title: Youth self-harm in low- and middle-income countries: Systematic review of the risk and protective factors.
abstract: BACKGROUND
  Self-harm (defined here as an act of intentionally causing harm to own self, irrespective of the type, motive or suicidal intent) is one of the strongest antecedents of suicide in youth. While there have been a number of studies of youth self-harm in low- and middle-income countries (LMICs), there is currently no systematic review of studies of prevalence rates and risk and protective factors.
  
  
  OBJECTIVE
  To systematically review the evidence relating to the prevalence rates and forms of self-harm in youth in LMICs and its relationship to family economic status, family functioning, relationship with the peer group, social relationships and academic performance.
  
  
  METHODS
  Electronic searches of three databases, MEDLINE, PsycINFO and Scopus, were performed. In total, 27 school-, community- and hospital-based studies evaluating self-harm in LMICs with youth focus (with participants between 12 and 25 years) were included.
  
  
  RESULTS
  The self-harm was divided into suicidal and non-suicidal depending on the nature of self-harm. The 12-month prevalence rates of non-suicidal self-harm varied from 15.5% to 31.3%, and the range of suicidal behaviour rates was from 3.2% to 4.7%. Banging and hitting were the most common in the community-based studies, followed by cutting, scratching and wound picking. Self-poisoning with pesticides was most commonly reported in hospital-based studies. Risk factors for self-harm were family conflict, peer groups with members indulging in self-harm, truancy and school absenteeism. Protective factors were having an understanding family, having friends and higher school competence. Risk factors for suicidal thoughts and attempts were lack of close friends and history of suicide by a friend.
  
  
  CONCLUSIONS
  The 12-month prevalence rates of youth self-harm in LMICs are comparable to high-income countries (HICs). The profile of risk and protective factors suggests that family-based interventions could be useful in treatment and prevention. Future studies should aim for greater consistency in assessment methods and the constructs under evaluation.
authors.affiliation: 1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: 2 Department of Pediatrics, Royal Children's Hospital, Parkville, VIC, Australia.|3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Patton
authors.affiliation: 3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.
authors.forename: Nicola
authors.initials: N
authors.lastname: Reavley
authors.forename: Shreenivas A
authors.initials: SA
authors.lastname: Sreenivasan
authors.affiliation: 1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.|4 Orygen: The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
mesh_terms: D000293:Adolescent; D002648:Child; D005190:Family; D006801:Humans; D011203:Poverty; D065840:Protective Factors; D012307:Risk Factors; D012574:Schools; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000517:prevention & control*; D012923:Social Class; D055815:Young Adult
keywords: Self-harm; low- and middle-income countries; protective factors; risk factors; youth