Adverse childhood experiences, coping and self-harm among adolescents attending public psychiatry and mental health clinics in Malaysia: a cross-sectional study.

Abstract

Adverse childhood experiences (ACEs) are increasingly recognised as key determinants of self-harm among adolescents, particularly within psychiatric and mental health service settings in Malaysia, where coping resources may shape vulnerability and resilience. A cross-sectional study was conducted among adolescents referred to psychiatry and mental health services in Malaysia. Of 1244 eligible patients aged 10-24 years, 1164 completed a clinician-administered, interviewer-guided questionnaire. Self-harm status was assessed in clinical care and was compared across ACE burden, individual ACE domains and coping-related protective factors through a clinician-led interview. Multivariable logistic regression was used to examine adjusted associations with self-harm. Among 1164 participants, 827 (71.0%) reported lifetime self-harm. In adjusted analyses, a greater burden of ACEs was strongly associated with higher odds of self-harm. Compared with participants with no ACE exposure, the odds increased in a dose-response manner, from an adjusted OR (aOR) of 2.54 (95% CI 1.27 to 5.20) among those with 2-3 ACEs to 6.14 (95% CI 3.13 to 12.40) among those with ≥4 ACEs. Several coping-related factors were associated with lower odds of self-harm, including the ability to cope with stress (aOR 0.32, 95% CI 0.23 to 0.45), a sense of responsibility towards children, loved ones or pets (aOR 0.71, 95% CI 0.51 to 0.98) and perceived social support (aOR 0.63, 95% CI 0.40 to 0.97). In secondary analyses of individual ACE components, violence against household members, emotional abuse, sexual abuse, bullying and witnessing community violence were independently associated with higher odds of self-harm. This study showed high prevalence of self-harm among adolescents attending the psychiatric and mental health services. A greater cumulative burden of ACEs was associated with increased odds of self-harm, whereas protective factors including effective stress coping, a sense of responsibility towards loved ones or pets and social support were associated with reduced odds. These findings emphasised the importance of trauma-informed assessment and interventions that enhance coping capacities and social connectedness among young people presenting to mental health services.