Inflicted to self-harm (ISH) or Deliberate self-harm (DSH) is ‘a behavior that emerges among children and adolescents in which a child/adolescent commits an act with the purpose of physically or psychologically harming himself/herself with or without a real intent of suicide’ [1]. Self-inflicted or deliberate self-harm is noticed across different age groups and socio-economic groups within the society on different scales [1,2,3]. However, it is more frequent among the adolescent population. Furthermore, the causes and severity of self-inflicted harm among adolescents varies within and between countries, and across different socio-economic settings [4, 5]. While there are many forms of self-inflicted harms like carving, scratching, branding, marking, picking or pulling skin or hair, burning, cutting, biting, hitting or excessive body piercing [1] that might not cause serious health outcome, there are other forms which are dangerous in nature and can cause serious injuries and deaths.
In case of India, very little attention has been paid by family members, the community, and even the government to those children and adolescents who have problems with self-infliction or associated risk behaviors. Adolescents surrounded by cultural and social situations determine their behavior in terms of self-inflicted harm, aggression, anxiety, substance abuse, and socio-psychological behavior [6,7,8]. High socio-economic inequality in India has led to an increase in self-inflicted harm among children and adolescents. For instance, adolescents belonging to lower social groups are more prone to deliberate self-harm than their counterparts who belong to higher social groups [9]. Furthermore, social and cultural norms play an enormous role in defining child and adolescent’s health and wellbeing in India, and it further molds behavioral change among them [8, 10].
Self-inflicted harm is a complex behavioral phenomenon and a symptom that results from a variety of factors [2, 11]. Adolescents or children who have difficulty in talking about their feelings may show their emotional tension or stress, aggressive behavior, physical discomfort, pain, and low self-esteem with self-injurious behaviors and many more [12]. For example, aggressive behavior is one such risk factor that causes self inflicted harm [13,14,15]. Studies have established a relationship between self-inflicted harm and aggressive behavior among children and adolescents [3, 16].
Inflicted self-harm (ISH) has been recognized worldwide as a major public health issue, with a severe and serious impact on the individual, their family, community, and the healthcare system per se [17]. There are cross-sectional studies that show a number of factors that are responsible for self-harm among adolescents [3, 12, 14, 18]. Adolescents who are inflicted with self-harm are more prone to suicide or suicidal ideation [3, 11, 19]. Researchers have identified various conducive factors such as peers, school, family, religious and others that affect suicidal ideation and self-inflicted harm in adolescents [1, 14, 18]. Recently research has also linked the aggravated effects of bullying including cyberbullying to inflicted self-harm and aggressive behaviour [20].
Self inflicted harm as a behavior is an interaction of multi-causal problems that often emerge among the young and adolescent population [21, 22]. Worldwide, a high prevalence of self-inflicted behavior is found among the young and adolescent population [23,24,25]. Additionally, it is caused at multiple levels like at the individual, household and community level [25,26,27]. Furthermore, the most significant factors that determine self-inflicted harm among adolescents are socio-psychological, economic and family-related problems [27,28,29]. In case of India, multiple causes invoke self-inflicted harm among adolescents like physical abuse in childhood, substance abuse such as alcohol and tobacco consumption, negative peer influence, family-violence, academic disturbance, aggressive behaviour, psychological problems, attention deficit-hyperactivity disorder, and loneliness [25]. Though it is highly prevalent in high income countries, however, recent trends have shown that the low and middle income countries including India are also facing an emergence of self-inflicted harm among children and adolescents that disrupt their health and social well-being [30, 31].
A survey of the recent literature show various factors that are associated with the occurrence of self inflicted harm among children and adolescents. For example, it can be due to genetic or hereditary reasons [22, 23, 32]. Again, some studies show it is not only hereditary in nature but there are other factors responsible for the emergence of such behavior among adolescents [27, 33,34,35,36]. These factors include previous aggression and violent behavior, exposure to violence in-home or community, use of drugs and alcohol, the combination of stressful socio-economic and family factors and further being a victim of bullying and abuse that lead to high aggression among children and adolescents [21, 23, 29, 37,38,39]. The risk factors for self inflicted harm can be classified as psychosocial conditions of the environment, individual-specific characteristics of the population and their interactions with several associated determinants [40].
The occurrence of self inflicted harm among adolescents is a self-destructive phenomenon and has a huge socio-psycho and health impact on individuals, families, friends and even communities [23, 39, 41]. This can be a huge problem for children and adolescents with both normal development and those with psychosocial disturbances [23, 24, 34]. Children and adolescents with such behaviour can also be destructive in nature and that includes a wide range of behaviors: explosive temper tantrums, physical aggression, fighting, threats or attempts to hurt others (including thoughts of wanting to kill others), use of weapons, cruelty toward animals, fire setting, intentional destruction of property and vandalism [27, 34, 39, 42, 43]. Further, it is also linked to suicidal ideation or behavior among them [25, 44]. Among the children and adolescent population, there are various causes that make them susceptible to self inflicted harm such as poor relationship skills, substance abuse, underlying health causes and stress or frustration [22, 34, 36]. Sometimes adolescent population also face the problem of loneliness, has difficulty with social interaction and interpersonal communication that leads to impulsiveness and aggressiveness [24, 27, 29]. Numerous research studies and clinical trials have concluded on different aspects of child and adolescent population such as health behavior, mental and psychological issues and anxiety, depression, self-inflicted harm [2, 3, 14], and suicidal tendency and found a complex interaction of factors that led to an increased risk of violent and aggressive and self-inflicted harm behavior in children and adolescents [24, 25, 28, 33, 40].
On the basis of previous literature, which has underlined the correlation between adolescents’ hereditary, psychological problems and drug abuse with their self-inflicted harm, however, a dearth of literature exist on their socio-economic characteristics as risk factors of their self-inflicted harm. Therefore, to understand the nuance of self-inflicted harm among adolescent population, this paper assesses its risk factors across different socio-economic settings in the two Indian states of Bihar & Uttar Pradesh. The paper hypotheses that there is no such self-inflicted harm among adolescents across different socio-economic settings.