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However, the association between frequent bullying and self harm behaviour remained after we controlled for lifetime exposure to physical maltreatment (table 1).
Existing studies are often limited by cross sectional designs, the possibility that unmeasured background risk factors can lead children both to be victimised and to self harm (selection effects), and reliance on the same person to report both exposure to bullying and self harm behaviour, which may create spurious associations (reporter bias).
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In line with previous research, 15 we classified self harm behaviours in which there was any evidence of self reported intent to die as suicidal self harm.
Our findings add to the international debate about the extent to which these self harm behaviours represent distinct concepts or part of a continuum of suicidal behaviour.
Children with low cognitive abilities are at greater risk of being targeted by bullies, 37 as well as engaging in self harm behaviours.
The strong associations with later mental health and substance use found in this study suggest that interventions aimed at reducing self harm behaviours should also focus on treating or preventing these additional problems.
Several factors are known to increase the risk of self harm: being brought up in a deprived area, a family history of self harming behaviour, maltreatment, co-occurring behavioural and emotional problems, and a low IQ have all been associated with high rates of self harm.
An odds radio was calculated to describe the association between reporting only self-harming thoughts at baseline and going on to report self-harm behaviour at 6 months, compared to reporting neither thoughts nor behaviours at baseline.
Participants who reported self-harming thoughts at baseline were more likely to develop self-harm behaviour at follow-up than those reporting neither thoughts nor behaviours at baseline (OR = 5.9, 95% CI 4.37-7.86).
Of the 376 (9.5%) participants reporting self-harm behaviour at the first assessment, 207 (55.1%) continued to report self-harming acts when assessed six months later.
However, self-harm behaviour can nevertheless occur at any age, including in the elderly population.
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