Radhika J. Kothadia, MD PGY-3 General Psychiatry Resident Prisma Health/University of South Carolina School of Medicine Columbia, South Carolina
Kaustubh G. Joshi, MD Associate Professor of Clinical Psychiatry Associate Program Director, Forensic Psychiatry Fellowship Department of Neuropsychiatry and Behavioral Science University of South Carolina School of Medicine Columbia, South Carolina
Richard L. Frierson, MD Alexander G. Donald Professor of Clinical Psychiatry Vice Chair for Academic Affairs Program Director, Forensic Psychiatry Fellowship Department of Neuropsychiatry and Behavioral Science University of South Carolina School of Medicine Columbia, South Carolina
Disclosures The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
Membership in certain youth subcultures (eg, emo or goth) has been evaluated as potential risk factors for depression and deliberate self-harm. Bowes et al33 found that for each unit increase in gothaffiliation (not at all, not very much, somewhat, more than somewhat, very much), youth were 1.52 times more likely to engage in SHB; these researchers also reported a dose-response association between goth identification and future SHB. This study asked participants if they have ever tried to harm or hurt themselves in any manner, but did not distinguish between individuals who had harmed themselves with and without suicidal intent.33
Personality traits such as impulsiveness and loneliness have been linked to NSSI among adolescents.34,35 A recent study found that adolescents who met the proposed DSM-5 diagnostic criteria for NSSI scored higher on the Barratt Impulsiveness Scale, specifically in measures of:
motor impulsiveness (ie, acting without thinking)
attentional impulsiveness (ie, making decisions quickly)
impulsiveness due to lack of planning (ie, failure to plan for the future).34
This study also found that adolescents who identified as being lonely based on scores on the Brazilian Loneliness Scale were at a higher risk for NSSI.34
A recent systematic review (32 studies) and meta-analysis (9 studies) found that school absenteeism was associated with a risk of self-harm (pooled aOR 1.37, P = .01) and suicidal ideation (pooled aOR 1.20, P = .03).36 This study suggested that school absenteeism, an important marker of social exclusion, was associated with both SHB and suicidal ideation in young people.36 It defined SHB as any act of self-injury or self-poisoning, regardless of intent.36
Finally, family-related factors have been associated with an increased risk of NSSI. One study of 11,814 children age 9 and 10 revealed that high family conflict (OR 1.09; 95% CI, 1.05 to 1.14) and low parental monitoring (OR 0.95; 95% CI, 0.93 to 0.98) were associated with NSSI.37 A smaller, community-based study found that adolescents with NSSI reported significantly less maternal support and warmth than nonclinical controls, but a cause-and-effect relationship has not yet been determined.38 Parental history alone may influence adolescents’ risk of NSSI. A study that included nearly 76,000 youth found that adolescents with perceived parental alcohol problems had higher odds of self-injury, suicidal ideation, and suicide attempts.39 Adolescents exposed to maternal or paternal adversities were also at a higher risk of self-harm (hazard ratio 1.5 to 5.4 among males, 1.7 to 3.9 among females).40
