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Problem-solving ability and repetition of deliberate self-harm: a multicentre study

Published online by Cambridge University Press:  29 September 2005

CARMEL McAULIFFE ,
PAUL CORCORAN ,
HELEN S. KEELEY ,
ELLA ARENSMAN ,
UNNI BILLE-BRAHE ,
DIEGO De LEO ,
SANDOR FEKETE ,
KEITH HAWTON ,
HEIDI HJELMELAND  and
MARGARET KELLEHER
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CARMEL McAULIFFE
Affiliation:
National Suicide Research Foundation, Cork, Ireland
PAUL CORCORAN
Affiliation:
National Suicide Research Foundation, Cork, Ireland
HELEN S. KEELEY
Affiliation:
National Suicide Research Foundation, Cork, Ireland
ELLA ARENSMAN
Affiliation:
National Suicide Research Foundation, Cork, Ireland
UNNI BILLE-BRAHE
Affiliation:
Unit for Suicidological Research, Odense, Denmark
DIEGO De LEO
Affiliation:
Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
SANDOR FEKETE
Affiliation:
Department of Psychiatry, University of Pecs, Pecs, Hungary
KEITH HAWTON
Affiliation:
Centre for Suicide Research, University of Oxford, England
HEIDI HJELMELAND
Affiliation:
Department of Social Work and Health Science, The Norwegian University of Science and Technology, Trondheim, Norway
MARGARET KELLEHER
Affiliation:
National Suicide Research Foundation, Cork, Ireland
AD J.F.M. KERKHOF
Affiliation:
Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
JOUKO LÖNNQVIST
Affiliation:
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
KONRAD MICHEL
Affiliation:
University Psychiatric Services Bern, Outpatients Clinic, Bern, Switzerland
ELLINOR SALANDER-RENBERG
Affiliation:
Department of Clinical Sciences, Division of Psychiatry, Umea University, Sweden
ARMIN SCHMIDTKE
Affiliation:
Clinic and Polyclinic for Psychiatry and Psychotherapy, University of Wurzburg, Germany
KEES VAN HEERINGEN
Affiliation:
Department of Psychiatry, University of Gent, Belgium
DANUTA WASSERMAN
Affiliation:
Department of Public Health Sciences, National and Stockholm County Council's Centre for Suicide Research and Prevention (NASP) at the National Institute for Psychosocial Factors and Health/Karolinska Institute, Stockholm, Sweden
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Abstract

Background. While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH.

Method. As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems.

Results. Factor analysis identified five dimensions – Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance – characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems – was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem.

Conclusions. The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

Type
Original Article
Information
Psychological Medicine , Volume 36 , Issue 1 , January 2006 , pp. 45 - 55
Copyright
2005 Cambridge University Press

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