Long-Term Trends in Pediatric Self-Injury in High-Income Countries

Importance Self-injury, the deliberate act of causing physical harm to oneself either with or without suicidal intent, is a leading cause of emergency department use among young people. Trend data in self-injury are lacking. Objective To provide temporal trends in self-injury rates among children and youth residing in Organization for Economic Co-operation and Development countries. Data Sources MEDLINE, Embase, Scopus, and PsycINFO and gray literature were searched for articles and reports published in English between January 2000 and December 2024. Study Selection Included were regional and national registry–based longitudinal and cross-sectional studies conducted within general populations, comprising individuals aged 24 years and younger, and with at least 5 years of data. Studies were included that measured (1) hospitalization or emergency department or physician visits for self-injury (2) surveys of self-reported self-injury. Data Extraction and Synthesis This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline with PROSPERO protocol registration. Articles were independently assessed for quality by 2 individuals. Random-effects meta-analyses were used to calculate overall and sex-specific pooled effect estimates and 95% CIs. Main Outcomes and Measures The primary outcome was the relative change in the annual rate of health care encounters for self-injury or from self-reported surveys. Results A total of 42 studies with a combined population of 234 054 520 individuals at study midpoints were conducted in 12 high-income countries; 35 studies used health care encounter data, and 7 studies used self-reported surveys. Based on health care encounters, there was a 3.5% (95% CI, 1.9-4.9) relative annual increase in self-injury over the study period (2000-2024), which was higher for female individuals (3.6%; 95% CI, 2.3-4.9) than male individuals (1.2%; 95% CI, 0.0-1.8). For self-reported surveys, there was a 2.5% (95% CI, 0.0-5.5) relative annual increase in self-injury. Conclusions and Relevance This systematic review and meta-analysis of 42 studies observed a relative increase in the annual rate of self-injury visits to health care and self-reported self-injury, with variability in baseline rates across studies in 12 high-income countries. Effective, contextually informed, large-scale prevention initiatives are urgently needed to curb the rise in self-injury within high-income countries, particularly among female individuals.