Problem-solving ability and repetition of deliberate self-harm: a multicentre study.
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.
McAuliffe
Carmel
C
National Suicide Research Foundation, Cork, Ireland. carmel.nsrf@iol.ie
Corcoran
Paul
P
Keeley
Helen S
HS
Arensman
Ella
E
Bille-Brahe
Unni
U
De Leo
Diego
D
Fekete
Sandor
S
Hawton
Keith
K
Hjelmeland
Heidi
H
Kelleher
Margaret
M
Kerkhof
Ad J F M
AJ
Lönnqvist
Jouko
J
Michel
Konrad
K
Salander-Renberg
Ellinor
E
Schmidtke
Armin
A
Van Heeringen
Kees
K
Wasserman
Danuta
D
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