A study at the U. Minnesota revealed a considerable increase of self-harm in youth going through a chronic illness.

Adolescents ranging in ages from 10 to 19 showed a considerable increase in instances of self-harm, suicidal thoughts and suicide when afflicted with mental and physical chronic illnesses, according to Dr. Andy Barnes, lead author of the study and assistant professor in pediatrics and adolescent health.

Barnes said chronic illness affects the youth in a way that is unique, and it stands out from other factors in the adolescent’s world.

“This is independent, and they contribute cumulative risk above and beyond things like poverty or coming from a broken home,” Barnes said.

Adolescents going through a physical chronic illness like cancer or asthma had about a 20 percent increase in self-harm, suicidal thoughts and suicide, according to the published study.

The study showed that children with only mental chronic illness had more than double the risk of having an instance of self-harm occur, which is not surprising, according to Barnes.

“If you commit suicide, you probably have a mental health condition to begin with,” Barnes said.

However, children with both mental and physical chronic illnesses occurring concurrently were at a much higher risk of self-harm, according to Barnes.

Barnes said this is significant for the treatment of children with physical chronic illnesses.

“It is an important clinical point that we really have to talk to these kids,” Barnes said. “We need to ask them how they are really doing, because they won’t tell you if you don’t ask.”

Dr. Michael Resnick, professor in the department of pediatrics and adolescent health, said the children are going through a developmental period, and the change occurring in the child’s body needs to be taken into account.

“The stuff that is going on in adolescence is mind-blowing in terms of their emotional repertoire and the ability to think and abstract,” said Resnick, a coauthor of the study.

With this kind of development, Dr. Donald Brunnquell, director of the Office of Ethics for Children’s Hospitals and Clinics of Minnesota, said chronic illness has an effect on how the adolescents view themselves in everyday life.

“It affects their social interactions with friends and family,” Brunnquell said. “It affects their image of themselves, which is in a constant state of flux.”

Dr. Sarah Jerstad, child psychologist for the department of oncology and hematology at Children’s Hospitals, said the unfamiliarity of the situation is another factor that contributes to the increased risk of self-harm.

“Kids have not really been exposed to the medical system,” Jerstad said. “It is a whole new world.”

Brunnquell said the experience of a chronic illness also takes a physical toll on the adolescent.

A physical illness affects hormonal balance, ability to eat or sleep and cognitive abilities, according to Brunnquell.

“Children can feel really off-balance with these kinds of symptoms,” Brunnquell said.

Jerstad said that for all these reasons, her counseling of children going through cancer is crucial.

“It is a preventative measure,” Jerstad said. “It is a high-risk population, and they are going through a really tough treatment.”

If a child has a chronic mental illness prior to being diagnosed with cancer, it is important to identify it, according to Jerstad.

To assess a child’s mental state, Jerstad said a screening process with the child and his or her family occurs at the beginning of the child’s treatment.

After the screening process, Jerstad said she either recommends her services or simply offers it.

“I just want to let them know you and your child are going to be going through a lot,” Jerstad said. “It is a life-changing process.”

Barnes said counseling like this is more effective than medication in decreasing instances of self-harm, suicidal thoughts and suicide.

“They are developing at such fast rates that they can rewire their brains pretty quickly in a positive way,” Barnes said.

Brunnquell said the cost of this kind of counseling along with expensive medical treatment contribute to it not being more common.

“There is a lot of pressure to reduce costs in treatment, and this gets in the way of making these services freely available,” Brunnquell said.

Regardless of this cost, Resnick said effective counseling makes a crucial addition to the overall quality of the treatment.

“It distinguishes the great practitioner from the good practitioner,” Resnick said. “One that knows, despite the health challenges, we are still dealing with a young person.”

The study will be published in the May issue of Pediatrics.