Worrying rise in reports of self-harm among teenage girls in UK

Behind the Headlines

Friday October 20 2017

"Steep rise in self-harm among teenage girls,” BBC News reports.

This follows a UK study that used reliable national databases to look at trends in reports of self-harm among young people aged 10 to 19 since 2001. It found annual rates of self-harm of 37 per 10,000 girls and 12.3 per 10,000 boys.

There were several other notable findings, including a 68% rise in rates of self-harm among girls aged 13 to 16 since 2011, something that wasn't seen in boys or any other age group in girls. Many cases involved drugs or alcohol, and the study also highlighted a social divide – finding higher rates in more deprived areas.

Despite some media speculation, the study didn’t explore the reasons behind these trends. It could be that due to greater awareness of the help available, more teenagers are willing to report self-harming. But we cannot ignore the possibility that many cases of self-harm may also go unreported.

Medical, social and public health services arguably need to come together to better understand and address these trends and inequalities, to ensure vulnerable young people are identified and get the help and support they need.

If you are having thoughts about self-harming, you can get support from the Samaritans at any time of the day or night. Call 116 123.

 

Where does the study come from?

The study was conducted by researchers at the University of Manchester and Keele University, and was funded by the National Institute for Health Research (NIHR). One of the authors has worked on self-harm, suicide prevention and other mental health guidelines.

The study was published in the peer-reviewed BMJ and is freely available to read online.

The UK media’s reporting of the study was broadly accurate, though some sources speculated about possible causes for the reported rise in self-harming, such as the impact of digital media on young people’s mental wellbeing.

While the study did cite related research on these subjects, it didn’t directly look at the reason(s) for the rise in reported cases.

 

What kind of research was this?

This was a population-based cohort study which used electronic UK GP records to look at trends over time in reports of self-harm among young people, by age and gender.

As the authors say, self-harm is a strong risk factor for suicide, and globally suicide is the second most common cause of death before the age of 25 after road traffic incidents.

In recent years there has been an increase in suicide reports among children and adolescents. In the UK between 2010 and 2015 suicide rates among 15 to 19 year olds rose from 3.2 to 5.4 per 100,000. Hence the need to look at reliable national data on self-harm rates.

This type of study is valuable for looking at rates but can’t fully explore the underlying factors contributing to risk of self-harm.

 

What were the basic results?

The study used the Clinical Practice Research Datalink (CPRD) database which contains anonymous records for 647 GP surgeries and covers 7% of the UK population.

For 60% of practices in England the data is linked with Hospital Episode Statistics (HES) data on hospital admissions, the Office for National Statistics (ONS) on mortality records, and the Index of Multiple Deprivation.

The study looked at annual rates of records of self-harm among children and adolescents aged 10 to 19 between 2001 and 2014. Self-harm was defined according to the guideline definition of “any act of self-poisoning or self-injury, irrespective of motivation.”

The researchers further analysed the rates by age bands:

  • pre-teenager (10-12)
  • early teenager (13-16)
  • late teenager (17-19)

They also categorised the results taking into account indexes of social deprivation.

They looked at whether a GP record of self-harming was accompanied by referral to mental health services and prescription of any medication in the first year after an episode. Mental health diagnoses were further analysed.

During the period 2001-14, the GP records analysed by the researchers showed that 16,912 young people had an episode of self-harm recorded. If a similar pattern was found across the UK then it is estimated that around 240,000 young people would have had an episode of self-harm recorded.

About three-quarters of the young people who self-harmed were girls and many had mental health diagnoses. Over a third of girls who self-harmed had a diagnosis of depression, while behaviour disorders, ADHD and autism spectrum disorders were more common in boys. The type of self-harm was mostly recorded, and in the vast majority of cases (83%), it was drug overdose.

Findings on annual self-harm rates included:

  • Overall rates across the study period were 37.4 per 10,000 in girls and 12.3 per 10,000 in boys.
  • Rates were highest in the most deprived areas, 27.1 per 10,000 compared to 19.6 per 10,000 in the least deprived areas.
  • Among girls aged 13-16 rates increased by 68% between 2011 and 2014, rising from 45.9 to 77.0 per 10,000.
  • Girls aged 13 to 16 were the only group where the rate of self-harm sharply increased across the study period.

Findings on what happened in the 12 months after self-harm was reported included:

  • In both boys and girls, roughly 1 in 5 self-harmed again, although this was slightly more common in girls.
  • Only 44% had a documented referral to mental health services – in 12% of cases this was before the self-harm episode.
  • About 1 in 5 girls were prescribed antidepressants.
  • Those in the most deprived areas were less likely to be referred or be prescribed medication.

Among young people with recorded self-harm episodes, 43 later died (0.5%). This compared with a rate of 0.1% among a random comparison cohort. Of these deaths, 65% were recorded as unnatural among the self-harm cohort compared with a quarter in the comparison cohort. About 40% of the unnatural deaths among the self-harm cohort were recorded as acute alcohol or drug poisoning.

 

What do the researchers conclude?

The researchers suggest that: “Gaining a better understanding of the mechanisms responsible for the recent apparent increase in the incidence of self-harm among early-mid teenage girls, and coordinated initiatives to tackle health inequalities in the provision of services to distressed children and adolescents, represent urgent priorities for multiple public agencies.”

 

Conclusions

This valuable study raises concerns about the large increase in rates of self-harm among young teenage girls, and the apparent inequality in both rates of self-harm and recognition of risk between areas of greater and lesser deprivation. It is also notable that alcohol or drug overdose was recorded in the majority of self-harm cases.

These suggest, as the researchers rightly say, areas to target public health attention. There are though, a few points to consider:

It can be difficult to distinguish between self-harm without intention of suicide and a suicide attempt. This distinction is usually made by discussing the intent with the person, but this can be harder with young people. The authors made rigorous attempts to analyse the records to distinguish “milder” forms of self-harm from near-fatal suicide attempts, but it can still be difficult to ensure all are accurately categorised.

It’s not easy to use this type of data to look into the cause of these trends – for example why rates are increasing among young teenage girls, or why there is a social divide. This makes it all the more important for all young people who may be at risk to be recognised and get the support they need.

If a young person is feeling low, anxious or helpless, it is extremely important that they speak with someone. Read more advice about getting help if you self-harm.

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

'Steep rise' in self-harm among teenage girls. BBC News, October 19 2017

Self-harm among girls aged 13 to 16 rose by 68% in three years, UK study finds. The Guardian, October 19 2017

'Heartbreaking' 68pc rise in self-harm among young teenage girls. The Daily Telegraph, October 19 2017

Links to the science

Morgan C, Webb RT, Carr MJ, et al. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. BMJ. Published online October 18 2017

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