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Population attributable risk of factors associated with the repetition of self-harm behaviour in young people presenting to clinical services: a systematic review and meta-analysis

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Abstract

The repetition of hospital-treated self-harm by young people is common. However, little work has summarised the modifiable factors associated with this. A thorough understanding of those factors most strongly associated with repetition could guide the development of relevant clinical interventions. We systematically reviewed four databases (EMBASE, Medline, PubMed and PsycINFO) until 15 April 2016 to identify all observational studies of factors for the repetition of self-harm or suicide reattempts (together referred to as ‘self-harm behaviour’) in young people. We quantified the magnitude of association with odds ratios (OR) and 95% confidence intervals (CIs) and calculated the population attributable risk (PAR) and population preventable fraction (PPF) for modifiable factors to provide an indication of the potential impact in reducing subsequent self-harm behaviour in this population. Seventeen studies were included comprising 10,726 participants. Borderline personality disorder (OR 3.47, 95% CI 1.84–6.53; PAR 42.4%), any personality disorder (OR 2.54, 95% CI 1.71–3.78; PAR 16.3%), and any mood disorder (OR 2.16, 95% CI 1.09–4.29; PAR 42.2%) are important modifiable risk factors. Severity of hopelessness (OR 2.95, 95% CI 1.74–5.01), suicidal ideation (OR 2.01, 95% CI 1.43–2.81), and previous sexual abuse (OR 1.52, 95% CI 1.02–2.28; PAR 12.8%) are also associated with repetition of self-harm. We recommend that clinical services should focus on identifying key modifiable risk factors at the individual patient level, whilst the reduction of exposure to child and adolescent sexual abuse would also be a useful goal for public health interventions.

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Acknowledgements

The authors gratefully acknowledge the help received by a research assistant, Humaria Maheen, in assisting with ancestry searching.

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Authors and Affiliations

  1. Turning Point, Eastern Health Clinical School, Monash University, Fitzroy, Australia

    Katrina Witt

  2. Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia

    Allison Milner

  3. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia

    Matthew J. Spittal & Jane Pirkis

  4. Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    Sarah Hetrick

  5. Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

    Sarah Hetrick

  6. Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    Jo Robinson

  7. Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Melbourne, Australia

    Gregory Carter

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Correspondence to Katrina Witt.

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Ethics approval statement

Ethical approval and participant consent were not required for this review, since the study involved review and analysis of previously published data.

Role of the funding source

This work was supported by the Victorian Department of Health and Human Services (DHHS) (Reference number: C4892). Individual authors would also like to acknowledge the following sources of funding: KW is funded by an American Foundation for Suicide Prevention Post-Doctoral Fellowship (Reference number: PDF-0-145-16), SH is funded by an Auckland Medical Research Foundation Douglas Goodfellow Repatriation Fellowship, JR is funded by an NHMRC Early Career Fellowship, and JP is funded by an NHMRC Senior Research Fellowship. Funders had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript.

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Witt, K., Milner, A., Spittal, M.J. et al. Population attributable risk of factors associated with the repetition of self-harm behaviour in young people presenting to clinical services: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 28, 5–18 (2019). https://doi.org/10.1007/s00787-018-1111-6

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