̽��ֱ�� of Cambridge - Stepheni Uh

Teenagers at greatest risk of self-harming could be identified almost a decade earlier

cjb250 — Tue, 15 Jun 2021 06:00:46 +0000

̽��ֱ��team, based at the MRC Cognition and Brain Sciences Unit, ̽��ֱ�� of Cambridge, found that while sleep problems and low self-esteem were common risk factors, there were two distinct profiles of young people who self-harm – one with emotional and behavioural difficulties, and a second group without those difficulties but with different risk factors.

Between one in five and one in seven adolescents in England self-harms, for example by deliberately cutting themselves. While self-harm is a significant risk factor for subsequent suicide attempts, many do not intend suicide but face other harmful outcomes, including repeatedly self-harming, poor mental health, and risky behaviours like substance abuse. Despite its prevalence and lifelong consequences, there has been little progress in the accurate prediction of self-harm.

̽��ֱ��Cambridge team identified adolescents who reported self-harm at age 14, from a nationally representative UK birth cohort of approximately 11,000 individuals. They then used a machine learning analysis to identify whether there were distinct profiles of young people who self-harm, with different emotional and behavioural characteristics. They used this information to identify risk factors from early and middle childhood. ̽��ֱ��results are published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Because the data tracked the participants over time, the researchers were able to distinguish factors that appear alongside reported self-harm behaviour, such as low self-esteem, from those that precede it, such as bullying.

̽��ֱ��team identified two distinct subgroups among young people who self-harm, with significant risk factors present as early as age five, nearly a decade before they reported self-harming. While both groups were likely to experience sleep difficulties and low self-esteem reported at age 14, other risk factors differed between the two groups.

̽��ֱ��first group showed a long history of poor mental health, as well as bullying before they self-harmed. Their caregivers were more likely to have mental health issues of their own.

For the second group, however, their self-harming behaviour was harder to predict early in childhood. One of the key signs was a greater willingness to take part in risk-taking behaviour, which is linked to impulsivity. Other research suggests these tendencies may predispose the individual towards spending less time to consider alternate coping methods and the consequences of self-harm. Factors related to their relationships with their peers were also important for this subgroup, including feeling less secure with friends and family at age 14 and a greater concern about the feelings of others as a risk factor at age 11.

Stepheni Uh, a Gates Cambridge Scholar and first author of the study, said: “Self-harm is a significant problem among adolescents, so it’s vital that we understand the nuanced nature of self-harm, especially in terms of the different profiles of young people who self-harm and their potentially different risk factors.

“We found two distinct subgroups of young people who self-harm. ̽��ֱ��first was much as expected – young people who experience symptoms of depression and low self-esteem, face problems with their families and friends, and are bullied. ̽��ֱ��second, much larger group was much more surprising as they don’t show the usual traits that are associated with those who self-harm.”

̽��ֱ��researchers say that their findings suggest that it may be possible to predict which individuals are most at risk of self-harm up to a decade ahead of time, providing a window to intervene.

Dr Duncan Astle said: “ ̽��ֱ��current approach to supporting mental health in young people is to wait until problems escalate. Instead, we need a much better evidence base so we can identify who is at most risk of mental health difficulties in the future, and why. This offers us the opportunity to be proactive, and minimise difficulties before they start.

“Our results suggest that boosting younger children’s self-esteem, making sure that schools implement anti-bullying measures, and providing advice on sleep training, could all help reduce self-harm levels years later.

“Our research gives us potential ways of helping this newly-identified second subgroup. Given that they experience difficulties with their peers and are more willing to engage in risky behaviours, then providing access to self-help and problem-solving or conflict regulation programmes may be effective.”

Professor Tamsin Ford from the Department of Psychiatry added: “We might also help at-risk adolescents by targeting interventions at mental health leaders and school-based mental health teams. Teachers are often the first people to hear about self-harm but some lack confidence in how to respond. Providing them with training could make a big difference.”

̽��ֱ��research was supported by the Gates Cambridge Trust, Templeton World Charity Foundation, and the UK Medical Research Council.

Reference
Uh, S et al. Two pathways to self-harm in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry; 14 June 2021; DOI: 10.1016/j.jaac.2021.03.010

Researchers have identified two subgroups of adolescents who self-harm and have shown that it is possible to predict those individuals at greatest risk almost a decade before they begin self-harming.

̽��ֱ��current approach to supporting mental health in young people is to wait until problems escalate. Instead, we need a much better evidence base so we can identify who is at most risk of mental health difficulties in the future, and why

Duncan Astle

Adrien Olichon

A man sitting in front of a screen

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Women in STEM: Stepheni Uh

sc604 — Thu, 24 Oct 2019 06:00:00 +0000

My research explores the neurophysiological bases of cognitive and emotional resilience in children growing up in poverty. It’s part of a large project in our lab: the Resilience, Education, and Development (RED) study. Poverty, lack of resources, and the stresses from this sort of deprivation are global issues.

Ultimately, we are interested in what underlies the ability to positively adapt to adversity at the brain level and how it manifests behaviourally, such as through educational outcomes or mental health. We will assess children via brain scans, cognitive tests in the form of iPad games, and mental health through various questionnaires for both children and parents. In this way, we hope to get insights into behavioural profiles and environmental factors that may link to brain physiology and areas that may be unique to the resilient children.

My first year has involved a lot of study design, recruitment, and experimental sessions for the RED project. There are multiple aspects of the study, but mainly I have been involved in designing an fMRI task to tap into different brain areas that are involved in both cognitive and emotional processing as well as running the study sessions, which are for children between seven and nine years old and involve structural and functional brain scans, plus behavioural games and assessments.

It's not every day you can pop into an MRI scanner and get a really cool 3D image of your own brain. It also really puts things into perspective about resilience in children when they are able to complete your study scan tasks. In particular, doing the resting state scan - a functional scan during which children are not completing any games or watching anything to capture their ‘brain at rest’ and are instructed not to fall asleep. I most definitely fell asleep.

I think there is a much more interest now in bridging the gap between science and policy but there is still much to be learned for how to properly translate one for the other - also considering how research works at a global scale. I hope my research will be translated into evidence-based policies and interventions to support the well-being of children from all backgrounds.

I’m a big advocate for the importance of looking at the ethical, legal, and social implications of any neuroscientific research. Especially with the rise in neurotechnologies that mimic - or try to mimic – human cognition, I think these are serious discussions that we must have alongside this scientific progress.

I have been extremely fortunate with my supervisor, the welcoming nature of my department, as well as the community provided by the Gates Cambridge Scholars. They all provide a level of support that I think is so important for postgraduate students, which is often overlooked despite the rising number of mental health issues in postgrads throughout the world. Furthermore, Cambridge itself is very unique in its global diversity. It is enlightening to be able to discuss perspectives and cultural insights about one particular idea or topic.

Stand your ground: there are always going to be people who tell you that it is impossible to do A, B, or C in consideration of other personal life choices you want to make. In the end, no one knows your capabilities better than yourself - be resilient, embrace and grow from failures, self-reflect, know when to say no to keep standing your ground to accomplish what motivated you to consider a STEM career in the first place.

Stepheni Uh is a PhD candidate in the MRC Cognition and Brain Sciences Unit and a Gates Cambridge Scholar. Here, she tells us about her research studying the cognitive effects of growing up in poverty, the gap between science and policy, and falling asleep in an MRI machine.

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