Rates of health care encounters for self-injury among patients aged 24 years and younger increased by about 4% per year across high-income countries from 2000 to 2024, with female patients driving the trend, according to a systematic review and meta-analysis.
Investigators reported that female patients experienced a steeper annual increase compared with male patients (3.6% vs 1.2%) and also had higher baseline rates of self-injury–related visits.
In the analysis, the investigators pooled data from 42 studies representing a midpoint population of more than 234 million patients across 12 Organization for Economic Co-operation and Development countries. They also found a 2.5% relative annual increase in self-reported self-injury in survey-based studies, showing similar directional trends across different measurement approaches.
Methods
The investigators searched the MEDLINE, Embase, Scopus, and PsycINFO databases as well as gray literature for studies published between January 2000 and December 2024. Eligible studies included patients aged 24 years and younger, and the investigators used registry-based, longitudinal, or repeated cross-sectional designs with at least 5 years of outcome data.
The studies assessed either health care encounters for self-injury, defined using diagnostic codes, or self-reported self-injury or suicide attempts. Studies that were limited to clinical subgroups, focused only on suicidal ideation, or were unable to distinguish ideation from self-injury were excluded.
Among more than 18,000 records screened, 42 studies met the inclusion criteria. Thirty-five of them used health care encounter data, and seven of them used self-reported surveys. Among the health care encounter studies, regions included North America, Europe and the Middle East, Australia and New Zealand, and the United Kingdom. Clinical settings included emergency departments, hospitalizations, primary care visits, and ambulance attendances.
Health Care Encounters for Self-Injury
In the primary meta-analysis of 32 studies, the investigators found a baseline rate in 2000 of 10.2 visits per 10,000 patients, with an annual increase of about 4% over the study period. The rates increased in most of the studies and were generally consistent across geographic regions.
Female patients had higher baseline rates compared with male patients and experienced a more pronounced increase over time. No statistically significant change in trends was observed prior to compared with following 2010.
Regional analyses produced similar estimates, with annual increases generally ranging from approximately 3% to 4%. Sensitivity analyses supported the robustness of the findings.
Substantial heterogeneity was observed across the studies, likely reflecting differences in health care systems, coding practices, access to care, cultural factors, and population characteristics.
Self-Reported Self-Injury
Five survey-based studies contributed to the meta-analysis of self-reported self-injury. The baseline rate was 275 per 10,000 patients, with an annual increase of about 3%. Too few studies reported sex-stratified results to allow meaningful subgroup analysis.
Interpretation
The investigators noted that the observed increase in self-injury is unlikely to be explained solely by trends in anxiety or depression, which have shown inconsistent or more modest changes in prior research.
They suggested that social media and online environments may contribute to the rising rates through mechanisms such as cyberbullying, body image concerns, and increased psychological distress. The COVID-19 pandemic may have amplified some of these factors but was unlikely to account for the long-term trend.
The investigators noted the need for targeted prevention strategies, including school-based mental health programs, community support initiatives, crisis services, and the evaluation of policies addressing online harms.
Limitations
The investigators noted that variability in coding practices across regions and over time may have introduced bias. For instance, some regions, particularly in Asia, were underrepresented. Overlapping age groups limited age-specific analyses, and most studies didn't report gender separately from biological sex. The exclusion of non-English studies may also have introduced bias.
Conclusion
“Effective, contextually informed, large-scale prevention initiatives are urgently needed to curb the rise in self-injury within high-income countries, particularly among female [patients],” wrote lead study author Natasha Saunders, MD, MSc, of The Hospital for Sick Children and Department of Pediatrics at the University of Toronto, and colleagues.
Disclosures can be found in the study.
Source: JAMA Pediatrics
