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Deliberate Self-Harm Among Youth in the Child Welfare System
Mica Goulbourne1, Farah W Brink1,2, Xueting Xia1
1Nationwide Children's Hospital, Columbus, Ohio.
JAACAP Open
|September 9, 2025
Summary
Youth in child welfare are at high risk for self-harm. Adolescents, girls, and those with prior self-harm or mental health disorders face the greatest risk following a child protective services investigation.
Area of Science:
- Child Welfare Research
- Mental Health Studies
- Public Health
Background:
- Youth in the child welfare system face elevated risks for self-harm and suicide attempts.
- Understanding factors associated with deliberate self-harm (DSH) after initial child protective services (CPS) investigations is crucial for intervention.
Purpose of the Study:
- To examine demographic and clinical factors associated with deliberate self-harm (DSH) among youth following their first child protective services (CPS) investigation.
Main Methods:
- Retrospective longitudinal cohort analysis of Ohio Medicaid claims and child welfare data (2010-2020).
- Included youth aged 5-17 with their first CPS investigation (N = 104,700).
- Cox proportional hazards analyses assessed risk factors for DSH within 1 year of CPS investigation.
Main Results:
- Adolescents (13-17) had a significantly higher risk of DSH compared to younger children.
- Increased hazard of DSH was observed for girls, youth with prior DSH, ADHD, anxiety, depression, substance use disorder, and thought disorders.
- The highest risk for DSH occurred within 15 days of a CPS investigation.
Conclusions:
- Prior DSH, mental health disorders, female sex, and older age are significant risk factors for DSH post-CPS investigation.
- Adolescents are particularly vulnerable in the first two weeks after a CPS investigation.
- Identifying these risk factors and high-risk periods can guide early interventions to reduce DSH in this population.
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