What was in the news and academic press about self-injury in May?

A new report¹ published this May sheds light on the evolution of hospitalization for deliberate self-harm (suicide attempts, self-poisoning and non-suicidal self-injury) in France from 2007 to 2022. The study is published by the DREES (Direction de la recherche, des études, de l’évaluation et des statistiques), which is in charge of analyzing stats, and Santé Publique France, the public health organization. The analysis reveals a sharp increase in deliberate self-harm hospitalizations for women aged 10 to 24 since the end of 2020, a worrying trend occurring across Western countries and one which we previously approached in the cases of Ireland and Wales, and in Canada. On the other hand, the rates of hospitalization for both men and women aged 30 to 55 decreased, which suggests that the risk was connected to a generation in particular. This decrease in middle-aged hospitalization, combined with the increase among female youth, gives a deceiving impression of stability in the rates of hospitalizations for deliberate self-harm. Voluntary self-intoxication with medication was the most frequent way people harmed themselves, followed by cutting, but these are only cases that led to hospitalization, and may not represent cases of self-harm that do not lead to medical care. People who came from disadvantaged cities and those who benefited from state health cover due to their low incomes were more at risk of hospitalization for deliberate self-harm. Such hospitalizations are also not uniform across the country, as some regions have higher rates of deliberate self-harm, such as the Hauts-de-France (North), or Brittany (West). But despite these social and geographical specificities, the increase in hospitalization among girls and young women is present in all regions, socioeconomic status (but the increase is sharper in disadvantaged cities), no matter the method used or the severity of the injury. In 2022, women made up 64% of patients hospitalized for deliberate self-harm. One theory for this gender difference is that men may express psychological distress in other, more external, ways, such as addictions, violence or risk taking behaviors.

In an article² published by Australian media ABC News, Professor Jayashri Kulkarni suggests several reasons for this increase of deliberate self-harm, eating disorders, anxiety and depression among young girls; suggesting that the health system doesn’t consider the gender-based specificities between men and women. Women are at risk of violence, domestic and sexual abuse for example, which can lead to trauma. The contrast between their reality, and content they see on social media regarding career aspiration or unrealistic body image can also cause stress. The Covid epidemic and lockdown has also taken a toll on women’s mental health, as it impacted their social life and made them feel lonely. Women are also frequently expected to control their anger, which is considered a more male emotion, and may in turn interiorize their frustration and self-harm. But the causes of girls’ anger and frustration must be taken into account, and that stereotypes portraying women who self-harm as manipulative only make them feel even more misunderstood. Professor Jayashri Kulkarni also argues that some reasons might be specific to the female body. Estrogen (a female sex hormone) has a protective influence, but the levels of estrogen fluctuate during the menstrual cycle, which can make women with trauma more vulnerable to depression and anxiety when the levels are low. Premenstrual dysphoric disorder can also cause depression in some women in the weeks before their period. A more in-depth and gender-based approach must be taken to understand women’s mental health in all its complexity, and consider the social, biological and psychological factors that can influence it.

Faced with the increasing prevalence of self-injury among youth and the evolution of society, some institutions have to adapt. The Australian Defence Force will scrap 14 medical criterias responsible for the automatic rejection of 70% applicants³, such as some past surgeries, gynecological conditions, orthodontic braces, acne and non-suicidal self-injury. While the removal of these conditions doesn’t grant automatic entry, it doesn’t lead to immediate disqualification either. Self-injury will be considered on a case-by-case basis. This change in enrolment conditions comes as the ADF is facing a recruitment crisis, and with the realization that strict universal eligibility requirements don’t represent the diversity of the population anymore.

References

[1] Hazo, J.-B., Pirard, P., Jollant, F., & Vuagnat, A. (2024). Hospitalisations pour gestes auto-infligés : une progression inédite chez les adolescentes et les jeunes femmes en 2021 et 2022. Études et résultats, 1300. https://drees.solidarites-sante.gouv.fr/sites/default/files/2024-05/ER1300MAJ230524.pdf

[2] Kulkarni, J. (2024, May 19). Why are girls suffering so much right now? The problem is bigger than you think. https://www.abc.net.au. https://www.abc.net.au/news/2024-05-20/mental-health-teenage-girls/103816056

[3] Miranda, C. (2024, May 25). Major changes to ADF recruits: 14 bans scrapped. https://www.dailytelegraph.com.au. https://www.dailytelegraph.com.au/news/national/adf-changes-medical-criteria-in-effort-to-boost-number-of-recruits/news-story/c63213ebdfb43e7f977b0a9d0e9e307e