Self Harm Linked to Violence Towards Others
Summary: Researchers report on a link between people who self harm and violent crime.
Source: Karolinska Institute.
There is a link between self-harm and the risk of violent criminality, according to a Swedish registry study carried out by researchers at Karolinska Institutet and published in the scientific journal JAMA Psychiatry.
Deliberate self-harm, such as cutting, burning or overdosing on drugs to escape distressing emotions or attempt suicide is a serious and common behaviour.
It has long been suspected that individuals who self-harm may also be prone to aggressive behaviours towards others, but the studies that have been conducted thus far have not been able to give conclusive answers. Researchers at Karolinska Institutet have therefore used Swedish registries to investigate the link between deliberate self-harm and violent crime convictions. The registries give unique opportunities to study this correlation since they cover the entire population.
The study included all Swedish citizens born between 1982 and 1998 and followed them from age 15 (1,850,525 individuals in total). During the study period 55,185 received self-harm associated clinical care, 66,561 were convicted of a violent crime, and 8,155 were both exposed to self-harm and convicted of a violent crime. Individuals who had at some time received clinical care for self-harm ran a five-fold risk of being convicted for a violent crime compared with those who had never received care for self-harm.
"A susceptibility to self-harm seems to increase the risk of violent expression, but we found no support for the hypothesis that self-harm causes violence crime," says Hanna Sahlin, doctoral student at the Department of Clinical Neuroscience at Karolinska Institutet. "When we reversed the analysis and examined the risk of self-harm in individuals convicted of a violent crime, we found a similar association. Taken together, this suggests that self-harm behaviour and violent criminality is a manifestation of a common underlying vulnerability."
Even after controlling for relevant confounders, such as psychiatric co-morbidity and socioeconomic factors, self-harm was still associated with a doubled risk of violent crime conviction, a finding that remained when men and women were analysed separately.NeuroscienceNews.com image is adapted from the Karolinska Institute news release.
Almost as many men as women received clinical care for self-harm during the study period. The risk of violent crime conviction was particularly high for self-harming women with comorbid substance abuse, with a seven times increased risk for violent crime conviction, compared to women who had never received clinical care for self-harm.
Even after controlling for relevant confounders, such as psychiatric co-morbidity and socioeconomic factors, self-harm was still associated with a doubled risk of violent crime conviction, a finding that remained when men and women were analysed separately.
"We need to ask about aggressive behaviour towards others when we assess and treat self-harming individuals, but we also need to ask about self-harm when we assess and treat aggressive individuals," says Ms Sahlin.
The study was financed by the Swedish Research Council, the Marcus and Amalia Wallenberg Memorial Foundation, Forte, Stockholm County Council and Karolinska Institutet.
About this psychology research article
Source: Karolinska Institute
Image Source: NeuroscienceNews.com image is adapted from the Karolinska Institute news release.
Original Research: Abstract for "Association Between Deliberate Self-harm and Violent Criminality" by Hanna Sahlin, MSc; Ralf Kuja-Halkola, PhD; Johan Bjureberg, MSc; Paul Lichtenstein, PhD; Yasmina Molero, PhD; Mina Rydell, PhD; Erik Hedman, PhD; Bo Runeson, MD, PhD; Jussi Jokinen, MD, PhD; Brjánn Ljótsson, PhD; and Clara Hellner, MD, PhD in JAMA Psychiatry. Published online April 5 2017 doi:10.1001/jamapsychiatry.2017.0338
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Karolinska Institute "Self Harm Linked to Violence Towards Others." NeuroscienceNews. NeuroscienceNews, 5 April 2017.
Association Between Deliberate Self-harm and Violent Criminality
Importance Individuals who self-harm may have an increased risk of aggression toward others, but this association has been insufficiently investigated. More conclusive evidence may affect assessment, treatment interventions, and clinical guidelines.
Objective To investigate the association between nonfatal self-harm and violent crime.
Design, Setting, and Participants This population-based longitudinal cohort study, conducted from January 1, 1997, through December 31, 2013, studied all Swedish citizens born between 1982 and 1998 who were 15 years and older (N = 1 850 252). Individuals who emigrated from Sweden before the age of 15 years (n = 104 051) or immigrated to Sweden after the age of 13 years (ie, <2 years before the beginning of the follow-up; n = 22 009) were excluded. Data analysis was performed from April 21, 2016, to June 4, 2016.Exposures Receipt of self-harm–associated clinical care.
Main Outcomes and Measures Conviction of a violent crime according to the Swedish penal code.
Results The study cohort consisted of 1 850 525 individuals (950 382 males and 900 143 females), and the mean (SD) follow-up time was 8.1 (4.7) years (range, 0-17.0 years; minimum age, 15 years; maximum age, 32 years). During a mean follow-up period of 8.1 years, 55 185 individuals (3.0%) received clinical care for self-harm. The crude hazard ratio was 4.9 (95% CI, 4.8-5.0) for violent crime conviction in exposed individuals compared with the unexposed group. Women who self-harm were at particularly high risk for expressing violent behaviors. After adjustment for relevant psychiatric comorbidities and socioeconomic status, an almost doubled hazard of violent offense remained (hazard ratio, 1.8; 95% CI, 1.8-1.9).
Conclusions and Relevance Self-harm is associated with an increased risk of conviction for a violent offense in both sexes. The risk of violence, as well as the risk of suicide and self-harm, should be assessed among offending and self-harming individuals.
"Association Between Deliberate Self-harm and Violent Criminality" by Hanna Sahlin, MSc; Ralf Kuja-Halkola, PhD; Johan Bjureberg, MSc; Paul Lichtenstein, PhD; Yasmina Molero, PhD; Mina Rydell, PhD; Erik Hedman, PhD; Bo Runeson, MD, PhD; Jussi Jokinen, MD, PhD; Brjánn Ljótsson, PhD; and Clara Hellner, MD, PhD in JAMA Psychiatry. Published online April 5 2017 doi:10.1001/jamapsychiatry.2017.0338
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