Emergency department visits for self-harm could provide an opportunity to prevent sexual abuse
Content warning: This story contains references to self-harm, suicide and sexual violence. If you are experiencing thoughts of suicide, this is a mental health emergency and you are deserving of help. Call the Mental Health Crisis Line at 988 or call your local mental health and addictions office to speak to a counselor. If you have experienced sexual violence, contact the Assaulted Women’s Helpline (416-863-0511), the Ontario Victim Support Line (416-314-2447) or a local service for supports. Additional mental health resources can be found on University of Toronto’s Health and Wellness website.
When a child arrives at the Emergency Department because of self-harm or a suicide attempt, the immediate concern is to ensure their safety by preventing future acts of self-harm. But children who self-harm face a variety of risks beyond suicide, and by broadening our understanding of these risks, we can provide them with better care.
Dr. Jacob Vorstman, Dr. Suneeta Monga, and their team are studying the relationship between self-harm and seeking care for sexual abuse. They recently published research indicating that emergency department visits for self-harm may provide an opportunity to prevent sexual abuse.
We spoke with lead author and PhD candidate Matisse Blundell about their findings.
What motivated this research?
MB: Growing numbers of children have been presenting to Emergency Departments for self-harm and suicide attempts. When caring for these children, the first priority for clinicians is trying to prevent future acts of self-harm.
While safety is essential, a growing body of research shows that children who self-harm or attempt suicide are at elevated risk of many negative psychological and social outcomes. This means that even if we succeed in preventing a child from injuring themselves again, that child could still experience other distressing and negative outcomes. Here, we focused on sexual abuse, a devastating yet understudied outcome in this population.
What was the most important finding of this study, in your opinion?
MB: We studied over 26,000 children aged 8-17 years who went to an Ontario Emergency Department because of self-harm or a suicide attempt between 2013-2022.
It is well known that children who self-harm or attempt suicide are much more likely than the general population to have a history of sexual abuse, and we confirmed this in our data. But our findings uncovered something surprising: in the 10-year period after going to the Emergency Department for self-harm or a suicide attempt, nearly 1 in 10 of individuals returned to seek care for sexual abuse. This was over 8 times the risk experienced by our control group and remained highly significant even after taking other factors into account, including a history of sexual abuse. Additionally, it couldn’t be fully explained by delayed disclosures (situations where an individual seeks care for abuse which occurred long ago).
Of those who self-harmed and later sought care for sexual abuse, the vast majority were female (97%), and they were more likely to have first presented for self-harm at a younger age (13 years and below).
How does this change service delivery in the future?
MB: If further research confirms these findings, sexual abuse risk screening and targeted intervention should be considered for children who come to the emergency department for self-harm.
Thinking more broadly, our results highlight the broad range of negative outcomes associated with childhood self-harm and suicide attempts. Echoing UK guidelines which recommend psychosocial assessment for all individuals presenting to Emergency Departments for self-injury, we advocate for a holistic approach to assessment and prevention for these children. For example, are there factors in their environment increasing their risk of self-injury? (Experiences of abuse, school difficulties, peer exclusion?) Are these factors likely to lead to other poor outcomes, beyond self-harm? Most importantly, how can we intervene (or refer to those who can)?
While strategies like safety plans and coping skills are a piece of the puzzle, they’re not necessarily the only one: a recent meta-analysis by our co-author Dr. Daphne Korczak did not support safety plans as a standalone treatment. We need to think about the more upstream causes of self-harm and how we can act on them, in order to prevent a variety of adversities downstream.
Any next steps?
MB: We encourage other research groups to attempt to replicate these findings, especially those with access to patient-reported data. A study using patient-reported data would capture events not disclosed in healthcare settings, better describe the timing of events, and provide insight into crucial social determinants we didn’t have access to, including gender, race, and ethnicity.
What is the major take home message for the public?
MB: As part of other work, I have had the privilege to meet children and families struggling with suicidality and self-harm. I have heard their stories and pain. This study advocates for taking child self-harm seriously and investing in comprehensive treatment. Beyond this study, we’ve got some other projects in the works aimed at making change (one of is already impacting treatment). If any members of the public are reading this and trying to support their own child with these issues, know that there are researchers out there who care and are trying to make things better.
Read this month's ImPACT paper.
Blundell M, Kurdyak P, Du Mont J, Gallagher L, Korczak DJ, Monga S, Vorstman JAS. Risk of Presentation for Sexual Abuse After a First Emergency Department Presentation for Self-Harm in Childhood or Adolescence. Am J Psychiatry. 2026 Feb 18:appiajp20250691. doi: 10.1176/appi.ajp.20250691. Epub ahead of print. PMID: 41703689.
