Prof Ellen Townsend: The impact of lockdown on self-harm in young people

Professor Ellen Townsend, University of Nottingham.

24th July 2020.

Even before lockdown, self-harm (self-injury or self-poisoning, regardless of intent or motivation) was on the increase in young people1. The risk of both self-harm and suicide dramatically increases in the teenage years (the steepest increase in risk for any age group), and over the past few months we have required young people to live in conditions that have exacerbated key risk factors for self-harm, including social isolation, loneliness2,3, entrapment, defeat and hopelessness4.

A recent nationally-representative study from the US showed that mental health problems, family conflict and unsupervised weekend screen time were significant risk factors for suicidal thoughts and behaviours in young children5. We know that mental health problems have increased in children and young people during lockdown6,7 and screen time has undoubtedly – necessarily – increased for the majority of young people as well. For many this will have been a lifeline, but for others it may mean significant additional exposure to harm (e.g. cyberbullying)8.

Family relationships have been strained by living in relentlessly close quarters during lockdown, and sadly calls to domestic violence helplines have soared during this crisis9. LGBTQ+ young people are a particular concern here if they have to come out to intolerant families, or are living in fear of being ‘found out’ – and this is a group with a particularly elevated risk of self-harm generally10. Data from the Multicentre Study of Self-Harm in England shows that family relationship issues are the most frequently reported life problem for young people who self-harm who are seen in hospital11.

Strong negative emotions such as anger and sadness12 and problems with regulating such emotions13 are important in youth self-harm. Young people protect others from their anger by turning it in on themselves, especially looked-after young people14.  Worryingly, we are seeing increasing problems with emotional and behavioral issues in younger children following lockdown15.

Young people from especially vulnerable backgrounds, such as looked-after children and young people in conflict with the law, are already at increased risk of self-harm and suicide16,17. These young people commonly have very traumatic backgrounds and often do not have access to digital technology that might afford them support through the crisis.

A large national study has shown that younger people were more likely to have experienced suicidal thoughts and self-harm than older people during the lockdown18, and a recent short-term exploration of child deaths during lockdown indicated a small rise in suicides (data until May 2020)19. (A study of school-aged children is currently collecting self-harm data20). Suicide is the leading cause of death in England in 5-19 year olds and many more young people will die from suicide and road traffic accidents than Covid-19 this year21.

Talking therapies17,22,23 and school-based interventions24 are effective in reducing suicidal thoughts and behaviours in young people. These should be made readily available (by increasing capacity)25 to those in distress, especially to those from vulnerable groups such LGBTQ+ youth, and those who are in conflict with the law, or in care.