The Exacerbating Influence of Hopelessness on Other Known Risk Factors for Repeat Self-Harm and Suicide
BACKGROUND:
Hopelessness
is frequently observed in people who harm themselves and is an established risk
factor for nonfatal self-harm repetition and suicide. Little is known about how
the presence of hopelessness in addition to other risk factors affects subsequent
risk.
METHOD:
Prospective
cohort of 19,479 individuals presenting with self-harm to one of three English
Emergency Departments between 1st January 2000 and 31st December 2010. Repeat
self-harm and suicide deaths within twelve months of the first assessed episode
were identified. Cox Proportional Hazards models were used to estimate Hazard
Ratios (HRs) for risk factors with and without hopelessness.
RESULTS:
A
clinical impression of hopelessness was associated with increased risk of
further self-harm (HR 1.35, 95% CI 1.16-1.58) and suicide (HR 2.56, CI
1.10-5.96) in the year following an index episode. For individuals who were
living alone or homeless, unemployed, reported problems with
housing, had received psychiatric treatment in the past, were currently
receiving treatment or used alcohol during the self-harm episode, an
exacerbation of an already elevated risk of repetition was observed amongst
those who were assessed as hopeless. Where individuals presented with forensic
problems, physical health problems or bereavement, an increase in risk was only
observed for those who were also assessed as hopeless.
LIMITATIONS:
A
clinical impression of hopelessness was assigned using a binary
"yes"/"no" classification rather than a validated scale.
CONCLUSIONS:
Hopelessness
intensifies the impact of several known risk factors for adverse outcomes
following self-harm. These findings highlight the importance of identifying and
therapeutically addressing this dynamic but potentially modifiable clinical
risk factor during the psychosocial assessment and in subsequent care.
- 1Centre for Suicide Prevention (http://www.bbmh.manchester.ac.uk/cmhs/), University of Manchester, United Kingdom. Electronic address: sarah.steeg@manchester.ac.uk.
- 2Department of Psychology, Northumbria University Newcastle, United Kingdom.
- 3Centre for Suicide Prevention, University of Manchester, United Kingdom.
- 4School of Psychological Sciences, University of Manchester, United Kingdom.
- J Affect Disord. 2016 Jan 15;190:522-8. doi: 10.1016/j.jad.2015.09.050. Epub 2015 Oct 28.
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