Help-seeking behavior among Japanese school students who self-harm: results from a self-report survey of 18,104 adolescents

Norio Watanabe,^1,* Atsushi Nishida,^2,* Shinji Shimodera,³ Ken Inoue,⁴ Norihito Oshima,⁵ Tsukasa Sasaki,⁶ Shimpei Inoue,³ Tatsuo Akechi,¹ Toshi A Furukawa,⁷ Yuji Okazaki<sup>8

1</sup>Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, ²Department of Schizophrenia Research, Tokyo Institute of Psychiatry, Tokyo, ³Department of Neuropsychiatry, Kochi Medical School, Kochi, ⁴Department Public Health, Fujita Health University School of Medicine, Aichi, ⁵Office for Mental Health Support, Division for Counseling and Support, University of Tokyo, Tokyo, ⁶Health Service Center, University of Tokyo, Tokyo, ⁷Department of Cognitive-Behavioral Medicine, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, ⁸Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan

^*These authors contributed equally to this work

Background: The aim of this study was to determine the prevalence of and factors associated with poor help-seeking among adolescents who self-harm and to explore the resources used for help.
Methods: A cross-sectional survey using an anonymous questionnaire was conducted in 47 junior and 30 senior high schools in Japan. Adolescent self-harm was defined as an adolescent who had harmed himself or herself in the previous year, as in previous studies reported in Western countries. Poor help-seeking was defined as not consulting anyone despite reporting current psychological or somatic complaints. Information about sociodemographic and psychological factors possibly associated with help-seeking, such as suicidal thoughts, depression, anxiety, and psychotic-like experiences, was also collected. Regression analyses were performed to examine associated factors.
Results: A total of 18,104 students (8620 aged 12–15 years, 9484 aged 15–18 years), accounting for 93% of all students in the relevant student classes, participated in the study. Two hundred and seventy-six (3.3%) junior and 396 (4.3%) senior high school students reported having self-harmed. Of these, 40.6% of adolescents in junior and 37.6% in senior high schools were classified as poor help-seeking. Poor help-seeking with regard to self-harm was significantly more common in those who reported not having consulted anyone about psychological problems (odds ratio 9.2, 95% confidence interval 4.6–18.4 in juniors; odds ratio 9.9, confidence interval 5.5–17.9 in seniors) and in those with current suicidal ideation (odds ratio 2.0, confidence interval 1.0–3.7 in juniors; odds ratio 1.9, confidence interval 1.1–3.4 in seniors). Family members were approached significantly less often as a resource for help by students who self-harmed than by those who did not, and school nurses were more often consulted by those who did self-harm.
Conclusion: Around 40% of adolescents who self-harmed in the previous year did not seek help. School-based mental health should screen students at risk of self-harm, and educate school nurses about preventative care.

Keywords: self-harm, adolescence, help-seeking, prevention, Japan