Direct and Indirect Forms of Childhood Maltreatment and Nonsuicidal-Self-Injury Among Clinically-Referred Children and Youth

Importance: Although exposure to direct forms of childhood maltreatment is among the most widely studied risk factors for nonsuicidal self-injury (NSSI), research on NSSI has largely neglected the role of exposure to indirect forms of child maltreatment (i.e., exposure to intimate partner violence). Objective: To address this gap in the literature, the present study examined associations among both direct and indirect forms of maltreatment and NSSI among clinically referred children and youth. It was expected that exposure to both forms of maltreatment would be associated with increased risk for NSSI engagement. Design: Data was collected from September 2014 – August 2015 using the interRAI Child and Youth Mental Health Assessment (ChYMH) at ten mental health agencies in Ontario, Canada. The ChYMH is a comprehensive standardized clinical assessment tool completed by trained assessors using multiple sources (e.g., child, parent, clinical charts, observations) at time of patient intake into clinical care. Setting: Data was collected by trained clinical assessors at both community-based mental health facilities and inpatient/residential treatment facilities in Ontario, Canada. Participants: The study included a convenience sample of 747 children and youth (68 % male) with complex mental health histories (i.e., impairments in physical, mental, and emotional functioning) referred for inpatient or outpatient care in Ontario, Canada. Participant eligibility criteria included: enrolled in outpatient/inpatient care at one of participating mental health agencies, informed consent from parent and child, verbal fluency in English for both parent and child, and the child or youth was between the ages of 8-18 years. Main Outcome and Measure: The primary outcome assessed was the presence/absence of NSSI as assessed on the Self-Injury Scale (SOS) on the ChYMH. Results: Univariate chi-square analyses reflected positive associations with NSSI and both direct (i.e., physical, sexual) and indirect child maltreatment (i.e., exposure to intimate partner violence). In a binary logistic regression analysis controlling for participant age and sex, only exposure to indirect child maltreatment emerged as multivariate predictor of NSSI. Conclusion and Relevance: The present study provides evidence that experiencing vicarious trauma in childhood is an important risk factor for NSSI. Implications for clinicians include developing targeted intervention and prevention strategies for NSSI among children and youth for children who have witnessed domestic violence in the home