Final Report Summary - SAVYP (Understanding the determinants of suicidal behaviour, serious accidents and violence in young people)
The overarching purpose of this 5-year ERC-funded research programme was to enhance our current understanding of the determinants of serious adverse outcomes among young people as they navigate the challenging transition from adolescence to adult maturity. Mental health epidemiologists tends to examine and report on a single outcome per study per published paper, but this programme took the novel approach of investigating an array of correlated adverse outcomes in this population. The collaborative research team consisted of experts in mental health, public health, epidemiology, statistics and the social sciences based at The University of Manchester in the UK and at Aarhus University in Denmark. The team focused its investigations primarily on the relationships between exposure to harmful early life experiences and subsequent risks of people engaging in fatal and non-fatal forms of self-harming and aggressive behaviour (internalised vs. externalised violence). Other adverse outcomes such as accidental death, imprisonment and being a victim of violent crime were also examined in some of the studies conducted in the programme. A particularly ground-breaking aspect of the work was an innovative exploration of the phenomenon known as 'dual harm' - when a person has physically harmed themselves as well as other people. Each component study in the programme was carried out using interlinked national Danish administrative registers - an excellent resource for conducting very large epidemiological studies in national birth cohorts. The research team implemented multiple between-register linkages to investigate the following potential determinants of adverse outcome: growing up as a first or second generation immigrant, residential mobility during childhood, family income trajectories through childhood, child-parent separation, trauma-related hospitalisations during childhood, parental age (teenager vs. age 40 and older), parental death during childhood, parents' mental illnesses (including alcohol/drug misuse and self-harm), cohort members' own mental illnesses and first discharge from inpatient psychiatric care. The programme generated a large volume of findings that have been disseminated widely via 17 peer reviewed scientific articles published to date, various academic conferences, prominent conventional media coverage, and extensive discussion on social media networks. Some of the programme's most salient findings are as follows:
1) Young people who harm themselves or who are aggressive or violent towards others have often lived through multiple psychosocial challenges, damaging experiences and traumas during their childhoods, and they should therefore be treated sympathetically rather than as being problematic and undeserving individuals.
2) Young persons who have lived through a greater number of more severe adversities, and those with histories of harming themselves and also being aggressive or violent toward other people, are at especially elevated risk for a range of adverse outcomes. More vulnerable individuals among these high-risk groups are likely to require coordinated and sustained effective input from a range of public services to enable them to successfully transition from adolescence to adult maturity.
3) The role played by socioeconomic inequalities in determining future risk trajectories beyond childhood requires a societal response. An incremental risk gradient is evident from children growing up in the wealthiest to the poorest families, but this gradient is non-linear. Thus, those children who grow up in the poorest families are at a disproportionately elevated risk as they transition to adult maturity. Furthermore, the longer that a child experiences the poorest conditions whilst they grow up, the greater their risk of subsequently experiencing adverse outcomes, and risk is also especially raised in those individuals who experienced downward socioeconomic mobility during childhood.
1) Young people who harm themselves or who are aggressive or violent towards others have often lived through multiple psychosocial challenges, damaging experiences and traumas during their childhoods, and they should therefore be treated sympathetically rather than as being problematic and undeserving individuals.
2) Young persons who have lived through a greater number of more severe adversities, and those with histories of harming themselves and also being aggressive or violent toward other people, are at especially elevated risk for a range of adverse outcomes. More vulnerable individuals among these high-risk groups are likely to require coordinated and sustained effective input from a range of public services to enable them to successfully transition from adolescence to adult maturity.
3) The role played by socioeconomic inequalities in determining future risk trajectories beyond childhood requires a societal response. An incremental risk gradient is evident from children growing up in the wealthiest to the poorest families, but this gradient is non-linear. Thus, those children who grow up in the poorest families are at a disproportionately elevated risk as they transition to adult maturity. Furthermore, the longer that a child experiences the poorest conditions whilst they grow up, the greater their risk of subsequently experiencing adverse outcomes, and risk is also especially raised in those individuals who experienced downward socioeconomic mobility during childhood.