Childhood maltreatment and non-suicidal self-injury: A systematic review and meta-analysis

BACKGROUND: Non-suicidal self-injury (NSSI) has been increasingly recognized as a significant public health concern. Identifying early and modifiable risk factors is necessary for advancing screening and intervention efforts, particularly early detection of at-risk individuals. As a step toward addressing this need, we aimed to examine childhood maltreatment, including its specific subtypes, in relation to NSSI. METHODS: We conducted a comprehensive meta-analysis of childhood maltreatment (overall, sexual abuse, physical abuse and neglect, and emotional abuse and neglect) in association with NSSI. We also provided a qualitative review of mediators and moderators of this association. Relevant articles published from inception to September 25, 2017, were identified through a systematic search of Embase, MEDLINE, and PsycINFO. OUTCOMES: We identified 71 publications meeting eligibility criteria. Overall childhood maltreatment was associated with NSSI (odds ratio [OR] 3·42, 95% CI 2·74–4·26), and effect sizes for maltreatment subtypes ranged from OR 1·84 (95% CI 1·45–2·34) for childhood emotional neglect to OR 3·03 (95% CI 2·56–3·54) for childhood emotional abuse. Except in the case of childhood emotional neglect, there was no evidence of publication bias. Across multiple maltreatment subtypes, stronger associations with NSSI were found in non-clinical samples. INTERPRETATION: With the exception of childhood emotional neglect, childhood maltreatment and its subtypes are associated with NSSI. Screening of childhood maltreatment history in NSSI risk assessments may hold particular value in community settings, and increased attention to childhood emotional abuse is warranted.