1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.
2 Department of Pediatrics, Royal Children's Hospital, Parkville, VIC, Australia.
Int J Soc Psychiatry. 2017 Jun;63(4):359-375. doi: 10.1177/0020764017700175. Epub 2017 Mar 29.
Self-harm (defined here as an act of intentionally causing harm to own self, irrespective of the type, motive or suicidal intent) is one of the strongest antecedents of suicide in youth. While there have been a number of studies of youth self-harm in low- and middle-income countries (LMICs), there is currently no systematic review of studies of prevalence rates and risk and protective factors.
To systematically review the evidence relating to the prevalence rates and forms of self-harm in youth in LMICs and its relationship to family economic status, family functioning, relationship with the peer group, social relationships and academic performance.
Electronic searches of three databases, MEDLINE, PsycINFO and Scopus, were performed. In total, 27 school-, community- and hospital-based studies evaluating self-harm in LMICs with youth focus (with participants between 12 and 25 years) were included.
The self-harm was divided into suicidal and non-suicidal depending on the nature of self-harm. The 12-month prevalence rates of non-suicidal self-harm varied from 15.5% to 31.3%, and the range of suicidal behaviour rates was from 3.2% to 4.7%. Banging and hitting were the most common in the community-based studies, followed by cutting, scratching and wound picking. Self-poisoning with pesticides was most commonly reported in hospital-based studies. Risk factors for self-harm were family conflict, peer groups with members indulging in self-harm, truancy and school absenteeism. Protective factors were having an understanding family, having friends and higher school competence. Risk factors for suicidal thoughts and attempts were lack of close friends and history of suicide by a friend.
The 12-month prevalence rates of youth self-harm in LMICs are comparable to high-income countries (HICs). The profile of risk and protective factors suggests that family-based interventions could be useful in treatment and prevention. Future studies should aim for greater consistency in assessment methods and the constructs under evaluation.
自伤（这里定义为故意伤害自己的行为，无论伤害的类型、动机或自杀意图如何）是青少年自杀的最强前因之一。虽然已经有许多关于中低收入国家（LMICs）青少年自伤的研究，但目前还没有关于流行率以及风险和保护因素的系统综述。
系统回顾与 LMICs 青少年自伤流行率及其与家庭经济状况、家庭功能、与同龄人群体的关系、社会关系和学业成绩的关系相关的证据。
对三个数据库（MEDLINE、PsycINFO 和 Scopus）进行电子检索。共纳入了 27 项基于学校、社区和医院的研究，这些研究评估了 LMICs 中以青少年为重点（参与者年龄在 12 至 25 岁之间）的自伤情况。
根据自伤的性质，将自伤分为自杀性和非自杀性。非自杀性自伤的 12 个月流行率在 15.5%至 31.3%之间，自杀行为率的范围在 3.2%至 4.7%之间。社区研究中最常见的是撞击和击打，其次是切割、划伤和伤口挑取。医院研究中最常报告的是农药自毒。自伤的风险因素包括家庭冲突、有成员沉溺于自伤的同伴群体、逃学和旷课。保护因素是有一个理解的家庭、有朋友和更高的学校能力。自杀想法和企图的风险因素是缺乏亲密朋友和朋友的自杀史。
LMICs 青少年 12 个月自伤的流行率与高收入国家（HICs）相当。风险和保护因素的特征表明，基于家庭的干预措施可能对治疗和预防有用。未来的研究应该旨在使评估方法和评估的结构更加一致。
