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Affiliation
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Children's Hospital of Eastern Ontario (CHEO) Senior Research Chair in Child and Adolescent Psychiatry, University of Ottawa, Ottawa, ON, Canada. wgardner@cheo.on.ca. |
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Abstract
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This comment refers to the article available at https://doi.org/10.1007/s00127-019-01794-8.
Sarah Steeg and her co-authors report a welcome and surprising finding [1]. In a study of Danish health administrative records, they found that the incidence rate of self-harm among adolescents aged 10–19 years peaked in 2007 (at 25.1/10,000 Danish youths), and then decreased steadily to 13.8/10,000 in 2016. This finding is welcome, because adolescent self-harm that requires medical attention is associated with future mortality, suicide, repeated self-harm, and increased health care costs [2].
This finding is surprising, because as the authors note, adolescents have been visiting hospitals for self-harm at increasing rates in many countries. I will focus on the contrast between Denmark and Canada, two prosperous Northern social democracies with extensive social safety nets, and high levels of personal happiness and social trust. However, in contrast to Denmark, in the Canadian province of Ontario, the rates of adolescents presenting at emergency departments (EDs) for self-harm fell 32% from 2003 to 2009, while Danish levels of youth self-harm were rising, but then rose 135% from 2009 to 2017, when Danish levels were falling [3]. Therefore, what does the Danish finding suggest about the causes of adolescent self-harm and about how Canadians might prevent it?
In looking for causes of the post-2007 increase in adolescent self-harm ED visits in Ontario, we noted that the Ontario economy went into recession in 2008, about the same time that visit rates started to rise. However, the Danish economy also experienced a recession in 2008, and yet visits there fell. A second possible explanation for the increase in Ontario was the spread of smartphones. The iPhone launched in 2007, and many adolescents have become increasingly immersed in social media. Twenge and her colleagues found that adolescents’ self-reported mental health complaints and self-harm were associated with spending more time online and less time interacting in person [4]. However, rates of social media penetration in Denmark are similar to those in other countries [5]. It follows that either we were wrong in believing that exposure to economic adversity or social media was a factor in promoting self-harm among Ontario’s youth, or there is some factor that Denmark has, and that Ontario does not have that protected Danish youth ...
Language: en |