This international comparative study addresses differences between adolescents who engage in deliberate self-harm (DSH) and who receive help following the DSH episode versus those who do not. A standardised self-report questionnaire was completed by pupils aged 14–17 in Australia, Belgium, England, Hungary, Ireland, The Netherlands, and Norway (n = 30 532). An act of DSH in the year prior to the study was reported by 1660 participants. Nearly half (48.4%) had not received any help following DSH, 32.8% had received help from their social network only and 18.8% from health services. Except for Hungary, cross-national comparisons revealed remarkably similar findings. Adolescents who had been in contact with health services following DSH reported more often a wish to die, lethal methods, alcohol/drug problems and DSH in the family compared to those who had not. However, those who received no help or help from their social network only were also heavily burdened.
In several countries the rates of deliberate self-harm among adolescents who attend A&E Departments have increased (Corcoran et al., 2003 and Hawton et al., 2003). A similar trend has been observed in recent population-based follow-up studies (Pages et al., 2004 and Rossow et al., 2005). Moreover, these studies show that the rates of deliberate self-harm among adolescents who do not come to the attention of health care services are much higher than the rates derived from hospital registrations (Hawton et al., 2002, Pages et al., 2004, de Wilde, 2000 and Ystgaard et al., 2003), supporting the notion that medically referred cases of deliberate self-harm represent the ‘tip of an iceberg’.
Findings from population-based studies indicate that some 10–20% of teenagers who engage in deliberate self-harm present to hospital as a result of this act (Hawton et al., 2002, Pages et al., 2004 and Ystgaard et al., 2003). These findings indicate that there is a ‘hidden population’ of distressed adolescents, including some who may have serious mental health problems.
So far, few efforts have been made to examine specific characteristics of adolescents who come into contact with health services following deliberate self-harm compared to those who do not. In a French study an association was found between being hospitalised following deliberate self-harm and problem behaviour (e.g. running away), use of illegal drugs other than cannabis and attending private school among girls, and physical violence and offences among boys (Pages et al., 2004). A study conducted in Norway revealed that low self-esteem, low socio-economic status and little social support were significantly associated with hospitalisation following deliberate self-harm (Groholt, Ekeberg, Wichstrom, & Haldorsen, 2000). However, no gender differences were taken into account. A further limitation of previous studies is that no comparison was made between hospitalised and non-hospitalised adolescents with regard to both the methods involved in their acts of deliberate self-harm and what motivated the act.
Little is known about what sort of help the teenagers who engage in deliberate self-harm and who have not been hospitalised may have received. One study indicates that a small proportion of those engaging in deliberate self-harm had been in contact with general practitioners or other mental health services and a larger proportion received help only from their social network, especially from friends. Approximately half of the young people had not received help from anyone (Rossow & Wichstrøm, 1997).
In order to facilitate assessment and treatment as well as effective outreach and preventive programmes for adolescents who engage in deliberate self-harm, detailed information on the characteristics of those who are currently not coming to the attention of the health services is required. The Child and Adolescent Self-harm in Europe (CASE) Study is a large-scale parallel survey conducted in seven countries which addresses the prevalence of deliberate self-harm among adolescents, associated mental health problems and contact with a broad range of health services and other helping sources. Using international comparative data, we have investigated differences between 1) adolescents who engaged in deliberate self-harm and who came to the attention of health services compared to those who did not, and 2) adolescents who engaged in deliberate self-harm and who only received help from their social network compared to those who did not receive any help, with regard to demographic characteristics, type of self-harming behaviour, suicidal intent, mental health problems and negative life events. Considering the comparative data, cross-national comparisons were made, in particular similarities and differences with regard to help-seeking behaviour following deliberate self-harm and associated factors.
