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Studies: Homelessness, self-harm risk factors for suicide :

March 19, 2018

Teens who are homeless or who previously harmed themselves are more likely to attempt or complete suicide than their peers, according to new research.

Two new studies looked at risk factors for suicide, which is among the leading causes of death for people in their teens and 20s.


Previous studies have found homeless youths are more likely to experience physical and mental health problems. To see if homelessness also is linked to self-harm and suicide, researchers analyzed data from the 2013 Minnesota Student Survey. More than 62,000 teenagers answered questions about housing, emotional distress and “developmental assets” like having a positive identity, social competency and positive connections to teachers and parents.

About 4% of students reported being homeless with an adult family member, and these teens were more likely to be male and a minority, according to the findings reported in “Emotional Health Among Youth Experiencing Family Homelessness” (Barnes AJ, et al. Pediatrics. March 19, 2018, https://doi.org/10.1542/peds.2017-1767).

Among homeless youths, 42% reported high levels of emotional distress, 29% reported self-injury, 21% reported suicidal ideation and 9% had attempted suicide in the past year. They were twice as likely to engage in any of these behaviors as their peers who were not homeless.

Homeless youths had slightly lower developmental assets than their peers. These factors provided protection from self-harm and suicide attempts for all teens, but that protection was not quite as strong for those who were homeless.

Authors said the findings reinforce AAP recommendations to screen patients for homelessness and care for them in nontraditional settings like mobile units and shelters.

“Clinicians can also use these results to discuss resilience with children and parents experiencing homelessness or unstable housing, including the importance of family-, school-, and individual-level factors that promote children’s emotional health even under circumstances of severe adversity,” authors wrote.


In another study, researchers looked at data from more than 32,000 Medicaid patients ages 12-24 who had deliberately harmed themselves.

About 68% were female and most were white. They commonly were diagnosed with depression, substance use and anxiety, and their self-harm most often included poisoning or cutting, according to the study “Suicide After Deliberate Self-Harm in Adolescents and Young Adults” (Olfson M, et al. Pediatrics. March 19, 2018, https://doi.org/10.1542/peds.2017-3517).

Forty-eight people in the study committed suicide within a year. Researchers found the suicide risk was 27 times higher for people who had engaged in self-harm compared to matched peers.

People who were American Indian/Alaska Native, male or whose self-harm had been violent had the highest risk of suicide.

The risk of patients harming themselves again was 100 times higher than their suicide risk and was highest for females, according to the study.

“Clinical priority should be given to ensuring the safety of young people after self-harm,” authors wrote, “which may include treating underlying psychiatric disorders, restricting access to lethal means, fortifying psychosocial supports, and close monitoring for emerging suicidal symptoms.”

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