Suicidal and deliberate self-harm ideation among patients with physical illness: the role of coping styles

The relationship between coping styles and suicidal ideation (SI) or deliberate self-harm (DSH) ideation among patients with physical illness was examined. Four hundred fifteen adult male medical inpatients completed the Coping Styles Questionnaire. Patients with and without SI, and with and without DSH, were compared on coping styles. Sixteen percent of patients (n = 67) had SI and 18.3% (n = 76) had DSH. SI was associated with higher scores on emotional coping and lower scores on rational and detachment coping styles, compared with those without SI. DSH, compared with those without DSH, was associated with significantly higher scores on avoidance coping strategies. These data suggest coping styles among medical patients with and without SI or DSH may differ. The mechanism of this link is not entirely clear, but it may be that coping styles reflect one possible pathway of the association between poor physical health and SI and DSH. Replication of these results in a longitudinal study is needed. If replicated, incorporation of these data into the development of intervention strategies focused on improving coping strategies may be worthwhile.     

Schizophrenia and deliberate self-harm: a systematic review of risk factors

Deliberate self-harm (DSH) is a strong predictor of suicide in schizophrenia. The aim of this review was to identify risk factors for DSH in schizophrenia. This systematic review of the international literature examined cohort and case-control studies of patients with schizophrenia or related diagnoses that reported DSH as an outcome. Studies were identified by searching electronic databases and reference lists, and by consulting international experts. Fourteen studies met the eligibility criteria. Of the 29 variables examined by two or more studies, five (past or recent suicidal ideation, previous DSH, past depressive episode, drug abuse or dependence, and higher mean number of psychiatric admissions) were associated with an increased risk of DSH, and one (unemployment) was associated with a reduced risk. Schizophrenic patients with these risk factors need careful follow-up and monitoring, with treatment of any associated comorbid depression or drug abuse. Large, prospective studies of DSH in schizophrenia are needed to further define risk factors and to build on the findings of this review.     

Correlates of relative lethality and suicidal intent among deliberate self-harm patients

Conflicting findings have been reported regarding the relationship between the potential lethality of acts of deliberate self-harm (DSH) and suicidal intent, and how each relates to patient characteristics. This study examines the relationship of suicidal intent of DSH to lethality, the relationship of both to patient characteristics, and determines if intent or lethality are risk factors for repetition of DSH. Potential lethality and Suicide Intent Scale (SIS) scores for DSH episodes were examined in a representative sample of 150 patients presenting to a general hospital. Follow-up interviews were completed 12 to 20 months later. Lethality was strongly associated with high intent. Both lethality and intent were associated with male gender. Suicidal intent but not lethality was associated with the presence of psychiatric disorder and depression. Intent was significantly correlated with hopelessness scale score. Although intent was correlated with both depression and self-esteem scale scores, these correlations became nonsignificant when the effect of hopelessness was removed. Repetition of DSH during the follow-up period was related to neither lethality nor intent scores for the original episodes. Lethality and suicidal intent, although related, have somewhat different correlates. Both should be considered when assessing DSH patients, but their relationship to further suicidal behavior does not appear to be straightforward.     

A strategic assessment of deliberate self-harm

This paper describes how patients are interviewed in the context of a general hospital after they have been involved in an episode of self-harm. The interview schedule is structured upon the principles of brief therapy, and uses the 'neutral' approach of the Milan Team (Weakland 1974; Palazzoli et al. 1980). The schedule provides information for referring on and has proved to be 'therapeutic' in itself. The method of interviewing has been used in other hospital contexts with families where a member has been referred 'in a crisis' threatening, or indicating suicidal behaviour. It is suggested that the identification of who is involved systemically is of paramount importance, and that this may not involve 'the family' but significant others in the social network. The important systemic involvement of the general practitioner is recognized.     

Social support-oriented coping and resilience for self-harm protection among adolescents

The study aimed to investigate the extent to which social support-focused coping and resilience can predict lower risk for self-harm by at-risk adolescents. Participants were 962 high school learners from nine high schools in the Free State Province, South Africa (female = 57.9 %; black = 70.7 %; mean age = 16.34 years). They completed the Revised Coping Schemas Inventory and the Resiliency Scale for Children and Adolescents. Logistic regression analysis was computed to predict risk for self-harm from social support-focused coping and resilience. The results indicate that higher levels of social support predict lower risk for adolescent self-harm. Social support-oriented coping and resilience predicted tension-reduction and emotional reactivity. Social support-focused coping seems to have an influence in lowering the risk of self-harm amongst adolescents.     

Recognition of problem drinking among young adult prisoners

Alcohol is a preventable cause of illness, offending and other adversities worldwide. Prisoners are especially vulnerable. The aim of this study was to test the hypotheses that younger adult male prisoners are more likely to be hazardous drinkers than their older peers, but less likely to recognize this. The study cohort comprised 100 male prisoners aged 18-20 years and 157 aged 21 and over, who were interviewed and completed standard alcohol and drug questionnaires just after reception into prison. It was found that younger men were significantly more likely to be hazardous drinkers than their older peers but less likely to recognise this, even at scores on the Alcohol Use Disorders Identification Test (AUDIT) indicating dependency. They were also less likely to experience withdrawal symptoms, the main factor associated with problem drinking recognition at any age. Younger prisoners were less likely to be depressed, more likely to rate their social support as good and less likely to be dependent drug users. We conclude that reliance on younger prisoners to recognise their hazardous drinking would identify about one-fifth of them. With a lower likelihood of withdrawal symptoms than older men, they are probably still metabolizing alcohol more effectively. Given their similarities to older prisoners in terms of any previous imprisonment and likely personality disorder, formal screening for hazardous drinking might prevent decline into problem drug use, depression, reoffending, re-imprisonment, and social disconnection.     

Solving the puzzle of deliberate self-harm: the experiential avoidance model

Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.     

Emotional antecedents and consequences of deliberate self-harm and suicide attempts

Emotional experiences immediately prior to (emotional antecedents) and following (emotional consequences) deliberate self-harm and suicide attempts in female inmates (N = 63) were examined. Anger was the antecedent emotion reported by the largest proportion of individuals who had engaged in deliberate self-harm (45.16%), suicide attempts (40.9%), and ambivalent suicide attempts (30%). Relief and other positive emotional shifts were more common in deliberate self-harm (41.94%) (involving no intent to die) than in suicide attempts or ambivalent suicide attempts, particularly for persons with borderline personality disorder. These findings underscore the utility of discriminating between deliberate self-harm and suicidal behavior and highlight the potential role of anger in triggering such behaviors.     

The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university

Despite the theoretical emphasis on the role of emotion dysregulation in deliberate self-harm (DSH), few studies have examined this relationship. The present study sought to examine the role of emotion dysregulation in DSH by extending the findings of Gratz (2006) regarding the environmental (i.e. childhood maltreatment) and individual (i.e. emotional inexpressivity and affect intensity/reactivity) factors associated with DSH among 249 female undergraduates. Specifically, the present study examined whether emotion dysregulation (a) is associated with DSH above and beyond these other risk factors and (b) mediates the relationship between these risk factors and DSH. Findings indicate that overall emotion dysregulation distinguished women with frequent DSH from those without a history of DSH, adding reliably to the prediction of DSH status above and beyond maltreatment, inexpressivity, and affect intensity/reactivity. Moreover, among self-harming women, emotion dysregulation accounted for a significant amount of additional variance in DSH frequency and mediated the relationship between emotional inexpressivity and DSH frequency. Results also suggest the particular relevance of two specific dimensions of emotion dysregulation to DSH: limited access to effective emotion regulation strategies and a lack of emotional clarity, each of which reliably improved the prediction of DSH status and accounted for unique variance in DSH frequency among self-harming women above and beyond the other risk factors in the models. Results suggest the potential utility of teaching self-harming women more adaptive ways of responding to their emotions, including nonavoidant strategies for modulating emotional arousal and the ability to identify, label, and differentiate among emotional states.     

Cross-national comparisons of the association between alcohol consumption and deliberate self-harm in adolescents

How differences in drinking patterns may affect the impact of alcohol consumption on deliberate self-harm among adolescents is explored in this international comparative study. Schools in Australia, Belgium, England, Hungary, Ireland, the Netherlands, and Norway (N = 30,532) were surveyed. In all countries the risk of deliberate self-harm was significantly elevated among adolescents who reported some or numerous episodes of intoxication, controlling for confounding factors. The results support the assumption that intoxication is significantly related to the association between alcohol consumption and deliberate self-harm in adolescents.     

Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder

Borderline personality disorder (BPD) and deliberate self-harm are clinically important conditions for which additional economically and clinically feasible interventions are needed. Literature on both the emotion regulating and experientially avoidant function of self-harm and the role of emotional dysfunction in BPD provided the rationale for developing a group intervention targeting emotion dysregulation among self-harming women with BPD. This study provides preliminary data on the efficacy of this new, 14-week, emotion regulation group intervention, designed to teach self-harming women with BPD more adaptive ways of responding to their emotions so as to reduce the frequency of their self-harm behavior. Participants were matched on level of emotion dysregulation and lifetime frequency of self-harm and randomly assigned to receive this group in addition to their current outpatient therapy (N = 12), or to continue with their current outpatient therapy alone for 14 weeks (N = 10). Results indicate that the group intervention had positive effects on self-harm, emotion dysregulation, experiential avoidance, and BPD-specific symptoms, as well as symptoms of depression, anxiety, and stress. Participants in the group treatment condition evidenced significant changes over time on all measures, and reached normative levels of functioning on most. While these preliminary results are promising, the study's limitations require their replication in a larger-scale randomized controlled trial.     

Painful engagement in deliberate self-harm: The role of conditional goal setting

Conditional goal setting is the tendency for people to see attainment of their future personal goals as necessary for their well-being. It has been argued that this represents an unhealthy way of relating to one’s goals, as well as being particularly problematic when goals are perceived as unlikely. High conditional goal setting has been found to be related to depression and to hopelessness. The present study examined conditional goal setting in deliberate self-harm, where problematic thinking about the future is very prominent. A group of individuals attending hospital for a recent episode of deliberate self-harm (N = 25) were compared with controls attending hospital for minor injuries (N = 25) as well as a psychologically disordered but non-suicidal control group (N = 25). Participants generated goals and rated goal likelihood, the extent to which those goals were seen as necessary for their future well-being (conditional goal setting), and also the extent to which the goals were seen as sufficient for their future well-being (goal sufficiency). Deliberate self-harm patients showed a higher degree of both conditional goal setting and goal sufficiency than did both of the other groups, further confirming the idea of painful engagement with personal goals, rather than disengagement, as characterising deliberate self-harm.     

Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India

Patients' accounts complement psychiatric assessment of deliberate self-harm (DSH). In this study we examined psychiatric disorders, and sociocultural and cross-cultural features of DSH. SCID diagnostic interviews and a locally adapted EMIC interview were used to study 196 patients after DSH at a general hospital in Mumbai, India. Major depression was the most common diagnosis (38.8%), followed by substance use disorders (16.8%), but 44.4% of patients did not meet criteria for an enduring Axis-I disorder (no diagnosis, V-code, or adjustment disorder). Psychache arising from patient-identified sociocultural contexts and stressors complements, but does not necessarily fulfill, criteria for explanatory psychiatric disorders.     

Promoting traffic safety among young male drivers by means of elaboration-based interventions

Previous research in social psychology has brought about significant changes in attitudes and behaviour by merely asking respondents to imagine, or reflect, on a phenomenon and arrive at their own conclusions. To test the potential of such interventions in the traffic safety area, an experiment comprising 353 young men 18–23 years old with a driver’s licence was conducted. Two experimental groups were induced to imagine a severe accident scenario and to visualize their feelings and the consequences on their future lives. A control group was interviewed about neutral issues. Attitudes towards risk-taking were measured post-intervention and at follow-up. The experimental groups showed more “ideal” attitudes than the control group post-intervention. At follow-up the attitudes of the experimental group remained unchanged, whereas the control group had changed towards more “ideal” attitudes. Self-reported risk-taking behaviour was measured pre-intervention and at follow-up. At follow-up all groups reported significantly less risk-taking behaviour than at pre-intervention. It is suggested that answering the questionnaires increased mental elaboration concerning risky driving, and it is concluded that interventions that unobtrusively make drivers reflect on their driving should be explored further as a means to promote traffic safety.     

Epidemiology of nonfatal deliberate self-harm in the United States as described in three medical databases

The absence of validated U.S. rates of nonfatal suicidal behavior places risk management and injury prevention programs at danger of being poorly informed and inadequately conceptualized. In this study we compare estimated rates of intentional self-harm from two ongoing surveys (National Electronic Injury Surveillance System-All Injury Program-NEISS-AIP; National Hospital Ambulatory Medical Care Survey-NHAMCS) to data from the Toxic Exposure Surveillance System. Results suggest that, for every 2002-2003 suicide, there were 12 (NEISSAIP) or 15 (NHAMCS) self-harm-related emergency department visits, and for every intentional self-poisoning death there were 33 intentional overdoses reported to poison control centers, of which two ultimately went untreated.     

The influence of cognitive emotion regulation strategies and depression severity on deliberate self-harm

Elaborating on previous studies on emotion regulation and deliberate self-harm (DSH), in the present study we distinguish between strategies of cognitive content (e.g., suicidal cognitions of perceived burdensomeness, helplessness, poor distress tolerance) and cognitive process (e.g., nonacceptance of emotional responses, lack of awareness of emotional responses). Young women who harmed themselves (n = 85) were compared with young women without a history of DSH (n = 93) across a broad range of strategies. Significant group differences were found for all measures, even when depression severity was controlled for. In addition, logistic regression analyses showed that both cognitive content strategies and cognitive process strategies made significant independent contributions to the prediction of group membership. Controlling for depression severity, suicidal cognitions, and nonacceptance of emotional responses independently predicted DSH. The strong association between suicidal cognitions and DSH seems to indicate the important role of these cognitions in recurrent and chronic DSH. The strong association between nonacceptance of emotional responses and DSH underscores the notion that DSH can be a way to avoid emotional problems. These findings are discussed in relation to recent cognitive-behavioral interventions and specific therapeutic techniques to further insight into how these interventions might work.     

Explaining the better-than-average effect among prisoners

We addressed explanations for why prisoners manifest the Better-Than-Average Effect (perceptions of superiority to the average peer), focusing on three biases: self-enhancing (social as well as temporal) comparisons, denial, and self-serving attributions. We tested the Better-Than-Average Effect in regards to prisoners’ perceptions of their worst trait, and assessed the relationship between the three biases and positive self-evaluations. Prisoners engaged in self-enhancing comparisons, differentiating themselves from other prisoners and their past selves who committed the crime, but also expected self-improvement in the future. Prisoners also demonstrated denial for intentions to commit the crime, planning of it, recidivism, and over-estimation of crime prevalence in the general population. Although prisoners made self-serving attributions by distancing their own character from their criminal behavior and reporting they had experienced more hardship relative to others, they did not attribute the cause of their crime to such hardship. More extensive self-enhancing temporal comparisons and denial predicted more positive self-evaluations of prisoners’ worst trait relative to the average community member. The strength of some of these biases varied with levels of narcissism and psychopathy.     

Identifying schizophrenia by means of scale 8 Sc of the MMPI

A sample of 38 schizophrenic inpatients was found to achieve significantly higher mean scores on Scale 8 of the MMPI relative to 38 schizophrenia-spectrum and 38 control patients regardless of whether K- or non-K-corrected scores were used. However, when patients were individually classified by means of a cutting score (greater than or equal to 70), only K-corrected scores accurately discriminated between schizophrenic and control patients at a statistically significant level.     

Perceived similarity and understanding in dyadic coping among young and mature couples

The study examined perceived similarity and understanding in dyadic coping among 197 young and 192 mature couples. Perceived similarity and understanding were computed through a dyad‐centered approach. To separate 2 equally important components of dyadic congruence (i.e., unique and stereotypical similarity) stereotype adjusted and unadjusted scores were computed. Results indicated that stereotype effects were higher among young couples than among mature couples; perceived stereotypical similarity was higher in young couples than in mature couples and stereotypical and partner‐specific understanding were higher in mature couple relationships. Stereotypical understanding was positively associated with relationship quality but only among mature couples. Partner‐specific understanding was not associated with relationship quality in mature couples, but it was negatively associated with relationship quality in young couples.