Abstract
This cross-sectional study examines data from the 1999 and 2004 surveys of Mental Health of Children and Young People in Great Britain to assess the prevalence of self-injurious thoughts and behaviors in a nationally representative sample of preadolescent individuals.
Self-injurious thoughts and behaviors in childhood have received increasing recognition as an important clinical concern. Self-injurious thoughts and behaviors in childhood have been reported to be associated with concurrent psychiatric impairment, particularly externalizing disorders,1 and to be predictors associated with negative outcomes, including subsequent self-injurious thoughts and behaviors1 and psychiatric hospitalization.2 Furthermore, the National Institute of Mental Health has identified childhood suicide as a priority; compared with studies of self-injurious thoughts and behaviors in adolescents and adults, there to date is a paucity of research on that topic with children.3 Several fundamental aspects of childhood self-injurious thoughts and behaviors remain unknown, including their epidemiologic characteristics, with prior studies examining at-risk or clinical populations.1,2 The current study characterizes the prevalence of self-injurious thoughts and behaviors in a nationally representative sample of preadolescent individuals in Great Britain.
Methods
The 1999 and 2004 surveys of Mental Health of Children and Young People in Great Britain were conducted with youths in England, Scotland, and Wales, obtained with permission from the UK Data Archives. For this study, analyses were restricted to individuals younger than 13 years. The unweighted number of participants was 13 126. Of those, 49.35% were female, 88.78% were white, 5.00% were South Asian, 3.34% were black, and 2.77% were other with a mean (SE) age of 8.53 (0.02) years.
The Development and Well-Being Assessment (DAWBA),4 a structured diagnostic interview for epidemiologic research to assess for psychiatric disorders, was conducted with children aged 11 and 12 years, and with parents of children aged 5 to 12 years. The DAWBA included 7 questions about self-injurious thoughts and behaviors. Queries about self-injurious thoughts covered the last month, and those about self-injurious behaviors the last month and lifetime. Parental psychiatric functioning was also assessed.5 This study used publicly available secondary data and was determined to be exempt from institutional review board approval and from informed patient consent according to the review board policy of Brown University.
Logistic regression was conducted for sociodemographic characteristics and psychiatric disorders in children and parental psychiatric functioning in association with current thoughts of self-injury and lifetime self-injurious behavior. Sociodemographic characteristics (age, sex, race, and parents’ employment status) were assessed at the bivariate level. Those characteristics found to be factors were included as covariates with all remaining factors in the corresponding multivariate model. To avoid confounding self-injurious thoughts with behaviors (ie, the possibility that an association with the former is better accounted for by the presence of children with the latter), children with a history of self-injurious behaviors were included in the reference group in analyses of self-injurious thoughts. All analyses were conducted in SPSS statistical software, version 23.0 (SPSS Inc) and weighted to obtain nationally representative estimates. All tests of significance were evaluated using .05-level 2-sided tests. Data analysis was completed in May 2019.
Result
In total, 2.18% (SE, 0.13%) of children experienced past-month self-injurious thoughts without any history of behavior (ie, pure ideators), 0.80% (SE, 0.08%) had past-month self-injurious behaviors, and 2.41% (SE, 0.14%) had lifetime self-injury. Among sociodemographic factors, only minority race was unrelated to self-injurious thoughts (odds ratio [OR], 0.81; 95% CI, 0.54–1.21; P = .30) or behaviors (OR, 0.67; 95% CI, 0.43–1.04; P = .07).
Multivariate analyses are presented in the Table. Age, male sex, both parents being unemployed, current parental psychiatric functioning, depression, anxiety, and externalizing disorders, except hyperkinesis, were associated with self-injurious thoughts. For example, the OR for anxiety with regard to current thoughts of self-injury in this population was 4.32 (95% CI, 2.89-6.44; P < .001). All factors were significant for self-injurious behaviors, except depression and parental employment. For example, the OR for anxiety with regard to lifetime self-injurious behaviors was 2.50 (95% CI, 1.64-3.82; P < .001).
Table. Multivariate Analyses of Self-injurious Thoughts and Behaviors in 13 126 Preadolescent Children in Great Britain.
| Factor | Current Thoughts of Self-injurya | Lifetime Self-injurious Behaviors | ||
|---|---|---|---|---|
| OR (95% CI) | P Value | OR (95% CI) | P Value | |
| Age | 1.22 (1.15-1.30) | <.001 | 1.35 (1.27-1.44) | <.001 |
| Male sex | 1.35 (1.05-1.75) | .02 | 1.32 (1.03-1.68) | .03 |
| Parental employment status | ||||
| Both parents unemployed | 1.61 (1.17-2.21) | .003 | 0.99 (0.71-1.38) | .93 |
| One parent unemployed | 1.21 (0.86-1.69) | .27 | 1.06 (0.77-1.45) | .74 |
| Both parents employed | 1 [Reference] | NA | 1 [Reference] | NA |
| Poor parental psychiatric functioning | 1.14 (1.10-1.18) | <.001 | 1.09 (1.05-1.13) | <.001 |
| Depression | 7.87 (2.92-21.21) | <.001 | 1.92 (0.75-4.91) | .17 |
| Anxiety | 4.32 (2.89-6.44) | <.001 | 2.50 (1.64-3.82) | <.001 |
| Oppositional defiant disorder and conduct disorder | 2.45 (1.61-3.72) | <.001 | 4.74 (3.31-6.80) | <.001 |
| Hyperkinesis | 1.15 (.61-2.17) | .66 | 1.98 (1.15-3.43) | .01 |
Abbreviations: NA, not applicable; OR, odds ratio.
Children with a lifetime history of self-injurious behaviors were included in the reference group to allow for analyses of ideation unconfounded by behavior.
Discussion
To my knowledge, this study provides the first analyses of the prevalence and sociodemographic and clinical factors of self-injurious thoughts and behaviors in a nationally representative sample of preadolescent individuals, showing that although low base-rate phenomena, self-injurious thoughts and behaviors are associated with significant psychiatric comorbidity. Self-injurious thoughts and behavior rates were higher among boys in the current and prior studies,1 contrasting with greater rates of suicidal ideation and attempts among girls in adolescence.6 Insofar as males are more likely to die by suicide6 and earlier onset of psychiatric problems is associated with worse trajectories, whether preadolescents with SITBs are at particular risk of suicide deaths warrants future study. Additionally, whether SITBs in preadolescents in the general population are associated with negative later-life outcomes1 or have changed in prevalence over time should be evaluated.
References
- 1.Whalen DJ, Dixon-Gordon K, Belden AC, Barch D, Luby JL. Correlates and consequences of suicidal cognitions and behaviors in children ages 3 to 7 years. J Am Acad Child Adolesc Psychiatry. 2015;54(11):926-37.e2. doi: 10.1016/j.jaac.2015.08.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Boekamp JR, Liu RT, Martin SE, Mernick LR, DeMarco M, Spirito A. Predictors of partial hospital readmission for young children with oppositional defiant disorder. Child Psychiatry Hum Dev. 2018;49(4):505-511. doi: 10.1007/s10578-017-0770-8 [DOI] [PubMed] [Google Scholar]
- 3.National Institute of Mental Health Identifying research priorities in child suicide risk. https://www.nimh.nih.gov/news/events/announcements/identifying-research-priorities-in-child-suicide-risk.shtml. Published 2019. Accessed November 15, 2019.
- 4.Goodman R, Ford T, Richards H, Gatward R, Meltzer H. The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry. 2000;41(5):645-655. doi: 10.1111/j.1469-7610.2000.tb02345.x [DOI] [PubMed] [Google Scholar]
- 5.Goldberg DP, Blackwell B. Psychiatric illness in general practice. A detailed study using a new method of case identification. BMJ. 1970;1(5707):439-443. doi: 10.1136/bmj.2.5707.439 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Cha CB, Franz PJ, M Guzmán E, Glenn CR, Kleiman EM, Nock MK. Annual Research Review: Suicide among youth: epidemiology, (potential) etiology, and treatment. J Child Psychol Psychiatry. 2018;59(4):460-482. doi: 10.1111/jcpp.12831 [DOI] [PMC free article] [PubMed] [Google Scholar]