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Childhood maltreatment may lead to nonsuicidal self-injury

Childhood maltreatment and its subtypes, with the exclusion of childhood emotional neglect, were linked to nonsuicidal self-injury, according to data published in Lancet Psychiatry.

“Nonsuicidal self-injury is a stronger predictor of suicide attempts than is a history of suicidal behavior. Clarification of the potential factors that underlie the cause of this phenomenon is important because it might inform the development of future prevention and intervention strategies, a pressing need given the paucity of empirically supported treatments for this behavior,” Richard T. Liu, PhD, from the department of psychiatry and human behavior at Alpert Medical School of Brown University, and colleagues wrote. “With the exception of a key early meta-analysis of sexual abuse and nonsuicidal self-injury, the association between childhood maltreatment and nonsuicidal self-injury has yet to be systematically and quantitatively reviewed.”

Prior research supports the identification of early and modifiable risk factors related to nonsuicidal self-injury to improve the screening and intervention efforts, particularly early detection of at-risk individuals, according to Liu and colleagues. Researchers conducted a comprehensive meta-analysis of childhood maltreatment (overall, sexual abuse, physical abuse and neglect, and emotional abuse and neglect) in association with nonsuicidal self-injury. Using online clinical databases, they identified relevant articles published from inception to Sept. 25, 2017 that provided continuous and categorical data and assessed for potential moderators.

In total, 71 publications met study criteria and were included in this analysis. Except in the case of childhood emotional neglect, childhood maltreatment and its subtypes were linked to nonsuicidal self-injury. The researchers found that overall childhood maltreatment was positively associated with nonsuicidal self-injury (OR = 3.42; 95% CI, 2.74-4.26), and the effect sizes for maltreatment subtypes ranged from 1.84 for childhood emotional neglect to 3.03 for childhood emotional abuse. In nonclinical samples, there were stronger associations between nonsuicidal self-injury and multiple maltreatment subtypes. When researchers used age as a categorical variable moderator, the strength of the association between overall maltreatment and nonsuicidal self-injury was stronger among adolescent samples than adults though it was not significant in a multivariate meta-regression model.

“Although screening for physical and sexual abuse are important in assessing risk for self-harm, this study demonstrates that emotional abuse is equally, if not even more, relevant to this outcome,” Liu told Healio Psychiatry. “Consequently, emotional abuse warrants greater attention in screening for risk, especially as it is the most prevalent form of childhood abuse.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.