University of Birmingham The development of first episode direct self- injurious behaviour and association with difficulties in emotional regulation in adolescence

Objective: Self-harm remains a serious public health concern, however, identifying adolescents at risk is challenging. Whilst self-harm has been linked with difficulties in emotional regulation post-injury, comparatively little is known about how such difficulties may impact on the future development of self-harm behaviour. Methods: 318 pupils aged 14-15 years completed measures on history of direct-self-injurious behaviour (DSIB), emotional regulation and depression and anxiety at two time points across a six-month period. Results: 13% (42) of participants reported their first episode of D-SIB over the six-month period and reported increased difficulties with emotional regulation prior to initial D-SIB. Regression analyses found significant associations for emotional regulation, and specifically lack of emotional clarity prior to first episode of D-SIB. Lack of emotional awareness and difficulties with impulse control were significantly associated in those with ongoing D-SIB. Conclusions: Prior to first episode of D-SIB young people may experience difficulty regulating emotions, a difficulty which appears less pronounced following their engagement with D-SIB. Our findings implicate difficulties in the early evaluation and understanding of emotions which may later impair attempts at emotion modulation and increase risk of D-SIB. Such findings might help inform early identification of adolescents at risk of initial D-SIB. Self-harm, Youth Mental Health, Risk Factors, Community