Adolescents with disabilities at higher risk of self-harm, but intersectionality also a vital consideration
Self-harm is a global public health problem (Hawton et al., 2003). In England, approximately 200,000 adolescents aged 12 to 17 years self-harm each year without receiving clinical support, and approximately 21,000 adolescents seek medical treatment following incidents of self-harm (Geulayov, et al., 2018; Morgan et al., 2017). ; Patalay and Gage, 2019).
Rates of self-harm among adults with disabilities are higher (Khazem, 2018; Khurana et al., 2021), but there are Variable results when it comes to adolescents with disabilities (King et al., 2019; Tejera et al., 2019).
Therefore, this study was conducted to contribute to the advancement of knowledge and better understand the prevalence and risk factors of self-harm in adolescents, both with and without disabilities.
Adults with disabilities are at higher risk of self-harm compared to those without disabilities. What about teenagers?
Methods
The researchers used secondary data from the Millennium Cohort Study; a cohort of children born between 2000 and 2002 (Plewis et al., 2007). Participants were randomly selected using child benefit records. Data were collected from adolescents aged 14 and 17 through interviews with parents and adolescents. At age 14, 11,726 adolescents participated in the interviews along with information from their parents, and at age 17, 9,528 adolescents participated in the interview.
Disability was assessed with an affirmative response to having physical or mental health conditions that lasted 12 months or longer. A follow-up response of reduced ability, either “a lot” or “a little,” was used to distinguish between a more or less limiting disability.
The authors also assessed the lifetime prevalence of self-harm at age 17 years and the 12-month prevalence of six different self-harm behaviors. Other possible risk factors for self-harm were sexual orientation, exposure to bullying, and self-reported measure of depression at age 14.
To address potential biases due to sampling and attrition, inverse probability weighting was performed. They also accounted for clustering in the survey design using survey data analysis options. Adjusted prevalence rate ratios were estimated to compare the likelihood of self-harm between adolescents with disabilities and those without disabilities.
Results
Disability prevalence
Of 9,528 participants aged 17 years:
- 12.4% of adolescents reported some type of disability
- 7.7% had less limiting disabilities.
- 4.7% had more limiting disabilities.
Prevalence of self-harm
The lifetime prevalence of suicide attempts was 25.5% among those with the most limiting disabilities, 21.9% among those with the least limiting disabilities, and 5.3% among those without disabilities. Adolescents with more severe disabilities were 3.87 times more likely to attempt suicide over their lifetime compared to adolescents without any disabilities, while those with less severe disabilities were 3.67 times more likely.
Functional deficiencies
After adjusting for sex, ethnicity and poverty, of nine functional disabilities, those related to mental health, learning and memory were strongly associated with higher rates of self-harm. For example, the adjusted prevalence ratios (APRR) for suicide attempts were 5.13 (95% CI: 3.58 to 7.36) for mental health limitations and 3.64 (95% CI: 2.72 to 4.88) for learning/comprehension deficiencies. Functional impairments such as vision and mobility did not show a significant association with self-harm behaviors in the past year.
Risk factors
The study identified several risk factors associated with the prevalence of self-harm among adolescents with and without disabilities.
In comparison, adolescents without disabilities who were female, LGBTQ+ oriented, raised in families with poor income, and self-reported depression increased the likelihood of lifetime self-harm among adolescents with disabilities. While self-harm in the previous year was reported by adolescents with disabilities who were female (5 acts of self-harm), more limiting disability, and ethnic minority (2 acts of self-harm).
For adolescents without disabilities, adolescents in the ‘non-heterosexual’ group had increased risk of lifetime suicide attempts and self-harm behaviors in the past year, followed by females and bullying at ages 7, 11, and 14 years. .
This research suggests that adolescents with mental health and learning problems are at greater risk of self-harm.
Conclusions
The study indicates that adolescents with disabilities face a significantly higher risk of self-harm and attempted suicide compared to their peers without disabilities, with a more pronounced risk among those with more limiting disabilities. The study also highlights the complexity of the relationship between disability and self-harm, suggesting that the risk is more related to cognitive and mental health impairments than to physical impairments such as vision and mobility. Being female or having LGBTQ+ orientation were key factors for self-harm among adolescents with disabilities.
Being an LGBTQ+ adolescent with a disability was identified as a key risk factor for self-harm.
Strengths and limitations
A major strength is that researchers have addressed a critical gap in the literature by focusing on adolescents with disabilities; a group that is underrepresented in self-harm research using data from the Millennium Cohort study which provides a nationally representative sample of adolescents in the UK. The categorization of functional impairment allowed a detailed analysis of different types of disabilities associated with self-harm behaviors.
Because data on self-injury and disability are based on self-report, there is potential for recall bias and social desirability bias for adolescents who may underreport information on self-harming behaviors.
Since this study is a cross-sectional design; Therefore, although associations can be identified, It is not possible to determine whether disabilities directly cause the increased risk of self-harm..
The study also does not take into account changes over time or repeated self-harm. This limits understanding of how self-harm behaviors have evolved or persisted as adolescents grow older.
While the researchers controlled for several confounding factors, there may be other unmeasured variables, such as school environment and family dynamics, that could influence the relationship between disability and self-harm.
There is also scope to explore the prevalence of self-harm among ethnic minority adolescents with disabilities; a population that may be even more marginalized.
Longitudinal studies are needed to better understand self-injury and disability among adolescents.
Implications for practice
The study has some crucial implications for practice. With a strong association between mental health decline and learning difficulties, there may be a need for mental health services to screen for risk of self-harm and depressive symptoms among these groups in schools and communities. There is undoubtedly a need to strengthen the mental health support provided both in schools and in the wider community. The study also highlights the need for anti-bullying programs that include students with disabilities, are accessible, and aim to reduce the impact of bullying.
Additional qualitative research will help explore aspects of bullying and the quality of mental health services as perceived by adolescents with disabilities, teachers, parents, and healthcare providers to provide a holistic picture. Given the increased risk of self-harm among adolescents with disabilities who identify as LGBTQ+, there is a need for counseling and support groups to address the needs of this unique population. Future longitudinal research can be conducted by monitoring adolescents with disabilities and detecting suicidal behaviors.
The study highlights the need to combat bullying among adolescents to protect marginalized populations most at risk of self-harm.
Declaration of interests
No conflict of interest.
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