Risk factors and correlates of deliberate self-harm behavior: a systematic review.
OBJECTIVE
Deliberate self-harm behavior--without suicidal intent--is a serious health problem and may be studied as a clinical phenomenon in its own right. Empirical studies of sociodemographic and psychological correlates and risk factors are systematically reviewed.


METHODS
We searched Medline, PsycINFO, PSYNDEX (German psychological literature), and reference lists. We targeted self-induced bodily harm without conscious suicidal intent. Studies on suicidal behavior or self-poisoning were only included if they also assessed nonsuicidal self-harm.


RESULTS
Fifty-nine original studies met the criteria. Deliberate self-harm may occur at all ages, yet adolescents and young adults are at a higher risk. Evidence on gender is complex. Only 5 studies realize a prospective design (6 months to 10 years) and test predictors. The majority use cross-sectional and retrospective methods. No longitudinal study (separately) examines new incidence. Evidence of correlates encompasses distal/proximal, person/environment, and state/trait factors. Many studies report associations between current self-harm behavior and a history of childhood sexual abuse. Adolescent and adult self-harmers experience more frequent and more negative emotions, such as anxiety, depression, and aggressiveness, than persons who do not self-harm. Two studies yield specific interactions between childhood trauma and current traits and states such as low emotional expressivity, low self-esteem, and dissociation with respect to a vulnerability to self-harm.


CONCLUSIONS
Evidence of distal, biographical stressors is fairly strong. Proximal stressors have rarely been investigated; protective factors, hardly at all. Despite many findings of correlates, the data do not yet justify terming them risk factors. Longitudinal studies are needed.
Fliege
Herbert
H
Department of Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin Berlin, Germany. herbert.fliege@charite.de
Lee
Jeong-Ran
JR
Grimm
Anne
A
Klapp
Burghard F
BF
D000293:Adolescent; D000328:Adult; D006801:Humans; D033182:Intention; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology; D055815:Young Adult