Differences Between Adolescents with Self-Harm Ideation and a History of Self-Harm. A Cross-Sectional Study Among Adolescents in Denmark.

Objective: Suicide is among the leading causes of death among adolescents. Many risk factors for suicide are well known, and self-harm ideation and behavior are among the strongest. Still, there is limited research on factors that distinguish those with self-harm ideation and those who self-harm. Our aim is to investigate nonpsychiatric risk factors that distinguish between adolescents with self-harm ideation, those who self-harm, and those who engage in repeated self-harm.

Method: This survey analysis was based on findings from a cross-sectional study (N = 7,943 adolescents). Multinomial logistic regression was employed to compare the effects of various exposures (including social relations, happiness, vulnerability, being bullied, self-worth, physical and sexual abuse) on self-harm ideation, self-harm, and repeated self-harm, using a reference group of adolescents without self-harming behavior.

Results: Adolescents exhibiting self-harming behavior showed significantly higher levels of exposure, with the highest exposure observed in the repeated self-harm group. Vulnerability and lack of self-worth emerged as the most significant risk factors. Additionally, we found a clear dose-response effect across all groups.

Conclusions: This study highlights the significant increase in the risk of self-harm with the accumulation of risk factors in adolescents' lives, emphasizing the importance of providing support and assistance to those exposed to multiple risk factors. Addressing these factors may help reduce the risk of suicidal behavior, as self-harm remains one of the strongest risk factors for suicide attempt and suicide. Furthermore, the findings point out the critical role of single risk factors, particularly vulnerability and lack of self-worth.