Adolescent self-harm in Ghana: a qualitative interview-based study of firsthand accounts
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Date
2020-06-01
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Psychiatry
Abstract
Background: Recent prevalence studies suggest that self-harm among adolescents in sub-Saharan Africa is as
common as it is in high income countries. However, very few qualitative studies exploring first-person accounts of
adolescent self-harm are available from sub-Saharan Africa. We sought to explore the experiences and first-person
perspectives of Ghanaian adolescents reporting self-harm - for deeper reflections on the interpretive repertoires
available in their cultural context for making sense of self-harm in adolescents.
Methods: Guided by a semi-structured interview protocol, we interviewed one-to-one 36 adolescents (24 in-school
adolescents and 12 street-connected adolescents) on their experiences of self-harm. We applied experiential
thematic analysis to the data.
Results: Adolescents’ description of the background to their self-harm identified powerlessness in the family context
and unwanted adultification in the family as key factors leading up to self-harm among both in-school and streetconnected
adolescents. Adolescents’ explanatory accounts identified the contradictory role of adultification as a
protective factor against self-harm among street-connected adolescents. Self-harm among in-school adolescents
was identified as a means of “enactment of tabooed emotions and contestations”, as a “selfish act and social injury”,
as “religious transgression”, while it was also seen as improving social relations.
Conclusions: The first-person accounts of adolescents in this study implicate familial relational problems and
interpersonal difficulties as proximally leading to self-harm in adolescents. Self-harm in adolescents is interpreted as
an understandable response, and as a strong communicative signal in response to powerlessness and family
relationship difficulties. These findings need to be taken into consideration in the planning of services in Ghana and
are likely to be generalisable to many other countries in sub-Saharan Africa.
Description
Research Article
Keywords
Street-connected adolescents, Sub-Saharan Africa, Suicide, Suicide attempt, Tramadol, Adolescents, Adultification, Self-harm, Ghana
Citation
Quarshie, E.N., Waterman, M.G. & House, A.O. Adolescent self-harm in Ghana: a qualitative interview-based study of first-hand accounts. BMC Psychiatry 20, 275 (2020). https://doi.org/10.1186/s12888-020-02599-9