Pathways to self-harm: Biological mechanisms and genetic contribution

年轻人的自我伤害是一个主要问题。多达六分之一的青少年曾在生活中的某个时候自残，10岁至16岁之间的自残尤为常见。自残的年轻人在成年初期似乎更有可能在许多方面表现不佳，包括更有可能出现心理健康问题，以及使用酒精和毒品等物质。它也是已知的自杀最强烈的危险因素。尽管自残在年轻人中很常见，但我们对其原因知之甚少。更好地了解那些会增加自我伤害风险的事情，以及它们是如何起作用的，可以帮助我们制定更有效的方法来预防自我伤害，并在年轻人需要的时候给予他们支持。研究表明，在生活的早期面对糟糕的经历(如身体和性虐待，以及情感上的忽视)会增加年轻人自我伤害的可能性。然而，我们还不知道这是如何运作的。我们知道，社会环境(包括逆境的发生)可能会对身体的内部工作产生影响，如炎症、基因周围化学物质的变化和荷尔蒙，而这些事情反过来又会导致自杀和自我伤害。在这项研究中，我们旨在调查早期的不良经历是否与三个不同的生物过程(炎症、DNA变化和青春期(阶段和时机))有关，并探索这些因素是否反过来与青春期的自我伤害有关。我们的研究还将调查炎症、DNA变化、青春期和自我伤害之间的联系是否真实存在，或者它们是否可能被其他因素解释。这项研究有助于确定未来自我伤害风险的潜在标记物，以及可能用于治疗自残年轻人的目标。我们还计划增加对是否存在明显不同类型的自我伤害的理解。一些研究人员提出，根据一个人是否有自杀念头，并有没有意图结束自己的生命而进行过自我伤害，将自我伤害分类可能是有用的。然而，很难判断一个人想要结束生命的程度，所以我们不确定在临床实践中尝试和判断这一点有多大用处。我们计划研究自我伤害的年轻人的基因是否根据他们是否有自杀意图而有所不同。这项工作将为未来关于自残的研究提供信息，并可以帮助从事自残青少年工作的从业者。为了推进这项研究，我们召集了一支来自两所大学的杰出科学家团队。这项拟议的研究将使用雅芳亲子纵向研究(ALSPAC)的数据。ALSPAC是一项长期研究，对1991-1992年间在布里斯托尔及周边地区出生的13,000多名儿童进行了跟踪调查，他们自出生以来一直通过定期问卷和研究诊所进行跟踪。很少有研究有如此多的人实时收集如此详细的问题。这一点很重要，因为人们的经历会对他们的记忆产生很大影响。对于这类研究来说，也有我们需要的生物样本来回答关于基因和人体内部生物过程的问题，这也是不寻常的。

Self-harm in young people is a major problem. As many as 1-in-6 teenagers have self-harmed at some point in their lives, and self-harm is particularly common between the ages of 10 and 16 years. Young people who self-harm seem to be more likely to do poorly in a number of ways in early adulthood, including being more likely to have a mental health problem, and to use substances like alcohol and drugs. It is also the strongest known risk factor for suicide. Although self-harm is very common in young people, we know little about what causes it. A better understanding of the things that increase the risk for self-harm, and how they work could help us to develop more effective ways to prevent self-harm and support young people when they need it.Research shows that facing bad experiences early in life (such as physical and sexual abuse, and emotional neglect) increases the chances that a young person will self-harm. However we do not yet understand how this works. We know that the social environment (including the occurrence of adversity) can have an impact on the body's internal working, such as inflammation, changes to chemicals around genes, and hormones, and that these things in turn are involved in suicide and self-harm. In this study, we aim to investigate whether early bad experiences are associated with three different biological processes (inflammation, alterations to DNA, and puberty (stage and timing)) and explore whether these factors are, in turn, associated with self-harm in adolescence. Our research will also investigate whether associations between inflammation, alterations to DNA, puberty and self-harm are real, or whether they might be explained by other factors. This research could help to identify potential markers of future self-harm risk, as well as possible targets for treatment for young people who self-harm. We also plan to increase understanding about whether there are clearly distinct types of self-harm. Some researchers have proposed that it may be useful to classify self-harm according to whether or not the person has suicidal ideas, and has self-harmed with the intention of ending their life. However, it can be difficult to judge the extent to which someone wants to end their life and so we are not sure how useful it is to try and judge this in clinical practice. We plan to study whether the genes of young people who self-harm differ according to whether or not they have harmed with suicidal intent. This work will inform future research studies of self-harm, and could help practitioners working with young people who self-harm.In order to take the research forward, we have assembled a team of outstanding scientists from two universities. The proposed research will use data from the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC is a long term study of over 13,000 children born in Bristol and the surrounding area in 1991-1992 who have been followed up since birth with regular questionnaires and research clinics. There are very few studies that have such a large number of people with such detailed questions that were collected in real time. This is important as people's experience can be a strong influence on what they remember. It is also unusual for this kind of study to also have the biological samples that we need to answer the questions about genes, and the body's internal biological processes.