Abstract
Previous studies of pubertal timing and self-harm are limited by subjective measures of pubertal timing or by the conflation of self-harm with suicide attempts and ideation. The current study investigates the association between an objective measure of pubertal timing - age at menarche - and self-harm with and without suicidal intent in adolescence and adulthood in females. Birth cohort study based on 4042 females from the Avon Longitudinal Study of Parents and Children (ALSPAC). Age at menarche was assessed prospectively between ages 8 and 17 years. Lifetime history of self-harm was self-reported at ages 16 and 21 years. Associations between age at menarche and self-harm, both with and without suicidal intent, were examined using multivariable logistic regression. Later age at menarche was associated with a lower risk of lifetime self-harm at age 16 years (OR per-year increase in age at menarche 0.87; 95% CI 0.80-0.95). Compared with normative timing, early menarche (<11.5 years) was associated with an increased risk of self-harm (OR 1.31, 95% CI 1.04-1.64) and later menarche (>13.8 years) with a reduced risk (OR 0.74, 95% CI 0.58-0.93). The pattern of association was similar at age 21 years (OR per-year increase in age at menarche 0.92, 95% CI 0.85-1.00). There was no strong evidence for a difference in associations with suicidal v. non-suicidal self-harm. Risk of self-harm is higher in females with early menarche onset. Future research is needed to establish whether this association is causal and to identify potential mechanisms.
Highlights
Self-harm is a major public health concern, affecting individuals both in clinical and community settings
Of the individuals who had self-harmed at age 16 years, 31.1% reported having done so with suicidal intent
The results suggest that a 1-year increase in age at menarche was associated with a lower risk of both non-suicidal self-harm (NSSH) (RRR 0.86; 95% CI 0.78–0.94) and self-harm with suicidal intent (RRR 0.90; 95% CI 0.79–1.02)
Summary
Self-harm is a major public health concern, affecting individuals both in clinical and community settings. The authors concluded that adolescents who started puberty earlier, and so were in later pubertal stages at the time of measurement, were at higher risk of self-. Some of this inconsistency may have arisen from the use of subjective measures of pubertal timing. Assessments of the validity of pubertal timing measures have concluded that perceived relative timing is biased towards the average compared to measures which do not require social comparison (Alsaker, 1992) Of those studies which have examined the association between pubertal timing and self-harm, few have distinguished between self-harm with and without suicidal intent. Our secondary aim is to examine whether the association differs for NSSH and self-harm with suicidal intent
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