Self-harm in Adolescents in Ghana

Background: While self-harm in adolescents represents a public health concern in most high-income countries, the phenomenon is under-researched within low- and middle-income countries, including Ghana. Methods: This PhD research involved three empirical studies. Study 1 was a systematic review synthesising the accessible literature on adolescent self-harm across sub-Saharan Africa. Following from Study 1, an explanatory sequential mixed methods approach was utilised to conduct two primary studies on adolescent self-harm in Accra, Ghana. Study 2 was a cross-sectional survey of 2107 in-school and street-connected adolescents in Accra describing the self-reported prevalence estimates, correlates, self-harm methods and reasons. Study 3 involved one-to-one semi-structured interviews exploring the lived experiences of 36 in-school and street-connected adolescents with self-harm histories, and the views of 11 key adult stakeholders regarding the phenomenon in Ghana. Results: Study 1 found considerable variability in the prevalence estimates of self-harm in adolescents across sub-Saharan Africa. Consistent with the evidence in Study 1, Study 2 showed that, overall, typically, one in five adolescents reported self-harming in the past year; however, the prevalence estimates were lower in street-connected than in-school adolescents. Self-injury was more frequently reported than self-poisoning by the two groups of adolescents. Adolescent self-harm in Accra was commonly associated with multiple intrapersonal and interpersonal factors within and outwith the family context. In Study 3, the participants’ accounts and meaning-making were elaborated more along the lines of social interactions with others and moral standards, with little emphasis on individual level difficulties and mental states. Conclusion: Self-harm in both in-school and street-connected adolescents in Accra, Ghana is a significant public health concern as it could be across other sub-Saharan African countries. Further studies of high methodological quality are recommended to expand the evidence base for the understanding, intervention and prevention of self-harm in adolescents in Ghana and within sub-Saharan Africa.