Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: a comparative study of findings in 11 European countries.
OBJECTIVE
To investigate the prevalence and associated psychosocial factors of occasional and repetitive direct self-injurious behavior (D-SIB), such as self-cutting, -burning, -biting, -hitting, and skin damage by other methods, in representative adolescent samples from 11 European countries.


METHODS
Cross-sectional assessment of adolescents was performed within the European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), which was conducted in 11 European countries. The representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9 ± 0.89) recruited from randomly selected schools. Frequency of D-SIB was assessed by a modified 6-item questionnaire based on previously used versions of the Deliberate Self-Harm Inventory (DSHI). In addition, a broad range of demographic, social, and psychological factors was assessed.


RESULTS
Overall lifetime prevalence of D-SIB was 27.6%; 19.7% reported occasional D-SIB and 7.8% repetitive D-SIB. Lifetime prevalence ranged from 17.1% to 38.6% across countries. Estonia, France, Germany, and Israel had the highest lifetime rates of D-SIB, while students from Hungary, Ireland, and Italy reported low rates. Suicidality as well as anxiety and depressive symptoms had the highest odds ratios for both occasional and repetitive D-SIB. There was a strong association of D-SIB with both psychopathology and risk-behaviors, including family related neglect and peer-related rejection/victimization. Associations between psychosocial variables and D-SIB were strongly influenced by both gender and country. Only a minor proportion of the adolescents who reported D-SIB ever received medical treatment.


CONCLUSIONS
These results suggest high lifetime prevalence of D-SIB in European adolescents. Prevalence as well as psychosocial correlates seems to be significantly influenced by both gender and country. These results support the need for a multidimensional approach to better understand the development of SIB and facilitate culturally adapted prevention/intervention.
Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
Romuald
R
Brunner
Michael
M
Kaess
Peter
P
Parzer
Gloria
G
Fischer
Vladimir
V
Carli
Christina W
CW
Hoven
Camilla
C
Wasserman
Marco
M
Sarchiapone
Franz
F
Resch
Alan
A
Apter
Judith
J
Balazs
Shira
S
Barzilay
Julio
J
Bobes
Paul
P
Corcoran
Doina
D
Cosmanm
Christian
C
Haring
Miriam
M
Iosuec
Jean-Pierre
JP
Kahn
Helen
H
Keeley
Gergely
G
Meszaros
Bogdan
B
Nemes
Tina
T
Podlogar
Vita
V
Postuvan
Pilar A
PA
Saiz
Merike
M
Sisask
Alexandra
A
Tubiana
Airi
A
Varnik
Danuta
D
Wasserman
D000293:Adolescent; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011584:Psychology; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D012737:Sex Factors; D011795:Surveys and Questionnaires
Direct self-injurious behavior; adolescents; gender; nonsuicidal self-injury; psychopathology; self-harm; suicide