Identifying Causal Risk Factors for Self-Harm Among Adolescents With U.S. Child Protective Services Contact

Abstract

Objectives

To estimate effects of potentially modifiable risk factors for self-harm among adolescents in the Child Protective Services (CPS) system.

Methods

Data came from the National Survey of Child and Adolescent Well-being, a nationally representative longitudinal survey. Candidate risk factors included child’s feelings of worthlessness, the presence of supportive adults in the child’s life, and parental psychological aggression. Propensity score weighting (PSW) was used to control for observed confounders, and the average effect of experiencing the risk factor among those who did was estimated using weighted logistic regression.

Results

Odds ratios for self-harm comparing youth with low and high parental psychological aggression to none were 0.93 (0.35–2.45) and 1.25 (0.55–2.82), respectively. The OR for feelings of worthlessness was 1.73 (0.70–4.27), and for supportive adults 0.58 (0.28–1.19). The combination of survey and propensity score weights may have affected statistical power.

Conclusions

Preventing self-harm in adolescents requires a multifaceted approach given the existing evidence base and lack of strong associations with individual risk factors. Fostering supportive relationships with adults merits future research given the observed, non-significant 42% reduction in odds of self-harm among CPS involved youth who had a supportive relationship with an adult, compared to those who did not.

Keywords:

• Adolescent
• causal risk factors
• child abuse
• child welfare
• self-harm

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Mr. Kahn was support by an National Institute of Mental Health (NIMH) T32 training grant [Grant # 1T32MH109436-01A1] and an NIMH NRSA training grant [Grant # 1F31MH120973-01) at the time this work was completed.

Notes on contributors

Geoffrey D. Kahn

Geoffrey D. Kahn*, PhD, Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI 48202-3450, USA

Holly C. Wilcox

Holly C. Wilcox, PhD, and Elizabeth A. Stuart, PhD, Johns Hopkins University Bloomberg School of Public Health, Mental Health, Baltimore, MD 21205-2103 USA.

Elizabeth A. Stuart

Holly C. Wilcox, PhD, and Elizabeth A. Stuart, PhD, Johns Hopkins University Bloomberg School of Public Health, Mental Health, Baltimore, MD 21205-2103 USA.