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Are Male Adolescents Who Self-Harm at Higher Risk for Suicide?


Long-Term Study Identifies Teens at Elevated Risk of Suicide

One of the first things parents of teens who engage in self-harming behaviors want to know is this:

Does self-harming behavior mean my teen wants to die?

The answer is complicated.

Research shows that teens engage in self-harming behavior – known by mental health experts as non-suicidal self-injury (NSSI) – for the following reasons:

  • 73% engage in self-harm for personal, internal reasons, called intrapersonal reasons. They self-harm to:
    • Escape negative emotions and/or thoughts
    • Induce positive emotions and/or thoughts
    • Punish them for perceived inadequacies, mistakes, or feelings of guilt
  • 45% engage in self-harm to send signals to others. These are called interpersonal reasons. They self-harm to:
    • Communicate their pain or difficulty to family, loved ones, and peers
    • Recruit the help of family, loved ones, or peers in managing their emotional pain
    • Punish others – often family members – for perceived wrongs

The fact teens self-harm to change their emotional state, or to communicate their internal state to others, implies an after. It implies they anticipate being alive at a time following the self-harm incident. They want to experience the desired emotional state – in contrast to the present state they seek to escape – or to experience/witness the change in others after they complete the self-harm incident.

That’s in direct contrast to a suicide attempt. Most suicide attempts imply the individual has no plan to be alive after the attempt.

As disturbing as self-harming behavior is, most parents of adolescents who self-harm find a small measure of reassurance in the fact the behavior is an extreme cry for help rather than an indication that they do not want to live.

This is where it gets more complicated.

Research also shows that teens who engage in self-harm behavior are at significantly higher risk of suicide than teens with no self-history of self-harm. To learn more about this elevated level of risk, please read this article:

Risk of Escalation from Self-Harm to Suicide Attempts in Adolescents:
Can Self-Harm Lead to Suicide in Teens?

The data we share in this article follows up on the data we share in that article. Teens who self-harm are at elevated suicide risk after an incident of self-harm. But which teens? And how long does the elevated risk persist?

A study published recently in the U.K. offers insight on these questions.

Suicide After a Self-Harm Incident: Who’s at Highest Risk?

Before we go any further, we encourage parents who are new to the concept of self-harming behavior to read our parent resource guide on self-harm:

Self-Harm in Adolescence

That guide defines self-harm and offers important information for parents of adolescents who engage in cutting, burning, branding, or any other type of self-harm.

Now let’s turn our attention to that paper published in the U.K. in 2020. It’s called “Mortality in Children and Adolescents Following Presentation to Hospital After Non-Fatal Self-Harm in The Multicentre Study Of Self-Harm: A Prospective Observational Cohort Study.” The study followed a group of 9,173 youth and adolescents (10-18) after hospital emergency room visits for self-harm. Using available public hospital records, researchers traced the subsequent medical history of each individual, collecting data from two time points: a year after the initial visit and ten years after the initial visit. They analyzed the data for repeat incidents of self-harm and suicide attempts, then compared rates of self-harm and suicide to demographically matched peers with no history of self-harm.

Here’s what they found:

  • At the one-year point, youth who engaged in self-harm committed suicide at 30 times the rate as those who did not engage in self-harm
  • Elevated suicide risk persisted for several years, but was greatest in the first year after the initial ER visit
  • Among the children and adolescents who committed suicide:
    • 53% had only one additional self-harm incident that required a hospital ER visit
    • 27% had two additional self-harm incidents that required hospital ER visits
    • 20% had three or more additional self-harm incidents that required hospital ER visits
  • Risk of suicide following self-harm was:
    • Twice as high in males than females
    • Higher in older adolescents than younger adolescents
    • Highest in males with repeated incidents of self-harm

The researchers end their study with the following additional observation:

“Self-harm is also associated with risk of death from accidental poisoning, particularly involving drugs of abuse, especially in young males.”

Although the study authors do not clarify that sentence, we associate the observation with drug overdose. This leads us to the following conclusion: risk of suicide following self-harm is greatest for older adolescent males – and it’s greatest within one year of the initial self-harm event for males who may also engage in illicit drug use.

How This Information on Suicide Risk After Self-Harm Helps

The top-line takeaway from this research is that parents, teachers, caregivers, and anyone involved in the life of a teenager needs to pay close attention to the emotional wellbeing of any teens they know. Self-harm – as discussed above – is most often the result of overwhelming emotions that youth and teens have no idea how to handle or process effectively.

Therefore, our first step is to screen for the emotional wellbeing of our youth and teens the same way we screen for physical issues. These screenings can be part of regular checkups. When experts identify issues, they can follow up with treatment, which can reduce the likelihood of an initial self-harm event.

Next, when a young person or adolescent engages in self-harm, we can ensure they receive the appropriate level of mental health treatment and support. The right care can give teens the skills they need to process the emotions that lead to self-harm and suicide. One evidence-based approach that works for self-harming teens is called dialectical behavior therapy (DBT).

Finally, we can use this data to prioritize the most at-risk demographic: older male adolescents with a history of more than one incident of self-harm. Girls and younger adolescents who engage in self-harm need targeted support to reduce risk and prevent subsequent self-harm or suicide, of course. They’re at elevated, risk, too. However, it’s important to leverage what we know to offer the best care available to those who need it most.

What we know is that older male adolescents are at high risk. We also know that in the context of professional help and support offered in specialized adolescent DBT programs, trained therapists can teach teens the skills they need to manage their emotions, improve their overall mental and emotional wellbeing, and reduce overall risk of suicide following self-harm.

Treatment works – the sooner the better.

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