Influences on and prevention of self-harm behaviour among the most at-risk adolescents

Adolescence is a period of growing up, the transition from child to adult. The characteristics of this period are not only the result of hormonal changes, but also of brain development, which has been better studied in recent decades, influenced by genetically determined developmental pathways and by the environment, through epigenetic changes. During this period, self-harm behaviour is common, with as many as a quarter of adolescents self-harming at some point in their lives without the intention of dying (non-suicidal self-injurious behaviour; NSSI), and a tenth of Slovenian secondary school pupils having attempted suicide. In Slovenia, a country with a traditionally high suicide rate, suicide is still the second cause of death in the 10-19 age group, with an average of 10 deaths per year over the last 20 years. Self-injurious behaviours are divided into those in which the person intends to die (suicidal behaviour) and those with other intentions (NSSI). There are many reasons for the development and persistence of self-injurious behaviour, divided into risk factors and protective factors, both of which can be roughly individual or external. The distribution, presence and absence of these factors influence the development, persistence and cessation of these behaviours in individuals in complex and not yet sufficiently understood ways. Recently, more and more research has focused on demonstrating the influence of the environment on an individual's vulnerability through changes in gene expression, epigenetic modifications. Research, the results of which are in some cases already being recommended for use in clinical practice, also shows that certain genetic predispositions influence the response of individuals with mental disorders to treatment, both medication and other treatments. In addition, there is currently no rapid and effective method for ongoing monitoring of adolescents' risk of self-injurious behaviour that would be useful for assessment of the need for intensive monitoring of adolescents who have been admitted to hospital. In the proposed study, we aim to pursue three objectives: 1. To develop a method to identify more effectively the acute and long-term risk of adolescents with the most threatening self-harm behaviours. 2. To identify the factors that influence the risk of self-harm behaviours and the success of treatment/treatment of these behaviours in the most at-risk adolescents (changes in these factors). 3. Develop guidelines for more effective treatment of the most at-risk adolescents. For this purpose, we will include a sample of approximately 200 young people who will be hospitalised for suicide risk (the most at risk in Slovenia) and an approximately equal number of healthy adolescents. At inclusion, we will assess the presence of several factors by reviewing demographic data, clinical diagnosis, self-assessment questionnaires and clinical psychological tests (CSSRS, B-NSSI-AT, VTM, PAI, ECR-RS, DASA-YV, ASHRS), social assessment, and blood sampling for genetic analyses (DNA isolation, sequencing, nucleotide sequence recognition, quantification and evaluation of short tandem repeats, identification of methylation sites). Longitudinal tracking of autoaggressive events and heteroaggressive events during hospitalisation will be performed and recorded on an ongoing basis. We will compare the risk and protective factors of the adolescents most at risk with a control group of adolescents. We will also reassess the same factors in the most at-risk adolescents after 6 months of treatment. The data will be collected in a data entry and storage system that will ensure the privacy of the data entered in accordance with the GDPR. This will allow us to identify young people at particular risk of severe self-harm behaviour more reliably, to target them for more intensive and effective treatment, and thus to improve their safety, quality of life and prognosis in the short and long term.