Self-harm from adolescent to adult

The first population-based study to assess the course of self-harm from adolescence to young adulthood has found that around 1 in 12 young people self-harm, with the balance skewed towards girls.

Published in The Lancet, the cohort study was conducted between August 1992 and January 2008 in Victoria, Australia, with participants aged 14-15 at the outset. The researchers, led by Paula Moran (Institute of Psychiatry), chose this period as one "characterised by major changes in health and a steep rise in deaths resulting from self-inflicted injuries".

Risks for self-harm increased substantially across puberty, 'a process that seems to be independent of age' according to the authors. Self-harm during adolescence was independently associated with the presence of depression and anxiety, antisocial behaviour, high-risk alcohol use, cannabis use, and cigarette smoking. Injury to the skin through cutting and burning was the commonest method of self-harm during adolescence, although by young adulthood no one form of self-harm predominated.

There is some good news though: 90 per cent of people who self-harm as adolescents will naturally stop in adulthood. "Our findings suggest that most adolescent self-harming behaviour resolves spontaneously," the authors said. "However, young people who self-harm often have mental health problems that might not resolve without treatment, as evident in the strong relation detected between adolescent anxiety and depression and an increased risk of self-harm in young adulthood."

Commenting on the age-related decline in self-harm in The Lancet, Keith Hawton (University of Oxford) and Rory O'Connor (University of Stirling) considered that as young people move from adolescence to young adulthood, the extent of exposure to peer self-harm might decrease. They also referred to a possibility not addressed by Moran and colleagues: the extent to which clinical interventions might have contributed to the reduction in self-harm.

"The results of Moran and colleagues' study will offer some reassurance to parents of adolescents who self-harm and to health and educational agencies,' Hawton and O'Connor said. 'Clinicians can offer encouragement to both young people who are self-harming and their families."