There are multiple risk factors for self-harm, including a history of abuse, trauma, physical and mental illness, and bullying. Identifying these factors is a key part of prevention, ensuring that those at risk receive appropriate support as early as possible — but despite this, predicting who may end up engaging in self-harming behavior is still tricky.

A new study from a University of Cambridge team suggests that this may be possible. Stepheni Uh and colleagues report that some at-risk adolescents could be identified ten years before they self-harm — offering what the team says is an “extended window” during which help and support can be offered.

Participants were part of an ongoing longitudinal study focusing on the experiences of young people in the UK; data has been gathered since participants were nine months old. At age 14, they had indicated whether they’d engaged in self-harming behavior, and completed a questionnaire about depressive feelings and behaviors. At various points throughout their childhood, their caregivers had also completed a questionnaire about the child’s mental and physical health, self-esteem, sleep, their home environment, the quality of their friendships and any adverse experiences including bullying.

The team then used a neural network to identify the risk factors for self-harming among their participants. This also examined whether there were any distinct subgroups who had different characteristics or risk factors.

Two profiles emerged. The first set of children had a long-term history of poor mental health, which was apparent as early as five years old, and were more likely to have caregivers who had their own mental health issues. This group was also more likely to have experienced bullying before they began to harm themselves, and faced other problems in their home life.

For this group, then, risk factors for self-harm were evident up to ten years before the first incident. The findings could allow for the development of interventions that target those at risk of self-harm far earlier than is currently the case. Work on child and adolescent mental health strongly suggests that early intervention is key: developing trauma-informed environments, anti-bullying measures, exercises to boost self-esteem, support for those dealing with parental illness, and, crucially, well-funded mental health services, could therefore go some way to prevent further harm.

However, the second, larger, group did not show the same long-term risk factors. Instead this group was characterised by impulsivity and risk-taking behaviours which developed during teenage years. They also tended to feel less secure with friends and family.

Because teens who fit this profile did not show the same risk factors in childhood, they may be harder to identify. But the research still provides potential ways of helping these at-risk young people too, co-author Duncan Astle says. “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.”

Crucially, the study shows that those who self-harm are not a homogenous group: there are many complex risk factors associated with self-harm that interact with other life experiences, personality and more. Early responses and interventions should therefore be tailored to these individual differences rather than relying on one-size-fits-all solutions.