Self - mutilation in adolescents admitted to Tara psychiatric hospital: prevalence and characteristics

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2016

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Stancheva, Venera Petkova

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Abstract

Self-mutilation in youth is a major public health problem with increasing prevalence all over the world and is associated with high risk of suicide. Studies suggest that this behaviour is more commonly observed among hospitalised adolescents The aims of the study were to estimate the prevalence of self-mutilation, identify the factors associated and describe the specific characteristics for this behaviour among clinical population of adolescents. A retrospective file audit of 334 patient files over four years (2006-2010) was conducted at Tara Adolescent and Eating Disorder Unit. The study compared adolescents who self-mutilated with those who did not self-mutilate. Multiple logistic regression analysis was used to identify risk factors (demographics, family structure, parental psychopathology, childhood trauma, substance abuse, previous suicide attempt and sexuality). Additional information regarding the precipitating factors, response to self-mutilation, methods of self-mutilation, locations and frequency was described according to gender. There were 183 patients who self-mutilated (age=15.8± 1.3 years, 73.2% females) and 151 non-self-mutilators (15.3± 1.2 years, 52.3% females). The prevalence of self-harm was 54.8% (95%CI, 49.1-59.7). Being a female, Caucasian, having a step-parent, having a parent with a mental illness, history of domestic violence, physical and sexual abuse and previous suicide attempts were found to be associated with self-mutilation (p<0.01). Smoking (adj OR 2.0 95% CI=1.3-3.2) and alcohol abuse (adj OR3.4 95%CI=2.0-5.5) increased the risk for self-harm. Females with increased number of comorbidities and emerging Personality Disorders self-harm more than their male peers. Superficial self-cutting was the most frequent method of self-mutilation (93.6%, 95%CI=90.2-97.0). The most common precipitating factor among both sexes was sadness (58.9%), followed by anger (45.0%). In conclusion, self-mutilation is a common and repetitive behaviour among hospitalised adolescents. The severity of the physical, sexual abuse and previous parasuicides increased the risk for self-harm in combination with smoking and alcohol abuse. However poor social support, academic problems, bullying, cannabis use and being homosexual was not associated with self-mutilation. Disruptive Behaviour Disorders were more prevalent among self-mutilators. Although superficial self-cutting was the most common method of self-mutilation, majority of the adolescents used different methods to self-harm. Clinicians should be aware of the increased risk to self-harm among hospitalised adolescents and develop strategies to decrease this behaviour.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2016

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