Western Sydney Local Health District, Sydney, Australia.
University Hospital of Ioannina, Greece.
J Am Acad Child Adolesc Psychiatry. 2018 Oct;57(10):733-741. doi: 10.1016/j.jaac.2018.06.018. Epub 2018 Aug 21.
To provide meta-analytic estimates of self-harm from all community-based studies of adolescents from 1990 through 2015, estimates of suicidal risk, and characteristics including age profile, frequency, types, seeking help, and reasons.
Databases, bibliographies, and the internet were searched for cross-sectional and cohort studies of 12- to 18-year-olds. Meta-analytic estimates of the prevalence and characteristics of self-harm, risk of suicidal behaviors, and rates comparing different methods were calculated.
One hundred seventy-two datasets reporting self-harm in 597,548 participants from 41 countries were included. Overall lifetime prevalence was 16.9% (95% CI 15.1-18.9), with rates increasing to 2015. Girls were more likely to self-harm (risk ratio 1.72, 95% CI 1.57-1.88). The mean age of starting self-harm was 13 years, with 47% reporting only 1 or 2 episodes and cutting being the most common type (45%). The most frequent reason was relief from thoughts or feelings. Slightly more than half sought help, but for most this was from a friend. Suicidal ideation (risk ratio 4.97) and attempts (risk ratio 9.14) were significantly higher in adolescents who self-harmed, but this was higher with more frequent self-harm. Methodologic factors also were associated with higher rates of self-harm.
Interventions that can lower suicidal risk should be made available to adolescents who self-harm frequently as soon as possible. Preventative interventions that help adolescents deal with negative feelings should be instituted at the onset of puberty. Because friends are frequently asked for support, interventions also should be developed for peer groups.
提供 1990 年至 2015 年间所有基于社区的青少年自我伤害研究的荟萃分析估计，自杀风险的估计，以及包括年龄分布、频率、类型、寻求帮助和原因在内的特征。
数据库、参考文献和互联网搜索了 12 至 18 岁青少年的横断面和队列研究。计算了自我伤害的流行率和特征、自杀行为风险以及不同方法比较的发生率的荟萃分析估计值。
共有 172 个数据集报告了来自 41 个国家的 597548 名参与者的自我伤害情况，其中包括在内。终身总患病率为 16.9%（95%CI 15.1-18.9），呈上升趋势至 2015 年。女孩更有可能自我伤害（风险比 1.72，95%CI 1.57-1.88）。开始自我伤害的平均年龄为 13 岁，有 47%的人只报告了 1 或 2 次，且切割是最常见的类型（45%）。最常见的原因是缓解思想或感觉。略多于一半的人寻求帮助，但对大多数人来说，这是来自朋友的帮助。有自我伤害行为的青少年自杀意念（风险比 4.97）和企图（风险比 9.14）显著升高，但随着自我伤害的频繁发生，这一比例更高。方法学因素也与更高的自我伤害率相关。
应尽快为经常自我伤害的青少年提供可以降低自杀风险的干预措施。应该在青春期开始时就实施有助于青少年处理负面情绪的预防干预措施。因为朋友经常被要求提供支持，所以也应该为同伴群体开发干预措施。
