https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61706-7.pdf

Burden and consequences of child maltreatment in high-income countries

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61238-0.pdf

No health without mental health.

Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

/pdf/suicide-and-suicidal-behavior-41x9ufvkfm.pdf

Suicide and Suicidal Behavior

Our future: a Lancet commission on adolescent health and wellbeing

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60322-5.pdf

Self-harm and suicide in adolescents.

Deliberate Self Harm in Adolescents: Self Report Survey in Schools in England

Objective: To determine the prevalence of deliberate self harm in adolescents and the factors associated with it.

Design: Cross sectional survey using anonymous self report questionnaire.

Setting: 41 schools in England.

Participants: 6020 pupils aged 15 and 16 years.

Main outcome measure: Deliberate self harm.

Results: 398 (6.9%) participants reported an act of deliberate self harm in the previous year that met study criteria. Only 12.6% of episodes had resulted in presentation to hospital. Deliberate self harm was more common in females than it was in males (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1 to 4.9). In females the factors included in a multivariate logistic regression for deliberate self harm were recent self harm by friends, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem. In males the factors were suicidal behaviour in friends and family members, drug use, and low self esteem.

Conclusions: Deliberate self harm is common in adolescents, especially females. School based mental health initiatives are needed. These could include approaches aimed at educating school pupils about mental health problems and screening for those at risk.

#### What is already known on this topic

What is already known on this topic Deliberate self harm is a common reason for presentation of adolescents to hospital

Community studies from outside the United Kingdom have shown much greater prevalence of self harm in adolescents than hospital based studies

#### What this study adds

What this study adds Deliberate self harm defined according to strict criteria is common in adolescents, especially females

Associated factors include recent awareness of self harm in peers, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem

https://www.bmj.com/content/bmj/325/7374/1207.full.pdf

Deliberate self harm in adolescents: self report survey in schools in England

The results of a systematic review of the international literature on the prevalence of suicidal phenomena in adolescents, including the influence of survey method, gender, and ethnicity are reported. The literature was searched using six electronic databases to identify all population-based studies of self-reported suicidal phenomena; 128 studies were included, comprising 513,188 adolescents. The mean proportion of adolescents reporting they had attempted suicide at some point in their lives was 9.7% (95% CI, 8.5-10.9), and 29.9% (95% CI, 26.1-33.8) of adolescents said they had thought about suicide at some point. Females were significantly more likely than males to report most suicidal phenomena. A lower prevalence of some suicidal phenomena was found for Asian populations. The prevalence of suicidal phenomena varied depending on the terminology used and tended to be higher in studies employing anonymous questionnaires than in studies employing non-anonymous methods (questionnaires or interviews), although most of these differences were not statistically significant.

The prevalence of suicidal phenomena in adolescents: A systematic review of population-based studies

Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies.

Objective To compare motives and premeditation between adolescent deliberate self-poisoners and self-cutters. Method In a sample of 6,020 pupils aged 15 and 16 years who completed a self-report questionnaire, those who had deliberately cut themselves in the previous year ( n = 220) were compared with those who had taken overdoses ( n = 86). Results More adolescents who took overdoses than those who cut themselves said that they had wanted to die (66.7% versus 40.2%, χ 2 = 14.94, p 2 = 4.14, p = .042). Female self-cutters were more likely than male self-cutters to say that they had wanted to punish themselves (51.0% versus 25.0%, χ 2 = 9.25, p = .002) and had tried to get relief from a terrible state of mind (77.2% versus 60.9%, χ 2 = 4.78, p = .029). More self-cutters than self-poisoners had thought about the act of self-harm for less than an hour beforehand (50.9% versus 36.1%, χ 2 = 5.25, p = .021) Conclusions There are differences between adolescents' motives for overdoses and for self-cutting, and also gender differences in the reasons for self-cutting. The often impulsive nature of these acts (especially self-cutting) means that prevention should focus on encouraging alternative methods of managing distress, problem-solving, and help-seeking before thoughts of self-harm develop.

Emma Evans

Papers

Deliberate Self Harm in Adolescents: Self Report Survey in Schools in England

Deliberate self harm in adolescents: self report survey in schools in England

The prevalence of suicidal phenomena in adolescents: A systematic review of population-based studies

Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies.

Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents.