Abstract
Early puberty is associated with an increased risk of self-harm in adolescent females but results for males are inconsistent. This may be due to the use of subjective measures of pubertal timing, which may be biased. There is also limited evidence for the persistence of pubertal timing effects beyond adolescence, particularly in males. The primary aim of the current study was therefore to examine the association between pubertal timing and self-harm in both sexes during adolescence and young adulthood, using an objective measure of pubertal timing (age at peak height velocity; aPHV). A secondary aim was to examine whether this association differs for self-harm with v. without suicidal intent. The sample (n = 5369, 47% male) was drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort study. Mixed-effects growth curve models were used to calculate aPHV. Lifetime history of self-harm was self-reported at age 16 and 21 years, and associated suicidal intent was examined at age 16 years. Associations were estimated using multivariable logistic regression adjusted for a range of confounders. Missing data were imputed using Multiple Imputation by Chained Equations. Later aPHV was associated with a reduced risk of self-harm at 16 years in both sexes (females: adjusted per-year increase in aPHV OR 0.85; 95% CI 0.75-0.96; males: OR 0.72; 95% CI 0.59-0.88). Associations were similar for self-harm with and without suicidal intent. There was some evidence of an association by age 21 years in females (adjusted per-year increase in aPHV OR 0.91; 95% CI 0.80-1.04), although the findings did not reach conventional levels of significance. There was no evidence of an association by age 21 years in males (adjusted per-year increase in aPHV OR 0.99; 95% CI 0.74-1.31). Earlier developing adolescents represent a group at increased risk of self-harm. This increased risk attenuates as adolescents transition into adulthood, particularly in males. Future research is needed to identify the modifiable mechanisms underlying the association between pubertal timing and self-harm risk in order to develop interventions to reduce self-harm in adolescence.
Highlights
Self-harm is one of the strongest predictors of suicide (Hawton et al, 2003), which is the second-leading cause of death globally among 15–29 year olds (World Health Organization, 2014)
Identifying the factors associated with self-harm, the unique risk factors experienced by males and females, is important for developing effective interventions
We investigate whether findings differ for self-harm with and without suicidal intent, as prior research has indicated there may be differences in the risk factors for these behaviours (Mars et al, 2014)
Summary
Self-harm is one of the strongest predictors of suicide (Hawton et al, 2003), which is the second-leading cause of death globally among 15–29 year olds (World Health Organization, 2014). Identifying the factors associated with self-harm, the unique risk factors experienced by males and females, is important for developing effective interventions. Previous research has reported a consistent association between early pubertal timing and an increased risk of self-harm in females (Roberts et al, 2019), but few studies include males or stratify by sex. Those that do find varying results in males, with an increased risk of self-harm having been reported in individuals experiencing early puberty (Michaud et al, 2006) and late puberty (Wichstrøm, 2000), or Downloaded from https://www.cambridge.org/core.
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