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Table 4 Associates, Risk and Protective Factors of Self-Harm (by year of publication)

From: Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review

Author
(year)
Country
Associates / Risk FactorsStudy quality
Personal aFamily bSchool cInterpersonal dAbuse and violence e
Cummins & Allwood
(1984) [83]
South Africa
▪ Psychiatric disturbance▪ Family dysfunction (including divorce)
▪ Family psychiatric illness
▪ School problems▪ Socialisation problems3/5
Pillay
(1987) [85]
South Africa
▪ Medical/psychiatric illness▪ Problems with Parents
▪ Problems with siblings
▪ Marital problems
▪ School problems▪ Problems with boyfriend or girlfriend3/5
Sefa-Dedeh & Canetto
(1992) [22]
Ghana
▪ Family harassment and dispute
▪ Failed sense of autonomy in the family
4/5
Kebede & Ketsela
(1993) [35]
Ethiopia
▪ Hopelessness
▪ Heavy alcohol intake
▪ Lower school grade5/5
Pillay & Wassenaar
(1997) [95]
South Africa
▪ Depression▪ Lower family adaptability
▪ Low family cohesion
▪ Low family satisfaction
▪ Hopelessness
▪ Psychiatric disturbances.
▪ Problems at school▪ Romantic relationship problems5/5
Wassenaar et al.
(1998) [23]
South Africa
▪ Hopelessness▪ Family communication breakdown
▪ Conflict with parents
▪ Authoritarian patriarchy.
4/5
Mhlongo & Peltzer
(1999) [88]
South Africa
▪ AIDS phobia
▪ Teenage pregnancy
▪ Mental illness
▪ Unemployment
▪ Financial problems
▪ Problem with parents▪ Academic failure▪ Romantic relationship problems3/5
Peltzer et al.
(2000) [36]
South Africa
▪ Suicidal ideation
▪ Suicide intent
▪ History of family suicide
▪ Parental divorced
▪ Large family size
▪ History of suicide by friend3/5
Madu & Matla
(2004) [96]
South Africa
▪ Family conflict4/5
Wild et al.
(2004) [38]
South Africa
▪ Depression
▪ Poor global self-worth
▪ Poor body image
▪ Female sex
▪ Poor schoolwork▪ Problems with peers4/5
Sommer
(2005) [39]
South Africa
▪ Female sex
▪ Previous psychiatric contact
▪ Perceived lack of family support
▪ Suicide attempt in the family
▪ Death of a friend2/5
Shiferaw et al.
(2006) [41]
Ethiopia
▪ Being sexually active
▪ Female sex
▪ Unwanted pregnancy
▪ Boredom
▪ HIV/AIDS positive status
▪ Family member attempted suicide
▪ Lack of family support
▪ Living with both biological parents
▪ Academic under-achievement▪ Friend suicide attempt
▪ Romantic relationship problems
2/5
Omigbodun et al.
(2008) [20]
Nigeria
▪ Drinking alcohol
▪ Having to go hungry
▪ Unstable family life
▪ Having a mother who had been married more than once
▪ Living in urban location
▪ Sexual abuse
▪ Physical attack
▪ Physical fights
4/5
Yéo-Tenena et al.
(2010) [89]
Ivory Coast
▪ Psychiatric problems (depression, substance addiction)
▪ Previous suicide attempt
▪ Emotional problems
▪ Familial conflict▪ School failure▪ Unwanted pregnancy▪ Sexual abuse4/5
Beekrum et al.
(2011) [24]
South Africa
▪ Hopelessness and despair▪ Previous suicide or attempted suicide by a close family member
▪ Conflictual, disengaged or over-protective family relationships
▪ Strained adolescent-parent communication
▪ Conflicting social roles and values in the context of contemporary acculturation pressures
▪ Academic failure▪ Breakup
▪ Lack of social support
▪ Physical and emotional abuse in the family5/5
Okoko et al.
(2011) [90]
The Congo
▪ Previous suicide attempt
▪ Psychosis
▪ Alcohol abuse
▪ Drugs abuse
▪ Emotional breakdown
▪ Conflict with parents
▪ Difficulty with family communication
▪ Parental divorce
▪ Parental death
▪ Kinship fostering
▪ Living in a stepfamily
▪ School problems▪ Breakup▪ Domestic violence victimisation
▪ Sexual abuse
▪ Neglect
▪ Incest
4/5
Pretorius
(2011) [29]
South Africa
▪ Personal history of suicide attempts suicide;
▪ Previous diagnosis of mood disorders (i.e., major depression, and bipolar disorder)
▪ Experience of human trafficking before removal from parental care
▪ Dysfunctional parenting (unavailability, conflict, or alcoholism) before removal from parental care
▪ Family history of attempted suicide
▪ Observation of the self-harm of another adolescent at the same children’s home▪ Abuse (i.e., physical, sexual, and emotional abuse) before removal from parental care.3/5
Campbell
(2012) [45]
South Africa
▪ Female sex;
▪ Coloured race;
▪ Stressful relationships with parents and extended family
▪ Financial hardship
▪ Stressful romantic relationship
▪ Negative life events
3/5
Shilubane et al.
(2012) [32]
South Africa
▪ Perceived accusations of negative behaviour
▪ Feelings of physical rejection
▪ Acute negative mood (e.g., depression, anger, hopelessness)
▪ Being unaware of community-support resources
▪ Personal history of attempted suicide
▪ Conflictual and strained family relationships
▪ Lack of family support
▪ Family member HIV positive status
▪ Death of close family member
▪ Family history of attempted suicide
▪ Family poverty
▪ Lack of trusted peer support
▪ Peer suicide attempt
4/5
Swahn et al.
(2012) [30]
Uganda
▪ Sadness
▪ Expectations of dying prior to age 30
▪ Parental neglect due to alcohol use4/5
Vawda
(2012) [47]
South Africa
▪ Family member suicide3/5
Gage
(2013) [25]
Ethiopia
▪ Currently employed
▪ Lost much sleep over worry
▪ Depression
▪ Receiving marriage request
▪ Both parents deceased
▪ Community involvement in child marriage prevention▪ Sexual violence victimisation4/5
Muula et al.
(2013) [48]
Zambia
▪ Female sex
▪ Aged ≤14 yrs.
▪ Loneliness
▪ Sleeplessness due to worry
▪ Hopelessness
▪ Suicidal ideation
▪ Marijuana use
▪ Drunkenness
▪ Use of dagga5/5
Shilubane et al.
(2013) [49]
South Africa
▪ Female sex
▪ Hopelessness
▪ Feeling unsafe
▪ Substance use
▪ Having unsafe sex
▪ Older adolescence
▪ Body dissatisfaction.
▪ Lower grade▪ Violence5/5
Chinawa et al.
(2014) [51]
Nigeria
▪ Depression
▪ Alcohol and drug use
2/5
Penning & Collings
(2014) [53]
South Africa
▪ Female sex▪ Domestic injury▪ Domestic assault
▪ Rape
▪ Emotional abuse
▪ Negative child sexual abuse appraisals
5/5
Randall et al.
(2014) [54]
Benin
▪ Male sex
▪ Anxiety
▪ Loneliness
▪ Substance use
▪ Being attacked5/5
Lippi
(2014) [52]
South Africa
▪ Severe depression 3/5
Cluver et al.
(2015) [56]
South Africa
▪ Older adolescence
▪ Female sex
▪ Orphanhood by AIDS,
▪ Previous suicide attempt
▪ Parental AIDS-illness
▪ Food insecurity
▪ Severe physical abuse
▪ Severe emotional abuse
▪ Sexual abuse or rape
▪ Community violence
▪ Domestic violence
▪ Orphanhood by homicide
4/5
Ng et al.
(2015) [57]
Rwanda
▪ Child mental health symptoms (i.e., Depression above diagnostic threshold; conduct problems).▪ Parenting style5/5
Giru
(2016) [58]
Ethiopia
▪ Family history of suicide
▪ Loneliness
▪ Hopelessness
▪ Mental illness
▪ Financial loss
▪ Family conflict
▪ Death in family
▪ Academic failure▪ Lack of social support3/5
Shaikh et al.
(2016) [59]
Malawi
▪ Female sex
▪ Early sexual debut
▪ Serious injury
▪ Loneliness
▪ Anxiety
▪ Suicide ideation
▪ Suicide planning
▪ Alcohol use
▪ Parental tobacco use▪ Lifetime sexual partners
▪ Number of days people smoked in presence weekly
▪ Having many close friends
▪ Bullied
▪ Physical fight
▪ Physically attacked
▪ Physically bullied
5/5
Asante et al.
(2017) [62]
Ghana
▪ Anxiety
▪ Loneliness
▪ Parental understanding▪ Food insecurity
▪ Having many close friends
▪ Bullied
▪ Being attacked
▪ Fighting
5/5
Asante & Meyer-Weitz
(2017) [31]
Ghana
▪ Female sex
▪ Aged 15 years or older
▪ Smoking
▪ Past alcohol use
▪ Present alcohol use
▪ Marijuana use
▪ Survival sex
▪ Assaulted with a weapon
▪ Having been robbed
4/5
Peltzer & Pengpid
(2017) [65]
Namibia
▪ Health risk behaviours
▪ Hunger
▪ Parental support
4/5
Amare et al.
(2018) [67]
Ethiopia
▪ Living alone
▪ Loneliness
▪ Hopelessness
▪ Sleep disturbance worries
▪ Being physically hurt
▪ Truancy▪ Poor social support5/5
Khuzwayo et al.
(2018) [68]
South Africa
▪ Aged 16 years and above
▪ Female sex
▪ Cannabis use
▪ Threatened in school with a weapon
▪ Bullied in school
▪ Dating violence victimisation
▪ Cyber bullying
3/5
Kritzinger
(2018) [26]
South Africa
▪ Anger
▪ Low mood
▪ Suicidal ideation
▪ Previous suicide attempt
▪ Impulsivity
▪ Unemployment
▪ Conflict with parents▪ Breakup
▪ Loss of significant other
▪ Domestic abuse victimisation5/5
van der Wal & George
(2018) [70]
South Africa
▪ Emotional reactivity
▪ Tension-reduction coping
▪ Social support3/5
Baiden et al.
(2019) [71]
Ghana
▪ Anxiety
▪ Illicit substance use
▪ Physical activity
▪ Having a close friend▪ Bullying victimisation5/5
Carvalho et al.
(2019) [97]
Cross-national study (Benin, Ghana, Mozambique,
Namibia, & Tanzania).
▪ Cannabis use5/5
Darré et al.
(2019) [73]
Togo
▪ Female sex
▪ Being aged > 18
▪ Sentimental problems
▪ Health problems
▪ Loneliness
▪ Unwanted pregnancy
▪ Distaste of life
▪ Abstinence
▪ Family history of suicide
▪ Financial problems
▪ Family problems
▪ Absence of parents
▪ Living as a couple
▪ Death of a loved one
3/5
Koyanagi, Oh et al.
(2019) [74]
Cross-national study
(Benin, Ghana, Malawi,
Mauritania, Mozambique,
Namibia, Seychelles, Swaziland, & Tanzania).
▪ Bullying victimisation5/5
Koyanagi, Stubbs, et al.
(2019) [75]
Cross-national (Benin, Ghana, Mauritania,
Mozambique, Namibia,
Seychelles, Swaziland, & Tanzania).
▪ Children and adolescent food insecurity5/5
Nguyen et al.
(2019) [76]
Cross-national (Nigeria, Uganda, & Zambia).
▪ Orphanhood prior to age 18▪ Coerced/forced sexual initiation5/5
Shayo & Lawala
(2019) [78]
Tanzania
▪ Loneliness
▪ Anxiety
▪ Younger age
▪ Food insecurity
▪ Parental care
5/5
Thornton et al.
(2019) [79]
Cross-national (South Africa & Guyana)
▪ Social stress2/5
Vancampfort et al.
(2019) [82]
Cross-national (Benin, Ghana, Mauritania,
Mozambique, Namibia,
Seychelles, & Tanzania)
▪ Sedentary leisure-time5/5
  1. aPersonal level factors: These include personal characteristics and histories, and factors related to personal (mental) health conditions
  2. bFamily level factors: These cover factors and circumstances within the family, and relationships and interactions with family members
  3. cSchool-level factors: These relate to academic performance and relationships and circumstances within the school context
  4. dInterpersonal level factors: These are circumstances related to the individual’s relationships with peers and neighbours, and other social relationships and interactions outside the family and school contexts
  5. eAbuse and violence: Based on previous evidence, we created this category to include all abuse and violence items – that is psychological, physical, emotional, and sexual abuse victimisation items