Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Accra, Ghana.
School of Psychology, University of Leeds, Leeds, UK.
BMC Psychiatry. 2020 May 14;20(1):234. doi: 10.1186/s12888-020-02587-z.
Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10-25 years) in sub-Saharan Africa.
We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence.
Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% - 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% - 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% - 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5-14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% - 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm.
Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.
无论是自杀还是非自杀动机导致的自伤，都与年轻人的许多不良后果有关，包括最终自杀。我们对年轻人自伤的理解很大程度上基于来自欧洲（尤其是英国）、北美和澳大利亚的文献。我们旨在综合现有关于撒哈拉以南非洲青少年（10-25 岁）的自伤发生率、常见的自伤方法、相关因素、风险和保护因素以及自伤原因的证据。
我们在 MEDLINE、PsycINFO、PubMed、African Journals OnLine 和 African Index Medicus 中检索了从 1950 年到 2019 年 8 月的记录，没有语言限制。我们通过搜索相关研究生论文的门户、参考文献收集、联系作者获取未发表的研究以及手动搜索相关印刷资源，补充了数据库搜索。我们对证据进行了叙述性综合。
来自 18 个撒哈拉以南非洲国家的 74 项研究符合纳入标准。中位终生患病率估计值为 10.3%（四分位距 [IQR]：4.6% - 16.1%）；中位 12 个月患病率估计值为 16.9%（IQR：11.5% - 25.5%）；中位 6 个月患病率估计值为 18.2%（IQR：12.7% - 21.8%）；中位 1 个月患病率估计值为 3.2%（IQR：2.5-14.8%）。来自撒哈拉以南西部非洲的研究报告了最高的 12 个月患病率估计值（中位数=24.3%；IQR=16.9% - 27.9%）。临床样本中常见的是药物过量，而非临床样本中最常见的是自伤。学业失败、性虐待、情感虐待、身体虐待、恋爱关系问题、家庭冲突、抑郁和以前的自伤被确定为自伤的关键相关因素。没有研究报告自伤的保护因素。
估计值的差异可通过小样本量以及使用的定义和测量方法的差异来解释。对关联、风险和保护因素的探索是基于高收入国家的概念和措施得出的。需要更详细和更敏感文化的研究来了解撒哈拉以南非洲青少年自伤的特定风险和保护因素。
