Self-harm risk between adolescence and midlife in people who experienced separation from one or both parents during childhood.
Experience of child-parent separation predicts adverse outcomes in later life. We conducted a detailed epidemiological examination of this complex relationship by modelling an array of separation scenarios and trajectories and subsequent risk of self-harm.



This cohort study examined persons born in Denmark during 1971-1997. We measured child-parent separations each year from birth to 15th birthday via complete residential address records in the Civil Registration System. Self-harm episodes between 15th birthday and early middle age were ascertained through linkage to psychiatric and general hospital registers. Incidence rate ratios (IRRs) from Poisson regression models were estimated against a reference category of individuals not separated from their parents.



All exposure models examined indicated an association with raised self-harm risk. For example, large elevations in risk were observed in relation to separation from both parents at 15th birthday (IRR 5.50, 95% CI 5.25-5.77), experiencing five or more changes in child-parent separation status (IRR 5.24, CI 4.88-5.63), and having a shorter duration of familial cohesion during upbringing. There was no significant evidence for varying strength of association according to child's gender.



Measuring child-parent separation according to differential residential addresses took no account of the reason for or circumstances of these separations.



These novel findings suggest that self-harm prevention initiatives should be tailored toward exposed persons who remain psychologically distressed into adulthood. These high-risk subgroups include individuals with little experience of familial cohesion during their upbringing, those with the most complicated trajectories who lived through multiple child-parent separation transitions, and those separated from both parents during early adolescence.
National Centre for Register-Based Research, Aarhus University, Denmark.
Aske
A
Astrup
National Centre for Register-Based Research, Aarhus University, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark.
Carsten B
CB
Pedersen
Centre for Mental Health and Safety, The University of Manchester, United Kingdom.
Pearl L H
PLH
Mok
Centre for Mental Health and Safety, The University of Manchester, United Kingdom.
Matthew J
MJ
Carr
Centre for Mental Health and Safety, The University of Manchester, United Kingdom. Electronic address: roger.webb@manchester.ac.uk.
Roger T
RT
Webb
D000293:Adolescent; D041923:Adolescent Development; D000328:Adult; D001010:Anxiety, Separation / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004243:Divorce / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology*
Child-parent separation; Epidemiology; Familial cohesion; Self-harm