Self-harm is a global public health problem (Hawton et al., 2003). In England, approximately 200,000 adolescents aged 12–17 years engage in self-harming behavior without clinical support each year, and an additional 21,000 adolescents seek medical treatment following self-harming events (Geulayov, et al., 2018; Morgan et al. , 2017; Patalay & Gage, 2019).
Rates of self-harm are higher among adults with disabilities (Khazem, 2018; Khurana et al., 2021), but there is different outcomes when it comes to teenagers with disabilities (King et al., 2019; Tejera et al., 2019).
Thus, this study was conducted to contribute to the development of knowledge and to better understand the prevalence and risk factors of self-harm in adolescents with and without disabilities.
Adults with disabilities are at higher risk of self-harm than those without – what about teenagers?
Methods
The researchers used secondary data from the Millennium Cohort Study; A group of children born between 2000 and 2002 (Plewis et al., 2007). Participants were randomly selected using child benefit records. Data were collected from 14- and 17-year-old adolescents through interviews with parents and adolescents. At the age of 14, 11,726 adolescents participated in the interviews with their parents' information, and at the age of 17, 9,528 adolescents participated in the interviews.
Disability was assessed by a positive response to a physical or mental health condition lasting 12 months or more. A follow-up response of “more” or “less” impairment was used to distinguish between more and less limiting disability.
The authors also assessed the lifetime prevalence of self-injury at age 17 and the 12-month prevalence of six different self-injurious behaviors. Other potential risk factors for self-harm were sexual orientation, exposure to violence, and a self-report measure of depression at age 14.
Inverse probability weighting was performed to remove potential biases related to sampling and attrition. They also considered clustering in survey design using survey data analysis options. Adjusted prevalence rates were estimated to compare the likelihood of self-harm among adolescents with disabilities to those without disabilities.
Results
Prevalence of disability
Of 9,528 17-year-old participants:
- 12.4% of teenagers reported having some form of disability
- 7.7% have a less restrictive disability
- 4.7% have a more limiting disability
Prevalence of self-harm
The lifetime prevalence of suicide attempts was 25.5% among those with more limited disabilities, 21.9% among those with limited disabilities, and 5.3% among those without disabilities. Adolescents with more severe disabilities were 3.87 times more likely to attempt suicide in their lifetime than adolescents with no disabilities, and adolescents with less severe disabilities were 3.67 times more likely.
Functional disorders
After adjusting for gender, ethnicity, and poverty, of the nine functional disorders, those related to mental health, learning, and memory were strongly associated with higher rates of self-harm. For example, the adjusted prevalence ratio ratios (APRR) for suicide attempts were 5.13 (95% CI 3.58 to 7.36) for mental health limitations and 3.64 (95% CI 2.72 to 4.88) was. Functional impairments such as vision and mobility did not show a significant association with self-injurious behavior in the past year.
Risk factors
The study identified several risk factors associated with the prevalence of self-harm among adolescents with and without disabilities.
In comparison, being female, LGBTQ+ orientation, growing up in poverty-income households, and experiencing self-depression among adolescents without disabilities increased the likelihood of lifetime self-harm among adolescents with disabilities. Self-harm in the previous year was reported by adolescents with a disability (5 acts of self-harm), more limiting disabilities and ethnic minorities (2 acts of self-harm).
For adolescents without disabilities, those in the “non-heterosexual” group had increased lifetime risk of suicide attempt and past-year self-injurious behavior, followed by exposure to female sex and violence at ages 7, 11, and 14.
This research shows that teenagers with mental health and learning difficulties are at higher risk of self-harm.
Results
Adolescents with disabilities are at greater risk of self-harm and suicide attempts than their non-disabled peers, and this risk is more pronounced among people with more limited disabilities, research shows. The research also highlights the complexity of the relationship between disability and self-harm, suggesting that risk is more associated with cognitive and mental health impairments than physical impairments such as vision and mobility. Being female or LGBTQ+ orientation were major factors in self-harm among adolescents with disabilities.
Being an LGBTQ+ disabled teenager has been identified as a major risk factor for self-harm.
Strengths and limitations
One of the main strengths is that the researchers addressed a critical gap in the literature by focusing on adolescents with disabilities; An underrepresented group in self-harm research using data from the Millennium Cohort study, a national sample of adolescents in the UK. The classification of functional impairments allowed a detailed analysis of the different types of disabilities associated with self-injurious behaviors.
With data on self-harm and disability based on self-report, there is potential for recall bias and social desirability bias for adolescents who may underreport self-injurious behaviors.
Since this work is a cross-sectional design; therefore, although associations can be identified, it is not possible to determine whether disabled people are directly at increased risk of self-harm.
The study also did not take into account changes over time or repeated self-harm. This limits understanding of how self-injurious behaviors develop or persist as adolescents grow older.
Although the researchers controlled for several confounders, such as school environment, there may be other unmeasured variables that may influence the relationship between disability and self-harm.
Opportunities also exist to examine the prevalence of self-harm among ethnic minority adolescents with disabilities; a population that can be further marginalized.
Longitudinal studies are needed to better understand self-harm and disability among adolescents.
Implications for practice
The study has some important implications for practice. With the strong co-occurrence of mental health disorders and learning difficulties, there is perhaps a need for mental health services to screen for risk of self-harm and symptoms of depression among these groups in schools and communities. There is clearly a need to strengthen mental health support, both in schools and in the wider community. The study also highlights the need for anti-bullying programs that are inclusive of students with disabilities, accessible and aimed at reducing the impact of bullying.
Additional qualitative research would help examine aspects of bullying and the quality of mental health services perceived by adolescents with disabilities, teachers, parents, and health care providers. With the high risk of self-harm among youth with disabilities who identify as LGBTQ+, counseling and support groups are needed to address the needs of this unique population. Future longitudinal studies could be done by following adolescents with disabilities and examining suicidal behaviors.
The study highlights the need to tackle adolescent violence to protect marginalized populations at high risk of self-harm.
Statement of interest
There is no conflict of interest.
Connections
Primary paper
Other references
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