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Factors associated with deliberate self-harm among Irish adolescents

  • E. M. McMahon (a1) (a2), U. Reulbach (a1) (a2), P. Corcoran (a1), H. S. Keeley (a3), I. J. Perry (a2) and E. Arensman (a1)...

Deliberate self-harm (DSH) is a major public health problem, with young people most at risk. Lifetime prevalence of DSH in Irish adolescents is between 8% and 12%, and it is three times more prevalent among girls than boys. The aim of the study was to identify the psychological, life-style and life event factors associated with self-harm in Irish adolescents.


A cross-sectional study was conducted, with 3881 adolescents in 39 schools completing an anonymous questionnaire as part of the Child and Adolescent Self-harm in Europe (CASE) study. There was an equal gender balance and 53.1% of students were 16 years old. Information was obtained on history of self-harm life events, and demographic, psychological and life-style factors.


Based on multivariate analyses, important factors associated with DSH among both genders were drug use and knowing a friend who had engaged in self-harm. Among girls, poor self-esteem, forced sexual activity, self-harm of a family member, fights with parents and problems with friendships also remained in the final model. For boys, experiencing bullying, problems with schoolwork, impulsivity and anxiety remained.


Distinct profiles of boys and girls who engage in self-harm were identified. Associations between DSH and some life-style and life event factors suggest that mental health factors are not the sole indicators of risk of self-harm. The importance of school-related risk factors underlines the need to develop gender-specific initiatives in schools to reduce the prevalence of self-harm.

Corresponding author
*Address for correspondence: E. Arensman, Ph.D., National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork, Republic of Ireland. (Email:
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Addeo RR, Greene AF, Geisser ME (1994). Construct validity of the Robson Self-esteem Questionnaire in a college sample. Educational and Psychological Measurement 54, 439446.
Beautrais AL, Joyce PR, Mulder RT (1999). Personality traits and cognitive styles as risk factors for serious suicide attempts among young people. Suicide and Life-threatening Behavior 29, 3747.
Borowsky IW, Ireland M, Resnick MD (2001). Adolescent suicide attempts: risks and protectors. Pediatrics 107, 485493.
De Leo D, Heller TS (2004). Who are the kids who self-harm? An Australian self-report school survey. Medical Journal of Australia 181, 140144.
Department of Public Health (2001). Suicide In Ireland. A National Study. Published by the Departments of Public Health on behalf of the Chief Executive Officers of the Health Boards.
Eurostat (2009). Suicide death rate, by age group ( Accessed 15 May 2009.
Evans E, Hawton K, Rodham K (2004). Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies. Clinical Psychology Review 24, 957979.
Evans E, Hawton K, Rodham K (2005). In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? Journal of Adolescence 28, 573587.
Fergusson DM, Woodward LJ, Horwood LJ (2000). Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychological Medicine 30, 2339.
Garland AF, Zigler E (1993). Adolescent suicide prevention. Current research and social policy implications. American Psychologist 48, 169182.
Gould MS, Petrie K, Kleinman MH, Wallenstein S (1994). Clustering of attempted suicide: New Zealand national data. International Journal of Epidemiology 23, 11851189.
Grosz DE, Lipschitz DS, Eldar S, Finkelstein G, Blackwood N, Gerbino-Rosen G, Faedda GL, Plutchik R (1994). Correlates of violence risk in hospitalized adolescents. Comprehensive Psychiatry 35, 296300.
Gunnell D, Hawton K, Ho D, Evans J, O'Connor S, Potokar J, Donovan J, Kapur N (2008). Hospital admissions for self-harm after discharge from psychiatric inpatient care: cohort study. BMJ 337, a2278.
Harrington R, Pickles A, Aglan A, Harrington V, Burroughs H, Kerfoot M (2006). Early adult outcomes of adolescents who deliberately poisoned themselves. Journal of the American Academy of Child and Adolescent Psychiatry 45, 337345.
Hawton K, Fagg J, Platt S, Hawkins M (1993). Factors associated with suicide after parasuicide in young people. BMJ 306, 16411644.
Hawton K, Houston K, Shepperd R (1999). Suicide in young people. Study of 174 cases, aged under 25 years, based on coroners' and medical records. British Journal of Psychiatry 175, 271276.
Hawton K, Rodham K, Evans E, Weatherall R (2002). Deliberate self-harm in adolescents: self report survey in schools in England. BMJ 325, 12071211.
Health Service Executive (2005). Reach Out: National Strategy for Action on Suicide Prevention 2005–2014. Health Service Executive: Dublin.
Keeley HS, Arensman E, Corcoran P, Hannon G (2008). Lost by CASE definition? Indications for ‘hidden’ cases of deliberate self-harm in an Irish school-based study. In 12th European Symposium on Suicide/Suicidal Behaviour, Glasgow. Hampton Medical Conferences Ltd: Hampton Hill, UK.
Lynch F, Mills C, Daly I, Fitzpatrick C (2006). Challenging times: prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents. Journal of Adolescence 29, 555573.
Madge N, Hewitt A, Hawton K, de Wilde EJ, Corcoran P, Fekete S, van Heeringen K, De Leo D, Ystgaard M (2008). Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. Journal of Child Psychology and Psychiatry 49, 667677.
Marusic A, Roskar S, Hughes RH (2004). Familial study of suicidal behavior among adolescents in Slovenia. Crisis 25, 7477.
Morey C, Corcoran P, Arensman E, Perry IJ (2008). The prevalence of self-reported deliberate self-harm in Irish adolescents. BMC Public Health 8, 79.
National Suicide Research Foundation (2009). National Registry of Deliberate Self-harm: Annual Report 2008. National Suicide Research Foundation: Cork.
Neeleman J, de Graaf R, Vollebergh W (2004). The suicidal process; prospective comparison between early and later stages. Journal of Affective Disorders 82, 4352.
O'Connor RC, Rasmussen S, Hawton K (2009 a). Predicting deliberate self-harm in adolescents: a six month prospective study. Suicide and Life Threatening Behavior 39, 364375.
O'Connor RC, Rasmussen S, Miles J, Hawton K (2009 b). Self-harm in adolescents: self-report survey in schools in Scotland. British Journal of Psychiatry 194, 6872.
O'Sullivan M, Fitzgerald M (1998). Suicidal ideation and acts of self-harm among Dublin school children. Journal of Adolescence 21, 427433.
Plutchik R, Van Praag H (1989). The measurement of suicidality, aggressivity and impulsivity. Progress in Neuro-psychopharmacology and Biological Psychiatry 13 (Suppl.), S23S34.
Plutchik R, Van Praag HM, Picard S, Conte HR, Korn M (1989). Is there a relation between the seriousness of suicidal intent and the lethality of the suicide attempt? Psychiatry Research 27, 7179.
Portzky G, De Wilde EJ, van Heeringen K (2008). Deliberate self-harm in young people: differences in prevalence and risk factors between The Netherlands and Belgium. European Child and Adolescent Psychiatry 17, 179186.
Robinson J, Gook S, Yuen HP, McGorry PD, Yung AR (2008). Managing deliberate self-harm in young people: an evaluation of a training program developed for school welfare staff using a longitudinal research design. BMC Psychiatry 8, 75.
Robson P (1989). Development of a new self-report questionnaire to measure self esteem. Psychological Medicine 19, 513518.
Rossow I, Ystgaard M, Hawton K, Madge N, van Heeringen K, de Wilde E, DeLeo D, Fekete S, Morey C (2007). Cross-national comparisons of the association between alcohol consumption and deliberate self-harm in adolescents. Suicide and Life-Threatening Behavior 37, 605615.
Sattar SP, Soundy T, Inamdar S, Din AU (2007). Differences in the self-reported reasons for adolescent drug use reported at admission vs. reported at discharge. Journal of the South Dakota State Medical Association 60, 225, 227229.
Scott MA, Wilcox HC, Schonfeld IS, Davies M, Hicks RC, Turner JB, Shaffer D (2009). School-based screening to identify at-risk students not already known to school professionals: the Columbia suicide screen. American Journal of Public Health 99, 334339.
Sullivan C, Arensman E, Keeley HS, Corcoran P, Perry IJ (2004). Young People's Mental Health. A Report of the Results from the Lifestyle and Coping Survey. National Suicide Research Foundation: Cork, Republic of Ireland.
Tidemalm D, Langstrom N, Lichtenstein P, Runeson B (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. BMJ 337, a2205.
Voros V, Fekete S, Hewitt A, Osvath P (2005). Suicidal behavior in adolescents – psychopathology and addictive comorbidity [in Hungarian]. Neuropsychopharmacologia Hungarica 7, 6671.
Walinder J, Rutzt W (2001). Male depression and suicide. International Clinical Psychopharmacology 16 (Suppl. 2), S21S24.
White D, Leach C, Sims R, Atkinson M, Cottrell D (1999). Validation of the Hospital Anxiety and Depression Scale for use with adolescents. British Journal of Psychiatry 175, 452454.
World Health Organization (1999). Factsheet 217: The Newly Defined Burden of Mental Problems. WHO: Geneva.
Ystgaard M, Arensman E, Hawton K, Madge N, van Heeringen K, Hewitt A, de Wilde EJ, De Leo D, Fekete S (2009). Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not. Journal of Adolescence 32, 875891.
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