Examining school attendance as a predictor of self-harm in adolescents: A series of longitudinal studies using linked mental health and education data

自我伤害是指一个人故意以任何方式伤害自己。超过十分之一的年轻人在18岁之前伤害自己。有或没有自杀意图的自我伤害是一个主要的担忧，因为它是痛苦的迹象，也是未来自杀的强烈预测。许多年轻人在开始自我伤害之前就已经有了一段时间的问题，但他们觉得自己无法寻求帮助。为了防止自我伤害，我们需要找到方法尽早识别那些处于危险中的人，以便提供正确的帮助。及早发现问题的好地方是在学校。然而，学校的资源有限，因此不能定期询问学生他们的应对情况。然而，学校确实记录了所有学生的出勤率，所以可以收集出勤率低的信息，这是年轻人开始显示出问题迹象的一种方式。我回顾了现有的研究，这些研究表明出勤率低会增加自我伤害的风险，但这些研究缺乏质量，而且没有定论。然而，之前的研究确实表明，出于许多原因，出席和后来的自我伤害之间的联系是可能的。就学不佳可能会增加社会孤立和孤独，众所周知，这会增加自我伤害的风险。此外，出勤率低可能是因为年轻人遇到了一些隐藏的问题，比如欺凌或父母身体不好，这也会增加自我伤害的风险。我的研究将探索，出勤率低是否可以提供年轻人有自我伤害风险的“早期预警信号”。我还将探讨为什么出勤率较低的人可能面临更高的风险，以帮助理解需要哪些类型的支持。不管是什么原因，如果这项研究表明出勤率低是风险较高的迹象，那么它将告知学校和政策制定者，为了防止自我伤害，这一群体需要额外的支持。我还将探索是否有心理健康问题的年轻人的上学模式可以为心理健康专业人员提供额外的信息，以确定年轻人是否有更高的严重自我伤害风险。在一般人群中增加自我伤害风险的事情可能不同于那些增加年轻人由于精神健康问题或自杀念头而已经脆弱的风险的事情。了解这一点将为改进临床实践提供信息。我的研究将包括两项研究。在一项研究中，我将检查与三组11-17岁儿童的教育记录相关的匿名心理健康记录，以探索学校出勤率是否可以预测谁更有可能出现自我伤害的急救，以及如何解释这一点。这三组人是：a)伦敦南部4个区的年轻人，b)参加过儿童和青少年精神卫生服务(CAMHS)的人，c)向CAMHS报告自杀念头的人。在另一项研究中，我将使用弹性、种族和青少年心理健康(REACH)研究的数据，该研究包括来自伦敦南部12所学校的11至14岁的儿童，他们可能从未就自己的问题寻求帮助。在这里，我将探讨出勤率是否可以预测谁更有可能自残，这一次是根据年轻人自己的报告，而不仅仅是那些向急症室报告的人。这些研究中使用的方法提供了一个重要的例子，可以利用学校和医疗服务机构经常收集的信息来了解哪些年轻人未来可能会有问题。类似的方法可以用来识别其他风险迹象，并帮助预测其他问题。我的研究结果将提供信息，帮助临床医生、教育专业人员和政策制定者了解哪些年轻人可能面临更高的自我伤害风险，并可能有助于制定自我伤害预防策略。

Self-harm is when a person hurts themselves on purpose in any way. More than 1 in 10 young people harm themselves before they turn 18. Self-harm with or without suicidal intent, is a major concern, as it is a sign of distress and a strong predictor of later suicide. Many young people have had problems for some time before they start to self-harm but do not feel able to seek help. To prevent self-harm, we need to find ways to identify those at risk as early as possible so that the right help can be provided.A good place to identify problems early is in school. However, schools have limited resources so cannot regularly ask their students how well they are coping. Schools do however keep records of all students' attendance and so information about poor attendance, which is one way that young people begin to show signs of problems, can be gathered.I have reviewed existing studies which suggest that poor school attendance increases the risk of self-harm but these studies lack quality and are inconclusive. However, previous research does suggest that a link between attendance and later self-harm could be possible for a number of reasons. Poor school attendance could increase social isolation and loneliness which are known to increase the risk of self-harm. Also poor attendance could result from hidden problems that a young person is encountering such as bullying or having an unwell parent, which can also increase the risk of self-harm. My research will explore whether poor school attendance can provide an "early warning sign" that young people are at risk of self-harm. I will also explore why those with poor attendance might be at higher risk, to help understand what type of support is needed. Whatever the reason, if this research shows that poor attendance is a sign of higher risk then it will inform schools and policy-makers that this group requires extra support in order to prevent self-harm.I also will explore whether school attendance patterns in young people who have known mental health problems could give mental health professionals extra information about whether a young person is at increased risk for severe self-harm. Things which increase the risk of self-harm in the general population may be different to those which increase the risk in young people who are already vulnerable due to having mental health problems or suicidal thoughts. An understanding of this would provide information to improve clinical practice.My research will consist of two studies. In one study, I will examine anonymised mental health records linked to education records for three groups of 11-17 year-olds to explore whether school attendance can predict who is more likely to present to Accident and Emergency (A&E) with self-harm and what may explain this. The three groups are: a) Young people in 4 boroughs of South London, b) Those who have attended Child and Adolescent Mental Health Services (CAMHS), c) Those who have reported suicidal thoughts to CAMHS. In another study, I will use data from the Resilience, Ethnicity and Adolescent Mental Health (REACH) study, which includes 11-14 year-olds in 12 schools in South London who may never have sought help for their problems. Here, I will explore whether school attendance can predict who is more likely to self-harm, this time according to young people's own reports rather than only those who present to A&E. The methods used in these studies provide an important example of using information which is routinely collected by schools and health services to understand which young people may be at risk of problems in future. Similar methods could be used to identify other signs of risk and to help predict other problems. The findings of my studies will provide information to help clinicians, education professionals and policy-makers understand which young people may be at higher risk of self-harm, and could contribute to the development of self-harm prevention strategies.