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Warning signs of self-harm could be identified up to a decade earlier

Early warning signs that an adolescent may self-harm can be identified up to a decade earlier, researchers from the University of Cambridge have said.

Currently children with mental health problems are supported once the problems emerged and escalate. However, the research suggests that there are two sub groups of teenagers who self-harm where it is possible to predict those at greatest risk.

Stepheni Uh, a Gates Cambridge Scholar and first author of the study, said: “Self-harm is a significant problem among adolescents, so it’s vital that we understand the nuanced nature of self-harm, especially in terms of the different profiles of young people who self-harm and their potentially different risk factors.”

The team of researchers, based at the MRC Cognition and Brain Sciences Unit, University of Cambridge, found that sleep problems and low self-esteem were common risk factors among adolescents who self-harm.

However, two distinct profiles of young people who self-harm emerged from the research. One subgroup experiences emotional and behavioural difficulties and a second group does not experience those difficulties, but has different risk factors.

For the second group, however, their self-harming behaviour was harder to predict early in childhood. One of the key signs was a greater willingness to take part in risk-taking behaviour, which is linked to impulsivity. Other research suggests these tendencies may predispose the individual towards spending less time to consider alternate coping methods and the consequences of self-harm. Factors related to their relationships with their peers were also important for this subgroup, including feeling less secure with friends and family at age 14 and a greater concern about the feelings of others as a risk factor at age 11.

Stepheni Uh added: “We found two distinct subgroups of young people who self-harm. The first was much as expected – young people who experience symptoms of depression and low self-esteem, face problems with their families and friends, and are bullied. The second, much larger group was much more surprising as they don’t show the usual traits that are associated with those who self-harm.”

Between one in five and one in seven adolescents in England self-harms. Self-harm is a significant risk factor for subsequent suicide attempts, but many adolescents self-harming do not intend suicide but face other harmful outcomes, including repeatedly self-harming, poor mental health, and risky behaviours like substance abuse.

Despite its prevalence and lifelong consequences, there has been little progress in the accurate prediction of self-harm.

The Cambridge team identified adolescents who reported self-harm at age 14, from a nationally representative UK birth cohort of approximately 11,000 individuals. A machine learning analysis was subsequently used to identify whether there were distinct profiles of young people who self-harm, with different emotional and behavioural characteristics. This information was used to identify risk factors from early and middle childhood.

Because the data tracked the participants over time, the researchers were able to distinguish factors that appear alongside reported self-harm behaviour, such as low self-esteem, from those that precede it, such as bullying.

The researchers say that their findings, published in the Journal of the American Academy of Child and Adolescent Psychiatry, suggest that it may be possible to predict which individuals are most at risk of self-harm up to a decade ahead of time, providing a window to intervene.

Dr Duncan Astle said: “The current approach to supporting mental health in young people is to wait until problems escalate. Instead, we need a much better evidence base so we can identify who is at most risk of mental health difficulties in the future, and why. This offers us the opportunity to be proactive, and minimise difficulties before they start.

“Our results suggest that boosting younger children’s self-esteem, making sure that schools implement anti-bullying measures, and providing advice on sleep training, could all help reduce self-harm levels years later.

“Our research gives us potential ways of helping this newly-identified second subgroup. Given that they experience difficulties with their peers and are more willing to engage in risky behaviours, then providing access to self-help and problem-solving or conflict regulation programmes may be effective.”

Professor Tamsin Ford from the Department of Psychiatry added: “We might also help at-risk adolescents by targeting interventions at mental health leaders and school-based mental health teams. Teachers are often the first people to hear about self-harm but some lack confidence in how to respond. Providing them with training could make a big difference.”

The research was supported by the Gates Cambridge Trust, Templeton World Charity Foundation, and the UK Medical Research Council.

Two Pathways to Self-Harm in Adolescence

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