Prevalence of deliberate self harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study
1 MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow G12 8RZ
Abstract
Objective To investigate whether deliberate self harm is associated with contemporary Goth youth subculture.
Design Longitudinal cohort study.
Setting School and community based study of young people living in the Central Clydeside Conurbation, Scotland.
, 百拇医药
Participants 1258 people aged 19, surveyed in 2002-4 and followed-up since age 11 (1994).
Main outcome measures Lifetime prevalence of self harm and attempted suicide and their association with Goth youth subculture, before and after adjusting for confounders.
Results Identification as belonging to the Goth subculture was strongly associated with lifetime self harm and attempted suicide, with a prevalence of 53% and 47%, respectively among the most highly identified group, and evidence for a dose-response relation. Adjusting for potential confounders did not significantly attenuate this association. Analysis of other youth subcultures showed that this effect was primarily associated with Goth subculture.
, 百拇医药
Conclusions Identification as belonging to the Goth subculture was the best predictor of self harm and attempted suicide. Although based on small numbers, additional longitudinal analysis suggests both selection and modelling mechanisms are involved, selection mechanisms possibly being more likely.
Introduction
Deliberate self harm is relatively common among young people, with rates of 7%-14% in the United Kingdom.1 2 Common acts of self harm include cutting, burning, and punching, usually resulting in relatively minor injury; rarer, more serious, acts include self poisoning.
, 百拇医药
Self harm is understood to be a maladaptive coping strategy intended to relieve negative emotions such as anger, anxiety, frustration, or guilt. It is usually unrelated to an immediate suicide attempt. Knowledge about risk factors is limited, but previous research has implicated peer modelling and depression.1 2 Self harm is related to later risk of suicide and psychiatric disorder and has a high prevalence among certain subpopulations, notably prisoners and homosexual and bisexual people.1-3 The media have linked contemporary Goth youth subculture with self harm,4 but evidence for this is sparse. "Goth" could be described as a subgenre of punk with a dark and sinister aesthetic, with aficionados conspicuous by their range of distinctive clothing and makeup and tastes in music.4 5 We investigated whether identification with Goth is associated with self harm.
, http://www.100md.com
Methods
We collected data on participants at age 19 through the west of Scotland 11-16 study, a longitudinal survey of health and lifestyles.6 7 Respondents were recruited during their final year (1994) of primary school (age 11, n = 2586) and resurveyed at ages 13, 15, and 19 (2002-4, n = 1258). As weights to adjust for attrition bias did not alter the results we report unweighted data. For youths aged 15 and 19 we used a computerised version of the diagnostic interview schedule for children (Voice-DISC)6 to collect data on psychiatric diagnosis, including a question on suicide attempts.
, 百拇医药
At age 19, during the Voice-DISC, participants were asked "have you ever in your whole life, tried to kill yourself or make a suicide attempt" One section of the survey interview asked "have you ever tried to hurt yourself or harm yourself deliberately," the methods used, and age at first act of self harm. Self harm was coded as any method and methods involving cutting, scratching, or scoring. In a separate section participants were also asked at what age and how much they identified (present and past) with a variety of youth subcultures, including Goth, on a five point scale. The two most extreme categories were collapsed and comprise the most highly identified group. We focus on current and lifetime peak (defined as highest current or past) identification.
, 百拇医药
We used logistic regression, with lifetime self harm and lifetime suicide attempt as outcomes, adjusted for sex, social class of head of household (coded, non-manual, manual, or unclassifiable according to the registrar general's schema of occupational social class),7 8 lifetime parental separation or divorce, substance use (smoking, any drug, alcohol), and the highest score on a depression scale administered at ages 11, 13, and 15.9
Results
, http://www.100md.com
Current Goth identification was strongly associated with lifetime prevalence of self harm and attempted suicide, with a prevalence of 53% for self harm (any method); 47% for self harm involving cutting, scratching, or scoring; and 47% for lifetime suicide attempt among the most highly identified, and evidence suggesting a dose-response relation. Predictors of self harm and suicide attempt were being female, having divorced or separated parents, smoking and any drug (not alcohol) use, and prior depression. Adjusting for these factors did not attenuate the Goth identification effect, which remained the single strongest predictor of either self harm or suicide attempt (table 2). Lifetime identification produced similar results (see table A on bmj.com).
, 百拇医药
Of 25 participants with a high identification (at some point in their lifetime) with the Goth subculture, 12 had harmed themselves; five before identification as Goth, two after, and four at about the same time (one participant had poor recall).
To determine how specific this identification effect was to Goth, as opposed to a general effect attributable to any other subculture, we carried out a series of additional analyses substituting Goth identification with 14 other common youth subcultures (table 3). Model 1 shows the association (odds) between each of the subcultures (dichotomised as "heavy" or "I am one," compared with "none," "just," or "quite a bit") and lifetime self harm, after adjusting for confounders. Although some other subcultures were also associated with self harm (Punk, odds ratio 4.42, 95% confidence interval 1.28 to 15.33; Mosher, 3.49, 1.08 to 11.27), the association was strongest for Goth (14.16, 4.42 to 45.39). Goth identification remained the only subculture which significantly predicted self harm after adjusting for other subcultures (model 2, table 3). Results were similar for self harm involving cutting, scratching, or scoring and for lifetime suicide attempt (see tables B and C on bmj.com).
, http://www.100md.com
Discussion
Identification by youth aged 19 as belonging to the Goth subculture was the best predictor of self harm and suicide attempt. This effect was not attenuated by adjusting for identification with any other youth subculture. Self harm could be a normative component of Goth subculture including emulation of subcultural icons or peers who self harm (modelling mechanisms). Alternatively, it could be explained by selection, with young people with a particular propensity to self harm being attracted to the subculture.
, http://www.100md.com
Although our study is based on small numbers, our data suggest that both processes are involved, with selection mechanisms possibly being more likely. Replication in alternative locations is needed to determine if this is widespread or localised, and a persistent or transient phenomenon.
What is already known on this topic
Deliberate self harm is common among young people
It has a high prevalence in certain subpopulations and may be associated with depression, attempted suicide, and various psychiatric diagnoses later in life
, 百拇医药
What this study adds
The prevalence of both lifetime deliberate self harm and attempted suicide is high within Goth youth subculture
The causal mechanism remains unclear
Additional tables are on bmj.com
This article was posted on bmj.com on 13 April 2006: http://bmj.com/cgi/doi/10.1136/bmj.38790.495544.7C
We thank Michael Van Beinum for help in formulating questions on self harm in adolescence, Chris Lucas for providing the Voice-DISC and software support, and Sally Macintyre and Paul Hodkinson for commenting on draft manuscripts.
, 百拇医药
Contributors: All authors contributed to the design and writing up of the study. RY carried out the analysis and is guarantor.
Funding: All authors are supported financially by the Medical Research Council of Great Britain.
Competing interests: None declared.
Ethical approval: Glasgow University ethics committee.
References
, 百拇医药 Hawton K, James A. ABC of adolescence: suicide and deliberate self harm in young people. BMJ 2005;330: 891-4.
Skegg K. Self-harm. Lancet 2005;28: 1471-83.
Skegg K, Nada-Raja S, Dickson N, Paul C, Williams S. Sexual orientation and self-harm in men and women. Am J Psychiatry 2003;160: 541-6.
Beyond the pale. Radio 1 2002; 2 Nov. www.bbc.co.uk/radio1/alt/stevelamacq/documentaries/beyond_the_pale20021104.shtml (accessed 7 Jul 2005).
, http://www.100md.com
Hodkinson P. Goth: identity, style and subculture. Oxford: Berg, 2002.
West P, Sweeting H, Der G, Barton J, Lucas C. Voice-DISC identified DSM-IV disorders among 15-year-olds in the west of Scotland. J Am Acad Child Adolesc Psychiatry 2003;42: 941-9.
West P, Sweeting H, Speed E. We really do know what you do: a comparison of reports from 11 year olds and their parents in respect of parental economic activity and occupation. Sociology 2001;35: 539-59.
Office of Population Census and Surveys. Standard occupational classification. London: HMSO, 1991.
Kandel D, Davies M. Epidemiology of depressive mood in adolescents. Arch Gen Psychiatry 1982;29: 1205-12., 百拇医药(Robert Young, Helen Sweet)
Abstract
Objective To investigate whether deliberate self harm is associated with contemporary Goth youth subculture.
Design Longitudinal cohort study.
Setting School and community based study of young people living in the Central Clydeside Conurbation, Scotland.
, 百拇医药
Participants 1258 people aged 19, surveyed in 2002-4 and followed-up since age 11 (1994).
Main outcome measures Lifetime prevalence of self harm and attempted suicide and their association with Goth youth subculture, before and after adjusting for confounders.
Results Identification as belonging to the Goth subculture was strongly associated with lifetime self harm and attempted suicide, with a prevalence of 53% and 47%, respectively among the most highly identified group, and evidence for a dose-response relation. Adjusting for potential confounders did not significantly attenuate this association. Analysis of other youth subcultures showed that this effect was primarily associated with Goth subculture.
, 百拇医药
Conclusions Identification as belonging to the Goth subculture was the best predictor of self harm and attempted suicide. Although based on small numbers, additional longitudinal analysis suggests both selection and modelling mechanisms are involved, selection mechanisms possibly being more likely.
Introduction
Deliberate self harm is relatively common among young people, with rates of 7%-14% in the United Kingdom.1 2 Common acts of self harm include cutting, burning, and punching, usually resulting in relatively minor injury; rarer, more serious, acts include self poisoning.
, 百拇医药
Self harm is understood to be a maladaptive coping strategy intended to relieve negative emotions such as anger, anxiety, frustration, or guilt. It is usually unrelated to an immediate suicide attempt. Knowledge about risk factors is limited, but previous research has implicated peer modelling and depression.1 2 Self harm is related to later risk of suicide and psychiatric disorder and has a high prevalence among certain subpopulations, notably prisoners and homosexual and bisexual people.1-3 The media have linked contemporary Goth youth subculture with self harm,4 but evidence for this is sparse. "Goth" could be described as a subgenre of punk with a dark and sinister aesthetic, with aficionados conspicuous by their range of distinctive clothing and makeup and tastes in music.4 5 We investigated whether identification with Goth is associated with self harm.
, http://www.100md.com
Methods
We collected data on participants at age 19 through the west of Scotland 11-16 study, a longitudinal survey of health and lifestyles.6 7 Respondents were recruited during their final year (1994) of primary school (age 11, n = 2586) and resurveyed at ages 13, 15, and 19 (2002-4, n = 1258). As weights to adjust for attrition bias did not alter the results we report unweighted data. For youths aged 15 and 19 we used a computerised version of the diagnostic interview schedule for children (Voice-DISC)6 to collect data on psychiatric diagnosis, including a question on suicide attempts.
, 百拇医药
At age 19, during the Voice-DISC, participants were asked "have you ever in your whole life, tried to kill yourself or make a suicide attempt" One section of the survey interview asked "have you ever tried to hurt yourself or harm yourself deliberately," the methods used, and age at first act of self harm. Self harm was coded as any method and methods involving cutting, scratching, or scoring. In a separate section participants were also asked at what age and how much they identified (present and past) with a variety of youth subcultures, including Goth, on a five point scale. The two most extreme categories were collapsed and comprise the most highly identified group. We focus on current and lifetime peak (defined as highest current or past) identification.
, 百拇医药
We used logistic regression, with lifetime self harm and lifetime suicide attempt as outcomes, adjusted for sex, social class of head of household (coded, non-manual, manual, or unclassifiable according to the registrar general's schema of occupational social class),7 8 lifetime parental separation or divorce, substance use (smoking, any drug, alcohol), and the highest score on a depression scale administered at ages 11, 13, and 15.9
Results
, http://www.100md.com
Current Goth identification was strongly associated with lifetime prevalence of self harm and attempted suicide, with a prevalence of 53% for self harm (any method); 47% for self harm involving cutting, scratching, or scoring; and 47% for lifetime suicide attempt among the most highly identified, and evidence suggesting a dose-response relation. Predictors of self harm and suicide attempt were being female, having divorced or separated parents, smoking and any drug (not alcohol) use, and prior depression. Adjusting for these factors did not attenuate the Goth identification effect, which remained the single strongest predictor of either self harm or suicide attempt (table 2). Lifetime identification produced similar results (see table A on bmj.com).
, 百拇医药
Of 25 participants with a high identification (at some point in their lifetime) with the Goth subculture, 12 had harmed themselves; five before identification as Goth, two after, and four at about the same time (one participant had poor recall).
To determine how specific this identification effect was to Goth, as opposed to a general effect attributable to any other subculture, we carried out a series of additional analyses substituting Goth identification with 14 other common youth subcultures (table 3). Model 1 shows the association (odds) between each of the subcultures (dichotomised as "heavy" or "I am one," compared with "none," "just," or "quite a bit") and lifetime self harm, after adjusting for confounders. Although some other subcultures were also associated with self harm (Punk, odds ratio 4.42, 95% confidence interval 1.28 to 15.33; Mosher, 3.49, 1.08 to 11.27), the association was strongest for Goth (14.16, 4.42 to 45.39). Goth identification remained the only subculture which significantly predicted self harm after adjusting for other subcultures (model 2, table 3). Results were similar for self harm involving cutting, scratching, or scoring and for lifetime suicide attempt (see tables B and C on bmj.com).
, http://www.100md.com
Discussion
Identification by youth aged 19 as belonging to the Goth subculture was the best predictor of self harm and suicide attempt. This effect was not attenuated by adjusting for identification with any other youth subculture. Self harm could be a normative component of Goth subculture including emulation of subcultural icons or peers who self harm (modelling mechanisms). Alternatively, it could be explained by selection, with young people with a particular propensity to self harm being attracted to the subculture.
, http://www.100md.com
Although our study is based on small numbers, our data suggest that both processes are involved, with selection mechanisms possibly being more likely. Replication in alternative locations is needed to determine if this is widespread or localised, and a persistent or transient phenomenon.
What is already known on this topic
Deliberate self harm is common among young people
It has a high prevalence in certain subpopulations and may be associated with depression, attempted suicide, and various psychiatric diagnoses later in life
, 百拇医药
What this study adds
The prevalence of both lifetime deliberate self harm and attempted suicide is high within Goth youth subculture
The causal mechanism remains unclear
Additional tables are on bmj.com
This article was posted on bmj.com on 13 April 2006: http://bmj.com/cgi/doi/10.1136/bmj.38790.495544.7C
We thank Michael Van Beinum for help in formulating questions on self harm in adolescence, Chris Lucas for providing the Voice-DISC and software support, and Sally Macintyre and Paul Hodkinson for commenting on draft manuscripts.
, 百拇医药
Contributors: All authors contributed to the design and writing up of the study. RY carried out the analysis and is guarantor.
Funding: All authors are supported financially by the Medical Research Council of Great Britain.
Competing interests: None declared.
Ethical approval: Glasgow University ethics committee.
References
, 百拇医药 Hawton K, James A. ABC of adolescence: suicide and deliberate self harm in young people. BMJ 2005;330: 891-4.
Skegg K. Self-harm. Lancet 2005;28: 1471-83.
Skegg K, Nada-Raja S, Dickson N, Paul C, Williams S. Sexual orientation and self-harm in men and women. Am J Psychiatry 2003;160: 541-6.
Beyond the pale. Radio 1 2002; 2 Nov. www.bbc.co.uk/radio1/alt/stevelamacq/documentaries/beyond_the_pale20021104.shtml (accessed 7 Jul 2005).
, http://www.100md.com
Hodkinson P. Goth: identity, style and subculture. Oxford: Berg, 2002.
West P, Sweeting H, Der G, Barton J, Lucas C. Voice-DISC identified DSM-IV disorders among 15-year-olds in the west of Scotland. J Am Acad Child Adolesc Psychiatry 2003;42: 941-9.
West P, Sweeting H, Speed E. We really do know what you do: a comparison of reports from 11 year olds and their parents in respect of parental economic activity and occupation. Sociology 2001;35: 539-59.
Office of Population Census and Surveys. Standard occupational classification. London: HMSO, 1991.
Kandel D, Davies M. Epidemiology of depressive mood in adolescents. Arch Gen Psychiatry 1982;29: 1205-12., 百拇医药(Robert Young, Helen Sweet)