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Study finds self-harm in childhood is a risk factor for experiencing future sexual violence
Summary:
Children and youth, especially females, who visit an emergency room for self-harm are more likely to later seek care for sexual abuse or assault.
Content warning: This story contains references to self-harm, suicide and sexual violence. If you are experiencing thoughts of suicide, this is a mental health emergency and you are deserving of help. Call the Mental Health Crisis Line at 988 or call your local mental health and addictions office to speak to a counselor. If you have experienced sexual violence, contact the Assaulted Women’s Helpline or a local service for supports.
New research from The Hospital for Sick Children (SickKids) reveals that children and youth who visit an emergency department for self-harm have an increased risk of returning to seek care for sexual abuse or assault, with females more than eight times more likely to do so than males.
Published in the American Journal of Psychiatry, the study analyzed data from over 26,000 children and adolescents aged eight to 17 years old who first presented to an emergency department in Ontario for self-harm, including a suicide attempt, between 2013 and 2022. Over a 10-year period, nine per cent of individuals later sought care for sexual abuse, compared to 1.3 per cent of the control group. For sexual assault, the cumulative incidences were 4.2 per cent versus 0.48 per cent of the control group.
When the team broke the findings down by biological sex, they found 11.3 per cent of females returned for sexual abuse, compared to 1.4 per cent of males.
“When a young person receives care after self-harm or a suicide attempt, it is an opportunity to prevent further adverse outcomes. The goal of our study is to help inform care providers of one potential devastating outcome and contribute to more thorough research on this at-risk population,” says Matisse Blundell, first author and PhD candidate in the Genetics & Genome Biology program at SickKids.
A new perspective on risk
While the research began by confirming previous findings that link sexual abuse with an increased risk of self-harm, this study is the first to suggest that the inverse may also be true: self-harm in childhood and adolescence may be a marker for future vulnerability to sexual abuse or assault.
The study team notes that only six to 27 per cent of sexual abuse survivors disclose in health-care settings, and the actual rates may be much higher.
“What we have uncovered is an uncomfortable yet critical reality: the need for broader awareness of potential risk factors and targeted support for children and youth at risk of abuse, alongside comprehensive acute mental health services,” says Dr. Jacob Vorstman, senior co-author, Senior Scientist in the Genetics & Genome Biology program, Child and Adolescent Psychiatrist, and Psychiatry Associates Chair in Developmental Psychopathology at SickKids.
Predicting those most at risk of future harms
Some children may self-harm once, while others experience an escalation in self-harm, often along with other mental health challenges. While other clinically relevant outcomes related to self-harm behaviors exist, they have historically received less attention, leaving a gap in understanding and predicting these patients’ health outcomes.
“We know that there are many reasons why children and young people may self-harm, but we have often lacked the data to demonstrate their clinical relevance. This study begins to fill that research gap so we can better understand and predict patients’ health outcomes,” says Dr. Suneeta Monga, senior co-author and Associate Psychiatrist-in-Chief.
As part of the Precision Child and Youth Mental Health initiative (PCYMH), a collaborative between SickKids and CHEO to more precisely identify and treat children and youth with mental health problems, the study was driven by a desire to better understand and predict the trajectories of young people who arrive at SickKids, and other emergency departments, with mental health concerns.
Although these findings need to be replicated to inform clear recommendations for care practitioners, the research team hopes that this data will increase clinicians’ awareness of potential future harms for this vulnerable population, including those outside of the initial reason for visiting a health-care setting.
“We need to take youth mental health seriously. Our work is about being as precise as possible to predict patient outcomes and intervene earlier to prevent future harms,” explains Vorstman, who is also Medical Co-Lead of PCYMH.
This study used data held at ICES and was funded by the Canadian Institutes of Health Research (CIHR) and the SickKids Psychiatry Associates Chair in Developmental Psychopathology.