Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review
Date
2020-05-14
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Psychiatry
Abstract
Background: Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor
outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is
based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the
available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors,
and reasons for self-harm, in adolescents (aged 10–25 years) in sub-Saharan Africa.
Method: We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records
from 1950 through August 2019, without language restrictions. We supplemented the database searches by
searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies,
and hand searching relevant print sources. We applied narrative synthesis to the evidence.
Results: Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime
prevalence estimate was 10·3% (interquartile range [IQR] 4·6% – 16·1%); median 12-month prevalence estimate was
16·9% (IQR: 11·5% – 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% – 21·8%); and the median
1-month prevalence estimate was 3·2% (IQR: 2·5–14·8%). Studies from Western sub-Saharan Africa reported the
highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% – 27·9%). Clinical samples commonly reported
overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual,
emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm
were identified as key correlates of self-harm. No study reported protective factors against self-harm.
Conclusion: Variation in estimates was explained by small sample sizes and variation in definitions and measures
used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from
high income countries. More detailed and culturally sensitive research is needed to understand the context-specific
risks and protective factors for self-harm in adolescents in sub-Saharan Africa.
Description
Research Article
Keywords
Adolescents, Attempted suicide, Self-harm, Sub-Saharan Africa, Suicide
Citation
Quarshie, E.N., Waterman, M.G. & House, A.O. Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review. BMC Psychiatry 20, 234 (2020). https://doi.org/10.1186/s12888-020-02587-z