Exploring the link between non-suicidal self injury, attempted suicide and adolescent identity

(Medical Xpress)—Around half (45.5%) of 'Alternative' teenagers self-injure and nearly 1 in 5 (17.2%) attempt suicide, according to scientists at the Medical Research Council (MRC) Social and Public Health Sciences Unit, University of Glasgow and researchers from the University of Ulm, Germany.

The researchers define 'Alternative' teenagers as Goths, Emos or Punks, based the definition used by the Greater Manchester Police (GMP). GMP consulted academic experts in both youth subculture (Paul Hodkinson) and Hate crime (Jon Garland) when deriving the definition.

This is the first research to look at why teenagers in certain subcultures are more likely to self-harm and how their motivations differ from other teenagers. Overwhelmingly, the reasons teenagers in this study gave to explain why they self-injure was to regulate distressing emotions and communicate this distress to friends and family. Earlier research finds that the majority of adolescents who self-injure have friends who also self-injure and suggests self-injury might be socially contagious. However in this study, only a few teenagers were found to self-injure because they wanted to 'feel more part of a group'.

The study, published in BMC Psychiatry, was conducted in Germany using 452 school pupils, aged 14-15 years. Pupils were asked to answer questions on how strongly they identified with different youth cultures, such as Alternative (Goth, Emo, Punk), Nerd (academic) or Jock (athletic). They were also asked about risk factors strongly linked to self-injury including, demographic (gender, immigration), social background (parent's social and economic status) and victimisation (physical bullying and verbal harassment).

Researchers found teenagers with an Alternative identity were 3-4 times more likely to self-injure and 6-7 times more likely to attempt suicide than other teenagers, even after allowing for known risk factors. Identifying as an 'Alternative teenager' was a stronger predictor of self-injury or a suicide attempt than being repeatedly bullied.

The scientists investigated if adolescents from different social groups are at greater risk of self-injury. Athletic teens (Jocks) are less likely to self-injure than others. The authors speculate this may be attributable to the effect of regular physical exercise which has been shown to improve mood and combat depression in adults.

Interestingly, the findings indicate that academic (Nerd) teens do not experience the peer exclusion and victimisation stereotypically associated with such pupils. Modern 'Nerds' seemed no more likely to self-injure or be suicidal than the other teenagers.

The authors recognise the study has several limitations. For example, information was self-reported and only a minority (7.4%, n=33) of pupils identified as Alternative youth. The scientists were clear the research does not 'prove' that identifying with alternative culture 'causes' teens to self-harm. Rather it is equally likely that isolated teenagers struggling with emotional difficulties are naturally drawn to a musical (sub)culture that expresses these feelings and membership may even have positive social or cathartic effects.

In previous research, Robert Young, Senior Investigative Scientist at the MRC Social and Public Health Sciences Unit and lead author of this study, found a strong association between self-injury and the Goth youth culture among Glasgow teenagers. Over half (53.5%) of Glaswegian Goth teens reported they had engaged in non-suicidal self-injury and 47% claimed to have attempted suicide. The complimentary German study suggests the "Alternative identity effect" has not diminished and is found among the current generation of teenagers.

Robert Young, Senior Investigative Scientist at the MRC Social and Public Health Sciences Unit said: "Our work highlights just how strongly adolescents' social identity is linked with their self-harming behaviours. We hope the findings can be used to both identify young people at risk and help them to manage their emotions in less destructive ways that are tailored to their natures. Future research should explore whether this phenomenon is exclusive to western society or if 'alternative' youth around the world experience the same effect."

Co-author Paul Plener, an Ulm University, Child and Adolescent Psychiatrist who specialises in music therapy for self-harming adolescence, comments: "Our research supports the notion that social mechanisms influence self-harm. This is a crucial finding when thinking of ways to address and prevent self-harm in adolescence. It may well be that building on the strong identification with a certain kind of music or youth group, therapeutic approaches such as music therapy in combination with strategies to decrease distress are a feasible option for addressing self-harm. "

Professor David Lomas, Chair of the MRC Population and Systems Medicine Board, said: "Global estimates suggest 30% of all teenagers have suicidal thoughts, 18% have self-injured and 4% actually attempt suicide and the overall rates in this study were typical for this age group (26%, 21% and 4% respectively). Understanding the reason why different groups of teenagers self-injure will hopefully lead to early detection and help develop effective interventions for those at risk from self-injury or suicide."