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Self-injurious behaviors are among the main reasons why children and adolescents consult in mental health emergency room

Monica Sancosmed i Ricard Ferrer Vall d'Hebron
Friday, 26 March, 2021

Researchers have analyzed 566 clinical episodes related to mental health problems that they attended in the Pediatric Emergency Room of Vall d’Hebron from 2015 to 2017.

A study published by the Psychiatry Service of the Vall d’Hebron University Hospital and the CIBERSAM (Center for Biomedical Research in Mental Health Network) has revealed that the prevalence of self-injurious behaviors among pediatric emergency room is high, being drug overingestion (38.8%) and cuts (24.1%) the most frequent behaviors. The study, published in Actas Españolas de Psiquiatría journal analyzed the prevalence of self-injurious behaviors among the reasons for consultation in pediatric emergency rooms from 2015 to 2017 and had the collaboration of the Pediatric Emergency Department.

Specifically, 566 clinical episodes related to a mental health problem that were treated in the pediatric emergency department from 2015 to 2017 were analyzed, and it has been found that a quarter had problems of self-harm (suicide attempts due to overingestion of drugs, cuts on the arm, self-inflicted blows, ideas of death, etc.).

This problem has been observed especially in girls with an average age of 15 years and often without underlying psychiatric pathologies. As stated by Dr. Marc Ferrer, head of the Hospitalization Section of the Psychiatry Service, principal investigator of the Research Group in Psychiatry, Mental Health and Addictions of the Vall d'Hebron Research Institute (VHIR) and leader of the study, these data “invite us to reflect on a growing and worrying problem. They are boys and girls who, due to their age, should be enjoying life without too many worries and instead have great emotional suffering and a manifest inability to bear it, and they reach self-harm and in some cases suicide”.

Dr. Mónica Sancosmed, from the Pediatric Service, explains that “any way of causing pain is a way of expressing suffering (anger, sadness, loneliness). They are emotions that they cannot express, and it is easier for them to control physical pain than emotional pain. With this, they release part of the anxiety they feel”. As for the cause that leads young people to self-harm, multiple factors interact. There are sociodemographic risk factors (predominantly female), psychopathological (low self-esteem, depression, conduct disorders, substance abuse) and psychosocial precipitating factors (bullying, parental divorce, family problems, sexual abuse, domestic violence, problems economic, unemployment, difficulties in social relationships, feeling different, ethnic and cultural differences).

According to Dr. Sancosmed, "the increase in precipitating situations such as those mentioned, added to the emergence of new technologies, has generated and promoted this phenomenon". Many adolescents and pre-adolescents, faced with negative experiences, “take refuge in the virtual reality of social networks, in which lately a change in perception has been added and they no longer see self-harm as a negative thing, and feel a certain well-being because of the belonging to a group and being part of something that is fashionable”. An example of this phenomenon, points out Dr. Sancosmed, are the #selfharm labels used on social networks such as Instagram or Twitter.

The age of young people with self-harm, decreasing

The study data show how the median age of boys and girls who consult the emergency room for a problem related to mental health has been decreasing over the years: from 16 years in 2015 to 12 years in 2017. "Unfortunately, the data from this study go in the same direction as those observed in similar studies in other countries and reinforce the evidence of the urgent need to obtain specific resources for this very vulnerable population that can later develop serious psychiatric disorders and that they can become chronic”, says Dr. Ferrer.

The World Health Organization (WHO), through its Mental Health Action Plans, considers it a priority to address the care gap between the needs of young people and the care currently provided to them, which is often insufficient quantitatively and qualitatively.

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