Research report
Early predictors of deliberate self-harm among adolescents. A prospective follow-up study from age 3 to age 15

https://doi.org/10.1016/j.jad.2006.02.015Get rights and content

Abstract

Background

To study predictors at age 3 and at age 12 for ideations and acts of deliberate self-harm at age 15 in a representative birth cohort.

Method

Information about ideations and acts of deliberate self-harm at age 12 and at age 15 was obtained from parents and children. Information about the child's problems was obtained at age 3 using the Child Behavior Checklist 2/3 (CBCL 2/3), and at age 12 with the CBCL and Youth Self-report (YSR). Furthermore, when the child was 12, mothers and fathers gave information about their own health, well-being and mental distress, and about family functioning measured with the Family Assessment Device (FAD).

Results

There was a significant increase in self-reported deliberate self-harm (ideations or acts) from age 12 to age 15, especially among girls (from 3% to 13%). Parent–child agreement on acts and ideations of deliberate self-harm was very low at both time-points (proportion of agreement 0.0–0.2). Self-reports of deliberate self-harm at age 12 independently predicted both acts and ideations of deliberate self-harm at age 15. Female gender, self-reports of internalizing problems and somatic complaints, parent reports of child's externalizing problems and aggressivity, mother's reports of her health problems, and living in nonintact family at age 12 independently predicted self-reported acts of deliberate self-harm 3 years later. Parent reports of child's learning difficulties, and self-reports of being bullied independently predicted ideations of deliberate self-harm at age 15. Parent reports of child's psychopathology at age 3 assessed with the CBCL 2/3 had no predictive association with ideation or acts of deliberate self-harm at age 15.

Conclusions

Acts of deliberate self-harm in mid-adolescence are due to an accumulation of earlier family and parental distress, and child's externalizing and internalizing problems. Information about deliberate self-harm at age 12 is an important warning sign of deliberate self-harm in mid-adolescence.

Introduction

For preventive, clinical and research purposes, population-based information about early antecedents of adolescent deliberate self-harm is important. A major limitation to research on deliberate self-harm in clinical samples is that it does not include the vast majority of adolescents with ideations or acts in the community. Of all adolescent suicidal attempters, only a minority have used any mental health services (Appleby et al., 1996, Garrison et al., 1993, Sourander et al., 2001). Previous studies have also shown that health professionals show rather poor recognition of adolescents' suicidal behavior. A number of different terms have been put forward to describe suicidal behavior, which has caused some confusion. The term suicidal behavior encompasses any form of intentional or deliberate self-injurious behavior (suicide, attempted suicide, deliberate self-harm). In the present article, deliberate self-harm is referring to self-injurious behavior with non-fatal outcome.

The continuum from deliberate self-harm thoughts to attempts and to completed suicide is not linear; the factors associated with ideations differ from those associated with acts. The present longitudinal study investigates predictors for adolescent ideations and acts of deliberate self-harm at two developmental stages, in very early childhood at age 3, and at age 12, reflecting the turning point from childhood to the adolescent stage. The follow-up period from age 12 to 15 is interesting because of the many changes related to adolescent development. Self-harm attempts reach a peak between 15 and 18 years of age after which there is a marked decline in frequency as adolescents enter early adulthood. Information about early childhood predictors for adolescent deliberate self-harm has relevance for the early detection of children at risk of suicidal attempts. There is a lack of population-based studies examining the continuity of deliberate self-harm from preadolescence to mid-adolescence, as well as studies examining possible very early childhood psychopathology predictors for deliberate self-harm in mid-adolescence.

Significant suicide risks include difficulties at school (Gould et al., 1996), sociodemographic disadvantage (Beautrais et al., 1996), living in broken families (Brent et al., 1993), parental psychopathology (Brent et al., 1988, Fergusson and Lynskey, 1995), difficulties in relationships with parents and stressful and traumatic life events (Beautrais et al., 1996, Lewinsohn et al., 1994). In particular, a combination of depressive symptoms and antisocial behavior has been shown to form the most common antecedent of teenage suicide (Shaffer and Fisher, 1981). Despite the overlap between self-harm attempts and ideations, and the significant prediction of future attempts from ideations, the diagnostic profiles of attempters and ideatiors are somewhat different (Haavisto et al., 2003). Apter et al. (1995) distinguished two types of suicidal behavior in adolescent inpatients: the first was characterized by a wish to die and common in depressive disorders, the second was characterized by impulse control problems and associated with externalizing problems.

The aims of the present study are: we studied 1. the prevalence of parent and self-reports of child's deliberate self-harm behavior at age 12 and at age 15; 2. the level of agreement between parents and children on deliberate self-harm behavior; 3. to which extent the child's psychopathology and competence at age 3 and at age 12 and the mother's and father's self-reports of their well-being and mental distress predict the child's reports of acts and ideations of deliberate self-harm at age 15.

Section snippets

Subjects

The present study is part of the Finnish Family Competence Study (FCC) launched in 1985 in the Province of Turku and Pori in South-Western Finland. The source population was an unselected sample from Central Hospital region of the Province of Turku and Pori in South-Western Finland with a total population of 713,000. Subject collection was based on stratified randomised cluster sampling. For stratification, the study area was divided into two parts, the southern area (Turku University Hospital

Prevalence of ideations and acts of deliberate self-harm at ages 12 and 15

Table 1 shows the prevalences of children at ages 12 and age 15 having only ideations of deliberate self-harm, and having acts of deliberate self-harm (including those who reported both ideations and acts) separately in parent and self-reports. In self-reports at age 12, 2.7% of girls and 3.1% of boys while at age 15, 12.6% of girls and 4.6% of boys reported deliberate self-harm (ideations or acts). However, according to parent reports, at age 12, 2.3% of girls and 3.1% of boys, and at age 15,

Prevalence and cross-informant agreement

The prevalence rate of self-reported deliberate self-harm increased dramatically from age 12 to age 15 among girls, but not in boys. Accordingly, the gender differences also increased during the 3-year follow-up period. The agreement between parents and children on ideations and acts of deliberate self-harm was very low, indicating that, in the majority of cases, parents are not aware of their children's deliberate self-harm. Previous studies have shown that suicidal acts are more common among

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