Pediatric Self-Harm Risk Factors

 

May is Mental Health Awareness Month

As we have discovered during this May’s observance of Mental Health Awareness Month, the United States currently finds itself mired in a mental health crisis, a predicament the American Academy of Pediatrics declared a national emergency for children and adolescents in 2021.

Self-harm (including cutting and burning) and suicide have been on the rise in the U.S. in recent years, especially during the pandemic. A study published this month in Pediatrics examines which children and teens are at highest risk for serious self-harm injuries and suicide. The researchers note that suicide risk is based on a number of personal and social factors:

Risk for suicide is likely the result of a complex interaction between a number of diverse and dynamic factors ranging from individual (eg, psychiatric comorbidities), family (family history of mental disorders, family conflict, and support), social support (friend network, outpatient psychiatric resources), and specific life events (interpersonal losses, academic stress, bullying including cyberbullying and physical/sexual abuse).

 

The researchers were able to identify four distinct risk profiles for children 5-18 years old who were admitted to two U.S. children’s hospitals after intentionally hurting themselves. Suicide attempts accounted for most of the self-harm behaviors:

Low-risk: Children 5-9 years old with no previous mental health diagnosis.

Moderate-risk: Children and teens with a past history of mental illness but not depression.

High-risk: Teen girls 14-17 years old with a combination of anxiety, depression, substance-use disorder, and trauma disorders. Personality disorders and eating disorders also upped the risk of serious self-harm behavior.

Very high-risk: Boys 10-13 years old with mood (conduct) and developmental disorders. Boys diagnosed with ADHD, bipolar disorder, or autism spectrum disorder had the highest risk of engaging in serious self-harm behavior that required hospitalization.

The AAP wants parents to know about other factors that can put teenagers at risk for self-harm and suicide:

Social pressures related to sexual orientation or gender identity. Young people who identify as lesbian, gay, bisexual, transgender, queer or two-spirit (LGBTQ2S+) are 4 times more likely to attempt suicide than their straight (heterosexual or cisgender) peers. However, sexual orientation and gender identity themselves are not directly linked to suicide. Rather, youth who identify as LGBTQ2S+ may experience discrimination, hostility and rejection, which can lead to suicidal thoughts and actions. One study found that when kids experience negative family and social reactions to coming out, this can raise suicide risks.

Racism. Racism, discrimination and related systemic bias are extremely harmful to mental health. Also, a history of systemic racism limits children’s ability to access developmentally and culturally responsive mental health services in communities and schools. Racism and discrimination have led to significant differences in suicide risk and rates based on race and ethnicity.

Alcohol and substance use. Substance use is a factor in roughly 1 in 3 youth suicides. Young people may intentionally take large doses of drugs as a way of ending their lives. Alcohol and drug use can also cause a break from reality, or psychotic episode, that causes hallucinations or delusions that lead to suicide.

Easy access to guns. Firearms are the top cause of death for teens 15-19 years old who die by suicide. Even when guns are locked up, studies show that teens who live in homes with firearms are more likely to kill themselves than those in homes without guns. Teens, whose brains are still developing, tend to be more impulsive than adults. A momentary decision to attempt suicide with a gun often leaves no chance for rescue. The safest home for children and teens is one without guns. If guns are kept in the home, they should be stored safety: locked and unloaded, with ammunition stored separately in a locked location. Family members should make sure the child does not know the codes to the locks or the location of keys.

Bullying and Cyberbullying. Kids who are bullied―and those who bully others―face higher risks of suicidal thoughts and actions. This is true whether bullying happens face-to-face or online (cyberbullying). A 2021 study found that adolescents who were bullied online were roughly 12 times more likely to have suicidal thoughts than peers who were not.

 

Read more about teen suicide risk and where to find mental health resources from the American Academy of Pediatrics here.

 

National Suicide Prevention 988 Lifeline

 

Contact the 988 Suicide & Crisis Lifeline 24/7 by calling or texting 988 or chat at 988lifeline.org if you or a loved one are experiencing mental health-related distress and need crisis support. All calls are confidential.

 

(Google Images)

 

source https://www.thepediablog.com/2023/05/17/pediatric-self-harm-risk-factors/