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In the Jack Tizard Memorial Lecture during the Association for Child and Mental Health National Conference at the Royal College of Physicians, Professor Keith Hawton, highlighted the very worrying recent increases in rates of suicide in England in older adolescents and the big rise in self-harm in young teenage females.

Professor Hawton described the Iceberg model of self-harm and suicide, emphasising the largely "hidden" population of teenagers who self-harm in the community, but do not present to clinical services. For each young person who self-harms and presents to hospital there are at least 10 individuals who self-harm and do not go to hospital.

Iceberg40.jpg

There is clearly a need for preventive interventions, especially in schools, and possibly online, together with good quality hospital-based clinical services and community treatment services for adolescents who self-harm.

Onset of self-harm is strongly associated with puberty, especially in girls. In the early teenage years girls self-harming outnumber boys some 4-6 fold.

A wide range of factors contribute to risk of self-harm and suicide, such as family disruption through separation or death, parental mental disorder and adverse childhood experiences, together with contemporaneous factors such as interpersonal issues with family or friends, bullying (including cyber-bullying) sleep disorders and mood instability.

The majority of youngsters who present to hospital following self-harm, or die by suicide, show evidence of mental disorder, particularly depression, anxiety, ADHD, and eating disorders. Alcohol misuse is a relevant contributory factor. Emerging personality disorder and psychological characteristics, such as low self-esteem, poor problem solving and perfectionism, are also relevant.

Contagion is a common feature of self-harm in young people, with exposure to self-harm by others increasing the risk. As a result, clusters of self-harm and suicide are not uncommon in teenagers. The influence of inappropriate media reporting and portrayal of suicidal behaviour is particularly strong in young people. Internet sites portraying self-harm are often accessed by young people prior to harming themselves. The extent to which support and interactions through social networking sites may be helpful or harmful is unclear.

Professor Hawton presented a new study led by the Oxford University Centre for Suicide Research of suicide following self-harm in children and adolescents. This showed that the risk of suicide following self-harm while less frequent than in adults continues well into adulthood, that certain methods of self-injury are associated with an increased risk of later suicide, and that there is commonly a change of method from self-harm to suicide.

Currently there is a relative paucity of evidence regarding effective preventive and treatment interventions. However, there are some positive results of school programmes focused on mental health awareness. Dialectical behavioural therapy appears to be a promising approach for young people who repeatedly self-harm.

In the final part of his lecture Professor Hawton considered the impact of self-harm on families.

 

Parents have clear messages for clinicians, including encouraging them to listen to young people who self-harm rather than simply checking a series of assessment questions, involving parents in treatment, and ensuring that they have access to well-researched resources and guidance. - Results from an interview study.

The results from an interview study carried out with nearly 40 parents of young people who were self-harming showed the enormous impact that discovery of a child's self-harm can have on parents and other family members. Often parents feel ashamed of the fact that their child is self-harming, resulting in them becoming socially isolated. Their parenting strategies may be affected.

Professor Hawton completed his lecture by highlighting specific resources produced from the Centre for Suicide Research, including a Healthtalkonline website, a booklet for parents and a guide on self-harm for school staff.

 

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