Social environmental risk factors for persistent self-harm in early-to-middle adolescence: data from the Tokyo Teen Cohort study.

Abstract

Background: While most adolescent self-harm (SH) is transient, a substantial minority of adolescents repeat and continue it, requiring intensive care. Although social environmental factors play an important role in adolescent psychological development, little is known about their role in the persistence of SH. Moreover, few studies have focused specifically on early adolescence, when SH often begins, hospital presentations after SH increase sharply, and many preventive programs typically commence. We aimed to identify social environmental risk factors at age 12 that predict the persistence of SH through ages 14 and 16 in a population-based cohort.

Methods: We used data from the Tokyo Teen Cohort study (N = 1501). The experience of SH was self-reported at three timepoints (12, 14 and 16 years of age), and categorized as none, transient (one timepoint), or persistent (≥ 2 timepoints). Potential risk factors were assessed at age 12, including family related factors, school and peer related factors, sociodemographic and developmental characteristics, and psychopathological experiences. Multivariable and multinomial logistic regression analyses were conducted to examine the associations of potential risk factors with transient and persistent SH.

Results: Of the 1501 participants 195 (13.0%) experienced transient SH and 53 (3.5%) experienced persistent SH. In fully adjusted models, maternal depressive/anxious symptoms and female sex predicted persistent SH (maternal depressive/anxious symptoms: OR 1.47, 95% CI 1.13-1.92, female: OR 4.74, 95% CI 2.18-10.29), whereas companionship with mother predicted lower likelihood (OR 0.50, 95% CI 0.28-0.89). Depressive symptoms and psychotic experiences (PEs) predicted both transient (depressive symptoms: OR 1.77, 95% CI 1.50-2.10, PEs: OR 1.57, 95% CI 1.36-1.82) and persistent SH (depressive symptoms: OR 2.03, 95% CI 1.55-2.66, PEs: OR 1.89, 95% CI 1.48-2.41).

Conclusions: Maternal depressive/anxious symptoms were the risk factor of persistent SH and companionship with mother was protective against persistence even after adjustment for other factors. Care for maternal depressive/anxious symptoms and support for mother-child relationships would be required to prevent the persistence of SH, in addition to the care for children's depressive symptoms and PEs.