Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
JAMA Netw Open. 2024 Jun 3;7(6):e2415436. doi: 10.1001/jamanetworkopen.2024.15436.
Nonsuicidal self-injury (NSSI) is a strong predictor of suicide attempts. The prevalence of NSSI has been increasing among female adolescents in North America and Europe, but less is known about trends in other geographical regions.
To examine sex differences in the prevalence of NSSI among adolescents within and between geographical regions.
MEDLINE and PsycINFO were searched using the keywords adolescents, self-injury, sex factors, and synonyms for articles published in English between January 1, 2000, and May 10, 2022.
Studies were included if they presented original data (any study design), included adolescents aged 10 to 19 years, reported results stratified by sex, and explicitly defined self-injury as behaviors occurring without suicidal intent.
This meta-analysis was registered with PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were assessed for quality by 2 independent coders (F.M. and J.A.). A random-effects model was used to calculate prevalence. Data were analyzed from July 2022 to April 2023.
The prevalence of NSSI in male and female adolescents within and between regions was the main outcome. Odds ratios (OR) with 95% CIs were calculated for community samples.
Eight hundred and two studies were screened, and 38 were included (266 491 participants). Across 17 countries, the pooled prevalence of NSSI was 17.7% (female:male OR, 1.60; 95% CI, 1.29-1.98). NSSI was twice as prevalent among female adolescents compared with male adolescents in North America (OR, 2.49; 95% CI, 2.16-2.86) and Europe (OR, 2.08; 95% CI, 1.69-2.58), but not in Asia (OR, 1.00; 95% CI, 0.71-1.41).
In this meta-analysis of sex differences in global prevalence of NSSI, the female predominance of NSSI observed among adolescents in North America and Europe aligned with rising rates of suicide in these populations. The comparable prevalence of NSSI among male and female adolescents in Asia also aligned with the lower male-to-female suicide ratio compared with other countries. More research is needed to characterize regional (and potentially cultural) sex differences among adolescents with NSSI to prevent and treat the behavior and to understand the possible interplay with corresponding regional trends in suicide.
非自杀性自伤（NSSI）是自杀企图的强烈预测因素。在北美和欧洲的女性青少年中，NSSI 的发生率一直在增加，但对于其他地理区域的趋势了解较少。
检查不同地理区域内和之间青少年 NSSI 的发生率的性别差异。
使用“青少年、自伤、性别因素”等关键词，在 MEDLINE 和 PsycINFO 中搜索了 2000 年 1 月 1 日至 2022 年 5 月 10 日期间发表的英文文章，检索了文献。
如果研究提供了原始数据（任何研究设计），纳入了 10 至 19 岁的青少年，按性别分层报告了结果，并明确将自我伤害定义为没有自杀意图的行为，则纳入研究。
本荟萃分析已在 PROSPERO 上注册，并按照系统评价和荟萃分析的首选报告项目进行。由 2 位独立编码员（F.M.和 J.A.）对文章进行质量评估。使用随机效应模型计算流行率。数据于 2022 年 7 月至 2023 年 4 月进行分析。
主要结果是区域内和区域间男性和女性青少年 NSSI 的发生率。计算了社区样本中 NSSI 的比值比（OR）及其 95%置信区间（CI）。
共筛选了 802 篇研究，其中 38 篇被纳入（266491 名参与者）。在 17 个国家中，NSSI 的总发生率为 17.7%（女性：男性 OR，1.60；95%CI，1.29-1.98）。与北美（OR，2.49；95%CI，2.16-2.86）和欧洲（OR，2.08；95%CI，1.69-2.58）的青少年相比，女性青少年的 NSSI 发生率是男性青少年的两倍，但在亚洲（OR，1.00；95%CI，0.71-1.41）并非如此。
在这项关于全球 NSSI 发生率的性别差异的荟萃分析中，北美和欧洲青少年中观察到的 NSSI 女性高发情况与这些人群中自杀率的上升相一致。亚洲男性和女性青少年 NSSI 的发生率相当，也与其他国家相比男性自杀率与女性自杀率的比值较低相一致。需要进一步研究来描述具有 NSSI 的青少年的区域（和潜在文化）性别差异，以预防和治疗这种行为，并了解与相应区域自杀趋势的可能相互作用。
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