The natural history of self-harm from adolescence to young adulthood : a population-based cohort study

Background Knowledge about the natural history of self-harm is scarce, especially during the transition from adolescence to young adulthood, a period characterised by a sharp rise in self-inflicted deaths. From a repeated measures cohort of a representative sample, we describe the course of self-harm from middle adolescence to young adulthood.

Methods A stratified, random sample of 1943 adolescents was recruited from 44 schools across the state of Victoria, Australia, between August, 1992, and January, 2008. We obtained data pertaining to self-harm from questionnaires and telephone interviews at seven waves of follow-up, commencing at mean age 15·9 years (SD 0·49) and ending at mean age 29·0 years (SD 0·59). Summary adolescent measures (waves three to six) were obtained for cannabis use, cigarette smoking, high-risk alcohol use, depression and anxiety, antisocial behaviour and parental separation or divorce.

Findings 1802 participants responded in the adolescent phase, with 149 (8%) reporting self-harm, More girls (95/947 [10%]) than boys (54/855 [6%]) reported self-harm (risk ratio 1·6, 95% CI 1·2–2·2). We recorded a substantial reduction in the frequency of self-harm during late adolescence. 122 of 1652 (7%) participants who reported self-harm during adolescence reported no further self-harm in young adulthood, with a stronger continuity in girls (13/888) than boys (1/764). During adolescence, incident self-harm was independently associated with symptoms of depression and anxiety (HR 3·7, 95% CI 2·4–5·9), antisocial behaviour (1·9, 1·1–3·4), high-risk alcohol use (2·1, 1·2–3·7), cannabis use (2·4, 1·4–4·4), and cigarette smoking (1·8, 1·0–3·1). Adolescent symptoms of depression and anxiety were clearly associated with incident self-harm in young adulthood (5·9, 2·2–16).

Interpretation Most self-harming behaviour in adolescents resolves spontaneously. The early detection and treatment of common mental disorders during adolescence might constitute an important and hitherto unrecognised component of suicide prevention in young adults.

Funding National Health and Medical Research Council, Australia, and operational infrastructure support programme, Government of Victoria, Australia.

Investigating ‘community’ through a history of responses to asbestos-related disease in an Australian industrial region

The government of the State of Victoria has been slow to acknowledge the social costs of asbestos-related diseases (ARD) in the Latrobe Valley. Despite the emphasis on ‘community’ in the discipline of public health and in public health services since the 1970s, ARD was only recognised as a community-wide health problem because of the advocacy of people directly affected by it. An historical view of responses to ARD in a community established as an appendage to the publicly owned power industry and infused with an ethic of public service, shows that contests over the definition of ‘community’ lay at the heart of these responses. It also shows that such disputes did not arise only from the reluctance of authorities to acknowledge the problems resulting from the extensive use of asbestos in power stations. The paper highlights the political nature of the notion of ‘community’ and in doing so raises questions that have implications beyond its narrow regional focus.

Book review : In the shadow of Gallipoli: the hidden history of Australia in World War I

Review of: In the Shadow of Gallipoli: the hidden history of Australia in World War I, by Robert Bollard. (Sydney: New South Wales, 2013)

A history of the lie of innocence: sons who become orphans

This thesis deals with a history of the lie of innocence, its inception in biblical representation and its development in literary representations from the eighteenth century to contemporary times. The aim is to disclose the way the lie functioned across time both in Christian societies and in the secular ones in their wake.

A history of wastewater irrigation in Melbourne, Australia

Reclamation of wastewater for irrigation has had an important role to play in Melbourne’s struggle to manage water resources as effectively as possible. Rapid growth within the first few years of the founding of the city led to a sanitary crisis, which provided the impetus for the construction of a large sewerage system. Interest in using the effluent from sewage treatment plants for irrigation gained attention in the late 1970s, but despite some activity in the early 1980s, it was not until 2005 that large-scale wastewater irrigation schemes became a reality. Successful to a degree, there have also been problems, and the future viability of one large irrigation scheme for commercial vegetable production is threatened by high salt concentrations in the treated wastewater. Greywater irrigation at the household level has also become commonplace in Melbourne over the last decade, but it is difficult to regulate and the health risks urgently need to be quantified. More recently, several third-pipe schemes, where treated wastewater is reticulated to households, have been commissioned with plans for many more, and treated stormwater is growing in popularity, particularly for irrigation of public open spaces.