Understanding self-harm in children

School Closures and Mental Health

And here we go again. As of January 17th, 2022, the Education Bureau of Hong Kong announced that all schools should cease in-person teaching and move everything online, with those taking final secondary school exams being exempted from this. Many universities have also followed suit and shifted to online teaching.

Though many students complain about heavy workloads, they also cherish the social aspects of school, being able to see their friends, or even their teachers, with whom some students share a close bond. As such, this latest wave of school closures as a result of COVID restrictions may lead to detrimental effects on the mental wellbeing of many students, culminating in increasing rates of depression, anxiety and deliberate self-harm.

Whilst many studies conducted abroad did not find a correlation with an increase in self-harm episodes amongst teenagers during the COVID period, the situation in Hong Kong is a little different.^[1][2] From 2019 to 2020, the rate of completed suicides for teenagers rose from 0.7 per 100,000 to 1.3 per 100,000.^[3] Researchers have not been able to explain why there has been an increase, and whether the pandemic has played any role in this. Indeed, as with other epidemiological studies of deliberate self-harm, the authors of the studies abroad contend that the rates might not reflect the genuine situation due to under-reporting or people refraining from attending the accident and emergency departments.^[4]

Self-Harm and Suicide

Deliberate self-harm has always been the subject of focus for clinicians and researchers. Whilst not all deliberate self-harm episodes carry a suicidal intent, it is the strongest predictor for future suicide attempts, more so than the presence of any mental illnesses or social factors.

1 in 6 teenagers who harm themselves are likely to do so again within a year, and some have even suggested up to 1 in 15 attempt to commit suicide within nine years.^[5] The true prevalence of deliberate self-harm may be hard to tally, but some estimates have suggested that the rates may be up to 16-18% of the global population.^[6]

Cutting oneself with a cutter or knife and overdosing remain the most common methods, and some people choose sites on the body that can be easily concealed, such as on the thighs or the waist, rather than the forearms.

There are many reasons why people may choose to harm themselves. Whilst some may be predisposed due to a family history of suicide or a history of childhood abuse and trauma, there often may not be an identifiable precipitating factor prior to each act. However, the risk may be perpetuated by the presence of mental illnesses, personality factors, physical problems or social issues, such as difficulties with academics or family members. Listening to those with such experiences, many will admit that their intent might not be to commit suicide, but instead seek deliberate self-harm as a form of relief. Many people, teenagers in particular, may struggle to verbalize or talk about their stressors or troubles. They can, however, recognise a strong sense of internal anguish and despair, which they may not be able to find a reason or solution to. As such, the physical pain through harming oneself may be preferable to the psychological distress, hence leading to the repetitive nature of this act.

What strategies can you use to help?

I know you might feel alone in facing these problems, but just remember we’re here for you

Finding signs of deliberate self harm in your own children can be a very scary and anxious experience, sometimes laden with self blame and guilt on what you have done to have led to this. In many cases, the child might not tell you straight away; not that they are deliberately hiding something from you, they might not be able to elaborate themselves. As such, one must remember to be patient and non-judgmental as your child talks about their problems. Something very trivial to you might be the world to your child.

• Phrases like “Sounds like it must have been a very tough time” or “I know you might feel alone in facing these problems, but just remember we’re here for you” will be helpful.
• Involving professionals, such as counsellors, psychologists or psychiatrists, might be needed in certain circumstances to assess for the presence of mental illnesses or other mental health support.
• Speaking to your child’s friends and teachers might be beneficial to find out more about the current problems your child is facing.

It is indeed very scary to find self-harm marks on your child – but help is always there when needed. A little more time, understanding and empathy can often go a very long way.

References

1. Ray, J.G., Austin, P.C., Aflaki, K., Guttmann, A. and Park, A.L., 2022. Comparison of self-harm or overdose among adolescents and young adults before vs during the CoViD-19 pandemic in Ontario. JAMA network open, 5(1), pp.e2143144-e2143144.

2. Chen, R., 2021. The complex picture of self-harm during the COVID-19 pandemic. The Lancet Regional Health–Europe, 6.

3. Hong Kong Jockey Club Centre for Suicide Research and Prevention, HKU

4. Kapur, N., Clements, C., Appleby, L., Hawton, K., Steeg, S., Waters, K. and Webb, R., 2021. Effects of the COVID-19 pandemic on self-harm. The Lancet Psychiatry, 8(2), p.e4.

5. Owens, D., Horrocks, J. and House, A., 2002. Fatal and non-fatal repetition of self-harm: systematic review. The British Journal of Psychiatry, 181(3), pp.193-199.

6. Muehlenkamp, J.J., Claes, L., Havertape, L. and Plener, P.L., 2012. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and adolescent psychiatry and mental health, 6(1), pp.1-9.