In our analyses of the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort, adolescents who had self harmed by age 16 years had an increased risk of mental health problems, future self harm episodes, and problem substance use in early adulthood compared with adolescents who had not self harmed. Those who self harmed with suicidal intent at some point were also at increased risk of poorer educational and occupational outcomes. Although associations were generally stronger for suicidal self harm than for non-suicidal self harm, those who had self harmed without suicidal intent were also at increased risk of adverse outcomes. Findings from the onset models indicate that associations were not entirely explained by pre-existing psychopathology. However, for some outcomes, most notably depression and anxiety disorder, associations with suicidal self harm were attenuated and as a result evidence for a difference in risk between the two self harm groups was no longer strong. Suicide attempts often occur in the context of psychiatric disorders,39 40 and a large proportion of participants with suicide attempts were found to have probable depression and
