Abstract
Background: A growing body of evidence from high-income contexts suggests a strong association between sexual violence victimisation and self-harm and eventual suicide. However, both sexual violence and self-harm among adolescents are still less researched in sub-Saharan African countries, including Ghana.Objectives: To estimate the 12-month prevalence of self-harm, and to describe the associated factors and reported reasons for self-harm among school-going adolescent survivors of sexual violence victimisation during the previous 12 months in urban Ghana.Methods: Analytic data came from a regional-based representative cross-sectional survey including in-school youth (N = 1,723) conducted in 2017 within the Greater Accra Region of Ghana. Of these, 297 (17.2%) self-reported sexual violence victimisation in the previous 12 months; this proportion of the participants (n = 297) was the focus of the current study. Items measuring sexual violence victimisation, self-harm, and correlates were adopted from the 2012 Ghana WHO–Global School-based Student Health Survey and the Child and Adolescent Self-harm in Europe Study. Data analysis involved multivariable logistic regression models.Results: The estimate of self-harm ideation during the previous 12 months was 45.8% (95% CI: 40–52), whereas the estimate of self-harm behaviour was 38.7% (95% CI: 33–44). About two in five of the participants who reported self-harm wanted to die by their last episode of the behaviour. While bullying victimisation was associated with increased odds of self-harm ideation (aOR = 1.97, 95% CI 1.17, 3.31, p = 0.010) and behaviour (aOR = 2.76, 95% CI 1.59, 4.80, p < 0.001), weekly alcohol use (aOR = 2.56, 95% CI 1.32, 4.93, p = 0.005), conflict with parents (aOR = 2.30, 95% CI 1.28, 4.12, p = 0.005), and physical abuse victimisation (aOR = 1.80, 95% CI 1.03, 3.15, p = 0.037) showed strong associations with increased odds of self-harm behaviour in the past 12 months.Conclusions: The evidence underscores the need for both universal and targeted multi-level intervention and prevention programmes to mitigate the offence of sexual violence and reduce the chances of self-harm among adolescent survivors of sexual violence in urban Ghana.
Highlights
According to the World Health Organisation (WHO), sexual violence1 is “any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work” (Krug et al, 2002)
A growing body of evidence suggests that sexual violence victimisation is a strong risk for self-harm2, suicidal ideations, and eventual suicide among adolescents (Brown et al, 1999; Beautrais, 2000; Martin et al, 2004; Ystgaard et al, 2004; Klonsky and Moyer, 2008; Miller et al, 2013; Seff and Stark, 2019; Alix et al, 2020; Baiden et al, 2020)
The findings of this study show that: (1) about four out of 10 school-going adolescent survivors of sexual violence victimisation reported self-harm ideation, while three out of 10 reported self-harm behaviour in the previous 12 months; (2) school-going adolescent survivors of sexual violence victimisation reported more intrapersonal reasons for their last episode of self-harm, about two in five wanted to die by their selfharm; and (3) lifestyle and social adversity factors were associated with increased odds of self-harm ideation and behaviour; in particular, bullying victimisation showed a strong association with both self-harm ideation and behaviour
Summary
According to the World Health Organisation (WHO), sexual violence is “any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work” (Krug et al, 2002). A growing body of evidence (mostly from high-income contexts) suggests that sexual violence victimisation is a strong risk for self-harm, suicidal ideations, and eventual suicide among adolescents (Brown et al, 1999; Beautrais, 2000; Martin et al, 2004; Ystgaard et al, 2004; Klonsky and Moyer, 2008; Miller et al, 2013; Seff and Stark, 2019; Alix et al, 2020; Baiden et al, 2020). A growing body of evidence from high-income contexts suggests a strong association between sexual violence victimisation and self-harm and eventual suicide Both sexual violence and self-harm among adolescents are still less researched in sub-Saharan African countries, including Ghana
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