SickKids research shows sustained rise in self-injury among youth globally

An international review led by researchers at The Hospital for Sick Children (SickKids) has found a steady, long-term increase in health-care visits for self-injury among children, adolescents and young adults. The findings highlight the need for earlier prevention-focused responses.  

The study team examined 42 studies spanning up to 25 years across many high-income countries, providing one of the most comprehensive views to date of how self-injury trends among young people have evolved over time.  

Their study, published in JAMA Pediatrics, identified an average 3.5 per cent increase each year in people under 24 coming to hospital or clinic because of self-injury. The team also found, through population-based surveys, that self-reported self-injury rose approximately 2.5 percent annually, suggesting that this trend exists outside of clinical data.  

In studies reporting health-care data by sex or gender, the steepest increases were observed among girls, with an average annual rise of 3.6 per cent — compared with 1.2 per cent among boys. 

To better understand these findings, we spoke with lead author Dr. Natasha Saunders, Senior Associate Scientist, Child Health Evaluative Sciences and Staff Physician at SickKids. 

How significant is this trend? 

Dr. Saunders: We anticipated that the rates of self-injury might be rising, but a 3.5 per cent relative annual rise is substantial, particularly when it’s sustained over decades. What stands out is that it is pervasive across geographic regions, health-care systems and time periods, suggesting this is not a short-term fluctuation or phenomenon tied to a single event like the COVID-19 pandemic.  

Many shorter studies have documented increases during the pandemic years, but our review shows that this upward trajectory extends back as far as 25 years. When you see the same pattern across multiple countries and data sources, it points to a longstanding, system-level challenge. What’s more is that these numbers likely represent only part of the picture, as many young people who self-injure never present for medical care. Health-care data may reflect the tip of the iceberg. 

Is self-injury the same as suicide or suicide attempts? 

Dr. Saunders: Self-injury and suicide are related, but self-injury refers to the intentional act of causing physical harm to oneself, with or without suicidal intent. 

For some young people, self-injury may function as a way of coping with intense or overwhelming emotions and sometimes be an early signal of emotional distress or emerging mental health challenges. 

Its distinction from suicide means that self-injury should be treated as its own public health issue for which we can target timely support to help individuals before the situation worsens.  

Why does the trend appear sharper among girls?  

Dr. Saunders: It’s important to frame this carefully — we’re talking about differences in trends over time, not simply comparing who has higher overall rates. 

While baseline rates vary from study to study, this increasing trend does tell us where the burden is growing most rapidly. Understanding these patterns helps identify where prevention and early intervention efforts may be most urgently needed, particularly for girls and young women. 

What may be causing the increase? 

Dr. Saunders: We didn’t examine specific causes, so we can’t point to a single factor. What we can say is that the long, sustained increase across countries suggests it is broader than a short-term event or clear explanation.  

In the broader literature, public conversation, and in my clinical experience, people often point to changes in young people’s social environments – including increased screen time and social media exposure – as potential contributors to distress. Many clinicians and researchers suggest that social media and online platforms may exacerbate emotional dysregulation, poor self-esteem, and mental health challenges, as well as expose young people to content related to self-injury. These areas deserve careful, evidence-based study.  

What needs to happen to reverse or slow this trend?  

Dr. Saunders: First, self-injury must be recognized as a distinct and important health issue that warrants dedicated research, surveillance and care strategies. We need to move beyond relying primarily on crisis-based responses. Emergency departments play a vital role when young people present in acute distress, but what’s truly needed is earlier prevention, better access to mental health supports, and stronger follow-up and continuity of care after people visit the hospital. 

We also need to create support systems that help young people feel they have a safe place to land when they’re struggling — in the community, in schools and of course at home.  

Large-scale prevention initiatives are essential, and social media is one area where thoughtful boundaries could help. We need to better explore how governments and tech companies can support families and educators in protect and promote young people’s mental health online, especially for girls and young women.  

At the same time, within the health system we must ensure we have the best mechanisms to support young people who do present in crisis, using emergency department visits as opportunities for safety planning, connection to mental health providers in the community, and helping young patients feel safe enough to keep seeking therapeutic care when they’re distressed. 

What draws you toward studying such sensitive areas?  

Dr. Saunders: As a general paediatrician, I’ve seen the whole spectrum of concerns that bring families into clinic or to the hospital. While we often focus on physical symptoms, it has become increasingly clear to me over time that mental health challenges are often at the root of many of the difficulties young people experience. We simply can’t achieve the best outcomes for patients without addressing those challenges directly and early.  

Working with families during these moments of vulnerability is both incredibly humbling and deeply meaningful. It’s really a privilege to be trusted during some of the hardest times of their lives and to be invited into that space alongside them.   

Please visit AboutKidsHealth for resources on self-harm in children and teens.