Identifying Risk Factors for Self-Harm Events in Children and Adolescents

Researchers identified four separate profiles to help medical professionals better assess children at elevated risk for a self-harm event. These profiles can be used to better inform clinical decision-making by providing a better assessment of the overall risk of self-harm.

The United States is in the midst of a mental health crisis with rising rates of hospitalization for suicide and self-harm events among children and adolescents. Hence, a new study published in the journal Pediatrics looked at how best to determine which children are at elevated risk for self-harm.

Overview Suicide
Suicide is an act of ending one's own life and it usually results from emotional isolations and inability to adjust and cope with one's environment.

‘Clinical profiles based on a more comprehensive and flexible framework can help identify children at elevated risk for a self-harm event.’

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Predicting which children are at risk for serious self-harm events, such as suicide attempts or self-injurious behaviors, in the emergency department is extremely challenging.

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This new study provides an important step in evaluating the whole child concerning self-harm risk assessment. These profiles can be used to better inform clinical decision-making by providing a better assessment of the overall risk of self-harm.

Four distinct profiles of psychiatric comorbidity in children and adolescents with varying levels of risk for a serious self-harm event were identified — low risk, moderate risk, high risk, and very high risk. The findings also showed unique and distinct patterns of comorbidity that are also distinguishable between age and sex.

The study identified 1,098 children 5-18 years of age hospitalized with a neuropsychiatric event at Monroe Carell and Children’s Hospital of Colorado in Aurora, Colorado between April 2016 and March 2020. Of those hospitalized, 406 (37%) were diagnosed with a self-harm event.

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Very high-risk profile consisted of males aged 10-13 with ADHD, bipolar disorder, autism spectrum disorder, and other developmental disorders.

Low-risk profile consisted of children ages 5-9 who had a non-mental health diagnosis and an absence of mood disorders, behavioral disorders, psychotic disorders, developmental disorders, and trauma or substance-related disorders.

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The high-risk profile included females ages 14-17 with depression and anxiety in conjunction with substance- and trauma-related disorders. Personality and eating disorders were also significant for this profile.

Moderate risk had a significant absence of depressive disorders, suggesting that these disorders play a major role in driving the risk of suicidality. The profiles considered demographic factors like age and sex, as well as overall underlying psychiatric and medical conditions.

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There are many interacting factors in children with self-harm events, ranging from individual, family, social support, and specific life events. Researchers know that psychiatric diagnoses are a well-established risk factor for self-harm.

Previous studies focused on the independent risk of psychiatric diagnoses, such as depression or bipolar disorder, on self-harm events. But this study provides a novel approach that takes the child’s entire medical and psychiatric profile into account and assesses what overall constellations of factors are associated with imminent self-harm.

Further study is also needed to validate these risk profiles in larger populations and develop prognostic and clinical decision support applications that provide real-time risk assessments for providers.

Source-Eurekalert