ARTICLES
Pubertal Stage and Deliberate Self-Harm in Adolescents

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ABSTRACT

Objective:

To ascertain the association between pubertal stage and deliberate self-harm.

Method:

Cross-sectional survey of 12- to 15-year-olds in 300 secondary schools in the U.S. state of Washington in February-April 2002 and the Australian state of Victoria in June-August 2002. A total of 3,332 students in grades 7 and 9 provided complete data on episodes of deliberate self-harm in the previous 12 months and pubertal stage. Pubertal stage was assessed with the Pubertal Development Scale.

Results:

The prevalence of deliberate self-harm was 3.7% with a more than twofold higher rate in females. Late puberty was associated with a more than fourfold higher rate of self-harm (odds ratio 4.6, 95% confidence interval 1.5-14) after adjustment for age and school grade level. In contrast age had a protective association (odds ratio 0.7, confidence interval 0.4-1.0). The sharpest rises in prevalence across puberty were for self-laceration and self-poisoning in females. Higher rates of depressive symptoms, frequent alcohol use, and initiation of sexual activity largely accounted for the association between self-harm and pubertal stage in multivariate models.

Conclusions:

Puberty is associated with changes in the form and frequency of self-harm. For adolescents with a gap between puberty and brain development, risk factors such as early sexual activity and substance abuse may be particularly potent.

Section snippets

METHOD

The International Youth Development Study (IYDS) is a binational, longitudinal study of adolescent health and development. Each state used a two-stage cluster sampling procedure. In the first stage, schools at each study year level were selected at random from a stratified sampling frame of all schools in Victoria, Australia (Catholic, independent, and government) and the U.S. state of Washington (public, private, and alternative). At stage two, single intact classes from each school for the

RESULTS

We excluded forty-four 16-year-olds and one 17-year-old because they were beyond the age at which puberty is usually complete, leaving 1,944 participants in grade 7 and 1,910 in grade 9 available for analysis, a potential analysis sample of 3,854. Valid self-harm data were available for 3,528 of the 3,854 participants and valid puberty data for 3,618. Data on both variables were available on 3,332 (86%) of all participants. This was used as the denominator for all further analyses. The mean age

DISCUSSION

Deliberate self-harm becomes common in early adolescence, with increases in self-poisoning and self-laceration particularly marked in females (Hawton et al., 2002). In this study, the odds of self-harm were four- to fivefold higher in late puberty after adjustment for age and school grade level. The association with pubertal stage was evident in boys but appeared more striking in girls in whom self-laceration and self-poisoning constituted the great proportion of self-harm from late puberty.

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    This research was supported by funding from the National Institutes of Health grant DA-12140, the Victorian Health Promotion Foundation, and the Australian Alcohol Education and Rehabilitation Fund.

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