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Abstract
BackgroundSelf-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10–25 years) in sub-Saharan Africa.MethodWe searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence.ResultsSeventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% – 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% – 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% – 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5–14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% – 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm.ConclusionVariation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.
Highlights
Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide
By comparison we know little about self-harm in young people in subSaharan Africa; instead much of our understanding is based on extrapolation from literature from Europe, the UK, North America, and Australia [5,6,7,8]
Because we wanted to include all acts that meet the World Health Organisation (WHO) definition, which does not include a requirement for a specific intent, given the contention about the soundness of the distinction between self-reported suicidal and nonsuicidal acts [21], which is likely to be a particular problem in countries where suicide is illegal and where different languages may not readily reflect the distinction, and as individual suicide risk is known to reside in all Definition and measurement of self-harm
Summary
Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. The World Health Organisation (WHO) defines selfharm as “an act with non-fatal outcome in which an individual deliberately initiates a non-habitual behaviour, that without intervention from others will cause selfharm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage, and which is aimed at realising changes that the person desires via the actual or expected physical consequences” [1, 2] This definition does not distinguish acts of self-harm according to intent, and for brevity in this review we use the term “self-harm” to refer to acts that are attributed to suicidal and non-suicidal motivations.
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