Children or teenagers who are seen in the emergency department (ED) for self-harm may be at significantly higher risk for later sexual abuse or assault compared with those who do not present for self-harm, according to a large population-based study appearing today in The American Journal of Psychiatry.Why It’s Relevant?
A history of sexual abuse has been linked to subsequent self-harm in adolescents. Emerging evidence suggests that self-harm may also increase vulnerability to future sexual violence. If corroborated, this association would have significant clinical implications for screening practices and preventive strategies in hospitals and elsewhere.
By the Numbers
- Researchers matched 26,857 children and adolescents (ages 8 to 17) in Ontario who made a first ED presentation for self-harm between April 2013 and December 2022 with 112,376 youth who presented at the ED for other indications.
- Following the index ED visit, the 10-year cumulative incidence of diagnosed or suspected sexual abuse was 9.06% among those who self-harmed versus 1.26% among the matched control group.
- Results were similar when examining 10-year incidence of sexual assault: 4.14% among those who self-harmed versus 0.48% among the matched control group.
What’s More
The researchers noted that a majority of individuals who have engaged in self-harm do not present to health services, so this study may likely underestimate the true relationship between self-harm and sexual abuse or assault.
The Other Side
The analysis couldn’t control for many factors potentially affecting the relationship between self-harm and sexual abuse or assault, due to unavailability in health care administrative data, potentially overstating the relationship. The analysis also didn’t differentiate nonsuicidal self-harm and suicide attempts, which may pose different risk levels for future sexual abuse or assault.
Takeaway Message
The researchers suggested that all children and adolescents presenting for self-harm be screened for previous, as well as ongoing, sexual abuse, given the high prevalence of sexual abuse in this population and the improved outcomes associated with early disclosure. “Considering the potential risk of future sexual abuse, until further evidence exists, we agree with recommendations to conduct psychosocial assessment with all young people presenting for self-harm,” the researchers added.
Related Information
Source
Matisse Blundell, et. al. Risk of presentation for sexual abuse after a first emergency department presentation for self-harm in childhood or adolescence. The American Journal of Psychiatry. Published February 18, 2026. doi:10.1176/appi.ajp.2025069
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