Risk of Presentation for Sexual Abuse After a First Emergency Department Presentation for Self-Harm in Childhood or Adolescence.

Abstract

Self-harm in childhood and adolescence is associated with a range of adverse outcomes. Limited evidence suggests that these individuals are at elevated risk of experiencing sexual violence in adolescence and young adulthood. This population-based cohort study identified children and adolescents with a first presentation to health services for self-harm and examined their risk of subsequent presentation for sexual abuse or assault. Health administrative data were used to identify all children and adolescents with a first presentation for self-harm over a 10-year period (2013-2022) in the province of Ontario, Canada (population 16 million). Time to first presentation for sexual abuse or assault was compared to that of individuals in a control group matched on age, sex, and area-level socioeconomic status using Cox proportional hazards modeling. The cohort included 139,233 individuals. After a first presentation for self-harm, the 10-year cumulative incidence of presentation for sexual abuse was 9.06% (95% CI=8.55, 9.57), compared to 1.26% (95% CI=1.17, 1.36) for the control group (hazard ratio=8.32, 95% CI=7.68, 9.02). Risk remained elevated after adjustment for factors influencing vulnerability to sexual abuse (hazard ratio=5.06, 95% CI=4.53, 5.65). Results were similar for the outcome of sexual assault (cumulative incidence, 4.14% [95% CI=3.76, 4.51] versus 0.48% [95% CI=0.41, 0.54]; fully adjusted hazard ratio=6.44, 95% CI=5.38, 7.71). Sex-stratified analyses revealed a greater absolute risk for females. Presentation for self-harm during childhood and adolescence, in addition to being concerning for potential sexual abuse history, may be a marker of vulnerability for future sexual abuse or assault. These findings suggest a need for further research and implications for clinical practice.