Examining the Independent Association Between Non-Suicidal Self-Injury and Referral to Psychiatric Services Among Adolescents with a History of Maltreatment in Canada: Findings from the 2013 Ontario Incidence Study of Reported Child Abuse and Neglect

Background and Purpose: Over the last three decades, there has been an increase in research on non-suicidal self-injury (NSSI), particularly among adolescents. This increase in research partly stems from the fact that NSSI among adolescents is a strong predictor of suicide. One of the major risk factors associated with NSSI that continues to receive considerable research attention is child maltreatment with various studies demonstrating strong association between child maltreatment particularly childhood sexual abuse and NSSI (Ford & Gomez, 2012; Yates, 2009). Studies have also found that although adolescents in the child welfare system are at an elevated risk of psychopathology, not all adolescents in the child welfare system who need psychiatric services receive them (Staudt, 2003; Villagrana, 2010). Some studies have examined the pathways that take adolescents to psychiatric services use. However, within the Canadian context, few studies have examined the association between NSSI and referral to psychiatric services among adolescents involved in the child welfare system. Thus, using data from the 2013 Ontario Incidence Study of Reported Child Abuse and Neglect (OIS 2013), the objective of this study was to examine the independent association between NSSI and referral to psychiatric services among adolescents with a history of maltreatment.

Methods: Data for this study were obtained from the OIS 2013 which is the fifth cycle of the child abuse and neglect incidence study to be conducted in Ontario, Canada. The primary objective of the OIS 2013 was to provide reliable estimates of the nature and characteristics of child maltreatment cases reported to child welfare agencies in Ontario. A weighted sample of 5,345 adolescents aged 10 to 15 years with substantiated investigated incidence of child maltreatment was analyzed with referral to psychiatric services as the outcome variable. The main explanatory variable examined was NSSI and was measured as a binary variable. The study also controlled for other covariates such as child demographic, case, and household characteristics, internalizing and externalizing behaviour problems, and type of primary maltreatment. Binary logistic regression model was fitted to identify the independent association between NSSI and referral to psychiatric services.

Results: Of the 5,345 adolescents examined, 18.5% were referred to psychiatric services. A little over one-third (38.3%) of adolescents with a history of NSSI were referred to psychiatric services. Results from the multivariate logistic regression model indicate that NSSI had an independent association with referral to psychiatric services. Controlling for all other factors, adolescents with a history of NSSI had 2.62 times higher odds of being referred to psychiatric services when compared to their counterparts with no history of NSSI (AOR=2.62, 95% CI=2.12-3.23). Other factors associated with referral to psychiatric services include: younger age, internalizing and externalizing behaviour problems, emotional maltreatment, neglect, and previous case opening.

Discussion and Implications: Understanding the association between NSSI and referral to psychiatric services could help in identifying maltreated adolescents who needs psychiatric services the most with interventions put in place to prevent future suicidal behaviours. The findings and implications for social work are discussed with some suggestions for future research.