title: Problem-solving ability and repetition of deliberate self-harm: a multicentre study.
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.
  
  
  METHODS
  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.
authors.affiliation: National Suicide Research Foundation, Cork, Ireland. carmel.nsrf@iol.ie
authors.forename: Carmel
authors.initials: C
authors.lastname: McAuliffe
authors.forename: Paul
authors.initials: P
authors.lastname: Corcoran
authors.forename: Helen S
authors.initials: HS
authors.lastname: Keeley
authors.forename: Ella
authors.initials: E
authors.lastname: Arensman
authors.forename: Unni
authors.initials: U
authors.lastname: Bille-Brahe
authors.forename: Diego
authors.initials: D
authors.lastname: De Leo
authors.forename: Sandor
authors.initials: S
authors.lastname: Fekete
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.forename: Heidi
authors.initials: H
authors.lastname: Hjelmeland
authors.forename: Margaret
authors.initials: M
authors.lastname: Kelleher
authors.forename: Ad J F M
authors.initials: AJ
authors.lastname: Kerkhof
authors.forename: Jouko
authors.initials: J
authors.lastname: Lönnqvist
authors.forename: Konrad
authors.initials: K
authors.lastname: Michel
authors.forename: Ellinor
authors.initials: E
authors.lastname: Salander-Renberg
authors.forename: Armin
authors.initials: A
authors.lastname: Schmidtke
authors.forename: Kees
authors.initials: K
authors.lastname: Van Heeringen
authors.forename: Danuta
authors.initials: D
authors.lastname: Wasserman
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033182:Intention; D008297:Male; D010507:Periodicity; D011340:Problem Solving; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D011795:Surveys and Questionnaires