Assessment of somatosensory function and self-harm in adolescents

Cummins, T. M., English, O., Minnis, H. , Stahl, D., O'Connor, R. C. , Bannister, K., McMahon, S. B. and Ougrin, D. (2021) Assessment of somatosensory function and self-harm in adolescents. JAMA Network Open, 4(7), e2116853. (doi: 10.1001/jamanetworkopen.2021.16853) (PMID:34255048) (PMCID:PMC8278268)

Abstract

Importance: Self-harm is a risk factor for suicide in adolescents, with the prevalence highest in young people in group and residential care programs. Although no established risk factors for self-harm exist, adolescents who self-harm may have decreased pain sensitivity, but this has not been systematically investigated. Objective To assess somatosensory function using quantitative sensory testing (QST) in children and adolescents living in care grouped by the number of episodes of self-harm in the past year and compare their somatosensory profiles with community control participants to investigate associations with the incidence or frequency of self-harm. Design, Setting, and Participants: Recruitment for this cross-sectional study began January 2019 and ended March 2020. Exclusion criteria included intellectual disability (intelligence quotient <70), autism spectrum disorder, or recent serious injury. Children and adolescents aged 12 to 17 years with no underlying health conditions were recruited from local authority residential care settings in Glasgow, UK, and schools and youth groups in London and Glasgow, UK. The volunteer sample of 64 participants included adolescents ages 13 to 17 years (34 [53%] females; 50 [78%] living in residential care; mean [SD] age, 16.34 [1.01] years) with varying incidents of self-harm in the past year (no episodes, 31 [48%]; 1-4 episodes, 12 [19%]; and ≥5 episodes, 2 [33%]). Exposures: Participants were tested using a standardized QST protocol to establish baseline somatosensory function. Main Outcomes and Measures: Associations between somatosensory sensitivity, incidence and frequency of self-harm, residential status, age, gender, and prescription medication were calculated. Secondary outcomes assessed whether self-harm was associated with specific types of tests (ie, painful or nonpainful). Results: A total of 64 participants ages 13 to 17 years completed testing (mean [SD] age, 16.3 [1.0] years; 34 [53%.] females and 30 [47%] males; 50 [78%] living in group homes). Adolescents with 5 or more self-harm incidences showed significant pain hyposensitivity compared with community control participants after adjusting for age, gender, and prescription drug use (SH group with 5 or more episodes vs control: −1.03 [95% CI, −1.47 to −0.60]; P < .001). Hyposensitivity also extended to nonpainful stimuli, similarly adjusted (SH group with 5 or more episodes vs control: −1.73; 95% CI, −2.62 to −0.84; P < .001). Pressure pain threshold accounted for most of the observed variance (31.1% [95% CI, 10.5% to 44.7%]; P < .001). Conclusions and Relevance: The findings of this study suggest that sensory hyposensitivity is a phenotype of Adolescents who self-harm and that pressure pain threshold has clinical potential as a quick, inexpensive, and easily interpreted test to identify adolescents at increased risk of repeated self-harm.

• Item Type: Articles
• Additional Information: Drs Ougrin and O’Connor, Mr English, and Dr Minnis were funded by grant MR/R004927/1 from the Medical Research Council. Dr Stahl reported receiving financial support from the National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. Dr Bannister was funded by grant RE15263 from the Academy of Medical Sciences Springboard Grant. Dr McMahon was funded by grant RE13065 from the National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: O'Connor, Professor Rory and Minnis, Professor Helen and English, Mr Oliver and Ougrin, Dr Dennis
• Authors: Cummins, T. M., English, O., Minnis, H., Stahl, D., O'Connor, R. C., Bannister, K., McMahon, S. B., and Ougrin, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: JAMA Network Open
• Publisher: American Medical Association
• ISSN: 2574-3805
• ISSN (Online): 2574-3805
• Published Online: 13 July 2021
• Copyright Holders: Copyright © 2021 Cummins TM et al.
• First Published: First published in JAMA Network Open 4(7): e2116853
• Publisher Policy: Reproduced under a Creative Commons License

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