Article Text

Original research
Self-harm among in-school and street-connected adolescents in Ghana: a cross-sectional survey in the Greater Accra region
  1. Emmanuel Nii-Boye Quarshie1,2,
  2. Farag Shuweihdi3,
  3. Mitch Waterman2,
  4. Allan House3
  1. 1Department of Psychology, University of Ghana, Accra, Ghana
  2. 2School of Psychology, University of Leeds, Leeds, UK
  3. 3Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  1. Correspondence to Dr Emmanuel Nii-Boye Quarshie; enquarshie{at}


Objectives To identify the prevalence, methods, associations and reported reasons for self-harm among in-school and street-connected adolescents in Ghana.

Design A cross-sectional survey. We applied multi-level regression models and model-based cluster analysis to the data.

Setting Three contexts in the Greater Accra region were used: second cycle schools, facilities of charity organisations and street census enumeration areas (sleeping places of street-connected adolescents, street corners, quiet spots of restaurants, markets, train and bus stations, and lorry and car parks).

Participants A regionally representative sample of 2107 (1723 in-school and 384 street-connected) adolescents aged 13–21 years.

Outcome measures Participants responded to a structured self-report anonymous questionnaire describing their experience of self-harm and eliciting demographic information and social and personal adversities.

Results The lifetime prevalence of self-harm was 20.2% (95% CI 19.0% to 22.0%), 12-month prevalence was 16.6% (95% CI 15.0% to 18.0%) and 1-month prevalence was 3.1% (95% CI 2.0% to 4.0%). Self-injury alone accounted for 54.5% episodes and self-poisoning alone for 16.2% episodes, with more than one method used in 26% of episodes. Self-cutting (38.7%) was the most common form of self-injury, whereas alcohol (39.2%) and medications (27.7%) were the most commonly reported means of self-poisoning. The factors associated with self-harm were interpersonal: conflict with parents (adjusted OR (aOR)=1.87, 95% CI 1.24 to 2.81), physical abuse victimisation (aOR=1.69, 95% CI 1.16 to 2.47), difficulty in making and keeping friends (aOR=1.24, 95% CI 0.85 to 1.80), sexual abuse victimisation (aOR=1.21, 95% CI 0.78 to 1.87) and conflict between parents (aOR=1.07, 95% CI 0.73 to 1.56).

Conclusions Self-harm is a significant public health problem among in-school and street-connected adolescents in the Greater Accra region of Ghana. Its origins are very largely in social and familial adversity, and therefore prevention and treatment measures need to be focused in these areas.

  • non-accidental injury
  • child & adolescent psychiatry
  • suicide & self-harm
  • public health

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  • Contributors EN-BQ, MGW and AH conceived, designed and organised the study. EN-BQ carried out the study, including data collection and coding of data for analysis. FS and EN-BQ performed the statistical analysis of the data, and MGW and AH contributed to the interpretation of the data. EN-BQ drafted the manuscript, and MGW, AH and FS critiqued the manuscript for important intellectual content. EN-BQ serves as guarantor for the contents of this paper. All authors read and approved the final version of the manuscript.

  • Funding This study was supported by the Leeds International Research Scholarship at the University of Leeds, School of Psychology, in the form of a doctoral scholarship to the first author (EN-BQ)—Grant No: CFN/sy/200631403.

  • Disclaimer The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The views expressed in this paper are those of the authors and not necessarily those of the Leeds International Research Scholarship.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study received ethical approval from two Institutional Review Boards (the School of Psychology Ethics Committee, University of Leeds, UK (Ref. No: 16-0373) and the Ethics Committee for the Humanities, University of Ghana, Accra, Ghana (Ref. No: ECH078/16-17)) and institutional permissions were also obtained to conduct this study. The participants provided a signed written consent prior to taking part in the survey. Written consent of the parents/guardians of in-school adolescents aged 13–17 years was sought, while the underage adolescents assented to participate. Written consent to participate in the study was obtained from the management of charity facilities and street social workers on behalf of street-connected adolescents aged 13–17 years.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.