Pubertal stage and deliberate self-harm in adolescents

J Am Acad Child Adolesc Psychiatry. 2007 Apr;46(4):508-514. doi: 10.1097/chi.0b013e31803065c7.


Objective: To ascertain the association between pubertal stage and deliberate self-harm.

Method: Cross-sectional survey of 12- to 15-year-olds in 300 secondary schools in the U.S. state of Washington in February-April 2002 and the Australian state of Victoria in June-August 2002. A total of 3,332 students in grades 7 and 9 provided complete data on episodes of deliberate self-harm in the previous 12 months and pubertal stage. Pubertal stage was assessed with the Pubertal Development Scale.

Results: The prevalence of deliberate self-harm was 3.7% with a more than twofold higher rate in females. Late puberty was associated with a more than fourfold higher rate of self-harm (odds ratio 4.6, 95% confidence interval 1.5-14) after adjustment for age and school grade level. In contrast age had a protective association (odds ratio 0.7, confidence interval 0.4-1.0). The sharpest rises in prevalence across puberty were for self-laceration and self-poisoning in females. Higher rates of depressive symptoms, frequent alcohol use, and initiation of sexual activity largely accounted for the association between self-harm and pubertal stage in multivariate models.

Conclusions: Puberty is associated with changes in the form and frequency of self-harm. For adolescents with a gap between puberty and brain development, risk factors such as early sexual activity and substance abuse may be particularly potent.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior
  • Child
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Female
  • Humans
  • Male
  • Mental Disorders / complications
  • Odds Ratio
  • Prevalence
  • Puberty*
  • Risk Factors
  • Self-Injurious Behavior / epidemiology*
  • Sexual Behavior
  • Substance-Related Disorders / epidemiology
  • Victoria / epidemiology
  • Washington / epidemiology