title: Substance use in adulthood following adolescent self-harm: a population-based cohort study.
abstract: OBJECTIVE
  To determine whether adolescents who self-harm are at increased risk of heavy and dependent substance use in adulthood.
  
  
  METHODS
  Fifteen-year prospective cohort study of a random sample of 1943 adolescents recruited from secondary schools across the state of Victoria, Australia. Data pertaining to self-harm and substance use was obtained at seven waves of follow-up, from mean age 15.9 years to mean age 29.1 years.
  
  
  RESULTS
  Substance use and self-harm were strongly associated during the adolescent years (odds ratio (OR): 3.3, 95% CI 2.1-5.0). Moreover, adolescent self-harmers were at increased risk of substance use and dependence syndromes in young adulthood. Self-harm predicted a four-fold increase in the odds of multiple dependence syndromes (sex- and wave-adjusted OR: 4.2, 95% CI: 2.7-6.6). Adjustment for adolescent anxiety/depression attenuated but did not eliminate most associations. Adolescent substance use confounded all associations, with the exception of multiple dependence syndromes, which remained robustly associated with adolescent self-harm (fully adjusted odds ratio: 2.0, 95% CI: 1.2-3.2).
  
  
  CONCLUSIONS
  Adolescent self-harm is an independent risk factor for multiple dependence syndromes in adulthood. This level of substance misuse is likely to contribute substantially to the premature mortality and disease burden experienced by individuals who self-harm.
authors: King's College London, Health Services & Population Research Department, Institute of Psychiatry, London, UK.
authors: P
authors: P
authors: Moran
authors: C
authors: C
authors: Coffey
authors: H
authors: H
authors: Romaniuk
authors: L
authors: L
authors: Degenhardt
authors: R
authors: R
authors: Borschmann
authors: G C
authors: GC
authors: Patton
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: epidemiology; self-harm; substance-related disorders