawton, K., Saunders. K. and O’Connor, R. (2012). Self-harm and suicide in adolescents. The Lancet, 379, 2373-82.
8 Hawton, K., Rodham, K., Evans, E., Weatherall, R. (2002) Deliberate self-harm in adolescents: self-report survey in schools in England. BMJ, 325, 1207–11.
9 Saying the unsayable: What’s affecting children in 2012. Report by ChildLine.