Self harm in adolescents is strongly associated with mental health problems, future self harm, and substance misuse in early adulthood, and suicidal self harm is also associated with poorer educational and occupational outcomes. However, it cannot be assumed that this association is causal, particularly as we are unable to rule out the possibility of residual confounding. Rather, our findings suggest that self harm itself acts as an important risk marker for adverse outcomes in adulthood, over and above previously existing psychopathology. Our findings add to the international debate about the extent to which these self harm behaviours represent distinct concepts or part of a continuum of suicidal behaviour.13 14 15 16 Although associations were generally stronger in relation to suicidal self harm, non-suicidal self harm was also associated with adverse outcomes in adulthood. This underscores the need for early identification and treatment of adolescents who self harm, regardless of the history of suicidal intent, to alleviate current distress and reduce the risk of future problems. The strong associations with later mental health and substance use found in this study suggest
