HQ Team
May 3, 2023: Mental health problems have exacerbated post-Covid, with many people reporting anxiety and stress disorders. An increase in the number of hospitalization for suicide, self-harm and other mental disorders are being reported. Children and adolescents form a big number of those affected by this mental health crisis.
A study, “Characteristics Associated with Serious Self-Harm Events in Children and Adolescents,” undertaken by Vanderbilt University, examined factors determining which children are more likely to risk self-harm.
“Self-harm is a big bucket of events from mild things like cutting on the arms or thighs to taking so much Tylenol that you die on purpose or jumping out of a window, and we wanted to find out which kids require hospitalization and more intensive treatment and monitoring,” said study author Dr. James Antoon, an assistant professor of pediatrics and hospital medicine at Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville, Tenn.
The Vanderbilt research team developed four profiles for serious self-harm based on age, gender, and psychiatric and medical condition
They were identified — low risk, moderate risk, high risk, and very high risk.
The categorization is based on previous works and assessments plus a comprehensive framework developed by the researchers.
“Our study provides an important step in evaluating the whole child in relation to self-harm risk assessment. These profiles can be used to better inform clinical decision-making by providing a better assessment of the overall risk of self-harm,” Prof. Antoon said.
The researchers observed the profiles of 1,098 children between the ages of 5 and 18 years of age hospitalized with a neuropsychiatric event at Monroe Carell and Children’s Hospital of Colorado in Aurora between 2016 and 2020. Of those hospitalized, 406 (37%) were diagnosed with a self-harm event.
The researchers found that:
Children males ages 10-13 with ADHD, bipolar disorder, autism spectrum disorder and other developmental disorders were found to be very high risk.
- Children ages 5-9 with no mental health diagnosis or, behavioral disorders, psychotic disorders, developmental disorders, and trauma or substance-related disorders were at very low risk.
- High-risk profile also included females aged 14-17 with depression and anxiety along with substance- and trauma-related disorders. Personality and eating disorders also played a significant role for this category.
- Moderate risk had a significant absence of depressive disorders, suggesting that these disorders play a major role in driving the risk of suicidality.
The study authors took into account factors like age and sex, as well as overall underlying psychiatric and medical conditions.
“There are many interacting factors in children with self-harm events, ranging from individual, family, social support and specific life events,” said lead author Mert Sekmen, a research assistant with the Division of Hospital Medicine at Monroe Carell.
“We know that psychiatric diagnoses are a well-established risk factor for self-harm. For example, 70% of children who die by suicide have more than two psychiatric diagnoses.”
The study authors said that previous studies considered independent risks such as bipolarism or depression in self-harm events. A holistic approach that factored in demographics along with societal, parental, and mental disorders and the complex interconnectivity of all was lacking.
“Meaning after taking everything else into account, what are the odds of self-harm in someone with bipolar disorder? Or with a child with autism? This approach fails to consider the holistic and complex interactions that make up risk for self-harm,” said Sekmen.
“We cannot evaluate these events without considering the whole child. For example, taking into account the interplay between age, sex, autism and ADHD at the same time.”
“Our study provides a novel approach that takes the child’s entire medical and psychiatric profile into account and assesses what overall constellations of factors are associated with imminent self-harm,” said Antoon.
The authors believe this study can be a precursor to further larger studies to analyze the elevated risk factors in children and adolescents. This will aid in developing prognostic and clinical assessments to gauge real-time risks.
The study was published online Monday in the journal Pediatrics.
