4 September 2017

Researchers say findings provide opportunity to target resources at new mental health initiatives in schools and local communities in order to tackle self-harm.

Young people in England who have a low sense of belonging to their school are nearly seven times more likely to self-harm than those who feel attached to it, according to University of Hertfordshire research based on data from a collaborative World Health Organisation study.

Research by the University’s Health Behaviour in School-aged Children (HBSC) England team, published in a recent issue of the International Journal of Public Health, has revealed the extent to which young people’s experiences of school, their local community and relationships with their parents can help decrease self-harming behaviour.

Data shows that 15-year-olds who feel a weak connection to the neighbourhoods in which they live are around three times more likely to self-harm than those who feel a sense of belonging.

Strong parental relationships play an important protective role in young people’s mental health. The odds of self-harm among those that struggle to communicate with their mothers are two-and-a-half times higher compared with those communicate easily - and with their fathers the odds are twice as high. However, friendships with other young people were not found to have a significant bearing on the likelihood of self-harm, the research found.

The research has built on the key findings from the most recent HBSC England survey: more than one in five (21.5%) 15-year-olds in England said they had self-harmed; nearly three times as many girls as boys reported they had self-harmed (32% of girls compared to 11% of boys); over the past decade rates of self-harm have been increasing among adolescents.

The results highlight the need for new school and community initiatives to prevent young people from self-harming, researchers said.

Dr Ellen Klemera, a Senior Research Fellow in Adolescent, Child and Family Health at University of Hertfordshire, said: “While our study has uncovered truly worrying levels of self harm among young people across England, these latest insights present an opportunity to focus attention on the places where the biggest difference can be made.

“The data on sense of belonging to schools is particularly striking and strengthens the argument that greater support should be offered to schools to implement prevention and early intervention measures that can establish and protect good mental health, and embed a positive ethos and culture of community within our schools.”

The potential to expand personal, social, health and economics education (PSHE) in schools to deliver these mental health interventions should be explored, researchers said. The HBSC England study showed PSHE education has a positive impact on the health and wellbeing of young people; nearly three quarters of boys and girls said PSHE classes help them to look after their own health.

“But interventions should not be confined to schools,” Dr Klemera said. “We also need to look at how community initiatives can have a more positive impact on teenagers’ health and wellbeing.”

Parents who have an “easy and open communication style” can help young people feel protected and reduce the likelihood of self-harm far more effectively than young people interacting with their peers, researchers added.

Dr Klemera said: “This challenges the simplistic view of young people’s social relationships and the notion that peers naturally displace parents in a young person’s life as the main social support network. Adult connections are an extremely important and influential part of a young person’s life.”

Reaction to findings

PSHE Association Chief Executive Jonathan Baggaley said:

“This research highlights the need for high quality, compulsory PSHE education in all schools to support pupils’ mental health and address issues such as self-harm, which affect an alarming number of young people.

“The indication that lacking a sense of belonging to schools or communities has such a negative impact on young people’s mental health is also alarming, and another area in which a joined up PSHE programme can help by fostering healthy, constructive relationships and self-esteem.

“That three quarters of pupils surveyed say PSHE helps them look after their own health further strengthens the argument for Government to ensure these lessons are taught regularly in all schools to all pupils.”

Tom Madders, director of campaigns at YoungMinds, said:

“This study reveals concerning figures that those who don’t feel a sense of belonging in their school may be more likely to self-harm.

“Feeling safe, comfortable and valued at school is how all children and young people should be. But at the moment, schools and students are under so much pressure to perform academically that wellbeing of students can often be pushed to the side.

“It is vital that the government rebalances the education system to focus on the wellbeing and mental health of students. There is no quick fix, wellbeing must be integrated into every part of a school to ensure that children and young people feel like a valued member of their school community.”

Study details

A total of 5,335 students aged 11-15 years completed the HBSC survey in England. Research into self-harm among 15-year-olds drew on data collected from 1608 respondents aged 15 as part of the Health Behaviour in School-aged Children (HBSC) England survey, which is led by the University of Hertfordshire.

The HBSC study is an international World Health Organization (WHO) collaborative study, which explores the determinants of young people’s health and wellbeing, and health behaviours. The study collects data from school students aged 11, 13 and 15 years, from 42 countries, through anonymous self-completed questionnaires which young people complete during class time.

In the first study of its kind, University of Hertfordshire researchers carried out further modelling of the data to uncover these latest insights into what extent family life, the school environment and neighbourhood factors act as ‘protective health assets’ for young people in relation to self-harming behaviour. Self-harm was measured by the question: “Have you ever deliberately hurt yourself in some way, such as cut or hit yourself on purpose or taken an overdose?”

Key data

  • Girls were estimated to have 3.60 times greater odds of reporting self-harm than boys.
  • Those with low ‘school sense of belonging’ (SSB) have 6.70 times greater odds of reporting self-harm as those with high SSB, and 3.16 times greater odds than those with medium SSB.
  • Those with low ‘neighbourhood sense of belonging’ (NSB) have 2.84 times greater odds of reporting self-harm as those with high NSB.
  • Those rating communication with their mother as ‘difficult’ have 2.47 times greater odds of reporting self-harm than those who rated their communication as ‘easy’.
  • Those rating communication with their father as ‘difficult’ have 2.14 times greater odds of reporting self-harm than those who rated their communication as ‘easy’.
  • Unlike adolescent/parent interaction, and experiences of school and neighbourhoods, peer support was not shown to be a ‘protective health asset’ in the context of self-harm.

Read the full, open-access academic paper on this study, published in the International Journal of Public Health.

Public Health England recently published three reports, authored by the HBSC England team, focusing on self-harm, cyberbullying and wellbeing of adolescent girls.