An Examination of Non-Suicidal Self-Injury Among Children and Adolescents Referred to Community and Inpatient Mental Health Settings in Ontario, Canada

Background and objective: The phenomenon of non-suicidal self-injury (NSSI), which is generally defined as “the direct, deliberate destruction of one’s own body tissue in the absence of suicidal intent” (Nock & Favazza, 2009, p. 9), is now recognized globally as a major public health issue, with up to 70% of children and adolescents with mental health problems engaging in NSSI. Whereas studies from other countries have investigated the effect of adverse childhood experiences (ACEs) on NSSI among adolescent inpatients, to date, few studies within the Canadian context have examined the effect of ACEs on NSSI among clinical samples of children and adolescents with mental health problems. Most studies on NSSI among children and adolescents in Canada are from the general population or relied on student samples where the proportion of individuals with a history of ACEs is much lower than that found in clinical samples. The objectives of this study were to examine the prevalence of, and determine the effect of ACEs on NSSI among children and adolescents referred to community and inpatient mental health settings in Ontario, Canada.

Methods: Data for this study were obtained from the interRAI Child and Youth Mental Health dataset. A total of 2038 children and adolescents aged 8–18 years (M = 12.49; SD = 2.88, 61.1% males) were analyzed. Binary logistic regression was fitted to identify predictors of NSSI as a function of ACEs, depression, and social support while simultaneously controlling for age, gender, type of patient, legal guardianship, history of foster family placement, and mental health diagnoses.

Results: Of the 2038 children and adolescents examined, 592 (29%) engaged in NSSI. In the multivariate logistic regression model, we found that the experience of adversity directed to the child (physical and sexual abuse) predicted NSSI whereas adversities indicative of parental risk such as parental mental health issues and domestic violence were not predictive of NSSI. Children and adolescents who were physically abused had 49% higher odds of engaging in NSSI (AOR=1.49, 95% C.I.=1.06-2.09) and children and adolescents who were sexually abused had 60% higher odds of engaging in NSSI (AOR=1.60, 95% C.I.=1.09-2.34), when compared to their non-abused counterparts. Each additional increase in age by 1 year increased the odds of engaging in NSSI by 21% (AOR=1.21, 95% C.I.=1.16-1.27).  Children and adolescents who had some form of social support had a 24% decrease in the odds of engaging in NSSI when compared to their counterparts who did not have some form of social support (AOR=0.76, 95% C.I.=0.58-0.99).

Odds were more than two times higher for females to engage in NSSI, when compared to their male counterparts (AOR=2.43, 95% C.I.=1.92-3.06). Other predictors of NSSI include: inpatient status, depression, attention deficit-hyperactivity disorder, disruptive behavior disorder, and mood disorders.

Conclusions and Implications:  Assessment procedures for indicators of mental health, particularly among children and adolescents with a history of ACEs, should also take into account NSSI. In addition to bolstering social support networks, addressing depression and related emotion regulation skills in childhood may help prevent future NSSI behaviors.