'Cutting,' Self-Harm Greatly Raise Suicide Risk for Teens
MONDAY, March 19, 2018 (HealthDay News) -- Young people treated for self-inflicted injuries face a far higher-than-average risk of suicide in the next year, a new study finds.
Among teenagers and young adults diagnosed with a "self-harm" injury, the risk of suicide in the next year was nearly 27 times higher than the U.S. norm, researchers found.
Certain young people were at particular risk -- including Native Americans, males and those who'd used especially violent means of self-harm, including guns.
It's been known that kids who self-harm can face a heightened risk of suicide. But health experts said the new findings help pinpoint some of the most vulnerable groups.
"When young people self-harm, it can be a sign of serious mental health distress," said lead researcher Dr. Mark Olfson. He's a professor of psychiatry at Columbia University Medical Center in New York City.
This study, he said, "helps us identify particularly high-risk groups who require close follow-up in the year following self-harm."
Olfson and his colleagues reported the findings online March 19 in the journal Pediatrics.
Statistics suggest that about 1 percent of people self-harm -- usually beginning in adolescence or early adulthood, according to the U.S. Department of Health.
This study defined "self-harm" as self-inflicted injuries that may or may not have had suicidal intent. The injuries ranged from cutting and burning to poisoning and gunshot wounds.
In the case of young people who used especially violent methods, there is a good chance the initial injury was a suicide attempt, according to Lori Evans. She is a clinical assistant professor of child and adolescent psychiatry at NYU Langone Health in New York City.
"But it's not clear from the data," said Evans, who reviewed the study.
Regardless, the findings highlight an important point, according to Evans.
"When you see signs of self-harming behaviors in kids, you do want to act quickly to address it," she said.
"The younger we get kids, the better," Evans said. If they get help, she explained, it's possible to keep self-harming incidents from becoming a "pattern of behavior."
The study findings are based on records from the Medicaid program, which provides health insurance for lower-income Americans.
Olfson's team focused on nearly 32,400 teens and young adults, aged 12 to 24, who'd been diagnosed with a self-inflicted injury. Half were treated in an emergency room. The rest were either hospitalized or had outpatient care.
Overall, 48 of those young people died by suicide in the following year. That rate is almost 27 times higher than the norm for Americans in their demographic, according to the researchers.
Those who'd harmed themselves with a firearm were at particular risk: Compared with young people who'd self-harmed through such means as cutting, they were 36 times more likely to kill themselves.
That, according to Olfson, underscores how important it is to keep guns away from those kids. It can be "lifesaving," he said.
Researchers also found that the risk of suicide was lowest among black and Hispanic young people, and highest among Native Americans. Their risk was over five times that of their white counterparts.
It's not clear why, according to Olfson's team, but other research has found that Native Americans have a higher risk of suicide in general.
Evans speculated that access to mental health care -- or health care, in general -- could be one issue.
Olfson said the specific treatment for self-harming depends on how severe the problem is, and whether there's an underlying mental health issue, such as depression, substance abuse or an anxiety disorder.
Some kids, he explained, harm themselves as a way to cope with overwhelming emotions -- sometimes in response to situations like being bullied.
Therapies, such as dialectical behavioral therapy, can teach those kids positive coping skills, Evans said. This type of treatment helps patients manage painful emotions and decrease conflict in relationships.
Having the family involved is critical, she noted. One reason is that parents need to learn whether things they do or say unwittingly "trigger" their child's behavior, she said.
In some cases, Olfson noted, families are reluctant to agree to therapy because of the continuing "stigma" attached to mental health issues.
Evans agreed that can be a barrier. "But families should know there are good, effective therapies out there," she said.
The National Alliance on Mental Illness has more on self-harm.
SOURCES: Mark Olfson, M.D., MPH, professor, psychiatry, Columbia University Medical Center, New York City; Lori Evans, Ph.D., clinical assistant professor, child and adolescent psychiatry, NYU Langone Health, New York City; March 19, 2018, Pediatrics, online