Adverse childhood experiences, coping and self-harm among adolescents attending public psychiatry and mental health clinics in Malaysia: a cross-sectional study
Siti Sabrina Kamarudin, Nor Asiah Muhamad, Nur Hasnah Maamor, Suria Husin, Shauo Ling Ling, Fatin Norhasny Leman, Tengku Puteri Nadiah Tengku Baharudin Shah, Nik Athirah Farhana Nik Azhan, 'Izzah ’Athirah Rosli, Norhafizah Mohd Noor, Nurul Hidayah Jamalluddin, Fariza Yahya, Norni Abdullah, Norliza Chemi, Norli Abdul Jabbar, Nurashikin Ibrahim, The My Self-harm Study TeamBackground
Adverse childhood experiences (ACEs) are increasingly recognised as key determinants of self-harm among adolescents, particularly within psychiatric and mental health service settings in Malaysia, where coping resources may shape vulnerability and resilience.
Setting
A cross-sectional study was conducted among adolescents referred to psychiatry and mental health services in Malaysia.
Data and participants
Of 1244 eligible patients aged 10–24 years, 1164 completed a clinician-administered, interviewer-guided questionnaire.
Outcome measures
Self-harm status was assessed in clinical care and was compared across ACE burden, individual ACE domains and coping-related protective factors through a clinician-led interview. Multivariable logistic regression was used to examine adjusted associations with self-harm.
Results
Among 1164 participants, 827 (71.0%) reported lifetime self-harm. In adjusted analyses, a greater burden of ACEs was strongly associated with higher odds of self-harm. Compared with participants with no ACE exposure, the odds increased in a dose–response manner, from an adjusted OR (aOR) of 2.54 (95% CI 1.27 to 5.20) among those with 2–3 ACEs to 6.14 (95% CI 3.13 to 12.40) among those with ≥4 ACEs. Several coping-related factors were associated with lower odds of self-harm, including the ability to cope with stress (aOR 0.32, 95% CI 0.23 to 0.45), a sense of responsibility towards children, loved ones or pets (aOR 0.71, 95% CI 0.51 to 0.98) and perceived social support (aOR 0.63, 95% CI 0.40 to 0.97). In secondary analyses of individual ACE components, violence against household members, emotional abuse, sexual abuse, bullying and witnessing community violence were independently associated with higher odds of self-harm.
Conclusions
This study showed high prevalence of self-harm among adolescents attending the psychiatric and mental health services. A greater cumulative burden of ACEs was associated with increased odds of self-harm, whereas protective factors including effective stress coping, a sense of responsibility towards loved ones or pets and social support were associated with reduced odds. These findings emphasised the importance of trauma-informed assessment and interventions that enhance coping capacities and social connectedness among young people presenting to mental health services.