• Bibtex: @mars2014
  • Bibliography: Mars, B., Heron, J., Crane, C., Hawton, K., Lewis, G., Macleod, J., Tilling, K., & Gunnell, D. (2014). Clinical and social outcomes of adolescent self harm: Population based birth cohort study. BMJ, 349, g5954. https://doi.org/10.1136/bmj.g5954

Example citation

Only 28% of those with self-harm at age 16 were free from mental health or substance use problems, and had adequate educational or employment status

My notes

  • UK birth cohort of children born 1991-1992, n = 4799. Data collection at age 16
  • 19% lifetime history of self-harm at age 16

Our study suggests that self harm in adolescents in the general population is a risk marker for future mental health, self harm, and substance use problems in early adulthood, regardless of suicidal intent. Suicidal self harm is also a risk marker for poorer educational and occupational outcomes. Associations with adverse outcomes are generally stronger for self harm with suicidal intent than for self harm without suicidal intent.


Objectives To investigate the mental health, substance use, educational, and occupational outcomes of adolescents who self harm in a general population sample, and to examine whether these outcomes differ according to self reported suicidal intent. Design Population based birth cohort study. Setting Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort of children born in 1991-92. Participants Data on lifetime history of self harm with and without suicidal intent were available for 4799 respondents who completed a detailed self harm questionnaire at age 16 years. Multiple imputation was used to account for missing data. Main outcome measures Mental health problems (depression and anxiety disorder), assessed using the clinical interview schedule-revised at age 18 years, self reported substance use (alcohol, cannabis, cigarette smoking, and illicit drugs) at age 18 years, educational attainment at age 16 and 19 years, occupational outcomes at age 19 years, and self harm at age 21 years. Results Participants who self harmed with and without suicidal intent at age 16 years were at increased risk of developing mental health problems, future self harm, and problem substance misuse, with stronger associations for suicidal self harm than for non-suicidal self harm. For example, in models adjusted for confounders the odds ratio for depression at age 18 years was 2.21 (95% confidence interval 1.55 to 3.15) in participants who had self harmed without suicidal intent at age 16 years and 3.94 (2.67 to 5.83) in those who had self harmed with suicidal intent. Suicidal self harm, but not self harm without suicidal intent, was also associated with poorer educational and employment outcomes. Conclusions Adolescents who self harm seem to be vulnerable to a range of adverse outcomes in early adulthood. Risks were generally stronger in those who had self harmed with suicidal intent, but outcomes were also poor among those who had self harmed without suicidal intent. These findings emphasise the need for early identification and treatment of adolescents who self harm. PDF: mars_2014_clinical_and_social_outcomes_of_adolescent_self_harm_-_population_based_birth.pdf