Help-seeking behavior among Japanese school students who self-harm: results from a self-report survey of 18,104 adolescents

Abstract

Norio Watanabe,1,* Atsushi Nishida,2,* Shinji Shimodera,3 Ken Inoue,4 Norihito Oshima,5 Tsukasa Sasaki,6 Shimpei Inoue,3 Tatsuo Akechi,1 Toshi A Furukawa,7 Yuji Okazaki81Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, 2Department of Schizophrenia Research, Tokyo Institute of Psychiatry, Tokyo, 3Department of Neuropsychiatry, Kochi Medical School, Kochi, 4Department Public Health, Fujita Health University School of Medicine, Aichi, 5Office for Mental Health Support, Division for Counseling and Support, University of Tokyo, Tokyo, 6Health Service Center, University of Tokyo, Tokyo, 7Department of Cognitive-Behavioral Medicine, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, 8Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan *These authors contributed equally to this workBackground: The aim of this study was to determine the prevalence of and factors associated with poor help-seeking among adolescents who self-harm and to explore the resources used for help.Methods: A cross-sectional survey using an anonymous questionnaire was conducted in 47 junior and 30 senior high schools in Japan. Adolescent self-harm was defined as an adolescent who had harmed himself or herself in the previous year, as in previous studies reported in Western countries. Poor help-seeking was defined as not consulting anyone despite reporting current psychological or somatic complaints. Information about sociodemographic and psychological factors possibly associated with help-seeking, such as suicidal thoughts, depression, anxiety, and psychotic-like experiences, was also collected. Regression analyses were performed to examine associated factors.Results: A total of 18,104 students (8620 aged 12–15 years, 9484 aged 15–18 years), accounting for 93% of all students in the relevant student classes, participated in the study. Two hundred and seventy-six (3.3%) junior and 396 (4.3%) senior high school students reported having self-harmed. Of these, 40.6% of adolescents in junior and 37.6% in senior high schools were classified as poor help-seeking. Poor help-seeking with regard to self-harm was significantly more common in those who reported not having consulted anyone about psychological problems (odds ratio 9.2, 95% confidence interval 4.6–18.4 in juniors; odds ratio 9.9, confidence interval 5.5–17.9 in seniors) and in those with current suicidal ideation (odds ratio 2.0, confidence interval 1.0–3.7 in juniors; odds ratio 1.9, confidence interval 1.1–3.4 in seniors). Family members were approached significantly less often as a resource for help by students who self-harmed than by those who did not, and school nurses were more often consulted by those who did self-harm.Conclusion: Around 40% of adolescents who self-harmed in the previous year did not seek help. School-based mental health should screen students at risk of self-harm, and educate school nurses about preventative care.Keywords: self-harm, adolescence, help-seeking, prevention, Japan