Abstract

PurposeGender differences in youth self-harm are sparsely studied regarding long-term prognoses. We aimed to study the gender differences in effects of adolescent self-harm in early adult life in four domains: 1/family situation, 2/education and employment, 3/mental illness and suicidal behaviour, and 4/suicide and all-cause mortality.MethodA register-based cohort study including all Swedish residents aged 20 during 2001–2005 was performed. Exposure was self-harm at ages 10–20, and outcomes were death and suicide and past-year records of self-harm, marital status/children, education/employment, and mental health at age 30. We used logistic regression for dichotomous outcomes, and Cox regression models for time-dependent outcomes. An interaction term was introduced to detect significant gender effects, in which case we performed stratified analyses.ResultsSubjects with self-harm before age 20 had a poorer prognosis for all studied outcomes, and risk estimates were similar for men and women for most outcomes including suicide. Significant interaction terms (ITs) were found, revealing gender differences, for being married (pIT 0.0003; ORmen 0.6, ORwomen 0.9), being a parent (pIT < 0.0001; ORmen 0.7, ORwomen 1.1), receiving unemployment support (pIT < 0.0001; ORmen 2.4, ORwomen 1.8), and death from any cause (pIT 0.006; ORmen 10.6, ORwomen 7.4).ConclusionsAdolescent self-harm was associated with later life adversities and affected men more than women regarding prognoses for unemployment and certain aspects of the family situation. We found no gender difference for the effect of self-harm on the risk of suicide. Future suicide risk should not be underestimated in young self-harming women.

Highlights

  • Self-harm and suicidal behaviour are common among young people

  • We were able to investigate whether the long-term effects of adolescent self-harm on adult life differed between men and women in four domains: marital status and children, education and employment, mental illness and self-harm, as well as death

  • The effect of self-harm in adolescence on young adult life is large in several domains

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Summary

Introduction

Self-harm and suicidal behaviour are common among young people. In other studies of self-harm, various terms are used. In this article the term “self-harm” is used, defined as direct self-injurious behaviour regardless of the degree of suicidal intent. If the referred studies use other definitions, this is stated in the text. There are considerable gender differences in suicidal behaviour during youth and young adulthood, with suicidal ideation and suicide attempts being more common in young women [11]. The same is true for non-suicidal self-injury (NSSI), for which there is a larger gender difference in clinical than in community samples [12]. For medically severe suicide attempts, the gender difference is less pronounced [11]. The “suicidal gender paradox” points to the fact that, despite the higher prevalence of self-harm among women

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