Abstract
Prompt access to appropriate professional care for adolescents with self-harm thoughts and respective behaviors (suicidal behavior and non-suicidal self-injury [NSSI]) is crucial as both are associated with an increased risk of suicide in later life. The present study aimed to describe the duration from initial onset of thoughts and incidents of self-harm until first clinical presentation in children and adolescents and to identify factors affecting help-seeking duration.Onset of self-harm thoughts and behaviors, time of first clinical presentation, and psychiatric and demographic variables were obtained from n = 672 adolescents (11–19 years) from the Germany-based AtR!Sk (Ambulanz für Risikoverhalten & Selbstschädigung) cohort-study at an outpatient clinic for risk-taking and self-harm behaviors. In 22% of overall cases, the first self-harm thoughts and behaviors occurred after contact to professional care was already established. Focusing on actual help-seeking delay only, it took between M = 0.99 years (after first suicide attempt) and M = 1.98 years (after first thoughts of NSSI) until participants sought professional help. Overall, help-seeking duration and help-seeking delay were longer for participants with more severe psychopathology (i.e., BPD, depressive symptoms, general symptom severity). The findings revealed a substantial delay of receiving appropriate professional care in adolescents with self-harm thoughts and behavior. The correlation between treatment latency and higher psychopathology may emphasize the need of prompt treatment. A better understanding of barriers and facilitators to professional help will contribute to enhance measures of tailored support for young patients in their help-seeking process.
Highlights
Self-harm, which includes both suicidal behavior and non-suicidal self-injury (NSSI), is common among adolescents
In cross-sectional and longitudinal studies, NSSI was associated with increased suicidality (Andover and Gibb, 2010; Groschwitz et al, 2015; Koenig et al, 2017), and self-harm regardless of suicidal intent increased the risk for later suicide in life (Morgan et al, 2017)
When only the negative values were included, boys reported longer durations than girls from first contact to a pro fessional child and adolescent psychiatric service to first suicide attempt (t(82) = 2.51, p = .014) and first NSSI (t(108) = 2.13, p = .036), with an average duration for males of − 5.57 years (SD = 2.21, 95% CI = − 6.85 to − 4.30) and − 4.57 years (SD = 2.31, 95% CI = − 5.62 to − 3.52) respectively
Summary
Self-harm, which includes both suicidal behavior and non-suicidal self-injury (NSSI), is common among adolescents. Lifetime prevalence of NSSI (i.e. the deliberate act of injuring one’s own body tissue without suicidal intent) in adolescents has been estimated at 17% (Muehlenkamp et al, 2012). In cross-sectional and longitudinal studies, NSSI was associated with increased suicidality (Andover and Gibb, 2010; Groschwitz et al, 2015; Koenig et al, 2017), and self-harm regardless of suicidal intent (including both NSSI and suicide attempts) increased the risk for later suicide in life (Morgan et al, 2017). DBT-A and family-centered therapy have been successfully implemented to reduce suicidal ideation and self-harm in adolescents (d = 0.48 - 0.58; Koth gassner et al, 2021, 2020)
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