Evidence-Based Prevention of Youth Self-Harm in Aotearoa New Zealand

Introduction: Self-harm is an important public health issue due to its association with increased suicide risk. In Aotearoa, the increased community prevalence of self-harm and corresponding demands for services expose an urgent need. Despite this, there are important epidemiological gaps regarding hospitalisation for self-harm to prioritise prevention strategies. Self-harm is established during adolescence, and schools are an ideal setting to intervene early; however, schools lack guidance and support to respond. Methods: The programme of work included 1) an epidemiological study of trends in all-age hospitalisation for self-harm between 01 January 1999 and 31 December 2022; 2) a systematic review of guidance provided to schools responding to self-harm; 3) the co-design of how to implement best practice for self-harm in school settings; with this culminating in 4) the development of action-oriented, co-designed guidelines for schools distributed via the Ministry of Education website. Results: The epidemiological study highlighted an upward trend in hospital-presenting self-harm rates, particularly among females and young people. Young people aged 15–19 years had the highest rates of self-harm at 619.4 per 100,000 in 2022. The total proportion of repeated hospitalisation for self-harm was 27.5% and was highest among those under the age of 19 years (59.3%) and among European (30.5%) and Māori (24.7%) ethnic groups. The total population all-cause mortality was 3.1% and was significantly higher among men and people over 65 years. The systematic review of guidance provided to schools recommended policies and procedures for responding to self-harm, but lacked detail on roles, responsibilities, or specific actions schools could take. Additionally, guidance lacked scientific evidence or was based on outdated approaches. Conclusion: Schools are an ideal setting to intervene early in cases of self-harm, but they need to be supported by co-design and implementation science with equity-focused, systemic solutions, which ensure a whole-of-system response to youth self-harm. Co-designed guidelines should be implemented in schools to enable a whole-of-school approach to self-harm

Name thesis:degree_name

PhD

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Suicide Prevention

Grantor dc:publisher

ResearchSpace@Auckland

Year dc:date.issued

2025

Author dc:creator

• Bowden, Linda Maya

Advisors dc:contributor.advisor

• Hetrick, Sarah
• Fortune, Sarah
• Clark, Terryann

• self-harm
• suicide
• youth
• schools
• implementation science
• Co-design

Statement dc:rights

• Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Licence dc:rights.uri

• https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm

Handle dc:identifier.uri

https://hdl.handle.net/2292/75646

OAI identifier oai:identifier

oai:researchspace.auckland.ac.nz:2292/75646