What factors are associated with self-harm in childhood?
Learning from review-level evidence

About this release

In this briefing paper we summarise learning from a rapid review of summary-level evidence to:

• determine what is known about the risk and protective factors associated with self-harm in children and young people
• find evidence on effective interventions that might help in the primary prevention of this harmful behaviour
• identify implications for policy-makers and practitioners and highlight important gaps in the evidence base

Our focus on summary-level evidence limits this review to previously synthesised evidence where it exists. However, this ensures we highlight the most robust evidence available.

Main points

We found significant gaps in the evidence base for the primary prevention of self-harm in children and young people.

Most notably we found no review-level evidence on the potential effectiveness of interventions to prevent onset.

We identified 15 reviews that considered the association between potential risk and protective factors and the risk of self-harm in children and young people.

The key findings were as follows:

• Family and friends: we found evidence that young people experiencing all forms of bullying victimisation, traditional bullying perpetration and a lack of parental or peer attachment are at a higher risk of self-harm.
• Individual: evidence suggests those suffering from alexithymia, body image issues, low self-esteem, dissociation, sleep disturbance and substance use are also at higher risk.
• Structural: the very limited evidence in this category suggests an increased risk of self-harm for those suffering discrimination due to their sexual orientation.

No reviews were found that examined associations with the learning environment or community risk factors.

Contextual qualitative studies highlighted the importance of understanding the motivations underlying young people’s engagement in self-harm and the impact of responses from those around them, both family and peers.

Implications for policy, practice and research

From a public mental health perspective, the evidence synthesised in this review suggests the need for self-harm prevention policies focused on supporting healthy familial and peer relationships for children. There is also a need to take action to overcome sexual diversity discrimination.

The individual risk factors identified here are less amenable to public health interventions at a population level. However, understanding these factors could be used to identify higher-risk groups, which may be relevant to service commissioners and planners when prioritising service development.

This review identified several gaps in review-level evidence, highlighting the need for systematic reviews in these areas, particularly to inform the development of primary prevention measures acting on structural determinants of mental health.

Background

Self-harm is increasingly common among young people and can be a sign of severe emotional distress. It has the potential to do serious harm, resulting in long-term physical and psychological damage to the individual and is a strong predictor for future suicide risk.

Statistics cited in the Scottish Parliament in 2021 highlighted a significant rise in the number of children presenting at hospital for self-harm in Scotland during the COVID-19 pandemic.