Journal Article

The natural history of self-harm from adolescence to young adulthood: a population-based cohort study

Carlin, John B, Moran, Paul, Borschmann, Rohan, Romaniuk, Helena, Olsson, Craig, Coffey, Carolyn, Patton, George C

2012

Overview

Knowledge about the natural history of self-harm is scarce, especially during the transition from adolescence to young adulthood, a period characterised by a sharp rise in self-inflicted deaths. From a repeated measures cohort of a representative sample, we describe the course of self-harm from middle adolescence to young adulthood. A stratified, random sample of 1943 adolescents was recruited from 44 schools across the state of Victoria, Australia, between August, 1992, and January, 2008. We obtained data pertaining to self-harm from questionnaires and telephone interviews at seven waves of follow-up, commencing at mean age 15·9 years (SD 0·49) and ending at mean age 29·0 years (SD 0·59). Summary adolescent measures (waves three to six) were obtained for cannabis use, cigarette smoking, high-risk alcohol use, depression and anxiety, antisocial behaviour and parental separation or divorce. 1802 participants responded in the adolescent phase, with 149 (8%) reporting self-harm, More girls (95/947 [10%]) than boys (54/855 [6%]) reported self-harm (risk ratio 1·6, 95% CI 1·2–2·2). We recorded a substantial reduction in the frequency of self-harm during late adolescence. 122 of 1652 (7%) participants who reported self-harm during adolescence reported no further self-harm in young adulthood, with a stronger continuity in girls (13/888) than boys (1/764). During adolescence, incident self-harm was independently associated with symptoms of depression and anxiety (HR 3·7, 95% CI 2·4–5·9), antisocial behaviour (1·9, 1·1–3·4), high-risk alcohol use (2·1, 1·2–3·7), cannabis use (2·4, 1·4–4·4), and cigarette smoking (1·8, 1·0–3·1). Adolescent symptoms of depression and anxiety were clearly associated with incident self-harm in young adulthood (5·9, 2·2–16). Most self-harming behaviour in adolescents resolves spontaneously. The early detection and treatment of common mental disorders during adolescence might constitute an important and hitherto unrecognised component of suicide prevention in young adults. National Health and Medical Research Council, Australia, and operational infrastructure support programme, Government of Victoria, Australia.

• Publisher: Elsevier Ltd,Elsevier,Elsevier Limited
• Subject: Addictive behaviors / adolescence / Adolescent / Adolescents / Adult / Adult and adolescent clinical studies / adulthood / Age / Alcohol / alcohols / antisocial behavior / anxiety / Behavior / behavior disorders / Biological and medical sciences / biomedical research / boys / Cannabis / Child development / Cigarettes / Clinical medicine / cohort studies / Consent / councils / Data collection / depression / divorce / Drug abuse / Female / General aspects / girls / Health services / Historical account / Humans / Internal Medicine / Interviews / Male / Medical sciences / Mental depression / Mental disorders / Miscellaneous / natural history / parental behavior / Psychology. Psychoanalysis. Psychiatry / Psychopathology. Psychiatry / Public health. Hygiene / Public health. Hygiene-occupational medicine / questionnaires / relative risk / Risk Factors / Risk-Taking / Schools / Self destructive behavior / Self-Injurious Behavior - epidemiology / Self-Injurious Behavior - psychology / smoking (habit) / Studies / Substance abuse treatment / Suicide / Surveys and Questionnaires / Victoria (Australia) / Victoria - epidemiology / Young Adult / Young adults