Adolescent non-suicidal self-injury, contextual and area-level inequalities: Insights from ten years of emergency department visits in northern Italy

Abstract

Objective: Non-suicidal self-injury (NSSI) is a growing mental health concern among adolescents. While individual-level risk factors are well documented, less is known about how area-level determinants influence pathways to emergency care for NSSI. This study aimed to examine the association between area-level contextual factors and Emergency Department (ED) visits for NSSI among adolescents in the Piedmont Region of Northern Italy.

Study design: Retrospective cross-sectional analysis.

Methods: A retrospective cross-sectional analysis of administrative health data covering all ED presentations for NSSI among individuals aged 5-19 years from 2011 to 2021 was conducted. Cases were georeferenced using three validated territorial indicators: the regional socioeconomic deprivation index, the Health Action Zones (HAZ) classification, and the national Inner Areas classification. Sex-stratified multivariable logistic regression models were used to assess the association between each contextual indicator and NSSI-related ED visits.

Results: Contrary to conventional expectations, adolescents living in less deprived areas showed significantly higher odds of NSSI-related ED visits, particularly among girls and those aged 15-19 years. In addition, a clear gradient was observed across territorial marginality, with higher odds among adolescents residing in belt and peripheral areas. These associations remained robust after adjustment for age and contextual interrelations. Traditional deprivation measures alone may therefore fail to capture emerging or context-specific vulnerabilities, while differential access to services and help-seeking pathways may contribute to observed patterns of ED utilisation.

Conclusions: Structural and contextual factors play an important role how adolescent self-injury is detected within emergency services. Place-sensitive prevention strategies and cross-sectoral planning are needed to address both visible and less readily detected vulnerabilities across diverse communities.

Keywords: Adolescent behaviour; Emergency service; Geographic health disparities; Hospital; Self-injurious behaviour; Social determinants of health.